Athletic Nutrition Checklist: Hydration… Protein… Electrolytes…

Hydration and proper nutrition is vital to helping athletes perform to the best of their ability. School Health has the products you need to stock athlete fueling stations WITHOUT fighting the big box stores.

Each day our athletes are called on to complete feats of strength, stamina, and endurance. Through training, athletes become stronger and more physically tuned. But for peak performance, it is important to include nutrition and hydration as part of our basic training regimen.

In 2014 the NCAA Division I deregulated restrictions on sports nutrition, allowing student athletes unlimited access to meals and snacks related to sports participation. With the sudden unfettered ability to fuel athletes, many athletic departments have been scrambling to create nutrition programs for the athletes they serve. As they try to keep supplement supplies stocked, many athletic trainers have resorted to big-box store shopping, which means last minute trips and costly purchasing.

School Health has worked to gather the best supplements to fuel athletic teams. And, with a School Health Supply List, keeping nutrition items stocked is easier than ever. With supply lists, athletes and athletic trainers can build customized lists of their favorite products, and even select automatic delivery!

Here is a quick reference to help athletes and athletic trainers know which products to use and when.

• Before and during a workout an athlete’s body requires high amounts of carbohydrates to saturate muscles with glycogen that fuel performance and provide endurance. Supplements like the Clif Shot Bloks Electrolyte Chews are a great way to get these carbohydrates in to your system.
• After a workout, protein helps facilitate repair and recovery of fatigued tissues. It’s easy to get this protein on-the-go with the LUNA Protein Bars.

And at all times athletes must maintain proper hydration to ensure that they stay strong and safe. Athletes can carry The Right Stuff concentrated drink additive – an easy way to add electrolyte rich hydration to your favorite water bottle!

Proper nutrition is also an integral part of building muscle mass, losing weight, and maintaining energy levels throughout the year, even when athletes are not training. Try CLIF Bar nutrition bars for a delicious and convenient way to maintain nutrition.

Here are some key tips to remember when integrating nutrition and hydration products into a daily training schedule:

•  Pre-event meals should take place 2-4 hours before an event, and then “topped off” with a high carbohydrate product like the Gatorade Prime sports drink 30-60 minutes before the event.
• During exercise, athletes should consume 16-24 oz of water or sports drink per hour. To stay hydrated, a good rule of thumb is for athletes to consume at least half of their body weight in fluid ounces (preferably water) per day. The School Health Horizontal Power System is an ideal solution to provide side-by-side water and sports drink hydration.
•  During high performance or in warmer temperatures when sweat rates are heavy, athletes can consume a high sodium snack or sports drink to stay hydrated.
•  Research has shown that recovery shakes and snacks are most effective within 30-60 minutes of a workout. We recommend products like the Gatorade Protein Recovery Shakes.
• Recovery products should have a 2:1 ratio of carbohydrates and protein. We recommend the First String Blast Protein Powder as a great way to gain this ratio.

Athletes who have long training sessions and burn extreme amounts of energy can see increased performance by using these recommended supplements.

School Health – Sports Medicine offers many other options to stock your nutrition and hydration station. Contact us today to tailor a delivery that fuels your team. 

10 Must-Have Features When Selecting an ECG System

Sudden cardiac arrest is the leading medical cause of death in athletes. A simple electrocardiogram (ECG) is a cost-effective method for identifying those at risk, far more effective than a physical exam and a review of medical history. There are many ECG manufacturers, and picking the right system for your needs can be challenging. Many organizations using older equipment face unmet needs that have led to cluttered and inefficient filing cabinets filled with paper. To remedy this, they must re-invest in appropriate technology.

This article highlights 10 key capabilities that are important considerations for your long term ECG system needs.

1. Digital Data. Digitally capturing every data element, observation, ECG trace, physician note, echo measurement and so on provides the flexibility that allows you to meet future and changing needs. Digital data will support your efforts in assessing program efficacy, process improvement, reporting and research studies. Don’t settle for just a 12-lead printout!

2. Customized Demographic Fields. Every organization has unique data collection needs: parent’s email address, clinic identifiers, medical illness, exercise frequency and so on. Customizable options for text entry and selection from drop-down lists are essential.

3. American Heart Association (AHA) 14 Point PPE questionnaire. The AHA recommends including these questions in the athlete’s Pre-Participation Exam. Important findings should be annotated on the ECG. For example, presence of syncope or chest pain while exercising might lead to a different recommendation or a second look at an ECG feature.

4. Modern Interpretation Criteria: The Seattle Criteria. The expected abnormal ECG rate is about 2%. Blinded studies demonstrate that it is uncommon for any physician to consistently read every record with an accuracy of 98– 100%. Obsolete ECG criteria that routinely provide misleading and inaccurate interpretations can distract the physician and reduce reading accuracy. Automatic interpretation using the recent Seattle Criteria provides strong physician support, similar to a consulting cardiologist assist, increasing accuracy and confidence that subtle features are appropriately noted and diagnosed.

5. Network Friendly, HIPAA Secure, Distributed Physician Overreading. The reviewing physician is often not onsite, or a consulting cardiologist may be required. Easy and secure network sharing and review of the ECG and associated digital data is an important consideration.

6. Post-Test Demographic Editing and Data Entry. Blunders happen, and the system needs to support post-test editing of errors and omissions and the addition of late arriving information.

7. Confirmed ECG PDF. Following physician review, a confirmed PDF of the ECG is generally required for the medical records, referring family physician and family. The confirmed ECG should include the physician’s name, date of confirmation, ECG status (Normal, Abnormal, etc), and physician comments. Creating the confirmed ECG PDF requires the digital ECG data and software tools that support electronic over reading.

8. Pre-Loaded Demographic Data. In large screening events entering the patient demographic information may be a time burden. When available in advance, it can be extremely helpful to pre-load these data so that just a mouse click populates the data entry screen. Importing an Excel spreadsheet is a convenient and efficient mechanism for this task. 

9. Cohort Reporting. Easy creation of an Excel spreadsheet containing all demographic data, responses to AHA questions, ECG measurements, abnormalities found, doctor’s confirmation notes, billing information, echo measurements, and so on is fundamental for managing and improving the screening process and research.

