Service Learning

The cornerstone of any health care profession is service, and in that spirit I will be leaving today for the Dominican Republic, where I'll be teaching an International Service Learning course to six of our current senior athletic training students.  This will be my tenth trip to a beautiful country with beautiful people.  We will work side by side with physicians, nurses, and hispanic study students as we travel village to village in remote settings to help provide medical care to those less fortunate.   I will be taking a couple of weeks off from blogging, but will start back up as soon as I return.
 The best part, although there are many, is that the student gets to work firsthand with the population and utillize their skills directly alongside faculty.  It makes for a truly unique and beneficial experience, for both teacher and student.  


Adios, mi amigos!

NFL to Hire ATC's to Follow Concussion Protocols

Last week, the NFL announced it will hire independent ATC's to aid in making sure that teams are following concussion protocols.  You can read the article here.


This is fascinating to me for a number of reasons;
1.  This is more of an independent (although not entirely) approach to health care.  It's often discussed in certain circles that it is a potential conflict of interest to be employed by a business and also make proper health care decisions in the best interest of an employee.  That is, is the decision being made independently and in the athlete's best interest?  Or the organization?  It's an interesting question, and a difficult one to answer.  This is definitely a step in the right direction, in my opinion.
2.  It would seem that the NFL hold's ATC's in high regard, as they would hire them to insure that protocols are being followed.  Who better to evaluate real time concussion symptoms than an ATC? 
3.  The author of the articles uses the term trainer, which many of my colleagues would frown upon.  Me, not so much.  A good health care provider is a good health care provider.  Does a physician complain about being called "Doc"?  Maybe, I don't know.  But I do know that you can call me whatever you want, as long as I'm decent at what I do.   Let's focus our energy as a profession on other areas, such as clinical proficiency and following our position statements more closely in clinical practice.

Fish Oil: Fact or Fiction?

Let's face it, your athletes are taking supplements.  And you might be too.  So it pays to be informed.  I subscribe to Consumer Reports, and highly recommend it to anyone who would like to see what independent, third party inspection thinks of everyday products to use.  Let's face it, sometimes it's hard to be objective, so for a small sum of money each year, I can have access to all sorts of information which help me make more informed decisions, both personally and professionally. (No, I don't receive any compensation for stating this; it's my humble opinion).

That said, fish oil is being consumed fairly readily.  The question is, do your supplements contain what the label states?  In this case, all tested showed the amounts claimed on the label for DHA, EPA and omega 3 fatty acids.  Good news.

A snippet can be found here: http://www.consumerreports.org/cro/2012/01/fish-oil-pills-vs-claims.html?EXTKEY=NH1CS00H 
At the bottom, click on the Fish Oil Ratings Chart; it charts out both efficacy and daily cost, which I thought was interesting.
You can read in much more detail if you already subscribe to Consumer Reports.

So what to do?  If you decide to take fish oil supplements, look for a USP label.  USP is a non profit which examines and verified authenticity of supplements.  More info on them here.
You can actually find a list of USP verified supplements here.  Again, it's no guarantee, but hopefully allows you to make a more informed decision/recommendation regarding supplement companies.

One last thought, you can likely obtain needed omega-3 by simply eating fatty fish a couple of times a week (salmon, etc.).  And remember, just because it's on the shelf to be sold, doesn't mean it's safe to consume. 

Shoulder Dislocations

A current student sent me this link...and I just spent over two hours on it.

Of particular interest is this section on relocation techniques It offers an excellent review/tutorial of several techniques.  I think we can all appreciate the difficulty encountered when attempting to relocate; in fact, several ATC's will choose not to relocate.  However, situations may arise when a relocation may be advised (think occluded blood supply).
Even more beneficial, the site offers videos of actual techniques performed on real dislocations...a great tool to prepare for what you might encounter!
For a nice review of shoulder dislocations, check out this nice little video:

What Price Victory

Just finished reading this excellent, excellent article in the NY Times on the late NHL hockey player Derek Boogaard.  It really makes you appreciate the sacrifice athletes make to reach the pinnacle of their sport.  So read, and feel free to share your thoughts!

http://www.nytimes.com/2011/12/04/sports/hockey/derek-boogaard-a-boy-learns-to-brawl.html?pagewanted=1&_r=2

Hip Flexor Assessment

I'm currently in Igls, Austria with the US Bobsled and Skeleton teams, and was working the other day with a chiropractor who did something that caught my attention.  She assessed hip flexor tightness using arm length!  A great reminder that our soft tissue is all connected.  Here is the premise:
1.  Athlete is lying supine, arms at side.
2. Clinician is standing at the athlete's head.
3.  Athlete raises arms to the ceiling, over the head and towards the clinician.
4.  The clinician then places the hands together; the "shorter hand/fingers" indicates tight hip flexors on the same side.

So, yet another interesting evaluative variation!. 

New Helmet Device to Prevent Concussions?!?!

As technology goes...so goes the nation.  A fascinating new technology is upon us:  The Impact Indicator. This new device is endorsed by Ndamukong Suh,  Keith Primeau, etc.  Basically, a light on the helmet flashes green normally.  When an impact is exceptionally high, it flashes red.  The software utilizes microsensor technology to measure hits at or above 240 HIC (see previous posts on this).  This device is located on the chinstrap, and can help take the guesswork out of when to assess for a concussion. 
A brief intro here:

It was developed by a company called Battle Sports Science.
If you are an ATC, coach, parent or athlete, do yourself a favor.  Take 10 minutes out of your day and watch this video. Perhaps the best aspect, is that it begins with some real, hard data from peer reviewed documents.

 

So, enjoy.  Your thoughts?

