The Power of Vitamins
Improving Grip Strength
A New Type of Clinic
September 2013 Vol. XXIII, No. 6, $7.00
Heads & Headers
A look at concussions in womenâ€™s soccer
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September 2013, Vol. XXIII, No. 6
Bulletin Board 7 Preventing muscle atrophy after ACL surgery … Mental health knowledge lacking … Improving performance through halftime activity … Shoe traction and injury rates. Q&A 12 Melinda Larson Whitworth University
4 11 17 45
Sponsored Pages Gatorade Athletes’ Performance Hi-Trainer Balanced Body
Product News 56 Nutritional Products 57 Pilates 58 Leg Strengthening
CEU Quiz 51 For NATA and NSCA Members
63 Next Stop: Web Site 64 Advertisers Directory On the cover: U.S. women’s soccer star Abby Wambach, who has scored over one-third of her goals on headers, competes in a contest against Japan last year. Our cover story examines concussions, headers, and physical play in women’s soccer, starting on page 26. Photo by APImages/Shizuo Kambayashi.
Get a Grip
Grip strength training is not very glamorous, but it is an important part of the University of South Carolina football program. By Joe Connolly, Justin Markley, & Michael Pimentel Treating the Athlete
26 After football, the sport with the highest rate of concussions Heads & Headers
is women’s soccer. A veteran athletic trainer takes a look at the causes and offers new ideas on prevention. By Maria Hutsick Nutrition
33 For athletes striving to reach the top of their game, The Power of Vitamins
understanding how vitamins work and which ones are most important can make or break a season. By Amy Culp
A SMART Idea
At Illinois State University, the opening of the SMART Clinic has provided more hands-on opportunities for athletic training students and a place for recreational athletes to receive treatment. By Dr. Justin Stanek Sport Specific
Play 47 Power How do you develop a training plan for athletes who need to
maintain strength and balance while competing on a sheet of ice? Notre Dame’s coach explains. By Tony Rolinski T&C SEPTEMBER 2013
Editorial Board Marjorie Albohm, MS, LAT, ATC Director, Ossur Americas Past President, NATA
Maria Hutsick, MS, LAT, ATC, CSCS Head Athletic Trainer Medfield (Mass.) High School
Jon Almquist, ATC Athletic Training Program Administrator Fairfax County (Va.) Public Schools
Christopher Ingersoll, PhD, ATC, FACSM Director of Graduate Programs in Sports Medicine/Athletic Training University of Virginia
Jim Berry, EdD, ATC, SCAT, NREMT Head Athletic Trainer Conway (S.C.) High School Christine Bonci, MS, LAT, ATC Associate Athletics Director Sports Medicine/Athletic Training University of Texas
Timothy Morgan, DC, CCSP Professor of Exercise and Health Sciences University of Massachusetts
Cynthia “Sam” Booth, PhD, ATC Visiting Assistant Professor SUNY Brockport
Jenny Moshak, MS, ATC, CSCS Assistant AD for Sports Medicine University of Tennessee
Debra Brooks, CNMT, LMT, PhD CEO, Iowa NeuroMuscular Therapy Center
Steve Myrland, CSCS Owner, Manager Myrland Sports Training, LLC Director of Coaching, Train-To-Play
Dan Cipriani, PhD, PT Associate Professor Deptartment of Physical Therapy Chapman University Gray Cook, MSPT, OCS, CSCS, RKC Clinic Director Orthopedic and Sports Physical Therapy Dunn, Cook and Associates Keith D’Amelio, ATC, PES, CSCS Nike Sparq Training Bernie DePalma, MEd, PT, ATC Assistant Athletic Director Head Athletic Trainer/Physical Therapist Cornell University Lori Dewald, EdD, ATC, CHES, F-AAHE School of Public Safety and Health American Public University David Ellis, RD, LMNT, CSCS Sports Alliance, Inc. Boyd Epley, MEd, CSCS Director of Coaching Performance National Strength & Conditioning Association Peter Friesen, ATC, NSCA-CPT, CSCS, CAT Head Athletic Trainer/Conditioning Coach Carolina Hurricanes Lance Fujiwara, MEd, ATC, EMT Director of Sports Medicine Virginia Military Institute Vern Gambetta, MA President, Gambetta Sports Training Systems P.J. Gardner, MS, ATC, CSCS, PES Athletic Trainer, Liberty High School, Colo. Joe Gieck, EdD, ATR, PT Director of Sports Medicine Professor, Clinical Orthopaedic Surgery University of Virginia (retired) Brian Goodstein, MS, ATC, CSCS, Head Athletic Trainer, DC United Gary Gray, PT President, CEO Functional Design Systems
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T&C SEPTEMBER 2013
Tim McClellan, MS, CSCS Owner and Strength and Conditioning Coach StrengthAndPeace.com
Leslie Bonci, MPH, RD, CSSD, LDN Director of Sports Medicine Nutrition Center for Sports Medicine University of Pittsburgh Medical Center
Cindy Chang, MD President, American Medical Society for Sports Medicine
September 2013 Vol. XXIII, No. 6
Allan Johnson, MS, MSCC, CSCS Sports Performance Director Velocity Sports Performance
Tim Neal, MS, ATC Assistant Director of Athletics for Sports Medicine Syracuse University
Publisher Mark Goldberg Editorial Staff Eleanor Frankel, Director R.J. Anderson, Patrick Bohn, Kristin Maki, Mary Kate Murphy, Dennis Read Circulation Director David Dubin Art Direction Message Brand Advertising Production Staff Maria Bise, Director Neal Betts, Trish Landsparger Business Manager Pennie Small
Mike Nitka, MS, CSCS Director of Human Performance Muskego (Wis.) High School
Special Projects Natalie Couch Dave Wohlhueter
Bruno Pauletto, MS, CSCS President, Power Systems, Inc.
Administrative Assistant Sharon Barbell
Stephen M. Perle, DC, MS Professor of Clinical Sciences University of Bridgeport College of Chiropractic
Marketing Director Sheryl Shaffer
Brian Roberts, MS, ATC Director of Sports Medicine and Business Operations, Xcelerate Physical Therapy Ellyn Robinson, DPE, CSCS, CPT Assistant Professor of Exercise Science Bridgewater State College Kent Scriber, EdD, ATC, PT Professor/Clinical Education Coordinator Ithaca College Chip Sigmon, CSCS*D Speed and Agility Coach OrthoCarolina Sports Performance Bonnie J. Siple, EdD, ATC Assistant Professor, Department of Exercise and Rehabilitative Sciences Slippery Rock University Chad Starkey, PhD, ATC, FNATA Division Coordinator, Athletic Training Program, Ohio University Ralph Stephens, LMT, NCTMB Sports Massage Therapist, Ralph Stephens Seminars Jeff Stone, MEd, LAT, ATC Head Athletic Trainer, Suffolk University Fred Tedeschi, ATC Head Athletic Trainer, Chicago Bulls Terence Todd, PhD Lecturer, Kinesiology and Health Education University of Texas
Advertising Sales Associate Diedra Harkenrider (607) 257-6970, ext. 24 Advertising Materials Coordinator/Sales Mike Townsend (607) 257-6970, ext. 13 T&C editorial/business offices: 20 Eastlake Road Ithaca, NY 14850 (607) 257-6970 Fax: (607) 257-7328 info@MomentumMedia.com Training & Conditioning (ISSN 1058-3548) is published monthly except in January and February, May and June, and July and August, which are bimonthly issues, for a total of nine times a year, by MAG, Inc., 20 Eastlake Road, Ithaca, NY 14850. T&C is distributed without charge to qualified professionals involved with competitive athletes. The subscription rate is $24 for one year and $48 for two years in the United States, and $30 for one year and $60 for two years in Canada. The single copy price is $7. Copyright© 2013 by MAG, Inc. All rights reserved. Text may not be reproduced in any manner, in whole or in part, without the permission of the publisher. Unsolicited materials will not be returned unless accompanied by a self-addressed, stamped envelope. Periodicals postage paid at Ithaca, N.Y. and additional mailing offices. POSTMASTER: Send address changes to Training & Conditioning, P.O. Box 4806, Ithaca, NY 14852-4806. Printed in the U.S.A.
HITRAINER IS REVOLUTIONIZING SPORTS TRAINING WITH A COMBINATION OF ADVANCED PERFORMANCE ANALYSIS SOLUTIONS AND HIGH INTENSITY TRAINING ON A SINGLE MACHINE
STRENGTH ENDURANCE SPEED ANAEROBIC R E CO V E R Y
REACTION ENDURANCE A C C E L E R AT I O N
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TOLL FREE 1 855 726 3300
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GATORADE SPORTS SCIENCE INSTITUTE THE CARBOHYDRATE COMMITMENT
Roberta Anding, M.S., R.D./L.D., C.D.E., C.S.S.D. Director of Sports Nutrition, Texas Childrenâ€™s Hospital Sports Dietitian, Houston Texans
All athletes require dietary carbohydrate as a fuel source for working muscles. However, carbohydrate needs can vary significantly depending on the type of sport and even within sport, by event or position. As a general rule, athletes participating in aerobically-based sports will require higher amounts of carbohydrate than those competing in anaerobic sports. The nutritional needs of athletes who participate in stop-and-start sports such as soccer, basketball and football need to be specialized not only by sport but also by position. THE AEROBIC ATHLETE Aerobic sports include distance runners/swimmers, triathletes and cyclists. The oxidation of glycogen (the storage form of carbohydrate in the body) and intramuscular triglycerides are the predominant form of energy in the aerobic athlete. High intensity endurance events (>85% VO2 max) maximally sustained for 90 minutes require large stores of glycogen, so adequate stores are critical. These athletes benefit most from carbohydrate loading (glycogen supercompensation) in the days leading up to competition. On low to moderate training days, these athletesâ€™ carbohydrate needs are estimated at 5-7 g/kg/day. On harder training days and during the active season, these endurance athletes will require 10-12 g/kg/day. Without adequate carbohydrate, these athletes will not be able to perform at maximal capacity. Before Exercise: Consume 1-4 g carbohydrate per kg body weight up to 4 hours prior to exercise During Exercise: Consume 30-60 g carbohydrate per hour up to 2.5 hours or 90 g carbohydrate in events lasting >2.5 hours After Exercise: Consume 1-1.2 g carbohydrate per kg/hr for the first 4 hours following exercise THE ANAEROBIC ATHLETE Anaerobic sports include but are not limited to sprinters, power lifters and gymnasts. Creatine phosphate is the primary source of energy for anaerobic athletes but is not readily stored in the body. In a 30-second sprint, creatine phosphate stores can be decreased by as much as 75%. The reduction in stores and the demand for continual energy, the secondary source of energy, is glycogen oxidation. Since anaerobic events are short in duration, the anaerobic athlete will require substantially less carbohydrate than the aerobic athlete. The regeneration of phosphocreatine is actually an aerobic process although little is known regarding the carobohydrate demand for recovery of stores. Most studies do not observe a significant benefit of a high-carbohydrate diet over a moderatecarbohydrate diet in these athletes. It is important to remember that although the event may be anaerobic in nature, it is the practice that can drive the carbohydrate need. The carbohydrate requirements for the anaerobic athlete are 5-7 g/kg/day and these athletes will most likely not benefit from carbohydrate loading days prior to competition.
THE STOP-AND-START ATHLETE Stop-and-start sports include basketball, soccer and football. These athletes have complex carbohydrate needs due to the fact they are activating both aerobic and anaerobic pathways throughout competition. Increased reliance on carbohydrate as an energy substrate parallels the increase in intensity. Conversely, the oxidation of intramuscular triglycerides and plasma-free fatty acids increase as duration increases (and intensity naturally decreases). Glycogen depletion is directly associated with fatigue and exercise intensity and, therefore, adequate carbohydrate in the diet is important in the stop-and-start athlete. Carbohydrate guidelines for stop-and-start athletes (Adapted from Sports Nutrition: A Practice Manual for Professionals 5th Edition) TIME
AMOUNT OF CARBOHYDRATE
1-4 hrs prior to competition
1 hr prior to competition
Liquid carbohydrates may be beneficial due to rapid stomach emptying
0.5-1.0 g/kg/hr; 30-60 g/hr
6% carbohydrate solution- Gatorade Thirst Quencher
Every 15-30 min for up to 4 hrs
CARBOHYDRATE COMMITMENT While most athletes fit into the three categories mentioned previously, the International Olympic Committee has created general recommendations for athletes based upon time commitment per day. These guidelines can be beneficial for the busy high school athlete as well as the elite athlete. The commitment to adequate carbohydrate is often challenging with school and practice schedules as well as common misinformation. Sports dietitians, strength coaches and athletic trainers need to follow evidence-based guidelines and use individual assessment skills to assist athletes in meeting their nutritional goals. COMMITMENT
AMOUNT OF CARBOHYDRATE
Low intensity exercise; 3-5 g/kg/day athletes with energy restriction 1 hr per day
1-3 hrs per day
>4-5 hrs per day
Carbohydrate needs cannot be addressed in a one-size-fits all approach. Prioritize carbohydrates appropriately depending on intensity, duration and nature of your sport for maximal performance benefits.
References: 1. Rosenbloom CA, Colemen EJ. (2012). Sports Nutrition: A Practice Manual for Professionals. Sports, Cardiovascular, and Wellness Nutrition Dietetic Practice Group. Academy of Nutrition and Dietetics. 2. IOC Consesus Statement on Sports Nutrition. J Sports Sci. 2011; 29: Suppl 1:S3-4.
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Par t of you r game plan Circle No. 104
Board Preventing Muscle Atrophy
New research from the University of Michigan has identified myostatin as a major inhibitor in the growth of muscle tissue following anterior cruciate ligament (ACL) reconstruction surgery. Produced primarily in skeletal cells, myostatin is a hormone that circulates in blood and acts on muscle tissue by binding to a cell-bound receptor. According to a study appearing in June’s online version of the American Journal of Sports Medicine, the discovery of myostatin’s presence following ACL reconstruction may spur the creation of a drug that would block its negative effects, and result in a quicker return to sport. “We’ve had several advances in technology to improve the recovery process for an ACL tear, but most patients still experience 30 to 40 percent muscle weakness— and that weakness largely limits the ability to return to the same level of sports,” Christopher L. Mendias, PhD, ATC, the study’s lead author and an Athletic Trainer and Assistant Professor of Orthopaedic Surgery and Molecular and Integrative Physiology at the University of Michigan, said in a school press release. “This is the first study in humans to open the door to a potential therapy to prevent muscle atrophy. We see this as an important step in restoring athletic and functional abilities in the short term, and in preventing osteoarthritis in the long term.” In the study, patients were examined before and after having ACL reconstruction surgeries following non-contact sports injuries. Prior to the procedure, scientists measured circulating levels of biomarkers for each patient and took objective knee strength calculations. They were then re-evaluated during six postoperative visits. In the end, it was noted that myostatin levels increased significantly early in the postoperative period and returned to pre-surgical baseline levels later in the rehab process. “In the sports world, there’s great concern about the short-term and long-term affect of an ACL tear on not only an athlete’s physical skills and ability to return to play, but also the longevity and health of the knee joint,” Asheesh Bedi, MD, senior author and Assistant Professor in Orthopaedic Surgery at the University of Michigan, stated in the release. “This is the first study to look into the biology of muscle tissue involved in an ACL tear and to show how Myostatin affects the muscle damage we see following surgery.”
There appears to be a “striking discrepancy” between college athletic trainers’ perception of their ability to recognize the signs and symptoms of mental health disorders in student-athletes and their actual capacity to do so. This is the conclusion of a study titled “Athletic Trainers’ Understanding of and Experience in Managing Mental Health Disorders,” authored by Andrew Krause, PhD, ATC, from Ohio University and presented at the American College of Sports Medicine meeting in May. The researchers surveyed 211 NCAA athletic trainers about their experience working with athletes with mental health disorders. While 70 percent of respondents said they felt competent in recognizing the signs and symptoms of mental illness, and 63 percent felt confident in their ability to manage mental health disorders acutely, many of them lacked crucial knowledge in this area. For example, when the athletic trainers’ ability to use diagnostic criteria for mental health disorders was assessed, only 44 percent “clearly understood the issues” and only 24 percent were aware of the norms in the most recent Diagnostic and Statistical Manual of Mental Disorders. “Nearly 90 percent of athletic trainers have encountered and managed at least one athlete with a mental health disorder,” Krause says. “However, the understanding of the spectrum of disorders […] and how to manage patients beyond referral appears to be lacking. “The take-home message from this study is that mental health diagnosis and management are complex,” he continues. “Entry-level professional competencies ask more of an athletic trainer than to just recognize and refer an athlete with a mental health diagnosis. The approach should be to recognize signs and symptoms, make appropriate clinical and referral decisions, and maintain a strategy throughout the duration of patientcentered care.”
To read the study’s abstract, visit: ajs.sagepub.com and type “Changes in Circulating Biomarkers of Muscle Atrophy, Inflammation, and Cartilage Turnover in Patients Undergoing Anterior Cruciate Ligament Reconstruction and Rehabilitation” into the search window.
Just Getting Warmed Up Halftime is usually seen as an opportunity for players to catch their breaths, hydrate, and listen to the coach’s plan for the rest of the game. However, a study published in the February issue of the International Journal of Sports Medicine found that athletes might be better off spending some of this time completing high-intensity, short-duration physical activities to boost performance for the second half. The randomized, crossover study involved eight male soccer players from the Victorian Football Federation in Australia. To simulate the level of exertion achieved during a soccer game, the subjects completed two identiT&C SEPTEMBER 2013
Board cal 26-minute sets on a non-motorized treadmill, with a 15-minute “halftime” break in between. During this time, players were either inactive or did “re-warm-ups”—five leg press repetitions or a three-minute soccer passing drill. Measurements for vertical jump (including the flighttime to contraction-time ratio), sprinting endurance, blood lactate concentration, and heart rate were taken before and after each group had completed its halftime activity and immediately following the second treadmill set. Each athlete also took the Loughborough Soccer Passing Test (LSPT) at these times. The athletes who completed the re-warm-ups were more powerful, more skilled, and faster than the inactive group. For example, when everyone was measured in the vertical jump at the end of halftime, individuals who participated in the leg press activity had a higher flight-time to contraction-time ratio than those in the other two groups. This ratio remained higher for the leg-press subjects when all were tested again after the second 26-minute set of running. Scores for maximum rate-of-force development, repeated-sprint ability, peak velocity, mean velocity, and acceleration were also greater for those who performed the leg press. Players who completed the three-minute passing drill during the break saw their end-of-halftime LSPT scores
increase 6.4 percent over their beginning-of-halftime numbers. The LSPT is a timed activity that requires athletes to execute 16 passes and hit a series of targets within a circuit of cones and grids. Points are deducted for inaccurate or poor passes. James Zois, PhD, lead researcher and Lecturer in the College of Sport and Exercise Science at Victoria University, suspects that halftime re-warm-ups may be as beneficial as pregame warm-ups when it comes to improving performance. “The findings encourage coaches…to really scrutinize how they warm up their athletes [before the second half] and to professionalize that component of preparation, as there is real performance-enhancing and injury-preventative potential,” Zois told The Conversation, an Australian news Web site that frequently features sports medicine research. To view the abstract of the study, “High-Intensity Re-Warm-Ups Enhance Soccer Performance,” visit www.pubmed.gov and search for the title.
