December 2011 Vol. XXI, No. 9, $7.00
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December 2011, Vol. XXI, No. 9
Bulletin Board ACSM partners for youth health group … Assisted vs. resisted sprint training … NCAA transgender policy update … Examining head injuries by position.
Comeback Athlete Austin Jensen Florida Atlantic University
Sponsored Pages 26 Power Systems 39 Fitness Anywhere
47 53 57 58
Product News State of the Industry Therapy Technologies Topical Analgesics More Products
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On the cover: Michigan State’s Adreian Payne goes over the back of an opponent for a basket. Our cover story about treating back pain starts on page 20. Photo by AP Images/Pat Lovell
No Looking Back
When an athlete has an eating disorder in their history, the objective is not to diagnose or treat, but to keep them moving forward. Here’s how an athletic trainer can help. By Brina Jergenson Treating The Athlete
20 An athlete who presents with low back pain may also have a Full Body Approach
movement dysfunction. Both problems need to be addressed in order for the athlete to fully recover. By Guido Van Ryssegem Optimum Performance
29 Great flexibility is an important tool in a football player’s repertoire. Flex Play
The key to improving it is a more dynamic approach to stretching. By Allen Hedrick Leadership
& Treating 35 Teaching Athletic training students’ best clinical experiences are with
instructors who know how to balance their teaching of students with their treating of athletes. By Dr. Kent Scriber & Courtney Gray Sport Specific
the Fences 41 For When the Cal State-Fullerton baseball coaching staff wanted to
take the team in a new direction, its strength and conditioning coach was challenged with making players bigger and stronger— and quickly. By Greg Vandermade T&C decemBER 2011
C48_T-C2011_208_T-C.qxd 1/29/11 1:19 PM Pa
Editorial Board Marjorie Albohm, MS, ATC/L President, National Athletic Trainers’ Association
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Jon Almquist, ATC Specialist, Fairfax County (Va.) Pub. Schools Athletic Training Program 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 President, American Medical Society for Sports Medicine Dan Cipriani, PhD, PT Associate Professor, Dept. of Physical Therapy Chapman University Gray Cook, MSPT, OCS, CSCS Clinic Director, Orthopedic & Sports Phys. Ther. Dunn, Cook, and Assoc. Keith D’Amelio, ATC, PES, CSCS Nike Sparq Training Bernie DePalma, MEd, PT, ATC Head Athletic Trainer/Phys. Therapist, Cornell University
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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, Makeplays.com 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 Myrland Sports Training, LLC, Director of Coaching, Train-To-Play Tim Neal, MS, ATC Assistant Director of Athletics for Sports Medicine Syracuse University 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.
Lori Dewald, EdD, ATC, CHES, F-AAHE School of Public Safety and Health, American Public University
Ellyn Robinson, DPE, CSCS, CPT Assistant Professor, Exercise Science Program, Bridgewater State College
Jeff Dilts, Director, Business Development & Marketing, National Academy of Sports Medicine
Kent Scriber, EdD, ATC, PT Professor/Clinical Education Coordinator, Ithaca College
David Ellis, RD, LMNT, CSCS Sports Alliance, Inc.
Chip Sigmon, CSCS Strength and Conditioning Coach, Carolina Medical Center
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
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
Vern Gambetta, MA President, Gambetta Sports Training Systems
Ralph Stephens, LMT, NCTMB Sports Massage Therapist, Ralph Stephens Seminars
P.J. Gardner, MS, ATC, CSCS, PES Athletic Trainer, Liberty High School, Colo.
Jeff Stone, MEd, LAT, ATC Head Athletic Trainer, Suffolk University
Joe Gieck, EdD, ATR, PT Director of Sports Medicine and Prof., Clinical Orthopaedic Surgery, University of Virginia (retired)
Fred Tedeschi, ATC Head Athletic Trainer, Chicago Bulls
Brian Goodstein, MS, ATC, CSCS, Head Athletic Trainer, DC United
Terrence Todd, PhD, Co-Director, Todd-McLean Physical Culture Collection, Dept. of Kinesiology & Health Ed., University of Texas-Austin
December 2011 Vol. XXI, No. 9 Publisher Mark Goldberg Editorial Staff Eleanor Frankel, Director Abigail Funk, Managing Editor R.J. Anderson, Patrick Bohn, Mike Phelps, Dennis Read Circulation Staff David Dubin, Director Sandra Earle Art Direction Message Brand Advertising Production Staff Maria Bise, Director Neal Betts, Trish Landsparger Business Manager Pennie Small Special Projects Natalie Couch, 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 info@MomentumMedia.com Training & Conditioning (ISSN 1058-3548) is published monthly except in January and February, May and June, and July and August, which are bimonthly issues, for a total of nine times a year, by MAG, Inc., 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© 2011 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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New Youth Sports Institute The American College of Sports Medicine (ACSM) is partnering with Sanford Health, a non-profit healthcare delivery system with 31 hospitals and more than 900 physicians in the upper Midwest, to form the National Youth Sports Health and Safety Institute (NYSHSI). The goal of the institute is to “be the recognized national leader and advocate for developing, advancing, and disseminating comprehensive research, education, recommendations, guidelines, and policy to enhance the experience, development, health, and safety of children and adolescents involved in sports and physical activity.” “The American College of Sports Medicine and Sanford Health are embarking on a partnership that holds great promise for our young athletes and those who work with and care for them, along with their parents and families,” Thomas Best, MD, PhD, past president of the ACSM, said in a press release announcing the formation of the institute. “Our expertise and our shared objective of helping young athletes enjoy sports more safely have led to the birth of this institute that has unprecedented potential to improve the experience of our youth engaged in sport and physical activity.” According to the press release, the NYSHSI will initially focus on four areas: mild traumatic brain injury/concussions; heat illness and injury; overuse/overload and injury risk; and unique clinical conditions in youth athletic populations, such as Type I diabetes, eating disorders, and the sickle cell trait. The institute’s Web site will provide information, links, and resources for athletes, medical professionals, coaches, and parents interested in youth sports. A poll taken by Kelton Research in August 2011 indicated that 91 percent of Americans feel youth sports participation is important and 94 percent feel more needs to be done to protect the health and safety of young athletes. “There is no question our young people need to be active, and participating in youth sports is an important component to that activity,” said Michael Bergeron, PhD, FACSM, Executive Director of the NYSHSI and Director of the National Institute for Athletic Health & Performance at Sanford Health. “However, too many of these young athletes are doing too much, too fast—some even suffering serious, life-threatening and life-altering injuries. This new institute will support youth athletics while also creating guidelines to protect their health and safety.” More information on the Institute can be found on its Web site at: www.nyshsi.org.
Assisted vs. Resisted Sprint Training Assisted and resisted sprint training both lead to faster sprint times, but in different ways, according to a recent study of women’s soccer players. Researchers found that assisted TR AINING-CONDITIONING.COM
training produced gains in the initial phases of a sprint while resisted training produced gains in the later phases. Conducted by David Upton, PhD, Assistant Professor at Texas Christian University, and published in the October issue of The Journal of Strength and Conditioning Research, the study looked at the effects of sprint training on 27 NCAA Division I women’s soccer players. The athletes were timed in a 40-yard sprint and then randomly split into three groups. One group performed resisted sprint training, another performed assisted sprint training, and the third group did sprint training without resistance or assistance. The players trained in 12 sessions over a four-week period, with the two test groups using specially designed harnesses connected to lines that either pulled against or with the athletes as they ran. In each session, all three groups performed 10 20-yard maximal effort sprints followed by a 20-yard deceleration to jog with three minutes of recovery between reps. After the four weeks, the players were tested again in a 40-yard sprint. The assisted training group showed a speed increase of 0.08 meters per second while the resisted training group increased their speed by 0.06 meters per second. The control group showed no change in speed. When researchers looked at the test groups’ split times, they discovered that the assistance-trained players had increased their speed and acceleration during the first 15 yards while the resistance-trained runners showed all their improvement over the final 25 yards. Thus, assisted training may be more appropriate for sports where initial quickness is desired, such as soccer, while resisted training may be better for athletes who need continued acceleration, such as a wide receiver in football. The study titled “The Effect of Assisted and Resisted Sprint Training on Acceleration and Velocity in Division IA Female Soccer Athletes” is available on The Journal of Strength and Conditioning Research Web site. Go to: journals.lww.com/nsca-jscr and type the title into the search window.
NCAA Adjusts Transgender Policy The NCAA Executive Committee has approved a new policy clarifying the rules governing participation opportunities for transgender student-athletes. The new policy continues to allow transgender athletes to compete on men’s teams, while eligibility for participating on women’s teams is dependent on the athlete’s use of testosterone treatments. Under the new policy, which was adopted in August, a trans male (female to male) athlete who has received testosterone treatments can compete on a men’s or mixed gender team, but not on a women’s team. Trans males who have not T&C decEMBER 2011
Board received testosterone treatments can continue to compete on either men’s or women’s teams. A trans female (male to female) athlete can continue to compete on a men’s team, but cannot compete for a women’s team until completing one year of documented
“The goals of these policies are to create opportunity for transgender studentathletes to participate ... while maintaining the relative balance of competitive equity.” testosterone-suppression treatment. If a trans female who hasn’t met the one-year requirement competes for a women’s team, that team would then be considered a mixed team and eligible to compete only in a men’s championship. Transgender athletes undergoing testosterone treatments need a medical exception because elevated levels of testosterone could otherwise result in a violation of NCAA drug testing rules. “As a core value, the NCAA believes in and is committed to diversity, inclusion, and gender equity among its student-athletes, coaches, and administrators,” NCAA Director of Inclusion Karen Morrison wrote in a memo to schools announcing
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the policy. “Since participation in athletics provides studentathletes a unique and positively powerful experience, the goals of these policies are to create opportunity for transgender student-athletes to participate in accordance with their gender identity while maintaining the relative balance of competitive equity within sports teams.” The policy resulted from a two-year process that started with a think tank titled “Equal Opportunities for Transgender Student-Athletes,” which was sponsored by The Women’s Sports Foundation and the National Center for Lesbian Rights. Part of the purpose of the think tank, which included representatives from the NCAA, was to develop model policies for college athletic programs that would ensure inclusion of transgender athletes. Several NCAA committees—including the Student-Athlete Advisory Committee— and other sports governance organizations also supplied input during the policy’s formation. The NCAA provides a variety of resources on transgender athletes, including a booklet titled “Inclusion of Transgender Student-Athletes,” a 30-minute video, and a slide presentation for administrators and studentathletes. These can be found by typing “transgender” into the search window at: www.ncaa.org.
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Board Football Head Injury Risk Varies by Position When it comes to hits to the head in football, running backs endure the hardest impacts while linemen are hit most frequently. These are the findings from a study that tracked players at three NCAA Division I schools over three seasons. The study used wireless sensors, which were placed in players’ helmets, to measure how often each player was hit, where on the helmet they were hit, and how hard the hit was. Researchers used the data to develop a composite score reflecting the combined exposure called HITsp. Running backs had the highest average HITsp score at 36.2, followed by quarterbacks at 34.5, and linebackers at 32.6. Although linemen showed the lowest scores (28.9 for defensive linemen and 29.0 for offensive), they received the largest number of hits to the head—more than double those at any position other than linebacker. The study, led by Joseph Crisco, PhD, Professor of Orthopaedics at Brown University and Director of the Bioengineering Laboratory at Rhode Island Hospital, recorded 286,636 hits during both games and practices among 314 players from Brown University, Dartmouth College, and Virginia Tech. He is now analyzing the findings and looking for insight on how the different head contacts can affect injuries sustained.
In a press release, Crisco—who is a former college football and lacrosse player—said he hopes the data will help equipment makers and football governing bodies find ways to make the sport safer by controlling exposures to injury-causing hits. One possible solution is designing helmets specific to the different positions played. In a separate commentary published in Current Sports Medicine Reports, Crisco and co-author Richard Greenwald, PhD, an Adjunct Professor of Engineering at Dartmouth, stated that curbing intentional use of the head in sport is critical. They also said that the addition of new playing rules may be an answer. “We propose the adoption of rules—or in some sports, we champion the enforcement of existing rules—that eliminate intentional head contact in helmeted sports,” they wrote. “When coupled with education that leads to modified tackling, blocking, or checking techniques, these rules will reduce head impact exposure and have the potential to reduce the incidence and severity of brain injury.” An abstract of the study titled “Head Impact Exposure in Collegiate Football Players” can be found by typing the title into the search window at the Journal of Biomechanics Web site: www.jbiomech.com.
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Austin Jensen Florida Atlantic University By Patrick Bohn
Florida Atlantic University football player Austin Jensen doesn’t remember the car accident that nearly killed him and cost him the 2010 and 2011 football seasons, although he has pieced it together from the accounts of others. On Feb. 13, 2010, Jensen, then a junior safety, was one of four passengers in a car being driven to the Owls’ postseason banquet. While traveling on I-95, the car was struck on the rear driver’s side—where Jensen was sitting—by another vehicle that had been sideswiped. The collision caused the car Jensen was in to flip a half dozen times, and despite wearing his seatbelt, Jensen was ejected from the vehicle. He landed on the highway, unconscious, and was taken to the hospital as soon as an ambulance arrived. While the other passengers were uninjured in the accident, Jensen’s skull fractured in two places, his pelvis fractured in four, and he suffered a major concussion and benign paroxysmal positional vertigo. He was put into a medically induced coma and spent a week in intensive care. When Jensen had recovered enough to process the accident, the last thing on his mind was football. “I kept asking if everyone else in the accident was okay,” Jensen says. “Football wasn’t important to me then. I wanted to make sure everyone else was all right and focus on getting out of the hospital.” However, Jensen’s time in the hospital wasn’t easy. “The pain was excruciating,” he says. “I wouldn’t wish a broken pelvis on anyone. And my head was so swollen that people told me when they looked at me, they couldn’t see my ears.” Jensen left the hospital two weeks after the accident, but his injuries were so severe he had to drop his classes and return to his parents’ house in Bradenton, Fla. “I couldn’t walk, and my concussion was so bad that I had to sit in dark rooms with sunglasses on,” he says. “I was fortunate to have a great support structure of friends and family, but it was a difficult time.” On March 2, Jensen met with John Walz, MPT, CLT, ACM, of Request Physical Therapy in Bradenton for an initial evaluation. Walz says that while he was struck by the severity of Jensen’s injuries, even at their first meeting he believed Jensen could return to the field. “Because he was an athlete, I knew he would work incredTR AINING-CONDITIONING.COM
After suffering two fractures in his skull, four in his pelvis, and a major concussion in a 2010 car accident, Jensen has returned to full functionality and hopes to play football again. ibly hard throughout the entire rehab,” Walz says. “And the body is such a unique machine, it can heal itself from a lot of injuries if given treatment and time. I knew Austin was going to undergo a transformation he might not have thought possible, but I had confidence he could do it.” The transformation began simply. Because Jensen’s hip and leg muscles had tightened due to the fracture, Walz used range of motion exercises to help him regain flexibility for much of the first week they worked together. “We concentrated on internal and external rotation of the hips and straightleg hamstring raises just to loosen those muscles up,” Walz says. “Austin also had some pain in his left hip, so to alleviate it, he would do pendulum exercises with his left leg. He would stand on a box a few inches off the ground on his right foot with a two pound weight around his left ankle, then swing his leg back and forth to lengthen the joint a little bit.” While working on Jensen’s range of motion and monitoring the pain level in his hip, Walz introduced what he called Patrick Bohn is an Assistant Editor at Training & Conditioning. He can be reached at: pb@MomentumMedia.com. T&C DECEMBER 2011
ComebackAthlete Austin Jensen Florida Atlantic University Sport: Football Injuries: Fractured skull, fractured pelvis, severe concussion Result: Hoping to play football for the Owls in 2012. May compete as a detached athlete in track and field.
