training & conditioning 14.5

July/August 2004Vol. XIV, No. 5$5.00

Searching for Symmetry

Addressing muscle imbalances through training

◆ An in-depth look at heart-related deaths

◆ Body image disorders among male athletes

Request No. 100

CONTENTS

F EATURES

Training & Conditioning • July/August 2004 • Vol. XIV, No. 5

P.37

◆ Spec ia l Focus ◆

In the Shadows..........13It’s not often discussed and just starting to be researched, but body-imagedisorders among male athletes are a real—and growing—problem.By R.J. Anderson

◆ In jury Prevent ion ◆

When a Heart Stops..........21Although it is rare, sudden cardiac death is a reality in the sports world.Here are the latest ideas on how to reduce heart-related deaths from bothtraumatic and nontraumatic causes.By Dennis Read

◆ Opt imum Per formance ◆

Searching for Symmetry..........31Athletes at all levels are prone to developing muscle imbalances. Makesure your strength training program is addressing this problem, ratherthan contributing to it.By David Pollitt

◆ Treat ing The Ath le te ◆

Soft Feet, Strong Legs..........37Want an easy way to help treat lower extremity injuries in your athletes?Orthotics are the answer, although it’s not clear whether they controlmechanics or alter neuromuscular activation patterns. By Dr. Jay Hertel and Dr. Lauren Olmsted

◆ Side l ine ◆

Hydration and Performance..........3

◆ Above the Cal l Award ◆

This Issue’s Winner..........4Nomination Form..........7

◆ Student Corner ◆

Choosing a Grad Program..........8By Dr. Debbie Bradney and Dr. Tim Laurent

◆ Compet i t ive Edge ◆

Down the Middle..........43Utilize your football athletes’ warmup time more effectively with thesepartner core stretches.By Gray Cook, Heath Hylton, and David Lee

Advertisers Directory..........58Heat Stress Prevention..........49Ankle & Footcare..........53Aquatic Therapy & Catalog Showcase..........56More Products & Services..........57Web News..........62CEU Quiz..........64

Special Pull-Out Guide…Web Site Supplier Directory…see page 11

P.21

P.43

P.13

Cover Photo: © Getty Images

DEPARTMENTS

◆ T&C J U L Y / A U G U S T 2 0 0 4 ◆ A T H L E T I C B I D . C O M2

Training & Conditioning (ISSN 1058-3548) is published monthly except in January andFebruary, May and June, and July andAugust, which are bimonthly issues, for a total of nine times a year, by MAG, Inc., 2488 N. Triphammer Rd., Ithaca, NY 14850.T&C is distributed without charge to qualifiedprofessionals involved with competitiveathletes. The subscription rate is $24 for one year and $48 for two years in the UnitedStates, and $30 for one year and $60 for twoyears in Canada. The single copy price is $5.Copyright© 2004 by MAG, Inc. All rightsreserved. Text may not be reproduced in anymanner, in whole or in part, without thepermission of the publisher. Unsolicitedmaterials will not be returned unlessaccompanied by a self-addressed, stampedenvelope. POSTMASTER: Send addresschanges to Training & Conditioning, P.O. Box 4806, Ithaca, NY 14852-4806.

Printed in the U.S.A.

Publisher Mark Goldberg

Editor-in-ChiefEleanor Frankel

Circulation Director Mark Shea

Associate & Assistant EditorsR.J. Anderson Dennis Read Kenny Berkowitz Greg Scholand David Hill Laura Smith Guillermo Metz

Art DirectorsKaren IresSuzanne Lynch

Production ManagerKristin Ayers

Assistant Production ManagerKristi Kempf

Production Assistants Jonni Campbell Hildi Gerhart

Prepress ManagerAdam Berenstain

Prepress Assistant Steve Rokitka

IT ManagerMark Nye

Business ManagerPennie Small

Special ProjectsDave Wohlhueter

Administrative AssistantsSharon Barbell Daniela ReisAmy Walton

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Advertising Sales AssociatesDiedra Harkenrider(607) 257-6970, ext. 24Sheryl Shaffer(607) 257-6970, ext. 21

T&C editorial/business offices: 2488 N. Triphammer RoadIthaca, NY 14850 (607) 257-6970Fax: (607) [email protected]

TRAINING & CONDITIONING • July/August 2004 • Vol. XIV, No. 5

Marjorie Albohm, MS, ATC/LDirector of Sports Medicine andOrthopaedic Research,Orthopaedics Indianapolis

Jon Almquist, ATCSpecialist,Fairfax County (Va.) Pub. SchoolsAthletic Training Program

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

Jim Berry, MEd, ATC,SCAT/EMT-BDirector of Sports Medicineand Head Athletic Trainer,Myrtle Beach (S.C.) High School

Leslie Bonci, MPH, RDDirector, Sports MedicineNutrition Program,University of PittsburghMedical Ctr. Health System

Christine Bonci, MS, ATCAsst. A.D. for Sports Medicine,Women’s Athletics,University of Texas

Cynthia “Sam” Booth, ATC, PhDManager, Outpatient Therapyand Sportsmedicine,MeritCare Health System

Debra Brooks, CNMT, LMT, PhDCEO, Iowa NeuroMuscularTherapy Center

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

Dan Cipriani, MEd, PTAssistant Professor,Dept. of Physical Therapy,Medical College of Ohio

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

Bernie DePalma, MEd, PT, ATCHead Athl. Trainer/Phys. Therapist,Cornell University

Lori Dewald, EdD, ATC, CHESAthletic Training ProgramDirector and Associate Professorof Health Education, University of Minnesota-Duluth

Jeff DiltsDirector, Business Development& Marketing, National Academyof Sports Medicine

David Ellis, RD, LMNT, CSCSSports Alliance, Inc.

Boyd Epley, MEd, CSCSAsst. A.D. & Dir. of Athletic Perf.,University of Nebraska

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

Lance Fujiwara, MEd, ATC, EMTDirector of Sports Medicine,Virginia Military Institute

Vern Gambetta, MADirector of Athletic Development,New York Mets

Joe Gieck, EdD, ATC, PTDirector of Sports Medicine andProf., Clinical Orthopaedic Surgery,University of Virginia

Brian Goodstein, MS, ATC,CSCS, Head Athletic Trainer, DC United

Gary Gray, PTPresident, CEO,Functional Design Systems

Maria Hutsick, MS, ATC/L, CSCSHead Athletic Trainer,Boston University

Christopher Ingersoll, PhD,ATC, FACSMDirector,Graduate Programs in SportsMedicine/Athletic TrainingUniversity of Virginia

Jeff Konin, MEd, ATC, MPTAssistant Athletic Director for Sports Medicine, James Madison University

Tim McClellan, MS, CSCSDirector of Perf. Enhancement,Makeplays.com Center forHuman Performance

Michael Merk, MEd, CSCSDirector of Health & Fitness,YMCA of Greater Cleveland

Jenny Moshak, MS, ATC, CSCSAsst. A.D. for Sports Medicine,University of Tennessee

Steve Myrland, CSCSOwner, Manager, Perf. Coach,Myrland Sports Training, LLCInstructor and Consultant,University of Wisconsin SportsMedicine

Mike Nitka, MS, CSCSDirector of Human Performance,Muskego (Wisc.) High School

Bruno Pauletto, MS, CSCSPresident,Power Systems, Inc.

Stephen Perle, DC, CCSPAssociate Prof. of Clin. Sciences,University of BridgeportCollege of Chiropractic

Brian Roberts, MS, ATCDirector,Sport Performance & Rehab. Ctr.

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

Kent Scriber, EdD, ATC, PTProfessor/Supervisor ofAthletic Training,Ithaca College

Chip Sigmon, CSCSStrength and Conditioning Coach,Carolina Medical Center

Bonnie J. Siple, MS, ATCCoordinator, Athletic TrainingEducation Program & Services,Slippery Rock University

Chad Starkey, PhD, ATCAssociate Professor,Athletic Training Educ. Program,Northeastern University

Ralph Stephens, LMT, NCTMBSports Massage Therapist,Ralph Stephens Seminars

Fred Tedeschi, ATCHead Athletic Trainer,Chicago Bulls

Terrence Todd, PhDCo-Director, Todd-McLeanPhysical Culture Collection,Dept. of Kinesiology & Health Ed.,University of Texas-Austin

Editorial Board

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Douglas J. Casa, PhD, ATC, FACSM

In sports, the difference between winningand losing often comes down to one criti-cal play. This is not a time for dehydrationto impact performance. If it does, theopponent is likely to walk away the win-ner.

That’s because your athletes need onlybe two percent dehydrated to feel itseffects on their physical and mental per-formance. At least that’s what a panel ofinternational experts discussed at arecent meeting of the American Collegeof Sports Medicine meeting in Boston.The group of exercise scientists, sportsphysicians and athletic trainers gatheredto examine the role of hydration on ath-letic performance and mental functioning.

Following are other findings andrecommendations:

Physical effects of dehydrationThe panel agreed that dehydration mightinhibit performance in athletes who losemore than two percent of their bodyweight in sweat. And that the effects ofdehydration on performance worsenwhen athletes are:

● Engaged in intense activity● Active in the heat, whether outside

on the field or inside a hot gym.

Fortunately, however, you can helpyour athletes by making sure they drinkenough to limit the extent of dehydration. While drinking water is bet-ter than nothing in providing some relief, the panel recommended aproperly formulated carbohydrate and electrolyte beverage as thebest option for rehydrating the body.

That’s because a good sports drink:● Replaces the fluids AND key minerals (like sodium) athletes lose

when they sweat. ● Provides carbohydrates for energy to sustain athletes throughout

training or competition.

Dehydration diminishes themental edgeWhile dehydration affects the body’sphysical skills and abilities, it alsocan—and often does—affect ath-letes mentally, according to thepanel’s findings. Memory, visualmotor skills and even mood might allbe diminished in a dehydrated play-er. It goes without saying thatreduced capacity does not bode wellfor athletic performance.

The panel also determined that it’sdifficult to move quickly and accu-rately and to understand verbalinstructions when dehydrated. Notgood, considering the challenges aperfectly healthy player faces on thefield—now worsened by the inabilityto think clearly.

Preventing Dehydration is EasyThe good news is these scenariosneed never happen because dehy-dration is easily preventable. Thepanel recommends doing that byworking with athletes to make surethey:

● Have a plan in place for drinkingbefore, during and after activity.

● Consume fluids at regular inter-vals to stay hydrated and main-tain performance and physiological function.

● Get an adequate amount of carbohydrates in a sports drink toenhance cognitive ability, mood, perceived exertion and performance.

Douglas J. Casa, PhD, ATC, FACSM is the director of the athletic trainingeducation program at the University of Connecticut.

Experts say Proper Hydration is Critical for Performance

For more information on hydration please visit the Sports Science Center at www.gssiweb.com.

Your athletes need only be two percentdehydrated to feel its effects on their

physical and mental performance..

AP/WIDE WORLD PHOTOS

4 ◆ T&C J U L Y / A U G U S T 2 0 0 4 ◆ A T H L E T I C B I D . C O M

T&C’s Above The Call AwardJuly/August 2004 WinnerEFISPORTSMEDICINE.COM

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Bubba Tyer un-retires to rejoin the Redskins.

Back For More

Kenny Berkowitz is an Assistant Editor atTraining & Conditioning.

By Kenny Berkowitz

beginning his own illustrious career.Tyer graduated from Nederland HighSchool in 1962, then enrolled at LamarUniversity in Beaumont, Texas, wherehe was mentored by athletic trainerBobby Gunn, who would later becomethe first president of the NationalAthletic Trainers’ Association (NATA).

Attending college before formalathletic training programs existed, Tyermajored in physical education, hopingto find a job at the high school level.Instead, Gunn steered him towards theMarines, and Tyer joined the Corps in1968. He spent three years as Head

Athletic Trainer for the athletics pro-gram at the Quantico, Va., MarineCorps base, where athletes competeagainst personnel from other militaryinstallations near Washington. Next,Tyer rejoined Gunn, who had movedon to the Washington Redskins.

The year was 1971, and theRedskins athletic training staff consist-ed of only two people: Gunn, as thehead athletic trainer, and Tyer, as hisassistant, who was responsible for the

Longtime Washington Redskins Athletic Trainer Bubba Tyer attends to another Redskins legend, linebacker Neil Olkewicz, in a photo from 1982.

When Lamar “Bubba” Tyer startedworking as an athletic trainerfor the Washington Redskins,repaired ACLs were routinely

wrapped with heavy plaster casts, andstrength and conditioning meant littlemore than lifting dumbbells. Over thenext 32 years with the Redskins,including 25 as Head Athletic Trainer,Tyer, ATC, witnessed a tremendousnumber of changes in the game and theprofession, throughout a career thatculminated in having his nameenshrined in FedEx Field’s Ring ofFame. Now, one year later, Tyer hascome out of retirement to become theRedskins’ new Director of SportsMedicine at the request of returningHead Coach Joe Gibbs.

“All it took was for Coach Gibbsto say, ‘I need you,’ and for me to say,‘Then I’ll come back,’” says Tyer. “Itdidn’t take any persuasion at all—Joe’s word was good enough for me.We’ve got about six coaches now whowere here in the past, and when we seeeach other in the hallways, we getthese big grins on our faces. We knowwhat to expect from each other, andit’s a great feeling.”

Growing up in Nederland, Texas,Tyer loved football, and though aninjury kept him from competing, hejoined the high school team as equip-ment manager, working under HeadCoach Bum Phillips, who was just

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Above The Call Award

entire strength program. In addition,the expectations of an athletic trainerweren’t clearly stated. “In those earlydays, part of my job was just to bearound the players,” says Tyer. Butevery day, Head Coach George Allenstopped by Tyer’s office to ask,“What have you done today to help uswin?” and every day, Tyer had to havean answer.

Year-round training hadn’t yet beeninvented, and Redskins athletes spentthe off season working second and thirdjobs, expecting to use the summer tobegin getting back in playing form. Soin the beginning, Tyer’s duties includedplaying racquetball to help get playersin shape, supervising rehabs with ath-letes who’d finally come out of theircasts, and leading the Redskins throughthe kind of strength training that peopleat the time thought was most effective:bench presses, overhead presses, powercleans, dead lifts, and full body lifts.

The game has changed a lot sincethen, mirroring Allen’s motto that“What you do in the off season deter-mines what you do in the season,” andTyer’s job changed along with it. For adecade, Tyer found himself doing moreand more hands-on work with athletes,until increases in the size of his staffled him to take a more administrative,supervisory role. Tyer has kept pacewith the changes by spending most ofthe last two decades working withyounger assistants like Kevin Bastin,Al Bellamy, Keoki Kamau, and RyanVermillion, who have all gone on tobecome head athletic trainers in theNFL. He learned a lot by hiring assis-tants who specialized in areas where heneeded the most help, watching them atwork, and using their skills to build thestrongest medical team possible.

“Bubba’s longevity in athletictraining is extremely remarkable,” saysVermillion, ATC, PT, Head AthleticTrainer for the Carolina Panthers, whoworked with Tyer in 2001. “You can’tstay in the NFL for this long without theability to adapt to a constantly changingenvironment. There’s more work now,more hours, more players. Today’s ath-letic trainers need to be well-versed inso many things that weren’t part of the

job 33 years ago, and Bubba has beenable to make those changes.”

Working under eight head coach-es—Allen (1971-77), Jack Pardee(1978-80), Joe Gibbs (1981-92), RichiePetitbon (1993), Norv Turner (1994-2000), Terry Robiskie (2000), MartySchottenheimer (2001), and SteveSpurrier (2002-03)—Tyer has remaineda constant presence, adapting to newdemands of the profession. “Over theyears, I’ve watched athletic trainingevolve,” says Tyer. “We’ve gottensmarter and smarter, and the equipmentthat we’re now using is a huge improve-ment over the old days, when we used toput athletes on a table and manuallyexercise them. With the advent of arthro-scopic surgery and the knowledge we’vegained in rehab, we’re moving athletesback to the field quicker than ever.

“But the biggest change,” contin-ues Tyer, “is in the attention we give.The more we specialize, the betterwe’re able to care for our athletes.”

In one of his earliest rehabs on theRedskins, Tyer remembers helpingRusty Tillman recover from knee sur-gery and shoulder surgery in the sameoff season, back in the days when ath-letes were kept in casts and harnessesfor weeks before rehab could evenbegin to address their mobility issues.In one of his later rehabs, Tyer remem-bers the broken leg that ended JoeTheismann’s career, followed by a

long, difficult rehab—but one that hasallowed Theismann to play golf andracquetball, and live a normal life.

In Tyer’s 32 years with theRedskins, the team has gone to fiveSuper Bowls, winning three. He’s beenthrough 14 playoff seasons and sevendivision titles, working with Hall ofFamers Ken Houston, John Riggins,Charley Taylor, and Sonny Jurgensen,who Tyer calls “a neuromuscular geniuswhen it comes to throwing a football.”He’s served on the NFL’s AdvisoryCommittee on Substance Abuse and asPresident of the Professional FootballAthletic Trainers Society (PFATS). Butthe thing that Tyer is proudest of is hisrelationships with the Redskins’players,coaches, and assistant athletic trainers.

“The people that I’ve worked withhave been fantastic, and I’m proud ofthe fact that I’ve made so many goodfriends over the years,” says Tyer.“About 30 of us play golf in the alum-ni group, and we always give eachother hugs, joke about the good times,and every now and then we talk aboutan old rusty knee that someone islimping around with. But as we getolder, the memories are all good.”

In 2000, the NFL recognized Tyeras the league’s top athletic trainer. In2001, Emageon, a medical imagingprovider, named Tyer the SuperAthletic Trainer of the Year, and earli-er this year, the NFL PhysiciansSociety honored Tyer with the FainCain Memorial Award as the NFL’sOutstanding Athletic Trainer.

Two years ago, when Spurrierarrived as the Redskins head coach,Tyer moved into the front office,where he helped smooth the transitionto a new athletic training staff beforeretiring in the spring. And in 2003, afew months into their first season with-out him, the Redskins inducted Tyerinto the Ring of Fame, where he’s thefirst athletic trainer to be honoredalongside 40 other Redskins players,coaches, and officials. “It is prettydamn neat,” says Tyer, “to look at thehandful of names on the stadium andknow that mine is one of them.”

“Along with having done such agood job for such a long period of time,

6

Award WinnerLamar ”Bubba” Tyer

Director of Sports MedicineWashington Redskins

T&C J U L Y / A U G U S T 2 0 0 4 ◆ A T H L E T I C B I D . C O M ◆ 7

Nomination Criteria and Procedures

Nomination Form

Name of Athletic Trainer:____________________________________

His/Her Phone No.: ________________________________________

Your Name: _______________________________________________

Your Affiliation: ____________________________________________

__________________________________________________________

Your Phone No.: ___________________________________________

Your Address:______________________________________________

__________________________________________________________

Send nominations to: Above The Call AwardTraining & Conditioning2488 N. Triphammer Road Ithaca, NY 14850

If you have any questions, feel free to call us at (607) 257-6970, xt. 18,or e-mail us at [email protected].



the thing that makes Bubba stand out ishis ability to manage an athletic trainingroom,” says Bastin, LAT, ATC, MSEd,Head Athletic Trainer for the HoustonTexans, who worked with Tyer from1989 to 2001. “He’s as good as anyoneI’ve ever been around, doing everythingfrom assessing injuries to seeing ath-letes finish their rehab. Bubba taught mea lot about people skills—finding thebalance you need as an athletic trainer towork with the athletes, the coaches, andthe medical team. He’s the perfectexample of a caring athletic trainer.”

Tyer advises younger athletic train-ers to get as much education as they canand follow their certification with addi-tional degrees that can expand theircareer opportunities. But no matter howmuch he loves his work, he warns otherathletic trainers that professional foot-ball isn’t meant for all of them.

“Not everyone is going to enjoyworking with this age group, commu-nicating with them, putting up withthem,” says Tyer. “For me, it’s the per-fect set-up. I love football. I love thecompetition. I love game days. I lovebeing part of the team. And I love thefeeling I get when we’ve won thegame, and we’re walking off the field.It’s just fantastic.”

Now, as the Redskins’ Director ofSports Medicine, Tyer is responsible formaintaining medical records for theentire team; coordinating communica-tions between the athletic training staff,coaching staff, and front office; prepar-ing medical reports on potential drafteesand free agents; and serving as the liai-son between the Redskins’ athletictrainers and the staff at MedStar-Georgetown University Hospital, whichprovides medical care to the entire team.

“It’s a great role, and I enjoydoing it,” says Tyer. “When I firstretired, I thought it was time to getout. But there’s a new enthusiasm herewith Coach Gibbs, and I’m excited tobe a part of it. I’m 62 years old, and Idon’t know how much longer I’ll wantto work. But I’ve signed on for oneyear, and Coach Gibbs said I can stayas long as I want. It’s a great feeling,and I’m looking forward to startingthe season.” ◆

he “Above The Call” AwardsProgram serves to honor outstanding athletic trainers for work not otherwise

recognized. This may includesomeone who has shown exem-plary dedication and devotion to his or her job or outstandingwork outside of the everydayATC duties. The goal is to honorthose athletic trainers who goabove and beyond the alreadyextraordinary demands placed on anyone in the profession.

