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MUSC Health Blog

Guest Post by:

Lindsey Clarke, MS, ATC, CMT
Athletic Trainer
MUSC Health Sports Medicine

“You work in athletics?  Awesome…that’s so cool!”

This is often the response I get when people learn that I am a Certified Athletic Trainer(ATC). It’s an understandable reaction, as most of the population will only ever see the glitz and glory of the bright lights, sidelines, and athletes from the TV screen or stands. It seems very exciting from those seats, but what they don’t see is the time spent in the training room doing treatments long before and cleaning up after the event has ended, packing sideline kits and bags for travel, arranging appointments, or prepping both lunch and dinner for the day as you’ll most likely be eating those meals on a bus, sideline or in your office while updating your athletes’ files. While being an ATC is immensely gratifying, it can also be a source of great stress. We are expected to be selfless, often putting other’s needs first, work long hours over nights and weekends, and perform at high levels to help our athletes recover and return to play. While all these demands are inherent to the job, these expectations can result in work-related stress. It is difficult to control work-related demands in any profession, but especially so with the constant flux of working in athletics; the game was rescheduled, practice ran later than anticipated, weather delays…the list goes on and on. In addition to scheduling, there is the ever-present threat of injury or emergency. While most of the time it may seem we are standing around observing, we are constantly scanning and taking note of hits to the head, mis-steps, and collisions. More often than not, the ATC is taping, evaluating and responding to manageable injuries, but sudden cardiac arrest, gross trauma or spinal injury are very real possibilities that are always at the back of our minds. The uncertainty of managing an ever-changing schedule, in addition to the emotional drain of providing care, can leave the ATC little time, opportunity or inclination for a life outside of their job.

To provide the appropriate care, an ATC’s training includes primarily academic and practical skills; unfortunately, the ATC does not commonly receive sufficient preparation for the emotional reality of their responsibilities and its impact on their personal functioning and self-fulfillment. If not managed properly over time, these constant stressors can create feelings of apathy, depression, chronic exhaustion, depersonalization towards your athletes, and reduced accomplishment towards one’s work or ineffectiveness in one’s role/performance.

This culmination of stressors and the resulting inability to effectively deal with them can lead to burnout; a very real psychological health concern among professionals working within dynamic, fast-paced environments. According to Merriam-Webster, burnout can be defined in a number of ways, but it all boils down to the exhaustion of physical and/or emotional strength and motivation; it is very common amongst service-related professions such as teachers, public servants, and health care providers. Occupational burnout is typically measured using the Maslach Burnout Inventory (MBI); one of the most commonly used tools to assess burnout in human service professions. In 2008, the Athletic Training Burnout Inventory(ATBI) was created to examine specific characteristics within the profession such as: emotional exhaustion & depersonalization, administrative responsibility, time commitment, and organizational support.

There are three hallmarks of burnout:

  • Overwhelming emotional and physical exhaustion from being overextended; the ATC feels drained, “used up”, barely able to face another day, practice, game or athlete presenting with a problem.
  • Reduced personal accomplishments at work; feelings of frustration, anger, cynicism, and inadequacy can lead to a sense of failure or ineffectiveness in helping their athletes or enhancing their work circumstances
  • Depersonalized attitude toward others; the ATC may adopt a callous or emotionally detached response to their athletes and co-workers.

Certainly, stress is felt differently for each individual, but this sense of burnout, caused by the prolonged response to chronic interpersonal stressors on the job, can impair social and personal functioning. This may cause the ATC to feel less than professional with these negative feelings, and may begin to question their ability and commitment to their profession, leading some to actually leave athletic training to pursue other careers. The specter of mental health disorders is constantly lurking in the background whenever the dynamic of burnout is present. Being a health care provider does not provide immunity from developing a mental health disorder. Rather, their very responsibilities may be putting them at a higher risk if they are unable to effectively deal with the inherent stressors that lead to burnout in the first place; this may put the ATC at risk for developing a mental health disorder, or exacerbating a present mental health disorder that is under control.

An ATC is exposed to stressful events on a daily basis. Knowing how to recognize how stress might affect you, and learning effective stress prevention and management strategies is extremely important. Below are a few preventative measures on how an ATC can help prevent and avoid burnout, and/or the possibly of developing a psychological disorder.

  • Workout, meditate or practice yoga on a regular basis.
  • Practice good nutrition. Be sure to eat; don’t skip meals. Be well hydrated.
  • Get enough sleep.
  • Don’t abuse alcohol or drugs.
  • Even if you are busy, try to establish a daily routine; disruptions of routine may cause stress.
  • Take time for yourself; even if for a short period of time, make time for a hobby or period of relaxation daily. Spend quality time with friends and/or family as they are your greatest support.
  • Try not to dwell on fleeting negative emotions or experiences. Doing so gives them momentum to negatively take over your day. It is OK to have a bad moment or day, but concentrate of moving forward to the next day or opportunity to make something positive happen.
  • Be candid with your departmental manager or supervisor. They know you work long and hard. When possible, they may be able to help arrange your schedule, by scheduling mornings and days off, working remotely for administrative work or reduced work hours for you during a less competitive season or on team off-days.

