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MUSC Health Blog

Keyword: sports-medicine

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!

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.

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 www.sisterstanschildren.org.

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:

https://www.choosemyplate.gov
https://health.gov/dietaryguidelines/2015/

 

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