EXAMPLES INCLUDE: ◆ Someone who is doing some-

thing different and exciting inthe profession.

◆ Someone who serves as a rolemodel and mentor to others.

◆ Someone who has taken onadditional significant duties inthe field.

◆ Someone who gives 110 percentin all that he or she does.

◆ Someone who has a special waywith athletes.

TO NOMINATE AN ATHLETIC TRAINER:Please fill in the form below, andattach a 500- to 1,000-worddescription of the athletic trainer’sachievements, including:◆ Why you think this athletic

trainer stands out from the crowd.◆ Where he or she is currently

working and any pertinent academic or work history.

◆ Testimony and/or quotes fromthose he or she works with.

T

✁


f you are planning on attending graduate school anytime in the near future, you need to start thinking aboutyour decision now. No two programs are exactly alike,and while any accredited university can provide a master’sdegree, finding the one that best fits your expectationsand priorities will ensure that you get the most out of

your graduate school years. To choose wisely, you need to dis-cover those schools that offer the best opportunities tocultivate and develop your personal interests.

To begin the process of selecting a graduate program, wesuggest looking within yourself to gain a sure sense of whatyou want. Developing clear goals will help you make theselection that’s best for you. What are your career aspirations? What is the best work setting for you? Do youwant to combine your athletic training expertise with anotherarea, such as nutrition, exercise physiology, or pharmacology?Do you want secondary credentials such as CSCS, PT, or PA?

Your academic interests should match your profession-al goals so that your graduate degree can provide you withthe knowledge and skills to pursue your ideal career. Some people pursue academic areas outside athletic training togive them additional career options, while others acquiredual credentials to reinforce their athletic training education.Still others simply desire advanced athletic training knowl-edge and skill to help prepare them for professional life.Knowing what you want will help you navigate a plethora ofgraduate school options.

Once you have surveyed your own interests, begin sur-veying graduate schools. Determine which schools and academic programs are acceptable to you, considering thelocation, size, and reputation of each school and program.Also consider the prerequisites and entrance requirementsfor each school.

An additional factor students need to consider whenlooking at athletic training master’s programs is whether

A special feature for your athletic training students

Student Corner . . . .

Debbie Bradney, DPE, ATC, is the Coordinator of ClinicalEducation, and Tim Laurent, EdD, ATC, CSCS, is the AthleticTraining Program Director at Lynchburg College in Virginia.

Sponsored by

they want their athletic training master’s degree to be entry-level or advanced. Entry-level master’s degrees are designedaround the same educational competencies and proficienciesas undergraduate accredited programs. So if you have com-pleted a CAAHEP-accredited undergraduate program, youprobably want to enter an advanced master’s program.Repeating an entry-level program will provide you with amaster’s degree, but it may not challenge you or advanceyour athletic training knowledge and skills.

Most graduate programs also offer assistantships to pro-vide students with a stipend, full or partial tuition remission,and hands-on experience. Athletic training students havenumerous choices. Many schools advertise their graduateassistantships through the NATA Career Center or sendannouncements to undergraduate athletic training programdirectors. (The NATA Career Center is available to NATAmembers at www.nata.org.) By looking at announcementsyou can learn about stipends, benefits, and responsibilities.Being informed about the types of graduate assistantshippositions a school offers will help you to choose a schoolthat fits your needs.

If you are thinking about taking on an assistantship, youneed to consider the responsibility that comes with it.Graduate assistants are considered to be staff members, andare treated as such. In your undergraduate athletic trainingexperience you were a student who was learning about athletic training. As a graduate assistant you will be a uni-versity employee who also goes to school. This is a largeshift, and you need to be cognizant of the difference. Youwill, of course, gain valuable experience, but you are alsothere to benefit your employer.

When comparing graduate assistantships, there are afew questions that need to be asked. What is your jobdescription? Are you expected to work over holiday andsemester breaks? When can you make autonomous deci-sions, and when do you have to consult with another staffathletic trainer?

As you look at graduate assistantship announcementsyou will notice that there are three types of assistantships:Teaching Assistantship (TA), Research Assistantship (RA),and Graduate Assistantship (GA). Being a TA often involvesteaching labs or freshman-level courses. These positions areexcellent for people who plan on teaching during their pro-fessional career. They allow you the opportunity to practiceorganizing and presenting information in a logical way thataids students’ learning.

The Master’s StepHow to choose a graduate program that best suits your needs.

By Dr. Debbie Bradney and Dr. Tim Laurent

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An RA position is excellent for the person who is mostinterested in publications, presentations, and research, andthey are typically available at large research institutions.With this position you will be assisting aprofessor in conducting his or her research.Before accepting an RA, make sure yourprofessor’s area of interest is compatiblewith your own by talking to him or her andreading his or her research publications.

A GA position in athletic traininginvolves providing athletic training healthcare service. Some of these assistantshipsare structured so that you serve as a colle-giate assistant athletic trainer. Others assign you to serve asthe head athletic trainer for one or more sports. Still othersprovide experience at local high schools or clinics. This typeof assistantship is beneficial for any future athletic trainingemployment, and it can also help you build your resume andestablish professional contacts. If you have interest in a par-ticular sport, a GA position can be an opportunity to getsome intense experience with that sport. If you are interest-ed in working at a high school, an assistantship with highschool responsibility is ideal. Students need to realize that,although the tasks of a GA are similar to those of an under-graduate athletic training student, the responsibility istypically much greater, and so is the stress level.

Assistantship application and graduate admissionapplication are often two separate processes. It is possibleto be accepted into a graduate school without receiving an

assistantship. Be sure that the school youchoose offers the entire package you want—one that will advance your knowledge andskill in your area of greatest interest.

Begin early. Your junior year should bedevoted to surveying your interests andcomparing them to graduate school offer-ings. Your senior year should be devoted to narrowing your choices and applying toprograms. Give yourself enough time to

thoroughly surf the Web, visit schools, talk to current stu-dents and alumni, and meet with the professors who will beyour mentors.

Graduate school is a tremendous beginning to your pro-fessional career. Do all you can to make the best choice. ◆

If you are interested in submitting a column of advice forathletic training students, please send it to: T&C’s StudentCorner, 2488 N. Triphammer Rd., Ithaca, NY 14850.Submissions must be double-spaced, 800-1200 words long,and accompanied by the author’s resume or curriculum vita.

To help you sort throughschools, degrees, and programsavailable, these two Web sites

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Imagine being in the funhouse ata carnival. You look into one ofthose distorted mirrors and see abody that is different than your

actual proportions. Your head is huge,your torso grossly elongated, andyour legs bow like bananas. It’s kindof funny.

Imagine looking into your bath-room mirror and having similar results.

After hours of working out at the gym,your chest is flat, your arms look likesticks, and your six-pack bulges out likea pitcher of Kool-Aid. Or at least that’show it seems to you.

If you were a competitive athlete,in the best shape of your life, youwouldn’t be very amused. And for manymen suffering from muscle dysmorphia,that is what happens every time theysneak a peak at their reflection.

Often referred to as reverse anorexia nervosa, muscle dysmorphia

is a body-image disorder primarilyaffecting males in which they becomepreoccupied with the misperceptionthat their muscles are too small.Individuals with the condition areoften driven to spend countless hoursin the gym, to the detriment of theirrelationships, social lives, and physi-cal well being. No matter how muchor how hard they work out, men with


◆ S P E C I A L F O C U S ◆

R.J. Anderson is an Assistant Editor atTraining & Conditioning.

By R.J. Anderson

They’re rarely discussed and just starting to beresearched, but body-image disorders amongmale athletes are a real—and growing—problem.

In the Shadows© Getty Images

Untitled-1 1 7/9/04 10:30:18 AM


muscle dysmorphia never feel muscu-lar enough. But that doesn’t stop themfrom trying.

“Male athletes who have muscledysmorphia tend to compulsively liftweights, ignoring signs of physical dis-tress to their ligaments and joints,” saysRoberto Olivardia, PhD, a clinical psy-chologist at McLean Hospital inBelmont, Mass., and muscle dysmor-phia researcher, as well as co-author ofThe Adonis Complex: The Secret Crisisof Male Body Obsession. “Even whentheir bodies tell them to stop, they con-tinue working out, thinking that more isbetter. They also tend to not pay atten-tion to other physiological needs likehydration and food intake. And a num-ber of them will use anabolic steroids.”

In a 2000 study, Olivardia foundthat 50 percent of men with muscle dys-morphia had used or were usingsteroids. Olivardia also notes that aboutone-third of men with muscle dysmor-phia have a current eating disorder, ahistory of an eating disorder, or idio-syncratic eating patterns—such asplacing an emphasis on extreme low-fat, high-protein diets.

Experts lay much of the blame onthe media’s increased glorification ofthe male physique. “Women have beensubjected to images of thin models fora long time and now men are subject-ed more and more to these hugelymuscular icons and imagery,” saysOlivardia. “Everything from WorldWrestling Entertainment to musicvideos showing rappers with theirshirts off revealing perfectly chiseledpecs and biceps. There’s definitely apressure that boys today feel, whichthey didn’t feel as much 15 years ago,to look fit and toned.”

As the pressure mounts, so do thestatistics. A recent study in Norwayrevealed that eight percent of elite maleathletes in that country suffer fromsome type of eating disorder. TheBritish Medical Journal found that thenumber of men who openly report dis-satisfaction with their physicalappearance has tripled in the last 20years, and that therapists report seeing50 percent more men for evaluation andtreatment for eating disorders than they

did in the 1990s. In the United States,however, the problem has not beenresearched much.

In this article we will take a lookat muscle dysmorphia and how torecognize its symptoms in your stu-dent-athletes. We’ll also talk to anumber of experts about how toapproach an athlete you suspect maybe in a phase of muscle dysmorphiaor experiencing an eating disorder.

FROM THE GYM TO THE FIELD

How prevalent is muscle dysmorphiain team-sport athletics? It’s hard toknow since much of the earliestresearch has focused on body builders.But anecdotal information about otherathletes is growing.

Heidi Skolnik, MS, CDN, anutritionist for the New York Metsand the New York Giants, sees theproblem at the professional level. “Ihave linemen who are very unhappyabout their bodies and it doesn’t mat-ter that they make a lot of money andcan outrun most people—they’re notnecessarily happy being that big,”says Skolnik. “It’s surprising to hear alineman say, ‘I feel fat, I don’t fit inmy clothes.’ Here’s a professionalathlete who you assume would beproud of their largeness, but insteadthey are very sensitive to how theirbodies look.”

Skolnik says that these athletesoften focus their obsession on oneparticular body part. “They say, ‘I’mokay with my chest, but I hate mystomach or my legs are too big,’” shesays. “And I think a lot of it comesfrom comparing themselves to otherguys around the locker room or on thecovers of magazines.”

At Ohio State University, JenniferCarter, PhD, a psychologist at theschool’s Sports Medicine Center, isworking with varsity athletes to studythe problem more systematically. Shehas surveyed Ohio State athletes for thepast two years and will do so again,along with athletes from three otherschools, this fall. (See “SurveyQuestions” on page 19.)

In her 2002 study, results showedthat one percent of the 882 athletes sur-veyed (of which 57 percent were male)showed possible signs of muscle dys-morphia. While that may not seem likean alarming statistic, Carter is quick topoint out that the questionnaire was notanonymous. She explains that one ofthe biggest problems with studyingmuscle dysmorphia is that men are veryreluctant to admit having any type ofnegative body image.

“The difficulty with this topic isthat men do not voluntarily discussthis,” says Carter. “As time has goneon, more men have talked to me duringindividual counseling about being con-cerned that they are not muscularenough, but a lot of people don’t evenknow this problem is going on. I talkto our athletic trainers and occasional-ly an athletic trainer might refer anathlete to me who they suspect mighthave this problem, but I don’t think itis being recognized as a huge problemas of yet.”

Olivardia explains that, becausebody image disorders are largelyviewed as only affecting women,most men are ashamed to admit theymay be suffering from them. “Theshame is enormous,” says Olivardia.“I’m often the first person, or theonly person, that a lot of men dis-close this problem to—and that’sbecause they know I’m an expert inthe field and I’ve written about it.

14


“

”

Women have been

subjected to images

of thin models for

a long time and now

men are subjected

more and more

to these hugely

muscular icons

and imagery.

Some of these men are married andtheir wives don’t even know that theystruggle with muscle dysmorphia orbulimia because they are so ashamed.”

A DEFINITION

Muscle dysmorphia is a subtype ofbody dysmorphic disorder (BDD).BDD is the diagnosis people get whenthey are preoccupied with how theirbody looks—whether it’s their nose,hair, skin, or any part of their body.Muscle dysmorphia is a type of BDDin which the preoccupation happens tobe with their muscularity and theirphysique. Because research within thisparticular branch of BDD is in itsinfancy, not much is known about theorigins of the disorder, nor is theremuch information regarding howmany people are affected.

“We do know that muscle dysmor-phia is associated with either a mood oran anxiety disorder,” says Olivardia.“Most men with muscle dysmorphia

tend to have an underlying depression,or underlying anxiety. But we don’tknow what comes first.

“A lot of men I work with whohave muscle dysmorphia say that work-ing out is a way of taking control,”Olivardia continues. “It is similar towhat you hear from women who haveeating disorders, except women usefood as a way of controlling their livesand managing their emotions, whilemen with muscle dysmorphia rely onexercise to take control. If they are atthe gym for five hours a day and theonly thing they have to focus on is theirbody, it can serve as a distraction awayfrom other things in their life that mightbe completely falling apart.”

As with eating disorders, there is awide range of severity. “Just like in thefemale population when we talk abouteating disorders being a continuum, I’dsay it’s the same thing for muscle dys-morphia,” says Skolnik. “There’s thisrange of eating patterns and body dis-

satisfaction that is occurring. It doesn’thave to be a full-blown dysmorphicphase, but many men are beginning totake on characteristics of the disordersthat are definitely not healthy.”

SPOTTING A SUSPECT

Not every athlete who puts in extra timein the weightroom is muscle dysmor-phic, and just because an athlete isconscientious about his diet, he doesnot necessarily have an eating disorder.But where is the line that tells us an ath-lete is doing too much? How do youknow when an athlete’s drive for healthhas become unhealthy?

“In general, coaches and athletictrainers should have a sense as towhere the boundaries are that the per-son has in working out,” saysOlivardia. “From there they will beable to notice how an athlete’s work-out routine affects his general attitudeabout his body and if it is getting inthe way of other things in his life—



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his relationships, his friendships, hiseating habits, his studying.”

Excessive mirror-checking is onewarning sign that may help tip offwhether a person is having issues withbody image. “Men with muscle dys-morphia often check mirrors as a wayof reassuring,” says Olivardia. “It’snot that they’re vain and like the waythey look. It’s actually for the oppo-site reason—they don’t like the waythey look, and they want to find a wayto improve it.”

If an athlete is noticeably weight-conscious or body-fat conscious, theymight be taking things too far. “I see alot of guys who get into restrictive eat-ing in the name of eating clean andtrying to be healthy,” says Skolnik. “Idefinitely don’t want to discourageguys from being thoughtful about whatthey eat, but they get to a point wherethey won’t eat something like a donut.They develop strict rules around whatthey can and cannot eat versus havingguidelines for trying to eat better.”

Carter echoes the sentiment.Athletes she has worked with who havebody image problems report thinkingabout food, diet, or working out 80 or90 percent of their day. She adds thatsubstance abuse often accompanies eat-ing and body image disorders amongcollege athletes.

Other signs include skipping mealswith the team, preferring to eat alone,wearing baggy clothing to cloak per-ceived inadequacies, not wearing shortsor short-sleeved shirts, and refusing totake their shirt off at the beach. And ofcourse, there is the matter of steroidabuse, the ultimate sign that an athleteis unhappy with his body.

“What’s ironic is that most of themen with muscle dysmorphia are invery good shape,” says Olivardia. “Insome cases they are above average interms of their muscularity. A lot ofthem have a very low body fat per-centage, and to the average eye theywould be deemed very muscular, butthey don’t see it.”

TREATMENT & THERAPY

When you or a member of your staffsuspects that an athlete may have anunhealthy preoccupation with bodyimage, how should you approach him?How can you find out what’s going onwithout causing him to feel ashamedand retreat into a defensive shell?

“The most important thing is totake a stance of concern and empathyfor that person as opposed to saying,‘What are you doing to yourself?’ orbeing sarcastic,” says Olivardia. “Youmight start by simply saying, ‘I thinkyou’re overdoing it in your workouts.’

“If you come from a point ofconcern rather than putting them onthe defensive, the denial is easier tobreak through,” Olivardia continues.“Share with them observable behav-iors like, ‘I see that you are isolatingyourself from the team,’ or ‘I noticedthat you worked out four and a halfhours today, when typically you’resupposed to work out an hour and ahalf,’ or ‘I see that you seem verysullen and very sad,’ as opposed tosomething like, ‘I think you might be depressed.’

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“Sharing with them the concretebehaviors makes it harder for them toargue with you, compared to if you say,‘I think that you have a body-imageproblem.’ Because they can just say,‘No, I don’t.’ Then the conversation ispretty much over.”

The idea is to engage the athlete ina preliminary conversation about theirhabits and fears to glean how seriousthe problem is. If the athlete’s focus onbody image seems fairly minor, thereare many ways to steer him back oncourse and away from full-blown mus-cle dysmorphia.

“Basically, just give a lot of posi-tive reinforcement in terms of what heis accomplishing,” says Olivardia.“Definitely do not use critical lan-guage, because men with muscledysmorphia are hyper-sensitive to crit-icism. Focus on their strengths and nottheir weaknesses.”

Olivardia says it’s also importantfor coaches to model balanced behav-ior themselves—especially strength

and conditioning coaches. “If you’re acoach who eats, breathes, and sleepsworking out, then the athlete will pickup on that,” says Olivardia. “As acoach, if you live a very balanced lifeyourself, an athlete can look upon youas a model of inspiration—somebodywho eats well-balanced meals, who

exercises appropriately, but also hasrelationships, has fun, is social, and iscomfortable with himself.”

Strength coaches can also encour-age athletes to seek out relaxationtechniques or other activities that offeran alternative to working out whenencountering stress. “Coaches shouldreally reinforce self-care,” saysOlivardia. “The idea is to make surethat not only are they eating well andworking out, but that they are sleepingwell, drinking enough water, and get-ting enough social stimulation.”

At Ohio State, Carter tells hercoaches to be particularly carefulwhen they talk to an athlete about los-ing or gaining weight. “We would likethem to consult with the medical stafffirst to see if it’s advisable and if theythink it will help the athlete’s perform-ance,” says Carter. “And if so, we thenrefer the athlete to a dietitian to makesure they are doing it in a healthy way.Often, athletes are instructed to lose orgain weight and have no clue how to do



Olivardia says it’s also important for coaches to modelbalanced behaviorthemselves—especially strength and conditioning coaches.

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that in a healthy way, which can lead tounhealthy behaviors.”

OUTSIDE HELP

If an athlete’s behavior or habits reach alevel of becoming obsessive or self-destructive, athletic trainers and strengthcoaches are encouraged to refer the ath-lete to a sports psychologist. When anathlete comes to her exhibiting symp-toms of an eating or body-imagedisorder, Carter uses a techniquecalled cognitive behavioral therapy.The technique examines the underly-ing assumptions athletes have aboutthemselves and how they feel the restof the world sees them.

Says Carter, “For example, whenaddressing the idea that, ‘People willaccept me only if I am very muscular,’we’ll ask, ‘What are some other aspectsof your self that people might like?What are some strengths that you have?Are there muscular people you knowwho aren’t necessarily popular?’”

Olivardia, who also utilizes cog-nitive behavioral therapy, says thetechnique helps correct a lot of dis-tortions these athletes have. “Theirthoughts are typically very negative,”says Olivardia. “The behavioral part

of cognitive behavioral therapyshould address any of those behav-iors that we either want to increase or reduce.”

To increase socialization, Olivardiaoften asks patients who have muscledysmorphia to step outside of theircomfort zone. If a patient feels uncom-fortable in social situations, and tendsnot to wear short-sleeved shirts orshorts because they feel like their armsor legs are too small, Olivardia willhave that patient establish a goal toovercome that fear. “I’ll say, ‘Okay,your goal this week is, if it’s 90 degreesoutside, you have to wear shorts,’” saysOlivardia. “I try to expose them to thevery things that they are fearing oravoiding in some way.

“To limit mirror-checking, I askpatients to take a baseline of how manytimes they look in a mirror in a day,”continues Olivardia. “The goal is toreduce the number of times that theyare checking the mirror each day.”

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Olivardia also employs generalpsychotherapy when treating patientswith eating or body-image disorders.He talks to patients about their back-ground, looking at some of the issuesthat might predispose them to the condition, including depression,anxiety, family history, child abuse,negative peer experiences, perfection-ist tendencies, or low self-esteem.

WHAT’S NEXT?

While muscle dysmorphia and eatingdisorders among males are not evenclose to approaching the levels of body-image problems experienced bywomen, they are important to look outfor. “I think athletes have an additional

layer of risk because the models they arelooking at are people who are specifi-cally invested in muscular physique andtoning up,” says Olivardia. “A lot of theproducts they might buy—proteinshakes or fat-burning supplements—typically feature endorsements frommen who probably got their bodythrough using steroids. So athletes aremeasuring themselves up against whatis an immeasurable body—one that isthe product of drug use.