Injury Risk & Traction Testing When it comes to shoe traction, most athletes believe
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Stay in the game with the all-new DonJoy Stabilizing PRO ankle brace. This low-profile, versatile brace has been designed for tough players who expect the best in ankle protection. Made of rugged materials and built to meet the needs of the most demanding athletes. Strap on the DonJoy Stabilizing PRO and know that your chances of ankle injury have just been reduced by 61%.* DJO Global offers a comprehensive portfolio of ankle braces including our Procare® and Aircast® brands. Call your local DJO sales rep or DJO Global direct. 800.793.6065 | 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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Board more is better. But is there a point where too much traction negatively affects performance or even increases injury risk? Researchers at the Human Performance Lab at the University of Calgary recently set out to answer this question with help from a unique test subject: a shoe-wearing robot. Traction can be broken down into two classifications: forward, which is when a spike, cleat, or sole digs into the surface to help propel the athlete straight ahead; and rotational, which allows the athlete to move sideways or shift directions. Many researchers have long hypothesized that rotational traction plays a much more significant role in injury risk than forward traction, but it’s a difficult theory to test without putting human subjects in harm’s way. To address this dilemma, researchers created a railmounted, shoe-wearing robotic tester. Able to move both sideways and straight ahead on a field at various speeds, the robot has “feet” that remain in contact with the ground. To collect data, the feet featured sensors that measured forward and rotational traction levels. For the study, which was published in May on the Medicine and Science in Sports and Exercise Web site, researchers borrowed shoes from local high school football players and had the robot calculate each shoe’s forward and rotational traction levels. After testing, the shoes
were returned to the players who wore them in the subsequent season, during which time athletic trainers from participating schools tracked non-contact leg injuries. Study leader John Wannop, PhD, a kinesiologist at the University of Calgary, told The New York Times that rates for non-contact ankle, knee, and ligament injuries were highest among players whose shoes provided the most rotational traction. In addition, shoes that provided the most forward traction tended to lead to fewer injuries. Meanwhile, injury rates for shoes worn on grass were similar to those worn on synthetic turf. Wannop told The Times that to provide ideal athletic performance benefits and minimal injury risk, a shoe should have high translational traction values and relatively low rotational traction values. He added that athletes would do well to avoid models with “multiple large, toothy cleats or rubbery nodules along the outside of the sole,” since they contribute to more rotational traction. Instead, he said, “look for groupings of shorter cleats in the forefoot, which provide safer, more forward-oriented traction.” For more information on the study, visit www.pubmed. gov and type “Footwear Traction and Lower Extremity Noncontact Injury” into the search window.
Honoring the Most Valuable During the Southwest Athletic Trainers’ Association 2013 annual meeting in Houston, Bob Marley, MA, ATC, LAT, CSCS, was honored for being named the inaugural winner of the Most Valuable Athletic Trainer award from Sports Health and Training & Conditioning magazine. The Senior Outreach Athletic Trainer in the Department of Orthopaedic Surgery at the University of Texas Health Science Center at Houston, Marley was recognized for going beyond his job duties to ensure high school studentathletes are receiving the best possible care. His job with the Health Science Center entails providing care to 22 school districts in 10 Texas counties, and he also serves as a contract athletic trainer for Needville High School. In addition to school sports coverage, Marley develops professional and community education seminars and assists with UT Health’s Memorial Hermann Ironman Sorts Medicine Institute Outreach Program. He has been awarded the Greater Houston Athletic Trainers’ Society’s Tom Wilson Service Award and the group’s Logan Wood Award for Meritorious Service. He has also won the Southwest Athletic Trainers’ Association’s John Harvey Humanitarian Award and the Greater Houston Football Coaches’ Association’s John Kelly Distinguished Service Award. Bob Marley receives a plaque commemorating his Most Valuable Athletic Trainer award and a Sports Health gift card from Sports Health’s Christine Carlton, during the 2013 Southwest Athletic Trainers’ Association meeting in Houston.
T&C SEPTEMBER 2013
& the evolution of Performance education By Nick Winkelman
s strength coaches, athletic trainers, physical therapists and registered dietitians we understand the value of information and staying on the cutting edge of our perspective fields. However, with the overabundance of available information and the next great training tool waiting to emerge, what can we do to capture and contain the most important information? How can we avoid this “re-invention of the wheel syndrome” that we replay over and over every time we learn about the next greatest training method or device? To answer this question we have to dissociate between methods and systems.
training device, or piece of research will make the system better, worse, or make no change at all.
The Athletes’ Performance Mentorship series provides every participant with transparent access to the system behind the top champions in sport, military, and the corporate space. Through practical and applied education sessions across mindset, nutrition, movement, and recovery, every participant leaves with a training system that can be molded to their unique environment and evolve as our field progresses. Our goal is to provide every participant with the most cuttingedge training tools, but at the same A method can be time provide the training toolbox to house the many tools that can be considered a technique, to correct and develop the huprotocol, or singular way used man system. In the end the methods of doing something, while we employ are only as good as the a system is a coordinated system from which they come.
A method can be considered a technique, protocol, or singular way of doing something, while a system is a coordinated body of methods or components that form a singular whole. Said another way, the method can be considered the tree Nick Winkelman MSc, CSCS*D, body of methods or and the system can be considered USAW, USATF, is the Director of the forest. If we only prescribe to components that form a Training Systems and Education at methods then we are limited to the singular whole. Athletes‘ Performance. Winkelman capacity of that method to produce leads the Athletes‘ Performance results, engage our clients, survive Education programs in addition to providing training to scientific rigor, and last the test of time. For example, the elite and professional athletes that train at Athletes‘ someone who only uses kettlebells, weightlifting, or Performance. power lifting will only receive the benefit those methods supply. Conversely, if we develop a system, we have Athletes‘ Performance Education programs offer the Perprinciple-based training components that seamlessly formance Mentorship program teaching the integrated integrate to create a complex whole, and it is within Athletes‘ Performance Training System, in addition to each training component that we apply the best training accredited education courses for rehabilitation specialists methods. and registered dietitians. At Athletes’ Performance we have spent the last 14 years creating and perfecting our training system, and we have been teaching this system to industry professionals through our Athletes’ Performance Mentorship program for the past 8 years. The goal of the Athletes’ Performance Mentorship program is to provide each participant with a training system that can house what they currently know, what they will learn through their Athletes’ Performance education experience, and what they will learn throughout the remainder of their career. This system allows each participant to be a better consumer of information and never again re-invent the wheel. A quality training system inevitably acts as a filter for information with the output uncovering if a new method,
For a complete list of courses, dates and to register, visit AthletesPerformance.com/Education.
Learn more at AthletesPerformance.com/Education | facebook.com/APEducation Circle No. 135
Q&A Melinda Larson Whitworth University
It’s a good thing Melinda Larson, MS, ATC, AT/L, is used to having a lot on her plate. When June began, she was serving in her dual role as Head Athletic Trainer and Associate Professor of Health Science at Whitworth University. But after the school’s athletic director announced he was leaving on June 12, Larson was immediately appointed Interim Athletic Director—trading in her position as the supervisor of the four-person sports medicine staff for a job that would have her lead a department with more than 60 employees. In 1995, Larson began juggling the responsibilities of teaching classes and providing hands-on care at Whitworth, while also being involved in many activities and committees both on and off campus. She currently serves as a member of the NATA’s College/University Athletic Trainers Committee and was selected in 2012 for a term on the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports. Over the last five years, she has also gone on two mission trips to Guatemala through Athletes in Action. Larson’s service has not gone unnoticed. In 2007, she was named Outstanding Educator by the Northwest Athletic Trainers Association, and in 2010, she received the NATA’s Outstanding Service Award. In July of 2012, Larson was invited to be a part of the Substance Abuse Prevention Program Delivery Group for a first of its kind partnership between NCAA Division III and NASPA, a professional group for student affairs administrators in higher education. The initiative aims to curb alcohol use and abuse among college students and athletes by developing educational and institutional programming. In this interview, Larson provides a glimpse into her three roles—athletic trainer, professor, and now, administrator. She explains how she found herself in the athletic director’s chair, how she has balanced all her responsibilities, and what she has learned from her student-athletes. T&C: What were your thoughts when you were named Interim Athletic Director? Larson: I was really happy about the opportunity. For some time, I was hoping my next step would be into athletic administration, whether that was on a college or high school campus, for a conference, or on a national level. Being a head athletic 12
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After serving as a professor and Head Athletic Trainer for 18 years, Melinda Larson was given the job of Interim Athletic Director at Whitworth this summer. trainer, I found that I enjoyed and was successful at administrative duties. And the support I’ve received over the past several years from the athletic department, university, and our president has helped me develop professionally. I can think of no better place to start this portion of my career. I’m not just a placeholder, and I’m certainly interested in the permanent position, so my next thought was that we needed to fill my old roles for the upcoming academic year. We have opened up a visiting faculty position and the head athletic training duties will be transferred to my most senior assistant. How did the administration at Whitworth help you prepare for this role? Our previous athletic director delegated a lot of responsibility throughout the department. We’ve never had any full-time assistant or associate athletic directors, so he put together a leadership team to handle duties such as athletic communications and event management. I became a part of the team and was exposed to many areas beyond athletic training, which gave me great experience and reinforced that administration was something I wanted to do. For example, one of my responsibilities was serving as advisor to the Student-Athlete Advisory Committee. One TR AINING-CONDITIONING.COM
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Q&A Melinda Larson Interim Athletic Director, Former Head Athletic Trainer Whitworth University Serves on the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports Member of NCAA Division III and NASPA’s Substance Abuse Prevention Program Delivery Group Named Outstanding Educator by the Northwest Athletic Trainers Association in 2007 Received the NATA’s Outstanding Service Award in 2010
of the most rewarding projects I did with that group was to help organize a last-minute food drive that brought in more than 500 pounds for our local food bank. We heard they were running low on supplies right around the holidays, so we decided to collect goods at a men’s basketball game. We rallied the Whitworth students into contributing to the cause, and I was amazed at everyone’s willingness to jump in, fill a need, and serve the community. What were the initial challenges of your new position? Making myself known to the community. As an athletic trainer, I’m used to working out of the spotlight. So some Whitworth supporters didn’t know who I was when I was announced as the interim athletic director. Once they met me, some said, “I’ve seen you on the sidelines or in the gym,” but they hadn’t yet connected my name to my face. In some ways, I think I’ll always feel like a behind-the-scenes support person, but I’m working with our president on ways to become a more public face of the department. How did you balance teaching and athletic training over the past 18 years? The first key to managing it all was routinely meeting with my department chairs so they understood the demands and unpredictability of the athletic schedule. They were usually helpful in making considerations regarding my class times and faculty responsibilities. For example, if I worked a weekend as an athletic trainer, I was permitted to miss the department meeting on Monday. It also required a lot of creative scheduling and efficient time management, which frequently meant combining two separate job responsibilities into one time frame. For example, I would sometimes meet with a student from my class while I was watching practice. I also supervised most of my rehabs during practice times. That way, I could dedicate the care needed to my injured athletes while also keeping an 14
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eye on what was happening on the field. In addition, I would grade papers during lulls in practice. What were the positive aspects of the dual position? In order to teach a course, I had to know as much as possible about the content it was going to cover, so I was constantly reading and studying about various aspects of health care. It allowed me to continue my education as a clinician. And being an active athletic trainer gave me practical experience and examples that I could share with students in the classroom. How do you achieve work-life balance? It’s something that I’ve worked on over the years. For me, it starts with a few daily habits. One is going for morning walks by the river with my Australian Shepherd who is my “exercise accountability partner.” That gives me a chance to pray and reflect before starting my day. It’s what I call “Melinda time.” I also try to do as much recreation as possible. To make sure I exercise at least a little every day, I ride my bike to and from work. I’m also a co-leader of a group called Believers on Mountain Bikes, which is a way to serve the community while also going out and enjoying the area’s mountains and trails. How is Whitworth implementing the new Division III rule on sickle cell testing? In the past, we would ask athletes for their sickle cell trait status, but we wouldn’t always get answers from everyone. The new policy requires that student-athletes know their status and bring us proof of testing. For those who don’t know this information, we provide resources at Whitworth—from how to get in contact with the right physician to contacting the state board of health. We also have an arrangement with a local lab that offers convenient testing for our student-athletes. Why did you work primarily with Whitworth’s soccer TR AINING-CONDITIONING.COM
Q&A teams when many head athletic trainers typically prefer to cover football? During my undergraduate years, one of my roommates played on the school’s soccer team, so I started going to her games and learned about the sport. But it wasn’t until I was in graduate school at Florida International University and worked with the women’s soccer program that I really fell in love with it. The team was ranked in the top 10 nationally and made the NCAA Division I tournament both years I was there. I’ve become a fan of pretty much every sport I’ve worked with, but I think I fell for soccer because of the type of athlete it requires and the overall flow of the game. It’s like no other sport. For example, I grew up playing basketball, and I played in college, but working soccer is much more enjoyable to me as an athletic trainer.
cohol prevention and treatment they can improve upon. In the final part, the National Institute of Alcohol Abuse and Alcoholism will deliver information on how schools can implement their own best practices with alcohol and drug curriculum. Twenty D-III schools started the two-year pilot program at the beginning of the 2012-13 academic year with the Personalized Feedback Intervention. The remaining tools will be implemented in the 2013-14 academ-
How did you get started doing service work in foreign countries? Several years ago, I became friends with a woman who was a missionary for the organization Athletes in Action, and in 2008, I decided to sign up for a service trip. I was enrolled in a five-day trip to Guatemala with a handful of other sports medicine
What are the benefits of working with the NCAA Division III Substance Abuse Prevention Program Delivery Group? I am thankful to be given the opportunity to be a part of this collaborative effort, because I’ve gotten to meet people in various fields from Division III schools all across the country. I’ve also learned a lot from experts about substance abuse, substance abuse prevention programs, and what goes into putting a plan together to combat abuse on the national level. What came out of your time with the collaborative? We developed a three-part web portal to help institutions tackle substance use and abuse on their campuses. The first component is a Personalized Feedback Intervention, which surveys students about their alcohol and drug practices and then immediately provides a response about their usage. In the past, this tool has been shown to decrease negative alcoholrelated consequences among college students. The second piece is a campus assessment that requires schools to identify what aspects of drug and al-
ic year, and the full initiative will launch in the fall of 2014.
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Q&A personnel. We spent our time there teaching at a training center for elite athletes. The medical professionals at the facility had an amazing desire to learn anything they could. For example, one day they led me around the clinic by the arm to ask my opinion on the treatment of some of their patients. I also sat down with a Guatemalan orthopedic surgeon who asked me every question he could think of regarding ACL recovery. Last summer, I decided to go there again with a new group. We went to a few different places near Guatemala City and had another fabulous trip. One of my recently graduated students also went on a trip this summer, and I was excited that she wanted to jump in and serve. How do you help injured athletes handle the emotional aspect of a rehab? I think that sometimes you need to have tough times to truly appreciate the positives in life. So I ask my athletes what they learned about themselves after recovering from an injury. I think it would be a tragic missed opportunity for a student-athlete to go through a life-altering event like an injury and not take the time to respond to and reflect on it. I encourage them to think about how the rehab changed them, their relationships, and their life. Having to fight back through the recovery process alters your identity and daily habits, so I think it would be a shame to pretend like those hard months didn’t happen or mean anything.
Of course, this self-reflection comes easier to some than others. A few student-athletes have that lightbulb moment right away while others take longer to realize how valuable the recovery process was to their growth. What was the key to developing your interpersonal skills with student-athletes? I tried to learn something from each student-athlete I interacted with. I heard a lot about their families, where they came from, and what was important to them. From these conversations, I learned that everyone is unique, and it was important for me as an athletic trainer to know my athletes as a person, not just as an injured ankle. I also made a rule for myself to always have the most charitable thought about any athlete I worked with, even if they were cranky, rude, not showing up for rehab, or not working as hard as I thought they should be. More often than not, there was a reason for their behavior. I would ask myself, “What’s the whole person here? What else could be going on in their life?” Then when I found out more about the situation, I would understand why they were acting that way. The nature of athletics and injuries brings so many emotions bubbling up to the surface. So as an athletic trainer, and now an athletic administrator, I have learned to be sensitive and aware of the effect it can have on people. Sometimes that means not being grumpy back to an irritable student-athlete or taking the extra time to talk with them. n
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At the top level 0.1% makes all the difference but it cannot always be seen without technology. But there are some major roadblocks to collecting data in training. Whether a coach is working one-on-one with an Olympic champion or in a high-turnover environment such as a high school, the process of collecting and compiling data can be time consuming.
When coaches have in-depth information on their athletes, they can create training programs that will help drive the athlete forward to success. a lack of data means individuals’ weaknesses may not be getting addressed, leading to a training program with a lot of working but little meaningful results.
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Dr. Bob Ward, Strength Coach for Dallas Cowboys (‘76-’89) and Performance Theory Expert (relating data to predicting success) states “Finding how an athlete is performing is absolutely essential prior to prescribing training programs.” in addition, there can be weaknesses hidden to the naked eye that are preventing an athlete from making those critical improvements. this could be hesitancy off the starting blocks or poor anaerobic recovery between plays.
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University of South Carolina Athletics
Connor Shaw lost only one fumble as the University of South Carolina starting quarterback last season, thanks in part to the grip strength training he and his Gamecocks teammates perform throughout the year.
