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Circle No. 100

Optimum Performance

15 The ZZZ FactorChronically sleep-deprived athletes probably don’t realize all the ways they’re hampering their performance. This article presents research on sleep’s many physical and mental benefits.

By Art Horne

Nutrition

23 Preparing for BattleThe yearly training cycle for wrestlers includes three distinct phases, and an optimal nutrition strategy should target specific goals for each one.

By Susan Kundrat

Treating the Athlete

30 Groin PainsWhether you call it a sports hernia or athletic pubalgia, recurring pubic-area pain can be a major hindrance for athletes. These authors devised a specialized training program for the Cornell University men’s hockey team aimed at addressing and preventing groin injuries.

By Dr. Paul Geisler & Ed Kelly

Leadership

37 For the RecordFrom helping you lobby for more resources to protecting your program against lawsuits, a top-notch medical record keeping system offers many benefits. Does yours?

By Jon Almquist

Sport Specific

42 Finishing StrongA college track coach—who also designs strength programs for some of the world’s top runners—explains how good things happen when strength training and track and field embrace each other.

By Danny Brabham

Bulletin Boards

4 An improved test for testosterone

doping … Why athletes shouldn’t wear

flip-flops … The ACC addresses injury

reporting … Study finds a predictor for

amenorrhea.

Comeback Athlete

8 Max Baumann

St. Xavier High School

Cincinnati, Ohio

Sponsored Page

13 Q&A with Dr. Nicholas DiNubile

Product News

49 Pain Management

55 Hot & Cold

57 More Products

59 Web News

56 Advertisers Directory

CEU Quiz

61 For NATA and NSCA Members

64 Next Stop: Web Site

On the cover: The Cornell University men’s hockey team saw a dramatic reduction in lower-body injuries last sea-son after implementing a new training program designed to prevent athletic pubalgia and sports hernias. Story begins on page 30. Photo by Patrick Shanahan.

October 2008, Vol. XVIII, No. 7

CONTENTS

42

T&C OCTOBER 2008 1 TRAINING-CONDITIONING.COM

2315

Publisher Mark Goldberg

Editorial Staff

Eleanor Frankel, DirectorGreg Scholand, Managing EditorR.J. Anderson, Kenny Berkowitz, Abigail Funk, Kyle Garratt, Mike Phelps, Dennis Read

Circulation Staff

David Dubin, DirectorJohn Callaghan

Art Direction

Message Brand Advertising

Production Staff

Maria Bise, DirectorJim Harper, Neal Betts, Natalie Couch

Business Manager

Pennie Small

Special Projects

Dave Wohlhueter

Administrative Assistant

Sharon Barbell

Advertising Materials Coordinator

Mike Townsend

Marketing Director

Sheryl Shaffer

Marketing/Sales Assistant

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Advertising Sales Associates

Diedra Harkenrider(607) 257-6970, ext. 24

Pat Wertman(607) 257-6970, ext. 21

T&C editorial/business offices:

31 Dutch Mill RoadIthaca, NY 14850 (607) 257-6970Fax: (607) [email protected]

October 2008 Vol. XVIII, No. 7

Marjorie Albohm, MS, ATC/L

Director of Sports Medicine

and Orthopaedic Research,

Orthopaedics Indianapolis

Jon Almquist, ATC

Specialist, Fairfax County (Va.) Pub. Schools

Athletic Training Program

Brian Awbrey, MD

Dept. of Orthopaedic Surgery,

Massachusetts General Hospital,

and Instructor in Orthopaedics,

Harvard Medical School

Jim Berry, MEd, ATC, SCAT/EMT-B

Director of Sports Medicine

and Head Athletic Trainer,

Myrtle Beach (S.C.) High School

Leslie Bonci, MPH, RD

Director, Sports Medicine

Nutrition Program, University of Pittsburgh

Medical Ctr. Health System

Christine Bonci, MS, ATC

Asst. A.D. for Sports Medicine,

Women’s Athletics, University of Texas

Cynthia “Sam” Booth, ATC, PhD

Manager, Outpatient Therapy

and Sportsmedicine,

MeritCare Health System

Debra Brooks, CNMT, LMT, PhD

CEO, Iowa NeuroMuscular Therapy Center

Cindy Chang, MD

Head Team Physician,

University of California-Berkeley

Dan Cipriani, PhD, PT

Assistant Professor

Dept. of Exercise

and Nutritional Sciences,

San Diego State Univ.

Gray Cook, MSPT, OCS, CSCS

Clinic Director

Orthopedic & Sports Phys. Ther.

Dunn, Cook, and Assoc.

Keith D’Amelio, ATC, PES, CSCS

Head Strength & Conditioning Coach/

Assistant Athletic Trainer, Toronto Raptors

Bernie DePalma, MEd, PT, ATC

Head Athl. Trainer/Phys. Therapist,

Cornell University

Lori Dewald, EdD, ATC, CHES

Health Education Program Director,

Salisbury University

Jeff Dilts, Director,

Business Development & Marketing,

National Academy of Sports Medicine

David Ellis, RD, LMNT, CSCS

Sports Alliance, Inc.

Boyd Epley, MEd, CSCS

Director of Coaching Performance,

National Strength & Conditioning Association

Peter Friesen, ATC, NSCA-CPT, CSCS, CAT,

Head Ath. Trainer/ Cond. Coach,

Carolina Hurricanes

Lance Fujiwara, MEd, ATC, EMT

Director of Sports Medicine,

Virginia Military Institute

Vern Gambetta, MA, President,

Gambetta Sports Training Systems

P.J. Gardner, MS, ATC, CSCS, PES, Athletic

Trainer, Colorado Sports & Spine Centers

Joe Gieck, EdD, ATR, PT

Director of Sports Medicine and Prof.,

Clinical Orthopaedic Surgery,

University of Virginia (retired)

Brian Goodstein, MS, ATC, CSCS,

Head Athletic Trainer, DC United

Gary Gray, PT, President, CEO,

Functional Design Systems

Maria Hutsick, MS, ATC/L, CSCS

Head Athletic Trainer,

Medfield (Mass.) High School

Christopher Ingersoll, PhD, ATC, FACSM

Director, Graduate Programs in

Sports Medicine/Athletic Training

University of Virginia

Allan Johnson, MS, MSCC, CSCS

Sports Performance Director

Velocity Sports Performance

Tim McClellan, MS, CSCS

Director of Perf. Enhancement,

Makeplays.com Center

for Human Performance

Michael Merk, MEd, CSCS

Director of Health & Fitness,

YMCA of Greater Cleveland

Jenny Moshak, MS, ATC, CSCS

Asst. A.D. for Sports Medicine,

University of Tennessee

Steve Myrland, CSCS

Owner, Manager, Perf. Coach, Myrland Sports

Training, LLC, Instructor and Consultant,

University of Wisconsin Sports Medicine

Mike Nitka, MS, CSCS

Director of Human Performance,

Muskego (Wisc.) High School

Bruno Pauletto, MS, CSCS

President, Power Systems, Inc.

Stephen Perle, DC, CCSP

Associate Prof. of Clin. Sciences, University

of Bridgeport College of Chiropractic

Brian Roberts, MS, ATC, Director,

Sport Performance & Rehab. Ctr.

Ellyn Robinson, DPE, CSCS, CPT

Assistant Professor, Exercise Science

Program, Bridgewater State College

Kent Scriber, EdD, ATC, PT

Professor/Supervisor of

Athletic Training, Ithaca College

Chip Sigmon, CSCS

Strength and Conditioning Coach,

Carolina Medical Center

Bonnie J. Siple, MS, ATC

Coordinator, Athletic Training

Education Program & Services,

Slippery Rock University

Chad Starkey, PhD, ATC

Visiting Professor, Athletic Training

Education Program, Ohio University

Ralph Stephens, LMT, NCTMB

Sports Massage Therapist,

Ralph Stephens Seminars

Fred Tedeschi, ATC

Head Athletic Trainer, Chicago Bulls

Terrence Todd, PhD, Co-Director,

Todd-McLean Physical Culture Collection,

Dept. of Kinesiology & Health Ed.,

University of Texas-Austin

Training & Conditioning (ISSN 1058-3548)

is published monthly except in January

and February, May and June, and July and

August, which are bimonthly issues, for

a total of nine times a year, by MAG, Inc.,

31 Dutch Mill Rd., Ithaca, NY 14850. T&C is

distributed without charge to qualified

professionals involved with competitive

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Ithaca, NY 14852-4806. Printed in the U.S.A.

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Circle No. 102


Sponsored by

BoardBulletin

A Better Doping TestUniversity of Utah scientists have developed a new test to

identify athletes who have taken testosterone to enhance per-

formance. By using mass spectrometry to measure levels of

both testosterone and the closely related epitestosterone in a

urine sample, researchers were able to detect doping more

quickly and accurately than with other existing methods.

Testosterone and epitestosterone levels vary widely among

individuals, but the two hormones are normally present in

the body at nearly equal levels. If an athlete takes additional

testosterone or drugs that boost testosterone production,

the test will detect an artificial imbalance in the testosterone-

epitestosterone ratio. The World Anti-Doping Agency consid-

ers a ratio of 4:1 or higher to indicate doping.

Testosterone-epitestosterone tests are already used in

some settings—in one famous example, Floyd Landis was

stripped of his 2006 Tour de France title after his ratio was

measured at 11:1. But the tests have been difficult to perform

and required specialized procedures.

This new mass spectrometry test can be performed using

standard lab equipment and is more sensitive than other

methods, because it increases the number of usable “diag-

nostic qualifier ions,” which are markers that indicate doping.

As a result, it may make testing for testosterone doping more

widely available. “Our system means that we can determine

the testosterone-epitestosterone ratio in a sample with great-

er confidence, and therefore be in a better position to spot

doping violations without falsely accusing innocent athletes,”

Jonathan Danaceau, MD, Preventive Medicine Specialist at

the University of Utah Hospital, said in a press release.

“Quantitative confirmation of testosterone and epitestoster-

one in human urine by LC/Q-ToF mass spectrometry for dop-

ing control” was published in the July 2008 issue of the Journal

of Mass Spectrometry. The journal can be found online at:

www.uclibs.org/PID/839.

Flip-Flops & Athletes: A Bad CombinationIt’s not hard to imagine why flip-flops can be bad for your feet,

since they offer very little cushioning and virtually no arch sup-

port. But now, research from Auburn University’s Department

of Kinesiology provides specific data about how flip-flops can

affect athletes who wear them.

“There’s plenty of anecdotal information out there that says

flip-flops can cause problems,” says graduate student Justin

Shroyer, MA, CSCS, who co-wrote Auburn’s flip-flop study

with Professor Wendi Weimar, PhD. “We wanted to look at

them scientifically to see what effects they have.”

In the study, researchers analyzed the way 39 college-age

men and women walked while wearing flip-flops, then com-

pared it to the way they walked in athletic shoes. With flip-flops,

subjects took shorter strides, hit the ground with less vertical

force, and increased the “attack angle” of their ankles during

the leg’s swing phase. When participants switched to sneak-

ers, some of the gait changes remained, causing discomfort.

The study raises questions that Shroyer and Weimar would

like to answer with further research: How do muscle recruitment

patterns differ when wearing flip-flops versus athletic shoes?

Does the shortened stride put athletes at risk for injury? How

much energy do foot muscles have to use to grip the flip-flop?

Does the flip-flop step cause muscles to work harder?

Shroyer stops short of drawing too many conclusions from

the initial study, and hasn’t yet tossed his own flip-flops. But

he does caution athletes against wearing them all day long.

“Flip-flops were made for the beach, the pool, and the shower,

and that’s where they should be worn,” he says. “There are

some great things about flip-flops: They’re easy to take off and

put on, and they help keep feet cool. But they’re not the best

choice for everyday footwear.

“If athletic trainers are trying to provide an optimal envi-

ronment for their athletes, they’ll want to eliminate anything

counterproductive,” adds Shroyer. “If athletes want to keep

wearing flip-flops, they should look for ones with more arch

support and a thicker cushion. And they should replace them

every three or four months. If they have to break out the duct

tape, they’ve gone way too far.”

Injury Reporting Revised in the ACCThis season, the Atlantic Coast Conference (ACC) is adopt-

ing the NFL model for reporting football injuries. The new

guidelines state that head medical personnel for each team,

rather than coaches, will report every Monday during the sea-

son which players are scheduled for surgery or are out for

the season. On Thursday, within 90 minutes of the end of

practice, teams will release a list classifying each player as

definite, probable, questionable, doubtful, or out. Teams won’t

release any injury information on Tuesday or Wednesday.

ACC schools used to release a full injury report on Monday,

as is standard practice in most other conferences. The new

policy was adopted to give teams more time to evaluate the

status of players, and to keep coaches from having to answer

media questions about medical issues.

“We’re not doctors, athletic trainers, or medical person-

nel,” says North Carolina State University Head Football

Coach Tom O’Brien. “This policy gets us out of the business

of answering questions about injuries. Trying to get an injury

report out on Monday after a Saturday game is almost impos-

sible, because you can’t really tell at that point if someone will

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Circle No. 103

BoardBulletin


BoardBulletin

be able to make it or not.”

O’Brien says he’ll work with athletic trainers and team phy-

sicians in much the same way he did before, but now, they will

be able to provide more accurate information to the media and

the public. This reporting process will also keep coaches from

having to worry about violating the Health Insurance Portabil-

ity and Accountability Act (HIPAA), which protects the privacy

of personal health information.

The new injury reporting system is voluntary, with no penal-

ties for deviating from the agreed upon protocols. No other

conferences are currently planning to follow the ACC’s lead,

though Head Football Coach Mack Brown of the University of

Texas (a Big 12 Conference member), has expressed interest

in adopting the system.

Study Finds Hormonal Link to AmenorrheaA study from Harvard University has found a possible predic-

tor for amenorrhea (the absence of menstruation in females

of reproductive age) among teenage female athletes. The hor-

mone ghrelin, which normally stimulates appetite, was found

to be at elevated levels in amenorrheic athletes.

Madhusmitra Misra, MD, a pediatric endocrinologist at

Harvard-affiliated Massachusetts General Hospital, studied

21 teenage athletes with amenorrhea alongside 19 normally

menstruating teenage athletes and 18 menstruating teenage

non-athletes. The non-menstruating athletes had significantly

higher average levels of ghrelin and lower levels of a corre-

sponding hormone called leptin than the other two groups.

The amenorrheic athletes also had lower bone density and

lower levels of estrogen, which is essential for bone growth.

Misra’s study says amenorrhea affects as much as 25 per-

cent of the high school female athlete population, compared

with two to five percent of teenage females overall. The higher

rate is usually linked to energy deficits caused by high-inten-

sity exercise and low caloric intake.

This most recent research helps clarify the role hormones

play, and may be a step toward identifying who is at great-

est risk for amenorrhea and the female athlete triad in gen-

eral. “These findings suggest that hormonal disorders may

explain why amenorrhea occurs in some but not all adolescent

athletes,” Misra said during a presentation at the Endocrine

Society’s June 2008 meeting. “In addition, ghrelin may be an

important link between an energy deficit state and the hor-

mones that regulate menstrual function.”

An abstract of Misra’s presentation, “Reproductive and Bone

Health in the Female Athlete,” can be found on the Endocrine

Society’s Web site at: www.abstracts2view.com/endo.

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Untitled-22 1 7/9/08 10:29:27 AM

Circle No. 104

Untitled-3 1 4/9/08 3:38:54 PM

Circle No. 105

T&C OCTOBER 2008 TRAINING-CONDITIONING.COM 8

Max BaumannSt. Xavier High School, Cincinnati, OhioBY R.J. ANDERSON

dure. “We wanted to get him ready mentally and physically be-

cause he was facing some long, hard months,” Gordon says.

“So we prehabbed him and had him do a lot of quad strength-

ening work to minimize atrophy before the surgery.”

The surgery on his left knee took place Dec. 7, three weeks

after St. Xavier’s last game, with Heidt performing an auto-

graft procedure using a piece of Baumann’s patellar tendon

to reconstruct the torn ACL. During the first four weeks after

surgery, Baumann was on crutches and followed what Gor-

don describes as a typical ACL rehab, doing continuous pas-

sive motion work and quad tightening, as well as increasing

his knee’s range of motion and overall flexibility. At the same

time, Baumann prehabbed for his upcoming shoulder sur-

gery using the strengthening program he had begun during

the season, which included band work, internal and external

rotations, front raises, and some light shrugging.

Baumann did his initial physical therapy at Wellington with

John Brehm, MEd, ATC, an athletic trainer at the clinic and

an Assistant Athletic Trainer at St. Xavier. During his school

ComebackAthlete

Max Baumann (no. 65) underwent three surgeries after the

2006 season to repair his shoulder and both knees. In 2007,

he helped lead St. Xavier High School to a state title.

After his team was blown out in the 2006 Ohio

Division I football regional finals by archrival

Colerain High School, St. Xavier High School

junior right guard Max Baumann was as low as

he’d ever been. With both knees and a shoulder

wrapped in large bags of ice, Baumann strug-

gled to understand how his season had ended

in the worst possible way: The team’s dream of

defending its state title was dead and his left

knee was shredded.

While pulling on a blocking assignment five minutes into the

fourth quarter, the 6-foot-2, 275-pound Baumann was blind-

sided. His left knee buckled awkwardly, and he heard a pop.

Later, an MRI revealed he had torn the ACL, MCL, and medial

meniscus—arguably the most feared triad of knee injuries.

There’s an old saying that “bad things come in threes.” For

Baumann, that turned out to be a very unfortunate reality. In

addition to the injuries to his left knee, Baumann tore his right

posterior labrum in the fourth game of the season, and two

games after that he tore the medial meniscus in his right knee.

St. Xavier Team Physician Robert Heidt, Jr., MD, an orthope-

dic surgeon at Wellington Orthopaedic & Sports Medicine,

told Baumann that by limiting his practice reps and managing

the injuries properly he could play through them. But Heidt,

also the Team Physician for the Cincinnati Bengals, told him

the injuries would require surgery at season’s end.

“He was mentally prepared to go through surgery for the

first two injuries, but the third one, which turned out to be

the most serious, left him in a state of shock,” says Michael

Gordon, ATC, Head Athletic Trainer at St. Xavier. “My heart

broke for him because I knew how hard he had worked to

play through all the pain from his previous injuries. To have

another surgery added to the lineup was very tough on him.”

Baumann’s rehab began as he sat in the locker room draped

in ice and disappointment. Seeing that he was hurting emotion-

ally as well as physically, Gordon put on his “sports psycholo-

gist” and “motivator” caps and sat down next to him. “I prayed

with him and told him we were going to help him get through

it,” Gordon says. “I told him it wasn’t going to be easy, but that

everything happens for a reason. I said, ‘You have to work your

tail off to get back out there for your boys next season.’”

It didn’t take long for Baumann to set his sights on the long

road that lay ahead. With a goal of returning for the first game

of the 2007 season, he prepared for his first surgical proce-

R.J. Anderson is an Assistant Editor at Training & Conditioning.

To nominate a comeback athlete, please e-mail him at:

[email protected].


ComebackAthletelunch periods, Baumann visited Gordon in the athletic train-

ing room to complete many of his home exercises for getting

range of motion back. There, his work included using a con-

tinuous passive motion machine with polar care and perform-

ing heel slides, wall slides, hamstring and calf stretching, and

quad strengthening exercises.

By Jan. 25, 2007, having learned to ambulate on one crutch,

Baumann underwent the procedure to repair the torn labrum.

At this point in his rehab, the hobbled high schooler was a

walking medical supply closet. “For a couple weeks he was in

the sling and on one crutch, with braces on both knees,” Gor-

don says. “If it wasn’t so sad, it would have been comical.”

On Feb. 9, Heidt performed the medial meniscus pro-

cedure on Baumann’s right knee, putting him back on two

crutches. By mid-February, with the surgeries behind him,

Baumann was rehabbing three body parts, working three

hours a day for three days a week.

In addition to physical therapy at the clinic for his knees

and shoulder, Baumann was also working with Gordon

after school. During those sessions, he concentrated on

core strength. “We worked really hard on his core be-

cause that was all we could really do then, strength-wise,”

Gordon says. “We knew strengthening his abs, low back,

and hip flexors would help get the ball rolling for when he

could ratchet up his other strengthening work down the

road, like leg extensions and curls.”