“muscular re-education” to Jensen’s core and lower body. “The goal was to reactivate muscles that he hadn’t used in a few weeks,” Walz says. “For his quads, we used heel slides, and for his glutes, he’d squeeze his butt just to fire the muscles. “I’d also have Austin do a ball squeeze to activate the inner thigh, pelvic, and lower abdominal muscles,” Walz continues. “And he would lay on his back with his knees up and a TheraBand around them and externally rotate his hips.” Though Jensen was coming in for rehab four days a week, Walz says the goal of these early exercises wasn’t to exhaust Jensen—it was just to get his muscles working again after a long period of inactivity. This was especially true of Jensen’s left side, where Walz says his gluteals had atrophied to the point where they were about half as strong as those on his right. “I tried to make the exercises challenging but not taxing,” he says. “These were very effective because as an athlete, Austin had excellent body awareness. He could activate the right muscles when I wanted him to.” The early exercises succeeded in reintroducing Jensen’s muscles to work, but he still needed to use a walker to move around and couldn’t bear weight on his left side. “I didn’t get discouraged often during the rehab, but using the walker to get around wasn’t fun,” he says. “It’s terrible when you’re in your early 20s and you have to learn how to walk again. I really looked forward to getting rid of the walker.” In mid-March, Walz prescribed a new series of exercises designed to help Jensen do just that. He started by working Jensen’s core, having him sit on a physioball while holding onto a Thera-Band and doing “chop and lift” exercises where he brought his arm across his body diagonally. The goal was to help him regain balance in his pelvis and begin bearing weight. After doing those exercises for about a week, Jensen was able to use crutches to walk, so Walz increased his weight-bearing load by having Jensen stand at a parallel bar and shift his weight from one foot to the other. “I wanted to start Austin small because he hadn’t put weight through his left side in over a month, but he pro10
T&C DECEMBER 2011
gressed quickly,” Walz says, “Three days after he started on two crutches, he needed only one, so I made the exercises a little more intense. I had him use the Chuck Norris Total Gym to work on bilateral weight-bearing. He’d lie on his back on the slideboard, put his feet on the bar, and do a squattingtype motion. I liked this option because he had some pain in his lower back as a result of the accident and it enabled him to keep his back out of the exercise. “He started doing 30 percent of his bodyweight on the Total Gym, and was up to 50 percent within two visits, which was exceptionally quick,” Walz continues. “Until that point, we had to move slowly while waiting for the bones to heal, but when we got to working his muscles, he responded very well. As a football player, his baseline strength was so much higher than that of an average person.” “I have always approached working out with a ‘let’s go’ kind of attitude, so those first few weeks when things were moving slowly were tough.” Jensen says. “I was used to training like a Division I athlete. As the rehab progressed and we got into more challenging exercises, things went a lot smoother.” Once Jensen was able to bear enough of his own weight, Walz says, “The fun began.” Jensen continued to use the Total Gym, but also added ball squats to work his pelvic and core muscles. By mid-April, Jensen was high-stepping on a trampoline in order to work his upper gluteals and stabilize his pelvis, and doing lunges and single-leg squats while holding a 10-pound dumbbell. “Austin approached every session like he approached a football practice,” Walz says. “It was his job, and he worked incredibly hard because he wanted to get back on the field.” In fact, Jensen was progressing so quickly, Walz had to make exercises more complex at each session. “Austin would be doing prone planks one day and they were so easy that the next day I’d have to add unilateral hip extensions to them,” he says. “To work his pelvis, he would do bird-dogs, where he’d get on his hands and knees and extend one arm out in front of him while extending the opposite leg back. I put a weight on his ankle and had him grip a weighted pulley in one hand to make it more challenging.” As April turned to May, Walz began incorporating football-specific exercises into Jensen’s routine. In one, Jensen would get down into a defensive stance while holding onto grips attached to a 27.5 kilogram weight stack before lunging forward and throwing his hands up like he was engaging an offensive lineman. Jensen also did power cleans, ran on a treadmill at about six miles an hour, and jumped on a trampoline. Despite Jensen’s fast progress, at one point in June, Walz did have to hold him back for his own safety. “We had started doing deadlifts, and Austin progressed to 185 pounds,” Walz says. “He came in the next week and told me he was stiff because he had lifted 305 pounds on his own over the weekend. I had to tell him it wasn’t a good idea to do that because he could break himself down.” Walz admits it can be tricky to tell an athlete to slow down, because their innate competitiveness can make them unwilling to listen to a non-athlete’s advice. “You have to gain their TR AINING-CONDITIONING.COM
No Looking Back
When an athlete has an eating disorder in their history, the objective is not to diagnose or treat, but to keep them moving forward. Hereâ€™s how an athletic trainer can help. By Brina Jergenson
T&C decEMber 2011
he transition to college is a difficult one for most students, but for an athlete who has a history of an eating disorder, it can be even more challenging. More and more young teens are being diagnosed and treated for eating disorders before they enter college. And while they may be stable upon graduating high school, all the challenges of being a freshman student-athlete can threaten that stability. Changes in living situations, schedules, and support systems can easily lead to relapse. Eating situations may suddenly be more or less structured than the athlete is
Brina Jergenson, RD, CSSD, is an eating disorder specialist at A New Beginning, an outpatient treatment center in Scottsdale, Ariz. She helps clients overcome their eating disorders by providing education and support throughout their recovery process, and can be reached at: email@example.com. TR AINING-CONDITIONING.COM
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NUTRITION used to. The types and amounts of food available at team training tables will likely be different. And things that may have been taken for granted, like portioning plates, suddenly are gone. When someone has struggled with an eating disorder, it is often wondered whether he or she will ever be able to completely recover. There are varying
actual behaviors. Regardless of which is true, it is rarely helpful to promote the former as it can lead to a sense of hopelessness that interferes with recovery. For an 18- or 19-year-old, it would be rare that he or she feels completely recovered from an eating disorder diagnosed and treated at a younger age. So what is the college athletic trainer’s role
Some believe that once diagnosed, an eating disorder is something the person will struggle with on and off for the rest of their life ... Others believe that total recovery is possible ... It is rarely helpful to promote the former as it can lead to a sense of hopelessness that interferes with recovery. opinions on this. Some believe that once diagnosed, an eating disorder is something the person will struggle with on and off for the rest of their life, even if they display healthy eating patterns and a healthy mindset about food. However, others believe that total recovery is possible. The person may have fleeting eating disorder thoughts and urges, but they never materialize into
when history of an eating disorder is on a student-athlete’s medical form? The keys are to gain a thorough understanding of the student-athlete’s situation and then to join his or her treatment team. UNDERSTANDING THEIR PAST In order to best help an athlete who is in recovery, it is important to understand the different levels of treatment
they may have experienced prior to arriving on campus. The four main levels of treatment for someone who has been diagnosed with an eating disorder include inpatient treatment, residential treatment, intensive outpatient treatment, and outpatient treatment. The severity of eating disorder symptoms and medical stability determine the appropriate level of care. Inpatient treatment: The most closely monitored form of treatment is inpatient. This is typically the recommendation when someone isn’t able to maintain medical stability or if their weight drops below 85 percent of their recommended weight. Most inpatient facilities, which generally require 45 to 60 days of treatment, are very structured. Patients’ days are planned to include group meals and snacks of specific caloric content with a table monitor present, along with therapy sessions—individual, group, and in some cases, family therapy. Activities are usually part of the daily schedule as well, though exercise may be limited if a patient previously abused exercise as part of their eating disorder or are underweight.
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NUTRITION The goal of inpatient treatment is to medically stabilize the patient, gain insight into their eating disorder, establish a period of time without eating disorder behavior, and restore their weight to a healthy range. The inpatient experience can be very intense emotionally and possibly even painful physically depending on the patient’s symptoms and behaviors. Residential treatment: Though it is structured similarly to inpatient treatment, residential treatment patients are not monitored as closely. Patients live in a group house or apartment together with staff who supervise them daily and throughout the night. Patients have much more free time and face fewer restrictions regarding when and what they eat. However, individuals absolutely must be medically stable before entering residential treatment. Because residential treatment is often recommended following inpatient treatment, patients are sometimes required and often encouraged to take on more “real world” responsibilities as they begin to transition back to their normal lives. Examples include sharing cooking responsibilities and household chores, going out to eat with the group and ordering something on the menu they had previously labeled as “bad,” and attending school or getting a job. Intensive outpatient treatment: This level of care means that the patient lives on his or her own or with their family, but attends a specified number of group meetings and/or hours of therapy per week. Depending on the program, patients may be asked to eat in a group setting. The goal of intensive outpatient treatment is for the patient to get back to their life as it was prior to their eating disorder, but with some structure and support as they do so. Outpatient treatment: The least structured form of treatment is outpatient. The patient lives independently or with his or her family and is completely responsible for their own nutrition needs, while regular therapy sessions, dietitian meetings, and/or group meetings are encouraged. The goal of outpatient treatment is to allow the patient to fully return to their life and balance it with recovery. INITIAL DISCUSSION Upon learning that an athlete has struggled with an eating disorder, the first step an athletic trainer should take is to TR AINING-CONDITIONING.COM
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CASE STUDY Sara is a college freshman on the women’s basketball team. She was diagnosed with an eating disorder toward the end of her junior year in high school. At that time, she went to inpatient treatment for 60 days, then was transferred to residential treatment for an additional 30 days. Sara is now at a healthy weight, but is struggling to accept it. She still sees her outpatient team and attends a weekly support group meeting. She knows she needs a lot of outside support to be successful in her recovery. At Sara’s initial meeting with the team’s athletic trainer, she is open and honest about her struggles and asks the athletic trainer to communicate with her treatment team back at home. They discuss who at the school and on the team is allowed to know her history. Sara decides that all of the coaches can know about her history, but only the athletic trainer and team dietitian will check in with her. Since Sara knows she needs a lot of support, she agrees that the athletic trainer will check in with her weekly and ask her questions such as: Have you experienced any eating disorder behaviors? Have you had any urges to follow through on eating disorder behaviors? Are you following your meal plan? Is there any other support you need? They also discuss other ways the athletic trainer might know Sara is struggling, such as certain behaviors she might exhibit. The athletic trainer then communicates with the therapist on Sara’s treatment team to discuss the plan they have come up with. The athletic trainer also sets up a meeting between Sara and the team dietitian. They determine together that they will also meet weekly to check Sara’s weight and discuss how she’s doing with following the meal plan. The team dietician then contacts the treatment team dietitian and discusses the specifics of Sara’s eating disorder behaviors and meal plan. They agree to be in touch weekly to talk about Sara’s weight and any concerns that might have come up. During Sara’s first few weeks of practice, she quickly grows close to some of her teammates and decides to tell
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one of them about her eating disorder history. She asks the teammate not to tell anyone but to occasionally ask her how she is doing in her recovery. Sara continues her weekly check-ins with the athletic trainer and team dietitian. Her weight is steady and she appears to be doing well in her recovery. On campus, Sara is often surrounded by classmates who are concerned about their current weight or gaining the “freshman 15.” Sara has to distract herself so as not to compare her body to any of her classmates’ or teammates’ bodies. She knows dieting and losing weight is not okay for her. When the season starts and the team begins to travel to away games, Sara begins to struggle. It starts slowly with some restricting behaviors at team meals. She discusses this with the athletic trainer and team dietitian and they make a plan to have the teammate who knows her history quietly encourage her during difficult meals. However, Sara continues to struggle and begins restricting some of her snacks. Her weight starts to drop and her performance on the court becomes sluggish. The athletic trainer and team dietitian meet with Sara together to discuss her difficulties and performance. They call the outpatient treatment team and decide together to provide Sara with more structure by having her eat some meals and snacks with either the athletic trainer or team dietitian. Sara seems relieved with the increased structure. She follows through and begins to follow her meal plan more closely, even when the team is traveling. Her weight is still slightly below her healthy weight range so she agrees to add more calories for weight gain. During this time, Sara has opened up about her struggles to a few more teammates who are eating snacks with her on a regular basis. She continues her weekly meetings with the athletic trainer and team dietitian to discuss her concerns and challenges whenever they pop up. Her weight gets back into her body’s normal range and she begins to slowly accept that her weight is healthy.
NUTRITION have a one-on-one meeting with them as soon as possible. The goal of the discussion is to determine how to help them continue their recovery. Here are some good questions to ask in this meeting: What is the history of your eating disorder? Finding out how long the athlete spent in treatment, at which level(s), and when provides insight into the severity of the athlete’s eating disorder. It will also help determine how much support they may need. For example, an athlete who has a recent history of an eating disorder with one or more inpatient stays and who still attends outpatient treatment will require much more support than an athlete who is no longer undergoing any treatment. The first athlete may be comfortable with weekly meetings with you for support in addition to their outpatient treatment, while the second may not need more than a monthly check-in. Are you comfortable with others knowing about your history? In general, an athlete with a fairly recent history of treatment is comfortable with a larger support network and may be open to
their coaches and teammates knowing about their struggles. However, some may prefer that others not know about their eating disorder history. This is an important point to clarify. Do you have a treatment team? A treatment team generally includes a physician, dietitian, and therapist, psychologist, or psychiatrist. If the athlete
would indicate the athlete should not participate in their sport? What behaviors would indicate that the athlete is struggling? What is the athlete’s “danger weight” that indicates they should not be competing? Especially if the athlete is currently receiving treatment, it is a good idea for you to become part of the team.
A common “trigger” for the athlete might be hearing how much they weigh. He or she may have weighed themselves numerous times per day or been obsessed with knowing their weight and body measurements when they were struggling with their eating disorder. has a treatment team, ask the athlete if you may contact a member of the team, and which person is best to talk to. When you talk to a member of the athlete’s treatment team, explain your role as the athletic trainer and ask how you can help. Other good questions include: Do you have any concerns about the athlete participating in their sport? Have you seen any warning signs that
This may entail attending staff meetings when all team members are present or speaking to different team members on the phone to discuss the progress of the athlete or any concerns you may have. It is essential to the athlete’s recovery that everyone involved in his or her care agrees on the course of treatment and sends a consistent message of concern for the athlete’s health and well-being.
