training & conditioning 20.6

Post-Concussion Management

Healthy Weight Gain

Strong as Bulldogs

A look at Butler's

conditioning program

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Circle No. 100

Nutrition

12 A Weighty IssueWhen athletes want to gain weight to meet performance goals, they require careful guidance to avoid packing on pounds of unhealthy fat.By Ingrid Skoog

Leadership

23 Cry For HelpAn athlete’s mental well-being is just as important as their physical health. Athletic trainers are in a great position to recognize the signs of anxiety and depression, and to step in if need be.By Dr. Nicki Moore

Special Focus

30 What Happens Next?In most contact sports, concussion risk comes with the territory. After the injury, safe and complete recovery depends on ample rest time—both physical and mental—followed by a gradual return-to-play protocol.By Dr. Steven Broglio

Treating the Athlete

37 Game TheoryIn more and more athletic training rooms, video game systems are being used for active rehab and injury prevention. This author has found creative ways to make gaming both fun and functional.By Dr. Kirk Brumels

Sport Specific

49 Strong as BulldogsMake no mistake—Butler didn’t get lucky as the Cinderella team of the 2010 NCAA Division I Men’s Basketball Tournament. The Bulldogs’ conditioning program was a key element of their run to the championship.By Jim Peal

Bulletin Board

4 Examining why ACL repairs fail ... Less knee pain with stronger hips? … Drinking milk for weight loss and muscle gain … Accuracy of BMI questioned.

Q&A

8 Brian Brewster Portage Health Sports Medicine Institute

Sponsored Pages

29 Balanced Body 45 Fitness Anywhere

Product News

55 Nutrition Products57 Lower Body Strengthening61 Pilates Equipment 61 More Products

46 Books & DVDs

58 Advertisers Directory

CEU Quiz

65 For NATA and NSCA Members68 Next Stop: Web Site On the cover: Butler University’s Shelvin Mack takes a shot during the 2010 NCAA Division I Men’s Basketball Tournament championship game. The Bulldogs’ strength coach offers a glimpse inside the team’s conditioning program in our story beginning on page 49. Photo by Bob Donnan-US PRESSWIRE.

September 2010, Vol. XX, No. 6

contents23

T&C SEPTEMBER 2010 1 TRAINING-CONDITIONING.COM

12

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Publisher Mark Goldberg

Editorial Staff Eleanor Frankel, Director Abigail Funk, Managing Editor R.J. Anderson, Kenny Berkowitz, Patrick Bohn, Mike Phelps, Dennis Read

Circulation Staff David Dubin, Director Sandra Earle

Art Direction Message Brand Advertising

Production Staff Maria Bise, Director Neal Betts, Natalie Couch, Trish Landsparger

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Special Projects Dave Wohlhueter

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T&C editorial/business offices: 31 Dutch Mill Road Ithaca, NY 14850 (607) 257-6970 Fax: (607) 257-7328 [email protected]

September 2010 Vol. XX, No. 6

Marjorie Albohm, MS, ATC/L President, National Athletic Trainers’ Association

Jon Almquist, ATC Specialist, Fairfax County (Va.) Pub. Schools Athletic Training Program

Brian Awbrey, MD Dept. of Orthopaedic Surgery, Massachusetts General Hospital, and Instructor in Orthopaedics, Harvard Medical School

Jim Berry, EdD, ATC, SCAT, NREMT Head Athletic Trainer, Myrtle Beach (S.C.) High School

Leslie Bonci, MPH, RD Director, Sports Medicine Nutrition Program, University of Pittsburgh Medical Ctr. Health System

Christine Bonci, MS, ATC Co-Director of Athletic Training/Sports Medicine, Intercollegiate Athletics, University of Texas

Cynthia “Sam” Booth, ATC, PhD Manager, Outpatient Therapy and Sportsmedicine, MeritCare Health System

Debra Brooks, CNMT, LMT, PhD CEO, Iowa NeuroMuscular Therapy Center

Cindy Chang, MD Team Physician, University of California-Berkeley

Dan Cipriani, PhD, PT Assistant Professor Dept. of Exercise and Nutritional Sciences, San Diego State University

Gray Cook, MSPT, OCS, CSCS Clinic Director, Orthopedic & Sports Phys. Ther. Dunn, Cook, and Assoc.

Keith D’Amelio, ATC, PES, CSCS Strength & Conditioning Coach for Men’s Basketball, Stanford University

Bernie DePalma, MEd, PT, ATC Head Athletic Trainer/Phys. Therapist, Cornell University

Lori Dewald, EdD, ATC, CHES, F-AAHE Department of Health Science, Kaplan University

Jeff Dilts, Director, Business Development & Marketing, National Academy of Sports Medicine

David Ellis, RD, LMNT, CSCS Sports Alliance, Inc.

Boyd Epley, MEd, CSCS Director of Coaching Performance, National Strength & Conditioning Association

Peter Friesen, ATC, NSCA-CPT, CSCS, CAT, Head Athletic Trainer/ Cond. Coach, Carolina Hurricanes

Lance Fujiwara, MEd, ATC, EMT Director of Sports Medicine, Virginia Military Institute

Vern Gambetta, MA, President, Gambetta Sports Training Systems

P.J. Gardner, MS, ATC, CSCS, PES, Athletic Trainer, Liberty High School, Colo.

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 Assistant A.D. for Sports Medicine, University of Tennessee

Steve Myrland, CSCS Owner, Manager, Perf. Coach, Myrland Sports Training, LLC, Instructor and Consultant, University of Wisconsin Sports Medicine

Mike Nitka, MS, CSCS Director of Human Performance, Muskego (Wis.) High School

Bruno Pauletto, MS, CSCS President, Power Systems, Inc.

Stephen M. Perle, DC, MS Professor of Clinical Sciences, University of Bridgeport College of Chiropractic

Brian Roberts, MS, ATC, Director, Sport Performance & Rehab. Ctr.

Ellyn Robinson, DPE, CSCS, CPT Assistant Professor, Exercise Science Program, Bridgewater State College

Kent Scriber, EdD, ATC, PT Professor/Supervisor of Athletic Training, Ithaca College

Chip Sigmon, CSCS Strength and Conditioning Coach, Carolina Medical Center

Bonnie J. Siple, MS, ATC Coordinator, Athletic Training Education Program & Services, Slippery Rock University

Chad Starkey, PhD, ATC Visiting Professor, Athletic Training Education Program, Ohio University

Ralph Stephens, LMT, NCTMB Sports Massage Therapist, Ralph Stephens Seminars

Fred Tedeschi, ATC Head Athletic Trainer, Chicago Bulls

Terrence Todd, PhD, Co-Director, Todd-McLean Physical Culture Collection, Dept. of Kinesiology & Health Ed., University of Texas-Austin

Training & Conditioning (ISSN 1058-3548) is published monthly except in January and February, May and June, and July and August, which are bimonthly issues, for a total of nine times a year, by MAG, Inc., 31 Dutch Mill Rd., Ithaca, NY 14850. T&C is distributed without charge to qualified professionals involved with competitive athletes. The subscription rate is $24 for one year and $48 for two years in the United States, and $30 for one year and $60 for two years in Canada. The single copy price is $7. Copyright© 2010 by MAG, Inc. All rights reserved. Text may not be reproduced in any manner, in whole or in part, without the permission of the publisher. Unsolicited materials will not be returned unless accompanied by a self-addressed, stamped envelope. Periodicals postage paid at Ithaca, N.Y. and additional mailing offices. POSTMASTER: Send address changes to Training & Conditioning, P.O. Box 4806, Ithaca, NY 14852-4806. Printed in the U.S.A.

Editorial Board

2 TRAINING-CONDITIONING.COMT&C sepTeMbeR 2010

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PFP results when a runner’s thigh bone rubs against the back of their kneecap. The pain typically begins with activ-ity, grows worse over the course of a run, and then subsides when the activity is completed.

The study examined five runners performing a hip strength-ening routine and a four-person control group that did not. Twice a week for 30 to 45 minutes, the five runners perform-ing exercises did single-leg squats and other work using a resistance band. Hip strength measurements were taken before and after a six-week period.

Running on a treadmill, the subjects performing the exer-cises began the six-week trial reporting an average pain level of seven on a scale of zero to 10. After the six-week strength-ening program, all the runners reported pain levels of two or lower on the same scale.

“I wasn’t expecting such huge reductions,” Dierks said in a statement. The findings were presented at the American Col-lege of Sports Medicine Annual Meeting in June. Dierks said he plans to seek funding to test the effect of the same exer-cises on a larger group of runners.

Milking It For Muscles

Women looking to tone up and shed a few pounds may find a helping hand in their refrigerator. A new study from researchers at McMaster University, which appeared in the June issue of Medicine & Science in Sport & Exercise, found that women who consumed two glasses of milk within two hours after weight-training lost fat and improved muscle tone.

The results caught the researchers a little off guard. “We expected the gains in muscle mass to be greater, but the size of the fat loss surprised us,” Stu Phillips, a professor in the Department of Kinesiology at McMaster, wrote in the study. “We’re still not sure what causes this but we’re investigating that now … The combination of calcium, high-quality protein, and vitamin D may be the key, and, conveniently, all of these nutrients are in milk.”

Conducted over a 12-week period, the study monitored young women who had not previously participated in a resis-tance training program. Their routine—which consisted of bench presses, chest flys, seated lateral pull-down abdominal exercises without weights, leg presses, and seated two-leg hamstring curls—was overseen by personal trainers who pro-vided technique instruction.

Two hours before each session, the women were pro-hibited from eating or drinking anything except water. Then immediately after exercising, one group consumed 500 milliliters of non-fat milk while another consumed the same amount of a similar-looking energy drink that was sugar-based. An hour later, the participants consumed another 500 milliliters of what they drank earlier.

What Causes Failed ACL Repairs?

It is estimated that 400,000 people have ACL reconstruc-tion surgery each year. Of those, 18,000 to 35,000 repairs will eventually fail and require surgical revision—a procedure that tends to be more complicated, less successful, and more challenging to rehab than the initial surgery.

While the reasons behind failed repairs vary, Jon Sekiya, MD, Associate Professor of Orthopaedics at the University of Michigan, says improper surgical techniques are usually to blame. “The most common reason for an ACL [repair] to fail is technical error, where the actual graft is placed in a non-anatomic position and the most common wrong position is too vertical—too up and down—which doesn’t allow the graft to restore rotation,” Sekiya told MedicalNewsToday.com.

Backing Sekiya’s claim is an American Board of Orthope-dic Surgery survey that found 85 percent of surgeons who perform ACL reconstruction surgeries do 10 or fewer per year. “I definitely don’t think that the exact number of surgeries you do is indicative of necessarily the skill level,” Sekiya said. “However, I do think there are subtleties to this surgery that if encountered during an operation, may not be recognized in a less experienced ACL surgeon and can lead to failure.”

Because experience is typically the best teacher, Sekiya advises those with torn ACLs to seek out surgeons with a strong body of work. “When trying to choose a place to take care of their ACL and their injury, [patients] should make sure the surgical staff and therapists are well versed to take care of all the problems they may encounter,” he said. “Patients can simply ask their surgeon if they are comfortable doing the procedure—they will likely get an honest answer.”

Ed Wojtys, MD, Director of the MedSport sports medi-cine clinic at Michigan, agrees with Sekiya’s assessment and advice. He also believes history is a fair indicator of risk for a second ACL tear. “Why those ligaments fail is subject to a lot of debate,” Wojtys told MedicalNewsToday.com. “But [it] probably has something to do with the techniques used the first time, and then the fact that so many [patients] go back to the sports that originally caused the problem.”

Strengthening Hips May Alleviate Knee Pain

Research out of Indiana University-Purdue University India-napolis (IUPUI) has shown that a twice-weekly hip-strength-ening regimen performed for six weeks can reduce and even eliminate patellofemoral pain (PFP) in female runners. Lead investigator Tracy Dierks, PhD, Assistant Professor in the Department of Physical Therapy at IUPUI, hypothesized that strengthening a runner’s hips would remedy the me-chanical flaws that lead to PFP and says his six-week pilot study is the first of its kind to test a possible treatment for PFP in female runners.

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All the traditional benefits of taping, but with all the adjustable flexibility and seamless construction under the foot you expect from a soft strap brace. If you’re a serious athlete this brace is definitely The One.

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Circle No. 103

BoardBulletin

BoardBulletin

high schools were examined by researchers who evaluated each subject’s body weight, height, body fat percentage, fat mass, and lean mass. According to the results, 45 of the players had a weight in the “normal” range, 18 were consid-ered overweight, and six were obese. However, based on BMI, only 26 players would be classified as being a normal weight, 21 would be overweight, and 24 would be obese.

In other words, around 40 athletes were misclassified as overweight or obese according to BMI.

“The use of age-adjusted BMI percentile rank in high school football players is not effective for determining over-weight/obesity levels as it can lead to misclassification of overweight and obese status,” said study presenter Gary D. Steffes, who completed his research as an exercise science major at Miami University. “This is especially true for bigger athletes such as linemen.” n

“The women who drank milk gained barely any weight because what they gained in lean muscle they balanced out with a loss in fat,” wrote Phillips, whose lab is conduct-ing a large clinical trial studying weight loss in women. “Our data show that simple things like regular weight-lifting exercise and milk consumption work to substan-tially improve women’s body composition and health.” The study also reported that the milk drinkers displayed better muscle tone than those who consumed the sugar-based energy drink.

To view the abstract of the study, “Body Composition and Strength Changes in Women with Milk and Resistance Exercise,” go to: bit.ly/MilkStudy.

Study Says Body Mass Index is Misleading

Though convenient and easy to calculate, Body Mass In-dex (BMI) is not an accurate indicator of obesity in high school football players, because it doesn’t differentiate between muscular bodies and fatter ones. So says a study presented at the 2010 American College of Sports Medi-cine Annual Meeting.

Following an overnight fast, 71 males from seven different

“The use of age-adjusted BMI percentile rank in high school football players is not effective for determining obesity levels as it can lead to misclassification. This is especially true for bigger athletes.”

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Circle No. 105

T&C SEPTEMBER 2010 TRAINING-CONDITIONING.COM8

Brian BrewsterCoordinator of Sports MedicinePortage Health Sports Medicine Institute

school in Nebraska, where I got my master’s and served as an assistant athletic trainer for five years. There, we had just two athletic trainers providing coverage for 500 athletes—it was good training for what I’m doing today. In 2005, I started at Portage as an athletic trainer and was promoted to Coor-dinator in 2007.

WhatareyourmainresponsibilitiesatMichiganTech?During the fall, about 95 percent of my job is working with the football team. During the winter and spring, 75 percent is spent working with all Tech athletes. I divide up the rest of my time providing home game coverage for a local high school hockey team and filling in wherever I’m needed.

Whatisyourphilosophyonworkingwithathletes?Athletic trainers need to do more than treat injuries. We need to be there to help with athletes’ personal lives, school, or anything else that’s bothering them. Athletic trainers should impact athletes not only during practice and competition, but also outside of athletics.

I like being in the athletic training room and having guys come in before and after practice. I like talking to them, con-necting on a personal level, and joking around and having fun—that’s why I love my job. Getting to know each other that

Brewster serves as Head Athletic Trainer and Strength Coach for the U.S. Paralympic Sled Hockey Team. Above, the team scrimmages in preparation for the 2010 Games.

Brian Brewster, ATC, Coordinator of Sports Medicine at Portage Health Sports Medicine Institute in Houghton, Mich., is a man of many hats and many miles. At Portage, his duties include planning athletic training coverage for Michigan Tech University, Finlandia University, and 750 athletes at five area high schools.

In addition to his supervisory role, Brewster provides hands-on care for the Michigan Tech football team and is an instructor in the school’s Exercise Science, Health and Physical Education Department. And those are just the jobs he gets paid for.

In fact, most of the miles on Brewster’s odometer have come while volunteering with the U.S. Paralympic Sled Hockey Team. As Head Athletic Trainer and Strength Coach, he’s traveled with the team to places such as the Czech Republic, Japan, and most recently the 2010 Van-couver Paralympics.

In this interview, Brewster shares thoughts from his jour-ney, including his philosophy on working with athletes and his unique employment arrangement. He also talks about his experience working with disabled athletes and the thrill of watching the team capture gold in Vancouver.

T&C:HowarePortageHealthandMichiganTechconnected?Brewster: Our services are contracted out by Portage, but my office is really in the Michigan Tech athletic training room. Our team physician has an office in Portage’s physical thera-py clinic, which is 300 yards away from Michigan Tech’s cam-pus. It works really well because we can get kids in to see him very quickly—it’s just a short walk to his office.

HowdoPortage’sphysicaltherapyservicesfitin?It’s a different dynamic from most college settings in that we send a lot of our rehabs to a commercial clinic. We have three athletic trainers at Tech working with about 300 ath-letes—I cover football by myself and am responsible for about 105 kids—so having the PT clinic so close is vital. Plus, I’ve learned a lot from them, and hopefully they have from me.

HowdidyougetstartedwithPortageHealth?After getting my bachelor’s degree at the University of Nebraska-Omaha, I went to Hastings College, an NAIA

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Q&Away also helps me to earn their trust. You need to work hard and have fun while you do it. If you’re not having fun, you’re probably not doing it the right way.

How did you hone your administrative chops?My current boss was promoted from the position I have now, so he’s given me a lot of guidance. Also, the head athletic train-er I worked under at Hastings taught me vital time management skills. He showed my how to do a task as well as I could, get it off my desk, and move on to the next thing as soon as possible.

With today’s technology, the organi-zational requirements aren’t that big of a challenge. Being able to text and e-mail from my phone makes me accessible all the time and allows me to communicate with our other athletic trainers pretty ef-ficiently.

How did you get involved with the paralympic sled hockey team?Basically, I was in the right place at the right time. I did a two-week volunteer-ship at the United States Olympic Train-ing Center in Colorado three years ago, when the team was holding tryouts and I was assigned to work with them. I was talking to Dan Brennan, the team’s gen-eral manager, about what they did for coverage during the rest of the year and he told me to send him my resume.

A couple weeks later, they had some turnover in their staff and he asked me to come work a camp. I’ve been with the team ever since.

What is the time commitment like?I don’t work with the sled hockey team during football season, but after the fall, I start traveling with them about one week a month. This past winter was busy. In November, for example, we were on the road for 10 days for a tournament in Prince Edward Island. In December, we had a five-day camp, and then in January, we traveled to Ja-pan for a weeklong tournament. We had another 10-day camp in Febru-ary, took five days off, and then went to Colorado Springs for a couple of days. Then it was on to Denver, and finally Vancouver for a little over two weeks for the Paralympics.

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Q&AHowdidMichiganTechandPortagefeelaboutyouspendingsomuchtimeaway?Everybody I work with realized it was important to me and were very supportive and happy that I had the chance to be involved with the team. Jen Nesseth and Chris Ipson, two other athletic trainers here at Portage, picked up a lot of the coverage slack for me while I was gone.

Whatwasthefirstthingyoulearnedworkingwithdisabledathletes?That they’re very self-sufficient. They have the same drive and motivation and they’re very competitive. What they do every day to participate in a sport they love is absolutely amazing.

There are a lot of things able-bodied athletes take for granted, like getting on and off a bus before and after games. That’s a chore for some of the guys on our team. But they just do it and take everything in stride. They don’t complain about

anything and like to joke around a lot and have fun. The team is a blast to work with.

Howdidyoufamiliarizeyourselfwitheachplayer’sphysicallimitations?I had each of them fill out a health history form—the same one our athletes here at Tech fill out. Probably five or six of our athletes have spina bifida, which is a birth defect that affects the spinal cord. There were also six amputees. I couldn’t even pronounce the names of some of the other disabilities or conditions, and I had to do a lot of research to educate myself. Then I learned about their limitations by talking to them and charting their injury histories.