By April, Baumann had completed his work at Welling-

ton and was doing all his rehab with Gordon and Brehm at

St. Xavier. To keep the sessions lively, Gordon implemented

sport-specific exercises whenever possible. “It’s not always

interesting or fun to continually do straight-leg raises or ride

the bike,” he says. “For instance, when we did balance exer-

cises that incorporated tosses, we used a football. Also, we

put him in his lineman’s stance whenever we could and uti-

lized a lot of ladders and foot-high hurdles that trained him to

chop his feet like linemen do in their position drills.”

The hours, days, and months of repetitive rehab often left

Baumann drained—physically and mentally. To keep him fo-

cused, Gordon introduced visualization exercises. “We’d say,

‘Imagine yourself on the podium, holding up that state cham-

pionship trophy,’” Gordon explains. “Or, ‘Imagine making a

pancake block against Colerain, and putting your arms around

your teammates knowing you worked your tail off to get there.’

“It was amazing to watch him stay motivated,” Gordon

adds. “I wouldn’t say every day was a great day, but every day

was definitely a progressive day.”

One of the more unusual aspects of Baumann’s recovery

was not what he gained, but what he lost during the rehab pro-

cess. With Baumann weighing 270 pounds at season’s end,

Gordon knew the hulking lineman had to drop some weight in

order to reduce the stress on his surgically repaired knees.

“Usually, when bigger guys undergo surgery—and I’ve

seen this at the high school, college, and professional lev-

els—they gain weight because they’re not active and they

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Circle No. 106

ComebackAthletedon’t really watch what they eat,” Gordon says. “I didn’t want

that to happen with Max, so we spent a lot of time talking

about the importance of a proper diet after his surgeries.”

Baumann heard the message loud and clear. “Right away,

Max was really proactive about changing his eating habits,

and he actually lost weight during his rehab,” Gordon says.

“His parents were great about changing the family’s meals.

They cut out fatty, fried foods and concentrated on eating sal-

ads, lean meats, and other proteins.”

Throughout the rehab, Gordon watched as Baumann’s

body became more and more lean. By the start of the team’s

summer strength and conditioning sessions, he was down to

240 pounds. “He didn’t lose it all at once—it was a slow pro-

gression,” Gordon says. “I monitored him to make sure he

wasn’t losing more than two pounds a week. I didn’t want him

to eventually put it all back on.”

In the spring, when Baumann’s rehab began to include

functional training, Gordon and Carlo Alvarez, CSCS, Head

Strength and Conditioning Coach at St. Xavier, worked to-

gether to design a program that addressed his weaknesses

and improved strength imbalances without interfering with

his progress. They incorporated a lot of proprioception and

balance work and used the school’s swimming pool for low-

impact hydrotherapy exercises. They also kept Baumann

away from heavy upper- and lower-body presses.

“We never put him on the bench press or leg press and

challenged him to max out to gauge how strong he was,” Gor-

Max BaumannSt. Xavier High School, Cincinnati, Ohio

Sport: Football

Injury: Torn ACL, MCL, and medial meniscus in left knee; torn medial meniscus in right knee; torn posterior labrum in right shoulder.

Result: After having three surgeries in less than two months, Baumann successfully rehabbed and led his team to a state championship.

Circle No. 107

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Circle No. 109

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ComebackAthletedon says. “Instead, we wanted to see how he looked bilateral-

ly—was he as strong on his left side as he was on his right?”

When football practices rolled around, Baumann was back

on the field, and 236 days after his ACL surgery he participat-

ed in the team’s first scrimmage. Despite adding five pounds

of lean muscle over the summer, he was still 25 pounds un-

der his 2006 playing weight. Freed from the extra weight as

well as the knee and shoulder injuries that dogged him during

his junior season, he felt quicker and stronger.

Baumann was named a team captain and started every

game of the 2007 season. Though he was able to play—and

play well—he had significant soreness after most games. “He

was still only eight months removed from an ACL surgery,

which can take a year or two to fully recover from,” Gordon

says. “Max basically lived in the athletic training room and got

treatment every single day—sometimes four, five, or six times.

But week after week, he toughed it out.”

To reduce the pounding on Baumann’s repaired knees and

shoulder, Gordon kept his practice load light. “Max was able

to do some hitting in a controlled environment, but we kept

him out of most contact drills,” Gordon says. “And if he was

really sore, I told the coaches, ‘You might not get him for even

one day this week. Let’s take him to the pool and stay away

from pounding his body.’”

Baumann says his comeback was complete when his team

capped an undefeated 2007 season by winning the Ohio Di-

vision I championship game. Standing on the awards podium

afterward, one of the visualization exercises from the early

days of his rehab came to life. “I was standing on that stage

holding the trophy with the other captains,” says Baumann,

who was named to the 2007 all-Ohio Division I first team. “As

I looked out at my teammates and our screaming fans, I knew

that all my hard work had paid off.”

Since graduating from St. Xavier, Baumann has lost 25 ad-

ditional pounds, bringing him down to 220. A freshman study-

ing finance at the University of Cincinnati, he turned down

several offers to play college football. “I talked to scouts who

said he could have gotten a full ride at a mid-level to major

NCAA Division I program,” Gordon says. “It’s not that he lost

the desire to play football, I think he was just physically worn

out and realized it would be very tough to keep playing week

after week for another four or five years. I also think he was

completely fulfilled by his experience playing with his friends

and teammates at St. Xavier and didn’t need to keep playing

just so he could say he played college ball.”

But that doesn’t mean Baumann is ready to retire to a

life on the couch. “Through this process, Max has seen the

benefits of healthy eating and being smart about his body,”

Gordon says. “He really appreciates how good it feels to be

physically fit and healthy and realizes he has a long life ahead

of him.”

Baumann concurs. “I will definitely miss playing football,”

he says. “But I’ll also be grateful when I’m 40 years old and

can walk without limping.” ■

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Circle No. 110

+elations.indd 1 9/10/08 9:56:44 AM

W hen you hear the words “arthritis” or “bone and joint pain,” you probably picture an aging man or woman with gray hair shuffl ing by. Certainly the incidence

of arthritis goes up with age, but the truth is, young and mobile athletes zipping around the court, rink, or fi eld are also subject to these conditions. In fact, Nicholas DiNubile, MD, an orthopaedic surgeon specializing in sports medicine with expertise in knee surgeries, says one out of three patients diagnosed with arthritis is under the age of 40.

But there are steps these athletes can take to help reduce their chances of serious aches and pains down the road. DiNubile, author of the best-selling book, FrameWork: Your 7-Step Program For Healthy Muscles, Bones, and Joints, who also serves as Orthopaedic Consultant to the Pennsylvania Ballet company and the NBA’s Philadelphia 76ers in addition to his private practice in Havertown, Pa., addresses common questions surrounding joint pain and arthritis in scholastic-age athletes in this interview.

Why should athletes be concerned about joint pain and arthritis?When most people think of arthritis or osteoarthritis, we think

of our grandparents or an older relative. But the reality is that we’re seeing joint damage in younger and younger patients—myself included, from an old high school football injury that has caught up with me.

That’s partly because of athletic kids playing on multiple travel teams or even playing on two or three teams in the same sport year-round. Traditionally, people think of arthritis as our bodies getting old and our joints wearing out. But athlete years are like dog years, and when an athlete tears his or her ACL or meniscus or even just comes down hard and knocks a piece of their joint surface off, that sets the stage for progressive early deterioration of that joint. Just because these athletes are young and feel invincible doesn’t mean they can ignore joint health and protection.

Can joint supplements play a role?Absolutely. I recommend them quite often in my offi ce practice.

Also, for many of the patients I do knee surgery on, whether it’s microfracture, a chondrocyte transplant to rebuild a damaged joint surface, or just someone with arthritis seen at the time of an arthroscopy, I absolutely insist they take these supplements. Glucosamine and chondroitin are the building blocks of your joint surface.

Joint supplements aren’t for everyone, however. If an athlete has joint pain, they need to know the reason for it. If it’s a meniscus

With Nicholas DiNubile, MD

tear or a muscle strain or some tendonitis, a joint supplement will not help. But if an athlete has arthritis or early osteoarthritis, I’m a big believer in the use of glucosamine and chondroitin sulfate to help counteract that. There is a lot of science behind the use of joint supplements with glucosamine and chondroitin in them.

What are the positives?Glucosamine and chondroitin are naturally occurring substances

in the body, so you don’t get all the issues that you have with NSAIDs (non-steroidal anti-infl ammatory drugs) like stomach ulcers, gastric bleeding, and even more serious complications. It’s nice to have a more natural option that has a tremendous safety profi le.

Another interesting thing about joint supplements is that they may also have something called a chondroprotective effect, which means they may actually slow down or help stop the progression of osteoarthritis. Arthritis medicine is really just aimed at controlling symptoms like infl ammation, whereas there is some early evidence that those patients who take joint supplements have less progression of their arthritis. Joint supplement pills or drinks are the only things you can put in your mouth that have actually been shown to possibly alter the course of the disease in a positive way, that is they may be disease modifying, rather than only symptom controlling.

Any words of caution?There are no real negative side effects that we know of. If

anything, we’re used to taking a pill and feeling better, but joint supplements are slow-acting so you’ve got to give them about a two-month trial. Athletes also want to be careful to get a good quality brand product.

What else can athletes with joint pain or arthritis do?You can’t treat damaged joints or arthritis in a vacuum. Taking

joint supplements has to be part of a comprehensive program that includes things like activity modifi cation, dietary changes, weight control, and a good strengthening and exercise program. Joint supplements are one piece of the puzzle, but a very important piece.

The other thing to remember is that once an athlete damages a joint they will never ever get it back to where it was, so it’s important to do everything they can from a preventive standpoint. Whether it’s conditioning, smart training programs, injury prevention programs, or the right kind of diet, all those things will help. Prevention is the key.

Joint Supplement Pills vs. Liquid FormPills may be easier to take on the road, but the supplements are more absorbable in liquid form. Procter & Gamble has done research that says when taking a pill with food and water, only about 77 percent is absorbed, but in liquid form, 93 percent is absorbed. There tends to be a better rate of compliance with patients who take joint supplements in liquid form as well, likely because unlike pills, it doesn’t have to be ingested at multiple time intervals throughout the day.

– Michelle St John, Elations Company

For more information, go to www.elations.com. Free shipping and professional discounts available.

Q&A

Using Supplements To Promote Joint Health

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+elations.indd 1 9/16/08 1:34:38 PM

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Circle No. 112


OPTIMUM PERFORMANCE

BY ART HORNE

Art Horne, MEd, ATC, CSCS, is Associate Director of Sports

Medicine and Strength and Conditioning Coach for men’s basketball

at Northeastern University. He can be reached at: [email protected].

IIn the past decade, recovery has become one of the hottest buzzwords in the athletic performance world. Athletes today go to great lengths to ensure that their post-workout habits help them recover optimally after practices, weightroom sessions, and competitions—whether that

means following a special nutrition program, performing a carefully planned cooldown routine, or even using modalities such as hydrotherapy or yoga. With so much time and money spent on recovery aids like these, it’s ironic that so many athletes overlook the most easily accessible, affordable, and time-tested recovery booster of all: sleep.

But the value of sleep isn’t limited to recovery. Its important role in athletic performance and overall health is well docu-mented, and few things are as intuitive as the need for a good night’s rest. Yet how many athletes in your setting truly take advantage of it? If you’ve ever looked around a team bus and seen heads bobbing up and down as athletes doze off during even short trips, it’s obvious that many are sleep deprived.

By educating athletes and coaches, you can help them realize that better sleep habits—or “sleep hygiene,” as our team phy-sician Gian Corrado, MD, has called it—can be a secret weap-on to improve performance and recovery. The latest research on how sleep affects mental and physical ability suggests that the time athletes spend on the pillow can be just as important as the time they spend in the weightroom and the gym.

SLEEP 101

Let’s begin with a short primer on exactly how sleep works. Every human brain has a built-in clock called the suprachias-

The ZZZ Factor

Chronically sleep-deprived athletes probably don’t realize all the ways they’re hindering their performance. By explaining sleep’s many physical and mental benefits, you can help them put the issue to rest.

© GETTY IMAGES


OPTIMUM PERFORMANCE

matic nucleus (SCN), which regulates our circadian rhythm. The SCN is lo-cated in the brain’s hypothalamus, just above where the optic nerves cross—and that’s important, because light ex-

posure is one factor that can greatly affect circadian rhythms and feelings of sleepiness or alertness.

If you could remove all the exter-nal elements of daily life that affect sleep patterns, including stress, sched-ule demands, alarm clocks, and next-door neighbors’ barking dogs, research indicates that most adults would sleep for about eight hours a night (slightly more according to some studies), and teenagers and college-age people would sleep for approximately nine hours. This amount of sleep produces opti-

mal physical and mental health, and in an ideal world, it’s the goal everyone should strive for.

What exactly goes on during those hours? Analysis of brain activity during

sleep reveals that it can be broken into five unique stages. Stages one and two comprise what is commonly referred to as light sleep, and stages three and four constitute deep sleep. The fifth stage, rapid-eye movement (REM) sleep, is the dreaming stage, and in most cases it oc-curs only after we have passed through the first four stages. During a typical night of undisturbed sleep, we complete a full cycle through the stages of sleep roughly every 90 minutes.

Each stage has its own function, and stages three and four—deep sleep—are

of particular importance to athletes. This is when the natural physical and mental processes of restoration are at their peak, and when growth hormone secretion occurs. Growth hormone is essential for building and rebuilding muscle and other body tissue, so when an athlete doesn’t sleep long enough to complete several cycles of deep sleep, they deprive themselves of key physi-ological benefits.

SLEEP DEBT & PERFORMANCE

Anyone who has pulled an all-nighter while studying for an exam is famil-iar with the concept of “sleep debt.” When the body fails to get an adequate amount of shut-eye, everything from mood to cognitive function to motor skills can suffer. But what about ath-letic performance in particular?

From a clinical perspective, the actual definition of sleep debt is still up for de-bate. Several researchers have attempt-ed to set parameters for it and quantify its effects, while others have questioned whether the concept is scientifically val-id at all. For this discussion, we’ll define sleep debt as what happens when “how

Each stage of sleep has its own function, and stages three and four—deep sleep—are of particular importance

to athletes. This is when the natural physical and mental processes of restoration are at their peak, and when

growth hormone secretion occurs.

Circle No. 113

Untitled-11 1 1/18/07 7:44:25 PM

Fibula

TibiaPosteriorinferiortibiafibularligament

Posteriortalofibularligament

Calcaneofibularligament

Anterior inferiortibiofibularligament

AnteriortalofibularTalusligament

Talus

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Untitled-11 1 1/18/07 7:44:25 PM

Circle No. 114


OPTIMUM PERFORMANCE

It’s the opportunity of a lifetime: One of your teams has been invited to play in a tournament in Hawai’i, or is finally taking that trip to Italy the coach has talked about for years. After months of planning, anticipation, and excite-ment, the plane touches down and the athletes can’t wait to put on their uniforms and compete. But when they meet for their first morning practice, they’re groggy, out of sync, and tiring much more quickly than usual. Jet lag has set in.

Adjusting to a new time zone can be a major challenge for teams that do long-distance travel, and unless there’s some advance planning, a dream trip can turn into a per-formance nightmare. Here are some pointers for making a smooth transition:

• Whenever possible, adjust practice and workout times to accommodate athletes’ internal clocks. For instance, if you usually practice at 3 p.m. in Boston and you’re traveling to Rome (which is six hours ahead), try hold-ing your first practice at 9 p.m. As your schedule allows, gradually move practices, workouts, and even sched-uled games “backward” to ease players into the new time zone and minimize circadian rhythm disruption.

• Athletes may be tempted to take long naps the first few days after arriving if they’re tired out by

jet lag, but this should be discouraged. It will only delay adaptation to the new time zone, as the body attempts to stick to the sleep schedule it’s used to back home. If a player must nap, a short doze of around 10 minutes can have some restorative effects without delaying time zone adaptation.

• Departure and arrival times can play a major role in jet lag, so try to schedule flights that will allow play-ers to get a full night’s sleep their first night in the new time zone.

• Tell athletes to avoid caffeinated foods and beverages on the plane if the team is arriving at its destination in the evening. Caffeine affects individuals differently, but for many, it can make falling asleep difficult for several hours after consumption.

• Remember that jet lag is worst when flying eastward, so a trip to Europe will require greater adjustment than a trip to Hawai’i, even if the actual difference in hours is the same. That’s because you “lose” hours when you travel east, winding the clock forward instead of back-ward. A westward trip may even afford an opportunity for players to resolve minor sleep debts by using the “gained” hours to get a great night’s sleep upon arrival.

TIME TRAVELTIME TRAVEL

much a person should sleep” and “how much they actually do sleep” are differ-ent enough that physical and mental ef-fects can be observed.

For athletic performance, both the physical and mental dimensions are im-portant. On the physical side, sleep-deprivation studies have shown that the primary negative effect of sleep debt is a decrease in time to exhaustion during activity. In prolonged perfor-mance tests, subjects who have gotten less sleep consistently tire more quickly than those who have gotten more.

Other key physical parameters, such as power output and aerobic and an-aerobic performance, are not usually impacted by a mild to moderate lack of sleep. However, ratings of perceived exertion (RPE) are almost always af-fected when a significant sleep debt is present: Athletes feel they are work-ing harder when sleep deprived, even if performance metrics say otherwise. Some study authors have attributed this to a self-fulfilling prophecy, since tired athletes expect physical activity to

be more strenuous and difficult due to their tiredness.

The mental effects of sleep debt, mean-while, are much more pronounced. And for competitive sports, in which deci-sions must be made in the blink of an eye and concentration is at a premium, this subject is worth exploring.

Research has shown that reaction time, stress level, alertness, irritability, and overall energy level or vigor are all negatively affected by sleep deprivation. Some studies in this area have looked at extremes, such as three consecutive sleepless nights (which even the busi-est student-athlete is unlikely to experi-ence), but others have found that even a relatively mild sleep debt, over time, takes a clear mental toll.

For example, after subjects in one study were limited to four to six hours of sleep per night over a two-week peri-od, their performance in cognitive tests was comparable to that of other sub-jects who were kept awake for more than 48 hours straight. Another study found that chronically sleep-deprived

people were outperformed on a reaction time test by well-rested people—who also happened to be above the legal al-cohol intoxication limit for driving at the time.

Findings like these reveal the cumu-lative nature of sleep debt: If an indi-vidual consistently doesn’t sleep enough over an extended period, the negative effects are compounded. Four to six hours of sleep a night is common for many high school and college students, so these results are significant.

Sleep debt can also wreak havoc on another key process for athletes: motor learning. It’s well known that practic-ing a given skill leads to improved pro-ficiency, and that the passage of time after practicing further enhances the gains—this is one of the concepts be-hind “muscle memory.” But a recent landmark study suggests it’s not the passage of time itself that makes the difference, but rather time spent asleep that causes additional proficiency gains to occur.

In the study, two groups were tested

in a specific motor skill, and then retested in the same skill 12 hours later. Members of the first group were initially tested at 10 p.m. and went to sleep shortly afterward. Mem-bers of the second group were initially tested at 10 a.m. and did not sleep afterward. When the groups were re-tested, those who had slept showed a statistically significant im-provement in performance, while those who had not slept showed no improvement. However, it’s interesting to note that after 24 hours, once members of the second group had gotten a night’s sleep, their performance at the skill im-proved significantly as well.

Scientists can’t explain precisely why this phenomenon oc-curs, but something happens within the brain during sleep that causes us to process movements and skills we’ve learned through practice in a way we can’t when we’re awake. This fact should be very interesting to anyone who takes foul shots, kicks field goals, executes volleyball serves, or performs count-less other athletic activities that rely on precision and learned movement patterns.

Perhaps most interesting of all, several studies have shown that test subjects who suffer cognitive and motor impair-ment due to a sleep debt are often unaware of their de-creased ability. This might help explain why athletes don’t take sleep habits as seriously as they should—they don’t re-alize how much it may be hampering their alertness, mental processing speed, reaction time, and other skills essential to athletic success.

