Challenged by a Coach n A Look at Nutrigenetics n Q&A with MSUâ€™s Sally Nogle
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March 2014, Vol. XXIV, No. 2
Bulletin Board New concussion recovery studies … Using stroboscopic eyewear … Athletes at risk for medication misuse … Back injuries in youth athletes.
Q&A 8 Sally Nogle Michigan State University Sponsored Pages 4 Balanced Body 13 Medi-Dyne 20 HiTrainer 26 HydroWorx 45 CSCCa IBC Lebert Fitness Product News 46 Catalog Showcase 48 Aquatic Exericse 48 Hot & Cold Products
A growing field that helps people optimize their diets based on their unique DNA, nutrigenetics is making its way into athletics. By Lauren Cahoon Roberts Leadership
21 It’s no secret that coaches will sometimes challenge your
decision on an athlete’s return to play. When should you draw a line in the sand? By Dr. Kimberly S. Peer Optimum Performance
28 The inherent asymmetries of the body can impact an athlete’s Finding Balance
performance. A new treatment program is focused on restoring inner balance through specialized postural and breathing exercises. By Michael J. Mullin Treating the Athlete
34 Treating a stress fracture can test the patience of even the To the Bone
most experienced athletic trainer. This two-part article provides a double dose of rehab secrets. By Summer McKeehan and Dustin Williams
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On the cover: Duke University center Elizabeth Williams is featured in one of two case studies on treating stress fractures, beginning on page 34. Photo by Timothy Sofranko
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A training program that draws inspiration from a variety of sports helps Oklahoma State University throwers develop the attributes they need to send their implements into orbit. By John Baumann T&C MARCH 2014
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
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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
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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 Former Associate 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
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T&C MARCH 2014
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
Gary Gray, PT President, CEO Functional Design Systems
March 2014 Vol. XXIV, No. 2
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 Patrick Pizzuti, Managing Editor R.J. Anderson, Patrick Bohn, Mary Kate Murphy, Dennis Read Circulation Manager Robin Flower 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© 2014 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.
Circle No. 102
It All Starts with the Feet By Daniel Wilson anD Beth PlaDson
n past issues we have talked about how important it is for athletes to maintain a strong core. After all, a strong core is tantamount to keeping the whole body healthy – especially the extremities, which obviously take a pounding because of the repetitive nature of an athlete’s motion. But the inverse is true as well. The condition of an athlete’s extremities- especially the feet- can have major repercussions on the rest of the body. Many mindful movement companies offer a variety of equipment to help the feet correct misalignments, lift the arch, and improve balance and gait. And many are inexpensive and (obviously) don’t take up a lot of space. Here’s a very effective massage/exercise for the feet that will help keep your athlete on his toes (pun intended). All it takes is a few bucks for a small, hard ball. These balls are especially affective at reaching the small muscles and fascia of the foot.
Stand with one foot on the ball and the other on the floor.
line of the foot until you reach the toes.
Starting point Begin with the ball at the back of the heel and press into it gently.
1) Lateral line Slowly move the ball toward the little toe pressing into each spot on the foot as you go.
Move the ball around the knuckles, gently massaging
3) Medial line After completing the middle line, place the ball back in the center of the heel and slowly move it forward along the medial line of the foot toward the big toe.
Move the ball to the toes, and gently grip the ball
Move the ball up the middle of the foot
2) Middle line Once you have completed the lateral line, place the ball back in the center of the heel and slowly move it forward along the middle
Interested in other products and props that can help the feet? Balanced Body offers a line of affordable equipment that will help strengthen, stretch, and improve over all foot health, creating a strong foundation. You can check it out at pilates.com/store.
Board Recovery Studies Making Headway Though current and retired professional athletes in highprofile sports generate most of today’s news about concussions, researchers are working hard to uncover optimal concussion management strategies for those not in the limelight. Two recently published studies focus on recovery predictors. In the first, researchers looked to identify factors predicting that post-concussion symptoms would last 28 days or longer. Published in the October 2013 Journal of Pediatrics, the study included 182 children ages 12 to 18 reporting sport-related concussions lasting at least four weeks. Based on their findings, researchers concluded that age, loss of consciousness, and amnesia could not be tied to the duration of symptoms. Instead, a higher Post-Concussion Symptom Scale score and lower performance on neurocognitive testing soon after the injury were better predictors of whether recovery would take longer than 28 days. In another study, researchers at the University of Rochester School of Medicine and Dentistry found that women who suffer a concussion in the two weeks leading up to their menstrual period heal more slowly than those whose injury occurred outside that time frame. Jeffrey Bazarian, MD, one of the study’s authors, believes this difference in recovery time is related to a woman’s level of progesterone, a brainprotecting hormone produced most abundantly in the two weeks before menstruation. In the study, published in November 2013 on the Journal of Head Trauma Rehabilitation website, follow-up evaluations revealed that of the 144 women treated for a concussion, those who suffered the injury within two weeks of their period were more likely to experience headaches and dizziness. On the other hand, Bazarian said, women who sustained the concussion in the two weeks after menstruating or women on birth-control pills, which prevent a drop in progesterone, reported less extreme symptoms. To learn more, type “Symptom Severity Predicts Prolonged Recovery after Sport-Related Concussion, but Age and Amnesia Do Not” into the search window at: www.jpeds. com and “Menstrual Phase as Predictor of Outcome After Mild Traumatic Brain Injury in Women,” into the search window at: journals.lww.com.
New-Look Performance Training Could practicing a sport while wearing glasses with lenses that alternate between transparent and opaque states improve an athlete’s performance? A new pilot study provides the first evidence that stroboscopic eyewear can directly impact sports performance in positive ways. TR AINING-CONDITIONING.COM
Appearing in the November/December 2013 issue of Athletic Training and Sports Health, the study tested the glasses on 11 NHL players from the Carolina Hurricanes during the team’s 2013 preseason training camp. Constructed of curved, plastic LCD lenses, the glasses alternately block and disrupt the athletes’ vision through a strobe or flicker effect. By switching between clear and obstructed vision, the eyewear trains the athlete’s brain to anticipate what’s coming when the eyes are blocked, which in theory improves their processing of visual information, timing, and ability to pick up on subtle motion cues. Designed and conducted by the team’s athletic training staff, the testing of the technology began with a baseline evaluation of the skill levels of seven forwards and four defensemen. The forwards completed a drill that demonstrated their skating and shooting proficiency, while the defensemen were tested on skating acumen and long pass precision. Next, four forwards and two defensemen in the group wore stroboscopic glasses for a minimum of 10 minutes per day over a 16-day period, performing typical on-ice drills. The five other players made up the control group, participating in the same workouts without wearing the eyewear. On the final day of training camp, all 11 players were retested using the same drill they completed for the baseline assessment. The group that had worn the stroboscopic eyewear averaged an 18 percent improvement in performance compared to their baseline score, whereas the control group showed no improvement. To read an abstract of the study, “Enhancing Ice Hockey Skills Through Stroboscopic Visual Training: A Pilot Study,” type “stroboscopic” into the search window at: www.healio.com.
Athletes at Risk for Medication Misuse The nature of participating on an athletic team often means sustaining sports-related injuries, which sometimes necessitate the use of prescription painkillers. A recent study indicates this puts male youth athletes at a heightened risk for medication misuse and abuse. In the study, 1,540 students ages 11 to 17 volunteered to take the Secondary Student Life Survey once a year from 2009 to 2012. The survey consisted of a series of questions about the students’ exposure to and use of prescription medications during the preceding 12 months, with a focus on opioids. Sixty-three percent of the participants were involved in organized sports over the course of the study. Published online in the Journal of Adolescent Health, the results showed that male athletes within the study group were 10.5 times more likely to take too much of an opioid medication and 4.01 times more likely to use it to get high. T&C MARCH 2014
Board However, female athletes in the study were not more likely to misuse opioids than female non-athletes. The researchers believe this problem is lessened through open communication. They encourage health care providers involved in the treatment and management of sports-related injuries to talk with athletes and their parents about the risks of medication misuse and abuse. “These drugs are being treated, or viewed, by adolescents [and parents] as something ‘safer’ than street drugs,” lead researcher Philip Veliz, PhD, told dailyRx News. “Although these drugs serve an important function to manage pain, they still have a high abuse potential.” To view the abstract of the study, “Painfully Obvious: A Longitudinal Examination of Medical Use and Misuse of Opioid Medication Among Adolescent Sports Participants,” search the study title at: www.pubmed.gov.
Back Injuries Are Third Most Common The lower back is the third most commonly injured area in athletes younger than 18, new research has found. The study was presented at the American Academy of Pediatrics’ National Conference on Oct. 28, 2013. Researchers
looked at 859 injuries suffered by 837 athletes aged eight to 18 who underwent sports physicals or injury treatment at Lurie Children’s Hospital between 2010 and 2013. A group of 360 uninjured athletes in the same age group made up the control group. Just over 15 percent, or 127, of the injuries observed in the study were of the lower back. Only knee (31 percent) and ankle (16 percent) injuries were more common. Of the lowerback injuries, nearly 40 percent were considered “serious,” such as stress fractures and the complications that can arise from them, like spondyloysis. The biggest contributing factor to lower-back injuries may be overuse, the study authors wrote. Athletes in the study with lower-back injuries spent an average of 12.7 hours a week playing sports, compared to an overall average of 11.3 hours among the injured athletes. Researchers recommend avoiding specialization in one sport before late adolescence and ensuring athletes spend fewer hours a week playing sports than their age number. To read an abstract of the study, “Risks of Specialized Training and Growth for Injury in Young Athletes: A Prospective Clinical Cohort Study,” go to: https://aap.confex. com/aap/2013/webprogram/Paper21503.html.
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Q&A Sally Nogle Michigan State University
When Sally Nogle, PhD, ATC, walked onto the Michigan State University campus in the fall of 1983 to begin her job as Assistant Athletic Trainer, she was taking the first steps of a trailblazing career. Thirty years later, she has become the school’s Head Athletic Trainer, is the only female Head Athletic Trainer for Football in the Big Ten Conference, and is a member of the NATA Hall of Fame. The 2013-14 year has been an especially exciting time for Nogle. Along with helping the Spartans to their first Rose Bowl win in 25 years, she is working to transition the athletic training department into a new age. Opening its doors last summer, the Sports Medicine and Performance Department at MSU brings athletic training, strength and conditioning, sports nutrition, and sports psychology and counseling all under the same umbrella. Nogle has also offered her services on the international level. In 1984, she worked the volleyball venue at the Los Angeles Summer Olympics and later provided coverage at the U.S. Olympic Sports Festivals in Baton Rouge, La., and Houston. Nogle served as the athletic trainer for the U.S. Women’s Basketball Team at the 1987 World University Games in Yugoslavia and for the U.S. Rowing Team at the 1988 Seoul Summer Games. Before starting her career in East Lansing, Nogle received both her Bachelor’s and Master’s degrees from San Diego State University, and in 2001, she earned her PhD from MSU. Her honors include an NATA Most Distinguished Athletic Trainer Award in 2004 and Michigan State’s Jack Breslin Outstanding Staff Award in 2006. She was inducted into the NATA Hall of Fame in 2012. Recognized as a great communicator, Nogle is known for building lasting trust with athletes, coaches, and colleagues. In this interview, she looks back at her three decades in athletic training and shares what she has learned along the way, including the importance of continuing to educate oneself and striking a healthy work-life balance. What were your career goals back in 1983? When I arrived at Michigan State, I was simply looking for experience. My goals were to eventually work my way up to being a head athletic trainer or to find an associate athletic trainer job in a place where I could be happy. Honestly, 8
T&C MARCH 2014
Michigan State Athletic Communications
In her first year as Head Athletic Trainer for the MSU football program, Sally Nogle (evaluating a player, above) helped the team become Rose Bowl champions. when I first started, I thought I would get some experience here and then go back to California. But East Lansing has been the perfect fit for my family and me and has given us quality of life. I’ve been very fortunate to work with great administrators, coaches, colleagues, and athletes, and that’s also what keeps me here. In the past, I had some offers, but I liked it at MSU too much. Also, when those offers came in, I had young kids and I didn’t want to uproot them or my husband just so I could be a head athletic trainer somewhere else. How did you break through the glass ceiling and begin working with the Spartan football team? At San Diego State, I was fortunate to study and work under Head Athletic Trainer Dr. Bob Moore, who was probably ahead of his time in that he allowed women to cover men’s sports. As a student, I worked and traveled with the football and men’s basketball teams. Then I came to Michigan State and was told I could TR AINING-CONDITIONING.COM
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Q&A If you’re paying attention to the details, you’re better able to communicate with coaches and keep them informed. That means you can’t wait until the last minute to tell them something about a player if it will impact a game or their practice plan. If a player is starting to feel sick, it’s important to let the coach know right away so that when practice rolls around and the player can’t go, the coach isn’t caught off guard. They don’t like being surprised. I also like to learn each coach’s style and preferences. Some might want to know about every little problem while others might not want to be bothered with minor issues. Over time, you learn what is and isn’t important to each individual coach.
Sally Nogle, PhD, ATC Head Athletic Trainer Michigan State University Major Accomplishments and Honors: 2012: Inducted into the NATA Hall of Fame 2013: First female Head Athletic Trainer for Football in the Big Ten
work with football players in the athletic training room, but I couldn’t be on the field or travel with the team. I was a little surprised by this, but after a year or two, then-Head Coach George Perles realized that I could do the job and it didn’t matter what my gender was. What did becoming the first female Head Football Athletic Trainer in the Big Ten last July mean to you? Since it was something I aspired to when I began my career, it’s very satisfying on a personal level. And if I’m a role model for other female athletic trainers, that’s great, too. It wasn’t my intention, but I’m glad to do it. How have you handled male coaches who may have had misgivings about working with a female athletic trainer? All you can do is work hard, do your job, and act professionally toward those coaches. You can’t control their behavior—only your response. If they were gruff with me, I would still be polite and respectful. It doesn’t matter if that coach is right or wrong, you still have to handle yourself professionally. What have you learned over the years about communicating with coaches and earning their trust? 10
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What’s your preferred method of communication with coaches? I like talking with them face-to-face. With football, we meet every day and I give the coaching staff a written injury report and go over it with them. I’ll also text them if a player comes in sick or injured to let them know he might not make it to practice. How has working as Head Athletic Trainer within the new Sports Medicine and Performance Department changed your job description? The department is designed to provide a more streamlined and comprehensive approach to athlete wellness and performance training. My focus remains on taking care of the athletes and keeping them on the field, but now I also have to learn more about some of the ancillary pieces like drug testing and insurance coverage. Having a bigger staff with different types of expertise within the department that I can lean on has helped with my learning curve. What are your goals for the athletic training staff in the new arrangement? That we shine. I want us to keep learning and getting better individually and as a group. We’re going to keep educating ourselves and make sure that’s a priority. My philosophy is not about pushing people and encouraging them to grind, it’s about creating an environment where we can help those we serve and enjoy what we’re doing. How do you bring out the best in your athletic training staff and keep them from burning out? I encourage my staff to be lifelong learners, because that’s something that helps keep us all fresh. We also try to help each other maintain a good work-life balance. No matter what you do, or where you work, family is still the most important thing and you have to speak up and let others know how important it is to maintain that balance. My colleagues and I are always willing to step up and cover for one another when things in our personal lives come up. Burnout is a big problem in our profession. Athletic trainers often leave the field because of the time demands, so we don’t currently have a lot of experienced athletic trainers in their 40s and 50s. That hurts, because TR AINING-CONDITIONING.COM
Q&A we need those people as role models to help maintain a high standard. You coordinate the mental health program for MSU’s student-athletes. Why is that important to you? Going off to college is often the first time a kid is away from home and it can be tough. They’re still growing up and maturing and some of them go through pretty big bumps in the road. As athletic trainers, we’re in a good position to watch out for homesickness and depression and other struggles they may be having. If you really observe and listen to your athletes, you can sense when things aren’t going well for them. If it’s something minor, we can try to talk them through it, but if it’s more serious we refer them to our sports psychiatrist or another trained professional. What drew you to working with national teams? It was really appealing to work with new people and learn about how they approach sports medicine and athlete care. Also, I got to see athletes at the pinnacle of their careers and help them try to reach their goals. Having the opportunity to visit a variety of countries that I probably wouldn’t have otherwise was also very appealing.
What did you learn from those experiences? One of the biggest things I learned was that the sports medicine coverage we have in the U.S. is the best in the world. It also helped me realize how special the collegiality amongst those in our profession is. Everyone is so willing to help one another and share their knowledge.
“My philosophy is not about pushing people and encouraging them to grind, it’s about creating an environment where we can help those we serve and enjoy what we’re doing.” Looking back, what’s the most memorable rehab you’ve conducted? There are many, but one that comes to mind is Amp Campbell, who broke his neck in 1998. That rehab was difficult, especially at the beginning when he was in a halo and really struggling with his situation. It was as much psychological as anything with him. But in his first game back, he recovered a fumble and ran it in for a game-winning touchdown. That was special to see.
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Q&A You’ve said that being a female can sometimes be an advantage when working with athletes. Why is this? A lot of our athletes come from single-parent homes, and even if they grew up in two-parent homes, their mothers were usually the ones who took care of them when they were sick or went with them to the doctor’s office when they got hurt. I’m not trying to be a mom to them, but I’ve found a lot of athletes really open up to female athletic trainers and feel they can tell us anything about how they’re feeling.
How do you approach working with athletic training students? It’s important to put the students in situations where they can learn. If an athlete gets hurt and the athletic training student can be hands-on with the injury, that’s great. If they can’t, let them watch you perform the exam. If you’re going to the doctor’s office with the athlete, have the athletic training student go as well. And if they’re skilled enough to pack a supply trunk, have them do it—then double-check their work. We make sure they get as much hands-on experience as possible.