Whatisthescariestscenarioyou’vedealtwithwhileworkingwiththeteam?The worst actually happened away from the ice during a tournament in the Czech Republic. We were out touring on an off day and one of our athletes started having a seizure on the bus. He didn’t have a history of them, so it was com-pletely out of the blue. An ambulance took him to the hos-pital and he had an MRI and CT scan. The results showed that he was fine and he has been ever since.

While that was great news to hear, the hospital refused to take his insurance, so we had to pay cash—it was like trying to bail him out of jail. Our general manager and I

“I see a lot of rotator cuff tendonitis. I tell the guys who use wheelchairs that

because they push so much in their daily lives, we need to work on keeping

their shoulders from rounding anteriorally.”

3165 ® Registered trademark of Merrithew Corporation, used under license. All rights reserved.

Get Started Today: visit www.stottpilates.comor call 1-800-910-0001 ext 250

Designed for the elite athlete, our unique Athletic Conditioning programs include DVDs and workshops that will increase power and improve performance.

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3165 Training and Conditioning.i1 1 8/4/10 12:23:33 PM

Circle No. 107


Q&AHowdidyoumanagetheteam’sstrengthtrainingprogram?Once I started working with the team, I sent out programs once a week—mostly ideas for off-ice workouts. Each ath-lete would update me weekly on how he was feeling, how much time he spent on the ice, and what he was doing in the weightroom. I just got them started in the right direction because they didn’t have any formal guidance for what they should do in terms of off-ice training and I wanted to be sure they were doing something.

Whatareyourmostmemorablemomentsfromthepastyear?The top professional moment in my life would have to be the Paralympics in Vancouver, specifically the opening ceremo-nies. We walked out in front of 65,000 people screaming for us. Winning the gold medal was the cherry on top. But re-ally, the best part was hanging with the guys. They’ve been so good to me, and so has the coaching staff. It was a great all-around experience.

Howhasworkingwiththesledhockeyteamimprovedyourskillsasanathletictrainer?When you’re traveling overseas you only have what you can fit in your kit, so you need to use your imagination on a lot of rehabs. For example, I learned a lot of manual therapy techniques to promote muscle energy, active re-lease, and soft tissue mobilization. I carried a lot of what I learned back to our athletic training room at Tech. Now, I don’t use modalities as much as I used to. I realized the power of laying my hands on a person and really got back to basics.

What’sthehardestpartofyourjob?Like any athletic trainer would say, it’s the hours. I love com-ing to work and I don’t mind working, but being away from my wife and family is the hardest. During the fall, I work close to 80 hours a week, but every Thursday, no matter what’s going on, my wife and I have a standing lunch date. It’s usually at the same place and we never skip it.

Whatelsewouldyouliketotryinyourcareer?I enjoy hockey and would like to work with a college team at some point. Being around the sled guys has exposed me to the sport’s culture, which I really enjoy. There are a lot of good people working in hockey. Currently, Chris Ipson works with our team at Tech and he’s been here for 23 years. If I hold out long enough, I may get the same chance. n

Brian Brewster Coordinator of Sports Medicine Portage Health Sports Medicine Institute

Duties: Plans athletic training coverage for Michigan Tech University, Finlandia University, and five high schools.

Head Athletic Trainer and Strength Coach for the U.S. Paralympic Sled Hockey Team.

Instructor in Michigan Tech University’s Exercise Science, Health and Physical Education Department.

“When you're traveling overseas you only have what you can fit in your kit ... Now, I don't use modalities as much as I used to. I realized the power of laying my hands on a person and really got back to basics.”

each went to the ATM and took out the maximum allow-able amount so we could pay the bill. Surprisingly, it was actually pretty cheap compared to what we would have had to pay in the United States for the same services—less than $1,000 for everything when all was said and done.

Whataresomecommoninjuriesyouencounterwithsledhockeyathletes?Lateral epicondylitis, or tennis elbow, might be the most prevalent injury I see on the team. I’ve worked on every player’s elbow at least once. They use their hands and arms to get around all day and then also grip their hockey stick for an hour and a half to two hours during practices and games, so that area of their body receives a lot of stress.

I also see a lot of rotator cuff tendonitis. I tell the guys who use wheelchairs that because they push so much in their daily lives even outside of playing sled hockey, we need to work on keeping their shoulders from rounding anteriorally. So we work on their back muscles a little more to keep them symmetrical.

3165 ® Registered trademark of Merrithew Corporation, used under license. All rights reserved.

Get Started Today: visit www.stottpilates.comor call 1-800-910-0001 ext 250

Designed for the elite athlete, our unique Athletic Conditioning programs include DVDs and workshops that will increase power and improve performance.

Train Hard. Train Smart. Achieve optimal results with STOTT PILATES®

3165 Training and Conditioning.i1 1 8/4/10 12:23:33 PM


NUTRITION

By IngrId Skoog

Ingrid Skoog, MS, RD, CSSD, is a sports dietitian in Eugene, Ore., specializing in performance nutrition for collegiate and elite athletes. She can be reached at: [email protected].

G aining weight isn’t difficult. Our country’s obesity rate, currently over 30 percent, provides ample evidence of that. But when

athletes want to gain weight, obesity isn’t what they have in mind.

Adding muscle mass, sometimes called “positive weight gain,” without accumulating fat in the process is much more challenging. Popular fitness mag-azines and Web sites often tell athletes the secret is in special supplements, pro-tein powders, and high-energy shakes. Yet while some of these products may

When athletes want to gain weight to meet performance

goals, they require careful guidance to avoid

packing on pounds of unhealthy fat.

A Weighty Issue

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Y

be helpful, they’re only a small part of the picture.

If an athlete wants to add mass to im-prove their sport performance, do you know how to advise them? An optimal strategy involves paying careful atten-tion to meal planning, body composi-tion, and training demands. Healthy weight gain is a long-term goal that requires serious commitment over an extended time period, with plenty of op-portunity for pitfalls along the way. But with the proper guidance, any athlete can increase their size and strength.

CONTROLLING FACTORSBesides the most obvious things—nutrition and training habits—sever-al other factors determine how easy or difficult it is for an individual to gain weight. Here’s a brief summary of three key players.

Body type. You can’t change your

6095-EAS11845M_Biceps_TrainCond.indd 1 4/13/10 4:46:13 PM

6095-EAS11845M_Biceps_TrainCond.indd 1 4/13/10 4:46:13 PM

Circle No. 108


NUTRITION

After drills, his team chills. The workout’s fi nished, the body isn’t. That’s why the Screaming Eagles of Eugene Ashley High School drink chocolate milk after games, practices and workouts. They know that the two hours after exercise are crucial for taking in the right balance of carbohydrates and protein, plus fl uids and electrolytes to help replenish what’s lost in sweat. And that research suggests that lowfat chocolate milk may be just as effective as certain commercial sports drinks in helping athletes refuel muscles after a workout. Coach Jason Tindal checked out the data, and he’s a chocolate milk believer. See the science for yourself, or even tell us your success story, at milkdelivers.org. You could be our next winner, with a Milk Mustache ad of your own.

Jason Tindal, Head Coach

Eugene Ashley High SchoolWilmington, NC

© 2010 America’s Milk Processors.got milk?® is a registered trademark of the California Milk Processor Board.

Tell us your story. visit milkdelivers.org

milkpep-spotlight-jason-traincon.indd 1 4/13/10 9:51:09 PM

LOW BODY FAT

BREAKFAST: 1,200 calories

2-3 egg omelet with lean ham and grated cheese

2 large pieces of toast with margarine and jam, honey, or peanut butter

2 cups of 2% milk

Banana

MID-MORNING SNACK: 700 calories

Peanut butter and jelly sandwich

Large fruit juice

LUNCH: 900 calories

Large bean, chicken, and rice burrito with cheese and salsa

Tortilla chips with guacamole

Vegetable or fruit juice

AFTERNOON SNACK: 400 calories

1/2 cup of mixed nuts

DINNER: 800 calories

Lean roast beef

Rice with seasoning and margarine

1 cup of steamed carrots

2 cups of 2% milk

LATE-NIGHT SNACK: 400 calories

Bowl of granola with milk and fruit

Total: 4,400 calories

MIDDLE-RANGE BODY FAT

BREAKFAST: 1,000 calories

2 cups of fruit and nut granola mixed with 2 cups of 1% milk

Banana

MID-MORNING SNACK: 700 calories

Peanut butter and jelly sandwich

2 cups of 100% fruit juice

LUNCH: 700 calories

Whole wheat pasta with meat sauce

Side salad with croutons and light dressing

AFTERNOON SNACK: 300 calories

Fruit and yogurt smoothie

DINNER: 800 calories

Baked chicken pieces

Baked potato with fixings

1 cup of steamed carrots

2 cups of 1% milk

LATE-NIGHT SNACK: 300 calories

Low-fat cottage cheese and fruit

Total: 3,800 calories

(Note: Serving sizes can be reduced as needed for female athletes.)

SAMPLE MENUThe menus below provide one day of optimal food intake for an athlete with low body fat (less than eight percent for males and 16 percent for females) and one day of intake for an athlete with body fat in the healthy “middle range” (eight to 16 percent for males and 16 to 24 percent for females).

The workout’s fi nished, the body isn’t. The two hours after exercise are when rebuilding begins. And lowfat chocolate milk has the right mix of carbs and protein, plus fl uids that can help student athletes refuel and rehydrate.

Tell us how you’ve helped your athletes refuel with chocolate milk. You could win a got milk?® cooler, or other great monthly prizes, and maybe even be our Spotlight On Winner for 2010, with a Milk Mustache ad of your own.

visit milkdelivers.org


milkpep-spotlight-third-traincon.indd 1 4/13/10 10:52:27 PM

After drills, his team chills. The workout’s fi nished, the body isn’t. That’s why the Screaming Eagles of Eugene Ashley High School drink chocolate milk after games, practices and workouts. They know that the two hours after exercise are crucial for taking in the right balance of carbohydrates and protein, plus fl uids and electrolytes to help replenish what’s lost in sweat. And that research suggests that lowfat chocolate milk may be just as effective as certain commercial sports drinks in helping athletes refuel muscles after a workout. Coach Jason Tindal checked out the data, and he’s a chocolate milk believer. See the science for yourself, or even tell us your success story, at milkdelivers.org. You could be our next winner, with a Milk Mustache ad of your own.

Jason Tindal, Head Coach

Eugene Ashley High SchoolWilmington, NC


Tell us your story. visit milkdelivers.org

milkpep-spotlight-jason-traincon.indd 1 4/13/10 9:51:09 PM

Circle No. 109


NUTRITION

DNA. I have talked with many people whose body type and genetic make-up undermine their goal of getting six-pack abs or gaining 20 pounds of muscle mass.

There are three main body types, each with its own unique characteris-tics that affect weight gain:

Endomorphs have stocky builds, and usually see rapid improvements in strength when training. They tend to gain both muscle mass and body fat more easily than other body types, but due to their higher body fat levels they may have a harder time achieving vis-ible muscle definition.

Ectomorphs have tall, naturally thin and lean bodies. These are the people who seem able to eat anything and ev-erything without gaining weight. Due to their long bones, they have longer muscles and often struggle to achieve large changes in muscle size and girth. They can and do still gain strength, but they don’t add muscle mass as easily as other body types.

Mesomorphs typically have wide shoulders, large chests, narrow waists, more muscle definition, and the sort of body shape and proportions traditional-ly seen as most desirable. These individ-uals have the best of both worlds—they

tend to gain muscle easily while being less prone to packing on body fat.

Knowing and understanding an ath-lete’s body type will help you talk with them about setting realistic goals. It will also help them to view progress toward weight goals realistically—two athletes with different body types shouldn’t expect the same gains just because they perform the same work-outs and share similar eating habits. But they can both improve fitness level and overall strength with a comprehensive strategy for diet and training.

Hormones. The most important members of this category are testoster-one, growth hormone, estrogen, pro-gesterone, insulin, glucagon, cortisol, leptin, and ghrelin. They all influence the body’s ability and predisposition to gain muscle mass and body fat. Their exact mechanisms are diverse and very complex, but for our purposes, it’s suf-ficient to say that anabolic and cat-abolic hormone levels increase and decrease according to stage of physical development, age, nutritional status, and stress level.

Males have the most success gain-ing muscle mass in their late teens and early 20s, when anabolic hormones like testosterone and growth hormone are elevated. Females in that age range have an advantage in adding muscle mass as well, but it’s less pronounced. That said, in my experience it is most of-ten male athletes who are interested in making large gains in mass to enhance sport performance.

Timing. This may be the most over-looked of all factors related to success-ful and healthy weight gain. Before an athlete makes a serious attempt at add-ing mass, you should discuss these five questions with them:• Do you have the time and motivation

to commit at least six months of consis-tent hard work to reach your goal?• Throughout that time, will you

have consistent access to resources (lift-ing facilities and control over food qual-ity and quantity) to support your goal?• Is your goal healthy and realistic?• Will reaching your weight goal help

you achieve the performance improve-ment you want?• If a coach is involved, does he or

she agree that gaining this amount of muscle mass is an appropriate goal for your sport and position?

For a plan to succeed, the answer to all those questions must be yes. If not,

COMMON MISTAKESWhen athletes struggle to achieve weight gain goals, it’s often because they made one of these mistakes:

• Too little fiber. Some athletes stay away from whole fruits, vegetables, and grains when trying to gain weight, assuming that these foods are rela-tively low in calories and/or fat. As a result, they end up without enough fiber, which can lead to constipation.

• Too much protein. Protein-rich foods promote satiety, which basically means they more quickly signal the brain that the stomach is full. They also take longer to break down during digestion, which delays the onset of subsequent hunger. Taken together, the result is decreased overall calorie intake. Encourage moderation in protein consumption, and remind athletes that feeling full doesn’t necessarily mean they have consumed enough energy to fuel muscle mass gains.

• Too few carbs. During periods of weight gain, around 50 to 65 percent of overall energy should come from carbohydrates, but some athletes still remember the anti-carb craze of a few years ago and mistakenly think “carbs = fat.”

• Taste fatigue. Athletes who rely on “weight gainer” products such as high-protein shakes tend to get tired of them quickly. Such shakes can be a great choice for a between-meal calorie boost with a good mix of carbs, protein, and a little fat, but encourage athletes to switch up their choic-es—a shake as a snack one day, a sandwich or bowl of granola the next.

• Sleeping in. Believe it or not, this is sometimes an athlete’s biggest bar-rier to successful weight gain. Getting up late simply pushes breakfast back to lunch, lunch to dinner, and dinner to a late-night snack. It’s much more difficult to spread energy intake evenly throughout the day and to support the critical periods before and after strength training when an eat-ing schedule is “running late.”

• Overdoing fast food. Athletes may hear the advice to increase their calorie intake as an invitation to hit the drive-thru early and often. Remind them that not all calories are created equal, and the highly processed, nutrient-poor options available at many fast food windows won’t provide the quality carbs and protein they need to support muscle growth.

Circle No. 110


NUTRITION

this isn’t the right time to pursue weight gain. Otherwise, we can move on to the next steps in creating a plan.

CRITICAL COMPOSITIONBefore we talk about eating, it’s im-portant to first determine the athlete’s baseline body composition. There are several good methods for determining body comp. A BodPod or hydrostat-ic weighing test are two very accurate methods, but aren’t always readily avail-able. A seven-site skinfod test using Harpenden, Lange, or AccuFitness cali-

pers can work well—AccuFitness also offers digital body fat calipers. Other options include bioelectrical impedance or a body comp scale, but research has shown these methods to be less reliable.

There are several reasons why an ini-tial body comp test and regular follow-ups are important during a period of planned weight gain. The extra calories that the athlete will consume are almost certain to produce weight gain—body comp will reveal whether it’s the kind of weight they want. For instance, if an athlete isn’t following his dietary plan

carefully but still sees higher numbers on the scale, he may think he’s doing fine, even if he’s actually gaining adi-pose tissue (fat) and little or no muscle.

Likewise, some athletes with higher initial body fat see no progress on the scale in the first several weeks of a quality training and nutrition program aimed at weight gain. This is because they’re simultaneously gaining muscle tissue and losing fat, so their overall body weight barely moves. Body comp tests will show that they’re still making good progress and just need to be pa-tient and stick to the plan—the weight gain will come eventually, and the strength gains have already begun.

One other reason body composition is such a valuable tool during planned weight gain is that it helps guide nutri-tion strategies. For example, if some-one starting a weight gain program is very lean—say, with less than eight per-

cent body fat for males or 16 percent for females—they’re actually better off gaining a small amount of body fat along with the muscle mass. This is be-cause individuals with very low body fat probably already have energy expen-diture greater than energy intake due to existing dietary habits, activity level, and metabolism. Such an energy defi-cit (too few calories coming in) while training will result in difficulty gaining significant muscle, and even worse, pos-sible muscle loss as the body becomes “starved” for energy.

Meanwhile, people in the healthy ini-tial body fat range of around eight to 15 percent for males and 16 to 24 per-cent for females probably have energy in-

The body needs regular fueling througout the day to

support muscle growth. But this is an area in which

many athletes are inconsistent, negligent, or

downright lazy ... Going long periods of the day without taking in any

calories at all must be discouraged when seeking

weight gain.

Circle No. 111

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NUTRITION

do, you’ve gone too long between meals.• Don’t drink a lot of liquid at meals,

as this fills you up faster and displaces whole food. • When drinking between-meal liq-

uids, choose high-calorie shakes or healthy beverages that contain calories, such as chocolate milk, fruit juices, and vegetable juices, instead of water.• Start eating early—have breakfast

before 9 a.m. This will allow you to take in more energy in the form of a mid-morning snack before lunch in the early afternoon.• Plan ahead and be prepared by

having an ample supply of food avail-able at all times. As for the composition of meals,

there is no universal secret to eating

eling throughout the day to support muscle growth. But this is an area in which many athletes are inconsistent, negligent, or downright lazy. The busy schedules of today’s high school and

college student-athletes often provide an easy excuse for going long periods of the day without taking in any calo-ries at all, and this must be discouraged when seeking weight gain.Nutrition planning is most effective

when tailored to an individual athlete’s needs, training habits, schedule, and other unique factors. But here are some basic points of advice that can help you advise them properly:• Eat small meals every two to three

hours throughout the day.• You should never feel hungry. If you

take fairly well matched to expenditure. These individuals are in the best position to gain muscle mass without additional body fat. Their bodies can draw on fat stores as needed to cover some of the energy costs of exercise, but they don’t have excess fat standing in the way of their health and performance goals. For males with body fat levels above

roughly 20 percent and females above 25 percent, it may be best to follow a weight loss plan to decrease body fat before focusing on significant muscle growth, because the stress of strength training for hypertrophy on already overloaded joints could increase inju-ry risk. Plus, adding extra muscle to a body that’s already laden with heavy fat stores can result in a slower, less responsive athlete with decreased over-all performance in their sport. In these cases, it’s wise to seek personalized ad-vice from a registered dietitian (RD) or physician who specializes in sports nu-trition before proceeding.

LET’S EATCalories are the currency of weight gain, and the body needs regular fu-

A salad of fresh veggies is very healthy, but to boost the calorie content, a weight-gaining athlete should be encouraged to add cubed cheese, lean meat, croutons, dressing, and perhaps almonds or walnuts. Likewise, a baked potato at dinner should never be eaten plain.

Circle No. 112


NUTRITION

better choice than regular ground beef on a white roll, and great snack choic-es throughout the day include milk-shakes, fruit smoothies, and bagels with light cream cheese. (See “Sample Menu” on page 14 for an entire day’s food choices for athletes with low and medium-range body fat.)

As mentioned earlier, those with high body fat (above 20 percent for males and 25 percent for females) should receive individualized atten-tion before actively attempting to gain weight. In most cases, they’ll want to bring their body fat into a healthier range before adding signifi-cant muscle mass.