Get a grip G Grip strength training is not very glamorous, but it is an important part of the University of South Carolina football program. By Joe connolly, Justin Markley, & Michael Pimentel
rip strength is one of the most underrated and neglected aspects of training football players. Most people don’t even think about its importance until it changes the course of a game. There’s no better example of this than the last play of the first half in the 2012 Capital One Bowl between the University of South Carolina and the University of Nebraska. With seven seconds remaining and the Gamecocks down 13-9, South Carolina quarterback Connor Shaw took the snap, pump-faked, and launched the ball toward the goal line where three of his receivers were flanked by four Nebraska defensive backs. Each player in the pack leapt for the ball, but wide receiver Alshon Jeffery came down with it, turned, and dove into the end zone to give South Carolina the lead as time expired. Joe Connolly, MS, SCCC, CSCS, USAW, is entering his second season as the Head Strength and Conditioning Coach for the University of South Carolina football team. Justin Markley, working on his master’s degree at Michigan State University, and Michael Pimentel, CSCS, working on his master’s degree at Bridgewater State University, completed summer internships at South Carolina. Connolly can be reached at: email@example.com.
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a receiver at the line, or a running back fighting against a strip attempt from a linebacker, grip strength is essential in football. But its benefits extend beyond the playing field. This article shows how we incorporate grip strength training at South Carolina, the dividends it pays in the weightroom, and how it can help prevent injuries.
Figure One: Pinch grip
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Figure Two: Support grip Many praised Shaw’s scrambling and the timing of Jeffery’s jump, but very few noticed the impact grip strength had on the play, starting with Shaw’s pump fake. The success of this movement relies on the quarterback’s ability to make it look like the ball is going to be thrown, so he needs to apply the
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GRIP BASICS Contrary to popular belief, grip strength involves more than just the hand. In fact, 35 muscles are utilized when moving the forearm and hand, and most of these play a part in gripping. For starters, solid grip strength wouldn’t be possible without the elbow joint. When programming for grip, it is important to train the flexion and extension actions of the elbow in order to keep a balance between its anterior and posterior muscle insertions. This results in better elbow stability, which in turn leads to increases in grip performance. It is also important to incorporate a variety of wrist and forearm positions when training for grip, such as extension, flexion, ulnar and radial deviation, pronation, and supination. Using different movements ensures that athletes maintain balance between the forearm flexors and extensors, which helps prevent injury. The final piece in training for grip strength is the hand. There are two
One of the exercises we utilize is the isometric hold with a jersey ... because it is less stable than a bar or other firm object. Using unstable tools forces the athlete to balance himself, resulting in greater proprioception.
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same force as if it is going to be released. Without a firm grip, this can result in a fumble. Next, Jeffery showcased his grip strength by bringing in a ball that six other players were fighting for. Frequently in Hail Mary situations, multiple hands are in contact with the ball, and more often than not, the player with the strongest grip comes down with it. Jeffery’s touchdown shifted the momentum of the game, as the Gamecocks rattled off an additional 14 points to eventually win 30-13. Whether it’s a defensive lineman shredding through an opponent’s block, a cornerback attempting to jam
primary hand movements to consider: flexion and extension. All of the muscles, bones, and joints in these areas work together to form the three different grip actions—crushing, pinching, and supporting. The crush grip is the action of closing the fingers against a resistance, whereas the pinch grip (see Figure One, above) occurs when an athlete grasps an object with the thumb and opposing fingers. And the support grip (see Figure Two, above) is when the fingers take on the majority of a load. There are a variety of concepts and equipment implemented in training for grip strength. Tools such as fat bars, TR AINING-CONDITIONING.COM
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optimum performance kettle bells, pull-up bars/balls, and even a household towel can be used to work a wide array of movements and muscles used for grip. One of the exercises we utilize at South Carolina is the isometric hold with a jersey. The athlete is required to complete a pull-up using a jersey without losing his grip. The jersey helps build grip strength because it is less stable than a bar or other firm object. Using unstable tools forces the athlete to balance himself, resulting in greater proprioception. This exercise is especially beneficial when training for football, because our athletes become acclimated to gripping jerseys, which they often have to do on the field.
Athletes are also likely to see increased strength gains, particularly when it comes to testing new weights on a lift. Because grip strength will not be a limiting factor in their success, the individual may be capable of working with heavier loads. Another exercise we do with our football athletes is the fat bar reverse-grip curl to overhead press. The fat bar offers a greater grip challenge than a standard barbell due to its larger circumference. Have the athlete stand in an athletic stance with their hands in a pronated position. With their shoulder blades depressed and retracted, the athlete should curl the bar up to their collarbone. From this position, the athlete should press the bar over their head and bring their head through their arms, locking their elbows and squeezing their shoulder blades together. We also utilize the farmer’s walk to work on the support grip action. Set an implement at the start of a prescribed distance (typically 20 or 30 yards) and have the athlete grip it at the start line. Then, they walk with the weight held away from the body, constantly squeezing the handles.
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WEIGHTROOM BENEFITS Besides the advantages that grip strength provides to on-thefield performance, it pays off in the weightroom as well. As an athlete’s grip becomes stronger, they gain better grip endurance when weight training, resulting in a greater work capacity. The reason behind this is the concept of “radiant tension,” which occurs when an object, such as a barbell, is effectively squeezed. With a firmer, stronger grip on the bar, the athlete produces more tension, creating an increased physiological response throughout the set. Continued squeezing causes the tension to be dissipated throughout the rest of the body. For example, let’s look at a shoulder military press or bench press. Attempting either of these movements with a loose or open grip will cause the bar to stray from its path, resulting in a potential safety risk and inconsistent performance for the athlete. When a firm, closed grip is used and tension radiates through the body, the bar path will be much smoother. In turn, this will both lead to more efficient lifts and ensure safety. The positive impacts of a developed grip can be seen in a variety of ways when training athletes, including better repetition endurance. In a movement where grip can be a limiting factor, such as high-rep heavy pulls like dead lifts, cleans, and TR AINING-CONDITIONING.COM
optimum performance clean-pulls, a stronger grip will lead to more reps. Athletes are also likely to see increased strength gains as a result of grip training, particularly when it comes to testing new weights on a lift. Because grip strength will not be a limiting factor in their success, the individual may be capable of working with heavier loads. INJURY PREVENTION Even with all the performance and training gains grip strength provides, it is important to remember that the first priority of a strength and conditioning coach is injury prevention. Athletes in training are going to get sore and run the risk of an overuse injury. With that in mind, coaches should employ various preventative techniques during all weightroom sessions. When it comes to grip training, taking care of muscle tissue should be the top priority. If the tissue is healthy, it is less likely that an athlete will experience an overuse injury. Stronger tissue also leads to a stronger grip. There are several ways to prevent injuries to the muscles and tissues associated with
grip, including self-myofascial release techniques and static stretching progressions. Self-myofascial release techniques deal predominantly with tissue health. Whenever a muscle contracts and re-
treated, and the athlete performs a movement that pushes them beyond this limitation, injury can occur in the form of muscle strains, pulls, tears, and even tendonitis. The muscles in the forearms and
There are several ways to prevent injuries to the muscles and tissues associated with grip, including self-myofascial release techniques and static stretching progressions. laxes—which it does almost constantly when training for or competing in athletics—it accrues tension. The stronger or more frequent the contractions, the more tension builds up in the muscle fibers, where adhesions, or “knots,” can eventually develop. These can be experienced as palpable nodules or tight bands of muscle tissue. Knots are especially common during weightroom work because as athletes lift greater masses, they force their muscles to produce stronger contractions. Adhesions can restrict the athlete’s range of motion. If they remain un-
hands that are used for grip are no different than any other muscles in the body and are prone to developing adhesions. If the flexors are carrying tension or knots, the athlete may experience pain when performing an action or find their range of motion limited. The same could be said for the extensors. Releasing this tension will not only ease discomfort and provide freedom of movement, but it will also allow the athlete to achieve a full contraction, resulting in greater grip strength. In order to release muscle fiber tension,
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Figure Three: Flexor self-myofascial release
Figure Four: Extensor self-myofascial release
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different implements can be utilized to perform self-myofascial release. To begin, an athlete needs to select an object that is appropriate for the area they will massage. For example, an athlete performing myofascial release on the forearm should use a golf or lacrosse ball rather than a softball. To treat the flexors, the athlete begins by sitting at a table or lying on the floor. They should position their forearm on top of the ball so the flexors are in contact. Then, have them gradually work the ball across the proximal end of the forearm while applying pressure and utilizing a small, rocking motion throughout (see Figure Three, above left). The athlete should slowly apply pressure across the entire soft tissue area, all the while feeling for knots in the muscle. To break up the adhesion and release the tension in a particularly sensitive area, the athlete should relax their muscle and position the ball underneath the troubled spot, slowly putting pressure on it for up to 30 seconds. Athletes should be advised against pushing too hard and causing the muscle to lock up, which makes it more difficult to break up the adhesion. Once they have successfully treated the tension, they can move on and search for other knots. Then, flip the arm over and repeat for the extensors (see Figure Four, above left). After myofascial release is completed, the athlete needs to stretch the area to regain any reduced flexibility or range of motion. To accomplish this, they should use a static stretching protocol of elongating the muscle fibers in the flexors and extensors. The first progression of the stretch has the athlete standing at arms’ distance from a wall. Have them place their hand flat up against the wall in a supine position above parallel (see Figure Five on page 25). If their flexors are particularly tight, they might not be able to do this movement, in which case they should slide their hand down the wall to a more comfortable position. Then, they should remain in the stretch for 30 seconds to a minute. The athlete should continue this stretch until they can comfortably get their arm above parallel. To stretch their extensors, the athlete can flip their wrist to a pronated position and again attempt to place their palm flat against the wall. Once the athlete can accomplish this TR AINING-CONDITIONING.COM
Figure Five: Static stretch, first progression
Figure Six: Static stretch, second progression
Figure Seven: Static stretch, third progression
stretch, they can move on to the second progression, which occurs on the floor. While on their hands and knees, the athlete will externally rotate their arms and position the back of their hands flat on the floor with their fingers pointing toward their knees and their wrists facing out (see Figure Six, above). From this position, the athlete can progress the stretch by gradually applying more pressure and moving the palms up the floor until a desirable position is reached. To stretch their extensors, the athlete can flip their hands
so their wrists are pronated. The final piece of the progression calls for elevated hands so the athlete can increase the range of their stretch. Have the athlete kneel by a bench or box and repeat the same stretching motion (see Figure Seven, below left). From this position, they will be able to put more pressure into the activity than they did against the wall or floor. In order to save time during a workout, a coach can fit these stretches into other lifts or warm-ups. For example, the “inch worm” stretches the hamstrings but can also work the flexors and extensors by telling athletes to keep their palms flat against the floor. Another option is pairing wrist flexibility with stretching the psoas. Although grip is often overlooked when it comes to strength training, a little emphasis can make a big difference during crunch time. Grip strength is something every strength and conditioning coach—especially those who work with football teams—should grab onto, because you never know when you might need a Hail Mary. n
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treating the athlete
HEADS & HEADERS Abby Wambach competes for the U.S. national team in a contest against Japan last year.
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treating the athlete
After football, the sport with the highest rate of concussions is women’s soccer. A veteran athletic trainer takes a look at the causes and offers new ideas on prevention.
By Maria Hutsick
AP PHOTOS/shizuo kambayashi TR AINING-CONDITIONING.COM
omen’s soccer superstar Abby Wambach is known for her dynamic and dramatic headers. She is admired by fans and competitors alike for her ability to leap in the air, perfectly position her head, and forcefully slam the ball into the back of the net. There is no better example of this than during the 2011 FIFA Women’s World Cup quarterfinals when Wambach scored on a game-tying header during overtime that forced the match into a shootout, earning the 2011 ESPY Award for Best Play of the Year. This past spring, Wambach was in the news for a very different type of head-on-ball occurrence. While playing a National Women’s Soccer League contest in April, an opposing player kicked a ball that struck Wambach in the head with great force and sent her tumbling to the ground. Wambach returned to her feet and continued to play. Although medical personnel were not called on the field at the time, it was determined after the match that she had suffered a concussion. In many ways, Wambach’s experiences sum up a growing and difficult problem in women’s soccer: Heading the ball has become a bigger part of the game and so have concussions. There is some confusion, however, over the correlation between heading the ball and concussions and why female soccer players seem to be increasingly at risk for this injury compared to their male counterparts. When we think of concussions, football is often the first sport that comes to mind. But according to recent research, soccer is not far behind. A study that examined the prevalence of concussions during the 2005-06 high school year found that while the most resulted from
football-related contact at 40.5 percent, the next highest sport was girls’ soccer at 21.5 percent. Also significant are the findings on boys’ soccer players as compared to girls. As detailed in the same study, girls also experienced a higher rate of concussions (.36 per 1,000 athlete exposures) compared to boys (.22 per 1,000). Concussions are taking a toll on female soccer players in a big way. As athletic trainers, we need to better understand the mechanism of injury, how to work with coaches, and how to bridge the gap with parents and youth leagues. THE CAUSES One of the more difficult aspects of preventing concussions in soccer is pinpointing the reason behind the injury. According to statistics compiled by the U.S. Consumer Product Safety Commission on concussions in high school soccer, 40 percent are attributed to head-to-player contact, 10 percent are head-to-ground, goal post, wall, or other surface, 13 percent are head-to-ball (including accidents), and 37 percent are unspecified causes. Clearly, concussions are occurring in many different ways. There is no one culprit. But from my seat on the sidelines, it’s clear that increased physical play has been a big contributor to the uptick in injuries. Maria Hutsick, MS, LAT, ATC, CSCS, is Head Athletic Trainer at Medfield (Mass.) High School and former Director of Sports Medicine at Boston University. She is a past president of the College Athletic Trainers’ Society and was honored with an NATA Athletic Trainer Service Award in 2010. She can be reached at: firstname.lastname@example.org. T&C SEPTEMBER 2013
treating the athlete The game has gotten rougher for both genders, but I’ve found that male players seem to fend off the physical play more effectively. Females often lack understanding of how to protect themselves during contact. This leads to the type of head-to-player impact that can easily result in a concussion. When two girls are competing for a ball in the air, they usually don’t keep the space around them protected. They reach for the ball with their necks extended like a turtle coming out of its shell, while their arms remain down by their sides or at waist level. Most boys, on the other hand, will raise their arms to their shoulders in an effort to ward off their opponent and keep them at bay to avoid a collision. I’ve also seen way too many girls shove an opponent from behind during a play, which can also cause a concussion. While they more frequently occur when
trouble in school, and a hard time comprehending information that she was learning in class. While she never had a specific concussion diagnosis, she eventually began showing signs and symptoms of post-concussion syndrome. She ended up having to take time off from the sport and was advised to avoid heading the ball when she returned. Athletic trainers at other schools have relayed similar stories to me. How can we know if and when cumulative hits are causing harm? Unfortunately, there is not a clear answer to this important question yet, but one recent study on men’s soccer players has shed a light on the topic. Published online in June in the journal Radiology, researchers at Albert Einstein College of Medicine at Yeshiva University studied 37 amateur adult soccer players (with a median age of 31) who had all played the sport since
“Our study provides compelling preliminary evidence that brain changes resembling mild traumatic brain injury are associated with frequently heading a soccer ball over many years ... controlling the amount of heading that people do may help prevent brain injury.” an athlete is hit straight on, a whiplash type of injury where the head is snapped backwards and the brain is shaken can be as bad as receiving a direct blow. Heading the ball can also be a mechanism of injury. A perfectly positioned head supported by a strong body rarely receives a concussion when performing a header. But improper form, as well as a heavy accumulation of head-toball contacts, appears to be detrimental. This is an area that needs more research, although it’s hard to ignore the anecdotal evidence. While I was the Director of Sports Medicine at Boston University, I had the opportunity to work with both the men’s and women’s soccer teams. The men’s squad experienced very few head injuries, and most were from hitting the ground after having their legs undercut by an opponent. I do not recall very many issues due to heading the ball. I can’t say the same about the women’s team, which had several concussions due to repetitive heading of the ball. One particular player who comes to mind was a midfielder known for her heading prowess. She began to have headaches, 28
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childhood. The study compared their self-reported frequency of heading the ball with scans of their brains using diffusion tensor imaging, an advanced MRI-based technique. It found that the players who accumulated between 885 and 1,550 headers a year had whitematter abnormalities similar to what is seen in patients with concussions. “Our study provides compelling preliminary evidence that brain changes resembling mild traumatic brain injury are associated with frequently heading a soccer ball over many years,” said lead author Michael Lipton, MD, PhD, Associate Director of Einstein’s Gruss Magnetic Resonance Research Center, in a university press release. “While further research is clearly needed, our findings suggest that controlling the amount of heading that people do may help prevent brain injury that frequent heading appears to cause.” PREVENTION As researchers continue to work on discovering more about the causes of concussions, I believe we need to upgrade our prevention efforts in soccer,
especially the girls’ game, immediately. These efforts should focus on two areas: helping soccer athletes better prepare for rough contact and addressing the role of heading the ball in concussions. One way to help ward off dangerous collisions is to enhance proprioceptive skills. Two of our concussions this year at Medfield (Mass.) High School were the result of the players not knowing who was around them. There are many exercises for teaching proprioception and awareness skills. Such activities will also enhance athletic ability, so they should be an easy sell to coaches. Also, the stronger the athlete, the better prepared they are to handle rough contact. Instead of playing on club teams year-round, it may be beneficial for soccer players to be in the weightroom during the off-season building body strength, with a focus on developing the upper back and neck muscles. Improved neck strength can help players absorb the impact of a hit and may help protect their brain by keeping their head stabilized. Neck and upper body exercises can easily be incorporated into on-field practice drills. Ideally, the athletic trainer and the strength coach can devise strength programs that address each athlete’s functional limitations. Functional movement screens that assess the athlete can help in developing a program tailored toward remedying weaknesses. Reducing concussions that result from heading the ball starts with talking to soccer coaches about preventive measures. The first step is to make sure they are teaching proper heading form with the right progression. Some coaches may believe that their players have already been taught how to head the ball at the youth level, but with the significant consequences of concussions, I would like to see coaches err on the side of caution and reteach proper form, at least at the j.v. and middle school levels. The Web site CoachingAmerican Soccer.com provides good instruction for how to teach heading. For newer players, it suggests a progression of starting with a balloon, then moving to a sponge ball, play ball, volleyball, partially deflated soccer ball, and finally a properly inflated soccer ball. When performed properly, heading should not hurt. This is because of thicker bone in the skull at the forehead to protect the brain from injury when TR AINING-CONDITIONING.COM