BETTER NIGHTS AHEAD

If you could improve athletes’ sleep habits simply by summa-rizing the research in this article and then telling them to hit the hay, I could stop here. But in reality, most sleep-deprived athletes got that way because they don’t know exactly what they’re doing wrong.

The first priority to address is time devoted to sleep. The aforementioned goal of nine hours per night for teens and college students will seem unrealistic to many, but the closer they can come to that number, the better they’ll feel and the more they’ll enjoy the health, recovery, and performance ben-efits of sleep.

Consistency in sleep time is valuable as well. Going to bed and waking up at the same time every day takes maximum ad-vantage of the body’s natural circadian rhythm, while having different bedtimes and wake-up times every day can throw off the internal clock. Once a routine is established, athletes will find they are able to fall asleep more quickly and sleep more soundly through the night.

OPTIMUM PERFORMANCE

Several studies have shown that test sub-jects who suffer cognitive and motor impairment due to a sleep debt are often unaware of their decreased ability … They don’t realize how much it may be ham-pering their alertness, mental processing speed, reaction time, and other skills essential to athletic success.


Untitled-1 1 4/23/08 11:06:26 AM

Circle No. 115


OPTIMUM PERFORMANCE

Sometimes, an athlete’s sleep problems aren’t caused simply by stress, neglect, or a busy schedule. Sleep apnea is a serious and possibly even fatal condition in which a person stops breathing while asleep, usually because their airway is obstructed. It can affect anyone, but three of the main risk factors are being male, being overweight, and having a large neck circumference—all of which describe most football linemen to a ‘T.’

A 2003 study in the New England Journal of Medicine made headlines when it looked at 300 NFL players and found that 34 percent of the linemen suffered from sleep apnea. Awareness was further raised the following year when 13-time all-pro Reggie White died unexpectedly in his sleep, and the medical examiner’s report said apnea may have been a contributing factor.

So when Middle Tennessee State University Athletic Director Chris Massaro proposed earlier this year that Head Football Coach Rick Stockstill send some of his linemen to participate in a sleep apnea study, it didn’t take much convincing. “Some of my friends had been tested for sleep apnea, so I was familiar with it,” says Stockstill. “I thought it would be a great idea for our bigger guys to get tested.”

The Sleep Centers of Middle Tennessee selected 16 MTSU linemen who displayed physical characteristics consistent with elevated sleep apnea risk. After analyzing their breathing during sleep, researchers led by Clinical Director Brian Wind, MD, found that two of the linemen suffered from severe sleep apnea, and 10 others had bor-derline or mild cases.

Sleep apnea causes the neck muscles to relax during sleep, allowing the soft tissue in the back of the throat to collapse and block the airway. This can halt breathing for 10 sec-onds or more, often causing the sleeper to snore loudly or wake up gasping for breath. These frequent interruptions in sleep can lead to daytime fatigue, morning headaches, and reduced blood oxygen levels. Untreated apnea can lead to high blood pressure, irregular heartbeat, and increased risk of stroke, heart disease, and even type 2 diabetes.

For treatment, the linemen diagnosed with severe sleep apnea were given Continuous Positive Airway Pressure (CPAP) machines, which use a mask or nasal tube to con-tinually force air into the throat to keep the airway open.

Wind says the mild cases can be treated more simply, through weight loss and teaching the athletes to avoid sleeping on their backs.

“We feel pretty good about being able to step in and help these guys,” says Wind. “The two athletes with severe cases most certainly would have had long-term conse-quences in both health and quality of life.”

“If a kid sleeps for three or four years with apnea and doesn’t do anything about it, eventually his heart is going to wear out. He can pass a physical and appear to be in great shape, but over time, his heart is just not capable of handling the load it’s given,” says former MTSU Head Athletic Trainer Joe-Joe Petrone, who recently moved to Auburn University. “The two athletes who are now on the [CPAP] machines have reported that they feel better dur-ing the day, and that they’re more alert in the classroom and during lifting and running.”

How do you decide who in your program should be tested for sleep apnea? “The two big screening questions are, ‘Do you snore?’ and ‘Are you sleepy during the day?’” explains Wind. “There are other signs as well. If you have a 19- or 20-year-old with high blood pressure, that’s a major red flag that they should be checked out.

“In putting players through the screening process, if noth-ing else we’re educating them about sleep apnea,” Wind continues. “I’d be willing to bet that 80 to 90 percent of these guys will have sleep apnea to a severe degree when they are done playing football. Ex-football players often see their weight shoot up once they stop playing and working out. By testing them, at least a seed has been planted so that when the symptoms kick in later in life, they say, ‘I remember learning about what this might mean.’”

Stockstill believes sleep apnea testing—which is fairly inexpensive and available at many sleep centers and clin-ics around the country—should become standard practice for athletic programs. “If you deal with bigger guys, you’re crazy if you don’t perform sleep apnea tests,” he says. “It’s not only good for them as athletes, it’s also an oppor-tunity to impact their whole lives in a positive way. You might even save someone’s life.”

—Kyle Garratt

ADDRESSING APNEAADDRESSING APNEA


OPTIMUM PERFORMANCE

Remember how the suprachiasmat-ic nucleus is located near the optic nerves? Even small amounts of light can affect levels of melatonin, the ma-jor hormone that regulates sleepiness, and that’s just one example of why creating the right sleeping environ-ment must be a priority as well. This can be difficult for student-athletes, particularly college students living in dorms, so here are some helpful tips to pass along:

• Eliminate as many light sources as possible when going to bed. This means turning off computer monitors, using dark curtains over dorm windows, and even rolling up a towel and putting it at the base of the door to block light from the hallway. If these steps are not pos-sible, try using a sleeping mask to cover your eyes.

• Try wearing soft foam earplugs to eliminate nighttime noises that might interrupt your sleep. Or, if you’re used to some ambient noise at night, use a fan, humidifier, or other appliance that creates “white noise” to make you more comfortable.

• Turn off the ringer on your phone(s)

before going to bed. Remember that in-terrupted sleep can deprive you of the deeper stages of the sleep cycle, which have so many crucial benefits.

• Engage in progressive relaxation ac-tivities as you prepare to go to sleep. Be-ing very physically active late at night, exposure to bright light right before bed (for instance from a computer monitor or television), or eating less than two hours before bedtime can delay “sleep latency,” making it harder to fall asleep and robbing you of total sleep time.

• Set the room at a cool, comfort-able temperature for sleep. Some people prefer warmer sleep environments than others, so when your team travels, try to find a roommate with a similar tem-perature preference.

Speaking of travel, this can raise several challenges for athletes’ sleep-ing patterns, especially when a trip in-volves crossing multiple time zones. It may take several days for circadian rhythms to adjust to the new daylight hours and sleep/wake times of a dif-ferent time zone, so teams should take this into account when planning trips. (For some specific advice on adapting

to time zone changes, see “Time Travel” on page 18.)

MUCH TO GAIN

Serious athletes will do whatever they can to get better at their sport. That’s why they come early to practice and stay late, wear themselves out in the weightroom, and spend countless hours on their own in the gym or on the field, honing their skills to gain even the slightest edge against future opponents. It’s your job to help them realize that devoting more time to sleep isn’t being lazy or slacking off—it’s enlightened self-interest.

Luckily, the research suggests that a moderate sleep debt can be cured with just a few consecutive nights of prolonged sleep, and once athletes develop better sleep habits, the per-formance advantages should show themselves fairly quickly. Well-rested athletes may soon find they’re recov-ering faster after workouts, perform-ing sport skills with greater accuracy and proficiency, enjoying improved cognitive and motor function, and feeling better all day long. ■

Circle No. 116

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Circle No. 117


NUTRITION

At first glance, wrestling seems like such a simple sport: It’s just you, your opponent, and the mat, and the objective is very straightforward. But

anyone who has worked with wrestlers knows it’s much more complicated than that. Success depends on a special combination of strength, power, agility, quickness, coordination, endurance, mental toughness, and tactical skill.

Nutrition planning for wrestlers has a very similar dynamic—what seems basic can actually be quite complex. To support optimal performance, a wres-tling nutrition program must be ver-satile enough to account for different phases of the training year—“bulking up” versus “leaning out”—and man-aged closely enough to deliver desired

Preparing Preparing for Battle for Battle

BY SUSAN KUNDRAT

Susan Kundrat, MS, RD, CSSD, LDN, is

President of Nutrition on the Move, Inc.,

based in Urbana, Ill., and consults with

athletes from the University of Illinois,

Northwestern University, and Bradley

University. She and sports dietitian

Michelle Rockwell, MS, RD, CSSD,

recently launched RK Team Nutrition

(www.rkteamnutrition.net), providing

sports nutrition handouts, training, and

workshops for health professionals who

work with athletes.

STEPHEN CARRERA

The yearly training cycle for wrestlers includes three distinct phases, and an optimal nutrition strategy should target

specific goals for each one.

weight loss without sacrificing valuable lean muscle.

In my 15 years of experience plan-ning nutrition programs for wrestlers at successful NCAA Division I pro-grams, I have developed strategies to help wrestlers go into every match well nourished, well hydrated, and fully en-ergized. In this article, I’ll lay out my goals for each phase of the training year, explain what dietary adjustments can be made to achieve them, and pro-vide some sample menus and meal ideas that have worked well for my athletes.

OFF-SEASON: BULKING UP

During the off-season and the months leading up to fall workouts, wrestlers generally focus on making strength gains by maximizing lean muscle mass.

They typically spend fewer hours on the mat and more in the weightroom. From a nutrition perspective, that means they must consume enough total calories to support muscular hypertrophy, with a special emphasis on protein consump-tion every day.

NUTRITION

Wrestlers from the University of Illinois and Northwestern

University compete at left. Both teams benefit from this author’s

sport-specific approach tonutrition counseling.

NUTRITION

Let’s take a closer look at the top pri-orities for this time of year:

Calories. When looking to add mus-cle, wrestlers should take in at least 500 calories per day above their stan-dard maintenance needs. For example, if a wrestler is training two hours per day in the off-season, he would require at least 20 calories per pound of body weight per day (3,300 calories for a 165-pound wrestler). Add 500 to that for lean muscle building, and you get a total of 3,800 calories per day.

An intense strength training program typically results in a robust appetite, so this energy intake goal shouldn’t be difficult for most wrestlers to achieve. I recommend eating several small meals throughout the day, and supplementing with snacks before and after workouts to maximize lean muscle gains.

Protein. Wrestlers can benefit from up to one gram of protein per pound of body weight per day when training to add strength. Protein consumption should be spread throughout the day to maximize muscle building, with the greatest attention paid to foods eaten before and after hard workouts—con-

suming protein at these times minimiz-es natural protein loss and maximizes muscle recovery.

Including proteins from a wide vari-ety of whole food sources ensures that athletes take in a broad spectrum of amino acids, creatine (which occurs naturally in many foods), and other key nutrients. Some excellent protein sourc-es are eggs, milk products, red meats, white meats, beans, peas, nuts, seeds, and whole grains.

Carbohydrates. Wrestlers should con-sume at least 50 to 55 percent of their energy in the form of carbohydrates (2.0 to 2.5 grams of carbs per pound of body weight per day), especially during periods of heavy training. For a 165-pound wrestler eating 3,800 calories per day, this means a minimum of 1,900 calories of carbs (475 grams) on a daily basis. There are many well-known and healthy sources of carbs, including whole wheat pasta, fruits and vegetables, lean dairy products, and legumes.

Fat. During strength building, wres-tlers should get at least 15 to 20 per-cent of their energy from fat—for our 165-pound wrestler, that means 63 to

84 grams of fat and 570 to 760 calo-ries from fat per day. With an adequate training volume, this amount won’t lead to unwanted fatty weight gain, but it will support optimum muscle growth and overall health. Foods high in ome-ga-3 fatty acids are the best choices, since they can help decrease inflam-mation (which may result from heavy training) and aid in muscle recovery. Some good examples include salmon, tuna, walnuts, and flax seeds.

Phase One in the “On the Menu” box on page 26 shows a sample day’s meal plan that would allow a typical 165-pound wrestler to meet all the nutrition goals I’ve outlined for muscle building. Note that protein-rich choices are in-cluded pre- and post-workout, and that I’ve added “extra water” with each meal to emphasize proper hydration.

PRESEASON: LEANING OUT

In the two months or so before the start of the competitive season, it’s critical for wrestlers who need to lose weight to follow a practical, sound plan for dropping body fat. This should be-gin with an initial weigh-in and body

Circle No. 118

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Circle No. 118 Circle No. 119

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Untitled-6 1 8/1/08 3:35:46 PM

Circle No. 120


NUTRITION

ON THE MENUON THE MENUAt right are sample menus for two different phases of a wrestler’s year: muscle building, which typically occurs in the off-season; and weight loss, which, if necessary, should occur in the two months leading up to the start of the competitive season.

The menu for Phase One contains roughly 3,800 calories, 550 grams of carbohydrates, and 100 grams of fat. The menu for Phase Two contains roughly 2,550 calories, 380 grams of carbohydrates, and 45 grams of fat. Both menus contain about 165 grams of protein or one gram of protein per pound of body weight (these were pre-pared for a 165-pound wrestler), since consistent protein intake is a key to building and protecting lean muscle.

Phase One: Muscle Building

Breakfast:2 whole wheat bagels with peanut butter 1 small banana2 cups of 100 percent orange juiceExtra water

Lunch:3 soft tacos1 side of beans1 side of riceExtra water

Pre-Workout Snack:1 cup of homemade trail mix with nuts, seeds, dried fruit, and granolaExtra water

Post-Workout Snack:1 recovery shake (250-300 calories)Extra water

Dinner:High-Protein Salad Dinner*2 slices of whole grain bread2 chocolate chip cookies Extra water

Snack:2 cups of whole grain cereal1 cup of skim milkExtra water

*High-Protein Salad Dinner: 3 cups baby spinach salad + 4 boiled egg whites + ½ cup cooked chicken breast + 1 cup mandarin oranges + 1 cup shredded carrots + 2 tablespoons fat-free Italian dressing.

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Circle No. 121


NUTRITION

composition analysis. Based on the ath-lete’s starting weight, you can then set specific goals and benchmarks that can help ensure safe weight loss.

The most important thing to moni-tor for wrestlers’ weight management is the rate of loss: An athlete should never lose more than 1.5 percent of their body weight per week. Shedding pounds faster than that can raise seri-ous health concerns, and once the sea-son begins, both the NFHS and the NCAA have rules prohibiting weekly weight loss beyond 1.5 percent. There are also limits in both high school and college for minimum body fat percent-age: High school wrestlers at NFHS-governed schools cannot drop below seven percent overall body fat during the season, and NCAA wrestlers must stay at or above five percent.

Returning to our 165-pound wres-tler, let’s assume his body composition analysis reveals 12 percent body fat. Since he is a college student, he wants to be near the NCAA minimum of five percent, which would set his minimum weight at 153 pounds. By losing be-tween one percent and 1.5 percent of

Phase Two: Weight Loss

Breakfast:Egg Scramble Breakfast*Extra water

Lunch:1 grilled hamburger on a bun 1 single-serving bag of baked chips1 appleIced tea or water

Pre-workout snack:1 light yogurt cup1 small bananaExtra water

Post-workout:1 recovery shake (250-300 calories)Extra water

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Snack:Peach smoothie: 2 cups skim milk + ½ cup light frozen yogurt + 1 cup unsweetened frozen peaches + iceExtra water

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Circle No. 122

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NUTRITION

TRAINING-CONDITIONING.COM

his body fat per week over an eight-week preseason, he could easily achieve his goal and compete in the 157-pound class.

One important note: Five percent is the minimum healthy body fat percentage for college-age wrestlers, but that doesn’t mean it’s the goal most wrestlers should strive for. Many find they have more energy and perform better at a higher body fat percentage—in fact, one study of NCAA champion wrestlers found their average body fat to be around 8.5 percent. Rather than focus on a set minimum, it’s much better to talk with athletes regularly about their energy level, their overall perfor-mance, and how they feel while they’re losing weight. This can help them find their own optimal body fat percentage.

So how can a wrestler safely lose weight? The goal is to drop adipose tissue (fat) while retaining muscle mass and lean tissue, so the best strategy is to lower caloric intake but maintain ade-quate protein consumption. Using the formula introduced earlier, the 165-pound wrestler would need 3,300 calories for mainte-nance—but now, instead of adding calories for muscle growth, we’ll take some away for weight loss. Subtracting 750 calories per day, for a total of 2,550, would result in about 1.5 pounds of weight loss per week. Over the course of two months, that would bring our athlete down to his legal minimum of 153 pounds.

The calorie reduction should come from adjustments to car-bohydrate and fat intake, with protein consumption holding steady at about one gram per pound of body weight per day. In addition to preventing lean muscle loss, protein also enhances feelings of satiety, making the athlete less likely to feel chroni-cally hungry as he scales back his daily caloric intake.

Phase Two in the “On the Menu” box on page 27 is a sam-ple day’s meal plan for fat loss. Post-workout fueling remains unchanged, since a quality recovery shake at this time can help protect lean muscle mass.

IN-SEASON: MAKING WEIGHT

During the season, wrestlers can optimize their nutrient stores and perform at a higher level by avoiding large fluc-tuations in weight. Because hydration status accounts for most weight change in a typical week, athletes should aim for consistency in hydration at all times.

Short-term weight loss (“weight cutting”) through dehy-dration causes losses in glycogen and lean muscle tissue, which can have several negative health and performance ef-fects—it may take 24 to 48 hours after a period of dehydra-tion to replenish muscle glycogen and body fluid levels. This is another area where governing bodies have stepped in to help keep athletes safe: At both the college and high school levels, weigh-ins must occur when the wrestler is in a hy-drated state as measured by a urine test of specific gravity.

It’s easy to teach athletes to self-assess hydration status by monitoring their urine throughout the day. Frequent trips to the bathroom and relatively clear urine is good, while infre-quent trips and darker color is a sign they need to drink more fluids. Encourage wrestlers to drink on a schedule before and during workouts, as fluid loss through sweat may exceed two liters per hour during hard exercise. Carrying a water bottle to classes and refilling it throughout the day is one simple and effective way to improve hydration habits.

Aside from consistent hydration status, weight maintenance should be the primary goal for in-season wrestlers. Addressing any weight issues in the preseason eliminates the burden of at-tempting weight loss during competitive cycles, so the athlete can focus simply on avoiding unwanted weight gain or loss.

Circle No.

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Circle No. 123


NUTRITION

One of the best ways to maintain weight consistency during the season is to avoid binge eating, so I encour-age wrestlers to eat smaller meals sev-eral times a day. In addition to helping prevent overeating, this strategy maxi-mizes available energy for workouts and matches. It also enhances recov-ery, especially if the athlete is working out (training, competing, or otherwise being physically active) more than once a day. Going into every workout with fuel on board is essential for optimal performance, and that can be achieved by eating a snack or small meal every three hours or so throughout the day.

Another way to promote weight con-sistency is by adjusting the energy den-sity of an athlete’s meals. Wrestlers are very physically active during their sport season, so they may be tempted to turn those frequent, smaller meals into fre-quent, larger ones. To avoid excess calo-rie consumption, you can help them find ways to boost total food volume without piling on too many calories.

Low-calorie fruits and vegetables, such as strawberries, cucumbers, car-rots, broccoli, cauliflower, and spin-ach are inexpensive and can be eaten in larger quantities without breaking the calorie budget. Foods with high water content, such as oranges, grapes, mel-ons, green beans, and celery are also great choices.

Lastly, smart protein consumption throughout the day can also boost sa-tiety and prevent overeating to assist in weight maintenance. Keeping the goal of one gram of protein per pound of body weight per day, wrestlers should focus on spreading that protein out across several meals.

For instance, they might have an egg or two with breakfast, choose lunchtime sandwiches with moderate amounts of meat, have a handful of nuts with a post-workout snack, and eat an evening meal with a serving of beans as a side dish. Protein in liquid form, such as that found in protein shakes, is less effective than solid pro-tein in promoting satiety, so I recom-mend that athletes focus on whole food sources whenever possible.