Gaining “positive weight” is one of the most challenging goals for a com-petitive athlete to achieve. It involves increasing overall food intake and usu-ally accompanies heavy strength train-ing, so carelessness can easily result in too much fat in the daily diet or too few calories to support the high ac-tivity level. But with proper planning and regular monitoring of body comp progress, athletes can eat smart, lift hard, and get bigger. n

mentioned lowest range (below eight percent for males and 16 percent for females) should focus on adding more unsaturated fats to their diet in ad-dition to carbohydrates and protein. They should include higher-fat snacks throughout the day, such as trail mix, mixed nuts, sandwiches with mayo, and tortilla chips with guacamole.

Athletes in the middle range of body fat (eight to 15 percent for males and 16 to 24 percent for females) should increase total calorie intake mainly by upping their consumption of complex carbohydrates and lean proteins. They don’t want to take in lots of extra fat, but shouldn’t look for non-fat options either—for instance, a turkey or chick-en burger on a whole wheat roll is a

for weight gain—the standard rules of healthy food selection apply, with a greater emphasis on choosing calo-rie-dense options over lower-calorie “fillers.” For example, a salad of fresh veggies is very healthy, but to boost the calorie contentof a salad, a weight-gaining athlete should be encouraged to add cubed cheese, lean meat, croutons,

dressing, and perhaps almonds or wal-nuts. Likewise, a baked potato at din-ner should never be eaten plain—add fixings such as low-fat chili or refried beans, low-fat sour cream, and grated cheese.

In terms of more specific advice, guidelines vary based on the athlete’s initial body fat as determined by the body comp test. Those in the afore-

Athletes in the middle range of body fat ... don’t want to take in lots of extra fat, but shouldn’t look for non-

fat options either—for instance, a turkey or chicken burger on a whole wheat roll is a better choice than

regular ground beef on a white roll.

Circle No. 113 Circle No. 114

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Pump Fits Both Half-Gallon And Gallon Bottle!

What’s the best way to use our Liquid Egg Whites? Imagine a protein drink that you can make taste like anything you want, any time you want. Chocolate, Vanilla, Ice Coffee, or just Orange Juice. You name it! You are only limited by your own imagination. Our All Natural, 100% Pure Liquid Egg Whites are pasteurized, Salmonella tested, USDA & Kosher approved. Best of all, they are double filtered to have the smooth consistency of milk. You can literally take one cup of our egg whites, and make the fluffiest omelet you have ever had. OR, take one cup of our liquid egg whites, and add some sugar free chocolate syrup, and you would not know it’s not chocolate milk. YES REALLY! One 8-ounce cup of our liquid egg whites supplies 26 grams of Pure protein, with only 2 carbs., No Fat, No Cholesterol, and only 120 calories. The worlds best protein for losing or managing weight, and for building muscle. It’s also a great protein for kids and adults with health issues who don’t get enough protein.

NOTE that this is not a supplement, it’s a Real, All Natural FOOD.

How much protein should you consume in a day? The average “Active” person requires approximately 1 gram of protein per pound of lean body weight per day. Protein is the building block for muscle growth as well as helping in the battle against body fat. Liquid Egg Whites are the perfect source of protein, for Gastric bypass patients, athletes, World Class Bodybuilders and everyone in between! How often do you use our Liquid Egg Whites? We recommend a minimum of

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1.25 Egg Whites 3.25g of Protein

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

Make an Informed Choice! INFORMED-CHOICE is a supplement testing and certification organization that works closely with responsible nutrition companies by screening their products for banned substances against the World Anti-Doping list. Our mission is to provide athletes, coaches, advisors, parents, etc. with an INFORMED-CHOICE with regard to supplements, as part of a general approach to risk management. While it’s NEVER possible to guarantee that any product is absolutely free of contamination, the choice is simple: If you choose to take a supplement, ensure that what you take has been tested for contamination using appropriately accredited tests Log on to www.informed-choice.org to learn more about the organization and the companies who are testing their products for banned substances. Make sure your athletes are well INFORMED and download a FREE copy of our “Athlete’s Guide To Nutrition” and pass onto your athlete’s today!

Untitled-21 1 7/18/08 11:07:36 AM

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Lose Weight Now!Join Our Success Stories!

Pump Fits Both Half-Gallon And Gallon Bottle!

What’s the best way to use our Liquid Egg Whites? Imagine a protein drink that you can make taste like anything you want, any time you want. Chocolate, Vanilla, Ice Coffee, or just Orange Juice. You name it! You are only limited by your own imagination. Our All Natural, 100% Pure Liquid Egg Whites are pasteurized, Salmonella tested, USDA & Kosher approved. Best of all, they are double filtered to have the smooth consistency of milk. You can literally take one cup of our egg whites, and make the fluffiest omelet you have ever had. OR, take one cup of our liquid egg whites, and add some sugar free chocolate syrup, and you would not know it’s not chocolate milk. YES REALLY! One 8-ounce cup of our liquid egg whites supplies 26 grams of Pure protein, with only 2 carbs., No Fat, No Cholesterol, and only 120 calories. The worlds best protein for losing or managing weight, and for building muscle. It’s also a great protein for kids and adults with health issues who don’t get enough protein.

NOTE that this is not a supplement, it’s a Real, All Natural FOOD.

How much protein should you consume in a day? The average “Active” person requires approximately 1 gram of protein per pound of lean body weight per day. Protein is the building block for muscle growth as well as helping in the battle against body fat. Liquid Egg Whites are the perfect source of protein, for Gastric bypass patients, athletes, World Class Bodybuilders and everyone in between! How often do you use our Liquid Egg Whites? We recommend a minimum of

twice a day. I dea l l y, as soon as you get up in the m o r n i n g , and just before b e d t i m e . For optimal results keep an extra bottle of Liquid Egg Whites at work to enjoy their benefits throughout the day! Why take Liquid Egg Whites before bedtime? Fitness enthusiasts have known for decades that if you don’t put protein into your body before you go to bed, your body will run out of protein in the middle of the night. Once your body digests all of its available proteins, your body thinks it is starving itself. To protect you, your body shuts down and starts storing your own fat cells. Your blood sugar still needs protein to keep you going, so it starts consuming the only protein source available at 3 am, your own muscle mass. Basically, you are storing fat and eating muscle. By drinking a high protein drink with Pure Liquid Egg Whites just before you go to bed, the egg protein will support muscle growth for up to 4 to 5 hours. Now the process is reversed for most of your sleep time. Rather than storing fat and eating muscle, the protein from the Liquid Egg Whites, is allowing your body to burn the fat at its normal rate while building on the muscle. You will get better nights sleep, and wake up more alert and refreshed, and not as hungry in the morning.

READ THIS!READ THIS!

PPuPuPuuPuPuAndAnAndAndnd

100 % Guaranteed Will stay good refrigerated

for 90 to 120 days, and can be frozen indefinitely.

WWW.EGGWHITESINT.COM 877-EGG-WHITESWWW.EGGWHITESINT.COM 877-EGG-WHITES

Chris LaCascia accomplished his amazing transformationof losing 130lbs in only 9 months by drinking LiquidEgg White Protein Shakes for 3 of his 6 daily meals.

For A Perfect Measurement 1 Pump Equals: 1 Ounce 1 Whole Egg

1.25 Egg Whites 3.25g of Protein

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

Circle No. 115

DON’T LET MRSATAKE YOU OUTOF THE GAME

USE HIBICLENS® TO HELP PROTECT YOUR ATHLETE.

Hibiclens and Hibistat are FDA regulated antimicrobial skin cleansers that contain chlorhexidine gluconate (CHG). CHG not only kills germs quickly, but it also continues to kill germs for up to 6 hours1 after use making Hibiclens and Hibistat an integral part of effective protection against MRSA and other skin infections. Hibiclens and Hibistat can help with effective infection prevention in your facility - helping prevent skin infections that could potentially take key athletes out for a game or an entire season. When washing with Hibiclens is not an option, continue infection prevention with Hibistat, available in convenient towelette packets.

You can fi nd Hibiclens in the fi rst-aid aisle at CVS, Walgreens, Rite Aid, Wal-Mart, and Target. Hibistat is available at CVS, Rite Aid, and Stop & Shop. Hibiclens and Hibistat are also available through your athletic distributor.

1Study #030917-150. The Mölnlycke Health Care, Biogel®, Hibiclens® and BARRIER® names and logos are registered globally to one or more of the Mölnlycke Health Care Group of Companies. Distributed by Mölnlycke Health Care US, LLC, Norcross, Georgia 30092. ©2010 Mölnlycke Health Care AB. All rights reserved. 1.800.843.8497 www.hibiclens.com

MRSA stands for methicillin-resistant staphylococcus aureus. It is a strain of staph infection that is resistant to the broad-spectrum antibiotics commonly used to treat it.

If you notice any of the below symptoms (or any abnormal skin conditions), NOTIFY YOUR MEDICAL STAFF IMMEDIATELY, it could be a matter of life or death.

Boils: tender, red lumps that swell and get pimple-like white heads. They can form on oily or moist skin such as neck, armpits, groin, and buttocks.

Small red bumps that look like spider bites or ingrown hairs.

Pain out of proportion to skin conditions.

Circle No. 116

T&C SEPTEMBER 2010 23TRAINING-CONDITIONING.COM

LEADERSHIP

An athlete’s mental well-being is just as important as their physical health. Athletic trainers are in a great position to recognize the signs of anxiety and depression, and to step in if need be.

By Dr. Nicki Moore

Nicki Moore, PhD, is a licensed psycholo-gist, AASP-certified sports psychology consultant, and Senior Associate Athletic Director at the University of Oklahoma, where she serves as in-house psycholo-gist for the athletic department. She can be reached at: [email protected].

Many people work with student-athletes on a daily basis: coaches, tutors, academic advisors, compliance personnel,

strength coaches, and plenty of others. I feel fortunate to have been among them as an in-house psychologist for the University of Oklahoma athletic department for the past six years. The student-athletes I’ve treated and the range of issues they’ve presented has made for a rich and interesting career—one that’s rewarding in many of the same ways I imagine athletic training is rewarding.

While the typical athletic trainer is concerned mainly with athletes’ physi-cal health, you are also well positioned to recognize when student-athletes are

CRY FOR HELP

©GETTY IMAGES

struggling with anxiety, depression, or a host of other mental health problems. At early morning workouts, you’re there. On long bus rides, you’re there. In the depths of despair following a ca-reer-altering injury, you’re there.

It’s not always easy knowing how to proceed when you observe the signs of a mental health issue in an athlete un-der your care. But the costs of doing nothing can be great, and the benefits of intervening can mean as much as—or even more than—any other form of treatment or service you provide. This article will familiarize you with anxi-ety disorders and clinical depression in athletes, and give you a blueprint for helping them through some of the most challenging health problems life has to offer.

MISUNDERSTOOD ILLNESSESSeveral myths about anxiety disorders and depression persist, and one of the most prevalent is that these illnesses are rare. The truth is that over the course of one year, about 16 percent of the U.S. population develops an anxiety disor-der, and about seven percent of men and 12 percent of women develop some degree of clinical depression.

Athletes, of course, are a special population, with factors that can both

LEADERSHIP


LEADERSHIP

increase and decrease their predisposition to these forms of ill-ness. On the positive side, the sense of self-worth, inclusion, and accomplishment provided by training for and competing in sports provides a measure of protection for some. But on the other hand, the stressors associated with competitive athletics can easily negate the protective factors. For that reason, any-one who works with athletes on a regular basis is very likely to encounter individuals who are facing anxiety or depression in some form.

Another common myth is that anxiety disorders and de-pression are transient things that an athlete just needs to “snap out of.” No doubt, every athletic trainer with more than a day under their belt has dealt with grumpy, irritated, stressed out, or dejected student-athletes—it comes with the territory. In most cases, a few encouraging words and a sym-pathetic ear are enough to help them through a bad day. But when the symptoms are especially pronounced and don’t go away with time, they may indicate an underlying disorder and not just a situational mood or reaction to specific events.

When anxiety or depression reach the disorder level, it means daily overall functioning has become impaired for an extended period, usually lasting at least two weeks with-out relief. With anxiety disorders, the main symptom is ab-normally high anxiety with no apparent reason or anxiety that’s out of proportion with the circumstances at hand. Be-sides those self-reported feelings, anxiety-related symptoms may include an increased heart rate, muscle tension, upset stomach, sleep disturbances such as insomnia, and difficul-ty focusing on or engaging in normal life activities.

There are at least seven specific types of anxiety dis-orders, including obsessive-compulsive disorder, phobias, and post-traumatic stress disorder, but all of them share at least some of the above symptoms. If you observe them in an athlete to a degree or duration that seems abnor-mal, they will most likely benefit from referral to a mental health professional.

Depression, which falls under the clinical category of mood disorders, is typically characterized by excessive, un-expected, prolonged feelings of sadness, emptiness, or hope-lessness, often accompanied by diminished interest in or ability to carry out normal activities, lack of energy or mo-tivation, difficulty concentrating, sleep disturbances, and possibly even suicidal thoughts. Physically, it can lead to sig-nificant weight loss or gain in a relatively short period.

Having a few symptoms of depression is quite normal. For student-athletes, it can be triggered by the doldrums or struggles of rehabilitation from injury, pressure surround-ing a big game, disappointment after a loss, or something not related to sports at all—a break-up, a family death, or academic problems.

But like with anxiety, the key factors that determine whether these feelings reach the disorder level are depth and duration. If the withdrawn, sad behavior lasts longer than seems rea-sonable given the circumstances, or if it’s so paralyzing that it interferes with daily life, the athlete should be steered toward seeking help. (To better understand the line between the sub-clinical and clinical range for depression-like symptoms, see “Sad or Depressed?” on page 26.)

BARRIERS TO OVERCOMEIf an athlete has a sprained ankle or torn ligament, there’s not much argument over the fact that they’re not healthy and need

Circle No. 117

LEADERSHIP

ing “moodiness” might be dismissed as frustration with a slow rehab or lack of on-field success, when it may in fact be caused by mental illness.

Sometimes, sports is among the last places that compromised mental functioning manifests itself. For many student-athletes, it is their escape—a refuge where they can leave behind ev-erything that’s bothering them. Thus, it’s not unusual for a student-athlete’s school work, social life, and relation-ships to be “falling apart” while their athletic life appears fairly normal.

pecially—their teammates and coach-es. Some choose to suffer in silence rather than acknowledge something that others may perceive as weakness or fragility.

Furthermore, some symptoms of anxiety and depression can be mistak-en for a normal response to sports-re-lated stressors. For example, significant or rapid weight loss is one of the most objectively observable warning signs of depression, but in a competitive athlete, it may be attributed to the pursuit of a performance goal. Likewise, ongo-

treatment. Mental illnesses are differ-ent because they’re more subjective and carry a stigma that makes acknowledg-ing the problem and seeking help more difficult.

In addition, the perceived conse-quences of a mental illness diagnosis are especially great for athletes. Besides the usual pressures of student life, an athlete whose performance is hampered by anxiety or depression may worry about things like reduced playing time and loss of a scholarship.

Some of the main obstacles that stand in the way of prompt intervention for athletes with anxiety disorders and/or depression are:

Recognition barriers. When im-mersed in an athletic culture, it’s easy to attribute symptoms to known and assumed stressors rather than to a di-agnosable psychological issue. Student-athletes tend to have a “suck it up” mentality, so symptoms can be ignored, masked, or misinterpreted for long pe-riods of time.

Furthermore, team strength is fre-quently built on a “no excuses” man-tra, so there is a tendency to attribute

deficiencies in attitude, motivation, or desire to character problems. An ath-lete might find him- or herself accused of not being a team player or not giving 100 percent out of selfishness or lazi-ness, when in fact they may be suffer-ing from a disorder that’s addressable through treatment.

The machismo associated with both men’s and women’s sports is another barrier, as it encourages athletes to display an exaggerated sense of tough-ness. Even if an athlete knows some-thing is wrong, they may go to great lengths to avoid admitting the problem to anyone, even—and sometimes es-

Student-athletes are ac-customed to many people keeping tabs on their medi-cal conditions, but they’re frequently hesitant to dis-cuss anything related to their mental health ... They fear a loss of trust in their ability to lead others.


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LEADERSHIP

ability to perform or lead others. Treatment barriers. Competitive

athletics has a subculture all its own, with unique languages, sets of rules, costumes, and rituals. For partici-pants, it’s often a source of personal identity. If a mental healthcare provid-er isn’t familiar with this culture, pro-viding counseling to student-athletes can be akin to working with someone from a foreign country. If they over-look, devalue, or simply don’t under-stand the cultural differences, they can create an unintentional barrier in the therapeutic relationship that’s difficult to overcome. That’s why it’s important to connect athletes with a professional who understands the cul-ture and pressures of sport—if your athletic department and campus don’t have a counselor or psychologist on staff, an off-campus referral may be the best option.

Another potential issue is that student-athletes may have heightened concerns about confidentiality that make them less forthcoming than typical counseling clients. Some, particularly higher-pro-file athletes, understand their personal value as a “sports property” and feel they must carefully guard their public image. Other times, they worry about their parents’ insurance being billed for therapy sessions and their families find-ing out that they are in counseling. Addi-tional reassurances and the explanation of strict privacy rules counselors must abide by can help athletes to openly en-gage in the process.

Time is another concern. Student-athlete schedules are generally rigid, overbooked, and both physically and emotionally draining. The idea of add-ing therapy appointments as another commitment may seem like a burden. There’s no easy answer to scheduling issues, but if a need arises, remember that an athlete may need assistance in this area—you might be able to tailor their athletic training room appoint-ment times, get your campus counseling center to make special arrangements, or set up quick and easy transportation to off-campus appointments.

Once they do start counseling, ath-letes may set unrealistic expectations about how quickly they should make progress, especially if it’s during their competitive season. It’s important for them to understand that treating de-pression or anxiety isn’t like healing a sprained ankle—it’s an ongoing process

stigma associated with anxiety disor-ders and depression, and you may find it’s difficult to take an athlete aside and tell them you think you’ve observed a problem and would like to refer them to a counselor or psychiatrist.

Student-athletes are accustomed to many people knowing about and keep-ing tabs on their medical conditions,

but they’re frequently hesitant to dis-cuss anything related to their mental health. They worry about coaches and teammates finding out, and fear re-percussions that can make their con-dition even worse, such as diminished responsibilities on the team, further isolation, or a loss of trust in their

Referral barriers. Compared to the extensive and trusted referral network of medical doctors athletic departments use to address physical problems, the network of mental health professionals is usually much less developed. It’s also often less accessible to someone on the front lines, such as an athletic trainer, who may observe an athlete struggling

with mental health. While athletic trainers are generally

quite aware of what it’s like to work with a physician and comfortable talk-ing to student-athletes about what to ex-pect in treatment, they often have little to no personal experience with mental healthcare. Add in the aforementioned

Athletes may set unrealistic expectations about how quickly they should make progress ... It’s important for them to understand that treating depression or anxiety

isn’t like healing a sprained ankle—it’s an ongoing process that takes time and effort to succeed.

SAD OR DEPRESSED?Everyone goes through periods of sadness brought on by life circumstances. But when those feelings persist for a long time or are severe enough to affect the ability to function, they may indicate clinically diagnosable depression.

The line between “normal” sadness and clinical depression is sometimes difficult to discern. Applying adjectives to the moods and behaviors of others is an inexact science, but the comparisons below can help you determine whether an athlete might be struggling with depression. If you suspect they are, or even if you’re unsure, consider referring them to a counselor or other mental health professional, who can use tools to evalu-ate whether the individual is clinically depressed.

Subclinical Range Clinical Range

Temporarily sad Consistently sad

Nervous Persistently anxious

Somewhat isolated Truly withdrawn

Irritated Explosive

Unmotivated Apathetic

Frustrated Having emotional outbursts

Angry Raging

Minor sleep disturbance Insomnia


LEADERSHIP

works best with their biochemistry to address a mental health issue.