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treating the athlete falling forward. If heading causes pain, it is likely being performed improperly, or a physical condition may exist that needs to be explored. If a player complains of headaches, dizziness, or blurred vision, they must stop participating in heading drills immediately. Coaches also need to consider the volume and frequency of heading drills their
new students the first week of school during their wellness classes. Those results are kept on file and used for comparison when an athlete is suspected of having a concussion. For their part, coaches are asked to take an online course on concussions. Afterward, a certificate of completion is kept on file with our athletic director. The
To get full school buy-in, I have found it important to be up to date on concussion research and reach out to other school personnel ... The nursing staff accompanies me to an annual concussion symposium offered nearby at the Harvard University Medical School. players do in practice. I have been fortunate in that the soccer coaches I have worked with have solid backgrounds in coaching the sport and never conducted repetitive drills for heading. The heading work was spread throughout the practice, so players were not exposed to multiple head blows in a short period of time. When it comes to head safety, many coaches and parents want to know if helmets are a preventive option. Several head guards have been developed to reduce the risk of head injuries in soccer, but the jury is still out on their effectiveness. One independent research study found that no product on the market provides substantial benefits against minor impacts, such as heading a soccer ball. A helmet may possibly reduce some of the impact when a blow is straight on but will not prevent a concussion that results from whiplash or rotational forces on the brain. Ideally, athletic trainers will work closely with their soccer coaches to implement prevention strategies. If your coach is not open to the idea, or if you cover too many sports to do this on a day-to-day basis, at least try to discuss the topic during the preseason. PROTOCOLS & PROCEDURES Over the past few years, more and more high school athletic departments have begun implementing thorough concussion protocol and education programs. The one I’ve developed here at Medfield is focused on all sports, including soccer, and has worked well. I collaborated with both the school nurse and guidance department in developing it. Our program begins by administering a computerized baseline concussion test to all incoming ninth graders and 0 3
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rest of our faculty is provided with an inservice on what a concussion is and how academic workload must be modified to allow the concussed student to recover both physically and cognitively. Some modifications may include complete rest at home, a partial school day, reduced homework, or going to the nurse’s office to rest during the day. It might also include longer time for test taking. To get full school buy-in, I have found it important to be up to date on concussion research and reach out to other school personnel. I have attended a number of concussion education programs and webinars. And the nursing staff accompanies me to an annual concussion symposium offered nearby at the Har-
lete is doing academically. Next, I contact the parents to discuss the athlete’s progress. If all seems okay, the athlete is allowed to transition back to full participation. I notify the nurse when an athlete has returned to play, and the academic accommodations are removed from the student’s plan. Of course, my work on the sidelines is also important. Along with assessing any athlete who appears to be shaken up, if I see an athlete receive a blow to the head or hit their head on the ground, I question and evaluate them on the spot. I also do everything I can to relay the seriousness of concussions on a daily basis. From talking to parents to relaying recent news stories to putting up posters throughout the building, our school population understands where I stand. Because of the education component we have in place, I have had players report teammates who displayed concussion symptoms during football games. starting young While there’s a lot we can do to decrease concussions in female soccer players in high school and college, what about at the youth level? With very few athletic trainers covering these programs, there is a dangerous gap in parents’ and coaches’ understanding of concussions. Recently, I have started a small side business that offers baseline concussion testing to the youth sports programs
How do coaches feel about removing heading from the youth game? “It is hard to picture the game of soccer without heading, but given the possibility of trauma and the lack of neck strength and brain development, I think it sounds reasonable that heading is not introduced until high school.” vard University Medical School. Massachusetts law allows an athletic trainer to evaluate a concussed athlete and decide when that athlete can return to play. To ensure others feel 100 percent confident in my ability to make these important decisions, I have implemented a thorough return-to-play protocol. It includes using both the baseline computerized test and a physical test. When the symptoms of a concussion have resolved, the athlete must run for 15 minutes, perform 10 sit-ups, do 10 squat jumps, and then retake the computerized test. The results are compared to their baseline scores, and I communicate with the guidance department to see how the ath-
in town at a reasonable price. This has enabled me to get involved in the youth soccer community, and I’m hoping to do more in this area. Parents at this level could benefit greatly from knowing more about recent research and recommendations pertaining to concussions. Robert Cantu, MD, FACS, FACSM, Chair of the Department of Surgery at Emerson Hospital in Concord, Mass., and co-director of the Center for the Study of Traumatic Encephalopathy at Boston University’s School of Medicine, made headlines when he published an eye-opening book last year titled, Concussions and Our Kids. In it, he explained how young brains are TR AINING-CONDITIONING.COM
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treating the athlete more susceptible to injury and suggests no contact in sports before the age of 14. With regards to soccer, he recommends eliminating heading until at least age 13, preferably waiting until the player is 15. Cantu explains that before the age of 14, children’s heads are larger than their bodies, and their neck musculature is not developed. By age 14 the head, body, and neck strength are better proportioned. Another medical fact that Cantu’s book discusses is the lack of myelin (fat) that insulates and covers the fiber tracts in youth brains. Cantu explains
it this way: “Think of a copper wire inside the wall of your house and the plastic or rubber coating around the wire. The coating insulates, protects, and strengthens that wire. The fiber tracts of an adult have a coating of myelin that acts the same way, protecting the fibers from injury or insult. Children’s brains have less myelin and structures in their brains are more easily damaged.” How do coaches feel about removing heading from the youth game? “It is hard to picture the game of soccer without heading, but given the possi-
bility of trauma and the lack of neck strength and brain development, I think it sounds reasonable that heading is not introduced until high school age,” says Nancy Feldman, Head Women’s Soccer Coach at Boston University. “It might even help kids improve their foot skills. This is a radical idea and it will be interesting to see if it can get traction.” “The soccer coach in me strongly believes heading does need to be taught,” says Deb Raber, Head Women’s Soccer Coach at Massachusetts College of Liberal Arts and an instructor for the National Soccer Coaches Association of America. “But coaches need to learn how to teach it properly and incorporate safe heading drills into their practices. I have seen youth coaches have ‘heading practices,’ which are not good. Teaching that way for a long period of time will result in headaches, and kids will eventually shy away from heading.” Many parents coaching youth soccer have little to no background in physical training principles nor any technical understanding of how to teach the fundamentals of the game. In these cases, heading drills should certainly be avoided. It can also be helpful to relay to parents the stories we see or hear about as athletic trainers. While attending the Harvard Medical School annual concussion symposiums over the years, I have had the chance to hear former pro football and ice hockey players reveal what they have gone through after sustaining multiple concussions. For example, during one session, Ted Johnson, former linebacker for the New England Patriots, told us about being concussed and unable to see the sidelines to get the defensive play signals. One of his teammates had to tell him what the coaches were calling so he could relay the play to the rest of the defense. Today, he suffers from memory problems, depression, and irritability. While most of the heart-wrenching stories about the long-term effects of concussions currently come from the football community, I don’t think it will be long until we hear about similar problems from soccer players. In the meantime, as athletic trainers, we should put prevention measures in place and continue to educate athletes, coaches, and parents. Along with football players, female soccer players need our attention in order to reduce the risk of concussions in their sport. n
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NUTRITION Players on the NCAA Division I defending champion University of Texas women’s volleyball team receive screenings and education to ensure they consume enough micronutrients.
AP IMAGES/GARRY JONES
The Power of Vitamins For athletes striving to reach the top of their game, understanding how vitamins work and which ones are most important can make or break a season. TR AINING-CONDITIONING.COM
By Amy Culp
t may be the most-asked question sports dietitians get from athletes: How do I know if I’m getting enough vitamins and minerals for optimal performance? Right behind it come two more questions. What foods pack the most punch for vitamins and minerals? Should I take a supplement? Here at the University of Texas, I am fortunate to collaborate with a dynamic group of athletic trainers, strength coaches, and sports medicine physicians to ensure our athletes are not deficient in their nutritional intake. Our student-athletes are screened for iron and vitamin D blood levels and offered nutritional consultations when they first arrive on campus. When needed, they are also provided nutrition intervention. And we continually educate Texas Longhorn student-athletes on all aspects of dietary health. But even if you don’t have access to the same resources—or are a oneperson team for your school’s sports medicine needs—there is much you can do to help your student-athletes meet their nutrient needs. It starts with understanding how micronutrients assist the body and continues with knowing the specifics of the key ones. ATHLETES’ NEEDS Student-athletes are often confused about how vitamins and minerals work, thinking they provide energy. Because they do not contain calories, micronutrients cannot boost energy stores. However, they are crucial for turning food into energy through metabolic pathways. For example, many B vitamins aid in energy being released from carbohydrates. Other important roles of micronutrients include aiding in the production of oxygen-carrying proteins, maintenance of bone health, proper immune system Amy Culp, RD, CSSD, LD, is an Assistant Athletics Director and the Sports Dietitian at the University of Texas. She has been coaching athletes on all aspects of fueling for optimal performance and health for over a decade and can be reached at: Amy.Culp@athletics. utexas.edu. T&C SEPTEMBER 2013
NUTRITION function, and fluid balance. They also help with the synthesis and repair of new muscle tissue and protect against oxidative stress. Since athletes have high rates of energy metabolism and need their bodies to function at intense levels, they tend to have higher micronutrient needs than non-athletes. In addition, exercise stresses the metabolic pathways where vitamins and minerals are utilized and may also result in biochemical adaptations that increase micronutrient needs. Routine exercise may also speed up the turnover and loss of vitamins and minerals from the body. But how much additional vitamins and minerals do athletes need, and which ones? To begin to answer that question, it’s important to understand Dietary Reference Intakes (DRIs), which are established by the Food and Nutrition Board of the Institute of Medicine. These provide a set of values used to plan and assess nutrient consumption and vary by age and gender. They include: Recommended Dietary Allowance (RDA): average daily level of intake sufficient to meet the nutrient requirements of nearly all (97 to 98 percent) healthy people. Adequate Intake (AI): established when evidence is insufficient to de-
problems rather than popping supplements left and right. This doesn’t mean they have to analyze all of the food they eat. But it does mean athletes should be aware of how their food choices affect their intake of vitamins and minerals. FOOD FIRST Sports dietitians tend to practice a “food first” approach. We feel it’s important for athletes to get a base performanceeating plan in place, and then fill in the gaps with dietary supplements. This is for many reasons, starting with the fact that eating is more fun than taking a pill! Just as important, many of the nutritional deficiencies seen in athletes can be related back to an energy intake deficit in their daily diet. It is best to first identify and understand the barriers that stand in the way of meeting these needs, and then help athletes strategize for success. Satisfying caloric needs is essential for making gains in strength and performance goals, overall energy levels, immune system functioning, and hormonal balance. That cannot be replaced with a supplement. Foods also appear to have a synergistic effect when consumed as part of a varied diet, which is difficult to duplicate by solely ingesting micronu-
Eating nutrient-dense foods is the best way to get vitamins and minerals ... What I’ve found works well is to ask athletes to choose nutrient-dense foods 80 percent of the time. That leaves 20 percent of food choices for fun. velop an RDA and is set at a level assumed to ensure nutritional adequacy. Tolerable Upper Intake Level (UL): maximum daily intake unlikely to cause adverse health effects. Because some athletes are tempted to mega-dose on vitamins and minerals, thinking it will give them a performance boost, they need to be acutely aware of UL numbers. Taking too much of a micronutrient will not help them play better and can cause harm by increasing the risk for toxicity (especially with fat soluble vitamins A, D, E, and K), as well as interfering with absorption and function of other micronutrients or medications. The key is for athletes to figure out where they may be deficient and come up with a dietary plan to rectify those 3 4
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trients. A great example of this is that some types of iron are difficult for the body to absorb and utilize when eaten alone, but when consumed with a food high in vitamin C, absorption is enhanced. In order to ensure adequate amounts of micronutrients are obtained from whole foods, there are five factors to keep in mind: Nutrient Density: Eating nutrientdense foods is the best way to get vitamins and minerals. This means foods with lots of color (fruits, vegetables), whole grains, nuts, seeds, and a variety of lean protein sources (including some vegetable sources of protein, such as beans). What I’ve found works well is to ask athletes to choose nutrient-dense foods
80 percent of the time. That leaves 20 percent of food choices for fun. Athletes can relate to this balance, and most find it doable. To assist athletes in making their choices a little easier, I also provide recipes for foods that are nutrient dense. One is a kale, oat, and blueberry smoothie and another combines butternut squash with quinoa, spinach, and walnuts for a hearty side dish. An easy snack food I recommend to our athletes is mixing a variety of nuts such as peanuts, almonds, walnuts, and Brazil nuts with raisins, dried fruit, sunflower and pumpkin seeds, soybeans, and granola. Balance: Athletes should also focus on getting the correct balance of macronutrients (carbs, protein, fat) from each of the food groups. Inevitably, some will try diet fads that will either include too many carbs or not enough carbs. Consuming the right ratio of carbs and protein will translate to having enough micronutrients in their diets. Variety: Choosing a variety of foods from each of the food groups can help greatly with getting adequate vitamins and minerals. The more variety, the more likely it is athletes will satisfy all of their micronutrient needs. Fortified Foods: Many foods today are fortified, especially those marketed to athletes. As athletes strive to get the right dosages of micronutrients, they need to be aware of the levels of vitamins and minerals in the fortified foods they consume. For example, nutritional shakes and bars can have large amounts of certain micronutrients that could cause an athlete to meet or exceed their needs without supplementation. Food Quality: Advise athletes to choose fresh fruits and vegetables that are in season or frozen when they are not. Frozen fruits and vegetables are picked at the peak of their ripeness (when they contain the most nutrition) and flash frozen. Look for those that are in their original form and not covered in sauces or breading. In addition, athletes should avoid overcooking vegetables, which causes micronutrients to diminish. Instead, they can steam, microwave, grill, or roast. These are all easy ways to cook vegetables and retain their nutrition. pack a punch In the above list, I put nutrient density first because it is the most important. Some foods are simply better than othTR AINING-CONDITIONING.COM
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Breaking it down The following provides information on the most important vitamins and minerals for athletes. The Recommended Dietary Allowance (RDA) amounts listed for athletes and Tolerable Upper Intake Level (UL) are per day. The listings with ranges depend on caloric consumption. Calcium RDA: Adult males and females: 1000 mg UL: 2500-3000 mg Best food sources include dairy products, leafy greens, calcium-fortified foods (juice, dairy alternatives), and legumes Iron RDA: Adult males: 8 mg, adult females: 18 mg UL: 40-45 mg Best food sources include liver, oatmeal, dried peaches and apricots, spinach, and meats Zinc RDA: Adult males: 11 mg, adult females: 8 mg UL: 40 mg Best food sources include meat, fish, poultry, shellfish, eggs, whole grain foods, vegetables, and nuts Magnesium RDA: Adult males: 400-420 mg, adult females: 310-360 mg UL: 350 mg Best food sources include dairy products, meat, nuts, whole grains, leafy greens, and fruit Thiamin (B1) RDA: Adult males: 1.2 mg, adult females: 1.1 mg UL: None known/established Best sources include whole grain cereals, beans, pork, and enriched grains Riboflavin (B2) RDA: Adult males: 1.3 mg, adult females: 1.1 mg UL: None known/established Best sources include dairy products, eggs, leafy greens, whole grain cereals, and enriched grains Niacin RDA: Adult males: 16 mg, adult females: 14 mg UL: 20-35 mg Best sources include dairy, eggs, whole grains, meat, fish, poultry, and enriched grains Pyridoxine (B6) RDA: Adult males: 1.3-1.7 mg, adult females: 1.3-1.5 mg UL: 60-100 mg Best sources include meat, fish, poultry, eggs, beans, whole grains, seeds, and oysters Pantothenic Acid RDA: Adult males and females: 5 mg UL: None known/established Best sources include poultry, seafood, nuts, seeds, avoca-
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dos, and whole grains Biotin RDA: Adult males and females: 30 mcg UL: None known/established Best sources include egg yolks, legumes, leafy greens, and fish Folate RDA: Adult males and females: 400 mcg UL: 600-1000 mcg Best sources include enriched grains, dark leafy greens, whole grain breads and cereals, and citrus fruits B12 RDA: Adult males and females: 2.4 mcg UL: None known/established Best sources include seafood, meats, dairy, eggs, and fortified breakfast cereals Vitamin D RDA: Adult males and females: 400-600 IU UL: currently set at 4000 IU Best sources include fortified milk and cereals, cod-liver oil, seafood, and eggs Vitamin C RDA: Adult males: 90 mg, adult females: 75 mg UL: 1200-2000 mg Best sources include citrus fruits (oranges, grapefruits, and tangerines), strawberries, sweet peppers, tomatoes, broccoli, and potatoes Vitamin E RDA: Adult males and females: 15 mg UL: 600-1000 mg Best sources include vegetable oils, nuts, and seeds Beta-Carotene RDA and UL: Not established Best sources include red, orange, yellow, and dark green fruits and vegetables. Note: Excess intake of preformed vitamin A (retinol) has clear toxic effects when taken in excess of the maximum upper limit, but beta-carotene does not have these same toxic effects (although it may turn the skin a yellowish color!) Selenium RDA: Adult males and females: 55 mcg UL: 400 mcg Best sources include meat, fish, seafood, whole grains, nuts, and seeds
NUTRITION ers for providing a lot of micronutrients. Below are some great choices for nutrient-dense foods: Kale: This dark leafy green vegetable has become increasingly popular in the past few years. Part of the reason is because it is packed with nutrition. It is a good source of vitamins K, C, A, and B6, as well as calcium. It also contains natural antioxidants and fiber. Kale can be eaten raw in a salad, roasted with a little salt to make kale chips, or sautéed into a wide variety of recipes. Butternut Squash: This orange vegetable is high in fiber and antioxidants. It is also starchier than other squashes, making it higher in carbohydrates and a cleaner-burning fuel source. It is packed with vitamins A and C and potassium. It can be roasted, boiled, or mashed, and is great in risotto. Whole Grains: Grains, in their unrefined form, provide important vitamins and minerals as well as fiber. They are also a fuel source, and some (such as quinoa) contain higher amounts of amino acids than others. In addition, whole grains have a lower glycemic index than other carbohydrates, which causes less
of a spike in blood sugar levels and allows for a longer duration of satiety. Beans: Edamame, kidney, lentil, garbanzo, and black beans are considered excellent sources of both protein and carbohydrates. They provide a fair amount of magnesium, iron, folate, potassium, and fiber. They can be prepared in soups or stews, made into spreads, or placed on a salad. Nuts: While nuts are high in fat, they provide unsaturated fats that have been shown to help decrease inflammation. They also provide protein, fiber, potassium, vitamin E, and folic acid. They are easy to make into a snack, can be added to many recipes, or used in cereal. A CLOSER LOOK Along with choosing a variety of nutrient-dense foods, some athletes should take a closer look at their micronutrient needs for a better understanding of each’s significance. Most important to focus on for athletes are calcium, iron, zinc, magnesium, the B vitamins, and vitamin D, as well as some antioxidants such as vitamins C and E, betacarotene, and selenium.
