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Keyword: sports medicine

Special guests visit Health Sports Human Physiology, Psychology Classes

Alecia Good and Savior
Athletic trainer Alecia Good and Saviour

November 14 was, for Pinewood's Head Athletic Trainer Alecia Good, a member of the MUSC Health Sports Medicine Team, "a wonderful reminder" of why she is a teacher. Good scheduled her friend Maurice Johnson, CO, BOCO, C.Ped, a certified orthotist and certified pedorthist from Floyd Brace Company (and Pinewood parent), to guest lecture in her Human Physiology and Psychology classes. Johnson asked to bring a model to help explain what he does for a living. The model was Saviour, a 10-year old boy from Ghana, Africa, who was born with cerebral palsy.

In Saviour's tribe, if babies are born with an anomaly (birth defect, maternal death, disease, or even twins or triplets), these babies are considered "spirit children" and are thought to have evil spirits that will be bad for the rest of the tribe. The parents are forced to make a difficult decision of moving the entire family to a "witch camp," where food and water are scarce, or getting rid of the "spirit child" and poisoning the baby.

Saviour was rescued by a local nun, Sister Stan, who cares for 57 other spirit children. Saviour could not walk or talk and got around by dragging himself by his hands. The scars on his knuckles mark the daily struggle he endured.

Sister Stan, through her charity, reached out to a retired nurse, Joan Tucker, who traveled to Ghana and advocated for surgery for Saviour. A long and difficult process finally brought Saviour to Shriners Hospital in Greenville, where he underwent a major reconstructive surgery at the end of June. He worked with a physical therapist to help build his strength and mobility. The physical therapist then referred him to Johnson for ankle foot orthotics.

Johnson, his assistant, Tucker, and Saviour all visited Good's classes that day. "Saviour spoke few words, but his smile lit up the room," said Good. He donned traditional attire as worn by chiefs in his tribe. He also had specially made New Balance shoes that provided a lift for a shorter leg. He had some orthosis on, but Johnson wanted to mold him for a new pair.

During Physiology class, Johnson explained the process of fitting, fabricating, and molding orthoses. He made casts on the ever-smiling Saviour and explained how they would help him walk. Saviour demonstrated his ability to walk across the room with one crutch and assistance from Tucker.

During Psychology class Johnson talked about the ability to allow his patients to participate more fully in life. Through the orthosis and a crutch, Saviour would now be able to move around and will not have to be carried or crawl.

Saviour's smile got even bigger when Tucker spoke about how excited he was to show his brothers and sisters in the orphanage how he could walk. Saviour plans to head home to Ghana in January, and Tucker will stay with him for a month while he learns to transition back into his regular life.

During the visit, the class also discussed the challenges Saviour will face after returning home. He will continue to grow, which creates the need for new shoes, braces, and longer crutches. Saviour and his team are hopeful these needs will all be met in time.

Said Good of the experience, "I'm not sure who learned more yesterday, my students or me. I thought that I was bringing in a guest lecturer to talk about a healthcare profession, but it was so much more. Instead of being the model, Saviour became the teacher.

"His story moved many of us to tears. His smile spoke volumes. His faith that has been instilled in him through Sister Stan was unshakable. The few words that he did speak brought joy to all our hearts. Saviour's presence was more impactful than any textbook could ever describe, any guest lecturer could ever explain, or any lesson I could ever plan."

Anna King, '18, also reflected on the visit: "It was an eye-opening experience that I will never forget. It was awesome to see how the things we are learning right now can help so many people in need."

For more information about Sister Stan's work, visit

Every new year, many people are tempted to try the newest fad diet to either help lose weight or enhance athletic performance or both. Many of these diets call to restrict certain food groups such as carbohydrates. While this may help with weight loss temporarily, if not monitored carefully, a low-carb diet can lead to decreased energy and athletic performance. Carbohydrates are the primary energy source for the body, and thus are important especially in an athlete’s diet. Once the body depletes its stores of carbohydrates, the body switches to use alternate fuels such as protein or fats.