A FINAL WARNING

Strength building and weight man-agement—the two major emphases of nutrition planning for wrestlers—are perennial hot topics in the nutritional supplement marketplace. There are lit-

erally hundreds of products available on store shelves and over the Internet claiming to offer a shortcut to fat loss, bigger muscles, and extra energy. So when talking to wrestlers about their nutrition and performance goals, sup-plements and their risks should always be part of the discussion.

Nutritional supplements raise con-cerns ranging from safety to effective-ness to contamination, but for a wrestler looking for fast results, the marketing hype may be difficult to resist. Your message needs to be clear: Virtually ev-

ery performance or body goal the ath-lete wants to take a supplement for can be achieved more naturally through a sound dietary plan.

In most cases, once athletes see their performance improving after making appropriate nutritional changes, the allure of supplements becomes much less of a problem. With a comprehen-sive nutritional strategy tailored for each phase of wrestlers’ yearly cal-endar, they’ll find themselves fueled, energized, and ready to perform at their best. ■

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Circle No. 125

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Circle No. 124

Groin Groin PainsPains

Whether you call it a sports hernia or athletic pubalgia, recurring pubic-area pain can be a major hindrance for athletes. These authors devised a specialized training program for the Cornell University men’s hockey team aimed at addressing and preventing groin injuries.

PATRICK SHANAHAN


TREATING THE ATHLETE

In the past few years, the term “sports hernia” has shown up with growing frequency in both athletic medicine circles and mainstream media coverage of sports injuries. For those

of us in the business of treating athletes, the sudden surge in popularity leads to one obvious question: Are more athletes suffering this type of injury than in the past, or have we simply developed a new term for an old condition?

Unfortunately, there is no simple an-swer. For one thing, despite how often the term is used, there’s no universally accepted definition for a sports hernia. It’s sometimes applied as shorthand for virtually any condition affecting an ath-lete’s lower abdominal region and groin area, though some researchers believe there are specific symptoms and pa-thologies that must be present to war-rant the diagnosis. Furthermore, there’s a basic misnomer involved—in a clini-cal examination, no actual “hernia” by common medical definition (the trade-mark bulge of tissue through muscle) is usually found. A more appropriate term is athletic pubalgia, though this is much less frequently heard.

Whatever you call it, the condition can pose serious problems for athletes. When a rash of athletic pubalgia struck the Cornell University men’s hockey team two seasons ago, we decided to take the opportunity to design and im-plement a proactive approach to treat the injuries, and more importantly, re-duce the likelihood they’d crop up again in the future. As you’ll see, we achieved significant success, and in the process, we learned much about this poorly un-derstood area of sports medicine.

NOT EASILY DEFINED

Various researchers have complicated the subject of athletic pubalgia in pub-lished literature by defining it strictly in terms of the anatomical structures and precise pathology involved, often con-tradicting each other’s definitions and creating much confusion. For instance, one study describes a sports hernia as a

BY DR. PAUL R. GEISLER & ED KELLY

Paul R. Geisler, EdD, ATC, is an

Assistant Professor and Director of

Athletic Training in the Department of

Exercise & Sport Sciences at Ithaca

College, and has over 20 years of

experience as an athletic trainer and

sports performance specialist working

with high school, college, and profes-

sional athletes. He can be reached at:

[email protected]. Ed Kelly, MS,

ATC, is in his 14th season as Athletic

Trainer for the Cornell University men’s

hockey and sprint football teams. He can

be reached at: [email protected].

“spectrum of pathology” involving the conjoined tendon, inguinal ligament, fascia transversalis, and internal and ex-ternal oblique muscles, caused by a dis-ruption of the inguinal canal without a clinically detectable hernia. Another de-scribes it as a weakening of the posterior inguinal wall without an inguinal hernia detectable during a physical exam.

Numerous other authors have added to the disorder by introducing their own terms, such as “hockey hernia,” and listing specific body parts or symptoms that must be involved for the diagnosis to apply. For instance, varying defini-tions for a sports hernia may include or exclude the presence of a palpable her-nia, and some incorporate the ilioingui-nal nerve, while others ignore it.

So where is the common ground, and what do we really mean when we say an athlete has a sports hernia or athletic pubalgia? Despite the conflict over de-tails, authors usually agree that a sports hernia involves a combination of inju-ries affecting both the groin area and the abdominal region. It’s actually more of a syndrome than a specific injury, en-compassing several conditions that can be difficult to differentiate.

It has been theorized that athletic pub-algia is the result of chronic shearing forces across the pubic symphysis gener-ated by repetitive adductor muscle activ-ity. Over time, pubic symphysis forces indirectly cause progressive micro-stress to the posterior abdominal wall, causing a separation of the transversalis fascia and internal oblique aponeurosis from the inguinal ligament. This leads to the pain that we typically associate with pubalgia or a sports hernia.

Recently, a leading specialist who sur-gically treats this condition has attempt-ed to create a more focused working definition for athletic pubalgia. Accord-ing to William C. Meyers, MD, it con-sists of chronic inguinal or pubic area pain in athletes that is exertional only and not explainable by a palpable hernia or other medical diagnosis. Thus, since true athletic pubalgia (by this definition)

does not include an occult internal-ring hernia, Meyers has called for the term “sports hernia” to be discontinued when dealing with conditions that don’t di-rectly involve the inguinal rings.

CLINICAL PRESENTATION

Research into athletic pubalgia has shown the greatest incidence among soccer, football, and ice hockey players. For instance, Meyers’s study of 157 ath-letes who required surgery for pubalgia found that 75 percent played one of those three sports. It’s also not uncom-mon for the pain to affect both sides of the abdominal-groin region—in Mey-ers’s study, 43 percent of the athletes presented with bilateral abnormalities.

The primary reason why clinical evaluation, diagnosis, and treatment for pubalgia are so challenging is that several contributing or co-existing fac-tors have been reported in the literature as being associated with the condition (see Table One on page 34). Also, sev-eral differential diagnoses must be con-sidered before concluding that athletic pubalgia is the cause of an athlete’s pain (see Table Two on page 34 for the most common examples).

By all accounts, the diagnosis of ath-letic pubalgia is clinically difficult be-cause no condition-specific test exists, and there is no one clear indicator that can confirm the diagnosis. Many factors may contribute to pain in the hip, groin, and abdominal regions, and the list of

historical findings and clinical signs and symptoms is also quite extensive (see Table Three on page 34 for examples).

Nonetheless, there are a few key things we know for sure about pain and stress to this area of the body. The pubic sym-physis functions as a pivot point for force transfer between the lumbo-pelvic and femoracetabular joints. As it is subjected to chronic strain and shearing forces, this can lead to micro-tears of the rectus abdominis muscle or its tendon at the pubic insertions. Movement of the femurs during athletic activity, and subsequent activation of the adductor muscles, may add to the stress.

Conceptually, there is a “chicken or egg” phenomenon in considering whether adduction forces affect the pelvis, or if pel-vic forces affect the femoral adduction component. Either way, however, tears of the tendinous insertion of the rectus abdomi-nis will undoubtedly alter the function of the pelvis, which then impacts femoral adductor function.

In addition, poor core stability can cause excessive anterior pelvic tilt, increasing tension in the adductor compartment

Figure One: The neutral pelvic positioning shown below was used to assess eccentric hip flexor and rectus abdominis strength. Exercises based on this position were also central to our prevention-based training program.



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Circle No. 126



and the femur. Likewise, poor adduc-tor strength or flexibility will place in-creased stress on the pubic symphysis, thus hampering the pelvic girdle’s func-tion and affecting various muscle at-tachments of the pelvis, including the obliques, rectus, and transversalis mus-cles, as well as the conjoined tendon.

THOROUGH SCREENING

During the 2006-07 season, the Cor-nell men’s hockey team suffered what you might call an outbreak of athlet-ic pubalgia. There were five confirmed cases, a rate that far exceeded historical trends within the program. Surgery is the gold standard for resolving athletic pubalgia symptoms, but because the re-turn-to-play timeline for surgical repair is typically 10 to 12 weeks, the sports medicine team decided a renewed focus on prevention was needed.

In the spring of 2007, we developed a specialized screening tool to look for his-torical markers and any other factors that might increase a player’s athletic pubalgia risk. To begin, each athlete completed an injury questionnaire that focused on the past and current health of the lumbar, ab-dominal, pelvic, and femoral areas. Spe-cifically, we wanted to know who had a history of pain or soreness in the lower back, abdomen, or groin areas, and who had sustained musculoskeletal strains of the abdominal, hip flexor, adductor, or hamstring muscles.

We also conducted a clinical assess-ment of each athlete’s core stability, hip flexibility, and strength, and took ab-duction/adduction muscle strength ra-tios with a handheld dynamometer. For core stability, the athletes performed a series of timed movements in the quad-ruped position while maintaining a neutral pelvis (contracting the trans-verse abdominals, lumbar multifidii, and abdominal obliques to do so). Ec-centric muscle strength of the rectus abdominis and hip flexors was assessed with a max time contraction test (see Figure One at left), and hip range of motion was assessed manually with a goniometer, a Thomas test, and a rec-tus femoris tightness screening. Hip muscle strength was measured with a handheld dynamometer. Finally, each athlete completed Gray Cook’s Func-tional Movement Screen, which we vid-eotaped for in-depth analysis.

Since we had already reviewed the literature on orthopedic concerns for high-level hockey players, we weren’t

surprised by most of the evaluation re-sults. Several athletes had histories of muscle strains in the abdominals, hip flexors, and adductors. Chronic epi-sodes of lower-back pain, as well as peripubic and lower-abdominal tender-ness, were common as well.

We did observe a few interesting trends. Specifically, the movement

screen and other tests revealed a high incidence of restricted abdominal and hip flexor flexibility, poor core stabil-ity, hip abduction/adduction strength imbalances (with the abductors stron-ger than the adductors), and poor ec-centric strength in the hip flexors and rectus abdominis. All five athletes with confirmed athletic pubalgia had a his-tory of at least two of these markers.

Our findings suggested that muscle imbalances and functional deficiencies were part of an acquired pattern for elite hockey players—and these prob-lems challenged the dynamic balance between the lumbo-pelvic and femorac-etabular joints and muscles. Given the physical demands of hockey, especially the biomechanics of movement and spe-cific muscular stresses involved in the sport, this was hardly surprising. The data we collected helped us set priori-ties for the new program we would now begin to design.

TRAINING FOR PREVENTION

Although there has been very little high-quality research to date on treat-ment and rehabilitation programs for athletic pubalgia, authors who have tackled the subject have focused mainly on the active tissues involved. For in-stance, one study showed that an ac-tive pelvic stabilization program was effective for treating adductor tendi-nopathy, while another revealed that rest and trunk stability exercises were effective in treating chronic groin inju-ries. And multiple studies have found that strengthening the pelvic floor and transverse abdominal muscles results in faster recovery and return to play. Still, no quality randomized and controlled studies or systemic reviews looking at non-surgical treatment of athletic pub-

algia have yet been published.The available research, our clinical

experience, and the evaluations we per-formed with the hockey team led us to a few conclusions. First, it’s clear that the hip adductors, hip flexors, and lumbo-pelvic stabilizers are part of an intricate functional relationship that controls the position and movement of the lumbar

spine, pelvis, and femur. Imbalances be-tween the control (timing), strength, en-durance, and flexibility of these muscles directly impact the type and magnitude of forces on the pubic symphysis, femo-racetabular joint, lumbar spine, posteri-or abdominal wall, and pelvic floor.

In addition, long-term participation in sports like hockey, soccer, and foot-ball tends to create certain muscle im-balances due to repetitive activity. If these are not addressed in a training program, the resulting concentric and eccentric strength and flexibility imbal-ances can leave an athlete more prone to lower abdominal and groin injuries, including athletic pubalgia.

Hip flexor and adductor strains are also very common in sports that require cut-ting and quick acceleration and decelera-tion movements. Muscle strains heal via scar tissue that decreases tensile strength and elasticity, so the treatment and reha-bilitation of those injuries is paramount for maintaining the dynamic relation-ship between muscles in the lumbo-pelvic region. Anatomical and postural abnormalities, such as increased lumbar lordosis or kyphosis and hip antever-sion or retroversion, can also affect this dynamic functional relationship and in-crease athletic pubalgia risk.

To translate these conclusions into a training program, we decided to isolate several key weaknesses or movement limitations, then set training priorities that would correct them. With this ap-proach, we hoped to address the most important factors that predispose an athlete to athletic pubalgia and other related injuries. Below is a list of the key factors, followed by the exercise focuses we used to address them:

Poor core stability. For athletes with this deficiency, we sought to improve

Muscle strains heal via scar tissue that decreases tensile strength and elasticity, so the treatment and rehabilitation of those injuries is paramount for maintaining the dynamic relationship between muscles in the lumbo-pelvic region.



control and endurance of the transverse abdominals, abdominal obliques, lum-bar multifidii, and quadratus lumborum muscles through a comprehensive core stabilization program. To be effective, core stabilization concepts needed to be incorporated throughout the athletes’ en-tire strength and conditioning program.

This meant going back to the basics of teaching athletes to maintain a neu-tral pelvis and spine, and activating the transverse abdominals in simple supine, sitting, and standing positions. We then gradually progressed toward more func-tional exercises utilizing these essential principles. We incorporated exercises with progressive resistance using plyo balls, tubing, and a physio ball with rotational and diagonal movements as well as other functional patterns. We also added lateral and prone plank ex-ercises with hip abduction, flexion, and extension perturbations to reinforce neutral pelvic and lumbar positioning.

Poor eccentric strength of the hip and trunk flexors. We discontinued concen-tric hip and abdominal flexion exer-cises for these athletes in an attempt to address the flexibility and eccentric strength imbalances, which we theo-rized were partly caused by concentric training. We then prescribed exercis-es that focused on building eccentric strength and improving control of the hip and trunk flexors, using slow, con-trolled movements and sometimes a four-way hip machine.

To ensure maximum benefit, we were careful to not allow anterior or poste-rior pelvic tilting during the exercises. We were concerned that such tilting might excessively activate the powerful hamstrings and hip flexors, thus over-powering the local fine-control muscles such as the transverse abdominals and external obliques.

Weak hip adductor muscles. We focused on building hip adduction strength (eccentric and concentric), and de-emphasized concentric hip abduc-tion exercises until the athletes’ abduc-tion/adduction ratio approached 1:1. This was accomplished using a stan-dard four-way hip machine, but we also could have used exercises incorporating pulleys, cables, and even therapeutic ex-ercise bands or cords.

History of lumbo-pelvic and femo-racetabular muscle strains. We worked individually with these athletes on the specific muscles that were most vulner-able to strain, exhibited the greatest

Table One: Co-Existing Factors for Athletic PubalgiaHistory of abdominal muscle pathology Hip flexor and/or adductor strainsAdductor tendinopathyPubic symphysitis or osteitis pubisLower abdominal, adductor, and hip flexor muscle imbalancesAdductor/abductor strength ratio under .80

Table Two: Differential Diagnosis ConsiderationsPubic symphysitis or osteitis pubisAdductor tendinopathyObturator/ilioinguinal neuropathyInguinal hernia (direct/indirect)Femoracetabular intra-articular lesionsFemoracetabular impingement syndromeLegg-Calve-Perthes diseaseAvascular necrosis of the femoral headOsteoarthritisLabral pathologiesSlipped capital epiphysesOsteochondritis dissecansPubic bone/femoral stress fracturesTesticular pathologyIntra-abdominal/pelvic floor pathology (genitourinary, reproductive, gastrointestinal systems)

Table Three: Common History & Symptom ComplaintsLower abdominal pain with exertionDistinct mechanism w/exertion often not recalledPain w/coughing, sneezing, or Valsalva maneuverPain in inguinal canal near rectus abdominis insertion on pubic symphysisPain absent/minimal at restPain progresses from unilateral to bilateral over timePain with resistive adduction and/or hip flexion reported in the lower abdominals, inner thigh, and/or testicular areasFailed response to conservative treatmentHistory of multiple hip, low back, and/or pelvic pathologiesInguinal tendernessPain with resistive hip adductionPain with resistive trunk flexionPeripubic tendernessAdductor longus insertional tendernessDirect pubic symphysis tendernessLower abdominal tendernessTesticular painAbsence of palpable inguinal mass



treating the condition as athletic pub-algia. It’s always a good idea to bring a physician into the picture if a correct diagnosis is elusive.

To prevent this type of injury in the first place, exercise programs should fo-cus on individual injury histories involv-ing the lumbar spine, abdomen, and hip joints, and also address functional core stability, which is crucial for protect-ing the lumbo-pelvic region. Building or restoring functional eccentric and concentric strength and flexibility bal-ance between the hip flexors/extensors and abductors/adductors must be prior-ities as well. Above all, because the risk is so individualized, training programs should be specifically crafted to address each athlete’s risk factors and their un-derlying causes. With that approach, you can help your athletes avoid this painful and debilitating condition. ■

The authors wish to thank Thomas

Howley, MS, CSCS, Cornell’s

Assistant Director of Athletics

for Athletes Performance, for his

assistance with this article.

inflexibility, or were most in need of re-cruitment. In some cases, athletes were instructed to focus more on flexibility of the adductor, iliopsoas, and/or rec-tus femoris muscles with side lying or supine stretches. For others, a clinician-assisted manual approach was required to address personal limitations. A few athletes had to incorporate trunk flex-ibility and mobility exercises into their workouts, such as prone press-ups and torso rotational patterns.

POSITIVE RESULTS

One year after implementing our pro-gram, we are pleased with the trends we have seen thus far, specifically a de-crease in the number of soft-tissue inju-ries to the lumbo-pelvic-femoral region. The team enjoyed a 40 percent reduc-tion in hip flexor and adductor muscle strains, and an associated 58 percent drop in days lost to injury during the 2007-08 season. There was a 17 percent reduction in lower-back pain episodes, with an associated 64 percent drop in lost days. And there were no new cases of athletic pubalgia.

Three players did suffer mild abdomi-

nal strains during the season, but each case was resolved with a conservative care program that re-emphasized the exercises that had been prescribed as part of the prevention program. Overall, we noted a significant reduction in the number of lumbo-pelvic-femoral related complaints, and saw improved return-to-play timeframes for minor strains and pain throughout the season.

So what did we learn by designing and implementing this program? First, athletic pubalgia is a complex condition involving several interrelated factors. Often confused with other orthopedic problems or lumped in with the general and poorly defined term “sports her-nias,” it is in fact a specific condition unto itself, and effective prevention and rehab exercise programs must address all the right components.

Whenever an athlete experiences groin pain, several anatomical struc-tures and biomechanical models may be in play. Because of the proximity of this area to vital parts of the digestive, re-productive, and genitourinary systems, you must take care to ensure that other potential diagnoses are ruled out before

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Circle No. 128


LEADERSHIP

Jon Almquist, ATC, is the Athletic Training

Administrator for Fairfax County (Va.)

Public Schools. He can be reached at:

[email protected].

From helping you lobby for more resources to protecting your program against lawsuits, a top-notch medical record keeping system offers many benefits. Does yours?

CH

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BY JON ALMQUIST

For the Record T

hink back to your days in an athletic training education or internship program, and try to remember what you were taught about note taking and

record keeping. When I was a student almost 30 years ago, this meant learning how to take SOAP notes (subjective, objective, assessment, and plan) and using the HOPS format (history, obser-vation, palpation, special tests), and many from my generation probably remember the same. To this day, SOAP and HOPS continue to be part of the curriculum approved by the Commission on Accredi-tation of Athletic Training Education, and for some programs, that’s where infor-mation management begins and ends.

Athletic trainers have widely vary-ing opinions on record keeping. Some consider it a necessary evil or a “re-quired waste of time,” adding to our already daunting workload and taking time away from the treatment of ath-letes. Others acknowledge its impor-tance, but don’t agree on exactly what information should be kept, how to ac-

complish the task most efficiently, or how to use the data gathered over time. And some have embraced it wholeheart-edly, implementing elaborate computer-based record systems or home-grown database programs, “syncing” them with handheld devices for instant up-dates, and finding ways to synthesize all the information into monthly, quar-terly, or annual reports detailing every-thing from man-hours to injury rates to how much they spent on supplies.