Talk to others you trust about your feelings in a safe and productive way. Know your resources. If an ATC feels the signs and symptoms of burnout or a mental health disorder, seek professional assistance through your place of employment. A good resource for learning about mental health and wellness, and steps to address stress to prevent mental health disorders can be found at Mental Health America. Knowing your limitations and acknowledging when you are struggling will not only make you a better healthcare provider, but it will set both you and your athletes up for long-term success.
 

Running is one of the most accessible fitness activities to get involved in. All it really takes is some space, comfortable clothing, and a good pair of running shoes. While we all have our preference on clothing, one thing that is absolutely essential is a comfortable, well-fitting pair of shoes. The proper shoe will reduce your risk for injury and keep you comfortable while running.

There are dozens of brands with hundreds of models to choose from. From bright pink to gray, you can choose virtually any shoe to be as stylish as you want. Unfortunately, style should not be your main objective when picking a running shoe. The size and shape of your foot, along with the type of runner you are, should dictate which shoe you purchase.

The first step is figuring out your foot type. Generally, there are three types of feet. Most but not all people fall into one of these catagories. Flat feet tend to have fallen flexible arches making them prone to rolling inwards while running. Neutral feet are biomechanically sound and neutral. High arched feet have well defined rigid arches that force the runner into landing on the outside edge of the foot. You can determine which type of foot you have by wetting your foot and stepping on a piece of paper. The more of your arch that you see on the paper, the lower your arch is. The less of your arch on the paper, the higher it is. While this technique doesn’t necessarily determine the flexibility of your foot, it will send you in the right direction.

Once you have a general idea about your foot type, choose your shoe type. A flat flexible foot should look into a higher stability shoe that will control over pronation. Neutral runners should try a moderate stability shoe. Lastly, high arched runners need to look at a cushioned shoe with flexibility.

If you feel overwhelmed by the process, find a running specialty store. Often times, they have qualified sales people that can analyze your foot and running technique. They can then suggest the best shoes for you. Finally, remember that the most expensive shoe might not be the best shoe for your foot. Buy the shoe for your foot, not the prettiest or flashiest shoe!

Barbara Head, M.D.
Guest blogger:
Barbara Head, M.D.

Spring is in the air and with the change in season; you may find yourself considering pregnancy. Whether you are the prospective mother or the prospective partner, this is an exciting time!  Will we have a boy or a girl?  Will the baby look like me?  What will we name our baby? Whether you are having your first baby or adding to your family, there are some important steps to consider before you get pregnant.

  1. Schedule a visit with your health care provider. Do you know that only 1 in 10 women see a doctor before becoming pregnant? Discussing your health with your obstetrician, family practitioner or midwife is essential! If you have health issues, medications may need to be adjusted before you become pregnant. In addition, your healthcare provider can review your vital signs including your weight and blood pressure, medical and family history to determine if any additional information is needed before you get pregnant. The obstetrical physician and nurse midwife providers at MUSC are skilled in providing preconception care.
  2. Take a daily prenatal vitamin with 400-800 mcg of folic acid. Folic acid is a crucial part of preconception (before you get pregnant) care and will decrease the chance of your baby having a neural tube defect or spina bifida. The neural tube closes in your baby within 2 weeks of missing your period. While not all spina bifida can be avoided with supplemental folic acid, taking folic acid before you become pregnant will decrease the chance of spina bifida in your baby.
  3. Stop drinking alcohol, using tobacco and/or drugs. These exposures may make it more difficult to get pregnant. Once you are pregnant, alcohol, tobacco and drugs risk the health of your pregnancy and increase the chance of having a miscarriage, birth defects, and low birthweight l babies, problems with the placenta, early delivery and even stillbirth. It may be difficult for you to stop and if it is, ask for help!  At MUSC, we have resources available to help you and your future baby.
  4. Eat a well -balanced diet and get daily exercise. Eating a well -balanced diet and getting daily exercise will help you to maintain a healthy weight or lose weight prior to pregnancy. Women who are very overweight (BMI or body mass index of >40) will be at risk for many more pregnancy complications than those who have a pre-pregnancy BMI <40. In some women who are very overweight, bariatric surgery may need to be considered to have the healthiest pregnancy. Our obstetrical and midwife providers at MUSC can discuss when this would be recommended. If you are interested in a weight loss program, we can guide you in that journey along with our certified nutritionists.
  5. Consider genetic testing. Remember that family reunion where you met very distant relatives?  Family history is important in determining potential conditions that can be passed on to your baby but there are many conditions that are “silent” in families and sometimes occur when two people with silent genes have a baby. There are a variety of genetic panels that can be performed even before you are pregnant to determine the chance of you having an affected baby. Having this information before you are pregnant will give you a chance to discuss this further with your partner and a genetic counselor. We have a team of highly trained genetic counselors available at MUSC to help you understand this testing if you are interested in further information.

