Friday, July 29, 2011

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.   

Wednesday, July 13, 2011

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.

Sunday, July 10, 2011

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. 

Tuesday, July 5, 2011

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

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!