By Joshua Colomar, iTPA Intern

Caffeine has been shown effective as an ergogenic aid in other sports involving high intensity intermittent actions like soccer, rugby sevens and rugby. Its effectiveness has been related to a reduced perception of exhaustion among other mechanisms such as increasing total running distance, lower limbs power output and increased upper body muscle performance.
Frequently, elite junior tennis players have much pressure to accomplish great results at a short age apart from educational obligations and many training hours a week. Added to this, energy drinks constitute a big part of this population’s consumption and are popular in their inner circle. It’s important for parents and coaches to be aware of the effects of commercially available energy drinks on junior tennis players and their performance during competition.

Studies such as Gallo-Salazar et al. (2015) give us an idea of caffeine implications in tennis players’ performance. 3mg of caffeine per kg of body mass in the form of an energy drink and after 60min to allow its absorption results in increased hand grip force (4.2%) in both hands, in addition to a higher running pace at high intensity (being this considered 18km/h or more) and a larger number of sprints during the match. As a result of these performance parameters, simulated game shows a higher tendency in percentage of points won when serving having ingested caffeine in comparison to placebo. On the other hand, ball velocity wasn’t improved during serve.

This gives us a clear vision of a better performance in some determinant physical aspects we find in tennis. Caffeine could be a nutritional aid to increase some factors associated with tennis success as was confirmed for adult population in previous studies and sports.

Nonetheless, as we all know, the most popular way of caffeine consumption is coffee. This makes us wonder if ergogenic properties remain while consuming caffeine through its most popular form. Studies like Hodgson et al. (2013), give us some hints about this matter. Although it’s not specifically focused on tennis players, trials were performed on athletes comparing coffee consumption, decaffeinated coffee, placebo and caffeine alone. After testing parameters such as average power output and performance times, differences were shown between the placebo/decaffeinated drink and coffee/caffeine drink, showing no significant differences between the two last. This concludes that in certain sports and situations caffeine intake in the form of coffee can be as effective as its consumption in the form of a prepared drink. Studies should focus on specific tennis situations and variety of ages/levels to be completely sure about this matter.

However, tennis coaches, parents, strength and conditioning coaches and nutritionists should be aware of negative side effects these kinds of drinks could induce. Other studies have revealed that some athletes report nervousness and insomnia hours after caffeine consumption. It’s a valid nutritional strategy to increase certain physical performance but must be assessed responsibly. First of all and before considering ergogenic options it’s essential to have a hydration and nutrition routine and/or guide to avoid risks and injuries. The consumption of appropriate fluid volumes before, during and after tennis play is essential to maintain performance.

Following indications provided by Kovacs (2008) we find that tennis players can sweat more than 2.5 liters per hour of play and replace fluids slower during competition than practice. In warm environments electrolyte enhanced fluids should be consumed on a personalized schedule, but somewhere between 200mL - 440mLper changeover is usually required. Nevertheless, coaches, parents and scientists need to individualize protocols and establish a hydration strategy. 
 
References:
Gallo-Salazar et al. Enhancing Physical Performance in Elite Junior Tennis Players With a Caffeinated Energy Drink. International Journal of Sports Physiology and Performance, 2015, 10, 305-310.
Kovacs, M. A review of fluid and hydration in competitive tennis. International Journal of Sports Physiology and Performance, 2008, 3(4): 413-23.
Hodgson, A; Randell, R; Jeukendrup, A. (2013). The metabolic and performance effects of caffeine compared to coffee during endurance exercise. PLoS ONE 8(4) e59561. doi:10.1371/journal.pone.0059561
 

Junior tennis injuries are starting to get more media attention as youth sport injuries have increased over the past decade; it is more common to see surgeries performed on young athletes for overuse injuries. Much of this media attention stems from other sports like baseball and football, but tennis is also one sport where overuse injuries is an area that every coach, parent, tennis performance trainer (TPT) and Certified Tennis Performance Specialist (CTPS) should hold a strong education. Many of these injuries, and even surgeries, used to be only performed on college and adult athletes. Fortunately for tennis, the average young tennis player experiences relatively few severe injuries and is considerably lower than many other sports [1]. However, overuse is a concern in competitive young tennis athletes. Although injury rates and types of injuries are not as well researched as in some other sports (i.e. baseball, soccer, etc.) some interesting data exists that can help us better understand young tennis athletes and the typical issues that they see. Over a multiyear period a major junior national tennis tournament 21% of participants sustained an injury [2]. Over the last few decades research has been inconsistent about where the majority of tennis injuries occur. Earlier research showed that a large percentage of injuries occurred in the lower body [3]. However, more recent research has showed that upper body and core injuries are becoming more prevalent [4]. This is likely due to the change in technique (more open stance movements and greater reliance of upper body in stroke production, the slower surfaces and new technologies in the racket and strings.)