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NUTRITION Are you following a meal plan? Most athletes who have struggled with an eating disorder were at one point on a meal plan. If the athlete is still following one, it should lay out what, how much, and when they are to eat during the day. Having a meal plan helps them to get enough calories and also gives them a sense of security in knowing that their plan doesn’t allow for too many calories and hence, weight gain. A typical meal plan is divided into macronutrients with specific servings laid out in a pattern. A breakfast meal plan may look like this: two grains, one protein, one to two fats, one fruit, and one dairy. This means breakfast could include one cup of cereal with milk (one grain and one dairy) one to two scrambled eggs (one protein), one slice of toast with butter (one grain and one fat), and one banana (one fruit).
to best discuss their weight and body composition. The solution may be to have them stand backwards on the scale when they weigh in so they can’t see their weight. Then you may only want to discuss their weight or body composition in terms of range: “You are right where you should be,” or “your weight should be higher or lower.” Sometimes the trigger is comparing their body or caloric intake to others on the team. If this is happening, remind the athlete that bodies come in all shapes and sizes and that the way his or her body is allows him or her to compete well at their sport. In terms of caloric intake, remind the athlete that everyone has different caloric needs and his or her needs may be higher due to a higher metabolism. Another trigger may be eating at restaurants or even in front of other peo-
A recovering athlete knows what tools and support systems work for them, but you will never know how you can help unless you ask them directly. The athlete may benefit from a weekly check-in with you, or from having a buddy to eat with. Knowing what the meal plan entails and how it works can help an athletic trainer spot when the athlete may be struggling at meals. For example, if the athlete is eating at the training table and consistently leaves items from the meal plan off of their plate, that is a warning sign. The athletic trainer can also help the athlete by asking whether they have been following their meal plan or what other support they need at meals. Do you have any “triggers” that I can help you avoid? This is an especially important question if the athlete participates in a sport like wrestling, gymnastics, competitive cheer, or track and field and cross country where bodyweight and body composition are regular topics of discussion. For example, a common “trigger” for the athlete might be hearing how much they weigh. He or she may have weighed themselves numerous times per day or been obsessed with knowing their weight and body measurements when they were struggling with their eating disorder. If weighing in is a requirement for their sport, or you perform body composition tests on all of the athletes in your program, establish with this athlete how 18
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ple. Encourage the athlete to sit next to people he or she feels safe eating with. If restaurants are an issue, plan ahead with the athlete what to order by looking at the menus online. Try to steer clear of any references towards the caloric values of items and don’t pick low calorie items from the diet portion of the menu. How else can I support you in your recovery? A recovering athlete knows what tools and support systems work for them, but you will never know how you can help unless you ask them directly. The athlete may benefit from a weekly check-in with you, or from having a buddy to eat with who can provide them with a distraction during meals and snacks. This is also a good time to discuss with the athlete how best to approach him or her if you have any concerns about their recovery. Throughout your initial discussion with the athlete, it is best to proceed with compassion and understanding. The athlete may fear being treated differently than their teammates, or they may be worried that the coaching and athletic training staff is watching them incessantly. Reassure them that they
will be supported in their recovery, even if they struggle. Remind them that their health and well-being are most important. It would not be supportive to threaten the athlete with removal from their sport if they begin to struggle with their eating disorder again. It is also not helpful to judge how “sick” the athlete was or wasn’t. For example, asking them how much weight they lost while struggling with their eating disorder, then saying that it doesn’t sound like very much is one of the worst things you can do. Also, never comment on the athlete’s appearance, even if you think it’s a compliment. A common remark made to someone with an eating disorder is that they don’t look like they had one. This undermines the athlete’s struggles and belittles their eating disorder, which can easily trigger a reoccurrence. IT TAKES A TEAM As the athletic trainer, you are in a great position to help an athlete who has a history of an eating disorder. But it’s important to note that these athletes usually need an entire team of supporters. You can’t, and shouldn’t, take on the responsibility alone. In addition to the athlete’s treatment team, the on-campus supporters who may be able to help include the athletic department dietitian, the athlete’s coach(es), and his or her teammates. The athlete’s parents may also be a part of this equation. As mentioned earlier, make sure to discuss with the athlete who they are comfortable with having knowledge of their eating disorder history. Though you can encourage them to do so, it should always be up to the athlete whether or not they want to share their struggles with anyone else. One of the most important people who should be privy to the athlete’s history is the athletic department dietitian. If the athlete is still seeing their treatment team, the athletic department dietitian should be communicating with the treatment team dietitian. They should discuss any past or current meal plans and if the athlete has any special nutritional needs. The athletic department dietitian must also be very aware of how any recommendations he or she gives to a team may affect this specific athlete. For example, the guideline to eat more calories during preseason practices or add a recovery meal between practice TR AINING-CONDITIONING.COM
NUTRITION and dinner can make the athlete fearful. They may become worried about an increase in calories leading to weight gain. If the athlete is on a meal plan already and still sees a dietitian, contact the dietitian to discuss what and where to add calories to the athlete’s meal plan. If the athlete does not see an outpatient dietitian, then the athletic department dietitian should meet individually with the athlete to discuss how to increase the athlete’s caloric consumption in a way that does not threaten his or her stability. Another area where the athletic department dietitian can be helpful is when the team is on the road. The sports dietitian can obtain copies of restaurant menus in advance so that they can discuss with the athlete what to order before the team leaves on its trip. The dietitian may also be able to help the athlete identify a teammate, coach, or athletic trainer they can sit by for support during the meal. Some athletes may also be open to having their coach or coaches be part of their support system. This can be extremely helpful since it allows for a
coach to be assigned the task of checking in with the athlete on a regular basis. During the athlete’s season, they see their coach almost every day, so coaches are in a great position to be support staff members. Teammates are another possibility. The athlete may find a supportive con-
ask the athlete about it or bring their concerns to you. Finally, some athletes’ parents may be a big part of their support system. If an athlete’s parents are already involved with their child’s care, you can talk to the athlete about keeping their parents informed of their progress and explore
The athletic department dietitian must also be very aware of how any recommendations he or she gives to a team may affect this specific athlete. For example, the guideline to eat more calories during preseason practices or add a recovery meal after practice can make the athlete fearful. fidante (or an entire team’s worth of them) if they choose to share their eating disorder history with their teammates. Because teammates are also the same age and going through the same life changes at college, the athlete may find it easier to talk to them if they are struggling. In addition, teammates are more likely to notice if the athlete is avoiding eating or eating less than usual, and they can be encouraged to
setting up a communication system with them. Overall, in all your communication with these athletes, be open. Start talking early, and talk often if the athlete is willing to discuss their challenges with you. Always remind the athlete that they are supported, even if they suffer a reoccurrence. And remember that you have the chance to help the athlete make a positive change. n
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Michigan Stateâ€™s Adreian Payne goes over the back of an opponent for a basket.
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TREATING THE ATHLETE
Full Body Approach An athlete who presents with low back pain may also have a movement dysfunction. Both problems need to be addressed in order for the athlete to fully recover. By Guido Van Ryssegem
ow back pain—whether sudden or gradual in onset—is one of the most common complaints athletes have. For gymnasts, swimmers, and tennis, volleyball, and football players, it ranks as a top reason for visiting the athletic trainer or team physician. Yet athletes seem to consider it a common result of their training regimen and many do not visit the athletic training room until the pain is unbearable and they are no longer able to participate in their sport. What these athletes don’t understand is that low back pain can cause imbalances and movement dysfunctions that strain other parts of the body, setting them up for injury. For example, let’s say an ice hockey player is experiencing some low back pain, but does not seek treatment. If the hockey player continues practicing, their body will naturally find a way to compensate for the pain. A common example would be if the athlete started to favor one side, which can lead to a muscle imbalance in the hips. It would only be a matter of time before they suffered a strained leg muscle or tore a knee ligament. Mounting evidence shows that athTR AINING-CONDITIONING.COM
letes with low back pain often exhibit movement dysfunctions such as the one detailed above. These athletes move differently to compensate for the pain, often to the point where it affects their gait pattern. This makes them vulnerable to injury as the dysfunctional pattern perpetuates the body’s kinetic chain. As important as it is to address an athlete’s back pain, for those of us who prevent, treat, rehabilitate, or recondition athletes, it is paramount to also identify and correct any movement dysfunctions that have surfaced as a result of the back pain. If we don’t, it is likely the athlete will suffer an injury or re-injury. DEFINING DYSFUNCTION Movement dysfunctions are actually normal neuromuscular adaptations to preserve function. If that sounds conflicting, think about it this way: Say you are walking across the African savannah gathering food. Suddenly a lion starts chasing you, looking for a quick and easy lunch. Luckily, there are some trees ahead where you can hide, but while sprinting you step in a hole and twist your back. Agonizing pain shoots through
your spine. What are the options? Either you stop running and become lunchmeat, or you keep running to save your life. Of course you would continue running, albeit with a dysfunctional movement pattern. Considering that the altered movement pattern was necessary in order for survival, what is wrong with how you ran? This is an extreme example, but the problem is that more often than not, survival patterns do not disappear— even after the back pain subsides. The dysfunctional movements become habit as the body has found the path of least resistance. And the longer an athlete is firing their muscles in a different sequence and changing the way their body’s kinetic chain is being used, the more likely they are to suffer an injury. For example, research has shown high Guido Van Ryssegem, MS, ATC, CSCS, NBFE, RN, is Coordinator/ Clinical Athletic Trainer at Oregon State University. He serves as Director for the Oregon National Strength and Conditioning Association and is the Founder of Kinetic Integrations. He can be reached at: guido.vanryssegem@ oregonstate.edu. T&C decEMBER 2011
TREATING THE ATHLETE correlations between low back dysfunction and knee injuries. A 2007 study found that athletes with low back pain showed a more forward-leaning posture, which altered their knee mechanics and actually forced them to rely on their already-hurting low back muscles even more than usual. The study also found weakness and imbalances in muscles around the ath-
ity joints and eventually caused injury. Through my 20-plus years of working with athletes at the professional and collegiate levels, I have noted that predictable patterns of dysfunction develop when the human movement system is not functioning optimally. For example, low back pain often results in postural dysfunction, poor balance control and body awareness, weak hip abduction
The first step to correcting a movement dysfunction is to find it ... Tests screen for strength weaknesses with respect to standard movement, limitations, and asymmetries. They can also help predict the potential for injury. letes’ hips and pelvises. If the hip muscles are not properly stabilizing the femur, it will rotate away from its normal alignment and have a destructive effect on the functioning of the knee and kneecap. All in all, the athletes who had low back pain placed a higher demand on weaker, fatigued, unbalanced, and possibly inhibited muscles, resulting in further movement dysfunctions that overloaded the low back, pelvis, and lower extrem-
and external rotation, and poor lumbopelvic stability. DETECTION PROCESS New diagnosis and treatment models that recognize low back pain as part of the movement system and kinetic chain are emerging. I have developed a model called Kinetic Integrations that is centered upon this idea. It is an evidence-based approach to reversing dysfunctional move-
ment that has arisen as a result of back pain through awareness, correction, and the formation of new habits. The first step to correcting a movement dysfunction is to find it. Kinetic Integrations uses simple tests to detect dysfunctions associated with back problems. Through careful observation, these tests screen for strength weaknesses with respect to standard movement, limitations, and asymmetries. They can also help predict the potential for injury should the weakness not be addressed. One of the tests is a modification of the eccentric step test, which is classically used to detect patellofemoral joint dysfunction. The procedure can detect movement dysfunctions in the form of internal knee rotation/adduction, poor neuromuscular control through descent, hip hiking, and/or early plantar flexion while performing a heel lift. Simple postural assessment that involves an athlete balancing on one foot with their eyes open and then closed, as well as muscle strength testing, nicely augment the movement dysfunction tests. Not only is movement often af-
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TREATING THE ATHLETE fected by low back pain, but strength, balance, proprioception, and stability are, too. All must be addressed before the athlete returns to activity. It’s important to note that some movement dysfunctions are more difficult to identify than others. For example, a wrestler comes into the athletic training room with low back pain and you don’t detect any imbalances or movement dysfunctions. Then he mentions that 10 years ago, he strained his back while wrestling in a youth club and had a limp for weeks afterwards. Even though the injury happened a long time ago, the body’s connective tissues and central nervous system still bear an imprint of that limping pattern. It may not be visible to the naked eye and the wrestler probably isn’t even aware of it, but he may still be favoring one side slightly just out of habit. In addition to compensating for pain in the low back area, movement dysfunction can also be the result of repetitive motions and/or poor posture. This is easily recognizable in the legs and foot placement of a ballerina and the hunched shoulders of a swimmer or
wrestler. Repetitive use and misuse of the body molds it. As active as athletes are during practices, training sessions, and contests, they are not immune to poor posture. High school and collegiate athletes
tem. Think of the kinetic chain: The head bone is connected to the neck bone, the neck bone is connected to the back bone, the back bone is connected to the hip bone, and so on. Historically, the Western medical
Historically, the Western medical model hasn’t been very helpful in dealing with low back pain, and I believe this is because it’s based on treating only the symptoms of low back pain and not the root cause of the symptoms. spend a lot of time sitting in classrooms, at team meetings, at the dinner table, watching TV, playing video games, studying for exams, and driving. How often are they slumped over, with their shoulders rounded and spine out of line? Pretty often, wouldn’t you say? BACK TO FUNCTIONALITY Once a movement dysfunction has been identified, it’s time to come up with a treatment plan to fix it. Even if the athlete is experiencing pain only in their back, it is important to remember that our bodies move as one complete sys-
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model hasn’t been very helpful in dealing with low back pain, and I believe this is because it’s based on treating only the symptoms of low back pain and not the root cause of the symptoms. I also believe this is why back pain has such a high recurrence rate. Even after an athlete is treated and returns to play, they are often haunted by the same pain again sometime down the road. For example, an athlete who shows signs of low back muscle spasms is often diagnosed with just that: low back muscle spasms. They are then prescribed treatment for the spasms, which may in-
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TREATING THE ATHLETE
back in action Billy is a college basketball player suffering from pain around his right kneecap. After being carefully questioned about his health history, it is revealed that in addition to his knee pain, he has a history of low back pain. For the last six months, he has been periodically experiencing the back pain when sitting in class and after he has been standing for a while. In the morning, his back feels very stiff and it takes a while for him to “loosen up.” He has tried icing his knee and back and replacing his running program with a cycling regimen for a few weeks, but every time he resumes running his knee pain returns. Billy has an obvious slouching posture, both when he enters the exam room and when he sits down. His knee exam reveals nothing except for some discomfort underneath the kneecap during a patellofemoral compression test, but his back exam reveals quite a bit: symptoms of spinal derangement in the lumbar and cervical spine with limited range of motion and a forward head position, poor thoracic spine mobility with poor rotation range of motion, atrophy and delayed contraction of his right low back multifidus, poor lumbopelvic stability, and poor balance with his eyes closed. Billy’s step-down test also reveals femoral internal rotation with increased adduction and knee discomfort when he bends his knee while stepping down. His right hip abduction isometric strength is weaker on his injured side and he has right anterior hip impingement with poor and uncomfortable range of motion. Lastly, an x-ray reveals that he has mild patellar chondromalacia. After explaining to Billy how his two injuries are connected, he understands their relationship and why manual therapy and corrective exercises are needed to get detrimental forces off his kneecap. His first treatment session
clude stretching and low back strengthening exercises. The stretching and strengthening may temporarily relieve the athlete’s symptoms and they may even return to full functionality, but the likelihood that they will again suffer from low back pain is very high. In the above scenario, the focus was only on the symptoms. The athlete’s spasms might resolve through these interventions, but the associated dysfunctions need to be addressed as well so that return to full function can occur with minimal risk of re-injury or injury somewhere else in the body. One of the main keys to resolving low back pain and any associated move24
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includes manual therapy to the neck and thoracic and lumbar spine, followed by McKenzie extension exercises. This immediately decreases his low back discomfort and increases his spinal range of motion. Hip and patellar mobilizations are applied, eliminating the hip impingement while also improving range of motion. Billy performs these exercises at home and continues to show improvement in symptoms and range of motion. A sitting hip stretch is added to his home exercise program. Now that Billy has mobility, corrective strengthening exercises can start. First is the hip mini-band exercise progression. While applying sound postural cueing and exercise repetition, improved motor control quickly becomes apparent. After performing just 10 repetitions of the first exercise, his step-down test improves dramatically and does not cause discomfort. A home balance exercise program is explained and demonstrated, and Billy is taken to the swimming pool to start running in the deep end with a floatation belt around his waist. To his surprise, neither his knee nor back bother him after deep-water running for 30 minutes. It is brought to his attention that when he started running in the pool he showed limited stride-length on his right side, exhibiting running movement dysfunction. Billy quickly learns how to correct it and expresses that he feels more normal running this way. Consecutive treatment sessions continue for manual mobilizations as needed, and his corrective exercises are progressed as tolerated. Kinetic Integrations trunk stabilization exercises are also applied prior to his return to the field. Seven weeks after he first came in for his knee pain, Billy is back to his old self and playing better than ever.