NEURO-PROTECTION ENDURANCE METABOLISM ANTI-AGING
Let’s start by looking at the key minerals: calcium, iron, zinc, and magnesium. Levels for these can be low, especially in female athletes. Inadequate energy intake or avoidance of animal products are typically the culprits. Calcium: Most athletes understand that calcium is important for the growth, maintenance, and repair of bones. It has many other important tasks, such as regulation of muscle contraction, nerve conduction, and blood clotting. There are two main forms of calcium supplements, if supplementation is needed: carbonate and citrate. Both forms are well absorbed, but individuals with reduced levels of stomach acid can absorb the citrate form more easily. Calcium carbonate is commonly available and inexpensive, and its absorption rate is most efficient when taken with food. Calcium citrate is absorbed equally effectively when taken with or without food. No more than 500 milligrams of calcium should be taken at a time to ensure optimal absorption and utilization. Iron: An inadequate iron status is
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NUTRITION probably the most common micronutrient deficiency among athletes. Endurance athletes require approximately 70 percent more iron on a daily basis than the general population. When this goal is not achieved, performance declines because of less than optimal levels of hemoglobin, as well as changes in the muscle—reduced amounts of myoglobin and iron-related enzymes that are involved in energy production. Hemoglobin and myoglobin are both oxygen-carrying proteins. The capacity to carry oxygen is essential for endurance exercise as well as for normal function of the nervous, behavioral, and immune systems. Iron deficiency, with or without anemia, can impair muscle function and limit work capacity. Iron depletion is typically related to inadequate energy intake. There are other factors that can affect iron sta-
To view and download a handout on meeting iron needs, please visit www.Training-Conditioning.com/ Iron_Handout.pdf.
tus, including following a vegetarian diet with poor iron availability, times of rapid growth in adolescence, training at high altitudes, and increased losses (sweat, urine, feces). It is prudent to perform routine iron screenings, including serum ferritin levels, to determine possible supplementation needs. Also note that revers-
are low is to consume calcium-rich foods and tea between meals. Also, focus on getting vitamin C-rich foods at meal times, especially when consuming non-meat iron sources. Zinc: This mineral aids in the growth and repair of muscle tissue, energy production, and immune status. Basal metabolic rate, thyroid hor-
Athletes should be cautioned against single-dose zinc supplements because they often exceed the UL of 40 mg. ing iron deficiency anemia can take three to six months. Good sources of iron include chicken and beef liver, Cream of Wheat, dried fruits, oatmeal, beans, lentils, and meats. Certain forms of iron from non-meat sources are absorbed more readily when foods with vitamin C are consumed at the same time. Also important to consider is that absorption is decreased when taken with tea, coffee, chocolate, dark leafy greens, whole grains, soda, and certain minerals. A good rule of thumb if iron stores
mone levels, and protein utilization have been shown to be directly affected by zinc status. Athletes, especially women, who are at risk for impaired zinc status are those who consume a diet low in overall calories and animal protein, but high in fiber. Athletes should be cautioned against single-dose zinc supplements because they often exceed the UL of 40 mg. Consuming too much zinc can lead to low HDL cholesterol and nutrient imbalances by interfering with absorption of other minerals, such as iron
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NUTRITION and copper. Magnesium: Playing many roles in the metabolism of carbohydrates, protein, and fats, magnesium also regulates neuromuscular, cardiovascular, immune, and hormonal functioning. Endurance performance is impaired by magnesium deficiency because of increasing oxygen requirements to complete submaximal exercise. Inadequate magnesium intake is typically related to overall energy deficit and an inadequate balance of food groups. Besides the four key minerals, the B vitamins are next on the list of important micronutrients and include thiamin, riboflavin, niacin, pyridoxine (B6), pantothenic acid, biotin, folate, and B12. The B vitamins thiamin, riboflavin, niacin, B6, pantothenic acid, and biotin are involved in energy production during exercise. Folate and B12 are required for the production of red blood cells, protein synthesis, and in tissue repair and maintenance. There has been some data to suggest that exercise may double the need for B vitamins. Severe deficiency of B12, folate, or both may result in anemia and reduced performance. In terms of supplementation, B vitamins are water-soluble, thus are not stored in the body in the same way as fat-soluble vitamins. Also know that excess intake can lead to problems. Vitamin D intake related to athletic performance is currently a hot topic. Although technically not a vitamin, this hormone is necessary for the absorption of calcium, making it essential for bone health. It also plays an important role in immune function and reducing inflammation. In recent years, more research has been done on the consequences of vitamin D deficiency in athletes. It has been shown that low levels can decrease physical performance and increase the incidence of stress fractures. The RDA was increased from 400 IU to 600 IU in 2010 as more information about the prevalence of deficiency and its role in maintaining good health and optimal athletic performance was uncovered. One more area to cover is antioxidants, particularly vitamins C and E, beta-carotene, and selenium, which play important roles in protecting cell membranes from oxidative damage. It has been hypothesized that frequent exercise produces a chronic oxidative TR AINING-CONDITIONING.COM
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NUTRITION stress on the muscles since exercise increases oxygen consumption, and thus ups the need for antioxidants. This idea remains controversial. There is some evidence that a combination of antioxidants may be helpful at reducing inflammation and muscle soreness. Strenuous and prolonged exercise has been shown to increase vitamin C needs from 100 to 1000 mg/ day. Athletes need to be advised to not exceed the UL for any antioxidant because higher doses could be pro-oxidative with possible negative effects. ADDING IN SUPPLEMENTS With our student-athletes at Texas, the goal is that they meet increased micronutrient needs through food alone. But that can be difficult to achieve consistently. This is especially true with athletes who have restricted eating patterns (intentional or unintentional), such as severe weight loss practices, disordered eating, a food allergy, or by following fad diets. A balanced, varied diet can also be tough for athletes with poor eating habits, inadequate finances, or an overcommitted lifestyle that
causes erratic meal patterns. Athletes falling into those categories would benefit from meeting with a sports dietitian and considering a daily multivitamin/mineral supplement. A basic multivitamin/mineral supplement can fill in the gaps when eating right is an issue. In some cases, here at Texas, individual nutrient supplementation, such as iron, calcium, or vitamin D, is recommended based on our protocols and my assessment of the athlete. If an athlete’s diet is adequate in calories and balanced most days with just some inconsistencies, I will often prescribe taking a multivitamin/mineral supplement every other day instead of daily. Another strategy I often use is to fill the nutritional gaps with fortified sports bars and other fortified foods that provide micronutrients. Choosing a multivitamin/mineral supplement can pose challenges due to limited regulation of dietary supplements. This issue will not be discussed in detail here, but there are some important points to consider: • Look for third party verification, such as Informed-Choice or NSF,
which helps to ensure the safety of the dietary supplement. • Avoid supplements marketed to burn fat, increase energy, or promise anything that sounds too good to be true. • Avoid supplements that offer megadoses of vitamins and minerals. • For more in-depth information about dietary supplements, visit the helpful Web site: www.usada.org/supplement411. In order to hammer home the importance of nutrition, we often tell our athletes, “You can’t out-train a poor diet.” The same could be said for supplements: “You can’t out-supplement a poor diet.” Multivitamin/mineral supplements are intended to fortify a strong nutritional foundation, and teaching athletes the importance of an overall adequate diet is the key to longterm success. n
The author would like to thank Maria Pugliese, dietetic intern, for her assistance in conducting research for this article.
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LEADERSHIP Some of the services offered at the SMART Clinic include (clockwise from top left) trigger point performance therapy, Graston Technique, stretching, and manual mobilization.
A SMART Idea At Illinois State University, the opening of the SMART Clinic has provided more hands-on opportunities for athletic training students and a place for recreational athletes to receive treatment. By Dr. Justin Stanek
t’s a Thursday afternoon and the Sports Medicine and Rehabilitation Therapy (SMART) Clinic at Illinois State University is humming. In one corner, an ultimate player is receiving rehab for a shoulder injury. In another, a dancer with a big performance over the upcoming weekend has a stim machine working on her lower leg. And just outside the door, members of an intramural basketball team are lined up to get their ankles taped in preparation for their title game that night. You won’t find any intercollegiate athletes in our space, but our patients are athletes who need the services of athletic training professionals. We have been able to meet their needs through a unique new program. Opened one year ago, the SMART Clinic is a result of collaboration among many entities at Illinois State to provide advanced care for ISU students in the areas of prevention, evaluation, and rehabilitation of athletic-related orthopedic injuries. It also allows clinical experience for our athletic training students, as well as a research resource for professors in our School of Kinesiology and Recreation. While it took a few years to get the project up and running, it has proven to be hugely successful. The SMART Clinic recently won the 2013 ISU Student Affairs Justin Stanek, EdD, ATC, is an Instructional Assistant Professor and the Clinical Education Coordinator for the CAATE Athletic Training Program in the School of Kinesiology and Recreation at Illinois State University. He can be reached at: firstname.lastname@example.org.
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LEADERSHIP Outstanding New Program award and received Honorable Mention for the Team Excellence Award at ISU’s 2013 Founder’s Day Convocation. STARTING UP The seeds for the SMART clinic were planted about seven years ago. At that time, two staff athletic trainers from the university’s athletic department began providing services to the general student population through Student Health Services as part of a pilot program. The collected data and patient feedback showed positive results. The patients treated by the athletic trainers regained their function and returned to activity, while Student Health appreciated the ability to closely monitor progress. However, limited space and resources within Student Health made the pro-
gram difficult to continue. In addition, the athletic trainers were finding it hard to work for two different entities in multiple places. As a result, the program was terminated after only two semesters of operation. In the fall of 2008, the idea for a therapeutic rehabilitation clinic for students was revisited thanks to new construction on campus. McCormick Hall, which serves as home to our athletic training program, was being expanded to include a fitness center and additional classrooms. Administrators and professors from the School of Kinesiology and Recreation proposed including a fully functioning athletic training room/laboratory in the design. The thinking was that this space could serve many needs. To start, it could expand the services of Student Health by offering students an on-cam-
Two students One of the most rewarding aspects of overseeing the SMART Clinic is watching an athletic training student thrive through hands-on experience. This was the case for one of our students (whom I’ll call Alvin) and a recent patient (Tim). Tim came to us two-weeks post-op ACL reconstruction. This was the second time he had torn his ACL, so he was not looking forward to the rehab process. He had a fairly significant amount of edema and was completely non-weight bearing when he arrived for his first visit. Alvin was a junior athletic training student and was taking our therapeutic rehabilitation class at the time. He had seen many acute injuries but had not been able to work with a post-op patient through an entire injury rehabilitation. He was excited by the opportunity. Knowing Tim’s history, Alvin was determined to not allow him to become bored with rehab. After carefully studying the protocol, Alvin worked diligently to create a variety of exercises that would keep Tim motivated but also on track to progress quickly. As Tim warmed up each day, Alvin was busy tweaking exercises based on Tim’s previous visit. Slowly, both began to see results. Hobbling along on crutches soon became pain-free for Tim, and his normal gait returned. Wall slides for mobility were replaced with stool scoot races and balancing contests between Alvin and Tim. Rehab games that Alvin had easily won were soon being won by Tim. As Tim continued to progress, Alvin began modifying portions of the treatment and searching for new exercises. By the end of the semester, Tim was running again and was able to begin more sport-specific training. As a result of their time together, both Tim and Alvin had gained confidence from the experience—along with a genuine mutual respect.
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pus location for treatment and rehab of athletic injuries. Second, it could provide an additional clinical education site for athletic training students. Third, professors could use the space for both teaching and research. Our proposal was approved, but there were hurdles to clear before the clinic could be up and running. One was to secure startup funding, which was needed to cover staffing, purchase a credit card machine, and pay for some minimal advertising and supplies, including collared shirts for staff. This money came from Student Health Services, the College of Applied Science and Technology, and the School of Kinesiology and Recreation. Fortunately, the majority of the necessary equipment was already owned for didactic instruction in the university’s athletic training program. We also needed to consider the interests of local rehabilitation clinics. These clinics have a direct relationship with the ISU undergraduate and graduate athletic training programs, as well as university intercollegiate athletics. We wanted to reassure them that the aim of the SMART Clinic was not to serve as a competitor to their operations—Student Health and our clinic would still be referring patients to them regularly. These communications were important in getting two prominent orthopedists in the area to agree to continue working with both our educational and athletic programs. The result of our efforts is a 3,500 square foot, state-of-the-art facility with an attached classroom. It is equipped with numerous treatment tables, a private examination room, an office, therapeutic modalities, and rehabilitation equipment commonly found in an athletic training facility. In the morning, it is used by professors as an instructional or research area, and in the afternoon it becomes a functioning clinic. As you might expect, the daily operations of the clinic require the combined efforts of numerous stakeholders from across the university. The clinic works closely with Student Health Services through the Division of Student Affairs. Additionally, the clinic shares resources with the College of Applied Science and Technology and School of Kinesiology and Recreation. Lastly, Campus Recreation handles all of the building maintenance, and maintains the schedules for the space. TR AINING-CONDITIONING.COM
LEADERSHIP DAILY OPERATIONS The current hours of operation are from 2:00 to 6:00 p.m. Monday through Thursday, and 1:00 to 5:00 p.m. on Friday. We sometimes adjust our regular hours to accommodate patients and allow weekend appointments as necessary. As the Clinical Education Coordinator of ISU’s Undergraduate Athletic Training Program, I serve as Director of the SMART Clinic and spend my afternoons there. The other certified athletic trainer on staff is a graduate student. She receives a graduate assistantship for this work as well as the opportunity to further her clinical skills and develop her leadership and mentoring abilities by overseeing the work of undergraduate students in our athletic training program. The two of us practice under the direction of the physicians at Student Health Services, as required by the Illinois State Practice Act, and are responsible for overseeing the day-to-day operations of the clinic. Some of our duties include patient care, scheduling, record keeping, communicating with Student Health, inventory and ordering of supplies, and tracking patient satisfaction and outcomes. However, a big part of our responsibility is overseeing the work of our undergraduate athletic training students. As the students progress through the program, they take on greater responsibilities with patient care. These experiences allow the students to transfer their classroom knowledge to a realworld context under the direction of preceptors who know and understand their current skill level. An added bonus for our students is that working at the SMART Clinic gives them athletic training experience in a unique setting with a relaxed atmosphere. A typical day begins around 1:30. The patient files for the day are pulled, and paperwork for new patients is assembled. Patients are greeted at the door upon arrival, payment is secured, and the plan of care is started. Each visit is documented via the daily SOAP note and rehab log. The graduate assistant and I work with the students to adjust rehab exercises and care based on the patient’s progress. After the last client has been treated, folders are filed and necessary records are faxed to Student Health. This schedule has worked well for patients and our students. The biggest challenge is that my time is of-
ten stretched too thin. During a typical week, I spend approximately 20 hours in the clinic on patient care, which can take away from my teaching and department duties. We are working on remedying this by shifting some responsibilities to our graduate assistant and students. CLIENTS & SERVICES To get the word out about the new clinic, we partnered with Campus Recreation to advertise on the television monitors placed throughout McCor-
mick Hall. Additional publicity included flyers placed at Student Health Services and ads in the student newspaper. A ribbon-cutting event was held shortly after opening, allowing local media the chance to tour and ask questions about the facility, resulting in some indirect advertising. We also provide a lot of information on our Web site (kinrec.ilstu.edu/smart), which serves as an advertising tool. The site details the services we provide, who we are, how to make an appointment, and costs. It also explains what an ath-
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LEADERSHIP letic trainer is and how we collaborate with other groups on campus. Most of our patients are referred to us by Student Health, which faxes the student’s diagnosis and any specific instructions for care directly to us. A crucial part of our client services is to take patient privacy very seriously. Student Health only shares necessary information related to the patient’s current athletic-related condition and SMART Clinic patient records are kept in a locked file cabinet, housed within the clinic office. Only the athletic training graduate assistant and I have immediate access to these records. Additionally, undergraduate students fulfilling their clinical education rotation with us sign verification forms indicating they understand the confidentiality and protected health information policies and procedures prior to any exposure to patient care. Also, all patients sign a student authorization/
and intramural participants. While we see a fair number from this population, it is certainly not the majority. We have learned a lot about the types of injuries that can occur in quidditch, ultimate, boxing, team handball, ROTC, rugby, and equestrian. We also have treated a number of runners training for half or full marathons and students from the College of Fine Arts who have suffered an injury during classes or rehearsing for an upcoming performance. A wide variety of both acute and chronic orthopedic conditions have walked (or hobbled) through our doors. Examples include post-operative rehabilitation procedures for ACL reconstruction, patellofemoral pain syndrome, ankle sprains, muscle strains, medial tibial stress syndrome, and low back pain. We utilize many different treatment approaches to address these conditions, such as myofascial release, muscle energy technique, Graston Technique,
Our overall goal is to fund all athletic trainer stipends and salaries, clinic equipment, and resource expenditures from patient fees ... After our first year, the clinic is on target to be self-sufficient. consent form for disclosure of protected health information. During the patient’s first visit, a thorough evaluation is performed and a plan of care is developed. Patient education of the diagnosis and treatment is emphasized during this initial visit and, if applicable, a home exercise program is developed. This information is sent back to Student Health to ensure they are aware of all rehabilitation procedures. If a student sustains an orthopedicrelated injury during regular SMART Clinic hours, but outside of Student Health Services hours (weekdays from 9 a.m. to 5 p.m.), an agreement is in place to allow myself or the athletic training graduate student to perform an initial evaluation and any necessary immediate care. However, if we determine care beyond basic first aid is needed, the student is referred to the emergency room for further evaluation by a physician. The student may be referred back to the SMART Clinic after this visit for follow-up care. We have been pleasantly surprised by the variety of students utilizing the clinic. Prior to opening, we thought the majority of our patients would be club sport 4 4
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joint mobilization and traction, therapeutic ultrasound, electrical stimulation, balance training, stretching protocols, and strengthening exercises. The clinic also offers students preventative joint taping (ankles, wrist, etc.) for a nominal fee. No appointment is necessary for this service. If the patient wishes to bring his or her own supplies, we offer the taping for free. In addition, sport clubs on campus may hire an athletic trainer for event coverage and are charged on an hourly basis. In terms of billing, the clinic charges $10 per visit, the same fee used by Student Health, and students can pay using a major credit card, cash, or check. Due to feedback from patients, this fall we’ve begun allowing patients to charge the fee to their student account. One challenge we have faced is patients not showing up for scheduled appointments. Unlike a traditional athletic training facility where you typically see the athlete daily, the clinic usually schedules patients for two to three visits per week. This seems to make it harder for them to remember their appointment. Additionally, we find that despite being referred from Student Health Ser-
vices, some patients never show up for their initial treatments. This leads to loss of revenue for the clinic, as it results in an open time slot. In response, we have instituted a noshow policy. Modeling this after Student Health Services, we now charge the student’s account $10 for the missed appointment if the student fails to notify us in advance. Our overall goal is to fund all athletic trainer stipends and salaries, clinic equipment, and resource expenditures from patient fees, and thus have a self-sustaining operation. After our first year, the clinic is on target to be self-sufficient, and all remaining profit will be put towards paying back our startup funding. WIN-WIN-WIN The SMART Clinic has proven to be a successful endeavor at ISU. Along with providing a unique and cost-effective service to our student body, it has provided many other benefits. First, the clinical opportunity for our students has been tremendous. The students assigned to the SMART Clinic say that the atmosphere allows them more independence than an intercollegiate athletic setting and they feel more confident in the low-risk environment. Second, the SMART Clinic has promoted the profession of athletic training and the athletic training major on campus. Not only do injured students receive education about their injuries, they also receive excellent care and some education about the knowledge and abilities of athletic trainers. Finally, the collaboration among groups on campus has been a very rewarding experience. The clinic has garnered the attention of administrators from across the campus and opened up doors for research partnerships between faculty and the physicians at Student Health. We have also joined with Health Promotion and Wellness to put together information on injury prevention. If the idea of starting a clinic like ours is something you are interested in exploring at your school, the importance of garnering support from many different constituents cannot be overstated. In our first year of operation, we have found these relationships to be extremely important and supportive in our efforts. Overall, the response we have received from both patients and the campus community has been very positive. n TR AINING-CONDITIONING.COM
Loosen those hamstrings and lower back! by Ken endelman
Psoas/Hamstring Stretch Movement Sequence
Psoas Figure 1
Inhale and Exhale – Straighten one leg down along the floor to stretch the psoas and hip flexors and reach the other leg up to the ceiling to stretch the hamstrings. Place your hands behind the thigh of the leg that is reaching up to the ceiling.
wo areas that are always a problem point for athletic injury are tight hamstrings and a tight lower back. The beauty of Pilates is that the exercises can work and stretch every part of the body effectively. Here are two stretches – one each for the hamstring (and psoas) and the lower back. All you need is a foam roller and mat!