One unique study involved a series of questions on training, technique, competition and other factors that was provided to all participants at the largest junior team tennis event in the US [5]. It was collected at 12 different locations and 861 junior tennis players completed the survey:

- 97% of individuals who completed the study

Gender breakdown:

• males-43% (356);
• females-57% (N=476).

Age: 10-17

As the goal of the study was to evaluate injury patterns and trends a clear definition of injury was important. “An event that forces a player to miss 3 or more consecutive days of tennis play, either practice or competition, or that requires medical attention from a trainer, therapist, or doctor.”

Major Findings From This Study

• For both the 12 and under and 14 and under age group the shoulder was the most often injured area. However for the 16 and under age group the back was the most commonly injured area.

• Only 51% and 54% (male and female) of respondents use free weights and only 38% and 39% use machines.

• Only 43% and 58% (male and female use medicine ball during training).

• 90% and 97% (male and female) use a double-handed backhand

• 20% and 22% (male and female) use an abbreviated/short service motion

• 83% of all players predominantly train and play on a hardcourt surface

• 81% of all injuries in junior tennis players were tennis related

• 51% of all athletes that reported an injury visited a Physician or Physical Therapist

Below are three charts that provide the breakdown of the location of injuries based on the three different age groups (12 and under; 14 and under; 16 and under).

When all the data was pooled together the following showcases the most common injury areas in the junior players who participated in this study (male and female combined ages 10-17)

Summary:

The shoulder and back are two major areas that need a greater focus in training and injury prevention programs. The high prevalence of hardcourt tennis play is something that needs to be taken into account when devising on and off-court training programs. The increase in injuries as athletes’ age through their junior career is also something that should be of major interest to coaches, trainers and administrators. More education is needed to ensure that appropriate understanding of volume and injury prevention programs are implemented to help reduce the likelihood of injuries in junior tennis players. This is something that requires good communication between tennis coaches, certified tennis performance specialists and parents to ensure that the young tennis players develop and optimize performance while limiting the occurrence of injury.

1.         Kibler, W.B. and M. Safran, Tennis Injuries, in Epidemiology of Pediatric Sports Injuries, D. Caine and N. Maffuli, Editors. 2005, Base, Karger. p. 120-137.

2.         Hutchinson, M.R., et al., Injury surveillance at the USTA boys' tennis championships: A 6-yr study. Medicine and Science in Sports and Exercise, 1995. 27(6): p. 826-30.

3.         Reece, L.A., P.A. Fricker, and K.F. Maguire, Injuries to elite young tennis players at the Australian Institute of Sport. Aust J Sci Med Sports, 1986. 18: p. 11-15.

4.         Winge, S., U. Jorgenson, and L. Nielson, Epidemiology of injuries in Danish championship tennis. Int J Sports Med, 1989. 10: p. 368-371.

5.         Kovacs, M.S., et al., Demogrpahic data and injury trends in American national junior tennis players. Journal of Strength & Conditioning Research, 2012. 26(1): p. S62.

For the last few decades, the discussion around whether young kids should lift weights or perform resistance training has progressed substantially. It is important to review the science around resistance training in young individuals and make decisions about training based on the best available science. Basing decisions on how to train young athletes without understanding the underlying science is not recommended and something that can put young athletes at greater risk of injury and/or slow the development and progress. Recently an international group of experts in youth resistance training were asked to review the large body of scientific literature and develop an International Consensus on “Youth Resistance Training.” Three individuals on the iTPA Certification Commission were heavily involved in the consensus document, and is something that should be read by all coaches, trainers, performance specialists, physical therapists, medical doctors, chiropractors, parents and sports administrators. 

The summary of the document concludes with this statement: “A compelling body of scientific evidence supports participation in appropriately designed youth resistance training programmes that are supervised and instructed by qualified professionals.”