“Muscle dysmorphia is a body-image disorder, but when you add theathletic world where there is a pres-sure to perform, it becomes evenmore pronounced,” he adds. “One ofmy patients had an athletic scholar-

ship, so his base of viability at theuniversity was dependent upon himdoing well athletically. As a result, hethought taking steroids was a neces-sary thing, to both grow his body andenhance his performance.”

Part of the problem is that for along time, the assumption was that thesetypes of disorders didn’t affect men. Butthey do. It just happens that men are par-ticularly good about hiding theseproblems, which Olivardia says makesthe disorders even more dangerous.

“We think that this problem isgoing to get worse before it gets bet-ter,” says Olivardia. “The images thatboys and men are bombarded with ofmuscular men are only increasing.” ◆



Survey Questions

___ I wish that I were more muscular.

___ I lift weights to build up muscle.

___ I use protein or energy supplements.

___ I drink weight-gain or protein shakes.

___ I try to consume as many calories as I can in a day.

___ I feel guilty if I miss a weight-training session.

___ I think I would feel more confident if I had more muscle mass.

___ Other people think I work out with weights too often.

Jennifer Carter, PhD, a psychologist at The Ohio State University Sports Medicine Center,

gives athletes the following survey to uncover any body-image disorders. The questions

originally appeared in the article “An Exploration of the Drive for Muscularity in Adolescent

Boys and Girls,” published in the Journal of American College Health. Athletes are asked

to answer each statement using a scale of one to six, one being never, and six being

always.

___ I think that I would look better if I gained 10 pounds in bulk.

___ I think about taking anabolic steroids.

___ I think that I would feel stronger if I gained a little more muscle mass.

___ I think that my weight-training scheduleinterferes with other aspects of my life.

___ I think my arms are not muscular enough.

___ I think my chest is not muscular enough.

___ I think my legs are not muscular enough.

Request No. 110

It can happen anywhere at anytime.Sometimes there’s a sign of what’sto come, often there’s not. During

the past year it occurred in settings asdisparate as a lacrosse game in upstateNew York and an empty basketballarena in Texas. But whether suddencardiac death occurs from a traumaticinjury or an underlying condition, peo-ple are left asking what can be done toprevent it from happening again.

The sad reality is that these deathsare sometimes not preventable.However, people around the countryare taking steps to try to reduce therisk of sudden cardiac death, fromidentifying those athletes most at riskto developing equipment that mightbetter protect the heart.

TRAUMATIC

When George Boiardi died on March17, the shock waves reverberated fromone college campus through an entiresport. A senior captain on Cornell

University’s men’s lacrosse team,Boiardi died after being struck in thechest by a shot late in a game againstBinghamton University. If Boiardi hada chance to survive, everything was inplace to make that happen: Athletictrainers responded immediately, an on-site AED was used, and EMTs arrivedminutes later. Yet none of these effortscould save Boiardi.

Unfortunately, the lacrosse worldwas already familiar with this type ofscene. Boiardi was the third collegiatelacrosse player in five years to die afterbeing hit in the chest by a ball. A highschool player also died the same wayduring that span.

The exact cause of Boiardi’s deathwill never be known. At the request ofhis parents, no autopsy was performed.


◆ I N J U R Y P R E V E N T I O N ◆

Bill Warren/The Ithaca Journal. All Rights Reserved.

When a Heart Stops

Although it is rare, sudden cardiac death is a reality in the sports world. Here are the latest ideas on how to reduce heart-related deaths from both traumatic and non-traumatic causes.

By Dennis Read

Dennis Read is an Associate Editor atTraining & Conditioning.


But the dangers of a blow to the chestare no secret. The three previouslacrosse deaths were blamed on com-motio cordis, which occurs when anon-penetrating blow to the chestdirectly over the heart during a verynarrow phase of the heart beat causesventricular fibrillation, or other typesof arrhythmia, in an otherwise healthyheart. In an article published inProgress in Biophysics & MolecularBiology, Mark S. Link, MD, of theNew England Medical Center, TuftsUniversity School of Medicine, report-ed that the vulnerable period lasts only10- to 30-thousandths of a second.

Commotio cordis is believed to berare, although the exact number ofcases is not known. The CommotioCordis Registry in Minneapolis hasdocumented more than 150 cases sinceit formed six years ago and typicallyadds between five and 10 cases peryear. But many past deaths likely wentundiagnosed and other cases may stillgo undocumented.

The risk of commotio cordisextends far beyond lacrosse. Of the 128cases recorded by the CommotioCordis Registry through 2001, 62 per-cent occurred in participants inorganized sporting events, ranging fromyouth to professional sports. Of those,46 involved baseball or softball while13 involved ice hockey. Five came inlacrosse. In most cases, the speed of theball or puck was typical for the sport. Athigher speed, physical damage to theheart also becomes a danger.

High school and youth athletesappear to be most at risk of commotiocordis. The average age of victims was14 years and nearly 80 percent of casesoccurred in people under 18. Someresearchers have attributed this toyounger athletes having a more pliablechest wall.

The search for ways to reduce therisk of traumatic heart death continues.Within lacrosse, both equipment andplaying rules are being looked at withan eye toward reducing risk.

“We’ve got to do something,” saysNCAA Lacrosse Rules CommitteeChair Willie Scroggs, Senior AssociateAthletic Director at the University of

North Carolina, where he was previ-ously the Head Men’s Lacrosse Coach.“We can’t just sit back and say, ‘I hopeit doesn’t happen again,’ if there arethings we can do rule-wise, technique-wise, or equipment-wise.”

The US Lacrosse Sports Scienceand Safety Committee has recom-mended changing the rules of thegame to penalize players who inten-tionally try to block shots by steppingin front of the ball. US LacrosseExecutive Director Steve Stenersensent letters to both the NFHS andNCAA rules committees asking themto consider a similar change.

Some college coaches, though,aren’t waiting for the rules to change.“Hockey players dive in front of thepuck all the time, but I’ve taken thattype of thing out of my coachingrepertoire,” says Dave Urick, HeadMen’s Lacrosse Coach at GeorgetownUniversity. “It’s not something weteach or encourage them to do any-more, and that’s a direct result ofwhat’s happened to these young men.I just felt like it made sense from asafety standpoint.”

CHEST PROTECTION

Efforts are being made on the equip-ment front as well. Under currentlacrosse rules, only goalies arerequired to wear chest protectors, mostof which are similar to those worn bybaseball and softball catchers. Other

players must wear shoulder and armpads, but unlike the equipment worn bymany hockey players, very few lacrossepads offer chest protection. Scroggssays that equipment manufacturers areworking with coaches, players, andmedical experts to develop more pro-tective equipment, but he doesn’texpect to see anything new introducedbefore next season because of thedevelopment and testing involved.

Equipment may not provide thefull answer, anyway. Of the 79 athleticdeaths recorded in the CommotioCordis Registry by 2001, 28 percenthappened to players wearing standardchest protection for their sport at thetime. Although some football andhockey players suffered their injurieswhen they were struck directly in the chest by objects that evaded theprotective equipment, seven casesinvolved baseball catchers and hockeyand lacrosse goalies who sufferedcommotio cordis despite having theirchest protectors take the blow.

Link and his fellow researchersconducted an experiment with anes-thetized pigs wearing commerciallyavailable chest protectors designed foryouth baseball players. The pigs werehit in the chest with baseballs fired at 40miles per hour. These researchers foundthat the likelihood of ventricular fibril-lation in pigs wearing chest protectorswas not statistically different fromthose not wearing chest protectors.

While chest protectors may notoffer full protection from commotiocordis, some people believe they arestill an important tool in reducing risk.In May, the NATA Age-Specific TaskForce issued a statement on commotiocordis that suggested the use of all-purpose chest protectors duringpractices and games as a way to reducethe danger.

At the same time, researchers arelooking for ways to construct chestprotectors that offer more protectionfrom commotio cordis. Most currentequipment is designed to protectagainst physical trauma, including thatwhich might directly damage theheart. The key will be finding a way todisperse the force of the impact over a

22


Seven casesinvolved base-ball catchers and hockey andlacrosse goalieswho sufferedcommotio cordisdespite havingtheir chest protectorstake the blow.

Untitled-1 1 7/7/04 4:50:26 PM

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Untitled-1 1 7/7/04 4:50:26 PM

Request No. 111


larger area so that less of it is transmitted to the heart, reduc-ing the chance of sending it into ventricular fibrillation.

“Research is finding that certain chest protectors don’twork,” says Keith Gorse, MEd, ATC, Clinical Coordinatorand Instructor in the Department of Athletic Training atDuquesne University. “What we’d like to do within theNATA is work with US Lacrosse to research the newer chestprotectors that are designed to disperse pressure away fromthe heart and see if they work.”

In the meantime, Gorse advises athletic trainers to decidewhat will work best for their athletes. “Chest protectors are abig question right now,” he says. “A lot of people are for themand a lot of people aren’t. The most important thing for ath-letic trainers to do is to research the different types of chestprotectors that are out there before buying them.”

Link’s study did find some promising prospects fortreating commotio cordis, as long as treatment can be pro-vided quickly. Test animals who received defibrillation afterone or two minutes of ventricular fibrillation survived 96percent of the time while the survival rate fell to 46 percentafter four minutes and 25 percent after six minutes. In reallife events, the Commotio Cordis Registry reported that 25percent of those who received resuscitative measures in lessthan four minutes survived, while in 38 cases of delayedresuscitation only one person survived.

In some cases where a player has received a dangerousblow to the chest, resuscitation efforts will prove futile, evenif, as in Boiardi’s case, they include an immediate responseand an AED. But prompt, proper treatment can increase theodds of recovery.

“Determine what the problem is as soon as possible,start CPR, and get an AED on that person right away,”Gorse says. “There’s a better than 50-50 chance of survivalif you start caring for the person within a minute. But thismeans making sure there’s an AED on site—it can’t be 400yards away.”

NON-TRAUMATIC

While awareness of commotio cordis is relatively new, med-ical professionals have long been aware of the connectionbetween athletic participation and sudden cardiac death fromnon-traumatic causes. The exact prevalence of sudden car-diac death in athletes is unknown, but estimates ranges fromone death in 200,000 athletes to one in 300,000 per year.

The most common cause of sudden cardiac death inathletes is hypertrophic cardiomyopathy, which is a thick-ening of the heart. In a June 2004 article in The Physicianand Sportsmedicine, Dennis Wen, MD, Associate Professorof Family and Community Medicine at the University ofMissouri, says that in fatal cases, hypertrophic cardiomy-opathy usually causes arrhythmias, such as ventricularfibrillation or ventricular tachycardia. It can strike withoutwarning, although some victims have histories of chestpains, fatigue, syncope, and palpitations.

Wen reports that echocardiography is considered the“gold standard” in diagnosing hypertrophic cardiomyopathy,

24


Untitled-2 1 6/22/04 10:02:07 AM

Request No. 112

but still has several limitations. First,hypertrophic cardiomyopathy may notbe apparent until an athlete hasreached full maturity, meaning a highschool athlete may still be at risk, evenif he or she has previously received anegative test. Second, some peoplewith hypertrophic cardiomyopathyhave very little risk of sudden cardiacdeath, but little is known about who isat risk and who is not.

In addition, heart murmurs, onceconsidered an effective screen forhypertrophic cardiomyopathy, areapparent in only a small number ofpeople with the condition.Electrocardiograms may show signsof hypertrophic cardiomyopathy, butthey also may not. As a result the firstsymptom often is death.

Wen reports that the second mostcommon cause of sudden cardiacdeath in athletes is coronary anom-alies. These can lead to ischemia,arrhythmia, or low blood flow into thecoronary artery.

These conditions may producefatigue, chest pains, and syncope, butnot always. Wen suggests coronaryangiography as the most reliablemeans of finding these anomalies.Echocardiography, especially trans-esophageal echocardiography, is alsohelpful.

Other rare causes of sudden car-diac death include myocarditis andarrhythmogenic right ventricular dys-plasia (ARVD). Myocarditis, which isan inflammation of the heart’s muscu-lar wall, can result from a variety ofcauses including viruses and bacteria,and may be indicated through echocar-diograms in some cases. ARVD affectsthe muscle in the right ventricle andcan cause abnormal heart rhythms.Electrocardiography and echocardiog-raphy can both be helpful in detectingARVD, however, some doctors consid-er MRIs to be more accurate.

TO SCREEN OR NOT?

Since sudden cardiac death can and

does occur without any prior symp-toms, the focus has been on screeningfor those who may be susceptible tothese diseases. Unfortunately, no singletest will identify every athlete at risk forsudden cardiac death. These conditionscan even go undetected in someonewho receives a full battery of tests.

“You can add layers and layers ofscreening tests, but a few are still goingto slip through no matter what you do,”Wen says. “The whole problem is thatthese are such rare conditions. Thingsthat are rare require screening meth-ods—whether they be histories orechos or whatever—that are bothextremely sensitive and extremely spe-cific. None of the things we do noweven come close to the levels of speci-ficity and sensitivity needed to beuseful for something this rare.”

Many people liken the screeningprocess to searching for a needle in ahaystack. Researchers estimate that,on average, finding one person with acondition that may lead to sudden car-



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diac death requires screening 200,000people, making the odds of finding oneperson at risk at any school veryremote. In addition, there are the prob-lems created by false positive and falsenegative results.

“So the question is, when does itbecome worthwhile to keep adding lay-ers and layers of screening tests only tofind a few more cases, when the major-ity will still slip through?” Wen says. “Ifyou screen enough kids you’ll find apositive here and a positive there, butdoes that justify doing millions of tests?Some people say it is worth it to findthat one needle in the haystack. Otherpeople say it’s not. In my article, I choseto argue that it’s not worth doing all thattesting just to find that one needle.”

Ramon Brugada, MD, Director ofthe Molecular Genetics Program at theMasonic Medical Research Laboratoryin Utica, N.Y., which studies cardiacarrhythmias and cardiac disease, holdsa different view. Brugada believes thatevery high school athlete should receive

a cardiological exam. “In Japan, every-body gets an electrocardiogram beforepuberty, and in Italy every newborn getsan electrocardiogram,” he says. “Thebenefit of doing the electrocardiogramovershadows the concerns about costand economical issues. Schools requirevaccinations, so why not require anEKG to make sure that everything isfine? The reality is that 99 of 100patients will be fine, but the single guywho drops dead at age 14 while runningat school justifies the testing.”

Others aren’t so sure. MichaelKoester, MD, FAAP, ATC, CSCS,Primary Care Sports Medicine Fellowat Vanderbilt University, served as ahigh school team physician in Oregonfor the past five years and recommendsagainst doing full cardiological examson all athletes.

“In times of limited budgets andlimited resources, I’m concerned thatif people start doing EKGs and echos,it will become the standard of care,” hesays. “Parents will think, ‘They’re

doing testing at that school, why aren’tthey doing the same testing at my kids’school?’

“There’s no single test that we cando that will prevent every case of sud-den cardiac death, and my biggestconcern is the high rate of false posi-tives,” he continues. “Even if you had atest that was close to perfect, you’regoing to get thousands of kids who aregoing to test false positive. And what doyou do with those kids? You can tell theparents the kid may be at risk of suddencardiac death, then they go through testafter test only to conclude that the kid isat a risk that is difficult to quantify.

“Or after scaring them half todeath, you tell them, ‘Nope, that was afalse positive and they aren’t at risk ofdying suddenly during athletic partici-pation.’ How much does that weigh onthe parents, along with the financialcost of having to do more referrals?”

For schools that do opt for testing,there is some debate about which tests are the best ones to do. Echo-

26


Request No. 114

cardiograms check the blood flow in theheart and are better at catching heartabnormalities such as hypertrophic cardiomyopathy. Electrocardiograms,meanwhile, are more likely to findrhythm disturbances, such as Wolff-Parkinson-White or long QT syndrome.

Some schools are employing anoutside company to administerechocardiograms to their student-ath-letes. These tests are provided at a flatrate, often around $60. In some cases,all athletes are tested. In others, athlet-ic trainers simply make the testingavailable for those willing to pay for it.

In the Myrtle Beach (S.C.) schooldistrict, administrators consideredadopting such a program before decid-ing to stick with the more traditionalscreening program they have beenusing. “We have nine high schools inour district with several thousand stu-dents who participate in athletics,”says Jim Berry, MEd, ATC, SCAT,NREMT, Director of Sports Medicineand Head Athletic Trainer at MyrtleBeach (S.C.) High School. “It was asituation where, if we offered it, whowould take advantage of it? Since wecouldn’t afford to cover the cost, was itfair to only test the kids who couldafford to have the test done?

“We discussed scheduling a timeand sending a letter out saying, ‘We’reoffering this opportunity if you wantyour child tested,’” he continues. “Butwhat if a kid gets tested, it comes backnegative, and they drop dead twoweeks later? What liability will wehave? So the district and the athletictrainers decided at this point it wasn’tsomething we wanted to explore anyfurther. We felt like the system we hadin place was appropriate.”

FOCUS ON EXAM

Instead of expensive screening tests,Koester suggests that schools rely ongood preparticipation physical exami-nations, including a thorough cardiachistory, to help shrink the haystack byidentifying athletes who should receivecloser examinations. “The most impor-tant thing that they need to include arethe guidelines set out by the AmericanHeart Association, looking mostly at

family history, the athlete’s own history,and physical exam findings,” he says.“There is a history form recommendedby the American Heart Association,the American Academy of Pediatrics,the American Academy of OrthopedicSurgeons, and the American Academyof Family Practice Physicians, whichis available in the PreparticipationPhysical Exam monograph. It’s notperfect, but it’s as close to perfect as we have when you look at cost-to-benefit ratios.”

Koester feels strongly enoughabout the importance of a thoroughpreparticipation physical exam, includ-ing cardiac history, that he suggestsfunding those efforts first. “I think ath-letic trainers are being pushed in thedirection of buying expensive pieces ofequipment like AEDs,” says Koester.“AEDs are great, but number one, sud-den cardiac death happens in about onein every 200,000 athletes, so the odds ofhaving an athlete need an AED are slim.Number two, there is no great evidencethat automatic external defibrillation isgoing to reverse the process of thesekids who go into a terminal arrhythmia.

“I think having those devices isgreat, but the person you’re most like-ly to use them on is the referee orsomeone in the stands,” he continues.“I think funds can be pushed in thatdirection, but there won’t be a greatreturn on them. The best thing to get isa thorough history and physical exam.”

Berry leans heavily on cardiachistories to identify athletes who maybe at risk of sudden cardiac death.“What we’ve done, and what SouthCarolina has done through its officialphysical form, is to strengthen the car-diological part of the history form,”Berry says. “It used to be that a lot ofphysical forms would just ask, ‘Haveyou ever had chest pains?’ Well, chestpain can be caused by a lot of things.So now we have a separate cardiac his-tory section with nine specificquestions that the kids or their parentsmust answer about their cardiac histo-ry. The family history is importantbecause there is such a strong relation-ship between what’s happened withthe mother or father and what tends tohappen with the children.”

Jody Jenike, MEd, ATC, HeadAthletic Trainer at Xavier University,also relies on the cardiac history as aprimary screening device. “We have afive-point questionnaire, and a certi-fied athletic trainer will ask thestudent-athlete each of those questionsto make sure they’re honestlyanswered,” Jenike says. “And we askthem these questions in addition to theform the family fills out in the sum-mer, so there are checks and balances.”

LISTEN TO THE HEART

Jenike also emphasizes the importanceof a thorough physical examination.One of her athletes was found to havean atrial septal defect—a serious, butnot life-threatening, heart problem—through an echocardiogram, which isperformed on all members of theschool’s men’s and women’s basket-ball teams. But Jenike believes thecondition should have been caughtearlier when the player received apreparticipation physical exam.

“At the time, we were workingwith an internist who was very good atdiscerning a murmur as being a one,two, three, or four,” Jenike says. “In aquiet room, he could tell you where itwas, and he worked alongside our car-diologist. At the time we did theplayer’s physical, the internist was run-ning late and a physician’s assistanthappened to listen to her heart. So she



“What we’ve doneis to strengthen the cardiologicalpart of the historyform … We nowhave a separatecardiac history section with ninespecific questionsthat they mustanswer.”


was halfway through the physical andonto the orthopedist when the internistarrived. Had we not done the cardiacexam we would not have picked this up.

“We don’t have a PA listen to theheart anymore,” she continues. “PAscan help with physicals, but my feelingis you should have an internist—whocan be given a quiet room—listen tothe heart. Everybody dreads the massphysicals and wants to get throughthem but I think it’s worth an extra twominutes per kid.”

Koester says that any primary carephysician should be able to pick upmurmurs, be it a pediatrician, internist,or family practice doctor. “In somestates, physician assistants and nursepractitioners are licensed to do thePPE and I think that’s reasonable—ifthey have the appropriate training,which many of them have,” he says.“But I don’t think the chiropractorsand naturopaths are able to show thatthey have the proper training in cardio-vascular disease and cardiovascular

physical exams to be able to performthe exam. If they can show that theyhave had training, that’s another thing,but with the standard level of trainingthat they have in detecting cardiac dis-ease, I don’t think they should beperforming those exams.”