10. Software Updates. Over the past few years the accuracy and effectiveness of the ECG in identifying athletes at risk has dramatically improved. False positive rates have fallen from 15-20% to about 2%. This is an exciting and productive time for research focused on improving the sensitivity and specificity of the athlete ECG to detect life threatening abnormalities. Be sure your system can easily be updated to benefit from new insights, and be sure your vendor is actively participating in ECG research.

Perhaps this comes as no surprise, CardeaScreen scores a perfect 10, and is extremely easy to use! Watch the CardeaScreen video below:

Sports Health offers the CardeaScreen as a solution to help identify young athletes who are at risk of cardiac issues, at pricing well below many other systems on the market.

View the CardeaScreen and call us to talk about how the CardeaScreen can be a solution for you.

This blog has been written by David Hadley, PhD. President, Cardea Associates, Inc. 

Sports Health Video Contest Winners Announced

Congratulations to the Winners of the "Every Athlete Deserves an Athletic Trainer" Video Contest!

Our judging panel truly appreciated the hard work that everyone put in to the creation of their videos. We hope that these videos will help bring awareness to the important role of the athletic trainer in our nation's schools and on the sidelines.

The winners below will receive a Sports Health Gift Card for their school to be used for sports medicine supplies and equipment. The Grand Prize winner will receive a $3,000 Gift Card, 1st place will receive a $1,500 Gift Card, and Runner-Up will receive a $500 Gift Card.

Watch the winning videos below:

Grand Prize

Alyssa Fredericks

Durango High School
Durango, CO

1st place

Meghan Chura

Henninger High School

Baldwinsville, NY

Runner-Up

Paige Erland

Harper College

Palatine, IL

Follow us on Facebook and Twitter to find out about future contests and giveaways from Sports Health!

Using foam rollers for therapy and conditioning? Try these helpful tips to maximize your results!

How to Properly Roll Out When Using Foam Rollers

• Make sure you are well hydrated- While rolling actually hydrates your tissue, you still need to prepare your muscles in advance – it is best to drink 10 to 20 ounces of water before each session.
• Roll both before and after workouts- Rolling can replace stretching as a warm up and cool down.  Rolling increases circulation so muscles and connective tissue get more oxygen and water than if one just stretched.
• Roll slowly- Rolling can hurt.  However, if you rush through each movement, you are wasting the chance to work your muscle tissue.  Use slow, purposeful motions. Focus on painful areas first because they need the most attention, hydration, nutrients, and oxygen.
• Move in multiple directions-Not all muscles and connecting tissue run in the same direction, or even in a straight line.  Go from side to side, not just up and down.  Rub the spot being rolled.  Flex and extend the joint being rolled. 
• Roll out daily- Make rolling part of your daily routine.  It will help your muscles and connective tissue, and eventually lessen pain you feel from rolling out.

Rolling out can be very advantageous for your muscles during sports and physical therapy. Here are a few things to avoid so that you are getting the most out of your foam rolling technique! 

• Don't roll directly where there is pain- Roll a few inches away from the area that is sensitive.  Take your time, and work in the region around sore areas.
• Don't roll too fast- Go slower so that the surface layers and muscles have time to adapt and manage the compression.  Use short, slow rolls over any sensitive spots.
• Don't spend too much time on one knot- Spend 20 seconds on each knot, and then move on.  You can also manage how much body weight you use on the knots to take some of the weight off the roller.
• Practice proper posture- You need to hold your body in certain positions over the roller.  That requires a lot of strength.  If you do not pay attention to form or posture, you may actually cause harm.
• Don't use the foam roller on your lower back-  You can use the foam roller on your upper back because the shoulder blades and muscles protect the spine.  Stop once you hit the end of the rib cage. 

Sports Health offers several options for foam rollers, please visit our website to see which product is best for you!

Shop foam rollers >> 

An Orthopedic Surgeon’s Solution for Treating Soft-Tissue Injuries

About the author: Dr. Riley J. Williams III, MD is an orthopedic surgeon, academic, and clinician-scientist specializing in the field of shoulder, knee, and elbow surgery.  Since 1993, Dr. Williams has been affiliated with the Hospital for Special Surgery (“HSS”), the #1 rated Orthopedic Surgery Hospital according to U.S. News and World Report, where he is also Director of the HSS Cartilage Institute.  Dr. Williams is inventor of Therma1™ and Chief Medical Officer, Head of Product Development, and Chairman of the Board of Directors of R2T2 Laboratories Inc., the company that markets Therma1™.  Dr. Williams graduated from Yale College and Stanford Medical School, where he won top medical science research awards.  Dr. Williams is team physician for the Brooklyn Nets and NY Red Bulls, and he has been associated with professional football and baseball teams.

The Science Behind Using Hot/Cold Therapy, Compression and Massage to Heal Soft-Tissue Injuries

I am an orthopedic surgeon, sports medicine physician, advisor to elite athletes, and pro sports team doctor.  I’m also a scientist.  When I invented Therma1, I based it on the science of recovery.

It is well documented that cold therapy or compression reduces inflammatory response. Recent studies indicate that soft-tissue compression combined with local temperature alterations demonstrate significant enhancement in the healing potential of soft-tissue injuries.

It is also well known that heat therapy or compression/massage increase tissue compliance.  Studies show that controlled increases in thermal temperature have a significant effect on the tensile properties of skeletal muscle, which results in increased joint range of motion and reduced muscle tension that help reduce potential muscle strain injuries.  Other studies demonstrate that warm and more compliant muscles absorb more energy than non-stimulated muscle tissue, which results in improved resistance to biomechanical load. 

The Need for a Unique New Therapy Device Turns into an Invention

My observations of scientific evidence, decades of sports medicine experience including thousands of patients and surgeries, and dialogues with sports therapy experts such as pro sports athletic trainers, physical therapists, and chiropractors, led to the invention of the Therma1™ Hot Cold Roller.  The goal of the design was to provide all four critical musculoskeletal therapy treatment modalities (heat, cold, compression and massage) in one portable, easy-to-use device – something that no other product on the market offered.  The U.S. Patent Office recognized Therma1™’s innovative and unique qualities and granted a design patent last year.

