Spring 1982 - Athletic Training History

zooio vwSli3SnH3VSSVN JO AINOna N30A08 1 »NVdJ3NVNH9n\n 8 S3WVPEIICiRnmincTHE JOURNAL OF THE NATIONAL ATHLETIC TRAINERS ASSOCIATION.IN THIS ISSUE —• CEU Quiz: The Burnout Syndrone Among Athletic Trainers• Electroacutherapy for Treatment of Inversion Ankle Sprains• An Evaluation of DMSO in Sports Medicine• The Sobering Symposium: Groin and Hamstring Injuries• More Tips from the FieldVOLUME 17NUMBER 1SPRING 1982

6oatellarstabilizers thatreally work.And are clinically proven effective for • Chondromalacia• Tendinitis • Normal patellar tracking • Jumper's knee• Patel/ar sub/uxation and dislocation• Osgood-Sch/atter's Disease • Posf operative therapyOnly PRO offers a choice of 6patellar stabilizers . . . each designed forhelping a specific problem . . . andwherever therapeutic heat, elasticcompression and support are indicated.PRO has been creating . . . not imitating. . . and producing knee sleeves andpatellar stabilizers for over 20 years.And they've been clinically proven asa conservative approach to patellarproblems.PRO100BDeluxeKneeSleeveThe classicNeoprene kneesleeve with a feltbuttress at lateraledge of the patellaropening for patellarcontrol and stabilization. Theconservative approach to treating patellarsubluxation. $24.95 U.S. Pat. No. 4,084,584PRO100BModifiedDeluxeKneeSleeveNew designfeatures pull straps,with Velcrofasteners, attachedto the ends of thefelt buttress at a 45degree angle, to provide firmer control ofpatellar tracking. $26.95Dr. "M"PatellarBracePatented designfeatures buttressesof orthopedic felt ina horseshoeconfiguration, in combination with twoadjustable Velcro pressure straps, toprovide optimum patellar stabilization.Medial and lateral stays add stability.Ideal for jumper's knee and patellartracking problems. $32.95U.S. Pat. No. 4,084,584Dr. "M-l"PatellarBraceThe Dr. "M" with thefelt horseshoeinverted to applycompression to theinfrapatellar tendonelevating the patella. Most helpful in thetreatment of Chondromalacia, tendinitisand Osgood Schlatter's Disease. $32.95Dr. "M-C"PatellarBrace(CartilageSleeve)The Dr. "M" with theaddition of elastic"X" straps applyingspecific pressureover the lateral andmedial menisci whileenforcing normal patellar tracking. $34.95PROKnee HingedStabilizingBraceBent knee sleevedesign withaluminum medialand lateral hinges.Four Velcro strapsprovide ideal fit. Feltdonut provides excellent patellarstabilization. Designed for active athleticparticipation. $30.95All PRO sleeves and braces arePROfessionally designed for maximumwearer comfort. . . use the highest gradeU.S. Neoprene rubber with nylon facing. . and are produced under our own strictflfiB ' quality control.For more information on these proven products, or to order,call TOLL-FREE—1-800/523-5611 from 9 to 5 Eastern Time(In PA call 215/265-3333). Write for our free catalog.PRO Orthopedic Devices, Inc. P.O. BOX 1, King of Prussia, PA 19405Why not use what the PROfessional athletes use?

Editor in Chiefand Journal Committee ChairpersonKenWolfertThe Southwest Ohio Sportsmedicine Center111 Buckeye StreetHamilton, Ohio 45011EditorGlint ThompsonMichigan State UniversityEastLansing, Michigan 48824Journal CommitteeDennis AtenEastern Illinois UniversityRay BaggettIndiana State UniversityEd ChristmanKnoxville, TennesseeJeff FairOklahoma State UniversityKathleen FoxUniversity of Central FloridaDonKavermanBig Rapids, MichiganJohn WellsMars Hill CollegeDave YeoMontgomery County Community CollegeEditorial BoardSue HalsteadUniversity of VirginiaKen KnightIndiana State UniversityDan LiberaUniversity of Northern ColoradoBob MooreSan Diego State UniversityJim RankinMichigan State UniversityBusiness ManagerBarbara ManningManaging DirectorMary EdgerleyP.O. Box 1865Greenville, North Carolina 27834919-752-1725Athletic Training is published in the Spring, Summer, Falland Winter by the National Athletic Trainers Association, anonprofit organization. Second class postage paid at Greenville,NC 27834, and additional mailing offices.The views and opinions in Athletic Training are those ofthe authors and not necessarily those of the National AthleticTrainers Association.Non-member subscriptions are available at $15.00 per yearand may be obtained by writing to Athletic Training, P.O.Box 1865, Greenville, NC 27834.CHANGE OF ADDRESS may be made by sending old addressand new address with zip code number. Instructions]ld state whether change is temporary or permanent,^llow thirty days for changeover. Address changes should besent to: P.O. Box 1865, Greenville, North Carolina 27834.ADVERTISING-Although advertising is screened,acceptance of the advertisement does not necessarily implyNATA endorsement of the product or the views expressed.Advertising rates available on request. Contact AthleticTraining, P.O. Box 1865, Greenville, North Carolina27834 (Telephone 919-752-1725).Copyright © Spring 1982 by the National AthleticTraining Association. (ISSN 0 160 8320). Printed by HunterPublishing Company, Winston-Salem, North Carolina 27103.152631333643573060346810122447RTHLETICTRnmincTHE JOURNAL OFTHE NATIONAL ATHLETIC TRAINERS ASSOCIATIONPresident's MessageEditor's RemarksAnnouncementsCurrent LiteratureCalendar of EventsPotpourriBook ReviewsAssociation ActivitiesVolume 17, Number 1, Spring 1982FeaturesThe Use of Electroacutherapy intheTreatment of Inversion Ankle SprainsWILLIAM E. PRENTICEAn Evaluation of the Present Indications ofDimethyl Sulfoxide (DMSO) in Sports MedicineJOHN WELLSConstitution of the National Athletic Trainers AssociationNational Athletic Trainers Association Code of EthicsCEU Quiz: The Burnout SyndromeAmong Athletic TrainersJOE GIECK, ROBERT S. BROWN, ROBERT H. SHANKThe Schering Symposium: Groin and Hamstring InjuriesPAULC.CASPERSONCase Report: Avulsion Fractures of theAnterior Superior Iliac Spine in High School TrackMARK LEE MILLERTips from the FieldVariation of the Longitudinal Arch StrappingKIM A. BISSONETTE, JOHN S. LEARD515254626464Innovation in Rehabilitation:Make Your Own Sand WeightsJANETLOZARDepartmentsAbstractsIn MemoriamIn MemoriamGuide to Contributors/Journal DeadlinesHave You Seen These?Our Advertisers

President's MessageDear NATA Member:I hope you are making plans to attend the 1982 Annual Meeting andClinical Symposium in Seattle. There are numerous discount fares offeredby the various airlines and if you thoroughly investigate these, yourattending our meeting will become a reality for you.One of the long standing problems of our National Office, particularlywith our growth, is getting information to each of you. It is important thatyou continue to get updated information and this is possible only if yourcorrect mailing address is on file with the National Office in Greenville.Also, the correct recording of your CEU's is extremely important and forthis your correct mailing address is essential. Please notify the NationalOffice when there is a change in your mailing address. It's yourresponsibility to do this.I want to encourage you to continue to support the NATA ScholarshipFund. The support for this important aspect of the Association that comesfrom each of you is essential. Our Association is fortunate to be able torecognize students in athletic training that have excelled academically anddemonstrated exceptional skills in the training room. The key to the futureof our profession is through quality education of our students. An excellentway to promote and support this is by making a contribution to ourScholarship Fund.As we continue to grow, increased demands are put upon each of us andour Association. It is important that we take a methodical approach to thechallenges we continually face. There is a vast difference between trainingfor a sprint and training for a marathon. It means very little to a marathonrunner if the first 100 yards is covered in ten seconds. A burst of speed isgood .... but in the long run it is the ability to stick with it mile after milethat counts. Steadfastness, not merely fastness, determines the winner. Itis important that you keep this in mind when asking why this or why that isnot done as fast as perhaps you think it should be. In making decisions,your officers concern themselves with NATA's future and the thought thateach of us will be spending the rest of our lives with that future.The continued communication between the membership and officers isappreciated. Please continue to express your concerns and ideas.Warm regards to each of you.Cordially,William H. ChambersJAthletic Training • Spring 1982 3

Editor's RemarksAn Appeal....Ken Wolfert, ATCThe National Office is in search of back issues ofATHLETIC TRAINING, The Journal of the NationalAthletic Trainers Association. The years 1958 through1970 are not on file. National Office staff members arecurrently attempting to set up a central source ofinformation for interested members and affiliatedpersonnel, but without the full Journal collection, thisathletic training information library is incomplete. Fromtime to time members write in search of informationnecessary for their research or presentations. TheNational Office staff is frequently unable to assist thesepersons with their requests for materials from pastJournals even though their citations for specific articleswere taken from the index in the Spring 1981 issue of theJournal.Herman Bunch, a 1980 Twenty-Five Year Awardrecipient and District Three member, has recentlydonated his entire Journal collection (1958 to date) to aRaleigh, North Carolina library. If you have made asimilar donation, or know of anyone who has, please notifythe National Office of its location so interested personsseeking material may be directed to the nearest Journalcollection. The NATA would find a donation of thecomplete library to the National Office an invaluablecontribution. Please consider this appeal with theknowledge that your action will benefit the entireAssociation.Address Change Reminder....The Journal staff endeavors in every possible way tomake sure that every issue of ATHLETIC TRAINING isreceived by Association members and subscribers;however, this goal is quite difficult, in some cases impossible,when the National Office is not apprised of addresschanges before publication dates.When a Journal is mailed to an incorrect address, thatparticular issue is thrown away by the addressee's localpost office unless prior arrangement has been made withthe post office for forwarding second class mail. Inasmuchas only a specific number of each issue is printed, backissues are frequently unavailable. So even at the $5.00cost per back issue, sometimes the National Office can notfurnish a missing issue because the supply is exhausted.There is a very simple way to avoid this problem andkeep your volumes of ATHLETIC TRAINING intactwhile paying no additional charges: When you changeyour address sign a second class mail forwardingagreement with your local post office. You must requestthis form. If you agree in advance to pay forwarding costs,the post office will forward your second class mail (usuallymagazines) and not throw it away.Do it and keep it safe ... ,(KW) +Electrostim 180Dramatically increasesmuscle strength andendurance, without pain.Now, you can administer the samepain-free, muscle-strengthening electrostimulationtherapy once enjoyedexclusively by elite soviet athletes.The newly-introduced Electrostim 180delivers a unique combination of currentand frequency, producing more intensemuscle contractions and an afferentnerve block that checks pain.THE SOVIET RREaKTHROUGH1IN ELECTRO- STIRIUUTIOnTHER3PY IS FinaiLY HERE!ClinicalmodelThe results areequally stimulating.Builds muscle strength and size.Increases muscular endurance. Preventionand loosening of adhesions. Improvesvenous and lymphatic drainage. Increasesvelocity of muscular contraction.Decreases subcutaneous fat. Relievespain. Re-educates muscle action.Facilitates muscle contraction. Trainsnew muscle action. No burning orirritation.Learnmore about thisphenomenal breakthrough.Get the facts on the amazing benefits ofElectrostim 180 ... You'll understandwhy this giant leap forward in electrostimulationtherapy has the westernsports medicine community so excited.Write today for complete details:NU-MED; 333 North Hammes Avenue,Joliet, IL 60435. Or call (815) 744-7060.NATA ConventionJune 13-16 Booth 607NU-MEDExclusive U.S.Sales & Distribution of Electrostim 180.4 Athletic Training • Spring 1982

THERAPYThe originator is still the innovator.Since its introduction over thirty yearsago, Chattanooga Corporation'sHydrocollator® moist heat steampack has been the leader in moist heattherapy. Its convenience, effectivenessand durability have made it astandard in physical medicine aroundthe world.Today, Hydrocollator moist heattherapy products are still the worldstandard. A complete line of stainlesssteel master heating units and steampacks are available for any treatmentapplication and location, including homeuse. Hydrocollator's new Cervi/Backpacks are ideal for treating neck andback areas. And the convenient browntab system lets you know at a glancewhich packs are heated and ready foruse. Chattanooga Corporation alsomakes a full line of terry covers,massage lotions, lotion warmers,Nylatex wraps and other accessoriesto complement your Hydrocollatormoist heat therapy program.Look to Hydrocollator for all yourmoist heat therapy needs. Look toChattanooga Corporation for:LEADERSHIP IN PHYSICAL MEDICINED I would like an officedemonstration.D Please send literature.NAME:__ADDRESS:CITY:___PHONE:_. STATE: .ZIP:- CHATTANOOGA CORPORATIONJ 101 Memorial Dr./P.O. Box 4287/Chattanooga,TN 37405Phone [61 5] 870-2281

AnnouncementsSPECIAL PURCHASE OFFER!ATHLETIC TRAINERS/STUDENTSPROCEEDINGS OF THENATA PROFESSIONAL PREPARATIONCONFERENCENashville, TennesseeJanuary 6-8,1978Take advantage of this opportunity to add an excellentreference to your library at special group rates (originalcost $10.00 each)! Offer good while supply lasts. The 142-page bound Proceedings contains reprints of elevenpresentations by nationally known athletic trainers,physicians, and others including:The Role of the Athletic Trainer in Sports MedicineMarcus Stewart, MDResearch in Athletic Training: The NAIRS Model -John Powell, ATCGyneocology for the Athletic Trainer Karl Giulian,MDSports Medicine: Keeping it Legit (Playing Doctor CanBe Dangerous) Laurence Graham, Attorney-at-LawEndurance and Strength Training: An UpdateDavid Costill, PhDNeurological Evaluation for the Athletic TrainerJoseph Maroon, MDNew Careers for Athletic Trainers Al Proctor, ATC;Phil Callicut, ATC; Richard Hoover, ATCOrthopaedic Evaluation for the Athletic Trainer ArthurEllison, MDProtective Equipment Fit Richard Malacrea, ATCNew Methods for Pain Management Larry Gardner,ATCSoft Tissue Healing and Repair: Update on Basic InformationConcerning Soft Tissue Healing AlexanderKalanek, MD(Orders must be accompanied by payment. MakeCHECKS PAYABLE TO: National Athletic TrainersAssociation)MAIL ORDERS TO: Gary Delforge, NATA ProfessionalEducation Committee, Department of PhysicalEducation, University of Arizona, Tucson, Arizona 85721.A Timely Reminder ....Your contributions and continuing support to theNATA Scholarship Fund are always welcome and arenecessary so that the endowment goal of $500,000 canbecome a reality. Please remember that our program offinancial assistance is a four-fold one that offers scholarships,loans, grants and part-time employment. Organizationalsupport from the NATA to the Fund continues,but your individual contributions are vital to the ScholarshipFund's ultimate success. All contributions are taxdeductible. Won't you consider now the importance ofyour participation in the NATA Scholarship Fund? Makeyour checks payable to Scholarship Program, and mailthem to this address: William E. Newell, Purdue UniversityStudent Hospital, West Lafayette, Indiana 47907.Brochure RequestsAll requests for the brochure entitled "Careers inAthletic Training" should go to the National Office. Singlebrochures are supplied upon request at no charge. NATAofficers and committees, schools havingan approved athletic training curriculum, and thosehaving an apprenticeship program are furnished multiplecopies of the brochure upon request at no charge.Change of Address and District TransfersPlease be advised that many of our members are listedincorrectly by District. This is partially due to the manyaddress changes we receive that are unaccompanied byrequests for District Transfers.In order to facilitate the District Transfer process andto aid in updating our records, could you please do thefollowing: 1) Check billing statement or membership cardas to the correct District listing, 2) When requesting addresschanges, if they are changing Districts, request aDistrict Transfer application.Many members are unaware as to the process involvedin transferring their records from one District to anotherand should be reminded of the correct procedures.Students must be members of the District in which theuniversity they attend is located. +Schedule of Future Sites and Dates for NATACertification Examinations may be found on page 55.ORDER FORM: Proceedings of the NATA ProfessionalPreparation Conference, Nashville, Tennessee, January6-8, 1978RATES: 15 or more ($3.50 ea.), 10-14 copies ($4.50 ea.), 9copies or less ($6.00 ea.)Please send. copies of the Proceedings to:Name __Address(Department) (University)City/State/ZipTotal Enclosed6 Athletic Training • Spring 1982TELL A FRIEND ABOUTBTHIETIC TRmnUIG

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Current Literature"Iliotibial Tract Friction Syndrome in Athletes," McNicol,K. et al. Canadian Journal of Applied Sport Sciences, 1867Alta Vista Dr., Box 8650, Ottawa, K1G068, Canada. 6(2):76-80, June, 1981."Indirect Assessment of Cardiovascular 'Demands' usingTelemetry on Professional Football Players," Gleim, G. etal. American Journal of Sports Medicine. 9(3): 178-83,May-June, 1981."Medical Aspects of Competitive Distance Running,"Williams, R. et al. Postgraduate Medicine, 4530 W. 77thSt., Minneapolis, MN 55435. 70(1): 41-4, July, 1981.Ed Christman, ATC, MEdKnoxville, Tennessee"A Factor Analytic Study of Effectiveness Criteria in IntercollegiateAthletics," Chelladurai, P. et al. CanadianJournal of Applied Sport and Sciences. 6(2): 81-6, June,1981."A Guide to the Prevention of Running Injuries,"Clement, D.B. Australian Family Physician, 70 JolimontSt., Jolimont 3002, Victoria, Australia. 10(3): 156-61,March, 1981."Anabolic Steroids and Athletics," Wright, J.E. Exerciseand Sport Sciences Review. 1(8): 149-202, 1980."Anterior Subluxation of the Cervical Spine: HyperflexionSprain," Green, J.D. et al. American Journal ofNeuroradiology. 2(3): 243-50, May-June, 1981."Athletic Records and Human Endurance," Riegel, P.American Scientist, 345 Whitney Avenue, New Haven,CT 06511. 69(3): 285-90, May-June, 1981."Baseball Injuries to the Hand," Dawson, W.J. et al. Annalsof Emergency Medicine, Box 61911, Dallas, TX 75261.10(6): 302-6, June, 1981."Blunt Chest Trauma Causing Myocardial Infarction AnUnusual Football Injury," O'Neill, S. et al. Irish MedicalJournal, 10 Fitzwilliam Place, Dublin, Ireland. 74(5): 138,May, 1981."Chronic Sprains of the Carpometacarpal Joints," Joseph,R.B. Journal of Hand Surgery, 11830 Westline IndustrialDr., St. Louis, MO 63141. 6(2): 172-80, March, 1981."Contempo '81. Sports Medicine," Haycock, C.E. Journalof the American Medical Association, 535 N. DearbornSt., Chicago, IL 60610. 245(21): 2223-5, June 5,1981."Continuous vs. Interval Training: A Review for theAthlete and Coach," MacDougall, D. et al. Canadian Journalof Applied Sport and Sciences. 6(2): 93-7, June, 1981."Guidelines for Pre-Event Eating," Laywell, P. TexasCoach. 25(2): 40, September, 1981."Heart Rate and Rope Skipping Intensity," Myles W. etal. Research Quarterly of Exercise and Sport, 1900Association Dr., Reston, VA 22091. 52(1): 76-9, March,1981."Hypnotic Projection in Sport," Saxon, L. AustralianFamily Physician. 10(3): 185-7, March, 1981.8 Athletic Training • Spring 1982"No Sweat," Schroer, D. Referee, P.O. Box 161,Franksville, WI 53126. 6(9): 26, September, 1981."Off-Season and In-Season Training to Diminish Injuries,"Rosser, L. Texas Coach. 25(3): 38, October, 1981."Physical Activity and Sport: Attitudes and Perceptionsof Young Canadian Athletes," Schutz, R. et al. CanadianJournal of Sport Sciences. 6(1): 32-9, March, 1981."Physiological Responses to Weight Lifting in Different, Planes," Kumar, S. Ergonomics, 4 John St., LondonWCIN, England. 23(10): 987-93, October, 1981."Preparation Health Screening of Young Athletes," Linder,C. et al. American Journal of Sports Medicine, 428 E.Preston SE., Baltimore, MD 21202. 9(3): 187-93, May-June, 1981."Rehabilitation of Non-Operative Ankle Injuries," Rosser,L. Texas Coach. 25(3): 55, October, 1981."Rehabilitation of Non-Operative Knee Injuries," Rosser,L. Texas Coach. 25(2): 26, September, 1981."Skier's Thumb. Surgical Treatment of Recent Injuries tothe Ulnar Collateral Ligament of the Thumb's MetacarpophalengealJoint," Gerber, C. et al. American Journalof Sports Medicine. 9(3): 171-7, May-June, 1981."Specificity in Strength Training," Sale D. et al. CanadianJournal of Sport Sciences. 6(2): 87-92, June, 1981."Sports Eye Injuries A Preventable Disease," Vinger, P.Opthalmology, 1833 Fillmore St., San Francisco, CA94115. 88(2): 108-13, February, 1981."The Challenge of Mass Medicine," Hanna, T. Journal ofthe Indiana State Medical Association, 3935 N. MeridianSt., Indianapolis, IN 46208. 74(5): 279-80, May, 1981."The Female Athlete," Hunter, L. Medical Times, 80Shore Rd., Port Washington, NY 11050. 109(G): 48-57,June, 1981."Whirlpool Therapy," Dowmer, Ann. Texas Coach. 25(3):24, October, 1981. +See YouinSeattle

