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March 2010 Vol. XX, No. 2, $7.00

Advising Vegetarian Athletes Coping with a Tighter Budget

Baring Their Soles

The many benefits of barefoot training



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March 2010, Vol. XX, No. 2

contents 35 41

17 Bulletin Board 5 California considers new concussion rules … Warning athletes against NSAID overuse … What type of exercise is best for bones? … A treadmill that simulates moonwalking. Q&A 9 Peter Friesen Carolina Hurricanes


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64 Next Stop: Web Site On the cover: Basketball players at Northeastern University use barefoot training to develop foot and ankle muscles that lie dormant during shoes-on exercise. Northeastern’s Art Horne describes his barefoot program beginning on page 24. Photo by Brian Tucker Bresnahan



17 As vegetarianism and veganism grow more and more popular, many No Meat, No Problem

people wonder how a meat-free diet affects athletic performance goals. Our expert dishes on the risks and the rewards. By Lisa Dorfman Optimum Performance

Their Soles 24 Baring Barefoot training is this author’s secret weapon for improving

movement efficiency, balance, and kinetic chain integrity in his athletes. By Art Horne Treating the Athlete

31 Facial injuries in sports run the gamut from black eyes and knockedWatch the Face!

out teeth to serious damage that can have lasting consequences. Are you prepared to deal with all the injuries you may face? By Dr. Jaime Garza Leadership

35 Sports medicine departments nationwide are dealing with tighter Making It Through

budgets and fewer resources in our current economic climate. In response, some athletic trainers are finding creative ways to keep their programs alive and well. By Dan Resing Sport Specific

41 The University of Minnesota’s year-round volleyball strength program Holding Court

incorporates movement prep, jump training, and power building with the goal of optimizing late-season performance. By Sara Wiley

T&C MARCH 2010


Editorial Board Marjorie Albohm, MS, ATC/L President, National Athletic Trainers’ Association 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, EdD, ATC, SCAT, NREMT 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 Co-Director of Athletic Training/Sports Medicine, Intercollegiate Athletics, University of Texas Cynthia “Sam” Booth, ATC, PhD Manager, Outpatient Therapy and Sportsmedicine, MeritCare Health System Debra Brooks, CNMT, LMT, PhD CEO, Iowa NeuroMuscular Therapy Center Cindy Chang, MD Team Physician, University of California-Berkeley Dan Cipriani, PhD, PT Assistant Professor Dept. of Exercise and Nutritional Sciences, San Diego State University Gray Cook, MSPT, OCS, CSCS Clinic Director, Orthopedic & Sports Phys. Ther. Dunn, Cook, and Assoc. Keith D’Amelio, ATC, PES, CSCS Strength & Conditioning Coach for Men’s Basketball, Stanford University Bernie DePalma, MEd, PT, ATC Head Athletic Trainer/Phys. Therapist, Cornell University Lori Dewald, EdD, ATC, CHES, F-AAHE Department of Health Science, Kaplan University Jeff Dilts, Director, Business Development & Marketing, National Academy of Sports Medicine David Ellis, RD, LMNT, CSCS Sports Alliance, Inc. Boyd Epley, MEd, CSCS Director of Coaching Performance, National Strength & Conditioning Association Peter Friesen, ATC, NSCA-CPT, CSCS, CAT, Head Athletic Trainer/ Cond. Coach, Carolina Hurricanes Lance Fujiwara, MEd, ATC, EMT Director of Sports Medicine, Virginia Military Institute Vern Gambetta, MA, President, Gambetta Sports Training Systems P.J. Gardner, MS, ATC, CSCS, PES, Athletic Trainer, Liberty High School, Colo.

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T&C MARCH 2010

Joe Gieck, EdD, ATR, PT Director of Sports Medicine and Prof., Clinical Orthopaedic Surgery, University of Virginia (retired) Brian Goodstein, MS, ATC, CSCS, Head Athletic Trainer, DC United Gary Gray, PT, President, CEO, Functional Design Systems Maria Hutsick, MS, ATC/L, CSCS Head Athletic Trainer, Medfield (Mass.) High School Christopher Ingersoll, PhD, ATC, FACSM Director, Graduate Programs in Sports Medicine/Athletic Training University of Virginia Allan Johnson, MS, MSCC, CSCS Sports Performance Director Velocity Sports Performance Tim McClellan, MS, CSCS Director of Perf. Enhancement, Center for Human Performance Michael Merk, MEd, CSCS Director of Health & Fitness, YMCA of Greater Cleveland Jenny Moshak, MS, ATC, CSCS Assistant 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 (Wis.) High School Bruno Pauletto, MS, CSCS President, Power Systems, Inc. Stephen M. Perle, DC, MS Professor of Clinical Sciences, University of Bridgeport College of Chiropractic Brian Roberts, MS, ATC, Director, 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

March 2010 Vol. XX, No. 2 Publisher Mark Goldberg Editorial Staff Eleanor Frankel, Director Greg Scholand, Managing Editor R.J. Anderson, Kenny Berkowitz, Abigail Funk, Kyle Garratt, Mike Phelps, Dennis Read Circulation Staff David Dubin, Director John Callaghan Art Direction Message Brand Advertising Production Staff Maria Bise, Director Trish Landsparger, Neal Betts, Natalie Couch Business Manager Pennie Small Special Projects Dave Wohlhueter Administrative Assistant Sharon Barbell Advertising Materials Coordinator Mike Townsend Marketing Director Sheryl Shaffer Advertising Sales Associates Diedra Harkenrider (607) 257-6970, ext. 24 Pat Wertman (607) 257-6970, ext. 21 T&C editorial/business offices: 31 Dutch Mill Road Ithaca, NY 14850 (607) 257-6970 Fax: (607) 257-7328 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., 31 Dutch Mill 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 $7. Copyright© 2010 by MAG, Inc. All rights reserved. Text may not be reproduced in any manner, in whole or in part, without the permission of the publisher. Unsolicited materials will not be returned unless accompanied by a self-addressed, stamped envelope. Periodicals postage paid at Ithaca, N.Y. and additional mailing offices. POSTMASTER: Send address changes to Training & Conditioning, P.O. Box 4806, Ithaca, NY 14852-4806. Printed in the U.S.A.




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Board Calif. Addresses Sports Medicine Concerns When it comes to protecting high school athletes, more and more Californians are noticing their state’s shortcomings. California is one of only three states still without ATC licensure, and its laws regarding return to play after concussions and mandatory education for coaches lag behind those of its more proactive neighbors. But with help from the state legislature, change may be on the horizon. A bill currently under consideration in the state assembly would require that instruction on head injuries, heat stroke, asthma, and cardiac arrest be added to the required CPR and first-aid education programs public high school coaches and athletic trainers must complete. A companion bill asks for tougher return-to-play standards after an athlete suffers a concussion. “We need to do more to protect our kids, and we can do that by training the adults closest to them at the time of injury,” Mary Hayashi, the assemblywoman sponsoring both bills, told Capitol Weekly. “We need to train coaches to be better able to recognize the symptoms of a concussion or serious injury. They can make all the difference in saving a student’s life.” The two bills were introduced in January during the same week the California senate held a hearing on brain injuries. The California Brain Injury Association (CBIA), a non-profit organization established in 2005, had pushed for the hearing to take place. “There needs to be more done,” Paula Daoutis, Administrative Director of the CBIA, told the San Jose Mercury News. “If you see a player take a hit on the head, you should take them off [the field] until they can be evaluated. When they get back in too soon and another concussion occurs, this is where more serious injuries are going to happen.” Meanwhile, the California Athletic Trainers’ Association told the Sacramento Bee in January that it is working to reintroduce a bill to bring ATC licensure to the Golden State. The state legislature passed a similar measure in 2006, but it was vetoed by Governor Arnold Schwarzenegger. The bills on educating coaches and return-to-play guidelines are expected to be heard by a California state assembly committee this spring. To check on their status, go to: and type “1646” and “1647” into the search window.

A Warning On NSAID Use Non-steroidal anti-inflammatory drugs (NSAIDs) are often recommended to reduce swelling and pain after an injury. But surveys and other research have shown that many athletes TRAINING-CONDITIONING.COM

ingest NSAIDs before workouts and competition, hoping to guard against inflammation and soreness. Medical experts have recently begun speaking out against this practice. Their main concern is that NSAIDs could mask an injury sustained during athletic activity. If the athlete continues to play because he or she doesn’t feel pain, the injury could become more serious. Stuart Warden, PhD, PT, FACSM, Assistant Professor and Director of Research at Indiana University, wrote an August 2009 editorial in the British Journal of Sports Medicine warning athletes against preventative NSAID use. “These agents are treatments for the symptoms of an injury, not the injury itself,” Warden told Medical News Today. “They may allow an athlete to exercise or train at a certain level, but pain occurs for a reason. It is basically the body’s mechanism of saying, ‘Hang on, you’ve got some sort of injury that should not be ignored.’” Masking an injury isn’t the only reason to caution athletes against NSAID overuse. Warden also wrote in his editorial that those who regularly take NSAIDs before workouts may see reduced tissue adaptation to physical demands placed on the body, which could predispose them to future injury. Various studies have shown that prolonged NSAID ingestion delays the healing of ligaments, muscles, and tendons. And overuse of NSAIDs may also be linked to increased risk for cardiovascular problems and stomach ulcers. “I want people, including recreational athletes, to think about the perceived benefits versus potential risks of taking NSAIDs, and to ask themselves why they are taking these agents,” Warden told Medical News Today. “They need to ask, ‘Do the benefits outweigh the risks?’” To read the full text of Warden’s editorial in the British Journal of Sports Medicine, go to:, click on “Archive,” then “2009,” then “August.”

What Builds Healthy Bones? Weight-bearing activity has long been touted as a pathway to better bone health—conventional wisdom holds that bones respond to stress by adding new cells, which in turn strengthens them. But new research is challenging that assumption, finding other types of exercise may achieve the same effect. Last fall, Medicine & Science in Sports & Exercise recapped an American College of Sports Medicine symposium titled “Muscle Forces or Gravity: What Predominates Mechanical Loading on Bone?” and published a series of papers on what other factors besides weight stress could lead to bone cell growth. The primary paper was written by a group of University of Colorado professors, who concluded T&C march 2010



Board that high-impact exercise was no better for bone health than low- or non-impact exercise. “There is no conclusive evidence from clinical studies that either muscle forces or gravitational forces play a more prominent role in regulating bone metabolism,� they wrote in their

“It is important to acknowledge that the relatively low bone mineral density levels observed in some athletes, such as cyclists, swimmers, and even long-distance runners, may result from factors other than the loading characteristics of the activity.�

low levels likely have other causes. “It is important to acknowledge that the relatively low bone mineral density levels observed in some athletes, such as cyclists, swimmers, and even long-distance runners, may result from factors other than the loading characteristics of the activity,� they wrote. “It has been estimated that dermal calcium loss (i.e., sweating) during moderate to vigorous exercise is ~70 mg.h-1 [approximately 70 milligrams per hour]. Thus, competitive cyclists and swimmers, who typically train more hours per week than athletes in other sports, may have increased calcium requirements.� Based on that theory, the authors hypothesize that too much exercise for too long could be detrimental to bone health due to calcium loss through sweat, though they were careful to point out there is currently no solid evidence to prove it. The take-home message is that exercise—of any type—is good for bone health in most circumstances, but more research is needed to determine what kinds of exercise regimens are best for bones.

conclusion. “When exercise training programs that included activities that generated ground-impact forces (e.g., walking, running, stairs) were compared with those that did not (e.g., weightlifting, rowing), both were found to have beneficial effects on bone mineral density.â€? One reason weight-bearing exercise is thought to “Anti-Gravityâ€? Treadmill Simulates improve bone health better than non-weight bearing Moonwalking exercise is the prevalence of low bone mineral density in athletes who participate in low- to no-impact activities, It can be difficult for injured or rehabbing athletes to keep like cycling and swimming. The paper’s authors say those      in shape when their workouts are limited to a bike or the






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Board pool. But what if athletes could continue running while rehabbing, without the downside of impact forces? Lost muscle mass and diminished aerobic capacity would be far less likely, and they could return to play more quickly if their training level never waned during the rehab process. That’s exactly what the AlterG AntiGravity Treadmill aims to do. Based on a NASA prototype first developed more than a decade ago, it allows users to reduce the force of gravity on their legs by up to 80 percent, essentially simulating the effect of walking or running on the moon. The user wears a pair of shorts that zip into a waist-high enclosure called the cockpit. Once sealed in, air pressure counteracts the force of gravity, allowing for a low-impact workout. The runner’s upper half remains outside the cockpit, and the enclosure has four clear plastic walls so a physical therapist or athletic trainer can see the athlete’s running form while they’re on the treadmill. “You don’t feel as if somebody’s lifting you,” Charles Burgar, MD, Medical Director of the VA Palo Alto Health Care System and a professor at Stanford University, told the San Jose Mercury News. “You feel like you are in water that has no viscosity, like you’re floating, but when you move your legs there’s no resistance … You can teach a person to run very, very fast by offloading their weight, and then building strength and endurance by increasing the weight.” AlterG’s growing customer base— which already numbers in the hundreds—includes pro sports teams, college athletic departments, and physical therapy clinics. At $75,000 each, the Anti-Gravity Treadmill is a major investment, but a new model costing around $25,000 recently debuted, and AlterG expects sales to continue increasing as a result. n Search for past articles from T&C or browse entire issues by visiting our Web site at: TR AINING-CONDITIONING.COM



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Peter Friesen

Head Athletic Trainer/Strength and Conditioning Coach, Carolina Hurricanes How’s this for elite company: When Peter Friesen visits the Hockey Hall of Fame in Toronto, Ontario, he can run his finger down the Stanley Cup and point to his own name etched into its silver surface, alongside legends like Howe, Gretzky, and Lemieux. Not bad for someone who’s never played an NHL game. When Friesen started out as an athletic trainer and strength coach for the Prince Albert Raiders, a junior hockey team in Western Canada, he could hardly have imagined he’d end up immortalized on the sport’s holy grail. But after decades of climbing the professional ladder, he landed his current job as Head Athletic Trainer and Strength and Conditioning Coach for the Carolina Hurricanes in 1999. He’s now living his dream of working with elite pro athletes, and was on board when the franchise captured its first NHL title in 2006. Outside the pro ranks, Friesen has spent time at the university level in Canada and advised Canadian Olympic teams in ice hockey, field hockey, soccer, figure skating, softball, wrestling, gymnastics, and volleyball. In this interview, he talks about being at the top level of a sport he loves, overcoming language and cultural barriers with players, and the annual fun run that he created for charity. T&C: How did starting your career at hockey’s lower levels prepare you for the NHL? Friesen: In the 1980s, I was a part-time school teacher and an athletic trainer and strength coach for the Prince Albert Raiders in Saskatchewan. I was also the team’s bus driver, equipment manager, and jack-of-all-trades. I really enjoyed it, but doing a little bit of everything helped me realize that being an athletic trainer and strength coach was what I wanted most. It also taught me to appreciate the resources I have now. Today I have a much larger budget, but I still focus on getting the most out of every dollar because I remember the lower levels, where you’re always doing more with less. What are the unique challenges of working with athletes from other countries? A lot of NHL players come from far away places, and they have their own training backgrounds. When they’re injured, I TR AINING-CONDITIONING.COM

©Getty Images

Friesen evaluates Hurricanes forward Rod Brind’amour on the ice during a game. In 2006, Brind’amour captained the team to its first ever Stanley Cup championship. might have to talk them out of doing things they’ve done their whole lives in order to minimize the chance of reinjury. Getting those players to change their training methods can be tough. Often, Europeans have a different understanding of what they can and can’t play through. Also, in North America, we push medication and medical care more than they do in Europe, so it’s important to explain that our doctors only prescribe things that are safe and beneficial to the healing process. How do you overcome language barriers with foreign players? I’ve found that body language and tone can help fill the gap. Body language is easy to pick up on, especially with a medical background, because I can see players laboring in different movements and notice what they lack mechanically. Also, most elite athletes are visual learners who pick things up very quickly if you use hand gestures to communicate your message. What is the toughest rehab you’ve ever encountered? I worked with Hall of Fame goaltender Grant Fuhr during the latter part of his career, after he tore his ACL. He was the first goalie to really come back from that type of injury and play the position at a high level without a knee brace. T&C MARCH 2010


Q&A He was a tremendous athlete but not necessarily known for a strong work ethic, so the trick was getting him to work hard enough to return to playing shape. As with most of my rehabs, I used group workouts with five to seven people. In that setting, the athletes really motivate each other to go harder, stronger, and faster. Grant was working with some very fit people, so he had to push himself just to keep up.