Great New Series

In class, I often tell students to look through the skin of their athletes, and envision the muscles, tendons and bones working in concert with one another to help identify how functional pathology can occur.  Well, this new series on Discovery does just that.  While each scenario isn't necessarily an athletic one, the parallels are certainly present which allows for a great cross-educational tool.  I've posted the direct links in the title above each video, if you'd like to view it in full screen.  A great show, and a great learning tool hope you enjoy!
The Human Body: Sensation

The Human Body: Strength

Of Athletic Trainers and Rectal Thermometers

A hot button topic in Athletic Training lately has been the use of rectal thermometers in the field.  Recent discussions with colleagues has revealed a somewhat divided stance, so let me do my best to set the stage.  WE are in the midst of a time where our profession is really pushing for the inclusion of evidence based practice, that is utilizing research to help dictate and guide our daily professional practice.  This is common in health care professions in the U.S.  Sometimes though, practitioners are resistant, for a variety of reasons, substantiated and unsubstantiated.  Essentially, the NATA Position Statement on Heat Related Illness, found here recommends utilizing rectal temperature as an evaluative tool to help differentiate between heat exhaustion and heat stroke.  It clearly states that oral, tympanic and axillary forms of temperature measurement are inaccurate pre and post exercise.  Research has shown that rectal assessment is the most accurate form of measuring core body temperature.  So why the resistance of ATC's to perform?  To be honest, I'm not sure.
We are educated to recognize life threatening conditions and to evaluate and treat them accordingly, and this is no different.  A rectal thermometer should be in every ATC's kit. It can be a valuable tool which provides valuable information. 
Let me be clear on this; when an ATC decides to take a rectal temperature, it's because bad things are happening (think life threatening emergency).  The athlete may be exhibiting cognitive difficulties, and systems are not functioning properly.  Scenario: An athlete collapses on the field during pre-season, clearly struggling.  The ATC makes the decision to call an ambulance for transport; the ambulance will take approximately 20 minutes to arrive.  During that time, many things can be done; including assessment of rectal temperature and cold water immersion (another statistically supported treatment method that is quicker at reducing core temp. than packing with ice bags).  Core temp is reduced (and you are monitoring it in real time) and again, literature has stated that heat stroke can be completely survivable if appropriate actions are taken immediately. 
My point:  Isn't that what we are here for?  I don't know about you, but I'd rather know exact temperatures than "guess" or speculate. 
Here is another recent take on the topic:
http://www.training-conditioning.com/2011/07/31/ahead_of_the_pack_2/index.php
 Best Line:  Would an ATC hesitate to use an AED on a female because her torso would be exposed?
For those interested, you can view an excellent "How To" of rectal temp here:
The bottom line:  If we are to be viewed as health care professionals, we should act in accordance.  Perhaps, if we acted as health care professionals (we teach our students to view the body objectively, don't we?), we might even be viewed as such!

Ankle Instability

 

 Check out that translation! What ligament(s) do you think have been damaged?

Sling Psychrometers for ATC's

One of the lesser known tasks for the ATC is measuring relative humidity (RH), and ensuring that athletes are participating in a safe environment.  The main concern is that when the humidity is high, the body lacks the environment for evaporation to occur. Just because an athlete is sweating doesn't necessarily mean they are cooling properly.  A common question I hear from our students is "Can't we just check online?"  It's another useful reminder  to educate them that utilizing online weather predictions is not only the easy way out, but it could also be highly inaccurate.  

Case in point:  If I go to an online weather service and type the town/city of an event I'm covering, the relative humidity reading is only as accurate as the exact location the measurement was taken.  On our campus alone, we may have several sporting events occurring simultaneously on a turf field, indoors, a grass field, or a track.  Why does this matter?  In a word, Temperature.  The higher the temp, the more likely adverse participation conditions exist.  For instance, if it is 70 degrees and raining, you would obtain a RH reading of 100%, but you wouldn't really be worrying too much about heat related illness.  However, if it is 90 degrees and not raining, but you obtain a high RH reading, the situation is a little more urgent.  Now, I could dive into synthetic fields but it's a topic for another blog.  I will attempt to be succinct.  As you can read here, synthetic fields are notoriously higher in ambient temperature than surrounding fields.  Depending on weather conditions, guidelines may have to be altered for practices/games on the turf field but not surrounding fields.  Now before it sounds as if I am unfairly biased against turf fields (which I am not), it is a fact that they "heat up"  more so than their natural counterparts, as stated here by a well known manufacturer.  More on that later though.

So how does it work?   I love sling psychrometers.  They are small, easy to use, and allow me to feel more comfortable if I have to make a decision regarding safe competition.

Personally, I prefer the manual, as relying on electronics isn't always the best option for me. It is small, fits in the kit, isn't affected if rain gets it wet from time to time and simple to use. They should be in every ATC's kit, regardless of what region of the country they work in.

Here are a couple of samples:Manual Sling  OR  Digital Sling

1.  Wet the wick on the Wet Bulb thermometer. 

2. Depending on the model, walk to the center of the field you are participating on, and "sling" the psychrometer for 1-3 minutes. 

3.  Working like a slide rule, take your dry bulb reading and wet bulb reading and align them.  A small arrow on the device points to the RH reading. 

Check out the clip below from Southern Mississippi, which does a nice job of explaining how and why we use these tools.

So what can an ATC do to prevent athletes succumbing to heat related illnesses?

1.  Go to the NATA website here, and familiarize yourself with consensus statement on Heat Acclimatization 

Then go to the CSMF website here for more info. (a fantastic resource in my humble opinion).

2.  Take regular, on-site RH readings, utilizing a hand held manual or digital sling psychrometer.

3.  Water down the field.  Manufacturers recommend watering synthetic fields down for 10 minutes, which will then lower the temperature (and of course effect RH readings).

4.  Understand acclimatization.  Just because you don't work or live in a "hot" climate, doesn't mean you shouldn't have a psychrometer to work with.  In fact, you may be the one who needs it most?  Take Maine for instance, we are not acclimatized to hot, humid weather, which means we are more likely to succumb to it.  

This will allow you to make accurate decisions on the field, and help protect the safety of your athletes. 

Advocates for Injured Athletes

This video was shared by a colleague and really speaks to having a knowledgeable ATC on the sideline during athletic competition.  Enjoy!

Anatomy Guy is Awesome

A former student sent me this link called, quite simply, Anatomy Guy.  Simply put, I love it!  Once you get the past the old school green screen effect, which reminds me of Mystery Science Theater 3000, (possibly one of the best shows of all time) the content is superb. 

The site breaks down into specific body regions, of which you can see actual cadaver tissue (an absolute bonus if your ATEP doesn't have a gross anatomy lab).  I think this is great for students at any level, as he breaks down each region into several categories:
Dissection Prep
Dissection Review
Clinical
Imaging
Surgical Subspecialties

In addition, they offer several shorter videos on specific injuries, injuries to regions, and special categories.  This is a great site which I think can really enhance studying and further understanding of basic anatomy, structure and function.  Check it out!

Oh, and here's another MST3K vid to carry you through the weekend. For those who don't know, the basic premise of the show was to take a horrible B movie and make fun of it.   Sorry I couldn't resist.
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Taping: Skill or Art?