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Calendar of EventsJeff Fair, ATC, MSOklahoma State UniversityMarch, 19823 University of Bridgeport's Third Annual SportsMedicine Symposium, Bridgeport, Connecticut. ContactContinuing Education Department, University ofBridgeport, Bridgeport, Connecticut 06601.8-12 Sports Medicine Physical Therapy—Basic Course,Atlanta, Georgia. Contact Ronald G. Peyton, The SportsMedicine Education Institute, Inc., 993 Johnson FerryRoad, Atlanta, Georgia 30342.8-12 Sports Medicine Postgraduate Course, Maui,Hawaii. Contact Bates Noble, MD, Course Director, NorthwesternUniversity Center for Sports Medicine, 303East Chicago Avenue, Chicago, Illinois 60611.11-13 Third Annual Sports Medicine Symposium. Runningfor Health, Tucson, Arizona. Contact Jack H.Wilmore, Professor, University of Arizona, Departmentof Physical Education, Tucson, Arizona 85721.13 Sportsmedicine Clinical Workshop, Youngstown,Ohio. Contact Dan Wathen, Youngstown State University,Sportsmedicine Center, Youngstown, Ohio 44555.18-20 District 4 NATA Winter Meeting, Sheraton West,Indianapolis, Indiana. Contact Pat Troesch, AssistantAthletic Trainer, Athletic Department, Miami University,Oxford, Ohio 45056.20-27 Sports and Ski Medicine Symposium, SteamboatSprings, Colorado. Contact Robert P. Nirschl, MD, 3801N. Fairfax Drive, Suite 60, Arlington, Virginia 22203.19-21 15th Annual Sports Medicine and ConditioningSeminar, Seattle, Washington. Contact Ken Foreman,PhD, Director of Education and Research, NorthwestSports Medicine Foundation, 1551 Northwest 54th, Suite200, Seattle, Washington 98107.26 Sports Medicine Symposium, Pittsburg, Pennsylvania.Contact Laurie Scherer, Continuing EducationServices, Allegheny General Hospital, 320 East NorthAvenue, Pittsburg, Pennsylvania 15212.27-28 Cybex/Isokinetic Clinical Workshop: "Hands-On-Experience", LaCrosse, Wisconsin. Contact George J.Davies, Orthopaedic and Sports Physical Therapy, c/oBethany St. Joseph Health Care Center, 2501 ShelbyRoad, LaCrosse, Wisconsin 54601-8099.29-30 Fourth Annual Dance Medicine Symposium, Cincinnati,Ohio. Contact Kathy Hoh, 2651 Highland Avenue,Cincinnati, Ohio 45219.10 Athletic Training • Spring 1982April, 19822-4 7th Annual Dogwood Conference, Atlanta, Georgia.Contact Registration Secretary, The Sports MedicineEducation Institute, Inc., 993 Johnson Ferry Road, Atlanta,Georgia 30342.14 "Prevention and Recognition of Athletic Injuries: AContinuing Education Approach," Dayton, Ohio. ContactDavid H. Shon, Program Chairman, Division of PhysicalEducation, Wright State University, Dayton, Ohio 45435.15-16 Cleveland Clinic Foundation Eighth AnnualSports Medicine Symposium, Cleveland, Ohio. ContactCleveland Clinic Foundation, Section of Sports Medicine,Department of Orthopaedic Surgery, 9500 Euclid Avenue,Cleveland, Ohio 44106.17 Uplifting Lifting: The Sport of Adolescent WeightLifting, Aurora, Illinois. Contact Jeri Steinmetz, DreyerMedical Clinic, 1870 West Jalena Blvd., Aurora,Illinois 60506.18 6th Annual Boston Marathon Sports Medicine RunningSeminar, Boston, Massachusetts. Contact Lyle J.Micheli, MD, 319 Longwood Avenue, Boston,Massachusetts 02115.19-23 Sports Medicine Physical Therapy—Basic Course,Dallas, Texas. Contact Ronald Peyton, The SportsMedicine Education Institute, Inc., 993 Johnson FerryRoad, Atlanta, Georgia 30342.21-24 Physical Therapy Forum '82, Columbus, Ohio.Contact Norma Jean Finissi, Ohio Chapter, APTA, 4355North High Street, Columbus, Ohio 43214.22-27 97th Annual Convention of the American Alliancefor Health, Physical Education, Recreation and Dance(AAHPERD), Houston, Texas. Contact AAHPERD, 1900Association Drive, Reston, Virginia 22091.23-25 Cybex Orthopaedic and Sports Medicine Seminar,Las Vegas, Nevada. Contact Vi Nicoll, Cybex, Division ofLumex, Inc., 2100 Smithtown Avenue, Ronkonkoma, NewYork 11779.28-30 7th Annual Meeting and Trade Show of theAssociation of Physical Fitness Centers, Houston, Texas.Contact Association of Physical Fitness Centers, 5272River Road, Suite 500, Washington, DC 20016.May, 19823-7 Sports Medicine Physical Therapy—Basic Course,New York, New York. Contact Ronald Peyton, The SportsMedicine Education Institute, Inc., 993 Johnson FerryRoad, Atlanta, Georgia 30342.7-9 The National Strength and ConditioningAssociation, Atlanta, Georgia. Contact Bob Knuth, ConventionCoordinator, NSCA National Office, P.O. Box81410, Lincoln, Nebraska 68502.14-16 American Scenic Challenge, Recreational andCultural Festival, Linville, North Carolina. Contact"Secretary", Century Festival, P.O. Box 816, Winston-Salem, North Carolina 27102.15-16 2nd Annual Clinical and Business Meeting of theColorado Athletic Trainers Association, ColoradoSprings, Colorado. Contact Andy Pruitt, University ofColorado, Boulder, Colorado 80309.

17-24 Sports and Tennis Medicine Symposium, HiltonHead, South Carolina. Contact Robert P. Nirschl, MD,3801 N. Fairfax Drive, Suite 60, Arlington,Virginia 22203.24-28 Sports Medicine Physical Therapy—Basic Course,West Chester, Pennsylvania. Contact Ronald Peyton, 993Johnson Ferry Road, Atlanta, Georgia 30342.26-29 American College of Sports Medicine AnnualMeeting, Minneapolis, Minnesota. Contact ACSM, 1440Monroe Street, Madison, Wisconsin 53706.June,19824-5 How to Set-Up and Manage a Sports MedicineProgram, Callaway Gardens, Georgia. Contact RonaldPeyton, The Sports Medicine Education Institute, Inc.,993 Johnson Ferry Road, Atlanta, Georgia 30342.4-6 Advanced Cybex-Isokinetic "Hands-On Experience"Clinical Workshop, LaCrosse, Wisconsin. Contact GeorgeJ. Davies, Orthopaedic and Sports Physical Therapy, c/oBethany St. Joseph Health Care Center, 2501 ShelbyRoad, LaCrosse, Wisconsin 54601-8099.7-10 Aerobics Workshop, Dallas, Texas. Contact TheAerobics Conference Center, 12200 Preston Road, Dallas,Texas 75230.13-16 NATA National Convention, Seattle, Washington.Contact NATA, P.O. Box 1865, Greenville, NorthCarolina 27834.21-24 Sports Medicine-Advanced (Football), AtlantaFalcon Training Camp, Suwanee, Georgia. Contact RonaldPeyton, The Sports Medicine Education Institute, Inc.,993 Johnson Ferry Road, Atlanta, Georgia 30342.28-July 2 Sports Medicine Workshop, Orlando, Florida.Contact Ronald F. Ribaric, Head Trainer, University ofCentral Florida, Orlando, Florida 32816.Athletic Training will be happy to list events of interestto persons involved in sports medicine,providing we receive the information at least two monthsin advance of publication. Please include all pertinentinformation and the name and address of theperson to contact for further information. This informationshould be sent to: Jeff Fair, Head AthleticTrainer, Athletic Department, Oklahoma State University,Stillwater, OK 74078. +1982 Cramer Workshops. Contact Cramer Products, Inc.P.O. Box 1001, Gardner, Kansas 66030.CRAMER STUDENT ATHLETICTRAINER WORKSHOPSDates SitesJune 6-9 Oklahoma State UniversityStillwater, OklahomaJune 6-9 Arizona State UniversityTempe, ArizonaJune 13-16 Louisiana State UniversityBaton Rouge, LouisianaJune 20-23 Cal Poly-PomonaPomona, CaliforniaJune 27-30 Kent State UniversityKent, OhioJune 27-30 Southern Colorado UniversityPueblo, ColoradoJune 27-30 Southern Methodist UniversityDallas, TexasJune 27-30 Texas LutheranSeguin, TexasJune 27-30 University of Tennessee-MartinMartin, TennesseeCRAMER COACHES ATHLETICTRAINING WORKSHOPSDates SitesMay 31- June 4 University of New MexicoAlbuquerque, New MexicoJune 16-20 University of OregonEugene, OregonJune 21-25 University of FloridaGainesville, FloridaJune 21-25 Montclair StateUpper Montclair, New JerseyJune 21-25 Texas TechLubbock, TexasJune 28 - July 2 Syracuse UniversitySyracuse, New YorkJune 28 - University of Tennessee - ChattanoogaChattanooga, TennesseeSLO-SALT-K® has 3 major advantages over conventionalsalt tablets.SALT-Slow release means no salt sickness or upset for the athlete.Slow release SLO-SALT-K® means continuous replacementof salt during competition.With SLO-SALT-K® a supplemental dosage of sodium and chloride, plus amaintenance dosage of potassium is automatic using a convenient andinexpensive 3 to 5 tablet dose one hour prior to competition.SLO-SALT-K MissionPHARMACAL COMPANYATHLETICAthletic Training • Spring 1982 11

UNIQUETHE RICH-MAR VI H.V.AS A PORTABLE AS A CONSOLEiTHE FIRST FCC APPROVED combination of ultrasoundand high voltage galvanic stimulation. Featuringa super smooth galvanic wave, used singly or incombination with ultrasound, thereby offering threemodalities —ultrasound —H.V. galvanic and the combinationof both.RM VI-H-V. Specifications:• Output Pulse Characteristics: High frequency pulsepairs. Single pulse width 45 micro seconds, pulsespacing 10 micro seconds.• Pulse repetition rate selectable from 5 to 80 pairsper second.• Pad Alternation rate selectable at 2.5-5 and 10seconds.• Output voltage continuously adjustable from 0 to500 volts peak.• Circuitry: Monolithic integrated linear circuits anddiscrete solid state devices.• Safety Circuits with reset switch.Accessories:• 1 - Hand held applicator with fingertip intensitycontrol and circuit opening switch.• 2-4" x 4" pads.• 1 —8" x 10" dispersive pad.• 1 - Spot electrode for localized areas.Ultrasound Specifications:• Ultrasound frequency 1 mHz. • Crystal area: 10 sq. cm.• Power output 20 watts, continuous or pulsed. • Pulseduty cycle: Selective from 5% to 25%. • Line voltage: 11 5-125V/50-60 Hz/1.6A. • Case Size: 16 3/"x 13%" x 7%". •Weight: 22 Ibs. • FCC U-378.All RICH-MAR ultrasound and stimulation models are safety engineered to surpass presentand proposed hospital electrical safety standards of 50 micro amperes line leakage.RICH-MAR products are available upon request with appropriate modifications for foreign use.RICH-MAR CORPORATIONMEDICAL ELECTRONICS DIVISIONP.O. BOX 49INOLA, OKLAHOMA 74036 U.S.A.918-543-2222

Head Trainer, Ralph Berlin, proved to the Pittsburgh Steelersthat the best defense against pain is a good of fense...• with the Nemectrodyn. 8"I've been successfully using theNemectrodyn 8 to treat everythingfrom knees, backs, and necks toshoulders and ankles—with the resultsfar exceeding my expectations.The players love it because it works(increased flexibility and acceleratedhealing time) and it's painless.I love it because it helps me to get injured players backinto action faster and it's easy to use.If you are presently using conventional modalities (TENS,Ultra-sound, High-volt, etc.) for pain management andmuscle stimulation, you owe it to yourself to try theNemectrodyn 8."Ralph Berlin, Head TrainerPittsburgh SteelersNemectrodyn 8, with its dynamic interferential current,modifies the information processing of pain in thenervous system and represents symptomatic relief for avariety of pain conditions:• Acute pain as a result of soft tissue injuries(sprains, strains, contusions)• Pain associated with arthritis• Radicular syndrome (low back pain, sciatica)Additionally, the Nemectrodyn 8 delivers excellent resultsfor muscle re-education, increased local blood flow,reduction of edema, relaxation of muscle spasm, preventionof disuse atrophy, and increased joint flexibility.Nemectrodyn 8 features: suction for quick electrodeapplication, oscilloscope, will not burn skin, maximumpatient comfort and acceptance.For complete details and free copies of our literature,send the request for information to:Memectjipn//; Canada:Mid-Canada Medical17 W. 56th St., NY, NY 10019or call toll-free: 800-223-0616 Canadain New York 212-541-8475 416-625-9936! — •••• REQUEST FOR INFORMATION •• "•Please send:D NEMECTRODYN 8 BrochureD Reprint — Marquette U. lecture on "Dynamic INTERFER­ENTIAL TENS Therapy"D Other reprints on INTERFERENTIAL Therapy • Successachieved with INTERFERENTIAL TENS • Comparativestudies on physiotherapy • Clinical effects and uses • Comparativestudies on therapeutic resultsName _____________________________OrganizationAddress __City____Zip —————.Phone._ State.

The Use of Electroacutherapyin the Treatment ofInversion Ankle Sprains4The term electroacutherapy (EA) is used in theliterature to refer to two different thoughrelated techniques for the relief of pain. One is theclassical needling or insertion of needles at specific pointswhere insertion of the needle is accompanied by an electricalcurrent rather than the more tedious twirlingand/or rocking of the needle by hand. The other refers toa needleless transcutaneous stimulation of specific pointsby using electrode plates placed on the skin. Anydiscussion of electroacutherapy necessitates a considerationof the principles of acupuncture upon which itis based.Acupuncture TheoryAcupuncture along with herbal medicine comprisestraditional Chinese medicine. It was well developed evenin ancient times as evidenced by the Hwang Ti Nei Ching, 9or the Yellow Emperor's Classic of Internal Medicine,which dates back to before 2000 B.C. and contains fairlyadvanced techniques and descriptions. It has beensuggested that rudimentary acupuncture may be as old as7000 years. 2 The first documented reference to acupuncturein Western culture was in the 16th century, but itwas not until the 19th century that much interest was apparent,as was evidenced by the number of workspublished on the subject. Most of this interest was inFrance and Italy. In the early 20th century acupuncturewas taught, studied and used extensively in France,mostly due to the efforts of Soulie de Morant, a diplomat,who researched and published a very influencial book onacupuncture in 1939. 24 However, it was not until the early1970's, with the visit of the American table tennis team in1971 and President Nixon's visit in 1972, that acupuncturein China entered the consciousness of the Americanpublic. Since that time, the amount of research,publications and interest in the theory and technique ofacupuncture in Western medical literature has increaseddramatically.The Chinese make no distinction between arteries,veins, or nerves when explaining the functions of thebody. 11 They concentrated instead on an elaborate systemof forces whose interplay was thought to regulate allbodily functions. This traditional philosophical ChineseDr. Prentice is an Assistant Professor in the Department ofPhysical Education, and Coordinator of the GraduateSpecialization in Sports Medicine at The University of NorthCarolina at Chapel Hill 27514-William E. Prentice, PhD, ATCGATE CONTROL INHIBITIONInformation ProcessingAreas of the BraintAscendingSpinal Tractsj Substantia j! Gelatinosa iLarge SmallDiameter DiameterFibers FibersFigure 1Athletic Training • Spring 1982 15

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explanation has little correlation with the more scientificallyoriented Western Concepts of Medicine whichrely heavily on anatomic and physiologic principles. Consequently,utilization of acupuncture as a therapeutictechnique in Western medicine has encountered considerableskepticism.The Chinese believe that an essential life force knownas Chi exists in everyone which controls all aspects of life.Chi is governed by the interplay of two opposing forces,the Yang (positive) force and the Yin (negative) force.Disease and pain result from an imbalance between thesepositive and negative forces. 10 The Yin and Yang flowthrough passageways or lines within the body called Jingby the Chinese and known as meridians in the West.There are twelve of these meridians within the bodynamed according to the organs with which they areassociated. The meridians on one side of the body areduplicated by those on the other. However, two additionalmeridians exist which cannot be paired. 11Along these meridians lie the acupuncture points whichare associated with that particular meridian. Wheneverthere is pain or illness, certain points on the surface of thebody become tender. 11 When pain is alleviated or thedisease is cured these tender points seem to disappear. 11According to acupuncture theory, stimulation of specificpoints through needling can dramatically reduce pain inareas of the body known to be associated with a particularpoint. Thousands of acupuncture points have beendescribed by the Chinese. In the Nei Ching7 365 points areenumerated which lie on the meridians. Additionalacupuncture points have also been described located onthe auricle as well as on the hand.In Western medicine, the counterpart of the acupuncturepoint is the trigger point. Trigger points like acupuncturepoints are associated with visceral structuresand stimulation of these points have also been demonstratedto result in relief of pain. 6Acupuncture and trigger points are not necessarily onein the same. However, a study by Melzack, Fox, andStillwell 15 attempted to develop a correlation coefficientbetween trigger points and acupuncture points for painrelief on the basis of two criteria: spatial distribution andassociated pain patterns. They found a remarkably highcorrelation coefficient of .84, which suggested thatacupuncture and trigger points used for pain relief thoughdiscovered independently, labeled by totally differentmethods, and derived from such historically different conceptsof medicine represent a similar phenomenon andmay perhaps be explained by the same underlying neuralmechanisms. 15Neurophysiologic ExplanationsIn Western medicine, there are currently threeneurophysiologic explanations of this pain control throughstimulation of specific points: 1) the Gate Control Theoryof Melzack and Wall 16 (Figure 1) 2) Control through sometype of central biasing mechanism in the brain 15 and 3)pain modulation resulting from the effects of endogenousopiate-like substances known as endorphins which areproduced in the brain. 19 20 22 These three theories are notnecessarily mutually exclusive. Recent evidence from anumber of investigators suggests that pain relief effectsmay be due to combinations of central nervous system aswell as endorphinergic mechanisms. 3 5The Gate Control Theory as first proposed by Melzackand Wall states that there are small diameter fibers andlarge diameter fibers that conduct nerve impulses to thebrain. These fibers pass through the substantia geletinosain the dorsal horn in the spinal cord which can modifythese incoming impulses before they are relayed to theprocessing regions of the brain. This modification occursbecause both the impulses from the small diameter fibers,which transmit pain sensations and the impulses from thelarge diameter fibers, which are associated with othersensations, must pass through the substantia geletinosawhich can block the further afferent transmission of thepain sensations from the small diameter fibers, i.e. "closethe gate." Acupuncture and electroacutherapy arei>CENTRAL BIASING MECHANISMINHIBITIONRaphe Nucleus1—EndorphiniEnkephalin1k I k I kAscending 3Tracts+1 r ^ ' 1 r•MMDescentTractIntenseStimulationof PointsDorsalHornNeurons18 Athletic Training • Spring 1982Figure 2

4thought to cause this closing of the gate becausestimulation causes a disproportionate increase in the activityof the large fibers over that of the small fibers, andthe resulting system overload blocks the transmission ofthe small fibers which are the pain impulses. This gate canalso be controlled by efferent pathways from the CNS, asfor example in the cases of anxiety or excitement. Otherresearchers have proposed two-gated9 or even multi-gatedtheories of pain and acupuncture analgesia. 2A second theory of pain modulation futher helps to explainthe relief of pain by brief intense stimulation ofacupuncture or trigger points (Figure 2). An area locatedin the brain stem referred to as the Raphe Nucleus isknown to exert a powerful inhibitory influence on transmissionof painful impulses entering through the ascendingspinal tracts. This inhibitory area in the brain stemacts as a type of central biasing mechanism and again ineffect closes the gate to those painful impulses which areprojected to other areas on the brain and the spinal cord. 14Stimulation of specific points affects the large receptivefields of the Raphe Nucleus and thus may have analgesiceffects in specific areas of the body 13 , possibly through theeffects of an endogenous opiate known as enkephalin.There is some evidence for the actual physical existenceof these points. 24 The electrical resistance of the skin atcertain points corresponding to the acupuncture points islower than that of the surrounding skin, especially when adisease state is present. Examining acupuncture points bysectioning indicated increased nerve endings at thesepoints. Russian investigators have reportedly discovereddifferences in skin temperature at acupuncture points.Despite this evidence, there is no definite physical attributeof all acupuncture points, nor is there a thoroughlydemonstrated mode of action for the technique. Whateverthe explanation, it appears that the locations and effectsof stimulation of acupuncture points for the relief of painwere determined empirically. 15There is considerable evidence that stimulation ofacupuncture points triggers the release of endorphinsfrom the anterior pituitary 5 8 19 20 22 25 B-endorphin alongwith enkephalin and ACTH, is produced through a breakdownof a molecular complex known as ACTH/Blipotropin18 (Figure 3). B-endorphin is thought to beprimarily responsible for the strong analgesic effects.This mechanism is not well understood; however B-endorphin along with enkephalin is known to exert aninhibitory influence on the Raphe Nucleus and is thoughtto be responsible for inhibition of pain impulses in descendingspinal tracts.ACTH is an adrenal stimulator causing the release ofcorticosteroids. Thus, increased corticosteroid levelsprovide anti-inflammatory effects while increased endorphinsprovide strong analgesic effects. 5Low frequency (1-5 Hz) high intensity stimulation ofacupuncture points is known to stimulate production of B-endorphin while high frequency (80-200 Hz) stimulationdoes not produce B-endorphin. 5 In addition, PCPA(paracholorphenylalanine), which is a serotonin synthesisinhibitor, partially blocks the pain relief due to highfrequency electroacupuncture, but has no effect on lowfrequency electroacupuncture pain relief.This suggeststhat the mechanism of relief in low frequency stimulationis endorphinergic, while the relief due to high frequencystimulation is due to the interference in pain pathways inthe CNS. 3Most likely, reduction of pain resulting fromstimulation of acupuncture or trigger points can be bestexplained by some as yet unidentified interaction of thesethree separate processes.Electroacutherapy Treatment of Post-Acute InversionAnkle SprainsThe preceding discussion of acupuncture applies directlyto electroacutherapy. The major difference is in theuse of electrodes to conduct current at the acupuncturepoints instead of needles. 1 There are some distinct advantagesto the use of electroacuptherapy over theneedling of acupuncture. Since there is no breaking of theskin, there is no risk of hemorrhage, infection or hepatitis,nor is there any risk of the needle breaking during insertionand manipulation. Furthermore, this method canbe self applied, which enables out-patient treatment. 21Disadvantages include the problems of incomplete musclerelaxation and incomplete pain relief. 1In considering the use of EA, or any type of pain relieftherapy, it is important to realize the function of pain as asign of injury or damage and thus as a protectivemechanism. Usually pain is one way in which the bodyprevents further harm to an already stressed area. Con-ENDORPHINERGIC INHIBITIONIntense Low FrequencyStimulation of Specific PointsPituitary/3-lipotropin/ACTH\Endorphins Adrenal GlandInhibitoryEffects atDorsal Horn(analgesia)StimulationofRaphe NucleusFigure 3Corticosteroidanti-inflammatoryAthletic Training Spring 1982 19