“If they’ve struck a major artery, you literally have only seconds to stabilize them. With Cam, we were thankful the blade didn’t hit a large artery or his quadriceps tendon.” In November, Hurricanes goaltender Cam Ward’s leg was sliced by an opposing player’s skate, leaving a pool of blood on the ice. How do you handle an incident like that? First of all, I just want to make sure the athlete doesn’t die. If they’ve struck a major artery, you literally have only seconds to stabilize them. With Cam, we were thankful the blade didn’t hit a large artery or his quadriceps tendon—it just went into his vastus medialis oblique. Once you develop a treatment plan for a laceration injury like that, the next part is minimizing the threat of MRSA and

other infections. MRSA can be very destructive and even fatal if ignored. So we made sure the wound was closed, gave him an antibiotic, and kept a close eye on the area while it healed. What was his rehab like? The wound was slightly above his knee, so for the first two weeks he wore a straight-leg brace and had only five or 10 degrees of movement. It was a pretty simple rehab overall, we just needed to make sure the tissue healed properly. Our biggest worry was the risk of secondary changes—that his period of limited mobility and inactivity would lead to stiffness in the knee joint and weakening of the muscles in his leg. As soon as he was physically able, we started progressive stretching and strengthening exercises. What’s your approach to caring for athletes after a concussion? I tell them to stay home until they’re symptom-free, and I don’t talk to them during that time—our team physicians do. That’s because when an athletic trainer talks to an athlete about an injury, there may be perceived pressure to get back in the lineup. To avoid even any semblance of that, we have our doctors handle the first steps of injury management for concussions. Before we consider letting them work out again, they

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Circle No. 108

Q&A must return to pre-injury baseline levels in their ImPACT testing. Then we start them out doing lighter work on the ice before gradually reintroducing body contact. Hockey players are notorious for playing through injuries, especially during the playoffs. What is it like helping them stay in the game when your gut tells you they should sit out? I don’t always have much say in the matter come playoff time. Athletic trainers across the league are put in tough positions in the playoffs, just trying to keep players from making an injury worse and helping them get through it as best we can. I’m continually awestruck at the pain tolerance some guys have, playing with broken bones and torn ligaments that would sideline them in normal situations. Winning the Stanley Cup is a dream come true for hockey players and they don’t get many shots at it, so we have to be sympathetic to that. We want to give them every chance to succeed, so you see a lot of innovation at playoff time, especially with techniques for strapping and wrapping various body parts. What’s your typical training approach in the offseason? My first goal is to get rid of any orthopedic problems as quickly as possible. Early in the off-season, I mostly have

guys do body weight exercises—things like push-ups, chinups, and squats. Those emphasize body control while not putting as much stress on the joints as heavy lifting. Later, we get into basic weight training with a standard periodization cycle that addresses endurance, then strength, and then power. By August, when preseason is a month

“Athletic trainers across the league are put in tough positions in the playoffs, just trying to keep players from making an injury worse and helping them get through it as best we can.” away, we start what I call “controlled chaos,” which incorporates a lot of different physical and mental elements. What is controlled chaos? We do various drills on the track, in the weightroom, in the pool, and on the ice, with a focus on presenting multiple challenges in rapid succession. For example, we’ll bring players to the track facility, and one right after another they’ll do a 400-meter run, walking over 10 hurdles, and a 20-yard bear crawl. Then they’ll immediately move to a running station and start patterns around cones, working on agility and acceleration. Next, they’ll sprint over to the high jump pit and perform depth jumps. After that


T&C MARCH 2010


Q&A Peter Friesen Head Athletic Trainer and Strength and Conditioning Coach, Carolina Hurricanes Education: BS, Bemidji State University MS, University of Saskatchewan First Job: Head Athletic Trainer and Strength Coach for the Prince Albert Raiders, a junior hockey team in Western Canada

they’ll run to an open space and do a sled drag, pulling 50 pounds for 20 yards, followed by some forearm work using a rope with weights attached to it. From there, they progress to speed ladder drills, followed by farmer walks with a 45-pound weight in one hand and a 25-pound weight in the other. The different weights make the exercise more awkward and force the athletes to adapt using their stabilizers. Next, they put on a 25-pound weighted vest and do 10 burpees—which some people call up-and-downs and which I think is the best abdominal exercise—followed by some low duck walks. Then they do a 100-meter sprint and they’re finished. Most players can perform the full circuit in about 11 minutes. In a typical workout, they’ll do it three times. They’re pretty knackered after that. What are the most common strength deficiencies or imbalances you see? Pro hockey players have the strongest hip flexors of any athletes in the world. I’ve seen a lot of MRIs and CT scans that show the hip flexors taking up almost the entire pelvic outlet. To withstand the forces generated by such strong hip flexors, most players’ lower abdominals and lower back need to be strengthened. Also, hockey players have tremendous quad strength, so we have to develop their hamstrings to prevent imbalances that can lead to injury. And they usually have great groin development, but their gluteus medius and adductors aren’t as strong, so we work on those muscles as well. What prompted you to start the Friesen 5K Fun Run, your annual charity event? Everybody in the NHL dreams about what they’d do with the Stanley Cup if their team won it. I’ve always been a runner, so I wanted to do something that involved running on my day with the cup. I also wanted to share it with our great fans. ­12

T&C MARCH 2010

As I was thinking of how to do that, I realized I could generate some money for charity at the same time. So I decided to put on a fun run, and the team’s management and players were all behind me. On my day with the cup, I had a breakfast with it, then took it over to our facility and took pictures of it in the weightroom, on a bike, and in my office. Then I took it to the run, and we raised over $25,000 for an organization that fights leukemia and lymphoma. We’ve been holding the run for four years now and have generated over $100,000. Anything about the cup that surprised you when you saw it up close? My name being on it. I never, ever thought that would happen. I grew up following hockey and knew almost every one of the names engraved on the cup, and it brought back some really fond memories of watching hockey with my dad as a kid. It was a humbling experience to see my name next to all those legends. What’s the best part of your job? Going into an NHL dressing room every day. This is my 13th year, and I still feel so lucky. I remember what it was like to ride buses through Western Canada for weeks at a time, stay at lousy hotels, and get by on a measly budget. So I’m whistling zip-a-dee-doo-dah every day because I’m in the National Hockey League, working with all these resources and some of the greatest athletes on the planet. If I can’t get fired up about that, I should get out of the profession. n ON THE WEB For more from our interview with Peter Friesen, visit: and click on “Blogs.” TR AINING-CONDITIONING.COM




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No Meat, No Problem


As vegetarianism and veganism grow more and more popular, many people wonder how a meat-free diet affects athletic performance goals. Our expert dishes on the risks and the rewards.

By Lisa Dorfman


hat do the NFL’s Tony Gonzalez and Ricky Williams, NHL “tough guy” Georges Laraque, track and field Olympians Carl Lewis and Edwin Moses, six-time Ironman champion Dave Scott, and ultramarathon runner Scott Jurek all have in common? For one thing, they’re all outstanding athletes. For another, they’re among the growing corps of athletes who are vegetarian or vegan. When most people think of an optimal diet for athletic performance, they imagine covering all corners of the food pyramid—after all, that’s the best way to ensure an athlete gets the carbohydrates, protein, healthy fat, vitamins, and minerals they need to fuel their engine and promote muscle growth, right? The fact is, vegetarian athletes can and do meet all their nutritional needs despite limiting the use of animal products or eliminating them altogether. In fact, some research suggests they even have an advantage over their meat-eating counterparts. There are many reasons why someone chooses to become a vegetarian. It may be rooted in religious beliefs, animal rights concerns, environmental consciousness, economics, health, or simply that they don’t like the taste of meat. Whatever the motivation, vegetarians who know how to adapt their diet to the demands of athletic performance enjoy much upside and practically no downside. CLEAR BENEFITS In 2009, The American Dietetic Association and Dietitians of Canada endorsed vegetarian diets for sports training in a joint position statement on nutrition and athletic performance. This official “seal of approval” backed up what many dietitians had been observing for years—that all else being equal, a carefully chosen plant-based training and competition diet can actually be superior to an omnivore’s regimen. Vegetarian diets are virtually always rich in both simple and complex carbohydrates, providing efficient fuel for all training intensity levels. In addition, vegetarians tend to consume larger quantities of phytochemicals—healthy plant-


Lisa Dorfman, MS, RD, CSSD, LMHC, is Director of Sports Nutrition and Performance at the University of Miami. She can be reached at: T&C march 2010


NUTRITION based compounds such as antioxidants that help protect muscle cells and assist with building strength, extending endurance, and enhancing recovery. With meat removed from the dietary equation, vegetarians typically don’t eat

animals, which may include food items such as honey and gelatin. Often they’ll even refuse to wear silk, wool, or leather clothing. Without careful dietary planning, they are at increased risk for deficiencies in vitamin B12, zinc, calcium,

It’s a good idea for all athletes, and vegetarians especially, to periodically undergo a dietary assessment in which they log all food intake for several days ... Blood tests can also be used to check for low levels of nutrients like iron and calcium. as much fat—especially saturated fat— or cholesterol. And the fat they do consume is more often “healthy fat,� such as the omega-3 fatty acids found in avocados, nuts, and seeds. While all vegetarians can enjoy those benefits and more, it’s important to note that vegetarianism isn’t a one-size-fitsall designation. People who self-identify as vegetarian have many different dietary profiles, generally fitting into one of these categories: Vegan. These individuals exclude all meat products, dairy, and eggs. In general, they avoid any products derived from

creatine, and some essential amino acids. Fruitarian. Members of this subset of veganism restrict their diet even further, eating only raw or dried fruits and vegetables, seeds, honey, and oil. Of all categories of vegetarians, these people are at highest risk for vitamin, mineral, protein, and essential fat deficiencies. Lacto-vegetarian. As a rule, lactovegetarians abstain from meat but do drink milk and eat dairy products. Accordingly, they have less difficulty meeting their dietary protein, fat, and calcium needs than non-dairy-eating vegetarians. Ovo-lacto-vegetarians are

a similar category, including eggs in their diet as well as dairy. Pesco-vegetarian. These individuals eat fish and other seafood, but no meat. They may or may not include dairy products and eggs in their diet, and they aren’t typically predisposed to any significant nutrient deficiencies. Flexitarian. This is just what it sounds like—flexitarians are flexible in their food choices, but typically eat meat only occasionally. Some use this term to describe a diet with low or moderate amounts of white meat such as chicken and pork, but no red meat. With so much variety in eating habits among those who practice a form of vegetarianism, it’s difficult to generalize about every potential deficiency risk. It’s a good idea for all athletes, and vegetarians especially, to periodically undergo a dietary assessment in which they log all food intake for several days and review the results with a nutritionist. Blood tests can also be used to check for low levels of nutrients like iron and calcium. This precaution may be especially helpful for athletes with the most restrictive diets, such as vegans.

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Some vegetariansâ&#x20AC;&#x201D;particularly vegans and others with highly restrictive dietsâ&#x20AC;&#x201D;are at risk for deficiencies in specific vitamins and minerals. Below is a list of the most common ones, along with suggested foods that can help a vegetarian athlete increase their intake for each. Vitamin/mineral Function Sources in vegetarian diets Zinc Involved in immune system function, Legumes, whole grains, nuts, seeds, soy, protein synthesis, carbohydrate dairy, fortified shakes and bars metabolism, and blood formation Iron Hemoglobin synthesis, transporting Fortified cereals, breads, legumes, beans, soy oxygen to muscles nuts, dried fruits, green leafy vegetables, shakes and bars Note: Consuming iron with foods rich in vitamin C increases absorption. Vitamin B12 Required for normal metabolism of nerve Dairy, eggs, fortified soy milk, sports bars, tissue, protein, carbohydrates, and fats sports drinks Vitamin D Promotes bone growth and absorption of Dairy, eggs, fortified soy products, bars calcium, nervous system and heart function, and shakes and regulation of inflammatory response Riboflavin (Vitamin B2) Involved in energy production and Dairy, soy milk, yogurt, cheese, fortified storage in muscles cereals, grains, textured vegetable protein Calcium Promotes nerve transmission, muscle Dairy, fortified soy milk and orange juice, tofu, contraction, vitamin D metabolism, yogurt, broccoli, kale, bok choy, tahini, almonds, blood clotting, and bone growth blackstrap molasses

Circle No. 113


DAILY MENUS Here are two sample meal plans for vegan athletes that provide an adequate supply of energy, carbohydrates, protein, and healthy fat along with vitamins and minerals and a broad spectrum of amino acids. DAY ONE:


BREAKFAST Egg Beaters (egg substitute) omelet with veggies and shredded soy cheese 1 cup of citrus fruit 1 whole-grain bagel with soy spread

BREAKFAST Whole-grain waffles with mixed berry topping 1 cup of soy yogurt 1 cup of mixed citrus fruit

MORNING SNACK Endurance drink with pretzels LUNCH 1 bowl of bean soup with whole-grain crackers Veggie pizza with soy cheese Green salad with mixed veggies AFTERNOON SNACK 2 ounces of almond cheese 1 apple 1 ounce of almonds DINNER Salad greens BBQ soy “beef” skewers 1 baked sweet potato with soy spread Soy yogurt parfait with granola and mixed berries LATE-NIGHT SNACK Hot chocolate made with rice milk

BALANCED FUELING Like all people, vegetarians who eat a healthy, balanced diet can be assured of getting ample amounts of vitamins, minerals, phytonutrients, fats, carbohydrates, and protein to fuel themselves for performance, while those who eat poorly are at risk for deficiencies in things like iron, calcium, zinc, vitamins D and B12, and essential fats and amino acids. The only major difference is that vegetarians have a smaller spectrum of foods from which to choose—much smaller in the case of the most restrictive types—so they need to pay closer attention to their intake than omnivores. When fueling for sports, one of the most basic concerns is adequate calorie consumption, which some vegetarians find challenging because plant-based foods often have lower calorie densities and more fiber. As a result, the athlete consumes less energy overall before feel­20

T&C march 2010

MORNING SNACK Soy-based energy bar 1 cup of soy, hemp, or almond milk made into a smoothie with a banana and berries LUNCH Veggie wrap with whole-grain tortilla and grilled tempeh strips Fruit salad: melon, banana, citrus, and pear Vegetable juice AFTERNOON SNACK Endurance drink with high-carb sports bar DINNER 3 cups of whole-grain spaghetti with red sauce and veggies 2 whole-grain rolls Green salad with mixed veggies LATE-NIGHT SNACK Jell-o with whipped soy cream

ing full. An easy way to overcome this is to consciously include calorie-dense foods at mealtimes—excellent choices include nuts, nut butters, seeds and oils, soy- and tofu-based meat alternatives, soy milk, textured vegetable protein, tempeh, and fruit juices and smoothies. Vegetarians should also place extra emphasis on consuming calories throughout the day in the form of snacks and beverages to increase energy intake. Calculating protein, carbohydrate, and fat needs for vegetarians can be somewhat different than for omnivores. Carbohydrates typically aren’t a problem—in fact, a meta-analysis of 63 research studies showed that vegans and vegetarians consistently had higher dietary percentages of carbohydrates than meat eaters. Carbohydrates for vegetarians come mainly from grains, fruits, vegetables, dairy, and dairy substitutes, and should constitute approximately six to 10 grams

per kilogram of body weight (2.7 to 4.5 grams per pound) per day to replenish glycogen stores and fuel activity. For endurance athletes who train more than 60 to 90 minutes a day, the vegetarian diet is especially beneficial because of its emphasis on complex carbs. Most fruits and starchy foods provide about 15 grams of carbohydrates per serving, while milk and dairy substitutes provide around 12 grams per cup, and vegetables roughly 10 grams per cup. As for protein, the American Dietetic Association advises that vegetarians eat roughly 10 percent more than the standard recommendation for meat eaters, because many non-meat proteins are less bioavailable than meat-based sources. This means an optimal daily intake for vegetarian athletes is roughly 1.3 to 1.8 grams per kilogram of body weight (0.5 to 0.8 grams per pound), depending on the intensity of training. TRAINING-CONDITIONING.COM

NUTRITION Even with meat out of the equation, there are many high-protein vegetarian food choices, including beans and peas, nuts, dairy products, fish, sport bars, and protein shakes, so getting enough just takes a little creativity and planning. Since vegans have fewer options due to the exclusion of dairy and fish, they can make up the difference with larger quantities of soy, seitan (wheat-based protein), and seeds. Different protein sources contain different essential amino acids (EAAs)— that is, amino acids the body does not produce naturally so they must be obtained through diet. These amino acids comprise the basic building blocks of protein, and while they’re plentiful in animal products, they tend to be more limited in other foods: While a plant or dairy source may be rich in one particular EAA, it may contain very little of others. Therefore, variety is key for vegetarian athletes. They must be discouraged from getting into food “ruts” in which they eat similar meals day after day. Those who do struggle with variety should be pointed toward soy products, as these are some of the only plant-based foods that

have all the essential amino acids. In high-intensity sports, the meatbased fuel source creatine provides extra energy for working muscles. Meat eaters typically get roughly one gram of creatine per day from their diet, and the body synthesizes approximately one more gram in the liver, kidneys, and pancreas using the amino acids arginine and glycine as precursors. Research shows that vegetarians consistently have lower creatine levels than omnivores, so some study authors suggest vegetarian athletes may benefit from moderate creatine supplementation. However, it’s important to note that the benefits and health risks of prolonged creatine use are still the subject of debate. Any athlete interested in creatine supplementation should first undergo a dietary analysis to see if they’re struggling with deficiencies that can be resolved to provide a performance and energy boost without the use of supplements. Fats are essential for long-term energy, hormone production, and the absorption of fat-soluble vitamins including A, D, E, and K. The standard recommendation is that fat should make up 20 to 35 percent


of total calories in an athlete’s diet. Research shows that vegetarians generally consume less fat than meat eaters, and this accounts for numerous health benefits, such as lower lipid levels and body mass index, and reduced risk for hypertension and diabetes. But too little fat can be problematic. In particular, diets that do not include fish or eggs can be low in beneficial omega-3 fatty acids. Not surprisingly, vegan athletes are most at risk for deficiency. These athletes should be encouraged to get their essential fatty acids through sources such as soy, walnuts, almonds, pistachios, flax, and canola oils. There are also algae-based supplements marketed to vegetarians that are rich in specific omega-3 fatty acids such as docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). VITAL VITAMINS When meat is eliminated from the diet, certain vitamin and mineral levels must be carefully monitored. Those who are new to vegetarianism may have been getting most of their vitamin B12, iron, calcium, and zinc from animal