Carbohydrates often get a bad name because they are often found in simple form in processed foods including refined sugars and white flour. These commonly are seen in cookies, sodas, pasta and white bread. These foods are generally not satisfying to the appetite and cause spikes in blood sugar. Complex carbohydrates, however, are digested more slowly, leaving you feeling fuller and having less effect on blood sugar levels.  Complex carbohydrates include whole grains, vegetables, fruits, nuts and legumes (beans, lentils and peas).

Dietary Guidelines for Americans recommends that carbohydrates make up 45 to 65 percent of a daily calorie intake. For an individual on a 2000 calorie per day diet, that would mean 900 to 1300 calories in the form of carbohydrates. Rather than having these calories come from “empty sources” such as processed foods, carbohydrates should come from nutrient-dense foods that are naturally occurring. My favorite diet tip is to stay to the outside of the grocery store when I am food shopping. On the outside you will find the fresh produce, meats, and dairy. Most processed food is in the center aisles. Natural foods will provide a better fuel for the body, improving overall health and athletic performance.

Rather than limiting a certain food group, the best nutrition advice is to ensure that your diet has variety, balance and moderation. A diet rich in nutrient-dense foods from all food groups will allow for the best result in the New Year and for many years to come.

For more information:

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.

With the start of October comes the start of wrestling conditioning before the official season starts. The conditioning helps to get the wrestler ready for the season as well and is a time for an athlete to start cutting weight safely, if needed, to determine a healthy weight class for competition. High school wrestling programs should have a weight management program that includes urine testing with a specific gravity test that does not exceed 1.025, a body fat assessment no lower than 7 percent for males or 12 percent for females, and a monitored weekly weight loss program that does not allow for more than 1.5 percent per week of the alpha weight. Before competing, all wrestlers must go through a weight assessment to determine an alpha weight to include hydration and skin fold testing. The alpha weight will be used to help determine possible weight class as well as used for any weight loss during the season.

The alpha weight, hydration assessment, and skin fold testing are to be tested all at the same time and required to be completed no later than two weeks prior to the district certification deadline, this includes any appeals. This is all prior to the start of any competition with another school for any of the athletes.

A trained assessor will perform the testing protocols on each wrestler and will record results on the proper weight certification forms. There are three parts that are tested:

  1. Hydration Assessment: This is a pass/fail urine test based on the specific gravity levels of less than or equal to 1.025. If greater than 1.025, the test is a failure and can be re-assessed after a 24-hour wait period. Specific gravity determines how hydrated the athlete is at the time of test. This urine test can be judged using a color chart, but to get a better or more accurate reading, the use of a dipstick or specific gravity refractometer or other hydration testing methods is acceptable. If the hydration assessment is passed, the athlete will then weigh in to determine the alpha weight right then with no exercise or delays between the tests. 
  2. Alpha Weight Determination: The wrestler weighs in on a certified scale and that weight is the athlete’s alpha weight for the year. The alpha weight is the weight used to calculate a descent calendar using the 1.5 percent loss per week rule. After the weigh in is performed the athlete will move on to the skin fold testing.
  3. Skin Fold Measurements: Using the proper testing calipers, the skin fold measurements are performed on the bare skin. Each site is tested three times and each measurement recorded accurately. This is to allow an average overall percentage to be determined. Skin fold sites that are tested are the abdominal, tricep, and subscapular areas for males and tricep and subscapular areas for females. All testing is performed on the right side of the body.

Once all testing has finished and all the data collected, it’s then recorded properly in a computer system that will determine a minimum weight class at which the athlete can compete. The weight class is determined by a predicted body weight at 7 percent for males and 12 percent for females including a 2 percent variance made by the system. If the predicted weight including variance is a specific weight class, then that is the athlete’s minimum weight class. But if the athlete's weight is in between weight classes, the higher weight class is determined as the minimum weight class. If the athlete already has a body fat percentage below the allowed 7 percent or 12 percent, then their alpha weight including 2 percent variance is used to determine minimum weight class.

Although there is not much to be done for the testing and protocols, these are very important steps that must be done for the safety of the athlete. Making sure all testing protocols are done properly and accurately is key and can play a big part in the athlete’s season.


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