Koester also suggests putting somethought into who checks the athletes’blood pressure. “One thing that is oftenoverlooked is whether the people takingblood pressures know what they’redoing,” he says. “To get accurate meas-urements, make sure you have goodcuff sizes, that you’re in a quiet area,and you have nurses or ATCs who aregood at measuring blood pressure.”

In addition to taking a detailed his-tory and having an internist listen to theheart, Jenike also screens athletes forrisk of Marfan syndrome by measuringtheir arm span. Marfan syndrome ismost often found in tall, slender peoplewith unusually long arms and legs, andcan result in a weakened aorta.

All athletes who raise any redflag through their physical exam orcardiac history are then sent to a car-diologist for a full cardiologicalevaluation. Koester recommends that,when possible, it’s best to send theathletes to a cardiologist who isfamiliar with sports medicine.

28


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KEEPING UP

Preventing heart-related deaths is not straightforward byany means. But for each individual situation, the beststrategy, Jenike says, is to keep up with the advances indetection techniques and keep moving your screening pro-gram forward.

“Everybody lives within their own comfort zone,”Jenike says. “Some schools are out in rural areas where theremay not be a cardiologist nearby. But could they have aninternist who is experienced listening to the heart brought infrom a hospital on the day of the physicals and have the ath-letic trainer ask the history questions? I believe they can. Andthe kids who are at risk get sent for further evaluation.

“Comfort zones are influenced by money and time,”she continues. “You have to jump in the water somewherebefore you can swim. You have to take a step and thenimprove it each year. If you keep saying you can’t do itbecause of this or that, you’ll never get there. I believe inhaving a one-year, three-year, and five-year plan, and youpush each year to add things.”

You also need to pay attention to any signs or symp-toms that can crop up when you least expect them to. “It’s important to be aware that there are some signals theheart gives out that indicate something is amiss,” Brugadasays. “If there is anything you don’t feel is normal, seekhelp. For example, passing out is not a simple thing. It’sa very complicated issue and because of the possibleimplications [of serious heart problems] it’s somethingthat has to be taken extremely seriously. Athletes shouldnot be passing out.”

But, in the absence of symptoms, Wen says it’s impor-tant for athletic trainers to explain to parents and otherinterested parties just how unusual these deaths are. “I thinkthey need to stress the rarity of this and let people know thatathletics are still safe and their sons or daughters on an ath-letic team are probably not at risk of dying,” he says. “We’retalking about an extremely rare thing. And sports and athlet-ic activities—whether recreational or organized—are stillvery safe. There’s still a lot more to be gained from partici-pating in athletics than not, so you shouldn’t be scared off bythe publicity over athletic deaths.” ◆



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RESOURCES

For more information on commotio cordis, go towww.la12.org/articles/med-research.htm. This pageis part of the Louis J. Acompora Memorial FoundationWeb site. Acompora was a 14-year-old high schoollacrosse player from Northport, N.Y., who was killedby commotio cordis in March 2000.

For more information on the American HeartAssociation recommendations for preparticipationphysical exams go to www.americanheart.org andtype “preparticipation” in the search window.

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I n the human body, nothing isperfectly symmetrical. Many peo-ple have a leg that is longer than

the other or maybe one bicep that isstronger than the other.

For athletes, such body imbal-ances can be problematic. They canlead to less-than-optimal output instrength, flexibility, and coordinationthat may have negative effects on per-formance. They can also eventuallylead to injuries. Conversely, obtaining

muscular balance allows the body tomove more efficiently, display morestrength, and reduce injury.

Most athletes, however, do notknow they have a muscle imbalanceuntil an injury results. At that point itcan be time consuming and frustratingto rehabilitate, rebalance, and relearnmovements in order to return to previ-ous levels of performance.

A better path is to test for imbal-ances before they become a problem,and develop training protocols thatfocus on body balance. To do this, it’simportant to understand the nuances of

unilateral balance, imbalances withinthe limb, and sport-specific balance.

UNILATERAL BALANCE

For a variety of reasons, the dominantform of strength training seems to bebilateral exercises such as the benchpress, squat, barbell curls, and so forth.While these are valuable movements,

◆ O P T I M U M P E R F O R M A N C E ◆

Searching for SymmetryAthletes at all levels are prone to developing muscle imbalances. Make sure your strength training programis addressing this problem,rather than contributing to it.

By David Pollitt

David Pollitt, CSCS, is the Owner of OptimalPerformance Strength and ConditioningConsulting, in Riverside, Calif., and the former Strength & Conditioning Coach forthe Banff Hockey Academy.

© Getty Images



Table One: Unilateral Tests

Overhead Squat (one handed with dumbbell)

Push Jerks (one handed with dumbbell)

Pistols (one-leg squats)

One-Arm Bench Press

One-Arm Rows

One-Arm Pull-Downs (one handed,pronated grip to the side)

One-Arm Biceps Curl, HammerCurls, Calf Raises, and RomanianDeadlifts

External Rotations of Knee

Saxon Side Bend

Turkish Get-Up

Shot Put

Standing Medicine-Ball Throws

Test each side maximally and compare the movements of the knees, hips,shoulder girdle, upper body, and depth of squat. Movements should lookidentical on the right and left sides.

Test each side and compare the shoulder girdle, ease of lift, maximal weighthandled on each side, upper-body lean, and hip action.

Test the depth of the squat, maximum number of repetitions performed ormaximal amount of weight for one rep, deviation from optimal form, and flexibility in the lower leg and hip.

Test each side maximally and compare ease of lift, deviation from the optimalpath of the dumbbell, speed of the movement, range of motion, and angles of the elbows.

Test each side maximally and compare ease of lift, path of the dumbbell, speed of the movement, and range of motion.

Test each side maximally, and compare the range of motion, weight handled, and deviations from an optimal path of resistance.

Test each side maximally and compare the weight lifted, movement of thedumbbell, speed of the lift, deviation from an optimal lifting path, and range of motion.

Sit on a flat bench, bring a knee up so it is bent at 90 degrees. Place the elbow of the same side of the body on the knee, and bend so the forearm is vertical.Internally rotate the arm toward your belly button, and return to the vertical position. Test the weight lifted for 10 repetitions for good form, range of motion, and speed of contraction.

Take two 10-pound dumbbells, press them straight overhead, and thenstraight to each side as far as possible. Test the range of motion, difficulty of the lift, and deviation from a straight side bend.

Start lying down with a weight extended vertically (straight arm). Withoutbending the arm and keeping the arm vertical, stand up. Test for eitherrepetitions or a maximal weight.

Test the distance thrown (after skill acquisition) on both sides.

Test rotational power development on both sides of the body.

The following are samples of unilateral testing exercises:

Untitled-4 1 7/9/04 11:26:28 AM

the negative is that they can help hideor even worsen an imbalance in an athlete’s body.

In my experience, many athleteslack the flexibility, strength, coordi-nation, and technique to do bilateralexercises correctly. When the weighton the bar is light, there is not usual-ly a problem. But, as weight is addedto the bar, the stronger, more flexible,or more coordinated limb tends totake on a greater role in the exerciseand the body twists, turns, bends, orstrains to get the weight up and com-plete the exercise.

These movements are repeatedworkout after workout, and the result isa furthering of the original imbalanceor the creation of a new imbalance. Atsome point, the imbalanced muscle orscar tissue that may be formed by theincorrect actions opens the athlete up topotential injuries.

It is also important to develop unilateral balance for enhanced per-formance on the field of play. As

explained by strength and conditioningcoaches Peter Twist, MPE, CSCS, andDusan Benicky, MS, in the Strengthand Conditioning Journal (Vol. 18.5,1996), imbalances can lead to poorreaction when sudden movements arerequired. In their example, if adefenseman in ice hockey has animbalance between his two legs, he

tends to favor the dominant leg by put-ting more body weight on it. When aforward on the opposing team tries toget around the defenseman to theweaker side, the defenseman must firstun-weight the strong leg, shift to theweaker leg, and then push off in thatdirection to intercept the forward. Thisbrief delay may be all the forwardneeds to elude the defenseman.

According to Charles Poliquin,MS, in The Poliquin Principals, stud-ies have shown that, in some athletes,the dominant leg may be as much as 20percent stronger than the non-domi-nant leg. The ramifications of this typeof discrepancy can therefore be disas-trous if not detected and corrected in atimely manner.

The benefit to isolating the limbsduring training is that neural drive tothe working limb is maximized to ahigher degree than with bilateral train-ing. Another advantage of unilateraltraining is the stimulus it provides to ahost of stabilizer muscles. In most


Untitled-4 1 7/9/04 11:26:28 AM

The benefit to isolating

the limbs during

training is that

neural drive to the

working limb is

maximized to a higher

degree than with

bilateral training.

Request No. 119


cases, the degree of the stabilizingeffect has a direct effect on the abilityof the prime movers to execute heavymovements.

For these reasons, it’s critical tofocus on unilateral strength and bal-ance before moving to bilateralexercises, which will go a long way tocorrecting imperfections. Using dumb-bells, kettlebells, or other single-limbexercises can provide a wide variety ofmovements, enhance stabilizer devel-opment, and rebalance potential

problem areas while developing a highlevel of strength.

It is also important to locate anybilateral imbalances. The best way isto test common actions that may showa discrepancy. (Table One, on page 32,outlines some common tests.) Whentesting specific actions it is importantto get as much feedback as possible tomake an informed decision. Use mir-rors, coaches, training partners, or avideo recorder to view the test. Thegoal of testing is to ensure that there is

less than a five percent variance instrength between limbs and discoverwhere any imbalance is located.

WITHIN THE LIMB

Imbalances within a single limb (suchas between the biceps and triceps orbiceps and forearm flexors) can alsohave a negative impact on perform-ance. Genetic flaws, motor recruitmentpatterns, technique of the exercise ormovement, or previous injuries maypotentially cause imbalances. As withother forms of imbalances, the strongermuscle or muscles tend to do a higherportion of the work compared with theweaker muscles, which further exag-gerates the strength differences.

For example, with one of myclients, his forearm flexors were verystrong and his biceps were muchweaker. I found this out by using acurling exercise that tested his strengthwith and without the use of his forearmflexors. Training for this client thenbecame a matter of trying to minimizethe involvement of the forearms withinmovements involving the biceps so thatthese muscles would have a chance todevelop and re-balance accordinglywith the stronger forearms.

The difficulty with imbalanceswithin the limb is that they can betough to detect until an injury occurs.Oftentimes people will not have anypain in the weaker part of the limb andare still able to make progress withstrength training.

The best method to evaluate bal-ance within the limb is to isolate thevarious muscles and compare thatstrength to the whole movement. Forinstance, when testing the upper arms,use a curling action and record theweight that can be lifted in a completemovement. Then isolate the biceps bybending the forearms backwardsthroughout the lift (called a Zottmancurl), and vary the hand positions usinga neutral and then pronated grip todetermine the strength variance whenother muscle groups are involved. Takenote of the differences in strength usingthe varying techniques.

A certain amount of difference instrength is acceptable, but when the

34


Request No. 120

differences between hand positions orwhen muscles are isolated are morethan 20 percent it is time to use cor-rective measures. (Table Two, above,outlines some tests for within-the-limbbalance.) Once you identify the areathat is weaker you can focus moreattention on correcting this problem.

SPORT-SPECIFIC BALANCE

Athletes are perhaps more prone toimbalances than the general trainingpublic. The repetitive movements inathletics such as the golf swing, hock-ey shot, swimming stroke, and runningstride create the potential for what iscalled a repetitive stress syndrome orpattern overload. These muscles arestressed over and over, perhaps thou-sands of times in a similar manner, andcan create an imbalance compared tothe other side of the body. The weak-ened state of the antagonist muscle ormuscle group compared with the muchstronger agonist or prime mover pre-disposes the athlete to injury.

The goal for all athletic actions isto improve performance, so the primemovers have to be developed in asport-specific manner. However, whencreating training programs, in order to

avoid imbalances, the movements haveto be analyzed to determine the bestcourse of training for the antagonistmuscle or muscles as well.

In the throwing action, forinstance, the external rotators arecalled upon much less than the primemovers of the abdominals, chest, andshoulders, but they still need to bestrong enough to decelerate the armand thus prevent injury. Another exam-ple is ice hockey for which manyconditioning programs fail to rebal-ance the abductors and adductors thatare under-developed from skating.When looking at sport actions, try todetermine what the antagonist muscleor muscles are that need to be workedand spend time bringing them up to anacceptable level.

The difficult task is to figure outwhat an acceptable level of balancedstrength is, as it depends on a numberof variables. Unfortunately, there areno hard and fast rules to govern thebalance within the body for maximalsport performance and injury preven-tion. In some actions, such as lateralmovements, it has been shown that thebest extensor-to-flexor ratio in theupper legs is between 75 to 97 percent.

In studies with top Canadian sprinters,the hamstring-to-quad strength was upto 125 percent.

For most sports, however, themost prudent plan is to develop theantagonist muscles that do not get asignificant amount of training fromsport activities and assess the particu-lar athlete. Coaches and athletictrainers should take into considerationthe range of movement, speed of thelimb during the sport action, sex of theathlete (men are typically stronger bybody weight than females), priorinjury status, and the sport beingplayed. Coaches can video their ath-letes performing many different sportand training movements, then watchthe athletes on a monitor in a sloweddown, frame-by-frame mode, wherehidden actions or tell-tale signs ofimbalances may be discovered.

In sports that include a rotationalcomponent (such as golf, baseball, rac-quet sports, hockey), also look tobalance the body by spending timestrengthening the same type of actionson the opposite side of the body. In thegolf swing, for instance, if the golferhits left handed, the right side of thebody should be developed withstrength-training exercises similar tothe sport action. In addition, a certainamount of sport practice on the rightside (perhaps with a right-handed golfswing or right-handed medicine balltoss) should be performed. The weak-er side may never achieve a similarperformance state as the dominantside, but by using similar sportingactions on the non-dominant side, thegoal of reducing potential imbalancescan be met.

Developing appropriate resist-ance training programs after acomplete assessment can be very ben-eficial for athletes wishing to traininjury free for any length of time.There are many training hazards thatcan have a negative impact on per-formance, and it becomes critical toreduce those potential problem areasin order to achieve optimal perform-ance. Understanding the importance ofbalanced strength in the body is a keyfactor in this process. ◆



Table Two: Within-Limb Tests

Compare one-arm bicep curls to one-arm hammer curls and conduct one-armZottman curls to test for arm balance. Results should be within 20 percent foreach lift.

Compare maximal front squats to maximal back squats to test for knee joint bal-ance. Front squat should be 85 percent of back squat.

Compare bicep curls to triceps dips to test upper-arm balance Results should be40-50 percent of max dip.

Compare dorsi flexion to calf raises (using the Dynamic Axial ResistanceDevice). Results should be 8 to 15 percent of max calf raise.

Compare hip flexors to hip extensors on multi-hip machine. Results should beclose to 50 percent or more.

The following are samples of within-the-limb testing exercises:

Request No. 121

W hether they like the Nike swoosh, the Adidasstripes or another brand

of footwear, most athletes are prettyparticular about their athletic shoes.They want them to fit well, be com-fortable, and look hip. But what mayactually be more important than theshoe they choose is what they are—orare not—putting in the bottom of it.

We are referring to foot orthotics,which should be an important part ofany athletic trainer’s treatment toolboxfor lower extremity injuries. Orthotics

frequently include posts, or wedges,on their bottom side that aim to alterthe biomechanics of the lower extrem-ity by controlling faulty motion.Another common use of orthotics is toincrease shock absorption by the mus-culoskeletal system during weightbearing. More recently, the role oforthotics in altering neuromuscularcontrol of the lower extremity has alsogained interest.

The purpose of this article is tohighlight the contemporary clinical usesof foot orthotics in sports medicine. Wewill also review the mechanisms bywhich these devices may influence themusculoskeletal system.

DIFFERENT TYPES

Foot orthotics are available in two types:off-the-shelf and custom-made. Off-the-shelf orthotics, such as full-length shoeinserts, arch supports, and heel lifts, aresold by shoe size and are not designed totreat specific individuals or pathologies.These devices are frequently sold at


◆ T R E A T I N G T H E A T H L E T E ◆

SOFT FEET, STRONG LEGSWant an easy way to help treat lower extremity injuries in your athletes?Orthotics are the answer, although it’s not clear whether they control mechanics or alter neuromuscular activation patterns.

Dr. Jay Hertel and Dr. Lauren Olmsted

Jay Hertel, PhD, ATC, is an AssistantProfessor with the Graduate AthleticTraining/Sports Medicine program in theCurry School of Education at theUniversity of Virginia. Lauren Olmsted,PhD, ATC, is the Clinical Coordinator andInterim Athletic Training EducationProgram Director in the Department ofKinesiology at Penn State University.

AP/WIDE WORLD PHOTOS


pharmacies, athletic shoe stores, andsports medicine clinics. Various types ofposts are available in some brands.

The more expensive custom-madeorthotics are constructed based on animpression of an individual’s feet. Theimpressions have traditionally beenmade from plaster or foam casts of thepatient’s feet, although more recentlydigital scanning techniques have alsobecome available. The custom-madeorthotic can be made from a wide vari-ety of materials, and specific postsprescribed by the clinician may beadded to the outside of the orthotic ormay be built directly into it.

For both custom and off-the-shelfmodels, there are three primary stiffnessclassifications: flexible, semi-rigid, andrigid. The more flexible an orthotic, theless motion can be controlled. Flexibleorthotics are prescribed when only asmall amount of motion control is need-ed but considerable shock absorption isdesired. Conversely, rigid orthotics aretypically used in extreme biomechanical

cases when a great deal of motion con-trol is needed and shock absorption isnot of primary concern. Semi-rigidorthotics are the most common orthoticsand provide a balance of motion controland shock absorption.

HOW DO ORTHOTICS WORK?

Traditionally, foot orthotics have beenthought to work by controlling the rangeand velocity of motion of the foot andproximal segments of the lower extrem-ity. And research has consistently shownthat medially posted orthotics decreasethe amount of foot pronation and inter-nal tibial rotation, as hypothesized.Additionally, these orthotics significant-ly decrease knee abduction andadduction movements, demonstratingthat orthotics can alter the mechanics ofthe proximal lower extremity joints.

However, there are still some ques-tion marks in the literature on orthoticsand biomechanics. For one thing, thereis research showing lack of significantmotion restriction and large variations

in individual responses to orthotic inter-vention. In addition, there has been verylittle research examining the differentialeffects of off-the-shelf and custom-made foot orthotics on motion control.

Much of the current research onorthotics examines the role that footorthotics have on the neuromuscular sys-tem. At least three studies have foundthat orthotics enhance the cutaneous sen-sation on the plantar aspect of the footthus changing the afferent input from thesomatosensory system. This change insensory input is thought to positivelyalter the neuromuscular activation pat-terns of the lower extremity. In a recentstudy at Penn State, off-the-shelforthotics, regardless of rearfoot posts,led to increased electromyographicactivity of the vastus medialis and glu-teus medius muscles, suggesting that thesensory, not the mechanical, effects ofthe orthotics led to positive changes inlower extremity neuromuscular activity.

Similarly, both off-the-shelf andcustom orthotics have been shown to

38


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improve postural control, a measure ofneuromuscular function. Also empha-sizing the importance of the sensoryeffect of orthotics is the finding thatorthotic comfort is significantly relatedto the kinematics, kinetics, and neuro-muscular activation patterns during gait.

Benno Nigg, PhD, Director of theHuman Performance Laboratory at theUniversity of Calgary, proposes a newparadigm to explain the effect oforthotics on motion control. He statesthat forces acting on the foot duringthe stance phase of gait provide aninput signal producing a muscle reac-tion. The orthotic is thus a tool thatmay be manipulated to influence thecutaneous receptors on the plantaraspect of the foot as well as the articu-lar and musculotendinous receptors ofthe lower extremity.

Sensory changes can alter motorpatterns in either a positive or negativemanner. If the adaptation process caus-es a preferred joint movement path fora given movement task, muscle activi-

ty will decrease. If an interventioncounteracts the preferred movementpath, muscle activity must beincreased. An optimal orthotic willreduce muscle activity and optimizelower extremity function. Furtherresearch, however, is needed to vali-date this intriguing hypothesis.

CLINICAL USES

While the research continues on boththe biomechanical and neuromuscularaspects of orthotics, athletic trainerscan be confident of the devices’effectiveness in the treatment of avariety of lower extremity conditions:

Lower Leg Pain: Perhaps the mostcommon use of foot orthotics is to con-trol hyperpronation, which has beenlinked to increased incidence of injuries,including medial tibial stress syndrome(shin splints). Excessive foot pronationis often caused by structural malalign-ments of the foot such as forefoot varus,pes planus, or rearfoot valgus. Thus,orthotics designed to limit excessive

hyperpronation aim to do one of threethings: control forefoot motion, increasearch support, or control rearfoot motion.

Control of forefoot motion in anindividual with forefoot varus is typi-cally accomplished by adding a medialpost to the orthotic at the level of themetatarsal heads. This is done in aneffort to provide a mechanical block toexcessive forefoot pronation.

Athletes with pes planus needincreased support of the medial longitu-dinal arch to limit hyperpronation. Thismay be done with a variety of materialsincluding foam, felt, rubber, or plastic.

Medial posts of the rearfoot will help to limit hyperpronation inpatients with rearfoot valgus. Limitingthe range and velocity of pronationthrough increased medial support isthought to reduce strain of the posteri-or tibialis and soleus muscle origins onthe posteromedial aspect of the tibia.