ACUPUNCTURE POINTLOCATIONSB59B60B6I BG.2Figure 4Ant.TibialisExt.HallucisS4Isequently, blocking the pain may lead to a dangeroussituation in which the athlete may not recognize the signsof exacerbation of an injury and the result may be furtheror even permanent damage. The therapist must use somediscretion when applying electroacutherapy as a modalityfor injury rehabilitation. Thus, electroacutherapy as atherapeutic modality is best used in the treatment of postacuteand chronic injury. By using acupuncture charts,specific points are selected which are described as havingsome effect on the area of pain. In the case of an inversionsprain of the ankle, pain is usually located in the area ofthe lateral malleolus. The acupuncture points used torelieve pain in this area are identified in Table 1. Figure 4shows the relative locations of these points schematically.It was suggested that impedence at acupuncture pointstended to be lower than the surrounding skin. 24 Severalmodalities (Neuroprobe, Staodyn PLS/mini® ) areavailable commercially which are not only capable oflocating specific areas of lowered resistance but whichalso electrically stimulate these points. An ohm metermay also be used in place of these more expensive devicesto locate acupuncture points. Once located, points may bemarked with a felt tip pen to save time in subsequenttreatments.Selection of a specific type of current for stimulation ofacupuncture points is variable. Frequencies ranging from50 cycles/minute to 200 cycles/second have been reported.4 12 23 Most of the literature seems to indicate thatbest results in pain relief are obtained by using lowfrequency (1-5 Hz) current. 5 8 1T A longer treatment isrequired to produce any beneficial effects; however, theanalgesic effects seem to last longer than with highfrequency stimulation. Treatment time is reduced withhigh frequency stimulation. Treatment time is reducedwith high frequency current, but the effects do not last aslong. 18The current of choice seems to be pulsed galvanic. 12 23The Microdyne® , EGS® , Mettler® Electrical Stimulatorand the Staodyne Vara/pulse® are each galvanici>TABLE 1ACUPUNTURE POINTS USED FOR INVERSION ANKLE SPRAINMeridian andPoint Number Name Location* Stomach (5)41Gall Bladder (GB)34*Gall Bladder (GB)39*Gall Bladder (GB)40Bladder (B)59Bladder (B)60Bladder (B)61Bladder (B)62Bladder

stimulators capable of producing pulsed low frequency DCcurrent.In the electroacutherapy technique, the large dispersiveelectrode may be placed anywhere on the body surface.If a small diameter treatment probe is not available,the pad should be removed from the second electrode tofacilitate stimulation of a specific point using the electrodeplug (Figure 5).Stimulation of acupuncture points for 30-45 seconds appearsto sufficiently inhibit pain. The intensity of thecurrent should be adjusted so it may be tolerated by thepatient, however some slight discomfort should be expected.Some athletes report immediate reduction of painwhile others experience a delayed pain reduction.SummaryElectroacutherapy involves intense transcutaneouselectrical stimulation of acupuncture points using lowfrequency, pulsed, galvanic current for the purpose ofpain relief. Regardless of the underlying mechanisms,whether it be the flow of Yin and Yang through themeridians or some combination of spinal level, centralbiasing and/or endorphinergic modulation, stimulation ofacupuncture and trigger points appears to be an effectivetherapeutic technique for pain reduction. +ReferencesFigure 51. Acupuncture Anesthesia. U.S. Department of Health,Education and Welfare, DHEW Publication N. 75-584, 1975,pp. 1-25.2. Acupuncture Anesthesia. Monograph published by PfizerPharmaceuticals, 1974, pp. 1-10.3. Anderson S, Ericson T, Holmgren E, Lindquist G: Electroacupunctureeffects on pain threshold measured with electricalstimulation of teeth. Brain Research 63: 393-396,1973.4. Chapman R, Benedetti C: Analgesia following transcutaneouselectrical stimulation and its partial reversal by anarcotic antagonist. Life Science 21: 1645-1648,1977.14.15.16.17.Melzack R: Prolonged relief of pain by brief, intense transcutaneoussomatic stimulation. Pain 1: 357-373,1975.Melzack R, Stillwell D, Fox E: Trigger points and acupuncturepoints for pain: correlations and implications. Pain 3: 3-23,1977.Melzack R, Wall P: Pain mechanisms: A new theory. Science150: 971-979,1965.Omura Y: Pathophysiology of acupuncture treatment: effectsof acupuncture treatment on cardiovascular and nervoussystems. Acupuncture Electrical Therapeutics ResearchInternationalJournal 1: 51-142,1976.5. Cheng R, Pomeranz B: Electroacupuncture analgesia couldbe mediated by at least two pain relieving mechanisms: endorphinand non-endorphin systems. Life Science 25: 1957-1962,1979.6. Fox E, Melzack R: Transcutaneous Electrical stimulationand acupuncture: comparison of treatment for low back pain.Pain 2: 357-373,1976.7. Hwang Ti Nei Ching. (Translation) Berkley: University ofCalifornia Press, 1973.8. Kenyon J: Acupuncture in Pain Relief. Persistent Pain:Modern Methods of Treatment. Edited by Lipton S, London:Academic Press, 1980, p. 203-222.9. Man PL, Chen CH: Acupuncture anesthesia — a new theoryand clinical study. Current Therapeutic Research 14: 390-394,1972.10. Manaka Y: On certain electrical phenomena for the interpretationof Ch'i in Chinese acupuncture. American Journalof Chinese Medicine 3: 71-74,1975.11. Mann F: Acupuncture: The ancient Chinese art of healingand how it works scientifically. New York: Random House,1973, pp. 1-58.12. Matsumoto T: Acupuncture for Physicians. Springfield, 111:Charles C. Thomas, Publisher, 1974, pp. 9-11.13. Mayer D, Liebeskind J: Pain reduction by focal electricalstimulation of the brain: an anatomical and behavioralanalysis. Brain Research 68: 73-93,1974.18. Omura Y: Electroacupuncture: Its physiological basis andcriteria for effectiveness and safety. Acupuncture ElectricalTherapeutics Research International Journal 1: 157-181,1975.19. Pomeranz B: Brain's opiates at work in acupuncture. NewScientist 73: 12-13,1975.20. Pomeranz B, Paley D: Electroacupuncture hypoalgesia ismediated by afferent nerve impulses: An electrophysiologicalstudy in mice. Experimental Neurology 66:398-402,1979.21. Roeser W, Meeks L, Veins R, Strickland G: The use oftranscutaneous stimulation for pain control in athleticmedicine. A preliminary report. American Journal of SportsMedicine 4: 210-213, 1976.22. Sjolund B, Eriksson M: Electroacupuncture and endogenousmorphines. Lancet 2: 1085,1976.23. Ten LT, Ten MC, Veith I: Acupuncture Therapy.Philadelphia: Temple University Press, 1976, pp. 26-27.24. Wei LY: Scientific advances in acupuncture. American Journalof Chinese Medicine 7: 53-75,1979.25. Wen HL, Ho WK, Ling N, Ma L, Choa G: The influence ofelectroacupuncture on Naloxone — induces morphine withdrawal.Elevation of immunoassayable beta-endorphin activityin the brain but not in the blood. American Journal ofChinese Medicine 7: 237-240,1979.Athletic Training • Spring 1982 21

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Book ReviewsKathleen Fox, ATC, MEdUniversity of Central FloridaNumerous charts, graphs, and photographs supplementmany of the articles, and a wide variety of topics andsubjects are covered. Each article's condensation isfollowed by comments and pertinent information providedby one or more of the yearbook's editors. This oftenprovides the reader interesting insight into the book'scontent. The editorial comments are both valid andentertaining. By providing a collection of each year'smajor Sports Medicine articles, this volume provides theAthletic Trainer, Physical Therapist, Physician, etc., theopportunity to conveniently stay up to date with currentresearch and literature. A similar volume annuallyaddressing itself to athletic training articles andliterature would also be a valuable contribution to theprofession. If desiring a single book to keep up to datewith current research and literature, The 1980 Yearbookof Sports Medicine is a sound and wise investment.Kathleen HeckThe 1980 Yearbook of Sports MedicineThomas B. Quigley, MD; Editor in Emeritus$36.00369Yearbook Medical Publishers, Inc.Chicago, Illinois1980This book is a comprehensive collection of the year'smost important articles contained within 85 professionaljournals. It is edited by six leading sports medicalauthorities: Thomas B. Quigley, MD; Editor in Emeritus;Col. James L. Anderson, FED; Frank George, ATC, RPT;Lewis J. Krakauer, MD, FACP; Roy J. Shephard, MD,PHD; Joseph S. Torg, MD; and the late John L. Marshall,DVM, MD. This volume is dedicated to the late Dr.Marshall. Noted as a sports enthusiast and a champion ofmany modern concepts regarding the anterior cruciateligament, Dr. Marshall served as physician for numerousprofessional athletic teams and individual athletes.The Yearbook is divided into seven major sections:Exercise Physiology, Biomechanics, General Medicine,Sports Injury, Pediatrics Sports Medicine, Women inSports, and Athletic Training. By indexing articlesaccording to author and subject, the reader can locate anddwell upon areas and sports of specific interest.Children and Exercise IXKristina Berg, MD and Bengt 0. Eriksson, MD$39.50388University Park Press233 East Redwood StreetBaltimore, MD 212021980This text is the Ninth Book to be published from theresearch presented by the Pediatric Work PhysiologyCongress. The text presents the latest research done onchildren and youth. The research is presented in five (5)specific areas:1. Body Growth, Body Composition and MotorLearning2. Physical Work Capacity3. Habitual Physical Activity4. Muscle Development, Structure and Function5. Exercise Studies in Handicapped ChildrenThe text would be of interest to anyone responsible forthe physical development of children and youth. Eacharticle is written using Research terminology whichmakes for some difficult reading.Michael D. Aitken +METTLER physical therapy equipmenthelps keep athletes in ACTIONLeading professional and college teams use Mettler P.T. equipment. Competitive sportsoffers a tough proving ground for physical therapy. That is one reason why top physicaltherapists provide Mettler equipment for their patients.corp.1333 S. Claudina St., Anaheim, CA 92805(714) 533-2221D I'd like a demonstration.D Send me FREE charts:Ultrasonic Treatment Chart,Chart of Motor Points andTrigger Points/Pain Patterns.NameAddressState_ Zip-24 Athletic Training • Spring 1982

NATIONAL ATHLETICTRAINERS ASSN.GOOD NEWSHERTZ HASJUST LOWEREDYOUR RENTEffective immediately, you'll payless when you drive off in a Hertz car*Why are you so special? Becauseorganizations like yours are now partof Hertz's winning team.As part of this team, we've givenyou the group I.D. number printedbelow and/or on your membershipsticker. When you rent a Hertz car,present your associationmembership card to our servicerepresentative. Your discount will besubtracted from the rental charges.And more good news. Thisdiscount is good whetheryou choose to travel for business orpleasure. At participating Hertzrental locations worldwide, you cannow pick up a car for less.So next time you rent, call Hertztoll free (800) 654-3131 or your travelconsultant to reserve a car. And getthe winning treatment that membersof your organization deserve.NATIONAL ATHLETIC TRAINERS ASSOCIATIONCDP I.D. #91239UNITED STATES5"d discount on published daily, weekly and monthly"Standard Unlimited Mileage" Rates, or30".. discount on published daily, weekly and monthly"Basic" Rates in the event that "Standard UnlimitedMileage" Rates are not available at the rentinglocation.INTERNATIONAL20"

An Evaluation of thePresent Indications ofDimethyl Sulfoxide (DMSO)In Sports MedicineJohn Wells, ATC, PhD, PTIntroductiondriving desire of the medical profession is toA seek new and better methods of treatingpatients. New surgical procedures for transplants arebecoming an everyday occurrence. Lives that hadpreviously been thought lost are being saved by"miracles" in the operating room. Pharmaceutical companies,medical schools, and universities are constantlyseeking new drugs to relieve man's ailments, to prolonghis life, and to make that prolonged life more enjoyable forhimself and more beneficial to mankind in general.The members of the medical profession specializing inthe area of Sports Medicine sincerely subscribe to all ofthe above desires and goals. In addition, there are two additionalgoals to be met. First is the return of the participantto participation as soon as medically possible afteran injury. Secondly, the educational aspects of this entirelearning experience for the individual participating inathletics. He must realize the long range physiologicalconsequences of his injury and he must be given everymedical benefit to prevent any pathological complications,either at the time of injury or at any future time in his life.In order to realize these last two goals Sports Medicinepersonnel are actively interested in any new procedurewhich will speed recuperation of their patients. DimethylSulfoxide (DMSO) is one of these proposed new pharmaceuticals.Many claims have been made for the possiblebenefits of this medication. Possible side effects have alsobeen identified.Since the first publication in 1964 of an article dealingwith the possible medical uses of Dimethyl Sulfoxidethere have been over 600 articles written on the subject.Many of these articles mention uses for the types of injuriessustained by athletes. Therefore, the topic "DMSO,Fact and Fantasy" was placed on the agenda of the 1966convention of the NATA held in Kansas City, Missouri.The speaker told of the potential side effects and how theactual benefits were not really as dramatic as people hadbeen led to believe by the glowing articles in theliterature. At the 1980 NATA meeting held inPhiladelphia, Pennsylvania, Dr. Stanley Jacob presentedhis latest work with DMSO.Dr. Wells is Associate Professor of Physical Education andSupervisor of Sports Medicine at Mars Hill College in Mars Hill,North Carolina 28754. In addition to serving as Abstract Coordinator/orATHLETIC TRAINING, the author is also Chairpersonof the NATA Drug Education Committee. This article isthe third in a series to be presented by the Drug Education Committee.26 Athletic Training • Spring 1982Development of Dimethyl SulfoxideDimethyl Sulfoxide is an industrial solvent which hasbeen in use since 1875. It is obtained from lignin (anorganic substance that is combined with cellulose to formthe main portion of woody plants). In 1952 DimethylSulfoxide received United States Patent Number2,581,050. Dimethyl Sulfoxide is manufactured as a byproductof the wood pulp manufacture of paper and alliedindustries. It is prepared by oxidation of dimethyl sulfidein the presence of nitrogen oxide. The chemical compositionis C2HeOS and is combined. 11CHs (I CHs0The foregoing equation yields the following composition.Carbon 30.74 percentHydrogen 7.74 percentOxygen 20.48 percentSulphur _____41.03 percent99.99 percentOther physical characteristics of Dimethyl Sulfoxide are:1. Supercools easily—that is, the temperature may dropbelow the freezing point without the solution actuallyfreezing.2. Slightly bitter taste with a sweet after taste (somereports of garlic and oyster taste have been reported).3. Flashpoint is 95 degrees celcius. This is the pointwhen DMSO will actually ignite into flame.4. The viscosity at 27 degrees celcius is 1.1 cp.5. The specific heat is .07 calorie (liquid).6. Dielectric constant is 45.7. Molecular weight is 78.15.8. A very hygroscopic liquid, that is, one that will absorbmoisture from the air.9. Soluable in:A. WaterB. EthanolC. AcetoneD. EtherE. BenzeneF. Chlorophorm10. Forms stable coordinate complexes with metals. 30

Because of the penetrative properties of DimethylSulfoxide this substance has been used to protect variousanimal tissues and cells during cold storage.Industrial Uses of Dimethyl SulfoxideDimethyl Sulfoxide is a solvent in the manufacture ofsynthetic fibers such as rayon and orlon. Polyurethaneand acrylic fibers are soluble in Dimethyl Sulfoxide. It is asolvent for acetylene, sulphur dioxide and other gases.Dimethyl Sulfoxide is used as an antifreeze or hydraulicfluid when mixed with water. It can be used also as a paintand varnish remover. Dimethyl Sulfoxide dissolves somehydrocarbons more than others. It has been used as acarrier for insecticides. The DMSO aids in transportingthe insecticide to the internal structure of the insects.Sports Medicine Uses of Dimethyl Sulfoxide—MembranePenetrationDimethyl Sulfoxide readily crosses most membranes ofthe body of the patient without destroying the integrity ofthese membranes. In its passage, DMSO permits a numberof compounds to move along with it. The phenomenonis reversible. Dimethyl Sulfoxide will not rapidlypenetrate the nails or the enamel of the teeth.Kligman has shown that when various dyes, steroids,and antiperspirants are dissolved in solutions of DimethylSulfoxide at 70 percent or greater they exhibit enhancedpenetration through human skin. 15Mailbach and Feldman studied the percutaneouspenetration of hydrocortisone and testosterone inDimethyl Sulfoxide in man. Maximal excretion of bothsteroids occurred within 36 hours. The authors concludedthat there was a threefold increase in dermal penetrationby these steroids dissolved in DMSO. 20Sulzberger and his associates studied the penetration ofDimethyl Sulfoxide into human skin employing methyleneblue, iodine, and iron dyes as visual tracers. Biopsiesshowed that the stratum corneum (outer layer) was completelystained with each tracer applied to the skin surfacewith DMSO. There was little or no staining below thislayer. They concluded that Dimethyl Sulfoxide carriedsubstances rapidly and deeply into the horny layer. Theysuggested that the usefulness of DMSO as a vehicle fortherapeutic agents in inflammatory dermatitis and superficialskin infections such as pyodermas. 31Perlman and Wolf demonstrated that allergens of smallmolecular weight such as penicillin G potassium mixed in90 percent DMSO were readily carried through the intacthuman skin. Allergens having molecular weights of 3000or greater dissolved in Dimethyl Sulfoxide did notpenetrate the human skin. 23 Smith and Herge hadpreviously recorded that antibodies to bovine albumindeveloped when a mixture of Dimethyl Sulfoxide andbovine serum albumin was applied to the skin of rabbits. 23In addition to permitting the passage through the skin,Dimethyl Sulfoxide will carry substances such ashydrocortisone or hexachlorophene into the deeper layersof the stratum corneum producing a reservoir whichremains for at least 16 days and resists depletion bywashing of the skin with soap and water or alcohol. 20Anti-InflammationGorog and Kovaks studied the anti-inflammatoryproperties of Dimethyl Sulfoxide in rats. They recordedthat carrageenin induced rat paw edema was improved byoral and topical application of DMSO. In the granulomapouch method of producing inflammation in rats, in whichmyobacterium butyricum is used as the irritant, DimethylSulfoxide was found to reduce the inflammatory exudateand the development of granulation tissue. Arthritis inducedby Myobacterium adjuvant was inhibited by oraland more strongly by topical application of DMSO.Similarly, powerful inhibition with topical DimethylSulfoxide was observed in experimental arthritisproduced in rats by feeding with 6 sulfanilamidoindazole. 7In understanding the mechanism of action of DimethylSulfoxide, particularly its anti-inflammatory effects, thework of Weismann, Sessa, and Bevans deserves special attention.These authors document that lysosomes can bestabilized against a variety of injurious agents by cortisone.When dissolved in Dimethyl Sulfoxide, the concentrationsof these agents necessary to stabilize thelysosomes is reduced from tenfold to one thousand fold.The possibility was suggested that DMSO might rendersteroids more available to their targets within tissues (themembranes of cells or their organeles). 32Analgesia (Nerve Blockage)Immersion of the sciatic nerve in 6 percent DimethylSulfoxide decreases the conduction velocity by 40 percent.This effect is reversible by washing the nerve in a bufferfor one hour. Shealy studied feline peripheral small fibersafter discharge. Concentrations of 5 percent to 10 percentDMSO eliminated the activity of C fibers within oneminute. After washing away the Dimethyl Sulfoxide theactivity of the C fibers returned. Shealy believed thatmeasuring the activity in the peripheral small fibers afterdischarge in cats is a good model for determining the efficiencyof analgesics. 28Cholinesterase InhibitionSams, Carrol, and Crantz studied the effects of concentrationsof .6 percent to 6 percent Dimethyl Sulfoxideon skeletal, smooth, and cardiac muscle. DMSO strikinglydepressed the response of the diaphragm to both direct(muscle) and indirect (nerve) electrical stimulation andcaused spontaneous skeletal muscle fasiculations. DMSOincreased the response of smooth muscle of the stomach toboth muscle and nerve stimulation. The vagal thresholdwas lowered 50 percent by the use of a 6 percent solutionof Dimethyl Sulfoxide. Cholinesterase inhibition couldreasonably explain fasiculation of skeletal muscle, increasedtonus of smooth muscle, and the lowered vagalthreshold observed in these experiments. In vitro essaysshowed that .8 to 8 percent DMSO inhibits bovineerythrocyte Cholinesterase 16 percent to 18 percentrespectively. 26Effect on CollagenIn biopsy specimens taken from the skin before treatmentand at three weekly intervals in patients withscleroderma it has been found that there is a dissolution ofcollagen with the elastic fibers remaining intact. Gries,Bublitz, and Linder studied rabbit skin before and after 24hours in vitro with 100 percent Dimethyl Sulfoxide. Afterimmersion with DMSO the collagen fraction extractablewith neutral salt solution decreased significantly. Theauthors recorded that topical DMSO in man exerted asignificant effect on the pathological deposition of collagein human postirradiation subcutaneous fibrosis, but didnot appear to change the equilibrium of metabolism ofcollagen in normal tissue. In patients with scleroderma increasedhydroxyproline content of the urine has beendemonstrated after topical treatment with DMSO.Keloids biopsied in man before and after DMSO therapyshowed histological improvement toward normal. 8 The1980 NIAMDD study was not available until late 1981. 33VasodilationAdamson applied Dimethyl Sulfoxide to a three to onepedicle flap raised on the back of rats. The anticipatedslough was decreased by 60 percent to 70 percent. It wassuggested that the primary action of DMSO on pedicleflap circulation was to provoke a histimine like response. 1Kligman had previously demonstrated that DMSOpossessed potent histimine liberating properties. 15Athletic Training • Spring 1982 27

Potentials for Dimethyl Sulfoxide in Sports MedicineDimethyl Sulfoxide has demonstrated its most studiedtherapeutic potential in the treatment of acutemusculoskeletal injuries and inflammations. It is also effectivein chronic musculoskeletal disorders where theresults are not so dramatic as those seen in the acutecases.Topical cutaneous administration of DMSO is associatedwith a rapid dimunition of pain and inflammation in softtissue injuries. Ecchymoses and hematomas fade rapidlyand reabsorb in response to topically applied DMSO.These observations have been confirmed in double blindstudies in man.Brown evaluated acute post traumatic soft tissue injuriesto the cervical, dorsal, and lumbar areas, sprainsand strains of larger joints of the extremities, and acutepost-traumatic soft tissue injuries associated with subcutaneousand intramuscular bleeding. Initially, it wasdetermined that a 70 percent azueous solution of DMSO inamounts ranging from 8 to 12 milliliters topically appliedat least three times per day to a wide area covering thesite of the pathology would provide an effectivetherapeutic response in 80 percent or more of the noncontrolledcases with substantial therapeutic benefitwithin 24 hours. Preliminary and prior testing of the samepatients with a 10 percent solution provided no clinicalbenefit during the 24-hour period. Thus, the effectivesolution dose for the condition treated was establishedand non-efficiency of the 10 percent solution wasestablished.Prior to double blind patient testing 187 patients withacute musculoskeletal disorders were treated with 90 percentto 70 percent DMSO in carbopol gel and 70 percentDMSO in aqueous solution. Physical measurements wererecorded to the severity in each case including pain,edema, ecchymosis, local tenderness, and limitation ofrange of motion. In the double blind study controlledseries with 92 patients, 8 to 12 ml of DMSO solution wasapplied by the patient or a member of his family over awide area circumscribing the affected part three timesper day.Patients who obtained complete, or nearly complete,relief of pain, spasm, and tenderness, who had completerestoration of the range of motion within one to one andone-half hours after the application of DMSO, and whowith continued use of the medication three times per daywere able to maintain symptomatic relief for the followingone to seven days, were classified as having excellentresults. Those who had some measure of relief for thefollowing one to seven days after the application of DMSOwere classified as having a good result. Anything lessthan the previous two categories were classified as havinga fair result.More than 80 percent of the patients in this rigidly controlledstudy had significant improvement with 60 to 90percent DMSO. None of the patients experienced good toexcellent results with the placebo (10 percent DMSO). 3Possible Indications for Dimethyl SulfoxideThe following injuries are felt by the Drug EducationCommittee to be worthy of consideration of research forpossible treatment with Dimethyl Sulfoxide.1. Abrasions2. Abcesses3. Achilles Tendon Strain4. Achilles Tendon Tenosynovitis5. Achillobursitis6. Acne7. Acromioclavicular Sprains8. Adductor Longus Strains9. Adductor Magnus Strains10. Ankle Dislocation11. Ankle Exostoses12. Ankle Sprain28 Athletic Training • Spring 198213. Ankle Subluxation14. Anterior Tibial Compartment Syndrome15. Anterior Tibial Tenosynovitis16. Arch Strain17. Arthritis18. Baseball Finger-interphalangeal contusions19. Bicipital Tenosynovitis20. Blisters21. Brachial Pleus Traction Injury22. Bunion23. Burns24. Bursitis25. Calcaneocuboid Ligament Strain26. Carbuncle27. Carpometacarpal Dislocation28. Carpometacarpal Subluxation29. Cellulitis30. Contusions31. Coccygodynia32. Costochondral Sprain33. Costochondral Strain34. Contact Dermatitis35. Seborrheic Dermatitis36. Hematoma Aurus37. Elbow Dislocation38. Elbow Subluxation39. Epicondylitis40. Epidermatophytosis41. Extensor Digitorum Longus Tenosynovitis42. Extensor Hallucis Longus Tenosynovitis43. Fat Pad Contusion44. Felon45. Fibular Collateral Ligament Bursitis46. Finger Dislocation47. Frostbite48. Furunculosis49. Gastrocnemius Strain50. Glenohumeral Dislocation51. Glenohumeral Subluxation52. Gluteus Medius Strain53. Gracilis Strain54. Granuloma55. Hamstring Strain56. Hamstring Tenosynovitis57. Heat Rash58. Hemorrhoids59. Herpes Simplex60. Hip Dislocation61. Hip Sprain62. Hip Strain63. Hives64. Iliopectineal Bursitis65. Iliopsoas Strain66. Impetigo67. Infrapatellar Bursitis68. Ischiogluteal Bursitis69. Knee Contusion70. Knee Dislocation71. Knee Sprain72. Larynx Injury (Contusion)73. Lumbosacral Sprain74. Lumbosacral Strain75. Lunate Dislocation76. Metacarpalphalangeal Dislocation77. Myositis Ossificans78. Nail, Subungual Hematoma79. Nail, Ingrown80. Nerve Contusion81. Neuritis82. Osgood-Schlatter's Syndrome83. Osteochondritis84. Osteochondritis Desicans85. Patellar Dislocation86. Patellar Tendon Strain