The Therma1’s size and shape was designed specifically to make it easier to treat hard to reach spots, as well as help pinpoint trouble spots and deliver trigger point therapy. In my experience, there was a lack of products on the market with this ability.

What Makes the Therma1 Hot Cold Roller Different from...

Massagers or foam rollers?  Its ability to deliver heat and cold therapy

Ice packs and heat pads? Its ability to deliver rolling compression and massage

Continuous-flow cold therapy machines? The dynamic nature of Therma1™ Hot Cold Roller treatment modality makes the likelihood of thermal injury very low.

How to Use Therma1 in a Sports Medicine Setting

• As a natural Performance Enhancement Device (PED) – Use Therma1 before activity to increase tissue compliance.
• To treat nagging injuries, such as:
  • Patellar tendonitis
  • Calf strain
  • Shin splints
  • IT Band syndrome
  • Strains in the forearms, biceps, triceps and neck area
  • Quad and hamstring strains

Therma1™ should be used in regiments of two – ten minutes, usually in combination with static therapy.  The treatment regiments should be repeated throughout the day as desired. 

View videos that demonstrate the Therma1 in action >>

How Therma1 Benefits Athletic Trainers

• Increases patient compliance (one of the leading drags on patient recovery time is noncompliance with prescribed therapies).
• Patients can use it on themselves or athletic trainers can roll the player (patients don’t need to contort the body to apply therapy like other rollers)
• You never have to worry about frostbite or heat burns
• Non-toxic, simply rinse spills if they get on skin

Tips for Buying Therma1 Products:

Therma1™ comes in Recharge and Instant models.

Therma1™ Recharge – Comes with two rollers. The rollers can be placed in the freezer or microwave.

Therma1™ Instant - Provides portability and convenience with its Instant Hot and Cold packs.  Each Therma1™ Instant model comes with one Recharge Roller, one Instant Roller, and a dozen Instant packs. The Instant Roller has a removable end-cap that accommodates a Therma1™ Instant Hot or Cold pack.

When using Therma1 for cold therapy, keep the following in mind:

Therma1™ Recharge (freezer) achieves colder temperatures than Therma1™ Instant (cold pack).  When left in a typical freezer overnight, Therma1™ Recharge reaches sub 10 degree temperatures and holds a sub twenty degree temperature for approximately twenty minutes with recommended intermittent use (two – ten minute increments, followed by two minute “rest”).  For best results when treating acute injuries, use the Therma1™ Recharge when possible. 

If you do not have a Therma1™ Recharge handy, Therma1™ Instant with Therma1™ cold packs can be used to decrease local tissue temperatures; studies show decreases in local tissue temperatures stimulate an effective anti-inflammatory response.  However, I recommend Instant Cold packs be used only when a cold Recharge Roller is not available.

Learn more about purchasing the Therma1 Thermal Therapy Device and Watch Demonstration Videos >>

Body Composition- The Basics

How much you weigh can be a heavy problem- but have you considered your body composition?

 Body composition refers to the proportion of fat and fat-free mass in the body. Those with a higher proportion of fat-free mass (muscle, bone)  to a lower proportion of body fat have a healthy body composition.

Obesity, Thinness, Leanness. What's the difference?

• "Obesity" refers to having excessive body fat leading to serious health issues such as hypertension, type 2 diabetes, joint problems, as well as heart and breathing issues.
• "Leanness" refers to the muscle, bone, and fat composition of your body weight. Although some lean individuals may actually weigh more than their "tabled" ideal body weight, low body fat lessens the risk of health problems. 
• "Thinness" simply refers to weighing less than the recommended values in age-height-weight tables.

According to the Center for Disease Control and Prevention (CDC), childhood obesity has more than tripled in the past 30 years. The CDC states that childhood/adolescent obese children are likely to become obese adults. Eating and exercise (or lack thereof) habits learned as a child and adolescent may be difficult to undo as a working adult, stressing the importance of encouraging our students and athletes to live healthy and active lifestyles.

Many athletes may be categorized as overweight or even obese on some charts due to their muscle weight in relationship to their height. While it is mildly important to know how much you weigh, it is much more important to know how much of what you weigh is fat. Our bodies need a specific amount of fat to function, but not too much.

Ways to assess your body composition, and body fat percentage, include measurement with calipers and composition analyzers,  body mass index tables, underwater body fat tests ,and the bioletrical impedence analysis (BIA). Sports Health offers a variety of body composition tools such as body scales with BMI function, body composition analyzers, and BMI calculators.

BIA measures how difficult it is for an electrical current to move through the body. The electrical current is so small that most people cannot feel anything. The more body fat one has, the harder it is for the electrical current to flow through the body. The less fat one has, the easier it is for the electrical current to flow through the body. This means your body's fat stops (impedes) this controlled electrical current, allowing the technician to assess your percent body fat.

The body mass index, BMI, is used to calculate a person’s body fat content based on his or her weight and height. The World Health Organization (WHO) has used the tool to calculate obesity rates since the 1980s. Despite its popularity, one major shortcoming of the test is that it doesn’t take into account frame size or muscularity of the athlete. Therefore, even a professional athlete may fall into the “obese” range on the index scale because of the weight of muscle on his or her frame.  The CDC has BMI calculators for adults and children- where do your students and athletes fall on the chart compared to their body composition?

Adult BMI Calculator  http://www.cdc.gov/widgets/#adultBMI
Children’s BMI Calulator http://www.cdc.gov/healthyweight/assessing/bmi/index.html

This blog was written by Phil Hossler, ATC. Phil has been an athletic trainer on the scholastic, collegiate and Olympic levels. He has authored 4 books and numerous articles and served as an officer in state and regional athletic training associations for 20 years. He is a member of four halls of fame including the National Athletic Trainers’ Association’s.

The Case for Adding the ECG to Pre-Participation Exams

Sudden Death in Athletes – Not so Rare!