With most medications, side effects are mild and last for only the first cou-ple of weeks. There is usually no nega-tive impact on athletic performance, and patients often find medication to be of great help, especially at first as they work to develop better coping skills and healthier supportive behav-iors. In some cases, long-term medica-tion use provides the best outcome.

Common problems in the student-athlete population related to pre-

and stressful thoughts and feelings. Over time, the patient develops a set of internal tools for mental health and coping mechanisms they can use for the rest of their lives.

Prescription medication. As with talk therapy, approaches to psychoactive medication vary from one practitioner to the next. There are many types of drugs on the market to address psycho-logical disorders, each with its own po-tential benefits and side effects. There’s sometimes an element of trial and er-ror before a patient finds the drug that

that takes time and effort to succeed, but the results are well worth it.

TREATMENT OPTIONSWhat happens after you refer an athlete for mental healthcare? Decisions are al-ways made on an individual basis, but the most common forms of intervention are counseling, also known as psychother-apy, and prescription medication. Prac-titioners often choose to treat a patient using both methods simultaneously.

Psychotherapy. While psychothera-pists vary in their training, credentials, and models for treatment, the first session for most types of counseling or “talk therapy” will have some com-mon components. The student-athlete will likely complete some paperwork in advance, and from the outset, most counselors will explain that confiden-tiality will be strictly followed except in a few specific circumstances, such as when a patient appears to be homi-cidal or suicidal.

From there, most therapists will ask the client to describe what brought them to counseling and encourage dis-cussion of short- and long-term symp-toms and concerns. The first session usually includes direct questioning by the therapist to ascertain individual and family history and various fac-tors that may impact diagnosis and treatment planning. A trusting and caring relationship is usually estab-lished rather quickly, and more often than not, patients leave the first ses-sion already feeling a bit better, as if a weight has been lifted.

In subsequent sessions, the thera-pist will help the patient explore the underlying causes for their anxiety and/or depression. Together, they will seek new ways to gain perspective on troubling issues and process negative

Options such as herb-al remedies, meditation, yoga, and acupuncture have varying levels of sci-entific support, but if they bring an athlete comfort, they may be worth explor-ing as a complement to traditional therapy.

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LEADERSHIP

scription medication use include lack of strict compliance, consuming alcohol or other drugs while on the medication, and lack of sleep, which may exacerbate side effects. If an athlete has been prescribed medication to deal with anxiety or depression, it’s a good idea to talk with them about avoid-ing these potential hazards.

Besides those two mainstays of mental healthcare, alterna-tive methods are sometimes used if the athlete or practitioner feels they may be helpful. Options such as herbal remedies, meditation, yoga, and acupuncture have varying levels of scientific and anecdotal support, but if they bring an athlete comfort and relief, they may be worth exploring as a comple-ment to traditional therapy.

YOUR ROLEThere’s no specific formula for how you should act if you suspect a student-athlete may be experiencing depression or have an anxiety disorder. The best course depends on your relationship and comfort level with them, the resources available in your department and at your school, and many other factors. Here are some tips that may be helpful if you’re ready to step in:• To broach the subject, tell the athlete about your con-

cerns in a private setting using objective, non-judgmental language. Use specific examples of what you have observed, and emphasize that if they are willing to consider treatment, you will help them find the best possible arrangement for mental healthcare while respecting their privacy.• Research the mental health resources available on your

campus and in your community in advance, so you are al-ready familiar with the available options when an athlete needs services. If your athletic department doesn’t already have a standing relationship with a mental healthcare pro-vider or at least a referral list, work toward creating one.• Before using any mental health professional for the first

time, meet with them to assess their ability to provide care for student-athletes. Someone with experience in sports psy-chology is better prepared to understand the unique culture and its role in an athlete’s mental health.• If the best available mental healthcare professional is not

familiar with the culture of sports, take some time to edu-cate them. Enhancing their sensitivity to the student-athlete worldview can go a long way in fostering a positive thera-peutic relationship. It may be helpful to remember the Four A’s, a set of concepts developed by Dr. Don O’Donaghue for team physicians that’s also applicable to other professionals who interact with student-athletes. A professional should be Affordable, Available, Amiable, and Accepting of the value of athletics to the athlete.• This may sound like common sense, but it’s worth a re-

minder: If a student-athlete makes comments that lead you to believe they are considering suicide, your top priority is making an appropriate referral and taking whatever steps necessary to ensure their immediate safety, even at the ex-pense of your relationship with them.

As an athletic trainer, you have an excellent opportu-nity to help athletes not just with physical maladies, but mental ones as well. If you take on this responsibility, you can positively impact the lives of your athletes in ways you might never have imagined when you chose this profession. It’s just one more avenue for achieving the goal of helping student-athletes be at their best. n

Pilates and the BackBy Ken endelman

what muscles should be recruited for a specific movement. Injured muscles will heal instead of getting hurt repeatedly. Pilates teaches an athlete to support his or her body throughout a wide range of motions while lying, sitting, standing or kneeling. The exercises can be done on a mat or on Pilates equipment, and em-phasize proper breathing and complete concentration on smooth, flowing move-ment.

To increase back strength or treat an injured back, Pilates equipment really comes into play. Apparatus like a Re-former or Chair are great because of the assistance the springs and ropes provide.

By selecting and appropriately modify-ing exercises on the equipment, a trainer can make the initial sessions very sup-portive and assisted. Athletes can learn to organize their bodies and put principles of Pilates into play. As they progress and strengthen, they can move on to more challenging movements.

What equipment is best for strengthen-ing the back? Each type of apparatus of-fers benefits. Part of your decision could depend on space and budget. Some of the more well-known pieces of Pilates equip-ment are:

What’s the main reason an athlete devel-ops back problems? Many trainers say that it’s a direct result of muscular imbal-ances, particularly if an athlete’s training focuses more on the repetitive motions of his or her competitive sport and less on a well-rounded cross-training regimen. It’s inevitable - certain muscles get built up, other muscles weaken and something as simple as a rudimentary movement can result in a back injury.

The lower lumbar spine is the site of fre-quent injury because it is the source of much of our mobility. This area has a lot to do with how we put together move-ments in our body.

Pilates teaches athletes how to access oth-er spinal segments and then to more eas-ily redistribute the load that goes through the spine, as opposed to movements be-ing dependent on one or two segments of the spine. With more segments to move through, less force is applied to each one. This is especially true in a chronic back injury. For example, the body of an ath-lete with a herniated disc will compensate for the injury by overusing other muscles in order to function. And thus, an imbal-ance is born.

Pilates focuses on creating an even mus-culature, correcting these muscle weak-nesses and re-educating the body as to

Ken Endelman is a contributing writer for Training and Conditioning and the Founder and CEO of Balanced Body®.

Pilates Chairs like the EXO Chair can strengthen the back and provide a challenging workout in a small footprint.

Reformer The Reformer is the main piece of equip-ment used in Pilates exercise. Extraordi-narily versatile, it is basically a carriage that glides inside a rectangular frame. Resistance is provided by springs, and the user moves the carriage by pushing or pulling with arms or legs, from a supine, sitting, kneeling or standing posture. Trapeze Table a.k.a. Cadillac The Cadillac is a horizontal table-top sur-rounded by a four-poster frame with an assortment of bars, straps, springs and levers attached. A tremendous variety of exercises can be performed on the Cadil-lac, from gentle, spring-assisted sit-ups to advanced acrobatics hanging from the upper bars.

Reformer with Tower This apparatus combines the Reformer and the Trapeze Table, with the “Cadil-lac” portion represented by a “tower” on one end The Reformer can be covered with two removable tabletop mats, and greatly increases the number of exercises possible.

Chairs Chairs provide a challenging strength workout within a small floor space foot-print. They resemble a stool with single or split steps at the bottom. You can add handles, chair backs, rotation discs and other accessories for increased variety. Balanced Body’s latest chair - the EXO Chair – has attachments for resistance tubing that give trainers the ability to of-fer many Reformer exercises in a fraction of the space typically required.

Arcs Arcs are great tools for mobilizing the spine, shoulders and hips, as well as for core, abdominal, rotation and back exten-sion work. They are also affordable and, in the case of Balanced Body’s Pilates Arc, are lightweight and easy to move around.

Circle No. 120

Pilates and the BackBy Ken endelman

what muscles should be recruited for a specific movement. Injured muscles will heal instead of getting hurt repeatedly. Pilates teaches an athlete to support his or her body throughout a wide range of motions while lying, sitting, standing or kneeling. The exercises can be done on a mat or on Pilates equipment, and em-phasize proper breathing and complete concentration on smooth, flowing move-ment.

To increase back strength or treat an injured back, Pilates equipment really comes into play. Apparatus like a Re-former or Chair are great because of the assistance the springs and ropes provide.

By selecting and appropriately modify-ing exercises on the equipment, a trainer can make the initial sessions very sup-portive and assisted. Athletes can learn to organize their bodies and put principles of Pilates into play. As they progress and strengthen, they can move on to more challenging movements.

What equipment is best for strengthen-ing the back? Each type of apparatus of-fers benefits. Part of your decision could depend on space and budget. Some of the more well-known pieces of Pilates equip-ment are:

What’s the main reason an athlete devel-ops back problems? Many trainers say that it’s a direct result of muscular imbal-ances, particularly if an athlete’s training focuses more on the repetitive motions of his or her competitive sport and less on a well-rounded cross-training regimen. It’s inevitable - certain muscles get built up, other muscles weaken and something as simple as a rudimentary movement can result in a back injury.

The lower lumbar spine is the site of fre-quent injury because it is the source of much of our mobility. This area has a lot to do with how we put together move-ments in our body.

Pilates teaches athletes how to access oth-er spinal segments and then to more eas-ily redistribute the load that goes through the spine, as opposed to movements be-ing dependent on one or two segments of the spine. With more segments to move through, less force is applied to each one. This is especially true in a chronic back injury. For example, the body of an ath-lete with a herniated disc will compensate for the injury by overusing other muscles in order to function. And thus, an imbal-ance is born.

Pilates focuses on creating an even mus-culature, correcting these muscle weak-nesses and re-educating the body as to

Ken Endelman is a contributing writer for Training and Conditioning and the Founder and CEO of Balanced Body®.

Pilates Chairs like the EXO Chair can strengthen the back and provide a challenging workout in a small footprint.

Reformer The Reformer is the main piece of equip-ment used in Pilates exercise. Extraordi-narily versatile, it is basically a carriage that glides inside a rectangular frame. Resistance is provided by springs, and the user moves the carriage by pushing or pulling with arms or legs, from a supine, sitting, kneeling or standing posture. Trapeze Table a.k.a. Cadillac The Cadillac is a horizontal table-top sur-rounded by a four-poster frame with an assortment of bars, straps, springs and levers attached. A tremendous variety of exercises can be performed on the Cadil-lac, from gentle, spring-assisted sit-ups to advanced acrobatics hanging from the upper bars.

Reformer with Tower This apparatus combines the Reformer and the Trapeze Table, with the “Cadil-lac” portion represented by a “tower” on one end The Reformer can be covered with two removable tabletop mats, and greatly increases the number of exercises possible.

Chairs Chairs provide a challenging strength workout within a small floor space foot-print. They resemble a stool with single or split steps at the bottom. You can add handles, chair backs, rotation discs and other accessories for increased variety. Balanced Body’s latest chair - the EXO Chair – has attachments for resistance tubing that give trainers the ability to of-fer many Reformer exercises in a fraction of the space typically required.

Arcs Arcs are great tools for mobilizing the spine, shoulders and hips, as well as for core, abdominal, rotation and back exten-sion work. They are also affordable and, in the case of Balanced Body’s Pilates Arc, are lightweight and easy to move around.

IllInoIs sports InformatIon

What happens

next?


SPECIAL FOCUS

E very year, an estimated 1.6 to 3.8 million concussions occur as a direct result of sports and recreational activity. As the sports medicine community has

learned more about this type of injury, we have become more sophisticated in our approaches to prevention and treatment. Evaluation and symptom recognition are better than ever, using powerful tools such as neurocognitive testing, balance assessments, and in some better-funded programs, high-tech instrumented football helmets that predict injuries by gauging impact force and location.

We also know more than ever about the serious consequences of ignoring a concussion or letting an athlete return to activity too soon after sustaining one. There’s still more work to do—it’s been estimated that over half of all concussions sustained by athletes in the U.S. go unre-ported—but this growing awareness has no doubt prevented many more serious injuries, and in some cases saved lives.

If you work with high school or col-lege student-athletes, you must be pre-pared to manage the post-concussion period. And thanks to ongoing research in this area, we now understand this means much more than just holding an athlete out of competition until symp-toms resolve. From their degree of physi-cal activity in the days after a concussion to how much they mentally exert them-selves while the brain heals, there are several factors that may determine the success of post-concussion recovery.

AFTER THE HITYou’re most likely already familiar with what a concussion looks like. Follow-

By Dr. Steven P. Broglio

Steven P. Broglio, PhD, ATC, is Director of the Neurotrauma Research Laboratory at the University of Illinois. He can be reached at: [email protected].

In most contact sports, concussion risk comes with the territory. After the injury, safe and complete recovery depends on ample rest time—both physical and mental—followed by a gradual return-to-play protocol.

ing the moment of impact, the athlete may or may not lose consciousness. In fact, only 10 percent of all concussions involved a loss of consciousness. Once brought to the sideline, they can typi-cally complete a given task, but slowed reaction times, impaired memory func-tion, and personality changes are all common clinical signs that result from impaired neuronal signal transmission.

The full spectrum of changes that oc-cur at the cellular level following a con-cussion are not fully understood, but it is thought the brain recruits pathways that bypass the injured areas to perform basic tasks and functions. Thus, reac-tion times may be slowed because the new pathway is simply longer or less ef-ficient than the original. It’s sort of like highway traffic being diverted to coun-try roads after an accident.

During the recovery process, physical healing within the brain eventually al-lows normal pathways to be restored—after a while the highway is cleared, and traffic can resume its usual pattern. Re-covery time varies based on the severity of the injury and individual factors such as brain chemistry, but this takes an av-erage of seven to 10 days in adults and roughly two weeks in children and ado-lescents. If an athlete returns to activity before fully healing, a second concussion can lead to second-impact syndrome, un-controlled cerebral swelling, and perma-nent brain damage or even death.

During the healing process, there is a progression from functional brain recovery to true recovery. You might think of it like a grade one lateral an-kle sprain: By one week post-injury, the athlete may be taped and sent out

to practice where he can perform at a functional level, but the ligament con-tinues to heal for some time afterward before returning to pre-injury integrity.

Functional recovery is achieved when the athlete can perform at pre-concus-sion levels on tests of reaction time, memory, and other basic functions. But this does not mean the neural path-ways have yet been completely restored. Indeed, while functional recovery typ-ically occurs within two weeks, true metabolic recovery from a concussion may take twice as long. What an athlete does in the post-concussive period—both physically and mentally—plays a major role in their overall outcome.

PHYSICAL RESTHolding an athlete out of activity fol-lowing a concussion isn’t just about re-moving the risk of a second blow to the head, though that’s critical. Any physical exercise in the days after a concussion redirects glucose away from the healing processes occurring within the brain—it slows the restoration of neural pathways and may exacerbate symptoms. For the athlete’s health and comfort during recovery, they should be held out of not only practice and compe-tition, but also weightroom work, phys-ical education classes, and anything else involving physical exertion.

Why does the brain require this in-flux of energy? That answer is compli-cated, but it essentially has to do with


SPECIAL FOCUS

ion imbalances generated by the injury. During the post-injury period, ions are actively moved across cell membranes in a process that requires fuel provided by glucose. This activity is accompanied by a phase of vasoconstriction in the brain, which may be a protective mech-anism against cerebral bleeding. Under normal circumstances there is plenty of glucose available for optimal function of both skeletal muscles and the brain, but in the post-concussion phase, the brain must have additional glucose to maximize energy availability.

Both animal and human studies have helped us understand the negative ef-fects of exercise on the post-concussive brain. One such investigation found that if rats were allowed to exercise immedi-ately after a concussion, their ability to learn and remember new information was impaired when measured against rats who were withheld from exercise immediately following injury. Likewise, a study of high school football players published in 2008 noted that those who were concussed and allowed to return to the same game or practice showed

the greatest declines in cognitive perfor-mance in the days after the injury.

In both these studies, the authors suggested that the cognitive impair-ments were a direct result of blood and glucose being directed away from the brain and thus delaying the heal-ing process. In short, the message was that optimal recovery depends in part on the body’s ability to focus its energy on repairing the brain instead of fuel-ing muscle activity.

MENTAL RESTMany people first heard about post-injury mental rest during the 2009 col-lege football season, when University of Florida quarterback Tim Tebow sus-tained a concussion in a game against the University of Kentucky. Tebow was subsequently removed from all phys-ical activity, had his academic load temporarily reduced, and was even in-structed not to read or watch televi-sion for several days after the game in which he was injured.

The concept of resting the brain is relatively new to concussion manage-ment, so there is less data available and fewer evidence-based recommen-dations to rely on. The basic idea is that the cognitive demands of school work, reading, and other mentally tax-ing activities (those requiring attention and problem solving) pull metabolic resources away from the brain’s ion restoration process.

Think of an athlete’s typical expe-rience after sustaining a concussion during a high school or college sport-ing event. They are usually held out of practice and competition until symp-toms resolve, but they almost always

Concussed athletes often report difficulty concentrat-ing, trouble staying awake,

headaches, and other symptoms that get worse throughout the day. This

all appears to result from working an injured body

part—the brain—without accounting for the healing

that must occur.

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Circle No. 121


SPECIAL FOCUS

of school work the first couple of days, with an additional hour added each day until their workload is back to normal.

Just like with physical recovery, the recurrence of symptoms is the best guide for whether an athlete is re-turning too quickly. In other words, if headaches, sleepiness, or other symp-toms emerge prior to the end of the day’s mental work, the activity should be scaled back.

Not surprisingly, an athletic trainer making the case for postponing home-work, reading assignments, and tests

will carry more weight with teachers than athletes themselves asking for these special consideration. To rein-force the idea that this is part of an important post-injury treatment plan and not simply an impromptu vaca-tion, you can emphasize the fact that all forms of mentally challenging activ-ity—even the recreational ones, such as text messaging and video games—will be curtailed during this time as well. In general, the athlete should be instructed to spend as much time in a mentally re-laxed state as possible.

remain in the classroom. They may even treat the time away from sports as an opportunity to bear down on school work to catch up or get ahead. Anecdotally, these athletes often re-port difficulty concentrating, trouble staying awake, headaches, and oth-er symptoms that get worse through-out the day. This all appears to result from working an injured body part—the brain—without accounting for the healing that must occur.

Not all student-athletes have the same luxury as a high-profile college quarter-back like Tebow, but the sports medicine staff should work with athletes and their parents and teachers to make accommo-dations. Part of this process is educating everyone involved about what a concus-sion really means: You may understand that it is a traumatic brain injury, but others might not, and some still have the outdated mentality that having one’s “bell rung” is no big deal. Once they understand the seriousness of the injury, they’re more likely to be receptive to

your suggestions on mental rest.There are no established “return to

cognitive activity” guidelines for the post-concussion period. In a perfect world, you would have an athlete com-pletely eliminate cognitive work until they are asymptomatic, but this is obvi-ously not realistic.

A reasonable compromise is to re-duce academic load as much as possible in the first few days after the injury, with an emphasis on eliminating espe-cially demanding tasks, such as test tak-ing, difficult reading, and mathematical problem solving. As the first week pro-gresses, the athlete can slowly return to normal coursework. For instance, they might be limited to one to two hours

The NATA recommends that athletes completely abstain from alcohol consumption post-concussion ... There is virtually no research show-ing a relationship between food and drink choices and concussion recovery, but al-cohol is known to impair ox-ygen delivery to the brain.

