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Keyword: athletic trainer

Athletic trainers are essential in triaging various types of athletic injuries on and off the field prior to allowing an athlete to return to play. It may be necessary to refer to a physician for clearance, particularly in head injuries in order to safely return the athlete to physical activities. Concussions are constantly in the media these days, with a great deal of discussion regarding health risks, both short and long term, in various sports; so it is very important to make the correct call when allowing an athlete to return to play. As a certified athletic trainer, I would like to share an interesting case about an athlete’s experience with a concussion. Hopefully, by sharing these types of experiences, it will help health care providers determine when it is appropriate for an athlete to return to play after a head injury.

In this case, a high school football player was hitting a pad in practice then fell down, hitting his head face first on the ground. He somehow bounced off the pad and then hit the back of his head on the ground. The player immediately experienced dizziness and headaches. However, he had no loss of consciousness, so I directed him sit out of practice and then evaluated him. I used the SCAT5 concussion assessment exam, which is tool that is used at all levels in order to evaluate a concussion. The score on test was slightly elevated due to his symptoms, which helped me promptly diagnose a concussion, so I instructed him to see his doctor for a formal evaluation. His mother took him to his primary care pediatrician and the doctor performed a basic exam where he only checked his eyes and asked about his current symptoms. The doctor subsequently wrote a note to clear him return to play. When I received the note, I was concerned because his symptoms had not completely resolved. I put him through intense running exercises and his symptoms immediately returned. Because I was concerned about the athlete’s persistent symptoms, I sent him to one of our sports medicine physicians, Dr. DeCastro, who commonly treats many of our concussions with MUSC Health Sports Medicine.

It is essential that physicians and athletic trainers to work to together when dealing with head injuries, so an athlete does not fall through the cracks. This head injury could have been more serious or even fatal if it had not been caught and the athlete held out of sporting activities. Currently this athlete continues to recover, but it has been nearly three months since the injury and this athlete continues to experience post-concussion symptoms. I would like Dr. DeCastro to share his experience from a physician’s point of view.   

Dr. Alec DeCastro, Chief of Primary Care Sports Medicine, MUSC Health:

Concussions have garnered a lot of media attention over the past few years, and are prevalent in football but even in non-collision sports. The Center for Disease Control (CDC) recently estimated that 1.7 million people in the U.S. suffer some form of traumatic brain injury every year, which is twice the number of heart attacks that strike Americans each year. About 75 percent of those brain injuries are considered concussions or other forms of mild injury. And 80 to 90 percent of people will recover from a concussion within a seven to 10-day period, according to the National Institutes of Health (NIH).

The hype regarding concussions has caused a lot of trepidation in sports, particularly after the recent movie starring Will Smith. Actually, the condition discovered in the movie by Dr. Bennett Omalu is called chronic traumatic encephalopathy (CTE). Education regarding concussions is the key, and recognizing early signs and symptoms may make all the difference for athletes, parents, and coaches. The CDC has created an initiative called Heads-up Concussion, which has resources and tools to help recognize, respond to, and minimize the risks of concussion.  

It is important that the physician and athletic trainer to work together and apply an individualized approach to the diagnosis and care management of athletes with these types of head injuries. One of the most valuable factors in managing concussions is the athletic trainer’s comprehensive knowledge of the individual athlete. It may be imperative that whoever works most regularly with the athlete reviews his or her treatment. The athlete’s history, behavior, and risk factors need to be included as well in order to figure out the best patient-centered care plan for speediest recovery of the athlete’s concussion.

Treat the Athlete, Not the Body Part

I recently attended a medical conference in New York, focusing on current sports medicine concepts in baseball.  The presenters were sports medicine providers including members of the sports medicine teams from both the New York Yankees and Chicago White Sox. The conference was outstanding, discussing some of the most current research and treatment techniques for injuries afflicting baseball players from the Major Leagues to collegiate and youth athletes.  There were over 20 different presenters from orthopaedic surgeons, physical therapists and athletic trainers; one of the biggest take home messages I learned was that there is little absolute consensus on treatments for different injuries.  There are a variety of different diagnostic and surgical approaches to a variety of shoulder and elbow injuries.  However, there was one consensus that ran through each section; the importance of core strengthening and stability as part of the athlete’s daily work-outs and rehabilitation process.