The leading medical cause of death in athletes is Sudden Cardiac Arrest (SCA). Although the purpose of the athlete Pre-Participation Exam (PPE), including review of the patient and family medical history and a brief physical exam, is to identify cardiovascular abnormalities that could progress to SCA, recent research has shown that the PPE does a particularly poor job of identifying risks. Conventional wisdom has proclaimed that including an Electrocardiogram (ECG) into the PPE to aid in finding those at-risk athletes is difficult, SCA is a rare event, and faulty initial evaluations (false positives) lead to unnecessary costs that would bankrupt the nation. But, as in most areas of health and science, technology and research can herald a new era. It’s time to take a fresh look at the value that can be garnered from the low-cost and highly sensitive ECG.

Who’s at Risk? 

Many screening organizations are reporting meaningful data on detection rates for cardiac abnormalities. It’s common to find that 2-3% of all participants actually have an ECG abnormality, compared to approximately 30 % of all participants who report abnormal findings in their medical history. Most of these abnormalities are unlikely to lead to SCA or disqualification from sports, but a significant number of them will impact the health of the participants over the course of their lives. Early detection can have a very positive impact on their lifetime health management. About 10 % of the abnormal group, or 1 in about 250 participants, have abnormalities that are strongly associated with SCA and follow-up is highly recommended.  Risks are also stratified by gender, ethnicity and sport:

Relative Risk	Higher	Lower
3x	Athletes	Non-Athletes
2x	Males	Females
3x	African-Americans	Caucasians
6.7x	Men's Basketball	All Sports

Sports that are characterized by sudden surges of energy, such as basketball, water polo and soccer, carry much higher risk than sports characterized by relatively constant effort, such as cross-country.  For an African-American male basketball player, the risk of death during 4 years of college play is about 1/1000, much higher than for other groups. These are risk levels that most of us would not knowingly accept.  It’s unconscionable to argue that high risk-athletes shouldn't be screened!

Where Do We Start?  

Available budget resources will guide how you begin a screening program that includes ECG.  We recommend that you initially gain experience and proficiency screening the higher-risk sports, with considerations for gender and ethnicity, with the goal of potentially saving the most lives possible with the available resources.  As efficiency and organizational support grow, you can extend the screening to a broader segment of your athletes.  The total cost of an ECG should be in the $10-$25 range, depending upon your providers – a fraction of the cost of a pair of athletic shoes.

What ECG system should we use?  

Most ECG systems implement automatic interpretation criteria that are outdated with respect to the best current consensus criteria for athletes, often referred to as the “Seattle Criteria,” ( Drezner, et al, British Journal of Sports Medicine, 2013). Use of these criteria have dropped false positive rates from around 12-15 % down to about 2 %, a factor of about 7x.  Although most cardiologists believe they can read an ECG correctly every time, recent blinded studies show that they are often in error 4 to 15 % of the time (reading based upon experience = 15 % error rate; reading based upon specific criteria with examples = 4 %).  An ECG device that implements the Seattle Criteria and is designed from the ground-up to deliver high-quality trace data, leveraging the tremendous data analysis capabilities of the modern PC, and with extended ECG recording time to improve beat estimates from bradycardic athletes, leads to much improved accuracy.  CardeaScreen is such a system and is being rapidly adopted in screening programs across America.

Learn more about the CardeaScreen (link includes FAQ's and video) >>

Sports Health would like to thank David Hadley, PhD, for writing this blog for us.

Dr. Hadley has over 30 years of hands-on experience blending customer needs with information technology through research and development. He spent nine years as Vice President of Research and Development for Quinton Cardiology. In this role, Dr. Hadley was responsible for rebuilding the engineering team, establishing robust new product architectures and developing the next generation of Quinton and Burdick diagnostic ECG products.

Prior to his role at Quinton Cardiology, Dr. Hadley was with Primus Knowledge Solutions and Sierra Geophysics. He earned his Ph.D. from the California Institute of Technology.

How to Save a Young Athlete’s Life: Pre-screen with an ECG

The Case for Using an ECG to Screen for Cardiac Disorders.

Does Pre-Screening Help Prevent Loss?

Each time a young athlete dies of a cardiac-related incident after athletic exertion, the debate over athletic pre-participation screening is reignited. The loss of a seemingly healthy young athlete to sudden cardiac death (SCD) is a jarring event that leaves people questioning what could have been done to prevent the tragedy. Cardiomyopathy leading to ventricular arrhythmia and SCD is actually the second leading cause of athlete death behind trauma. While SCD is rare, the statistics cause concern: almost 80 percent of athletes who die of a cardiac-related incident showed no symptoms prior to their death, and over 90 percent of SCDs in young athletes occur during or shortly after exercise. The NCAA estimates that nearly a dozen college student-athletes in the U.S. suffer sudden cardiac arrest each year.

The Gap in Current U.S. Recommendations

Current American Heart Association (AHA) standards do not recommend routine pre-participation screening for athletes, citing expense, burden to the healthcare system and false positive results. Rather, the AHA suggests use of a screening tool that includes 12 questions about personal and family medical history and a physical exam to identify aspects of an athlete’s health that could signal a cardiovascular problem.
But what about athletes who are not aware of, or do not have access to, extensive family history or who are reluctant to report these potential health issues for fear of being excluded from participation in their sport?
In 2005, the European Society of Cardiology recommended universal screening, and this position has been endorsed by the International Olympic Committee. Israel also requires ECGs as part of athletes’ pre-participation physicals (PPE).
These pro-screening policies are largely a result of a population-based study conducted in Italy which examined the athletic and nonathletic populations between the ages of 12 and 35 years. The annual incidence of SCD in athletes decreased by 89 percent between 1979 and 2004; whereas the incidence of SCD among the nonathletic population did not change significantly. Most of the reduced mortality rate was due to fewer cases of sudden death from cardiomyopathies.
Recent research supports the viability of screening with ECGs, despite concerns about cost and false positive results. A study commissioned by the NCAA screened 2,471 athletes from 14 NCAA Division 1 universities who had not previously received an ECG screening. Seven athletes were diagnosed with serious cardiac disorders, all of whom had abnormal ECGs, but only two of those athletes had an abnormal history or physical exam.

A Trend Toward Cardiovascular Screening in the U.S.

A recent survey of head athletic trainers in NCAA Division 1 football programs found that 35 of the 116 schools were already incorporating non-invasive cardiovascular screening (NICS) in their PPEs.
As the trend in the U.S. moves toward a more proactive approach to screening, and with mounting evidence pointing to the value of screening athletes with ECGs, perhaps athletic trainers and programs should consider partnering with contracted medical staff, or better yet should invest in an onsite ECG, like the ones found on Sports Health to have ECG testing readily available. After all, it could mean the difference between life and death for a young athlete.