"Taping is an ART."
"You will learn the skill of taping."
I have been greeted with both of those when learning various taping techniques at workshops/courses etc.  I think the truth lies somewhere in between.  Either way, we must be adept at it in order to perform our job.  Truth is, when an athlete is injured, how many times has a coach or athlete said, "Can't you just tape it up?"  It is perhaps as synonymous with athletic training as any other task we perform, and rightfully so.  We should be good at it, if not the best.
I've even heard colleagues state "Taping is dead.  Braces are the way to go."  I'm not so convinced.  Many athletes still prefer taping to bracing, and since we are a service based profession, I believe taping is here to stay.  What it will continue to do, much like everything else, is change and evolve (hello Kinesio taping!)
That said, here is a basic closed basket weave for an ankle, perhaps the most common taping technique regularly applied.  A classic, very diverse and useful:

Here is a variation; just a couple of tweaks, but the basic premise remains the same.

Some basic points on ankle taping:
1.  Avoid continuous tape; this often provides pressure and not necessarily support.  Shorter strips tend to hold up well.
2.  As a colleague down the hall says every day "Taping is your signature.  Make it look good."
3.  Be wary of the 5th metatarsal; don't tape to tightly over it, but don't stay behind it either.  It's a spot that is easily aggravated.
4.  Every ATC has their own "style" of taping; as long as the ankle mortise is receiving adequate support, then variations are OK.  Basically, if the tape is performing it's intended function, then it shouldn't matter at what specific point you apply your heel lock, figure eight, etc. It's OK to be different, but be efficient!

So who out there exclusively tapes?  Exclusively braces?  Tell us why, I'd sure be interested in hearing your thoughts.  

Combative Patient Restraint During Spine Boarding

One of the tasks assigned to AT educators is to properly instruct aspiring ATC's on the logistics of spine boarding (back boarding) of patients.  I have found that students respond readily to repeated rehearsal of the tasks associated with efficient and timely spine boarding.  However, the difficulty often lies within the patient themselves.  What to do when a patient is non-compliant or combative? When students practice in simulation, the assumption is that the patient is either unconscious or conscious and will automatically comply with verbal communication from the medical staff.  It has been my professional experience that this is not always the case.  If the athlete is unconscious and becomes alert midway through the process, they may be confused and, understandably, resist personnel who are attempting to do their job.  If they have suffered a head injury, or in the classic "fight or flight" mechanism, their reactions may be in complete contrast to the compliant patient we all envision when anticipating performing the act of spine boarding.  So what to do?  Well, in this case, go to the experts.  EMS personnel spine board more patients than most, if not any other health care profession.  And they do so in a variety of challenging and not so ideal environments. 
Question my students have posed after mock scenarios:  Do I restrain a combative patient who attempts to resist the immobilization process mid-way through?

My response: GREAT question. 
So we turn to Firehouse Magazine, and an interesting article found here. 
Take Home Points:
1.There are 4 methods of restraint:  Verbal, Non-Verbal, Physical & Chemical.  Use Verbal and Non Verbal as your first choice.  When those fail, physical restraint may be necessary.
2.Have four people ready to control each limb (this shouldn't account for everyone, though).
3. Use necessary, but not excessive force.

Mike Weaver writes in this article that much like firefighters training again and again for fires (which occur relatively infrequently when compared proportionately to training exercises), personnel can become more adept at handling challenging cases when they present.  He suggests this same logic be applied to spine boarding the combative patient.  Some take home points here:
1. Position the patient to your advantage: Holding them in a "T" position (arms abducted and elbows extended to 90 degrees, legs straight) takes mechanical advantage away from the patient.
2. Acceptable minimum number of trained personnel should be six persons.
3. Don't "crowd" the patient.  Give some space.

Some general rules I teach students to follow:
1. Don't assume that because you know all of your athletes, that they will automatically respond to you in a positive manner.
2.  Maintain a calm demeanor and constant eye contact with the patient (best if done by person at head position).
3.  Don't take it personally; they are in physical distress, and perhaps psychological distress.  Remain calm and in control.
4.  Remember, at sporting events, it's likely family and friends are in the direct vicinity.  Do your job, but be professional about it, in both physical and verbal commands.
5.  Use your verbal commands, and negotiate with the athlete.  Remember that excessive force at the head can actually increase severity of the injury; potentially catastrophically. Your struggle to hold the head and neck down may actually hurt them more.
6.  Know your equipment.  Every spine board and buckle/strap system is different, and there are many variations currently utilized.  Familiarize yourself with these wherever you go.

Great food for thought, a true gray area. Feel free to share your thoughts!

New Shoulder Pads Allow Easier Access for ATC's.

Back in June, Riddell unveiled a new product called the RipKord (TM) Shoulder Pad Release System. This year, the Chicago Bears will be the first NFL team to use them.  A common difficulty for ATC's is that we practice helmet and facemask removal constantly, but removal of the shoulder pads usually presents a significant problem:  How do we remove them while also trying to simultaneously remove shoulder pads AND limit cervical spine motion?  Beyond that, any significant torso injury needs to be accessed while trying to minimize athlete movement.  This is an interesting twist on the old design.  Below is a great video which depicts how the pads are removed utilizing the new system..

Similar to other shoulder pad removal systems, it begins much the same with removal of straps under the arms, around the torso, as well as the chest string.  The beauty of this design is that you then pull the "rip chord", the pads are then slid down the torso to each side, and then pulled away from the body.  A stroke of genius.    Let's hope this catches on, as it will make emergency management much more fluid. 

Fitting your shoes online? No Way!

Runners World has a new online tool which  fascinates me.  Not that I think it's a great idea to substitute a visit to your local running store and be fitted by an actual expert, but the idea is intriguing.  Check it out here and try it for yourself.  If you know your foot type well, it can indeed be very useful.  For the beginner, I would recommend seeing a specialist prior to solely relying on this tool.  The main upside is it can be a nice tool to educate your athletes with, and get them invested in the notion of being in the right shoe.

To learn more about terms and conditions prevalent to runners, check out this link.

When I input my own data, the shoes varied a bit.  I currently run in a pair of Brooks (pictured above) which I love, but the recommendations were primarily Adidas, which tend not to fit me well at all as they run narrow on my feet.  The fact that they recommend shoe types which won't necessarily account for how a specific brand fits speaks to the tools limitations.  But, it's fun to play with.  Enjoy.