The clinical efficacy of footorthotics in the treatment of lower legpain related to hyperpronation has



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for the quadriceps and hamstring mus-cles. Half the subjects were alsotreated with soft orthotics with appro-priate medial forefoot and rearfootposts to help limit hyperpronation.

Both groups demonstrated im-provement in symptoms over eightweeks, but the group treated with theorthotics had significantly greaterreduction in symptoms than the control group. The authors speculatethat the benefits of using orthotics in the treatment of PFPS are derivedfrom altering the biomechanics associ-ated with hyperpronation at thetibiofemoral and patellofemoral joints.

Lateral Ankle Sprains: Use of footorthotics in the treatment of lateral anklesprains is less commonly advocatedthan with lower leg and knee pain, but itis an area that is gaining interest. Somerecommend laterally posted rearfootorthotics, while others suggest usingneutral orthotics with no posts.

Laterally posted orthotics arehypothesized to work via a mecha-

40


been long-established, but some prac-titioners are also recommending theprophylactic use of custom orthotics.A study among military recruitsshowed that using orthotics onhealthy subjects proved to be benefi-cial in the prevention of lowerextremity stress fractures.

Another use for orthotics in thetreatment of lower leg pain involvesathletes who have suffered stress frac-tures but have limited foot pronation.Athletes with rigid pes cavus, or high,arched feet do not dissipate as muchshock through their arches as do ath-letes with more flat and less rigidarches. This places them at increasedrisk of lower leg stress fractures as thetibia and fibula must then absorb moreshock during the stance phase of gait.These athletes often benefit from usingflexible orthotics made of very com-pliant materials that absorb shock.

Patellofemoral Pain: Usingorthotics also works well to help treatchronic patellofemoral pain. Like with

treating lower leg pain, the clinicalrationale is that the orthotic will limithyperpronation. By limiting footpronation, internal rotation of the longbones of the leg is also reduced.

Historically, patellofemoral painhas been linked to abnormal lateraltracking of the patella in the distal femoral groove. But a morecontemporary theory suggests thattoo much internal rotation of thefemur is actually the culprit. Thisleads to a femur that is rotated too farmedially and a patella that then rubsagainst a more prominent lateralfemoral condyle.

One study, conducted by JaniceEng, PhD, and Michael Pierrynowski,PhD, and published in PhysicalTherapy in 1993, focused on femaleadolescents suffering from PFPS withgreater than six degrees of rearfootvalgus or forefoot varus. All the girlswere subject to a supervised rehabilita-tion program that emphasizedstrengthening and flexibility exercises

Untitled-2 1 7/6/04 10:37:34 AM

Request No. 125

nism opposite that of medially postedorthotics. Since the mechanism ofinjury for lateral ankle sprains ishypersupination (comprised ofexcessive plantar flexion, inversion,and internal rotation), an orthotic thatlimits hypersupination would preventthe rearfoot from returning to theposition in which the lateral liga-ments were injured. Laterally postedorthotics limit hypersupination ratherthan hyperpronation.

The use of a neutral orthotic in thetreatment of lateral ankle sprains isadvocated for maintaining the subtalarjoint in the midrange of its range ofmotion, which keeps the ankle awayfrom the extremes of both hyperprona-tion and hypersupination. This isthought to reduce the strain on the heal-ing ligaments that support the subtalarjoint including the calcaneofibular, cer-vical, and interosseous ligaments.

When might you use the two differ-ent types? Although this is only ouranecdotal experience, we’ve found that

athletes with pes planus will respondbetter to neutral orthotics, whereas thosewith normal foot structure or pes cavusrespond better to lateral posts.

Another idea is to use rearfootorthotics as an intervention to improvepostural control in ankle injured subjects. Rearfoot orthotics are hypoth-esized to stabilize the subtalar joint andthus provide a more stable base of sup-port. One study found that patientssuffering from acute lateral anklesprains who wore orthotics had betterbalance and less pain while jogging thanthose who did not wear orthotics.Another study found that athletes recov-ering from acute ankle sprainsdemonstrated less postural sway duringsingle leg stance when they were pre-scribed foot orthotics versus a group notprescribed foot orthotics. Overall, thereis not enough empirical evidence yet tosupport or refute the efficacy of footorthotics in the treatment of lateral ankle sprains, but these studies showpromise.

HOW TO CHOOSE

There is still much that is not knownabout the exact workings of orthotics.The mechanism by which orthoticswork is most likely a combination ofbiomechanics and neuromusculareffects, but the specific contribution ofeach component is unknown. In addi-tion, there are no rules about when touse off-the-shelf orthotics and when tohave them custom-made.

Our recommendations: Considerusing orthotics when rehabilitating ath-letes with lower extremity injuries andconsider using them as a prophylacticmeasure if the athlete has suffered a pre-vious injury that was likely caused byhyperpronation, or in the case of stressfracture, too little pronation. If cost is afactor, starting with an off-the-shelfmodel is justified before getting a pre-scription for a custom-made orthotic. ◆

For a copy of references for this article, please go to

www.AthleticSearch.com/footrefs.


Request No. 126


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Utilize your football athletes’ warmup time moreeffectively with these partner core stretches.

One of the greatest challengesfacing today’s coaches is organ-izing strength or conditioning

sessions that involve a large group ofathletes. Ideally, a strength coach wantsto give as much individual attention aspossible during workouts, but in a largegroup setting, that can be difficult.

However, that’s no excuse forshortchanging your strength program.With a little creativity, almost any goalcan be accomplished, no matter howlarge the group of athletes. It is notnecessary to accept a lower-qualityworkout simply because multiple ath-letes are involved in an activity.

Recently, our challenge was to cre-ate a series of exercises for a team ofhigh school football players that could

be accomplished during their warmupand would make the most effective useof their limited time. In response, wecreated a group of core training partnerexercises that can be done on the fieldwith limited supervision.

The focus of the exercises is onstrengthening the core, a key elementfor football athletes. A strong coreenables both mobility and stability ofthe body and helps prevent injuries,asymmetries, and muscle imbalance.Because core training is so importantfor the football athlete, it must be con-tinued throughout the season. Makingthese exercises a consistent part of thewarmup allows the core to maintain itsstrength up to the very last game.

It was also critical to design theexercises based on functional movementpatterns, not isolated muscle training.Football athletes will sometimes beskeptical about exercises that don’t have

weights on them, so it is important toexplain to them that simply becomingstronger will not yield a better move-ment pattern. They must develop acombination of strength, stability, jointmobility, and muscular flexibility,which happens through functional drills.

Why are core training partner exer-cises an effective use of time? First of all,by making them part of the warmup, weaccomplish two goals at once. Often,time is wasted during the warmup asplayers loosen up and get ready for prac-tice in a haphazard way. But this isvaluable time that can contribute to the


C O M P E T I T I V E E D G E

▼

By Gray Cook, Heath Hylton, and

David Lee

Gray Cook, MSPT, OCS, CSCS, is ClinicDirector, Heath Hylton, PTA, CSCS, isClinic Coordinator, and David Lee is anExercise Physiologist at Orthopedic &Sports Physical Therapy, Dunn, Cook, andAssociates, in Danville, Va. Cook is also the author of Athletic Body in Balance,published by Human Kinetics.

A special thanks to the Pittsylvania County(Va.) high school coaches for their continualsupport of and feedback on our programs.

DOWN THE MIDDLEDOWN THE MIDDLE

David Crane


overall development of the athlete. Thisprogram gives structure and meaning tothe first 10 to 15 minutes of on-fieldwarmup activity.

They are also time-efficient becausethey use a partner system, which enablesthe strength coach to occupy all individ-uals on the field in a session. While halfare doing the exercise, the other half arelearning more about the exercise byhelping their partner. This cuts down ondistraction. It also cuts down on the levelof supervision needed, as coaches onlyneed to watch half the number of athletesperforming the specific move.

Of course, partnering also providesa necessary rest break for the individualwho is not performing the exercise. This

is not to say that the individual is totallyresting. It is an active rest where the levelof intensity is not that of the partner, buthe is actively watching, participating,and paying close attention to detail.

In the following text, we describeseveral exercises that we developed forthis program—all of which can be per-formed at varying degrees of difficulty.They are based on what we call theFunctional Movement Screen™ (Pleasesee “Weak Links” in T&C April 2002for more detail) and focus on movementpatterns like the squat, hurdle step,lunge, push-up, and active straight-legraise. These are the movements we feelhelp athletes most effectively elongatemuscles and activate the core.

One thing to note is the impor-tance of matching athletes withpartners of equal size, strength, andflexibility. This creates a fair level ofcompetition and provides more consis-tent feedback between partners.

It is important to give the partner anactive role with respect to support, spot-ting, and the opportunity for feedbackand technique modification. The partneris almost assuming the role of assistantcoach. You should make it clear to theathletes that if a bad set is observed, it isthe fault of the partner as much as theexercising athlete. It is important thatboth individuals feel ownership of thedrill even though one will obviously beworking his muscles harder.

44


▼

DEEP SQUAT SHOULDER STRETCHPURPOSE: To improve deep squat and shoulder mobility movement patterns.

INSTRUCTIONS: The deep squat shoulder stretch incorporates the mobilitymaneuver needed in the lower extremities to execute a deep squat with the heelsflat. Since athletes have varying degrees of ability with a full deep squat, the part-ner stands with one leg supporting the low back and buttocks region andencourages the squatting athlete to lean forward as much as possible and then toerect the spine in an upright tall spine position. This will engage the core.

Once a complete deep squat has been executed, the squatting athlete is cued topress the knees outward using his elbows to create an adductor stretch. He is toldto hold the knees in this position and maintain this abducted position of the hipswhile reaching upward, first with the right arm and then with the left. The part-ner gives an upward pull or traction stretch and the athlete performing the stretchis encouraged not to let the knee cave in on the side of the stretching arm.

NOTE: The arm is not pulled backward. It is pulled upward, thus creating a safeshoulder stretch for the lats and pecs.

HALF-KNEELING ROTATION MOBILITY AND STABILITYPURPOSE: To improve lunge, rotary stability, and shoulder mobility movementpatterns.

INSTRUCTIONS: Both athletes get into a half-kneeling position with the left knee up.One person puts his arms in a “T” position with shoulders abducted 90 degrees. Thepartner then performs a mobility assist by rotating the first person’s shoulders leftand right to 90 degrees while the athlete is instructed not to allow any rotation at thehips or pelvis. They are cued to stay as tall as possible and keep the hip of the backleg extended as much as possible throughout the stretch. The sequence is reversedand the other partner then performs the same stretch. Once both athletes havestretched in a left and right direction, the knee position is reversed.

Next, the athletes get into a push-hands position in the center of their bodies and exe-cute an isometric rotation into each other while stabilizing their hip and shoulderposition and keeping the spine as tall as possible. They are told to push as hard aspossible without losing balance and then to perform the same movement with theopposite hands. The half-kneeling position is then switched to the opposite knee.

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▼STABILITY STRIDEPURPOSE: To improve hurdle step and trunk stability push-up movement patterns.

INSTRUCTIONS: The athletes assume a wheelbarrow position where one athleteis in the push-up position and the other holds the partner’s ankles at the level ofhis hips with a slight knee bend. The supporting athlete can take a stride positionto narrow his base and allow for easy cycling action of the legs. The athlete inpush-up position cycles each leg, one at a time, toward his chest and back. Hemust maintain a flat back and a stable core with a head-up position and tuck theright hip as the supporter releases the ankle of the right leg. The athlete isinstructed to bring his hip as close to his chest as possible followed by extendingit back to the start position and quickly pulling the left leg into the same position.

The goal is smooth, quick leg speed while maintaining a stable trunk. The sup-porter is encouraged to use quick hand action to alternate supporting each leg asthe active athlete goes through this stride position.

MODIFICATIONS: The athlete exercising can widen or narrow his hand positionto change the level of difficulty or go to a prone-on-elbows position to reduceupper-body stress.

PLANK POSITION CRUNCHPURPOSE: To improve trunk stability and push-up shoulder mobility movementpatterns. This exercise serves to demonstrate to athletes that the spine has bothstabilizing and mobilizing roles. The muscles of the spine can either hold thetrunk stable or create a curl or twist action.

INSTRUCTIONS: One athlete assumes a push-up position (plank position) with theother athlete lying across his back perpendicularly. The athlete on top is instruct-ed to do crunches in the same fashion he would do over a stability ball (fullflexion and extension).

MODIFICATIONS: The athlete in the support position holding his push-up positioncan modify his position if he becomes weak by going to a quadruped position.

SIDE BEND SHOULDER STABILITYPURPOSE: To improve rotary stability, shoulder mobility, and trunk stabilitypush-up movement patterns.

INSTRUCTIONS: The athlete performing the exercise assumes a side-lying posi-tion on the elbow with the forearm flat and palm down. The partner assumes aquarter-squat position holding the ankles. The athlete on the ground is instructedto elevate the hips up and through until an erect and straight spine can beobserved. This move is performed both on the left and right sides.

MODIFICATIONS: The athlete doing the side bend can stabilize with the top armby gripping the wrist on the ground. This will reduce the natural shoulder twistthat occurs with the move.

TRUNK STABILITY SHOULDER PRESSPURPOSE: To improve stability push-up, rotary stability, shoulder mobility, anddeep squat movement patterns. This also provides a double quadriceps stretch forthe partner.

INSTRUCTIONS: One athlete holds a push-up position while his partner placesthat athlete’s ankles on his shoulders while in a tall kneeling position. The sup-porting athlete keeps the hips as far forward as possible, getting a slight anteriorthigh stretch, and then performs a shoulder press holding the ankles of the athletein push-up position. The athlete in push-up position is instructed to keep astraight and erect spine throughout the entire movement.



▼HIP LIFT WITH PLYO LEG RAISEPURPOSE: To improve hurdle step and active straight-leg raise movement patterns.

INSTRUCTIONS: The first athlete lies on his back with his head between the feetof his partner and holds the lower ankle and heel on each side. The athlete on theground performs a bridge by lifting his buttocks with the knees in a 90 degreeflexed position. He then extends one leg and lifts it in a straight-leg position com-ing backward toward the standing partner. As soon as the leg reaches its full rangeof motion, the partner pushes the leg downward in a brisk, shoving motion withone arm. The athlete slows down the lower extremity, changes direction, andbrings it back upward again. This is done on each side. While performing thisexercise, the athlete on the ground is instructed to maintain a hip lift position andnot lose hip extension during the leg cycle lift activity.

EXTENSION PRESSPURPOSE: To improve rotary stability and shoulder mobility movement patterns.

INSTRUCTIONS: One athlete sits with his arms supporting him from behind and liftsthe legs so that the supporting athlete can hold both the ankles in a quarter-squatposition. The athlete on the ground is instructed to press the hips upward until thespine is as straight as possible and to keep the chest up and shoulders back.

MODIFICATIONS: The athlete doing the press can go to an “on elbows” positionto reduce arm and shoulder stress. ◆

INJURY : ANSWER Groin strain : The BodyGuard

Hamstring : The BodyGuard

Quadricep : The BodyGuard

Hip Flexor : The BodyGuard

Shoulder subluxation : The BodyGuard

Shoulder dislocation : The BodyGuard

Shoulder separation : The BodyGuard

BodyGuards are designed for the prevention and treatment of upper and lower-body soft tissue injuries using the theory of Stored Elastic Energy Transfer (“SEET”). BodyGuards: used by 13 of 32 NFL teams and numerous collegiate programs during the

2003-2004 season in a wide variety of sports.

Antibody s goal is to improve the Athletic Quality of life of all athletes.

Antibody, Inc.

To purchase and learn more visit us at www.antibodywear.comphone (301) 782-3700 fax (301) 782-3701

“LET THE BODYGUARD PROTECT YOUR TEAM”

“The BodyGuard worked perfectly for me...I wouldn t have played without it.”Troy Vincent - Philadelphia Eagles/Buffalo Bills

“The BodyGuard made me feel like I had an extra layer of muscle that gave me the ability and the confi dence to perform. I recommend The BodyGuard for any athlete that has suffered an injury similar to mine.”Triple H - World Wrestling Entertainment

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Request No. 131

UNDERSTANDING HEAT ILLNESS Heat Stress can appear in many different forms, and it’s important to understand the differ-ences in order to keep your athletes safe.

By: Greg Scholand

Preventing heat stress is an importantresponsibility that should always be atop priority for athletic trainers and any-one else who is responsible for athletes’welfare. High-profile instances of heatillness resulting in serious injury ordeath at the high school, college, andpro level have opened the eyes of thesports world to the importance of keep-ing athletes safe during strenuous out-door activity. In order to keep heatstress from posing a threat to your ath-letes, it’s essential that you understandthe different types of heat illness, what

causes them, and how they can beprevented.

The Inter-Association Task Force onExertional Heat Illnesses, a group spear-headed by the National Athletic Trainers’Association, issued a consensus state-ment in June of 2003 outlining the vari-ous types of heat illness and how theyshould be addressed. The statementbreaks down the different types of heatillness as follows:

Dehydration occurs whenever an athleteloses fluids at a faster rate than he orshe replaces them. Dehydration is prob-

lematic not just because of its negativeeffects on athletic performance, but alsobecause it can interfere with the body’sability to maintain normal temperatureduring prolonged strenuous activity. Theeasiest way for athletes to avoid dehy-dration is very simple—they shouldhydrate themselves adequately before,during, and after exercise, especially inadverse weather conditions.

Heat Cramps are a common form ofheat illness often accompanying dehy-dration, and they can be very debilitatingfor exercising athletes. While not fully

Heat Stress Prevention

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understood, cramping is thought toresult from the depletion of both fluidand sodium through sweat during stren-uous activity. Research has shown thatsome athletes are chronically moreprone to cramping than others, and thismay be due to habitually insufficientsalt intake through diet along withhigher than normal salt concentration insweat. Heat cramps can be treated andprevented by replacement of lost fluidsand sodium through sports drinks

(which can have salt added to increasesodium content), along with stretchingand treatment of the affected musclearea. Using sports drinks instead ofwater to replenish fluids can also helpto prevent Hyponatremia, a condition inwhich excessive water intake coupledwith high sodium loss dilutes the sodi-um in an individual’s bloodstream to anunsafe level.

Heat Exhaustion is a more seriousform of heat illness, caused by dehy-dration combined with strenuous exer-cise in warm or hot weather conditions,and resulting in difficulty sustainingphysical activity, decreased overallperformance, and elevated body tem-perature. Heat exhaustion can be pre-vented by adequate hydration and byproviding frequent breaks during strenu-ous activity, especially in hot, humidconditions. It’s important to rememberthat factors like the amount of paddingworn and exposure to sunshine con-tribute to increased body temperatureas well, and so they can make athletesmore susceptible to heat exhaustion.

Exertional Heat Stroke is a severeform of heat illness that can causeserious bodily harm or even death.Strenuous exercise combined with ahot, humid environment causes bodytemperature to rise dramatically (typi-cally to 104˚F or above) and results innervous system dysfunction, which mayinclude disorientation, convulsions, orlost consciousness. Heat stroke mustbe treated immediately and aggressive-ly by cooling the body as quickly aspossible, ideally with cold water immer-sion. It is also essential that medicalattention be provided as soon as possi-ble, as serious complications such asorgan failure and tissue damage mayoccur.

The best strategies for keeping athletessafe from all forms of heat stress,particularly when they will be active in ahot, humid environment, incorporateproper hydration, adequate rest peri-ods, access to shade and/or air condi-tioning, and careful monitoring of healthand performance. Athletes must beactively discouraged from feeling thatthey should “suck it up” if they feelfatigued, nauseous, overheated, orunable to continue exercising. A planshould also be in place for treatingathletes who are showing signs of heatstress, and it should address both on-site treatment and ready access toemergency medical care.


In today's ultra competitive sportsenvironment, managing the health andsafety of athletes is paramount to

winning. Exertional heat illnesses inhibitan athlete's ability to perform at peaklevels, threatens their life safety andexposes your organization to potentiallysignificant liabilities. Quest Technologiesis the world leader in heat stressmonitoring technologies thatallow accurate, real-timeunderstanding of environmentaland physiological conditions

that directly affect an athlete's ability tostay healthy and compete successfully.Quest Technologies offers a total solutionincluding monitors on a purchase, rentaland rent-to-own basis as well as on-siteeducational seminars on the subject ofheat stress.

To learn more, call 1-800-245-0779 or visit our web site at www.Quest-Technologies.com.

Introducing the QUESTemp° Series

www.Quest-Technologies.comRed, Rugged and Reliable ISO 9001:2000 Registered Company

& ISO 17025 Accredited Calibration Lab

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Acumen, Inc.800-852-7823WWW.ACUMENINC.COM

Acumen’s Hydra-Alert allows users to con-currently monitor radiant body temperature,heart rate, and humidity to accurately gauge

fluid loss duringphysical activity.Athletes and fit-nessenthusiasts

often fail to properly re-hydrate themselvesduring and after exercise, and dehydrationnegatively affects physical performance.Hydra-Alert’s unique features include fluidcheck, a heat-index monitor, and the abilityto prompt users to re-hydrate with an appro-priate quantity when necessary. All thishelps users maintain proper hydration,achieve maximum performance, and avoidheat stress-related injuries.