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CorTemp® Ingestible Temperature Sensor “Compared with rectal temperature (the criterion standard), gastrointestinal temperature was the only measurement that accurately assessed core body temperature. Oral, axillary, aural, temporal, and field forehead temperatures were significantly different from rectal temperature and, therefore, are considered invalid for assessing hyperthermia in individuals exercising outdoors in the heat.” *

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*Casa D.J. et al. Validity of devices that assess body temperature during outdoor exercise in the heat. Journal of Athletic Training. 2007;42(3):333-342. Circle No. 114 TRAINING-CONDITIONING.COM

T&C march 2010



ON THE SHELVES As meat-free lifestyles continue to grow in popularity, it’s easier than ever to find quality vegetarian products at supermarkets and specialty stores. This list contains some brand names to look for at your local store. Many of the products listed can also be purchased online. Arrowhead Mills: Grains and cereals Amy’s: Frozen vegetarian and vegan foods Boca: Veggie burgers and frozen vegetarian foods Clif & Luna: Vegan energy bars Earth Balance: Vegan “butter” Eden: Soy milk and pasta Ener-G: Egg substitute for baking Fantastic Foods: Bean dip mixes and dried soups Field Roast: Vegan sandwich slices Gardenburger: Frozen meat substitutes Lightlife: Meat substitutes and meals

products without knowing it. Studies have found that zinc levels are typically lower in vegetarians than omnivores, which is not surprising since 50 to 70 percent of zinc in our diet regularly comes from meat and dairy. Zinc is essential for protein synthesis, immune system function, and new blood cell formation. The recommended daily amount is 11 milligrams for men and nine milligrams for women, but these values may be too low for competitive athletes, since strenuous exercise can lead to increased zinc loss through sweat and urine. To further complicate matters for vegetarians, a plant compound called phytate found in the hulls of many nuts, grains, and seeds may inhibit zinc bioavailability in humans. According to The American Dietetic Association’s position paper on vegetarian diets, one way to increase zinc absorption from beans, grains, and seeds is to soak them in water before eating them. Another effective method is to eat fortified cereals and other zinc-rich foods together with citrus fruit, which helps promote absorption. Calcium recommendations for active males and pre-menopausal females are typically 1,200 to 1,500 milligrams daily for adolescents and 1,000 milligrams for adults. Calcium is essential for bone integrity and also plays an important ­22

T&C march 2010

Linda Loma: Meat substitutes and non-dairy beverages Morningstar Farms: Frozen meat substitutes Nasoya: Tofu and tofu-based products Soy Delicious: Soy ice cream Silk: Soy milk Soymage: Vegan “cheese” Sunergia Soyfoods: Marinated tofu Vega: Shakes, bars, smoothie mix, and electrolyte formula Vitasoy: Soy milk Vegenaise: Non-dairy mayo Yves: Meat substitutes and vegan prepared meals

role in circulatory and nervous system health. Low calcium intake can increase the risk of stress fractures, especially in amenorrheic female athletes. Some research suggests that vegetarians may have lower calcium needs than omnivores because the higher protein and sodium intake typical of meat eaters leads to greater calcium excretion, but the jury is still out on that theory. In any case, there’s no need to gamble, since calcium is easy to find in dairy products and fortified dairy alternatives like soy, rice, and almond milks, tofu, juices, shakes, and greens. Iron is critical for all athletes because it synthesizes hemoglobin and myoglobin, which transport oxygen to muscles. Athletes and growing adolescents are at particularly high risk for iron deficiency, partly because of the natural demands of physical growth and partly due to iron loss through heavy sweating. Another iron-related issue is hemolysis, or the destruction of red blood cells, which can be caused by highvolume endurance training. As with zinc, the standard daily recommendation for iron (which ranges from eight to 18 milligrams per day depending on age and gender) is likely too low for vegetarians because of the lower absorption rate of non-meat iron sources. The form of iron found in plants, called non-heme iron, is less bioavailable than

the heme iron found in meat and fish. Many vegetarians take an iron supplement to ensure they get an adequate supply of this vital mineral. But it’s not hard to get enough iron in the vegetarian diet through beans, fortified cereals, greens, and dried fruits. Consuming iron-rich foods along with citrus fruit and other fruits and vegetables rich in vitamin C, such as broccoli, red and green peppers, and strawberries, also helps to increase iron absorption. One other nutrient for which vegetarians may be at risk of deficiency is B12. Found only in animal products and foods fortified with it, B12 is an important coenzyme required for the normal metabolism of protein, carbohydrates, and fats. The daily recommendation is 2.4 micrograms, which can be obtained through fortified cereals, bars, shakes, rice and soy milk, and nutritional yeast. If a vegetarian athlete is unsure of their B12 level, a simple blood test can determine if they have a sufficient supply. Athletes who choose the vegetarian lifestyle can give themselves an edge over their meat-eating peers. Whether they do it for health reasons, moral reasons, or simply personal preference, as long as they monitor their intake of key macro- and micronutrients, they’re well positioned to achieve optimal fueling for performance and health. n TRAINING-CONDITIONING.COM

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Negotiating an agility ladder on synthetic turf in bare feet is one exercise Northeastern University menâ&#x20AC;&#x2122;s basketball players use to recruit the muscles of their feet and ankles.

Brian Tucker Bresnahan Photography

Optimum performance

Baring Their Soles Barefoot training is this author’s secret weapon for improving movement efficiency, balance, and kinetic chain integrity in his athletes.

By Art Horne


t the 1960 Summer Olympics in Rome, Ethiopian runner Abebe Bikila earned worldwide fame by winning the marathon with a world-record time of 2:15:16. The attention focused not just on his remarkable feat, but on his remarkable feet—Bikila completed the marathon without wearing shoes or socks. Some would say that event catapulted the concept of barefoot training into mainstream consciousness. But in reality, athletes around the world trained barefoot in various ways long before Bikila’s accomplishment—in fact, you might argue that barefoot training is as old as athletics itself. Barefoot training advocates argue that “shod” (shoewearing) athletes miss out on many benefits, ranging from proprioception and motor development to recruitment of important muscles that remain underutilized and practically dormant inside rigid, restrictive modern footwear. There is very little research providing clear answers on how best to implement barefoot work into today’s training strategies. But as an athletic trainer and strength coach who has employed barefoot training with basketball players at Northeastern University ©getty images for several years, I firmly believe it’s TRAINING-CONDITIONING.COM

well worth the time investment. In this article, I’ll explain the concepts behind barefoot training, outline how I use it with my athletes, and discuss the benefits I’ve seen from having athletes bare their soles during workouts. THEORY BEFORE PRACTICE Anyone who has walked barefoot on a beach or grassy field can grasp the theory behind barefoot training and its athletic benefits. By letting the foot return to its primitive state, in which it must grip the earth to produce efficient movement, you can feel the engagement of intrinsic muscles of the toes, midfoot, heel, and ankle—muscles that receive little opportunity for strengthening in our shoes-required world. The idea behind barefoot training is that developing these muscles improves foot and ankle function, while also providing benefits up the entire kinetic chain. Barefoot proponents point to increased proprioception related to the movement of the feet and ankles in time and space, lower impact forces due to reduced heel strike, higher efficiency in running as measured by lower oxygen consumption, and an increase in bone density throughout the foot and ankle. Humans’ relationship with shoes is a surprisingly complex one, involving both physical and psychological ele-

ments. For example, in a 1997 study, researchers had subjects repeatedly step onto and off of a box, each time landing on a pad made of material commonly found in shoe insoles. The material was the same each time, but the authors used different terms to describe the landing pad, and found that participants landed with greatest impact forces when stepping down onto surfaces described with words like “advanced technology” and “used in the most expensive sneakers.” The authors noted the natural human tendency “to be less cautious when using new devices of unknown benefit because of overly positive attitudes associated with new technology and novel devices.” If that’s true, it may mean today’s athletes, who wear more and more advanced footwear and often receive custom tape jobs before each practice and competition, pay less attention than ever to the fundamentals of foot movement and function, possibly harming their performance and increasing their risk for injury. Barefoot training can help reverse those practices. Art Horne, MEd, ATC, CSCS, is Strength & Conditioning Coach and Coordinator of Care for men’s basketball at Northeastern University, and is currently serving as the Interim Director of Sport Performance. He can be reached at: T&C march 2010


Optimum performance Consider a more specific example: High-top sneakers with stiff soles are worn almost universally in basketball, and many athletes wear ankle braces or tape underneath them, even for workouts. This practically ensures a weak and dormant foot and ankle complex. Kinematic data suggests that the hal-

and running. For many athletes, this effect contributes to an adaptive shortening of the gastroc/soleus complex and Achilles tendon over time. On the advice of our podiatrist, we have actually made lateral cuts to the bottom of many of our basketball players’ shoes. The cuts extend from one side

For those with normal soreness, we recommend general soft tissue work, such as plantar fascia rolls ... We tell them their foot muscles have been dormant for years in their shoes, so this new engagement and mobilization will be fatiguing—but it shouldn’t be seriously painful. lux (big toe) requires 20 degrees of extension and the ankle needs around 20 degrees of dorsiflexion to allow for normal forward motion. Both those movement dimensions are commonly limited by basketball shoes, tape, and braces. In addition, modern sneakers are usually built with some form of “air cells” or other shock absorbers or supports that raise the heel above its normal resting elevation during standing, planting,

of the forefoot to the other through the full-length fiberglass insert, directly under the first metacarpophalangeal (MP) joint, basically running across the ball of the foot to alleviate manufactured stiffness and allow for normal big toe extension. We started doing this after several complaints of Achilles tendon pain and anterior knee pain, both of which were alleviated after normal foot motion was restored. Increasing natural foot mobil-

ity can also help athletes improve their movement mechanics. FREE THE FOOT When athletes perform activities such as dynamic warmup and movement prep with bare feet, they recruit the muscles of their feet and ankles and experience feedback and proprioception in the plantar surface of the foot. At Northeastern, we strongly believe this leads to better positional sense and may contribute to injury prevention and performance enhancement. For those reasons, we have implemented year-round strategies for our men’s basketball players to promote the normal motion of the athletes’ feet, toes, and ankles. During evaluations at the beginning of the year, each player undergoes goniometric testing of the ankle, knee, and hip, traditional movement screening (including jumping and landing measures), and an examination of their feet for existing pathologies or mechanical challenges. This is essential, because certain foot-related conditions can make barefoot training counterproductive and even dangerous.


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Circle No. 117 ­26

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Optimum performance For example, athletes with excessively high arches are excluded from our barefoot work, because most physicians agree that high-arched feet require support to prevent excessive plantar stress and decrease injury risk. In addition, we exclude athletes who have experienced a stress fracture or other serious injury, or have had surgery on the foot or ankle (such as fixation of the navicular bone). To let these players’ feet strike the ground repetitively without support during barefoot training would produce injury risks that outweigh any potential benefits. Some believe that excessive pronators must have firm support from custom orthotics during all activities, but it’s been my experience that these athletes do very well in a progressive barefoot program. In fact, I’ve found that symptoms such as anterior knee pain typically seen in pronators are often resolved when barefoot work is added to their overall training plan. Nonetheless, it’s always best to consult a physician, preferably a podiatrist, if you have doubts about the safety of barefoot training for a particular athlete.

BARE ESSENTIALS Before beginning our barefoot program, we hold an educational session to introduce the athletes to this strategy and explain what they should expect. We tell them it’s normal to feel some residual foot soreness after training in bare feet, especially if they’ve never trained this way before. However, we note that if the soreness lasts for more than a day, if it’s accompanied by sharp or shooting pain, or if it leads to sudden knee or back pain, they should see us for an evaluation, which might lead us to discontinue their barefoot program. These symptoms may indicate an unresolved previous injury, such as a stress reaction or fracture. For those with normal soreness, we recommend general soft tissue work, such as plantar fascia rolls on a tennis or field hockey ball and basic warmup activities such as ankle mobility drills, static gastroc/soleus stretching, and general dynamic movement patterns. We tell them their foot muscles have been dormant for years in their shoes, so this new engagement and mobilization will be fatiguing—but it shouldn’t be serious-

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ly painful. If it is, we want to know right away so we can determine the cause. One of the first priorities when implementing barefoot training is to find a workspace with the right type of surface. Synthetic turf is the best choice, and we are fortunate at Northeastern to have two indoor surfaces (a field house and a turf area located in our weightroom). Since much of the benefit of barefoot training comes from athletes’ ability to use their foot muscles to “grip” the ground and feel feedback from a soft ground-foot interface, synthetic turf is far superior to a gym floor or weightroom mat. So what does the barefoot portion of a workout actually look like? For us, it begins with cold stretching, including plantar fascia rolls, foam rolling, and standard static pre-workout stretches. We’ll then put the athletes through a series of simple dynamic movements and agility ladder drills such as skips, butt kickers, spidermans, toe kicks, inchworms, and shuffles in all directions. Next come mobility drills, such as lunges in various planes, hurdle walks/ duck-unders, single-leg reaches in multiple planes, and various balance activi-



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Optimum performance ties such as one-quarter jump-and-lands on one or two legs, hops, balancing on one leg with eyes closed, single-leg chopping patterns with core balls, and light bounding. We also use our barefoot training time as an opportunity to develop the core with a number of upright standing exercises, such as partner anti-rotation, cable

ular conditioning sessions, weightroom workouts, and sled work, we might have them perform cooldown and stretching in bare feet on our indoor turf to keep the foot muscles engaged and maintain the strength gains they’ve made. One question we have considered at length is how much barefoot training athletes should perform. We believe

By placing the athletes in positions that imitate live basketball action but without the usual support of their shoes, we enhance the sport-specific foot and ankle sensory system. chops, and resisted lumbar cable extensions. By placing the athletes in positions that imitate live basketball action but without the usual support of their shoes, we enhance the sport-specific foot and ankle sensory system. And by improving the foot’s tactile feedback and gripping strength, we provide benefits not only for the foot and ankle complex but all the way up the kinetic chain to the knee, hip, and lumbar spine. At the end of a barefoot session, stretching and recovery includes strap stretches and foam rolling. We also use light jogging in the cooldown portion of some workouts, along with locomotion patterns such as walking with toes and feet pointed in, out, and up, walking on toes, shuffling in circular patterns, and backward jogging and running. In addition to our traditional cooldown modalities, we also employ yoga during some sessions, particularly in the summer and the early preseason. This allows additional opportunities to stretch and maintain tissue quality while providing a refreshingly different type of ground-foot interaction. The most striking thing about yoga work with our players is the extent to which they struggle to maintain the balance necessary for even basic poses such as the warrior series, high lunges, extended triangles, and downward facing dog. But improving balance is part of the reason we use barefoot training in the first place, so as they make progress in yoga, we know they are adding a new dimension of awareness and proficient mobility that will transfer to the entire kinetic chain. As our athletes grow more comfortable with barefoot training, we gradually get them out of their shoes more and more often. For example, after reg­28

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that once they’ve been evaluated and introduced to barefoot work, they should do as many training activities unshod as is practical. In our conditioning program, the barefoot portion of a workout typically takes between five and 20 minutes—so while it’s certainly not the bulk of training, it is a significant part of the broader program.

I’ve seen very positive results from incorporating this type of training into athletes’ workouts on a regular basis. Since we first implemented barefoot work in the summer of 2007, we’ve noticed a significant drop in episodes of anterior knee pain, ankle sprains, and low back pain among our basketball players. In fact, during the 2008-09 men’s season, no one missed a game due to an ankle sprain or any form of lower extremity pain. Is barefoot training the secret to solving all foot, ankle, and gross movement problems? Certainly not. But with the outcomes we’ve witnessed, we won’t be dropping it from our training program any time soon. After all, why would humans have such an incredibly complex mechanism as the foot if it wasn’t intended to move freely? n To learn more about barefoot training, check out March’s Monthly Feature column at:

STAYING SAFE While barefoot training is a safe way to enhance foot strength and functionality, like every training activity it carries some risk. Here are a few pointers on how to minimize the chance of injury: • Before every barefoot training session, inspect the surface for sharp objects, such as broken glass, pieces of metal, or anything else that could cause cuts or puncture wounds. • Athletes with a wound on their foot should not train barefoot, especially if they cannot keep the wound covered with a secure bandage. Diabetic athletes should be especially cautious, as they have an increased tendency to develop foot ulcers. • In most cases, athletes should not go barefoot in the weightroom— the risk of dropping a plate, dumbbell, or other piece of equipment on an exposed foot is too great. There are just two exceptions in our facility: during prep work when no one in the weightroom is handling free weights, and while I evaluate squatting technique, because it is beneficial to see the unshod foot as it moves during squats. • As mentioned in this article, athletes with high arches and those with pre-existing foot or ankle conditions usually should not go barefoot, as they may need cushioning and/or orthotic support at all times to avoid injury. When in doubt, consult a podiatrist. • As with any new form of training, the body requires an adaptation period. When introducing barefoot training, start with just a few minutes of light stretching and movement prep at each workout, and gradually add greater challenges as the athletes grow more comfortable.