King Devick Test to Predict Concussions

I was reading an article online regarding current concussion management, and an interesting advertisement displayed on the side of my screen.  It read "King Devick Test: Eye Test for concussions!"   I hadn't heard of it.  So began the search. Unlike ImPact, or other assessment tools, it is designed to be administered directly on the sideline.  The big selling point to ATC's: it only takes 2 minutes to administer.
Basically, it begins with administering a baseline to the athlete prior to athletic competition (this is similar to others) to be sure you are directly comparing themselves with, well, themselves.
After that, when you have an athlete on the sideline you are concerned about, you can use a card (or an IPad or laptop) in which the athlete has a set amount of time to read a series of numbers which are connected by arrows in a left to right fashion, and then downwards.  To view a demo card,which likely shows you better than I can explain, click here.  A more detailed description can be found here: http://kingdevicktest.com/

Surprisingly, this test isn't all that new.  It has been used for the past couple of decades to evaluate eye movements and reading difficulties.  It was originally developed to evaluate  saccadic eye movement.  Saccadic basically means fast, voluntary eye movements.  For more detail on how this relates, check out this fantastic explanation .here.

Moreover, the test has some early applicable data attached to it.  The American Academy of Neurology recently published a study in which it was used on boxers and MMA fighters, and their study showed that it had a high accuracy rating.  Although, the authors fully disclose that in order for it to be utilized more widely in athletics by athletic trainers, both interrater and test-retest reliability need to be further examined.  It should also be noted that one of the researchers is Dr. Devick, a developer of the test itself. 


One last bit, it's not free. The test costs anywhere from $45-$1750 per year, which some may balk at.  I challenge this initial thought.  At what point is a test of this importance too expensive?  Think of how ImPact has revolutionized concussion assessment.  We are at a point where we need to start looking at preventative measures and diagnostic procedures closely, and weighing that against the more long term effects/costs of brain injury.

It will be interesting to see if/when this is integrated into current concussion management on the sidelines.  So check it out, and decide for yourself!

Ironman 70.3 Follow Up

Big congrats to Renee for finishing her first 70.3, and judging by the way she feels, I'm guessing it won't be her last.   We also got a great pic from a very gracious Chrissie Wellington, who won the women's race (and beat most of the men).  This was an amazing event to witness; approximately 2100 competitors in the field and a true testament to mind over body. 

Also of note, local triathlete Mike Caiazzo finished second overall in the men's race.  Check out his blog, located at       http://mikecaiazzo.com/

Off to the Timberman Ironman 70.3!

Today we leave for the Timberman Ironman 70.3 in beautiful Gilford, NH.  My wife will be attempting her first half-Ironman, which is a 1.2 mile swim, followed by a 56 mile bike, and concluding with a 13.1 mile run.

We are partaking in all of the pre-race activities, and hope to meet up with 3 time World Ironman Kona champion Chrissie Wellington.   FMI on her, check out her website here.

So here's a GREAT VID that really captures the spirit of these amazing endurance athletes.  There are some incredible aerial shots in here as well.  Hope you enjoy.

Posterior Tibialis Irritation

This is an injury which continues to annoy me as a clinician.  At it's worst, it requires prolonged immobilization and/or surgery.  In the physically active population, it can be a nuisance for those who experience pain and discomfort, yet can still perform a portion of their activities.

The Posterior Tibialis Tendon (PTT) is an interesting structure which runs along the medial and posterior aspect of the lower leg.  It originates on the lateral aspect of the posterior component of the tibia, runs posteriororly just behind the tibia, and snakes down behind the medial malleollus where it inserts on the navicular tuberosity.  I should note here that most muscles/tendons have multiple attachment points, however I am listing the major areas of  attachment for ease.  This places it in the posterior compartment, along with the flexor digitorum longus and flexor hallucis longus (taught to many of us as the group acronym  Tom, Dick and Harry or TDH for Tib Post, Digitorum and Hallucis; get it?) Due to it's location, it has a notorious reputation for having a poor blood supply, thereby inhibiting it's ability to heal.  It's prime functions include providing medial ankle stability, inverting and plantaflexion.  The main concern here is a fallen medial longitudinal arch; and we all know that a "flat foot" or pes planus is associated with lots of other issues.  Avoid it at all costs.

The main issue for athletes here is that immobilization or surgery might not be an attractive option.  So how to manage?  Well, for this you can travel down several paths.
It's used for a reason; RICE.can work well.
Rest when you can; get off your feet for awhile.  You might be bored, but do you want to get better or what?
If effused, ice and elevate.  But do it the right way; after combining icing and elevating simultaneously for a period of time (a topic for another blog, lots of schools of thought on this, but 20 minutes is  a good starting point) take the ice off and keep the lower leg elevated for another 30 minutes.  That's right.  Lie down for an hour; keep the limb above the athlete's heart; remember that even while sitting effusion will have to work against gravity.  Repeat several times daily.
I have seen a variety of supportive taping and bracing options work; from kinesio tape running directly over the PTT, to a Low Dye arch taping technique, to simply inserting an over the counter orthotic with a slightly pronounced arch to help maintain natural foot shape. 
If NSAIDS are your thing, then they can take over the counter ibuprofen per the label; or see your team physician for something stronger.  I say this with the utmost caution though; it is a medication and should be used carefully.  I have seen an increase in the topical anti-inflammatories (Voltaren is one brand) recently, as well as the advent of Arnica Gel.
Lastly, if you have access to a walking boot; get your athlete in one.  They can wear it to help adequately rest the PTT, as the rigid or stiff sole will aid in limiting motion.  It's not uncommon to see athletes walking around in boots, in order to conserve for game day competition. A regimen of eccentric exercises can also help aid in balancing out immobilization and activity.
Remember to evaluate the other foot prior to making modifications.  As I remind students; Always compare bilaterally!

Intersection Syndrome or DeQuervain's?

I love it when former alums swing by my office to chat.  I really enjoy hearing the clinical cases they've come across as professionals and how they've handled them.  Last week, Rob Brookes, an ATC currently working summer camps in between his graduate assistant responsibilities, stopped by and during conversation mentioned how he came across a lacrosse athlete who suffered a direct blow to the forearm, and suffered consequent pain and "creaking" in his distal forearm.  The diagnosis: Intersection Syndrome.  While this condition can be caused by an acute trauma, it is often seen as an "overuse injury" (think rowers/weight lifters).   Now comes the interesting part...I searched through the index of my AT texts looking for this particular term, and could not find it. Anywhere.
Curiosity piqued, I turned to the internet.
Pain is exhibited along the "thumb line" on the lateral aspect of the distal wrist (remember lateral, because we're describing it in the anatomical position.  It can easily be confused for DeQuervain's Syndrome, which is usually diagnosed utilizing Finkelstein's Test, seen here.