Shop ECG Machines >>


Danielle Masursky, PhD
Janice Riley, RN, CRA

Bibliography

Corrado D, Basso C, Pavei A, Michieli P, Schiavon M, Thiene G.Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA. 2006 Oct 4;296(13):1593-601.
Coris EE, Sahebzamani F, Curtis A, Jennings J, Walz SM, Nugent D, Reese E, Zwygart KK, Konin JG, Pescasio M, & Drezner JA. Preparticipation cardiovascular screening among National Collegiate Athletic Association Division I Institutions. British Journal of Sports Medicine.2013; 47(3):182-4.
American Medical Society for Sports Medicine. NCAA-Funded Study Supports Screening NCAA Athletes for Sudden Cardiac Death Risk. [Press Release, April 21, 2013]. Retrieved from http://www.amssm.org.
American Heart Association: Pre-participation Cardiovascular Screening of Young Competitive Athletes: Policy Guidance (June 2012) Retrieved from http://newsroom.heart.org.

BOSS Hydration System Review

This blog was written by Phil Hossler, ATC. Phil has been an athletic trainer on the scholastic, collegiate and Olympic levels. He has authored 4 books and numerous articles and served as an officer in state and regional athletic training associations for 20 years. He is a member of four halls of fame including the National Athletic Trainers’ Association’s.

As a certified athletic trainer and director of several large sporting events, properly and adequately hydrating participants is one of my standard safety concerns. There are multiple solutions available to provide hydration depending upon budget and number of participants. These options range from bottles and coolers to cups, hoses and drinking stations.


In reviewing products, I was intrigued by the BOSS Drinking System. About two decades ago, I actually thought along these lines and developed a lid with a hand pump idea. I was glad to see BOSS refine this idea to one of battery power. The product seems to be well conceived with a lid that does not have to be exclusively used on ONLY their coolers but can be used on any screw on 7- or 10-gallon cooler.


Often the large 10-gallon coolers can be too heavy for many high school age athletes to transport so the inclusion of a cart by BOSS was a nice touch. The BOSS system provides a four hose assembly with auto shut-off capabilities so that when not in use the nozzle can shut off to conserve battery power. The power is provided by a 12-volt DC rechargeable battery.


There are, however, some possible negative points that I would like to explore. There are several vendors that carry the BOSS system. I found Sports Health to be the most detailed and offer the greatest variety of combinations. If I had the chance I would like to actually use the BOSS system, but my school budget will not permit me to do such an experiment.


So, my following thoughts are based on experience and product review but not on actual use:

1. It appears that the cart may not be substantial enough to last long with the weight of a 10-gallloon cooler. It appears to be aluminum and the arm holding the actual cooler should be longer to reduce the axial load at the fulcrum point.
2. Sports Health does a nice job, actually better than www.outdoorboss.com does explaining the different options available.

Learn more about BOSS Drinking Stations

Concussion Book & Documentary a Must-Read for Anyone Involved in Sports

Head Games- You need to know the rules to this game

This blog was written by Phil Hossler, ATC. Phil has been an athletic trainer on the scholastic, collegiate and Olympic levels. He has authored 4 books and numerous articles and served as an officer in state and regional athletic training associations for 20 years. He is a member of four halls of fame including the National Athletic Trainers’ Association’s.

To say that head injuries, specifically concussions, are more in the spotlight now than ever before, would be understating the obvious. With a number of retired National Football League (NFL) players coming forth since 2006, the subtle, yet substantial, effects of diagnosed concussions and “sub-concussive” head trauma have gained national attention.

One the leader of this heightened awareness is Christopher Nowinski from Boston. Chris is a Harvard graduate, former Harvard football and former WWE professional wrestler. Looking back now, Chris realizes how many and how serious some of his “dings” throughout his career(s) actually were. His book, Head Games details the National Football League’s dealings and misdealings in the area of player safety as it relates to head trauma. The combination of the text and now film is perhaps the finest, most detailed and comprehensive regaling of the underbelly of this country’s most beloved sport. These are must reading and viewing by anyone associated with sports, not just football.

The award-winning documentary is a feature length by an acclaimed director. It combines actual stories from players, surviving loved ones and some of this nation’s finest brain trauma experts. Dr. Ann McKee, MD, Dr. Robert Cantu, MD and Dr. Robert Stern, PhD - who are now known internationally for their work and examination of deceased brain tissue changes of former athletes from a variety of sports and age groups.

As someone who played 4 years of high school and 4 years of college football, I identified with the stories. On one occasion I was knocked unconscious in college practice. It took me considerable time to remember the play I was carrying the ball on. I am glad now that I did not act upon the invitation letter to attend an NFL non-drafted player tryout.

The film is an outstanding tutorial; it is not a condemnation of sports. It supports the inherent value of sports, overcoming obstacles, teamwork and life values. But all these objectives must be tempered with safety, rule changes, age-specific alterations and increased scrutiny of participants’ health. Several former professional athletes now must live their lives filled with mental and physical shortcomings. Several deceased athletes that we all loved to watch display their talents are believed to have succumbed to dementia, Alzheimer’s or depression.

Chris’s involvement and narration on the documentary expertly delves into boxing, college football, girls’ soccer as well as professional ice hockey and football. These experts detail the need to decrease or eliminate the “military mentality of organized war with rules” that sports have so often become. Dr. Cantu, father of the first grading protocol for concussions, says that with the rise in sports participation every high school that offers a sports program should have a certified athletic trainer on staff. If not, then schools should not offer sports that give rise to concussive trauma. He goes on to state that the number of practices that allow head trauma should be reduced to reduce the incidences of “sub-concussive” head trauma. He points out that the NFL typically has only one practice day a week with contact.

This five star detailing of accounts, history and real stories make the text and documentary film a requirement for every high school and college athletic department’s must read/view list.