What was it like having your daughter play for the MSU basketball team? It was special to have Tracy playing here because I could tape some ankles for football and then walk over to the arena and watch her games. It was also interesting because she would come talk to me about things going on with the team and I would have to listen with a mother’s perspective, even though I obviously had additional insight because of my relationship with the coaches and other athletes. I tried to listen and be there for her but not get too involved. Just like any other athlete, she had to learn to handle things on her own and work through challenges.
What did your induction into the NATA Hall of Fame mean to you? It was very humbling. I love what I do and here I am getting paid for it! Then, on top of all that, you want to honor me for it? I was blown away. The most satisfying part was being mentioned alongside all of the great athletic trainers who are already enshrined. I’m in the same hall of fame as my mentors and role models and that’s really cool. n
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In the next issue of T&C: Announcing the winner of the 2014 Most Valuable Athletic Trainer Award
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Maintaining Lower Leg FLexibiLity to reduce injuries: RangeRoller & ProStretch Plus a Success
ead Track and Field and Cross Country Coach Justin Leonard has built a dominant program at Southlake Carroll (Tex.) High School during his career. In October 2013, both the boys and girls’ crosscountry teams captured their 3rd State championship in 3 years, with three individual medalists, two of whom have committed to run for the University of Texas next year. For the girls’ team, this year marked the 10th straight season in which they finished 3rd or better in the state. Both teams have also had significant success at the Nike Team Nationals, with a combined seven wins and an additional six top-five finishes. In 2012, the boys’ squad finished eighth at the Nike Nationals and the girls’ squad placed second. And during the 2013 track season, several runners won individual accolades, including Courtney Krieghauser, who won the state title in the girls’ 1600-meter run. While it’s never easy to maintain success over a long period of time, Leonard has kept Carroll Southlake at the top thanks to a simple coaching philosophy: if you want to succeed, you have to stick around and earn it. “We have a large cross country program—142 kids,” Leonard says. “And only seven boys and seven girls can make the varsity team. But I tell every one of my runners every year that I don’t know who’s going to be on the varsity, so any one of them can make it if they work hard enough. I have some girls who are seniors and that’s the first time they get on the varsity team. But they stick with it because they’ve seen others do it before them.” But another secret to Carroll Southlake’s success has been the critical pre- and post-race work that can make the difference between winning and losing. For Leonard, this began two years ago, when he learned about the potential benefit his team could gain by using Medi-Dyne’s RangeRoller, a massage therapy tool, he knew he needed to take a closer look. “For the most part, our runners had done standard stretching and warm-ups with a partner,” Leonard says. “But when I heard about the RangeRoller from a member of the team, I decided to look more deeply into it.” Leonard was impressed and not long after his inquiry, several members of the team began using the RangeRoller. Now, they’re ubiquitous at track and cross-country meets at Carroll. “One of our top runners began using it and experienced success, and once the other kids saw that, the popularity took off,” he says. “Now, almost every member of the team has one, and they carry them in their backpacks.” Carroll Southlake runners begin using the RangeRoller about 45 minutes prior to the start of a race, rolling the bar over their calves, quads, and hamstrings. They often repeat the process once they’ve completed the rest of their warm-up, and Leonard says the effects are noticeable. “The athletes have told me that using the RangeRoller feels great,” he says. “They say it really relaxes them and gets their muscles ready for a race. And post-race, they say it helps wash out the lactic acid and get the blood flow back to those areas.” Leonard heard about another Medi-Dyne product, the ProStretch Plus, which has a rocker design that helps hold a runner’s foot in the proper position for a proper lower leg stretch. “After the success we had with the RangeRoller, I thought it would be a good idea to look at what
other products Medi-Dyne had that could be beneficial to our athletes,” Leonard says. “I found the ProStretch Plus fits the bill perfectly. Not only does it help kids get raceready, if they’re feeling tight after running, it’s a great way for them to get ready for practice the next day. ProStretch Plus plays a critical role in keeping calves, hamstrings, Achilles tendons and plantar fascia flexible. Making it key to preventing shin splints, Achilles tendonitis and plantar fasciitis.” “The more we can alleviate soreness and get them back to 100 percent for the next workout, the better off everyone is going to be,” Leonard says. “The ProStretch Plus has helped us do that.” The team has about ten ProStretch Plus units, which Leonard says he brings to all the meets to give to runners as needed both before and after races. In addition to helping muscles recover and stretch, he says another benefit of both the RangeRoller and ProStretch Plus is their ability to allow runners to stretch themselves. “Four or five years ago, runners were stretching with each other or with me, and that was challenging for a number of reasons,” Leonard says. “For them, it made it more difficult to focus on their own routine and get prepared for their race, and for me, I had to juggle the need to help runners get ready and time those who were already competing. Now, they can do an effective warm-up on their own, and it’s great.” Leonard says he’s seen his whole squad thrive from using both the RangeRoller and ProStretch Plus, using the same culture of togetherness he tries to instill in his J.V. practice or anything like that. The boys don’t train separately from the girls. We all pull together. “In the same vein, once some of our runners started using the two Medi-Dyne products, and once they started experiencing success, the rest of the team followed suit quickly,” Leonard adds. “As a result, the whole team has benefited from using the products, and I think that will continue in the future.” For more information on the RangeRoller and the ProStretch Plus, please visit www.medi-dyne.com.
My early days of bodybuilding were all about getting some muscle on my skinny 6’1, 170lb frame! Year after year I would consistency gain 10lbs of hard earned muscle and became very adept at pumping iron. After 5 years of lifting and weighing 220lbs I remember going back home to see my high school friendsthey were blown away.
EQUALIZER™ Quick Tips 1 Great for agility and mobility drills 2 Basic core bodyweight (bodybuilding) exercises like dips and rows
3 Made of steel and will support 400lbs 4 Marries strength and function 5 Portable and versatile
From Aesthetics to Function ~
Never felt stroNger T
hen I got into martial arts and boxing and realized that, while strong and naturally athletic, I had a lot of work to do moving my body in this new way. So I changed the way I lifted- rep schemes, types of lifts, uni-lateral, explosiveness, core, etc. It wasn’t just about the aesthetic look anymore but about function and performance. A few things happened too that I didn’t expect. I may have lost some overall strength but I was faster, more adaptive and flexible in my other training, my core was stronger (tended to not work that much with bodybuilding- at least not rotation) and my claves and shoulders came in amazing (from all the skipping and high reps but they didn’t respond to the heavy weights like my chest, quads and back did).
So now I have an appreciation and understanding for both types of training and as much as I love “functional” training, I think that many people do not have enough of a strength base before they get too complicated with the functional moves. Going for the wow factor over core competencies first. So let’s look at some basic bodyweight strength moves like dips and push-ups. Why do people think they need to do full bodyweight or advanced versions when they can’t go full range of motion with control. If pushups need to be on the knees and dips need to be leg assisted so be it. Proper form needs to be built in and the prime movers need to be experienced and working.
basically a PORTABLE PULLEY MACHINE and I can do those towel pulls but also many uni-lateral exercises and the harder you work, the more resistance you get with INSTANT TENSION ADJUSTING CAPABILITIES. This is cool because being strong is just part of being a great fighter you NEED muscle endurance! And the type of crazy muscle endurance that blurs the lines of all the energy systems and this is exactly what we do- my MMA guys (and clients/club members too) row as hard as they can for 3 minutes with constant challenges in the line of pull. From the sides, up high, on the floor- always moving and keeping the long rowing motions going with hands to the rib cage and reaching out keeping strict form, consistent cadence (if possible) and rowing with all they have. The power output may drop but the tension is always adjusted and correct. So my strength training continues as do my goals and I find the use of both core bodybuilding exercises with some functional (and sometimes funky) progressions keep me challenged and stronger than ever!
Buddy System™ Quick Tips 1 Portable pulley machine 2 Bi & Uni-lateral exercises 3 INSTANT tension adjusting capabilities (extend sets, drop sets) 4 Core and stability training from the ground up
Now when proficient at the dips and push-ups this is where 5 Adds I love to add “function”! I do my dips on the EQUALIZER™ nice and low, explode up and go into a leg raise with feet way over head. Tons of core. For chest I do a whole series of incline presses on the EQUALIZER™ with knee drives, Spiderman’s and high knees. Never felt stronger. For back I used to do deadlifts, chin-ups, t-bar rows, etc and finish with towels. Mt workout partner and I would do one arm rows against each other for 100 reps on each arm. This was 20 years ago and I don’t remember seeing anyone else do it or how we came up with it but I remember it well. I couldn’t hold my water after! This was the genesis of my Buddy System™ so I could keep doing these exercises not only in the gym but in the dojo too. The Buddy System™ is
a little bit of friendly competition
Marc Lebert Marc Lebert is the owner of Lebert Fitness Inc and is also a Fitness Club Owner, a Taekwondo Black Belt who has competed at the National level, a Certified NLP (Neuro-Linguistic Programming) Practitioner and International Presenter. Marc was the Silver Lining Entrepreneur of the Year 2010, named Top 100 Fitness Entrepreneurs in the Industry and a finalist for Canfitpro Fitness Professional of the Year 2012. Marc Lebert developed the Lebert EQUALIZER™, BUDDY SYSTEM™ and STRETCH STRAP™. Marc is very committed to giving back having raised a considerable amount of money for worthy causes. To see more please visit www.LebertFitness.com
Reaching Down Deep A growing field that helps people optimize their diets based on their unique DNA, nutrigenetics is making its way into athletics. By Lauren Cahoon Roberts
A AP Photos/Kathy Kmonicek
s a triathlete who routinely competes in Ironman competitions, Addison Huddy is always looking for an edge. For most endurance athletes, that edge comes from tried and true methods such as rigorous training, healthy eating, and high-quality sleep. But to get the most out of those tactics, Huddy underwent a personalized analysis of his DNA to better understand his nutritional needs and optimize his diet accordingly. Along with a small but growing number of athletes around the world, Huddy now knows which vitamins and nutrients will maximize his performance. Access to this information is being made possible by a relatively new and still developing scientific discipline called nutrigenetics, which is only just gaining visibility among athletic professionals. Nutrigenetics examines how an individual’s unique genetic code affects their response to different nutrients. With this information, an athlete can take a more personalized approach to nutrition and eating for performance. Instead of athletes trying to optimize their diets through trial and error, a quick cheek swab and corresponding lab test can yield more accurate information on the nutrients most likely to help them be at their best. While the technology is available to anyone who can pay the fee, which ranges from $65 to $500, depending on the company and service, it’s relatively untested. Nevertheless, for Huddy, having his genes tested was a no-brainer. “I’m a big believer that knowledge is power,” he says. “I think it’s pretty amazing where genetics is going to take us.”
Lauren Cahoon Roberts is a freelance writer based in Ithaca, N.Y., who has covered issues in health and wellness for a broad range of publications. She can be reached at: cahoon.lauren@ gmail.com.
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NUTRITION THE SCIENCE At the center of nutrigenetics are nucleotides, which form the basic building blocks of DNA and play a key role in metabolism. Every human being has variations in their genes known as polymorphisms, which can comprise long
CAFFEINE BREAKTHROUGH Caffeine, most notably in the form of coffee, presents a clear example of how genes can dramatically affect a person’s response to certain foods. “After decades of being perplexed about why there are extreme differences in how
Unrelated people are genetically distinct by approximately two to three million single-nucleotide polymorphisms (SNPs). When it comes to nutrition, SNPs are important because they can change the production and function of proteins in the body. sequences of DNA or just one nucleotide variation within a link of the DNA chain. While long-chain polymorphisms can affect a body’s ability to process nutrients, single-nucleotide polymorphisms (SNPs) are by far the most common. SNPs are variations in a person’s DNA sequence that are passed down through one’s parents. They originated at some point during human evolution when minor copying “errors” were made by nature as DNA was replicated during reproduction and growth. They occur about once every 1,500 nucleotides and the pattern of different SNPs is unique to each individual. Considering the huge number of nucleotides in the body, this means unrelated people are genetically distinct by approximately two to three million SNPs. When it comes to nutrition, SNPs are important because they can change the production and function of proteins in the body. These proteins interact with nutrients such as vitamins in a variety of ways, and they play a vital role in how the body responds to different foods. For example, some proteins bind to vitamins and help them get absorbed by cells. Others convert them into useful biological building blocks. A third type of protein will degrade vitamins and cause them to be expelled from the body. Changes to any of these proteins can impact how well certain foods are metabolized. That means two individuals can respond differently to any number of foods, depending on their genetic makeup. A number of SNPs have proven connections to certain nutrients. These SNPs have been identified as useful markers around which diet and supplement regimens can be designed. 16
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caffeine affects people, scientists looked at users’ genotypes, and that helped solve the mystery,” says Nanci Guest, MS, RD, CSCS, a dietitian and personal trainer who collaborates with the nutrigenetics company, Nutrigenomix. A single gene known as CYP1A2 is most influential in the metabolization of coffee. CYP1A2 has two variations—one causes the body to metabolize caffeine quickly, while the other is responsible for slower metabolization. Knowing which variation they have can be vital to athletes who utilize caffeine as a performance enhancer. For athletes who metabolize caffeine more slowly, consuming a large amount just prior to competition may not have the desired effect. In addition, since the stimulant remains in their system for a longer period of time, it
“Since their enzymes access caffeine in the bloodstream in a delayed fashion, if they take it too close to their event, they could overshoot and the beneficial effects of the substance won’t kick in until long after they’re needed. “On the other hand, those who metabolize caffeine faster should generally take it closer to the beginning of their event, as well as during the event if necessary,” he continues. “Otherwise, they may lose its benefits before the competition’s over.” After getting his DNA tested at the Stanford Sports Genetics lab and discovering he was a fast caffeine metabolizer, Huddy changed his intake approach. “Instead of only doing one big burst of caffeine, I spread it out over the course of the day to sustain the benefits,” he says. “That was a big element they discussed with me in my genetic counseling at Stanford.” According to Kim, the bottom line is that if an athlete knows their own particular caffeine metabolism, they can better time their intake to improve performance. “It could give you a leg up,” he says. OTHER GENETIC CLUES Beyond caffeine, there are a number of performance-enhancing nutrients that are thought to affect individual athletes differently depending on their genes. In its testing program, the Stanford Sports Genetics Program looks at a span of 150 different polymorphisms. For ex-
Vitamin C is a well-known antioxidant and another nutrient that can be spotlighted by genetic testing. According to Nanci Guest, because every athlete has a unique genetic makeup, vitamin C should not be supplemented in a one-size-fits-all manner. may increase their risk of negative side effects such as high blood pressure and heart attack. These athletes have to be cautious in their approach to caffeine supplementation. “We think slow metabolizers should take less caffeine, and they should do it well before their competition,” says Stuart Kim, PhD, Professor of Developmental Biology and Genetics at Stanford University and founder of the Stanford Sports Genetics program, which provides nutrigenetic and other types of gene tests to athletes.
ample, results have shown that certain athletes have genetic predispositions to vitamin D, calcium, and iron deficiencies, among others. “We’ve found a large number of genetic variations in people’s vitamin and nutrient absorption,” says Kim. “Athletes can use the test results to address deficiencies and make sure they’re at their peak.” Vitamin C is a well-known antioxidant and another nutrient that can be spotlighted by genetic testing. According to Guest, because every athlete has TR AINING-CONDITIONING.COM
NUTRITION a unique genetic makeup, vitamin C should not be supplemented in a onesize-fits-all manner. “If you take too much, it can inhibit your body’s adaptation to training,” she says. “But if you have too little, you can be at risk of impairing your body’s ability to repair muscles and repair oxidative damage.” How much is enough again depends on an athlete’s genetic code. Nutrigenomix has a test for the GSTT1 gene, which affects a person’s efficiency in utilizing vitamin C. Similar genetic tests exist for other nutrients and these includes folate (MTHFR gene), which assists in red blood cell formation, tissue repair, and amino acid metabolism, and omega-3 fatty acids (NOS3 gene). Additionally, Nutrigenomix has a test for the ACE genotype, which, according to the company, indicates if someone is at risk for salt-sensitive hypertension. Since sodium is an electrolyte, this test can be particularly important in preventing athletes with the ACE genotype from aggravating the condition by replacing their elec-
trolytes after workouts via high-sodium foods. Other genetic testing can examine an individual’s susceptibility to certain health problems based on their diet. Tests for the APOA2 gene variant can tell if someone is more or less at risk for heart disease, type 2 diabetes, or obesity if they eat a diet high in saturated fats.
while others see a spike in their glycemic load in response to processed foods. According to Guest, athletes could be tested for the TCF7L variants to determine if they would benefit from a whole grain, low glycemic index diet. SUCCESS STORIES Along with providing athletes with a
“When I talk to the athletes, I find they aren’t always complying with their regimens—sometimes skipping vitamins—so their efforts are often below the optimal level. A personal nutrigenetic report could dramatically change an athlete’s attitude and compliance.” Another gene variant is TCF7L, which is linked to an individual’s susceptibility to type 2 diabetes when exposed to a traditional Western diet high in red, processed meat, and low in fiber. This variation may explain the fact that some individuals are seemingly able to eat whatever they want and still maintain a low glycemic load,
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breakdown of their needs, nutrigenetics can serve as a motivator for many athletes who may not always adhere to healthy diet and exercise plans. “When I talk to the athletes, I find they aren’t always complying with their regimens— sometimes skipping vitamins or certain weight-training exercises—so their efforts are often below the optimal level,”
NUTRITION says Kim. “A personal nutrigenetic report could dramatically change an athlete’s attitude and compliance.” Stephen Bauer can confirm this. As an ex-triathlete, current sports performance coach for football, wrestling, and track and field, and an exercise physiologist for the Stanford program, he got his own DNA tested and found that he’s susceptible to both vitamin D
the United Kingdom, his clients have also benefitted from the testing. One of these was a cyclist looking to lose weight in order to improve his speed. “He wanted to be sure that if we put him on a low-carb, protein-rich diet, it would work for him,” says Chamberlain. “And the test bore out that if he did eat a lot of carbs, he would store them around his belly, which would
An area of concern is how genetic test results are used ... “We can help make sure we empower athletes with a new edge and not hinder their careers,” says Stuart Kim. “We don’t want some quarterback being cut because something in his DNA was red-flagged.” and iron deficiencies. This knowledge has changed his attitude towards these nutrients. “Despite being at the level where you should be very cognizant of your nutrition, it’s easy to lapse,” says Bauer. “With this information, though, I’m more diligent in maintaining my nutrient levels.” According to Paul Chamberlain, founder of Beyond Nutrition, a sports and nutrition counseling firm based in
make it difficult for him to lose the weight. That was my inclination already, but it was nice to have it confirmed by the test data.” PROCEED WITH CAUTION While the fundamental science behind SNPs is sound and a growing number of athletes claim the testing has benefitted them, nutrigenetics has yet to receive widespread recognition as an effective tool for improving athletic per-
TEST TIME In addition to the Stanford Sports Genetics program, Beyond Nutrition, and Nutrigenomix, there are a few other companies around the world that offer nutrigenetic testing, with a range of services and prices. These include Pathway Genomics in San Diego, Calif., and DNAlysis in Illovo, South Africa. For those who want to pursue the testing, these companies offer a range of services and prices. The Stanford program asks for a $299 donation in exchange for a DNA genotype analysis that looks for variants associated with certain vitamin and mineral levels, caffeine metabolism, and iron levels. Nutrigenomix offers similar testing for $250, plus $100 for the requisite dietitian consult. Beyond Nutrition offers a range of tests, including a vitamin D status test for about $65, a test to measure the efficiency of the stomach and small intestine for around $320, and a more comprehensive test which examines amino acids, vitamins, minerals, antioxidants, organic acids, and oxidative stress for roughly $500. Pathway Genomics will analyze 75 genetic markers in your body known to impact metabolism, energy, and exercise, for about $300. For around $135, DNAlysis will test 20 genes involved in seven key biological processes related to the absorption of nutrients.