Saving Knocked-Out Teeth During Sports 800,000 teeth are knocked out during sports each year! These teeth can be saved, but do you know what to do? Now you can have Save-A-Tooth® as a vital first aid component Each year approximately eight hundred thousand teeth are knocked out (avulsed) during sports activities in the U.S. alone. Studies have shown that only 10% of athletes comply with rules that require wearing their mouthguards during all sports activities. Knocked-out teeth begin to die within 15 minutes, and teeth knocked out during sports events have little chance of being saved unless prompt action is taken. Why can knocked-out teeth be saved… Every tooth is connected to its surrounding bone by a ligament, the periodontal ligament (PDL). (See figure on right.) The tooth and surrounding cementum, bone, and gingiva receive nourishment from the blood supply through this ligament. When a tooth is avulsed, this ligament is stretched and splits in half; half stays on the tooth root and half stays on the socket wall. If these two halves can be kept alive, the tooth can be replanted and the halves of the ligament will reattach and the tooth will remain vital. The half that stays on the socket wall, since it remains connected to the bone blood supply, is naturally kept alive. However, the PDL cells that remain on the tooth root must be artificially maintained. They must be protected from two potentially destructive processes: cell crushing and loss of normal cell metabolism. Although some dentists advise that the best treatment for an avulsed tooth is immediate replantation, for a variety of reasons this is often difficult. Often multiple teeth are avulsed and an athletic trainer may not know into which socket an individual tooth belongs. The athlete may have other more serious injuries that require more immediate attention such as a severe eye injury or a severely lacerated bleeding lip or gum that prevent easy visualization of the socket. Bone chips or debris may be in the sockets, which will prevent complete reimplantation. If avulsed teeth are not reimplanted immediately, then all treatment between the time of the accident and the ultimate replantation must be focused on preventing further damage to the teeth and maintaining the PDL cells in the optimal condition.

Save-A-Tooth®… In order to be prepared for these incidents, athletic trainers should have Save-A-Tooth , emergency tooth preserving systems, available with their first aid supplies. Save-A-Tooth® contains a pH-balanced cell preserving solution, called Hank’s Balanced Salt Solution, and a removable basket and net that suspends knocked-out teeth in the solution preventing cell crushing. According to Henry Rankow, DDS (from Pennsylvania), “SaveA-Tooth overcomes all of the obstacles encountered with avulsed tooth storage. It preserves and protects the tooth for 24 hours successfully.” A recent study showed that knocked-out teeth stored in Save-ATooth® showed 91% success and another study found that 20% of Save-A-Tooth kits are used within the first year. One of these kits was used by the Director of Health and Athletics for Baldwinsville Central School District, who wrote about his experience: Last year we had an unfortunate incident at one of our boy’s varsity soccer matches where one of our students lost a tooth during play. Luckily, we had one of the Save-ATooth kits in our medical box and the tooth was preserved and successfully implanted back into our player. Athletic trainers must be prepared to institute the optimum treatment for knocked-out teeth, and this includes having Save-ATooth available. In the case of knocked-out teeth, being prepared and knowing what to do can mean the difference between athlete’s losing knocked-out teeth for life or keeping their own natural smiles.

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with other coaches, exchange ideas, share solutions


coach-specific articles and information


athletesâ&#x20AC;&#x2122; parents with educational resources Circle No. 119



Facial injuries in sports run the gamut from simple black eyes and knocked-out teeth to serious damage that can have lasting consequences. Are you prepared to deal with all the injuries you may face? By Dr. Jaime r. Garza


ap photos/bill kostroun

acial protection in athletics has come a long way since the days of leather football helmets and bare-knuckle boxing. The evolution hasn’t always been smooth—Jacques Plante, the first NHL goalie to regularly wear a mask in games, was famously accused of cowardice by his coach in the 1950s when he donned the device after a slap shot broke his nose, and debate over the value of masks in hockey lasted for years. Thankfully, common sense has prevailed throughout the sports world. Today it’s very common to see cages on baseball and softball batting helmets, protective eyewear on field hockey and women’s lacrosse players, state-of-theart mouthguards on football fields and basketball courts, and many other types of highly effective protection. Nonetheless, thousands of facial injuries occur among athletes at all levels each year. According to one report, facial injuries are present in somewhere between 11 and 40 percent of all athletic injuries.


Jaime R. Garza, MD, DDS, is Clinical Professor of Surgery and Otolaryngology at the University of Texas Health Science Center in San Antonio. He has served as contributing team physician for the University of Texas-San Antonio and Trinity University, and as a medical consultant to the New Orleans Saints and San Antonio Spurs. T&C march 2010


TREATING THE ATHLETE Sports injuries to the face can run the gamut from superficial skin damage to potentially life-threatening trauma affecting the integrity of the airway. While the former are happily much more common than the latter, the best athletic trainers are prepared to treat and manage the full range of possibilities. SKIN & SOFT TISSUE The most common soft tissue injuries to the face include abrasions, contusions, and lacerations. Not surprisingly, these injuries usually occur over the most prominent areas—the nose, cheeks, and upper and lower lips. Lacerations to the face are often described as “burst” injuries, with compression from an external source essentially pinching the skin and other tissue against bone or teeth until the skin breaks. After any such injury, the immediate priorities are to stop bleeding and decrease swelling, typically through the application of pressure and ice. The standard rules of wound care apply—keeping the site clean and covered while it heals, irrigating it when necessary, and monitoring it for any signs of infection. Beyond immediate concerns, a longer-term priority with facial injuries is to minimize the potential for scars. Besides the aesthetic impact of facial scars,

scar tissue is more vulnerable to reinjury in the future. To reduce scarring, an athlete can be instructed to gently selfmassage the area near a facial abrasion as it heals, as this helps break up dense collagen bonds that contribute to visible scar formation. Applying antibiotic ointment or a scar-management product such as Mederma can also help. A common home remedy for scar prevention is applying vitamin E to the wound site, but this should be avoided—studies have found it to be ineffective, and it causes contact dermatitis in some people. The ears are especially susceptible to deformity due to athletic injury. If you’ve spent time around experienced wrestlers or boxers, you’ve likely seen examples of hematoma auris, commonly known as cauliflower ear. While some grapplers consider this condition to be almost a badge of honor, it is medically undesirable, since it increases the risk of ear infections and can even contribute to hearing loss. Cauliflower ear is caused by shearing forces on the ear that lead to bleeding below the skin surface, often accompanied by separation of the skin from the cartilage beneath it. Because ear cartilage receives its blood and nutrients from the skin of the ears, the separation causes scarring (fibrosis) and death of the cartilage, leading to deformation.

SLIDE AND SLAM The temple-mandible joint (TMJ) is the most targeted and traumatized structure in boxing, and it’s vulnerable in other contact sports as well. The condyles, or posterior extensions of the lower jawbone, are located in a socket near the base of the skull, accompanied by a cartilage meniscus that’s very similar to the meniscus of a knee joint. When an athlete receives a lateral blow to the chin or lower jaw, it can result in something called the slide and slam phenomenon. In essence, as the jaw is forced to move laterally, one condyle gets forced up into the mandibular fossa (the place on the skull’s temporal bone where the jaw hinge is situated), causing damage to the meniscus, microfractures of the tympanic plate or the base of the skull, and even trauma to the temporal lobe of the brain. Repeated instances of this phenomenon in an athlete can result in progressive chronic injuries to the TMJ and the brain. The best protection against slide and slam injury comes from a quality custom-made mouthguard. Besides cushioning the teeth to prevent dental injury, an adequate mouthguard acts as a shock absorber that allows the condyles to pull away from the skull base properly, which helps prevent transmitted forces from reaching the delicate structures of the skull and brain.


T&C march 2010

This condition can almost always be prevented with proper treatment. An ear that has been subject to blunt trauma or shearing forces typically presents as swollen, tender, and bruised. A physician can treat the subsurface bleeding with an incision and drainage under sterile conditions. A compression bandage is usually placed over the site and left there for at least 48 hours. The physician will often prescribe an antibiotic to ward off infection, and return to full activity usually occurs within a week. The use of headgear is an obvious protective measure against cauliflower ear and similar injuries. In sports like wrestling, which involve direct physical contact with the head, ear guards should be standard equipment. And in any sport, after an injury to the ear that requires incision and drainage, headgear should be worn for at least two to four weeks. TO THE BONE Facial bone and joint injuries occur most commonly to the nasal bones, dentoalveolar complex (the bony area that anchors the teeth), cheekbones and orbital bones, and upper and lower jaw. These injuries often occur in combination, and the most prominent facial bones—those in the nose, cheeks, and lower jaw—are the most susceptible. When examining the face for signs of injury, one of the best visible indicators of fracture is asymmetry. Soft tissue injuries to the face can cause rapid swelling that produces obvious asymmetry, but it can also be due to fracture of an underlying bone. With fractures around the orbital cavity, the athlete may report double vision (diplopia) or loss of sensitivity around the cheek and gums of the affected side, and you may observe recession of the eyeball within the orbit (enophthalmos). Another part of any facial examination is asking the athlete to produce their normal bite with their lips open. In addition to helping identify dental injuries, an abnormal bite (for instance, one in which the upper and lower teeth are not properly aligned) may indicate trauma to the upper or lower jaw or the temple-mandible joint (TMJ). If there is any blood in or around the mouth, it’s essential to determine the source—if no laceration can be found, the presence of blood is another potential sign of a jaw injury. (For more on injuries to the TMJ, see “Slide and Slam” at left). TRAINING-CONDITIONING.COM

TREATING THE ATHLETE When an athlete presents with a bloody nose (epistaxis), nasal septal fracture is a strong possibility. Bleeding due to a broken nose usually occurs only anteriorly (with blood draining from the nostrils), and it can be stopped with ordinary cotton rolls. However, any sign of posterior nasal bleeding, with blood draining at the back of the throat, may be a sign of a more serious injury for which the athlete should be treated by a physician or taken to the emergency room. If the nose doesn’t appear crooked and bleeding stops within a few minutes, the injury may heal on its own with only the application of ice and short-term use of over-the-counter nasal decongestants to aid in breathing. But with any sign of external deformity, a physician will likely recommend surgery. Persistent facial pain or headaches after a broken nose may indicate the fracture has extended into the periorbital bone or down to the upper jaw, also possibly requiring surgery. Any time a facial fracture is suspected, the athlete should not return to activity before seeing a physician, pref-

erably one who specializes in orofacial injuries. Diagnostic x-rays can determine the extent of any damage (CT scans are best for this), and surgical intervention may be required to ensure that the fractures heal properly. It typically takes six to eight weeks for full healing. But depending on the

rior maxilla (upper jaw), and the most common are lacerations of the lips and surrounding tissue. A knocked-out tooth is one injury for which an athletic trainer’s immediate response can play a major role in the outcome. Acting fast and correctly may make the difference between

While some grapplers consider cauliflower ear to be almost a badge of honor, it is medically undesirable, since it increases the risk of ear infections and can even contribute to hearing loss. location and severity of the fracture, a physician may allow return to play as quickly as one to two weeks post-injury, particularly if surgery isn’t required and an appropriate facemask can be found to protect the injured area. THE ORAL CAVITY The mouth and teeth are highly susceptible to athletic injury, particularly when athletes don’t wear mouthguards. Among oral injuries, roughly 80 percent occur at the ante-

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a simple one-time trip to the dentist and much more complex and lengthy treatment. First, a brief primer on dental anatomy: The outside of the tooth is covered with enamel, the middle lining consists of a substance called dentin, and the internal portion is pulp, which contains neurovascular tissue that supplies sensation and blood. At its base, each tooth is surrounded by tiny connective tissue fibers collectively known as the periodontal ligament, which connect it

TREATING THE ATHLETE to surrounding spongy bone and essentially attach it to the skull. Even when a tooth is not completely knocked out, this connection can be damaged, typically resulting in intraoral bleeding, pain or altered sensation in the area, and the tooth being visibly out of position. When a tooth is loose but not completely out of its socket, there has been some degree of damage to the periodontal ligament. In these cases, the tooth should be gently Staphylococcus Aureus

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such damage, oral surgery is usually required. When a tooth is chipped but not loosened or removed from its socket, any retrievable pieces should likewise be stored in moisture. Depending on their size, a dentist may be able to reattach tooth chips through a simple cosmetic procedure. Chipped teeth are often accompanied by lacerations inside the mouth, and any such wounds should be in-

After a blow to the chin and mouth, knocked-out teeth may be the most conspicuous visible injury, but before reaching for a tooth-saving kit, first ensure that the athleteâ&#x20AC;&#x2122;s airway is not affected. Trauma to this area may have damaged the trachea or larynx, and recognizing the more serious injury is essential. manipulated back into its normal position, allowing the athlete to assume a normal-looking and normal-feeling bite. The athlete should visit a dentist immediately. If a tooth is completely avulsed (knocked out), the best immediate step is to replant it in its socket as quickly as possible and refer the athlete to a dentist. Note that this only applies to adult teeth, and not deciduous â&#x20AC;&#x153;babyâ&#x20AC;? teethâ&#x20AC;&#x201D;when a youth athlete loses one of these, it should not be replanted, as the risk of infection outweighs any potential benefit. In the case of multiple knocked-out teeth and other situations where replanting is not possible or practical, or if the athlete finds it very painful, the tooth must be kept surrounded by moisture. Tooth-saving kits consisting of a small vessel of sterile liquid can easily be stored in first-aid bags. If none is available, workable substitutes include milk, saline solution, and saliva. The tooth should never be scraped or brushed to remove debris, as this can further damage remnants of the periodontal ligament. In fact, the tooth should only be handled by its crown (the non-root end) to avoid damaging or contaminating the root. If the tooth is replanted or otherwise surrounded by moisture and the athlete quickly sees a dentist, this injury can usually be treated quite simply. The dentist will examine the injury site to determine whether any damage has occurred to the alveolar bone that holds the teeth in place, and if there is any

spected to ensure they do not contain tooth fragments, which pose a serious infection risk. Significant lacerations of the mouth should always be referred to a physician, who may recommend sutures. Allowing intraoral lacerations to heal without treatment could lead to scarring and uneven surfaces that cause problems with chewing and speech. An important final note on treating all facial injuries is that itâ&#x20AC;&#x2122;s critical to establish priorities before deciding how to proceed with immediate treatment. For instance, after a serious blow to the chin and mouth, knockedout teeth may be the most conspicuous visible injury, but before reaching for a tooth-saving kit, first ensure that the athleteâ&#x20AC;&#x2122;s airway is not affected. Trauma to this area may have damaged the trachea or larynx, and recognizing the more serious injury is essential. Likewise, a blow to the upper face may result in a bloody nose, but if thereâ&#x20AC;&#x2122;s also potential damage to the eye or its socket, that should usually take precedence when providing firstaid care and arranging for further treatment. When in doubt, bring a physician into the picture as quickly as possible. Todayâ&#x20AC;&#x2122;s facemasks, eye protection, and mouthguards are more advanced than ever, and happily, more and more athletes are using them. But as long as sports exist, there will be facial injuries. Armed with knowledge to handle all types of them, you can keep your athletes as safe as possible in any sport. n TRAINING-CONDITIONING.COM


Hawai’i Pacific University senior midfielder Max Anton (2) splits two defenders from the University of Hawai’i-Hilo.

Sports medicine departments nationwide are dealing with tighter budgets and fewer resources in our current economic climate. In response, some athletic trainers are finding creative ways to keep their programs alive and well.