ment dysfunctions is to create new neuromuscular options so old (bad) habits can go by the wayside. This is achieved through the conscious practice of new movement and stability patterns. There has also been a growing amount of research in the field of motor control. Studies have identified a number of motor control issues that can affect the overall stability of the lumbar spine, and research has identified key muscles that play
an important role in spinal stability, including the multifidus, transverse abdominis, the pelvic floor muscles, and the diaphragm. Low back pain is a common problem in the athletic population. Research has shown that it is associated with movement dysfunctions. Addressing these overlooked dysfunctions will facilitate more efficient return to activity, prevent re-injury, and optimize sports performance. n
To lean more about Kinetic Integrations, visit the Web site at: www.kineticintegrations.com. To view full references for this article, go to: www.Training-Conditioning.com/references. TR AINING-CONDITIONING.COM
TREATING THE ATHLETE
Circle No. 118
equipment solutions TREATING THE ATHLETE
Competition Kettlebells These steel kettlebells are all the exact same physical size and shape. This can help eliminate detrimental effects to skill technique. The unpainted handle allows for ease of movement as well as chalk application. Color coded by weight; colors may vary. Handles are 1 3/4". Available in sizes: 8, 10, 12, 14, 16, 18, 20, 22, 24, 26, 28, 30, 32, 36, 40, 44, 46, and 48kg.
Place the kettlebell handle at a 45 degree angle from your body out in front or back between your legs. Lower the hips back and down keeping the shin at a vertical angle. Grasp the handle with an overhand grip. Your arm, torso and neck should move all as a single unit. Contract the muscles of the hip area and legs standing straight up while pulling the kettlebell with extended arms to chest or head height. Allow gravity to bring the kettlebell down and repeat the movement
Place the kettlebell handle at a 45 degree angle from your body out in front or back between your legs. Lower the hips back and down keeping the shin at a vertical angle. Grasp the handle with an overhand grip. Your arm, torso and neck should move all as a single unit. As the kettlebell travels upward to shoulder level pull the handle back quickly and loosen your grip slightly to allow the kettlebell to begin to flip over. Punch through straight up and ending with kettlebell on the back of the forearm with the elbows and knees locked straight
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Place the kettlebell handle at a 45 degree angle from your body out in front or back between your legs. Lower the hips back and down keeping the shin at a vertical angle. Grasp the handle with an overhand grip. Your arm, torso and neck should move all as a single unit. On the upswing as the kettlebell reaches waist height bend your elbow and loosen your grip allowing the kettlebell to flip over. Keep the elbow in tight to the body allowing the kettlebell to rest in the crook of the arm. Push the kettlebell off the forearm flipping it and returning to the starting position.
One-Arm Push Press
From a Clean racked position, slightly dip by bending the knees, drive through the heels and forcefully extend the hips while simultaneously pressing the kettlebell straight upward. Lock the elbow and knees at full extension. The elbow should be directly over the hips. Lower the arm back to the rack position and repeat the exercise.
Double Front Squat
Begin the movement from a Clean racked position. Lower into a squat by initiating the hips and legs while keeping the back flat and the shin angle vertical. Once thighs are parallel or lower drive through the heels and return to the starting position. Repeat for the desired number of repetitions
Begin the movement from a Swing or Clean racked position as shown. Dip by bending the knees, push through the feet and forcefully extend the hips while simultaneously pressing the kettlebell straight upward. Your heels may leave the floor Drop under the kettlebells and catch the weight in a semi-squat position with locked elbows. Fully extend the hips and lock the knees. The elbows should be over the hips. Controllably lower the arm back to the rack position and repeat.
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Flex Play Great flexibility is an important tool in a football player’s repertoire. The key to improving it is a more dynamic approach to stretching. By Allen Hedrick
lexibility plays a larger role in achieving optimum performance than a lot of football players realize. After all, a slightly longer reach could help a receiver snag a high pass. More flexible hips and hamstrings could mean evading an opponent’s tackle. There is also another important reason flexibility deserves a lot of attention in football strength and conditioning programs: decreased injury risk. The same flexibility that provides a performance edge over a not-so-flexible opponent also allows a player to walk away uninjured from a play that would result in a strain or pull for a less-flexible player. Here at Colorado State UniversityPueblo, flexibility is a vital part of our football team’s strength and conditioning program. In this article, I will explain how we train flexibility, modify our program based on individual players’ needs, and keep our athletes motivated while taking part in flexibility training. FLEXIBILITY PRIMER Defined as the range of motion of a joint or series of joints, flexibility can
ap photos/elise amendole TR AINING-CONDITIONING.COM
Allen Hedrick, MA, CSCS*D, is the Head Strength and Conditioning Coach at Colorado State University-Pueblo. He formerly held the same position at the NSCA’s national headquarters and the U.S. Air Force Academy. He can be reached at: email@example.com. T&C DECEMBER 2011
Optimum performance be improved through various types of stretching that target muscles, ligaments, and tendons. There are a variety of methods that can be used to increase flexibility: Ballistic stretching involves rapid
volves passively moving the joint into a near maximal position and holding the stretch for an extended period of time—usually 15 to 30 seconds. Static stretching appears to work well, though depending on the sport and the athlete,
Although all of our football players generally perform the same flexibility stretching routine, we do individualize the program for those who have specific flexibility problems ... These athletes are prescribed additional work to perform on their own. movements that use momentum to carry the targeted body part(s) through their range of motion until the muscles are stretched to their limits. Because ballistic stretching is performed at high speeds, the rate and degree of stretch, as well as the force applied to induce the stretch, are difficult to control. Once widely used, ballistic stretching is no longer considered a safe method for increasing range of motion because of the potential for injury. Static stretching is the method most commonly used by individual athletes and teams to increase flexibility. It in-
it can take a lot of time to complete a sufficient routine. Proprioceptive neuromuscular facilitation (PNF) involves a couple of steps and a partner. First, the athlete’s partner slowly moves the targeted muscle into a static stretch, while the athlete keeps the muscle relaxed. While still stretched, the muscle is briefly contracted isometrically against an external force (their partner) sufficient enough to prevent movement in the joint. Then the muscle or joint is taken out of the stretched position for a brief amount of time before the stretch is performed a second time, potentially resulting in
greater range of motion. While published studies suggest PNF stretching increases flexibility better than static stretching, some of the techniques are impractical because a partner is often needed. Dynamic stretching involves sportspecific functional-based exercises that ready the body for activity. In many cases, the actual stretching movements are identical to static stretching movements, but dynamic stretches are preceded and followed by full-body movements. Developing a dynamic flexibility program requires analyzing the movements associated with a sport and developing stretches to enhance flexibility based on those movements. Dynamic flexibility is more applicable to athletic performance because it more closely duplicates a given sport’s movement requirements. This also means that dynamic stretching can be used to teach or reinforce sport-specific movements. Another benefit is that the exercises can be made more effective by progressing from a standing position to a walk and then a skip or run. For these reasons, dynamic stretching is the method
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Optimum performance we employ most with the football team here at CSU-Pueblo. INSIDE THE PROGRAM Because dynamic flexibility training is based on the movements that occur in a given sport, the only limiting factor is the creativity of the coach designing a flexibility training program. I have a core group of exercises I like to use with our football players because I have found they best mimic the movements they perform on the field. All the exercises we use are performed as players walk over a distance of 15 to 20 yards. A routine of five to six movements is performed every dayâ€”either in the weightroom prior to strength and power training on Mondays, Wednesdays, and Fridays, or on the football field before we perform speed/agility/ conditioning activities on Tuesdays and Thursdays. We also perform static stretching routines to finish our sessions on Tuesdays and Thursdays. To avoid monotony and make this a fun activity (while still emphasizing good technique) I use different movements each day and mix up the order.
This way, the athletes will not dread this portion of their training. Although all of our football players generally perform the same flexibility stretching routine, we do individualize the program for those who have specific flexibility problems. The large number of athletes on the team keeps us from performing a formal movement screen on each athlete, but athletes with flexibility issues are easily identifiable when participating in our strength and power training program. For example, an athlete may display limitations when trying to properly rack the bar with a high elbow position when cleaning, or not be able to achieve a full squat position when squatting or catching a full clean. These athletes are prescribed additional flexibility work to perform on their own. The system seems to work well because we put an emphasis on correct technique in the weightroom and our athletes do not like to be singled out in front of teammates as having deficient exercise technique. We also make it a point to constantly stress to our athletes that it is possible to increase strength and improve flexibil-
ity at the same time. For example, deep squats, full range of motion side lunges, and well executed cleans allow for the development of flexibility and strength/ power simultaneously. Many football players only think about getting bigger and stronger, so this is a way to get them to take the flexibility work seriously. OUR EXERCISES Following is a partial list of dynamic flexibility exercises we use with the football team here at CSU-Pueblo. This is by no means an all-inclusive list, but is a good starting point for a football program. Lunge walk: While clasping his hands behind his head, the athlete steps forward and drops into a lunge position with his torso leaning back slightly. The back knee hovers just off the ground, where he pauses for a count, then switches to move the opposite leg forward. This exercise can also be completed as a reverse lunge walk, where the athlete moves backwards. Lunge walk/palms to floor: With his hands at his sides, the athlete steps forward and drops into a lunge position. Here, he places both palms on the floor
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Optimum performance outside of his front foot with fingers pointing forward. After pausing for a count, he rises and repeats on the opposite leg, progressing forward with each step.
Twisting lunge walk: With his hands clasped behind his head, the athlete steps forward with his right foot and drops into a lunge position. As he
WARMUP VS. STRETCH It is important to note that a static stretching routine is not a sufficient way to warm up. Because a team stretching routine is a deep-rooted tradition in a lot of sports, some coaches still use it as a warmup. But the truth is, athletes should stretch only after they have warmed up. Warming up is an activity meant to raise body temperature, which readies the body for vigorous exercise. Static stretching is a passive activity, so there is minimal friction of the sliding filaments. There is also little, if any, increase in the rate of fuels being metabolized. Therefore, itâ€™s easy to see that static stretching results in minimal increases in core body temperature. A proper warmup before stretching is necessary because the decreased muscle, tendon, and ligament viscosity that results from an elevated core temperature allows range of motion to increase, which means the athlete will get more benefit from stretching and be at less risk for injury. If their bodies are not properly warmed up, the athletes will feel stiff and be at higher risk for injury.
drops, he twists his upper body so that his left elbow touches the outside of the right leg. After pausing in this position for a count, he stays down but twists the opposite way so that the right elbow touches the inside of the right leg. He then repeats with his left leg forward, touching the outside of the left leg with the right elbow, then the inside of his left leg with his left elbow, progressing forward with each step. This exercise can also be completed as a reverse twisting lunge walk, where the athlete moves backwards. Hockey lunge walk: While clasping his hands behind his head, the athlete steps forward, placing his front foot about eight to 10 inches outside of his shoulder, and then drops into a side lunge position. Both feet should be pointing directly forward with the back knee hovering just off the floor, head up, and back slightly arched, just like in a forward-stepping lunge. After pausing for a count in the bottom position, he repeats with the opposite leg, progressing forward with each step. Walking side lunge: The athlete takes a long lateral step with the right foot,
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Optimum performance keeping his toes pointed forward. Keeping the left leg straight, he sinks his hips back and to the right in a groin stretch. With his back arched, he pauses for a count at the bottom, then stands back up before pivoting and repeating the movement with the left leg leading. Lunge out on all fours/walk hands between: The athlete lunges out on all fours, with the body extended long and supported by the hands and feet. Keeping his hands stationary and legs as straight as possible, the athlete walks his feet up between his hands. At the top of the movement, he lunges out on all fours again and repeats the movement, attempting to get his feet further through the hands with each repetition. Walking knee tuck: Stepping forward with his left leg, the athlete pulls his right knee up to his chest, using his hands to assist. After pausing for a count, he steps with the right leg and pulls the left knee, trying to pull the knee higher with each repetition. Walking knee tuck/lift the foot: The athlete steps forward with the left leg and pulls his right knee to his chest as if performing the walking knee tuck, but at the top of the movement, he moves his right hand to his right foot, then pulls the foot toward his shoulder while standing tall. After pausing for a count, he steps with the right leg and repeats the pulling action with the left leg. Walking over/under: Turning sideways, the athlete imagines a series of high and low hurdles progressing down the track. He first swings his right leg and then his left up and over the first high hurdle, keeping his toes pointed forward. After clearing the first high hurdle, the athlete drops into a squat position and moves laterally under the first low hurdle. After moving under the low hurdle, he pivots to the opposite direction and repeats the two movements. Walking leg swing to opposite hand: The athlete steps forward with his left leg and left hand outstretched. After returning his left leg to the ground, he swings his right leg up to touch his left hand while keeping his right leg straight throughout the swinging motion. He repeats the movements with the opposite leg and hand, attempting to swing the leg slightly higher with each repetition. Walking knee over hurdle: The athlete imagines a line of intermediate hurdles running down the track, alternating to the right and left sides. Leading with the right knee, he lifts his right leg up and TR AINING-CONDITIONING.COM
over the first hurdle, placing the right foot down in front of him. He repeats the movement, leading with his left leg and attempting to bring the leg slightly higher over the hurdle with each repetition. As the athlete becomes proficient at performing each dynamic flexibility movement, the exercises can be “complexed” into combinations. For example, the athlete can perform a knee tuck to a lunge walk, alternating legs after each movement has been performed. There are two primary advantages of combining movements. First, it becomes
a more sport-specific way to train because in football, the athletes do not repeat the same movement often. Second, it becomes a more efficient way to train because a larger number of muscle groups are stretched when performing a combination of stretches rather than duplicating the same stretch repeatedly. This also shows the wide array of options available with dynamic stretching. Simply use the movements athletes make on the field and you’ll find increased performance during training, and more importantly, during games. n
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recent study in the American Journal of Sports Medicine of over 2,000 high school football players proves that the DonJoy Stabilizing Ankle Brace reduces the incidence of acute ankle injury by 61%. This study revealed critical evidence that the brace did not increase the incidence of acute knee injuries or other lower extremity injuries between athletes wearing ankle braces and the control group who were not.