In my own setting as the Athletic


LEADERSHIP

of an athlete’s injury, what our obliga-tion was to provide a certain level of care, and whether there was any breach of that duty. By being able to review our files and say, “Our written records show that the chain of events was X, Y, and Z,” I’m sure we have nipped several potential lawsuits in the bud.

Communication. Anyone who works in high school or college athletics is fa-miliar with the potential for miscom-munication between athletic trainer and athlete, athlete and parent, ath-lete and coach, athletic trainer and par-ent, and so on. A good record keeping system can streamline the sharing of

information, help prevent miscommu-nications, and resolve problems more quickly when they occur.

For instance, a parent may contact the school with concerns about how their child was treated. Maybe they re-ceived incomplete information from a coach, or their son or daughter left out some key details when describing what happened. If you can say definitively that the athlete was given certain direc-tions, or that messages were left on the voicemails of two phone numbers in an attempt to contact the parent, their at-titude often does a complete 180.

Parents today want to take a more active role in their children’s activities, especially in matters of health and safe-ty. With the proliferation of cell phones and e-mail, athletic trainers must be prepared to maintain a higher level of communication, and to thoroughly document what athletes and their par-ents have been told.

Proof of worth. In the high school setting, some administrators still think of certified athletic trainers as a luxury. In college, many departments are un-derstaffed and not given all the resourc-es they need. The best way to correct these problems is to have a comprehen-sive record of all the ways athletic train-ers add value to an athletic program.

Keeping excellent records allows you to generate detailed reports for admin-istrators and school boards illustrating the true impact athletic training has on

the student body. For example, Fairfax County Public Schools is now the 12th largest school system in the nation, with over 170,000 students. Each of our 25 high schools has two certified athletic trainers (one full-time and one associate who also teaches). Our record keeping system allowed us to complete a recent analysis showing that our football play-ers alone suffered a total of 24,207 inju-ries and 4,276 time-loss injuries over one five-year span, for an average of 3.93 in-juries per 1,000 athlete exposures.

Whenever resources are being allo-cated, putting hard data like this in the hands of decision makers presents a much more compelling case than anec-dotes, testimonials, and complaints of being understaffed. A professional sum-mary of athletic training activities can also help you advocate for new equip-ment or a larger facility. Even adminis-trators who don’t view athletics as a top priority can be convinced when they see that treatment from on-site athletic trainers reduces classroom time missed by student-athletes.

Finally, analysis of your injury data can help you set priorities in the athletic training services you provide. A spike in ACL injuries among your female bas-ketball players might spur you to talk to the coach about adding preventive exercises to their warmup routine. Or a sudden drop in lower-body injuries on your football team might validate the new ground-based training program the strength coach is using. The possibilities for putting the data to use are endless.

WHAT TO RECORD & HOW

Here’s the simplest possible summary of what thorough record keeping really means for today’s athletic trainers: Ev-ery problem or injury that’s brought to your attention should be represented in your files by its own record, contain-ing information about the initial eval-uation, the mechanism of injury and any pre-existing or contributing fac-tors, and what treatments and other in-terventions were provided to resolve the situation. For problems or injuries that require more than a one-time interven-tion, the record should document all evaluations, treatments, and progress made until the return to full function.

Sounds simple enough, right? But if you tried following the above guidelines without some careful front-end planning, you’d quickly find yourself spending most of your day taking notes or sitting at your

Training Administrator for a public school system, we have made record keeping a priority, and it has paid off for us in several ways. In this article, I’ll outline the benefits of a complete and well-organized information man-agement system, and explain how it has helped us improve the care we provide for athletes every day.

WHY IT MATTERS

There are some key reasons why certi-fied athletic trainers should document every action we perform within our scope of practice. The most basic is that if we want to be considered credible

healthcare professionals, we must ac-knowledge that thorough record keep-ing is the standard of practice in today’s medical world. Everyone from physi-cians to physical therapists to dentists maintains complete records of their evaluations and treatments, and athlet-ic trainers should be no exception.

There are other crucial reasons for record keeping as well. They include all of the following:

Legal liability. If an athlete feels they were not treated correctly, they or their parents need only pick up a phone and call an attorney to begin a sequence of events that can make any athletic trainer miserable. Anyone who has been on the receiving end of a lawsuit will tell you that accurate and complete records are the best defense. If you have documenta-tion showing what happened each time the athlete was under your care, proving you acted appropriately is as simple as finding the right folder or computer files.

Without complete records, it is your word against the athlete’s, and key details of past treatments can be difficult to nail down. If your records don’t “tell a story” from the initial evaluation through the release to participate without restriction, you could be taking a serious risk if some-one ever questions what you did.

Our school system has been contact-ed several times by attorneys’ offices to inquire about an athlete’s treatment. When lawyers are deciding whether to file suit, they first investigate the extent

Analysis of your injury data can help you set priorities ...A spike in ACL injuries among your female basketball

players might spur you to talk to the coach about addingpreventive exercises to their warmup routine.

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Circle No. 129

LEADERSHIP

computer. Before long, you’d adjust by taking briefer notes, or perhaps limiting your records only to injuries that result in time loss. But this shortcut leaves you vulnerable—if what at first seemed like a minor injury or condition takes a turn for the worse, you’re already behind in your records and some pertinent information about early symptoms and treatments has been lost.

Clearly, one of the biggest keys to ef-fective record keeping is finding a way to fit it into your daily tasks and schedule efficiently. I’ve found that a computerized record management program is by far the easiest solution for achieving this goal. Whether you purchase a software pack-age dedicated to medical record keeping or develop your own database or spread-sheet-based system, given the many ad-vantages, there’s no reason to not be using a computer to manage your records.

Computer-based electronic medical record (EMR) systems usually include point-and-click options with drop-down menus, which make it easier to create consistent records because you use the same format to input data for each entry. Most systems also have note

fields where narratives and comments can be added as needed.

Drop-down menus make up the foun-dation of some computer systems, and they’re a great way to ensure that entries are uniform and thus can be used to compile trend data. The menus are often very detailed, covering everything from clinical impressions and mechanisms of injury to amount of pain reported by the athlete and various treatment op-tions. Based on the selections you make from the menus, a program will create reports with summaries of injuries and injury rates, types of injuries sustained most frequently by sport, average num-ber of treatments provided per injury or type of injury, and so on.

If you have a computer-based system, some simple logistics planning can make it as user-friendly as possible. For in-stance, at our schools we’ve found it very helpful to set up a computer right in the athletic training facility, with the key-board and mouse at countertop height. This allows easy access for entering in-formation, so it often takes as little as 10 or 20 seconds to record routine treat-ments. Our athletic trainers can even fill

out some parts of the form as the athlete answers questions. We’ve learned from experience that if the only available com-puters are at desks with chairs, there’s a tendency to wait until “after the rush” to input information—and in the interim, important details can be forgotten.

Simple ongoing treatments, such as the application of special pads or rou-tine taping and bracing, need just a short note in the athlete’s file stating what was done, when, and any relevant con-text information (for instance, whether a treatment was provided before or af-ter practice). Re-evaluations of existing injuries, such as when you’re determin-ing an injured athlete’s participation sta-tus, should take a minute or two as you provide notes on the evaluation results, injury progress, and new status. Evalu-ations of new injuries generally take the most time to document, so you may find it’s best to take brief (but detailed) notes during or immediately after your time with the athlete, and write up a full ac-count later on when you’re less busy.

Some athletic trainers have found that documenting everything right as it hap-pens is the best way to ensure the records

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Circle No. 130Circle No. 131

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LEADERSHIP

leave no holes. This method, known as real-time record keeping, can help im-prove accuracy, but it does force athletes to wait as you complete notes from the previous patient. Others take a break to update their files after every two or three athletes they treat. However you decide to structure your record keeping sched-ule, remember that the shorter the time between when treatment is provided and when it is recorded, the better.

IN MY SETTING

When I started at Fairfax County Public Schools in 1983, I was one of the first people hired through a school board ini-tiative aimed at bringing in certified ath-letic trainers for each of the 23 high schools we had at the time. We were full-time teachers who received a stipend to provide athletic training services after school hours. As it became evident that one athletic trainer per school was not enough, we added an associate position for each school in the late ’80s.

Back then, we compiled injury stats using data from our paper-and-pencil records, and we used those stats to de-velop an event coverage policy based on

each sport’s injury frequency and sever-ity. Our policy was often challenged by administrators who would see one injury in a low-risk sport and instantly decide it should be a higher priority. The statistics we had compiled helped us defend our policy, but doing so was very time- and labor-intensive.

In 1997, we began using a computer-based EMR program. Each school com-piled its own data, and uploaded the information to our Sports Injury Moni-toring System (SIMS) for district-wide analysis. This was a huge leap forward in making our information manage-ment more effective and less burden-some, and before long, we were putting the results to use.

In 2001, we had 24 high schools and the two athletic trainers at each school both had teaching responsibilities. We proposed converting one position for each campus to full-time athletic trainer with no teaching duties—something we defi-nitely needed, but which carried a $1.3 million price tag. Thanks to our record keeping system, we were able to lay out concrete facts to support our proposal.

We noted that student-athletes in our

system incurred over 3,800 time-loss in-juries and 8,100 minor injuries per year based on data collected over a three-year period. We also explained that our athletic trainers conducted more than 82,000 treatments and rehab sessions over that time span, a figure that clearly demonstrated the need for a full-time athletic healthcare provider.

That first attempt didn’t succeed, but we kept compiling the data and presenting more and more facts and figures documenting the athletic train-ing workload. Finally, in 2005, the re-structured athletic trainer position was funded and implemented. That taught us two key lessons: Don’t give up, and use all available data to your advantage when making your case.

You didn’t become an athletic trainer because of your love for spreadsheets, medical note taking, or software pro-grams that analyze trend data. But I have learned through experience that in athletic training, the old axiom “in-formation is power” is truer today than ever. Excellent record keeping takes time, but with so many benefits, it’s definitely a wise investment. ■

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Circle No. 132 Circle No. 142

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SPORT SPECIFIC

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BY DANNY BRABHAM

A college track coach—who also designs strength programs for some of the world’s top runners—explains how good things happen when strength training and track and field embrace each other.

Having coached track and field for 35 years, I have seen the sport change and evolve in many ways. One of the most exciting

progressions has been the integration of strength training into our athletes’ workouts.

A traditional fear of bulking up and the difficulty of working with strength coaches who primarily focus on the school’s football squad have long kept track and field athletes out of the weightroom. In addition, as track coaches, we like to control every as-pect of our athletes’ training and don’t necessarily want to turn one part of it over to a coach who doesn’t specialize in our sport.

But over the past decade, I have had the opportunity to work with three strength coaches here at Baylor Uni-versity who have helped me develop

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Circle No. 133


SPORT SPECIFIC

44

JOHNSON 2000JOHNSON 2000The following is a sample workout developed for Michael Johnson as he was training for the 2000 Olympics. He rested 30 to 60 seconds between sets and one to two minutes between exercises.

MondayBench 2 x 8 1 @ 75 percent, 1 @ 80 percent

Squat machine 4 x 5 Begin at 150 lbs., progress in 50 lb. increments

Front raises 2 x 6 10 lb. dumbbell

Leg extensions/curls 2 x 6 Single leg, 60, 30 lbs.

Pull-downs 2 x 10 150, 160 lbs.

Running curls 2 x 20 Quickly, with 20 lb. dumbbells

Flexor pulls 1 x 10 Quickly, with half-inch exercise band

Switches 2 x 20 Quickly, leg at 90 degrees, one minute rest

Flat dumbbell 2 x 8 65-70 lbs.

WednesdayIncline dumbbell 3 x 5 Single arm, 40, 45, 40 lbs.

Lateral raises 4 x 5 10 lb. dumbbell

Pec deck 3 x 5 Begin at 100 lbs., progress in 10 lb. increments

Dumbbell curls 3 x 5 30, 35, 30 lbs.

Ad/ab band 1 x 15 half-inch exercise band, each leg

Horizontal arm/leg lifts 1 x 45 5 lbs. in each hand

Upright rows 2 x 8 90 lbs.

Back raises-hamstrings 1 x 20 25 lbs.

Bench 3 x 8 145 lbs., regular/wide/narrow grips

Sit-ups 3 x 25 2 flat, 1 float

ThursdayBench 1 x 10 175 lbs.

Dumbbell rolls 2 x 5 30 lbs.

Leg extensions/curls 2 x 8 Double, 110, 50 lbs.

Curls 3 x 5 Standing, 25 lbs. each + bar

Push-downs 4 x 6 50, 60, 80, 70 lbs.

Six-stage flys 1 x 15 Standing, quickly, with 10 lbs.

Running curls 1 x 20 20 lbs.

Pull-downs 1 x 15 140 lbs.

Medicine ball twists 1 x 20 To wall, each side, 12 lb. ball

specific training protocols for track ath-letes. I’ve also served as strength coach for two of our nation’s premier 400-meter runners, Michael Johnson and Jeremy Wariner. My work with them has helped me to develop a specif-ic strength training program for long sprinters, which can be used by runners at any competitive level.

A LITTLE HISTORY

When I began my coaching career at Baylor (after coaching at the high school level for 16 years), there was no effective means for our athletes to perform any sort of strength training. There was only a small, cramped, hot room at the end of the track where our athletes trained on outdated machines. After some time we were allowed to use the football weightroom, and as anafterthought one of the strength coach-es was assigned to work with our team. But the coach seemed to give us very ge-neric workouts and rarely spoke to our athletes one-on-one or even as a group.

In 1999, however, LeBaron Caruthers arrived as Baylor’s Head Strength and Conditioning Coach. Not only was he an NSCA national strength coach of the year (1992), but he was also a for-mer track and field athlete (two-time All-American in shot put). He brought sport-specificity to the weightroom and opened the doors to our team.

He understood the importance of lis-tening to what the sport coach was hop-ing to achieve. From the first time we talked about our goals for the track and field team, he was receptive to our ideas. Although he was hired by our football coach, LeBaron found time to design workouts for different track and field events, even tweaking programs based on the goals of each individual athlete.

Just as important, he actively worked with our athletes when they were in the weightroom. One of the main points we discussed was developing a relationship with our team members, letting them know that he was genuinely interested in what they accomplished both on and off the track. This really paid off as the athletes began to trust him.

The program we implemented was not fancy. We began our lifting regimen by concentrating on flexibility, warmup, and strength gain. The first six weeks of training were designed to get the athletes strong enough to avoid injuries once we began event work. We lifted three days a week, with two of those days con-


SPORT SPECIFIC

centrating on Olympic lifts, snatches, cleans, deadlifts, and squats (both front and regular). A dumbbell circuit was included in these workouts, as were nu-merous body weight exercises. The third day was designed to improve speed and flexibility by doing such lifts as step ups with a bar on the back, fast cleans, accel-erated overhead dumbbell pulls from the floor, hamstring and quadriceps work, and bench presses.

We then gradually moved from a strength phase to different event phas-es. The athletes were able to adapt with-out much of the soreness and negative thoughts that had previously been asso-ciated with the weightroom.

After LeBaron left, we were assigned another strength coach, Torre Becton (who has since moved on to Iowa State). He, too, was extremely focused on what our athletes achieved in the weightroom and during competition. From there, Milton Leal took over and he has been

another great weightroom partner. My thanks to them for enabling our athletes to compete at the highest level possible.

I relay the above thoughts for two main reasons. One is so that strength coaches know why track and field ath-letes and coaches often aren’t big fans of the weightroom. The other is to help strength coaches understand that if you do give our sport some attention, we will respond to it.

FOCUS ON THE 400

Baylor University is nicknamed “Quar-ter Mile U” because it has produced some of the nation’s and even the world’s top 400-meter runners. Alumni Michael Johnson and Jeremy Wariner have been the top 400-meter athletes in the world for the past two decades. Along with

helping to coach them as undergradu-ates, I have had the pleasure of serving as personal strength coach for both of them since they’ve graduated.

The programs I’ve designed for them have not been elaborate. In our sport, so much energy is needed for workouts on the track that strength training must never overload the athlete. My focus has been to specifically target all the muscle groups these athletes use in their event, concentrating on strength gain without much body weight gain.

One key has been to develop a routine

that balances all the muscle groups as-sociated with the athlete’s racing in or-der to reduce injury risk. We also look specifically at the athlete’s injury history and try to correct any imbalances.

When I began training Michael, we did exercises that would essentially de-velop all the opposing muscle groups. Most of the squat work was done on squat machines or simply with his body weight. Very seldom would we load heavy weight on his shoulders because he had issues with lower-back stability and alignment. This proved very success-

I relay the above thoughts for two main reasons. One is so that strength coaches know why track and field athletes and coaches often aren’t big fans of the weightroom. The other is to help strength coaches understand that if you do give our sport some attention, we will respond.

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SPORT SPECIFIC

46

ful, and also helped him avoid injury. In addition, we worked with Dale Smith, a physical therapist based in Dallas.

Another key with Michael was for me to explain the reasoning behind each of the exercises and what exactly they would do for his racing strategies. Mi-chael was always willing to work ex-tremely hard to excel in his sport, and knowing the why behind the work re-ally motivated him.

The table titled “Johnson 2000” (on page 44) details the workouts Michael did in preparation for the 2000 Olym-pics, at which he won a gold medal in the 400 meters. Most of the bench workouts are based on percentages of his bench max, which we tested approx-imately three to four times per season. At the time of this workout, Michael’s bench max was 315 pounds.

Monday’s workout focused on the chest, triceps, and shoulders. Wednes-day’s workout was for the chest, biceps, and pecs. And Thursday was about the chest, triceps, and shoulders again. Ev-ery day also included work on the legs.

Some of the leg work, such as leg ex-tensions and curls, involved both single-leg and double-leg exercises. On thedouble-leg workouts, we would push a hard toe in/toe out and do straight ex-tensions to load the quads and ham-strings in different planes. This helped us avoid injury. (Michael was 33 years old at this point in his career—in a sport plagued by leg injuries.)

These specific workouts were con-ducted one month prior to the Olympic trials. As we got closer to the trials and then the Olympic Games, he only did one set of each exercise. One week prior to the Olympics, he performed just the Monday and Wednesday workouts with a reduction in sets.

In 2004, I began to work with Jeremy, and we progressed through the same ba-sic scenario that Michael had. For Jeremy, however, we also wanted to address some imbalances. He had a weak core that caused alignment problems and could potentially lead to injury. Our physical therapist in Dallas helped diagnose his weaknesses and make sure the strength program addressed the problems.

We added stability ball and band ex-ercises in order to stabilize his weak-er core muscles. We also worked on strengthening his hip flexors, adductors, abductors, abdominals, and the smaller muscle groups along his back by doing horizontal arm/leg lifts with five- to 10-

WARINER 2008WARINER 2008The following workout was performed by Jeremy Wariner in preparation for the Beijing Olympics, where he won silver in the 400. We placed a lot of emphasis on alignment and core strength.

MondaySeated ball leg lift 1 x 40 Each leg

Bench 2 x 8 145, 155 lbs.

Squat machine 3 x 5 Begin at 150 lbs., progress in 50 lb. increments

Front raises 2 x 6 Right up, left up: 25 lbs.

Leg extensions/curls 2 x 6/3 x 4 Each leg: 60, 30 lbs.

Running curls 1 x 30 Quickly, with 15 lbs.

Flexor pulls 1 x 25 At 45 degree angle, with half-inch exercise band

Flat dumbbell 3 x 6 45, 50, 55 lbs.

Short stroke push-down 2 x 25 1 minute rest

WednesdayIncline dumbbell 3 x 4 Both arms: 35, 40, 35 lbs.

Lateral raises 3 x 5 15 lbs.

Pec deck 2 x 6 100, 110 lbs.

Curls-standing 2 x 8 1 in, 1 out: 25 lbs.

Horizontal arm/leg lift 1 x 30 5-10 lbs.

Ad/ab band 1 x 10 Each leg in/out, front/back

Upright rows 2 x 5 Each hand, with 35 lb. dumbbell

Back raises 1 x 20 25 lbs.