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formance. Shawn Arent, PhD, CSCS, FACSM, an Associate Professor in the Department of Exercise Science and Sport Studies at Rutgers University, is familiar with nutrigenetic testing, but cautious about acknowledging its role in improving athletic performance. “[Nutrigenetic testing is] in its infancy right now,” he says. “I’d be hesitant to recommend it to athletes at this point.” Arent explains that, as it stands now, nutrigenetic testing is more proven in the arena of basic health maintenance and improvement. “In terms of health, it’s easily the next frontier,” he says. “In the areas of cardiovascular disease and obesity, I don’t dispute that we now have more knowledge [from nutrigenetics] about these problems. How does that information translate to athletic performance? That’s less clear.” In addition, the findings of nutrigenetic testing aren’t always revelatory, says Kendra Sticka, MS, MEd, RD, LD, an Assistant Professor of Dietetics and Nutrition at the University of Alaska Anchorage. She cites the MTHFR gene variant, which influences a person’s folate requirements, as a prime example. “There’s a very clear SNP there,” she says. “People with the MTHFR variant need a higher level of folic acid to have certain metabolic pathways function correctly. But it’s common knowledge that if you take the recommended amount of folate, you should be fine. It’s nice to know about your genetic predispositions, but do you need that much information to make a commonsense decision? “Right now, the testing leads us back to what we already know,” Sticka continues. “The results don’t change our recommendations. If we discover that a person would be particularly responsive to exercise, that’s good to know, but we’re not telling anyone not to exercise.” Nutrigenetic testing also raises some ethical concerns for Arent. “Who’s delivering the results?” he says. “If an athlete gets this genetic information, who’s explaining it? Is it someone selling the promise of the science, but without the genetic background to explain it?” Despite Arent’s concern, most nutrigenetics testing facilities ensure that trained physicians, scientists, and dietitians are the only ones allowed to analyze a person’s nutrigenetics test data. Some companies have tried to sell test results directly to consumers, but were stopped by the FDA. TR AINING-CONDITIONING.COM
NUTRITION Another area is how genetic test results are used and who sees them. This issue is a high concern for Kim, who would like to ensure that his services empower but not hinder athletes in professional sports organizations. “By getting in on the ground floor in sport genetics, we can help make sure we empower athletes with a new edge and not hinder their careers,” he says. “We don’t want some quarterback being cut because something in his DNA was red-flagged.” Thus, Kim prefers to have individual athletes contact his program themselves and make their own choices around the test results. “We have a lawyer and two bioethicists working on this project because we don’t want to cause discrimination,” he says. “We’re really setting policy on how this plays out.” IN THE FUTURE Despite some setbacks, the field of nutrigenetics doesn’t look like it will be going away any time soon. As companies continue to spring up and the testing is adopted by more users, the cost of the services is likely to go down. “In the next five years, every athlete is going to be genotyped to see what nutrients they need to perform optimally,” says Guest. “It’s a field that’s just exploding.” Rikki Keen, MS, RD, CSSD, CSCS, a sports and clinical dietitian at Alaska Regional Hospital in Anchorage, believes it’s important for sports dietitians, athletic trainers, and strength coaches to educate themselves on the benefits of nutrigenetics. “It’s coming, and we need to be proactive about researching it so we can get on board when it arrives,” she says. However, Keen doesn’t believe the testing will provide all the answers to athletes’ dietary questions. “I don’t think it will be the only tool that’s used, but I do think it will be valuable when combined with other tests,” she says. “For example, I’d like to compare the results to what I know from the metabolic testing and see how that’s going to correlate.” Keen’s employer has decided to incorporate nutrigenetic testing into its suite of patient services. The hospital is training physicians and other medical staffers to read the results of the tests Keen and her colleagues are preparing to conduct. The hospital also plans to compare the results to other information they typically gather from athletes. TR AINING-CONDITIONING.COM
“It’s going to be interesting to link the patients’ genetic profile to our results,” says Keen. “The same goes for nutrition. I’m hoping the genetic testing can explain some of the differences we see between individuals.” Guest believes nutrigenetics will undoubtedly benefit elite athletes. “Athletes on professional, world, or Olympic teams want to have that competitive edge,” she says. “As sports dietitians, we need as many tools in our toolbox as possible. If [nutrigenetic testing] can give an athlete a slight edge, that could
be the difference between getting a gold medal or not.” With all that it promises in the future, athletes who have undergone the testing see it as a long-term investment. Huddy says he gets e-mails every couple of months from the Stanford researchers alerting him of newly identified genetic markers that may shed more light on his personal DNA. “Who knows what they’ll find next,” he says. “And the more knowledge I have about myself, the more confident I’m going to be as an athlete.” n
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IMPROVING SPRINT PERFORMANCE
ee Evans is one of the legendary sprinters in U.S. track and field history. While winning two gold medals during the 1968 Olympics in Mexico City, he set a world record in the 400 meters with a time of 43.86, and he still ranks among the all-time 10 fastest men in the event. He also anchored the 4x400 relay team that set a world record at 3:56.1, which is still among the top 10 times ever recorded.
dependence on one leg over the other throughout the sprint, he can work with the athlete to overcome those barriers to improved speed.
Despite this legacy of speed, close friend and long-time track and field coach Charley Baker feels that with the technology available today, Evans could have been even faster. “I’m not sure how much, but I believe he could have been even better had we access to some of the tools we now have,” says Baker, who coached Evans at San Jose City College and later It shows the coached at Indiana University. “In those athletes how much days, it was mostly about repetition, better they perform acceleration runs, when doing things hill climbs, and stadium steps. Now, the proper way. we have so many more options to help athletes improve.”
In addition, with the coach being stood beside the athlete throughout the sprint, he can get a closer look at the biomechanics Analyzing Biomechanics and provide feedback on the HiTrainer on the fly. Baker says one tenet to sprint success is arm position, “You’ll see people trying to run fast, but their arms are flailing all over the place,” Baker says. “To improve speed, your arms and legs have to work together and the arm action should be a short pendulum motion. If you leave your arms extended, it can cut your speed by 20 to 40 percent.’’ By using the HiTrainer Pro, an athlete and coach can instantly see the results of any change in technique, “It shows the athletes how much better they perform when doing things the proper way.” explained Baker.
One of Baker’s favorite new tools is the HiTrainer Pro, a selfpowered treadmill-based device that offers coaches and athletes unprecedented access to real-time information on an athlete’s sprint performance, as well as an advanced energy system development workout: The HiTrainer does not replace the track, what it does is enable a coach to identify otherwise hidden imperfections in an athlete’s sprint that could be costing them valuable fractions of a second, making it a valuable tool in any high speed sport. Onboard sensors collect detailed data otherwise invisible to the naked eye. If a coach is able to identify leg imbalances and/or
Real-Time feedback Face to face with the console
Another big difference is the variable, yet precise, resistance the HiTrainer can provide runners during their workout. Since the athletes provides the power for the treadmill, adding 10 or 20 pounds of resistance will force the athlete to work that much harder. However, rather than dealing with cords or parachutes as they would on a track, coaches can add that resistance with the press of a button. “This makes it much easier and more efficient and requires less of the athlete’s training time.” Said Baker.
www.hitrainer.com HiTrainer Pro Performance analysis:
Lines on the Sidelines It’s no secret that coaches will sometimes challenge your decision on an athlete’s return to play. When should you draw a line in the sand?
s football season was kicking off last fall, The Chronicle of Higher Education 1 released results of a study and presented an article about what happens when athletic trainers for football disagree with the head coach regarding concussion returnto-play decisions. The report revealed that athletic trainers in the NCAA’s Football Bowl Subdivision are regularly pressured in this area and that some have lost their jobs when they refused to back down. While the article hopefully spurred discussion among university administrators about reporting lines and the overreach of football coaches, athletic TR AINING-CONDITIONING.COM
By Dr. Kimberly S. Peer trainers in the trenches were not surprised by the study’s findings. From those who share the sidelines with big-name coaches to those at the high school level, sports medicine professionals know that some coaches will challenge return-to-play decisions, regardless of the sport. And in some cases, butting heads with coaches can have career-altering ramifications. So how can athletic trainers best han-
dle these difficult scenarios? What are some strategies to pursue when your judgment is questioned by a coach? How do you weigh the ethical dilemma that arises? Confronting such a situation is not easy by any means, but thinking about it in advance and having a game plan ready can help. LAWS & GUIDELINES The very nature of sport itself creates
Kimberly S. Peer, EdD, ATC, FNATA, is an Associate Professor at Kent State University. She serves on the CAATE Ethics Committee and the NATA Committee on Professional Ethics and is co-author of Professional Ethics in Athletic Training. She is a Past President of the Ohio Athletic Trainers’ Association (OATA), is a member of the OATA Hall of Fame, and has been honored with the NATA Most Distinguished Athletic Trainer Award and GLATA Outstanding Educator Award. She can be reached at: firstname.lastname@example.org. T&C MARCH 2014
iN THE TRENCHES A high school athletic trainer, who will remain anonymous, explains his first-hand experience with a difficult coach.
everal years ago, I worked as a certified athletic trainer at a high school in which the head football coach continually questioned my judgment and put his athletes’ health in danger. Initially, I rolled with the punches, believing this coach just needed time to get to know me and my level of competence. But things only got worse. He would suggest to me that he knew the athletes’ conditions better than I did and that he felt they were faking injuries. He would come into the athletic training room and publicly tell athletes that they weren’t being tough enough and didn’t need to be there. Often, a player would give me a doctor’s note that limited his participation or required him to undergo specific treatment prior to practicing. Some of these instances involved the return to practice following concussions. The coach often wanted me to ignore the physician’s directions. Then some parents informed me that the coach was telling athletes who were injured and wanted to come see me to stay away from the athletic training room, because he figured I would just pull them out of competition, regardless of the severity of the injury. At that point, I knew I had to do something. My first step was to document everything. This was not hard to do since I had been recording every instance when parents or athletes contacted me with these concerns—much like any medical professional would do in a patient’s chart under the subjective portion of the SOAP note. While I was compiling evidence against the coach, I continued to carry out my duties as best as I could, making sure to discuss the treatment of the athletes and participation guidelines almost daily with the team physician. I also leaned on a fellow athletic trainer at another school, who is a great friend and mentor to me, for advice and support. I knew that I could be risking my job by issuing a complaint against the football coach, but I did not think about this much. I felt that the risks of doing nothing were
many ethical challenges—from cheating and gambling to commercialization to character development 2-5. As athletic trainers, we are not alone in having to deal with moral issues in athletics. That’s one reason there are guidelines in place to keep us honest to our profes22
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far greater. What if an athlete suffered a permanent or catastrophic injury because I remained silent? If this injury was determined to be due to negligence on the part of the sports medicine team, I could lose more than my job. I could lose my license and ability to practice. Ultimately, I believed I had to take a stand against the coach to ensure the safety of the athletes. When I went to the athletic director with my complaint, I had clear documentation about the risks of the situation. I felt I explained the situation professionally. But the athletic director didn’t want a confrontation, and the superintendent didn’t want to get in the middle of our situation. The district decided to “go in another direction” with the sports medicine program, and I was let go. This was a difficult outcome to stomach, but I felt confident I could rebound. And fortunately, I landed on my feet. I was able to secure a position as both an athletic director and athletic trainer at another school, and the two jobs have worked well together. I have never regretted standing up to the coach, but I might have done a few things differently. I could have involved the athletic director sooner to show how the decisions I made were medically backed and not a personality conflict. It might have worked well to ask the athletic director for advice each time the coach ignored recommendations for limited practice or participation. It also might have helped to have the support of the team physician to show the coach and athletic director that we were united on the treatment of the athletes. My advice to other athletic trainers dealing with this situation is to document and communicate. Write down everything that is going on and involve as many members of the sports medicine team as possible in the treatment of athletes. Communicate with the head coach and assistant coaches verbally and in writing on a daily basis— do not assume that player status or practice restrictions are communicated to the entire staff when you only speak to one coach. Finally, don’t be afraid to ask for help from others. Speak to veteran athletic trainers you know and respect as well as administrators in your school. Ask friends to be a sounding board. Know that you have the athletic training community behind you, and don’t be afraid to do the right thing.
sion and organizations to back us when our judgment is questioned. To start, athletic trainers are bound by specific licensure and/or certification guidelines. In states with licensure, the law governs the scope of practice and a violation results in legal action.