Take the Offensive Against Acute Ankle Injury with DonJoy® Stabilizing Ankle Brace And when you tally the final scores, bracing also comes in as a low-cost alternative to athletic tape, especially when considering the application time and material factors. If the game is about preventing ankle injuries and reducing costs, DonJoy’s low profile and versatile Stabilizing Ankle Brace has clearly earned MVP status. DJO Global offers a comprehensive portfolio of ankle braces, ideal for foot and ankle injury prevention and treatment. For more information, call 760.727.1280 or 800.793.6065 or visit djoglobal.com. Source: McGuine T.A., Brooks A. Am J Sports Med.2011 “The Effect of Lace-up Ankle Braces on Injury Rates in High School Football Players”
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Co-author Courtney Gray works with an Ithaca College athletic training student while she completes her clinical rotation in the athletic training room.
Teaching & Treating Athletic training students’ best clinical experiences are with instructors who know how to balance their teaching of students with their treating of athletes. By Dr. Kent Scriber & Courtney Gray
thletic trainers are constantly striving to find balance. Many of us balance our teaching loads with the time we spend providing coverage to athletic teams, and almost all of us try to balance long hours at work with our personal lives. But athletic trainers who are also clinical instructors face another balancing act: Providing excellent care to their athletes while also guiding athletic training students’ learning experiences during clinical assignments. Clinical instructors should never sacrifice an athlete’s care in order to give an athletic training student more
clinical experience. But they should also allow the athletic training student to get as much hands-on experience as possible. These sometimes opposing objectives provide challenges that clinical instructors must anticipate and plan for. Kent Scriber, EdD, ATC, PT, is a Professor and the Clinical Education Coordinator for the Athletic Training Education Program at Ithaca College. He can be reached at: firstname.lastname@example.org. Courtney Gray, MS, ATC, is a Clinical Assistant Professor and Athletic Trainer at Ithaca. She can be reached at: email@example.com. T&C decEMBER 2011
LEADERSHIP One of our goals in the Athletic Training Education Program (ATEP) at Ithaca College is to make sure that our students get useful, educational experiences during their clinical assignments, whether they are on or off campus. Therefore, we put many strategies in place to set up and then foster this type of balanced environment. GREAT START To get both the clinical instructor and the athletic training student off on the right foot, we require that they meet before the student’s clinical experience begins. Whether the student will be working on or off campus, this meeting gives the clinical instructor the opportunity to communicate their ex-
pectations and sets the proper tone for the experience. We have found that most problems between students and clinical instructors result from a lack of clear communication, so we try to foster good communication early on. For example, a student may have looked at the game schedule they were given by their clinical instructor and assumed they were done after the last regular season game because the possibility of postseason participation was not discussed. Then when the team makes it into the postseason, the student assumes they aren’t expected to attend practices, and the clinical instructor ends up upset because the student doesn’t seem to want to finish the season.
STUDENT TIPS The following is a list we put together for athletic training students about to embark on their first clinical assignment. We hope it helps them understand what will be expected of them and how they can get the most out of this valuable experience. • Communicate early and often. Talk to your clinical instructor about your expectations and what you hope to get out of the internship. This way, they can better guide your experience. • Discuss what the clinical instructor’s expectations are regarding travel, days off, school holidays/breaks, etc. • Be professional. Approach your internship the same way you would approach your first job. Be on time and dress professionally. • Get involved. You may be hesitant and understandably nervous, but you are going to learn more by doing. • Be enthusiastic. Clinical instructors are passionate about what they do and appreciate your energy. • Respond to feedback. If your clinical instructor makes a suggestion, listen to them. They are trying to help you do better. • Do things without being asked. If you know what needs to be done, don’t be afraid to take initiative. • Ask questions. If you face something you haven’t seen before or you aren’t sure, just ask. • Don’t be afraid to be wrong. You are there to learn and no one expects you to get it right all the time—just that you try. • Make suggestions. If you have an idea or remember something you learned in class that is related to the case, ask the clinical instructor if it makes sense to try it. • Have fun! Athletic trainers love what they do and want to share their passion with you.
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All clinical instructors have their own approaches to student supervision, so this initial meeting is a good time for them to let the student know how “far” they may go in terms of performing an injury evaluation or providing treatment under their watchful eye, when it is appropriate to ask questions, and when they should just observe. Some clinical instructors want students to learn more by doing and being directly involved, whereas others prefer to perform their jobs and let students observe and model after them. Both approaches can be effective depending on the situations and people involved. The key is that they are discussed up front. For example, some clinical instructors may tell a student they should handle any injury that doesn’t appear life threatening. Then the instructor can provide feedback as the student gains the valuable experience of performing important skills or making clinical decisions somewhat on their own. Other clinical instructors may want students to observe for the first few weeks, and start doing hands-on work only after the instructor deems that they are ready. Though gaining hands-on experience by performing evaluations, administering treatments, and planning rehabilitation programs is a main goal of the clinical experience, students must also be made aware that they are still students and will be closely supervised while performing their duties. Both our students and clinical instructors are aware that state practice acts make it illegal for students to provide treatments, conduct rehabilitation exercises, or make return-to-play decisions without a certified or licensed professional directly supervising. At this point, students are not the decision makers, but they can discuss their thoughts and recommendations with their clinical instructor. For example, a student may be able to recommend that an athlete would benefit from a particular treatment based on what they have been taught, but the supervising athletic trainer will ultimately make the decision. We encourage our clinical instructors to have the students assist to their level of knowledge and experience so they can develop their clinical reasoning and decision making skills. As the semester progresses, the clinical instructor usually TR AINING-CONDITIONING.COM
LEADERSHIP lets the student provide more of the patient’s care while guiding them through the process, but the clinical instructor always has the final say. Supervisors and students should also discuss when the student may not be included in certain aspects of an athlete’s care. For example, a soccer player who has just suffered a season-ending ACL tear and is in emotional and physical pain may not tolerate a knee evaluation performed by a student. It is up to the clinical instructor to determine which instances are hands-on teachable moments, and when the student should observe and wait for guidance. This may also be the case when it involves something that the athlete wants kept confidential, such as personal issues like eating disorders, sexual health, or mental illness. Although our students are taught and adhere to the laws and rules regarding patient privacy, in many cases the student and athlete may be peers, and the athlete’s right to privacy should be respected. GOING OFF-CAMPUS We have had the good fortune to work with several offcampus sites on fieldwork experiences for many years. In fact, over the past six years, more than 90 percent of our program graduates have completed at least one off-campus fieldwork assignment. Utilizing off-campus sites allows our students to: • Work with different patient populations (adolescent athletes
The student may not be included in certain aspects of an athlete’s care ... This may be the case when it involves something such as personal issues like eating disorders, sexual health, or mental illness. at area high schools, NCAA Division I athletes at Cornell University, or a more general population at clinics) • Work with different clinical instructors (athletic trainers, physical therapists, physicians, and surgeons) to extend students’ knowledge and professional networks beyond their experience at Ithaca College • Work with different sports not offered at Ithaca College • Be exposed to different facilities, treatment equipment, and rehabilitation protocols. Because we don’t want there to be a severe distinction between our on- and off-campus fieldwork opportunities— both are great experiences—it is very important that all of the clinical instructors at these sites are just as familiar with our program expectations as the clinical instructors here on campus. There are several ways that we make sure all of our clinical instructors are on the same page. We take advantage of regularly scheduled clinical instructor workshops every three years to disseminate pertinent information to both our on- and off-campus clinical instructors. This allows ATEP administrators to ensure that all clinical instructors are up to date on national accreditation and program requirements set forth by the Commission on Accreditation of Athletic Training Education (CAATE). The workshops are also valuable for providing a model for the consistent delivery of athletic training clinical education TR AINING-CONDITIONING.COM
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LEADERSHIP while promoting autonomy among the institution, clinical instructors, and students. Program expectations and relevant policies and procedures for students and clinical instructors are reviewed, and this makes the clinical instructors aware of the sequence of competencies and proficiencies that should be covered for each particular semester’s clinical coursework. It also shows the off-site clinical instructor the sequence of academic
expectations for students regarding their clinical decision making. For example, we are well aware that a student may see a knee joint injury at a team practice before we have covered the topic in the classroom. If a student has not yet learned a particular technique, they should only observe the clinical instructor. The clinical instructor should not expect a student to assess an athlete’s injured ankle until they have learned
Approximately halfway through each assignment, the student is required to do a self-evaluation and review it with the clinical instructor. This completed form is sent to the program director or clinical education coordinator and placed in the student’s permanent file. courses the athletic training students are taking (which varies based on year in school), the clinical skills the students should already have, and the clinical skills the students are expected to learn during their particular clinical experience assignment. This ensures that the instructors have the correct
and practiced the skill in class, just as they should not have a student select parameters for an electrical stimulation treatment until they have learned about it in their therapeutic modalities course. This ensures that students are not practicing skills that they don’t have a sound background in.
INSTRUCTOR TIPS A main goal of our Athletic Training Education Program is to help our students get the best clinical experiences possible. Here are some of the tips we pass along to the clinical instructors who are guiding our students through clinical learning. • In addition to hands-on assessment and treatment, students should also be mentored in regard to professional attitudes and behaviors, ethical practices, interactions with coaches and physicians, and administrative responsibilities. • Try to maximize potentially idle or “free” time. For example, students can practice and review clinical skills like assessment, taping, functional training activities, or other skills, or become involved in the on-field rehabilitation of a student-athlete who may be returning after a surgery and not yet participating in official practices. This time can also be a great opportunity for upperclassmen to mentor younger students by reviewing and teaching skills they may be starting to learn in their athletic training courses. • Our students are placed in various settings to learn and practice in an environment where they will be prepared to perform as future professionals. It is paramount that the students are not viewed as an inexpensive labor force.
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FEEDBACK & ASSESSMENT Clinical skills must be taught, practiced, and mastered with appropriate and timely feedback. We encourage our clinical instructors to provide regular feedback throughout each student assignment. Students typically seek constant feedback and assessment of how they are doing, so we also discuss the timing of these assessments. One student might find it valuable to be given feedback immediately while performing a technique on an athlete, while another may dislike being corrected in front of a patient. Additionally, written student evaluations for clinical and professional performance are completed a minimum of two times during each of their assigned clinical experiences. Approximately halfway through each assignment, the student is required to do a selfevaluation and review it with the clinical instructor. This completed form is sent to the program director or clinical education coordinator and placed in the student’s permanent file. Then at the completion of each assignment, the clinical instructor completes the form, reviews it with the student, and sends it to the ATEP administrators. Verbal and written comments are invaluable for assisting the student in improving their overall performance. Regular meetings also ensure that the student and clinical instructor talk face-to-face and discuss any concerns or problems that may have surfaced. The program director and clinical education coordinator also communicate regularly with all the clinical instructors throughout the semester via site visits, telephone conversations, and various electronic mediums. In addition to monitoring a student’s clinical and professional progress, this practice of regular communication has the added benefit of preventing potential problems and making sure the clinical experience is meeting our program objectives. It should be clear that a great deal of effort, cooperation, and communication goes into the academic and clinical preparation of athletic training students. When the clinical instructor finds the right balance between providing care to their patients and guiding students’ learning, they become a key to helping them progress to entry-level professionals. n TR AINING-CONDITIONING.COM
Integrating Core Strength and Stability with the TRX® SuspensionLEADERSHIP Trainer™ Mike Robertson, M.S., C.S.C.S., U.S.A.W. Mike Robertson is the co-owner of Indianapolis Fitness and Sports Training and the President of Robertson Training Systems in Indianapolis, Indiana. Mike has made a name for himself as one of the premier performance coaches in the world, helping clients and athletes from all walks of life achieve their physique and sports performance goals. Core training is a huge buzzword within the fitness industry. Regardless of how you define the core, intelligent core training is critical in the development of athletes, whether your goal is to decrease the likelihood of injury or improve their sports performance. The core needs to be both strong and stable for optimal performance and while I use many types of exercises and modalities as part of a core training program, I have a few favorite core training options using the TRX Suspension Trainer, which allows me to vary the demands of the exercise to provide the appropriate blend of strength and stability. TRX® Roll-Outs – Similar to an ab wheel, TRX Roll-Outs train the anti-extension function of the core. Begin with straps over the shoulders and arms extended, the chest up and out, and the core tight. Depending on the angle of the body and the range of motion, this exercise could be a progression or a regression of a prone plank.
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Slowly raise the arms, allowing the torso to “fall” forward. Focus on keeping the chest out, the abdominals tight, and do not allow the lower back to arch excessively. Return to the starting position. Perform this for 2-3 sets of 8-12 repetitions.
TRX® Flutters – This exercise is a mix between a static exercise like a front plank, and a more dynamic exercise like the TRX fallout. Start in a position similar to the above, and then alternate flexing one shoulder while extending the other. Your torso will stay in the same position throughout – focus on keeping the chest up and out, and the core tight. Instead of performing repetitions, I like to perform this for 2-3 sets of 15-30 seconds
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TRX® Side Plank – A new spin on a classic exercise, this is fantastic for people who need more core stability. Set-up in a traditional side plank position with the exception being your feet will be in the foot cradles of the TRX. Elbow placed underneath the shoulder, the chest is up and out, and the hips are extended with the glutes tight. The entire body should be in one straight line from the head to the toes. Again, I like time here as opposed to reps – typically 2-3 sets of 20-40 seconds works well. Regardless of the athletes you work with, core training on a TRX can provide fun and challenging progressions – just make sure to master the basics first. Enjoy!
F I N I S H
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Cal State-Fullerton’s Khris Davis swings for the fences.