C87. Periostitis88. Peroneal Nerve Contusion89. Peroneal Tenosynovitis90. Plantar Wart91. Plantaris Strain92. Tenosynovitis93 - Muscle Strains94. Sprains95. Insect Bites96. Stye97. Tarsal Tunnel Syndrome98. Carpal Tunnel Syndrome99. TendonitisThe preceding 99 indications for possible research withDimethyl Sulfoxide were listed in the Standard Nomenclatureof Athletic Injuries. 2 * The reader will realize thatthere are many more possibilities for research.Dimethyl Sulfoxide is Still in the Category of a New InvestigationalDrugEven though the Food and Drug Administration (FDA)regulation establishing specific requirements for clinicaltesting of Dimethyl Sulfoxide was completely revoked asof June 12,1980, DMSO is still in the category of a new investigationaldrug. 32 (Dr. Jacob's presentation at theNATA meeting was June 11, 1980.) At the present time,DMSO is approved only for use in the treatment of InterstitialCystitis. However, a medical doctor may nowuse prescription DMSO to treat other medical conditionsfor which he feels the medication may be beneficial.Research Industries Corporation, Salt Lake City, Utah, isthe only company marketing an FDA approved DMSO,Rimso 50, which will cost around $13.95 for 50 milliliters of50 percent solution. Industrial type Dimethyl Sulfoxidemay be obtained on a non-prescription basis from manysources, reliable and non-reliable. The price of this DMSOmay run around $15.00 a pint for 99 percent solution.However, this DMSO may not be safe to use on humans.Warnings from the FDA, Marv Roberson at BrighamYoung University, and William Powell, RPh, Mars HillCollege Pharmacist, strongly advise against the use of industrialtype DMSO on humans. Dr. Norman A. David,MD, Chairman, Department of Pharmacology and Chairman,Investigational Drug Committee, University ofOregon Medical School, states, "The commercialunrefined grade of DMSO is not only more toxic becauseof the impurities but is more likely to cause skinirritations and rashes. AND SHOULD A DOCTOR ORLAYMAN USE THIS PREPARATION WITHOUTFOLLOWING THE PROPER F.D.A. AUTHORITY, HEMAYBE INVESTIGATED BY THE F.D.A. AND CON­VICTED OF A FELONY. " 37As of March 27, 1981, Richard Lebovitz could find noevidence that the F.D.A. had changed this philosophy. Inaddition, Mr. Lebovitz advises that any individual usingindustrial type DMSO would be leaving himself open tocivil suit. 35ConclusionsIf there is any phrase to sum up this article it wouldhave to be "Jacob versus the world." Dr. Jacob is the manwho started the medical investigations of DimethylSulfoxide. A great deal of evidence supports Jacob, butnobody is as crusading as Jacob for the use of DMSO inmedicine. This matter of Jacob versus the world is similarto the situation 28 years ago of Spike Dixon versus theworld over the matter of ice as a therapeutic modality.Time has now proven that Spike was right and people arenot admitting that they should have listened to him then.Dimethyl Sulfoxide has been shown to have therapeuticvalue. No evidence has been presented that DMSO is amiracle cure or that it is the only medication that shouldbe used. Dimethyl Sulfoxide needs further continuous investigationby qualified Sports Medicine personnel todetermine optimum dosage in athletic injuries.Again, industrial type Dimethyl Sulfoxide should not beused on human patients. Only prescription DMSO is consideredsafe for human use. +References1. Adamson JE, et al: The Effects of Dimethyl Sulfoxide on theExperimental Pedice Flap: A Preliminary Report, PlasticReconstruction Surgery 37: 105-108,1966.2. Basmajian JV and Grant JC, Grant's Method of Anatomy,Williams and Wilkins Co., Baltimore, Maryland, 1965, 775 pp.3. Brown JH: Clinical Experiences with DMSO in AcuteMusculoskeletal Conditions, Comparing a NoncontrolledSeries with a Controlled Double-Blind Study, Annals of theNew York Academy of Sciences 141: 496-500,1967.4. Callen DF and Philpot RM: Cytochrome P-450 and the Activationof Promutagens in Saccharomyces Cerevisiae, MutaRes 45: 309-324,1977.5. Engel MF: Indications and Contraindications for the use ofDMSO in Clinical Dermatology, Annals of the New YorkAcademy of Sciences 141: 638-642,1967.6. Gordon DM and Kleberger KE: Effect of Dimethyl Sulfoxide(DMSO) on Animal and Human Eyes, Archives of Opthamology79: 423-427,1968.7. Gorog PM and Kovacs IB: Effect of Dimethyl Sulfoxide (DM­SO) on Various Experimental Inflammations, CurrentTherapeutic Research 10: 486-492,1968.8. Gries GB, et al: The Effect of Dimethyl Sulfoxide on theComponents of Connective Tissue (Clinical and ExperimentalInvestigations), Annals of the New York Academy of Sciences141: 630-635,1967.9. Hucker HB, et al: Studies on the Absorption, Excretion andMetabolism of Dimethyl Sulfoxide (DMSO) in Man, Journalof Pharmaceutical Experimental Therapy 155: 309-317,1967.10. Jacob SW, et al: Dimethyl Sulfoxide (DMSO): A New Conceptin Pharmacotherapy, Current Therapeutic Research 6:134-135,1964.11. Jacob SW: DMSO: Potential Usefulness in PhysicalTherapy, Journal of the American Physical TherapyAssociation 49: 470, May, 1969.12. Jacob SW, et al (editors), Dimethyl Sulfoxide, Vol. I:Biological Concepts of DMSO, M. Dekker, New York, 1971.13. John HI and Laudahn GE: Clinical Experience with TopicalApplications of DMSO in Orthopedic Diseases: Evaluation of4,180 Cases, Annals of the New York Academy of Sciences141: 506-511,1967.14. Killian DJ and Picciano DJ: Cytogemetic Surveillance of IndustrialPopulations, in A. Hollaender (editor) ChemicalMutagens, Vol. 4, Plenum Press, New York, pp. 321-329,1976.15. Kligman AM: Topical Pharmacology and Toxicology ofDimethyl Sulfoxide (DMSO): Part 1, Journal of theAmerican Medical Association 193: 923-928,1965.16. Kligman AM: Topical Pharmacology and Toxicology ofDimethyl Sulfoxide (DMSO): Part 2, Journal of theAmerican Medical Association 193: 923-928,1965.17. Kolb KH, et al: Absorption, Distribution and Elimination ofLabled Dimethyl Sulfoxide in Man and Animals, Annals ofthe New York Academy of Sciences 141: 85-88,1967.18. Lapeyre, Jean-Numa and Bekhor I: Effect of 5-Bromo-21-Deoxyuridine and Dimethyl Sulfoxide on Properties andContinued on page 48Athletic Training • Spring 1982 29

A Tip From the FieldVariation ofthe LongitudinalArch StrappingKirn A. Bissonette, ATC and John S. Leard, ATCFor years Athletic Trainers have used the standard"figure 8" strapping for the longitudinal arch andassociated problems. We offer a modification of this strappingthat has proven effective in treating these cases. Thelongitudinal arch strap, as documented by Klafs andArnheim, uses the conventional, alternation strips fromthe first metatarsal head to the fifth metatarsal head.(Fig. 1.) We propose changing the strap so that all supportivestrips of tape be consistent with more of a medialThe authors are both Assistant Athletic Trainers at NortheasternUniversity, Boston, Massachusetts 02115.supportive concept. This strapping has proven effective intreating longitudinal arch problems, as well as plantarfascitis and shin splints.The strap is applied from the head of the fifth metatarsalin a circular fashion around the heel, with tension appliedto the medial aspect of the foot, adding support tothe origin of the plantar fascia. The strap is then anchoredto the medial aspect of the dorsum of the foot anterior tothe malleolus. (Fig. 2). Each subsequent strip is applied inthe same fashion forming a "fanning" effect both on theplantar aspect of the foot, as well as on the medial aspectof the supporting longitudinal arch. (Fig. 3). The strap isclosed with support strips going lateral to medial andfrom the calcaneous distally to the metatarsal heads. (Fig.4). The strapping can be further supported with circularstrips of any elastic product as to allow foot spreadingduring any weight bearing activity. (Fig. 5).We do not intend for this technique to replace thestandard longitudinal arch strapping, we simply offer analternative that has proven successful in treating a largepercentage of our foot and lower leg problems. +Editor's Note: Anyone wishing to have an idea,technique, etc. considered for this section should send onecopy to Ken Wolfert, 111 Buckeye Street, Hamilton,Ohio 45011. Copy should be typewritten, brief, and concise,using high quality illustrations and/or black andwhite glossy prints.Figure 1 Figure 2 Figure 3 Figure 4 Figure 5Athletic Training • Spring 1982

Constitutionof theNational Athletic Trainers AssociationRevised June 19782/1/81Article I -- NameThe name of this organization shallbe the National Athletic Trainers'Association.Article II -- ObjectivesThe objectives of this associationshall be:(1)The advancement, encouragement,and improvement of the athletictraining profession in all itsphases, and to promote a betterworking relationship among thosepersons interested in the problemsof training.(2)To develop further the ability ofeach of its members.(3) To better serve the commoninterest of its members by providinga means for a free exchange ofideas within the profession.(4)To enable members to becomebetter acquainted personallythrough casual good fellowship.Article III - MembershipSection IThere shall be eight (8) classes ofmembership as follows:(1) Certified(2) Associate(3) Retired(4) Student(5) Affiliate(6) Advisory(7) Allied(8) Honoraryand no individual shall be eligible formore than one (1) class ofmembership at the same time.Section 2Qualifications for membership andthe rights and obligations of membersshall be as indicated in the By-Laws.Article IV -- Election of MembersSection 1Application: Each applicant for anyclass of membership shall sign anapplication stating his desire andintention to become a member of theassociation, to advance its bestinterests in every reasonable mannerand to accept as binding upon himselfits constitution and By-Laws.Section 2Membership in the National AthleticTrainer's Association is based on approvalof each District's membershipcommittee, the National AthleticTrainers' Association membershipcommittee, in addition to completionof requirements for membership aslisted in the By-Laws.ARTICLE V- DUESSection 1The dues of all classes of membersshall be as prescribed by the By-Laws.ARTICLE VIMEMBERSHIPSUSPENSION OFSection 1Membership cancellations may berecommended by any member of theassociation for a cause and themembership of any member becaused to cease by a two-thirdsmajority vote of those memberspresent at the annual businessmeeting.Section 2Appeals: A person whose membershipis cancelled in accordance withSection 1 shall be allowed, either inperson or through some member ofthe association, to appeal to the NationalMembership Committee for reconsideration.Information in theappeal shall be presented to theBoard of Directors and the Boardshall, by a majority vote, decidewhether to submit the question of themembership cancellation to the associationmembership for another onein accordance with Section 1.ARTICLE VII - - VO TING PO WERSection 1Certified and certified retired membersshall be entitled to one vote uponall questions submitted to the associationfor decision.ARTICLE VIII - ORGANIZATIONSection 1National: The governing body of thisorganization shall be The Board ofDirectors.Section 2Regional: Each District AthleticTrainers' Association will be selfgoverningas per its own specificConstitution and By-Laws. Nothingin a District Constitution and By-Laws shall be contrary to the NationalConstitution and By-Laws. Inits relations with the National Organization,the District Association willbe under the jurisdiction of the NationalAthletic Trainers' AssociationConstitution and By-Laws.(a)For the purpose of facilitating thework of the National AthleticTrainers' Association the UnitedStates and Canada shall be dividedinto ten (10) geographic areas andeach district organization shallhave district jurisdiction throughoutone of the areas. District areaboundaries shall be set by theBoard of Directors, and the districtsshall be designated and identifiedby the numbers one (1)through ten (10).(b)Each District shall elect a DistrictDirector who must be a Certifiedmember of the National AthleticTrainers' Association. Each DistrictDirector shall serve as amember of the Board of Directorsof the national organization andact with full authority for the districtin carrying out the functionsand responsibilities of The Boardof Directors.Section 3(a)President: The president shall beelected by a majority popular voteof the voting membership of theNational Athletic TrainersAssociation. The Board of Directorsshall be the nominating committee.Candidates must have servedon the Board of DirectorsAthletic Training • Spring 1982 31

some time during the four yearsimmediately preceding themeeting at which nominations aremade. Two candidates shall benominated at the meeting in Juneone year before the end of theterm of the current President. Thebiography of each candidate shallbe published in the fall issue ofthe Journal of the N.A.T.A.ATHLETIC TRAINING followingthe nominations.The membership voting shall beby mail. A ballot shall be mailed toeach voting member at his/her addressof record by November 15thand the marked ballot must bereturned by mail to the ExecutiveDirector at the designated addressand be postmarked no later thanDecember 1st.The term of the President shall betwo years and he/she may notserve more than two consecutiveterms. The term of office shallbegin at the business meeting ofthe Association at the AnnualMeeting and Clinical Symposiumfollowing the election.(b)Vice President: The District Directorfrom one of the ten districtsshall be elected to the office of VicePresident by the Board of Directors.One or more district directorsmay be nominated by membersof the Board and election shallbe by majority vote.The Vice President must be aDistrict Director, also..If the VicePresident ceases to be a DistrictDirector a new Vice Presidentmust be elected.The term of office of the VicePresident shall be one year andhe/she may be reelected.If the office of President becomesvacant before the end of the termfor which the President was elected,the Vice President shallbecome President immediatelyand shall serve as President forthe remainder of the term forwhich the previous President waselected. In the event that thePresident-elect is unable toassume the office of President, theVice President shall become thePresident-elect and then becomePresident at the beginning of theterm for which the originalPresident was elected, and servefor the full term. It is thereforepossible that a vice-presidentcould serve a partial term asPresident followed by a full term.In such a circumstance a Presidentshall be eligible for nomination and32 Athletic Training • Spring 1982election for one consecutive termfollowing the first full term.The Vice President has no constitutionalduties other than toassume the office of President orPresident-elect as prescribed.Section 4Removal of Officers: All nationalofficers may be impeached andconvicted on the following grounds:embezzlement, malfeasance in office,and actions contrary to or in violationof this Constitution and its By-Laws.Before impeachment proceedings canbe instituted, a brief, containing thecharges shall be drawn up and presentedby a board member to theBoard of Directors sitting in executivesession. The aforementionedbrief must then be adopted by amajority vote prior to the formal presentationof the charges. Impeachmentof any officer shall require atwo-thirds vote of the voting membershipof the Association present atthe annual meeting.ARTICLE IX - POWERS AND DUTIESOF OFFICERSSection 1The officers are the President, Vice-President, Board of Directors andExecutive Director.Section 2All powers and duties of officersare as prescribed in the By-Lawsand Article VIII Section 3 of theconstitution.ARTICLEX - COMMITTEESAll committees, except themembership committee, shall beappointed by the President with theapproval of the Board of Directors.ARTICLEXI - MEETINGSSection 1The annual business meeting shall beheld each year at a time and place setby the Board of Directors.A quorum for the annual meetingshall consist of one-fifth of the votingmembership of the Association,excluding Certified Retired membersin figuring the one-fifth.Section 2The Board of Directors may submititems of association business tothe voting membership for a vote bymail. Approval of items so submittedshall require a "yes" majority ofa respondence of at least one-fifth ofthe voting membership of the association.Section 3The Board of Directors shall meet atthe National Convention and at anyother time that the Presidentdetermines it necessary to call aBoard meeting.A quorum for a Board of Directorsmeeting shall be six (6).The President may submit appropriateitems of association business tothe Board of Directors for a vote bymail. For such a voting procedure thePresident shall first secure a"second" to the proposal and thensubmit the proposal to each memberof the Board by mail with a request tomail a "yes" or "no" vote on the proposalby a definite date not soonerthan ten (10) days after the mailing ofthe proposal. Board approval of itemssubmitted shall require a "yes" voteof at least six members of the Board.The President may submit emergencyitems of Association businessthat are appropriate for Board actionto the Board of Directors for a vote bytelephone. For such a voting procedurethe President shall firstsecure a "second" to the proposal andthen call each member of the Boardfor his vote on the proposal. Boardapproval of items so submitted shallrequire a "yes" vote by at least sixmembers of the Board.ARTICLE XII - AMENDMENTS TOTHE CONSTITUTIONSection 1All proposed amendments to theconstitution shall be submitted inwriting to the Executive Director atleast six weeks prior to the annualbusiness meeting. The ExecutiveDirector shall distribute copies of theproposal to all voting members atleast three weeks prior to the annualbusiness meeting.Section 2A proposed amendment to the constitutionthat has been properly submittedshall be read at the annualbusiness meeting and a two-thirds(2/3) majority vote of the votingmembership present shall be necessaryfor the adoption of the saidamendment.ARTICLE XIII - AMENDMENTS TOTHE BY-LAWSThe By-Laws may be amended atany official meeting of the Board ofDirectors by a majority vote.By-Laws may not be added, deletedor amended by a vote by mail ortelephone. +

National Athletic Trainers AssociationCode of EthicsPREAMBLEOne outstanding characteristic of a profession is thatits members are dedicated to rendering service tohumanity. Also, they are committed to the improvementof standards of performance. In becoming a member ofthe athletic training profession, the individual assumesobligations and responsibilities to conduct himself inaccordance with its ideals and standards. These are setforth in the Constitution and By-Laws, and are emphasizedin the CODE OF ETHICS. Any athletic trainer whodoes not feel that he/she can or does not deem it necessaryto comply with the principles set forth in the CODEshould have no place in this profession.The members of the athletic training profession mustadhere to the highest standards of conduct in carryingout their significant role in athletic programs at all levels.It is for this reason that the Board of Directors of theNational Athletic Trainers Association has continuallyrevised the CODE which has been in effect sinceJune, 1957.*In approving the Code, the Board of Directors recognizesand believes that unless the standards and principlesthat are set forth in this document are accepted ingood faith and followed sincerely, it will not be effective incontinuing to improve the contributions of the professionand its members to athletics and sports-medicine.Ethics is generally considered as conduct in keepingwith moral duty, and making the right actions relative toideal principles. Let it be understood that all members ofthe National Athletic Trainers Association will understandand apply the principles set forth in this code andmake every effort to do the right thing at the right time tothe best of their ability and judgment.*1971,1973,1974,1976,1977,1978,1979,1980.PurposeThe purpose of this CODE is to clarify the ethical andapproved professional practices as distinguished fromthose that might prove harmful or detrimental, and toinstill into the members of the association the value andimportance of the athletic trainers' role.ObjectivesThe stated objectives of the National Athletic TrainersAssociation in its constitution are:1. The advancement, encouragement and improvementof the athletic training profession in all itsphases, and to promote a better working relationshipamong those persons interested in the problemsof training.2. To develop further the ability of each of its members.3. To better serve the common interest of its membersby providing a means for free exchange of ideaswithin the profession.4. To enable the members to become better acquaintedpersonally through casual good fellowship.Article I — Basic PrinciplesThe essential basic principles of this CODE are Honesty,Integrity and Loyalty. Athletic trainers who reflectthese characteristics will be a credit to the association,the institution they represent and to themselves.When a person becomes a member of this Association,he/she assumes certain obligations and responsibilities.A trainer whose conduct is not in accordance with theprinciples set forth in the following sections shall beconsidered in violation of the CODE.Athletic Training • Spring 1982 33