In states where there is no licensure, the Board of Certification defines scope through the Role Delineation/Practice Analysis6 . This document spells out the domains and tasks relevant to the athletic trainer. The Board of Certification also has a Standards of Professional TR AINING-CONDITIONING.COM
LEADERSHIP Practice document that clarifies professional practice standards, including ethical conduct. Further, the NATA has an established Code of Ethics that defines ethical behaviors and mechanisms for reporting violations and the Committee on Professional Ethics to investigate violations. Recently, there has been a surge to increase accountability of members to report anyone who is practicing athletic training without the proper credentials, bolstered when the Strategic Alliance of Athletic Training issued a joint statement entitled, “Legal and Ethical Responsibility to Report Unregulated Practice7.” In essence, if a coach or any other athletic professional oversteps their boundaries in regards to an injured student-athlete, they may technically be practicing athletic training without a credential. Return-to-play decisions often fall in this area if a coach or administrator overrides the athletic trainer’s finding. THOUGHT PROCESS Knowing there are laws and national
O O %
governing bodies on your side can ensure an athletic trainer does not feel alone when challenging a coach regarding an athlete’s recovery. But the individual still has to think through how they wish to proceed. A bit of ethical theory can help to understand the considerations to weight when moving forward. In the book Moral Courage8, author Rushworth Kidder presents four paradigms for evaluating most situations: honesty versus loyalty, individual versus community, short term versus long term, and empathy versus justice. These paradigms help us to resolve issues by framing them in one or more of these perspectives. For example, if you are discussing with a coach a return-to-play decision for a star athlete who had a recent ankle injury, he or she may be looking at the situation from a community perspective (team) and short-term perspective (win). An athletic trainer, on the other hand, has an individual and long-term (potential future disability) perspective. Both viewpoints could be viewed as ethical. So what do we do when our views collide? Kidder suggests examining three elements when developing moral courage:
O N L I N E
Principles: The first component asks us to think about the values and principles that guide our behaviors. When we are faced with ethical dilemmas, we try to resolve them by framing them as “right versus right” or “right versus wrong.” Right versus right decisions occur when moral values are violated in order to do something we feel is justified or important. We may violate ethics to achieve a worthwhile goal. Right versus wrong decisions appear to be much clearer, but they are not. Wrong is defined as a violation of law or acts of moral turpitude, and most of us draw a line in the sand to define our own level of tolerance for committing a wrong. Where we get into trouble is when we move the line in the sand to please others, avoid consequences, or remove conflict. For example, a return-to-play decision for a star player in a highstakes game may be more of a dilemma than making the same call for a thirdstring player in a scrimmage. Coaches and administrators might pressure you to consider each athlete individually. But both athletes should be considered
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LEADERSHIP in exactly the same way. If the right decision is to hold an athlete out due to the injury circumstances and the evaluation of objective data, then their status or the stakes involved should be irrelevant. Moving the line in the sand violates our own principles. As athletic trainers, pressure from coaches and administrators skews our perceptions of right versus wrong because we are part of the team as a health care provider and
Lastly, intuition is often referred to as a “gut feeling,” and is the hardest to trust. Many of us know deep down when a decision isn’t right, but we sometimes override that feeling or rationalize our behavior. As athletic trainers, it’s imperative that we trust our instincts. Enduring the pressures associated with a delayed return to play is where the athletic trainer has to really dig in
The second element of moral courage involves recognizing the risks. All decisions have risks associated with them, and some have higher risks than others. What we have to do is determine which risks are worth taking based on our values and principles. truly want the team to succeed. But honoring our principles means standing our ground to protect the athlete—every time. Danger: The second element involves recognizing the risks. All decisions have risks associated with them, and some have higher risks than others. What we have to do is determine which risks are worth taking based on our values and principles. For example, not standing our ground in a return-to-play decision can expose us as not having strong principles. On the flip side, disagreeing with a coach can sometimes mean the loss of a job and decreased standing in the community. Both situations have inherent risks, and it’s up to the individual to decide which outweighs the other. Endurance: The last component of moral courage involves enduring the hardships, which involve the factors of experience, faith, character, and intuition. Experience is a powerful teacher and informs our decisions daily. It is most powerful when combined with thoughtful reflection about the lessons learned prior. Faith is what we firmly believe in. Character is that component of yourself that evolves from doing things consistently over time. Many have compared character to an old oak tree. The oak stands tall and strong and withstands the storms but is quickly brought down with a chainsaw. Like the oak tree, our character takes a long time to establish but can be destroyed with one bad decision. 24
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and take a stance. We are the health care providers, and we are the ones trained to protect the athlete. Sometimes we must have the courage to go the distance when tough decisions need to be made. IN ACTION How do guidelines and theory work in practical terms? Consider this scenario: You are an athletic trainer treating an athlete who has recently experienced a meniscal injury of the knee. The player’s physician has given a “go-as-can” status. The athlete has performed rehabilitation on a consistent basis but still has intermittent pain and is fearful of reinjury. The team is slated to begin conference play in a week, and the coach is pressuring you to get the athlete back on the field. You explain the reservations of the athlete and the limitations seen in rehabilitation, but the coach argues the athlete is healthy enough to return—as reflected in the physician’s release. Clearly, this situation is not life or death. However, it is riddled with ethical elements that will impact the relationships between the athlete and coach, athlete and athletic trainer, and athletic trainer and coach. To start, it is imperative to consider the rules and regulations that govern our profession. Athletic trainers work under the direction of a physician and are bound by either law or standards to their scope of practice. In this situation, the athletic trainer is following the directions of the physician, which is to
allow the athlete to practice “as can.” However, that does not mean the athlete is cleared to play, and this may need to be explained to the coach. The dilemma evolves further because the coach is pushing the athletic trainer to get the athlete back as soon as possible. But if the athlete is unable to return either psychologically or physically based on objective measures, the athletic trainer should consider the primacy of the patient and be cautious in returning him or her too soon. Being persuaded by a coach to go against objective measures relative to physical or mental readiness to play is clearly an ethical violation. What if the coach insists that you return the athlete and a contentious situation arises? This is where thinking ahead of time about ethics and the elements of moral courage can help. To start, what are your principles—do you feel it is okay to allow the athlete to return if he or she is not ready? What are the dangers to think through? And can you call upon experience and intuition to help you make your decision? It’s also important to stay calm, focused, and objective. Emotions typically lead us into discussions that have little relevance to the matter at hand. Keeping feelings out of the conversation will help diffuse the situation. If the interaction continues to escalate, it may be useful to walk away. Explain to the coach that you are going to leave the argument and that you will gladly talk to him or her at a later time when emotions are calmer. It is okay to leave the conversation, especially if you are being demeaned or challenged in public. If you do this, be sure to follow up with the coach in a timely fashion. It is recommended that you have a colleague or supervisor with you. Documenting the interaction and conversations for future reference can also be helpful. Let’s look at a similar situation through a different lens. What if the athletic trainer is adamantly against an athlete returning to play based upon objective testing and functional criteria, yet the physician clears the athlete? This is more complex, as the athletic trainer works directly under the direction of the physician. The best solution would be to discuss the objective findings with the physician and try to reach a compromise regarding the athlete’s return. TR AINING-CONDITIONING.COM
LEADERSHIP This can be done through open communication and thorogh documentation and discussion of findings. Should the physician remain adamant that the athlete is ready to go despite your recommendations, a second opinion is always an option. There are certainly some risks associated with this method, but if the patient is the top priority, we are obliged to provide him or her with a second opinion. This is exactly what moral courage is all about—standing up for what you believe in even in the face of impending consequences. Know yourself, trust yourself, and believe in yourself, because when you do, you will not be swayed by peer pressure. Listen to your intuition—if it feels bad, it probably is. Losing yourself is far worse than any consequence that could emerge. THE RIGHT THING Athletics is an area where ethical dilemmas often occur. Emotions are involved, and the stakes can be high. But in life, the stakes are even higher. When dealing with serious injuries, such as concussions, there is no room for error. While it is discouraging that so many athletic trainers fear for their jobs when they do not support a coach’s desire to return an athlete to play, it is important to be true to our profession. If we are certain that it is not in the best interest of the athlete to return, then it is critical to stand strong and advocate for their proper care despite the risks involved to us personally and professionally. Recent concussion literature is redefining the rigor with which we consider head trauma and return to play. The consequences for failing to use extreme caution are severe. Although in the heat of the moment, some may believe it is worth the risk to play the athlete and get the win, retrospectively, the risks are far too high. Athletic trainers should not be concerned with a win-loss record—we should be focused on players’ lives and futures. Knowing where you stand before these situations arise is critical in making the right decision. Thomas Jefferson once said, “In matters of style, swim with the current. In matters of principle, stand like a rock.” Knowing when to stand like a rock and when to swim with the current is imperative. And when you do stand like a rock, do it with conviction. Demonstrate your moral courage and do the right thing. Nothing is worth the consequences of returning an athlete too soon. n References: (1) http://chronicle.com/article/Trainers-Butt-Heads-With/141333/ Accessed Jan. 8, 2014 (2) McNamee, M., & Parry, S. (1998). Ethics and Sport. Routledge Press, New York, NY. (3) French, P. (2004). Ethics and College Sports. Bowman & Littlefield Publishers, Inc., Lanham, MD. (4) Simon, R. (2004). Fair Play. Westview Press, Cambridge, MA. (5) Shogan, D. (2007). Sport Ethics in Context. Canadian Scholars Press, Inc., Toronto. (6) Board of Certification. (2010). The 2009 Athletic Trainer Role Delineation Study. Omaha, NE: Stephen B. Johnson. (7) Strategic Alliance Releases Statement: Legal and Ethical Responsibility to Report Unregulated Practice. Nov. 12, 2013. Accessed at www.caate.net on Jan. 9, 2014. (8) Kidder, R. (2005). Moral Courage. Harper Collins Publishers, New York, NY. TR AINING-CONDITIONING.COM
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An Inside Look at the Trend We talked with two different athletic trainers from the MAC to get a bit more insight on this growing trend: Phil Voorhis MSEd., ATC, Assistant Athletic Director at Northern Illinois University and Brian Jones, Assistant Athletic Director for Sports Medicine at the University of Toledo. Voorhis decided to incorporate aquatic therapy in their facility, simply because they were aware of the advantages of water. Additionally, they had a staff member who has aquatic therapy training and would be able to utilize it effectively with the athletes. Jones wanted to incorporate aquatic therapy —Brian Jones. Asst. AD for Sports Medicine, University of Toledo to provide the best treatment and care to their studentathletes. More specifically, Jones says “In a world where we need to get our SA’s back as soon as possible, hydrotherapy gives us another “tool” in providing the best possible care to all our student-athletes.”
“We have had fantastic results using the HydroWorx pool. We use it as part of a rehab program, exercise, conditioning and other various uses. ALL our Coaches also use it as a “recruiting tool” during the official visit.”
Because of the positive feedback and referrals from colleagues and other universities, both Jones and Voorhis chose Hydroworx pools for their sports medicine facilities.
Overcoming the Challenges of Adding Hydrotherapy As with any large purchase, planning time and resources are required. This can raise a number of challenges and concerns. For Voorhis, at Northern Illinois University, his concerns involved “the logistics and mechanics of this large product as well as getting all of the parties involved (architects, engineers and vendors) on the same page.” Voorhis found that conference calls, in-person visits and emails with all parties involved kept the project running smoothly. At the time of purchase, the University of Toledo was remodeling their facility; therefore Jones was worried about the budget and making the pool “fit” into their space. Jones found success by working with the athletic administration at the University of Toledo to “sell” the pool as a rehabilitation tool as well as a “major enhancer in recruiting.” In order to achieve the best results possible, communication was key to their success. Both universities have seen benefits in recruitment, faster return to play and enhanced performance in their athletes as a result of having an aquatic therapy pool.
TEAMS WITH HYDROWORX POOLS NCAA Division I college programs aren’t the only ones installing aquatic therapy pools for their student athletes. Here’s a list of DII and DIII programs that utilize HydroWorx in their sports medicine programs. St. Cloud State University Alderson Broaddus College Carson-Newman College Gaston College Lindenwood University Merrimack University Valdosta State University Washburn University Missouri Western Northwest Missouri State University NorthWood University Nova Southeastern University Salem International University Calvin College Concordia College Ferrum College Frostburg State University Georgia Military College Gettysburg College Ithaca College Lebanon Valley College University of St. Thomas Wartburg College Randolph Macon College
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The inherent asymmetries of the body can impact an athlete’s performance. A new treatment program is focused on restoring inner balance through specialized postural and breathing exercises.
AP PHOTOS/RICH SCHULTZ
Finding Balance By Michael J. Mullin
elping athletes reach their athletic goals requires a complex and multifaceted approach, with nutrition, injury avoidance, and recovery just a few of the many components that need to be considered. However, another crucial piece of the puzzle is only beginning to receive attention—the structural and functional asymmetry of the body and its influence on the way we breathe and move. Internally, human anatomy is asymmetrical, so the various systems of the body— neurological, respiratory, circulatory, visual—are not the same on the left side as they are on the right, with one side usually more dominant than the other. Since our muscular patterns are determined by how these systems are integrated, the differences on our left and right sides have a direct influence on our body alignment and posture, shaping our respiratory function and movement. These anatomical asymmetries are normal and don’t typically cause problems unless they become pronounced enough that the body is unable to control them. This can happen when a particular pattern of movement is repeatedly reinforced and ingrained over time during high-impact sports or exercise, or even through simple, everyday activities such as the way a person sits in a chair. Michael J. Mullin, ATC, LAT, PTA, PRC, is a clinical athletic trainer at OA Centers for Orthopaedics in Portland, Maine. He has over 23 years of experience working with athletes from the youth to professional levels and is a certified practitioner through the Postural Restoration Institute. He can be reached at: firstname.lastname@example.org.
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Optimum performance When asymmetries are pronounced, the body begins to compensate for them in such a way that it can no longer maintain stability in these areas. Over time, this can begin to significantly shift bones and joints—and the muscles that cross them—out of a balanced, or neutral, position, restricting muscle movement in the affected areas and increasing the risk for musculoskeletal pain and injuries. An effective method of curtailing such asymmetries is through a treatment approach developed by the founder of the Postural Restoration Institute (PRI), Ron Hruska, MPA, PT. The discipline utilizes specific exercises, manual techniques, and positional corrections that combine with the body’s innate balancing mechanisms to enhance athletic performance and treat a variety of sports-related injuries. NEW BALANCE Reciprocal activity is the body’s primary method of preventing major imbalances. When muscles are active, the body counters the activity and maintains balance in a number of ways, such as relaxing
other muscles. In PRI, practitioners look at the muscle activity on one side of the body as counterbalancing that of the other side. Something as basic as walking is a good example of this concept. During the left-stance phase of a person’s gait, the pelvis rotates backward on the left side of the body as the left leg goes underneath the body, while the mid to upper thorax counterrotates to the right to balance the movement. The right arm also provides balance by swinging backward to match the action of the left leg. This process is called alternating reciprocal activity and should occur equally and evenly on both sides of the body. If muscles are overactive and working too hard on one side of the body, methods of reciprocal action are employed elsewhere to help inhibit this excessive muscle activity. However, these methods also involve activating or facilitating other muscles to help equal out the imbalance and allow the body to move efficiently. This can negatively affect an athlete’s performance because the muscles best suited to the activity aren’t as active, and other, less ideal muscles are being used instead. PRI techniques seek
to address these asymmetries and help patients retrain their movements. RESPIRATION IS KEY One of the most common ways for anatomical asymmetries to affect performance is through the respiratory system. The diaphragm is stronger, better positioned, and has greater leverage on the right side of the body—its tendon (crura) attaches to three lumbar vertebrae on the right and only two on the left, the right lung has three lobes while the left lung only has two, and our liver sits on the right side of the body, providing more support to the right side of the diaphragm. When our core muscles are not able to maintain balance, the diaphragm begins to take on more of a static, postural role. This causes it to change its orientation and length, making it less effective for optimal air exchange. As a result, other muscles begin to perform the diaphragm’s normal function. This can lead to a number of different compensations and movement dysfunctions, from structural abnormalities such as a forward head posture, scapular malposition, and
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Optimum performance increased kyphotic and lordotic postures, to breathing dysfunction issues such as hyperinflation, paradoxical breathing, shortness of breath, fatigue, and even exercise-induced asthma. If not addressed, a static, malpositioned diaphragm can ultimately result in reduced athletic performance and any one of a number of acute or chronic injuries. Many of the muscles that cross multiple bones and joints are called polyarticular muscle chains. These groups of muscles run in the same direction and are structurally and neurologically connected—when one of them is active, the others are influenced as well. There are three dominant polyarticular muscle chains that greatly affect the respiratory system—one of each on the left side and one of each on the right. From the cervical region distally, these chains are: Brachial Chain: Anterior to the spine, the brachial chain muscles help connect and coordinate movement between the head and the thorax. This chain includes the diaphragm, anterior and lateral intercostal, deltoid and pectoralis, triangularis sterni, sternocleidomastoid, and scalene muscles.
First Step Training athletes using Postural Restoration Institute techniques starts with identifying any potentially restrictive imbalances in the athlete’s body. A thorough evaluation is performed using a number of tests, including: Adduction Drop Test: Evaluates the position of the pelvis and is similar to the Ober test. An inability of one or both femurs to adduct to the table suggests a malpositioned pelvis. Horizontal Adduction Test: Looks at the position of the scapula on the thorax, which should be equal on both sides when arms are hanging off the side of a table. Imbalances suggest a rotated thorax. Humeral Glenoid Internal Rotation Test: Examines the position of the scapula on the thorax. The forearm should be able to freely rotate when lying supine on a table with arms in a 90/90 position. Imbalances suggest a rotated thorax. Shoulder Flexion: With the rib cage and pelvis flat on the table, the arms should be able to flex freely and bilaterally above the table. Imbalances suggest an overextended thorax.
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INTERDISCIPLINARY INTEGRATION GAS & GRAVITY April 10-11, 2014 Lincoln, NE Speakers Dr. Paul Hodges, PhD Director NHMRC Centre for Clinical Research Excellence in Spinal Pain, Injury & Health The University of Queensland, Australia Emily Soiney, DPT, CST, RYT, PRC Owner and Physical Therapist at Shine Integrative Physical Therapy Portland, OR Susan Henning, PT, PRC Owner and Physical Therapist at Advance Physical Therapy Chapel Hill, NC Ron Hruska, MPA, PT Co-Founder of PRI Vision, Director of PRI and Consultant at Hruska Clinic Lincoln, NE Clayton Anderson Retired NASA Astronaut Houston, TX Chris Poulin, ATC, CSCS, PES, PRT Founder and Owner of Sandhills Sports Performance Pinehurst, NC
register at: posturalrestoration.com Circle No. 115 30
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Optimum performance Anterior Interior Chain: Anterior to the spine, the anterior interior chain muscles help connect and coordinate movement between the thorax and the pelvis. This chain includes the diaphragm, iliacus, psoas, tensor fascia latae, vastus lateralis, and biceps femoris muscles. Posterior Exterior Chain: Posterior to the spine, the posterior exterior chain muscles help with alternating but reduce reciprocal functioning. This chain includes the latissimus dorsi, quadratus lumborum, serratus, and external rib rotator muscles. As an athlete becomes more active and they task their respiratory muscles more, the diaphragm has to pull harder and faster, along with the pelvic floor and deep abdominal muscles. Due to a stronger pull from some of the key anterior interior chain muscles on the right, the pelvis and lumbar spine become rotated to the right. The thorax has to counterrotate to balance this pull, which also affects the shoulders and cervical spine. Below the pelvis, femoral and lower-leg orientation is often affected as well. This creates a great deal of torque to the body.
As this imbalance continues, it produces a change in the position and function of some muscles. They can become over- or underactive and can even change their orientation to adapt to their new positions. The diaphragm, for example, begins to shorten and tighten from the increased breathing rate and from its attempts to help the stabilizer muscles control the body as it moves. This scenario can be seen in athletes who demonstrate increased thoracic and lumbar extension (arched backs), shortness of breath, an inability to squat deep or jump and land with their feet flat, and poor alignment control of their legs, among other things. Ultimately, the muscle imbalance affects the polyarticular chains, causing them to work in a dyssynchronous way, and the result is referred to as a left anterior interior chain pattern. A rightsided dominance emerges as a result of overactivity of the right diaphragm, adductors, and biceps femoris, and the left iliopsoas, tensor fasciae latae, and vastus lateralis. This means the athlete favors and puts more weight on the right side of the body when standing, leaning, pushing off, or side-bending.