Learn more about how to purchase Head Games

Athletic Trainer Helps Save High School Referee with AED

Watch the video of the Athletic Trainer reunited with the referee who's life she helped save on Thursday, February 7th during an exciting overtime Girls' Basketball game at Eastchester High School in NY. Neil Berniker, teacher, coach and high school referee in the Bronx, suddenly collapsed and hit the floor while officiating the game. Jason Karol, the school's Athletic Director, along with Ellen Bastoni, the school's Certified Athletic Trainer, came to his rescue.

"As soon as I ran over, I saw he wasn't breathing and I yelled to call 911," Karol said. "I told the [athletic] trainer to get the AED because he was gasping for air but he wasn't breathing." Karol, a first year athletic director, began CPR until Bastoni returned with the LIFEPAK 500 AED (Automated External Defibrillator).

Once the AED was connected to the referee, it advised a shock. Incredibly, through the efforts of Karol, Bastoni and a parent bystander, Berniker was successfully revived in front of the 200 people watching solemnly from the stands. "We saw his eyes open and he started breathing again," Karol said. "He was confused and I just held his hand until the EMT's got there. He didn't know what happened."

Once EMT's arrived, Berniker was put on oxygen and transported to the intensive care unit. It was reported that he is recovering well, and that he was up and walking and making jokes by the next day.

Eastchester has 23 AEDs located strategically throughout their buildings. Interestingly, the week before the referee collapsed during the basketball game, the placement of the AEDs was reviewed and the one used to save Berniker's life was placed in a more accessible location in the gym so that it could be utilized after normal school hours.

Sports Health is a leading provider of AEDs to schools and athletic organizations across the country. The AED Program at Eastchester High School was implemented with the help of a School Health/Sports Health Representative. If you would like more information, please contact us and one of our knowledgeable representatives will get in touch with you.

Request an AED Consultation and Download "The 10 Common Mistakes Made By School AED Programs">>

Video courtesy of Lohud.com

About Sickle Cell Disease and Athletes

Sickle cell trait needs to be identified in athletes

Sickle cell disease (SCD) is a condition in which  red blood cells can develop a “C” shape similar to the old farm tool called a sickle that was used to harvest grains. The danger of the “C” shape blood  cells is that they die early which causes a shortage  of red blood cells. Due to their non-round shape they can also become stuck and clog smaller blood vessels resulting in pain and other complications.  Tissue that does not receive a normal blood flow eventually becomes damaged. This is what causes the complications of sickle cell disease. Read more: http://www.nhlbi.nih.gov/health/health-topics/topics/sca/

Disease (SCD) or Trait (SCT)?

SCD is a genetic condition that is present at birth having been inherited from one or both of their parents. Persons who have inherited one sickle cell gene and one normal gene have SCT. This means the person won’t have the disease, but will be a trait “carrier” and can pass it onto their children. Sickle cell trait is not a type of sickle cell disease. People with sickle cell trait are generally healthy. Persons with SCD can pass either SCD or sickle cell trait (SCT) onto their children.

SCT affects 1 in 12 African Americans in this country. Estimates are that 3 million people in the United States have SCT and many are unaware of the condition. SCT is also frequently found in people living in or have families in South and Central Americans, Caribbean, India, Arabia and Mediterranean counties such as Turkey Greece and Italy.

Chances of Inheriting SCD or SCT

• Both parents have SCT = 50% chance of SCT in their children; no symptoms in children of SCD; but they can pass SCT onto their children
  
• Both parents have SCT=25% chance of SCD in their children; 25% of no SCD in their children
  
• One parent has SCT= 50% chance of SCT; 50% chance of no SCT
  

How do you know?

A simple blood test is used to detect SCT. For several decades now blood testing for sickle cell and other blood conditions has been standard on newborns. Families with inherited SCD and SCT tendencies should see a genetic counselor (contact your family physician or local hospital) to investigate the number of relatives on the husband’s and wife’s side of the family who are carriers before deciding on having children of their own.

Knowledge of medical problems possibly associated with sickle cell trait and their appropriate management is good clinical practice for athletic programs so check with the school physician and/or the athlete's physician.

How Improving Listening Skills Can Improve Athletic Healthcare

Being is a good listener is half of being a good speaker. Americans spend 80% of their waking hours communicating. We spend 45% of the time listening, but we only listen at about 25% of our ability to do so.

Student-athletes need to understand their assignments, know the techniques of the sport and to listen to -  not just hear - instructions. The following guidelines will help student-athletes and student trainers become more effective communicators by improving their listening skills:

• In order to listen you have to stop talking.
• Listen actively. You can hear someone without really listening to them. 
• Don’t get ahead of the person talking. 
• Wait. Don’t jump to conclusions. 
• Listen to them without turning their story into your story.
• Don’t finish other people’s sentences. Be patient and do not interrupt. 
• Become a student of human behavior. Observe their nonverbal language. 
• When appropriate, summarize to show you were actually listening. 

When tending injured athletes, care providers must pay attention to details that affect decisions. Asking and listening are key evaluative tools used by all health care providers. Injured athletes need to feel comfortable and reassured by the person who is caring for them. Powerful body language, positive facial expression, eye contact and professional verbal skills are trademarks of successful people in all walks of life. This is especially true in the emotional, fast paced world of athletic healthcare.

Shop on www.sportshealth.com for products that improve athletic performance >>

Successful Verbal and Non-Verbal Communication Key to Success in Athletics

Communication is the key to successfully accomplishing any task in athletics. From the catcher’s signals with the pitcher to the coach’s pep talk before the game, effectively conveying your message is crucial. Successful leaders throughout history have been effective communicators.

People use as many as 40,000 words in a normal day. Each day we typically spend 45% of our day listening, 30% speaking, 16% reading and 9% writing. Unfortunately, most of our training is just the opposite - with most of our time being taught how to write and very little time spent teaching how to be an effective listener. Effective communication is made easier by finding what you have in common. Focus on the common goals, not the common obstacles.

Your appearance is how someone initially molds their opinion of you. First impressions are lasting ones and are often formed with the first three minutes.

Your body language conveys a powerful message. Learn to stand and sit tall. When speaking, stand firmly on both feet and make eye contact with the person, but don’t stare or will make them uncomfortable. Don’t clench your fist or tap your fingers. Take a breath; relax and speak slowly and deliberately. Avoid quick snappy answers that you later take back.