Here are a few take-home messages from the “Position statement on youth resistance training: the 2014 International Consensus” which was published in the British Journal of Sports Medicine this year.

1. “The use of resistance training by children and adolescents is supported on the proviso that qualified professionals design and supervise training programmes that are consistent with the needs, goals and abilities of younger populations.”

2. “Parents, teachers, coaches and healthcare providers should recognize the potential health and fitness-related benefits of resistance exercise for all children and adolescents. Youth who do not participate in activities that enhance muscle strength and motor skills early in life may be at increased risk for negative health outcomes later in life.”

3. “Appropriately designed resistance training programmes may reduce sports-related injuries, and should be viewed as an essential component of preparatory training programmes for aspiring young athletes.”

4. “Regular participation in a variety of physical activities that include resistance training during childhood and adolescence can support and encourage participation in physical activity as an ongoing lifestyle choice later in life.”

5. “Resistance training prescription should be based according to training age, motor skill competency, technical proficiency and existing strength levels. Qualified professionals should also consider the biological age and psychosocial maturity level of the child or adolescent.

6. The focus of youth resistance training should be on developing the technical skill and competency to perform a variety of resistance training exercises at the appropriate intensity and volume, while providing youth with an opportunity to participate in programmes that are safe, effective and enjoyable.”

Read the position stand for more detail:

• The use of resistance in youth is recommended
• The need exists for appropriately designed programs
• Programs need to be appropriate for training age, motor skill competency, technical proficiency and current strength levels.

Read the full International Consensus below:

Position statement on youth Resistance Training the 2014 International Consensus

Please follow the iTPA Facebook page (www.facebook.com/itpatennis), the twitter feed (@itpatennis) and the iTPA website for more information on this topic and other updates related to tennis-specific performance enhancement and injury prevention www.itpa-tennis.org

               Keep Kids in the Game for Life Through the STOP Sports Injuries Campaign

                              Healthcare and, Business Leaders, and Professional Athletes Join Forces to  Help
                                                                    Young Athletes Play Safe and Stay Healthy

Atlanta, Ga. –– Today, leaders at International Tennis Performance Association are coming together with the American Orthopaedic Society for Sports Medicine, American Academy of Orthopaedic Surgeons, American Academy of Pediatrics, American Medical Society for Sports Medicine, National Athletic Trainers’ Association, National Strength and Conditioning Association and Safe Kids USA to promote the STOP Sports Injuries campaign. 

The campaign educates athletes, parents, athletic trainers, coaches and healthcare providers about the rapid increase in youth sports injuries, the necessary steps to help reverse the trend and the need to keep young athletes healthy. The STOP Sports Injuries campaign highlights include teaching proper prevention techniques, discussing the need for open communication between everyone involved in young athletes’ lives, and encouraging those affected to sign The Pledge to be an advocate for sports safety. The campaign website and pledge are available at www.STOPSportsInjuries.org.

Sports injuries among young athletes are on the rise.  According to the national Centers for Disease Control and Prevention (CDC), high school athletes, alone, account for an estimated two million injuries, 500,000 doctor visits and 30,000 hospitalizations every year. 

The iTPA is excited to join this important campaign, as a major emphasis of our education is focused on preventing and limiting injuries in young tennis players,” said Dr. Mark Kovacs, iTPA Executive Director.

The high rate of youth sports injuries is fueled by an increase in overuse and trauma injuries and a lack of attention paid to proper injury prevention. According to the CDC, more than half of all sports injuries in children are preventable.

“Regardless of whether the athlete is a professional, an amateur, an Olympian or a young recreational athlete, the number of sports injuries is increasing – but the escalation of injuries in kids is the most alarming,” said Dr. James Andrews, former president of the American Orthopaedic Society for Sports Medicine (AOSSM) and STOP Sports Injuries Co-Campaign Chair.  “Armed with the correct information and tools, today’s young athletes can remain healthy, play safe, and stay in the game for life.”

Supporting the STOP Sports Injuries campaign are the country’s leading sports medicine organizations along with professional athletes and business leaders who have signed on as members of the campaign’s Council of Champions. This Council will help raise additional awareness about this growing epidemic of youth sports injuries.  Some of the founding members of the Council include former Olympic champions Christie Rampone, Eric Heiden and Bonnie Blair, professional golfer Jack Nicklaus, NFL Hall of Fame quarterback Bart Starr, MLB baseball player John Smoltz, NFL Hall of Fame defensive end, Howie Long, and Heisman Trophy winner and St. Louis Rams quarterback Sam Bradford.