The typical way in which the body compensates for the left anterior interior chain pattern involves an overrotation of the thorax to the left, which itself can cause an imbalance in the upper body called a right brachial chain pattern. This in turn can cause overextension and overuse of the back extensor muscles, another imbalance known as the posterior exterior chain pattern, which is a back-to-front imbalance. The key to this domino effect on the body is the imbalanced diaphragm. Using non-manual techniques, or occasionally a combination of manual and non-manual techniques, PRI seeks to restore optimal, balanced breathing by establishing a zone of apposition in the area of the thorax directly apposed by the diaphragm. The zone of apposition is a neutral space that enables the diaphragm to return to its proper position and function normally. POSTURAL TRAINING To achieve a zone of apposition and maintain balance in the respiratory system, the body must be able to empty the lungs of air upon exhalation. It
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Figure One: Modified AllFour Belly Lift
Figure Two: Right SideLying Respiratory Left Adductor Pullback
Figure Three: 90/90 Hip Lift with Hemibridge must also restore balanced activity to the polyarticular muscle chains, re-educate the proper muscles with some corrective exercises, and change how the athletes carry themselves. To start, a number of tests are used to assess for respiratory, pelvic, and thoracic imbalances (see “First Step” on page 30). The athlete is then taught how to establish a zone of apposition through non-manual techniques, after which he or she is briefly reevaluated to determine if neutrality has been established in the target areas. If not, the practitioner will perform some manual techniques to assist with this. A few corrective, repositioning exercises are then introduced to reinforce the proper muscle-firing patterns necessary to help maintain 32
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this new position. PRI uses various forms of ventilation training to exercise the expiratory muscles. Here are a few examples of some non-manual zone of apposition techniques: Stair Short-Seated Balloon: Because of its effectiveness in restoring optimal breathing, this exercise is best used prior to physical activity. A balloon is used to train the expiratory muscles because it provides resistance during the exhalation phase and sends feedback to the respiratory system to help it re-inhale properly. (In case of latex allergy, or if a balloon is not available, a flexible straw can be used instead.) To start, sit on a step with feet and knees together and left fingertips under
left toes. It’s important to maintain a rounded back and refrain from using the neck muscles or cheeks when performing this activity. Use the right hand to place the balloon in the mouth between lightly pursed lips. Round out the back and roll the pelvis under to feel the ischial tuberosities, or sit bones, on both sides of the body. After inhaling through the nose—without losing the rounded posture—stabilize the balloon with the right hand and blow into it slowly, but fully. Pause for three seconds, using the tongue to press the balloon against the roof of the mouth to prevent air loss. Maintain this position and take another breath in through the nose. Slowly blow air into the balloon, repeating this sequence until the fourth inhale. When finished, take the balloon out of the mouth and deflate it. Repeat for three to five sets. Modified All-Four Belly Lift: This is another great exercise to use prior to physical activity. Starting on the hands and knees with the back rounded toward the ceiling, tuck the pelvis underneath and shift the weight forward until the nose is over the fingertips. While rounding the back further to maximize abdominal activity, inhale deeply before exhaling fully, but not forcefully (see Figure One, above). Pause in the exhaled state for three seconds and repeat the sequence for a total of four full breaths. As breathing becomes less restricted, the exercise is then performed on hands and toes with hips up. Once the zone of apposition has been established and the diaphragm repositioned, the body can be much more easily retrained to reduce the pull of the left anterior interior chain pattern. In doing so, the left pelvis rotates back and into a well-oriented position that supports standing, pushing off, rotating, and turning. In this position, the over- and underactive muscles take on different roles as their positions change. Some need to be inhibited on one side of the body while others need to be facilitated on the other side. The left proximal biceps femoris and adductors, left gluteus medius and abdominal obliques, and right iliopsoas have to be facilitated using corrected patterns of the pelvis and trunk. PRI describes correcting these positions as the ability to “shift” into the left pelvis by moving the left femur back, TR AINING-CONDITIONING.COM
Optimum performance while subsequently rotating the left pelvis back. This muscle repositioning work keeps the athlete’s body in balance and enables him or her to freely flex, squat, and rotate with minimal risk for joint compression and tissue strain. The following repositioning exercises are used to help correct a left anterior interior pattern, and they should be performed after the zone of apposition work. To avoid worsening an imbalance, they need to be done exactly as listed below and not on the opposite sides of the body: Right Side-Lying Respiratory Left Adductor Pullback: Lie on the right side of the body with the back rounded and the hips and knees at a 90-degree angle. Press the feet into a wall with a bolster such as a rolled-up towel between them so the left knee is lower than the left ankle (see Figure Two, at left). Begin by inhaling slowly through the nose while shifting or pulling the left leg back. This movement corrects the position of the anteriorly rotated left pelvis. Next, exhale fully while squeezing the left knee and bringing it down towards the right thigh. Inhale again, pull the left thigh back further, then exhale and
press the left knee down again. Continue this sequence for four or five full breaths, trying to pull the left thigh further back with each inhalation. Perform three or four sets. 90/90 Hip Lift with Hemibridge: Lie on the back with feet flat on a wall— preferably with shoes on—and both knees and hips bent at a 90-degree angle (see Figure Three, at left). Inhale through the nose and, while exhaling through the mouth, perform a posterior pelvic tilt by lifting the tailbone slightly off the ground. Instead of simply pushing the feet into the wall, the athlete should think about pulling through the heels as they lift the tailbone. Next, while keeping the left leg on the wall to maintain the hip lift, take the right leg off the wall and straighten it. Slowly take the straight right leg on and off the wall while maintaining good breathing patterns that feature full—but not forced—exhalations. Perform three sets of 10 repetitions each. Left Side-Lying Knee Toward Knee: Lie on the left side of the body with hips and knees bent at a 90-degree angle, back rounded, and feet pressed into a wall with
a bolster underneath. Shift the right thigh forward and lift it or turn it out. Holding this position, lift or turn in the left thigh until it’s just behind the right. Hold the position for four or five deep breaths and repeat three or four times. There are many benefits of introducing PRI concepts into training and conditioning programs. Athletes who have plateaued in their performance level are often limited because underlying imbalances are reducing their ability to produce the necessary power. Performing some of the assessments at the onset of treatment would reveal if the brachial chain, anterior interior chain, and/or posterior exterior chain muscles are playing a role, and through the establishment of a zone of apposition and use of repositioning exercises, the athlete should be able to return to free, unrestricted movement. Introducing components of PRI techniques into warm-ups, muscle preps, and as part of a larger training or injury-reduction program will only improve your athletes’ performance and recovery. And better positioning their systems for optimal function will take them up yet another level. n
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Duke University center Elizabeth Williams was able to play through and recover from a tibial stress fracture, thanks to the work of Athletic Trainer Summer McKeehan, who authors the first section of this article.
treating the athlete
To The Bone Treating a stress fracture can test the patience of even the most experienced athletic trainer. This twopart article provides a double dose of rehab secrets.
By Summer McKeehan
n more than a decade of working with the Duke University women’s basketball team, I’ve treated stress fractures in bones ranging from the metatarsal to the navicular. Last year, I got a lesson in just how “stressful” these injuries can be while rehabbing a player with a persistent injury to her tibia. Our starting center, junior Elizabeth Williams, was diagnosed with a tibial stress fracture in her right lower leg as she neared the end of her freshman year. Over the next 14 months, our medical and coaching staffs worked hard keep her on the court and avoid surgery. We did so—Elizabeth earned All-America honors her sophomore season—by using every resource at our disposal and implementing some creative rehab ideas. Elizabeth came to Duke with no history of bone injury, shin splints, or any other lower-leg problem. In fact, she hardly spent any time in an athletic training room until March 2012. At our first practice in between the Atlantic Coast Conference Tournament and the NCAA Tournament, Elizabeth walked into the athletic training room complaining of pain in the middle of her right shin. She said she’d been experiencing it for three weeks but hadn’t said anything, hoping it was nothing and would go away on its own. She told me the pain would come and go frequently during practice, and she often felt it just after practice ended. Upon examination, I found a visible and palpable lump over the middle of her anterior tibia bone. The area was extremely sore to the touch, as was the medial ridge of the tibia. An X-ray showed a stress fracture in the right tibial shaft, and an MRI found periostitis along the medial ridge of the tibia. Alison Toth, MD, the Director of the Duke Women’s Sports Medicine Program and our Team Physician, determined that it would be safe for Elizabeth to play in the NCAA Tournament if she felt she could cope with the pain. Elizabeth committed to playing through the pain but her game time would have to be limited and she’d likely have to sit out most practices, so we had to ask her coaches if they were okay with this. After receiving their go-ahead, we started working on a treatment plan. Summer McKeehan, MS, ATC, LAT is Associate Athletic Trainer for women’s basketball at Duke University, where she has been on staff since 2001. She has also served as the athletic trainer for the USA Basketball Women’s U18 and U19 National Teams. She can be reached at: firstname.lastname@example.org.
TR AINING-CONDITIONING.COM Timothy Sofranko
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treating the athlete With input from our team physical therapists, physicians, an orthotist, and other sports medicine staff members, I decided to place Elizabeth in a stirrup leg brace which she was to wear whenever she put weight on her leg. I also began massaging the soft tissue around the injury and performed joint mobilizations on the ankle, knee, and hip of her injured leg, often on a daily basis. Another point of focus for the treatment was to ensure Elizabeth was getting adequate calcium. We increased
bearing exercises, with the exception of walking to class. During that time, we focused her treatment exclusively on non–weight-bearing hip- and corestrengthening exercises, reintroducing the stationary bike after she remained pain free for the entire two weeks. We also imaged her tibia once a month to ensure the treatment was producing the desired results. When she made it through the remainder of April and into May without being bothered by the injury, we added
There was still one non-surgical treatment we wanted to explore ... Due to the overpronation and metatarsus varus of Elizabeth’s feet, we felt we could take a lot of the stress off her tibia by creating an orthotic that was supportive and added four to six degrees to the medial arch. her intake to 1,200 mg daily and introduced a once-a-day dose of calcitonin (Fortical), a biphosphonate drug that slows the rate of bone thinning and provides some pain relief. In addition to the medication, we began using the Exogen Ultrasound Bone Healing System on Elizabeth for about 20 minutes each day. The Exogen system uses low-intensity, pulsed ultrasound to stimulate bone growth and accelerate the healing process. Her practice time was very limited and she generally only participated a day or two before a game. Even when she did take part, we only let her go for about five to 10 minutes. Her game time was cut by an average of six minutes per game, to around 32 minutes, and she was substituted in and out more frequently than during the regular season. To keep her cardio up, Elizabeth used the stationary bike or performed deep-well running in the pool, with instructions to stop if she experienced any pain. While not an ideal training regimen when preparing for the NCAA Tournament, it enabled Elizabeth to continue playing in the competition. Though it was obvious to those who had seen her play during the season that her jumping ability and reflexes weren’t as sharp, she was able to help the team reach the Elite Eight and scored in double figures in all four games. Once the season was over at the end of March, we gave Elizabeth two weeks off from all cardio and weight36
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a number of exercises, such as mini squats, hip hikes, and hip exercises utilizing an elastic band. She was also allowed to shoot with her feet planted on the floor. At the end of May, Elizabeth was still doing well despite the additional workload, so we took her treatment to the next level and incorporated the Tibia Stress Fracture Protocol (TSFP), which would progress her from walking, to jogging, to sprinting exercises. Elizabeth spent three weeks advancing through the walking and jogging steps of the TSFP without pain in her shin during or after workouts. However,
several pain-free weeks, we added running. We always had Elizabeth wear shoes while walking or running in the pool to provide extra support for her feet and aid in shock absorption for her shins. By the beginning of July, Elizabeth was again pain free. We continued rehab in the pool and added elliptical work outside the pool at the end of the month. Due to her progress, we decided to try the TSFP again in September. However, just as in May, Elizabeth experienced pain in her shin when she tried to sprint. At this point, we began to discuss the possibility of surgery with Elizabeth and her parents, but there was still one non-surgical treatment we wanted to explore. I set up an appointment with the team’s specialized orthotist, Harvey Johnson, CO, to have her evaluated for orthotics. Due to the overpronation and metatarsus varus of Elizabeth’s feet, Johnson felt he could take a lot of the stress off her tibia by creating an orthotic that was supportive and added four to six degrees to the medial arch. This pitch would help decrease the stress put on the tibia by the medial musculature and tibialis anterior muscle. With new orthotics in both shoes, we began working to get Elizabeth back to running. However, when she made another attempt to progress through the TSFP, a new problem arose—pain on the lateral side of her left foot. An MRI revealed a stress reaction in her cuboid
With new orthotics in both shoes, we began working to get Elizabeth back to running. However, when she made another attempt to progress, a new problem arose—pain on the lateral side of her left foot. An MRI revealed a stress reaction in her cuboid and fifth metatarsal. when the protocol called for sprinting, she would experience pain that prohibited her from finishing the workout. After a week of rest, we’d start the protocol over again, gradually progressing to sprints, but with the same result each time. At this point, we made the decision to stop following the TSFP and transfer Elizabeth’s rehab to our HydroWorx pool. We began with walking, squatting, and hip abduction, adduction, extension, and flexion exercises, and after
and fifth metatarsal. Johnson shared my opinion that the orthotic, coupled with possible overcompensation for the stress fracture in her right tibia, was likely causing the pain in Elizabeth’s left foot. Johnson unloaded the area of the fifth metatarsal on Elizabeth’s orthotic to relieve some of the pressure on the bone and constructed a forefoot fracture brace for her left foot. Generally, I place an athlete with a foot stress injury in a walking boot, but it worsened the TR AINING-CONDITIONING.COM
treating the athlete pain in Elizabeth’s right shin, so we eliminated the boot and had her wear her fabricated orthotics and forefoot fracture brace full time. At this point, Elizabeth was suffering from a tibial stress fracture, periostitis, and a stress reaction—all bone-related problems. To cover all the bases, we decided to get a blood work-up done on Elizabeth and requested testing for complete blood count, calcium, phosphorus, bone alkaline phosphatase, thyroid panel, basic metabolic panel, 125 OH vitamin D total, parathormone OP panel, and serum parathyroid hormone. Thankfully, all results came back normal. Fortunately, the fracture brace began to help ease Elizabeth’s discomfort, and in early October I decided to institute a new plan to help get her back practicing again. In order to determine how much activity was required of players in her position, I timed our other post players during several practices, focusing only on the time spent in drills or other activities. I found that during a two-hour practice, our posts were participating in around 30 minutes of activity.
We continued using the ankle- and footjoint mobilizations, orthotics, and fracture brace for the remainder of the season. It certainly wasn’t an exact science, and we kept Elizabeth out of practice if she had pain, but we were able to get and keep her where she wanted to be—on the court. Elizabeth’s pain was much better than at the end of the previous season, but was still an issue. I decided to start with allowing her five minutes of activity during each practice. Based on the rehab efforts earlier, we knew we could control her pain better if she practiced on two consecutive days, followed by a day off. By increasing the amount of activity by a few minutes each week, we graduated to two full practices per week by November and added a third in January. When we reached the end of February, she was practicing full time. We continued using the ankle- and foot-joint mobilizations, orthotics, and fracture brace for the remainder of the season. It certainly wasn’t an exact science, and we kept Elizabeth out of practice if she was experiencing pain in the area of the fracture, but we were able to get and keep her where she wanted to be—on the court. She finished her sophomore campaign as a John R. Wooden Award finalist, Associated Press Third-Team All-American, and ACC Defensive Player of the Year. With the season over, we decided that Elizabeth should take two consecutive months off, with no exercises other than non–weight-bearing core work and hip strengthening. In June, we used the TSFP and continued to limit her summer practice hours. The protocol worked much better this past summer than in 2012 and she progressed to sprinting without problems. Elizabeth has been pain free since June and is having a standout junior year. She continues to compete in practices and competitions without physical restrictions or time constraints. Everyone involved in her treatment agrees it was a challenging journey. However, we’re all overjoyed to have avoided surgery and achieved such a positive outcome. TR AINING-CONDITIONING.COM
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treating the athlete After two years of struggling with stress fractures in her feet, Brigham Young University pole vaulter Rachel Fisher underwent surgery.