The idea of treating the entire athlete is not new; it is something that is discussed at almost every sport medicine conference and a topic that I have presented on a number of times in the past.  Unfortunately, players, coaches, and parents do not always have access to this information.  So there can be a lot of misconceptions out there amongst the non-medical population with regards to baseball players:

  • My shoulder hurts so I need to just rehab my rotator cuff
  • I want to throw harder so I need to hit the gym and get stronger
  • I lose my control the deeper into the game I throw, so I need to throw more in practice

For ideal results in performance, injury prevention and rehabilitation, the athlete’s entire body has to work in symmetry.  It is not about just one body part or one muscle group; it is about the entire body working in harmony to achieve a common goal.  So for the athletes that I work with, their programs focus on a variety of body parts from the rotator cuff to the peri-scapular musculature (latissimus dorsi, trapezius muscles, rhomboids, serratus anterior) to core and pelvic musculature, to the lower body.  The goal is to build strength, stability, and muscular endurance throughout the entire body to support the demands of their sport. 

You may now be thinking, how am I going to do this, my workout will take hours?  There is definitely a time and place for isolation, but the majority of the time, you can combine exercises to achieve the desired results.  There are still thousands of different exercises that you can do, but here are my top 6 exercises that I give to the majority of my throwing athletes to incorporate into their workouts:

  1. “Y’s” –  bilateral shoulder scaption prone on a stability ball
  2. “T’s” – bilateral shoulder horizontal abduction prone on a stability ball
  3. Bilateral scapular retraction to external rotation prone on a stability ball
  4. “I’s” – bilateral shoulder extension prone on stability ball
  5. Push-ups on stability ball or BOSU ball with holds
  6. Shoulder external rotation while in a side plank position

* Exercises should include high repetitions with little to no weight (zero to two pounds at most) focusing on slow controlled movements, body mechanics, and alignment. 

One of the athletic trainers at the conference said that “throwing programs should always be written in pencil, since they are constantly changing to meet the needs of the individual athlete.” I could not agree more, but I also take this philosophy to include all strengthening, rehabilitation, and maintenance programs. Every athlete is different and their program should be tailored to meet their specific needs, focusing on the entire athlete.
 

Guest Post by:

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

I’m sure you’ve heard the sayings “no rest for the weary” or “Jack of all trades”.  I’m willing to bet someone was referring to an Athletic Trainer when they said that.  Attempting to describe a day in the life of a Certified Athletic Trainer would be like an astronaut describing what it’s like being in space…you just don’t know until you’ve done it for yourself! Okay, so that may be a bit dramatic, but the demands of this position are very unique, and unlike most jobs out there.  Certified Athletic Trainers(ATCs) are highly qualified health professionals who are trained in preventing, recognizing, managing and rehabilitating injuries that result from physical activity and sports.  They are part of a team of sports medicine specialists, that if when injured, help get you back on your feet and back in action as soon as possible…all while pulling some pretty unorthodox hours.

While they’ve been behind the scenes and on the sidelines long before, the American Medical Association has recognized athletic training as an allied health care profession since 1990.  As an important part of a comprehensive healthcare team, the certified athletic trainer works under the direction of a physician and in cooperation with other healthcare professionals, athletics administrators, coaches and parents.  ATCs work in a variety of different professional settings, including:

Professional and collegiate sports                       Sports medicine clinics
Secondary and intermediate schools                   Occupational settings
Performing arts                                                          Law enforcement and military
Hospital emergency rooms and rehab clinics        Physician offices

If an athletic trainer works with a sports team, their hours will ebb and flow with the offseason, preseason, and regular season. Trainers working in hospitals and clinics may have a more regular schedule and often conduct outreach work at various locations.  While there are various settings, the basic duties are common across the board.

Prevention of Injury  Injury prevention is one of the most important roles an ATC has in dealing with any athlete. While managing injuries once they’ve happened is our bread and butter, pre-participation screenings, development of strengthening programs, education of sport specific equipment, and hydration and nutrition counseling are just a few examples of ways to help avoid injury.

Recognition, Evaluation, and Assessment  Athletic trainers must possess the skill to recognize, evaluate, and assess athletic injuries in order to care for them properly, and apply those skills to the field.

Immediate Care  In the event of an injury, it is imperative that the athlete can be cared for immediately and appropriately. It is crucial that in emergency situations, athletic trainers act without hesitation in responding with knowledge and control.

Treatment, Rehabilitation, and Reconditioning  Providing daily treatment helps manage any niggling aches, pains, or minor injuries. Rehabilitation helps minimize injury time and allows the injury to fully heal. Reconditioning, or sports-specific training, is very important to regain the optimal physical condition of the athlete and helps minimize chances of re-injury upon return to play.