Improving youth physical fitness is a major objective of city, state, regional and federal government agencies, multiple organizations and trade associations, non-profits and private companies. Below is an article provided by SHAPE America (The Society of Health and Physical Education – formerly AAHPERD). The goal of this article was to provide physical educators and health professionals with new and relevant information about physical fitness. This is a very good resource that covers in greater detail the following 10 Concepts of Youth Physical Fitness.


1)      Fitness education is an important part of the total physical education program

2)      Health-related physical fitness assessment is an important part of physical education and fitness education programs.

3)      The relationship between health-related fitness and health  varies by age, but it exists for people of all ages.

4)      Although the strength of health relation­ships varies for different parts of fitness among youth, it is important to teach about all health-related fitness components in fitness education programs.

5)      Functional fitness is an important consideration in fitness education.

6)      Health-related fitness test items for use in fitness education may differ from those used in research or for national surveillance.

7)      Cardiorespiratory endurance is the recommended term for the fitness component frequently described as cardiovascular fit­ness, aerobic fitness, cardiorespiratory fitness, or cardiovascular endurance.

8)      An understanding of the term aerobic capacity is important for fitness education

9)      Fitness components classified as health-related are also criti­cal to performance in a variety of sports and other activities.

10)   Power, formerly considered a skill-related fitness component, can also be considered a health-related component of physical fit­ness.

 
Information from : Corbin et al. Youth Physical Fitness. JOPERD, 85 (2), 24-31, 2014

Download the 10 Aspects of Youth Physical Fitness PDF HERE

 A few months ago  we posted a short blog titled Tennis The Best Sport For Education and Health In The Young Athlete (http://www.itpa-tennis.org/1/post/2013/03/tennis-the-best-sport-for-education-and-health-in-the-young-athlete.html) highlighting some of the findings of the report from a study commissioned by USTA. Here are a few more interesting facts from the report. In a very interesting report funded by USTA Serves (The National Charitable Foundation of the United States Tennis Association) were data from over 54, 000 youth in the United States between 8th and 10th grade were analyzed with 4,278 of these youth being tennis participants. The purpose of the study was to analyze various academic, social and behavioral outcomes (Sabo, Veliz et al. 2013).   Achieving an “A” in School The data presented in 2013 seems to show a shifting on the typical tennis youth participant from a history of being an “elite” or “country club” sport to being similar to other non-contact sports in the US demographic. The suggestions in the report that this shift is likely due to greater opportunities and accessibility to tennis over the past two decades (Sabo, Veliz et al. 2013).

The percentage of tennis participants in this study who reported an average grade  of “A” was almost twice as high as non-sports  participants. 48% of tennis players throughout the US reported an average grade of “A” as compared with only 25% for non-sport participants. (Sabo, Veliz et al. 2013). 48% of students in 8-10th grade reporting an “A” is a very interesting statistic. Interested to hear from the iTPA membership what you feel this statistic is saying. Is it how smart tennis players are? Is it a sign of grade inflation in the school system? Is it due to parental/family expectations on academics over individuals that do not play sports?  

Suspensions In School
17% of tennis participants reported being suspended during the past school year, which was considerably lower in contact sports (27%), non-contact sports (23%), non-athletes (27%) (Sabo, Veliz et al. 2013).    “Because youth athletic participation in the U.S. is generally greater among more affluent and predominantly White populations, the discovery of positive outcomes attributed to sport participation are often later found to be owed to socioeconomic differences or racial/ethnic differences (Sabo, Veliz et al. 2013).” What are initially considered the “benefits” of youth sports participation are often more fundamentally owed to larger social forces that flow through sports rather than the primary influence of sports (Sabo, Veliz et al. 2013). However, this study found that positive relationships between tennis participation and academic performance were evident across family socioeconomic levels (low, middle and high) (Sabo, Veliz et al. 2013).  Meaning that at every socioeconomic level, tennis participation was most highly correlated with higher academic performance than other sports participation and non-sport participation (Sabo, Veliz et al. 2013). This paragraph is one of the most impactful findings from the entire report. It clearly shows that tennis participation is linked to greater academic performance even when socioeconomic levels are accounted for.