Section 1 — Athletics in GeneralAn athletic trainer shall show no discrimination inhis/her efforts while performing his/her duties.Section 2 — DrugsThe membership of the National Athletic TrainersAssociation does not condone the unauthorized and/ornon-therapeutic use of drugs. The Association recognizesthat the best and safest program is comprised ofgood conditioning and athletic training principles.Section 3 — Testimonials and EndorsementsIn any endorsement in which the trainer's nameand/or reference to the athletic training profession isincluded, the wording and illustration, including anyimplications of the endorsement shall be such that nodiscredit to the training profession may be construed.(Any endorsement that is not in keeping with the highestprinciples and standards of the athletic training professionshall be considered unethical). The NATA name, logo,trademark and/or insignia may not be used in any testimonialsand/or endorsement service products, programs,publications and facilities, by individual membersor groups of members of the Association.Section 4 — SportsmanshipMembers of this Association shall not condone, engagein or defend unsportsman-like practicesSection 5 — Fellow TrainersAny trainer who by his/her conduct or comments, publiclydiscredits or lowers the dignity of members of hisprofession is guilty of breach of ethics.Section 6 — MembershipIt is unethical for a member to sponsor a candidate formembership in the National Athletic Trainers Associationwho does not know the candidate and his/herqualifications.Section 7 — Solicitation of Patients for FeeIt is unethical for a member that is actively engaged inthe profession, and/or teaching in an approved EducationCurriculum to solicit or use any form of advertisingfor the purpose of acquiring for fees, "outside" patients.(See last page for definition of actively engaged.)Article n — Educational Preparation & CertificationAny certified member of this Association must be consideredan educator if he/she is involved with the professionalpreparation of students pursuing National AthleticTrainers Association Certification through any of theapproved certification routes.Section 1 — Educational StandardsThe athletic trainer-educator must adhere to theeducational standards and criteria set forth by thisAssociation.Section 2 — Selection of StudentsThe athletic trainer-educator is responsible for theselection of students for admission into a professionalpreparation program, must insure that policies are nondiscriminatorywith respect to race, color, sex, or nationalorigin.Section 3 — Publication and RepresentationPublication and representation of the professionalpreparation program by the athletic trainer-educatormust accurately reflect the program offered.34 Athletic Training • Spring 1982Section 4 — Evaluation of StudentsEvaluation of student achievement by the athletictrainer-educator must be done in a prudent manner.Section 5 — Recommendation for CertificationIt is unethical for a member to knowingly recommend acandidate for the national certification examination whohas not fulfilled all eligibility requirements as specifiedby the Board of Certification.Section 6 — Confidentiality of National CertificationExaminationIt is unethical for any member to reproduce in writtenform, or reveal in any other manner, any part of thewritten or oral-practical examination for the purposeof aiding certification candidates in passing theexamination.Article m — EnforcementSection 1 — Reporting of Unethical ConductAny member of the Association who becomes aware ofconduct that he/she considers unethical and that he/shebelieves warrants investigation, shall report the incidents)in writing to the President and the ExecutiveDirector of the Association, who will in turn initiateinvestigation through the Ethics Committee. He/sheshall include in the communication all pertinent data.Section 2 — Investigation and ActionIn accordance with the By-Laws of the Association, theEthics Committee investigates reported incidents ofunethical conduct and if, in the judgement of a majorityof the committee members, it finds that the accusedperson has violated the National Athletic Trainers AssociationCode of Ethics, it communicates its decision tothe accused and to the Board of Directors in writing andrecommends to the Board one of the following disciplinaryactions:1. Letter of CensureCopies to immediate supervisor and DistrictDirector.2. Period oj Probation: (This shall be determined bythe Board of Directors.) During the period of probationthe member shall not be eligible for any of thefollowing:a) Hold an office at any level in the Association.b) Represent NATA in the capacity of liaison withanother organization.3. Initiate ProcedureJor Cancellation oJMembershipSection 3 — Action by the Board of DirectorsThe decision of the Board of Directors in Code of Ethicsis final, except that if the decision is to initiate cancellationof membership, this shall be done as prescribed inArticle VI, Section 1 and 2 of the Constitution.The National Athletic Trainers Association definitionof "ACTIVELY ENGAGED" is as follows:A person must be an employee on a salary basis, not afee for service or vendor contract basis of an accreditededucational institution (public, private or parochial elementaryor secondary school or a degree granting collegeor university) or of a professional athletic organizationfor the duration of the institution's school year or theprofessional athletic organization's season and who performsthe duties of athletic trainer, and is recognized assuch, as a major responsibility of his or her employment.NATA approved Clinical Instructors whose responsibilityis teaching or supervising in a NATA approved athletictraining curriculum is considered an Actively EngagedAthletic Trainer. +Revised 810408

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CEU Credit QuizThe Burnout SyndromeAmong Athletic TrainersJoe Gieck, EdD, RPT, ATCRobert S. Brown, PhD, MDRobert H. Shank, MS, ATCABSTRACTStress affects people in all health professions, includingthe athletic trainer. The purpose of this paper is toinvestigate the causes, effects, and the use of modifiers toreduce the effects of stress for health professionals.The burnout syndrome is often seen in the individualwho feels guilty for taking time off for work. His quality ofwork decreases while his quantity increases. Excessivedevotion to his profession with gratification only from hisjob exemplify the burnout syndrome.Physiological, psychological and behavorial changestake place. Constant giving drains him, often causing anegative or sarcastic personality.The use of modifiers to reduce stress include: an activeoutside life, exercise, creation of a positive perspective,analysis of job stress, job duties and occupational goals.Dr. Gieck is the Head Athletic Trainer and Assistant Professorat the University of Virginia, Charlottesville, Virginia.Dr. Brown practices Psychiatry in Charlottesville where he isalso Professor of Education and Clinical Associate Professor ofPsychiatry at the University of Virginia. His research is focusedon the role of exercise in mental health. He is a member of theSports Medicine Committee of the Medical Society of Virginia.Robert Shank is head athletic trainer at Dickinson College.36 Athletic Training • Spring 1982Flexibility in the job and control of job environment alsoreduce stress.BURNOUT SYNDROMEIntroductionThe lifestyles of those employed in an athleticsetting by nature is stressful. Tothe public it is glamourous and exciting. To the athletictrainer it may begin this way, but unless constantawareness of the potential stresses, and active solutionsare employed to defuse these stresses, the trainer is a candidatefor the syndrome of burnout. Burnout effects thosein their first year of employment, and those with manyyears experience.The long hours, heavy work loads, and pressingresponsibilities of the Industrial Revolution have beenreplaced by easier work conditions, but the stresses oftoday's work produce more physical illness and anxieties. 1Freud saw work as a basis for attaching the individualfirmly to reality, "work...gives him a secure place in aportion of reality in the human community." Not only thatit was essential for one's economic base and socialusefullness, but also that it served as a vehicle for the

discharge of many other emotions. He further felt that werely to a great extent on work as a source of selfevaluationand as a basis on which to pattern modes ofadaptive behavior. 2Calvin summed up in his protestant work ethic that onelak°red earnestly without complaint and withdiligence, was doing God's work on earth. Voltaire in hisCandide expressed, "Work keeps at bay the great evils:Boredom, vice, and need." 2"No one ever died of overwork" is often quoted, but theindividual does cease to operate effectively. Some peoplelack the inner governor, and for various reasons ignoremany of the commonplace signs and symptoms signalingthe need for rest and recreation. Many articles fill theliterature with the inability or unwillingness to work, butfew deal with the problems of overwork. Overwork mayrepresent an effort to maintain a clear conscience bysaying to the world, "See, I am blameless. I have done allthat I could, even working to the edge of totalexhaustion." 2No one needs a definition of the Burnout Syndrome; thename is too descriptive, the pictures it brings to mind aretoo vivid, the effects it produces are too real. Itsprevalence seems to be widespread; it respects nosocioeconomic or cultural group; it may be found amongall age groups; and it may be found in both men andwomen. It strikes all professions, including athletictrainers who actually may be at a higher risk owing tosome of their unique vulnerabilities. The purposes of thispaper are to identify some of the early warning signs andsymptoms of Burnout, examine a cross-section of itspervasive effects in several occupations, and to suggestsome prevention measures, and finally, to prescribetreatment.Case HistoriesTom, a 43-year-old dentist suffers from dysphoria: "Ijust don't feel good and I can't remember how long it hasbeen since I felt relaxed." He is married, has threechildren, his practice is active, he has no majorindebtedness — but he is often tired. He cannot seem wellwithout medication and he is seriously considering"quitting" or "just walking out of my office and nevercoming back." All his life he wanted to be a dentist but hedoesn't enjoy it much anymore. "I find that little thingsirritate me and when a new patient comes to my office, Ifind myself more nervous than the patient. I've done thesame examination a thousand times; I don't know why I'mnervous." It has been a long time — years — since he tooka vacation: "I don't feel good when I take time off — Ican't relax." Even though he feels bad generally, he feelsbest at work. He feels guilty when he takes time off:"When I go home early on Friday afternoon, I stay by thephone in case someone needs me." He feels exhausted.Psychiatric treatment for depression produced marginal,temporary improvement, even with antidepressantmedication. He was impatient with free time in his officeand impatient with his children at home. "No problemwith the wife." Pathetically, he said, "I've got what mostother people want: a good home, a family, and a goodjob....but I'm not happy." In his most telling statement (anescape fantasy) he said, I feel like I would like a pipe and acouple of pounds of tobacco and to be left alone byeverybody."Diagnosis: The Burnout Syndrome.Premorbid Condition: passive dependent person.Contributing Factors: overworked, overstressed,failure to relax.Possible Complications: suicide.Treatment: Reduce office hours to four days per week;take off one week every three months.Ann, a 30-year-old nursing supervisor, reports that hernurse employees are insubordinate. She feels they don'tlike her. She is overly conscientious at work, conies backafter her regularly scheduled hours and feels incompetentwhen she compares herself to the younger, lessexperienced women at work. She can't relax. At home hertime is devoted to work projects — "I like to make thingsas gifts for my daughters and husband." She also findstimes to go back to the hospital at night to visit a sick"friend." The impression she makes is one ofsuperficiality: she has a cliche for most things, a shallowreply to direct questions. Her marriage is on the rocks.Twice she has impulsively and abruptly asked herhusband to leave. The first time he complied with herrequest. On the second occasion he said, "This is it! If youmake me leave now then I'm not coming back." Her lastvacation? An obligation visit to her mother with whom shehas a strained relationship. She feels bad most of the time,but at work she seems able to psychologically manage alittle better.Diagnosis: Burnout Syndrome.Premorbid Personality: First husband was killed inVietnam. She "handled" her grief by throwing herself intoher work.Contributing Factors: She is the boss at work, but sheworks harder there than any of the younger nurses.Possible Complications: divorce.Treatment: Work eight hour shift only. Stay away fromthe hospital when off duty. Take up exercise to relieveanger and anxiety.Gene, a 40-year-old university athletic trainer; married;two children; financial stability; nationally ranked athleticteams. Chief complaint: "I'm exhausted; I wake up in themorning and I dread the day. I don't look forward tothings; I dread things — even vacations. I fear I may fallapart. Things I've automatically done for years I now getup-tight about. Team trips — I hate them. I also wish we'dlose, but the strain is just as great. I'm the first personthere at work and the last person to leave. I've forgottenhow to relax. I find myself hanging around the treatmentroom even when we are closed. It's no better at home:Everything is a hassle. Occasionally, I get a tip and make agood business investment — something that used to exciteme — but now it means nothing. I used to enjoy thetelevision and newspaper coverage but now it all seemssilly.Diagnosis: Burnout Syndrome.Premorbid Personality: frustrated athlete or coach.Contributing Factors: His work has been so highlysuccessful it has come to be expected; not muchrecognition now — no time really away from work.Treatment: Take a sabbatical — at least one semesteroff, perhaps pursuing travel or hobby.What is now recognized as the Burnout Syndrome isbasically a maladaptive form of coping with stressthrough excessive "devotion" to work: work loses itscharm and challenge and the victim of the BurnoutSyndrome becomes enslaved to work as a form ofdrudgery.Clinically, the Burnout Syndrome presents as a form ofdepression; however, it does not respond to the usualtreatment of depressives and it is an atypical form ofdepression, not the usual triad of hopelessness,helplessness, and haplessness. The most telling symptomwhich patients with the Burnout Syndrome complain of isworking longer hours and enjoying work less withintolerances for time away from their job.StressThe physical aspects of work often produce a pleasantfatigue. However, the stresses and anxieties of the job, incombination with the physical fatigue may lead toburnout. Stress in itself is not bad. Positive effects ofstress can increase alertness and efficiency. Without somechallenge of stress, a task soon becomes boring as seen inAthletic Training • Spring 1982 37

many common hourly jobs. 3 The stress that motivatessome has an adverse affect on others. Some require aquiet, relaxed atmosphere to function best, while othersare happiest in a faster-paced environment." 5 6 Too littlestress is as bad as too much.Stress is a phenomenon with which everyone mustcope. Everyone learns to deal with stress in their ownway. One way to relieve stress is to be content with thesituation causing the problem. Another way is to be awareof the situations which cause stress and know how to dealwith them accordingly. Behind the glamourous andexciting occupation of the athletic trainer, there arestresses that can make the uninformed trainer a candidatefor the Burnout Syndrome. The Burnout Syndrome orBurnout is the result of overworking under stressfulconditions. The excessive demand on a person's time andmind causes a gradual deterioration of that person'sability to do productive work. Burnout affects trainers atall levels of experience from novice to expert.Physical Signs and SymptomsThe trainer begins his professional career with a highlevel of interest and enthusiasm. He is bursting with ideasand desires to implement them. The classic work patternof dedication and commitment becomes over-dedicationand over-commitment. The pace of the first to arrive andthe last to leave becomes a schedule he feels he mustmaintain. He perceives the pressures of his profession:multiple decision making with regard to care of injuredplayers, the player and coach interactions with regard to aplayer's return to competition, the disruptions of travel,and just meeting these schedules week after week. As aresult of these pressures, frustrations increase,exhaustion develops, and the individual becomes lesseffective.The student trainer, for example, often receives hiseducation under the watchful eyes of the head trainer. Asa result, the student trainer has little or no perception ofthe actual stresses of the profession. All that is exposed tohim is the glamour and excitement of athletics and athleticmedicine. When he finally perceives the reality of thefrustrations of his profession as an actual trainer, he findshimself in a conflict.Perhaps those educating student trainers need toexpose their students to the stressful situations of theprofession. Without this exposure, the reality of the jobsituation (e.g. 65-80 hour work weeks), frequently resultsin the loss of the student's ideals, he becomes cynical andpessimistic about his effectiveness.This situation is repeatedly observed in women. Thosewho have worked only with women's sports in college, andare suddenly confronted on their first job by the footballcoach with a pressure and unpleasant situation are in atraumatic position to say the least. Or the opposite mayoccur. The woman who has worked with male contactsports, and then becomes employed to work only withwomen's sports, is recurrently disillusioned by what sheterms a babysitting role with little involvement in thecare, treatment, and rehabilitation of the scale that isinvolved in male contact sports. She sees herself as justputting in time.Physiological Signs and SymptomsAlthough there are physical indications to the BurnoutSyndrome, the major and most significant indicators ofBurnout are physiological, psychological, and behavioralin nature.In the normal operation of the human body, the bodywith its infinite wisdom knows how to deal withdisturbances that occur on a day-to-day basis. However,when the body is put under a great deal of stress, the dailydisturbances become chronic. The body indicates thesephysiological changes in many ways, such as increasedpulse rate, shortness of breath, headaches, neuromuscular38 Athletic Training • Spring 1982disorders, gastrointestinal, or cardiovasculardisturbances, and fatigue. 7The athletic trainer works extensively and intimatelywith administrators, coaches, doctors, and athletes overan extended period of time. This requires the constantgiving of himself to others with his own needs becomingsecondary. The emotional involvement of meetingeveryone's needs, as well as his own is taxing even for thebest adjusted athletic trainer. Burnout is extremely highin health professions. 8If the job begins to drag down the trainer, he beginscomplaining of being overworked and dreads going towork. He may find himself in a role conflict, "What am Idoing this job for?" He finds that he needs lots of sleep,but still has a constant low energy level. His concentrationand motivation are adversely affected, he cuts cornersespecially with details, and he loses touch with the day-todaysatisfactions of the job. 5 He ceases to be a contributor,but he becomes a pessimist and fault finder, notrecognizing good qualities in others. 4 Thus he has anegative effect on his training room staff, administrators,coaches, and players. He sees himself as without fault; itis others who have the problem adjusting to him.The quantity of work he performs increases, but thequality is drastically reduced. He finds himself workingharder, but accomplishing little. He may have memorylapses, even suicidal thoughts, or personality change. 9Generally, he has low self-esteem. This low self-esteem isfrequently associated with a low pay scale; thusconfounded, many athletic trainers change professions. 5Psychological and Behavorial Signs and SymptomsPsychological manifestations include anxiety anddepression, sleeplessness, and the inability to handlestress. Most of his illnesses are psychosomatic, includingproblems of sexual dysfunction.The individual is exhausted. Fatigue is the mostcommon symptom, but is usually not properly diagnosed. 210 As a result, the patient may resort to dependency ontobacco, alcohol, or drugs. 2 The more life stresses andadjustments which are required at anytime, the morelikely the individual is to become organically sick later. 14Behavioral signs start when the trainer begins to loseperspective of his job, when the athletes becomesecondary to him in his daily hierarchy of needs. Thisperspective is the need for the overall health of theathlete, team and sports in general. This loss ofperspective is characterized by the "winning iseverything" attitude.The trainer may merge himself with his job. Allgratification comes from his job, thus he is constantlyseeking stroking and praise for his efforts. He gives upseeking meaningful relationships and outside activities,and has no time for himself. Thus any attack or perceivedattack on anything he is associated with is in essenceperceived as a personal attack. In short, he becomeshypersensitive, suspicious and sometimes even paranoid.The individual becomes rigid, resistant to change,inflexible and stubborn. Change threatens the exhaustedperson, therefore he fights change, "this idea won't workanyway." Although he may be unaware, he graduallybecomes anti-everything. 9Agression and WithdrawalThe burnout victim may seek aggressive control or hemay become more withdrawn. Since he is suspicious ofothers and their control over him, the aggressiveapproach may be an attempt to control others and theimmediate situations. He only can do a task "right;" hedoes not delegate authority to others. 9 Athletes mustcome in for treatment when he designates, everyone mustadhere to his directives in all situations.The withdrawal approach consists of delegatingauthority whenever possible. Here the trainer removes

himself from the treatment situation: he finds himselfmore often doing busy work. 812 The shuffling of papers is atrap many trainers may fall into, neglecting the needs ofathletes. Withdrawal may become associated with acallous attitude toward athletes, the loss of concern andfeeling for them.With personality change the more extroverted maybecome quiet, resigned, bored, confused, and hopeless inthe situation. He is quick to anger, reacting to situationswith instantaneous irritation. 9The Type A individual is an ideal candidate for burnout.He is characterized by an excessive sense and anxietyabout time and urgency. He is constantly involved withdeadlines, competitively drives himself, and is impatientand compulsive. 1213Reexamination of the SituationThere is no single solution that fits all the burnoutsyndromes. 2 Fortunately the season or year in which thestress is occurring ends, and the athletic trainer naturallyrecharges his batteries by getting away from the hecticroutines of 65-80 + hours/week. This is why for manyathletic trainers life is simply too short to work summercamps, thereby perpetuating their own problems, gettingno break at the end of the year.With the building of stress and resultant anxiety,restructuring of behavior is desirable. Begin byreexamining current attitudes. Much negative stress maybe reduced by the way a situation is viewed. 6 Toparaphrase Epicteus, "nothing is upsetting in itself, it isonly the way it is perceived." An Austrian-Hungarianproverb also expresses this, "Imitate the sundial's ways,count only the pleasant days." Quickly forgetunpleasantries, bear no grudges, as you only punishyourself. 6Analyzing job stress is necessary to relieve the anxietyinvolved. The art of the trainer must not be neglected.Some trainers are so caught up with administrativeduties, the sprained ankle, the fractured fibula, or theknee rehabilitation program that the humanistic approachof athletic training is forgotten. Take the time to beinterested in the staff and athletes as people and not assituations. Simple, brief conversations showing interest inpeople will go a long way toward creating a positiveimpression: personal relationships develop. Listening towhat an individual feels rather than what he says mayhelp to increase patience and tolerance thus reducinganxiety levels.Reexamine daily duties. Whenever possible endeavorto delegate authority and responsibility to other staffmembers and student trainers to lighten the loadsomewhat. Rotate usual functions and tasks within thestaff. 9No athletic trainer ever seems to have enough time.Therefore a re-examination of time spent is valuable. Tryto pace oneself and limit the hours spent at work.Productivity decreases drastically with overwork.Consider rescheduling of hours. Too often an entire staffwill sit around in the morning looking at each other,putting in hours. It seems that some people justify theirexistence by the amount of time put in.Reexamination of occupational goals is necessary insevere cases of burnout. 5 Were the goals realistic,achievable? Was the field entered to help others or,because of a need to be loved by all, for the glory,glamour, of the job? Many beginning trainers only pursueprofessional or college jobs despite the often lower pay,when the real need is at the secondary school level. Ispower and ego, or hero worship a reason for entering thefield? It must be remembered that the person one isworking with is more important that the task. 9It is interesting to note that athletic trainers withoutgood technical skills are recognized as excellent byadministrators, coaches, and athletes simply on the basisof their good interpersonal relationship qualities. Thereverse is often noted also, a highly qualified athletictrainer with the inability to get along with others isregarded as poor. 14 For a successful relationship thetrainer, staff, and athletes must get along professionallyeven though their philosophy differs. The trainer is theone most often who has to take the initiative to work atmaking the relationship successful. Sacrifice of goodathletic health care does not have to be made. In short itfrequently depends on the interpersonal relationshipskills of the athletic trainer to create a positiveatmosphere.Active SolutionsActive searching for solutions to the problems of theBurnout Syndrome are essential. Time must be spentfinding solutions for Burnout; complaining and worryingabout it accomplishes nothing nor does it remove theproblem. Complaining and worrying only reinforces theanger, frustration and despair, and depletes theindividual's already low energy supply. 11Time should be channeled toward prevention olBurnout: an active outside life, proper health habits,restructuring behavior, and analyzing job stress.Prevention requires conscious awareness of potentialboredom, frustrations, and diminishing returns associatedwith the job of an athletic trainer. 9 Prevention must beconsciously emphasized; administrators, coaches, players,and athletic directors all have their limitations.The use of modifiers is one way of defusing a stressfulsituation. A modifier is something that is done to reducethe stress. 13 One of the most effective modifiers of stressis an active outside life. The athletic trainer looks out forhimself by being necessary to others. Hubert Humphreyoften said, "If you have a well and draw from it, it fills; ifyou don't it grows stagnate. You have to learn to giveyourself." But to help others, the individual must have asuccessful outside life, part of his life that is his own. 9 Onthe short-term, it can be as simple as stopping and havinga social visit with the staff on the way home,decompression by talking over recent events. In this way,the job is not taken home at night. Taking the job homecauses one to relive the stresses. 8 Another modifier can bean extended vacation when time permits.Athletic programs are expanding, without thenecessary increase in the number of athletic trainingpositions. Secondary schools often expect full classteaching loads in addition to athletic training duties, thusthe trainer has his time further compromised. Trainersshould seek the time a professional needs to keep up withthe advances in his field and profession by research,teaching, writing, attending conferences and seminars,and the creativity which comes from thinking andreflecting; all excellent modifiers in stress management.Almost no valid research is done by athletic trainers.Most do not have the time, money for research tools, orthe educational background to perform research. And yetwithout valid research the athletic training professioncannot advance. Research would add to hour quality andbe an excellent stress modifier.Henry Ford was once chastised by an efficiency expertregarding an employee who sat around with his feet on hisdesk much of the time. His reply was, "That man once hadan idea that saved us millions of dollars. At that time, Ibelieve his feet were planted right where they are now." 1Flexibility in the job of an athletic trainer is a must"nothing is certain in athletics but uncertainty." Thetrainer who cannot maintain this flexibility is in for agreat deal of stress and anxiety.New behavior is never acquired unless it is practiced. 12The trainer should create a positive perception of his ownself image. Retrain old emotional responses to meetAthletic Training • Spring 1982 39