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OTHER INTERVENTIONSNothing is more important than rest af-ter a concussion to promote the healing process and avoid disruptions that may cause discomfort and complications. But there are a few other approaches worth mentioning as part of the post-injury management discussion.

Hyperbaric chambers. Very recently, some elite athletes have experimented with the use of specially designed cham-bers that deliver oxygen at a pressure level higher than in the normal atmo-sphere. A few studies involving animals suggest that these chambers may im-prove metabolic activity that aids in recovery, but some scientists have spec-ulated that the human brain and its

recovery patterns are so complex that hyperbaric chambers do not help after a concussion.

Interestingly, the use of hyperbar-ic chambers to address the long-term effects of concussion may hold great-er promise. Two recent studies found that high-pressure oxygen delivery to concussed soldiers well after their inju-ry—three years in one case—resulted in improved cognitive functioning and sleep patterns and a marked decrease in symptoms that extended eight to nine months after the treatments ended.

It’s difficult to interpret how find-ings like these might apply to athletic populations. But given the mixed re-sults of research and scholarly inquiry into the use of hyperbaric chambers, and the lack of any large-scale ran-domized studies focused on athletes specifically, the use of these devices does not seem prudent at this time.

Pharmacology. The use of medication in the post-concussion period can be differentiated into two distinct catego-ries: drugs used to treat post-concussion symptoms, and those used to improve or accelerate the healing process.

In the first category, a physician may prescribe medication to control sleep dis-turbances or reduce headaches. This is fairly common in cases where such prob-lems are prevalent, and it does not ap-pear to pose significant health concerns

PROGRESSIVE APPROACHNo athlete should ever be permitted to return to their sport until completing a progressive return-to-play protocol. Such a protocol should only begin once the athlete is no longer experiencing any functional deficits caused by the inju-ry, including self-reported symptoms, physical balance issues, or cognitive im-pairment. At that point, the return to pre-injury activity level must be gradual.

According to a consensus statement adopted at the Third International Conference on Concussion in Sport in 2008, the newly symptom-free athlete should start with light aerobic exercise that keeps the heart rate below 70 per-cent of the typical max for their age. If the athlete can complete this step with-out a return of any concussion symp-toms, light sport-specific exercise can begin a day later.

As a next step, the athlete can advance to more stressful non-contact work, such as running pass routes, walk-throughs of planned plays, and resistance training. At this point, a physician should re-eval-uate the athlete before final clearance to participate in contact drills, full train-ing, and finally, competition.

Each step in this process should take roughly one full day. If even minor con-cussion-related symptoms re-emerge, the athlete must return to the previous stage following 24 hours of rest. Using this strategy, depending on the age of the athlete and the severity of the injury, most will be cleared for a return to com-petition in one to two weeks.

Concussion remains one of the most difficult and complex challenges faced by sports medicine personnel. Injury to the brain doesn’t produce easily visible or tangible symptoms, and relying only on athletes’ own assessment of their readiness to return is not acceptable.

Ultimately, each concussed athlete must be managed individually, and it’s impossible to predict how long recovery will take. But with a comprehensive plan that focuses on both physical and mental rest and provides for a gradual return to activity, you can help any concussed ath-lete return to their sport safely and ready to perform at their best. n

as long as the athlete follows all physi-cian instructions and uses the drugs only as directed.

However, one important note in us-ing these products is that the athlete must be able to stop taking them and remain symptom-free before beginning a return-to-play protocol. A headache medication, for instance, may mask pain that indicates the brain is not yet healed, which would mean the athlete is not ready to return to workouts.

The second category includes med-ications such as corticosteroids, free radical scavengers such as vitamin C, glutamate receptors, calcium channel inhibitors, and drugs that affect the arachidonic acid cascade. All these

have been studied to various degrees without producing consistent positive results.

The most promising pharmacolog-ical agent for boosting recovery ap-pears to be progesterone. The exact mechanism of how this hormone may improve concussion recovery isn’t fully understood, but it is thought to de-crease the post-injury inflammatory response in the brain. Progesterone treatments for concussion are enter-ing large-scale clinical trials later this year, so we may have firmer answers on the value of this type of treatment in the near future.

Dietary adjustments. In its position statement on managing sports-related concussions, the NATA recommends that athletes limit fat intake, eat a high-carbohydrate diet, and complete-ly abstain from alcohol consumption in the post-concussion period. There is virtually no research showing a re-lationship between food and drink choices and concussion recovery, but alcohol is known to impair oxygen de-livery to the brain, and production of energy from fat molecules requires an abundance of oxygen. The carbohy-drate recommendation was most likely added because carbs aid in the pro-duction of glucose, which may help provide the brain with needed energy for healing.

REFERENCESTo view full references for this article, go to: www.Training-Conditioning.com /References.

No athlete should ever be permitted to return to their sport until completing a progressive return-to-play protocol. Such a

protocol should only begin once the athlete is no longer experiencing any functional deficits caused by the injury.

What is ImPACT?ImPACT is a sophisticated, research-based computer test developed to help clinicians evaluate an indi-vidual’s or athlete’s recovery following concussion. ImPACT is a 20-minute neurocognitive test battery that has been scientifi cally validated to measure the effects of sports related concussion. In the preseason, each athlete is given a baseline test. And, when a concussion is suspected, during the season, a follow-up test is administered to see if the results have changed from the baseline. This comparison helps clinicians to diagnose and manage the concussion. Follow-up tests can be administered over days or weeks so clini-cians can continue to track the individual’s or athlete’s recovery from the injury.

Why use ImPACT?ImPACT can help clinicians answer diffi cult questions about an individual’s or athlete’s readiness to return to play, protecting them from the potentially serious consequences of returning too soon. While traditional neurological and radiological procedures such as CT and MRI are helpful in identifying serious brain injuries (e.g., skull fractures, hematomas), they are ineffective at identifying the effects of a concussion. Consequently, clinicians must often rely on subjective observations or patient self-reports to diagnose and track a concussion. This is where ImPACT can help.

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TREATING THE ATHLETE

able games can be adapted to add value to an athletic training program. The technology in today’s systems has brought gaming far beyond the days when it was only a workout for the thumbs—with some games out there today, playing is truly a total-body experience.

Of course, there’s more to it than buying the latest game console, setting it up with a TV in the corner, and telling your athletes to have at it. But with clear goals in mind, video gaming can be fun and functional at the same time.

By Dr. KirK Brumels

Kirk Brumels, PhD, ATC, is Associate Professor of Kinesiology and Director of the Athletic Training Program at Hope College. He can be reached at: [email protected].

GAME THEORYIn more and more athletic training rooms, video game systems are being used for active rehab and injury prevention. This author has found creative ways to make gaming both fun and functional.

During a typical day in our athletic training program, some injured athletes snowboard down huge mountains as part of their rehab. Some compete in intense dance competitions. And others use their feet to stomp on moles as they emerge from their

holes.Sound ridiculous? It would be, if these activities occurred

in actual reality instead of virtual reality. Here at Hope Col-lege, we use video gaming as an integral part of our athletic training and rehabilitation programs.

There are no video games on the general market today that specifically target rehabbing athletes. But with some creativ-ity and willingness to experiment, many commercially avail-



WHY USE IT?The goals of typical injury prevention and rehab exercises are relatively sim-ple. They need to improve flexibility, strength, endurance, and functional characteristics such as balance, agil-ity, and coordination. Every athletic trainer knows a battery of exercises and movements that can do all of those things, but sometimes the very best ex-ercises are, for a lack of a better word, boring.

Repetitive drills can be laborious for even the most dedicated athlete, de-

spite our efforts at inspiration. When attention wanders, form and mechan-ics deteriorate and effort is less than we want. Thus, making an exercise fun and engaging is about more than help-ing the athletes have a good time. It’s an important way of promoting com-pliance, and getting athletes to view rehab as something they want to do in-stead of something they have to do.

Video games are designed for en-tertainment, and there’s no denying they’re very good at that. But when us-ing them as a rehabilitation tool, the

main goal isn’t for the user to have fun—though that’s a pleasant side ef-fect. Video games in the rehab setting must be evaluated just like any new exercise or piece of equipment, with a few key questions in mind:• Do they help meet our rehab ob-

jectives?• Do they provide a challenge for the

injured athlete that he or she is physi-cally capable of handling?• Do they present minimal risk for

re-injury or injury aggravation?• Do they achieve a specific benefit,

and do so more effectively than other available methods?

In my experience, a well-designed rehab protocol incorporating video games can answer “yes” to all those questions.

In particular, I have found video games can help bridge the gap between static and functional movements and specifically target weight acceptance, muscular control, balance, coordina-tion, core stability, strength, endur-ance, and proprioception. In addition, video game-based rehabilitation offers great versatility, as it can be modified for both the athletic training room and the athlete’s home or dorm.

I recently conducted a study along with several of my athletic training students at Hope College to compare the effectiveness of video game-based rehabilitation exercises and tradition-al exercises. We looked specifically at lower-leg and ankle balance programs, and found that athletes who partici-pated in the video game program not only showed a statistically signifi-cant improvement in ability relative to the non-video game users, but also

Light-hearted competition for high scores develops among athletes who are

prescribed similar activi-ties during their rehab pro-

grams. And though they often don’t realize it, they

push themselves harder and perform the exercises

with greater precision as a result.

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Some Wii games can be used just as designed by the manufacturer. For in-stance, the yoga, strength, and balance activities in the Wii Fit and Wii Fit Plus game bundles provide ample chal-lenge just by following the on-screen prompts and directions. However, we have also increased the difficulty by adding dumbbells, tubing, or other im-plements and rehabilitative tools. Some other games can be used simply to pro-mote movement and diversion during traditional exercises, such ankle and knee stability work.

HOW WE DO ITSo what exactly do our video game-based exercises look like? One of our (and our athletes’) favorites is perform-ing step-up, wall sit, or squatting exer-cises (See Figure 1 below) on a BOSU apparatus while playing a game like the Duck Hunt game from the Wii Play program (Duck Hunt is just what it sounds like—the player aims the con-troller like a gun at small ducks fly-ing against a sky background on the screen).

To make this exercise more difficult, the athlete plays while performing wall sits or squats and squeezing a Pilates ring or weighted ball between their distal thighs.

body fatigue, and facilitates perfor-mance improvement. We’ve modified game play in many ways to achieve specific training results, sometimes mimicking the demands and benefits of well-known exercises and move-ments such as the Star Excursion Bal-ance Test. See “DDR Breakdown” on page 43 for several examples.

The 2008 introduction of another gaming platform, the Nintendo Wii Fit

bundle, greatly enhanced our options for video gaming in rehabilitation. Anyone who has used a Wii knows it’s different from any other gaming experience. The controller is handheld

like with older game consoles, but it is highly sensitive to motion and ac-celeration in all directions. Depending on the game, it can be swung like a golf club or tennis racket, thrust like a boxing glove, or tilted and turned like a steering wheel.

The Wii Fit system comes with a balance board, which is critical to many of the exercises and features we use with our athletes. It’s essentially a force plate that responds to changes in body position and center of balance, providing constant feedback about the player’s performance.

When we purchased the Wii gaming system and the Wii Fit bundle, we im-mediately found several applications for them. Many Wii games provide auditory and visual stimulation and competitive situations that force the user to concentrate on changing body position and performing challenging movements.

And because these exercises require minimal supervision once learned, there are countless opportunities to fit them in. For instance, we encour-age athletes who are waiting for ankle taping to participate in Wii-assisted balance improvement exercises for ex-tra injury prevention at a time when they’d otherwise sit around and so-cialize.

reported that their training was “more enjoyable” and “less strenuous,” even though both groups performed the same amount of work.

This backs up our growing body of anecdotal evidence showing that—big surprise here—college students en-joy working with video games. Light-hearted competition for high scores develops among athletes who are pre-scribed similar activities during their rehab programs. And though they of-ten don’t realize it, they push them-selves harder and perform the exercises with greater precision as a result. Some even come in for extra rehab and inju-

ry prevention work, in order to defend their “record high score” against an-other rehabbing athlete.

GETTING IN THE GAMEWe have been using video game-based rehabilitation exercises in our ath-letic training program for nearly five years. Our first foray into this method utilized the game Dance Dance Rev-olution (DDR) as a way to improve balance and agility in healthy athletes and those rehabbing from injury.

DDR was at the forefront of the “ac-tive gaming” movement, being one of the first games to require weight bear-ing physical activity instead of the typ-ical handheld controller. The interface is a floor mat with a grid of pressure-sensitive pads activated by the user’s feet.

During play, visual commands are presented on a television screen accom-panied by auditory cues. The player must respond to a scrolling series of ar-rows pointing left, right, up, or down by moving their feet and touching the corresponding arrow on the game mat at just the right time.

The tempo and difficulty of the pat-terns increase as the player progresses through the levels, ultimately leading to an experience that stimulates me-tabolism, creates general and specific Figure 1

Because these exercises require minimal supervision once learned, there are countless opportunities to fit them in. For instance, we encourage athletes who are waiting for

ankle taping to participate in Wii-assisted balance improvement exercises for extra injury prevention at a

time when they’d otherwise sit around and socialize.

That’s just one way we get the most out of a game. Here are some more examples of successful adap-tions we’ve used.

• Shaun White Snowboarding and Wii Fit balance games both use the Wii’s balance platform, which we place on an upside-down BOSU. We sometimes have ath-letes play Snowboarding while in a plank position, with their hands instead of their feet on the balance platform.



Figure 4Figure 2

Figure 3

• Both DDR and Mole Stomper from the Active Life Outdoor Challenge pro-gram are based on foot movement pat-terns (though we don’t only use them for foot work). They can be played with surgical tubing around the ankles to add resistance.

We’ve also had athletes play these games with their hands. The athlete places their feet are on a physioball or has them held and perturbed by a practitioner, which indeed is just as hard as it looks (See Figure 2 at left).

Circle No. 129

• Various Wii games, including boxing and tennis, can be played while the athlete performs pike ex-ercises on a BOSU (See Figure 3 at left).

• In Wii boxing, which involves holding a game controller in each hand and “punching” an on-screen opponent with full arm extension, we have attached surgical tubing to an athlete’s hands or given them dumbbells to hold in addition to the controller (See Figure 4 below).

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What equipment is necessary to add video game protocols to your athletic training room? Here’s the rundown:

Television. You definitely don’t need a fancy wall-mounted big-screen HDTV. We use an old TV set discarded by our school’s Information Technology office, and the only thing fancy about it is the exquisite faux wood veneer on the sides. If your set doesn’t have the correct audio/visual jacks to connect the game console, you can usually find an inexpensive adapter.

Our television is on the top shelf of a rolling cart for easy movement, storage, and visibility during both “high” (standing) and “low” (near the floor) exercises. For extra visibility, we’ve added a second, smaller set on the lower shelf of the cart. This way, an athletic trainer or other observer can follow the activity on the larger screen while the athlete in a low position looks at the smaller one.

Gaming System. We started out with the Nintendo Game Cube system, but we now use the Nintendo Wii. Our old Game Cube games (such as the Mario Mix version of Dance Dance Revolution) are still usable because they’re

compatible with the Wii. In my opinion, the Wii is by far the most suitable gaming system for athletic training use.

Games. The possibilities are extensive and continually growing. The ones I most highly recommend for the Wii are Dance Dance Revolution, Wii Fit or Wii Fit Plus (this game is packaged with the pressure-sensitive balance platform), Wii Play, and Outdoor Life Challenge.

Memory Device. This is critical for storing data created by each user’s participation in various games. Many games have certain activities or levels that need to be “unlocked” via repetition or obtaining a high score. Once they are unlocked, you want the ability to save them for future use and play. In addition, a memory device makes it easier for athletes to repeat a previously used routine.

Accessories. Most of the implements we use to add an extra challenge to the games can be found in any athletic training room or rehab center. We’ve used surgical tubing, physioballs, dumbbells, cuff weights, step-up platforms, and unstable surfaces.

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DDR BREAKDOWNAs we have grown more sophisticated using the Dance Dance Revolution (DDR) game, we’ve learned to impro-vise by adding implements and “activity distracters” to make the game more demanding.

Here are some ways we’ve applied DDR to assist with specific aspects of rehab:

LOWER EXTREMITIES

Weight Shifting• Stand on both feet in the middle of the control pad. Step onto direction arrows as directed by game, then return to the middle (normal game play).• Same as above, but instead of returning to the middle, stay on each direction arrow until the next movement command.

Single-Leg Balance• Use a single-leg stance in the middle of the pad with the knee slightly bent. Respond to game commands with the opposite foot, without unloading the standing leg.• Increase difficulty by utilizing an unstable surface for the standing leg, such as a foam roller, foam disc, wobble board, or balance disc.

• Same as above, but also engage the upper extremi-ties with matrix patterns using dumbbells, tubing, or a BodyBlade, or with partner-assisted catching, throwing, or swinging activities.• With a single-leg stance on an elevated platform at the center of the pad, use squat movements to touch the directional arrows with the non-standing heel as directed by the game. Mini-squats can be performed while waiting for the next directional prompt.

UPPER EXTREMITIES• Starting in a push-up position, respond to game com-mands by tapping the correct directional arrow with either arm. Use this progression to increase difficulty:1. Begin with knees in “modified push-up” position2. Progress to full push-up position3. Elevate the legs onto a platform, table, or physioball• While performing the above, do push-ups in between directional arrow commands and tap the arrows with one hand when prompted.

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TREATING THE ATHLETE Are your Players Ready for Game Day? By Chris Frankel, M.S. Director of Programming, Fitness Anywhere As the resident TRX Professor, Chris Frankel draws from over 25 years of experience as a trainer and strength and conditioning coach. He earned an MS in Exercise Physiology from the University of New Mexico, where he is currently completing his doctorate in Exercise Science. Before taking the position of Director of Programming at Fitness Anywhere, Chris was an instructor in the Department of Health, Exercise and Sport Sciences at the University of New Mexico.

TRX® Suspension Training® bodyweight exercise provides an excellent way to integrate multiple components of movement for football strength and conditioning. Using Suspension Training to load and unload movements using resistance and stability provides obvious applications for strength, mobility, range of motion and metabolic challenges. In addition, there are exercise progressions unique to Suspension Training to develop movement quality directly transferable to traditional strength training and field performance for football athletes. The following TRX movements fall into a category termed “self limiting” exercises. These exercises demand greater engagement and greater physical awareness. The athlete receives immediate sensory feedback on performance because they will be unable to maintain balance, alignment and posture or simply lack strength, mobility or stability in specific areas.

TRX Overhead Squat (extend arms overhead, back of hands in foot cradles, feet hip width apart. Pull arms back, lower hips down and back, weight in heels)

This exercise can be used as a standalone exercise or as movement preparation before and during a squatting or snatch program depending on the needs and abilities of the athletes. Many players are not able to perform an effective overhead bodyweight squat while maintaining a stable core, mobile hips and ankles. Using the TRX to provide stability and to activate the posterior chain most athletes can demonstrate improved move-ment quality and therefore can train stability and mobility in the appropriate places. If the athlete is able to perform a good bodyweight overhead squat this exercise can be used to activate the posterior chain and strengthen an already strong movement pattern. An advanced progression would be to perform the overhead squat with both foot cradles on one hand which makes the exercise more challenging because the athlete has to resist rotational forces.