Organization and Administration  There is much more to being an athletic trainer than simply caring for athletes.  It is important for the athletic trainer to be prepared for any situation.  This includes developing emergency action plans, policies and procedures for safe participation, facility operations, and maintaining compliance with all safety and sanitation standards.  In addition to all this, accurate athlete/patient files and injury reports must be kept up to date, and regular communication with coaches and physicians made on a daily basis.  ATCs often handle insurance as well as being responsible for staying on top of budgetary issues when making supply orders.  In smaller organizations, planning travel and accommodations can fall to the athletic trainer as well.

Professional Development and Responsibility As in every other profession, athletic trainers hold the responsibility of playing a part in the professional development for the athletic trainers while obeying and adhering to all laws and guidelines that impact the athletic training profession.  This includes doing the necessary work to maintain certification and licensure, and helping advance the athletic training profession. According to the Department of Labor, 46 states require trainers to be licensed or registered.  It is important for athletic trainers, now more than ever, to education the public on the importance of athletic trainers and our profession.

 Dependent on the setting, certain responsibilities and hours may vary, but the one common denominator is that an athletic trainer's day may change from day to day and even hour to hour. Flexibility (to both schedule and personalities), empathy, patience, creativity, strong decision-making skills, and being even-tempered are all qualities that not only a good, but effective athletic trainer make. Most importantly, you must be a good listener.  Possessing the ability to react to a situation all while maintaining a strong controlled attitude is only half the battle…you must be able to connect with your athlete and gain their trust.  Athletic trainers are hard-working and passionate in caring for and helping their athletes.  They’re usually the first to arrive and the last to leave all just to be repeated the next day.  Sometimes working upwards of 60+ hours a week, athletic trainers make tough decisions in high-pressure situations on a daily basis.  Our athletes’ lives are quite literally in our hands…caring not only physically, but emotionally for them can be quite stressful.  So, the next time you see your trainer eating their yoghurt with a tongue depressor because they forgot their spoon, reading through their home-study continuing education course all while filling one of many water coolers over their lunch break, just give a little thanks for these un-sung heroes that keep these bodies in motion moving.

Guest post by:

Kathleen Choate, ATC, CSCS, CEAS
Athletic Trainer
MUSC Health Sports Medicine

No one likes being injured.  It's painful, expensive, takes time away from the sports we love, affects our daily life, and can even lead to pain and disability later in life.  Wouldn't it be nice if we could enjoy the sports we love without this risk?  While it isn't possible to completely eliminate the risk, there are ways to prevent them.

Stretch

            Before participating in physical activity, a good warm-up should be in order.  Both static and dynamic stretches are acceptable prior to participation, but you may choose one or the other depending what your goal is. Stratching on track

            Static stretches involve holding a muscle in a lengthened position for an extended period of time.  For example, a static stretch could include sitting on the ground in a pike position with legs fully extended, reach for your toes, and hold it for 30 seconds.  If you choose to primarily use static stretching prior to physical activity, try to incorporate things like jogging, jumping jacks, or squats to increase your body temperature.

            Dynamic stretches involve bringing a muscle through a full range of motion; it comes with an active movement that should be slow and controlled.  One benefit of using dynamic stretching over static stretching is that it also increases your body temperature, which helps to increase elasticity of the muscles right before physical activity.  An example of a dynamic stretch would include slow and controlled lunges with a straight instead of bent back knee. 

            Ballistic stretches involves a bouncing motion at the end range of a stretch and should not be used as a way to warm-up since it is likely to lead to a muscle strain.  Regardless of your warm-up, remember that it should never be painful.

Equipment

            Proper equipment should be a no-brainer with any sport.  Runners need shoes, football players need helmets, pads, and mouth guards, and wrestlers need headgear.  Not only are these pieces of equipment necessary to be worn, but they should also be fitted correctly.

            Shoes are especially important for sports with a high volume of running including cross country, track and field, soccer, field hockey, and basketball.  While quality shoes are pricey, they are the only piece of equipment a runner needs.  Running is a fairly straightforward movement compared to other sports.  It involves a series of repetitive movements over the course of several miles.  If your feet hit the pavement 1,000 times in one mile, then a faulty running gait or a worn out pair of shoes can cause injuries anywhere from your feet to your back.  It can be difficult to spend our hard earned money on a pair of running shoes; however this investment can prevent you from having to spend hundreds or thousands of dollars at the doctor’s office.  Since shoe needs are going to vary from person to person, consult with your Athletic Trainer for guidance prior to making this purchase.  Also, plan to replace your shoes every 300-500 miles.