For the Fences When the Cal State-Fullerton baseball coaching staff wanted to take the team in a new direction, its strength and conditioning coach was challenged with making players bigger and stronger—and quickly. By Greg Vandermade
very team you work with shou ld c om e i nto t he weightroom with a main goal or focus during the off-season. It’s also likely that this goal changes from year to year. One year the coaching staff may say it needs its athletes to be better conditioned so they can compete at a high level for longer when the postseason rolls around. The following year the coaches might tell you they’d like to see their players faster and more explosive. Whatever the goal is, you must design a strength and condi-
tioning program to meet it. Here at California State UniversityFullerton, the baseball team is going through a big shift, and as a result, so is the team’s strength training program. The coaching staff is transitioning the team from a bunt-and-steal style of play to a power hitting offense. In short, that means my job is to make our players bigger and stronger this off-season. MAIN INGREDIENTS As I considered how to help the players safely add mass before spring, my
first step was to examine which movement types would be most appropriate for the training goal. I made sure to keep the moves specific to baseball— the goal is to build bigger and stronger baseball players, not to morph the athletes into bodybuilders. Here are the four key areas of movement we are concentrating on this off-season: Greg Vandermade, MS, CSCS, is the Head Strength and Conditioning Coach at California State University-Fullerton. He can be reached at: gvandermade@ fullerton.edu. T&C DECEMBER 2011
sport specific Explosive training is a key part of strength training here at Cal StateFullerton and baseball is no exception. Force application to the ground is crucial in order to increase a player’s ability to run faster and jump higher. In baseball, this can mean the difference between scoring a run and getting tagged out at home, or snagging a line drive and missing it because the player wasn’t quick enough on his feet. To train explosiveness, we use plyometrics and the Olympic lifts and their variations. The plyometric movements we tend to focus on are speed skaters, standing long jumps, and plyo pushups. All these movements greatly enhance our baseball players’ explosiveness, and it has also been documented that plyometrics help with injury prevention. Traditionally, not a lot of baseball teams incorporate the Olympic lifts. But if taught properly, they not only dramatically increase explosive power, but also strength and size in general. Because the Olympic lifts are technical and tough for athletes to execute properly without a lot of practice, we utilize variations that are easier to teach and perform. These include power shrugs, high pulls, jerks, and split jerks. Our pitchers never perform snatches, but will do snatch grip pulls and high pulls. The main reason we stay away
from snatches with our pitchers is to eliminate added stress to the shoulder girdle and rotator cuff muscles. Multiple-joint ground-based movements should be the cornerstone of any baseball strength training program and are an absolute must for increasing size. Multiple-joint movements incorporate larger amounts of muscle, which allows for greater release of critical muscle-building hormones like testosterone and growth hormone. Because most sports are played on two feet, it makes sense to train in a ground-based fashion. This ensures the greatest level of core activation among the athletes—which is another way to initiate the release of muscle-building hormones. Some of our favorite multiple-joint ground-based movements include the front squat, deadlift, Romanian deadlift, and close grip bench press. Unilateral strength training is the next element of our training because it helps to improve muscular balance when an imbalance is present. But we must train both the upper and lower body extremities bilaterally as well as unilaterally. So for every bilateral movement performed, we match it with a unilateral movement for those muscle groups. Some of our favorite unilateral lower body movements include: • Bulgarian split squats
HYPERTROPHY All exercises in the hypertrophy phase are performed for eight sets of 12 repetitions. Position players and pitchers follow the same program, with one exception when performing bench presses. Day One Pairing one: Front squats and pull-ups Pairing two: Dumbbell lunges and single-arm dumbbell arm rows Day Two Pairing one: Close grip bench presses (position players) or narrow grip dumbbell bench presses (pitchers) and Romanian deadlifts Pairing two: Dumbbell shrugs and single-leg Swiss ball curls Day Three Pairing one: Deadlifts and inverted rows Pairing two: Single-arm dumbbell bench press and Swiss ball hip lifts
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• Crossover step-ups • Box lunges • Curtsy lunges • Lateral step-ups/lunges • Single-leg dumbbell • Romanian deadlifts • Single-leg hyperextensions • Single-leg Swiss ball leg curls/hip lifts. Some of our favorite unilateral upper body movements include: • Single-arm dumbbell neutral grip bench presses (both flat and incline variations) • Single-arm dumbbell rows • Single-arm dumbbell shoulder presses • Single-arm TRX rows • TRX pushup variations. Core/trunk strengthening is the final key to our off-season training. In every sport, an athlete’s trunk acts to support the spine. It is also the athlete’s means of transferring power from the lower body to the upper body. We like to incorporate as much standing core work as possible because it is much more functional for baseball players. The only time our players should be lying on the field is in a dog pile in Omaha. Our ground-based movements provide some training of the core, but we also incorporate targeted abdominal exercises. Because of the physical demands of throwing and hitting, we focus on developing exceptional rotational strength using exercises like medicine ball slams and tosses, band anti-rotational punches, and the band pull-to-press. FOUR PHASES Keeping these areas in mind, I developed the team’s periodized strength training program geared toward increasing mass. This included selecting exercises, assigning volume, and figuring out how much time should be spent in each phase. Hypertrophy: The first phase begins after three weeks of active rest following the postseason. For three weeks, the athletes perform a limited number of exercises, but they are extremely high in volume. The goal is to gain mass as quickly as possible. During this phase, the team lifts three days per week. On day one, the players perform a bilateral lower body pushing exercise paired with a bilateral upper body pulling exercise. A second pairing includes a unilateral lower TR AINING-CONDITIONING.COM
STRENGTH Olympic and strength movements during the strength phase are preceded by two warmup sets. This would be a typical week for our position players. Day One
Olympic movement: Power shrugs (5 x 5)
Olympic movement: Snatch grip high pulls (5 x 5)
Olympic movement: Singlearm dumbbell snatches (5 x 3 each arm)
Olympic movement: Push presses (5 x 5)
Strength movement: Front squats (6 x 6)
Strength movement: Close grip bench press (6 x 6)
Pairing one: Dumbbell lateral lunges (4 x 6) and weighted pull-ups (4 x 6)
Pairing one: Romanian deadlifts/shrug (4 x 6) and dumbbell full cans (4 x 8)
Pairing two: Dumbbell cheat rows (4 x 6) and weighted single-leg squats (4 x 6)
Pairing two: Single-leg hyperextensions (4 x 6 each leg) and dumbbell shoulder presses (4 x 6)
Strength movement: Sumo deadlifts (6 x 6)
Strength movement: Single-arm dumbbell bench presses (6 x 6 each arm)
Pairing one: Barbell lunges (4 x 6) and side-to-side pull-ups (4 x 6)
Pairing one: Med ball pushups (4 x 10) and single-leg Swiss ball leg curls (4 x 6)
Pairing two: Dumbbell incline rows (4 x 6) and dumbbell Zottman curls (4 x 6)
Pairing two: Reverse barbell lunges (4 x 6) and barbell shrugs (4 x 10)
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STRENGTH & DYNAMIC EFFORT This example of a pitcher’s program details the second half of the strength and dynamic effort phase. Day One
Olympic/explosive movement: Power shrugs (5 x 5)
Olympic/explosive movement: Band-resisted standing long jumps (5 x 5)
Olympic/explosive movement: Depth jump to box jumps (5 x 5)
Olympic/explosive movement: Box jumps (5 x 5)
Strength movement: Front squats (4 x 4) Pairing one: Curtsy lunges (4 x 5 each leg) and neutral grip weighted pull-ups (4 x 6) Pairing two: Reverse grip bar rows (4 x 5, paired) and band rotators (4 x 10)
Strength movement: Neutral grip dumbbell bench presses (4 x 4) Pairing one: Dumbbell offknee external rotation (4 x 8 each arm) and glute ham raises (4 x 6) Pairing two: Alternating kettlebell swings (4 x 10) and TRX speed skaters (4 x 5 each direction)
Strength movement: Bulgarian split squats (6 x 5) Pairing one: Inverted rows (4 x 6) and dumbbell lateral step-ups (4 x 6) Pairing two: Weighted chin-ups (4 x 6) and speed skaters (4 x 10)
Strength movement: Single-arm dumbbell high incline bench presses (5 x 5 each arm) Pairing one: Dumbbell full cans (4 x 8) and single-leg Swiss ball hip extensions (4 x 6 each leg) Pairing two: Dumbbell post deltoid raise (4 x 8) and reverse hyperextensions (4 x 8)
MAXIMAL STRENGTH & POWER The following illustrates a position player’s typical week in the final phase of our program. Day One (maximal effort)
Day Two (maximal effort)
Day Three (maximal power)
Olympic movement: High pulls (4 x 3)
Olympic movement: Hang cleans (4 x 3)
Explosive movements: Jump squats (8 x 3) and neutral grip dumbbell bench press (8 x 3)
Strength movement: Front squats (4 x 1-3)
Strength movement: Close grip barbell bench press (4 x 1-3)
Pairing one: Single-leg squats (4 x 5) and inverted rows (4 x 6)
Pairing one: Med ball single-arm pushups (4 x 5 each arm) and Romanian deadlifts (4 x 6)
Pairing two: Alternate grip bar rows (4 x 5) and dumbbell Hammer curls (4 x 6)
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Pairing two: Dumbbell three-way shoulder presses (4 x 5 each direction) and glute ham raises (4 x 6)
Pairing one: Med ball chop/side tosses (5 x 5 each direction) and close grip inverted rows (4 x 6) Pairing two: Plate pinch farmer’s walk (4 x max distance) and kettlebell swings (4 x 10)
sport specific body push paired with a unilateral upper body pull. Day two follows a similar format, but the emphasis shifts to lower body pulling exercises and upper body pushing exercises. The emphasis on day three is total body. We incorporate a lower body push paired with an upper body pull, followed by an upper body push paired with a lower body pull. Every exercise on each of the three days is performed for eight sets of 12 repetitions. (For an example, see “Hypertrophy” on page 42.) Strength: For the next three weeks, the players continue to work with the same push/pull philosophy for balance. However, we increase lifting days to four per week and begin to incorporate Olympic lift variations. The goal is to start explosive training while continuing to strive to gain as much mass as possible. Each day consists of six exercises: An Olympic lift variation, a strength movement, and two pairings. The Olympic lifts consist of two warmup sets, followed by four working sets of five repetitions. The strength movement gets the same two warmup sets,
but is followed by four working sets of six repetitions. Because volume has dropped considerably, intensity must increase dramatically. (For an example of a position player’s program, see “Strength” on page 43.) At the end of the strength phase, the players get a de-loading week to allow them time to recover from the previous six weeks of intense training. During this time, we emphasize active recovery to help facilitate the greatest strength and size gains possible. Strength and dynamic effort: By this phase of the program, the players have begun to realize mass gains, so now we want to turn that mass into functional strength. The intensity of the lifts increases again, but the players work with minimal volume. For one month, the program continues four days per week with the same design: an Olympic lift or explosive movement, a strength movement, and two pairings. The first two days of the week are designed for maximal effort, and days three and four are intended to be dynamic effort days. The first two weeks’ worth of exercises are gener-
ally done with sets of four repetitions, but the players’ reps decrease in weeks three and four. (For an example of a pitcher’s program, see “Strength & Dynamic Effort” on page 44.) Maximal strength and power: The final phase of our team’s program takes us to the start of preseason. This is the time when all of the pieces we’ve put in place come together. We back off to training three days per week. The emphasis is on developing maximal effort strength in the early portion of the week on days one and two and then turning to maximal effort power on day three with a total body workout. (For an example, see “Maximal Strength and Power” on page 44.) Thus far, utilizing this programming style has greatly added size and strength to our baseball players. Our coaching staff has noticed considerable gains in players’ lean body mass, as well as improved hitting. I believe this program will be a huge asset to the team this season and help the squad get to Omaha, where they will hopefully vie for a national championship. n
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Industry Trend: With the advent of popular exercise programs such as CrossFit and boot camps, the current industry trend is moving back toward more athletic, military-style exercises that focus on intensity, variation, and explosive power. As a company that has always focused on the athletic performance side of the fitness market and Americanmade value, Legend Fitness has worked hard to develop several variations of the Glute/Ham/Back Developer for every budget. From the industry-first Partner GHD to the sturdy Pro Series GHD, Legend offers a posterior chain training tool for pro sports teams to garage gyms and everything in between. Benefits:
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Industry Trend: Athletic trainers know that trigger points influence sports performance in profound ways. Trigger points shorten muscle fibers, which results in muscles not being able to prepare for the next leap, lunge, or throw. Reduced strength, power, endurance, and delay can all be the result of trigger points inhibiting muscle action. If trigger points can be found and eliminated, injury can be avoided and goals can be reached. A well-known secret among performance athletes and their conditioning coaches is that systematic deep muscle self-care before, during, and after all muscular activity is a cornerstone of the serious athlete’s injury-prevention strategy. Benefits: The Pressure Positive Company manufactures
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Multi Radiance Medical • 800-373-0955 www.multiradiance.com
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The Solaris D702 delivers two independent treatments at the same time: one infrared probe and one unattended Dynatron XP Light Pad treatment. This product generates a total of 8,500mW of light and features one-touch operation. • Laser class: Class II, Type B • FDA approval for temporary increase in blood circulation, temporary relief of minor muscle and joint aches, pain, stiffness, and relaxation of muscles, as well as muscle spasms, minor pain, and stiffness associated with arthritis. • Introduced in 2003/2004 • Battery operated option available • Multiple energy levels • Multiple wave lengths • Two-year warranty on D702 and applicator soundheads • Purchase directly or through a distributor
Dynatronics • 801-568-7000 www.dynatronics.com TR AINING-CONDITIONING.COM
Rich-Mar’s Winner EVO Series has evolved into a revolutionary therapy system. With the Applicator Plug and Play (APP) concept, you have the flexibility to create a custom ultrasound/stim/laser hybrid. All units feature the Rich-Mar electronics that have been used by clinicians all over the world for 40 years. • Hands-free AutoSound, superior ultrasound • Hands-free AutoPrism, 500mW 870nm SLD/LED • Laser Prism Emitter 200mW 785nm • Therapy hammer 2-5cm ultrasound • TruStim waveforms quadpolar IFC, Pre Mod IFC, Russians, Hivolt, and Bi-Phasic • StoreMore Cart • Three-year warranty • Rich-Mar provides a full comprehensive product and treatment educational program • Certified to offer fully accredited CEU courses Rich-Mar • 888-549-4945 www.richmarweb.com
Circle No. 540
Pro Sport Package