current stresses. Work on new approaches to problemswith a free mind open to change. 17 Other areas include:decreasing worrying, learning to say no to every newtask requested that one doesn't have time to perform, andthe detachment of oneself from areas that don't concernhim. 5In working for a change, the individual often has totemporarily learn to cope with the situation as itpresently is, not as it should be. The best refresher is notescapism, but learning to cope with the situation as itexists by rational self-management. 11 The individual oftenhas to come to grips with the fact that he is not the wholeshow, merely a part of a team effort. There needs to be abalance between concern for change, an objective view ofthe problem, and understanding of the reasoning andneeds of others. 8Some situations cannot be changed, therefore theperson either accepts and adapts to the situation orwithdraws from it. The latter is often seen in the disgustand disillusionment of athletic trainers who leave thefield. This is particularly true of trainers who begin toestablish a family and cannot balance the job with theirfamily needs. Salaries which are not adjusted accordinglyfurther increase the disillusionment.Control of One's EnvironmentControl of one's environment is equally important. 12 Incontrolling one's environment, organization is a must,with discipline in organization. Scheduling ofappointments, treatments, and administrative duties isimportant. There will frequently be situations arising thatthrow off schedules, and the trainer may fall into the rutof simply sitting back and dealing with crises as theyarise. Set daily priorities, finish old tasks before beginningnew ones and if possible, allow an extra five orten minutes between tasks to prevent stress build-up.Plan something to look forward to each day. 5 Write downstressful situations and their possible successfulsolutions.The athletic trainer must be in control of his job. Itcannot be the coach who dictates what his role will be orstress will not be reduced. All too often the trainer givesin to all requests by coaches, thus he is no longer in controlof his situation.The successful athletic trainer has to have his ownactivities, his own space, time to think and reflect, timefor aloneness, creativity, privacy, hobbies, family,friends, and spontaneous events. 9 He must have time forpleasurable activities of his own, whether it is reading,fishing, or a physically demanding activity such as cuttingwood, working cattle, etc. The physical fatigue can bepleasant. These activities vary with the season and thetime the trainer makes available, but many productiveideas may be thought of during such times.Proper physical health habits are important to goodmental health. Proper diet, sleep and exercise areimportant. 17 Sitting, standing, and walking properlyproject an aura of confidence important to good selfimage. Relax with music, relaxation techniques, ormeditation to regroup resources for the next stress. Evena fifteen minute session of relaxation will refresh theindividual. Vigorous physical exercise can be valuable.Physical exhaustion is needed, not further mentalexhaustion. 9Leisure time is valuable and should be scheduled. 5Without scheduling, the person often finds himselffloundering, lost in his leisure, not enjoying himself. Thisis particularly true with family life. Time for outside socialand family activities contribute to good mental health.Meal schedules are often excellent times for familyinteraction, even if the meal must be delayed until 7:30 or8 o'clock during a busy season. This is a time whendiscussing and listening to family activities,achievements, and problems may be accomplished in amore relaxed atmosphere. It is the quality of time spentrather than the quantity spent with one's family that ismost important.Finally the athletic trainer has to have certain valueswhich will sustain him during time of stress. Whetherthey be spiritual or moral, without these values theindividual will probably not succeed in handling the stressof the job or life itself.ConclusionNo matter how exciting the job, boredom may set inunless the individual is constantly on guard against it. 9Observations and reflections of one's own stress levels arenecessary. Burnout does not produce an immunity, butlearning from experience can give an insight to preventreoccurrence."Remember, they're not driving you crazy,you are! Overwork does not cause mental illness, it is aserious symptom of underlying problems. +1. Horn J: Bored to Sickness. Psychology Today, p. 92, November1975.2. Rhoads JM, MD: Overwork. JAMA, 237(24): 2615-2618,1977.3. Freudenberger HF: Speaking from Experience, Burn-Out:The Organizational Menace. Training and DevelopmentJournal, pp. 26-27, July, 1977.4. Beehr TA, Walsh JT, Taber TD: Relationship of Stress to Individuallyand Organizationally Valued States: Higher OrderNeeds as a Moderator. Journal of Applied Psychology, 61-41-47,1976.5. McGuire WH: Teacher Burnout. Today's Education, pp. 5,34-39, November-December, 1979.6. Selye H: On the Real Benefits of Eustresses. PsychologyToday, pp. 60, 63, 69, 70, March, 1978.References9.10.11.12.13.14.Freudenberger HJ: The Staff Burn-Out Syndrome in AlternativeInstitutions. Psychotherapy: Theory, Research andPractice, 12(1): 73-82,1975.Cotton CC, Browne PJ: A Systems Model of OrganizationDevelopment Careers. Group and Organization Studies, 3:185-198,1978.Golman D: Meditation Helps Break the Stress Spiral.Psychology Today, pp. 82, 84, 86, 93, February, 1976.Suinn RM: How to Break the Vicious Cycle of Stress.Psychology Today, pp. 59-60, Fecember, 1976.Gavin JF, Axelrod WL: Managerial Stress and Strain in aMining Organization. Journal of Vocational Behavior, 11: 66-74,1977.Gieck JH: The Athletic Trainer and Counselor Education.Athletic Training, 12(2), 1977.7. Maslach C, Jackson S: Burned-Out Cops and TheirFamilies."Psychology Today, pp. 59-62, April-May, 1979.8. Pines A, Maslach C: Characteristics of Staff Burnout in MentalHealth Settings. Hospital and Community Psychiatry,29(4): 233-237, April, 1978.40 Athletic Training • Spring 198215.16.17.Hewitt P: The Health Hazards of Teaching. Virginia Journalof Education, 70: 9, May, 1977.U.S. News and World Report, June 16,1980.Landsmann L: Is Teaching Hazardous to Your Health?Today's Education, pp. 48-54, April-May, 1978.

CEU credit quizTHE BURNOUT SYNDROME AMONG ATHLETIC TRAINERSJoe Gieck, Robert S. Brown, Robert H. ShankAs an organization accredited for continuing medical education,the Hahnemann Medical College and Hospital certifies that thiscontinuing education offering meets the criteria for .3 hours ofprescribed CEU credit in the program of the National AthleticTrainers' Association, provided the test is used and completed asdesigned.To participate in this program, read the material carefully andanswer the questions in the test. Mark the answers you select byplacing an X in the proper square. Then tear out the test sheet, fillin your name, address and other information, and mail with $12 forprocessing to: School of Continuing Education, HahnemannMedical College, 230 N. Broad St., Philadelphia, PA 19102.The NATA National Office will be notified of all members withpassing scores of over 70%. CEU credit will be issued to eachmember's record at that time. All participants in this effort can expectto receive notification from the National Office if CEU credithas been earned. Participation is confidential.a b c d e1. Might an athletic trainer develop a Burnout Syndrome within a. Yesthe first six months of employment in this capacity? b. No2. Which of the following is a feature of the Burnout Syndrome? a. 1,2,3b. 1,31. hopelessness c. 2, 42. helplessness d. 4 only3. haplessness e. 1, 2, 3, 44. working longer hours and enjoying work less3. Which of the following is & positive effect of stress? a. increasing ofalertnessb. increasing ofefficiencyc. both a and baboved. none of theabove4. The Burnout Syndrome occurs as a result of overworking un- a. Trueder stressful conditions. b. False5. Physiological changes which occur when an individual is un- a. 1, 2, 3der a great deal of stress include: b. 1, 3c. 2,41. increased pulse rate d. 4 only2. shortness of breath 3. neuromuscular disorderse. 1,2,3,44. fatiquefi. The stresses of life may cause illness to a. psychosomaticoccur. b. organicc. both a and baboved. none of theaboveAthletic Training • Spring 1982 41

a b c d e7. The Type individual is an ideal candidate for burn- a. Type Aout. b. TypeB8. Which of the following is only required in severe cases of a. re-examination ofburnout? current attitudesb. re examination ofdaily dutiesc. re-examination oftime spentd. re-examination ofoccupational goals9. The athletic trainer with a Burnout Syndrome should a. 1, 2, 3b. 1,31. create a positive perception of his own self image c. 2,42. retrain old emotional responses to meet current stresses d. 4 only3. learn to say no to every new task requested that one does e. 1, 2, 3, 4not have time to perform4. detach oneself from areas that don't concern him/her10. Should the coach dictate the athletic trainer's role? a. Yesb. NoFor credit, form must reach Hahnemann Medical College by September 15,1982.Name ___________________________________________Institution or Team ____________________________________Address ___________________________________________City__________________ .State. .Zip_Social Security No. ____________Mail with $12 fee to:School of ContinuingEducationHahnemann Medical College230 N. Broad St.Philadelphia, PA 19102Check oneD certified certification number.D associate membership number.NOTE: This address has changed andalso applies to the quiz in the Winter1981 issue.42 Athletic Training • Spring 1982

• The Schering SymposiumGroinGroin and Hamstring Injuriesand hamstring muscle injuries frequentlyoccur in athletic activity. They are painful, debilitatingand frequently chronic in nature. Understandingthe anatomy and cause of these injuries can be helpful inprevention, treatment, rehabilitation and insuring rapidreturn to normal athletic function.AnatomyThe Hamstring muscles consist of the Semitendinosus,Biceps Femoris, Semimembranosus, and the posteriorportion of the Adductor Magnus. These muscles arisefrom the ischial tuberosity and all, with the exception ofthe Adductor Magnus, are two joint muscles crossing boththe hip joint and the knee (Figure 1).The Semitendinosis produces simultaneous flexion ofthe knee and extension of the thigh, and can produce someadduction and inward rotation at the hip.The Biceps Femoris, as per its name, has two heads: thelong head extending downward and laterally from theischial tuberosity, and the short head arising from thelateral tip of the linea aspera. The short head is the moreDr. Casperson is in the practice of Orthopedic Surgery, 1125 E.17th Street, Suite N 360, Santa Ana, CA 92701.Paul C. Casperson, MDEdited byDon Kaverman, ATCpotent flexor at the knee and the long head is a potentextensor of the hip. The biceps has two motor points: onemotor point is innervated by the tibial nerve and thesecond motor point is innervated by the peroneal nerve.The Biceps Femoris is classified by Grant as a hybridmuscle and it is felt by Burkett that this dual innervationmay be one of the etiologies of hamstring tear. That is,contraction of the quadriceps and the short head of theBiceps Femoris occurs simultaneously and the dualinnervation of the Biceps Femoris could pose a potentialneural mechanism for hamstring strains.The Semimembranosus arises from the ischialtuberosity, extends down the posterior surface of theAdductor Magnus and has multiple insertions about theknee. It also may act independently at the hip and theknee.The Adductor Magnus, posterior portion, arises fromthe ischial tuberosity and inserts above the knee in theadductor tubercle. This is the only one of the hamstringmuscles that does not cross the knee joint. It also acts asan adductor and serves as a rotator of the hip.The groin muscles are divided into anterior and medialgroups. The anterior group is made up of the Sartorius,the Quadriceps, and the Rectus Femoris (Figure 2). TheSartorius is the longest muscle in the body and arises fromFigure 1. HAMSTRING MUSCLES - Semitendinosus,Biceps Femorus, Semimembranosus, Adductor Magnus(posterior portion).Figure 2. GROIN MUSCLES - ANTERIOR GROUP -Sartorius, Quadriceps, Rectus Femoris.Athletic Training • Spring 1982 43

the anterior-superior iliac spine, extends distally andmedially to an insertion in the superior portion of the pestendons. This muscle is a two joint muscle crossing boththe hip and the knee, and functions to flex, abduct, andexternally rotate the hip joint while simultaneouslyflexing the knee joint.The Rectus Femoris originates from two bony sites onthe pelvis. The direct head arises from the anteriorinferioriliac spine and the reflected head arises from theilium just superior to the acetabulum. These join andinsert with the remaining quadriceps muscles into thetibial tubercle. The Rectus Femoris is a two joint muscleand functions to flex the hip and extend the knee.The medial musculature, or groin muscles, consist ofthe Adductor Longus, Adductor Brevis, AdductorMagnus, Gracilis, and Obturator Externus (Figure 3).The Gracilis is the only muscle of this group crossingboth the knee and the hip. The Adductor Longus andBrevis originate from the pubis interior to the pubictubercle. The Adductor Longus passes distally to insert inthe medial lip of the linea aspera while the AdductorBrevis passes to the superior half of the linea asperatoward the lesser trochanter. These two muscles areadductors and flexors of the thigh.The Adductor Magnus is a large muscle arising fromthe pubic ramus and from the ischial tuberosity. Thefibers insert on the superior portion of the linea asperaand a portion of the shaft of the femur.The Gracilis originates from the body of the pubis nearthe symphysis and inserts below the knee in the pestendon.The Obturator Externus is the most deeply placed ofthe adductor group musculature. It originates from theobturator membrane on the outer surface of the pubis andischium and inserts into the trochanteric fossa. Thismuscle is primarily a lateral rotator of the hip but alsoserves to adduct the hip.As noted, the anatomy of the groin and hamstringmusculature is complicated and, occasionally, definitivediagnosis of specific injury is difficult. However, obtaininga history and careful palpation frequently serve toidentify the specific muscle injured.InjuryThese muscles have a linkage connecting the muscle tothe bone and allowing the muscle to function as a primemover of the joint. Any portion of this linkage can bedisrupted causing an injury and it is important todifferentiate the site of injury in ascertaining the type oftreatment that will be rendered. The linkage of bonetendon-muscleoccurs both at the origin and insertion ofthese muscles.The first injury that must be suspected is a fracturewhich is a disruption of bone-from-bone in the linkage.This type of injury can occur both in adult and adolescentathletes. If the bone is the weakest link in the chain,avulsion of bone from adjacent bone can occur. This is amore prevalent in the adolescent athlete and is manifestedby avulsion of an apophysis or growth plate in the pelvis(Figure 4). This type of injury can only be diagnosed by x-ray and, therefore, x-ray should be a mandatorydiagnostic procedure in the early evaluation of groin andhamstring injuries accompanied by tenderness andhemorrhage about the bony attachment. If a fracture oravulsion of a growth plate is present, the treatment mustbe modified in accordance with the type of injury.Injury to the muscle tendon unit is classified as a strain.This would be disruption of the tendon from the bone, anintertendinous disruption, musculotendinous disruption,or a disruption within the muscle belly itself. In thediagnosis of these types of injuries obtaining a history isthe first step. In obtaining the history it is important toknow how the injury occurred, when it happened, andwhere it happened. It is important in evaluating peopleentering the Training Room with pain about the groin orhamstrings to think of several possible alternativeexplanations; those being synovitis of the hip joint,sciatica, hernia, stress fracture of the femoral neck or thepubis, bursitis in any of the multiple bursae about the hipand finally, tumor—bony or soft tissue.Figure 3. GROIN MUSCLES - MEDIAL GROUP -Adductor Longus, Adductor Brevis, Adductor Magnus,Gracilis, Obdurator Externus.44 Athletic Training • Spring 1982Figure 4. Radiograph of adolescent pelvis. Note openapophyses, iliac and pubic.

After the history is obtained, the physical examinationis performed and frequently this is initially conducted bythe trainer in the Training Room or on the field. Afrequent physical finding associated with groin orhamstring injuries is pseudoparalysis. Pseudoparalysis isa false paralysis of the extremity involved and can occuras a result of pain and guarding. It can also occur becauseof hemorrhage about the sciatic nerve which is intimatelyassociated with the hamstring muscles. It can result in aninability or unwillingness to move the extremity.Tenderness is an invariable adjunct and the maximumarea of tenderness will most frequently be in the area ofthe injury. A palpable gap in the tendon or muscle may bepresent in severe injuries and local swelling can occurrapidly with subsequent hemorrhage. As time passes, thehemorrhage becomes visible in the subcutaneous tissue.The athlete will have pain on contraction of the muscle aswell as pain on passive stretching of the involved muscle.The next step in diagnosing the injury is x-ray. X-raysshould be obtained prior to initiation of any form oftreatment as occasionally the x-ray will show fracture or,potentially, a tumor that was unsuspected. The treatmentfor these injuries differs substantially from the treatmentfor musculotendinous injuries.TreatmentThe initial treatment in all soft tissue injuries calls forrest, ice, compression and elevation. This can be initiatedprior to obtaining an x-ray of the involved area. If the x-ray reveals bony injury, surgery may be indicated. Afterx-ray has been obtained and it has been determined thereis no fracture or bony problem requiring furthertreatment, an attempt should be made to reduceinflammatory response and decrease the edema and scartissue characteristic of the healing process. The use ofsteroids is controversial. However, the use of injectableor phoresed steroids is not contra-indicated and can bebeneficial in obtaining more rapid healing with lessresidual scar formation in injuries of the muscle belly. Theuse of steroids proves less effective in treatingmusculotendinous injuries and least effective in treatingintratendinous injuries. Steroids should never be usedwithout the knowledge and consent of the team physician.The use of DMSO (dimethyl sulfoxide) is morecontroversial in treating musculotendinous injuries thanis the use of steroids. The advertisement, availability, andopen discussion of the use of DMSO in athleticpublications and daily newspapers has led many athletesand non-athletes to try it on their own. The use of DMSOin treating acute strains of groin or hamstringmusculature has proven extremely effective in reducingthe inflammatory response, initial swelling, and thediscomfort associated with gentle early stretching andmotion associated with this type of injury. If the patientrequests this form of therapy, it is most efficacious whenused in conjunction with an inert dilutent bringing thepercentage of DMSO to sixty percent. Skin reactions aremore prevalent when the more concentrated forms ofDMSO, available in the local hobby shops and health foodstores, are used.Oral non-steroid anti-inflammatory agents are effectivein reducing both the pain and edema accompanying thistype of injury. These non-cortisone, anti-inflammatoryagents function to reduce the inflammatory responsewhile releasing endogenous endorphins, the natural painkiller, which is present in the human central nervoussystem. The use of injectible local anesthetics can behelpful in reducing spasm when therapy is initiated. It isimportant to note that none of these treatment modalitiesare recommended solely for the purpose of allowing theathlete to return to competition. They serve as adjunctsto maximize the healing rate and insure a rapid return toconventional therapy. They should never be used as apanacea to allow the athlete to return to competition priorto the healing of the injury. These patients should beplaced on crutches until their acute pain has subsided oruntil they are able to ambulate without discomfort.During this time, the modality treatment available in theTraining Room can be initiated. These agents also areaimed at reducing the scar tissue and edema associatedwith the healing process. Ultrasound is helpful as is theuse of transcutaneous nerve stimulation andelectromuscular stimulation: the transcutaneous nervestimulator to diminish the discomfort and theelectromuscular stimulator (EMS) to initiate isotoniccontractions. Friction massage as described by Cyriax isvery helpful in mobilizing scar tissue. The use of whirlpooland local heat can also be helpful. When full range ofmotion can be obtained without pain, gradual progressiveresistance activities, exercises utilizing free weightsand/or pulley systems, Nautilus and Universal systemsshould be initiated. Gradual resumption of activities, totolerance, can then be allowed.Of these forms of treatment, rest is perhaps the mostimportant followed by a stretching program which ismaintained until a full range of motion is achieved.There are multiple predisposing factors that can beidentified prior to the actual injury. These predisposingfactors include selective muscle weakness, imbalance ofthe quadriceps and hamstrings, and muscle/ligamenttightness. The quadriceps-hamstring ratio can be a factorand Klein and Allman have suggested a .60 ratio. That is,the hamstrings should be 60% as strong as thequadriceps. Liemohn has demonstrated in athletes thathip joints injured were less flexible than the opposinguninjured joints. Hamstring-quadricep strength ratios, aswell as strength imbalances between the left and rightlegs may be a predisposing factor in causing injuries.Burkett found there was a relationship in differentialstrength between the hamstrings (right and left). That is,an unequal bilateral flexion-extension strength ratiopredisposed one to hamstring injuries.The time the athlete loses from activity is significantfor any of these injuries and pre-activity evaluation isessential in prevention. This pre-season evaluation shouldbe done prior to competition and should consist offlexibility and strength evaluations, and identification ofpotential injuries. Preventative measures such asstrengthening and stretching programs should beinitiated under the guidance of the trainer. Once theappropriate strength ratios and flexibilities have beenobtained, it is important to continue with a warmup andstretching period prior to vigorous physical exercise,either practice or competition. It is the duty of the trainerto clarify this to the coaches involved. +NOTE: "A special thank you to Mary Roberts for allowing thepictures of herself to be usedin the illustrations."References1. Grant JC, Basmajian JV: Grant's Method of Anatomy.Baltimore, Md., The Williams and Wilkins Company, 1965.2. Burkett LN: Investigation into Hamstring Strains: TheCase of the Hybrid Muscle, Journal of Sports Medicine, 3(5):228-231,1975.3. Burkett LN: Causative Factors in Hamstring Strains,Medicine and Science in Sports, 2(1): 39-42,1970.4. Liemohn W: Factors Related to Hamstring Strains, Journalof Sports Medicine, 18: 71-76,1978.5. Klein KK, Allman FL: The Knee in Sports, Austin,Pemberton Press, 1969.Athletic Training • Spring 1982 45

BostonMedicineInstituteThird AnnualBoston Sports Medicine/Athletic Training Seminar21-25,1982Learn to prevent, diagnose and treat sports injuries this summer at a five-day clinic given by the SportsMedicine /Athletic Training Institute.The clinic will be directed by Dr. Alfred Roncarati, R.P.T., A.T.C., and his staff of nationally-known athletictrainers, physical therapists and physicians known for their work in sports medicine.Learn the many aspects of sports medicine /athletic training along with the latest theories and techniques in thisrapidly changing field.Participants will be awarded a certificate of achievement at the completion of the clinic and will receive threeacademic credits from the University of Massachusetts at Boston. Continuing Education Units for the clinic have beenapproved by the National Athletic Trainers Association (NATA).So if you're an athletic trainer, coach, allied health professional or interested student, this opportunity is for you.SPORTS MEDICINE /ATHLETIC TRAINING SEMINARJune 21-25, 1982Tuition: $210 includes three graduate or undergraduate creditsMastercard and Visa acceptedREGISTER NOW, ENROLLMENT IS LIMITED TO 100Dormitory facilities available for out-of-town students at nearby Emmanuel College.For further information please call (617) 731-0487.STAFFThe professional staff will be headed by Dr. Alfred Roncarati, R.P.T., A.T.C., former head trainer for NortheasternUniversity and presently a full-time faculty member at the University of Massachusetts at Boston, as well as a privatepractice Physical Therapist.Jack Baynes, A.T.C., Head Trainer, Northeastern University, Boston, MALouis DiNitto, A.T.C., Head Trainer, University of Massachusetts, Boston, MABrian Fitzgerald, R.N., Athletic Trainer, University of Massachusetts, Boston, MAJohn Leard, R.P.T., A.T.C., Physical Therapist and Athletic Trainer for Northeastern University, Boston, MAHarriet Pearce, A.T.C., Women's Head Trainer, Massachusetts Institute of Technology, Cambridge, MAPeter Stone, R.P.T., Sports Medicine Resource Center, Brookline, MAtNameFor complete information on the Third Annual Boston Sports Medicine/Athletic Training Seminar, mail thiscoupon to:Sports Medicine/Athletic Training InstituteUniversity of Massachusetts/Boston (Boston State College)Program of Continuing Education625 Huntington AvenueBoston, MA 02115Address.City__Deadline for applications: June 14,1982. State. Zip.