Dayne Teves

Making It Through By Dan Resing


hen I first arrived at Hawai’i Pacific University in the fall of 2006, the athletic training room was a tiny office into which they had crammed two treatment tables, a computer, a refrigerator for cold packs, and a few other essentials. I was not an employee of the university, as HPU had long been contracting out sports medicine services from a private physical therapy clinic. But there was a plan in the works to bring athletic training in-house, and after my first year, that’s just what happened—with me as the department’s first true Head Athletic Trainer. At that point, everything was look-


ing up for HPU athletic training. In addition to hiring its first two full-time athletic trainers (myself and an assistant who had worked with me under the old contract), the school brought in two graduate assistants to expand our coverage capabilities. We doubled the size of the athletic training room by taking over an adjacent office and purchased new equipment, including a laser therapy device, an ultrasound machine, and a four-channel combo tower electrotherapy unit. Our budget grew to include money for staff CEUs, CPR certification, NATA and NSCA dues, professional liability insurance, and even cell phone reimbursement. The school was making a serious in-

vestment in sports medicine, allowing us to become one of the most comprehensive athletic training departments in Hawai’i and in the Pacific West Conference. It was exciting to lead a program that was growing right before my eyes. Then, in the fall of 2008, the realities of the economic downturn caught up with us. Suddenly we faced a shrinking budget, and like many programs across the country, the universityimposed cuts ran deep, affecting both our resources and our personnel. It’s never easy to deal with less than Dan Resing is Head Athletic Trainer at Hawai’i Pacific University. He can be reached at: T&C march 2010


LEADERSHIP youâ&#x20AC;&#x2122;re used to. But until the economy recovers from its current recession, athletic trainers in practically every setting are having to make do. At HPU, weâ&#x20AC;&#x2122;ve worked hard to limit the effects budget cuts have on our athletes and the services we provide. Hopefully, some of the solutions weâ&#x20AC;&#x2122;ve come up with can help your program get through these rough times as smoothly as possible. CUTTING COSTS, NOT CORNERS When looking to trim the budget, our first decision was that direct care for athletes was the top priorityâ&#x20AC;&#x201D;after all, thatâ&#x20AC;&#x2122;s the reason weâ&#x20AC;&#x2122;re here. We would look for any other places to make cuts before altering coverage for workouts, practices, and competitions. Thus the first thing we scaled back was staff travel to non-athletic events. For one thing, this meant we would not send anyone to the NATA Annual Meeting. Anyone who has been to an NATA convention knows itâ&#x20AC;&#x2122;s an incredible opportunity to learn about the latest research in our field, network with colleagues at other schools, and expand our professional horizons in countless

ways, so this was a tough decision to make. But we had to acknowledge that convention attendance was something of a perk, and not truly a necessity in a cash-strapped year. Our travel cuts also meant forgoing various sports medicine conferences and seminars, which in the past have provided opportunities to earn CEUs. I researched other ways for our staff to earn CEUs, and found that if you look hard enough, there are plenty of alternatives. For example, the NATA Web site recently started offering free CEU quizzes online to members, and the Hawaiâ&#x20AC;&#x2122;i Athletic Trainers Association offers some free and low-cost opportunities as well. Since our department could no longer afford to pay for staff CEUs, these resources have proven invaluable. Many other state associations offer similar programs. We learned that another way to get free CEUs is to become an Approved Clinical Instructor (ACI). This involves taking a simple one-day course that prepares you to work with athletic training students and play an active role in their learning process. It provides

TODD DURKIN: ELITE STRENGTH AND CONDITIONING COACH. Iâ&#x20AC;&#x2122;m helping my athletes move their bodies to maximize speed, power and agility with the TRXÂŽ. Watch my workouts and get with the movement.


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CEUs while also enhancing your departmentâ&#x20AC;&#x201D;working with students is a great way to get extra help and groom the next generation of athletic trainers. Many universities with athletic training education programs offer this course for free to any athletic trainer who has been BOC-certified for at least one year. They do this to expand the list of athletic trainers and sites that their students can work with and learn from. The course is usually offered during the summer to prepare for the upcoming fall semester, but it can also be held over winter break if there is sufficient demand. The certification is good for one year, and ACIs must take a short refresher course each summer to maintain certified status. Those cuts were a good start, but we needed to go furtherâ&#x20AC;&#x201D;we realized we would have to cut back on athletic trainers traveling with teams to away games. As you might expect, with more than half our conference members being over 2,000 miles away on the mainland, travel is one of our greatest expenses. This was a tough realization, as no athletic trainer wants to leave the re-

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sponsibility of caring for their athletes in the hands of coaches, or athletic trainers at host schools who are unfamiliar with the athletes’ medical histories. But when we saw it was a necessity, we tried our best to minimize the impact on our athletes. We do this by establishing communication with the home team athletic training staff every time a team will be traveling without us. Via phone or e-mail, we share any important details about individual athletes’ status and potential treatment needs. We find it is helpful to report how many athletes may need taping or other treatment, so the host athletic training staff can plan ahead for the extra demand. Luckily, our colleagues at opposing schools have been very gracious about caring for our athletes, and we offer to return the favor when their teams come to our campus. Another trick we learned for games when we can’t accompany a team is teaching athletes how to do a tape job themselves—especially if they require special or unique taping. Even if they can’t actually perform the taping on their own body, they can guide a host athletic trainer through the process. For every contest where we won’t be there in person, we provide the coach with an athletic training kit containing basic supplies as well as insurance information and emergency contacts for each athlete. The athletic trainers in our conference have also been working on a great new idea for this—a system where each school would have a visiting team supply bag on hand, thus preventing the hassle and expense of toting one to away games. It would contain a predetermined list of basic supplies agreed upon by each athletic trainer in the conference, plus any special supplies a team may request. The visiting team’s staff would then only have to worry about bringing insurance and emergency contact information for their athletes.





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LEADERSHIP put her in a difficult spot personally, but she found an excellent solution. She worked with the leaders of our schoolâ&#x20AC;&#x2122;s nursing department to develop some entry-level sports medicine classes she could teach over the summer to supplement her salary. This proved to be a winwin for the time being, as it provided the extra income she needed while giving the nursing program a simple and cost-effective way to expand its offerings. The hardest cut we had to make came just this past fall, when lower-thanexpected enrollment forced us to lay off the assistant athletic trainer. At the time, she was primarily responsible for our womenâ&#x20AC;&#x2122;s volleyball team, which was in the middle of its season and fighting for a conference title. The players felt this loss immensely, as they had formed strong bonds with their athletic trainer, and we were of course very sad to lose a valued member of our staff. The change was logistically tough as well, as the rest of usâ&#x20AC;&#x201D;two graduate assistants and Iâ&#x20AC;&#x201D;had to put in extra hours to cover the work she had been doing. We learned early on that keeping everyoneâ&#x20AC;&#x2122;s sanity required frequent

short meetings to plan the schedule weeks in advance. In addition to volleyball, we were also covering menâ&#x20AC;&#x2122;s and womenâ&#x20AC;&#x2122;s soccer and three competitive cheer teams in the fall. At the same time, menâ&#x20AC;&#x2122;s and womenâ&#x20AC;&#x2122;s basketball were starting official practices. It was clear we would need to ration our coverage, so we looked at the schedule and made a few common-sense decisions. Hereâ&#x20AC;&#x2122;s a specific example of a challenge we faced with our smaller staff and how we met it: Both menâ&#x20AC;&#x2122;s and womenâ&#x20AC;&#x2122;s soccer practice typically started at 4:30 p.m. and didnâ&#x20AC;&#x2122;t finish until at least 6:30, while menâ&#x20AC;&#x2122;s basketball practice started at 6:00 at a facility 13 miles away. We didnâ&#x20AC;&#x2122;t have enough staff to cover both in their entirety, so we talked to the coaches and devised a plan that would meet the needs of both teams. I decided it was most important to be there at the beginning of team practices to provide taping and any needed treatment, and to evaluate any problems athletes may have noticed once they began working out. I would arrive at roughly 3:45 for a 4:30 soccer practice and stay until about 5:15,

then head to the menâ&#x20AC;&#x2122;s basketball facility, where I would arrive by 5:45 so I could tape the athletes who needed it and prepare the team for practice. It obviously wasnâ&#x20AC;&#x2122;t a perfect system, but we made it work. The players knew in advance when I would and wouldnâ&#x20AC;&#x2122;t be there, so they understood the need to plan their taping and treatment time around the modified schedule. And when the soccer team had a home game, I stayed with them for the entire contest and was â&#x20AC;&#x153;on callâ&#x20AC;? for the basketball team via cell phone in case of an emergency. Likewise, when the soccer team had a light practice the day before a game, I would have soccer players who needed taping come into the athletic training room earlier in the day and get taped, allowing me to attend all of basketball practice that day. Whenever there are events without athletic training coverage, itâ&#x20AC;&#x2122;s especially important to ensure that coaches are certified in CPR and first aid. All our coaches are certified by the American Red Cross, and while we hope they never need to use that training, we feel itâ&#x20AC;&#x2122;s an essential precaution.

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T&C march 2010


LEADERSHIP Anytime you lose a staff member, you lose a unique set of skills that’s difficult to replace. At such times it’s especially important to look for untapped resources that may help. For instance, the assistant athletic trainer we were forced to lay off had been our staff’s only certified kinesiotaping practitioner. That modality has become increasing popular with our athletes in recent years, so we were happy to learn one of our assistant women’s soccer coaches is also certified in kinesiotaping. We worked out an agreement whereby she tapes athletes who need the modality as long as we provide her with the specialized kinesiology tape. To make this as convenient as possible for her, we sometimes arrange to send athletes to the shiatsu clinic where she works in the daytime (just down the street from our campus) to receive their tape jobs. EXTRA HANDS When budget cuts are required, it’s easy to make the mistake of thinking only about subtraction: “What will we have to do without?” But this is also a time to think about adding cost-effective alternatives to fill gaps and minimize the impact of losses. Immediately after we laid off our assistant athletic trainer, I met with the athletic director to discuss what we could do to get through the busy fall semester. He understood my concerns, and agreed that one full-time athletic trainer and two grad assistants weren’t enough to care for the 350 athletes in our department. He was able to secure funding for a part-time athletic trainer to work up to 20 hours a week. It’s always more difficult to fill part-time positions— especially on an island in the middle of the ocean—but we were able to find a real estate agent who was also a certified athletic trainer looking for part-time work. Her schedule was complicated by the fact that she has young children, but we found ways to schedule around her other responsibilities, and her kids became a regular fixture at games she covered. The part-time hire was obviously a stopgap measure. For the longer term, we’ve decided the best way to meet our needs and work within our limitations is to add a third graduate assistant. For less than the cost of a full-time employee, we can cover more practices and games with this approach. While the main impetus for adding an extra grad assistant was to save money, we felt it was important to not shortchange the applicants by skimping on the benefits package. With that in mind, we are offering a full tuition waiver, books, and a very competitive stipend that will allow the assistant to pay for rent, food, and other living expenses. In addition to the compensation they receive directly through the assistantship, we always try to offer our graduate assistants other ways to earn money, since a stipend can only go so far. For instance, it’s a great idea to set up opportunities for them to provide athletic training services at various camps or intramural sporting events on your campus or in your area. Another nice touch is to pay NATA dues for your graduate assistants, since that can be a large expense for someone on a limited budget. Nothing is easy about making cuts that change the way your department runs. But as economic realities force programs everywhere to do more with less, I choose to see a silver lining. When we have no choice but to be more efficient, to communicate better, and to get creative in dealing with tough situations, we often find ways to refine our operations and the care we provide to athletes. When times improve and the funding returns, as I’m optimistic they will, our program is poised to be better than ever. n TR AINING-CONDITIONING.COM

Circle No. 127


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Circle No. 128

sport specific

Middle hitter Lauren Gibbemeyer goes up for a kill during the Golden Gophers’ 2009 NCAA Division I national semifinal match against the University of Texas.

Holding Court

University of Minnesota

By Sara Wiley


ou could justly describe the 20 09 Universit y of Minnesota volleyball season as a breakout year. Despite not cracking the top ten in preseason rankings and entering the NCAA Division I tournament as the 11th seed, we made it all the way to the national semifinals for the first time since 2004 and finished the season ranked fourth in the country. Even Head Coach Mike Hebert admitted after our final match that he was surprised by just how far this year’s Golden Gophers advanced. Yet while many people were astonished by our success, I saw it more as the logical culmination of a 12-month commitment on the part of our athletes. TRAINING-CONDITIONING.COM

The University of Minnesota’s year-round volleyball strength program incorporates movement prep, jump training, and power building with the goal of optimizing late-season performance. We have worked hard to build a training regimen focusing on the specific aspects of volleyball performance that we believe separate the elite players from the rest of the pack. The cornerstones of our program are mobility and flexibility, movement mastery, and strength and power development. We strive to help every athlete

excel in force absorption, power production, and jumping ability. To achieve those goals, we set precise priorities and devise targeted workouts all year long. MOBILITY & FLEXIBILITY We want all our players to move around the court in ways that maximize efficiency and minimize injury risk. With that in mind, each strength and conditioning session begins with a dynamic warmup and flexibility/ mobility training. We focus primarily on three body areas: the ankles, hips, Sara Wiley is Associate Director of Strength & Conditioning at the University of Minnesota. She can be reached at: T&C march 2010


sport specific and thoracic spine. Ankles. Our ankle mobilization exercises improve range of motion, especially dorsiflexion in the sagittal plane. From a performance standpoint, especially for defensive specialists and liberos, this type of mobility allows proper setup and alignment in low defensive power positions, which is essential for dynamic defensive movements close to the ground. Proper ankle mobility is also useful for keeping the knees optimally aligned, because the ankles serve as the foundation for practically every movement of the lower kinetic chain. To achieve this mobility, we use exercises such as single-leg tri-planar squats, kneeling ankle mobility (the athlete takes a knee as if in a lunge position, places her hands on the ground,

injuries to the shoulder and the hip, we have noticed that many athletes with shoulder issues also seem to have a corresponding problem with the opposite hip. For that reason, our hip mobility exercises always include at least one activity that requires coordination between the hip, trunk, and shoulder. Some of our staple exercises for building hip mobility include spider lunges and backward lunge-and-reaches. For engagement of the hip, trunk, and shoulder together, we use step-ups with rotation and reverse lunges with shoulder proprioceptive neuromuscular facilitation (PNF) diagonal movement (not to be confused with PNF stretches). For corresponding glute activation, we use three-way anterior reaches, the Cook hip lift, and bird dogs (opposite arm-leg

The athletes receive verbal cues and hands-on positioning—we literally manipulate their bodies into the correct positions prior to a jump or after a landing, so they can feel the difference between that position and the one they’ve used in the past. and rolls her body weight forward while attempting to keep the front heel down), and ankle circles with a BAPS (biomechanical ankle platform system) board. We also have the athletes perform squats and lunges in bare feet, which forces them to use the stabilizer muscles of the ankle to maintain balance and perform the movement correctly. Hips. At the hip, mobility exercises seek to open the flexor muscles while also improving range of motion in all planes of movement. Shortened, overactive hip flexors can disrupt optimal pelvic motion and lead to lower-back pain and changes in spinal alignment. That in turn may affect scapular alignment and ultimately play a role in a variety of shoulder ailments. Volleyball players spend a lot of time with their hip flexors in a shortened position due to the stances and movements required in the sport. To counteract that, it’s essential to invest time re-establishing a sound length-tension relationship between the flexors and extensors of the hip, mainly by working to lengthen the flexors and promote efficient firing of the gluteus muscles. In addition, while there is not much research to prove a causal link between ­42

T&C march 2010

raises on hands and knees). Thoracic spine. Mobility in the thoracic spine is critical for practically every movement pattern volleyball players use on the court. A lack of flexibility in this area is associated with increased injury risk and inefficient movement. Furthermore, poor thoracic extension may lead to compensatory movements in the lower back to achieve adequate range of motion during the arm swing—this frequently leads to volleyball players’ lower-back problems. To target thoracic spine mobility, we use four-point kneeling with thoracic extension and seated rotations with side bends. We also use thoracic extensions performed over a physioball. Beyond those three key areas, we use PNF stretching throughout the year to focus on the quadriceps and shoulders. Our quad-hip flexor stretch is performed in a stretch-contract-relax-stretch sequence, while our shoulder PNF stretch uses the same sequence but with a locked overhead position that traps the shoulder blade. This helps the athletes stretch their internal shoulder rotators while performing trunk rotation. It also helps build sport-specific range of motion that’s especially valuable in the volleyball take-away position.

MOVEMENT PATTERNS Even at the NCAA Division I level, there is wide variation in athletes’ movement efficiency during both lateral and vertical moves. Some of the most pronounced deficiencies occur in lateral movement, change of direction, and jumping and landing technique. By the time an athlete enters our program, it’s obvious she’s found a way to make her movement patterns work on the court. But we still believe we can often take her game up a notch by correcting movement flaws and teaching new patterns. Beginning early in the off-season (mid to late January), our training sessions include individualized instruction and drills that reinforce proper jumping and landing technique. The athletes receive verbal cues and hands-on positioning— we literally manipulate their bodies into the correct positions prior to a jump or after a landing, so they can feel the difference between that position and the one they’ve used in the past. Some of our favorite drills to reinforce optimal movement patterns are the simplest ones: in-place jumps with a stick, landing both vertically and horizontally and both single- and doublelegged. We instruct the players to land “quietly,” using full-body coordination to absorb force and soften foot impact. We also tell them to pay attention to body position from head to toe—eyes up, chest up, shoulders in line with the knees, knees in line with the toes, and toes dorsiflexed. We address lateral movement by emphasizing push-slant and push-drive mechanics, which volleyball players must use regularly to cover the court. Although these drills seem rudimentary, they serve as the base from which we refine mechanics through more complex and intense plyometric and agility drills. Once the players display mastery of the simple drills, we add shuffling and sprinting combinations, shuffling and jumping combinations, and short sprints with multiple changes of direction. We also add cone-based agility drills with various footwork patterns, using verbal or visual cues to signal changes in direction or activity, and sometimes incorporate a reaction component to the drill. For instance, when I flash a blue card, an athlete performing a footwork drill must cut left, and if I flash a red card, she must cut right. Other TRAINING-CONDITIONING.COM

sport specific times, the athletes must react to the color cues by running to a cone of a corresponding color. The reaction challenge forces heads-up running and eliminates the potential for just “going through the motions” during a drill. STRENGTH & POWER Our strength program is designed to be as functional and sport-specific as possible, which for volleyball means focusing on ground-based compound movements such as squats, box squats, and front squats, and their single-leg variations. We also emphasize developing strength in the posterior chain using Romanian deadlifts, glute-ham work, back hypers, pull-throughs, and good mornings, again along with their singleleg variations. During our strength development phase, which begins in March, we implement an isometric training block of two to three weeks followed by an eccentric block of two to three weeks, then finally a traditional concentric block. The isometric emphasis comes first because that’s the best way to teach athletes to develop tension and

stay tight during the “weaker” (less strenuous) portions of a lift. Next, when we focus on eccentric movements, they experience high motor unit recruitment and improve neuromuscular efficiency. In the final weeks, targeting concentric work, we put those previous training elements together into the same workout. At all times during our lifting program, we instruct the athletes to move the weight as quickly as possible to stimulate and recruit fast-twitch muscle fibers. Because volleyball requires frequent lateral and rotational movements, we complement our core lifts with exercises that require the athletes move into a full range of motion in the transverse and frontal planes, such as lateral squats, chopping movements, lateral step-ups, and lunging in multiple directions. For upper-body power development, we rely mostly on traditional vertical and horizontal pressing and pulling activities. We prefer dumbbells over barbells, because they allow the athletes to take greater control over shoulder positioning and require more engagement of the stabilizer muscles.