The main difference between the two is location of discomfort.  In the case of Intersection Syndrome, pain is more proximal to the wrist whereas in DeQuervain's, pain would be a bit more distal to the thumb.  Anatomically, the difference between the two can be explained as follows:
Intersection:  Inflammation at the intersection of both the extensor carpi radialis brevis and longus, as well as the abductor pollicis longus and extensor pollicis brevis.
DeQuervain's: Inflammation of either/both abductor pollicis longus and extensor pollicis brevis.

This video, which seems to be shot in an ER, does and excellent job of briefly but accurately describing the malady as well is offering a clinical differentiation  between DeQuervain's and Intersection.

An interesting clinical differentiation which can help make us all a more effective health care provider!

Proper Bicycle Fitting

Fresh off a great trip to the Dominican Republic, I was greeted by my wife who is in the midst of training for the Timberman Ironman 70.3 in a few weeks.  My welcome back included a reluctant trip to the local bike shop, where she has been mulling switching from her Specialized road bike to a true tri-bike.  What an interesting trip it turned out to be. The staff at Gorham Bike & Ski, specifically Kyle and Greg, introduced us to some cool technology I didn't even know existed.

Renee was fitted  for her prospective tri-bike with a new technology called  Body Scanning.  It utilizes laser measurements combined with software to fit for each unique rider and body type.  What was really interesting to me was that it also took into account her style of riding for a highly individualized fitting recommendation.  A computer graphic is then generated with ideal measurements such as saddle height, aerobar placement, etc.  Greg then set up a bike for her and she took it for a spin.  After a couple of quick adjustments, she went off for a longer ride.    Switching from regular handlebars to an aero-bar promises improved

speed and faster times, but has to be carefully fitted to insure protection against nagging injuries which can occur while spending 2-3 hours in the saddle.  Even for shorter distances, relatively small adjustments to handlebar angle can drastically change both upper and lower extremity numbness/tingling which can occur.  She said it felt great, and likely my bank account will be taking a hit soon. So if you are a bicyclist, regardless of your fitness level, I recommend finding a dealer in your area which has this system. Who knows, maybe it will help turn riding into a pleasurable experience for you again.  It is quick, easy, and often free!

In Vivo Biomechanical Analysis of C6 Fracture in Football Player

Football season is almost upon us, and just in time comes this reminder of what athletic trainers need to be ready for as pre-season approaches.  The New England Journal of Medicine recently published this correspondence piece online.  It contains video of an actual C6 fracture in real time, and the article describes the events which took place during and after injury.  You can see the axial load component take place; but what makes this most interesting is that it contains, what researchers believe to be for the first time, true data as it relates to forces imposed on an athlete during an actual cervical injury.  Not to dramatize, but this is HUGE.  This could potentially be a big step forward in the prevention of catastrophic cervical injuries.  Many of us speculate, but this gives us some real data to sink our teeth into.
Hang on to your pocket protectors, this is going to get geeky...
The players helmet was equipped with a fascinating bit of technology known as the Head Impact Telemetry System (Simbex), which utilizes several accelerometers within the helmet that measures not only  impact location, but  magnitude as well.  As I learned a month ago in New Orleans, in order to quantify this data, one must take into account both linear and rotational forces (think 3D movements; most collisions in sport don't involve just one plane of movement but several).  As stated in the article,  The Gadd Severity Index (GSI) and Head Injury Criteria (HIC) were used to help compile data. Now to break it down.  The GSI is a standard that can help predict a helmet's ability to accept and quickly decrease forces upon impact, which can then help protect the brain.  HIC looks more at head acceleration, and duration of the acceleration, also very important when examining potential injuries, or in this case actual injury.  Of interesting note, acceptable GSI values during helmet testing are 1200 for football helmets and 1500 for lacrosse helmets, noted in this study on lacrosse helmets (a great article I use in class each semester).  You'll  notice that the levels reported in this specific athlete that the values were well below those levels. 
It's good to know that this athlete was cleared to play basketball after a period of recovery.  For you students out there, please take note that this athlete suffered BOTH a concussion and a cervical fracture, truly reiterating the fact that you must examine/rule out both on the field.  A concussion is a serious and potentially catastrophic injury, and a cervical fracture must always be initially managed as a catastrophic injury in terms of emergency management.  His Borg pain scale values were between 3 and 5, which some might incorrectly assume to be higher with such an injury.  It is a good clinical reminder for us to not rely solely on one evaluative finding, but the combination of several when making clinical decisions.   

International Service Learning

If you've read my earlier post on multi-culturalism and cultural competency, you know that this is a topic very near and dear to me personally and professionally.  Tonight, I'll leave with six athletic training students to embark on a two week journey into the mountains of the Dominican Republic.  We'll travel alongside nursing students, and several health care practitioners of all types to provide care to those less fortunate.   I am looking forward to returning and seeing my Dominican friends.  We'll be hiking and driving to remote mountain villages and setting up clinics; our students will be performing evaluations and prescribing rehabilitation plans under supervision from ATC's and physicians.
International Service Learning (ISL for short) combines classroom instruction with hands on learning.  We don't just travel to another country; we interact and actually treat the population.  We go into their homes, schools and churches.  True cultural immersion.  It's a great way to learn and in my opinion unparalleled.  I believe service learning should be required of every student in the U.S.   FMI, click on an editorial I wrote here. which better explains what service learning can be about for athletic training students.
It's an incredible trip every time, and can teach us all about several lessons in life.   Here are a few I've experienced.
1.  Perspective.  You don't need a lot in life to be happy.  Yes, that includes smart phones and laptops. Health and pain free living go a long way.
2. Students know more than they let on.    I get a chance to work with our students on true clinical cases.  They have to think on their feet, and make adjustments.  There are no BAPS boards or BIODEX units; we have to pick items they have handy. Our students return with sharper clinical skills, and perhaps most importantly, increased clinical confidence.
3. The real world continues to be the best classroom.

So on that note, I am off to the Dominican Republic, and will be away for a couple of weeks.  I should be back to blogging after the 28th.  Adios, mi amigos.

On bicycling

Yeah, I've got it.  Tour de France fever.  This sport is under a lot of scrutiny, but you can't deny both the physical and mental toughness of these endurance athletes.  Check out this video of today's crash caused by a media car, sending 2 riders to the ground, one of them into a barbed wire fence. Amazingly, both riders finished the stage.  Astounding.

On another note, I just watched a very interesting documentary on the sport, Hell on Wheels.  Yeah, I know it's old, from way back in 2005, but it's good.  I especially liked how it displayed many of the "behind the scenes" aspects of the sport itself; all of the prep work and support staff, from the medical team to mechanics.  You can purchase it off Amazon, or it's currently running for free if you have Netflix.  It truly makes you appreciate the hard work these athletes put in, and just how demanding the sport is on their bodies..  Best quote from one of the sore and fatigued riders "I should have taken up surfing."  After watching this documentary, you'll likely agree. 