Psoas only: Keep the top knee bent to focus on the psoas alone.
Psoas Figure 2
Repeat 4-8 times in each direction. Variations: Pelvic Clock: Roll the sacrum in a circle on the
Hip Sways Figure 2
Repeat for 3 to 8 breaths. Variation:
Exhale – Draw the abdominals in to bring the legs back to the starting position. Switch sides.
Hip Sways Figure 1
Exhale – Start with both knees bent and the feet off the floor in a chair position. Inhale – Rotate the torso and lower both knees toward one side.
roller rather than just moving side to side. Straight legs: Straighten both legs for either the Knee Sways or the Pelvic Clock. See why Pilates has become a crucial component is the training regimen of elite athletes all over the world visit pilates.com. Ken Endelman is the Founder and CEO of Balanced Body.
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POWER PLAY How do you develop a training plan for athletes who need to maintain strength and balance while competing on a sheet of ice? The University of Notre Dame’s coach explains. By Tony Rolinski
Notre Dame powered its way to a 2513-3 record and the Central Collegiate Hockey Association tournament title in 2012-13.
ike other sports, the physical demands of ice hockey dictate that players perform complex motor skills at a high rate of speed. During the course of a game, they have to rapidly accelerate and decelerate to change direction, deliver and absorb physical contact from opposing players, and react to a constantly changing environment. Unlike other athletes, though, hockey players have to do all that on a sheet of ice while balancing on one-eighth inch wide blades of steel. Hockey players require power to propel themselves around the ice. And they need strength to maintain balance through quick starts and stops, sharp turns, and devastating body checks. Here at the University of Notre Dame, we help them build that strength and power through a well-designed progressive plan based on Olympic lifts and other multi-joint movements. Then there’s the interval nature of the game. Typically, players are on the ice for 45 to 60 seconds, giving maximum effort. Then they get three to four minutes of rest before taking the ice for their next playing shift. So in addition to maximizing their strength and power, we must also condition these athletes to recover quickly. Over the past decade, Fighting Irish players have been able to transfer success in the Tony Rolinski, MS, SCCC, CSCS, is Director of Strength and Conditioning for Olympic Sports at the University of Notre Dame, where he oversees training for 25 sports and works directly with the men’s ice hockey team. He has been a strength coach at Notre Dame for 15 years, and served as the Head Strength and Conditioning Coach at Duquesne University and North Hills High School in Pittsburgh, Pa. He can be reached at: firstname.lastname@example.org.
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sport specific weightroom to the ice. The team has reached the NCAA Division I Frozen Four twice in the last six seasons while winning two Central Collegiate Hockey Association tournament titles and earning four NCAA playoff berths. While the credit for these successes undoubtedly belongs to the players and coaching staff led by Head Coach Jeff Jackson, I am confident that our strength and conditioning program has helped the team reach its full potential. BUILDING A FOUNDATION Here at Notre Dame, we identify two simple, straightforward goals for all student-athletes, including our hockey players. The first is to help reduce the risk of injury. Because hockey is a physical and violent game played at high velocities on a very unforgiving surface, we know there is no way to completely prevent them from occurring. However, by helping the athletes strengthen their bodies to build a figurative suit of armor, we help them more safely absorb the inevitable collisions they will experience and reduce their odds of getting hurt. These efforts can also decrease time lost from any injuries that do occur. Our second overarching goal is to help improve sport performance. I view strength and conditioning as an opportunity to develop the raw materials of performance, namely the players’ bodies. Therefore, the mission is to provide
a well-designed training program that is based on sound physiological principles. We do this by incorporating a sport specific focus on conditioning based on the energy systems used in hockey while utilizing safe strength training methods within a periodic plan. However, we rarely try to mimic hockey movements in the weightroom. Hockey specific skills are developed on the ice by our sport coaches through team and individual practice. Instead, we believe that improvements in strength, power, speed, agility, and conditioning will allow our hockey athletes to perform their sport specific skills at higher levels. All we ask is that players give great effort, engage one another, and pay attention to detail during each training session. THE MENU Before they enter the weightroom at Notre Dame, we make sure all our athletes understand the basic underpinning of our strength and conditioning program—the repetition. When designing training sessions for hockey, as well as all our other sports, we build up from the perfectly executed repetition. Whether we are training for strength, power, or speed, the repetition and how it is performed lay the foundation for performance gains. Even the most well designed plan will be of little use if repetitions are done in a haphazard manner. We take the time to coach consistent
Off-season Strength Here is a week of sample off-season strength-training workouts for the Notre Dame men’s ice hockey team.
5-way neck machine & 5-way neck machine & manual resistance manual resistance
Back squat clusters
DB split jerk
Weighted towel pullups Walking hockey lunge
Thick bar row
SL leg curl
Thick bar incline press
TRX inverted row
DB floor press
Banded monster walks
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technique before effort, and we talk about the importance of rep integrity every day. We explain to our players that it will take hundreds of properly performed sets and reps before they will see a change in their physical attributes, but a few poorly performed repetitions can hinder their progress or put them at risk for injury. The philosophy in the weightroom is based on training compound, multi-joint movements. We use variations of the Olympic lifts for power development, especially clean and snatch pull variations (from both the knee position and the floor), hang cleans, dumbbell snatches, dumbbell split jerks, shrug pulls, and dumbbell or kettle bell swings. Our primary compound lower body strength movements are squatting (back and front), trap bar deadlifts, hip presses, Romanian deadlifts, and glute/ham gastroc raises. Our auxiliary lower body movements include lunge and step-up variations, single-leg Bulgarian squats, single-leg pistol squats, single-leg Romanian deadlifts, hamstring eccentrics, and reverse hypers. The players especially enjoy our hockey-specific variations. One is the walking hockey lunge, in which they step out at a 45-degree angle similar to what they do when skating. We also have them perform Messier squats where they use a wider base and lighter weight than regular squats. Once they are in the squat position, they rock back and forth similar to a side lunge, but instead they swivel their hips. This helps stretch and train their groin, which is a common source of injury in hockey players. We maintain a range of three to five reps for strength and power movements throughout the year. This allows for continued improvement in technique, reduces fatigue, and improves the athlete’s rate of force development. The players also perform plyometrics during the off-season and preseason as another way to train athletic triple-extension movements. The stretch-shortening component of these bounding exercises helps maximize speed of movement and develop the horizontal power a hockey player needs. Our upper body compound movements provide a balance between pulling and pressing exercises designed to help increase shoulder stabilization and integrity. We build around major pulling exercises such as heavy rowing movements and weighted pullups and chinups. Push presses as well as TR AINING-CONDITIONING.COM
sport specific bench, incline, and narrow grip pressing are also frequently used. Additional upper body exercises involve singlearm dumbbell work, weighted dips, upright rows, shrugs, and direct threeway shoulder work (posterior, lateral, and anterior deltoid focus). We also use medicine ball throws and slams and Keiser functional trainers to perform chopping motions that build rotational power through the torso. The head, neck, and trap areas are especially vulnerable to injury from collisions. Development of the trapezius takes place through heavy pulls and shrugs done throughout the workout. To strengthen the neck, we use a fiveway neck machine like many schools, but we also do some manual resistance work as well. In these exercises, a player lies on a bench and a strength coach puts one hand on the player’s forehead and the other under his chin. He then applies resistance as the athlete moves his head through four planes of movement—flexion, extension, and laterally in each direction. The speed-controlled movements typically last two seconds in the concentric phase and four to six seconds in the eccentric phase. Once players have mastered this exercise, we teach them how to properly supply resistance to a teammate, allowing them to work in pairs. FOUR PHASES We break our training year into four phases: off-season, preseason, in-season, and postseason. Here’s a look at the training regimen for each of these periods. Off-season: This phase covers 16 weeks from the beginning of summer break to the start of official team workouts in September. While these sessions are voluntary under NCAA rules, we have traditionally had very good turnout with most, if not all, players remaining on campus to train while taking summer classes. During this period, we work hard to build the physical attributes that hockey skills draw upon as well as improving the players’ overall athleticism and addressing individual weaknesses. There is no hockey practice, film study, or meetings during this time, so our players can focus on enhancing their strength, speed, power, and agility. We split this phase into two eightweek cycles, which are then divided into four-week blocks. The plan is progressive within each four-week block as well as over the full 16 weeks. TR AINING-CONDITIONING.COM
Our players do three strength training sessions a week during the offseason phase. These are evenly split between weeks of three total body sessions and weeks consisting of one total body day, one upper body day, and one lower body day. (See “Off-season Strength” on page 48 for sample workouts.) Each strength session also includes post-workout exercises that focus on players’ specific needs. We split the team into groups based on the area that needs to be developed. Typically these areas in-
clude shoulder stability, groin isometrics, and posterior chain/core activation. Twice a week, our players do dry land training, which is a hockey term for conditioning and agility work that takes place outside the weightroom. The main goal here is to start training the aerobic system to assure a fitness base in preparation for anaerobic sprint work. Hockey is not an aerobic sport, but having the ability to recovery quickly for the next high-intensity shift is critical. However, since we’re most interested in building a strong base at this point, we use a work-
Circle No. 130 T&C SEPTEMBER 2013
Off-season Dryland Here is a week of sample off-season dry land workouts for the Notre Dame men’s ice hockey team. Tuesday Thursday Plyos: Plyos: Hurdle jumps 4x3 and 5-yd sprint x4
Squat jumps 2x8
Tuck jump into 3 broad jumps x4 sets Lateral tuck jumps 2x8 R/L Skate jumps 3x6 R/L
Power skip 2x40 yards
Split squat jumps 3x6 R/L
Heidens 3x5 R/L
Acceleration drills: One knee starts (lateral push)
Acceleration drills: Cat/mouse scramble
Max effort sprints 4x15 yards (2R/2L) Max effort sprint and chase 4x10 yards
5-yard square patterns (x4 each)
Figure 8 drill x 4 (2R/2L)
3-cone drill x 4 (2R/2L)
Pro shuttle x 4 (2R/2L)
Shuffle R/shuffle L/sprint diagonal
5-yard continuous shuffle x 2 at 15 seconds
L shuffle/R diagonal
Conditioning: Conditioning: Shuttles (50 yards and back x6)
Shuttles (50 yards and back x6)
In-season Strength Here is a week of sample in-season strength-training workouts for the Notre Dame men’s ice hockey team. Monday Wednesday
5-way neck machine
Manual 4-way neck
DB single arm snatch or shrug pull
Front or back squat
Glute/ham or RDL
SL hamstring curl
DB or seated row
Weighted pullups or chinups
DB SA incline press
SL compound movement (choice)
3-way med ball groin
3-way shoulder raise
Keiser rotational chopping
T&C SEPTEMBER 2013
to-rest ratio of 1:5 for speed work and 1:4 or 1:3 for agility and conditioning. We also use plyometrics as part of our dryland training, starting with basic exercises performed in a single response manner (vertical, horizontal, and lateral movements), then progressing toward more complex multiple response jumps and bounds at the end of the phase. This helps build both power and endurance at the same time. Before each dryland session, athletes perform a dynamic stretching routine as a warm up. This typically includes 20yard down-and-backs, butt kicks, carioca walks, toe touches, inch worms, and similar exercises. (See “Off-season Dryland” at left for sample workouts.) Preseason: Shortly after the start of the fall semester, the team begins its official preseason workouts. We use one six-week cycle during this time and are limited by NCAA rules to eight hours per week. In this phase, our weightroom volume drops from high to moderate as individual on-ice skill development with the hockey coaching staff takes priority. Our exercise selection generally stays the same as the off-season, although we do incorporate more plyometrics into our weightroom work by using a heavy strength movement, such as a 3RM squat, prior to an explosive activity, such as a tuck jump. The goal is to induce central nervous system stimulation for greater motor unit recruitment. Our players lift four days a week, with two upper body days and two lower body days. The intensity of our lifting sessions remains high, but the total volume of sets and reps is reduced. Speed and agility sessions are still held twice a week, but we change the workto-rest ratios for these six weeks to 1:2 or 1:1 and focus on intervals of 15, 30, or 45 seconds, depending on the drill. Because these workouts are very intense, they are also very brief, lasting 15 to 20 minutes. The purpose is to induce a level of hypoxia similar to how they feel at the end of a shift. I want our players to understand what that feels like before the season starts so they’re not surprised when it happens in a game. To avoid overworking their joints, much of the metabolic work is done on stationary bikes. We’ll also use slide boards, which prepare and condition the hips, glutes, and groin area. In-season: For me, this is the most important of the four phases. Our players spend months working to increase their TR AINING-CONDITIONING.COM
sport specific power and strength, and letting up on strength work once the season starts would put that time to waste. In addition, players need to maintain, or ideally increase, their strength levels to help reduce injury risk and sustain a high level of performance throughout the six-month season. Games, practices, meetings, film study, and individual skill development leave little time for strength training, though. Our coaching staff allots me two of the 20 hours the athletes are available each week based on NCAA rules. To make the most of this limited time, once the playing season begins, we dial back the strength training to two times per week (three for players not regularly in the line up) while working around the game schedule. With most games played on Friday and Saturday nights, our typical training days are Mondays and Wednesdays. Both sessions have a total body focus, and we rely on compound multi-joint movements to maintain players’ strength efficiently and effectively. As we get into the dog days of February and March, we usually drop to one session a week to assist with recovery of those players
logging a lot of ice time, while developmental players will continue to train with two to three brief sessions during the week. (See “In-season Strength” at left for a sample workout.) Postseason: After the season ends— hopefully at the Frozen Four in early April—we give the players about two weeks off to recover physically and mentally from the grind of the long season. This usually leaves us with four to six weeks of work before the end of the semester. I use this period to jumpstart activities in the weightroom by gradually increasing the training volume through general physical preparedness activities. I will also re-introduce some of the more demanding exercises we may not have performed during the season. The goal is to establish the work capacity the players will need to see gains during the upcoming off-season phase. To allow their bodies to heal, all conditioning work during this postseason period is non-impact. This includes stationary bike sprints, upper-body ropes exercises, slide boards, and non-traditional activities, such as sledge hammer
swings and tire flips. The hockey coaching staff may also do some on-ice instruction during this time, which usually includes a conditioning component. While our philosophy of using Olympic lift variations in conjunction with compound, multi-joint movements works for us at Notre Dame, I recognize that it’s not the only way to train hockey players. But regardless of the specific exercises you use, the ultimate goal is to show the players a vision of what they can become and then help them achieve it. To do that, you have to coach them with firmness, fairness, and dignity; get them comfortable with being uncomfortable; and hold them accountable for their actions. Only then will you and your athletes be able to enjoy success. n The author would like to thank the Notre Dame hockey coaching and support staff for their confidence and support in the development of hockey athletes. He would also like to thank his staff (Elisa Angeles, Craig Cheek, Kaitlin Sweeney, Matt Howley, Glenn Clarke, and Geoff Puls) for the knowledge and dedication they share on a daily basis.
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T&C july/august 2013
Maximizing Weight Room Space
trength and conditioning coaches never have enough space in their weight rooms—even at the top level of college athletics. With so much they want to accomplish, they often run out of room before they run out of ideas. But when a couple of NCAA Division I strength coaches went looking for a way to get the most out of their facilities, they found Infinity Performance Flooring willing and able to help. At The Ohio State University, Mickey Marotti, Assistant Athletic Director for Football Sports Performance, recently had Infinity Max flooring installed in his weight room. As part of the flooring project, he also had the raised weightlifting platforms replaced with inlaid Infinity Max solid, seamless rubber platform centers that left the lifting areas flush with the rest of the weight room floor. “Having the inlaid platforms gives us a lot more space to work with,” Marotti says. “We now have a lot more flexibility to do conditioning, agility, and speed work in the room since we don’t the raised the platforms in the way. Plus, to be honest, I was getting tired of always tripping over the platforms as I moved around the room.” Marotti also likes the way the Infinity Max surface performs, for both athletes and coaches. “It’s a very user-friendly floor,” he says “You can do foot quickness and plyometrics on it, yet it’s held up well to the weights that get dropped on it. “Another thing I really like about the surface is that it doesn’t get slippery when athletes sweat on it,” Marotti continues. “Other floors you’re always having to wipe the sweat off to keep the athletes safe, but I really don’t have to worry about that now.” Emil Johnson, Director of Strength and Conditioning at Yale University, also chose to replace wood platforms with Infinity Max’s inlaid “Synthetic Wood” rubber platform centers when the school renovated its weight room earlier this year. “We usually have three or four teams training in the weight room at one time, so we need a lot of open area for everyone to move around without having to worry about tripping over a raised platform,” he says. “Plus, it’s a great lifting surface because it has a lot of grip. When our athletes are squatting or doing dead lifts, they feel secure because they know they won’t slip at all.” In addition to the Infinity Max flooring, Johnson also had the Yale facility outfitted with Infinity’s new iTurf, which is specially designed for running, jumping, and agility drills. Yale has a 10-foot wide, 42-yard long strip of 1.25” thick iTurf running down the center of its weight room. It’s marked for three lanes with a two-yard start box at one end and crash pads on the wall at the other. “This is one of the best indoor surfaces I have ever trained on, and we do all of our speed, acceleration, and change-ofdirection work on the iTurf now,” Johnson says. “It’s got great grip, but at the same time it has a little more force absorption to
Infinity Performance, Inc.