An interesting finding for parents: High School tennis athletes had lower rates of consumption for alcohol, marijuana and cigarette smoking compared to other athletes and especially to non-athletes (Sabo, Veliz et al. 2013). Interesting tip for parents: One way to reduce your child’s potential for performing illegal activities and using illicit substances is to have them participate in tennis.  

Here is the link for the executive summary of The USTA Serves Special Report, More Than a Sport: Tennis, Education and Health  http://assets.usta.com/assets/822/15/More_than_a_Sport_Executive_Summary-v7-web.pdf 

Here is the link for the full report of the survey data of The USTA Serves Special Report, More Than a Sport: Tennis, Education and Health  http://assets.usta.com/assets/822/15/More_than_a_Sport_Full_Report_2.27.13.pdf

Watch the below iTPA video demonstrating and discussing the Overhead Squat Stability Progression. This is a rather simple exercise, but is an important exercise for tennis athletes as it helps to develop functional flexibility, strength and stability in the lower body as well as control of the muscles around the lower back and abdominals (core). All these factors are important for every tennis player. This movement should be taught to tennis players and if performed at least three days per week will provide a noticeable benefit in only a few weeks. It is recommended to add this movement to a weekly routine to improve and/or maintain stability and mobility. Performing 2-3 sets of 10-12 repetitions is recommended. As the athlete improves, greater range of motion can be attempted and even adding resistance may be appropriate for more advanced athletes. Speak to your Certified Tennis Performance Specialist (CTPS) for a personalized program and to develop a tennis-specific training program.

 “A growing epidemic of preventable sports injuries is dismantling the hopes and dreams of young athletes at an early age.” – Dr. James Andrews and the STOP (Sports Trauma and Overuse Prevention) Sport Injuries Organization.

As April is National Youth Sport Safety Month, it is important to evaluate the quality and quantity of training and competition that your young athletes are exposed to. Tennis is a sport that typically has a very high volume at a young age, and although tennis is an early initiation sport, it should be a late specialization sport. This means that to be highly successful (i.e. earning a college scholarship or dreams of playing professionally) in the sport an individual needs to be exposed to the sport at a young age – typically before 10 years of age. However, it is a late specialization sport. This means that it is important to learn the sport at a young age, but also participate in multiple sports to at least till 12-14 years of age. Over the past decade a number of studies in different sports have consistently shown that athletes that specialize in one sport from a very young age have a greater number of injuries. Some of the most recent research was presented at the American Medical Society for Sports Medicine (AMSSM) meeting in San Diego in April. The study is titled “Risks of Specialized Training and Growth in Young Athletes: A Prospective Clinical Cohort Study” and was led by Dr. Neeru Jayanthi (iTPA Certification Commission member) http://www.itpa-tennis.org/certification-commission.html.

Below are some of the most relevant notes from the study :

• Between 2010 and 20103, Neeru Jayanthi (iTPA Certification Commission member) and colleagues at Loyola and Lurie Children’s Hospital of Chicago enrolled 1,206 athletes ages 8 to 18 between who had come in for sports physicals or treatment for injuries.

• There were 859 total injuries, including 564 overuse injuries, in cases in which the clinical diagnosis was recorded. The overuse injuries included 139 serious injuries such as stress fractures in the back or limbs, elbow ligament injuries and osteochondral injuries (injuries to cartilage and underlying bone). Such serious injuries can force young athletes to the sidelines for one to six months or longer.

• Young athletes who spent more hours per week than their age playing one sport – such as a 12-year-old who plays tennis 13 or more hours a week – were 70 percent more likely to experience serious overuse injuries than other injuries.

• The study confirmed preliminary findings - that specializing in a single sport increases the risk of overall injury, even when controlling for an athlete’s age and hours per week of sports activity.

• Young athletes were more likely to be injured if they spent more than twice as much time playing organized sports as they spent in unorganized free play — for example, playing 11 hours of organized soccer each week, and only 5 hours of free play such as pick-up games.

• Athletes who suffered serious injuries spent an average of 21 hours per week in total physical activity (organized sports, gym and unorganized free play), including 13 hours in organized sports. By comparison, athletes who were not injured, participated in less activity – 17.6 hours per week in total physical activity, including only 9.4 hours in organized sports.