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Cool Draft Scientific866-676-1636WWW.COOLDRAFT.COM

Heat stress is a major concern among

coaches and trainers.Keep your players upand running with theCool Draft. Theportable Cool Draftreduces temperaturesup to 30˚. Many NFL,college, and highschool football teamsaround the country use

this system. The 18-inch fan produces5800 CFM of fan-propelled mist. For eightyears the Cool Draft has evolved to becomeone of the most portable and dependablemisting systems on the market. To learnmore about heat stress, call or visit thecompany's Web site.

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For 2004, Cool DraftScientific is launching thelong awaited Evolution lineof high pressure mistingfans. Now your school canafford the same high-qualitymisting systems used byNFL and college teams.Cool Draft Evolution is acomplete line of high-pres-

sure misting fans designed for sidelinesand practices. The Evolution was built tomeet the needs and budgets of highschools and colleges. Call or visit CoolDraft's Web site for information and pricing.

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CoreControl888-AVACOREWWW.AVACORE.COM

Training and competing in extreme conditionscan affect even the most cautious athlete.The portable, non-invasive CoreControl™

cools athletes fromthe inside out byextracting heatthrough “thermal por-tals” in the hand.This innovativemethod accelerates

core body cooling rates, working 200% fasterthan conventional skin surface cooling meth-ods. CoreControl can be used anywhere tokeep athletes safe from the health risks ofheat stress, while also enhancing work capac-ity and endurance.

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Energice888-467-9499WWW.ENERGICE.NET

Heat stress dehydration is one of the greatestchallenges for competitive athletes, AthleticTrainers and Strength & Conditioning Coaches.

Energice® is a revolu-tionary product thatgoes beyond ordinaryrehydration benefits. Bysynergistically address-ing rehydration needs,

core body temperature cooling, and post exer-cise muscle recovery, Energice enables athletesto train harder longer and come back faster.Energice combines a key amino acid matrix,valuable mineral electrolytes, and antioxidantvitamins in a refreshing frozen delivery system.

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Extech Instruments781-890-7440WWW.EXTECH.COM

Heat stress has become a growing concern forrecreational and competitive sports enthusiasts.Athletic trainers, coaches, and physical educa-tion teachers are particularly concerned aboutthe combination of temperature and humidity

that may become dan-gerous to their athletes.The HeatWatch™, withits user-set heat indexalarm, is a new, patent-ed, fully-featured, multi-function, professionalstopwatch which also

displays day, date, time, temperature, relativehumidity, and calculated heat stress index.

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HQ, Inc.941-721-7588WWW.HQINC.NET

Assessing core temperature on the field is criti-cal for the prevention of exertional heat illness.The CorTemp™ Core Body TemperatureMonitoring System, featuring the CorTemp

ingestible temperature pill, rec-ognizes elevated core tempera-ture during practices andgames, enabling the ATC to actquickly if heat illness treatmentbecomes necessary. The patent-ed pill wirelessly transmits theathlete’s temperature harmless-ly through the body to the

CorTemp ambulatory data recorder, held by theATC. The ATC gains immediate knowledge as tothe vital physiological status of athleteswirelessly, comfortably, and with the highestdegree of accuracy—every time.

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Mini Mitter Co., Inc.800-685-2999WWW.MINIMITTER.COM

VitalSense® is a new wireless system thatallows for continuous, reliable, accurate moni-

toring of core-body and skintemperatures of athletes inhot weather. Core tempera-tures are transmitted everyfew seconds from a swal-lowable Jonah™ capsule,while skin temperaturesare monitored with adhe-

sive patches. Both transmit data to aVitalSense monitor, which, in Medic Mode™,can receive data from all sensors in range.

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Quest Technologies, Inc.800-245-0779WWW.QUEST-TECHNOLOGIES.COM

Exertional heat illnesses inhibit an athlete’s abil-ity to perform at peak levels, threatens theirsafety, and can expose an organization tounprecedented liabilities. Quest’s environmen-

tal monitors enable athletictrainers, coaches andsports medicine researchersto obtain comprehensiveand accurate information inreal-time, display and recordcorrelated core temperatureand heart rate, and providereal-time alerts and time his-

tory profiles of measured data that directlyaffect an athlete’s safety and performance.

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RG Medical Diagnostics888-596-9498WWW.RGMD.COM

RG Medical Diagnostics has introduced theDataTherm® continuous temperature monitorfor use by sports medicine professionals in the

diagnosis and treatmentof Extertional HeatIllnesses (EHI) andExertional Heat Stroke(EHS). The DataTherm, acompact (1.7 oz.) dataprocessor, continuouslydisplays and records in

memory an athlete's body temperature in realtime. The instrument, priced under $200, ispackaged in a hard case and is supplied with afull array of accessories.

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Request No. 135


Ankle & Footcare

Aircast, Inc.800-526-8785WWW.AIRCAST.COM

The AirHeel™ from Aircast®, Inc., is specif-ically designed to relieve the pain associat-

ed with plantarfasciitis andAchilles tendonitisthrough dynamicfunctional treat-ment. With eachstep, the AircastAirHeel providesintermittent com-pression throughan aircell under

the plantar arch interacting with an aircellsurrounding the Achilles tendon. The pulsat-ing compression from these aircells helpsminimize swelling and discomfort, and pro-motes fast pain relief.

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Since 1978, the Aircast Air-Stirrup AnkleBrace has been the "standard of care" forthe functional management of ankleinjuries. Aircast Ankle Braces feature

anatomicallydesigned shells linedwith the patentedDuplex™ aircell sys-tem. This exclusivesystem providesboth support andgraduated compres-sion to promote effi-cient edema

reduction and help accelerate rehabilitation.Each Ankle Brace comes with a patientguide providing information on brace appli-cation and rehabilitation exercises.

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Cropper Medical, Inc.541-488-0600WWW.BIOSKIN.COM

The TriLok™ fromCropper Medical securesankle motion withoutrestricting plantar-flexionor dorsi-flexion. With apatent-pending softdesign, the TriLok is alsocompact enough to fit

comfortably in your shoe. Patented BioSkin® material also provides optimal propri-oceptive feedback. The TriLok is being usedin clinics, on playing fields, and in gymsacross America. It is functional,comfortable, and effective—the most effec-tive and versatile brace to replace taping.

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Cho-Pat, Inc.800-221-1601WWW.CHO-PAT.COM

The Achilles Tendon Strap helps alleviatethe pain and discomfort associated withachilles tendonitis. It reduces strain on

the tendon by spreadingmuscular contraction andpromoting early heel rise.Developed in cooperationwith the Mayo Clinic, thispatented strap is usedby many sports medicineprofessionals, who recog-

nize it as an effective addition to the tradi-tional achilles tendonitis treatmentprocedures.

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Secure FootingValue Pricing

Designed to fit either rightor left foot, the PRO 610Arizona Ankle Brace isconstructed of heavy duty nylon for a low-profile, durable and lightweight brace. Two straps encirclethe foot in a figure eightpattern providing easilyadjustable lateral and medialsupport. A neoprene tongueprovides a comfortable padunder the laces. Used bythousands of athletes from the pro's to high school, this low-profile brace will notchange your shoe size. All for $14.95.

To order, or for more information, call PRO at1-800-523-5611.

Request No. 136

Stabilize Chronic ShoulderDislocators, Separators,

and SubluxatorsWith over a decade of experience in shoulder bracedesign the MAXTM Shoulder Brace by BraceInternational, Inc. is an evolution in shoulder girdlesupport. The snug-fitting, lightweight material(under 2 pounds) allows for comfort with movementwhile its strap design system allows for many optionsto help protect the glenohumeral joint.

Maximum Protection, Maximum Range of Motion

We highlyrecommend itsuse for allsports.

800-545-1161 Toll Free - www.braceint.comRequest No. 137

Ankle & Footcare


Cramer Products, Inc.913-856-7511WWW.CRAMERSPORTSMED.COM

Cramer's new AS1 Ankle Brace combinesthe support of a heel-lock strapping system

and superior value versuscomparable ankle braces.The brace is constructedwith an 840 D nylon shellwith a soft neoprene linerfor comfort and feel. Non-stretch straps lock in theheel and spring steelstays on each side of the

brace provide additional support.Circle No. 216

Foot Management, Inc.800-HOT-FOOTWWW.FOOTMANAGEMENT.COM

The Ortho Arch® Custom Orthotic, manu-factured from a durable and long-lastingmaterial called E.V.A., is a semi-rigid

orthotic designed to fiteasily into the shoe.The orthotic is lessbulky and lighter inweight than other semi-rigid devices. The OrthoArch aids in shockabsorption, pressurerelief, and biomechani-cal control, while

remaining flexible, allowing the foot to bea mobile adapter. This Foot Managementorthotic can tolerate all weatherconditions.

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The Tenderfoot® Medium CustomOrthotic from Foot Management is manu-factured from a high-density foam. It is

designed for thepatient whodesires a highlevel of cushion-ing as well as adegree of supportand control. Thisorthotic can toler-ate all weather

conditions. Tenderfoot Firm and TenderfootSoft orthotics are also available.

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Jump Stretch, Inc.800-344-3539WWW.JUMPSTRETCH.COM

Jump Stretch, Inc. founder Dick Hartzell hasperfected a way of treating ankle sprainsthat gets the athlete up and running (literal-

ly) within minutesor hours, ratherthan weeks ormonths. Hartzellcontends thatRICE is antiquat-ed, and the Rest

and Ice actually prolong the healingprocess. A video detailing the tractioningtechnique is available for $15. Three FlexBands® (one average and two mini) arenecessary to perform the treatment.

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Kelly Kinetics888-645-3559WWW.KELLYKINETICS.COM

Kelly Kinetics has introduced the PivotPlate, which utilizes a patented VariableOffset Pivot (V.O.P.) system. To increase ordecrease the neuromuscular demand, the

fulcrum can beplaced at varying-moment arm lengths.The fulcrum can alsobe selectively placedin the bestbiomechanical posi-tion to target selectmusculature forstrengthening. Unlike

with traditional balance boards, the PivotPlate user is affixed to the platform, whichallows the user to vary their center of gravi-ty position for a range of resistance levels.

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The Ankle Isolator™, from Kelly Kinetics,combines an adjustable weighted columnthat provides a unique resistive torsion and

proprioceptivefeeling with apatented biome-chanical isolationchannel thatallows for preciseplacement of theresistance over

the insertion of the targeted musculature.Whether it's post-injury or preventativestrengthening, stretching, or manipulation,this versatile non-weight-bearing device canbe easily adjusted in half-pound incrementsto accommodate both early-stage patientsand fully functional athletes.

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McDavid Sports MedicalProducts

800-237-8254WWW.MCDAVIDINC.COM

The #188 Ultra Ankle from McDavid

Sports Medical Products is a professionalquality hinged ankle brace designed to

treat all ankle injuriesincluding high anklesprains. Engineered toreduce the excessiveinversion, eversion,and rotation that caus-es most ankle injuries,Ultra Ankleincorporates advancedfeatures that make it

superior to other hinged ankle braces.Those features include the patented LDC(Lock Down Cuff) Technology with a pivot-ing posterior cuff that helps reduce exces-sive rotary forces. The thermal responsivemolded pad system provides optimumcomfort and fit. The adjustable quick-fitLock Down Strap allows for quick applica-tion and removal.

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McDavid Sports Medical Products offersthe #195 Ultralight Ankle Brace. This topquality product features a lightweight

nylon/vinyl fabric withstirrup straps thatmay be adjustable atanytime during playwithout removing theshoe. These strapssimulate aprofessional tapingtechnique that lends

additional support and protection for com-mon injuries. Other support and comfortfeatures include: a padded lining, notchedfront, elastic heel and tongue, and asewn-in arch support.

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Medical Specialties, Inc.800-582-4040WWW.MEDSPEC.COM

The ASO® ankle stabilizing orthosis, fromMedical Specialties, is a patented anklestabilizer that can be worn either preven-

tively or during the treat-ment of an acute anklesprain. Features include"figure 8" stabilizingstraps and an elasticcuff design that providessuperior functionalityand support. The fingerpulls allow for quickadjustments and contin-

ual support. The ASO is made from ballis-tic nylon and the low-profile design fitseasily inside the shoe.

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Ankle & Footcare


Mueller Sports Medicine800-356-9522WWW.MUELLERSPORTSMED.COM

The new ATF® Ankle Brace from MuellerSports Medicine features the patentedinner ATF® Strap now redesigned to self

adjust to each individ-ual foot for a univer-sal fit. The braceoffers superior protec-tion against inversionsprains while allowingcomplete plantar anddorsal flexion. Bi-directional stretchelastic over the

Achilles tendon area, Comfort Windows™,and flexible steel springs add to the effec-tiveness of this brace. The high-strengthcordura fabric eliminates the need for metaleyelets and adds to the comfortablecustom fit. Available in sizes XS -XL.

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OPTP800-367-7393WWW.OPTP.COM

The Resting Foot Sling from OPTP is alightweight, comfortable positioning slingdesigned to place the foot perpendicular

or slightly dor-siflexed forpassiveprolongedstretching ofthe lower legand foot. The

Resting Foot Sling was developed by aphysical therapist and may be used totreat plantar fasciitis, achilles tendinitis, orgeneral stretching. It is an excellent alter-native to expensive molded night splints.The Resting Foot Sling can be worn whilesleeping, lying, or sitting down. It shouldnot be worn or used for walking.

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The versatile Multi Challenge Board fromOPTP is designed to offer an extra degreeof challenge as user proficiency increases.

A simple twist adjust-ment increases theboard angle from 14degrees to 17degrees. Use theOPTP Multi ChallengeBoard for active andreactive rehabilitationof ankle injuries, core

muscle conditioning and stabilization,stretching, improved proprioception and

balance, and motor skill training, as wellas ROM and strength conditioning for thelower kinetic chain.

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Pro-Tec Athletics800-799-3372WWW.INJURYBEGONE.COM

Tired of Achilles tendon pain? Pro-TecAthletics has the answer with the AchillesTendon Support. This Achilles Tendon

brace offerscomfortable com-pression to sta-bilize the tendonand reducestress. It alsofeatures an elas-

tic strap, which provides a lift to the heel,preventing excessive stretching to the ten-don. Comfortable and effective, theAchilles Tendon Support will help preventfurther damage and enhance the healingprocess, allowing your athlete to get backinto competition sooner.

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Pro-Tec Athletics also offers the ArchSupport. The Arch Pro-Tec applies upward

compressionto the arch,alleviatingconditions ofplantar fasci-itis and heelspurs.

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Tekscan, Inc.800-248-3669WWW.TEKSCAN.COM

The F-Scan® Mobile system, fromTekscan, is used to enhance thetechnique and performance of your players

by improving weight trans-fer and timing during vari-ous activities. By placingpaper-thin insole sensorsinside the shoe or cleat,you can record subtle dif-ferences in bi-pedal plantarpressures. The informationcan be used to fine-tunetechnique, benchmark per-formance, optimize stance

and positioning, evaluate cleat and orthot-ic efficacy, and re-train after injury. Thelightweight system won’t interfere with nor-mal activity so you can capture data virtu-ally anywhere, for any activity.

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Modern training techniques can makeanyone faster, stronger, and more power-ful. ISSA’s Specialist in SportsConditioning and Youth Fitness Trainerprograms have been designed to provideyou with the knowledge, expertise, andspecific training techniques necessary toenable athletes to expand the capacity oftheir bodies to perform the most difficultathletic feats, while remaining strong andfree from injuries. Written by Professorand champion athlete Thomas D. Fahey,PhD, ISSA’s SSC and YFT programs equipyou to properly and effectively train ath-letes and open the door to a new andprofitable client base.

That’schanged.

Until recently, most peoplebelieved that power athleteswere born and not made.

Call today for FREE information

1.800.892.4772Please mention source code TC804

FitnessEducation.com

GI Bill Approved

Request No. 138


Aquatic Therapy

Ferno Performance Pools888-206-7802WWW.FERNOPERFORMANCEPOOLS.COM

Transform a traditional swimming or lappool into an aquatic exercise environmentwith the Ferno AquaGaiter™ Underwater

Treadmill.Combining tradition-al treadmill trainingwith the naturalproperties of watersuch as buoyancy,resistance, andheat, theAquaGaiter is per-fect for a low-impact

workout. The AquaGaiter features variablespeed adjustments ranging from .5 to 8mph for any level of conditioning. TheAquaGaiter provides athletes the ultimatewater workout by strengthening musclesand reducing joint impact.

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Ferno offers over 250 custom andfiberglass therapy, rehabilitation, and fit-ness pools. With various sizes, depths,

and customconfigurationsavailable,Ferno offers apool for everyfacility. Addan underwa-

ter treadmill, aquatic bike, or high-resistance therapy jets for the ultimatelow-impact workout or therapy session.Other accessories include pool lifts,benches, and exercise bars. Ferno poolsinclude professional installation by factorytechnicians. Maximize your athletes’ per-formance with Ferno Performance Pools.

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Perform Better800-556-7464WWW.PERFORMBETTER.COM

Perform Better offers Aquajogger, thedeep water exercise belt that is adjustableand helps you to stay upright during an

aquatic workout.Use it for cardio-vascular train-ing, rehab frominjury, or simplyas a supplemen-tal workout withlow-impact resis-tance training. It

takes the stress off joints. It is availablein men’s and women’s models and a spe-

cial model for those weighing over 200lbs. Aquajogger is part of the 2004Perform Better collection.

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Power Systems, Inc.800-321-6975WWW.POWER-SYSTEMS.COM

Use Eco Bells and Bar Float from PowerSystems on top of the water for buoyantsupport and stabilization. Use the products

underwater forresistance. Theyfeature open-cellfoam, and areheat sealed forsoft, comfortable

feel. The products have sturdy constructionwith a cushioned handgrip and offer threeresistance levels for versatility. The BarFloat is a longer version (27” long) of the“heavy” Eco Bells. An illustrated exerciseguide is included. Contact Power Systemsfoor more information on all of its productsand programs.

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Reduce strain and stress on the body andperform exercises you might be unable todo on land with the Water RunnerFlotation Belt from Power Systems.

During long vigorousworkouts, individualswho are overweight orhave joint/muscle paindue to injuries cannotcomplete dynamic tasksdue to the high demandsbeing placed on theirbody. In weight loss orrehabilitation exercises,

individuals need to be able to reduce theamount of stress being placed on theirbody while also be challenged so that theycan get the results they need and desire.The Flotation belt allows individuals toexercise and rehab injuries at a high levelof intensity without overloading the body’sphysical ability/limits. Power Systemsoffers a complete line of Aquatic Trainingequipment to fit your needs.

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SwimEx Systems800-877-7946WWW.SWIMEX.COM

Simulating the elliptical motions ofrunning, the SwimEx Hydrorunner™ is thefirst aquatic machine of its kind. Withadjustable resistance, incline, andfootplate positions, the SwimEx

Hydrorunner is per-fect for aerobicgroup activity, cir-cuit training class-es, athletic trainingprograms, andrehabilitation condi-tioning for recoveryof the lower limbs.Retails at $3,000.

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The SwimEx Hydrorecline™ allows theuser to pedal while keeping the bodyimmersed in water, with legs out in front

in a reclined seat-ing position. It isideal for rehabilita-tion programs torecondition theknee ligaments fol-lowing reconstruc-tive surgery orsprains. The

SwimEx Hydrorecline is also an effectivefitness solution, as the thrusting of thelegs promotes a superior cardiovascularworkout. Retails at $2,400.

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Catalog Showcase

Creative Health800-742-4478WWW.CHPONLINE.COM

Creative Health Products, in business since1976, is a leading discount supplier ofRehabilitation, Fitness, Exercise andAthletic Equipment and also Health,

Medical,Fitness Testingand MeasuringProducts—all atdiscountedprices.Productsinclude HeartRate Monitors,Blood PressureTesters, PulseOximeters,

Bodyfat Calipers, Scales, Strength Testers,Flexibility Testers, Stethoscopes,Pedometers, Exercise Bikes, Ergometers,Stopwatches, Fitness Books and Software,Exercise Bands, Step Benches, Hand andFinger Exercisers, Heating Pads and more.

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More Products

3-Point Products888-378-7763WWW.3POINTPRODUCTS.COM

Reflex® Putty with Memoryflex®, from 3-Point Products, increases resistance themore it is pulled. Reflex® Putty can be pulled

and stretchedlike exercisebands but,unlike bands, itprovides con-

sistent resistance throughout the range ofstretch. Muscles receive resistance through-out their contraction for a more effectivestrengthening regime. Available in three resis-tance levels and in the NEW Pro Series forathletes and others requiring a higher resis-tance level for rehabilitation.

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Acumen, Inc.800-852-7823WWW.ACUMENINC.COM

Acumen’s Eon 101 and Eon 102 are heart-rate monitors embedded in analog watchesthat offer precise quartz movement. Theseunique heart-rate monitors feature a scratch-resistant crystal lens, fluorescent minute and

hour hands for viewing any-time and anywhere, and anEZ-Set Target Zone with visu-al and audible alarms. TheEon 101 and Eon 102 arethe perfect heart-rate moni-tors for health-conscious indi-viduals seeking to safelyenhance their fitness leveland have a watch for every-day use.Circle No. 240

Antibody, Inc.513-310-4316WWW.ANTIBODYWEAR.COM

The BodyGuard compression shorts preventand accommodate lower-body injuries to thegroin, hamstring, quadriceps, hip flexors, andhip pointers. Because of their inner surface

and custom design,they attach to thewearer and transfertheir stored elasticenergy to the muscles,creating torque andassisting with muscleflexion and extension.They also provide con-

stant compression, strain distribution, impactabsorption, heat circulation, and absorptionof fatigue-inducing muscle vibrations causedby repetitive use.