Circle No. 129

During balance pressing work, we pay special attention to the athletes’ technique in scapular retraction, downward scapular rotation, and external rotation. It’s very easy for volleyball players to develop imbalances in the upper back and chest, and those imbalances must be addressed in strength training to reduce injury risk. In addition to body rows and dumbbell rows, we target the lower and middle trapezius, rhomboids, serratus anterior, and external rotators of the shoulder with face pulls, kneeling reach roll-and-lift exercises, push-ups plus, and wall slides. To make force gains as functional as possible for volleyball, it’s vital to focus on the rate of force development. Volleyball is an explosive sport, and if explosiveness is developed at different rates in different muscle areas, players will suffer from inefficiencies and energy leaks. We combat this by incorporating total-body lifts into our training, including the power clean and power snatch—performed both from the floor and from hanging positions—as well as the clean and jerk, clean pulls, and snatch pulls.

sport specific As preseason approaches, total-body lifts account for a larger portion of our training volume, and we begin to combine our strength exercises into complexes with jumping activities. The coupling of a loaded strength exercise with an unloaded explosive exercise further increases motor-unit recruitment and stimulates fast-twitch motor fiber. We boost arm and shoulder muscle power with medicine ball exercises, including overhead throws, overhead triceps tosses, pullover throws off a physioball, slams, and single-arm tossbacks. In addition, we employ timed lifts— requiring an athlete to perform as many reps as possible in four or six seconds—

to build explosiveness. Once an individual reaches a rate of more than one rep per second, we add more resistance and they work to reach the same number of reps. Progressively increasing load and achieving the same number of reps with heavier weight translates into more work per unit of time: the very definition of power. JUMPING IN Jump training is one of the most important forms of development for volleyball players. From low-intensity ballistic jumping exercises to the technique refinement on take-offs and landings described earlier, practically all great volleyball players are highly proficient jumpers.

During the strength development phase of our program, which typically lasts from March through May, the athletes perform jump training twice a week, and the activities mirror the focus of our strength training blocks. For example, during the isometric block, our jumping activities may involve an isometric push against a partner followed by jumping upon release. As we progress through the summer, we have two unique periods of programming that focus heavily on shock-level plyometrics—plyo work that involves high nervous system activation, such as altitude landings and depth landings. (See “Jump Phases” below to learn how these periods fit into our broader jump

JUMP PHASES During the off-season, we break our jump training into three phases, each with its own unique emphasis. Here is a breakdown of the phases, including sample exercises: GENERAL PREP


Duration: Four weeks, beginning in January

Box jumps: isometric hold to jump

Goals: Prepare for more intense work to come, master technique for in-place jumping and landing, build strength in landing positions, reinforce proper movement patterns

Hurdle jumps


Block jumps

Broad jumps Lateral bounds

Jump rope

Approach jumps

Line hops

Shock-level plyos: depth landings (in the final three weeks)

Squat jumps with stick Single-leg jumps with stick


Forward, backward, and lateral jumps with stick

Duration: Eight to 10 weeks, beginning in June

Tuck jumps

Goals: Improve rate of force production, improve force absorption (landings), maximize sport-specific gains

Pike jumps Barrier jumps with stick STRENGTH DEVELOPMENT Duration: 10 to 12 weeks, beginning in March Goals: Introduce more complex and higher-intensity jumping, include ballistic jumping to incorporate strength speed/power activities, add shock-level plyos to maximize nervous system challenge

­4 4

T&C march 2010

Exercises: Approach jumps Shuffle blocks Push drive/slant block jumps Lateral bounds to jumps Lateral barrier jumps to vertical jumps Shock-level plyos: depth landings or depth jumps (in the final three weeks)


sport specific training schedule.) Each phase lasts roughly three weeks and begins with two days of drop landings, which allow us to focus on the eccentric portion of the jumps and thereby improve the players’ ability to absorb and use accumulated kinetic energy from downward momentum. Absorbing force effectively results in shorter coupling times between the eccentric and concentric components of a jump, leading to greater jump height over time. During drop landings, we begin at a height equivalent to the athlete’s vertical jump in inches, which is tested in January right after winter break, in early May before the spring semester ends, and in August when the athletes return for preseason camp. The height then progresses slightly each week, provided the athlete can maintain landings with good form in terms of knee bend, not sinking the upper body below the knees, and avoiding heel touch. Because shock-level plyometric work is extremely stressful, we use it only during those two distinct phases of the training cycle. The last phase of shock work ends in mid-July, roughly three weeks before the start of preseason camp, giving the athletes adequate recovery time prior to testing and the start of team training. It’s important to note that the training described above applies to all our players, but we do account for some position-specific needs. For the libero and defensive specialists, jump training includes a greater emphasis on lateral movements, with activities such as skater hops and lateral bounding. We also stress sustaining eccentric forces in defensive postures, using Jump Stretch bands to create a speed overload into a lateral drop step. In addition, defensive players focus on push lunges—a partner applies force in the form of a controlled shove, the player lunges with the shove, and she “sticks the landing” in an athletic position. TIMELY PEAKING When preseason training camp begins, on-court activity is paramount. As the players increase their workload through team practices, we scale down weightroom and jump training work significantly. Strength training occurs in the form of medicine ball drills for the upper body and trunk, and the athletes hit the weightroom roughly twice a week for short sessions at 80 to 85 percent inTR AINING-CONDITIONING.COM

tensity. At this time, the goal is to maintain strength and conditioning gains made in the off-season. Once the competitive season begins, the players continue to strength train twice a week with low training volumes. Early in the week, we use lower intensities (65 to 75 percent of max effort and resistance) and emphasize speed of movement. The last session of the week before a weekend of matches includes higher intensities (up to 85 percent) to help the athletes maintain their strength levels. Our exercise selec-

tion aims to not overstress the body before competition—we use basic pulling and compound movements, such as box squats and front squats, and jumping is limited to 20 to 30 reps per session. Using this strategy, our athletes are primed for optimum performance every time they step on the court. They hold onto the strength gains they made during the off-season, their risk of injury from overuse or poor mechanics is reduced as much as possible, and we hope to see them reach new heights every year. n

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If you’re like most athletes, you enjoy locker room. the camaraderie It’s a place to in your team’s relax, feel safe, But a locker room and bond with can also be a teammates. infection that harbor for MRSA can be deadly , a type of staph if left untreated.

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Warning Signs: How to spot the warning signs of MRSA

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You can download any of these posters for FREE or you can receive all eight 12” x 18” high quality color posters for $35 per set. To order, visit: Circle No. 131

Battling Bacteria Many of the companies that advertise in Training & Conditioning have products which are antimicrobial products. Below is information from several of these companies on a few of their products. Athletix disinfectant wipes are registered in all 50 states. They help athletic programs prepare for sickness outbreaks in their facilities. This product kills CA-MRSA, MRSA, staph, VRE, and Influenza A2 (H2N2). Athletix disinfectant wipes are free of orthophenylphenol, bleach, ammonia, and alcohol. The EPA believes this product’s effectiveness against Influenza A2 will also demonstrate effectiveness against H1N1. Athletix Products by Contec, Inc. 800-289-5762 Circle No. 500 Hibiclens is an FDA-approved antiseptic skin cleanser indicated for use as a surgical hand scrub, hand wash for healthcare personnel, patient pre-operative skin preparation, skin wound cleanser, and general skin cleanser. Its active ingredient, CHG, works in a unique way—it kills germs on contact and bonds to the skin to keep killing microorganisms for up to six hours after washing. Molnlycke Health Care 800-843-8497 Circle No. 503 Whizzer is a concentrated cleaner and deodorizer that kills a broad spectrum of bacteria, including MRSA, as well as viruses and fungi on non-porous surfaces. Whizzer is EPA-registered, and one gallon makes 128 gallons of cleaner/disinfectant. This product inhibits the growth of mold and mildew (and their odors) when used as directed. Versatile and powerful, Whizzer kills HIV-1 (the AIDS virus), hepatitis B and C, herpes simplex 1 and 2, SARS, and other viruses. It also kills strep, staph (including MRSA), and fungus on contact. In addition, it helps prevent the spread of athlete’s foot. Mueller Sports Medicine 800-356-9522 Circle No. 504 TR AINING-CONDITIONING.COM

Str a ight Talk

With its formulation of 70 percent isopropyl alcohol + 0.5 percent chlorhexidine gluconate (CHG) and emollients, Hibistat® healthcare personnel hand antiseptic has been proven to provide fast acting antimicrobial protection on contact. It provides a broad spectrum of activity, continuing to fight germs much longer than soap and water, or isopropyl alcohol alone. Requiring no water for use, Hibistat is ideal for use in the field or the facility. It is also safe for frequent daily use and has a quickdrying formula. Molnlycke Health Care 800-843-8497 Circle No. 505 New GymWipes FORCE is an EPAregistered disinfectant product designed to clean and sanitize health club surfaces and equipment, including seat pads, leg/arm rests, benches, hand grips, chrome plating, painted surfaces, steel and rubber surfaces, tanning beds, and electronic panels. It protects against 50 pathogens, including MRSA and the H1N1 virus. The pads are premoistened and disposable, with a fresh scent and no phenol, bleach, or alcohol. Stands and wall mounts are available. GymWipes 888-977-3726 Circle No. 502 TELFA wound dressings by Covidien are effective against MRSA and Staphylococcus aureus. AMD dressings contain PHMB (polyhexamethylene biguanide), an antimicrobial component proven to resist bacterial colonization within the dressing and also resist bacterial penetration through the dressing. At just pennies per day, this product offers inexpensive infection control. It is compliant with existing protocols, and proven to prevent bacterial proliferation and limit cross-contamination. Studies have demonstrated AMD’s effectiveness against a host of bacteria, including Staphylococcus aureus and MRSA. Covidien 800-962-9888 Circle No. 501 T&C march 2010



Pro-Tec Athletics is a leading sports medicine company specializing in orthopedic supports and hot/cold and massage therapy products. In 2010, ProTec Athletics will maintain its innovative edge by introducing four new foam rollers, two foam roller covers, LiquiCell® Nipple Protectors, an ankle brace, and plantar massage balls, while continuing to improve existing product designs. Most products and this year’s catalog include “Injury Guides,” which recommend stretching and strengthening exercises to expedite the recovery process. Pro-Tec Athletics 800-779-3372 Circle No. 529

Joint Effort

Knees, legs, ankles, elbows, and arms take a beating. Cho-Pat’s innovative preventive and pain-reducing sports/medical devices incorporate unique design characteristics, excellent craftsmanship, and quality materials to help reduce pain and discomfort and assist in healing. All of the company’s American-made products allow full mobility and are highly recommended, easy to use, comfortable to wear, and available in sizes for more specific and effective results. Cho-Pat 800-221-1601 Circle No. 512

Advance Your Career

Since 1987, the National Academy of Sports Medicine (NASM) has been a global leader in providing evidence-based certifications and advanced credentials for health and fitness professionals. Training and conditioning professionals can earn the preferred injury prevention or sports performance training credentials of professional athletes and teams with the NASM Corrective Exercise Specialist (CES) and Performance Enhancement Specialist (PES) advanced specializations. NASM also offers access to the CES and PES credentials through two online master’s degree programs in conjunction with the academy’s higher education academic partners. The NASM education catalog features course descriptions, customer testimonials, continuing education, and athletic trainer gear. NASM 800-460-6276 Circle No. 515 50

T&C march 2010

The Leverage Advantage

Fitness Anywhere produces and sells Suspension Training equipment and programs to athletic trainers, clubs, athletes, the military, and fitness enthusiasts. Suspension Training body weight exercise develops strength, balance, flexibility, and core stability simultaneously. It requires the use of the TRX Suspension Trainer, a highly portable performance training tool that leverages gravity and the user’s body weight to enable hundreds of exercises for every fitness goal. Fitness Anywhere, Inc. 888-878-5348 Circle No. 513

Find What You Need

This is the 2010 Perform Better catalog—76 pages of selected equipment that becomes your reliable guide to functional training. The catalog is neatly divided into 18 specific categories for easy reference. Typical categories are balance and stabilization, band and tube training, body weight training, cardiovascular training, flexibility and recovery, and much more. Items have been carefully pre-tested by the Perform Better staff for quality, function, and value. This catalog is available free upon request. Perform Better 800-556-7464 Circle No. 514

Many Innovations

OPTP is proud to present the new Volume 24 catalog, complete with over 60 new products, including Sanctband, the SmartRoller, Treat Your Own Shoulder, and SpiderTech. The Volume 24 catalog also includes a new foot management section as well as a complete index, making it even easier to find what you need. OPTP 800-367-7393 Circle No. 517

Heat and Support

Offering more than 20 patented products, PRO Orthopedic is constantly upgrading designs and materials to give you the best support possible. The four-way stretch properties of neoprene, combined with therapeutic heat retention, make neoprene so effective in controlling edema. Compression alone cannot produce the same results, and all PRO neoprene products are latex-free. PRO Orthopedic Devices, Inc. 800-523-5611 Circle No. 518 TRAINING-CONDITIONING.COM


Since 1976, Samson Equipment has designed, manufactured, and sold heavy-duty industrial-strength weightlifting equipment to all five branches of the military, top high schools, colleges, and professional teams, health clubs, and recreational facilities all over North America, Europe, Asia, and the Caribbean. Samson’s equipment line includes a wide variety of freeweight racks and benches as well as selectorized machines and plate-loaded equipment. Samson Equipment, Inc. 800-472-6766 Circle No. 519

Defy Gravity

The AlterG Anti-Gravity Treadmill features revolutionary unweighting technology that’s reinventing rehabilitation. Recover from surgery and injury faster and with less pain, and work toward regaining function like never before. Leading hospitals and professional sports organizations use this revolutionary machine to help patients train through injury by walking on air. Go online to learn more. AlterG, Inc. 510-270-5900 Circle No. 520

Outstanding Selection

Creative Health Products offers a variety of rehabilitation products at discounted prices. Items include resistance bands, hand and finger exercisers, vinyl-coated dumbbells, thermophore heating pads, step benches, medicine balls, physioballs, goniometers, flexibility testers, strength testers, heart rate monitors, spirometers, anthropometers, and posture and alignment grids. Creative Health Products 800-742-4478 Circle No. 522

Goes Down Like Milk

100-percent pure liquid egg whites are heat pasteurized and salmonella tested, making them liquid but not “raw.” They are double-filtered to have the smooth consistency of milk and are completely tasteless and odorless, making the perfect add-in to your protein shakes. Eight ounces will supply 26 grams of protein with no fat, two grams of carbs, 120 calories, and the essential amino acids. Egg Whites International 877-344-9448 Circle No. 523

Trusted for Decades

The 35th-anniversary New York Barbells catalog is now available. Since 1974, New York Barbells has been a leading supplier of sports performance, fitness, and strength equipment. The 24-page catalog displays the company’s products from flooring to the latest biometric unilateral equipment. Call or go online to find out more. New York Barbells 800-446-1833 Circle No. 516

The Thera-Band catalog features professional training, fitness, and rehab products for every lifestyle. Introduced by the Hygenic Corp. in 1978, the Thera-Band brand has gained an international reputation with athletic trainers and personal trainers for quality, proven efficacy, and leadership in research and new product development. The catalog provides product specifications plus information on the searchable database of exercises, instruction guides, research, and case studies, all available at Performance Health 800-321-2135 Circle No. 524

Versatile and Effective

More Than Ever

Everything You Need

The Athletix Products line from Contec is the solution for your members and staff and was specifically developed for health clubs, wellness centers, and athletic facilities. Athletix products are effective, affordable, easy to use, and safe for use on heavy-duty as well as delicate equipment. Athletix Products by Contec, Inc. 800-289-5762 Circle No. 521 TR AINING-CONDITIONING.COM

Award-winning equipment provider Power Systems has released its newly redesigned 2010 catalogs. The Sports Performance catalog packs 80 pages with both traditional and innovative sports training products, while the comprehensive Performance Equipment catalog has been expanded to 112 pages to offer more sports and fitness products. Power Systems 800-321-6975 Circle No. 525 T&C march 2010


Testimoni als

Your Body Is The Driver “Just wondering if you received my last order for four more Buddy Systems. The product is just fantastic! What a complete workout! There is nothing you can’t do with this piece of equipment. I have introduced it to my exercise science students, and they all love it. Talk about conditioning for athletes—you won’t find a better piece of equipment. From working the core to strength, stamina, and cardio, you get it all. Hats off to you for introducing a new revolution in training equipment.”

—John Krentz, Department Chair, Exercise Science, Bay Mills Community College

“Very rarely does a product come into my training studio that is found to be highly useful by all of my trainers. The simple Lebert Stretch Strap is one of those exceptional products. My studio’s most experienced trainer mentioned several times how much he thought the Stretch Strap added to his sessions. This product is a must-have for any trainer, but especially those who train less flexible or reduced-mobility clients.”