TRX Single Leg Chest Press (Lower chest in push-up motion. Extend one leg to the side. Switch extended leg)

Often athletes of all levels are “disconnected” when performing pressing exer-cises. Using a single leg stance for a chest press requires integration of upper, core and lower body to maintain alignment, resist rotation while generating strength and power in the press. The important coaching point here is to maintain a stable core and focus on hip extension in the grounded leg throughout the entire range of motion. Bringing the opposite leg up into triple flexion replicates an acceleration position, reinforcing extension in the drive leg and often “fixes” excessive lumbar extension often seen in pushups and other exercise where core stability is lacking

TRX Sprinter Start (Walk back into 45 degree angle, step back into lunge with right leg. Bring right knee up and forward. Perform complete set then repeat on other leg)

Another powerful way to exploit the unique benefits of Suspension Training takes a different approach to a step up pattern to improve single leg balance, strength and explosiveness. It is not uncommon for athletes to focus on the knee drive during starts and acceleration at the expense of contralateral hip extension and core stabil-ity. By initially relating the TRX Sprinter Start to a “step up” exercise where triple extension is the focus the knee drive can be trained without sacrificing force produc-tion or unwanted spinal flexion. Focus on having the athlete earn their appropriate level of progression from slow controlled movements with short isometric holds at the start and midpoint of the movement to continuous movement and finally to explosive movements always driving from hip extension and not “short stroking” from the knee and or ankle. This progression translates extremely well to sled work.

Figure 6Figure 5

• For various Wii games that re-quire manipulating the handheld con-troller either through punching or swinging, we have the athlete play while performing different exercises on a physioball (See Figures 5 and 6 at left). This is a “freestyle” form of ex-ercise that varies greatly based on the chosen game, our rehab or condition-ing goal fort he athlete, and any injury limitations they may have. It can also include balance or strengthening work specific to the injury rehab program they have been given.

We’re very pleased with the new dimension video gaming has added to our bag of tools for our athletes’ rehabilitation and skill development. Besides getting athletes excited about coming to the athletic training room, which we all know can be quite a challenge at times, it has produced functional benefits for the many of them who have embraced using it. And as we continue experimenting with new games and new ways to adapt video gaming to our training and rehabilitation goals, it will only get better. Play on. n

Circle No. 132

Are your Players Ready for Game Day? By Chris Frankel, M.S. Director of Programming, Fitness Anywhere As the resident TRX Professor, Chris Frankel draws from over 25 years of experience as a trainer and strength and conditioning coach. He earned an MS in Exercise Physiology from the University of New Mexico, where he is currently completing his doctorate in Exercise Science. Before taking the position of Director of Programming at Fitness Anywhere, Chris was an instructor in the Department of Health, Exercise and Sport Sciences at the University of New Mexico.

TRX® Suspension Training® bodyweight exercise provides an excellent way to integrate multiple components of movement for football strength and conditioning. Using Suspension Training to load and unload movements using resistance and stability provides obvious applications for strength, mobility, range of motion and metabolic challenges. In addition, there are exercise progressions unique to Suspension Training to develop movement quality directly transferable to traditional strength training and field performance for football athletes. The following TRX movements fall into a category termed “self limiting” exercises. These exercises demand greater engagement and greater physical awareness. The athlete receives immediate sensory feedback on performance because they will be unable to maintain balance, alignment and posture or simply lack strength, mobility or stability in specific areas.

TRX Overhead Squat (extend arms overhead, back of hands in foot cradles, feet hip width apart. Pull arms back, lower hips down and back, weight in heels)

This exercise can be used as a standalone exercise or as movement preparation before and during a squatting or snatch program depending on the needs and abilities of the athletes. Many players are not able to perform an effective overhead bodyweight squat while maintaining a stable core, mobile hips and ankles. Using the TRX to provide stability and to activate the posterior chain most athletes can demonstrate improved move-ment quality and therefore can train stability and mobility in the appropriate places. If the athlete is able to perform a good bodyweight overhead squat this exercise can be used to activate the posterior chain and strengthen an already strong movement pattern. An advanced progression would be to perform the overhead squat with both foot cradles on one hand which makes the exercise more challenging because the athlete has to resist rotational forces.

TRX Single Leg Chest Press (Lower chest in push-up motion. Extend one leg to the side. Switch extended leg)

Often athletes of all levels are “disconnected” when performing pressing exer-cises. Using a single leg stance for a chest press requires integration of upper, core and lower body to maintain alignment, resist rotation while generating strength and power in the press. The important coaching point here is to maintain a stable core and focus on hip extension in the grounded leg throughout the entire range of motion. Bringing the opposite leg up into triple flexion replicates an acceleration position, reinforcing extension in the drive leg and often “fixes” excessive lumbar extension often seen in pushups and other exercise where core stability is lacking

TRX Sprinter Start (Walk back into 45 degree angle, step back into lunge with right leg. Bring right knee up and forward. Perform complete set then repeat on other leg)

Another powerful way to exploit the unique benefits of Suspension Training takes a different approach to a step up pattern to improve single leg balance, strength and explosiveness. It is not uncommon for athletes to focus on the knee drive during starts and acceleration at the expense of contralateral hip extension and core stabil-ity. By initially relating the TRX Sprinter Start to a “step up” exercise where triple extension is the focus the knee drive can be trained without sacrificing force produc-tion or unwanted spinal flexion. Focus on having the athlete earn their appropriate level of progression from slow controlled movements with short isometric holds at the start and midpoint of the movement to continuous movement and finally to explosive movements always driving from hip extension and not “short stroking” from the knee and or ankle. This progression translates extremely well to sled work.

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Circle No. 133


sport specific

By Jim Peal

An athletic department-wide philosophy that demands commitment, the “Butler Way” denies selfishness, accepts reality, and seeks

improvement every day while putting the team above all else. It is practiced by every Bulldog athlete and coach—including the strength and condi-tioning department.

As the men’s basketball strength coach, I believe I play a vital role in the team’s fate and am blessed to have sport coaches who promote a year-round commitment to strength and conditioning. They trust me to design and implement a program with the goal of keeping our team strong all year long. Our players are never “out of shape.”

The program we use allows our play-ers to compete at high levels through-out the season and maintain their fitness into the NCAA tournament, including last year’s historic run to the championship game. What follows is an inside look at the year-round strength and conditioning program that helped launch Bulldog basketball into national prominence.

Jim Peal, MS, CSCS, is Head Strength and Conditioning Coach at Butler University. He can be reached at: [email protected].

Strong as Bulldogs

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Make no mistake—Butler didn’t get lucky as the Cinderella team of the 2010 NCAA Division I Men’s Basketball Tournament. The Bulldogs’ conditioning program was a key element of their run to the championship.


sport specific

50

leg day of the week. We consider it our heaviest day, and the session lasts about 45 minutes. We start with a to-tal-body warmup, then do three to four sets of five reps of hang clean to squats followed by two to three more sets of hang cleans with two to four reps.

Next, we move on to heavy squats. After a three-week acclimation period, our players perform timed clusters of eight to 12 sets with two to three reps each. This squat work is very similar to our leg press progression, except that the squats are never performed to max effort. I have found sub-max clusters of squats are the best way to train legs for basketball, mainly because they force the athletes to really push themselves and their teammates. We keep it simple by starting each set on the minute, at around 72 to 75 percent of the player’s estimated one-rep max. Last summer, 12 of our 14 players were able to squat 335 to 365 pounds for multiple sets of three reps.

After that, we spend roughly 20 minutes on various exercises designed to correct strength imbalances be-tween the right and left legs. Lunges are a staple of our program and we include many variations, such as twist, side, reverse, and overhead for three to four sets while holding 45 pounds and walking 20 yards (the length of our weightroom).

Because basketball involves dynamic multi-planar movements, our players do at least four sets of single-leg exer-cises in addition to their lunge work. Examples include one-legged leg press-es, heel touches while standing on a bench, split squats, step-ups, and one-legged RDLs.

The last five minutes of the Wednes-day workout are dedicated to ham-string-specific work. With a partner, players perform glute-ham exercises and leg curls. To finish up, we do su-perset hamstring work and lunges with core exercises such as V-ups, sit-ups, and Russian twists.

Thursday is our final lifting day of the week. We begin these sessions with an upper-body warmup, then go straight to the Jammer or to barbell-based jerk exercises. Players typically perform five sets of five reps, starting each lift on the minute to set a tempo for the workout.

Next, we move on to chest work using two of my favorite exercises: flat dumb-bell bench presses and 10-degree incline

coaching staff pays close attention to each player’s progress in the bench press, setting individual goals for both one-rep max and 185-pound rep max. These workouts typically begin with a basic upper-body warmup and then proceed directly to the bench.

We typically prefer to use flat bench or flat close-grip bench presses, especially when using heavy weight, and primar-ily train with sets in the four- to six-rep range. But in the last few weeks before fall testing, we will add more weight and lower the reps to two or three to prepare for the upcoming max-out.

Next come cleans, presses, and/or use of a push-movement machine called the Hammer Strength Jammer. My assistant Ross Bowsher and I like the Jammer because it’s biomechani-cally safe on the shoulders and the motion is very similar to the jerk move-ment, which promotes triple extension of the ankles, knees, and hips in a way that transfers very well to the explosive demands of basketball.

After that, the next 30 minutes of the Monday workout is less struc-tured, with the athletes performing prescribed exercises for the shoulders, lats, and upper back. We usually as-sign one or two exercises for each muscle group, such as DB shoulders, alternate presses, shrugs, seated rows, standing bent-knee rows, lat pull-downs, and my favorite, chin-ups. The combinations vary greatly—perhaps the only constant is that we never do movements behind the head because the injury risk associated with them is too high.

The last five minutes of the ses-sion include several different stations, from partner resistance exercises to running the stack on biceps curls and triceps extensions. Finally, I like to challenge the players with a different finisher at each workout. For this, we frequently use chin-ups to exhaustion, partner push-ups, partner towel pulls, or planks.

Wednesday is usually our second

SUMMER SETUPOur summer program is completely voluntary, but we have great atten-dance from athletes who spend those months in and around Indianapolis (those who don’t receive simplified, written training instructions before they leave). I tell the players that how much they improve over the summer is up to them—all I ask is that they give their best and make an effort to do the work. However, effort usually isn’t an issue—most players strive to get better because they are driven by the Butler Way.

From June to August, our athletes perform a four-day upper-body/low-er-body split routine. The big-picture goal is for players to meet individually assigned benchmarks for strength and fitness.

On Sunday evenings, the players train their legs after a 90-minute open gym session. We consider this our mod-erate leg day, with each player spend-ing a total of about 30 minutes in the weightroom.

During these workouts, the key lifts involve the leg press machine and ham-string strengthening. The leg presses begin with four sets of 10 at 60 to 70 percent of personal max in the first three weeks, then proceed to clusters of 10 to 15 sets of two to three reps each at 75 percent of max and up—the play-ers are free to decide for themselves how high they go.

For the hamstrings, partner glute-ham work is a staple. We also mix in stiff-leg deadlifts, single-leg deadlifts, Romanian deadlifts, and leg curls. Players round out these workouts with 10 minutes of core work and stretching using Swiss balls and bands.

Sunday is very important to us be-cause it’s usually the only time we are in the weightroom together as a team. The other weekly sessions are more open-ended, scheduled around each player’s class and internship commitments.

Monday is an upper-body day, and the sessions last about 50 minutes. Our

We do a 15-minute agility program ... Our agility work focuses first on body control, then speed. The phrase “Agil-ity is the ability to control your mass and change direction” is posted in our weightroom to serve as a reminder of how

important body control is to success.

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Circle No. 134

bench presses with a barbell. I keep the reps high (eight to 10) and weight in the range of 65 to 80 percent of max. For a new progressive challenge, we are cur-rently experimenting with the addition of chain-resisted bench presses.

To avoid overtraining, and because this is our second chest workout in five

days, I carefully monitor the players to make sure they stay within my recom-mended ranges for sets, reps, and effort percentages. The final 20 minutes of Thursday workouts are similar to our Monday upper-body routine, but with a greater emphasis on the posterior chain. For example, I like to finish with part-ner-assisted towel rows, chin-ups, and side deltoid raises.

Thursday is also when we implement

sport specific

conditioning and agility components into our workouts. In this part of our training, we mainly want to overload the energy system to a greater degree than typically happens on the court.

After a 15-minute active warmup consisting of movements like high knees, butt kicks, lunges, slides, and

various types of skips, we do eight to 10 sets of simple plyos. I prefer using bleacher bounds to lessen the impact on the players’ joints, and we avoid high-stress plyos such as depth jumps. Then, after a brief water break, we do a 15-minute agility program em-phasizing proper defensive positions. During these exercises, I want play-ers to concentrate on maintaining a slightly lower knee bend than they’re

used to—Coach Brad Stevens is very fond of telling players to “stay lower, longer.”

Our agility work focuses first on body control, then speed. The phrase “Agility is the ability to control your mass and change direction” is posted in our weightroom to serve as a re-minder of how important body control is to success. Changing direction on the court usually involves unbalanced, dynamic one-legged movements. For that reason, we perform a lot of decel-eration drills on Thursdays to comple-ment the single-leg work we do on Wednesdays.

Players who enter our program can already run and jump proficiently, but they often do not understand the im-portance of decelerating under con-trol and landing in a position they can react from. To be clear, we work on both acceleration and deceleration, but body control always comes first. You must control your body before you can control your opponent.

To improve agility, we employ an agility ladder and various footwork drills. The body’s positioning during

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Circle No. 135

T&C sepTember 2010 TrAINING-CONDITIONING.COm52


sport specific

line and back, half court and back, far foul line and back, and far baseline and back. We want them to average between 27.5 and 29.5 seconds. This is an excel-lent gauge of speed, acceleration, and ability to change direction.

With the exception of a body fat test, all our test results are evaluated against

teamwide goals set by the coaches. The team has until the season starts to reach those goals, and we have succeeded in each of the past four years—a span during which the team’s overall record was 118-22.

If we have an athlete who is be-hind in his test results, we will in-clude one to two special workouts with a focus on conditioning only. We strive to make our conditioning

coaches a pretty good idea of where each player is in his conditioning and helps us adjust his workouts accord-ingly. Our expectation is that post players can complete the mile in un-der six minutes, wing players in under 5:45, and guards under 5:30. Howev-er, we adjust expectations for certain

players upward or downward based on their ability.

To measure strength, we use the 185-pound bench press max rep test as well as one-rep max. Last season, six players benched over 300 pounds. Ad-ditionally, we test players on sit-up reps and the leg press.

During the preseason, players must also pass our four-line test: Starting on the baseline, they must run to the foul

the drills is of prime importance—I al-ways stress quiet feet.

After agility work, we finish with 200-meter and 100-meter runs for roughly one mile of total distance. We then wrap things up with a cooldown jog and band stretching.

FALL INTO PRESEASONDuring the fall, we stay with the same basic four-day lifting schedule. It has been my experience that basketball players do best when the workouts are short (35 to 45 minutes) and fre-quent. We also stay with one condi-tioning-based workout each week.

By this time, coaches have begun in-dividual skill work with players twice a week for 40 minutes at a time. These are very intense sessions in which the player works on sport-specific skills.

Before we implement any fall work-out programs, our players undergo a battery of baseline body composi-tion and strength and conditioning tests. A staple of these is the mile run, which is held as soon as players re-turn for the fall semester. Though not overly sport-specific, the run gives our

We strive to make our conditioning sport-specific, emphasizing elements such as posture, change of direction, and sustaining a high energy level. Our players train to become better basketball players—not to do well on cardiovascular tests.

Circle No. 136

Circle No. 136


sport specific

54

Based on our past success, includ-ing last season’s championship game appearance, I consider our approach to in-season lifting very successful. In fact, eight days after that game, we administered the 185-pound bench press rep test and found that the team maintained just over 90 percent of its preseason strength baseline.

At Butler, we are blessed to have athletes who accept their responsibil-ity to prepare for the upcoming sea-son all year long. Our sport coaches and conditioning staff all contribute by maintaining a 12-month commit-ment to physical preparedness, so on any given day, our team is never too far from game shape. Add it all up, and you have the Butler Way. n

work. Still, our goal is to get in two weekly lifting sessions.

Because we are focused on winning games, not building weightlifters, the last thing I want to do is wear a play-er down in the weightroom. That’s why our basic approach is to perform total-body lifts for 30 to 40 minutes during these sessions, supersetting

opposing muscle groups. We work the upper body at 85 to 95

percent intensity in-season, and stick to 75 to 80 percent intensity on the lower body. As the season advances, we back off another 10 percent or more. And in the postseason, we do almost no leg work other than some step-ups, lunges, and hamstring curls—usually totaling no more than six sets.

sport-specific, emphasizing elements such as posture, change of direction, and sustaining a high energy level. Our players train to become better basketball players—not to do well on cardiovascular tests.

STRONG IN-SEASONWhen official practices begin and the season is around the corner, we cut down to three days a week in the weightroom. We also back off on leg work because the players’ legs take such a pound-ing during practices and games. For in-stance, squats are phased out in favor of body weight work, lunges, and step-ups with reps in the 10 to 12 range.

We continue to hit the upper body hard, and most of our work is per-formed in the five- to eight-rep range. In a typical workout, we ask players to work at 72 to 80 percent of their one rep max if doing five reps, and 62 to 70 percent if doing eight reps.

Once the game schedule begins, we pare down our weightlifting even more. When playing two to three games and practicing three to four times per week, there isn’t much time left for strength

I consider our approach to in-season lifting very success-ful. Eight days after last season’s championship game appearance, we administered the 185-pound bench press rep test and found that the team maintained just over 90 percent of its preseason strength baseline.

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BalancIng actG Series Pro Protein Recovery Shake provides balanced nutrition for consumption after exer-cise to help jump-start recovery. With carbohy-drates for glycogen restoration and an effective amount of protein containing all the essential amino acids needed to help support muscle recovery after training or competition, G Series Pro Protein Recovery Shake provides a nutri-tional bridge between an athlete’s workout or competition and the next meal.

Gatorade • 800-884-2867www.gatorade.com Circle No. 506

HIgH ProteInAll-Pro Science Complete Veggie Protein combines 23 grams of all-natural protein from three high-protein sources—brown rice, peas, and hemp—into a great tasting blend that’s fortified with vitamins, minerals, and flaxseed. It’s perfect for athletes or vegetar-ians who wish to add more protein to their diet, and comes in vanilla and berry blast.All-Pro Science • 949-222-1009www.allproscience.com Circle No. 501

BuIldIng a Better BodyReady to take your workout to the next level? Start off with Pro Science Push. It’s an advanced combo of carbs, creatine, and beta-alanine that’s been clinically shown to increase workout ca-pacity and boost muscle strength. Then, end your routine with Pro Science Fin-ish, a high-protein recovery formula that’ll help you build muscle and increase lean body mass. Safe and effective, it’s real science working for you.EAS • 800-297-9776www.eas.com/pro-science Circle No. 507

56 T&C SEPTEMBER 2010 TRAINING-CONDITIONING.COM

Nutrition

The RighT RaTioAll-Pro Science Recovery Advanced Sports Formula replenishes the body after a gruel-ing workout so athletes can rebound faster and continue training hard. This unique 3:1 carbohydrate-to-protein ratio drink rehydrates and refuels athletes and exercising individuals alike. Taken after workouts, 3:1 drinks can

help reduce fatigue, soreness, and recovery times while assisting muscle synthesis. Flavors include fruit punch, pineapple, orange, and lemonade. All-Pro Science • 949-222-1009www.allproscience.com Circle No. 509

No FaT oR FilleRsWhey Isolate is a premium-quality, lactose-free whey protein supplement with amazing taste sat-isfaction. Each serving provides 25 grams of pure whey protein isolate. Fat-free, sugar-free, lactose-free, and gluten-free Whey Isolate provides more of what athletes want and none of what they don’t. It’s available in six great-tasting flavors: vanilla creme, chocolate, sour apple, pineapple banana, tangy orange, and blue raspberry. CytoSport • 888-298-6629www.cytosport.com Circle No. 510

oveR The BRidgeG Series Pro Nutrition Bar and G Series Pro Nutrition Shake are a convenient bridge between meals that help elite athletes meet their daily calorie needs. With a mix of high-quality protein, simple and complex carbo-hydrates, fat, and a blend of 15 vitamins and minerals, G Series Pro Nutrition Bar and G Series Pro Nutrition Shake help keep athletes’

bodies fueled and nourished for training and competition.Gatorade • 800-884-2867www.gatorade.com Circle No. 508 KNowledge is PoweR

Informed-Choice is committed to helping ensure the purity of nutritional supplements, and it relies on HFL Sport Science to conduct product tests. HFL Sport Science has been testing supplements since 2002. The lab tests more than 5,000 sam-ples annually, and currently works with more than 100 com-panies worldwide, including over 40 American and Canadian brands. HFL works closely with supplement manufacturers and suppliers to reduce the risk of contaminated products finding their way into sports, thus helping ensure that athletes know exactly what they are putting into their bodies. Informed-Choice • 720-289-2401www.informed-choice.org Circle No. 550

Rolling Muscle Massager

“Thank you formaking great tools—

your company is the only one I trustand recommend to my patients/colleagues."