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The BodyGuard shoulder brace, fromAntibody, Inc., is designed to accommodateshoulder injuries, including dislocations,subluxations, and slight separations.

Because of itsinner surface andcustom design,the BodyGuardactually attachesto the wearer andworks with the

entire muscle group, providing strain distrib-ution over the entire garment andsignificant compression to the injured area.The BodyGuard is effective for a wide arrayof sports in which shoulder injuries occur,including baseball, football, basketball,wrestling, hockey, and volleyball.

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Brace International, Inc.800-545-1161WWW.BRACEINT.COM

Brace International offers the MAX™, amajor advancement in the design of shouldergirdle support. The snug-fitting, lightweightmaterial allows for comfort with movement,

yet at the same timehelps protect theglenohumeral jointfrom subluxationsand dislocations. Itsstrap design systemallows many optionsfor maximal stabilitywhere needed while

giving the required range of motion.Circle No. 243

Cropper Medical, Inc.541-488-0600WWW.BIOSKIN.COM

Compression Shorts by Cropper Medical,Inc., made of the patented Bio Skin® mate-rial, are breathable, light, thin, durable,

hypoallergenic, andmachine washable.Studies show that com-pression shorts reducemuscle fatigue andimprove strength,power, and endurance.Improvements in outputresult from reduced

muscle oscillation, improved proprioception,better hip positioning, and the psychologicalbenefit derived from wearing the shorts.Indications: Quad contusion, ischiocapsularstrain, iliofemoral strain, thigh strain.Available in black and white.

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Biofreeze800-246-3733WWW.BIOFREEZE.COM

For pain management programs, useBiofreeze, from Performance Health, Inc., toreduce swelling, pain and stiffness, next-dayaches and pains, and recovery time. It can

also help to increasemobility and flexibility,and will aid in the over-all healing process.Biofreeze can be usedin situations requiringice and breathablewraps and can be blend-

ed with water for ice cups. Biofreeze will alsoprolong the effects and benefits of ultrasoundand massage therapy treatments. Biofreezeis endorsed by the Florida ChiropracticAssociation, ProSports Chiropractic, theUnited States Taekwondo Union, The FloridaState Massage Therapy Association, The NYState Society of Massage Therapists, TheTexas Association of Massage Therapists,and is approved for use by the AmericanPhysical Therapy Association.

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Catalog Showcase

Power Systems, Inc.800-321-6975WWW.POWER-SYSTEMS.COM

Since 1986, Power Systems has been aleading supplier of sport training, healthand fitness products. The company prides

itself on being theone resource for allof your trainingneeds. Its 2004catalog has a newlook, with bettergraphics and pho-tos. Categoriesinclude corestrength, medicineballs, speed, plyo-metrics, agility,

strength equipment, strength accessories,and flooring. The catalog is full of hundredsof new products, and dozens of productsavailable exclusively from Power Systems.The company has lowered some of itsprices, enabling the customer to get premi-um products at great prices. Go online orcall Power Systems to request a free 2004catalog today.

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P R O D U C T S D I R E C T O R YCIRCLE COMPANY PAGE CIRCLE COMPANY PAGE CIRCLE COMPANY PAGENO. NO. NO. NO. NO. NO.

A D V E R T I S E R S D I R E C T O R YCIRCLE COMPANY PAGE CIRCLE COMPANY PAGE CIRCLE COMPANY PAGENO. NO. NO. NO. NO. NO.

115 . . . . 3-Point Products (Oval-8) . . . . . . . . . 28

131 . . . . Acumen (Hydra-Alert) . . . . . . . . . . . . 48

107 . . . . Aircast. . . . . . . . . . . . . . . . . . . . . . 16

130 . . . . Antibody (BodyGuards) . . . . . . . . . . . 47

103 . . . . Biofreeze. . . . . . . . . . . . . . . . . . . . . 9

105 . . . . BioSkin Performance Supports . . . 12

139 . . . . Brace International (Fluk) . . . . . . . . 61

137 . . . . Brace International (MAX) . . . . . . . . 53

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

141 . . . . Compex Technologies . . . . . . . . IBC

112 . . . . Cool Draft Scientific . . . . . . . . . . . 24

116 . . . . CoreControl . . . . . . . . . . . . . . . . . 28

110 . . . . Cramer . . . . . . . . . . . . . . . . . . . . . 20

102 . . . . efi Sports Medicine . . . . . . . . . . . . . 5

119 . . . . Ferno Performance Pools . . . . . . . 33

135 . . . . FitBALL USA (Ball Dynamics) . . . . . . . 52

122 . . . . Foot Management . . . . . . . . . . . . 38

108 . . . . Gebauer . . . . . . . . . . . . . . . . . . . . 17

111 . . . . Graston Technique . . . . . . . . . . . . 23

114 . . . . HeartSine Technologies. . . . . . . . . 26

109 . . . . Hormel HealthLabs (Plus-2) . . . . . . . 18

132 . . . . HQ . . . . . . . . . . . . . . . . . . . . . . . . 49

138 . . . . ISSA . . . . . . . . . . . . . . . . . . . . . . . 55

129 . . . . Jump Stretch. . . . . . . . . . . . . . . . . 45

126 . . . . Kelly Kinetics (Pivot Plate) . . . . . . . . . 41

121 . . . . McDavid . . . . . . . . . . . . . . . . . . . . 36

125 . . . . Medical Specialties . . . . . . . . . . . . 40

134 . . . . Mini Mitter . . . . . . . . . . . . . . . . . . 51

124 . . . . Mueller Sports Medicine . . . . . . . . 39

128 . . . . NASM . . . . . . . . . . . . . . . . . . . . . . 45

142 . . . . Oakworks . . . . . . . . . . . . . . . . . . BC

113 . . . . OPTP . . . . . . . . . . . . . . . . . . . . . . 25

106 . . . . Perform Better . . . . . . . . . . . . . . . 15

120 . . . . Power Systems . . . . . . . . . . . . . . . 34

104 . . . . PoweringAthletics . . . . . . . . . . . . . 10

136 . . . . PRO Orthopedic . . . . . . . . . . . . . . 53

117 . . . . Pro-Tec Athletics. . . . . . . . . . . . . . 29

100 . . . . PROTEAM by Hausmann . . . . . . . IFC

133 . . . . Quest Technologies . . . . . . . . . . . 50

123 . . . . Super Feet . . . . . . . . . . . . . . . . . . 39

127 . . . . SwimEx . . . . . . . . . . . . . . . . . . . . 42

140 . . . . TurfCordz/NZ Manufacturing . . . . 61

118 . . . . VertiMax . . . . . . . . . . . . . . . . . . . . 30

239 . . . . 3-Point Products . . . . . . . . . . . . . . 57

240 . . . . Acumen (Eon 101/Eon 102). . . . . . . . . 57

200 . . . . Acumen (Hydra-Alert) . . . . . . . . . . . . 51

213 . . . . Aircast (Air-Stirrup Ankle Brace) . . . . . . 53

212 . . . . Aircast (AirHeel). . . . . . . . . . . . . . . . 53

241 . . . . Antibody (compression shorts). . . . . . . 57

242 . . . . Antibody (shoulder brace) . . . . . . . . . 57

245 . . . . Biofreeze . . . . . . . . . . . . . . . . . . . 57

246 . . . . Biofreeze (Single Use Dispenser) . . . . . 59

244 . . . . BioSkin/Cropper (compression shorts) . 57

214 . . . . BioSkin/Cropper (TriLok) . . . . . . . . . 53

243 . . . . Brace International . . . . . . . . . . . . 57

215 . . . . Cho-Pat. . . . . . . . . . . . . . . . . . . . . 53

201 . . . . Cool Draft Scientific . . . . . . . . . . . 51

202 . . . . Cool Draft Scientific (Evolution) . . . . 51

203 . . . . CoreControl . . . . . . . . . . . . . . . . . 51

216 . . . . Cramer (AS1 Ankle Brace). . . . . . . . . . 54

260 . . . . Creative Health Products. . . . . . . . 56

204 . . . . Energice . . . . . . . . . . . . . . . . . . . . 52

205 . . . . Extech Instruments . . . . . . . . . . . . 52

232 . . . . Ferno (AquaGaiter) . . . . . . . . . . . . . . 56

233 . . . . Ferno (custom pools) . . . . . . . . . . . . . 56

217 . . . . Foot Management (Ortho Arch) . . . . 54

218 . . . . Foot Management (Tenderfoot) . . . . 54

249 . . . . FSI North America. . . . . . . . . . . . . 59

247 . . . . Gebauer . . . . . . . . . . . . . . . . . . . . 59

248 . . . . Graston Technique . . . . . . . . . . . . 59

250 . . . . HeartSine Technologies. . . . . . . . . 59

206 . . . . HQ . . . . . . . . . . . . . . . . . . . . . . . . 52

251 . . . . ISSA . . . . . . . . . . . . . . . . . . . . . . . 60

219 . . . . Jump Stretch. . . . . . . . . . . . . . . . . 54

221 . . . . Kelly Kinetics (Ankle Isolator) . . . . . . . 54

220 . . . . Kelly Kinetics (Pivot Plate) . . . . . . . . . 54

222 . . . . McDavid (Ultra Ankle) . . . . . . . . . . . . 54

223 . . . . McDavid (Ultralight Ankle Brace) . . . . . 54

224 . . . . Medical Specialties . . . . . . . . . . . . 54

207 . . . . Mini Mitter . . . . . . . . . . . . . . . . . . 52

225 . . . . Mueller Sports Medicine . . . . . . . 55

253 . . . . NASM (Body Map) . . . . . . . . . . . . . . 60

252 . . . . NASM (Optimum Performance Training) . 60

254 . . . . Oakworks . . . . . . . . . . . . . . . . . . . 60

227 . . . . OPTP (Multi Challenge Board) . . . . . . . 55

226 . . . . OPTP (Resting Foot Sling) . . . . . . . . . . 55

234 . . . . Perform Better . . . . . . . . . . . . . . . 56

262 . . . . Power Systems (catalog) . . . . . . . . . 57

235 . . . . Power Systems (Eco Bells/Bar Float) . . 56

236 . . . . Power Systems (flotation belt) . . . . . . 56

256 . . . . PRO Orthopedic (PRO 11 Scissors) . . . 60

255 . . . . PRO Orthopedic (Versa-Cool) . . . . . . 60

228 . . . . Pro-Tec Athletics (Achilles Tendon Support) . 55

229 . . . . Pro-Tec Athletics (Arch Support) . . . . . . . 55

258 . . . . PROTEAM by Hausmann (model A9068) . 61

257 . . . . PROTEAM by Hausmann (taping stations) 61

208 . . . . Quest Technologies . . . . . . . . . . . 52

209 . . . . RG Medical Diagnostics . . . . . . . . 52

259 . . . . Rich-Mar . . . . . . . . . . . . . . . . . . . . 61

238 . . . . SwimEx (Hydrorecline) . . . . . . . . . . . . 56

237 . . . . SwimEx Systems (Hydrorunner) . . . . . 56

230 . . . . Tekscan. . . . . . . . . . . . . . . . . . . . . 55


More Products

United States Air ForceAcademy Enlists SwimEx

“At the United States Air Force Academy, wewere in dire need of an aquatic therapy pooldesignated solely for sports rehabilitation andconditioning. Although we have twonatatoriums on campus, the cadets only havea few hours in the afternoon for aquatic train-ing and the pools are always full.

“We lobbied for an aquatic therapy pool,Congress sent a committee to review our cir-cumstances, and it was decided that theUnited States Air Force Academy, indeed,needed an aquatic sports medicine solutionfor our injured cadets.

“Without hesitation, we knew we wanted aSwimEx. For years, SwimEx has beenrecognized as the true standard of the indus-try—the very best. We knew the DenverBroncos had a SwimEx in their training room,so we went up and saw the practice facility.We were extremely impressed.

“At that point, we were in the planning stagesof building a new facility. We put SwimEx onour wish list, and when we were granted thefunding, we were very pleased. The people atSwimEx were gladly willing to work with us,even though we were five years away fromerecting the new building. They were looking tobuild a relationship with us and they accom-modated our needs at every turn.

“The SwimEx was installed in January 2004,and our athletic training staff is just beginningto explore the range of protocols that are nowpossible. We will be able to treat both upper-and lower-body injuries, and it will be all up tothe creativity of the athletic trainer.”

Larry Willock, Head Athletic TrainerUnited States Air Force Academy

SwimEx Systems373 Market Street, Warren, RI [email protected]

WWW.SWIMEX.COM


Customer Testimonial

Performance Health, Inc., the makers ofBiofreeze Pain Relieving Gel, is proud tointroduce the new “Single UseApplication Gravity Dispenser” package.

The new singledose dispensingsystem is perfectfor clinical and train-ing room use toeasily dispenseBiofreeze topatients and

athletes for trial use and at home.Biofreeze helps provide a deeper, longer-lasting relief from pain than most coolinggels. Biofreeze effectively enhances thera-py and relieves pain from arthritis, musclestrains, and backaches. It also aids inreducing edema and myospasm. Applygenerously for penetrating relief from painand stiffness of muscles and joints. Thecooling effect accelerates the rate ofbasic healing processes throughrelaxation of stiff and aching muscles.

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Gebauer Company800-321-9348WWW.GEBAUERCO.COM

From the most trusted name in skin refriger-ants for over 100 years comes a new, non-prescription topical skin refrigerant,

Gebauer's InstantIce™. Use it like ice forthe temporary relief ofminor pain and swellingfrom sprains andstrains, minor sportsinjuries, bruising andcontusions. Now insteadof using ice to treat on-

the-scene minor sports injuries, high schooland recreational league coaches, highschool athletic trainers, and others will beable to use what professional athletic train-ers use. In fact, Jim Ramsay, head athletictrainer for the New York Rangers, has beenusing Gebauer topical skin refrigerants foryears. "Instant Ice is great for on-the-scenecare," said Ramsay. "If a player gets hit onthe wrist or takes a puck off the shin, I caneasily anesthetize the area with Instant Iceto reduce the pain, allowing the player toget back in the game quickly.

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Graston Technique866-926-2828 WWW.GRASTONTECHNIQUE.COM

Taught by some of the nation’s leadingauthorities on soft tissue, Graston

Technique® (GT) is an advanced form ofinstrument-assisted soft tissuemobilization that provides clinicians with a

mechanicaladvantage indetecting/treat-ing/resolving con-nective softtissue

dysfunction. Six stainless steelinstruments are used to detect fibrotic tis-sue and treat at greater depth and speci-ficity. To register for a GT seminar nearyou, call the company or visit its Web site.Where applicable, 12 hours of CE creditscan be earned.

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FSI North America440-891-1523WWW.FSINORTH.COM

FSI North America has introduced its lineof portable, inflatable Cooling Shelters.These shelters deploy in as little as one

minute, andcan be set upvirtually any-where. Airconditioningand/or heat-

ing units are also available in varioussizes, and configurations can be ductedinside the unit. FSI North America is oneof the largest suppliers of inflatable shel-ters in the world. Shelters are available inmultiple sizes, from 7’ by 7’ up to thelargest sealed berm shelter in the world—the 1,500 sq. ft. 30’ by 50’ size.

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HeartSine Technologies, Inc.866-HRT-SINEWWW.HEARTSINE.COM

HeartSine has introduced the Samaritan®AED, a defibrillator that is designed forpeople with basic CPR/AED training. Each

Samaritan®comesequipped with alarge backlit dis-play for easyviewing. Clearon-screen andaudible instruc-

tions guide the rescuer through a rescueevent. The Samaritan® AED uses a newescalating biphasic waveform, calledSCOPE™. Event data is recorded reliably,in the Data-Pak™ Battery / Memorysystem.

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ISSA800-892-4772WWW.FITNESSEDUCATION.COM

The International Sports SciencesAssociation is a teaching and certificationagency for fitness professionals worldwide.ISSA's Specialist in Sports Conditioning

programprovidesthe knowl-edge,expertise,and train-

ing techniques you need to enableathletes to expand the capacity of theirbodies, while remaining strong and freefrom injuries. ISSA's Youth Fitness Trainercourse teaches you program design, sportpsychology, sports nutrition, injury preven-tion, and fitness assessment specificallyfor kids and teens.

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National Academy of SportsMedicine (NASM)

800-460-6276WWW.NASM.ORG

The athlete’s ability to consistentlyperform at higher levels while avoidinginjury is essential to his or her long-term

success in any sport-ing arena. Drawing onthe exclusiveOptimumPerformanceTraining™ (OPT™)method—a systemthat has successfullyempowered peak per-formance inprofessional, Olympic,

college, and high-school athletes—Optimum Performance Training™ for thePerformance Enhancement Specialist setsthe international pace for athletic trainingand sports medicine professionals.

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The National Academy of Sports Medicine isproud to present Body Map, a unique, state-of-the-art dynamic movement assessment

and program-design toolthat will revolutionize theway you train. Whetheryour goal is to lose fat,gain muscle or increaseyour performance in aspecific sport, Body Maphelps you reach yourgoals quickly, safely, andeffectively. Based on

NASM’s exclusive Optimum PerformanceTraining (OPT™) model, Body Map takes lessthan 10 minutes and creates individualizedassessments and corrective strategiesincluding flexibility, postural control, and func-tional strength. If success is your destination,let the Body Map be your guide. For moreinformation about where you can get yourBody Map, visit the company's Web site.

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Oakworks, Inc.800-558-8850WWW.OAKWORKS.COM

Because the game isn’t played in the lock-er room, you need the Oakworks PortableTaping Table. It is the only portableadjustable-height table on the market.

Weighing only35 lbs., thistable folds flatfor easy stor-age and trans-portation.Features like amarine-grade

plastic top, adjustable height range of 32 -42 inches, UL weight rating of 500 lbs.,and durable carrying case will maximizeeffectiveness for every ATC.

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PRO Orthopedic Devices, Inc.888-523-5611WWW.PROORTHOPEDIC.COM

The PRO Versa-Cool Portable ColdTherapy Unit offers many features notfound in other cold therapy products. It willoperate for two hours on the rechargeable

battery, or indef-initely on wallpower. It canachieve temper-atures as lowas 34 degreesfrom simple iceand water. Thelow-profile insu-lated bag main-

tains ice for hours. Optional 12 voltconverter allows operation in vehicles.

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The PRO 11 Scissors from Pro OrthopedicDevides represent the evolution of the

original SuperPro Scissors.The new modelfeatures asmaller, easierto use safetytip. The offset

“Our athletes ask forthese products by name.”

"Pro-Tec Athletics offers the most effec-tive and comfortable orthopedic bracesand supports. Our athletes are askingfor them by name. More specifically,we have found the Shin SplintsCompression Wrap to be very efficientin its ability to alleviate the pain anddiscomfort of medial and anterior shinsplints."

Sharon Allanson, ATC (19 yearsexperience)

Hamilton College, Clinton, NY

"As an avid walker and tennis player, Iwas having problems with PlantarFasciitis. I am thrilled with the supportand relief I have experienced with theArch Pro-Tec. I want to thank you somuch!!!"

Roz BerkWalker, Tennis Player

"I recommend Pro-Tec knee supports,far and above the rest, to any athlete orperson with chronic knee pain. TheKnee Pro-Tec is extremely effective,despite allowing plenty of mobility. TheShort Sleeve gives me the warmth andcompression I need, and The Lift is agreat combination of both!"

Dax Holdren#1 ranked professional volleyball player,

AVP TOUR

Pro-Tec Athletics2743 152nd Ave., NE, Redmond, WA [email protected]

WWW.INJURYBEGONE.COM


Customer Testimonial

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handle and large finger rings provide addi-tional leverage and comfort. The newpower lock screw will not loosen. They’reindispensable on the field or in the train-ing room.

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PROTEAM by Hausmann888-428-7626WWW.PROTEAMTABLES.COM

PROTEAM by Hausmann offers the athletictrainer a complete line of all-laminatetreatment furniture designed to enhance

the func-tionalcapacityandappear-ance ofthe ath-letic

trainer’s room. PROTEAM Modular TapingStations are available in a wide variety ofsizes and with many options. Individual

Taping units are finished on all sides andcan be easily re-positioned to fit yourneeds or space changes in the future.PROTEAM also offers a wide selection oftreatment tables, split-leg tables, cabinets,and stadium lockers.

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PROTEAM by Hausmann offers the athlet-ic trainer a complete line of all-laminatetreatment furniture designed to enhancethe functionality and appearance of the

athletic train-er’s room. Themodel A9068Split Leg LiftTablefeatures: spa-cious full cabi-net storage,

an optional air spring backrest, a weightcapacity of 400 lbs. and positive locking,padded leg rests that adjust up to 45°.PROTEAM offers a wide selection of treat-ment tables, modular taping stations,

cabinets, and stadium lockers. Circle No. 258

Rich-Mar Corporation800-762-4665WWW.RICHMARWEB.COM

Rich-Mar now offers the AutoPrism, anautomatic, hands-free light therapy prod-uct. This unique device is a super-luminous diode array that can provide over

600mWoutput. It canbe used as ahandheldpiece to deliv-er quick treat-ments, or as

an automatic, hands-free strap-on lighttherapy applicator. The AutoPrism allowsyou to use all of the various protocols toapply more energy to your patientsefficiently and effectively.