Opting for Surgery By Dustin Williams
reating stress fractures is unlike working with other injuries due to the unpredictability of the recovery process, especially when you’re trying to avoid surgery. Just when you think you’re making progress, another issue can pop up and derail your rehab. While I was an athletic tra iner at Brigham Young University in 2009, Rachel Fisher, a freshman pole-vaulter, reported in her pre-participation physical exam that she had been diagnosed with a navicular stress reaction in her left foot the previous spring. The injury was bad enough to keep her from competing in the high school state championships. Dustin Williams, ATC, is an Associate Athletic Trainer at the University of Arizona, working primarily with the men’s and women’s cross country and track and field teams. Previously, he worked as the Head Athletic Trainer for Cross Country and Track and Field at Brigham Young University and was on the USA Track & Field Team staff at the 2012 London Olympic Games. He can be reached at: email@example.com. 38
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Her treatment had entailed crutches and a restriction to non-weight bearing movements for four weeks. She then spent another four weeks in a boot that enabled her to put minimal weight on the foot, and after progressing through walking, jogging, and light-running rehabs, she eventually went on to win the pole vault competition at the AAU Junior Olympics that August. When she arrived on campus a few weeks later, the injury had healed, so our primary goal was to prevent a recurrence. To help achieve this, we tried to increase her ankle strength and proprioception by using resistive bands, balancing work, and single- and double-leg bounding exercises. We also had her custom-fitted for orthotics to support her foot and ankle joint. We spoke with Rachel and thenAssistant Pole Vault Coach Erik Rasmussen about the importance of not overtraining—we wanted them to focus on quality, not quantity, especially in her pole-vaulting exercises. Coach Rasmussen substituted about 30 percent of Rachel’s sprint workouts for deep-water running and bicycle sprints, and he put
her through many of the pole-vaulting drills at a walking pace. We also requested that she practice on soft surfaces whenever possible, so Coach Rasmussen had her do many jump and take-off drills on the pole-vault mat. Rachel stayed healthy and did very well during the indoor season, qualifying for the NCAA Division I Indoor Championships and finishing 16th. However, shortly after the indoor season, her left ankle began to bother her in the same area in which she had suffered the stress fracture the year before. BYU’s Head Team Physician, Mitchell Pratte, MD, prescribed her an NSAID for what we thought was a soft-tissue ankle strain and not a recurrence of the stress fracture. We began treating Rachel’s ankle with various modalities, including ice, e-stim, ultrasound, Graston technique, and NormaTec compression. We also adjusted her training to include more bike and pool workouts to unload the ankle joint as much as possible. However, after about two weeks, she started developing soreness in her left mid-foot region. An MRI revealed that she had a stress-reactive marrow edema throughout the navicular, without a focal fracture line. She had also developed a stress fracture of the fourth metatarsal. We immediately referred her to our foot and ankle orthopedist, Robert Faux, MD. Dr. Faux noted that Rachel also had a moderate-to-severe cavus foot with first metatarsal overdrive. He felt the stress fracture in her fourth metatarsal was the result of compensation from the return of the stress reaction in her navicular. She was instructed to discontinue the NSAID and was prescribed a new orthotic with first metatarsal head release and a more rigid hindfoot and arch structural support. She was also instructed to take 1,500 mg of calcium with vitamin D daily. Surgery was discussed at this point, but Rachel wanted to return to competition as quickly as possible, and surgery would have kept her out for six to eight months. We decided to try a conservative approach and agreed to revisit the surgical option down the road if we weren’t getting results. We kept Rachel in a walking boot and had her do some pool therapy after a week, including deep-water jogging and sprinting and bounding exercises in the shallow end. To assist the healing proTR AINING-CONDITIONING.COM
treating the athlete cess, we utilized a bone stimulator, Graston technique, fascial stretching, NormaTec compression, and ice. A week later, at the end of April, we started her on jogging and running progressions on our AlterG Treadmill. For the next four weeks, Rachel did most of her training on the AlterG. Her workouts were done at 70 percent of her bodyweight and included five minutes of jogging and 10 sprints of 20 seconds each, with 40-second rest intervals between each sprint. She was allowed to do vault drills, mainly on the pole-vault mat, but nothing that involved running. Communication with Assistant Strength and Conditioning Coach Josh Morzelewski, MS, CSCS, was essential in making sure Rachel followed the proper progression during her lifting sessions. Utilizing the pole-vault mat to provide more cushioning for her ankle, we began with plyometric exercises, such as doubleleg bounding, skips, and simulated vault take offs. We also introduced lifts such as Romanian deadlifts, glute-hamstring raises, and push presses, and slowly introduced a variety of Olympic lifts such as
squats, dead lifts, and clean pulls to help strengthen her lower legs without significantly impacting her ankle. Thanks to her strong performances during the indoor season, Rachel had qualified for the USA Junior Track and Field Championships at the end of June, and she was determined to compete in
a result of the technique issues and she did not place well. Afterward, she went home for the remaining six weeks of the summer so we decided her recovery would be best served if she trained very lightly to allow for more healing in her foot and ankle. For the fall training, we designed a
An MRI of the right ankle showed that she had diffuse bone marrow edema in her navicular bone, without a fracture line. Because this was her fourth stress fracture in a two-year period, we also did a DEXA scan and had blood work done to evaluate her bone density. that meet. She was pain free at this point and her conditioning was nearly back to an optimum level, but her vaulting technique wasn’t as sharp as it had been in the past. We had been limiting this type of activity because we felt it was too risky and might compromise her recovery. We supported her foot and ankle joint by integrating arch and ankle taping to prevent a reccurrence of the fracture. However, her performance suffered as
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rehab program aimed at stabilizing the ankle joint using strengthening exercises with TheraBands, balancing exercises on an Airex pad and trampoline, and plyometric and pole-vault drills on the pole-vault mat. We also included sprint workouts on the AlterG, and as a preventative measure limited her other running to what she was doing with a pole during practice. During the 2011 indoor season, Ra-
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treating the athlete chel—now a sophomore—was competing well and had no pain in her left foot or ankle. We did an arch tape and ankle tape for all vaulting practices and competitions and would ice her foot regularly. Then, after breaking BYU’s indoor pole-vault record and qualifying for the NCAA Indoor Championships, she began to develop pain in her right ankle for the first time. It appeared to be a softtissue ankle strain so we incorporated similar treatments that we utilized for her left ankle. She was able to compete in the indoor championships, but this time the pain hindered her performance and her results suffered. The pain persisted, so we had Rachel seen by our physician and orthopedist again. An MRI of the right ankle showed that she had diffuse bone marrow edema in her navicular bone, without a fracture line. Because this was her fourth stress fracture in a two-year period, we also did a DEXA scan and had blood work done to evaluate her bone density, but all the tests came back in the normal range. She was instructed to wear a walking boot and use a kneeling scooter for two to three weeks and we planned to slowly
transition her back into full activity as the symptoms lessened. However, at this point Rachel had grown very frustrated with the situation, especially since she was now dealing with injuries to the navicular bones in both feet. After three weeks of very little progress, and following a thorough discussion with Dr. Faux, Rachel and her parents decided it was time to pursue surgical options. The decision was difficult for them because Rachel had experienced some success with conservative treatments and didn’t want to miss an extended period of time while she recovered from surgery. However, it had become apparent that the risk of re-injury was high with the non-surgical approaches we had been taking. Ultimately, Rachel decided to have both feet operated on simultaneously. The surgery—a bilateral navicular percutaneous ORIF procedure—was successful. Afterward, Rachel was restricted to a wheelchair for two weeks and instructed to wear bilateral walking boots and use the kneeling scooter for the next four weeks. After the ini-
tial two weeks, we began light pool workouts and ankle range-of-motion exercises. As she progressed, we introduced some work on the bike, as well as foot and ankle intrinsic rehab exercises with gradual increases in both reps and duration. I was hired by the University of Arizona in the fall of 2011, but was later informed that Rachel continued working with the sports medicine staff to slowly progress back into full activity. Using the AlterG Treadmill and the same progression plan that we had developed for her prior to surgery, she was able to return to competition approximately eight months after her surgery. This past year, she won a number of competitions and qualified for the first round of the NCAA Division I Outdoor Championships. I certainly don’t feel that surgery is required for every athlete who suffers a navicular stress fracture, and I’ve had success with non-operative treatments when the injury is detected early. However, if the injury is recurrent, surgery can be a valuable tool in helping the athlete return to competition. n
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OSU Media Relations
Junior weight and hammer thrower Nick Miller demonstrates the strength, power, and balance that’s helped him become a three-time All-American.
Prepared to launch A training program that draws inspiration from a variety of sports helps Oklahoma State University throwers develop the attributes they need to send their implements into orbit.
ll too often the throwing events of track and field are treated like s t ro n g m a n c o nt e s t s . Athletes are asked to hurl heavy implements as far as possible, so it’s assumed the best way to train them is to simply make them as strong as possible. However, the top discus, shot put, hammer, and javelin athletes have training regimes that are far more complex. Great throwers require a unique synthesis of abilities associated with a number of other sports. They need the athleticism of multi-event track
By John Baumann athletes (decathletes and heptathletes), the strength of powerlifters, the speed and explosiveness of Olympic lifters, the dynamic strength of gymnasts, and the fluid movements that integrate all these attributes. Over the years, I’ve built a comprehensive training program for throwers by tapping into experts in all five of these areas, and by finding athletes who are willing to take on a high volume of work, improve their weaknesses, and develop the qualities needed to succeed in their particular event. This program is not the only way to successfully train throwers, but it’s the one
that has worked best for me. BUILDING BLOCKS During my career, I’ve had the pleasure of seeing my throwers win national and conference championships and I’ve John Baumann, CSCS, is in his ninth year as an Assistant Track & Field Coach at Oklahoma State University, working primarily with men’s and women’s throwers. He has also worked at the University of Illinois and George Mason University, where he was Head Strength Coach. He can be reached at: john.baumann@ okstate.edu. T&C MARCH 2014
SPORT SPECIFIC coached athletes who have competed in the Olympics. However, I wouldn’t have enjoyed nearly as much coaching success without the varied group of mentors who helped shape my training philosophy along the way. I learned from Cliff Rovelto, Kansas State University’s Director of Cross Country and Track & Field, that the speed, strength, agility, and explosiveness required of multi-event track athletes are also needed in the throwing events. His workouts showed me how to build strength without sacrificing speed and agility, and vice versa. The key is to find the right balance of exercises so you can accomplish your goal without taxing other energy systems in the body. Powerlifting has become a significant part of my program because it is great for building absolute strength.
There’s no time limit within which the throwers have to finish a lift, and no explosive movement is necessary at the end, so absolute strength is the primary requirement. And the slow movements of the lifts require the throwers’ bodies to spend a great deal of time under tension, which also helps make gains. This aspect of my training regimen comes from legendary strength coach Louie Simmons, owner of Westside Barbell, who has been a competitive powerlifter for more than 50 years. He helped me see that throwers require the same absolute strength that powerlifters possess in order to defeat inertia when starting a throw. The Olympic lifting component of my program drew a great deal of inspiration from two giants of the sport, Roger Nielsen, two-time USA Men’s Olympic Weightlifting Team Coach,
and Mike Gattone, MS, CSCS, USA Weightlifting Senior International Coach. They showed me that Olympic lifting is perfect for throwers because it emphasizes power and explosiveness by having the athletes move sub-maximal weights at a very high rate of force development. Olympic lifters begin their lifts slowly and then apply a massive amount of force to finish, which is the same process a thrower undergoes on every attempt. I use Tendo Units to measure the wattage and speed of Olympic lifts like snatches and cleans, which is invaluable in optimizing a thrower’s movement. It allows me to train throwers to perform cleans at an ideal range of 1.3 to 1.7 meters per second and snatches at around 2.0 meters per second. The fourth pillar of my training philosophy may be surprising to some
SAMPLE WEEK The following off-season workout was created for a female Oklahoma State University hammer thrower, who came to the university unable to throw competitive distances. By the time she was a senior, she had progressed to placing well in elite competitions. Percentages are based on her max weight for each exercise.
Stop Squat 1 x 3 @ 50% 1 x 3 @ 57% 3 x 3 @ 64%
Hurdle Hops or Box Jumps 25 reps for height
Jump Rope 150 contacts
Hang Power Snatch 3 x 3 @ 50% 2 x 4 @ 60% 5 x 5 @ 70% 1 x 3 @ 80% 1 x 2 @ 85%
Hang Power Clean 3 x 3 @ 50% 2 x 4 @ 60% 5 x 5 @ 70% 1 x 3 @ 80% 1 x 2 @ 85%
Rickshaw Deadlift 1 x 9 @ 50% 1 x 8 @ 60% 5 x 5 @ 70% 1 x 3 @ 80% 1 x 2 @ 90%
Back Squat 1 x 5 @ 50% 1 x 5 @ 60% 1 x 5 @ 73% 1 x 3 @ 80% 1 x 2 @ 85% 1 x 5 @ 75%
Explosive Harvards 3 x 33 (1 minute rest between sets)
Jump Rope 150 contacts
Hang Power Snatch 1 x 3 @ 50% 2 x 4 @ 60% 5 x 5 @ 70% 1 x 3 @ 80% 1 x 2 @ 85%
Hang Power Clean 3 x 3 @ 50% 2 x 4 @ 60% 5 x 5 @ 70% 1 x 3 @ 80% 1 x 2 @ 85%
Rickshaw Deadlift 1 x 9 @ 50% 1 x 8 @ 60% 5 x 5 @ 70% 1 x 3 @ 80% 1 x 2 @ 90%
Stop Squat 1 x 3 @ 50% 1 x 3 @ 57% 3 x 3 @ 64%
Hurdle Hops or Box Jumps 25 reps for height
Jump Rope 150 contacts
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SPORT SPECIFIC strength coaches: gymnastics. My gurus in this field are Yoshi Hayasaki, former Head Men’s Gymnastics Coach at the University of Illinois, and Bob Starkell, an Assistant Gymnastics Coach at North Carolina State University. They both taught me the importance of bodyweight workouts in preventing injuries, and Starkell showed me the usefulness of gymnastics bar apparatuses for pushups, pull-ups, and upper-body, lat, and triceps work. Hayasaki also explained how to use various circuit-type, full-body workouts that include exercises such as seated and floor twists, arm swings, rotations with barbells, and different types of sidebends and snatches to train highly dynamic movements. Using these exercises in my workouts has really helped our throwers develop as athletes. Over the years, I’ve also come to understand the importance of zeroing in on training a thrower’s movement instead of focusing on particular muscle groups. Because each throw in an event involves only a few seconds of explosive exertion, to be successful, throwers
have to use every muscle in their bodies when launching their implements, so I train their bodies to perform through their full, natural range of movement. Exercises such as compound lifts and various presses provide this motion while also activating a number of muscles, and I keep my workouts low in reps and high in intensity to train that explosiveness. This concept is central to the work of strength and conditioning innovator Vern Gambetta, MA, President of Gambetta Sports Training Systems and former Director of Conditioning for the Chicago White Sox. MAKING A PLAN I design individualized strength workouts for each thrower, and I begin by determining if they are more in need of strength work or explosive (neural) work. To do this, I test their vertical leap on a jump mat, once while they hold kettlebells and once without them. Based on the results, I put athletes into three categories that indicate their balance of strength and power: • 80 percent strength, 20 percent power
• 60 percent strength, 40 percent power • 40 percent strength, 60 percent power. Athletes in the 80/20 category have great strength but need a lot of power work, so I incorporate squats, deadlifts, pushing, and pressing into their workouts. However, I’m also careful not to neglect maintaining and enhancing their strength. Like the 80/20 athletes, those in the 60/40 category need to focus more on improving power, so I assign them a few more strength exercises and a few less power exercises than those in the 80/20 group. Athletes in the 40/60 group need to concentrate more on building strength, so their workouts have a higher number of strength exercises. However, I use many of the same exercises for all three groups. The difference is that I vary each group’s reps on these exercises according to the strength and power needs of the athletes. Besides testing, another factor I consider when creating workouts is the gender of the athlete. For female
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SPORT SPECIFIC throwers, I incorporate more bench and power-clean exercises, at or above bodyweight. These are traditionally difficult exercises for women to perform, so they make great training tools. This is an approach I learned from track and field coach Dan Pfaff, who is the Education Director and Jumps Coach at the World Athletics Center. In my workouts for male athletes, I tend to emphasize their strengths. For example, if an athlete excels in deadlifting but has a difficult time with squats, I’ll give him a number of exercises reinforcing pull strength, while also building leg strength to assist with the squats. I take this approach because I’ve found males generally
based on where we are in our competitive calendar. On average, my throwers increase their squat maxes by about 50 pounds during each 12-week period. However, the first time athletes do the routine they tend to increase their maxes by an average of one hundred pounds. My squat program includes front, stop, and back squats. The front squat is always done in sets of three, with two reps per set, and I vary the weight max according to the athlete. When I’m looking to develop speed using this exercise, I use what the athlete can clean as the front-squat max. But when I want to focus on building strength, I get a true max.
I sometimes have the athletes lift a log during the front squat because it provides a great lower-back exercise. It’s difficult to lean forward with a log curled in your arms, so this movement helps develop strength in an upright position. respond to positive reinforcement in keeping their confidence levels up. I give special strength exercises to all the throwers to improve work capacity and structural development, including rotations with a barbell, snatches beside the body, sidebends with weights held overhead, and narrow grip snatches. I also use plyometric exercises such as hurdle hops and box jumps to increase speed and power. WORKING OUT My workouts for throwers, both inseason and during the off-season, bring them into the weightroom five days a week. Mondays, Wednesdays, and Fridays are strength days, while Tuesdays and Thursdays are power days. Each workout session lasts about 30 to 45 minutes. Three of the main exercises throwers focus on in the weightroom are squats, Olympic lifts, and deadlifts. Squats: Since the legs are the prime movers in throwing events, squats are great for developing the driving, blocking, and lifting movements required. When it comes to training, I have a 12-week squat routine that I use year-round. It was introduced to me by Olympic weightlifting coach John Thrush, CSCS. The routine changes in its degree of difficulty every 12 weeks 4 4
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I sometimes have the athletes lift a log during the front squat because it provides a great lower-back exercise. It’s difficult to lean forward with a log curled in your arms, so this movement helps develop strength in an upright position. The loads for the stop and back squats vary. Because the stop squat features a one-second pause in the bottom position instead of the one continuous motion of the back squat, we use less weight for the stop squat. The stop squat is usually done in three sets of three reps. Due to the difficulty of the lift, the weight stays almost constant throughout the workout. For the back squat, we generally use four sets consisting of five, three, two, and five reps, with the weight increasing in increments from set to set. The athletes rotate the bars they use for the stop and back squats every four weeks during the 12-week routine, utilizing spider, safe, camber, and normal squat bars. By doing this, different muscles are worked and the athletes’ vertebral columns don’t have to bear the weight the same way each time. Because the straight bar is the only safe one to use when performing a front squat, it does not get rotated. Olympic lifts: For Olympic lifts, I determine the volume of each lift based
on what the athlete needs to work on. For example, if a thrower needs to work on pulling, I add a large number of sets to their routine. Here is a sample routine for an Olympic hang power snatch lift that includes sets, reps, and volume: Hang Power Snatch 3 x 3 @ 50% (of predicted max) 4 x 2 @ 60% 5 x 5 @ 70% 1 x 3 @ 80% 1 x 2 @ 85% Deadlifts: For deadlifting, I like to use the rickshaw bar from Elitefts. It’s easy to use and forces athletes to use their legs and glutes to finish the lift, maximizing their ability to defeat inertia. I determine these deadlift reps based on what an athlete does after reaching 60 percent of the predicted or actual max. Below is an example of a rickshaw deadlift rep scheme for a female who lifted 500 pounds and a male who put up 800 pounds: Rickshaw Deadlift 1 x 9 @ 50% (of predicted max) 1 x 8 @ 60% 1 x 5 @ 70% 1 x 8 @ 60% 1 x 5 @ 70% 1 x 3 @ 80% 1 x 2 @ 90% EVENT-SPECIFIC TRAINING Along with strength and power exercises, throwers receive event-specific exercises that isolate the different attributes required to excel in their event. For example, a program for a shot-putter will emphasize bench presses, incline presses, pull presses, and regular squats, while a hammer thrower’s program will feature snatch pulls, clean pulls, deadlifts with rickshaw bar, and stop squats. Throwers complete up to 15 reps of each exercise in the workout, with the reps varying based on whether it’s the regular season or off-season and how close the athlete is to the next competitive event. We reduce the number of exercises and reps as competitions come near. The biggest lesson I’ve learned from my years of working with mentors in various different sports is that a strength coach can never stop being a student. I’ve been in my job for many years, yet I strive to learn something new in every training session. n TR AINING-CONDITIONING.COM
a d v e r t i s i n g f e at u r e
he 2014 CSCCa National Conference will be held in Salt Lake City, Utah, at the Salt Palace Convention Center. The official conference hotel will be the Downtown Salt Lake City Marriott Hotel.