Being a Leader and Ubuntu

I received a book as a gift earlier this spring, and like most people I guess, I tucked it away in my "to do pile".  Well, I just finished reading it, and found it completely refreshing, while also kicking myself for letting it sit on my shelf for so long.   The book is called Mandela's Way: Fifteen Lessons on Life, Love & Courage by Richard Stengel. Stengel spent years at Mandela's side, at both matters professional and personal, public and private.
Among many things, the book touches on how Mandela had to evolve over time; from a young dissident, to a calmer, more mature person.  He learned to listen, be patient, and know when to lead from the front, and when to lead from behind.  Perhaps the most enjoyable aspect of the book for me was the topic of ubuntu.  Ubuntu is described by Stengel as "the idea that people are empowered by other people, that we become our best selves through unselfish interaction with others." Simply put, I love this.  It both confirmed and refreshed my own philosophy of leading.  Most poignantly though, it educated me.  If you lead anyone, or aspire to lead, in any type of forum, I believe this to be a must read.  It reads very easy and quick, and you'll have trouble putting it down. 

You can find more information on the book here at http://www.mandelasway.com/

NATA releases Safe Weight Loss & Maintenance Practices Statement

This was one interesting read, and I recommend it to anyone out there.  As athletic trainers, we are often faced with questions from athletes regarding proper nutrition, weight loss, weight gain, etc.  Some ordered and random thoughts (the article is VERY in depth, these are just a few points it touched on)...

The article begins by identifying that weight and body composition are believed to influence both physical performance and aesthetics of performance.  I found it refreshing they made the distinction. The authors also utilized the Strength of Recommendation Taxonomy, which essentially uses scientific evidence in order for the reader to weigh current legitimacy of topics...basically lending credence to proposed guidelines.  A nice touch.

While many sports have weight class systems (think crew, wrestling, etc.), few use standard weight/body composition guidelines.

Body fat minimums are higher for high school athletes than collegiate athletes.

Make sure your athlete is well hydrated prior to performing body composition assessment.

In children, just a 1% reduction in hydration caused both an increase in core temperature and a decrease in aerobic capacity.  In adults, a 2% reduction in hydration caused decreased reflexes, max oxygen consumption, work capacity, and both muscle strength and endurance. 

Disordered eating: It's not just females.  11% of wrestlers have had eating disorders or disordered eating (another neat distinction, which I've touched on in classes in the past),  I actually thought this number might be much higher. 

All in all, a good review of some concepts, along with integrating some new information I was unaware of.  The authors clearly had a difficult topic to tackle; I often hear athletes complain of coaches who say "You need to lose weight." or "You need to add some muscle".  But often times, they are in fact, seeking out that type of feedback themselves in order to improve their performance and/or body image.  Some feel it's a taboo topic to discuss, but it's often at the forefront of every athlete's mind.  I think we all feel a twinge of hesitation when dealing with this topic, but truth be told, sometimes the answer is not in what you say, but how you say it.  Perhaps most importantly, we need to be able to guide the athlete on how to successfully navigate accomplish their goal in a structured fashion, or at least point them in the right direction of someone who can.

Very interested in hearing your thoughts on this!  

Food Guide Pyramid Toppled

Rather quietly it seems, the USDA recently changed the pyramid format for nutrition in the U.S. to a plate.  When I typed in the old URL, www.mypyramid.gov, it redirected to http://www.choosemyplate.gov/  While many have issues with components of the recommendations, it is indeed a decent foundation in which to start understanding proper nutrition.  Personally, the plate idea isn't a bad visual, and is hopefully better to understand. Sadly, while it has recommendations for the general public, pregnant moms, and kids, it does not include athletes specifically as a sub-group.  It does ask for daily activity levels though, which is nice.  As with other topics, there are no absolutes, and information should be taken with a grain of salt.  My advice to all students and ATC's is to go to the website, enter your personal data (height, weight, age, sex) and check out what it has to say.  Like a said it's a good starting point.  Having used this site in courses in the past, at first glance and with an hour or so of playing around with the site, it does seem a bit more user friendly than the older version. 
The reason I post this is twofold; one, the NATA released a new position statement on weight loss last week in New Orleans, which I will review in my next post.  Two, we as professionals are bound to have at least a basic knowledge of nutrition, and this is a good place to start figuring it out for yourself.  How many of you have heard athlete's ask "What should I be eating?"  I for one have found it best to give broad advice, but there is no substitute for a registered dietician or nutritionist.  Their knowledge base, in my experience, has been astounding and incredibly educational.  If you get a chance, look up a local one in your area and have an assessment done.  Money well spent in my opinion. 

NATA Clinical Symposia: Helmet Issues

One of the most interesting sessions I witnessed, ,"Emerging Technologies in Helmeted Sports", featured 3 speakers, each focusing on football, hockey, and lacrosse helmets.  Here are just a few of the topics addressed:

Football Helmets: Both rotational and linear forces need to be considered when addressing concussive injuries.  It's not always the direct hit which causes a concussion.  Dr. Guskiewicz spoke about reinforcing proper technique, which is still in issue in high level athletes.  A valid reminder as well that concussions are great at protecting the head and face, but the brain itself is a separate entity which can still move violently, while the outer "shell" or cranium remains relatively uninjured. A good historical reminder that was mentioned was that football helmets were developed to prevent the high rate of catastrophic injuries that were occurring in the sport, and if we use that criteria, the helmets themselves do a great job of just that. 

Hockey Helmets:  A big problem here is fit.  Dr. Mihalik stated that during his recent study of 18 hockey helmets, none of them fit properly!  In fact, he said, 7 of them could be removed without loosening or adjusting any straps at all.  He showed one clip of a hockey athlete securely fastened to a spine board with his helmet, and had the athlete mimic cervical movement.  He had substantial motion, which may speak to the thought process of simply removing the helmet when spineboarding a hockey athlete.

Lacrosse Helmets:  This presentation detailed the lacrosse helmet and, amongst other items, the difficulty with the pop rivet.  Dr. Higgins explained and displayed video of an equipment manager removing all pop rivets and replacing them with ones that could be "unscrewed".  Some in the audience voiced concern over whether this in fact voided the helmet warranty.  There was no clear answer.  It seems the best course of action is to read the fine print, and check with the helmet manufacturer you are currently working with. 