Bench 2 x 10 Regular/wide, 135 lbs.

Sit-ups 2 x 25 1 flat, 1 float

ThursdayBench 2 x 8 155, 175 lbs.

Dumbbell rolls 2 x 6 15 lbs.

Leg extensions/curls 2 x 8 Double, 110, 60 lbs., toes in/out

Push-downs 3 x 5 100, 110, 120 lbs.

Six-stage flys 2 x 8 Seated on stability ball, 10 lbs.

Running curls 1 x 30 15 lbs.

Pull-downs 3 x 6 90, 110, 130 lbs.

Bodyweight squats 2 x 50 To 90 degrees, 1 minute rest

SPORT SPECIFIC

pound plates in each hand. This solved most of his alignment problems, and it was great to see both sides of his body begin to work together more efficiently.

The table titled “Wariner 2008” (at left) details Jeremy’s program in the month before this summer’s Olympics. When the preliminary heats in Bei-jing were two weeks away, we reduced the workouts to two days a week. The week he competed, he did just one day of maintenance work and reduced the bench weight to 155 pounds.

THE SPECIFICS

Doing an exercise correctly, of course, is key to making it effective. While many of our exercises are self explana-tory, there are some I’d like to provide specifics on.

Seated Ball Leg Lifts. The athlete sits upright on a stability ball with arms across his chest and feet together, fac-ing a mirror. He is instructed to keep his shoulders level and head aligned with no movement. The athlete lifts one leg off the floor with the last contact coming from the heel. The knee moves to about 10-20 degrees past horizontal. At this

point the foot returns to the floor for the next rep. This is done until one leg has completed the proper number of reps. Then the opposite leg does the exercise.

Front Raises. The athlete takes a dumbbell in each hand and stands on one foot. He then raises each dumbbell, one at a time (alternating arms), bring-

ing it up to shoulder height for the as-signed number of reps. The exercise is repeated on his other foot.

Running Curls. The athlete takes the dumbbell in one hand and lifts it up un-til there is a 90 degree angle in his arms. Performing a running motion, he moves the dumbbell from behind his hip to shoulder height, repeating until he has done the assigned number of reps. The reps are then performed with his op-

posite arm. The emphasis should be on maintaining the 90 degree angle during the entire sequence of reps.

Flexor Pulls. The athlete attaches a half-inch rubber resistance band to the top of his foot at floor level. He then places a stationary object, such as a bench or rail, far enough away to stretch

the band to three or four times its length. Leaning at 45 degrees, he then moves through a running motion, keeping the ankle of the drive leg above the knee of the leg on the floor. He does each leg for the assigned number of reps. Keeping the 45 degree angle is key.

Short Stroke Push-Downs. This exer-cise is done with a two-inch resistance band through four planes: front, right side, left side, and reverse pull. The band

Another key with Michael was for me to explain thereasoning behind each of the exercises and what exactly they would do for his racing strategies. Michael was always willing to work extremely hard to excel in his sport, and knowing the why behind the work really motivated him.

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SPORT SPECIFIC

48

is placed on a stationary object approx-imately seven to eight feet high. The athlete holds the band with both hands and stands back until it is at a 45 degree angle. He then pulls the band straight down until his arms are also at a 45 de-gree angle. With a very fast motion, he pushes down until the number of reps is reached. The distance of the push-down should not exceed one inch.

To complete the exercise on the right and left sides, he shifts his feet to 45 de-grees with the shoulders rotating back to be parallel with the wall. He then

pulls to the outside of the hip across his body. To do a reverse pull, he turns around and pushes down while fac-ing away from the machine or wall to which the band is secured.

Horizontal Arm/Leg lifts. The athlete lies on his stomach on top of a stability ball, with his hips in the middle of the ball and weights in each hand. He lifts his right arm and left leg to parallel. He then repeats on the opposite side until the proper number of reps is reached. Some of these exercises are done with a five-second hold on top, while others

are done with no hold at all.Ad/Ab Band. Using a half-inch re-

sistance band, the athlete attaches the band to a stationary object at floor lev-el and then to one of his feet. With the shoulders parallel to the band, he walks out to three or four times the band length. He then pulls the band across his foot until the band is at least one foot length past the foot on the floor. He does this exercise pulling the band both in front of and behind the station-ary foot. Once the assigned reps are done, he switches to the other foot.

Dumbbell Rolls. Lying on his back on a bench or stability ball, the ath-lete takes a dumbbell in each hand. Be-ginning with the dumbbells straight up above his shoulders, the athlete alter-nately rolls the weight until one is touch-ing his thigh and the other is at shoulder level overhead. The weights switch posi-

tions until all reps are completed.Six-Stage Flys. Standing with his feet

together, dumbbells in each hand and to the side, the athlete takes the weight on both sides up until his arms are straight out and even with his shoulders. He then takes the weight to the front, even with his shoulders. Next, his arms go straight up until both are overhead, then back to the front, sides, and down to his legs. That is one rep, and the athlete repeats until all reps are completed. There is one full minute between reps on this exer-cise. This can also be done while sitting on a stability ball with feet together.

Whether working with a track and field team or one elite athlete, I have found strength training to be critical for reaching goals. Track coaches can be hesitant to let you into their circle, but if you show that you’ll listen and work with them, the rewards are great. ■

We worked on strengthen-ing his hip flexors, adduc-tors, abductors, abdominals, and the smaller muscle groups along his back ... This solved most of his alignment problems, and it was great to see both sides of his body begin to work together more efficiently.

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TRAINING-CONDITIONING.COM T&C OCTOBER 2008 49

PAIN MANAGEMENT

Cho-Pat800-221-1601www.cho-pat.com

Cho-Pat’s newest product, the Bicep/Triceps Cuff, affords protection from overuse injuries for individuals performing repetitive lifting in activi-

ties such as weight training. This patent-pending device applies dynamic circumference pres-sure to the upper and lower portions of the biceps and triceps muscles, particularly at the tendon attach-

ments. This action spreads out the stress and direct pull on the muscle attachments, which helps reduce the likelihood of developing bicipital and tricipital tendonitis or tendonosis.

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Clinton Industries, Inc.800-441-9131www.clinton-ind.com

The Clinton Classic Wood Taping Station features the beauty of real wood in four popular finishes, famous Clinton durable construc-tion, and desirable standard features—like leg extensions that save valuable space and comfort-able adjustable back rests. With more than 14 available options, this product is sure to be on every athletic trainer’s wish list. Plus, Clinton’s modular design, avail-able in four depths, allows the units to be configured to fit large or small sports training facilities.

Circle No. 501

Clinton’s Style Line Laminate Taping Station is packed with value for large and small athletic training rooms. With

easy-clean laminates in 15 stan-dard colors and custom laminates to match your

school colors, Clinton’s Style Line Laminate Taping Station can comple-ment any facility. Standard features

include leg extensions and adjustable back rests. The units are available with 14 options, four depths, and a modular design allowing multiple stations to be joined in a row.

Circle No. 502

Dynatronics800-874-6251www.dynatronics.com

The Dynatron X5 is a highly effective treatment for both acute and chronic pain. This remarkable machine features

two inde-pendent channels and six treat-

ment modes, and it includes both large and small treatment probes. It features four frequency sweeps, frequency ranges from 0 to 200 Hz, a conduc-tance meter, and a two-year warranty. The X5 is lightweight and affordable. Feeling is believing—for a free dem-onstration, contact your Dynatronics dealer or call the company directly.

Circle No. 503

Let Dynatronics furnish your athletic facility with individual taping stations, cabinets built to your specifications, and units with your team logo debossed in the Naugahyde color of your choice. Dynatronics manufactures tables in beautiful, durable hardwoods to fit every need. With 30 years of experi-ence, Dynatronics offers outstanding craftsmanship and design, with sturdy construction, reinforced stress points, and great long-term performance. Go online to learn more.

Circle No. 504

Elations513-321-4072www.elations.com/professional

Elations is a fruit-flavored glucosamine and chondroitin drink that is more absorb-

able than pills and designed to improve joint health and reduce joint discomfort. Elations’ unique formula includes a pat-ented, more absorbable form of calcium and boron to help minimize soreness and stiffness due to exercise and overly strenuous daily activities. A professional discount program and a profit program are available at the company’s Web site. With Elations, there will be no more pills to swallow.

Circle No. 505

Hygenic PerformanceHealth Products

800-246-3733www.biofreeze.com

Applied generously, Biofreeze pain-relieving gel and roll-on effectively relieve pain from heel injuries, sore

arches, mus-cle spasms, strains, sprains, and tendonitis, and will help minimize next-day

aches and pains. Use it up to four times a day. It’s available in a 16-ounce spray bottle and 16-ounce, 32-ounce, and gallon gel pump bottles. Also available is a gravity dispenser box with 100 five-gram single-use applica-tion packets for clinical settings.

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Jump Stretch, Inc.800-344-3539www.jumpstretch.com

“Don’t Ice that Ankle Sprain!” by Jump Stretch founder Dick Hartzell and Dr. Michael Shimmel will introduce you to the FlexBand Ankle & Strengthening Traction Technique, which is designed to reduce pain and swelling and to speed recovery time from ankle injuries. You will never deal with a sprain the same way again. This 85-page book includes a com-panion DVD, and covers horizontal trac-tion, vertical traction, deferred pain, and more. It also includes testimonials from athletes and healthcare professionals.

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50 T&C OCTOBER 2008 TRAINING-CONDITIONING.COM

PAIN MANAGEMENT

HydroWorx International, Inc.800-753-9633www.hydroworx.com

HydroWorx pools with the InstaFit option offer a convenient, plug-in answer for sports professionals who need immedi-

ate access to the benefits of aquatic ther-apy. The 500i and 600i units leave the com-pany’s work-shop skirted, prepackaged,

and ready to perform. The 500i is up and running after being set in place and connected to an electrical source at its rehab and exercise destination. The 600i can be carried through a standard doorway and quickly assembled and plumbed on site, so it can fit into virtually any spot too confined for the 500i.

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Kustomer Kinetics800-959-1145www.kustomerkinetics.com

Pain Blocker is an effective topi-cal pain-relieving lotion. This product from Jay Alan, a division of Kustomer Kinetics, will ease the discomfort associated with muscle sore-ness, muscle spasms, strains, sprains, exercise overuse, tendonitis, bone and joint pain, and arthritic pain. It is formulated with potent analge-sics and skin-softening emollients in a soothing lotion. Apply Pain Blocker generously to trouble spots for quick relief. Call for more information.

Circle No. 509

Multi Radiance Medical800-373-0955www.multiradiance.com

Multi Radiance Medical has introduced the new FDA-cleared LaserStim emit-ter for the TerraQuant laser device. The new technology allows therapists

to identify inflamma-tion areas and pro-vide highly targeted treatment.

The LaserStim is a patented hybrid emitter that combines phototherapy and e-stim in one device. With the LaserStim, powered by Multi Radiance

technology, clinicians can now receive insurance reimbursement for this attended combination modality. The product provides 25,000 mW of super-pulsed laser peak power, resulting in rapid pain relief with no risk of burning tissue. The results have been proven by numerous clinical studies.

Circle No. 510

The TQ Solo Laser from Multi Radiance Medical is the only handheld portable device with exclusive Multi Radiance

technology, which syn-ergistically incorpo-rates four proven radiances to pro-vide the ultimate phototherapy envi-

ronment for relieving pain: a super-pulsed

laser, infrared light, red light, and a static magnetic field. With up to 18 hours of battery power, the TQ Solo’s pain-relieving power is there when you need it. There are no side effects and the product is easy to use. It is used by pro athletes worldwide.

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Oakworks800-916-4603www.oakworks.com

Strong, stable, and remarkably dura-ble, PowerLine treatment tables are in a league of their own, with a massive 500-pound weight capac-ity. The solid hardwood construction with heavy-duty hardware ships partially assembled, resists humidity, and will continue to promote your professional image year after year. Choose a 27-inch or 30-inch wide H-brace, and a flat rectangular or manual back rest top with an optional storage shelf and 20 upholstery colors.

Circle No. 512

With a 500-pound weight capacity, the Oakworks Portable Taping Table is one of the strongest and most durable

taping tables on the market. Fully portable, this table provides an ideal sideline evaluation and taping station both at home and on the road. Plus, with independently

adjustable legs and unique field feet, the Portable Taping Table can handle

any uneven surface or rugged terrain without a problem.

Circle No. 513

OPTP800-367-7393www.optp.com

Kinesio Tape is a high-quality elastic athletic tape specifically designed to be worn for an extended period of time

as well as during strenuous exercise or hydrotherapy. The heat-activated adhesive will not leave residue when removed. Kinesio Tape is latex-free and has an elastic-

ity of 140 percent, matching the basic elasticity found in skin and allowing it to work with the body. Call or go online to request a free OPTP catalog.

Circle No. 514

The original McKenzie® night roll from OPTP is designed to compensate for poor sleeping positions by sup-porting the spinal structures and main-taining proper lumbar posture while an individual sleeps on their side or back. The user can easily tie the night roll around their waist, and the exclusive tapered ends allow comfort and free-dom of movement without loss of sup-port. Request your free OPTP catalog online or by phone today.

Circle No. 515

PRO Orthopedic Devices, Inc.800-523-5611www.proorthopedic.com

The PRO 180 Dr. “M” Patella Brace has become the time-tested, suc-cessful, conservative approach to

patella problems. Designed with several unique features, it’s so revolutionary that it’s patented. A but-tress of orthopedic felt in a horseshoe configuration is posi-tioned underneath the

sleeve, taking advantage of the com-pression of the sleeve over the but-tress. This ensures proper positioning and control of patella movement.

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PAIN MANAGEMENT

The PRO 110 standard knee sleeve from PRO Orthopedic is the classic knee sleeve that spawned a revolu-

tion in the treatment of knee problems and created a whole new industry. The time-proven design is made from the highest grade 1/8-inch neoprene rub-ber and features a nylon outer cover

for durability. Measuring 13 inches in length, the outer oval pad helps control sleeve stretch and fit while increasing the concentration of heat over the patella area. The PRO 110 is helpful for arthritis, strains, and post-operative knee problems. It is comfortable and effective.

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PROTEAM by Hausmann888-428-7626www.proteamtables.com

PROTEAM by Hausmann now has the ability to dress up your athletic train-ing room by adding your team logo to your tap-ing station back rests, seats, or table tops. Your logo can be embossed in multi-colored raised pan-els that really make your athletic train-ing room pop, or you can deboss a monochrome logo into the upholstery for a more subtle look. Go online to see images of some of the company’s recent work.

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PROTEAM by Hausmann offers a complete line of laminate treatment furniture designed to enhance the

functional capacity and appearance of the athletic training room. PROTEAM Modular Taping

Stations are available in a wide variety of sizes and options. The individual taping units are finished on all sides and can be easily re-positioned to fit your needs now and in the future. Visit the company online for a wide selection of treatment tables, split-leg tables, cabinets, and stadium lockers.

Circle No. 519

Sprint Aquatics800-235-2156www.sprintaquatics.com

Sprint Aquatics has been supply-ing the aquatics world with aquatic therapy products for more than 36 years. The company’s combination of quality, price, and customer service makes Sprint an industry leader. The company has brought a myriad of

innovative and thought-provok-ing products to the market over the years—prod-ucts that have altered the course of aquatic therapy and helped set

the pace for the entire field. Circle No. 520

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Untitled-5 1 9/17/08 9:34:34 AM

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PAIN MANAGEMENT

Watkins, Inc.507-457-3300www.jrwatkins.com

For 140 years, Watkins has been America’s pioneer in natural living, utiliz-ing the finest natural ingredients in its

products, including topical analgesics. To this day, Watkins adheres strictly to the same quality standards set forth by company founder J.R. Watkins. Through its topi-cal analgesics, first

aid, and natural personal care offerings, Watkins continues to provide products that are good for the earth, good for oth-ers, and good for you.

Circle No. 521

Keffer Development Services888-328-2577www.athleticsoftware.com

The Athletic Trainer System (ATS) is a multi-team, multi-sport system designed to assist athletic trainers in tracking and reporting information related to athletes and injuries. This information ranges from evaluations and rehabilitations to drug testing and purchase orders. New fea-tures are reviewed by the company’s advisory council of athletic trainers. ATS consists of three modules: ATS Core, ATS Smartphone, and ATS Web Portal. All three modules share information without the need to synchronize.

Circle No. 522

NExTT Solutions, LLC574-233-6695www.nexttsolutions.com

NExTT Injury Management is a lead-ing provider of electronic medical recording for sports organizations. The

software pro-vides a simple and efficient way for athletic trainers, doc-tors, and other

medical professionals to easily enter, manage, and share important medi-cal information on behalf of the entire organization. The system is designed for multi-sport and multi-site consoli-dation and serves as accurate docu-mentation for all insurance and legal purposes. Take the NExTT step.

Circle No. 523

Swede-O, Inc.800-525-9339www.swedeo.com

Swede-O has launched the patented Thermoskin Heel-Rite for effective daytime treatment of plantar fasciitis. The innovative tension support straps

lift and sup-port the arch to provide compression to the plantar fascia for pain relief. The lightweight, low-profile

design fits easily into most footwear to provide pain relief during normal everyday activity. The Heel-Rite applies effective support to relieve tension and pain on the plantar fascia during the day, when athletes need it most.

Circle No. 524

BSN Medical, Inc.800-537-1063www.bsnmedical.com

Lightplast Pro is a lightweight stretch tape that’s ideal for all-purpose taping and strap-ping of ankles, wrists, and fingers. It’s easy to tear and unwinds consistently for smoother, faster wrapping. It even holds securely in the presence of moisture. This tape is available in black or white.

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Coverlet adhesive bandages by BSN Medical are made to absorb liquid quickly. In addition, each Coverlet fea-tures an extra-large wound pad capable

of absorb-ing 10 times its weight in water. The 360-degree adhesive

surrounding the island pad helps seal the afflicted area against dirt and con-tamination, keeping wounds clean and providing an environment conducive to healing. Coverlet bandages are available in 13 different shapes and sizes, making them perfect for use on knees, elbows, chins, noses, knuckles, and other hard-to-bandage areas. The elastic fabric moves with the curves and contours of the skin and the body, sticking with ath-letes wherever they go.

Circle No. 526

Chattanooga Group800-592-7329www.chattgroup.com

The economical Opti-Ice helps reduce athlete pain and swelling and speed rehabilitation. Its motorized, eight-quart-

capacity system provides con-tinuous, consistent cold therapy for up to seven hours through the pat-ented semi-closed loop system. Opti-

Ice has an easy-to-use external con-sole and thermometer to help maintain an accurate, safe water temperature. Instructions are printed on the lid for easy referral, and the fill line is molded inside the cooler for accurate filling.

Circle No. 527

Chattanooga Group, a DJO company and one of the world’s largest manu-facturers of rehabilitation equipment, was recently awarded “Best in Show” at the NATA Annual Meeting in St. Louis for its Intelect TranSport® Combo. The TransPort® Combo, a portable device that delivers both electrotherapy and ultrasound, was voted tops in the electrotherapy category. “We’re very excited to receive this dis-tinction,” says Jeff Gephart, National Sales Manager for Chattanooga Group. “The Intelect TranSport is one of our most innovative and popular products because it was designed with the ath-letic trainer in mind.”

Circle No. 528

Kneebourne Therapeutic866-756-3706www.eliteseat.com

The Elite Seat by Kneebourne Therapeutic is a portable knee-extension device designed for the non-operative treatment of degenerative knee condi-

tions. By evenly distributing force across the leg, the Elite Seat provides effec-tive full-knee hyperextension and reduces pain

in bent knees caused by any of these conditions: acute ACL injury; inadequate post-operative rehabilitation after ACL reconstruction; total-knee arthroplasty; arthrofibrosis; deconditioned knee with a flexion contracture; and arthritis.

Circle No. 529


In your opinion, is stretching ben-eficial? If so, do you recommend it before or after a workout?

Some studies indicate that stretching before a workout either has no effect on performance or may actually impede performance. To some extent, I would agree with that, because the stretch-ing done in most of these studies is static, which is a complete waste of time. Instead, we recommend dynamic stretching, which can be appropriate before, during, and after a workout.