—Product Review, PFP Magazine

“Lebert Equalizer: Twin free-standing supports, made of 28-inch-tall steel tubes with foam handle grips in the middle, allow a variety of exercises. Likes: Surprisingly effective—even for hard-core athletes. My initial skepticism over the bare-bones devices disappeared with an opportunity to do real dips, push-ups, one-legged squats, kneeraises, and weird but hard supine pull-ups. A laminated chart offers several more bodyweight exercises, stretches, and even an upright row (using one support as the weight). Easy 20-minute assembly consists of screwing in eight Allen bolts; wrench included. Dislikes: None.”

“We Have Not Had One Case of MRSA So Far”

“There Is No Comparison”

“This fall, we installed Hibiclens dispensers in all our locker room showers and provided education and instruction for our studentathletes regarding its use. We have not had one case of MRSA so far.”

“In the past I’ve used several different brands of resistance bands without putting much thought into which brand I was using. But I recently started using the real Thera-Band exercise tubing with handles and new resistance loops, and I realized that there was a big difference. Sometimes you forget how superior Thera-Band is to the competition. It is worth the extra pennies to go for the real Thera-Band products. There is no comparison to the feel and quality of resistance they provide.”

—Melinda Larson, ATC, Whitworth University

“We clean all our turf burns and minor wounds with Hibiclens, and have never had one case of MRSA or any type of infection. Our athletes ask for Hibiclens because they know how widely the product is used in hospital settings. Hibiclens is our product of choice for cleaning wounds, and it is in all our med kits for the teams at all practices and games.”

—Dave Teo, ATC, Eastern Connecticut State University

“When looking for a cleaning solution for wounds and general personal hygiene, Bowdoin College instituted the daily use of Hibiclens. This efficient multi-purpose product is easy to use and fits specifically to our athletic needs. After implementation of the Hibiclens solution, Bowdoin athletics did not have a MRSA case during the fall athletic season for the first time in four years. I could not be more satisfied with Hibiclens, and I would highly recommend this antiseptic/ antimicrobial solution to any athletic trainer. I would like to thank Hibiclens for this amazing product.”

—Dan Davies, Director of Athletic Training, Bowdoin College

—Product Review, Los Angeles Times

Lebert Fitness Olean, NY, USA Mississauga, ON, Canada 905-785-0626 52

T&C march 2010

.. Molnlycke Health Care 5550 Peachtree Pkwy., Ste. 500 Norcross, GA 30092 800-843-8497

—Michael Reinold, PT, DPT, SCS, ATC, CSCS, Head Athletic Trainer, Boston Red Sox; Assistant Director, Medical Services-Coordinator of Rehabilitation Research & Education, Massachusetts General Hospital, Department of Orthopedic Surgery, Division of Sports Medicine

“I have used Thera-Band products for over 25 years for clinical treatment of injuries, preventative conditioning programs for athletes, and research applications. I trust and have come to rely on the consistent resistance levels and high quality of the TheraBand product line. I greatly appreciate the considerable body of evidence that supports the clinical application of Thera-Band products, as well as the resources made available to our profession regarding evidencebased progressions and product use. I would recommend these products to any physical therapist or rehabilitation professional, especially those involved with sports medicine and performance enhancement training.”

—Todd Ellenbecker, DPT, MS, SCS, OCS, CSCS, Clinic Director, Physiotherapy Associates Scottsdale Sports Clinic; National Director of Clinical Research, ATP Tour

Performance Health 1245 Home Ave. Akron, OH 44310 800-321-2135 • Fax: 330-633-9359 TRAINING-CONDITIONING.COM

Can’t get enough

Training & Conditioning ? Start your week off right with’s Weekly Blog series. Every Monday, our award-winning authors and industry leaders post a new article profiling what’s hot in the fields of athletic training and strength and conditioning. T&C Weekly Blogs provide a valuable resource for tracking trends and sharing industry ideas. It’s information you won’t find anywhere else. Give us five minutes and we’ll get you ahead of the game. 53


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aquatic equipment

Evenly Distributed

To reduce stress on the lower back and assist in maintaining a vertical position during aquatic workouts, strap on the Power Systems Premium Water Flotation Belt. Its contoured shape provides comfort and long-lasting support by distributing buoyancy around the torso. The flotation belt is constructed with soft, nonabrasive closed-cell EVA foam with an adjustable nylon waist belt. It’s available in small, medium, and large sizes based on weight. Power Systems, Inc. 800-321-6975 Circle No. 540

The Choice of Those Who Know

SwimEx and Woodway have partnered to create the ultimate aquatic


CREATIVE HEALTH PRODUCTS We stock popular brand name instruments for Fitness Measuring and Testing at the lowest prices.



Fluid Movement

5148 Saddle Ridge, Plymouth MI 48170






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T&C march 2010

therapy environment. Combining the smoothest water flow and smoothest running environment brings you the ultimate in aquatic therapy. SwimEx’s unique paddlewheel technology offers the deepest, widest current to provide a better therapy environment than jet pools. SwimEx and Woodway deliver one of the industry’s most challenging running/walking workouts, making conditioning and protocol possibilities unlimited. SwimEx, Inc. • 800-877-7946 Circle No. 541

For Extra Challenge

To increase the intensity of your aquatic workouts, fasten on a pair of Premium Water Cuffs by Power Systems. Designed for versatility, these cuffs can be worn on the ankles or wrists. Simply adjust the nylon strap to the desired size and secure it with the Velcro™ closure. The cuffs are made of soft, non-abrasive closed-cell EVA foam, so they won’t chip or absorb water. One size fits most. Power Systems, Inc. • 800-321-6975 Circle No. 545

Anyone Can Float

The AquaJogger Pro Plus belt is ideal for athletes with minimal body fat who need maximum flotation for vertical aquatic training and rehab. This belt option is 50 percent more buoyant than the Classic model. The maximum waist size is 44 inches, but longer elastic belts are available for wider waistlines if needed. This product was specifically designed for “sinker” body types. AquaJogger • 800-922-9544 Circle No. 542

Flexible Functionality

The 900T offers the ultimate in flexibility. With an overall depth of 5’6”, the 900T can be adapted with a second floor to offer another water depth anywhere from 3.5 to 4.5 feet, with or without an integrated treadmill. Patients gain the benefit of shallow workstations, an optional integrated motorized treadmill, and deep-water exercise all in the same pool. SwimEx, Inc. • 800-877-7946 Circle No. 544

To Better Times

Olympians and novice swimmers alike rely on StrechCordz to improve stroke, stamina, power, and individual medley times through in-water and dry-land training activities. Developed by NZ Manufacturing, a leader in resistance training and physical rehabilitation products, StrechCordz provide maximum function and comfort, while withstanding the rigorous demands of team, clinic, and personal use. NZ Manufacturing also engineers MediCordz and TurfCordz resistance products. NZ Mfg., LLC • 800-886-6621 Circle No. 546 TRAINING-CONDITIONING.COM

product l aunch

Athletix™ Disinfectant Wipes Unique features: • EPA-registered in all 50 states and the U.S. territories • Kills CA-MRSA, staph, MRSA, VRE, Influenza A2, and many other germs • Non-hazardous chemistry makes it safe for people and equipment • Free of o-phenol, alcohol, and bleach

Athetlix Products by Contec, Inc. 864-503-8333 Circle No. 550

Benefits for the user: • Because of the fast surface contact times, the trained staff members can disinfect equipment during peak usage hours.

Lebert Stretch Strap™

Unique features: • Padded handles allow for a comfortable grip while reducing wrist tension • Strap is a double-loop system (much like a figure-8) that easily wraps around hands and feet for a secure and confident hold • Portable, versatile, and an exceptional value— comes complete with two straps, color poster, 55-minute instructional DVD, and carrying pouch

Performance Health/ Hygenic Corporation 800-246-3733 Circle No. 552

Benefits for the user: • Provides maximum intensity making it strong enough for the deepest pain • Convenience - singleuse, disposable wipes are available in 24-count packs • Biofreeze® Pain Reliever is the #1 clinically used and recommended topical analgesic in the US


Lebert Fitness 905-785-0626 Circle No. 551

SmartRoller ®

New Biofreeze ® Pain Relieving Wipe

Unique features: • First pain relieving wipe in the market • First high potency product in the Biofreeze line

Benefits for the user: • A safe stretching product that will assist you in not overdoing your stretches • Will help you reach positions more comfortably that may not have been possible before, and let you hold stretches longer • Education is provided by Olympian and Master Yoga Instructor Ann Green

Unique features: • Patented two-in-one foam roller • Rounder side increases roller movement, while flatter side decreases movement • Ideal exercise prop for yoga, Pilates, Feldenkrais®, and more • Approximately 36” x 4”

OPTP 800-367-7393 Circle No. 553

Benefits for the user: • With the flatter side down, it can be sat or stood on for balance movements • With the rounder side down, it provides a more challenging dynamic workout

T&C march 2010


Director ies Circle Company No.

Advertisers Directory Page No.

Circle Company No.

Page No.

117. . Ab Coaster. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

109. . OPTP. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

112. . AlterG. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

106. . Perform Better. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

125. . AquaJogger . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

118. . Perform Better (seminars) . . . . . . . . . . . . . . . . . . . . . . . . . 27

121. . Athletix Products by Contec . . . . . . . . . . . . . . . . . . . . . . . . 34

130. . Power Systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

107. . Biofreeze速/Performance Health . . . . . . . . . . . . . . . . . . . . . . 8

127. . PRO Orthopedic Devices. . . . . . . . . . . . . . . . . . . . . . . . . . . 39

135. . BudgetSavers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

129. . Samson Equipment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

104. . California University of Pennsylvania. . . . . . . . . . . . . . . . . . . 6

100. . SpiderTech. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IFC

101. . Cho-Pat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

113. . SwimEx . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

119. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

105. . The PolarPool. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

102. . Covidien. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

131. . MRSA Prevention Posters. . . . . . . . . . . . . . . . . . . . . . . . . . 48

133. . Creative Health Products . . . . . . . . . . . . . . . . . . . . . . . . . . 54

132. . T&C Web . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

111. . Egg Whites. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

108. . Total Strength and Speed . . . . . . . . . . . . . . . . . . . . . . . . . . 10

123. . GymWipes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

122. . TRX Suspension Training (Fitness Anywhere) . . . . . . . . . . . 36

128. . Hibiclens. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

124. . TurfCordz/NZ Mfg.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

114. . HQ, Inc. (CorTemp). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

110. . Weitz & Luxenberg. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

103. . Mueller Sports Medicine. . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

126. . VacuMed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

137. . Muscle Milk (CytoSport). . . . . . . . . . . . . . . . . . . . . . . . . . . BC 120. . NASM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 136. . New York Barbells of Elmira. . . . . . . . . . . . . . . . . . . . . . . IBC

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570. . Ab Coaster. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

569. . NUCAP Medical (USBSF partnership). . . . . . . . . . . . . . . . 58

582. . AccuFitness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

517. . OPTP (catalog). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

571. . AlterG (Anti-Gravity Treadmill). . . . . . . . . . . . . . . . . . . . . . 58

553. . OPTP (new product). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

520. . AlterG (catalog). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

565. . OPTP (Treat Your Own Shoulder). . . . . . . . . . . . . . . . . . . . 57

542. . AquaJogger . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

543. . Perform Better (Aqua Bags). . . . . . . . . . . . . . . . . . . . . . . . 57

500. . Athletix Products by Contec . . . . . . . . . . . . . . . . . . . . . . . . 49

514. . Perform Better (catalog) . . . . . . . . . . . . . . . . . . . . . . . . . . 50

521. . Athletix Products by Contec (catalog). . . . . . . . . . . . . . . . . 51

531. . Performance Health (Biofreeze速). . . . . . . . . . . . . . . . . . . . 58

550. . Athletix Products by Contec (new product). . . . . . . . . . . . . 55

524. . Performance Health (catalog). . . . . . . . . . . . . . . . . . . . . . . 51

512. . Cho-Pat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

564. . Performance Health (Latex-Free Bands). . . . . . . . . . . . . . . 57

501. . Covidien. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

552. . Performance Health/Biofreeze速 (new product). . . . . . . . . . 55

580. . Creative Health Products . . . . . . . . . . . . . . . . . . . . . . . . . . 59

525. . Power Systems (catalog). . . . . . . . . . . . . . . . . . . . . . . . . . . 51

522. . Creative Health Products (catalog). . . . . . . . . . . . . . . . . . . 51

540. . Power Systems (Flotation Belt) . . . . . . . . . . . . . . . . . . . . . 54

560. . Egg Whites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

545. . Power Systems (Water Cuffs). . . . . . . . . . . . . . . . . . . . . . . 54

523. . Egg Whites (catalog) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

518. . PRO Orthopedic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

502. . GymWipes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

529. . Pro-Tec Athletics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

561. . HeartFlex. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

519. . Samson Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

581. . HQ, Inc. (CorTemp). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

576. . Save-A-Tooth速. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

551. . Lebert Fitness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

544. . SwimEx (900T). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

503. . Molnlycke Health Care (Hibiclens). . . . . . . . . . . . . . . . . . . 49

541. . SwimEx (Woodway). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

505. . Molnlycke Health Care (Hibistat) . . . . . . . . . . . . . . . . . . . . 49

532. . The PolarPool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

562. . Mueller (MAX knee strap) . . . . . . . . . . . . . . . . . . . . . . . . . 57

513. . TRX Suspension Training (Fitness Anywhere) . . . . . . . . . . . 50

504. . Mueller (Whizzer) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

546. . StrechCordzNZ Mfg. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

515. . NASM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

568. . TurfCordz/NZ Mfg. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

516. . New York Barbells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

575. . VacuMed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

563. . NUCAP Medical (K-Active Europe) . . . . . . . . . . . . . . . . . . 57


T&C march 2010


Great Ideas, Great Value Goes Down Like Milk

Egg Whites International’s 100-percent pure liquid egg whites are heatpasteurized and tested for salmonella, making them “liquid” but not “raw.” They are double-filtered to achieve the smooth consistency of milk, and they’re completely tasteless and odorless for making the perfect protein drink. An eight-ounce serving supplies 26 grams of protein with no fat, no cholesterol, two grams of carbs, 120 calories, and all the essential amino acids. Egg Whites International 877-EGG-WHITES Circle No. 560

Lightweight Comfort

The Mueller MAX knee strap is a lightweight and comfortable support for relieving pain associated with soreness, stiffness, and arthritis. Compression tubes target above, below, and on both sides of the knee. This lightweight and comfortable support provides targeted compression without reducing mobility. Upper and side compression tubes target misalignment and help improve patellar tracking. Breathable mesh fabric allows for an all-day comfortable fit. Mueller Sports Medicine 800-356-9522 Circle No. 562

Crossing the Ocean

Europe is about to get taped in an entirely new way. Nucap Medical, developer of SpiderTech pre-cut tape-based therapeutic supports, has partnered with K-Active Europe for the European distribution of SpiderTech products. Made from the proven Nitto-Denko tape—the original kinesiology tape from Japan—SpiderTech will be distributed through K-Active Europe’s extensive network of providers and medical product distribution groups under the brand name K-Active Tape PreCut. Nucap Medical • 416-494-1444 Circle No. 563

Winning Resistance

Professional sports teams and international Olympians train and condition with TurfCordz to increase speed, endurance, and flexibility through explosive start drills, footwork exercises, and simulated play action. Developed by NZ Mfg., a leader in resistance training and physical rehabilitation products, TurfCordz provide maximum function and comfort while withstanding the rigorous demands of team, clinic, and personal use. NZ Mfg. also engineers StrechCordz and MediCordz resistance products. NZ Mfg., LLC • 800-886-6621 Circle No. 568 TR AINING-CONDITIONING.COM


The Name Says It All

Treat Your Own Shoulder, by Robin McKenzie, educates readers on the importance of self-management and self-treatment when shoulder problems arise. It provides a stepby-step overview of how to manage present symptoms and help prevent or minimize future problems. Informative and easy to read, Treat Your Own Shoulder provides a detailed exercise program and guidance on when to incorporate the exercises to help treat pain and stiffness. Call or go online for more information or a free catalog. OPTP • 800-367-7393 Circle No. 565

It’s In the Bag

Perform Better introduces the new Aqua Bags. These bags are the ultimate tools for unstable training. Fill them with water to change the weight and instability—the fuller the bag, the heavier and more stable it will be. Less water makes them lighter but more unstable. These bags are great for all Olympic movements, as well as swings, chops, step-ups, rows, and more. Adjustable handle positions allow for more variety in your exercises. These bags are available in two sizes and can hold approximately 70 pounds of water. Perform Better • 800-556-7464 Circle No. 543

Energize Your Warmups

HeartFlex strengthens the wrists, forearms, shoulders, chest, and back. Its passive resistance helps treat tendonitis. Its compactness and portability make it convenient for warm-ups, maximizing physical performance and assisting in preventing cold muscle injuries. HeartFlex • 800-920-8118 North Coast Medical • 800-821-9319 Circle No. 561