After listening to these three speakers, and the questions which followed the session, I couldn't help but think aloud to my colleague "We're just going to be teaching to completely remove the helmet all the time when spine boarding.", to which he replied "I've been saying that for years!"  Essentially, if the helmet doesn't fit properly, it should be removed prior to spine boarding, as your main goal is to stabilize the cervical spine.  Nonetheless, a fascinating topic, and judging by the massive attendance to this session, a very topical one to today's practicing ATC.   So I ask you, are you ensuring all of your athletes are properly fitted, regardless of sport?

National Men's Health Month

Not sure if you know this, but June is National Men's Health Month here in the U.S.  As ATC's, we need to be proponents of a healthy, active lifestyle, and that includes being knowledgeable about all topics related to general health and well being.   Check out this site FMI. 

Off to New Orleans

For the 2011 NATA Annual Meeting & Clinical Symposia.  From what I've seen, this looks to be a great lineup and I'm ready to absorb some great information!  I will be back to posting after next Thursday.
 FMI, click on the following link:     62nd NATA Annual Meeting & Clinical Symposia

It's All in the Hips

A common foe of the athlete and ATC is patellofemoral pain (PFP) syndrome, or runner's knee.  This nagging issue can be difficult to successfully treat.  Often times, we can treat the immediate area with ice, massage or a combination of electrical modalities and obtain favorable results.  Sometimes, we find ourselves at a crossroads; the athlete is doing everything right in terms of appropriate rest and treatments, but their symptoms persist. A new study suggests that perhaps implementing a twice weekly hip strengthening program can reduce PFP symptoms.  While it is a relatively small sample size, I think it still has merit; remember to treat the condition, but evaluate the body.  The cause may not be where pain is located.  The article goes on to speak of some classic findings with PFP, including the abnormal contact between the femur and the patella, and the classic valgus lean upon squatting which is commonly seen those suffering from this malady.   This article really speaks to the benefits of overall strength/conditioning.

The video here is not related to the article directly, but I think it has some great examples of rehabilitative exercises that can be utilized when working with an athlete whom you feel needs "core" (and I use that term loosely) strengthening. Not all exercises may be appropriate, but it can give you a good idea of really using a combination of both verbal and visual cues to guide your athlete through the process.  I wanted to add a video of Happy Gilmore and Chubs saying "It's all in the hips", but this should do just as nicely, I suppose.

Multiculturalism and Cultural Competency

A task those of us in athletic training education face is teaching specific orthopedic skills while balancing actually dealing face to face with athletes.  These athletes may be of many different ethnic origins, and have different religious or belief systems which the ATC has to take into account.  A few years ago, I read a fantastic book called The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures  It essentially documents a specific case of a growing population in the U.S., and the disconnect which can occur when both health care professional and patient fail to fully understand where the other is coming from.  ATC's and students can work with a variety of populations, and it can prove to be challenging and frustrating for both sides when cultural practices are not fully understood.
Cultural competency is a complex definition; thankfully, the U.S. Dept. of Health and Human Services has done a nice job of explaining it here.
There are also a number of good, scholarly articles on the subject if you spend the time searching.
My question to you: Do you feel as though you are comfortable treating an athlete from a different culture than one you are familiar with?  As health care providers, we must serve our patient base regardless of ethnic origin, and we need to be prepared to do a little research in order to be most effective.  A new text was released this past fall specifically geared towards ATC's.   Cultural Competence in Sports Medicine is a huge step in the right direction.  It's on my bookshelf, and it should be on yours!

GI Issues

This topic can frustrate both the ATC and the athlete; what to do when an athlete complains of gastrointestinal issues?  Very recently, a study correlated high intensity sports with GI issues, and of particular note, crew athletes were singled out as having issues which could impact quality of life.  It makes sense from an anatomical position standpoint, spending long amounts of time in a seated position, constantly "squishing" internal organs while performing a repetitive motion.  When you hear of complaints, look at all angles.  Think beyond simply asking "Did you eat anything funny in the last 24 hours?"  Not to discount diet at all, but perhaps the nature of the activity can itself be exacerbating the condition.  When attempting to aid your athlete in performing at his/her highest level, take into account all aspects.  It really lends credence to evaluate globally, and work your way focally, rather than the other way around.  You might just find the cause that much quicker, making you and your athlete much happier.

National Running Day

Happy NRD 2011!  I know, there are a lot of "useless" holidays out there, but this is one all of us physically active folk can appreciate.  Use it as an impetus to get in a workout today, whether it means running 3 minutes, 3 miles, or 3 hours.  FMI, check out http://www.runningday.org/site/

Alcock's Syndrome, Pudendal Nerve & Obturator Internus

Now this is a topic even us educators need to be educated about!  Pelvic pain and dysfunction can be somewhat of a sticky wicket for us ATC's.  A good friend and colleague of mine recently published this article in  the International Journal of Athletic Therapy & Training. If you can access it, (which you should if you are on a college campus) you will be enlightened.  Alcock's syndrome is when the pudendal nerve becomes entrapped.   I have to say, the obturator internus can be easily overlooked due to it's anatomical location, and this article does a fantastic job of walking the clinician through both internal and external stimulation of this muscle.  It just goes to show you that we have to treat the human body very objectively to obtain results for our patients.  It is certainly one of the most enlightening  articles on the topic I've seen as it relates to ATC's.  For those of us who work with athletes "in the saddle", this information is indispensable.  If you can't access the article above, check out this link to the Society for Pudendal Neuralgia, a non-profit which seeks to educate health care professionals about the subject.

Tick Season

It's that time of year again.  As a kid, I can remember my mother saying "OK kids, tick check!"  Boy, has that phrase evolved into something scary over the years.  With any outdoor activity (sports included) this has to be a concern for the ATC.  Several years ago, I was working with a baseball player rehabilitating a post-op menisectomy, when he developed pain and effusion in his knee.  Consulting initially with his orthopedist, we scaled back our regiment thinking we were too aggressive.  Several weeks and  setbacks later, this "simple" case was frustrating all of us.  Only when some routine bloodwork was performed did an unlikely answer come back: Lyme Disease.  It was a big turning point for me as a clinician in looking beyond orthopedic causes of health issues in athletes.   I strongly recommend a documentary "Under Our Skin", which details the origins of lyme disease interweaved with stories of current sufferers.  A word of caution, it is fairly shocking to see how some are affected.  It also looks at the relationship between universities, researchers, and funding from insurance and pharmacology companies.   
Some key points the film raised (there are many more):
Lyme disease is prevalent; 35000 cases currently, perhaps as many as 420,000 (far exceeding HIV and West Nile); it is the 6th most common disease in the U.S.
It seems a stigma exists in that some health care professionals either don't recognize the symptoms soon enough, or they fail to associate the widely varying symptoms of Lyme to the disease itself.
Further complicating the issue, some physicians question the symptoms of lyme, perhaps suggesting that the symptoms are psychological. 
Nine out of 14 authors of the IDSA Lyme Disease Guidelines have rec'd money from lyme disease vaccine manufacturers.
Some words of advice:
Make sure your athletes and their parents are aware of ticks and to check regularly for them.
FMI, check out what the CDC has to say about it here.
Interesting CDC fact: 95% of cases occurred in 12 states (yes, Maine is one of them)

Take home point: Be a knowledgeable consumer.  In every aspect of your life.  Assume no one will advocate for you, except for you, and research for yourself!