Circle No. 259

Check out www.AthleticBid.com to contact these companies.

TurfCordz ProCordz Gives You...• Explosive Off-The-Line Starts!• Faster Effortless Footwork! • The Safety and Reliability Pro

Football Players Demand!• Call 800-556-7464 or Online

at www.performbetter.comTurfCordz are distributed by M-F Athletic Company

© 2004 NZ MFG LLC, Tallmadge, OH (TC0704)

This Football Season be Faster! Quicker!Stronger!

Perfo

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ithPro

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Request No. 139 Request No. 140

Web News


McDavid Launches NewProducts to BetterProtect AthletesInnovation has been a trademark of the protec-tive equipment manufactured by McDavidSports Medical Products, and the companyhas recently introduced new products that uti-lize technology to provide better protection andcomfort to athletes.

McDavid has taken protective clothing to a newlevel with its Hexpad™ Protective Apparel. TheHexpad line of clothing features hundreds ofindividual pads permanently bonded betweentwo layers of moisture transport 4-way stretchcompression fabric. The resulting hexipads arethen strategically placed into compressionbody shirts, compression shorts, arm sleevesand football girdles.

The result of the Hexpad System is a line ofpadded undergarments for athletes that aremore protective, super lightweight and breath-able. The Hexpads also conform to the body,and flex and stretch far better than any otherproduct on the market.

New Hexpad products include: The #755Hexpad Football Girdle with permanently

attached hip and tailHexpads—with this girdle,you don’t need to purchaseseparate hip and tail pads;The #787 Body Shirts withrib, spine and shoulderHexpads that can be usedin football, lacrosse, andhockey; The #760Compression Vest with ster-

num pad for protection in baseball andfootball; and The #651 Arm/Elbow Sleeves.

McDavid has also recentlydebuted the new Flexcup™: ahard cup with a resilient impactdampening flexible liner that ispermanently molded to theinside. This innovative designprovides softer sides for muchimproved comfort compared totraditional hard cups.

McDavid10305 Argonne Drive, Woodridge, IL [email protected]

WWW.MCDAVIDINC.COM

AIRCAST WEB SITE OFFERS NEW INTERACTIVE PATIENT CENTER Aircast®, Incorporated, the trusted leader in orthopedic devices, now makes it simple to learn aboutinjuries such as sprains, muscle strains, tendonitis, and turf toe (to name just a few) using the PatientCenter on the Aircast Web site. Accessible throughout the site, the Patient Center allows users topoint and click to quick, interactive information about their symptoms and conditions. For each condi-tion, the Center also suggests clinically proven Aircast products to help treat ailments and relievesymptoms. www.aircast.com

NEW LINE OF MISTING FANS FEATURED ON WEBCool Draft Scientific is now highlighting on its Web site the long-awaited Evolution line of high-pressuremisting fans. Visit the site to learn all about the Evolution system, which offers the same high qualityenjoyed by NFL and college teams at a price that fits the budgets of high school programs. You canalso see product specs, pictures, and pricing for all of Cool Draft’s climate control and personal cool-ing products, read customer testimonials and information about misting fans, lights, and heaters, andfind out how to contact a Cool Draft representative. www.cooldraft.com

WATCH VIDEO DEMONSTRATIONS FROM DM SYSTEMS ON-LINE Informative videos on the Cadlow™ Shoulder Stabilizer are available atwww.dmsystems.com/videos.html. The promotional video gives an overview of the product from con-cept to development, punctuated by interviews with the inventors as well as athletes who wear thestabilizer. Dramatic video showing athletes in action demonstrates the ease with which the athletesperform while wearing the Cadlow™ Shoulder Stabilizer. The “Sizing and Application” video is intendedfor the healthcare professional who will be responsible for fitting the stabilizer. It illustrates the fittingand application process in step-by-step detail. www.dmsystems.com/videos.html

FOOT MANAGEMENT’S WEB SITE UPDATED WITH NEW PRODUCTSFoot Management’s newest line of prefabricated insoles is listed on its Web site under ConsumerProducts. The One Stop E.V.A. and Shocker® Firm fill a need in every setting. The Shocker Firm islightweight, thin, full length, and available in sizes up to 18—unheard of for off-the-shelf insoles. TheOne Stop E.V.A. can be heated and molded as an accommodative device or used as-is for extra sup-port. Surf the Foot Management Web site for these and other exciting products. www.footmanagement.com

HORMEL HEALTHLABS MAKES IT WASY TO FIND THE RIGHT NUTRITIONAL PRODUCTS To help our customers quickly find any one of our many nutritional products, we have organized the fullline of Hormel HealthLabs products by the condition or situation to which they apply. Full nutritionallistings on all products and access to online pharmaceutical stores for 'home use' purchases are alsoavailable. www.hormelhealthlabs.com

POWER SYSTEMS’ NEW WEB SITE MAKES ON-LINE SHOPPING EASIER THAN EVER You spoke and they listened! The Power Systems Web site has been completely revamped to serviceyou, the customer, more efficiently and effectively. Major enhancements include a “My Account” fea-ture, providing quick and customized access to your ordering history and the status of existing orders;an improved search engine that makes the site easier than ever to navigate, returning more relevantlinks on any search phrase; and a quick order form for customers who know the product numbers ofthe items they want to buy. All these helpful features are designed to streamline your Power Systemsshopping experience. www.power-systems.com

NEW TOTAL GYM POWER TOWER BY EFI SPORTS MEDICINE FEATURED ON-LINEefi Sports Medicine’s Web site provides in-depth information on the new Total Gym Power Tower, afully electronic functional training machine that delivers level changes at the touch of a button for phys-ical therapy and athletic training environments. Additionally, the new press section hosts all the latestnews, product releases, updates, and information on events where you can see the products inaction. www.efisportsmedicine.com

TRAIN TO PLAY’S WEB SITE OFFERS A HOST OF TRAINING INFORMATIONEverything you want to know about training and conditioning products can be found on Train To Play’sWeb site. On the site, you have full-catalog access with secure online order processing, training semi-nar information, performance-enhancing articles, instruction guides, and training recommendations.Tradeshow schedules can also be seen. www.traintoplay.com

Company News

AQUATIC THERAPY OPTIONS FROMDAVID PATTERSON

David

Patterson,

Vice President

of Sales and

Marketing for

Ferno-

Washington’s

Ille Division, is

a native of Elkton, Maryland. He

has a bachelor’s degree from

Bowling Green State University

with a major in Business

Administration, and an MBA from

Lake Erie College.

David has over 20 years of expe-

rience in the medical industry,

having served as President for

OptiCenter, Inc., Vice President

for TLC Laser Eye Centers, and

Vice President of Sales and

Marketing for Global Vision, Inc.

In his current role at Ferno, David

is responsible for three of the

company’s divisions: Ferno

Performance Pools, Ferno Vet

Systems, and Ferno Mortuary.

Company Q& A

Q. WHAT TYPES OF POOLS DOESFERNO OFFER?Ferno has the largest range of pools on themarket today, with over 250 configurations.We are also the only company that offersboth custom-built and fiberglass pools. Thepools can be installed totally in-ground, par-tially in-ground, or above-ground, with multi-ple floor depths. For trainers who usecontrast therapy, Ferno offers a dual pool,consisting of a hot pool and a chiller poolseparated by a common wall seat; or these

two pools can be ordered separately. SinceFerno has such an extensive range of pools,customers are able to tell us exactly whatthey want, and we can give them exactlywhat they need for their facility.

Q. WHAT ARE THE POOL SIZES?We have pools to fit both small and largefacilities. Since we have the ability to cus-tomize each pool, we can make a pool thatwill fit anyone’s needs. We also offer differ-ent shapes—everything from the traditionalrectangles and squares to octagon-shapedpools.

Q. WHAT OPTIONS ORACCESSORIES DO YOU OFFER TOENHANCE YOUR POOLS?Ferno has numerous options andaccessories that can create a total rehab orconditioning pool. The AquaGaiter™ variablespeed underwater treadmill provides a rigor-ous cardiovascular workout with reducedimpact and stress on joints. The swim-in-place system gives the swimmer a smooth,variable-speed current to swim against. Weoffer three different models of aquatic bikesalso. Viewing windows can be added to thecustom-built pools that are partially in-

ground or above-ground, so the athlete’srehab and gait can be monitored. In additionto the windows, a video monitoring systemis available to observe the athlete’sprogress. Ferno completes the package withpool lifts, whirlpool/resistance jets, exerciserails and grab bars, therapy benches, waterline tile or striping, underwater lights, digitaltemperature display, and water sanitizersystems.

Q. HOW ARE THE POOLSINSTALLED?Our pools are installedby Ferno technicians,and the delivery andinstallation methoddepends on the poolsize and the installationsite. The pools can beshipped pre-plumbedand in one piece, orthey can be shipped insmaller sections to fitthrough standard door-ways or windows. Thisflexibility allows for easyinstallation at new con-struction sites or reno-

vation projects.

Q. WHAT ARE FERNOPERFORMANCE POOLS MADE OF?The custom-built pools are constructed ofpre-stressed laminated beams with a heavy-duty, custom-manufactured polyvinyl liner.The fiberglass pools are manufactured withthe Aqua-Tuff 1000® process that providesa layer-on-layer build-up of fiberglass andresins to obtain the optimum strength andresistance to water penetration. The poolshell is then covered with reinforcing strutsbuilt into the fiberglass to make the poolfreestanding. The pool floor also has a level-ing skid built into it to provide floor strengthand a means of leveling the pool, shouldthe floor be uneven or have irregularities.

Q. WHAT ADVANTAGES DOESFERNO PERFORMANCE POOLSHAVE OVER ITS COMPETITORS?Custom, choice, variety, flexibility, quality,prices to fit your needs, the greatest num-ber of options in the industry, service, tech-nical support, factory installation, you nameit—Ferno gives you the best the industryhas to offer.

FERNO PERFORMANCE POOLS70 WEIL WAYWILMINGTON, OH [email protected]

WWW.FERNOPERFORMANCEPOOLS.COM


Training & Conditioning is pleased to provide NATA and NSCA members with the opportunity to

earn continuing education units through reading issues of the magazine. The following quiz is based on articles that appear in this issue of Training & Conditioning. By satisfactorily completing the quiz and mailingit back to T&C, readers can earn two BOC Athletic Training and 0.2 NSCA continuing education units (twohours).

INSTRUCTIONS: Fill in the circle on the answer form (on page 66) that represents the best answer foreach of the questions below. Complete the form at the bottom of page 66, include a $15 payment toTraining & Conditioning, and mail it to the following address: Training & Conditioning, ATTN: 14.5 Quiz, 2488N. Triphammer Road, Ithaca, NY 14850. Readers who correctly answer 70 percent of the questions will benotified of their earned credit by mail no later than October 15, 2004.

IN THE SHADOWS (pages 13-19)Objective: To understand the danger that muscledysmorphia can pose to athletes, as well as learn toidentify the warning signs of the disorder and how toapproach athletes who may be at risk.

1) Muscle dysmorphia is considered to be:a) A systemic disorder.b) A muscle dysfunction.c) An eating disorder.d) A body-image disorder.

2) Muscle dysmorphia primarily affects:a) Adolescents.b) Children.c) Men.d) Women.

3) Body dysmorphic disorder is the diagnosis people attainwhen they:a) Work out excessively.b) Are preoccupied with how their body looks.c) Have a significant change in their body physique.d) Have an eating disorder.

4) Muscle dysmorphia is defined as:a) Poor muscle definition.b) Preoccupation with one’s muscularity and physique.c) A mesomorph body type.d) Preoccupation with one’s masculinity.

5) Roberto Olivardia utilizes ___________ to help correct distortions that athletes havea) Measurement of body fatb) Athletic therapyc) Measurements of strengthd) Cognitive behavior therapy

6) To increase socialization, Olivardia asks patients/athletes who have muscle dysmorphia to:a) Keep a log of food intake.b) Go outside their comfort zone and overcome

uncomortable social situations.c) Limit gym time to 2.5 hours per day.d) Spend 2 hours per week in social situations.

7) Those with muscle dysmorphia tend to:a) Ignore physical signs of distress to their ligaments

and joints.b) Prefer early morning workouts.c) Have a nutritious diet.d) Increase hydration.

8) Experts largely blame the ____________ for increased glorification of the male physique.a) Drive to turn professional in one’s sportb) Sport coachesc) Strength coachesd) Media

9) According to Olivardia, the most important thing to do when approaching an athlete you are concerned about as possibly having muscle dysmorphia is:a) Take a stance of empathy and concern.b) Approach with direct, critical language.c) Focus on body image.d) Display a drive for perfectionism.

SEARCHING FOR SYMMETRY (pages 31-35)Objective: To understand the importance of muscularsymmetry and learn how to use a strength-training program to recognize, correct, and avoid muscle imbalances.

10) According to Charles Poliquin, studies have shown that ______________ is maximized to a higher degree when using unilateral training versus bilateral training.a) Muscle fiber recruitmentb) Neural drivec) Muscle strengthd) Muscle elongation

11) The goal of testing specific actions is to:a) Ensure that there is less than 5% variance in

strength between limbs.b) Identify baseline strength.c) Devise a strengthening program.d) Ensure that there is less than 10% variance in

strength between agonists and antagonists.


CEUQUIZ

T&C July/August 2004 Vol. XIV, No. 5

12) When testing strength with the utilization of different hand positions or specific muscle isolation, deficits ______________ should undergo corrective measures.a) Greater than 5%b) Greater than 10%c) Greater than 20%d) Less than 20%

13) For most sports, a prudent plan is to develop:a) Antagonist muscles that do not get a significant

amount of training from sport-specific activities.b) Concentric strength more than eccentric.c) Eccentric strength more than concentric.d) Agonist muscles that are primary movers in their

sport.

SOFT FEET, STRONG LEGS (pages 37-41)Objective: To learn about the different types of footorthotics, with a focus on what they do to help athletesand how they can be used to treat a variety of lower-body injuries.

14) Custom made orthotics are constructed based on impressions made from:a) Polymer casts.b) Plaster casts, foam casts, or digital scanning.c) Photographs.d) Plaster casts and computerized topography.

15) Flexible orthotics are prescribed when:a) Only a small amount of motion control is needed

but considerable shock absorption is desired.b) Significant motion control is needed.c) A heel lift is needed.d) Torsion control is needed.

16) Rigid orthotics are prescribed:a) When a balance of motion control and shock

absorption is needed.b) To counteract supination.c) When a great deal of motion control is needed and

shock absorption is not a primary concern.d) When posting is necessary.

17) Research has consistently shown that ____________ orthotics decrease the amount of foot pronation and internal tibial rotationa) Laterally postedb) Medially postedc) Semi-rigidd) Rigid

18) Three studies have found that orthotics enhance the ____________ on the plantar aspect of the feet thus changing afferent input from the somatosensory system.a) Intrinsic musclesb) Sympathetic inputc) Motor inputd) Cutaneous sensation

19) Athletes with rigid pes cavus may benefit from:a) Flexible orthotics made of very compliant material

to absorb shock.b) Laterally posted orthotics.c) Off the shelf semi-rigid orthotics.d) Plantar fascia and gastroc stretching.

20) One study conducted by Eng and Pierrynowski speculated that:a) Laterally posted orthotics change stride length.b) Use of orthotics with shock absorption is a key

factor in the treatment of PFPS.c) The benefits of using orthotics in the treatment of

PFPS are derived from altering hyperpronation at the tibiofemoral and PF joints.

d) Biomechanics cannot be altered with orthotics.

21) The mechanism for a lateral ankle sprain is:a) Dorsi flexion, inversion, and external rotation.b) Plantar flexion, inversion, and internal rotation.c) Plantar flexion, eversion, and external rotation.d) Dorsi flexion, eversion, and internal rotation.

22) Foot orthotics have been shown to be effective in the treatment of:a) Compartment syndrome and medial ankle sprains.b) ACL and PCL insufficiencies.c) Achilles tendonitis and MCL sprains.d) Stress fractures, PF pain, and lateral ankle sprains.

DOWN THE MIDDLE (pages 43-47)Objective: To learn how to incorporate core stretching aspart of an effective and efficient warmup regimen forfootball athletes.

23) A strong core enables the facilitation of both ____________ in the body.a) Prevention of injuries and faster healingb) Mobility and stabilityc) Stamina and stabilityd) Static and dynamic stabilization

24) _______________ develop(s) a combination of strength, stability, joint mobility, and muscular flexibility.a) Weight trainingb) Functional drillsc) Sprintsd) Isolated weight training

25) When matching athletes with partners for core training, it is important to:a) Match athletes of similar positions.b) Perform exercises in small groups.c) Match athletes of equal size, strength, and

flexibility.d) Rotate partners frequently.

ANSWER SHEET IS ON PAGE 66

CEUQUIZ


CEU Quiz Answer Form

INSTRUCTIONS: Fill in the circle on the answer form below that represents your selection ofthe best answer for each of the previous questions. Complete the form at the bottom ofthis page, include a $15 payment to Training & Conditioning, and mail it to the followingaddress: Training & Conditioning, ATTN: 14.5 Quiz, 2488 N. Triphammer Road, Ithaca, NY14850, no later than September 30, 2004. Readers who correctly answer 70 percent of thequestions will receive 2.0 BOC Athletic Training and 0.2 NSCA CEU’s, and will be notified oftheir earned credit by mail no later than October 15, 2004.

1. ❍ ❍ ❍ ❍2. ❍ ❍ ❍ ❍3. ❍ ❍ ❍ ❍4. ❍ ❍ ❍ ❍5. ❍ ❍ ❍ ❍6. ❍ ❍ ❍ ❍7. ❍ ❍ ❍ ❍8. ❍ ❍ ❍ ❍9. ❍ ❍ ❍ ❍

In The Shadows

A B C D

Last Name_______________________________________First Name_________________________________MI______

Mailing Address______________________________________________________________________________________

City___________________________________________________State_________________Zip Code________________

Daytime Telephone_________________________________E-Mail Address____________________________________

Payment Information

__ $15 check or money order (U.S. Funds only) payable to: Training & Conditioning

__ Visa __ Mastercard __ Discover __ American Express

Account Number_______________________________________________Expiration Date________________________

Name on Card_____________________________________Signature__________________________________________


10. ❍ ❍ ❍ ❍11. ❍ ❍ ❍ ❍12. ❍ ❍ ❍ ❍13. ❍ ❍ ❍ ❍

Searching For Symmetry

A B C D

14. ❍ ❍ ❍ ❍15. ❍ ❍ ❍ ❍16. ❍ ❍ ❍ ❍17. ❍ ❍ ❍ ❍18. ❍ ❍ ❍ ❍19. ❍ ❍ ❍ ❍20. ❍ ❍ ❍ ❍21. ❍ ❍ ❍ ❍22. ❍ ❍ ❍ ❍

Soft Feet, Strong Legs

A B C D

23. ❍ ❍ ❍ ❍24. ❍ ❍ ❍ ❍25. ❍ ❍ ❍ ❍

Down The Middle

A B C D

CEUSection

CEU Accredited as a Home Study Course by NATA, NASM & NSCA

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wynn.indd 1 6/22/04 3:57:13 PM

Presenting educational and advancement programs available to ATCs


EARN BOC CEUs• Complete quizzes found in the

Strength & Conditioning Journal• Complete online quizzes at

www.nsca-cc.org

888-746-2378

E-mailToll Free

[email protected]

Phone

402-476-6669

NATA CEU AD STRENGTH AND COND M 1 6/25/04 11:41:06 AMGet CertifiedOnsite—At Home—Online

Musculoskeletal Disorders& Ergonomics

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Onsite Tuition: $395.00$355.00 if received at least 14 days in advance

Ergonomics: Practical Applications andThe Practice & Management of Occupational

Ergonomics courses also available.Please call or visit website for details.

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Have an upcoming CEU programor event that you’d like to promote?

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Association CornerThe following associations offer services of interest to our T&C readers.

The Voice of the Doctors who care for the Pros

The PTP provides resources and services for allsports medicine professionals.

Visit www.proteamphysicians.com to find a PTP doctor, ask a question of a PTP doctor, orexplore the educational materials from PTP regarding

prevention, treatment and performance.

SPECIALIST IN SPORTS CONDITIONINGISSA Certification Program

• Be the conditioning coach for your team.• Expand strength & conditioning programs.• Maximize earning potential as a coach.• Learn to enhance athletic performance.

CALL FOR FREE INFO: 1.800.892.4772www.FitnessEducation.com

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Athletic Therapy. Rapid return to work and play.

Athletic Therapists are dedicated to the promotion and delivery of qualitycare through injury prevention and rehabilitation and emergency services.

In collaboration with other health care professionals, athletic therapistswork to create a healthier environment that encompasses the needs of the

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For more information please visit us online at www.athletictherapy.org

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• Earn CEUs for NASM, NATA, NSCA

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OR REGISTER ONLINE

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training & conditioning 14.5

Documents

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