At our gym, we use FlexBands by Jump Stretch to perform a controlled dynamic stretch. This is more of a

“real world” stretch and simulates the way an athlete’s body works. Muscles extend and flex in microseconds when running. One muscle lengthens while its antagonist muscle shortens, and this happens quickly.

Can you give an example?

At Jump Stretch, we do three rounds of stretching on the hamstring. Round one is a moderate stretch of approxi-mately 10 leg raises with the bands, keeping the knee straight and the toe pointed back. Next, we grasp the band up high, take a small bend to the knee, and lock out for 10 reps. For rounds two and three, we repeat the sequence of 10 leg raises and 10 bends, bringing the leg back a little further each time. This activity “re-educates” the Golgi tendon behind the knee to improve flexibility in the long run.

The way we teach the hamstring stretch, the leg moves through a full range of motion, with the athlete con-trolling the intensity of the stretch. This

brings blood flow to the area, helping to improve range of motion, which translates into increased stride length and greater running speed.

Is there any risk of injury with this type of stretching?

We’ve never had an injury stretching this way. Rarely do teams that cor-rectly use the FlexBands suffer injuries. The idea that dynamic stretching can cause injury originated with a study done on inactive people in a nursing home, not a population of athletes. I have, however, seen athletes do a stat-ic stretch and then go into a dynamic activity and get hurt. Why a person would do a static stretch before going into a ballistic or dynamic activity like running or kicking is beyond me.

Who else can benefit from FlexBands?

An interesting study done at the University of Wisconsin-LaCrosse showed that phase III cardiac rehab patients who used FlexBands to perform dynamic stretches showed increases in hamstring and lower-back flexibility

versus those who did traditional non-resistance static stretches. On average, the FlexBand group improved flexibility from the 30th percentile to the 60th by the end of the study.

Since it has been shown that the use of FlexBands is safe, effective, and an innovative method of improving lower-back and hamstring flexibility for cardi-ac rehab patients, it is not a far stretch (pun intended) to assume that it could also help prevent and rehabilitate inju-ries in the lower-back and hamstring areas of athletes.

Understanding the Benefits of Dynamic Stretching

Carl LaRosa, son-in-law

of FlexBand inventor

Dick Hartzell, is the chief

instructor for the FlexBand

Training Seminars, held

bimonthly at the Jump

Stretch Fitness Center

in Youngstown, Ohio. He

currently serves as the

CEO, helping Jump Stretch

to grow in the U.S. and

around the world.

Jump Stretch1230 N. Meridian Rd.Youngstown, OH 44509800-344-3539Fax: 330-793-8719www.jumpstretch.com

COMPANY Q&A


CASE STUDY

and H. Alfredson reported on a study showing that drugs that inhibit or block cyclooxygenase pathways (COX-2) also interfere with tendon, bone, and cartilage repair. Alfredson said that NSAIDs not only inhibit COX-2, but also inhibit tenocytes—thus virtually blocking protein synthesis in muscle.

This means athletes who take NSAIDs to control pain and inflammation so they can work out may actually be undermining their own effort. Two steps forward, one step back.

The counter-productive effects of NSAIDs may be great-est for athletes recovering from broken bones. In his presenta-tion, Dimmen noted that “the COX-2 enzyme is critical for fracture and bone healing and it is especially involved in repair during the first three weeks after a fracture. NSAIDs and COX-2 inhibitors impair fracture healing.” For this reason, he recommended avoiding NSAIDs and other COX-2 inhibitors in all cases of fracture or cartilage dam-age.

Other recent research on NSAIDs has revealed more concerns. Dr. Steven McAnulty of Appalachian State University and colleagues found that using NSAIDs may be bad for muscles, even in cases where there is no dam-age initially. In their recent study, run-ners who took ibuprofen as a prophy-laxis before strenuous exercise reported more soreness the following day than runners who didn’t take the drugs.

Oxidative stress is another problem for athletes who use NSAIDs. Analysis of blood and urine samples has revealed remarkable differences in the levels of protein carbonyls (PCs) between people who took NSAIDs and people who didn’t. These results indicate that oxidative stress is much more prevalent among NSAID users. Oxidative stress can lead to toxic effects ranging from cell damage to atherosclerosis, Parkinson’s Disease,

Alzheimer’s Disease, and other neuro-degenerative conditions.

Fortunately, there are safer and healthier options for athletes in today’s marketplace. Over the past six years, research conducted at the medical centers of the University of Missouri and the University of Nebraska have shown that the new compounds found in StayActiv® (formerly known as AminoActiv®) can effectively relieve

pain without the toxicity or

impedance to healing. Necropsy studies

reveal that even super-

therapeutic doses have no effect on blood chemistry or organ profiles. In addition to being safe, these compounds contain no banned substances as defined by the NCAA, NFL, IOC, and other sports governing bodies.

The compounds rely on natural anti-inflammatories, not synthetic chemicals with potentially harmful side effects. They do not inhibit the COX-2 enzyme, but instead reduce prosta-glandin release from cells using a dif-ferent mechanism called mitochondrial membrane stabilization. As an added benefit, they are also known to have anti-oxidant properties.

Research shows that these new compounds are just as effective as the leading NSAID (ibuprofen) in slowing the production and release of prostaglandin from cells, which essentially means the products have similar analgesic and anti-inflamma-tory effects. But unlike NSAIDs, they actually enhance the rate of tissue recovery after over-exertion or com-mon athletic damage. That means pain isn’t just being masked—it’s actually being relieved, while recov-ery is actively promoted.

Imagine, healthy pain relief and unimpeded recovery: That’s a much-improved prognosis. It’s two steps for-ward, without any steps back.

More Reasons to Not Treat Athletic Pain with NSAIDSBy Mark C. Faulkner

Mark C. Faulkner has spent more

than 20 years in the business of bio-

medicine. After working in diagnostics

for Abbott Labs, he co-founded Aegis

Analytical Laboratories, Inc., and

focused largely on athletic doping

control (analysis for banned drugs).

After 10 years, he shifted from testing

for illegal supplements to researching

and manufacturing safe and legal

performance-enhancing supplements.

ProMera Health, LLC61 Accord Park DriveNorwell, MA [email protected]

When an athlete is injured, you want to get him or her back into competition as quickly as possible. That means managing the pain so the athlete can start working out once his or her body can handle the activity. Many athletes turn to non-steroidal anti-inflammatory drugs (NSAIDs), like ibuprofen or aspi-rin, for help at these times, hoping the drugs will control their pain and get them on the fast track to recovery.

According to recent research, this is like taking two steps forward and one step back. A growing body of evidence says NSAIDs can raise serious prob-lems for athletes who use them.

The FDA has long warned of liver, kid-ney, and stomach damage from popu-lar pain relievers such as acetamino-phen, ibuprofen, and aspirin, and the medical community cautions that too many people take these drugs habitu-ally. Now, the sports medicine com-munity is learning that there are even more reasons to be wary of NSAIDs.

At the Fifth World Congress on Sports Trauma, Drs. Bjorn Dimmen


TESTIMONIALHOT & COLD

Pro-Tec Athletics800-779-3372www.injurybegone.com

Experience the benefits of direct, active ice massage with the Ice Up portable ice massager. It offers effec-

tive treatment in just five to seven min-

utes, and quick deep-tissue relief for ligament, tendon, and mus-cular inju-ries. Ice

massage increases treatment effective-ness and speeds recovery. The Ice Up has a leak-proof design to keep your sports bag dry. A portable carry cooler keeps the Ice Up stick frozen for up to 12 hours, so it can be taken anywhere for pre- or post-activity ice massage.

Circle No. 530

Pro-Tec Athletics’ Hot/Cold Therapy Wrap has gotten even better. The new XL form-fitting shoulder wrap offers the same great dual strapping system

that allows for even, effective compres-sion of the entire target area, but with wider (4.5-inch)

straps. Advanced gel technology packs remain flexible during applica-tion and retain cold or heat longer—and now there are two of them. The addition of a second pack allows for greater coverage and treatment to both sides of the shoulder.

Circle No. 531

Therapy Innovations, LLC541-550-7347www.therapyinnovation.com

Therapy Innovations has introduced its new portable Smart Heat system. This system is a true heat therapy

modality that can be used any-where. Internal thermal con-trols guaran-tee accurate temperatures every time. Simply plug

the unit into a standard electrical

outlet (120 volts), and the pads will be ready to use in less than seven min-

utes. The therapy pads are extremely flexible and durable. They come with washable covers and a travel bag for a completely portable modality.

Circle No. 532

Whitehall Mfg., Inc.800-782-7706www.whitehallmfg.com

Whitehall’s complete line of moist heat therapy units is designed for easy and convenient use. The Thermalators are available in five sizes. The two-, four-, six-, eight-, and 12-pack Thermalators come with high-quality heating packs, locking casters, and coved bot-toms, and they are UL-listed.

Circle No. 533

The Hydrolift from Whitehall Mfg. is essentially two whirlpools in one, allowing you to treat lower and upper

extremities with the same unit. The heavy-gauge tubular stainless-steel lift raises the whirlpool three feet for easy and safe treatment. The Hydrolift is avail-

able with 10-, 15-, and 22-gallon whirl-pools.

Circle No. 534

The Polar Pool617-480-7683www.thepolarpool.com

The Polar Pool cryotherapy spa offers cold water therapy, hot water therapy, and saltwater therapy--all in one. It’s completely por-table, so you can provide athletes with state-ofthe- art treatment and pain relief without installing new plumbing or rede-signing your entire facility. Users can sit or kneel in the pool, and the puri-fication and sanitization systems keep the water clean while the solidstate cooling system maintains the tempera-ture you want.

Circle No. 535

A Popular Choice for Explosive Drills and MoreTurfCordz™ are used in high-level athletic training by professional foot-ball, baseball, hockey, and basketball teams. They’re great for explosive start drills, power-building footwork exer-cises, and simulated play action.

Here are just a few satisfied TurfCordz users:

Arizona CardinalsCincinnati RedsColorado AvalancheDenver BroncosGeorge Washington UniversityIndiana UniversityKenyon CollegeMcMaster UniversityOhio State UniversityPennsylvania State UniversityPurdue UniversityStanford UniversityUniversity of CaliforniaUniversity of DenverUniversity of Notre DameU.S. Air ForceU.S. Marine CorpsU.S. Olympic Swim TeamU.S. Olympic Speed Skating TeamTexas Rangers

Contact NZ Manufacturing to request a free catalog.

NZ Manufacturing, Inc.P.O. Box 2146Stow, OH 44224800-886-6621Fax: 866-320-3653www.nzmfg.com


A D V E R T I S E R S D I R E C T O R Y

CIRCLE COMPANY PAGE CIRCLE COMPANY PAGE

NO. NO. NO. NO

P R O D U C T S D I R E C T O R Y

CIRCLE COMPANY PAGE CIRCLE COMPANY PAGE

NO. NO. NO. NO

506 . . . Biofreeze®/Hygenic Performance Health® . . . . . . . . . . . . . . . . . . . . 49

526 . . . BSN Medical (Coverlet) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

525 . . . BSN Medical (Lightplast Pro) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

528 . . . Chattanooga Group (Intelect TranSport®) . . . . . . . . . . . . . . . . . . . . . . . . . 52

527 . . . Chattanooga Group (Opti-Ice) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

500 . . . Cho-Pat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

502 . . . Clinton Industries (Laminate Taping Station) . . . . . . . . . . . . . . . . . . . . . . . . 49

501 . . . Clinton Industries (Wood Taping Station) . . . . . . . . . . . . . . . . . . . . . . . . . . 49

551 . . . Concentra . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

538 . . . Creative Health Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

503 . . . Dynatronics (Dynatron X5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

504 . . . Dynatronics (taping stations) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

505 . . . Elations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

539 . . . Fitnessrubber.com . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

508 . . . HydroWorx . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

507 . . . Jump Stretch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

522 . . . Keffer Development (Athletic Trainer System) . . . . . . . . . . . . . . . . . . . . . . . 52

529 . . . Kneebourne . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

509 . . . Kustomer Kinetics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

549 . . . Lifexpand (Glyc’N Go) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

550 . . . Lifexpand (Lyte’N Go) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

542 . . . Medi-Dyne Healthcare Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

510 . . . Multi Radiance Medical (LaserStim) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

511 . . . Multi Radiance Medical (TQ Solo Laser) . . . . . . . . . . . . . . . . . . . . . . . . . . 50

552 . . . NASM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

540 . . . NCCPT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

523 . . . NExTT Solutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

513 . . . Oakworks (Portable Taping Table) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

512 . . . Oakworks (PowerLine treatment tables) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

514 . . . OPTP (Kinesio Tape) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

515 . . . OPTP (McKenzie® night roll) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

543 . . . Perform Better (Elite) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

544 . . . Perform Better (Tiger Tail) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

545 . . . Power Systems (Airope) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

546 . . . Power Systems (X-Ladder) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

517 . . . PRO Orthopedic (PRO 110) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51

516 . . . PRO Orthopedic (PRO 180). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

530 . . . Pro-Tec (Ice Up) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

531 . . . Pro-Tec (shoulder wrap) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

519 . . . PROTEAM (Modular Taping Stations) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51

518 . . . PROTEAM (team logo) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51

547 . . . Save-A-Tooth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

537 . . . Shuttle Systems (Balance) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

536 . . . Shuttle Systems (Shuttle MVP) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

548 . . . Speed to Win . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

520 . . . Sprint Aquatics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51

524 . . . Swede-O . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

535 . . . The Polar Pool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

541 . . . Thera-Band®/Hygenic Performance Health® . . . . . . . . . . . . . . . . . . 57

532 . . . Therapy Innovations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

521 . . . Watkins, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

534 . . . Whitehall Manufacturing (Hydrolift). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

533 . . . Whitehall Manufacturing (Thermalators) . . . . . . . . . . . . . . . . . . . . . . . . . . 55

131 . . . Athletic Trainer System (Keffer Development). . . . . . . . . . . . . . . . . . . . . . . 40

103 . . . Biofreeze®/Hygenic Performance Health® . . . . . . . . . . . . . . . . . . . . . .5

129 . . . BSN Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

132 . . . BushwalkerBags . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41

109 . . . Chattanooga Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11

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

102 . . . Clinton Industries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

119 . . . Concentra . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

141 . . . CytoSport . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . BC

140 . . . Dynatronics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IBC

120 . . . Egg Whites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

138 . . . FitBALL USA (Ball Dynamics) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51

142 . . . Flexall . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41

121 . . . G&W Heel Lift . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

116 . . . Gebauer Company . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21

112 . . . Glyc’N Go (Lifexpand) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

105 . . . Hibiclens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7

110 . . . Jump Stretch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12

108 . . . Kustomer Kinetics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

113 . . . Medi-Dyne Healthcare Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16

104 . . . NASM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6

136 . . . NCCPT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47

130 . . . NExTT Solutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

128 . . . Oakworks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

122 . . . OPTP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

106 . . . Perform Better . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

137 . . . Power Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

123 . . . PRO Orthopedic Devices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

115 . . . Pro-Tec Athletics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

114 . . . PROTEAM by Hausmann . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17

134 . . . Samson Weight Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

124 . . . Save-A-Tooth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

133 . . . Shuttle Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

139 . . . Speed to Win . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51

118 . . . Sprint Aquatics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

127 . . . TerraQuant (Multi Radiance Medical) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

107 . . . The Polar Pool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

117 . . . TheraBand®/Hygenic Performance Health® . . . . . . . . . . . . . . . . . . . 22

135 . . . Therapy Innovations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47

125 . . . TurfCordz/NZ Mfg. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

100 . . . Watkins, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .IFC

126 . . . Whitehall Manufacturing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32


MORE PRODUCTS

Shuttle Systems800-334-5633www.shuttlesystems.com

Used by 26 NFL teams, 20 NBA teams, 14 MLB teams, and counting, the Shuttle MVP helps you develop

explosive functional power while reducing impact on the ankles, knees, hips,

and spine. The patented Horizontal Rebounding Technology, shuttle glide, and padded kickplate give you a smooth, controlled exercise experi-ence. Use sport-specific protocols with the MVP to increase functional power and muscle memory. Increase your athletes’ performance and prolong their athletic careers with the MVP.

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The Shuttle Balance from Shuttle Systems functionally trains the neuromuscular systems of athletes and seniors alike. It has long been recognized that the body’s ability to negotiate unpredictable changes in force direction and placement in space at the neuromuscular level are critical building blocks for performance and skill devel-opment. The Shuttle Balance provides a safe platform for individuals to develop and hone proprioceptive responses while performing a variety of activities.

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Creative Health Products, Inc.800-742-4478www.chponline.com

Since 1976, Creative Health Products has been a leading discount supplier of

rehabilitation, fitness, exercise, and athletic equipment, as well as health, medical, and fitness testing and measuring prod-ucts, all available at reduced prices. Creative Health

Products offers heart rate monitors; blood pressure testers; pulse oxime-ters; body fat calipers; scales; strength

testers; flexibility testers; stethoscopes; pedometers; exercise bikes; ergom-eters; stopwatches; fitness books and software; exercise bands; step benches; hand and finger exercisers; heating pads; and more.

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Fitnessrubber.com888-894-0204www.fitnessrubber.com

Fitnessrubber.com is a new Web fit-ness resource that offers Manufacturer

Direct Pricing for all your weight training needs. Check out the Flexgard brand of rubber-coated cast iron weight plates, available from 2.5 to 45 pounds. The Grip collec-

tion features a three-handle grip design on all weight plates, even the 2.5- and five-pound weights. If you are looking for a one-stop shop to purchase your weight training equipment, including weights, racks, bars, and dumbbells, Fitnessrubber.com has exactly what you need. In addition to the already excellent savings, log on now and receive a $25 discount on your initial Web site order over $100.

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NCCPT800-778-6060www.nccpt.com

The National Council for Certified Personal Trainers is the only personal trainer certification company that compensates its members for referrals. Members of the NCCPT receive up to 20-percent dis-counts on select products and services while receiving commissions on mem-bership dues and referrals four levels deep. The NCCPT has been in business since 1995 and provides personal train-ers with the tools to succeed in their field. Many companies recruit directly from the NCCPT. Call or go online for details.

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Thera-Band/Hygenic Performance Health

800-246-3733www.thera-band.com

The new Thera-Band® Rehab and Wellness Station is designed for

strength, balance, and core training. It features Thera-Band clip-connect

resistance tub-ing, stability train-ers, and the new Pro Series SCP™ exercise ball. It pro-vides three planes of movement for upper- and lower-extremity strength training. Slide tracks with one-

hand lockdown capability provide significant flexibility for user setup, charting, and documentation.

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Medi-Dyne Healthcare Products800-810-1740 www.medi-dyne.com

StrengthRite™ provides an innovative, proactive solution for the prevention and rehabilitation of ankle, shin, calf, and Achilles tendon injuries. StrengthRite’s patent-pending design enables you to adjust the tension for varying levels of resistance and focus. No other product on the market allows you to strengthen the muscles control-ling all four planes of ankle motion this easily. StrengthRite provides one of the most cost-effective, complete ankle-strengthening solutions on the market.

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Perform Better800-556-7464www.performbetter.com

Perform Better’s specially constructed Elite molded foam roller lasts up to three times longer than traditional white foam rollers. It will not break

down or flatten out. Use it for self-myofascial release and alignment, and use the half-round

version for balance and stabilization. These rollers improve alignment and mobility while increasing core flexibility. Request your 2008 Perform Better cat-alog by calling the company or going online today.

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MORE PRODUCTS

Perform Better800-556-7464www.performbetter.com

New in the 2008 Perform Better Catalog, the Tiger Tail deep-pressure trigger-point massage tool relaxes,

loosens, and soothes sore muscles and helps increase blood flow to mas-saged areas. Designed

with a neoprene rolling surface that helps relieve tightness and increase flexibility, it is available in 18- and 22-inch sizes. Request your 2008 Perform Better catalog by phone or online today.

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Power Systems800-321-6975www.power-systems.com

Revolve to evolve. All athletes can intensify their workouts with the new Airope. With handles like a jump rope

and soft PVC balls on the ends, this weighted rubber rope creates swing resistance, intensifying cardio con-ditioning and recruit-ing the upper body. Perform traditional jump rope actions, incorporate it into sport-specific drills, or combine it with other equipment. It’s avail-

able in original and pro models—the pro has a thicker rope for increased resistance.