Deep Vein Thrombosis in Athletes

General medical conditions occurring in athletes is one of my high interest areas, and I came across this case report recently that really caught my eye.  AT textbooks tend to lean their attention towards the lower extremity,  which in turn can  lull us into a state of thought which restricts DVT's from occurring in the upper extremity, when in fact, they can and do.  This particular case involved the non-dominant arm of an offensive lineman, which  might throw off your evaluation for two reasons:
1. It's the non-dominant arm 
2. Presentation occurred in a "traditionally" non-overhand athlete (as compared to say a baseball or volleyball player).
Additionally, he had no recollection of specific trauma.
Treatments can range from oral anti-coagulant therapy, to thrombolysis or even surgical intervention, (or combination of  case dependent of course. In this athlete's case, he was treated solely with oral anti-coagulant therapy for a shorter period of time than most (4 weeks). 
So how do thromboses occur?  For that, we turn to Virchow's Triad.  What is that? Well,  this link shows a great chart which helps explain the causes therein; Essentially, Virchow's Triad lists blood coagulation issues, vessel wall abnormalities, and blood flow issues as causes.  The chart displays specific examples (trauma, varicose veins, and malignancy, to name a few) as well.   

Orthopedic Special Tests

Review, review, review.  One of the benefits of the internet is the availability to watch special tests performed "real time", rather than just reading them out of a textbook or seeing them once or twice at clinicals.  While some tests are more valid than others, it's always good to fill your evaluation arsenal with as many as possible.  Over time, you may come to realize which ones work best for you and which are better predictors of specific pathologies.  

 To study, you can either click on the link to Musculoskeletal Special Tests on the upper right hand side of the blog or, check out this website which also offers detailed explanation of several tests.   It can be a great way to stay "fresh" over the summer!

Student Resources

Students often ask me, "Where can I learn more about athletic training internships/scholarships/opportunities, etc?"  Short of both the textbooks  I require and specific peer reviewed journals I recommend, there are some high quality sites available. 
In addition to the National Athletic Trainers' Association website (which should go without saying), one of particular interest to students is the Collegiate Sports Medicine Foundation which highlights a number of topics currently pertaining to athletic training.  They cover everything from study abroad opportunities, to injury photos/videos, and even current topics covering legal issues and catastrophic injuries in sport.  So the next time you have a few minutes, check this site out.  Good for ATC's and students alike!

Supplements: Are you keeping up?

In this day and age, there is much talk and practice of supplementation.  Are they good or bad? A difficult task for the ATC can be staying informed on what commonly used supplements are viable or not.  This google document collected information on various  supplements, and connects them directly to peer reviewed research which examines their use and effects.
http://www.informationisbeautiful.net/play/snake-oil-supplements/
Simply click on a balloon for a specific item, or use the tab on the right to see empirical data for supplements as they rate for specific conditions.  


I also read this study on additives in supplements which may serve to help educate athlete's about what they are actually ingesting  http://www.consumerreports.org/cro/magazine-archive/2010/july/food/protein-drinks/whats-in-your-protein-drink/index.htm

Once in the article, click on links on the upper left hand side to peruse the article.  This topic truly is a moving target, and highly individualized. 

History of Athletic Training

 Everyday, ATC's and students find themselves educating others about who we are, and what we do.  We often are confused with personal trainers, which is a great profession, but we differ in what we do on a day to day basis.  This article can be used to help educate others on not only our origins, but the level of education we have prior to even taking our certification exam.  It may be a little dense, but I find it an interesting read.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1322875/pdf/jathtrain00005-0067.pdf

Football Helmets

One of the most common tasks for the athletic trainer during the sports seasons is helmet fitting.  Not only must they know  proper fitting protocols, but they also must be well versed and proficient at it's removal in an emergency situation.  A difficulty for today's ATC is that they may have a team which has several different helmet styles on one team, meaning that they have to familiarize themselves with the appropriate, or most efficient removal method for each style.  Recent advancements in helmet technology may provide a quicker release system.  Check it out!

Anatomy of a Football Helmet
A nice schematic which takes a look at the helmet from the inside out, courtesy of the NY Times.

http://www.riddell.com/usafootball
Overview of the Quick Release System on Riddell Football Helmets

Google Body: Visualizing the Human Body

A common issue amongst AT students is that not all can learn by simply looking at pictures in a textbook, and not all educational programs can provide a gross anatomy course (which is indispensable, in my humble opinion).  Google has unveiled a new tool in which you can scroll almost 3 dimensionally throughout the body, and click on specific areas to reveal terms for the different systems in the body.  This is the best free tool I have found in some time for students to study...this can be a fantastic augmentation to your studies.  Enjoy!

http://bodybrowser.googlelabs.com/

Of note:  this works best with Google Chrome, which is easily downloadable if you don't already have a browser which supports the feature.  

Palpation Lab Activity

A frequent frustration for students can be to understand the purpose of palpation.  While at times it is taught as a way to identify anatomical structures, it must also be understood as a way to identify abnormal structures.  How many students could correctly identify a fascial bind?  What about a muscular "knot"?  Don't even get me started on a partial tear.  Here is a link to a fantastic article I read recently:
 http://nataej.org/5.4/0504-170175.pdf
Not only is it spot on, but it can make an otherwise drab lecture turn into a powerful teachable moment.  Essentially, each student completes various tasks including:
1.  Palpating a penny and describing it in a tactile fashion.
2.  Palpating bundled Twizzler candy with various deformations/abnormalities in it.
3.  Using their index fingers to compress a scale at specific pound intervals.
I tried this last week and the result was a resounding success.  Students loved it, and it took palpation to the next level for them.  Great article, great tool for educators.