–Haley N. Masbruch, LMP

Use with

• Press deeply intoover stressedmuscles

• Self treat dailywear and tear of muscles

• Comes apart for easytravel and storage

• Four colors availablewww.pressurepositive.com

• Massage and soothe tired or overworked muscles

• Prepare conditioned muscles for action

• Save fingers and hands from fatigue

• Dense foam roller spins smoothly

• Easy to clean with antibacterialgel/spray

• Completely portable

• For best results, use with The Original Backnobber® II

Circle No. 141


Lower-Body Strengthening

Ergonomically corrEctThe Hammer Strength Linear Leg Press

was developed through years of col-laboration with athletes and coaches to simulate the most natural, ergo-

nomically-correct paths of motion. The machine’s long-lasting linear bearings create a smooth feel, and

the intuitive flip-in, flip-out weight racking mechanism is easy to use. Hammer Strength • 800-634-8637www.hammerstrength.com Circle No. 511

nEw and improvEdSled Dawg provides outstand-ing leg strengthening results. It was redesigned this year with added push handles for powerful hip and leg drive and new flat bottom rails for more consistent resistance. Sted Dawg is built

with 11-gauge steel to create an extremely strong frame, and comes with a shoulder harness attachment that allows for an even load. Perform Better • 800-556-7464www. performbetter.com Circle No. 512

Jump-Start trainingThe high-impact TurfCordz

Jump Belt, used by profes-sional sports teams and international Olym-pians, strengthens leg

muscles to enhance vertical leap. With five resistance levels, it’s ideal for basketball, football, and track training. Designed to meet the extreme demands of high-level athletic training, the easy-to-use Jump Belt features an adjustable cam buckle closure that fits up to a 36-inch (90-centimeter) waist and two 30-inch (75-centi-meter) rubber tubes that connect to foot straps.NZ Manufacturing • 800-866-6621www.turfcordz.com Circle No. 513

rEducing rEcovEry timEi-Shape’s unique Tonic Vibration Reflex (TVR) technology offers whole body vibration training featuring a distinctive stretching cage, dual vibrating platform, and intuitive virtual LED coach to guide users through multi-level, full-body work-

outs. Athletes can utilize i-Shape to stimu-late stretch-reflex muscle contractions with targeted lower-body exercises to quickly and

effectively reduce recovery time post-injury and increase muscular strength, explosive power, flexibility, and range of motion. efi Sports Medicine • 800-541-4900www.efisportsmedicine.com Circle No. 514

agility and rEactionThe Multi Challenge Board provides two levels of balance challenges. Simply pull out and turn the sphere base to adjust the board angle from 14 to 17 degrees. Regular use provides improved balance and coordina-tion, increased leg strength and ankle range of motion, better proprioceptive awareness for injury prevention, and more. OPTP • 800-367-7393www.optp.com Circle No. 515

gaining powErSpecifically designed for the athletic performance market, the Keiser Runner focuses on starting strength and acceleration—two skills that are crucial for sports that involve explosive power. The Runner allows athletes to train the lower body by using the components of speed and resistance, and can improve the performance of any individual looking for a competitive edge.Keiser • 800-888-7009www.keiser.com Circle No. 516

good vibrationSExervibe is a whole-body vibration stepper that provides athletic enhance-ment when used in either the static (standing) or dynamic (stepping) posi-tion. Vibration stimulation is applied simultaneously to the feet, hands, arms, and core. The Exervibe is a cardio stepper and a vibration trainer in one. It has a step range from one to 18 inches, an adjustable seat, and a control module with four different set-tings. It is an extremely versatile device that efficiently and effectively implements the benefits of vibration. VersaClimber • 800-237-2271www.versaclimber.com Circle No. 518

two machinES in onEThe Leg Curl and Extension features a contoured rear seat back to promote proper body alignment and an extra-wide front seat. It’s made with heavy-duty 2” x 4” construction and designed for Olympic and standard plates. Hold-down rollers, an adjustable and removable T-bar, and easy pull-pin adjustment let you switch from leg extensions to leg curls quickly and conveniently. There’s also a rotary range-of-motion adjustment to enable various starting positions. New York Barbells of Elmira, Inc. • 800-446-1833www.newyorkbarbells.com Circle No. 517

Directory

Advertising Directory

138. .AAE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

111. .AccuFitness . . . . . . . . . . . . . . . . . . . . . . . . . . 18

110. .All-Pro Science . . . . . . . . . . . . . . . . . . . . . . . 17

119. .Balanced Body . . . . . . . . . . . . . . . . . . . . . . . 27

122. .Biodex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

130. .California University of Pennsylvania . . . . . . . 42

113. .CeraSport . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

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

121. .Concussion Vital Signs . . . . . . . . . . . . . . . . . . 32

125. .Cramer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

140. .Creative Health Products . . . . . . . . . . . . . . . . 62

126. .DJO/DonJoy . . . . . . . . . . . . . . . . . . . . . . . . . 38

108. .EAS/Abbott Nutrition . . . . . . . . . . . . . . . . . . . 13

127. .efi Sports Medicine/Total Gym . . . . . . . . . . . . 39

115. .Egg Whites . . . . . . . . . . . . . . . . . . . . . . . . . . 21

100. .Empi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .IFC

102. .Gatorade . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

135. .Hammer Strength . . . . . . . . . . . . . . . . . . . . . 52

112. .Healthy Shot . . . . . . . . . . . . . . . . . . . . . . . . . 19

116. .Hibiclens & Hibistat . . . . . . . . . . . . . . . . . . . . 22

124. . ImPACT Applications . . . . . . . . . . . . . . . . . . . 35

114. . Informed-Choice . . . . . . . . . . . . . . . . . . . . . . 20

105. .Keiser . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

142. .McDavid . . . . . . . . . . . . . . . . . . . . . . . . . . . IBC

109. .MilkPEP . . . . . . . . . . . . . . . . . . . . . . . . . . 14-15

103. .Mueller . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

143. .Muscle Milk (CytoSport) . . . . . . . . . . . . . . . . . BC

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

134. .New York Barbells of Elmira . . . . . . . . . . . . . . 51

128. .OPTP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

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

133. .Power Lift . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

120. .PRO Orthopedic Devices . . . . . . . . . . . . . . . . 28

131. .Pro-Tec Athletics . . . . . . . . . . . . . . . . . . . . . . 43

129. .RX24 QuadraStep System (Nolaro24) . . . . . . . 42

136. .Samson Equipment . . . . . . . . . . . . . . . . . . . . 53

139. .Save-A-Tooth . . . . . . . . . . . . . . . . . . . . . . . . 62

107. .STOTT PILATES . . . . . . . . . . . . . . . . . . . . . . . 10

141. .The Pressure Positive Company . . . . . . . . . . . 56

118. .Thera-Band®/Performance Health . . . . . . . . 25

137. .TurfCordz/NZ Mfg. . . . . . . . . . . . . . . . . . . . . . 54

132. .UCS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

117. .VersaClimber . . . . . . . . . . . . . . . . . . . . . . . . . 24

Product Directory

Circle # Company Page # Circle # Company Page # Circle # Company Page #

Circle # Company Page # Circle # Company Page # Circle # Company Page #

556. .AccuFitness . . . . . . . . . . . . . . . . . . . . . . . . . . 62

501. .All-Pro Science (Complete Veggie Protein) . . . 55

509. .All-Pro Science (Recovery Advanced Sports Formula) 56

529. .Balanced Body (CoreAlign) . . . . . . . . . . . . . . . 61

527. .Balanced Body (EXO Chair) . . . . . . . . . . . . . . 61

544. .Biodex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

554. .CeraSport . . . . . . . . . . . . . . . . . . . . . . . . . . . 62

532. .Cho-Pat . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62

557. .Concussion Vital Signs . . . . . . . . . . . . . . . . . . 63

545. .Cramer (Cohesive Stretch Tape) . . . . . . . . . . . 64

547. .Cramer (Sideline Emergency Kit) . . . . . . . . . . 63

502. .CytoSport (Complete Casein) . . . . . . . . . . . . . 55

510. .CytoSport (Whey Isolate) . . . . . . . . . . . . . . . . 56

500. .EAS (P3 Technology) . . . . . . . . . . . . . . . . . . . 55

507. .EAS (Pro Science Push) . . . . . . . . . . . . . . . . . 55

514. .efi Sports Medicine (i-Shape). . . . . . . . . . . . . 57

520. .efi Sports Medicine (Total Gym) . . . . . . . . . . . 59

504. .Egg Whites . . . . . . . . . . . . . . . . . . . . . . . . . . 55

551. .Fyrst USA . . . . . . . . . . . . . . . . . . . . . . . . . . . 64

508. .Gatorade (G Series Pro Nutrition Bar/Shake) . . 56

506. .Gatorade (G Series Pro Protein Recovery Shake) . . 55

511. .Hammer Strength (Linear Leg Press) . . . . . . . 57

524. .Hammer Strength (V-Squat) . . . . . . . . . . . . . . 60

503. .Hormel Health Labs (Healthy Shot) . . . . . . . . . 55

555. .Hydrate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62

563. . ImPACT Applications . . . . . . . . . . . . . . . . . . . 61

550. . Informed-Choice . . . . . . . . . . . . . . . . . . . . . . 56

519. .Keiser (Air300 Squat). . . . . . . . . . . . . . . . . . . 59

516. .Keiser (Runner) . . . . . . . . . . . . . . . . . . . . . . . 57

533. .McDavid (True Compression Leg Sleeves) . . . 62

543. .McDavid (True Compression Recovery Suit) . . 63

505. .MilkPEP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

535. .Mueller . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

517. .New York Barbells (Leg Curl and Extension) . . 57

521. .New York Barbells (Premier Leg Press) . . . . . 59

515. .OPTP (Multi Challenge Board) . . . . . . . . . . . . 57

526. .OPTP (Thera-Band Band Loops) . . . . . . . . . . . 59

522. .Perform Better (Plyo Boxes) . . . . . . . . . . . . . . 59

512. .Perform Better (Sled Dawg) . . . . . . . . . . . . . . 57

538. .Performance Health (Biofreeze fall promotion) 64

546. .Performance Health (Thera-Band Foot Roller) 63

548. .Power Lift (Body Weight Leg Curl) . . . . . . . . . 59

549. .Power Lift (Pro Select Reverse Back Extension) 60

523. .Power Systems (Adjustable Lateral Plyo Box) . 60

531. .Power Systems (Pilates Versa-Tube) . . . . . . . 61

542. .PRO Orthopedic (ice wraps) . . . . . . . . . . . . . . 64

539. .PRO Orthopedic (latex tubing units) . . . . . . . . 60

540. .Pro-Tec . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

537. .RX24 QuadraStep System (Nolaro24) . . . . . . . 61

561. .Samson (Belt Squat) . . . . . . . . . . . . . . . . . . . 59

560. .Samson Equipment (Sprinter) . . . . . . . . . . . . 60

541. .Save-A-Tooth . . . . . . . . . . . . . . . . . . . . . . . . 64

528. .STOTT PILATES (Split-Pedal Stability Chair) . . 61

530. .STOTT PILATES (Workout Kit) . . . . . . . . . . . . . 61

513. .TurfCordz/NZ Mfg. . . . . . . . . . . . . . . . . . . . . 57

553. .UCS (Elite Plyo-Safe boxes) . . . . . . . . . . . . . . 59

552. .UCS (Plyo-Safe G2 boxes) . . . . . . . . . . . . . . . 60

518. .VersaClimber (Exervibe) . . . . . . . . . . . . . . . . . 57

525. .VersaClimber (Portable VersaPulley) . . . . . . . . 60




All in OneTotal Gym enables free, unrestricted movement

through multiple planes of motion for more than 250 functional exercises on a single ma-

chine: the Total Gym GTS or To-tal Gym PowerTower commercial models. A groundbreaking study published in the North American

Journal of Sports Physical Ther-apy proved Total Gym provides a

reliable, accurate measure of lower extremity functional performance in individuals with restricted weight-bearing ability at an earlier stage in the rehabilitation process.efi Sports Medicine • 800-541-4900www.efisportsmedicine.com Circle No. 520

Strength And BAlAnceAvailable in four resistance levels and three diameters, Thera-Band Band Loops can be used for a variety of applications, particularly in lower-body exercises to increase strength and balance. These continuous loop bands are available in the same colors and resistances as the Thera-Band Progressive Resistance System. OPTP • 800-367-7393www.optp.com Circle No. 526

high PerfOrmAnceThe Keiser Air300 Squat combines low-impact technology with the ability to move safely at higher speeds. The result is unmatched, explosive power—the key to superior athletic performance. Thumb buttons for resistance are conveniently positioned on the ends of the handgrips for greater control and stability during

exercise, and a range-limiting feature helps prevent ligament and joint injury to the knee.

Keiser • 800-888-7009www.keiser.com Circle No. 519

A SteP UPPlyo Boxes are great for developing explosive leg power, leg strength, and dynamic balance. Designed for safety with a large landing surface, they are durable enough to hold the largest and most powerful people in athletic and clinical settings. Plyo Boxes are made from 1 1/4” 14-gauge tubular steel with a 3/8” polyurethane rubber stop,

and are available in six-, 12-, 18-, 24-, 30-, and 36-inch heights and from 18” x 18” to 36” x 36”. Perform Better • 800-556-7464www. performbetter.com Circle No. 522

BUilt tO lAStThe Premier Leg Press is mounted on eight heavy-duty rollers and features an extra-wide steel deck foot plate. The deluxe three-inch thick stitched padding and heavy-duty stoppers ensure athlete comfort and safety. This unit is 49” wide x 47” deep x 75” high and weighs 196 pounds. It has a 1,000-pound capacity to accommodate all levels of strength train-

ing by serious athletes in all sports. New York Barbells of Elmira, Inc. • 800-446-1833www.newyorkbarbells.com Circle No. 521

hAmStringS & glUteSThe Power Lift Body Weight Leg Curl is the newest ham-string and glute training ap-paratus from Power Lift. The Power Lift Body Weight Leg Curl features thick pads for user comfort, angled footplate, ankle pads with four height adjustments, wheels, and a handle to assist with movement. Band pegs are included and can be used to assist the user with the movement. The Bodyweight Leg Curl is a great complement to any strength training facility.Power Lift • 800-872-1543www.power-lift.com Circle No. 548

PlyOmetricS mAde SAferUCS Strength and Speed’s fully padded Elite Plyo-Safe boxes offer the ultimate combination of dura-bility, stability, and safety, provid-ing protection from common plyo box injuries. The understructure is made of 3/4-inch oak covered in a dense foam and upholstered in tough 38-ounce vinyl. A raised lip on all the boxes allows for stacking and locking of the lids. The 24-inch box is bottomed with 3/4-inch high-density rubber for stability. UCS, Inc. • 800-526-4856 www.ucsspirit.com Circle No. 553

ideAl fOr everyOneThe Samson Belt Squat’s brand new design limits the amount of floor space needed for this unique piece while making it easy for athletes of all different sizes to use. It features adjust-able handles, a unique load release that brings the athlete’s hands closer together while per-forming the exercise, an adjustable yoke that allows the athlete’s hips to stay in their natural range of motion, and an adjustable chain with three different size belts. Samson Equipment • 800-472-6766www.samsonequipment.com Circle No. 561



Durability anD reliabilityThe Hammer Strength V-Squat ma-chine provides Iso-Lateral technology that replicates the body’s natural move-ments. Athletes can perform a natural squatting motion on the V-squat since it is designed to reduce back and knee strain through a curved arc of motion. Standard counter balance provides lower starting resistance and dual selectorized weight stacks preserve the

integrity of independent leg action. Hammer Strength • 800-634-8637www.hammerstrength.com Circle No. 524

Select choiceThe Power Lift Pro Select Reverse Back Extension is the latest Pro Select lower body piece. All Power Lift Pro Select machines feature extra large pads for user comfort, 7-gauge steel construction, weight stack guards, and instructional placards. Key features for the Reverse Back Exten-sion include a 400-pound weight stack, an adjustable start position, adjustable ankle

pad, and multiple hand grip positions to accommodate a wide range of user sizes.Power Lift • 800-872-1543www.power-lift.com Circle No. 549

ProviDing reSiStanceSupplementing a rehab or conditioning program is easy with PRO’s variable resistive latex tubing units. Available in three resistances, each unit has a handle/foot stirrup attachment at each end with a moveable door jam attach-ment in the center, and comes with a webbed running belt, basic exercise booklet, and nylon travel bag.PRO Orthopedic Devices • 800-523-5611www.proorthopedic.com Circle No. 539

Safety that laStSUCS Strength and Speed’s Plyo-Safe G2 boxes provide a lightweight, safe, and sturdy option for your plyometric routines. An extra-large landing surface (30” x 36”) is covered in durable 21-ounce vinyl. The 100-percent foam core will not break down, delaminate, or soften over time. Handles allow for quick repositioning. Each box has three two-inch strips of Vel-

cro™ to enable stacking and prevent slipping during use. UCS, Inc. • 800-526-4856 www.ucsspirit.com Circle No. 552

a SteP uP Athletes can achieve explosive lateral move-

ments and strong, quick direction changes with the Adjustable Lateral Plyo Box. The highly durable platform adjusts to 25, 35, or

45 inches tall to target all the muscles of the ankle, leg, and hip, and the reinforced non-slip platform provides

a stable, secure contact area for the user. Each side can also hold a 45-pound plate,

which is sold separately.Power Systems • 800-321-6975www.power-systems.com Circle No. 523

Performance enhancerThe Portable VersaPulley combines speed, power, and functional mobil-ity through any range of motion with accommodating inertial resistance at any speed. Its lightweight, compact design and ease of mobility is ideal for on-field or on-court training by simply securing with adjustable straps. While the Portable VersaPulley weighs just 70 pounds, its patented technology can produce up to 800 pounds of explosive force resistance. Athletic trainers now have the ability to hand carry this unit to a field and apply a multitude of safe, sport-specific training drills. VersaClimber • 800-237-2271www.versapulley.com Circle No. 525

SPrinting towarD StrengthThe new Samson Sprinter is yet another way Samson Equipment is leading the way in heavy-duty custom equipment. This unique piece allows your athletes to perform a sprint motion while in a biome-chanically sound running position. Adding resistance is made easy with the plate-loaded weight horns that are designed to prevent any plate movement. Created with comfort, durability, and adjustability in mind, the new Samson Sprinter will fit every athlete comfortably, and just like any other Samson piece, it will last a lifetime. Go online for a video demonstration. Samson Equipment • 800-472-6766 www.samsonequipment.com Circle No. 560

Looking for a fast, easy way to get CEUs?You can now take CEU quizzes of T&C issues online!

Click on “CEUs & Courses” on the toolbar at the top of the page at:

www.training-conditioning.com

➤ No pencil, envelope, or stamp needed. Just fill in the easy-to-use online form.