T&C SEPTEMBER 2013
it, which makes it perfect to jump on and do plyometrics on. And, it’s not at all abrasive, so the athlete can do kneeling exercises on it comfortably as well.” Johnson says the athletes’ reaction has been nothing short of tremendous. “They absolutely love it,” he says. “And it’s really helped our football team prepare for the season. We like to finish fast and this surface is a perfect way to end our workouts with some 5-10-5s or practice our starts without having to leave the weight room.”
www.infinityperformance.com TR AINING-CONDITIONING.COM
T&C September 2013 Volume XXIII No. 6
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 sheet (on page 55) that represents the best answer for each of the questions below. Include a $25 payment to MAG, Inc., and mail it to the following address: MAG, Inc., ATTN: T&C 23.6 Quiz, 20 Eastlake Road, Ithaca, NY 14850. Readers who correctly answer at least 70 percent of the questions will be notified of their earned credit by mail within 30 days.
Bulletin Board (pages 7-10)
Objective: Learn about recently published or presented research. 1. What did researchers discover about myostatin’s role in recovery from ACL reconstruction? a) It encourages growth of muscle tissue b) It inhibits growth of muscle tissue c) It has no effect d) It does not return to pre-surgical baseline levels during the rehab process 2. According to the study authored by Andrew Krause, PhD, ATC, nearly what percentage of athletic trainers have encountered and managed at least one athlete with a mental health disorder? a) 90 b) 70 c) 63 d) 44 3. Which of the following is not one of the entry-level competencies Krause suggests athletic trainers possess in regards to mental health diagnosis and management? a) Recognize signs and symptoms b) Make appropriate referrals c) Diagnose the disorder d) Maintain a strategy throughout the duration of care
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4. What did the study on highintensity re-warm-ups discover? a) There was no difference in performance with a re-warm-up b) The re-warm-up had a negative effect on players c) The results were inconsistent between the two re-warm-up groups d) The athletes who completed the re-warm-ups were more powerful, more skilled, and faster than the inactive group 5. After studying a high school football team’s shoes, what type of traction did the study leader recommend? a) Groupings of shorter cleats in the forefoot b) Large, toothy cleats along the outsole c) Shoes with a high “rotational” traction d) None of the above
Get a Grip (pages 19-25)
Objective: Discover the benefits grip strength provides when training for football and how it can help prevent injuries. 6. Why should a variety of wrist and forearm positions be used in grip training? a) They reflect the movements used during a competition b) Each grip style can be trained c) Athletes are less likely to become bored with the exercises d) They maintain a balance between forearm flexors and extensors, which could help prevent injury
7. Which of the following is not a type of grip? a) Crush grip b) Pinch grip c) Press grip d) Support grip 8. Which of the following is cited by the author as a benefit grip strength provides in the weightroom? a) Better repetition endurance b) Ability to perform a greater variety of exercises c) Decreased chance for an overuse injury d) Increased range of motion 9. Why is self-myofascial release important in grip training? a) It increases grip strength b) It releases the tension that builds up in the forearm muscles c) It allows for greater endurance when strength training d) It decreases the recovery time between exercises 10. Why should static stretching be completed after self-myofascial release? a) To regain any reduced flexibility or range of motion b) To break up any remaining forearm adhesions c) To locate any knots that weren’t treated d) To serve as a cool-down activity
T&C SEPTEMBER 2013
CEU QUIZ Heads & Headers (pages 26-32)
The Power of Vitamins (pages 33-40)
Power Play (pages 47-51)
11. According to the article, approximately what percent of concussions during the 2005-06 high school year resulted from girls’ soccer? a) 10 percent b) 21 percent c) 35 percent d) 42 percent
16. According to the article, which of these statements about micronutrients is FALSE. a) Micronutrients turn food into energy through metabolic pathways b) Micronutrients boost energy stores c) Micronutrients aid in the production of oxygen-carrying proteins d) Micronutrients help with the synthesis and repair of new muscle tissue
21. How long is an ice hockey player on the ice during a typical shift? a) 5 to 10 seconds b) 20 to 25 seconds c) 45 seconds to one minute d) Two to three minutes
Objective: Learn about how concussions are becoming a growing concern for female soccer players.
12. Which of the following does the author not give as a potential factor to explain why girls’ soccer players suffer more concussions than boys’ players? a) Inherent genetic differences b) Improper heading form c) A lack of understanding in how to protect themselves in the air d) A tendency to shove an opponent from behind 13. Which of the following is mentioned in the article as a possible concussion prevention strategy? a) Enhancing players’ proprioceptive skills b) Developing players’ upper back and neck muscles during offseason weight training c) Coaching proper heading technique d) All of the above 14. Which of the following was not included as a part of the author’s return-to-play protocol? a) 20 minutes of sport-specific drill work b) A 15-minute run c) 10 sit ups and 10 squat jumps d) Re-taking the computerized baseline test 15. According to a study referenced in the article, how many headers per year resulted in white-matter abnormalities similar to what is seen in patients with concussions? a) 250-750 b) 885-1,550 c) 1,750-2,300 d) 2,500-3,200
T&C SEPTEMBER 2013
Objective: To understand the role of vitamins and minerals for athletes seeking top performances.
17. Adverse effects of taking too much of a micronutrient include: a) Increasing the risk for toxicity b) Interfering with absorption and function of medications c) Both of the above d) None of the above 18. Which vitamin best helps with the body’s absorption of iron? a) Vitamin A b) Vitamin B c) Vitamin C d) Vitamin D 19. According to the author, antioxidants, particularly vitamins C and E, beta-carotene, and selenium, play important roles in: a) Protecting cell membranes from oxidative damage b) Increasing oxygen consumption c) Calcium absorption d) Production of red blood cells 20. The following food choices are examples of nutrient dense foods: a) Lean protein sources b) Whole grains, nuts, and seeds c) Fruits and vegetables d) All of the above
Objective: Learn about the strength training program used by the Notre Dame men’s ice hockey team.
22. What is the basic approach behind the Notre Dame hockey strength training program? a) Help players improve by making them stronger and better conditioned b) Teach players hockey skills c) Focus on upper body lifts and exercises d) Work on endurance over strength and power 23. Which of the following is not a lower-body exercise used by the Notre Dame hockey training program? a) Romanian dead lift b) Squats c) Hip presses d) Jumping jacks 24. Which phase of the Notre Dame hockey training program does strength coach Tony Rolinski believe is the most important? a) Off-season b) Preseason c) In-season d) Postseason 25. What work-to-rest ratio does Notre Dame hockey use during the preseason phase of its training program? a) 1:1 b) 3:1 c) 1:3 d) 5:1
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CEU QUIZ Answer Form Instructions: Go to www.training-conditioning.com and click on “CEUs” to take the quiz online. You may also
mail your quiz to us: Fill in the circle on the answer sheet below that represents your selection of the best answer for each question. Include a $25 payment to MAG, Inc., and mail it to the following address: MAG, Inc., Attn: T&C 23.6 Quiz, 20 Eastlake Road, Ithaca, NY 14850. Readers who correctly answer at least 70 percent of the questions will receive 2.0 BOC Athletic Training and 0.2 NSCA (two hours) CEUs, and will be notified of their earned credit by mail within 30 days. Questions? Problems? E-mail: CEU@MomentumMedia.com.
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Get a Grip
Heads & Headers
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The Power of Vitamins
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T&C SEPTEMBER 2013
Nutrition Fuel They Need
Give it everything you’ve got. Gatorade is dedicated to providing high school athletes with the fuel they need to achieve their best during practice and competition. That’s why Gatorade offers G Series performance packages to high school coaches and athletic trainers at a significant discount. To get the most out of every play and every player, visit the Web site to learn more and place your order.
Gatorade • 800-88-GATOR www.gatorade.com/coaches
Keep Your Brain Healthy Brain Armor is formulated for athletes to help support brain and cardiovascular health by delivering 1,050 milligrams of DHA per serving. Brain Armor was developed by DSM Nutritional Products, a leading innovator in the development of algal-based DHA omega-3 products that promote health and wellness through every stage of life. DSM Nutritional Products • 888-OK-BRAIN www.brain-armor.com
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Simple and Delicious Invigorate Your Regimen
For athletic performance, eye health, brain health, joint health, cardiovascular health, and beautiful skin, there may be no better suite of evidence-based ingredients than Astaxanthin, Omega 3 Fish Oil, and Vitamin D3. In 1800ATHLETE’s new Certified Astaxanthin with Fish Oil, you’ll find all three of these popular super-nutrients in a unique triple-action formula that goes a long way to invigorate your health regimen.
1800athlete.com • 516-301-5015 www.1800athlete.com
Science supports what elite athletes have known for years: low-fat chocolate milk has what it takes to help recover after a hard workout. High-quality protein helps rebuild, the right mix of protein and carbohydrates refuels, while fluids and electrolytes help replace what’s lost in sweat. It’s a simple, effective, and delicious way to help your body recover so you can perform at your next race, game, practice, or workout. MilkPEP • 202-737-0153 www.gotchocolatemilk.com
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Drops of Energy
Monster Amino™ is an ultra-concentrated BCAA formula that delivers an 8:1:1 ratio of leucine to isoleucine to valine. Recent university research shows that a leucineenriched beverage consumed along with exercise synergistically activates and prolongs activity of the mTOR signaling pathway, which increases muscle anabolic potential (muscle growth). The mTOR pathway is the “trigger” that signals the very genesis of muscle protein synthesis. CytoSport, Inc. • 888-298-6629 www.cytosport.com
Cytomax Energy Drops™ are a portable and chewable means to deliver a precise blend of carbohydrates and essential electrolytes. Cytomax Energy Drops™ may be used before and during training. Each portable pouch provides 10 individual chews. Cytomax Energy Drops™ are available in two great-tasting flavor options: Tropical Fruit + Pomegranate Berry (non-caffeinated), and Orange + Tangerine (50 mg of caffeine per pouch). Tropical Fruit + Pomegranate Berry is collegiate compliant. CytoSport, Inc. • 888-298-6629 www.cytosport.com
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Optimal Recovery Ratio
Rockin’ Refuel is a high-quality, natural protein beverage with the great taste of real milk. Rockin’ Refuel Intense Recovery provides the 2:1 carb-to-protein ratio optimal for muscle recovery with 20 grams of protein. Muscle Recovery has 17 grams of protein, with no added sugar. And it’s NCAA compliant, which is why more than 140 college and university athletic departments choose Rockin’ Refuel. It starts with real milk, and ends with real results.
Shamrock Farms • 602-272-6721 www.rockinrefuel.com
T&C SEPTEMBER 2013
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Harnessing the power of Creapure® Creatine, Certified Creatine™ works like a battery charger in your muscles. It regenerates ATP and ignites superior performance. Featuring a proprietary combination of Creapure® Creatine in combination with Vitamin D3, CoffeeBerry ®, and patented FruiteX-B® Boron, Certified Creatine™ is NSF Certified for Sport and available exclusively from 1800ATHLETE.com. Certified Creatine™ supports muscle strength and size, endurance in training, and fast recovery—as well as healthy brain function. 1800athlete.com • 516-301-5015 www.1800athlete.com
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Nutrition Increase Mitochondrial Function
N(r) is a breakthrough natural supplement with dramatic potential to help athletes and health conscious individuals worldwide. N(r) has research proven application for increasing mitochondrial biogenesis and function, which can greatly increase performance and metabolism. N(r) can also assist in protecting neurons for brain and nerve health and optimizing sirtuin function for anti-aging. High-Performance Nutrition • 206-232-9138 www.HPNFormula1.com
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Klean Multivitamin, part of the Klean Athlete™ line of nutritional supplements, is specially formulated for the unique needs of athletes. Each tablet has been carefully developed to contain the right proportions of vitamins, minerals, trace elements, and other nutrients without the danger of toxic build-up or other side effects. The unique fruit and vegetable blend contains ingredients such as Lutein, Lycopene, Zeaxanthin, Astaxanthin, and Pterostilbene, which are not found in other multivitamins. Klean Multivitamin uses EZ Swallow Technology and a twice-daily dose to assist with compliance for daily consumption. Klean Multivitamin is NSF Certified for Sport ®. Klean Athlete by Douglas Laboratories • 855-255-5326 www.kleanathlete.com Circle No. 544
Challenge Core Strength
Explore movement with 40 intermediate to advanced exercises using the OPTP PRO-ROLLER™ in PRO-ROLLER™ Pilates Challenge, by Angela Kneale, OTR. Combine these exercises into a personalized routine that emphasizes key principles like proper alignment, control, fluidity, concentration, and breath. Incorporating the PROROLLER with Pilates exercise is a motivational way to deepen mind-body awareness, promote better posture and symmetry, and challenge core strength and balance.
OPTP • 800-367-7393 www.optp.com
The Orbit ® is ideal for athletic conditioning professionals who would like the functional training benefits of Pilates but don’t have space for larger equipment pieces. The Orbit is lightweight and small enough to store anywhere. Athletes can sit, lie, kneel, or stand to perform a variety of exercises designed to challenge the entire body and keep the core engaged. It can improve balance, coordination, and strength. Includes a 35-minute workout DVD. Balanced Body • 800-PILATES www.pilates.com
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Intuitive and Simple
The Allegro® 2 Reformer was designed in collaboration with fitness professionals to be intuitive and simple to use. It helps enhance the flow and effectiveness of Pilates-based and functional athletic conditioning sessions. The Allegro® 2 Reformer features a footbar that adjusts vertically by lifting it up and moving it, even with the feet, and it slides the entire frame length to accommodate different body sizes. The Allegro 2 also allows users to make instant, one-touch, rope adjustments—even while they are lying on the carriage.
Unlike firmer rollers, the OPTP PROROLLER™ Soft provides gentle support that yields to the body’s natural pressure points and is easy on tight, sore muscles. Even though it’s soft, the closed-cell construction will stand up to heavy use and is perfect for multi-user environments, like Pilates studios. The PROROLLER Soft is an ideal complement to Pilates, core work, self-massage, and relaxation techniques.
Balanced Body • 800-PILATES www.pilates.com
OPTP • 800-367-7393 www.optp.com
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Lower-Body Strengthening Competitive Advantage
Athletes’ Performance is an expert in human performance, delivering an unparalleled competitive advantage to the world’s top athletes, teams, and military operators. Athletes’ Performance shares its integrated methodology that has supported the world’s top champions in sport through industry-leading accredited education programs. Education programs focused on performance training, nutrition, and rehabilitation are offered at Athletes’ Performance’s worldclass facilities, providing hands-on, practical, and researchbased education to industry colleagues.
Athletes’ Performance • 480-449-9000 www.athletesperformance.com/education
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The HiTrainer Pro is designed to significantly improve an athlete’s fitness in the minimum amount of time, making it an essential addition to training routines for any highintensity sport. It helps significantly develop anaerobic recovery, strength endurance, and cardio fitness. The less time an athlete requires working on conditioning in the gym, the more time that athlete can dedicate to his or her real sportrelated training.
HiTrainer • 855-726-3300 www.hitrainer.com
VersaClimber/HeartRate, Inc. • 800-237-2271 www.versaclimber.com Circle No. 511
The Thera-Band® Roller Massager+ is an innovative tool for myofascial release and deep-tissue massage. Its unique patentpending ridged design supports both superficial and deep-tissue mobilization while providing a massage-like experience. Use of the Roller Massager+ can help increase blood flow and circulation in targeted areas, while helping to increase muscle flexibility and range of motion. The Thera-Band Roller Massager+ is available in a standard and portable version with retractable handles. Performance Health • 800-321-2135 www.thera-band.com
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Push or Pull
The TDS Pro Sissy Squat is useful for toning, reducing, bulking, or conditioning the hams, glutes, and quadriceps. Use the TDS Pro Sissy Squat with bodyweight for toning and conditioning, or with dumbbells for bulking and building mass. This product is a commercial-quality machine, with heavy-form padding for a comfortable feel and an adjustable front foot holder and rear pad for a precise fit. The TDS Pro Sissy Squat is white powder-coated and made of 2” x 4” steel tubing.
New York Barbells of Elmira, Inc. • 800-446-1833 www.newyorkbarbells.com Circle No. 510
Exervibe is a whole-body vibration stepper that provides athletic enhancement when used in either the static (standing) or dynamic (stepping) position. Vibration stimulation is applied simultaneously to the feet, hands, arms, and core. The Exervibe has a step range from one to 18 inches, an adjustable seat, and a control module with four settings. It is an extremely versatile device that efficiently and effectively implements the benefits of vibration.
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Tone and Condition
Train Your Legs
The Drive Sled II is the perfect sled for pushing and pulling exercises. The handles allow for quick changes of direction, while the flat bottom allows for smooth pushing and pulling on multiple surfaces. The sled is constructed of heavy-duty welded steel for maximum durability and has multi-point attachments, which allow for even loads during exercises. The Drive Sled II is available in Perform Better’s 2013 catalog. To request your free copy, please call Perform Better or visit the company’s Web site. Perform Better • 800-556-7464 www.performbetter.com
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The Power Lift 40-degree Uni-Lateral/ Bi-Lateral Leg Press features a unilateral/bi-lateral locking mechanism, adjustable back pad with lumbar support, weight storage, seven-gauge steel construction, and an adjustable start position. The Uni-Lateral motion is ideal for users who want to train each leg individually. Sixteen highgrade liquid-cast polyurethane wheels guarantee smooth operation of carriage. Alternative angles are also available.
With the Step360™ Pro, you can step, stand, jump, and lie on it. This unique tool provides a safe and superior balance challenge for all core, range of motion, strength, power, and performance workouts. The secret is the two inflated air chambers beneath the flat, stable platform. Increase your quality of movement, body alignment, posture, and balance with the Step 360 Pro. It will also improve your muscle stamina and strength, as well as enhance explosiveness and agility.