2013 saw the highest attendance ever at a CSCCa national conference and even more are expected to attend in 2014. The conference will include outstanding speakers, activities, and events, including an exhibit hall with over 175 booths showcasing the latest strength training, conditioning, speed development, and nutritional products. Thursday’s conference presentations deal with various aspects of strength and conditioning applicable to all strength and conditioning coaches—no
About the CsCCa
he Collegiate Strength and Conditioning Coaches association (CSCCa) is a non-profit, professional, educational organization solely designed for collegiate and professional-level strength and conditioning coaches and for students and interns preparing for a career in this profession. The CSCCa was organized in 2000 and began with a small number of collegiate strength and conditioning coaches from around the country. During the past 14 years, however, the organization has experienced tremendous growth, with now well over 1600 members, as collegiate and professional-level strength and conditioning coaches have realized the value of being part of an organization specifically committed to understanding and servicing the unique needs of their profession. The CSCCa offers a comprehensive, three-part certification program to ensure that individuals holding the organization’s prestigious certification—Strength and Conditioning Coach Certified (SCCC), possess the necessary knowledge, skills, techniques, experience, and expertise to be a competent and effective strength and conditioning coach. The first step in the certification process is completion of a 640-hour practicum/internship under the guidance and supervision of a CSCCa-approved mentor. The primary goal of the practicum/internship experience is to prepare the candidate to enter the strength and conditioning coaching profession well prepared and equipped to effectively meet the demands of being a strength and conditioning coach on the collegiate or professional level, including hands-on, practical experience in safe and effective exercise prescription and teaching and demonstrating proper exercise technique.
matter what sport or gender they coach—including, among other topics, Olympic-style lifting, speed & power development, team building and motivation, health and safety, and achieving excellence in strength and conditioning coaching. Friday sessions will include a variety of presentations by CSCCa member coaches regarding various aspects of their respective strength and conditioning programs, including sport specific programs, training tools, methods, and philosophies. Gatorade will be hosting a free Pre-Conference Sports Nutrition Symposium, from 2:00-5:45 p.m. on Wednesday, May 7, to discuss how food and nutrition enables athletes to train harder and recover faster. Attendees will be updated regarding the latest in training and nutrition by exercise researcher Keith Baar and the Gatorade Sports Science Institute and will learn best practices from an NFL strength coach and sports dietitian team. The Pre-Con will wrap up with a hot-topic panel discussion moderated by a leading sports dietitian from the Collegiate and Professional Sports Dietitians Association (CPSDA). For more information or to register to attend, please visit the organization’s website located at www.cscca.org or call the CSCCa National Office at 801-375-9400.
Catalog Showcase American Public University
PRO Orthopedic Devices, Inc.
American Public University offers more than 180 undergraduate and graduate degree and certificate programs designed for sports and health science professionals, coaches, athletic directors, and working adults like you—completely online. American Public University has been nationally recognized by the Sloan Consortium for effective practice in online education. Classes start monthly with eight- and 16-week courses. Call or go online for more information.
The HiTrainer Pro combines the science of high-intensity interval training, instant performance feedback, and its patented full-time drive phase running position to provide unparalleled conditioning with minimum impact. It helps to significantly develop anaerobic recovery, strength endurance, and cardiovascular fitness. The less time athletes require working on conditioning means more time dedicated to their real sport-related training.
Offering more than 20 patented products, PRO Orthopedic is constantly upgrading designs and materials to provide the best support possible. The four-way stretch properties of the material, combined with therapeutic heatretention qualities, make neoprene effective in controlling edema. Compression alone cannot produce the same results, and all PRO neoprene products are latex-free. Call or go online for more information.
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California University of Pennsylvania
In sports and in everyday life, being hurt and on the sidelines is no fun. Game Ready® goes beyond treating the symptoms of acute injury, enabling you to actively accelerate your recovery. Game Ready’s revolutionary ACCEL® Technology integrates active compression and cold therapies in the treatment system of choice for thousands of orthopedic specialists, physical therapists, athletic trainers, and elite athletes.
855-PWR-PLAY (797-7529) powerplay.us
PowerPlay™ is one of the most affordable and portable cold and compression therapy systems available. Currently being used by athletes, athletic trainers, and coaches across the U.S., the cold and compression therapy aids in post-surgery, post-injury, or chronic pain recovery, helping athletes get back in the game faster. Check out the company’s products online or request a free brochure. Circle No. 506
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NZ Manufacturing 800-886-6621 nzmfg.com
Cal U’s Global Online office conveniently offers over 10 different programs in Exercise Science, Wellness and Fitness, and Sport Management. They are all available 100-percent online in a convenient, flexible format for busy professionals. Go online for more information on any of Cal U’s Global Online programs.
Made in the USA with unsurpassed quality and patented safety features— these are the hallmarks of NZ Manufacturing’s TurfCordz®, StrechCordz® and MediCordz®. Whether your resistance needs are for sports training, swim training, or rehabilitation, all the products featured in the catalog are engineered to meet the most rigorous demands of team, clinical, and personal use. The various resistance levels and accessories deliver a rewarding workout that’s tailored to individual needs.
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Innovative new products, exclusive pricing for health and fitness professionals, and attractive quantity pricing make OPTP’s Professional Catalog Vol. 31 a must have. Vol. 31 organizes OPTP’s broad selection of affordable tools and resources by specialty for an efficient shopping experience and introduces exclusive new products like the Anatomical Roller™, PRO-ROLLER Arch™, and Thoracic Lumbar Back Support. Request a catalog by calling or going online.
Since 1976, Samson Equipment has designed, manufactured, and sold heavy-duty, industrialstrength weightlifting equipment to all five branches of the military, top high schools, colleges, and professional teams—as well as health clubs and recreational facilities—all over North America, Europe, Asia, and the Caribbean. Samson’s equipment line includes a wide variety of free weight racks and benches, as well as selectorized machines and plateloaded equipment.
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Quick and Convenient Cleaning
Medi-Dyne produces easy-to-use products that really work. The company’s brands include 2Toms®, Cho-Pat®, Tuli’s®, ProStretch®, StretchRite®, CoreStretch®, Skin-on-Skin®, and RangeRoller®. Medi-Dyne products protect and strengthen tight muscles, stretch important muscle groups, and prevent pain and injury. Online instructional stretching guides provide easyto-follow guides for general and indicationspecific stretching, making it easy for athletes to work out on their own. Circle No. 534
Perform Better 800-556-7464 performbetter.com
Perform Better’s 2014 catalog is now available. This 100-page catalog is better than ever with new, top-notch products that are perfect for everyone who trains or rehabs clients, patients, or athletes. With categories ranging from flexibility and recovery to speed and agility to weight training, this catalog is the perfect choice to meet everyone’s functional training needs. Call or go online for your free copy.
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New York Barbells 800-446-1833 newyorkbarbells.com
Athletix Disinfectant Wipes are a quick and convenient way for your athletes and trainers to disinfect surfaces in your fitness facility. Pre-moistened and ready to use, the durable, disposable wipes are packaged in a portable dispenser bucket. EPA-registered in all 50 U.S. states, Athletix Disinfectant Wipes kill antibiotic-resistant bacteria MRSA and CA-MRSA and are effective against many common bacteria, such as Staphylococcus aureus (staph), Salmonella, Streptococcus pyogenes (strep), and Escherichia coli (E. coli). Most effective when used on hard, nonporous surfaces, Athletix Disinfectant Wipes are ideal for disinfecting athletic and gym equipment, cycling equipment, weights, yoga mats, fitness balls, benches, lockers, and more. These orthophenylphenol-free wipes contain no ammonia, bleach, or alcohol and are safe for most surfaces found in fitness facilities and gyms, including acrylic, chrome, rubber, vinyl, ceramic tile, and fiberglass.
The latest New York Barbells catalog is now available. Since 1974, New York Barbells has been a leading supplier of sports performance, fitness, and strength equipment. The 24-page catalog displays the company’s products, from flooring to the latest biometric unilateral equipment. Call or go online to find out more.
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Experts Choose Ropes from Global Bodyweight Training
“I recommend GBT’s products to every one of our Spartan SGX coaches, because GBT’s rope quality is second to none. When it comes to the volume we spend training with ropes at Spartan Race—my coaches rely on that durability for the safety and satisfaction of their clients.” —Joe DiStefano, CSCS, Co-Creator of Spartan Race’s SGX Coaching Certification
“We’ve tried different kinds of fitness ropes, and GBT’s are definitely the best we’ve found. GBT staff helped us choose the perfect size and type of rope for our needs—our clients love the feel of the poly dac material, our fitness professionals love the versatility offered by ropes, and I love the product’s durability.” —Cody Patrick, Owner, U-Fit Health and Performance
“I’ve been delighted by GBT’s black poly dac rope in every way—the splicing and sealing are all tight and top notch, greatly exceeding the quality of products I’ve purchased from other companies. They’re holding up exceptionally, even to outdoor Colorado winter training. In addition, GBT’s service was equally noteworthy. It’s a great product from a great company that I have warmly recommended to all my clients.” —Michael Lloyd-Billington, Yoga Instruction, Counseling & Personal Training
Athletix Products by Contec, Inc.
Global Bodyweight Training
888-691-2906 GlobalBodyweightTraining.com T&C March 2014
Hot & Cold
Superior Spa Pools and Plunge Tanks
Keep your athletes in peak condition as well as rehabilitate injuries. The SwimEx aquatic therapy and fitness pools feature an industryexclusive paddlewheel propulsion system, which creates the smoothest but most powerful water flow available. The pools offer multiple depths, built-in workstations, adjustable water flow, optional Woodway treadmills, and a durable fiberglass and gelcoat construction. SwimEx also offers hot and cold plunge tanks, one piece or sectional, for easy installation. To view the company’s aquatic therapy pools, visit: www.swimex.com/ commercial/athletic-conditioning/. SwimEx, Inc. • 800-877-7946 www.swimex.com
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Encourage active recovery with the use of the HydroWorx ThermalPlunge and PolarPlunge pools. Utilization of these innovative hot and cold pools can be a catalyst in regeneration. In a PolarPlunge pool, the water is kept at a therapeutic 50 degrees to help control joint inflammation and to stimulate the release of endorphins. ThermalPlunge pool therapy heats muscle and tissue to increase circulation and restore blood flow to the body. HydroWorx International, Inc. • 800-753-9633 www.hydroworx.com Circle No. 531
Plunge Tanks for Recovery
SwimEx Hot and Cold Plunge Pools offer the ultimate recovery and revitalization environment for athletes. Used by athletes around the globe, SwimEx tanks are available in four basic sizes, can be crafted to a custom size, or even made in sections to fit any facility. The tanks are freestanding, self-supporting, and may be installed in or above ground. The pool’s fiberglass sandwich construction results in superior cold and heat retention. For more information, visit: www.swimex.com/ commercial/pool-models/hot-cold-plunge-pools.php. SwimEx, Inc. • 800-877-7946 www.swimex.com
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The HydroWorx 2000 Series is a radically functional aquatic therapy pool. This state-of-the-art aquatic therapy equipment boasts a host of high-performance features that represent the cooperative efforts of visionaries, engineers, and clinicians. The moveable floor, 8’x12’ underwater treadmill, resistance jet technology, and computer and camera systems satisfy the varied demands of traditional sports medicine, as well as those of dominant, world-class athletes. The pool and underwater treadmill comfortably accommodate one to four athletes at a time. HydroWorx International, Inc. • 800-753-9633 www.hydroworx.com Circle No. 532
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New Standard of Care
Do you want to help get your players back into the game fast? Go with Game Ready ®, the injury treatment system of choice for pro sports teams and elite orthopedic clinics. Game Ready enables the simultaneous circulation of ice water and pneumatic progressive compression through anatomically specific wraps, uniquely integrating proven cold and compression therapies in a dual-action treatment system that sets a new standard of care in injury and post-op recovery. Game Ready • 888-426-3732 www.gameready.com
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The Ice-Up Portable Ice Massager is a breakthrough product in the world of ice treatment for soft-tissue injuries. The Ice-Up comes within a portable, insulated carry cooler, which keeps sticks frozen up to 12 hours. Plus, the leak-proof design keeps you dry during travels, so you can take it anywhere for an immediate post-activity ice massage. Pro-Tec Athletics • 800-779-3372 www.pro-tecathletics.com
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Cold & Compression Therapy On the Go PowerPlay™ is a portable cold and compression therapy system for joint relief and muscle recovery. At approximately one pound, PowerPlay goes wherever your game takes you. One affordable unit lets you treat up to three athletes or sites at once, and delivers cold through form-fitting, re-freezable gel wraps. PowerPlay’s intermittent, sequential compression reduces swelling while optimizing tissue healing, blood flow, delivery of oxygen, and lymphatic drainage. Recover faster and boost performance with PowerPlay. PowerPlay • 918-744-1078 www.powerplay.us
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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. The wraps are 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. 539 TRAINING-CONDITIONING.COM
Our Business is Sport
More Products Instant Tension-Adjusting Capabilities
The Lebert Buddy System™ is like a portable pulley machine with no fixed anchor or set-up required. This tandem-training tool has instant tension-adjusting capabilities. Use it for rowing motions to effectively train back muscles with both bilateral and unilateral training in unlimited planes. Strength moves, resisted running drills, tug-of-war, and crossbow are all possible, and because the tension adjusts instantly, this product is great for long sets of muscle endurance. Lebert Fitness • 905-812-0555 www.lebertfitness.com
“USD’s Sport Management program provides students with exceptional classes, professors, and opportunities to succeed. Skills are developed, and professional networks are created. I’m truly proud to be a Sport Management alum!” —Ty Munneke, Golf Customer Service Representative, Nike
“The Sport Management program at USD provided a unique experience that I won’t forget. It revealed a passion for sport that I will carry with me for the rest of my life.”
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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 leucine-enriched 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
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—Morgan Lunz, Event Operations Intern, Kansas City Chiefs
Sport management is a multi-billiondollar business, making it one of the largest industries in the United States. The mission of the University of South Dakota’s Sport Management program is to provide quality preparation for positions within the sport industry. Achieving this mission requires an integration of sport management theory and practice with the interaction of sport management academics, practicing sport managers, and goal-oriented students. Due to our program’s versatility, a large number of opportunities exist in multiple areas of the sport industry. Supervising employees at a professional sport stadium, managing a large sport fitness complex, conducting event management logistics, or coordinating the compliance policy for an intercollegiate athletic department are just a few of the career choices for graduates of the USD Sport Management program.
Measure Abdominal Force
Tendo AbEx is one of the first abdominal machines with a “Force” measurement system that strengthens all abdominal muscles, including rectus abdominis, internal and external obliques, and transverse abdominus. The Force unit measures average force for concentric contraction of the abdominal muscles. If bodyweight has been entered, the microcomputer provides average force relative to bodyweight. The exercise machine uses an adjustable isokinetic hydraulic resistance system with six speed levels. Tendo Sports Machines www.tendosport.com
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University of South Dakota
The Activ8r™ soft-tissue release system is designed to prevent nagging injuries, maximize performance, and rehabilitate from injury or daily stress. The contoured figure-eight profile and silicone construction help it sink deep into tight tissues for an efficient myofascial release. The Activ8r is perfect for clinic, gym or home exercise programs. It’s compact, freezable, dishwasher-safe, benefits the entire body, and includes an instructional poster.