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TCCEUOnline_sixth.indd 1 8/19/10 1:16:16 PM


Feel the WaveDesigned to help increase the natural blood flow around muscles, Mueller Kinesiology Tape features a revolutionary wave pattern adhesive that moves with skin and muscles to reduce muscle pain, increase mobility, and enhance recovery. Applied to the skin in patterns that mimic muscles, it aids in the treatment of liga-ment injuries, muscle conditioning, fascia repositioning, and even carpal tunnel syndrome. The 100-percent cotton tape is latex-free and is available in four colors. Mueller Sports Medicine • 800-346-9522www.muellersportsmed.com Circle No. 535

What’s Your Foot tYpe?The Rx24 QuadraStep system is based on a clinical algorithm identi-fying 24 unique foot types. These 24 types are subdivided into six group-ings of four, known as Quads. Each Quad has its own specific foot and gait characteristics, contributing to various conditions and pathologies that can afflict patients throughout their lives. Unlike other prefabricated orthoses that have a “one shape fits all” limi-tation, the Rx24 QuadraStep system offers a more tailored solution for each foot type. Nolaro24, LLC • 877-RX24-NOWwww.whatsmyfoottype.com Circle No. 537

expanding the possibilitiesThe ExO Chair delivers a unique and challenging Pilates-based workout. Athletic trainers can now get a wider range of options with a split-pedal ver-sion that allows both reciprocal and

rotational exercises. And by adding a functional resistance kit, they gain even more possibilities, including many exer-cises that could previously be done only on a Reformer. Balanced Body • 800-745-2837www.pilates.com Circle No. 527

a total-bodY FocusImprove athletic performance and reduce the risk of sports-related injuries by incorporating the STOTT PIlATES® Split-Pedal Stability Chair™ into any athletic training program. This multi-function Pilates machine targets almost all muscle groups to build on the strength, power, and agility of the whole body. It

enables athletes to condition both the core and periphery, and balance stability with mobility while improving focus, awareness, control, and coordination. StOtt PiLateS® • 800-910-0001www.stottpilates.com Circle No. 528

upping the antelooking for a new way to add challenge to your training regimen? The Pilates for Ath-letic Conditioning Workout Kit is equipped with everything athletic trainers need to increase strength, boost stamina, prevent injury, and increase variety in any workout.

StOtt PiLateS® • 800-910-0001www.stottpilates.com Circle No. 530

the poWer oF resistanceAthletes can strengthen the core muscles while improving flexibility and postural awareness with the Pilates Versa-Tube.

This compact tool simulates Reformer- or Cadil-lac-style workouts without the heavy equip-ment, and is available in four resistances to

meet the needs of any user. Four equal-length resistance tubes with two handles and two ankle/foot cuffs allow for full range of motion movement in the arms and legs.Power Systems • 800-321-6975www.power-systems.com Circle No. 531

combination approachThe CoreAlign combines cardiovascu-lar work and integrated, full-body ex-ercises with a mind-body approach. It stimulates core stability muscles to fire while performing exercises, stretches, and core-controlled aerobic training.

The CoreAlign’s sliding carts move independently, with variable resistance/assistance possible in both directions. Balanced Body • 800-745-2837www.pilates.com Circle No. 529

Pilates More Products

concussion management There is strong evidence demon-strating the impact of balance deficits on functional performance and increased risk of re-injury. Play It S.A.F.E. is a concussion management system that combines cognitive and functional assess-ment using the Biodex BioSway Portable or the Biodex Balance System SD and the cogni-tive tool of choice. It’s a “single source” program that adds vestibular and objective balance assessment, which are critical in concussion management.Biodex Medical Systems • 800-224-6339www.biodex.com/concussion Circle No. 544

What is impact?ImPACT is a sophisticated, research-based software tool developed to help sports-medicine clinicians evaluate recov-ery following concussion. The program is a 20-minute test battery that can be ad-ministered in the pre-season for a baseline and post-injury to track a concussion. The ImPACT program evaluates and documents multiple aspects of brain functioning including memory, processing speed, reaction time, and post-concus-sive symptoms. In addition, the ImPACT program provides a user-friendly injury documentation system.imPaCt • 877-646-7991www.impacttest.com Circle No. 563


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Greater reliefCho-Pat’s patented Dual Action Knee Strap provides an extra dimension of relief for painful and weakened knees. First, it applies pressure on the patellar tendon below the knee to reduce instability and improve patel-lar tracking and elevation. Then, it applies pressure on the patellar tendon above the knee to further strengthen and provide an additional level of support and stability for the joint. It is easy to apply and comfortable to wear, and the fabric-covered neoprene construction allows for full mobility. In addition, this American-made support is available in five sizes to provide more specific and effective results. Cho-Pat • 800-221-1601www.cho-pat.com Circle No. 532

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recovery for runnersFrom McDavid, the innovators of muscle compression tech-nology, True Compression Leg Sleeves reduce the buildup of lactic acid and increase the circulation of the blood. They compress calves and shins for effective muscle recovery, while HydraVent hDc moisture management keeps lower legs dry and comfortable.McDavid • 800-237-8254www.mcdavidusa.com Circle No. 533

sustained HydrationCeraSport and CeraSport EX1 rice-based hydration and performance drinks, developed along with doctors from Johns Hopkins, are a patented blend of brown rice and essential electrolytes, including citrate to counteract acidosis. CeraSport is fat-free and certified gluten-free. It provides energy for performance and quick, yet sustained hydration. Available in several flavors and in powder, concentrate, and ready-to-drink, CeraSport can be delivered to your home or office. CeraSport • 866-237-2770www.cerasport.com Circle No. 554

Water WHerever neededThe Hydrate cart is well known for performance and reliability. Its warranty is unmatched in the industry, and the machines are very easily transported. If you want a machine that will last and equipment that you can count on, trust Hydrate for your hydration system needs. Go online for more information. Hydrate, LLC • 407-694-1034www.hydrate1.com Circle No. 555

Body composition measurinG & trackinGMeasure, calculate, track, and chart body fat, lean body mass, and body composition results using the FatTrack Gold Premium Digital Body Fat Caliper with free Body Tracker software and MyoTape. The Cali-per is compact, portable, and accurate. It calculates body fat percentage on the spot, making it perfect for athletic trainers. Enter information for each athlete into Body Tracker software to calculate with multiple formulas, track and chart results over time. Photos can also be uploaded for visual progress comparisons. AccuFitness provides outstanding fitness tools for training and conditioning professionals.AccuFitness • 800-866-2727www.accufitness.com Circle No. 556

Train, CompeTe, reCoverDesigned to be worn after grueling workouts or heavy competition, McDavid’s True Compression Recovery Suit utilizes true compression fabric to increase blood circulation and reduce the amount of lactic acid build-up in the muscles, which promotes faster, more com-

plete recovery of torn and damaged muscle tissue. Large muscles groups are targeted with compression to promote

fast recovery, while reducing pressure on knees, shins, and groin muscles to allow comfort and unrestricted movement during recovery. Designed to reduce stitches at inner thighs and eliminate hot spots, the TCR Suit includes a Spandex elastic waistband and hemmed legs for comfort and firm fit. McDavid • 800-237-8254www.mcdavidusa.com Circle No. 543


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on a rollThe Pro-Tec Foam Roller is a great tool for stretch-ing, promoting flexibility, and myofascial release. The high-density Foam Roller alleviates muscle and soft tissue tightness of the upper and lower back, IT band, hamstring, adductors, upper arm, and much more, helping increase blood flow and circulation. To

facilitate use of the Foam Roller, a color exercise program is included with stretching exercises, techniques, and photos. The foam rollers come in four sizes: 4” x 12”, 4” x 35”, 6” x 18”, and 6” x 35”.Pro-Tec Athletics • 800-779-3372www.injurybegone.com Circle No. 540

essenTials on HandWith a heavy-duty PVC tarpaulin shell, the Cramer Sideline Emergency Kit is designed to bring together all the necessary emergency management tools into one easily identifiable and easy-to-organize wheeled bag. The four interior bags can be labeled for a variety of specific needs, and they’re color-coded for fast visual recognition in an emergency.

Cramer Products, Inc. • 800-345-2231www.cramersportsmed.com Circle No. 547

Cool rollerThe Thera-Band Foot Roller is an ideal tool for ath-letes seeking temporary relief from pain associated with plantar fasciitis and over-activity. Following the illustrated exercise instructions, athletes can

use the roller to stretch the plantar fascia and toes to increase flexibility. Those experiencing soreness from tired feet will find the massag-ing benefits of the roller pleasant and therapeutic. In all applications, the Foot Roller can be chilled or frozen to help reduce inflammation. Performance Health • 800-321-2135www.thera-band.com Circle No. 546

Testimonials

ConCussion TesTing plaTformConcussion Vital Signs is an easy-to-use sports concus-sion testing platform that enables the rapid assessment of neurocognitive function, concussion symptoms, and sports concussion history to help you efficiently evaluate and manage concussion injuries. Your annual subscrip-tion provides unlimited use for both baselining and post-

injury testing. For more information or for a free demo, call or go online. Concussion Vital Signs • 888-750-6941www.concussionvitalsigns.com Circle No. 557

Your Body Is the Driver

Lebert Equalizer™: “Surprisingly effective—even for hard-core athletes. My initial skepticism over the bare-bones devices disappeared with an opportunity to do real dips, push-ups, one-legged squats, knee-raises, and weird but hard supine pull-ups. A laminated chart offers several more body-weight exercises, stretches, and even an upright row (using one support as the weight). Dislikes: None.”

—Product review, Los Angeles Times

Lebert Buddy System™: “I’m just wondering if you received my last order for four more Buddy Systems. The product is fantastic! What a complete workout! There is nothing you can’t do with this piece of equipment. I have introduced it to my exercise science students, and they all love it. Talk about conditioning for athletes—you won’t find a better piece of equipment. From working the core to strength, stamina, and cardio, you get it all.”

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

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

—Product review, PFP Magazine

Lebert Fitness • www.lebertfitness.com905-785-0626www.lebertequalizer.comwww.lebertbuddysystem.comwww.lebertstretchstrap.com


Company News

No LimitsThe Biofreeze 2010 fall promotion offers free products and discounts. When custom-ers buy 10 patient-size Biofreeze products, they get two free, plus an additional 15-per-cent discount off any Hands-Free Applicator or Max Strength Wipes deal. There are no deal limits, and this offer is valid until September 30, 2010. Pre-orders are accepted. Performance Health • 800-246-3733www.biofreeze.com Circle No. 538

The evolution of the Waterboy

There are photos of football games in the early days of the sport showing a water bucket on the sidelines beside the old leather helmets and leather shoulder pads. There was no ice in the buckets and they held only one-two gallons of water that was dispensed with a ladle. But, of course, back then only the weak drank water.

Once coaches and athletic trainers understood the importance of keeping their players hydrated, coolers were created offering five and 10 gallons of ice water dispensed into cups. However, the process of filling, refilling and carrying the coolers was extremely cumbersome.

Then the portable water fountain came onto the scene, with several models introduced. But in 1997, the business of hydrating football players all changed. That’s when Waterboy Sports began selling hydration units to meet the changing needs of football players, athletic trainers and coaches.

Waterboy Sports’ innovations in the industry include the following:

• Integration of 20-, 40-, and 65-gallon (non- leaking) tanks to store the water and wagons instead of dollies to transport the water• Creation of the “Chiller,” enabling the athletic trainer to add ice to the water and not have to refill the water unit for the entire practice• Design of inline systems with individual shut off valves to take the place of the old coach built PVC pipes with holes drilled in them and to design. “Gravity” units that allow a trainer to adapt his inexpensive coolers to hydrate four players at one time• “Quick- Fill” bottles that eliminate lid removal and deter dipping into coolers, and “Safety Spouts” to combat contamination• Hydration unit models offered in a price range that smaller schools and youth leagues can afford

The evolution of the “Waterboy” is an example of a product being created and expanding to solve the needs of its customers. And Waterboy Sports will continue to evolve as these needs change, because, unlike in the “old days,” it’s known that hydration and football performance go hand in hand.

Waterboy • 888-442-6269 www.waterboysports.com

More Products

EmErgENcy HELpThe #911 Sport Medical Kit and Refill Pack have antimicrobial skin wipes to kill MRSA and flu viruses and a blot-blood-off cloth that removes blood quickly from uniforms. Pre-packed sport wound care kits for field injuries, a blister kit with second skin and pressure pads, antiseptic pads, large instant cold packs that remain at 33 degrees for up to 30 minutes, a cold pack holder with a hook and loop, and an ID tag for emergency information complete this refillable kit.Fyrst USA • 800-782-1355www.fyrstusa.com Circle No. 551

Wrap it rigHtCramer Cohesive Stretch Tape is an inno-vative choice that beats traditional stretch-ing and self-adhering tape. It has excellent tensile strength, tears clean, and features a non-slip grip, making it superior to many traditional tapes. It’s excellent for use as an anchor for tape applications or compression bandages. The stretch tape contours easily to the body, allowing athletic train-ers to effortlessly wrap any appendage. Cramer Products, Inc. • 800-345-2231www.cramersportsmed.com Circle No. 545

coLd comfortPRO ice wraps are an excellent way to apply cold therapy to most minor injuries. Made with quality neoprene for durability, these wraps are designed for treatment of pulls and strains, and are available for the shoul-der (#439), knee (#103), or back (#208). The wraps are quick and easy to use, allowing for adjustable compression to keep ice packs in place. PRO Orthopedic Devices • 800-523-5611www.proorthopedic.com Circle No. 542

BEcausE timE mattErsWithout proper care, a knocked-out tooth begins to die in 15 minutes. The Save-A-Tooth® emergency tooth preserv-ing system utilizes Hank’s Balanced Salt Solution (HBSS) to not only preserve, but also reconstitute many of the degenerated cells. The patented basket and net container are designed to pro-tect tooth root cells. This is the only system that keeps tooth cells alive for up to 24 hours. Save-A-Tooth® • 888-788-6684www.save-a-tooth.com Circle No. 541


CEU QUIZQuicker & Easier!

You can now take our CEU quizzes online...

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Click on “CEUs & Courses” at:

www.training-conditioning.com

T&C September 2010Volume XX, No. 6

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

Instructions: Go to www.training-conditioning.com and click on “CEUs & Courses” to take the quiz online. You may also mail your quiz to us: Fill in the circle on the answer form (on page 67) that represents the best answer for each of the questions below. Complete the form at the bottom of page 67, include a $25 payment to MAG, Inc., and mail it to the following address: MAG, Inc., ATTN: T&C 20.6 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: Learn about recent research, current issues, and news items of interest to athletic trainers and other sports medicine professionals.

1. Jon Sekiya says the most common reason ACL repairs fail is _____.a) Athletes returning to play too soonb) Technical errorc) The wrong rehabilitation programd) Poorly-made knee braces

2. An American Board of Orthopedic Surgery survey found 85 percent of surgeons who perform ACL recon-structions do _____ or fewer per year.a) 10b) 15c) 20d) 25

3. Subjects in the IUPUI study who participated in the hip-strengthening program reported a pain level of _____ after a six-week trial period.a) 10b) Sevenc) Four to fived) Two or lower

4. What serving sizes of milk did the women in the McMaster University study drink?a) 500 millilitersb) A half-gallonc) One literd) Eight ounces

5. Study researchers who presented at the ACSM Annual Meeting said around _____ of the athletes they evaluated were misclassified as overweight or obese according to BMI.a) 20b) 30c) 40d) 50

A Weighty Issue (pages 12-20)Objective: Get advice on how you can help athletes gain weight in a healthy and effective way.

6. Which body type has a stocky build and tends to gain both muscle mass and body fat easier than other body types?a) Endomorphsb) Ectomorphsc) Mesomorphsd) Massomorphs

7. Which body type has tall, naturally thin and lean bodies?a) Endomorphsb) Ectomorphsc) Mesomorphsd) Massomorphs

8. During periods of weight gain, around _____ percent of overall energy should come from carbohydrates.a) 20-30b) 35-45c) 50-65d) 70-80

9. Males have the most success gaining muscle mass at what age?a) Late teens and early 20sb) 13c) Over 21d) Late 20s and early 30s

10. A healthy initial body fat range for males is _____ percent.a) 16 to 24b) Eight to 15c) 25 to 30d) Less than 5

Answer sheet is on page 67...or take this quiz online and get instant results:www.training-conditioning.com

click on CEUs & Courses


CEU QUIZ

11. A healthy initial body fat range for females is _____ percent.a) 16 to 24b) Eight to 15c) 25 to 30d) Less than 5

12. One of the author’s points of advice is to have athletes eat small meals every _____ throughout the day.a) Half-hourb) Hourc) Two to three hoursd) Five hours

Cry for Help (pages 23-28)Objective: Learn to spot the signs of anxiety and depression in athletes.

13. Over the course of one year, about _____ percent of the U.S. population develops an anxiety disorder.a) 4b) 8c) 12d) 16

14. Over the course of one year, about _____ percent of women develop some degree of clinical depression.a) 5b) 8c) 12d) 20

15. Anxiety-related symptoms may include:a) Increased heart rate, muscle tension, upset stomachb) Increased heart rate and low blood pressurec) Muscle tension and normal heart rated) Upset stomach, weak muscles, ease falling asleep

16. Why is it not unusual for a depressed student-athlete’s athletic life to appear normal?a) They “suck it up” at practices and gamesb) Sports is their escape or refuge where they can leave be-hind anything that’s bothering them.c) They have a “no excuses” mantrad) Athletes are often “moody” on the athletic field anyway

17. Examples of behaviors that fall into the clinical range of depression include: a) Irritated but not explosive, frustratedb) Persistently anxious, apathetic, insomniac) Minor sleep disturbances, sometimes sadd) Nervous, somewhat isolated, angry

18. When seeking a mental healthcare professional to work with an athlete, the author says it may be helpful to remember the Four A’s, which are:a) Affordable, Available, Angry, and Acceptingb) Amiable, Accountable, Asking of questions, and Af-fordablec) Apathetic, Accepting, Affordable, and Availabled) Affordable, Available, Amiable, and Accepting

What Happens Next? (pages 30-35)Objective: Learn how to safely return a concussed athlete to play.

19. It’s been estimated that _____ of all concussions sus-tained by athletes in the U.S. go unreported.a) A quarterb) About 30 percentc) Just under 50 percentd) Over half

20. Post-concussion, physical healing within the brain takes an average of _____ days in adults.a) Seven to 10b) 14c) Four to fived) 21

21. What is the most promising-looking pharmacological agent for boosting recovery after a concussion?a) Corticosteroidsb) Progesteronec) Calcium channel inhibitorsd) Vitamin D

Game Theory (pages 37-44)Objective: See how one athletic trainer is using video game systems in the athletic training room for rehab and injury prevention.

22. What is the name of one of the video games the au-thor has used for rehab purposes?a) P90Xb) Mario Brothersc) Dance Dance Revolutiond) Wii Bowling

23. To get more out of Wii games like boxing and tennis, the author has athletes perform what type of exercises on a BOSU ball?a) Chest pressesb) Pikec) Toe curld) Single-leg squat

Strong as Bulldogs (pages 49-54)Objective: Get an inside look at the Butler University men’s basketball strength and conditioning program.

24. The coaching staff’s expectation for the mile run test is that post players complete it in less than _____.a) Six minutesb) 5:45c) 5:30d) Five minutes

25. How many players benched over 300 pounds in last season’s one-rep max bench press test?a) Sixb) Sevenc) Eightd) Nine


CEU QUIZ AnswEr Form

Instructions: Go to www.training-conditioning.com and click on “CEUs & Courses” to take the quiz online. You may also mail your quiz to us: Fill in the circle on the answer form below that represents your selection of the best answer for each ques-tion. Complete the form at the bottom of this page, include a $25 payment to MAG, Inc., and mail it to the following address: MAG, Inc., Attn: T&C 20.6 Quiz, 31 Dutch Mill Road, Ithaca, NY 14850. Readers who correctly answer 70 percent of the questions will receive 2.0 BOC Athletic Training and 0.2 NSCA (two hours) CEU’s, and will be notified of their earned credit by mail within 30 days. Questions? Problems? E-mail: [email protected].

Last Name ____________________________________ First Name _______________________________ MI______

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A B C D A B C D

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