Power Lift • 800-872-1543 www.power-lift.com
SPRI Products • 800-222-7774 www.spri.com
T&C SEPTEMBER 2013
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Lower-Body Strengthening Strength and Stability
Power Lift® offers a unique method of exercising the glute and hamstring muscles with the Rotating GluteHam Bench. This machine more effectively works the hamstrings, gluteus maximus, gastrocnemius, and erector stabilizers for more pelvic stability than traditional methods. The large rotating pads greatly reduce discomfort in the thighs, allowing for complete stretches and contractions of the hamstrings. An Easy Glide sliding mechanism effortlessly adjusts the machine so lower knee pads can properly position the body for a more fulfilling workout. Power Lift • 800-872-1543 www.power-lift.com
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Total Leg Development
The TDS Tibia Dorsi Calf Machine is great for runners, jumpers, and those interested in general leg sculpting. This product exercises the gastrocnemius and soleus, and has superior isolation of the tibia. Users can exercise each leg independently or both simultaneously. The TDS Tibia Calf Machine pivots on two industrialgrade pillow blocks. It is also commercial-quality with a steel deck plate and heavy padding for comfortable use. New York Barbells of Elmira, Inc. • 800-446-1833 www.newyorkbarbells.com Circle No. 515
Stretch the Limits
The new ProStretch Plus delivers unparalleled benefits for increasing flexibility in the plantar fascia, Achilles tendon, calves, shins, and hamstrings. Uniquely customizable, the patent-pending ProStretch Plus includes an adjustable, elevated heel rest, which both customizes fit and increases stability. An exclusive adjustable toe lift provides superior plantar fascia and toe stretch, and a larger platform comfortably fits most shoe sizes and allows for progressive stretching without readjusting the foot.
The Super Bungie kit allows you to push the limits of agility and strength training. Designed to meet the rigorous demands of professional athletic conditioning, the Super Bungie Kit features three interchangeable Super Bungie Cordz. The cords come in 75-, 150-, and 200-pound resistance levels, and the included handle and belt allow athletes to increase core strength and agility by training individually or with a partner. The patented safety elements found in TurfCordz® resistance products provide a safer, more comfortable workout.
Medi-Dyne Healthcare Products, Ltd. • 800-810-1740 www.medi-dyne.com Circle No. 546
NZ Manufacturing • 800-886-6621 www.turfcordz.com
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More Products Effective Challenge
The XTS Training System is a uniquely designed, total-body training tool that increases the intensity of upper-body, coremuscle, and lower-body workouts. The optional XTS thick-grip, anodized aluminum handles, available in two- and 2.5-inch diameter, are the perfect next progression from the 1.5-inch handles. The easily interchangeable handles add an effective grip challenge to enhance chest, back, shoulder, and arm muscle activation, while promoting optimal hand/wrist/forearm alignment.
SPRI Products • 800-222-7774 www.spri.com
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Multiple Grip Options
The First Place Sandbag Pods are durable, neoprene sandbags that are great for strength training, dynamic movements, and any bodyweight activity. The shifting sand inside the Pods challenge targeted muscles and core stability. Their unique shape provides multiple grip options, making them ideal for throwing and slamming. These First Place Sand Pods are a great alternative to use instead of a medicine ball, dumbbell, or kettlebell. Perform Better • 800-556-7464 www.performbetter.com
Protect Athletes’ Futures
Pearson • 800-627-7271 www.concussionvitalsigns.com
Rich-Mar • 423-648-7730 www.richmarweb.com
Concussion Vital Signs® (CVS), designed for student-athletes’ developing brains, aligns to current sports concussion management guidelines. This scientifically based system, used as part of a medical evaluation, enables confident return-toplay decisions while helping to protect the future of your athletes in sports, academics, and life.
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Gel-SHOT is the next generation of patented ultrasound technology from Rich-Mar. Gel-SHOT provides a no-mess, high-outcome solution to treatments. It features no freight cost, lower application cost, sterility, no mess, superior coupling, dosage control, extended treatment area, and better efficiency and outcomes. Circle No. 537 T&C SEPTEMBER 2013
More Products Perfect Cold Therapy
PRO ice wraps are the perfect method for applying cold therapy to most minor injuries. Made with quality neoprene for durability, these wraps are perfect for treatment of pulls and strains. Wraps are quick and easy to use, allowing for adjustable compression to keep ice packs in place. Available for the shoulder (#439), knee (#103) or back (#208). These wraps are available in black only.
PRO Orthopedic Devices, Inc. • 800-523-5611 www.proorthopedic.com Circle No. 524
The ESS Ankle Compression Sleeve’s patented articulated ankle joint allows for unrestricted movement while providing mild compression and support to the joint. Compression provides a performance-enhancement benefit as well as mild muscular support. The unique knitted design allows for lightweight fit and exceptional stretch and comfort. Cramer Products, Inc. • 800-345-2231 www.cramersportsmed.com
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Hibiclens® is a skin-friendly liquid antimicrobial skin soap that bonds to the skin and provides up to six hours of continuous killing action. Hibiclens is proven to kill many harmful bacteria including MRSA, viruses, and fungi. Washing with Hibiclens before contact with potentially harmful germs will significantly reduce the risk of transfer. Hibistat ® wipes do not require water and offer the same continuous killing action (up to six hours) found in Hibiclens. Circle No. 523
Used by many professional and college football players, the VETTEX DoubleGuard mouth guard features lip protection and breathing channels. Made by Markwort and available at IthacaSports.com, this onepiece, custom-fit mouth guard has double impressions with an adjustable strap. It’s available in 23 colors and comes in three sizes—pee wee, youth and adult. For free shipping, contact Ithacasports.com today.
IthacaSports.com • 800-716-9382 www.ithacasports.com
T&C SEPTEMBER 2013
Celliant is one of the world’s leading responsive textiles with clinically proven benefits. Celliant mineral technology is designed to recycle visible and infrared light into the body in a form it can use for energy. Moisture-wicking clothing, socks, orthopedic wraps, and bedding containing Celliant can enhance tissue oxygen and circulation, leading to better performance, quicker recovery, faster healing, and balanced temperature. Enhance your life with Celliant and claim your free socks online at the company’s Web site. CelliantTX • 866-315-4891 www.EnergyTextiles.com
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Medically designed, athlete-proven MediDyne products are easy-to-use tools that relieve tight muscles, stretch important muscle groups, and prevent pain and injury. With patented stretching, strengthening, foot, knee, and blister products, the Medi-Dyne family of brands includes: Cho-Pat ®; Tuli’s®; ProStretch®; StretchRite®; CoreStretch®; Skin-on-Skin®; and RangeRoller®. These products are known for both their effectiveness and ease of use. Medi-Dyne is dedicated to providing innovations in pain relief and prevention. Medi-Dyne Healthcare Products, Ltd. • 800-810-1740 www.medi-dyne.com Circle No. 528
Hibiclens/Hibistat • 678-250-7940 www.hibiclens.com
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Fits Your Schedule
American Public University offers more than 170 undergraduate and graduate degree and certificate programs designed for sports and health science professionals, coaches, athletic directors, and working adults like you— completely online. APU has been nationally recognized by the Sloan Consortium for effective practice in online education. Classes start monthly with eight- and 16-week courses. For more information, visit APU online. American Public University • 877-777-9081 www.studyatapu.com/sports
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Climb Your Way Back
The SRM Rehab Model VersaClimber is a total-body, closed-chain, rehabilitation exercise machine. The SRM allows patients to progress from non- to partial- to full-weight bearing, full-body exercise. It is fully adjustable to fit the height, weight, and length of all types of athletes and patients. Rehabilitation routines have been developed to provide a continuous arm and leg action in a seated or standing position, using varying stroke lengths, rates, and resistance levels. VersaClimber/HeartRate, Inc. • 800-237-2271 www.versaclimber.com Circle No. 530 TR AINING-CONDITIONING.COM
More Products Simple Solution
PRO Orthopedic Devices, Inc. • 800-523-5611 www.proorthopedic.com Circle No. 531
Mission Competition Fitness Equipment • 310-776-0621 www.ironneck.net Circle No. 526
Comfortable Shoulder Support
Ice bath therapy can be a very effective modality. Unfortunately, this therapy regimen can elicit complaints of extreme discomfort in personal areas. The PRO #805 Ice Bath Therapy Briefs, which are constructed of 1/8-inch-thick neoprene with hook and loop fasteners on each side for easy application, are an easy solution to this problem. Available only in black, the Ice Bath Therapy Briefs come in sizes medium, large, x-large, and xx-large.
Every roll of Cramer 100-percent cotton porous tape is like the next, which means you can count on it to unwind consistently, conform better, and adhere longer. Cramer 950, constructed with a latex-free adhesive, is perfect for athletic trainers or athletic programs looking for a high-quality, economically priced porous tape alternative. Cramer Products has been an industry leader in sports medicine and athletic training room supplies for more than 85 years. Cramer Products, Inc. • 800-345-2231 www.cramersportsmed.com
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The National Strength and Conditioning Association (NSCA) is an international educational association. The NSCA develops the most advanced information regarding strength training and conditioning practices, injury prevention, and research findings. Unlike any other organization, the NSCA brings together a diverse group of professionals from personal trainers, strength coaches, researchers and educators. These individuals are all in pursuit of achieving a common goal—improve athletic performance and fitness. NSCA • 800-815-6826 www.nsca.com
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PolyMem is an innovative, adaptable, drug-free wound care dressing. PolyMem dressings have been shown to reduce swelling, bruising, and pain associated with both open and closed wounds. PolyMem also helps localize the inflammatory reaction to the actual zone of injury, reducing the spread of inflammation and swelling into surrounding tissues. PolyMem dressings are available in both standard and antimicrobial silver formulations and come in a wide variety of shapes and sizes. Ferris Mfg. Corp. • 800-765-9636 www.polymem.com TR AINING-CONDITIONING.COM
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Mission Competition Fitness Equipment launched The Halo at the CSCCa Convention in May 2012, and the company marked it’s oneyear anniversary by introducing the product’s new name: The Iron Neck—a dynamic rotary neck strengthening cable attachment. The Iron Neck works out the neck by applying horizontal resistance during neck rotation. Mission Competition’s goal is to help prevent concussions and neck injuries by increasing the athlete’s neck strength.
Brace International offers the MAX ™, a major advancement in the design of shoulder girdle supports. The snugfitting, lightweight material allows for comfort with movement while protecting the glenohumeral joint from subluxations and dislocations. Its strap design system offers many options for maximal stability where needed, allowing athletes to reach their required range of motion. Brace International, Inc. • 800-545-1161 www.braceint.com
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Athletic Training Education
Florida International University (FIU) offers an accredited, professional Master of Science in Athletic Training degree through its College of Nursing & Health Sciences. Students are educated in cognitive and psychomotor skills related to recognition, treatment, and rehabilitation of injuries involving the physically active as well as risk management, healthcare administration, pharmacology, diagnostic imaging, and medical ethics. Upon graduation, students are eligible to challenge the national certification exam. Florida International University • 305-348-3398 www.go.fiu.edu/at Circle No. 542
Rich-Mar debuted a state-of-the-art composite heating unit at the 2013 NATA Convention. With no metal, this unit does not rust. It also features a low-voltage control digital thermostat, digital low water sensor, isolated heating element, and five composite slide-out dividers for packs—no tongs are necessary. The deluxe model features a dual-purpose circulation/drain pump, and a folding shelf. This product is available in 12-pack, six-pack, and four-pack models. Rich-Mar • 423-648-7730 www.richmarweb.com
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STAy CUrrEnT Our redesigned Web site features... • Headlines of the day • A blog dedicated to sports medicine and strength training • CEU opportunities • Special digital supplements • A searchable database of articles
VISIT US AT
Advertisers Directory Circle #. Company. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page #
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121 . 1800Athlete.com. . . . . . . . . . . . . . . . . . . . . 35
126 . Ferris Mfg. Corp.. . . . . . . . . . . . . . . . . . . . . . 39
124 . NSCA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
127 . AlterG. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
109 . Florida International University. . . . . . . . . . . 16
131 . OPTP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
117 . American Public University. . . . . . . . . . . . . . 25
103 . Gatorade . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
108 . Perform Better. . . . . . . . . . . . . . . . . . . . . . . 15
136 . Athlete’s Guide to Nutrition. . . . . . . . . . . . . . 62
115 . Hibiclens® & Hibistat® . . . . . . . . . . . . . . . . . 23
111 . Power Lift®. . . . . . . . . . . . . . . . . . . . . . . . . . 18
135 . Athletes’ Performance. . . . . . . . . . . . . . . . . 11
122 . High-Performance Nutrition. . . . . . . . . . . . . 37
114 . PRO Orthopedic . . . . . . . . . . . . . . . . . . . . . . 22
128 . Balanced Body. . . . . . . . . . . . . . . . . . . . . . . 43
102 . HiTrainer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
100 . Rich-Mar . . . . . . . . . . . . . . . . . . . . . . . . . . . IFC
110 . Brace International. . . . . . . . . . . . . . . . . . . . 16
123 . IthacaSports.com. . . . . . . . . . . . . . . . . . . . . 37
130 . Samson Equipment. . . . . . . . . . . . . . . . . . . 49
118 . Brain Armor by DSM Nutritional Products. . 29
125 . Medi-Dyne . . . . . . . . . . . . . . . . . . . . . . . . . 39
107 . Shamrock Farms Rockin’ Refuel. . . . . . . . . 13
119 . Concussion Vital Signs® - Pearson. . . . . . . . 31
113 . MilkPEP (Ironman®). . . . . . . . . . . . . . . . . . . 21
116 . SPRI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
104 . Cramer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
112 . MilkPEP (Refuel Buddies). . . . . . . . . . . . . . . 20
120 . The Iron Neck (Mission Competition). . . . . . 32
106 . DJO Global (Donjoy® Stabilizing PRO). . . . . . 9
134 . Muscle Milk® (CytoSport™). . . . . . . . . . . . . . BC
101 . TurfCordz®/NZ Manufacturing. . . . . . . . . . . . 2
133 . DJO Global (Fast Freeze). . . . . . . . . . . . . . IBC
129 . New York Barbells of Elmira. . . . . . . . . . . . . 46
105 . VersaPulley & VersaClimber. . . . . . . . . . . . . . 8
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501 . 1800Athlete.com (Astaxanthin with Fish Oil). . . 56
500 . Gatorade . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
513 . Perform Better (Drive Sled II). . . . . . . . . . . . 58
507 . 1800Athlete.com (Creapure®). . . . . . . . . . . 56
523 . Hibiclens® & Hibistat® . . . . . . . . . . . . . . . . . 60
518 . Perform Better (First Place Sandbag Pods). 59
529 . American Public University. . . . . . . . . . . . . . 60
543 . High-Performance Nutrition. . . . . . . . . . . . . 57
512 . Performance Health . . . . . . . . . . . . . . . . . . 58
508 . Athletes’ Performance. . . . . . . . . . . . . . . . . 58
509 . HiTrainer. . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
535 . Power Lift® (Leg Press) . . . . . . . . . . . . . . . . 58
520 . Balanced Body (Allegro® 2 Reformer). . . . . 57
545 . IthacaSports.com. . . . . . . . . . . . . . . . . . . . . 60
534 . Power Lift® (Rotating Glute-Ham Bench). . . 59
521 . Balanced Body (Orbit®) . . . . . . . . . . . . . . . . 57
544 . Klean Athlete by Douglas Laboratories . . . . 57
531 . PRO Orthopedic (Ice Bath Therapy Briefs). . 61
538 . Brace International. . . . . . . . . . . . . . . . . . . . 61
528 . Medi-Dyne. . . . . . . . . . . . . . . . . . . . . . . . . . 60
524 . PRO Orthopedic (ice wraps). . . . . . . . . . . . . 60
504 . Brain Armor by DSM Nutritional Products. . 56
546 . Medi-Dyne (ProStretch Plus). . . . . . . . . . . . 59
537 . Rich-Mar (Gel-SHOT). . . . . . . . . . . . . . . . . . 59
527 . CelliantTX. . . . . . . . . . . . . . . . . . . . . . . . . . . 60
505 . MilkPEP . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
540 . Rich-Mar (heating unit) . . . . . . . . . . . . . . . . 61
539 . Concussion Vital Signs® - Pearson. . . . . . . . 59
526 . Mission Competition (The Iron Neck). . . . . . 61
503 . Shamrock Farms Rockin’ Refuel. . . . . . . . . 56
532 . Cramer (950 tape). . . . . . . . . . . . . . . . . . . . 61
510 . New York Barbells (Pro Sissy Squat) . . . . . . 58
514 . SPRI Products (Step360™ Pro). . . . . . . . . . . 58
525 . Cramer (ESS Ankle Compression Sleeve) . . 60
515 . New York Barbells (Tibia Dorsi Calf Machine). . 59
517 . SPRI Products (XTS Training System). . . . . . 59
506 . CytoSport (Cytomax Energy Drops™). . . . . . 56
533 . NSCA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
511 . VersaClimber (Exervibe). . . . . . . . . . . . . . . . 58
502 . CytoSport (Monster Amino™). . . . . . . . . . . . 56
516 . NZ Manufacturing . . . . . . . . . . . . . . . . . . . . 59
530 . VersaClimber (SRM Rehab Model). . . . . . . . 60
536 . Ferris Mfg. Corp.. . . . . . . . . . . . . . . . . . . . . . 61
519 . OPTP (PRO-ROLLER™ Pilates Challenge). . . 57
542 . Florida International University. . . . . . . . . . . 61
522 . OPTP (PRO-ROLLER™ Soft). . . . . . . . . . . . . 57
T&C SEPTEMBER 2013
Target Pain Relief Fast Fast Freeze is a colorless formula that is 100% Paraben-free and is available in convenient roll-on, spray or gel.
Stay in the game and target pain relief with naturally cool Fast Freeze today. Visit BetterBraces.com\FastFreeze or call 800-226-4799
ÂŠ2013 DJO, LLC
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FOR TEAM SALES INFORMATION: PERFORMANCE@CYTOSPORT.COM 707-747-3372 • CYTOSPORT.COM
*Our products are tested for athletic banned substances in compliance with the NSF International Certified for Sport® program, which includes semi-annual facility audits, verifying that no NSF 306-Certification Guideline Annex A List banned substances exist in our facility.
©2013 CytoSport, Inc. MUSCLEMILK.COM
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WORKOUT RECOVERY FUEL
TO WORK HARDER TO RUN FASTER TO WIN