Same Performance, No Latex

Introducing Thera-Band Latex-Free Professional Resistance Bands, a latex-free alternative that matches the performance of the Thera-Band latex bands trusted for 30 years. The new formula delivers identical performance to latex and is scent- and powder-free. Latex-Free Professional Resistance Bands are provided in the established Thera-Band colors and resistances of yellow/thin, red/medium, green/heavy, blue/extra heavy, and black/special heavy, making them easy to identify and integrate into your practice. Performance Health • 800-321-2135 Circle No. 564 T&C march 2010



The commercial-strength line of Ab Coaster exercise equipment provides a challenging core workout for athletes at every level. Winner of the FIBO Global Innovation Award for 2008, the Ab Coaster features a patented curved track design that allows the user to perform a lower abdominal lift in perfect form. The Ab Coaster is currently being used in over 3,000 health clubs around the world, as well as by universities, professional sports teams, and the U.S. military. The Ab Coaster Co. 866-219-5335 Circle No. 570

Space-Age Technology

The AlterG Anti-Gravity Treadmill is reinventing rehabilitation by advancing recovery from injuries and surgery. It is the only unweighting fitness equipment developed by NASA and tested by Nike’s Oregon Research Project. It is the first FDA-cleared medical device of its kind. Athletes can enhance performance and reduce the frequency of injury by using the AlterG. Leading professional sports teams, athletes, and fitness programs use the AlterG as part of their training regimen. AlterG 510-270-5900 Circle No. 571

Exciting New Sponsorship

The U.S. Bobsled and Skeleton Federation (USBSF) has announced a new two-year partnership with Nucap Medical, maker of SpiderTech kinesiology and therapeutic tape. It is the first major foray into winter sports for SpiderTech. “We are proud to be the newest sponsor of U.S. Bobsled and Skeleton. They are one of the top U.S. teams heading into the Vancouver Games, a team that is competitiontough, and we love to see our products on the world’s best athletes,” says Bill Payne, Nucap’s Vice President of Marketing. Nucap Medical 416-494-1444 Circle No. 569

A New Option

The Biofreeze Pain Relieving Wipe is the first pain-relieving wipe in the market, and the first high-potency product in the Biofreeze line. The high potency is obtained through an integrated cooling technology and 58

T&C march 2010

provides maximum intensity, making it strong enough for the deepest pain. These single-use disposable wipes are available in 24-count packs. Biofreeze is the number-one clinically used and recommended topical analgesic in the U.S. Performance Health 800-321-2135 Circle No. 531

No Plumbing Required

The PolarPool™ cryotherapy spa offers cold water therapy, hot water therapy, and saltwater therapy—all in one. It’s completely portable, so you can provide athletes with stateof-the-art treatment and pain relief without installing new plumbing or redesigning your entire facility. Users can sit or kneel in the pool, and the purification and sanitization systems keep the water clean while the solidstate cooling system maintains the temperature you want. The PolarPool 617-480-7683 Circle No. 532

Great Way to Test

How high? How fast? How far? How often? If you want the answers to these questions about your athletes, you’ll want to try the Electronic Jump Mat, a high-precision contact device for biometric cinematic tests. The tests include six evaluation groups including velocity, frequency and fatigue, and provide real-time training feedback. In addition, you can couple multiple mats for distance and speed and compare test results of single or multiple athletes. Includes PC software. VacuMed 800-235-3333 Circle No. 575

Because Time Matters

Without proper care, a knocked-out tooth begins to die in 15 minutes. The Save-A-Tooth emergency tooth preserving system utilizes Hank’s Balanced Salt Solution (HBSS) to not only preserve, but also reconstitute many of the degenerated cells. The patented basket and net container are designed to protect tooth root cells. This is the only system that keeps tooth cells alive for up to 24 hours. Save-A-Tooth® 888-788-6684 Circle No. 576 TRAINING-CONDITIONING.COM


Since 1976, Creative Health Products has been a leading discount supplier of rehabilitation, fitness, exercise, and athletic equipment, as well as health, medical, and fitness testing and measuring products, all available at reduced prices. Creative Health Products offers heart rate monitors; blood pressure testers; pulse oximeters; body fat 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. Creative Health Products, Inc. 800-742-4478 Circle No. 580

Accuracy Matters

“Compared with rectal temperature (the criterion standard), gastrointestinal temperature was the only measurement that accurately assessed core body temperature. Oral, axillary, aural, temporal, and field forehead temperatures were significantly different from rectal temperature and therefore


are considered invalid for assessing hyperthermia in individuals exercising outdoors in the heat,” says an article in the Journal of Athletic Training from 2007. The CorTemp wireless monitoring system, featuring the CorTemp ingestible temperature pill, is FDAregistered and has been used by sports professionals for over 22 years. HQ , Inc. • 941-723-4197 Circle No. 581

Weight Monitoring Made Easy

Measure, track, and chart body fat with the Accu-Measure Personal Body Fat Tester, or FatTrack Gold Digital Body Fat Caliper and Body Tracker software. Calipers are compact, portable, and accurate, making them perfect for athletic trainers. Enter results into the Body Tracker software to track and chart them over time for each athlete, and upload photos for visual progress comparisons. AccuFitness offers outstanding tools for training and conditioning professionals. AccuFitness • 800-866-2727 Circle No. 582

Circle No. 135

T&C march 2010


Case Study

Revolutionary Rehab Study Reveals Most Reliable Measure of Post-Rehab Functional Performance

A leader in functional exercise equipment for athletic training and physical therapy, efi Sports Medicine has announced the results of a groundbreaking rehabilitation study using the Total Gym, efi’s flagship body weight resistance training apparatus. The study, recently published in the North American Journal of Sports Physical Therapy (NAJSPT), was conducted by researchers at San Diego State University (SDSU) and the University of Toledo’s Health Science Campus, who found that Total Gym could be used to accurately measure the functional status of patients recovering from lower-extremity injuries. Few options exist for rehabilitation specialists to precisely measure lowerextremity performance in individuals with restricted weight-bearing ability. In the past, rehab specialists had to conduct manual muscle tests to determine strength and functional performance in a patient’s lower extremities (hip, knee, foot, or ankle) in order to bear full weight without aid, which is often an inaccurate measure. The study’s lead investigator, Daniel Cipriani, PhD, PT, an associate professor at SDSU, saw the need for a more reliable partial weight-bearing (PWB) test to track patient progress earlier in the rehabilitation process. He helped develop a consistent tool to measure leg strength using Total Gym. A total of 37 adult patients recovering from an injury and/or surgery to the ankle, knee, or hip were recruited from orthopaedic surgery and physical therapy clinics in San Diego, Calif., and Toledo, Ohio. All patients were tested using the Total Gym PWB performance tests, which included the number of one-legged 60

T&C march 2010

squat repetitions a patient could do in 30 seconds and the time needed to complete 20 squat repetitions on one leg—all at an incline level that used 55 percent of the individual’s body weight as resistance. Patients also went through timed ascending/descending stair tests, walking speed tests, and single-leg hop tests. “Measuring leg performance on Total Gym provides meaningful information about the current functional status of a patient earlier in the rehabilitation and recovery process,” says Cipriani. “The Total Gym tests were able to reliably detect change in patient status, such as functional improvement, or whether a patient exhibited no change or loss of performance.” The research found a significant connection between how many repetitions a patient could do on the Total Gym and how fast that patient could walk and climb stairs. After four to six weeks, patients returned for follow-up testing and those who showed improvement in the Total Gym performance tests also showed improvement in their stair-climbing ability and walking speed. “Total Gym has evolved from solely an exercise apparatus for rehab patients to now a measurement tool to provide valid information about a patient’s progress toward full weight-bearing function,” explains Cipriani. “The research proves that the partial weight-bearing tests on Total Gym were responsive to the positive changes in patients’ progress.” In addition, Cipriani noted that patients were very receptive to the Total Gym tests, whereas “stair climbing and hop tests could cause anxiety or fear.” The Total Gym tests allow patients to “really give their best effort” without fear of falling or injury. In addition, the potential benefits for safely training the deconditioned population—such as individuals 55 years of age and older—are significant. To view an abstract of the original research, visit: Media/Uploads/files/Public/ CiprianiAbstract.pdf.

Total Gym/efi Sports Medicine 7755 Arjons Drive San Diego, CA 92126-4366 800-541-4900 Fax: 858-764-0018 TRAINING-CONDITIONING.COM



T&C March 2010 Volume XX, No. 2

uic You c an no ker & w tak and g Easi e our et yo er! ur CE CEU q U uizze r e s C u s onli li lt c s ko www a .train n “CEUs & C nd credit ins ne... tantly ou ing-c . ondi rses” at: t

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



Instructions: Go to and click on “CEUs & Courses” to take the quiz online. You may also mail your quiz to us: Fill in the circle on the answer form (on page 63) that represents the best answer for each of the questions below. Complete the form at the bottom of page 63, include a $25 payment to MAG, Inc., and mail it to the following address: MAG, Inc., ATTN: T&C 20.2 Quiz, 31 Dutch Mill Road, Ithaca, NY 14850. Readers who correctly answer 70 percent of the questions will be notified of their earned credit by mail within 30 days.

Bulletin Board (pages 5-7)

No Meat, No Problem (pages 17-23)

1. California is currently one of only three states in the U.S. without: a) Licensure for ATCs b) State subsidies for first-aid care c) A law requiring AEDs in schools d) Mandatory medical training for high school coaches

6. Vegetarians tend to consume larger quantities of healthy plant-based compounds called: a) Omega-3 fatty acids b) Phytochemicals c) Retiarii d) Free radicals

2. A recent editorial in the British Journal of Sports Medicine warns athletes against overuse of: a) Creatine b) Human growth hormone c) Non-steroidal anti-inflammatory drugs (NSAIDs) d) Whey protein

7. Of all categories of vegetarians, ______ are at highest risk for vitamin, mineral, and protein deficiencies. a) Pesco-vegetarians b) Fruitarians c) Flexitarians d) Lacto-vegetarians

3. Prolonged NSAID ingestion has been linked to: a) Delayed healing of ligaments, muscles, and tendons b) Increased risk for diabetes c) Increased risk for hemolysis d) Hypertrophic cardiomyopathy

8. Vegetarians who eat fish and other seafood often selfidentify as: a) Vegan b) Pesco-vegetarian c) Fruitarian d) Ovo-lacto-vegetarian

Objective: Learn about recent research, current issues, and news items of interest to athletic trainers and other sports medicine professionals.

4. A recent paper from the University of Colorado suggests that high-impact exercise is no better for bone health than: a) A sedentary lifestyle b) Calcium supplementation with no physical activity c) Low- or non-impact exercise d) Isometric exercise 5. A new anti-gravity treadmill is based on a prototype developed by: a) NOAA b) NORAD c) USA Hockey d) NASA

Objective: Learn about the nuances of vegetarian and vegan diets and how to advise non-meat-eating athletes on optimizing their nutritional intake.

9. The American Dietetic Association advises vegetarians to eat roughly ______ more protein than meat eaters. a) 10 percent b) 30 percent c) 40 percent d) 50 percent 10. Soy products are some of the only plant-based foods that have all the essential: a) Complex carbohydrates b) Flavonoids c) Antioxidants d) Amino acids 11. The form of iron found in plants is called: a) Biotrophic iron b) Heme iron c) Non-heme iron d) Hydrolyzed iron

Answer sheet is on page 63...or take this quiz online and get instant results: click on CEUs & Courses TR AINING-CONDITIONING.COM

T&C march 2010


CEU QUIZ Baring Their Soles (pages 25-28)

Objective: Understand the theory behind barefoot training and how performing exercises in bare feet can provide significant benefits for athletes. 12. Kinematic data suggests that the big toe requires ______ of extension to allow for normal forward motion. a) 10 degrees b) 15 degrees c) 20 degrees d) 30 degrees 13. At Northeastern University, athletes with excessively ______ are excluded from barefoot training. a) Long toes b) Short femurs c) Flat feet d) High arches 14. Athletes with ______ should be especially cautious in barefoot training because of their increased tendency to develop foot ulcers. a) Immune deficiencies b) Influenza c) High arches d) Diabetes 15. Since implementing barefoot training in 2007, the author has noticed a significant drop in athletes’: a) Quad-hamstring imbalances b) Ankle sprains c) Shin splints d) ACL injuries

Watch the Face! (pages 31-34)

Objective: Learn about the full range of facial injuries that can occur in athletics and how to provide immediate and longer-term care and treatment. 16. The author advises against using the “home remedy” of applying ______ to facial wounds to prevent scarring. a) Vitamin E b) Vitamin B c) Vitamin D d) Vitamin C 17. The slide and slam phenomenon describes trauma occurring at the: a) Orbital cavity b) Nasal septum c) Temple-mandible joint d) Lower forehead 18. Hematoma auris is better known as: a) A black eye b) Cauliflower ear c) Swimmer’s ear d) Malocclusion


T&C march 2010

19. Fractures around the orbital cavity can cause double vision, also called: a) Enophthalmos b) Strabismus c) Pseudostrabismus d) Diplopia 20. Each tooth is connected to the skull by a collection of fibers known as the: a) Dentin b) Enamel c) Periodontal ligament d) Mandibular fossa

Holding Court (pages 41-45)

Objective: Follow the training program used by the women’s volleyball program at the University of Minnesota and learn how the team meets specific conditioning goals. 21. In mobility and flexibility training, the Minnesota volleyball program focuses mainly on the ankles, hips, and: a) Elbows b) Thoracic spine c) Neck d) Wrists 22. The author’s program for ankle mobilization aims to improve range of motion, especially dorsiflexion in the: a) Sagittal plane b) Transverse plane c) Calf muscles d) Coronal plane 23. Volleyball players typically spend a lot of time with their ______ in a shortened position. a) Trapezius b) Sartorius c) Anterior cruciate ligaments d) Hip flexors 24. The author has observed that many athletes with shoulder issues also have a corresponding problem with the opposite: a) Ankle b) Knee c) Elbow d) Hip 25. Plyometric work that involves high nervous system activation is know as: a) Fast-twitch b) Vertical c) Shock-level d) Integrated


CEU QUIZ Answer Form Instructions: Go to and click on “CEUs & Courses” to take the quiz online. You may also

mail your quiz to us: Fill in the circle on the answer form below that represents your selection of the best answer for each question. Complete the form at the bottom of this page, include a $25 payment to MAG, Inc., and mail it to the following address: MAG, Inc., Attn: T&C 20.2 Quiz, 31 Dutch Mill Road, Ithaca, NY 14850. Readers who correctly answer 70 percent of the questions will receive 2.0 BOC Athletic Training and 0.2 NSCA (two hours) CEU’s, and will be notified of their earned credit by mail within 30 days. Questions? Problems? E-mail:





Bulletin Board

1. 2. 3. 4. 5.

m m m m m

m m m m m

m m m m m

m m m m m

m m m m m m

m m m m m m

m m m m m m




No Meat, No Problem

6. 7. 8. 9. 10. 11.

m m m m m m

Baring Their Soles







m m m

m m m

m m m

m m m

m m m m m

m m m m m

m m m m m

m m m m m

m m m m m

m m m m m

m m m m m

m m m m m

13. 14. 15.

Watch the Face!

16. 17. 18. 19. 20.

Holding Court

21. 22. 23. 24. 25.

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

❏ $25 check or money order (U.S. Funds only) payable to: MAG, Inc. (please note “T&C 20.2 Quiz” on check) ❏ Visa ❏ Mastercard ❏ Discover ❏ American Express (Please note: the charge will appear as “MomentumMedia” on your credit card statement)

Account Number _______________________________________________ Expiration Date ____________________ Name on Card _________________________________________________ Card Validation Code* _____________ *Card Validation Code: Visa/MC/Discover: 3-digit code on back after credit card number, Amex: 4-digit code on front above credit card number

Signature __________________________________________________________________________________________


T&C march 2010



Next Stop: Web Site Our editorial continues on Here’s a sampling of what’s posted right now:

AP Photo/David Zalubowski

Web Exclusives

Phoenix Suns Head Athletic Trainer Aaron Nelson wraps forward Amar’e Stoudemire’s left wrist. We profiled Nelson, last season’s NBA Athletic Trainers Association Athletic Trainer of the Year, in a recent Monthly Feature online.

Q&A with Aaron Nelson

Talk to any veteran NBA player, and he’ll tell you that the fountain of youth does exist—in the Phoenix Suns athletic training room. But in reality, those healing and career-resurrecting powers can be attributed to cutting edge techniques practiced by Aaron Nelson, MS, ATC-L, PES, CES, CSCS, the team’s Head Athletic Trainer. One of the most respected voices in his field, Nelson’s views on life in the NBA and his approach to corrective exercise are a must-read.

More Features Creating Value in Your Workplace

Elements of Motivation

In an industry where supply far exceeds demand, those who have a job as a strength coach are extremely fortunate. Read what Rich Jacobs, MS, SCCC, CSCS, Assistant Strength & Conditioning Coach at Xavier University, has to say about acquiring and keeping a strength coaching position in this tough and competitive economic environment.

At Wayzata (Minn.) High School, Head Strength and Conditioning Coach Ryan Johnson has cultivated program-wide pride among all of the school’s athletic teams. By simplifying its training approach and actively recruiting new participants, Wayzata has turned its off-season training program into “the place to be.”


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The protein to help build athletes from the inside out. Adrian Peterson, Pro Running Back For Team Sales & Information 707.747.3377 Š2010 CytoSport, Inc. Benicia, CA 94510 USA

Circle No. 137

Training & Conditioning 20.2  

March 2010

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