Most of what you say goes without saying; actions and body language speak louder than words.

Shop at Sports Health for more products that improve athletic outcomes >>

Dancer's Foot Information and Treatment Suggestions

Dancer's Foot

Sesamoid bones are one of nature’s most amazing anatomical creations. Sesamoid bones are unique in that they are “floaters” - not connected to another bone - and they are embedded in a tendon or muscle. They provide a smooth surface over which tendons can slide to increase mechanical (muscle) power. The leverage advantage produced by the exact location of this bone gives us leg power (patella bone) as well as foot movement. The sesamoids in the forefoot (directly under the first toe joint) assist with weight bearing and help elevate the bones of the great toe.

Like other bones, sesamoids can break and tendons surrounding the sesamoids can become irritated or inflamed. This is called sesamoiditis. When the patella is dislocated or the Q angle (angle between thigh bone and larger shin bone) is excessive, the patella may not glide smoothly each time the leg is flexed or extended. If the underside of the patella loses its smoothness a condition called chondromalacia may develop.

On the underside of great toe there are two sesamoid bones. The great (big) toe is critical to walking, dancing and running. These two sesamoid bones improve the angle and effectiveness of the toe-off portion of the gait cycle. When injured there may be no swelling and bruising with pain localized directly under the joint of the big toe. If this pain appears quickly you should seek physician care for an x-ray. If you experience pain bending/straightening the big toe even when non-weight bearing, suspect sesamoiditis.

The American Academy of Orthpaedic Surgeons offers the following guidance for sesamoiditis:

• Stop the activity causing the pain.
• Take aspirin or ibuprofen to relieve the pain.
• Rest and ice the sole of your feet. Do not apply ice directly to the skin, but use an ice pack or wrap the ice in a towel.
• Wear soft-soled, low-heeled shoes. Stiff-soled shoes like clogs may also be comfortable.
• Use a felt cushioning pad to relieve stress.
• Return to activity gradually, and continue to wear a cushioning pad of dense foam rubber under the sesamoids to support them. Avoid activities that put your weight on the balls of the feet. 
• Tape the great toe so that it remains bent slightly downward (plantar flexion).
• Your doctor may recommend an injection of a steroid medication to reduce swelling.
• If symptoms persist, you may need to wear a removable short leg fracture brace for 4 to 6 weeks.

There are specific pads for sesamoiditis in the foot that are intended to re-distribute body weight off of the bones upon weight bearing. Find these pads on the Sports Health’s web site >>

Easily Improve Your Fitness Level Using a Pedometer and These Walking Tips

Walking for Health

In our current fast paced world, we still can’t find enough time to do that one thing that we need: mild to moderate exercise repeated often. For the majority of Americans we do not need military-like fitness goals, we just need to do something actively and do it often.

Examples of lifestyle changes are common, well known and yet still underutilized, such as park the car in the last row at the mall instead of the closest row, stop the elevator one floor early and walk the stairs to your floor and walk yourself (or your dog) for that 15-30 minutes every night after dinner.

For many of us, we have grown accustomed to measuring, assessing and defining our lives and for this crowd using a pedometer is perfect. A pedometer is a device that senses your movements to tally up the number of steps you take. It can be worn, clipped, tucked or carried. Pedometers can be simple (clip it on your belt and start walking) or advanced (determine your stride length, weight, pulsating rhythm as you walk, calories burned and can be downloaded onto your computer). Choose a pedometer that has a display you can easily read in different lights, can be worn comfortably and has the features you want.

Prices range from $10 to over $100. If you are new to the walking idea and the keeping track of your “motion minutes”, start simple and move up when needed. Once you are ready to get started, try wearing it around your normal day for about 2-4 days just to see how many steps you take in a typical day. You can now begin to add steps by scheduling that 10, 20,30 minute walk and add them onto your total. If you want to measure distance instead of steps, find that local track or measured distance by car, walk the ¼ mile and see how many steps or strides it took you, multiply by 4 and there you have your mile number. Remember this is an estimate, but after all, we are in this to be in motion not measure in exact feet or yards!

According to the staff at the Mayo Clinic, you should

• Set long-term step goals. Think about your overall fitness and activity goals. Your short-term goals are the building blocks to these long-term goals. A long-term goal may be walking 10,000 steps a day, or about five miles (eight kilometers), several times a week as part of your new daily routine. You may also want to set a goal of walking faster as your fitness level improves. Keep in mind that the Department of Health and Human Services recommends that, in general, healthy adults get at least 150 minutes a week of moderate aerobic activity or 75 minutes a week of vigorous aerobic activity.
• Track your progress. To see how you're doing, monitor your progress over time. Your pedometer may or may not have a memory function to track your steps on a weekly or monthly basis. You can choose to use that feature or record your steps in a log of your own making. Or upload the information digitally to your computer or mobile device. Tracking your progress can help you see whether you're meeting your goals and when it may be time to set fresh goals.
• Check with your physician before beginning, especially if you have been sedentary for a while, have any orthopedic problems or have any medical issues that are being monitored.

To read more about different pedometers, shop Sports Health pedometers online >>

Wound and Bleeding Care Basics PLUS What to Buy for Your First Aid Kit

Wound and Bleeding Care

The majority of wounds should be handled by putting pressure directly on the wound using sterile gauze. Gauze pads hold the blood on the wound and help the components of the blood to stick together, promoting clotting. If you don't have gauze, terrycloth towels work almost as well. If the gauze soaks through with blood, add another layer. Never remove the initial bandage since peeling blood soaked gauze off a wound removes vital clotting agents and encourages bleeding to resume.

Blood needs to clot in order to start the healing process and stop the bleeding. Step two to control bleeding is to elevate the wound above the heart. By elevating the wound, you slow the flow of blood. As the blood slows, it becomes easier to stop it with direct pressure. Remember, it must be above the heart and you must keep direct pressure on it.

Types of Wounds

The acronym PAIL identifies the four major types of wounds: puncture, abrasion, incision and laceration.

Puncture wounds caused by a pointed implement such as a nail, cleat or pin may be deep and are difficult, if not impossible, to clean. Puncture wounds have the greatest chance of tetanus due to bacteria being left in the wound as the implement is withdrawn. Determine the implement, date of last tetanus shot and depth of penetration.