AssociationActivitiesBob Behnke, Indiana State University, Rick Carter, HolyCross University, and Jim Conboy, Air Force Academy,worked with their staffs and MIZLOU Television Networkin producing the feature.The program emphasized the professional preparationand continuing education of the athletic trainer, andhighlighted the value of the trainer and proper equipmentin preventing and treating injuries. The efforts of thesethree trainers will benefit all athletic training programs.Suggestions for future editions of "They Keep 'EmPlaying" will be welcomed by MIZLOU TV, 535 FifthAvenue, New York, New York 10017.Member CreditsDavid Yeo, ATC, DPEMontgomery CountyCommunity CollegeDr. Holly E. Wilson, one of the first five women in 1970to become a certified athletic trainer, received IndianaState University's Distinguished Alumni Award in October.Dr. Wilson is a sports medicine consultant for theAmerican Red Cross, and works for a sports medicineclinic in Berkeley. She has written a basic care andprevention of athletic injury text geared for the volunteercoach.Trainers at World Games for the DeafDavid Bullock, Talawanda High School (Ohio), KathyFox, University of Central Florida, Jack McNeeley,Cleveland State University, Chris Neuman, AmericanScientific Products (formerly of Kansas State University),and Ken Wolfert, Southwest Ohio Sportsmedicine Center,were the trainers for the United States team at the 14thWorld Games for the Deaf held in Cologne, West Germanylast July. The five trainers prepared our 172 deaf athletes,ages 12-30, for competition in volleyball, tennis, track,swimming, water polo and wrestling. Following a threeweektraining camp at Morganton, North Carolina, theU.S. competed against athletes from 31 nations, andgathered 109 medals. The USSR earned the secondhighest number of medals, 55. These 1981 games markedthe first time that the American Athletic Association forthe Deaf had affiliation with the U.S. Olympic Committee.In 1985 the World Games for the Deaf will be held in LosAngeles. It is hoped that many of our trainers will have anopportunity to participate in this rewarding, fulfilling,and challenging experience.* * *Joe Godek of West Chester State College, while chairmanof the National Athletic Trainers Council of theNational Association for Sport and Physical Education,coordinated ten articles on the theme "Sports Health andPreventive Care" which appeared in the September issueof the NASSP Bulletin, the journal of the NationalAssociation of Secondary School Principals. Includedwere articles on administering a program, guidelines, certificationof trainers and liability. This Bulletin shouldserve as a valuable resource for school administratorslooking into the sports health and preventivecare programs for their schools.* * *Several NATA members were responsible for theathletic training program, "They Keep 'Em Playing", PartVI, shown during the Tangerine and Bluebonnet Bowls.John "Jake" Nevin of Villanova University was honoredwith "Jake Nevin Appreciation Night" in November. Therecognition, which took place prior to Villanova's basketballgame against Cibona of Yugoslavia, paid tribute toJake who is entering his 53rd year of service to athletictraining, all at Villanova University. Jake has been inductedinto the Villanova and Big 5 Athletic Hall of Fame,and received the NATA 25-Year Service Award in 1963.* * *Olympics for the Physically DisabledBy Larry Leverenz, ATCWestern Illinois UniversityJune 21, 1981, marked the opening of one of the largestsporting events in the world. Since its origin in 1960, theOlympics for the Physically Disabled have provided anarena of competition for thousands who otherwise wouldnot have an opportunity to participate in an internationalsporting event. Unfortunately, with the exception ofthose involved, the event goes practically unnoticed in theUnited States.The games originated under the guidance of ProfessorDr. Sir Ludwig Guttman in Stoke Mandeville, northwestof London. On an assignment of the British government heestablished a rehabilitation center for war invalids. Theprimary object was to increase the chances of survival ofthe patients, despite their handicaps. This led to sporttherapy.This branch of disabled sports athletics has grown andgrown throughout the years. Since the originalwheelchair games the Olympics has been expanded toinclude not only paraplegics but also amputees, blind, andthose athletes with cerebral palsy.This year the sixth Olympics were held in Arnhem andVeenendaal, Netherlands. Approximately 2000participants from 42 countries were present. This is anincrease of about 500 over the 1976 games in Toronto. Forthe Netherlands this was the largest international sportsevent since the Olympics in 1928 in Amsterdam.The United States sent a team of approximately 150athletes and 35 support staff to Arnhem. Representationby disability included approximately 60 paraplegics, 50blind, 15 amputees (these were all D class amputees inwheelchairs, no standing amputees attended for theUSA), and 25 cerebral palsied athletes. The U.S. made agood showing in Arnhem bringing home 198 medals, morethan any other nation represented. Poland was secondwith 178.The Dutch Organizing Committee did a tremendous jobproviding for the special medical problems encounteredby the disabled athletes. They had physicians, dentists,nurses, physical therapists, and a pharmacy in theOlympic village as well as medical personnel at the gamesites. They also provided individual team medical staffsworking space and supplies as needed.Immediately upon arriving in the Olympic village theathletes were required to have a medical evaluation toofficially verify their classification within each disability.Athletic Training • Spring 1982 47

For example, the blind team members are divided intotwo groups. Class A athletes are those athletes who aretotally blind or possessing light perception only. Class Bathletes are those athletes possessing a visual acuity ofnot better than 20/400 (6/120m).The International Sports Organization for the Disabled(ISOD) has accepted the offer by the United States to hostthe 1984 games. This event will require not onlyorganization of facilities, transportation, and officials butalso involvement of the sports medicine community.Although there has been individual involvement byphysicians, nurses, physical therapists, athletic trainers,and other medical personnel, to my knowledge no sportsmedicine group has established a committee within theirorganization to deal with this group of very fine athletes.It is hoped that through the preparation for the 1984games, progress will be made in this area also. As abeginning step in this direction the USABA SportsDevelopment Committee has established a SportsMedicine Committee. Dr. David M. Wilson of the MayoClinic, and Larry Leverenz, Western Illinois University,were appointed co-chairpersons of this committee. It ishoped that through this effort sports medicineinformation can be disseminated to local coaches and somebasic areas of possible research and data gathering can beestablished.District NewsDistrict 2—Update on Licensure in PennsylvaniaNegotiations are continuing with the PennsylvaniaPhysical Therapy Association concerning the statecredentialing of athletic trainers. A special credentialingtask force, as established by the State Board of PhysicalTherapy Examiners, was expected to introducelegislation to the State House and Senate in January,1982. Certification by the State Physical Therapy BoardDMSO Continued from page 29Structure of Chromatin, Journal of Molecular Biology 87:137-162,1974.19. McCann J, et al: Detection of Carcinogens as Mutagens inthe Salmonella/Microsome Test: Assay of 300 Chemicals,Proceedings of the National Academy of Sciences USA 72:423-427,1967.20. Maibach HI and Feldman RJ: The Effect of DMSO on PercutaneousPenetration of Hydrocortisone and Testosteronein Man, Annals of the New York Academy of Sciences 141:423-427,1967.21. Mollet P: Toxicity and Mutagenicity of DMSO in 2 Strains ofDrosophila Melanogaster, Archives of Genetics 47: 184-190,1974.22. Mollet P: Lack of Proof of Induction of Somatic Recombinationand Mutation in Drosophila by Metyl-2-Benzimidazole Carbonate, Dimethyl Sulfoxide and AceticAcid, Mutation Research 40: 383-388,1976.23. Perlman FW and Wolfe HF: Dimethyl Sulfoxide as aPenetrant Carrier of Allergens Through Intact Human Skin,Journal of Allergy 38: 299-307,1966.24. Percy EC and Carson JD: The Use of DMSO in Tennis Elbowand Rotator Cuff Tendonitis: A Double Blind Study,Medicine and Science in Sports and Exercise 13: 215-219,1981.25. Rachun, Alexius, Standard Nomenclature of Athletic Injuries,American Medical Association, Chicago, Illinois, 1966,157 pp.26. Sams WM, Jr, et al: Effects of Dimethyl Sulfoxide onIsolated Innervated Skeletal, Smooth and Cardiac Muscle,Proceedings of the Society for Experimental BiologicalMedicine 122: 103-108,1966.will be administered by an Advisory Committee of threecertified athletic trainers appointed by the governor. Theproposed state credentialing will have two levels of certification.Full implementation is hoped for by July, 1982.allowing Pennsylvania to join Georgia, Texas, Kentuckyand Oklahoma as states with some system of legislationregulating the practice of athletic training.Flashbacks in NATA HistoryORIGIN OF ATHLETIC TRAININGMike O'Shea, ATCUniversity of MiamiThrough research, it appears that athletic training hadits beginning during the days of primitive man and theearly civilization of Greece. The primitive man could notlet minor injuries keep him from hunting game, thus,someone had to care for these injuries, which were usuallythe shaman or the medicine man.Athletics were a large part of the life of the Greekpeople. The Greeks had athletes as well as athletictrainers. They called the trainers paidotribes or "boyrubbers", aleiptes or "annointer", and gymnastes or onewho had knowledge of the effect of diet, rest, and exerciseon the development of the body. All of these suggestedthat massage was an important part of the duties of thetrainer.The greatest of all Greek trainers was said to beHerodicus of Megura who was considered a physician aswell as a trainer.Claudius Galen was considered as one of the firstathletic trainers and team physicians. He consideredhimself one of the greatest physicians and trainers of thisperiod. Galen and Hippocrates, "father of modernmedicine", both wrote on the values of physical training.ASSOCIATION ACTIVITIES Continued on page 5627. Scherbel AL, et al: Alteration of Collagen in GeneralizedScleroderma (Progressive Systemic Sclerosis) After Treatmentwith Dimethyl Sulfoxide, Cleveland Clinical Quarterly32: 47-50,1965.28. Shealy CN: Physiological Substrate of Pain, Headache 6:101-102,1966.29. Smith RE and Hegre AM: The Use of DMSO in Allergy SkinTesting, Annals of Allergy 24: 633-635,1966.30. Stecher PG, The Merk Index 8th Edition, p. 745.31. Sulzberger MB, et al: Some Effects of DMSO on Human Skinin Vivo, Annals of the New York Academy of Sciences 141:437-440,1967.32. Weismann GD, et al: Effect of DMSO on the Stabilization ofLysosomes by Cortisone and Chloroquine in Vitro, Annals ofthe New York Academy of Sciences 141: 326-332, 1967.33. DMSO: No Proof of Miracles, PDA Consumer, pp. 29-39,September, 1980.34. Yee B, et al: Biological Effects of Dimethyl Sulfoxide onYeast, Biochemical Biophysiological Research Communications49: 1336-1342,1972.35. Richard Lebovitz, Chief Counsel's Office, Drug EnforcementAgency, Washington, D.C. 202-633-1141.36. William P Powell, RPH, Community Medical Center, MarsHill, NC 28754.37. David, Norman A, MD: Use of Dimethyl Sulfoxide (DMSO)In Acute Musculoskeletal Injuries and Inflammations,presented at the National Coaches Clinic, June 17,1965.48 Athletic Training • Spring 1982

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AbstractsJohn Wells, ATC, PT, PhDMars Hill College"Cryotherapy," John E. Hocutt, Jr., American FamilyPhysician 23: 141-144, March, 1981.For many years, physicians have debated the questionof whether heat or cold should be used in treatment ofmoderate to severe acute traumatic injuries. Today, thereis general agreement that direct application of cold to theinjured area is the treatment of choice in the immediatepost-traumatic period. This period ends when the initialtissue response to trauma is completed or stabilized(usually 24 to 72 hours). The completion of the injuryprocess marks the beginning of the rehabilitation period,which continues until maximum rehabilitation is achieved.The application of ice or equivalent cold to human skinproduces four phases of sensation. In Stage 1, the patienthas a cold feeling, which lasts one to three minutes afterapplication. Two to seven minutes after initiation ofcryotherapy, the patient experiences a burning or achingsensation (Stage 2). In 5 to 12 minutes, local numbness ofanesthesia is achieved, defined by a marked decrease inconductivity of regional nerve fibers (Stage 3). At thispoint, pain and reflex impulses are inhibited and the painspasmcycle is interrupted. Twelve to fifteen minutes ofice exposure produces a reflex deep-tissue vasodilation,without an increase in metabolism (Stage 4). Immediatelyafter the injury, ice should be applied to achieve Stage 3cryotherapy. Once the injury phase has been stabilized,Stage 3 cryotherapy should be combined with mildmovement and/or controlled exercise. As healingprogresses, exercise may become more forceful. Mostathletes are willing to endure the brief burning or achingassociated with cryotherapy. Once injured athletes seethe results and experience the comfortable sensation ofStage 3 and 4 of cryotherapy, maintenance ofrehabilitation is often easy.Linda Murray"Selective Training of the Vastus Medialis Muscle UsingEMG Biofeedback," Barney F. LeVeau and Carol Rogers,Physical Therapy: The Journal of the American PhysicalTherapy Association 60: 1410-1415, November, 1980.The purpose of this study was to determine if, by usingEMG biofeedback, the vastus medialis could be trained tocontract independently of the vastus lateralis. If so, thealignment of the patella could be adjusted by muscle control.Subjects were five male and five female volunteers.Their ages ranged from 22 to 29 years. The instrumentationused for the study was two EMG biofeedbackunits. Daily training sessions were five days a week,one half hour each day. The total training was threeweeks, or seven and one-half hours. The study had twoparts. In part one, subjects were asked to decrease themuscle activity level in the VL while maintaining a percentageof reference activity level in the VM. Training forpart one lasted two weeks. In part two, subjects wereasked to increase the activity of the VM while maintainingthe activity of the VL below a daily determined percentageof the reference activity level. For both parts ofthe investigation the muscle activity reference levels forVL and VM were determined daily from the maximumamounts of weight the subject could hold at 170 degrees ofextension of the dominant leg. During the final week oftesting, emphasis was placed on raising the muscle activitylevel of the VM while keeping that of the VL below afixed level. The success of the training was assessed byusing independent tests designed to compare 1) the activitylevels of the VM and the VL, and 2) the spread betweenthese two activity levels. This study indicates that,by using EMG biofeedback, the VM may be trained to contractindependently of the VL. Implications can be drawnfrom this investigation to knee rehabilitation. If thistechnique can be successfully used with patients, kneedisorders such as hypermobile patella, chondromalacia,progressive lateral subluxation, and degenerative arthritisof the patellofemoral joint may be able to betreated conservatively.Bob and Kathy Doyle"Mandibular Position and Upper Body Strength: AControlled Clinical Trial," Martin S. Greenberg, et. al.,The Journal of the American Dental Association. 103:576-579, October, 1981.An increasing number of clinicians, dentists, and otherspecialists treat various disorders by repositioning themandible with mouthpieces, templates, and bite plates.Because repositioning appliances have received muchpublicity and athletes have purchased them on the basis ofthese claims, it was thought that a controlled trial waswarranted. A total of 14 members of the University ofPennsylvania varsity basketball team participated in thestudy. To structure a blind study, the subjects were toldthey would be part of a study to evaluate two differenttypes of appliances. This allowed testing placebo againstexperimental, and the combined appliance data against noappliance. Shoulder abduction and adduction were testedon the subject's dominant shooting arm with adynamometer (Cybex II Isokinetic Dynamometer). Nosubject tested had clinical or historic evidence of TMJdysfunction, myofacial pain dysfunction syndrome(MPDS), or posterior bite collapse. Results clearlydemonstrate no change in strength while the bite openingappliance is worn. It is likely that reports of increasedstrength are related to a placebo effect rather than to thedirect result of the appliance. The results indicate thatopening the bite will not increase upper body strength ofthe normal subject.John Wells +Athletic Training • Spring 1982 51

JOSEPH N. ABRAHAMMay 4, 1919 - December 26, 1981Joseph N. Abraham, 62, Head Trainer and retired Athletic Director of Hobart College,died in Geneva General Hospital on December 26.A member of the Hobart faculty since 1945 when he became an instructor in physicaleducation, he became chairman of the department in 1955, full professor in 1968,and, from 1979 to 1981, served as athletic director.Born in Wilkes-Barre, Pennsylvania, and graduated from Geneva High School, he receiveda bachelor of science and masters degree from Ithaca College. He began his career asa physical instructor at Windham Central School and later served in the Army Air Corpsduring World War II.One of the founding fathers of the Eastern Athletic Trainers Association, he served assecretary-treasurer for the past 17 years. In 1970, he was named to the Helms Hall ofFame, and in 1976, received the Thomas Sheehan Award for his contributions to athletictraining in New York State.Honors included selection as a trainer for the U.S. Olympic team to the 1968 and 1972summer games and to the 1980 Lake Placid winter games. He was chosen five times as atrainer for the annual North-South All-Star Lacrosse game.In November, Abraham was honored with a testimonial dinner by Hobart College andAthletic Association, at which time he received an award "for support and outstandingleadership." On December 24, Joseph Abraham was presented the honorary degree ofDoctor of Humane Letters.Surviving are his wife, Mary; one son, Dr. William Abraham; one daughter, Mrs. JoanneDwyer; two grandsons; and three brothers, Anthony, Daniel, and Floyd.A recent note in the Eastern Athletic Trainers Association newsletter regarding Joebears repeating:"We may never fully realize all that he has done for us over the years,and surely there was no fanfare surrounding the effort. Others preceded,there will be others still to follow, however none can duplicate hispresence. We are deeply indebted to him for his time, patience, and sacrifice."52 Athletic Training • Spring 1982

2412 St. Marys Ave., Omaha, NE 68105Time Out offers a complete lineof athletic foot comfort products.With Time Out products trainersdevelop simple, effective and economicalsolutions to athletic foot care problems. Properfoot care saves time and money, and helps assurethe maximum number of playing hours for young athletes.ATHLETIC TRAINING ROOM PRODUCTSFOR FOOT CARE AND FOOT COMFORTTURF TOERELIEF &PREVENTIONTime Out introduces an inexpensivesolution to the universalturf toe problem. Theexclusive Time Out Turf ToeShoe Liner helps preventinjury, and aids healing andminimizes pain when injuryoccurs. A special stainlesspolished spring steel plateadheres to a 1/16" shoe linerfor easy insertion into anyathletic shoe.ORTHOTICCOMFORT KITWith the Time Out do-it-yourselfOrthotic Comfort Kit you build effective,comfortable support devicesright in the training room. Thecombination of devices is almostlimitless. Your finished product isdurable; it can be washed anddried repeatedly.The Orthotic Comfort Kit includes:Arch Supports Heel CradlesMetatarsal Pads Heel LiftsVarus Wedges Glue3/4 Comfort InsertsMALLEOLUSWRAPThe Time Out Malleolus Wrapis a simple protective devicedesigned specifically to preventmalleolus strain. Whenstrain does occur the wrapaids the healing process. Thewrap, a 3" x 6" pad of Va"foam, rests comfortably onthe malleolus bone. The padsare so practical and economicalyou can use them onevery player every day.To order the above products or any Time Out athletic foot comfort product call:TOLL FREE 1-800-228-9482. In Nebraska call collect 402-342-2985.Do you have a specific athletic foot care need? Call us at the above number, we canhelp. Time put can custom cut items you use in quantity. With Time Out on your teamyou'll save time and money, too.TIME OUT. MANUFACTURING FOOT CARE PRODUCTS IN OMAHA, NEBR. FOR 55 YEARS.

NFRANCIS J. SHERIDANMay 22,1924 - October 8,1981Francis J. Sheridan, 57, Head Trainer at LafayetteCollege for 20 years, died October 8, 1981. He joined theLafayette staff in 1960, and retired in 1980 to take a job asSupervisor of Physical Therapy at Hunderdon StateSchool.Mr. Sheridan served in the U.S. Air Force duringWorld War II with the Flying Tigers. He was HeadTrainer at Phillipsburg High School, in New Jersey, from1950-59. Fran also served as Trainer at the 1967 Pan AmGames and for the USA, AAU Track Teams in 1973 and1976.A Vice President of the EAIA in 1961, he was thePresident in 1962. Mr. Sheridan served on the NATABoard from 1968-75, as the District Two Director. From1971-75, he was Vice President of the Board. He was amember of the National Membership Committee for eightyears.In 1974, Fran earned the 25-year award and wasinducted into the Citizens Savings Athletic Foundation'sNATA Hall of Fame in 1977.Surviving are his wife, Gladys; a daughter, Mrs. LeonHarrison and two sons, Phillip and Michael.54 Athletic Training • Spring 1982

Schedule of Future Sites and DatesNATA Certification ExaminationRevised: July, 1981REGIONAL(All regional sites subject to a minimum of six candidatesper site and limited to a maximum of thirty candidates.)ALL SITES SUBJECT TO CHANGE.January 17,1982Eugene, OregonFort Worth, TexasGrossingers, New YorkAtlanta, GeorgiaDayton, OhioDeadline for requesting application forms:October 15,1981*Deadline for returning applications:December 1,1981*March 21,1982Odessa, TexasLexington, KentuckyEugene, OregonRaleigh, North CarolinaPhiladelphia, PennsylvaniaDeadline for requesting application forms:December 15,1981*Deadline for returning applications:February 1,1982*San Jose, CaliforniaRaleigh, North CarolinaAnn Arbor, MichiganLawrence, KansasTucson, ArizonaAnn Arbor, MichiganNew Britain, ConnecticutSan Jose, CaliforniaLincoln, Nebraska*(District 5 meeting)(test date 3-19-82)(Please indicate the date you wish to take the exam whenrequesting the application; also indicate the section underwhich you plan to apply: SEC I - NATA ApprovedCurriculum, SEC II - Apprenticeship, SEC III - SpecialConsideration, and SEC IV - Physical Therapy.)NATIONAL CONVENTIONJune 13, 1982 National Convention Site: Seattle,Washington.(Subject to a maximum of 50 candidates - applicationsare accepted in order of remittance - only 25 additionalcandidates accepted for the written examination. Juneand August applications are processed under the samedeadlines.)August 1,1982Ann Arbor, MichiganCedar Falls, IowaLexington, KentuckyEugene, OregonNew Britain, ConnecticutDeadline for requesting application forms:March 15,1982Deadline for returning applications:May 8,1982Application forms available from:NATA Board of CertificationP.O. Drawer 1865Greenville, NC 27834Raleigh, North CarolinaPhiladelphia,PennsylvaniaIndianapolis, IndianaSacremento, CaliforniaNOTE: The 1983 Exam dates will approximate the 1982dates and sites on a regional basis. The national exam willbe given at the site of the annual NATA convention withsimilar numerical limitations.*A11 items must be received by the NATA Board of CertificationOffice by the specified deadline date.MIISNIPLIKE APROThe OriginalSuper PRO 10ScissorsThe perfect tape removal shears.Long-lasting edge cuts throughmultiple layers of tape, felt and othercast materials. Easy-on-the-fingerslarge handles. Double-plated chromeover nickel prevents rusting. Fullyresharpenable. A must for thetraining, treatment and cast room.Only $17.95Other Training Aidsfrom PROPRO Wichita LinemanThe emergency kit-on-a-belt. Designedfor quick access while on the field. Snapson your belt. Carries (not provided):ammonia capsules, oral screw, SuperPRO 10 Scissors, adhesive tape.Only $14.95PRO Scissors HolderSturdy, heavy duty leather holster snapsto belt. Designed for years of service.Welt seams and rivets at stress points.(Scissors not included)Only $9.95Order today. Use the coupon or ^SS*call TOLL FREE 1-800/523-5611 •• •PRO • Orthopedic Devices, Inc. IP.O. Box 1, King of Prussia, PA 19406215/265-3333Please send me:___ Super PRO 10 Scissors @ $17.95 ea.___ PRO Wichita Lineman @ $14.95 ea.___ PRO Scissors Holster @ $9.95 ea.Plus $3.00 shippingTotal amount enclosed $______D CHARGE IT.Card #____Expiration Date-Name_____Address.City/State/Zip_I PA residents add 6% sales tax.D VISA D Master ChargeJAthletic Training • Spring 1982 55