• Injured athletes scored 3.3 on researchers’ six-point sports-specialization scale. Uninjured athletes scored 2.7 on the specialization scale. (On the sports specialization scale, an athlete is given one point for each of the following:

1. Trains more than 75 percent of the time in one sport;
2. Trains to improve skill or misses time with friends;
3. Has quit other sports to focus on one sport;
4. Considers one sport more important than other sports;
5. Regularly travels out of state;
6. Trains more than eight months a year or competes more than six months per year.

Dr. Jayanthi offers the following tips to reduce the risk of injuries in young adults:

• Do not spend more than twice as much time playing organized sports as you spend in gym and unorganized play.
• Do not specialize in one sport before late adolescence.
• Do not play sports competitively year round. Take a break from competition for one-to-three months each year (not necessarily consecutively).
• Take at least one day off per week from training in sports

The iTPA Parent’s Guide To Basic Injury Prevention

The iTPA has created a Parent’s Guide To Basic Injury Prevention Course which is specifically designed to help the tennis parent to appropriately work with their junior players to help reduce the chance of injury through appropriate prevention exercises. The course comes with over one hour of practical video instruction showing detailed injury prevention exercises and tutorials, in addition to an 85-page color Workbook. Please see the webpage for a detailed description and sample videos of the course http://www.itpa-tennis.org/parentcourse.html

Perspective below from Dr. Ellen Rome, Head of the Center for Adolescent Medicine at The Cleveland Clinic and a Member of the iTPA Certification Commission (www.itpa-tennis.org/certification-commission) and a member of the USTA Sports Science Committee.

• How does the brain develop when an athlete is very young?
• Adolescent age and stage is important.
  
• Understanding the differences between the different stages is important for the Tennis Performance Trainer or Certified Tennis Performance Specialist.

AUDIO clip below:

The USTA Serves Special Report, More Than a Sport: Tennis, Education and Health

According to USTA Serves (the national charitable foundation of the USTA), this is the first nationwide study to analyze the educational, behavioral and health benefits for adolescents who participate in tennis. Below you will find the major take-homes from the research; all these points are beneficial to understand to help promote the benefits of tennis – especially to parents.

1) Tennis is a unique catalyst for educational advantage.

Compared to non-athletes as well as the top nine high school sports, tennis athletes devote more time each to homework, report higher grades and are more likely to attend a four-year university.
Remember that this highlights a correlation – not a causation. This means that just playing tennis alone will not cause better grades or going to a four year college. Socio-economic status, parental influence, geography, aptitude among many other factors contribute.

2) Tennis players reported significantly lower rates of suspension from school and other disciplinary measures than participants in other sports as well as non-athletes.

3) Educational advantages among tennis players occurred across and within all family and socioeconomic levels.

“Half of U.S. adolescent tennis participants come from families in which parents have less than high  school education, a high school degree only or some college—indicators of middle and lower socioeconomic levels. The perception that tennis is a “country club” sport benefiting only one segment of the population is at most only 50% correct. The educational and social advantages associated with tennis participation were strongest among adolescents from higher-socioeconomic-level families, but still present in families with middle and lower socioeconomic levels and often higher when compared to adolescents who participate in other high school sports or do not participate in sports at all.

4) Adolescent tennis players are well-rounded.

The research found that tennis players performed more extracurricular activities and volunteered in their communities at higher rates than other high school athletes and students who did not participate in sports.

5) Tennis contributes to improved adolescent health.

Participation in tennis was associated with lower rates of:

-    Cigarette smoking
-    Binge drinking
-    Marijuana use
-    Being overweight
-    Being obese

6) Adolescent participation:

•    Whites: 77%
•    Blacks: 9%
•    Hispanics: 14%
•    Male: 47%
•    Female: 53%
•    Live in the South: 33%
•    Live in the West: 26%
•    Live in the North Central States: 20%
•    Live in the Northeast: 20%

Here is the link for the executive summary of The USTA Serves Special Report, More Than a Sport: Tennis, Education and Health
http://assets.usta.com/assets/822/15/More_than_a_Sport_Executive_Summary-v7-web.pdf

Here is the link for the full report of the survey data of The USTA Serves Special Report, More Than a Sport: Tennis, Education and Health
http://assets.usta.com/assets/822/15/More_than_a_Sport_Full_Report_2.27.13.pdf