Get an edge on the competition with accelerated pain relief, healing, and optimized performance. • 25,000-50,000 mW; more power than most class IV lasers with a higher degree of safety • Relieves both acute and chronic pain • Improves stamina and performance • Use on-the-field and in-clinic; also in pre- and post-game travel • Console and cordless units • Three console ports • Exclusive LaserStim with TARGET (Treatment Area Recognition and Guidance Enhanced Technology) enables clinicians and assistants to find areas to treat and automatically dose with the proper amount of laser energy • Super pulsing: the most optimal mechanism for laser therapy delivery • LaserSweep prevents bodily adaptation/resistance to laser energy’s healing effects • Two-year warranty with option for up to five years • 400,000 install base • Used by more than 15,000 private practitioners Multi Radiance Medical • 800-373-0955 www.multiradiance.com
Circle No. 543
Circle No. 520 T&C DECEMBER 2011
Therapy Technologies Therasound Evo
With the Applicator Plug and Play (APP) concept, you have the flexibility to create a custom Evo Therapy System with laser/sound. The handsfree ultrasound with simultaneous light/laser maximizes outcomes for both acute and chronic pain. • Patented Hands-Free Ultrasound • Hands-free AutoPrism 500mW 870nm SLD/LED • Laser Prism Emitter 200nW 785nm • Therapy hammer 2-5cm ultrasound • Three-year warranty • Rich-Mar provides a full comprehensive product and treatment educational program • Certified to offer fully accredited CEU courses • All units feature the Rich-Mar Electronics that have been used by clinicians all over the world for 40 years
Rich-Mar • 888-549-4945 www.richmarweb.com
Circle No. 541
The D950 Plus provides interferential, premodulated, high volt pulsed stimulation, Russian, biphasic, microcurrent, ultrasound, and combination therapy. • Three frequency ultrasound (1, 2, and 3 MHz) • Interferential patented target and target sweep • Combine ultrasound with high-volt, Russian, biphasic, premodulated, or microcurrent stimulation • TENS, MENS, NMS, high voltage, interferential • Six channels • Timer • Combination units available • Two-year warranty on D950 Plus and applicator soundheads • Purchase directly or through a distributor Dynatronics • 800-874-6251 www.dynatronics.com
Circle No. 521
Plyometrics A Solid Choice
With a stable square frame and a large landing area, this heavyweight plyo box is a solid choice for plyometric training for athletes of all sizes and abilities. The platform of the Premium Power-Plyo Box™ is covered with an extra-thick mat and the perimeter is rounded for added safety. Featuring square tubular steel construction, the tops are reinforced 3/4inch plywood covered with a 1/8-inch solid rubber mat. This product is stackable, can be used indoors or outdoors, is black, and comes with a five-year limited warranty. Power Systems, Inc. • 800-321-6975 www.powersystems.com
Circle No. 522
Agility and Quickness Training
From the National Strength and Conditioning Association comes Developing Agility and Quickness, packed with 100-plus drills to help in the development of agility and quickness training programs. The NSCA hand-picked its top experts to present the best training advice, drills, and programs for optimizing athletes’ linear and lateral movements. Applicable to almost every sport, this new book focuses on improving athletes’ fleetness of foot, change-ofdirection speed, and reaction time. Human Kinetics • 800-747-4457 www.humankinetics.com
T&C DECEMBER 2011
Circle No. 524
New Catalog Coming
Perform Better’s 2012 Functional Training catalog is on its way. This year’s edition is conveniently categorized for easy merchandise selection including special sections for plyometrics, balance and stabilization training, bodyweight and cardiovascular fitness, group exercise, flexibility and recovery, speed, agility, and weight training. There are also special sections for selected in-demand products such as bands and tubing, dumbbells, exercise mats, kettlebells, stability balls, ropes, and more. Perform Better serves all who train or rehab clients, patients, or athletes. Perform Better • 800-556-7464 www.performbetter.com
Circle No. 523
Titan Plyometric Platforms feature heavyduty 1 1/4-inch by 14-gauge square steel tube construction. The top has a 3/4-inch CD plywood base with 3/4-inch Americanmade non-toxic non-skid rubber. An extended base on two sides reduces the risk of tipping, while rubber pads on four corners of the base prevent markings on floors. Three sizes are available: 12” H Top 16” x 16” - 16” W x 22” L; 18” H - Top 20” x 20” - 20” W x 26.5” L; and 24” H - Top 24” x 24” - 24” W x 30.5” L. New York Barbells of Elmira, Inc. • 800-446-1833 www.newyorkbarbells.com Circle No. 525 TR AINING-CONDITIONING.COM
Manage Knee Pain and Help Decrease Patients’ Pain Medication
JO Global, Inc., a leading provider of medical device solutions for musculoskeletal health, vascular health, and pain management, recently announced the launch of the Empi Active Knee TENS System to treat knee pain, a condition which may affect more than 19 million Americans. Transcutaneous Electrical Nerve Stimulation (TENS) uses comfortable electrical stimulation to inhibit pain signals from reaching the brain and thus effectively blocking the pain sensation. The Empi Active Knee, with predetermined electrode placement built into a specialized wrap, delivers a proprietary TENS waveform to the knee to manage acute, chronic, and arthritic pain while minimizing the interruption of daily activities. The technology delivers a similar physiologic response as pain medication, but without the possible negative side effects from chronic use of medication. Dr. Melisa Estes, a physiatrist and board certified pain medicine physician, says, “I find that the Empi Active device can be helpful in decreasing the amount of pain medications that a patient may take. I also find it very useful for patients who have difficulty tolerating usual medications such as muscle relaxants or non steroidal anti-inflammatories.” “Chronic knee pain from osteoarthritis, tendonitis, and other conditions is an obstacle to maintaining healthy and active lifestyles and often leads to prolonged inactivity that can create other, more serious health consequences,” says Mike Mogul, president and chief executive officer of DJO Global. “With our broad portfolio of orthopedic preventative and rehabilitative products, DJO is uniquely positioned to help these patients.” The Empi Active Knee System follows DJO Global’s success with its 2010 release of Empi Active Back, which uses the same proprietary TENS waveform technology to target back pain. Back pain affects approximately 65 million Americans and is the second most common reason people visit a doctor. Similar to the Empi Active Back, the Empi Active Knee System allows primary care physicians, orthopedic surgeons, pain specialists, rheumatologists, and physical therapists to better manage their patients’ knee pain without disrupting their daily activities. The Empi Active Knee TENS System is available with a physician prescription and is covered by many insurers for home use. For more information, visit: EmpiActivePainControl.com.
760-727-1280 • www.djoglobal.com
T&C DECEMBER 2011
Advertisers Directory Circle #. Company. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page #
Circle #. Company. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page #
Circle #. Company. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page #
106. American Public University. . . . . . . . . . . . 7
129. Human Kinetics . . . . . . . . . . . . . . . . . . . 45
107. Rich-Mar . . . . . . . . . . . . . . . . . . . . . . . . . 8
140. AMREX®. . . . . . . . . . . . . . . . . . . . . . . . 46
124. Legend Fitness. . . . . . . . . . . . . . . . . . . . 33
128. Samson Equipment . . . . . . . . . . . . . . . . 43
101. Cho-Pat. . . . . . . . . . . . . . . . . . . . . . . . . . 2
118. McDavid. . . . . . . . . . . . . . . . . . . . . . . . . 25
122. Sanctband™. . . . . . . . . . . . . . . . . . . . . . 31
119. Cosamin® (Nutramax Laboratories). . . . . 28
130. MedPac . . . . . . . . . . . . . . . . . . . . . . . . . 52
132. T&C Online CEUs . . . . . . . . . . . . . . . . . . 60
116. Creative Health Products . . . . . . . . . . . . 22
123. Multi Radiance Medical . . . . . . . . . . . . . 32
141. The Parent’s Guide To Concussions. . . . . 51
125. DJO™ Global (DonJoy® Ankle Brace). . . . 34
134. Muscle Milk® (CytoSport). . . . . . . . . . . . BC
117. The Pressure Positive Company. . . . . . . 23
100 .DJO Global (Reaction Knee Brace). . . IFC
113. NASM (Academic Partner). . . . . . . . . . . . 17
103. Thera-Band®/Performance Health . . . . . . 4
133. Dynatronics . . . . . . . . . . . . . . . . . . . . . IBC
108. NASM (CES + PES). . . . . . . . . . . . . . . . . 11
110. Thera-Gesic® (Mission Pharmacal). . . . . 14
109. EAS . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
127. New York Barbells of Elmira. . . . . . . . . . 40
121. Treatment Options . . . . . . . . . . . . . . . . . 30
115. Ferris Mfg. Corp.. . . . . . . . . . . . . . . . . . . 22
120. NSCA Coaches Conference. . . . . . . . . . . 30
131. TurfCordz™/NZ Manufacturing . . . . . . . . 52
105. Flexall . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
112. Perform Better. . . . . . . . . . . . . . . . . . . . 15
111. Z-Health Performance . . . . . . . . . . . . . . 14
102. Gatorade . . . . . . . . . . . . . . . . . . . . . . . . . 3
126. PRO Orthopedic Devices. . . . . . . . . . . . . 37
114. Gebauer Company. . . . . . . . . . . . . . . . . 19
104. Recovery Pump . . . . . . . . . . . . . . . . . . . . 6
Circle #. Company. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page #
545. American Public University. . . . . . . . . . . 59
524. Human Kinetics . . . . . . . . . . . . . . . . . . . 54
522. Power Systems (Premium Power-Plyo Box™). 54
549. Ari-Med (Flexall 454®) . . . . . . . . . . . . . . 57
529. MedPac . . . . . . . . . . . . . . . . . . . . . . . . . 58
531. Power Systems (Pro Power Jumper™). . . 58
534. Creative Health Products . . . . . . . . . . . . 59
519. Multi Radiance Medical (MR4) . . . . . . . . 53
541. Rich-Mar (APP). . . . . . . . . . . . . . . . . . . . 54
536. CytoSport (Complete Casein) . . . . . . . . . 59
543. Multi Radiance Medical (Pro Sport Package). 53
540. Rich-Mar (Winner EVO). . . . . . . . . . . . . . 53
526. CytoSport (Whey Isolate). . . . . . . . . . . . . 58
533. New York Barbells (Back Extension) . . . . 58
528. Sanctband™. . . . . . . . . . . . . . . . . . . . . . 58
521. Dynatronics (D950 Plus). . . . . . . . . . . . . 54
525. New York Barbells (Titan Plyometric Platforms).54
518. Thera-Gesic® (Mission Pharmacal). . . . . 57
520. Dynatronics (Solaris D702). . . . . . . . . . 53
523. Perform Better . . . . . . . . . . . . . . . . . . . . 54
515. Treatment Options . . . . . . . . . . . . . . . . . 57
546. EAS . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
517. Performance Health (Biofreeze ). . . . . . 57
527. TurfCordz™/NZ Manufacturing . . . . . . . . 58
532. Gatorade (Original G) . . . . . . . . . . . . . . . 58
530. Performance Health (Thera-Band® Rollers). . . 58
547. Z-Health Performance . . . . . . . . . . . . . . 59
535. Gatorade (Prime 01™). . . . . . . . . . . . . . . 59
544. Performance Health (Hand Xtrainer). . . . . . . . 59
516. Gebauer . . . . . . . . . . . . . . . . . . . . . . . . 57
537. Power Plus 2 . . . . . . . . . . . . . . . . . . . . . 59
514. Cho-Pat. . . . . . . . . . . . . . . . . . . . . . . . . 50
509. McDavid . . . . . . . . . . . . . . . . . . . . . . . . 49
505. Performance Health. . . . . . . . . . . . . . . . 48
538. DJO Global. . . . . . . . . . . . . . . . . . . . . . . 50
539. Multi Radiance Medical . . . . . . . . . . . . . 51
510. PRO Orthopedic Devices. . . . . . . . . . . . . 49
512. Dynatronics . . . . . . . . . . . . . . . . . . . . . . 50
500. NASM . . . . . . . . . . . . . . . . . . . . . . . . . . 47
504. Recovery Pump . . . . . . . . . . . . . . . . . . . 48
502. Ferris Mfg.. . . . . . . . . . . . . . . . . . . . . . . 47
507. NSCA. . . . . . . . . . . . . . . . . . . . . . . . . . . 48
513. Samson Equipment . . . . . . . . . . . . . . . . 50
501. Human Kinetics . . . . . . . . . . . . . . . . . . . 47
511. Nutramax Laboratories. . . . . . . . . . . . . . 49
508. The Pressure Positive Company. . . . . . . 49
506. Legend Fitness. . . . . . . . . . . . . . . . . . . . 48
503. Perform Better. . . . . . . . . . . . . . . . . . . . 47
542. Treatment Options . . . . . . . . . . . . . . . . . 51
State of the Industry
T&C DECEMBER 2011
Topical Analgesics All-Natural Relief
Hyland’s Muscle Therapy Gel offers all-natural relief of the symptoms of musculoskeletal pain, swelling, and bruising due to trauma or exercise. This FDA-approved formula contains Arnica Montana, the number-one natural medicine for muscle trauma pain, as well as other proven natural remedies effective in the healing and recovery of injuries. Hyland’s Muscle Therapy is safe and effective with no contraindication, drug interactions, and no reported side effects. Treatment Options • 800-456-7818 www.txoptions.com
Spray and Stretch topical anesthetic skin refrigerant provides a fine stream of spray with a cooling effect. It’s designed to be used in conjunction with the spray-and-stretch technique and triggerpoint therapy to help manage myofascial pain syndromes in the head, neck, shoulders, extremities, and lower back. The product is non-flammable and non-ozone depleting. It can be purchased through a medical supplier or wholesaler, or directly from Gebauer, Rx. ®
Circle No. 516
On-The-Go Pain Relief
Biofreeze® Pain Reliever, a top recommended topical pain reliever by hands-on healthcare professionals, is now available in a unique single-use application that provides all the benefits of Biofreeze in an innovative, no-touch, no-mess package. Plus, it’s small enough to fit in a pocket, gym bag, purse, or briefcase. It’s the perfect on-the-go pain reliever—because pain also happens away from home. Available in 10-count boxes. Performance Health • 800-321-2135 www.performancehealth.com
Circle No. 517
Brand of Choice
Thera-Gesic® is the brand of choice for many athletic trainers for relief of muscle soreness, aches, and stiffness. This water-based, greaseless formula does not stain clothing or equipment, and contains one-percent menthol and 15-percent methyl salicylate. When applied evenly in a thin layer, Thera-Gesic becomes colorless and transparent. Once it penetrates the skin, the area may be washed, leaving it dry and fragrance-free without decreasing its effectiveness. Mission Pharmacal Co. • 800-373-3037 www.missionpharmacal.com
Circle No. 518
The Get-Well Gel
Depend on Flexall 454® topical pain-relieving gels from Ari-Med Pharmaceuticals for clinical and athletic training room settings. Flexall gels are used by leading athletic trainers to treat the world’s top athletes and enhance ultrasound, cryotherapy, TENS, and massage therapy. Flexall gels feature unique vitamin E-enriched aloe vera gel formulas with menthol as the active ingredient. They’re absorbed quickly and are greaseless, non-staining, and gentle on the skin. Professional sizes are available. Ari-Med Pharmaceuticals • 800-527-4923 www.ari-med.com TR AINING-CONDITIONING.COM
Ensuring Safe Environments for Athletes
Circle No. 515
Cools The Pain
Gebauer Company • 800-321-9348 www.gebauer.com
Circle No. 549
PROTEX™, a cleaner/disinfectant from Parker Laboratories, was recently named the exclusive cleaner/disinfectant to be used in athletic training rooms at the Prudential Center, home of the NHL’s New Jersey Devils, men’s and women’s professional basketball, and Division I collegiate sports, as well as 100 other events every year. According to Neal Buchalter, President of Parker Laboratories, “It ensures the safest possible environment for the athletes that pass through Prudential Center’s doors.” Devils Arena Entertainment President Rich Krezwick added, “Such assurance is in keeping with the high quality reputation that we seek to maintain at our first-class facility.” PROTEX is a powerful one-step cleaner/disinfectant that is effective against a broad spectrum of pathogens, including MRSA, H1N1, HIV, and many others. It is useful in disinfecting vinyl exam tables and athletic mats, counter tops and hard surfaces, exercise equipment, ultrasound transducers, and other hard, nonporous, non-surgical surfaces. In addition, it is registered by the U.S. Environmental Protection Agency. “We are proud that PROTEX™ has been selected by the Prudential Center to protect the athletes and visitors who are attending events at the third-busiest arena in the country,” said Buchalter. “In addition, it is very important to us that New Jersey’s leading sports and entertainment facility has aligned with a New Jersey-based company to maintain safety and health.”