ASSOCIATION ACTIVITIES Continued from page 48Following this period and up until the 19th centurythere was a lack of professional training and research.There did exist athletic trainers, and the first recordedprofessional athletic trainer associated with aneducational institution was James Robinson of Harvard in1881.Prior to 1860, most athletes cared for themselves, if anycare was given at all, but in the middle 1800's came thebeginning of intercollegiate sports and with them cameinjuries. The athletic trainer, if there was one, was seldommentioned because the team physician and the coachwould take the responsibility. It can be seen why theathletic trainer took the title "water boy" or "rubber" inthe early 1900's.During the 1900's, until 1940, the athletic trainer lackedprofessionalism and education, but mostly lacked anassociation for the sharing of ideas. Although thestandards of the trainer were low and the trainer wasseldom mentioned, there were men who were trying to upgradethe profession to strive for unity among all athletictrainers.People such as Dr. S.E. Bilik, the "father" of ModernAthletic Training, Oliver J. DeVictor, a dean of athletictraining, Matt Bullock, Herb Patchin, Jack Heppinstalland Henry Schmidt are all responsible for paving the pathfor this profession and giving ideas for a nationalassociation.The people who have as much as anyone to do withathletic training reaching the high standards of today andwho should be given long overdue credit are Frank andCharles Cramer of the Cramer Company of Gardner,Kansas.Correction:In the Fall 1981 issue of Athletic Training, an NATAPostgraduate Scholarship was described as being sponsoredby the National Basketball Association. The actualsponsor is the National Basketball Trainers Association.Reminder...This column of the Journal is intended to summarizemember credits, district news, historical flashbacks,liaison affairs, international news, and awards. In order tobe comprehensive and effective, information andacknowledgments must be submitted by the NATA membership.All members are invited to forward news and information,of themselves or others, to:Dr. David G. YeoMontgomery County Community CollegeBlue Bell, PA 19422Phone: 215-641-6510 +MOVING?Please notify the NationalOffice of your newaddress as well as yourold address.Don't Miss Out!!!Subscribe now toAthletic Tra in in gand get in on thelatest developments insports medicine!RTHLETIITRBinmcP.O. Box 1865Greenville, N.C. 27834Please enter my subscription for Athletic Training magazine:( ) $15.00 for 1 year subscription*( ) $25.00 for 2 year subscription*( ) $35.00 for 3 year subscription*Name _Address.City .....__.—._-* Foreign subscribers add $5.00 per year for postage.(Please enclose check or money order.)State_______ .Zip.56 Athletic Training • Spring 1982

Case Report:Avulsion Fractures of theAnterior Superior Iliac Spinein High School TrackMark Lee Miller, BS, RPTIntroductionIndividuals participating in athletic events andindividuals working with athletes know that the humanbody must be pushed to its limits in order to improveor excel. However, when doing this, athletes subject theirbodies to possible traumas, and increase their odds ofsustaining an injury as compared to less sedentary andnon-athletic individuals.Certain athletic injuries are common to all sports,whereas other injuries occur in much higher incidence inspecific sports. Age of individuals also has a bearing onthe type and frequency of injury. This case report onavulsion fractures of the anterior superior iliac spineinvolves both of these two common characteristics—aspecific sport and the age of the individuals. Avulsionfractures of the anterior superior iliac spine are of ahigher incidence in adolescent athletes and are morerelated to springing and/or kicking sports.It is the intent of this author to report on and to educatethose involved in athletic training to a not so commonathletic injury—one that can often be correctly assessedby the trainer prior to roentgenological and physiciandiagnosis.The avulsion usually occurs following an unusuallysudden forceful muscular contraction of the sartorius ortensor fascia lata in a running or jumping event. 3 It ispeculiar to those sports of the sprinting or hurdlingnature, soccer, football kicking or punting, andoccasionally high jumping and pole vaulting. In a study byOrva and Ala-Ketola 4 of thirty-four individuals withdiagnosis of avulsion fractures, nine of the injuries wereto the anterior superior iliac spine. Also noted as the factthat some of the fractures were not instantaneous, asathletes felt pain at the fracture site before theReview of LiteratureThe anterior superior iliac spine is the bony attachmentor origin for the tensor fascia lata and the sartoriusmuscle. The sartorius, the longest muscle of the body, is aflexor of the hip and knee and is a secondary externalrotator of the hip. It arises from the extreme portion ofthe anterior superior iliac spine, and inserts into theproximal part of the medial surface of the tibia. 1 Thetensor fascia lata causes flexion of the hip and someinternal rotation to occur upon contraction. Its origin is onthe outer border of the anterior superior iliac spine, withinsertion between the two layers of the iliotibial band ofthe fascia lata. 1Review of the literature reveals little information oninjury of this specific area. Rockwood and Green 6 statethat, until 1935, as few as 50 cases of avulsion fractures ofthe anterior superior iliac spine were reported. Most ofthe medical literature reports are of athletes in the mid tolate teen group, as this is the approximate age that theiliac crest unites with the ilium.Mr. Miller is Director of Physical Therapy at St. Mary'sHospital, Streator, Illinois 64364, and is currently a graduatestudent at Illinois State University, completing the curriculumfor an MS in Health, Physical Education, Recreation — AthleticTraining.Figure 1. The arrow in the center of the pictureillustrates the avulsion fragment of the anterior superioriliac spine of subject #1. All other bony structures arenormal.Athletic Training • Spring 1982 57

occurrence of the actual ruptures or avulsions.Following a fracture of this nature, an athlete willusually complain of extreme local pain and tenderness ofthe anterior superior iliac spine. Active hip flexion orpassive flexion of the knee with the hip extended willcause pain directly in the area with the intensitydependent upon individual pain tolerance and severity ofthe avulsion. These two characteristics usuallydifferentiate the fracture from a contusion. Palpation ofthe fragment may be possible, with the fragment as muchas one inch inferior to the attachment of the superior iliacspine. Passive flexion of both the hip and knee oftenrelieves the discomfort. It should be noted also that anavulsion of the tendon only may occur without the bonefragment. 3 Ambulation may be possible, but a definitedeviation will be noted, and more than likely the athletewill not want to walk after attempting a few steps.Treatment of the injury is varied. Conservativetreatment consists of bed rest with the hip and kneeflexed. The hip may also be abducted and/or externallyrotated. Individuals with this condition are allowed to sitwhen they wish, with the thighs being slightly abducted.Ambulation, when initiated, is usually with crutches, nonweight bearing on the involved side.Occasionally an individual is placed in a hip spica cast. Ifnecessary, surgical intervention may be used, internallyfixating the fragment and then applying a spica cast.Robertson 5 has reported such a technique. Recoveryusually takes longer because of the completeimmobilization.Case ReportThis report involves two such injuries, which ironically,occurred on successive nights. One involved a male in highschool track, the other a female also in high school track.Both athletes participated in the same type of event, the440-yard relay. The male was running the third leg of theevent, the female the second leg.Case one was a 16-year-old male, and the incidentoccurred on April 16, 1980 during competition. The injurywas witnessed, and a hamstring strain was suspected asthe athlete "pulled up" after a few running strides. Whenquestioned, the athlete reported that he had warmed up inhis usual manner. However, during his second or thirdstride after receiving the baton, he reported feeling avery sharp pain in the left anterior hip area during stancephase of the left lower extremity. Stance phase is definedas beginning when the heel strikes the ground and endswhen the toe rises at the end of the stride. During runningthis phase is much shorter and more stressful than duringwalking. Palpation of the area revealed point tendernessand pain over the anterior superior iliac spine. The athletewas able to walk with short strides only. He wasinstructed to discontinue competition, go home, and to liesupine with hip and knee flexed and to ice the area with anice bag. If pain persisted, he was told to report to thetrainer/therapist at the hospital the next morning, or, ifthe pain was intense, to contact his family physician. Atthis point in time, the avulsion fracture was not suspectedby the trainer. The pain persisted, and the next morningarrangements were made for x-ray diagnosis and anexamination by his physician. The x-ray (Figure 1)revealed an avulsion fracture of the left anterior superioriliac spine.The athlete was placed on non weight-bearingambulation, using crutches, with no physical therapytreatments ordered, and no external immobilizationutilized. He was able to attend school, but participated inno extra-curricular activities. He resumed normalactivities approximately 6-8 weeks post incident. He didnot participate in any sport other than track, and resumedrunning with no further complications.THE FUTURE ISWITH THE AMERICA'SNATIONAL SCHOOLOF SPORTASSISTANTSHIPS/SCHOLARSHIPSFORTHOSE PEOPLE LOOKINGFOR A CHALLENGINGAND INNOVATIVEMASTER'S PROGRAM IN:SPORT MEDICINEFITNESS MANAGEMENTWrite:Academics or JobsUNITED STATESSPORTS ACADEMYDept. DP. O. Box 8650Mobile, Alabama 36608EEO/AAE58 Athletic Training • Spring 1982Figure 2. The arrow on the right of picture illustrates theavulsion fragment of the anterior superior iliac spine ofsubject #2. The apparent increase in size of this fragmentmay be secondary to the angle of the x-ray.

Case two involved a 15-year-old female, and the injuryoccurred during track competition on April 17, 1980. Thetrack meet was held in another community, and followingher injury, the athlete was transported to a local hospitalby ambulance. The mechanism of her injury was similar tothat of the young man in the previous case (above) in thatit occurred as she was in the stance phase of the left lowerextremity. She too felt the sudden sharp pain in heranterior hip. However, this athlete was unable to walkand required hospitalization. Figure 2 is a view of her x-ray.Hospitalization continued for several days aftertransfer back to the facility near her home. Managementof the condition consisted of bed rest. When ambulationwas initiated, no weight was placed on the left lowerextremity and crutches were also used as the ambulationassistive device. After 6-8 weeks she, too, was allowed toresume activities, and five months later she wasperforming her activities as a cheerleader. Following thecheerleading season she did attempt to return to her trackactivities, but since has discontinued track participationbecause of a burning sensation in the area of the anteriorsuperior iliac spine.DiscussionAvulsion fractures of the anterior superior iliac spinemay occur in any athlete. However, because of its growthrelatedness, individuals involved with high schoolathletics should suspect this injury with any type oftrauma to this anatomical area. Proper treatment by thetrainer could alleviate discomfort of the athlete prior toexamination by the team and/or family physician. Atminimum, and dependent upon pain, the trainer shouldapply an ice pack to the area, and place the hip and knee inslight flexion. Transportation of choice is by stretcher. Ifthis is not available, non weight-bearing crutchambulation or assistance by two other athletes allowingnon weight-bearing on the involved extremity may beutilized. A hip spica using an ace bandage or bandagesmay be utilized for limiting mobility prior to seeing thephysician, especially if any length of time before physiciancare is anticipated. Any sensory loss should be welldocumented and the wrap should never impede circulationto the extremity.Caution should be taken with the extremelycompetitive athlete who might consider the injury amuscle pull that can be "walked off. The injury shouldnot be confused with a groin pull as the discomfort is toofar superior and lateral for a groin injury. A spica wrapmight be utilized for assistance once the athlete has beencleared by his/her physician, or when they are allowed tostart weight bearing activities. Dependent upon theathlete, follow-up treatment may be initiated using eitherwhirlpool or hydrocollator packs prior to range of motionexercises. Rehabilitation, utilizing progressive resistiveexercises, should also be considered at a later date. Ifsurgical intervention is necessary, a routine of isometricexercises would benefit and retard atrophy. Any form ofrehabilitation should be preceded by a physician's order.SummaryAvulsion fractures of the anterior superior iliac spineare not a common injury in sports. They do occur inathletes in the prepuberty stage more than in matureathletes, and occurrence can often be detected by theathletic trainer.These two case reports may provide moreunderstanding and insight into the injury that is usuallycaused by a sudden forceful contraction of the sartoriusmuscle. It is important that those coaches, teachers,school nurses, trainers, and family physicians dealingwith the young athlete recognize the severity of thisinjury and not classify it as simply another pulled musclewhich can be "walked off. +References1. Gray H: Anatomy of the Human Body. 28th edition.Philadelphia, Lea and Febigar, 1971, pp. 238, 495-496, 501-502.2. Krusen FA: Handbook of Physical Medicine andRehabilitation. Philadelphia, WB Saunders Co., 1971, pp. 92.3. O'Donoghue DH: Treatment of Injuries to Athletes. 2ndedition. Philadelphia Saunders, 1970, pp. 446-447.4. Orva S, Ala-Ketola L: Avulsion Fractures in Athletes,British Journal of Sports Medicine, 11: 65-71,1977.5. Robertson RC: Fractures of the Anterior Superior Spine ofthe Ilium, Journal of Bone and Joint Surgery, 17(4): 1045-1048,1935.6. Rockwood CA, Green DP: Fractures. Philadelphia, J.B.Lippincott, 1975, pp. 926-927.Athletic Training • Spring 1982 59

A Tip From the FieldInnovation in Rehabilitation:Make Your Own Sand WeightsJanet Lozar, ATC, MSMany universities and high schools do not have thefinancial resources available to purchase expensiveweight apparatus for rehabilitation of athletic injuries.Therefore, many of these injuries are not properlyrehabilitated and the injured are left in a weakened state.By making your own sand bags to use as weight apparatusyou can help to minimize this problem.Materials (Figure 1)Sand (mixed with small rocks for added weight)Bread wrappers3" Orthopaedic StockinetteProcedureFill bread wrappers approximately half full with sandand tie each bread wrapper in a knot. In order to minimizeleaking, place the filled bag in another wrapper and tie italso. (Fig. 2).Have enough stockinette available to contain the sandMs. Lozar is the Women's Athletic Trainer at the University ofTennessee at Martin, Tennessee 38238.bags with some left over for tying the weights to the extremity.Work the sand bags through the stockinette sothat the bags become evenly distributed. Place thedesired amount of weight into the stockinette. It may benecessary to make more than one sand bag stockinette inorder to allow for additional weight. (Fig. 3).Tie a knot at each end of the stockinette in order to keepthe sand bags in place. Use a square knot and tie theweights onto the extremity that is to be rehabilitated.(Fig. 4).ConclusionsMaking sand bag weights out of orthopaedic stockinetteis a fairly inexpensive way to rehabilitate some athletic injuries.With careful instructions on their usage, theseweights can be sent home with athletes over vacations sothat their rehabilitation program is not interrupted. +Editor's Note: Anyone wishing to have an idea,technique, etc. considered for this section should send onecopy to Ken Wolfert, 111 Buckeye Street, Hamilton,Ohio 45011. Copy should be typewritten, brief, and concise,using high quality illustrations and/or black andwhite glossy prints.1 ROLLCURITYORTHOPEDICSTOCKINETTESFigure 360 Athletic Training • Spring 1982Figure 4

June 12-16, 1982SEATTLEYou Can Fly For LessSAVE $ on individualTo SeattleNATIONAL ATHLETIC TRAINERS ASSOCIATIONwith AMERICAN AIRLINES makes this outstanding service— available to attendees20% to 45% discount off regular coachfares onPAYMENT: Major CREDIT CARD acceptable to the airline*or Invoice. No Invoicing after May 12, 1982(Call The Airline DIRECTLY)American 800-433-1790Identify Yourself with » STAR 5668 «(In Texas Call 800-792-1160)*Placing of reservation with Credit Card numberDEPART/RETURNwill be your authorization to charge your accountDepart Thursday, FridaySaturday. Stay 1 night CONVENIENCEminimum. , ,.Immediate routing andconfirmation on ALL airlines.Cambridge Lord Corporation* "¥.Park Ridge, Illinois is officially appointed by the Associationfor air transportation.Athletic Training • Spring 1982 61

Guide to ContributorsAthletic Training, the Journal of the NationalAthletic Association, welcomes the submissionof manuscripts which may be of interest to personsengaged in or concerned with the progressof the athletic training profession.The following recommendations are offeredto those submitting manuscripts:1. Seven copies of the manuscript should beforwarded to the editor and each pagetypewritten on one side of 8'A x 11 Inchplain paper, triple spaced with one Inchmargins.2. Good quality color photography is acceptablefor accompanying graphics but glossyblack and white prints are preferred.Graphs, charts, or figures should be ofgood quality and clearly presented onwhite paper with black ink. in a formwhich will be legible if reduced for publication.Tables must be typed, not hand written.Personal photographs are encouraged. 4-All art work to be reproduced should besubmitted as black and white line art(either drawn with a Rapldograph [technicalfountain pen] or a velox stat or PMTprocess) with NO tonal values, shading,washes. Zip-a-tone — type screen effects,etc. used.All artwork to be reproduced In black plusa second (or more colors) should be submittedas black and white line art (seeabove paragraph), with an Amberlith® orsimilar-type overlay employed for eacharea of additional colorfs). Also, all areas oftonal value, shading, "washes", etc. shouldalso be supplied on a separate clear orfrosted acetate or Amberlith® overlay. Inaddition, all areas to be screened (a percentor tint of black or color) should besupplied on an Amberlith® overlay.3. The list of references and citations shouldbe in the following form: a) books: author,title, publisher with city and state of publication,yean b) articles: family names,initials and title* of all authors, title ofarUdeJoumal title, with abbreviations acceptedas per Index Medicus, volume, page,year. Citations In the text of the manuscriptwill take the form of a number inparenthesis, (7), directly after the referenceor name of author being cited, Indicatingthe number assigned to the citationbibliography. Example of references 5.to a journal, book, chapter In an editedJournal DeadlinesIn order to avoid confusion anddelays for any contributions youhave for the Journal the deadlines forvarious sections of the Journal areprovided below.Send all materials for any selectionof the Journal other than formal articlesand "Calendar of Events" to:Ken Wolfert111 Buckeye StreetHamilton. OH 45011This includes sections such as"Tips From the Field," "Announcements,""Case Studies," "Letters tothe Editor," etc. The deadlines are:Journal DeadlineFall Issue June 15Winter Issue September 15Spring Issue December 15Summer Issue March 15Deadline for "Calendar of Events":62 Athletic Training • Spring 1982book, and presentation at a meeting areIllustrated below:a Knight K: Preparation of manuscriptsfor publication. Athletic Training11(31:127-129, 1976.b. KlafsCE.ArnheimDD: Modern Principlesof Athletic Training. 4th edition.St. Louis. CV Mosby Co. 1977 p.61.c. Albohm M: Common injuries In womensvolleyball. Relevant Topics InAthletic Training. Edited by ScriberK, Burke EJ, Ithaca NY: MonumentPublications, 1978, pp. 79-81.d. Behnke R Licensure for athletic trainers:problems and solutions. Presentedat the 29th Annual Meetingand Clinical Symposium of the NationalAthletic Trainers Associaton.Las Vegas, Nev, June 15. 1978.In view of The Copyright Revision Act of1976, effective January 1, 1978, all transmlttalletters to the editor must containthe following language before manuscriptscan be reviewed for possible publication:"In consideration of the NATA takingaction in reviewing and editing mysubmission, the authoris) undersignedhereby transfers, assigns or otherwise conveysall copyright ownership, to the NATAIn the event that such work is publishedby the NATA." We regret that transmlttalletters not containing the foregoing languagesigned by all authors of the manuscriptwill necessitate return of the manuscript.Manuscripts are accepted for publicationwith the understanding that they are originaland have been submitted solely toAthletic Training. Materials taken fromother sources, including text, illustrations,or tables, must be accompanied by awritten statement from both the authorand publisher giving Athletic Trainingpermission to reproduce the material. Photographsmust be accompanied by asigned photograph release form.Accepted manuscripts become the propertyof the Journal. For permission to reproduce'anarticle published In AthleticTraining, send requests to the Edltorin-Chief.Manuscripts are reviewed and edited toimprove the effectiveness of communica-Information on upcoming eventsshould be sent to:Jeff Fair, ATCAthletic DepartmentOklahoma State UniversityStillwater, Oklahoma 74074Fall IssueWinter IssueSpring IssueSummer IssueJune 15September 15December 15March 15Manuscripts must be sent to:Glint ThompsonJenison GymMichigan State UniversityEast Lansing, Michigan 48824(517)353-4412The Editorial Board will then revieweach paper and work with authorsto help prepare the papers forpublication. Each is handled on anindividual basis.tlon between the author and the readersand to assist the author in a presentationcompatible with the accepted style of AthleticTraining. The initial review processtakes from six to eight weeks. The timerequired to process a manuscript throughall phases of review, revision, and editing,to final publication is usually six to eightmonths depending on the timeliness ofthe subject. The author accepts responsibilityfor any major corrections of themanuscript as suggested by the editor.If time permits galley proofs of acceptedpapers will be sent to the author for correctionsprior to publication. Reprints ofthe article may be ordered by the author atthis time.6. It is requested that submitting authorsinclude a brief biographical sketch andacceptable black and white glossy photographof themselves. Please refrain fromputting paper clips on any photograph.7. Unused manuscripts will be returned,when accompanied by a stamped, selfaddressedenvelope.Address all manuscripts to:Glint ThompsonDepartment of AthleticsMichigan State UniversityEast Lansing, Michigan 48824The following recommendations are offeredto those submitting CASE HIS­TORIES:1. The above recommendations for submittingmanuscripts apply to case studies aswell but only two-copies of report need besent to the Editor-in-Chief.2. All titles should be brief within descriptivelimits. The name of the disability treatedshould be included in the title if it is therelevent factor if the technique or kind oftreatment used is the principal reason forthe report, this should be in the tide. Oftenboth should appear. Use of subtitles isrecommended. Headings and Subheadingsare required in the involved reportbut they are unnecessary in the very shortreport. Names of patients are not to beused, only 3rd person pronouns.3. An outline of the report should include thefollowing components:a. Personal data (age, sex, race, maritalstatus, and occupation when relevant)b. Chief complaintc. History of present complaint (Includingsymptoms)d. Results of physical examination (Example:"Physical findings relevant tothe physical therapy program were. . . ")e. Medical history - surgery, laboratoryexam, etc.f. Diagnosisg. Treatment and clinical course (rehabilitationuntil and after return tocompetition) use charts, graphswhen possibleh. Criteria for return to competitioni. Deviation from the expectedj. Results - days missed4. Release FormIt is mandatory that Athletic Trainingreceives along with the submitted case asigned release form by the individual beingdiscussed in the case study injurysituation. Case studies will be returned ifthe release Is not included.The following recommendations are offered tothose submitting material to be considered as aTIP FROM THE FIELD:1. The above recommendations for submittingmanuscripts apply to tips from thefield but only one copy of the paper need besent to the Editor-in-Chief.2. Copy should be typewritten, brief, conslse,in the third person, and using high qualityillustrations and/or black and whiteglossy prints.

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