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The X-Ladder from Power Systems features three separate sections for setting up multiple configurations, so

athletes can perform forward, back-ward, and lateral movement patterns in the same run. Two sections measure

67 inches and one measures 158 inch-es. They attach together with

buckles. The ladder has high-impact round PVC rungs that stay fixed and provide instant feedback when stepped on. The X-Ladder comes with its own carrying bag.

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Save-A-Tooth®888-788-6684www.save-a-tooth.com

Without proper care, a knocked-out tooth begins to die in 15 minutes. The Save-A-Tooth emergency tooth pre-serving system utilizes Hank’s Balanced Salt Solution (HBSS) to not only pre-serve, but also reconstitute many of the

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WEB NEWS

Check Out Elite Resistance Productson NZ’s Site TurfCordz resistance products by NZ Manufacturing meet the demands of high-level athletic training. Leading profes-sional sports teams and international Olympians train with TurfCordz for explosive start drills and power-building foot-work to enhance performance through resistance. Visit the company’s Web site to view NZ’s extensive line of TurfCordz, StrechCordz, and MediCordz resistance products. You can purchase products, request a catalog, access usage guide brochures, receive overstock item discounts, and get free UPS Ground shipping to the contiguous U.S. on any order placed through the site (certain restrictions may apply).www.nzmfg.com

SPRI’s Web Site Offers Valuable Free VideosThe most popular features on SPRI’s Web site are probably the free exercise videos. SPRI offers more than 350 exercise videos, categorized by product, which you can view and also download to your computer or a video-enabled device, such as an iPod. The videos are great for adding exercise ideas to any workout routine or learning how to better utilize a new product you are interested in purchasing or have already purchased. The videos are used by personal trainers, coach-es, and active individuals on a daily basis. Go online today to check them out for yourself.www.spriproducts.com

degenerated cells. The patented bas-ket and net container are designed to protect tooth root cells. This is the

only system that keeps tooth cells alive for up to 24 hours.

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Speed to Win, Inc.866-324-9282www.speedtowin.com

Speed to Win provides on-campus sports performance training centers for schools and athletic sites. The pro-

gram is delivered to your campus, so the whole team can train and improve together. Your on-site center comes with everything you need, from a world-class curriculum accessed with Web-based software to state-of-the-art train-ing equipment called SpeedStations, which are scalable to train both small and large teams. The Speed to Win training curriculum leverages years of experience training professional athletes such as Jamal Lewis, Osi Umenyiora, J.J. Hickson, and many others.

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Lifexpand866-399-5433www.lifexpand.com

Glyc’N Go is a revolutionary new food supplement shown in controlled clinical trials to truly increase levels

of nitric oxide and enhance blood flow to exercising muscula-ture. This product also contains the only form of carnitine that is able to shuttle fatty acids into the mitochondria to serve as an energy source. Glyc’N Go is

available in tasty chewable tablets, which provide a significantly faster dis-solution rate than standard capsules.

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Lyte’N Go from Lifexpand is a con-venient, tasty, chewable electrolyte-replacement tablet. In addition to electro-lytes, all-natural Lyte’N Go con-tains vitamins and minerals that research has shown to be important for athletic performance, including vitamins B3, B5, B6, B12, and C, folic acid, zinc, chromium, and calcium. Several studies have found that these ingredients can reduce oxi-dative stress, boost energy, and aid in recovery after strenuous physical activity.

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Concentra800-232-3550www.concentra.com

Concentra is currently seeking certi-fied athletic trainers for positions in its onsite occupational health clinics and

medical centers. As a

leading provider of healthcare to the American workforce, the company operates more than 260 on-site facili-ties in 39 states and more than 320 medical centers in 41 states. You can earn a competitive salary and enjoy access to a complete benefits pack-age. Visit Concentra online for more details on available positions and to submit your resumé.

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NASM800-460-6276www.nasm.org/pes

Outperform the competition with the updated Performance Enhancement Specialist (PES) advanced specializa-tion. Learn cutting-edge performance assessment tech-niques and sport-specific program design. The course content is now delivered 100-percent online, with a brand new NASM look and feel. Course materials and the exam can be purchased separately, and an optional Print On-Demand manual and Burn On-Demand CD-ROM are now available at addi-tional costs with the course purchase.

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MORE PRODUCTS


TESTIMONIAL TESTIMONIAL TESTIMONIAL

Develop Explosive Power While Protecting the JointsTo develop explosive power, there is no substitute for jumping. However, jumping from a gravity-induced position can be risky. By training athletes from a hori-zontal position, the Shuttle MVP helps reduce the negative impact of load on the ankle, knee, hip joints, and spine. The patented Horizontal Rebounding Technology, shuttle glide, and padded kick plate provide a smooth and con-trolled exercise experience.

That’s why 26 NFL teams, 20 NBA teams, and 14 MLB teams use the MVP:

Shuttle Systems by Contemporary Design

P.O. Box 5089Glacier, WA 98244800-334-5633Fax: [email protected]

Olympians Benefit from Top-Notch Treatment Tables“The Oakworks therapy tables supplied to the U.S. Olympic track and field team in Beijing performed

beautifully. With the incredibly high level of repeated use, with a variety of techniques and modalities, the Oakworks tables held up better than ever. With portability and table height adjustability, the Oakworks tables were able to accommodate every sports medicine professional. Thank you, Oakworks, for your contribution of high-quality therapy equipment to the U.S. Olympic effort.”

Benny Vaughn, ATC, LMT, CSCSBeijing, China, 2008

Since 1977, Oakworks has been setting industry standards for quality and innovation, resulting in some of the finest portable, stationary, and electric-lift treatment tables and positioning devices in the marketplace. The company’s products provide the basis for a wide range of treatment applications and procedures for the athletic training, physical therapy, medical imaging, spa, and massage therapy market sectors. Oakworks’ leadership, innovation, and work ethic truly set the company apart.

Oakworks923 E. Wellspring Rd.New Freedom, PA 17349800-916-4603Fax: 877-562-4787www.oakworks.com

Four Products That Ease Athletes’ Pain“I’ve found Pro-Tec products to be a great addition to my patient care, as they are very patient-compatible.”

Jim Whitesel, MS, ATCFormer Seattle Seahawks Head

Athletic Trainer(1976-1998)

President, Whitesel Pro

Therapy, Inc., Kirkland, WA

“I have found the Iliotibial Band Wrap to offer unmatched effectiveness in

alleviating conditions of iliotibial band syndrome. We are recommending it for our patients.”

Dr. Shintaro OhtakeAim Treatment Center

“Finally, because of the Shin Splints Compression Wrap, I feel no pain in my shins during strenuous activity.”

Lisa DukeBallerina and Runner

“Thanks to the Arch Pro-Tec, the plan-tar fasciitis in my foot has completely disappeared.”

Christina Cambra3rd-Place Finisher, Ironman Austria

“With Ice Up, the benefits of ice massage are ready for me anytime, anywhere.”

Scott Jurek, PTSeven-Time Champion, Western States Ultra 100-Mile Marathon

Pro-Tec Athletics2743 152nd Ave. N.E.Redmond, WA [email protected]

New York GiantsNew England PatriotsBuffalo BillsMiami Dolphins New England Patriots New York Jets Baltimore Ravens Cincinnati Bengals Indianapolis Colts Tennessee TitansDenver Broncos Oakland Raiders San Diego Chargers Dallas Cowboys Philadelphia Eagles Washington Redskins Chicago Bears Green Bay Packers Minnesota Vikings Atlanta Falcons Carolina Panthers New Orleans Saints Tampa Bay

Buccaneers Arizona CardinalsSt. Louis Rams San Francisco 49ersSeattle SeahawksNew Jersey Nets Philadelphia 76ers Chicago Bulls Cleveland Cavaliers Indiana Pacers

Boston Celtics Los Angeles Lakers San Antonio SpursAtlanta Hawks Orlando Magic Washington WizardsMinnesota

Timberwolves Oklahoma City

ThunderPortland Trail BlazersUtah Jazz Golden State

Warriors Los Angeles Clippers Sacramento KingsHouston Rockets Memphis Grizzlies Toronto Blue Jays Cleveland Indians Minnesota Twins Chicago White Sox Oakland Athletics Los Angeles Angels Seattle Mariners Washington Nationals Philadelphia Phillies Milwaukee Brewers Chicago Cubs Pittsburgh Pirates Cincinnati Reds Los Angeles Dodgers

CEU QUIZ


T&C October 2008Volume XVIII, No. 7

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 and mailing it to MAG, Inc., readers can earn 2.0 BOC Athletic Training and 0.2 NSCA (two hours) continuing education units.

Instructions: Fill in the circle on the answer form (on page 63) that represents the best answer for each of the questions below. Complete the form at the bottom of page 63, include a $25 payment to MAG, Inc., and mail it by November 30, 2008 to the following address: MAG, Inc., ATTN: T&C 18.7 Quiz, 31 Dutch Mill Road, Ithaca, NY 14850. Readers who correctly answer 70 percent of the questions will be notified of their earned credit by mail within 30 days.

Bulletin Board (pages 4-6)Objective: Read summaries of the latest sportsmedicine news, research, and published studies.

1. What ratio of testosterone to epitestosterone does the World Anti-Doping Agency consider to indicate doping?a) 1:1.b) 2:1.c) 3:1.d) 4:1.

2. The Health Insurance Portability and Accountability Act:a) Helps protect the privacy of personal health information.b) Increases the speed of reporting.c) Helps delay the release of injury reports until Thursdays.d) Shifts responsibility to athletic directors.

3. A study from Harvard University has found that an elevated level of _____ may be a predictor for amenorrhea.a) Ghrelin.b) Progesterone.c) Testosterone.d) Leptin.

Comeback Athlete (pages 8-12)Objective: Follow the comeback story of a highschool football player who had three surgeries inthe same off-season.

4. What specific method was used to help the athlete in this article stay motivated?a) Positive feedback.b) Visualization exercises.c) Strengthening exercises.d) Two days off per week from rehabilitation.

The ZZZ Factor (pages 15-21)Objective: Learn about the importance of sleep for athletic performance and how to get athletes to make “sleep hygiene” a higher priority.

5. What regulates our circadian rhythm?a) Supraspinal nerves.b) Suprachiasmatic nucleus.c) Optic nerve.d) Circle of Willis.

6. The article indicates that approximately _____ hours of sleep per night produces optimal physical and mental health for teenagers and college-age people.a) Seven.b) Eight.c) Nine.d) 10.

7. Sleep stages three and four constitute:a) The doze-off stage.b) Light sleep.c) Deep sleep.d) REM.

8. The fifth stage of sleep is _____ sleep.a) Arousal.b) Light.c) Deep.d) REM.

9. It takes approximately how many minutes to complete one cycle through the sleep stages?a) 30.b) 60.c) 75.d) 90.

10. Growth hormone secretion occurs during which stage?a) The first.b) Light sleep.c) Deep sleep.d) REM.

11. Studies have shown that the primary physical effect of a sleep debt is:a) An altered ego.b) Flattened affect.c) A decrease in the rate of perceived exertion.d) A decrease in time to exhaustion during activity.

12. A landmark study indicates that additional skill proficiency gains occur after time is spent:a) Sleeping.b) Reading.c) Receiving coaching instruction.d) Static stretching.

Answer sheet is on page 63

CEU QUIZ


Preparing for Battle (pages 23-29)Objective: See how a nutrition consultant works with wrestlers to create the best nutrition plan for year-round training.

13. During the wrestling off-season, wrestlers should take in how many extra calories per day for lean muscle building?a) 500.b) 100.c) 200.d) 1,000.

14. The author recommends that wrestlers consume _____ gram(s) of protein per pound of body weight per day when training to add strength during the off-season.a) One.b) 1.5.c) Two.d) 2.5.

15. Wrestlers should consume at least what percentage of their energy in the form of carbohydrates during the off-season?a) 25-45.b) 45-50.c) 50-55.d) 60-70.

16. During strength training, a 165-pound wrestler should consume _____ grams of fat per day.a) 43-53.b) 63-84.c) 90.d) 90-94.

17. Weight loss should never exceed what percentage of an athlete’s body weight per week?a) .5.b) .75.c) 1.0.d) 1.5.

18. High school wrestlers at NFHS-governed schools cannot drop below _____ percent overall body fat during the season.a) Seven.b) Eight.c) Nine.d) 10.

19. One study of NCAA champion wrestlers found their average body fat percentage to be:a) Five.b) Seven.c) 8.5.d) 10.2.

20. It may take up to how many hours after a period of dehy-dration to replenish muscle glycogen and body fluid levels?a) 12 to 16.b) 16 to 24.c) 24 to 48.d) 48 to 72.

21. One of the best ways to maintain weight throughout the season is to:a) Consume protein shakes.b) Eat several small meals throughout the day.c) Use nutritional supplements.d) Drink more water.

Groin Pains (pages 30-35)Objective: Get an inside look at a college hockey team’s specialized training program for treating and preventing groin injuries.

22. William C. Meyers, MD, reports that what percentage of athletes requiring surgery for athletic pubalgia played soccer, football, or ice hockey?a) 25.b) 50.c) 75.d) 95.

23. _____ is the gold standard for resolving athletic pubalgia symptoms.a) Surgery.b) Rest.c) Stretching.d) Strengthening.

24. After experiencing a high rate of athletic pubalgia, the Cornell University men’s hockey team implemented a training program to address key weaknesses or movement limitations. One year later, the team had:a) A 50-percent decrease in incidence.b) No new cases of athletic pubalgia.c) Only two new cases of athletic pubalgia.d) An 83-percent drop in days lost to soft-tissue injury.

For the Record (pages 37-41)Objective: Understand how best to keep records on athletic injuries and learn how to put the information you collect to good use.

25. The most basic reason certified athletic trainers should document every action performed is that:a) Follow-up should be consistent.b) Multiple athletic trainers work in most athletic training

rooms.c) Thorough record keeping is the standard of practice in the

medical world.d) It promotes professionalism.

Answer sheet is on page 63

CEU QUIZ ANSWER FORM


Instructions: Fill in the circle on the answer form below that represents your selection of the best answer for each of the previ-ous questions. Complete the form at the bottom of this page, include a $25 payment to MAG, Inc., and mail it to the following address: MAG, Inc., ATTN: T&C 18.7 Quiz, 31 Dutch Mill Road, Ithaca, NY 14850, no later than November 30, 2008. Readers who correctly answer 70 percent of the questions will receive 2.0 BOC Athletic Training and 0.2 NSCA (two hours) CEU’s, and will be notified of their earned credit by mail within 30 days.

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 18.7 Quiz” on check)

❏ Visa ❏ Mastercard ❏ Discover ❏ American Express

Account Number _______________________________________________ Expiration Date ____________________

Name on Card _____________________________________ Signature ______________________________________

A B C D A B C D

Bulletin Board 1. ❍ ❍ ❍ ❍

2. ❍ ❍ ❍ ❍

3. ❍ ❍ ❍ ❍

Comeback Athlete 4. ❍ ❍ ❍ ❍

The ZZZ Factor 5. ❍ ❍ ❍ ❍

6. ❍ ❍ ❍ ❍

7. ❍ ❍ ❍ ❍

8. ❍ ❍ ❍ ❍

9. ❍ ❍ ❍ ❍

10. ❍ ❍ ❍ ❍

11. ❍ ❍ ❍ ❍

12. ❍ ❍ ❍ ❍

Preparing for Battle 13. ❍ ❍ ❍ ❍

14. ❍ ❍ ❍ ❍

15. ❍ ❍ ❍ ❍

16. ❍ ❍ ❍ ❍

17. ❍ ❍ ❍ ❍

18. ❍ ❍ ❍ ❍

19. ❍ ❍ ❍ ❍

20. ❍ ❍ ❍ ❍

21. ❍ ❍ ❍ ❍

Groin Pains 22. ❍ ❍ ❍ ❍

23. ❍ ❍ ❍ ❍

24. ❍ ❍ ❍ ❍

For the Record 25. ❍ ❍ ❍ ❍

Next Stop: Web SiteOur editorial continues on www.Training-Conditioning.comHere is a sampling of what’s posted right now:

MONTHLY FEATURES

Finding a RhythmWith school back in session, there is no shortage of headlines about automated external defi brillators (AEDs). Th is month, T&C examines AED news from around the country.

Back From BeijingDavid Andrews, ATC, Athletic Trainer at Gig Harbor (Wash.) High School and Northwest Sports Physical Th erapy, is back in Washington aft er spending the summer in Beijing as the Head Athletic Trainer for the U.S. men’s Olympic soccer team. In this interview, Andrews talks about preparing for the Olympics, mak-ing tough choices, and the diff erence between working with high school and Olympic athletes.

WEEKLY BLOGS

Lightning SafetyWhile spring may be the time of year most oft en associated with thunderstorms, there’s plenty of action—and danger—in the skies during the fall. Numerous college and high school football games were delayed or ended early by lightning this season. Now is a good time to review the basics of lightning safety and some of the new technology that can help keep your athletes safe. Athletic Trainers in the NewsSpending most of their time working behind the scenes, athletic trainers rarely receive the kind of recognition their work deserves. When they do make headlines, we like to spread the word with a selection of links to articles featuring athletic trainers in action.

www.training-conditioning.com/blogs.php

WWW.TRAINING-CONDITIONING.COM

OVERTIME

www.training-conditioning.com/features.php

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Check out the weekly blog on lightning safety for a review of the most up-to-date storm warning technology.

TC.comTC1807b.indd 1 9/17/08 10:14:02 AM

THETHE

“The results are impressive. We notice immediate reduc-tions in acute edema and joint stiffness.

The student-athlete’s response to the X5 has been highly positive. Our athletes are impressed by the immediate de-crease in joint stiffness after treatment of an acute injury.”

“My athletes love the X5 unit. It is user friendly and allows us to treat both acute and chronic injuries with amazing success. The ability to treat multiple athletes with the dual channels is vital during pre- and post-practice treatments. You can actually see immediate results following treatment and more importantly, my athletes notice the difference.”

THETHE

Mike Cembellin, ATCDirector of Sports MedicineSanta Clara University

David Gable, MS, ATC, LAT, CSCSAssociate Director of Sports MedicineHead Football Athletic TrainerTexas Christian University “The X5 has been a huge addition to the way I treat

my patients. I typically do not use modalities with my patients. However, after trying the X5 for a few weeks, I was convinced that it would become a permanent part of my treatment plan. Most patients feel the improvements in motion and pain immediately after the first treatment. The best part is, it lasts and the improvements are built upon each session. I’m glad that I added this to my bag of tricks.”

Mike Dixey PT, Cert. MDT, NASM-PES, CSCSClinic DirectorOrtho Rehab Specialists, Inc.Eden Prairie, MN

Feeling is Believing! Call Dynatronics for a

Free Demo800-874-6251

TM

DYNATRON X5™ Hear What Athletic Trainers Are Saying About

Soft-Tissue Oscillation Therapy

Introducing. . .

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TIMING ISEVERYTHING.

GET SOME.

When it comes to sport nutrition, timing is crucial.Getting enough fuel to make it through another day of training, class, practiceand studying can be difficult for today’s time-constrained student-athlete.

That’s where Collegiate branded products from CytoSportTM can help.

Muscle Milk® Collegiate nutritional shakes, powders and bars help athletes re-fuelafter grueling workouts, practices and games. Muscle Milk Collegiate taken immediately post-workout

helps stimulate glycogen replenishment along with muscle recovery and repair.

Complex carbohydrates • Multi-source proteins • Advanced lipid complex

Providing a combination of glucose, fructose, PolylactateTM, and electrolytes –Cytomax fuels and hydrates like no other sport drink today.

[email protected]©2008, CYTOSPORT, Benicia, CA 94510

PRE-FUELwith CYTOMAX®

RE-FUELwith MUSCLE MILK®

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training & conditioning 18.7

Documents

strength training

new training program

specialized training

wrestlers groin

groin injuries

watkins incorporated

manufacturers coupon

cornell university