Abrasions are superficial in depth and may cover large areas. Due to the large amount of skin surface, they have a high chance of infection. First aiders should rinse the surface with a wound wash, pat dry with sterile gauze, apply antibiotic ointment and cover. Moist wounds have been shown to heal faster than the old days of “letting it air out to dry”. So, first aid cream and a bandage are the order of the day.

Incision wounds are made with sharp, straight instruments such as scalpels, metal buckle edges and knives. The wound has straight edges and may be long-short or wide-narrow. The wound should be washed with water or sterile wound wash and wiped in the direction of the incision to ensure proper removal of any debris. Depending upon length and depth, stitches may be necessary.

Laceration wounds have rough, uneven edges and involve the greatest amount of tissue damage. The wound should be thoroughly irrigated and wiped lengthwise to avoid lodging any debris under the multiple edges of the wound. Stitches may be required and may involve both internal and external sutures depending upon depth and size.

Universal Precautions

As is the case when dealing with any body fluids, the use of universal precautions is prudent. Gloves, sterile bandages, dressing to hold the bandage in place, wound wash/water and referral to additional care when needed are typical wound care steps.

For the rest of your first aid kit, you'll need:

· tweezers

· wound wash

· alcohol wipes

· antiseptic hand cleaner

· medical adhesive tape

· sterile gauze elastic bandages

· several sizes of adhesive bandages

· insect bite swabs

· triple-antibiotic ointment

· bandage scissors

· triangular bandages

· instant cold packs

· exam gloves

· barrier device for CPR

 Shop a wide range of first aid and emergency supplies >>

High School Athletic Trainer MVP Award

High School Athletic Trainer MVP Award

Sports Health and Training & Conditioning Magazine are excited to announce a new awards program honoring high school athletic trainers. High school athletic trainers are the unsung heroes of interscholastic sports and many work countless hours educating and caring for student-athletes on and off the field.

Applications are being accepted to recognize the efforts of an individual who does his/her job very well, but also go beyond the expected.  Certified athletic trainers who work with athletes in schools or through outreach to schools that are respected by all those around them, but may not be recognized for all they do, now have the avenue to broaden and deepen their impact.

High school athletic trainers have always been the “make it work” and “do a lot with a little” group of professionals. Momentum Media publishers of Training & Conditioning magazine has joined with Sports Health to offer a tremendous, stand-alone program to recognize one high school athletic trainer.



The winner of the MVP award will be featured in the April issue of Training & Conditioning magazine, receive a plaque commemorating the honor, product-related prizes as well as being featured in an announcement at the national athletic trainers’ meeting in June, 2013.

Nominations can be emailed to MVatc@MomentumMedia.com before December 31, 2012.

Learn more >>

The ABC's of AEDs

An automated external defibrillator or AED is a portable electronic device that automatically diagnoses the potentially life threatening cardiac arrhythmias of ventricular fibrillation and ventricular tachycardia in patients and is able to treat them through defibrillation, the application of electrical therapy which stops the arrhythmia, allowing the heart to reestablish an effective rhythm. As reported in USA Today, November 12, 2003 a National Institute of Health showed defibrillators can double the survival rates of sudden cardiac arrest. It is estimated that 350,000 people die annually due to sudden cardiac arrest and that in ages 15-34 the incidence has risen 10% in the last decade. (Read more about sudden cardiac arrest and high school athletes here).

The first AEDwas originally designed and created by American biomedical engineer Joshua L. Koelker and Italian emergency medical professional Jordan M. Blondino to allow defibrillation in common public places. AEDs are designed to be simple to use for the layman, and the use of AEDs is taught in many first aid, first responder, and basic life support (BLS) level CPR classes in schools.

Conditions that the Device Treats

An automated external defibrillator is used in cases of life threatening cardiac arrhythmias which lead to cardiac arrest. The rhythms that the device will treat are usually limited to:

1. Pulseless Ventricular tachycardia
2. Ventricular fibrillation

In each of these two types of shockable cardiac arrhythmia, the heart is active, but in a life-threatening, dysfunctional pattern. In ventricular tachycardia, the heart beats too fast to effectively pump blood. Ultimately, ventricular tachycardia leads to ventricular fibrillation. In ventricular fibrillation, the electrical activity of the heart becomes chaotic, preventing the ventricle from effectively pumping blood. The fibrillation in the heart decreases over time, and will eventually reach asystole.
AEDs will not start a stopped heart, that is, it will not be effective in a coronary attack.  Its purpose is to counter a “fluttering” (fibrillation) of the heart muscle before it goes into cardiac arrest. The asystolic patient only has a chance of survival if, through a combination of CPR and cardiac stimulant drugs, one of the shockable rhythms can be established, which makes it imperative for CPR to be carried out prior to the arrival of a defibrillator. Estimates are that CPR alone is only 6-8% effective but CPR plus the use of an AED within 6 minutes is 80% effective.

The American Heart Association recommends automated external defibrillators in any place where there are large numbers of people. This includes airports, stadiums, large offices or industrial buildings, public buildings and large fitness centers, for example. 

Read more: American Heart Association Defibrillation Guidelines | eHow.com http://www.ehow.com/way_5577375_american-heart-association-defibrillation-guidelines.html#ixzz1NQ2GEXt1
Several states require scholastic coaches to be certified in first aid and CPR/AED usage. In 2010, the American Heart Association (AHA) released their updated guidelines for treating sudden cardiac arrest (SCA) and heart attacks.The purchasing and placement of AEDs at schools and during athletic events is both critical and legally prudent.  The American Heart Association recommendation is that an AED should be within a 2-minute walk from anywhere on school grounds/building.

Implement a School AED Program

While emergency response plans should be developed by both physical education and athletic departments, so too should be annual “simulated episodes” requiring staff to respond to various scenarios and in various locations on school grounds.

Request a free AED consultation and download the 10 common mistakes made by school AED programs >>

For additional information about AED usage and programs implementation go http://www.quickmedical.com/defibrillator/aha.html and Project ADAM at http://www.chw.org/display/PPF/DocID/26050/router.asp.