For more information or to schedule an appointment with one of our providers, call 843-792-5300 or visit MUSC Women's Health pregnancy services on the web.

How many times have you heard or said: “New year, new you”? Probably too many times to count. About this time of year, many have started their New Year resolutions. But research shows that only 19 percent of people who make resolutions are successful. Since one of the most common resolutions involves exercising, I am here to give you a little insight into how we use resolutions in sports medicine.

In rehabilitation of injuries, the sports medicine team works with the patient to create goals for returning to function and activity. We never just say, “Your goal is to return to sport.” That is not specific. Likewise, you should never set nonspecific goals such as “I am going to exercise more” or “I am going to lose weight.” In rehabilitation, we use the SMART framework to formulate goals for our patients. It is an acronym for the following components of a goal:

Specific – Keep goals simple. They should clearly define what you plan to do.
Measurable – How are you going to determine progress? How are you going to determine if you achieved the goal?
Achievable – The goal is realistic given the timing, conditions, and environment.
Relevant – You actually care about the goal. It directly relates to your life and well-being.
Time-Bound – Set very specific timelines to meet your goal. Remember it is okay for those timelines to adapt and change. Focus on the progress.

An example of a SMART goal for an injured basketball player: Return to basketball with no limitations or restrictions within 6 months, so he is ready in time for varsity tryouts.

This goal is much more specific and measurable. It also sets us up to create hundreds of short-term goals along the way, such as “patient will gain 10 degrees of active range of motion of knee flexion within 2 weeks following surgery.” The SMART framework provides the athlete with actionable steps and enhanced motivation.

Here are a few additional points that are important when making goals for injured athletes. They're also applicable to your resolutions.

  1. Form a tribe.
    When our patients are recovering from injuries, they have a support team behind them here at MUSC. Find your support team and encourage it to keep you motivated.
     
  2. Don’t be restrictive.
    During rehabilitation, we focus on the abilities of the patient, rather than the disabilities. Focus on all the abilities you are creating for yourself with your new resolution. If you focus on the restrictions (“I can’t eat sweets,” “I can’t watch TV because I’m exercising”), you are setting yourself up for failure.
     
  3. Be passionate.
    Athletes are generally very motivated people. Why is that? It’s because they love what they do. If your resolution is to incorporate more cardio into your exercise routine, find a cardio-based activity that you love. Don’t spend hours on the treadmill, if it is not something that gets you fired up.

It’s not too late! If you have a resolution in this new year, stop what you are doing right now, and ask yourself: Is it a SMART goal? If not, get out your pen and paper and make a plan by writing down the S-M-A-R-T of your goal. Make sure you are truly passionate about this goal and go find your tribe. Like our athletes at MUSC Health do every day, you too, can accomplish your goals.

Rendering of the new comprehensive cardiology floor of the Shawn Jenkins Children's Hospital
Rendering of the new comprehensive cardiology floor PCICU corridors and the courtyard waiting area

MUSC Children’s Heart Center has consistently been named one of the top pediatric heart centers in the country by U.S. News & World Report, with a ranking of #11 for 2017-2018. And our 99 percent, 30-day survival rate following complex cardiac surgery ranks us among the best centers in the world and in the top group of U.S. News-ranked elite centers.  

Looking down the road are new changes that will propel us to even greater heights. Two world-class facilities directly impacting cardiac services for patients are under construction now. The new MUSC Shawn Jenkins Children’s Hospital and Pearl Tourville Women’s Pavilion is slated to open in fall 2019 in downtown Charleston with the entire third floor dedicated to comprehensive cardiac care.

No other center in the region can provide the scope or depth of care for children with heart problems Including open-heart surgeries, heart transplantation, ventricular-assist device implantation and more. The unit will feature up to 29 cardiac ICU and step-down beds and allows for maximum flexibility so that some beds may be converted from one use to another when needed.

The floor will include catheterization/electrophysiology suites and cardiac-specific operating suites. It also allows for hybrid procedures, combining surgical and catheterization procedures simultaneously for the advanced treatment of children born with congenital heart anomalies.

Inpatient services will be centralized in a single location allowing the medical team to respond more quickly and efficiently to a patient’s changing condition, and patients will benefit with less movement from unit to unit.

In addition to the new children’s hospital, also under construction is the new MUSC Children’s Health Ambulatory Campus in North Charleston. This 100,000-square-foot facility opens in early 2019 and will serve as a hub for outpatient services for cardiac patients in the tri-county area. Among its many amenities are a pediatric outpatient surgical facility and pediatric multispecialty medical office building that will include an urgent care clinic, imaging facility and infusion rooms.

 

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