OPTP • 800-367-7393 www.optp.com
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More Products Immediate Relief and LongTerm Healing
Plantar fasciitis is one of the most common issues faced by athletes. Studies prove that a combination of targeted calf stretching and heel support provides the most significant relief and promotes healing. Athletes can be pain free in 2Steps™: The pairing of ProStretch® Plus and Tuli’s® Heel Cups is a proven and easy-to-use solution that provides both the immediate relief and long-term healing needed to keep athletes on their feet. Medi-Dyne Healthcare Products, Ltd. • 800-810-1740 www.Medi-Dyne.com Circle No. 518
Goes Beyond Cleaning
Athletix™ Products Equipment Cleaner Wipes are non-alcohol based, easy to use, effective, and safe for vinyl, leather, chrome, foam grips, rubber, painted surfaces, metal, and electronic displays. Athletix Equipment Cleaning Wipes go beyond just cleaning—they also neutralize odors that tend to build up on soft surfaces. In addition, utilizing nanopolymer technology, they lay down a protective barrier against odor penetration. Athletix Products • 864-503-8333 www.athletixproducts.com
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Drops of Energy
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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Reach Your Goals Faster
Dymatize’s fastest-absorbing protein designed for the hardest-working athletes, ISO•100® has everything your body needs to build and repair muscles faster. Each serving delivers 25 grams of hydrolyzed 100-percent whey protein isolate and 5.5 grams of branched-chain amino acids (BCAA)–including 2.7 grams of the BCAA LLeucine, which is depleted during intense training. ISO•100® is free of gluten and lactose, with less than one gram each of sugar and fat per serving. Since ISO•100 is composed of hydrolyzed 100-percent whey protein isolate, you get all the nourishment you need almost instantaneously. Work harder. Recover quicker. Achieve your goals faster. Dymatize Nutrition • (888) 334-5326 dymatize.com
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Changing Training Forever The Tendo unit easily hooks to the barbell, plate stack, or athlete and measures average and peak velocity in meters per second up to a 2.6-meter range of motion. If the proper mass of the barbell or athlete has been entered into the microcomputer, the unit gives velocity as well as power output measurements for up to 250 reps before having to reset. These units are very popular in the college and NFL markets. Sorinex • 877-543-8667 www.sorinex.com
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Posture is a reflection of the “position” of many systems that are regulated, determined, and created through limited functional patterns. PRI offers live and homestudy continuing education courses and professional credentialing opportunities for physical therapists, physical therapy assistants, occupational therapists, athletic trainers, and strength and conditioning specialists. Supplemental products include non-manual exercise technique CDs, manual technique instruction on DVD, illustrations, and models. Explore this revolutionary approach to physical medicine. Postural Restoration Institute® • 888-691-4583 www.posturalrestoration.com Circle No. 533
The Quick Recovery Test lets you assess players’ recovery in five minutes. Its instant group feedback provides a recovery score from 0 to 100 percent and recovery progress at individual and group level. The Overnight Recovery Test lets you detect early signs of overtraining and see how daily stress factors influence the body. Firstbeat Technologies Ltd. • 310-259-2277 www.firstbeat.com
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Offsets Poor Posture
Bad posture is a direct result of today’s lifestyles. While watching television, working at a computer, or driving, the muscles in the front of your shoulders and chest become extremely tight from the constant flexion, and the muscles of your upper back become extremely weak – and that’s without the impact felt from participation in sports. Posture Medic™ has been designed specifically for the purpose of offsetting these imbalances by helping you to stretch the muscles of your chest and strengthen the muscles of your upper back. Posture Medic • 800-461-0100 thepostureperfector.com
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More Products Full Control for Greater Results
The Lebert Equalizer™ is a simple, portable, multi-purpose, and versatile piece of strength training equipment that works the arms, chest, back, and core muscles, using your own bodyweight as resistance. This simple versatility allows the user full control over the amount of bodyweight used for a given exercise, and the result is greater muscle endurance and strength. This product is great for dips, rows, agility, and mobility drills. It is made of steel and supports 400 pounds. Lebert Fitness • 905-812-0555 www.lebertfitness.com
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Athletix™ Disinfectant Wipes are a quick and convenient way to disinfect surfaces in your athletic training room or fitness facility. Pre-moistened and ready to use, these durable, disposable wipes are packaged both in a portable dispensing bucket and a two-roll refill pack. Now with more wipes for the same price, Athletix Disinfectant Wipes kill antibiotic-resistant bacteria like MRSA and CA-MRSA and are effective against many common bacteria. Athletix Products • 864-503-8333 www.athletixproducts.com
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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. VersaClimber/HeartRate, Inc. • 800-237-2271 www.versaclimber.com Circle No. 522
Easier Clean Up
The New PRO 11T Scissors have a non-stick coating that withstands adhesive build-up and cleans much easier than the chrome-coated scissors. You will find that these non-stick coated scissors work great on kinesio tape and elasticon. Plus, they make clean up a snap. PRO Orthopedic Devices, Inc. • 800-523-5611 www.proorthopedic.com Circle No. 527
The GymWipes product line offers full-spectrum protection with its cost-effective solutions to safely clean and sanitize all fitness equipment surfaces. These wipes are bactericidal, virucidal, and fungicidal. Plus, the company’s EPAregistered disinfecting/sanitizing formulas protect against more than 50 dangerous pathogens. Safe and effective, GymWipes contain no harmful ingredients such as alcohol, phenol, and bleach—and they are tested and approved by leading manufacturers. The wipes come in 700 to 1200 counts, with attractive dispensers and stands available. GymWipes • 888 977-3726 www.gymwipes.com
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Provides Comprehensive Nutrition
Feed, build, and sustain lean muscle every day and at anytime with Elite Fusion7. Perfect for fueling the body with seven high-quality proteins throughout the day, Elite Fusion7 keeps you nourished and energized. Whether you use it for post-workout recovery, a convenient meal replacement, or a decadent protein-enhanced snack between meals, you’ll get comprehensive nutrition with every shake. Enjoy delicious, new flavors like Orange Dreamsicle and Strawberry Banana, along with classic favorites like Rich Chocolate Shake and Creamy Vanilla Shake. Get delicious protein nutrition every day, anytime with Elite Fusion7. Dymatize Nutrition • (888) 334-5326 dymatize.com
Circle No. 538
Top Industry Professionals Improve Fitness
The HiTrainer Pro is designed to significantly improve athlete’s fitness in the minimum amount of time. It makes high-intensity cardiovascular training easier to do, helping athletes significantly improve their anaerobic recovery, strength endurance and cardio fitness with minimum impact to their bodies. The HiTrainer Pro’s onboard performance analysis features make it easy for athletes to monitor their performance, track training and set targets. HiTrainer • 855-726-3300 www.hitrainer.com TR AINING-CONDITIONING.COM
Circle No. 526
The National Strength and Conditioning Association (NSCA) is an international educational association. The NSCA develops some of 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 to strength coaches to researchers and educators. These individuals are all in pursuit of achieving a common goal—improving athletic performance and fitness. National Strength and Conditioning Association • 800-815-6826 www.nsca.com Circle No. 530 T&C March 2014
Advertisers Directory Circle #. Company. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page #
Circle #. Company. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page #
105. American Public University. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
106. NSCA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
121. Athlete’s Guide to Nutrition. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
119. OPTP. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
109. Athletix™ Products by Contec . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
117. Parents’ Guide to Sports Concussions. . . . . . . . . . . . . . . . . . . . . . 31
110. California University of Pennsylvania. . . . . . . . . . . . . . . . . . . . . . . 23
116. Postural Restoration Institute® . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
126. Cramer Protective Apparel by Stromgren . . . . . . . . . . . . . . . . . . . . 7
115. Posture Medic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
102. Dymatize Nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
100. PowerPlay™ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IFC
112. Firstbeat Technologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
120. PRO Orthopedic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
124. Rogue Fitness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IBC
111. GymWipes® . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
122. Samson Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
104. HiTrainer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
103. SwimEx . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
113. HydroWorx. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
123. Tendo. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
118. Medi-Dyne . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
101. TurfCordz®/NZ Manufacturing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
125. Muscle Milk® (CytoSport™). . . . . . . . . . . . . . . . . . . . . . . . . . . . . BC
108. VersaPulley & VersaClimber . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Circle #. Company. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page #
Circle #. Company. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page #
500. American Public University. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
509. New York Barbells. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .56
524. Athletix™ Products (Disinfectant Wipes). . . . . . . . . . . . . . . . . . . . 51
542. New York Barbells (catalog) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
519. Athletix™ Products (Equipment Cleaner Wipes) . . . . . . . . . . . . . . 50
530. NSCA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
504. California University of Pennsylvania. . . . . . . . . . . . . . . . . . . . . . . 46
505. NZ Manufacturing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
510. Cool Systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
529. OPTP (Activ8r™) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
520. CytoSport™ (Cytomax Energy Drops™). . . . . . . . . . . . . . . . . . . . 50
507. OPTP (catalog). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
516. CytoSport™ (Monster Amino™). . . . . . . . . . . . . . . . . . . . . . . . . . 49
541. Perform Better . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
538. Dymatize Nutrition(Elite Fusion7) . . . . . . . . . . . . . . . . . . . . . . . . . 51
533. Postural Restoration Institute® . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
. . . . . . . . . . . . . . . . . . . . . . . . . 50
536. Posture Medic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
525. Firstbeat Technologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
506. PowerPlay™ (catalog). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
535. Dymatize Nutrition (ISO•100 ®
513. Game Ready . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
514. PowerPlay™ (cold/compression therapy). . . . . . . . . . . . . . . . . . . 48
503. Game Ready® (catalog) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
527. PRO Orthopedic (11T Scissors). . . . . . . . . . . . . . . . . . . . . . . . . . . 51
528. GymWipes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
502. PRO Orthopedic (catalog). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
543. HawkGrips. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
539. PRO Orthopedic (ice wraps) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
501. HiTrainer (catalog) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
540. Pro-Tec Athletics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
526. HiTrainer (Pro) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
508. Samson . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
532. HydroWorx (2000 Series) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
537. Signature Athletic Tape. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
531. HydroWorx (ThermalPlunge/PolarPlunge) . . . . . . . . . . . . . . . . . . . 48
521. Sorinex. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
515. Lebert Fitness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49
512. SwimEx (Hot and Cold Plunge Pools). . . . . . . . . . . . . . . . . . . . . . . 48
523. Lebert Fitness (Equalizer™). . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
511. SwimEx (product line). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
518. Medi-Dyne (2Steps™). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
517. Tendo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
534. Medi-Dyne (catalog). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
522. VersaClimber/HeartRate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
T&C March 2014
T&C March 2014 Volume XXIV No. 2
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 24.2 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 5-6)
Objective: To learn about recently published research in sports medicine. 1. According to a study on the duration of post-concussion symptoms, which of the following factors was an effective predictor whether symptoms would last more than 28 days? a) Lower neurocognitive testing score soon after the injury b) Loss of consciousness c) Amnesia d) Age of the athlete 2. Researchers found that women who suffered a concussion within two weeks leading up to menstruation were more likely to: a) Heal more quickly than others b) Heal more slowly than others c) Heal at the same rate as others d) Experience fewer headaches and dizziness 3. Stroboscopic glasses can enhance training by: a) Increasing an athlete’s peripheral vision b) Eliminating the need for corrective lenses c) Improving the processing of visual information d) Protecting the eye from injury
4. Compared to students who don’t play sports, high school male studentathletes are: a) Much more likely to take too much opioid medications b) Slightly more likely to take too much opioid medications c) Less likely to take too much opioid medications d) Less likely to use opioid medication to get high 5. Researchers who found that the lower back is the third most commonly injured area in young athletes include which step among their recommendations for reducing the risk of lower-back injuries? a) Wearing back braces during practices b) Active stretching before practice c) Avoiding contact sports for younger athletes d) Keeping weekly practice hours at or below the athlete’s age in years
7. Which of the following is not mentioned in the article as a nutrient affected by individual genetics? a) Vitamin D b) Vitamin C c) Calcium d) Creatine 8. What does Stuart Kim see as a potential problem with nutrigenetics? a) There are too many companies offering testing b) It could cause unnecessary stress c) Test results could hinder a professional athlete’s career d) All of the above
Lines on the Sidelines (pages 21-25)
Objective: To understand how athletic trainers can handle situations in which coaches disagree with their return-to-play decisions.
Objective: To learn how genetic testing is helping some athletes discover their nutritional needs and optimize their diet.
9. In states with no licensure guidelines for athletic trainers, their scope of practice is determined by: a) The American Medical Association b) The NATA Board of Certification’s Role Delineation/Practice Analysis c) The NCAA and NFHS d) The institution’s athletic director
6. Why are SNPs important to athletes and sports performance? a) They can reveal the presence of fasttwitch muscle fibers b) They can indicate how an athlete’s body processes specific nutrients c) They can tell athletes which sports they would best at d) They can tell who is the better athlete
10. The NATA investigates ethics violations through which of the following groups? a) Board of Legal and Ethical Responsibility b) Strategic Alliance of Athletic Training c) Committee on Professional Ethics d) The Professional Development Committee
Reaching Down Deep (pages 15-19)
T&C March 2014
CEU QUIZ 11. Drawing from the book, Moral Courage, which of the following paradigms does the author apply to the article topic? a) Honesty versus loyalty b) Individual versus community c) Empathy versus justice d) All of the above
16. PRI seeks to restore optimal, balanced breathing by: a) Returning the diaphragm to normal function in its proper position b) Increasing an athlete’s core strength c) Improving balance and proprioception d) Enhancing lung capacity
21. Which treatment modalities were not used when Fisher suffered a recurrence of her navicular stress fracture? a) Bone stimulator b) Fascial stretching c) Graston technique d) New orthotics
12. According to the author, who has the ultimate say in whether an athlete can return to activity? a) The athlete b) The coach c) The athletic trainer d) The physician
17. The Horizontal Adduction Test examines the position of the: a) Scapula on the thorax b) Pelvis c) Femurs d) Shoulders
Prepared to Launch (pages 41-44)
13. What does the author recommend as a possible course of action should an athletic trainer disagree with a physician’s decision to clear an athlete for activity? a) Refuse to let the athlete practice b) Obtain a second opinion from another physician c) Convince the coach to keep the athlete out of practice d) Convince the athlete to stay out of practice
Finding Balance (pages 28-33)
Objective: To understand how a treatment focused on restoring the body’s inner balance can help improve athletic performance. 14. When core muscles are not able to maintain proper balance, the diaphragm changes its orientation and length, which: a) Makes an athlete more susceptible to cramps b) Reduces the risk of an asthma attack c) Increases an athlete’s VO2 max d) Leaves it less effective for optimal air exchange 15. Which of the following is not cited as a sign of a tightened diaphragm: a) Shortness of breath b) An arched back c) Inability to squat deeply d) Sharp pain
Objective: To learn about the strength and conditioning program used to train throwers at Oklahoma State University.
To the Bone (pages 34-40)
Objective: To learn about the treatment of two types of stress fractures. 18. Author Summer McKeehan began treatment of Elizabeth Williams’s tibial stress fracture treatment with: a) Soft tissue massage b) Hip hike exercises c) Core-strengthening work d) Cortisone shots
T&C March 2014
23. Which of the following attributes of powerlifting does he believe best applies to throwers as well? a) Power b) Absolute strength c) Explosiveness d) Speed
19. In the early stage of treatment, McKeehan increased Williams’s daily intake of: a) Protein b) Carbohydrates c) Calcium d) Sodium chloride
24. How do the workouts Baumann designs for female throwers differ from those for male throwers? a) Increased repetitions b) Lower intensities c) More plyometrics d) More bench and power-clean exercises
20. When pole vaulter Rachel Fisher arrived on campus, author Dustin Williams worked to prevent a recurrence of a previous stress fracture by using: a) Resistive bands b) Soft-tissue massage c) NormaTec compression d) Electrical stimulation
25. Why does Baumann sometimes have throwers lift a log during the front squat? a) To provide variety b) It helps develop strength in an upright position c) It improves an athlete’s balance d) Logs are harder to grip
icker You c an no & Ea w tak and g si e our et yo ur CE CEU q er! U res u izzes ults a onli www C .train lick on “CEU nd credit ins ne... tantly s” at: ing-c . o nditi
22. Author John Baumann’s strength and conditioning program for throwers has been influenced by sports such as: a) Gymnastics b) Lacrosse c) Baseball d) Ice hockey
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 24.2 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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Last Name ____________________________________ First Name _______________________________ MI______ Title ______________________________________________________________________________________________ Mailing Address ____________________________________________________________________________________ City ________________________________________________ State _________ Zip Code _____________________ Daytime Telephone ( _________ ) ________________________________________ E-Mail Address ____________________________________________________________________________________ Payment Information
❏ $25 check or money order (U.S. Funds only) payable to: MAG, Inc. (please note “T&C 24.2 Quiz” on check) ❏ Visa ❏ Mastercard ❏ Discover ❏ American Express (Please note: the charge will appear as “MomentumMedia” on your credit card statement)
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T&C March 2014
Circle No. 509
Circle No. 510
New York Barbells of Elmira, Inc. 800-446-1833 newyorkbarbells.com
Cool Systems, Inc. (makers of Game Ready® ) 1-888-426-3732 gameready.com
Benefits for the user:
Benefits for the user:
• The 1.75-inch heavy wall tubes on the large unit and knurled tubing on the Paralletes provide for secure gripping • Easily moved, these bars can facilitate numerous exercises at any location
• TDS Parallel bars and the smaller Paralletes are effective tools for strength and endurance training as well as rehabilitation • These affordable tools have unlimited exercise potential • These bars are great for everything from gait and core exercises to sport-specific training— including dips, push-ups, muscle-ups, handstands, and planks
• First-ever integrated cold and compression wrap for hand, wrist, and forearm injury and post-op recovery (trauma, sprains, fractures) • Removable and adjustable ergonomic hand support • Customizable insulation zones to assure effective therapy and patient compliance
• Wrap leverages physician-recommended ACCEL® technology and is available for use with the Game Ready system
HawkGrips Therapy Instruments
Signature Athletic Tape
HawkGrips 484-351-8050 www.hawkgrips.com
Signature Athletic Tape 877-741-TAPE (8273) www.signatureathletictape.com
Circle No. 543
Circle No. 537
Benefits for the user:
• The best in the NCAA have their own athletic tape • Now your team can have its own customized logo tape • Easy to order your team’s custom tape
• High-quality, breathable athletic tape used by professional athletic trainers • 100-percent cotton with zinc oxide adhesive • Protects joints from injury and sprains and provides support to help speed recovery • Serrated edge for easy tear
• Instruments are ergonomically designed to ease the strain placed on the hands of the clinicians, which extends career longevity • Cross-hatched, textured gripping significantly enhances control of the instrument, allowing for maximum feedback
T&C March 2014
Benefits for the user:
• The stainless steel instruments are used to break down scar tissue and fascial restrictions, increasing range of motion and decreasing pain
Circle No. 124
GIVE ME STRENGTH
FOR TEAM SALES INFORMATION: PERFORMANCE@CYTOSPORT.COM 707-747-3372 • MUSCLEMILK.COM ©2013 CytoSport, Inc. MUSCLEMILK.COM
Circle No. 125
WORKOUT RECOVERY FUEL
TO JUMP HIGHER TO OWN THE BOARDS TO WIN