Technique

            Have your coaches ever sounded like a broken record?  Maybe they told you ten times in one practice to follow through, keep your head up, or to bend your knees more.  Good technique doesn't just make you a throw a ball better, score more points, or run faster; it prevents injury.  The more obvious injuries are the ones that happen when a movement is performed incorrectly one time and sudden pain is felt.  The injuries that creep up on you are ones that arise from consistently flawed technique.  Next time your coach tells you to correct a motion, do everything in your power to fix it the first time!

Rest

            Rest is the word athletes never want to hear, but it's vital to preventing injury.  Give yourself at least one day off a week to let your body recover.  This may seem like slacking to some, but it will prevent overuse injuries and burnout. 

            As athletes, it’s tempting to play through pain, especially during a game.  The pain level may feel tolerable, and you don’t want to let your teammates down.  Choosing to continue to participate with a possible injury will most likely make the injury worse and recovery time longer.

Strength and Conditioning

            Condition your body for the sport you are participating in.  A great strength and conditioning program will vary depending on your age, level of training, sport, and time of year.  A strength and conditioning specialist is your best resource to put a conditioning program together with all factors considered.

Athletic Trainers

            Athletic Trainers are often thought of as the person that runs onto the field when a player gets hurt.  That may be when we are viewed most publicly; however we have many other roles with regards to injury management, including (but not limited to) preventing the injury from happening in the first place.  Consult with your Athletic Trainer about injury prevention to identify a plan that is specific to you as an individual.

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Guest Post by:
Michael Barr, PT, DPT, MSR
Sports Medicine Program Manager
MUSC Sports Medicine

Sitting on the sidelines I hear the sounds of hard hits, players grunting, and fans cheering … I bet most of you reading this think I am talking about covering a high school football game on Friday night, but I am not. Women’s roller derby … is one of the most dynamic, hard hitting, and exciting sports that I have been involved with, in my 10+ years as a medical professional.

One of our athletic trainers and I cover the Lowcountry Highrollers, women’s roller derby team; at the bouts this past Sunday we diagnosed and treated multiple ankle sprains, 2 concussions, a shoulder subluxation, countless number of contusions, dehydration and general fatigue. Overall this was a slow night for us; there were no fractures, tears, or lacerations.Roller Derby Action

Afrodite Superstar said to me, “I am in the best shape of my life, but I accept the fact that I am going to have daily pains” she also explained that the morning after a bout is always the worst, “just getting out of bed hurts”, but once she laces up her skates at the next practice, she is back to herself again.

This description by Afrodite Superstar sounds very similar to an article written by Elizabeth Merrill from EPSN about Matt Birk, former Baltimore Raven’s center, where she describes his Monday morning ritual:

Birk pops one elbow, then the other, and fans his legs until his pelvic bone makes a cracking noise. He takes a couple of deep breaths, and his feet hit the floor. The first few steps are similar to tiptoeing through hot coals. But it’ll get better; it always gets better once he makes it to the bottom of the staircase.
It’s Monday, and time to start another week in the NFL.

Roller Derby CompetitionUnlike the players in the NFL, the Lowcountry Highrollers are all professionals, in something other than their sport; they do not have the luxury of having a recovery day, they have to get up Monday morning and go to work, just like the rest of us.

As I am sitting in my office this morning, talking to Jungle Jane, president of the Lowcountry Highrollers, about a minor injury she sustained at the bout last night, and what she needs to do to expedite her recovery, I asked her why she plays? She answered, “I do enjoy the full contact part of the sport, but even more, it helps me build confidence not just on the court but in my everyday life.”

In the same article by Merrill, Matt Birk was asked a similar question; he answered, “You get so much from the game,” Birk says. “The camaraderie, the friends you make. You don’t mind having to pay that price because you get so much out of it.”

As this years’ season is coming to an end, we are starting to prepare for their off-season which includes a mandatory 2 month break from contact and reduced time on skates. During this time they have an off-season strengthening program designed for the specific needs of their sport. It includes 2-4 days/week of strengthening, muscular endurance and stability exercises, in addition to endurance, sprint, and skating specific skill training. Just like players in the NFL, they use the off-season to recover but also to get stronger, increase their fitness and improve their individual skills, so when they return to the rink in January they are ready for the next season.

The Lowcountry Highrollers’ season is coming to an end on November 9th, their home team championships; if you are interested in seeing a fast pace, high hitting sport, come to their next bout; for more information go to their Facebook page.

 

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