Parker Laboratories, Inc. 800-631-8888 www.parkerlabs.com T&C DECEMBER 2011
More Products Supplement Your Workouts
Whey Isolate is a premium-quality, lactose-free whey protein supplement. Each pleasant-tasting serving provides 20 grams of pure whey protein isolate. Sugar-free, lactose-free, and gluten-free, Whey Isolate provides more of what athletes want without all the fillers. It’s available in six flavors: vanilla creme, chocolate, sour apple, pineapple banana, tangy orange, and blue raspberry. CytoSport, Inc. • 888-298-6629 www.cytosport.com
Circle No. 526
Low in Powder and Protein
Sanctband’s Low Powder Reduced Protein latex resistance bands and tubing are developed according to the methods used in producing powder-free latex gloves. Sanctband products are low in powder, and latex protein—found to cause most cases of latex allergy—is reduced during processing. Sanctband resistance bands are available in a 3-in-1 combo dispenser, a 30-piece dispenser, and six-yard and 50-yard roll dispensers.
Sanctband • 605-201-2800 www.sanctband.com
Circle No. 528
MedPac is now offering two new products: the Mini Medtrunk and the Wheeled Bacpac. Both these products have a heavy-duty wheeled assembly, with rigid bottom, smooth rolling wheels, and convenient, telescoping handle to easily transport supplies and maneuver reliability. The Mini Medtrunk offers the same benefits and features of the Medtrunk Plus, in a smaller version. Its dimensions are 21” long x 17” high x 16 1/2” front-to-back, and it retails for $299.99. The Wheeled backpack is similar to the current backpack with the addition of wheels, and retails for $279.99.
MedPac Bags, Inc. • 800-414-9031 www.medicalbags.com
Circle No. 529
Original G, part of the G Series, is a sports drink designed to enhance hydration during prolonged training and competition when fluid and electrolyte losses can be significant. It delivers a unique formula of sodium, potassium, and essential carbohydrates to your muscles and mind during the heat of a battle. G2 is a low-calorie thirst quencher option that delivers functional hydration, but with less than half the calories of Gatorade Thirst Quencher.
T&C DECEMBER 2011
The Thera-Band® Pro Foam Rollers, when used in conjunction with the patent-pending Thera-Band Foam Roller Wraps+, are ideal for training, injury prevention, and rehabilitation. This novel tool helps increase the athlete’s flexibility and range of motion, while offering added versatility to a product category you probably already utilize. Just pick the level that’s right for the specific user/situation, put on the wrap, and roll. This product is individually packaged with detailed exercise instructions. Performance Health • 800-321-2135 www.thera-band.com
Circle No. 530
Improve jump height and reaction time for better overall performance with the Pro Power Jumper™. Train your athletes with “maximal” jumps for power, repeated jumps for reaction and endurance, and lateral jumps for improved agility. The large 30” x 50” non-slip jumping platform is counterweighted on each side with a 45-pound weight plate (sold separately). The unit includes resistance tubing, choice of harness or belt, and jump frame. This product should be used indoors only and comes in red/black. Power Systems, Inc. • 800-321-6975 www.powersystems.com
Circle No. 531
Quality Back Extension Machine
The 82655-Back Extension Machine with equal stroke resistance features an adjustable foot pad and hand grips, as well as a step for easy access and three-inch top pad for comfort. This commercial-quality unit’s weight carriage rides on chromeplated rods, and has pre-stretch built into foot placement pads. The machine is available plate-loaded with 150-, 200-, and 250-pound weight stacks. It is 58”W x 64”L x 83”H and 300 pounds (plate-loaded). New York Barbells of Elmira, Inc. • 800-446-1833 www.newyorkbarbells.com Circle No. 533
Gatorade • 800-884-2867 www.gatorade.com
An Ideal Tool
Circle No. 532
The TurfCordz™ Cuff Tuff can strengthen your shoulder rotator cuff through internal and external rotation exercises. Whatever you’re training for—from baseball to golf—this single four-foot (1.2-meter) rubber tube with a handle and combination mounting loop will help you achieve the ultimate workout. The Cuff Tuff is available in five resistance levels, from three to 34 pounds. TurfCordz resistance products are designed to meet the extreme demands of high-level athletic training. NZ Manufacturing • 800-866-6621 www.turfcordz.com
Circle No. 527
More Products Leading Supplier
Creative Health Products is a leading supplier of fitness and health monitoring products. CHP is now a provider of the HeartSine PAD. This AED is portable at only 2.4 pounds, durable, with a sevenyear unit warranty, and is user-friendly, featuring easy to understand visual and oral prompts.
Creative Health Products • 800-742-4478 www.chponline.com
Circle No. 534
Maximize Energy For Muscles
G Series Prime 01™ is a pre-workout or pregame fuel in a convenient and functional fourounce pouch. With 25 grams of carbohydrates, it is designed to be used within the 15 minutes before a workout or competition to provide energy by maximizing the availability of carbohydrate energy to muscles. Gatorade Prime 01 also contains three B vitamins that help with energy metabolism as part of a daily diet. Gatorade • 800-884-2867 www.gatorade.com
Circle No. 535
The Ultimate Tool
The new Thera-Band® Hand Xtrainer is the ultimate hand therapy tool. It is fun, versatile, clean, professional, and ideal for home exercise. The Hand Xtrainer is available in four progressive resistance levels and supports a broad range of finger, hand, wrist, and forearm exercises, making it an ideal replacement to putty and an economical alternative to hand extensors. This product’s patented latex-free formula supports both hot and cold therapy.
Performance Health • 800-321-2135 www.performancehealth.com
Complete Casein delivers 25 grams per serving of anti-catabolic, slow-digesting protein from micellar casein and calcium and sodium caseinates. Because casein protein digests slower, it provides amino acids over a longer period of time than whey protein. Complete Casein contains aminogen—a digestive enzyme—to help promote efficient and complete protein utilization and uptake. Complete Casein is lactose- and gluten-free. CytoSport, Inc. • 888-298-6629 www.cytosport.com
Circle No. 536
Build Strength Through Teamwork
The Power Plus 2 weight training machine is a twoperson teamwork lifting machine that allows athletes to do more than 15 different lifts. It rapidly builds strength, unity, trust, and confidence among teammates and pushes athletes to make themselves stronger than ever. Power Plus 2 is the number one thing a coach can use to take his or her team to the next level, as 75 percent of teams that use it have become champions. Power Plus 2 • 888-772-9272 www.powerplus2.com
Circle No. 537
The Nutrition You Need
Whether it’s to build muscle or get lean and toned, EAS® is there to provide the specific nutrition you need. To get the most from your workout, start with Phos Force™ preworkout supplement to provide you the energy and focus you need to push your workout to the limit. Then finish with either Muscle Armor ® or Betagen® post-workout supplements to help build muscle and aid in recovery. EAS • 800-297-9776 www.eas.com
Circle No. 546
Circle No. 544
Cutting-Edge DVD American Public University offers more than 150 degree and certificate programs in a wide variety of specialties. Whether you are working in a municipal, commercial fitness, school, or military setting, APU offers a flexible and affordable program to fit your lifestyle. APU’s tuition is far less than other top online universities so you can further your education without breaking the bank.
Filmed at its acclaimed “Essentials of Elite Performance” course, Z-Health’s 6.5-hour mini-course DVD teaches you what no other product does--the science, rationale, and practical drills to take yourself and your clients from good to exceptional. Learn cutting-edge science applied to injury rehab, pain relief, and sensory integration training. Also, gain insight into world-class athletic movement and speed development, and learn the six personal-assessment skills that help the user gauge progress.
American Public University System • 703-334-3870 www.studyatAPU.com/athletic-mgmt Circle No. 545
Z-Health • 888-394-4198 www.zhealth.net
Circle No. 547 T&C DECEMBER 2011
Looking for a fast, easy way to get CEUs BEFORE the end of the year?
You can take CEU quizzes of T&C issues online... both this issue and all 2011 issues!
No pencil, envelope, or stamp needed. Just fill in the easy-to-use online form.
Your results will be tabulated immediately, and your CEU certificate of credit will be made available as a PDF within minutes.
You can also take CEU quizzes from back issues online. Read past issues and take the quiz all in one sitting!
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T&C DECEMBER 2011
Circle No. 132
T&C December 2011 Volume XXI, No. 9
uicke You c an no r&E w tak and g asi e our et yo ur CE CEU q er! U res ults a uizzes on www li C .train lick on “CEU nd credit ins ne... tantly s” at: ing-c . o nditi o
Training & Conditioning is pleased to provide NATA and NSCA members with the opportunity to earn
continuing education units through reading issues of the magazine. The following quiz is based on articles that appear in this issue of Training & Conditioning. By satisfactorily completing the quiz, readers can earn 2.0 BOC Athletic Training and 0.2 NSCA (two hours) continuing education units.
Instructions: Go to www.training-conditioning.com and click on “CEUs” to take the quiz online. You may also mail your quiz
to us: Fill in the circle on the answer form (on page 63) that represents the best answer for each of the questions below. Include a $25 payment to MAG, Inc., and mail it to the following address: MAG, Inc., ATTN: T&C 21.9 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 Looking Back (pages 12-19)
Full Body Approach (pages 20-24)
1. When studying assisted and resisted sprint training, what test did researchers use to measure improvement? a) A 10-yard sprint b) A 20-yard sprint c) A 40-yard sprint d) A 60-yard sprint
5. Which type of treatment is recommended when someone isn’t able to maintain medical stability or drops below 85 percent of their recommended weight? a) Inpatient treatment b) Residential treatment c) Intensive outpatient treatment d) Outpatient treatment
8. Low back pain is a common complaint from gymnasts, swimmers, and tennis, football, and _____ players. a) Lacrosse b) Field hockey c) Baseball d) Volleyball
Objective: Learn about recent research, current issues, and news items of interest to athletic trainers and other sports medicine professionals.
2. Assistance-trained players increased their speed and acceleration _____. a) Not at all b) During the first 15 yards c) Over the final 25 yards d) Throughout the sprint 3. Resistance-trained players showed improvement _____. a) Throughout the sprint b) Not at all c) During the first 15 yards d) Over the final 25 yards 4. Which position had the highest average HITsp score? a) Running backs b) Quarterbacks c) Linebackers d) Linemen
Objective: Learn how you can help an athlete who has recovered from an eating disorder stay on the healthy path.
6. In addition to a physician and therapist, psychologist, or psychiatrist, who else is generally on a treatment team? a) A strength and conditioning coach b) The patient’s parents c) A friend of the patient’s d) A dietitian 7. What is a common “trigger” for an athlete with an eating disorder history? a) Attending a therapy session b) Hearing how much they weigh c) Being asked if they are following a meal plan d) Having their team’s athletic trainer join their treatment team
Objective: Taking a look at the importance of correcting movement dysfunctions along with low back pain.
9. _____ make athletes vulnerable to injury because they perpetuate the body’s kinetic chain. a) Weak upper backs b) Upper back pains c) Movement dysfunctions d) Weak lower backs 10. Research has shown high correlations between low back dysfunction and what type of injury? a) Hamstring injuries b) Quadriceps injuries c) Knee injuries d) Ankle injuries 11. The author’s diagnosis and treatment model reverses dysfunctional movement through awareness, correction, and _____. a) The formation of new habits b) A strength training program c) A physical therapy program d) A back brace
Answer sheet is on page 63...or take this quiz online and get instant results: www.training-conditioning.com / click on CEUs
T&C DECEMBER 2011
12. What is an eccentric step test classically used to detect? a) Low back pain b) Patellofemoral joint dysfunction c) Upper back pain d) An ACL tear 13. In addition to compensating for pain in the low back area, movement dysfunction can also be the result of _____. a) Muscular imbalances b) Poor neck strength c) Flat feet d) Poor posture 14. Research has found that the multifidus, transverse abdominis, the pelvic floor muscles, and the _____ play important roles in spinal stability. a) Diaphragm b) Oblique muscles c) Neck d) Knees
Flex Play (pages 29-33) Objective: Learn how dynamic flexibility works for this football team—and how it can work for yours, too. 15. Why is ballistic stretching no longer widely used? a) It takes too long b) The potential for injury c) A partner is necessary d) It doesn’t work 16. What is the most common stretching method used by athletes? a) PNF b) Ballistic c) Static d) Dynamic
T&C DECEMBER 2011
17. At Colorado State UniversityPueblo, the team performs how many dynamic flexibility movements every day? a) As many as the players feel is necessary b) Five to six c) 10 d) 15 to 20 18. What other type of stretching besides dynamic does the CSUPueblo team perform? a) Static b) Ballistic c) Yoga d) PNF
Teaching & Treating (pages 35-38) Objective: See how the Ithaca College Athletic Training Education Program helps its clinical instructors give students the best clinical experiences possible. 19. In order to get students and clinical instructors communicating early, the ATEP administrators require that they _____ before the student’s clinical experience begins. a) Make up a contract b) Have a phone conversation c) Exchange emails d) Have a meeting 20. How often do clinical instructors attend workshops at Ithaca College? a) Every three years b) Every year c) Every semester d) Every two years
For the Fences (pages 41-45) Objective: See how the Cal State-Fullerton baseball team’s strength training program changed when its approach to the game went from bunt-and-steal to a power-hitting offense. 21. What does the author use to train players’ explosiveness? a) Bodyweight exercises b) Plyometrics and Olympic lifts c) Dumbbell exercises d) Sprints 22. Cal State-Fullerton’s pitchers never perform _____. a) Shrugs b) Jerks c) High pulls d) Snatches 23. When it comes to core work, the author likes to incorporate as much/ many _____ as possible. a) Standing core work b) Crunches c) Hover work d) Pilates 24. What is the goal during the hypertrophy phase? a) To guard against injury b) To gain mass as quickly as possible c) To turn the players into bodybuilders d) To get the players more explosive 25. The coaching staff has noticed _____ since this strength training program was implemented. a) Better balance b) Better base running c) Better hitting d) Better explosiveness
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quiz to us: Fill in the circle on the answer form below that represents your selection of the best answer for each question. Include a $25 payment to MAG, Inc., and mail it to the following address: MAG, Inc., Attn: T&C 21.9 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) CEUs, and will be notified of their earned credit by mail within 30 days. Questions? Problems? E-mail: CEU@MomentumMedia.com.
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Teaching & Treating
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Breaking New Ground In 2007, Sue Falsone, ATC, SCS, CSCS, became the first female physical therapist in Major League Baseball when she was hired by the Los Angeles Dodgers. Recently, the team promoted Falsone to Head Athletic Trainer/Physical Therapist, making her the first female head athletic trainer in major professional sports. Recently, Falsone talked to T&C about her historic climb.
All Eyes on Field Hockey
When it comes to student-athlete safety, one of the most challenging things to balance is making sure equipment protects players without being intrusive. A new eye protection rule in high school field hockey is the most recent to struggle with the problem. We take a hard look at the issue in a recent Web Monthly Feature.
The Bureau of Labor Statistics has predicted that in the 10-year period from 2008 to 2018, athletic training job opportunities will grow almost 37 percent. In response, universities are looking to provide more accredited athletic training education programs for students. Donâ€™t miss T&Câ€™s analysis of this coming trend.
Circle No. 133
Circle No. 134
Published on Feb 28, 2012