A site dedicated to athletic training students, athletes, parents, coaches and anyone interested in learning more about injuries at they pertain to sport.
One of the course I regularly teach is CPR/AED for the Professional Rescuer. It's funny, because almost universally, whether students or health care professionals are enrolled in the course, I always get that "is this going to take a long time?" sense from those enrolled. I've never quite understood it, because it's possibly the most valuable tool one can learn. It is simple, but sometimes details get lost in real life situations. Call EMS, Begin CPR, use an AED as soon as possible. These three items can play an integral part in the survival of an athlete or anyone who collapses at a sporting event. Earlier this week, a local high school in Maine and more specifically, athletic training students and the athletic trainer displayed how proper training can be used effectively. You can read about this story here.
Several weeks ago, a physician was presenting at a conference and stated "Who are we responsible for at a sporting event?" It was a great point. He said we often think about providing health care to athletes, but what about the coaches, officials, game support staff, and the family and friends in the crowd? In this case, a game official collapsed and was attended to immediately. It just goes to show you the value of having an AED and trained medical staff on site, and in this case, a positive outcome.
Kudos to Anita Dixon MS, ATC and her athletic training students from USM and UNE.
Her presentation was essentially a primer on how to maintain life balance. I found it interesting; we even meditated for 15 minutes or so. And, I was relaxed afterwards. I felt clearer. To be honest, I never would have done that had I not been forced to. She challenged us if we were truly relaxing regularly, recommended several books I hadn't heard of, but sound interesting, and introduced us (ok, maybe just me) to the Chinese Clock. Very informative, and incredibly enlightening. An unorthodox topic from an ATC...and one that was well heeded.
Then it was off the Maine Athletic Training Student Symposium in Presque Isle, Maine. Each year, one of the four ATEP's in the state host a symposium for all students. For our students, it's a chance to experience something different in a relatively relaxed format. For us educators, it's a chance to catch up and visit. It's always fun. If you haven't seen UMPI yet, you should. It's slogan, "North of Ordinary", is quite accurate and fitting. And I LOVE it. The faculty and students were fantastic hosts, and put on a great program. Bruce Hamilton Dick, MD presented on a variety of topics. I have to say, natural teacher and orator. Very well presented, and he consistently incorporated and challenged students during his lectures. His topics ranged from Hip Arthroscopy and Athletic Pubalgia (phenomenal anatomy review), to the Female Athlete Triad and Asthma. Great, great stuff. His time was much appreciated by all. I only wish all of our students could have attended!
Trying something a bit different; lots of smaller newsworthy (I think) items...
Very interesting meeting the other night. I had a chance to meet up with Kevin Melanson, a fellow ATC who shared his experiences taking athletic training students to Haiti this past summer. It was his first trip, and he plans on returning again this winter. You can actually read about his experience here.
Some pictures of his students:
I can't tell you how refreshing and uplifting listening to his story was for me personally. Having advocated or the inclusion of service learning for some time, it sure is nice to see. I heard so many similar experiences, thoughts, revelations, etc. All I could really do was smile! Experiences like this always remind me of a lingering question: Why isn't service learning mandated as part of a core curriculum? As part of a general education requirement, this could easily be infused into all US Colleges & Universities. There is a need EVERYWHERE, here and abroad.
I blogged about how the NFL was making some changes to how medical personnel manage injuries during the game a while back. Well, this recent newspaper article was passed along to me by a colleague, and I found it to be a quick and fun read. Great to see how recent advancements can be used to improve communication and overall initial management. Enjoy
October is fully upon us; leaves falling, colder weather, and pink is everywhere. Every sporting event I seem to watch on TV or go visit our students at seems to have some eye catching pink item for sale. High school, college and even professional sports have fully embraced the movement. Now before I begin, I encourage you to read the entire post to understand where I'm coming from...you don't have to agree, but just understand where I'm coming from.
I don't like pink everywhere (and been quite vocal about it for years). I also don't like saying so, because I also don't like cancer, and saying I'm against Pink insinuates I'm against Breast Cancer Awareness. Or at least that's the impression I sense. I'm all for philanthropy and helping others. I'm left with the question burning in my mind: But is it doing anything? I just don't think we are going about it the right way. I think it may be more about the movement than actually helping determine what causes cancer. I think it's much more commercialization than anything else. And where does all that money go? Well, enter the documentary, Think Pink Inc. Here is a brief trailer:
It's an edgy topic for sure. How can you not like "pink movements" which promote breast cancer awareness. My question has always been, where does the money go, and what about the other cancers? Check out this link which shows you the death rates and occurrence of cancers. Indeed, according to the CDC link provided, breast cancer is most common in women, but prostate cancer actually has a higher rate of occurrence (144/100,000 as compared to 122/100,000). Perhaps even more interesting, though, is mortality rate. It's not even close. Lung cancer has the highest mortality rate in both men and women (actually, almost double the rate in women when compared to breast cancer).
Well, here are a few points teased out from the documentary I watched last night which I thought were interesting.
1. Less than 5% of money raised actually goes to researching prevention of cancer. This means that it's not going to finding a cause or potential causes of cancer.
2. Cancer rates have actually increased over the decades, from 1 in 22 to 1 in 8.
3. People need to talk. What if all researchers stopped "racing each other", and opened up a dialogue about what they were studying; it could prevent overlap, and may gain some headway.
4. When physicians found that early mammograms were giving too much radiation and therefore unsafe, they were shipped to developing countries for use there. (global responsibility?)
5. Susan G. Komen for the Cure has now expanded internationally, holding events all over the world. There is no doubt they have raised vast amounts of money and donated much...but a fair question to ask is "Is it doing what we need it to do?"
6. Many companies actually stand to profit from increased consumerism surrounding purchasing their pink lines (Avon, Yoplait, Pharmaceutical Companies, etc.)
I think what really got to me was later in the documentary, they actually described the origin of the salmon ribbon, started by a woman to promote cancer awareness. She was approached by both a magazine and retail provider, who wanted to market her ribbon. Her response: No. She didn't want it to be used for commercial purposes. Their response: they simply changed the color from salmon to pink and took it. Gotta love corporate America baby!
I thought the real drive home point was that the documentary wasn't really "anti-pink", as much as they just wanted to show the real face of cancer, which isn't pretty and nice, and really use money to look at potential environmental causes, etc, rather than medications to treat. Perhaps the most emotional part of the film was listening to the Stage IV group, who took exception to the terms "survivor" (does anyone really survive) and "fight", implying that they didn't give it their all when "fighting" cancer. In fact, they stated that it's not really a fight as much as it is enduring difficult treatments. For those who are unaware, Stage IV is the final stage. There is no Stage V for cancer. At any rate, an interesting documentary (although the geek in me wanted way more statistics) and worth a shot if you want to know where all that money you are donating is actually going to. I won't give away too much more (you really should watch the video for yourself on Netflix)
If you navigate the Pink Ribbon website, it appears the same as others, but if you examine the homepage more closely, it differs in the fact that it actually tells you the percentage of donated money used, and where it goes. Novel concept. It also has a link to the cosmetic safety database, which is an awesome tool. You can enter your common household items for cleaning, or beauty and see where their ingredients stack up on the carcinogen or toxic list. It's good stuff.
One last question: Does this movement inspire hope for cancer patients...or the loved ones surrounding them...or both? Does any of this matter? For instance, who cares where the money goes as long as one person is helped. Talk about an intersection topic. At any rate, feel free to share your thoughts.
Gotta love innovation. The Kerr Collar is being marketed as a way to absorb some of the impact forces during collisions in football. Here's how it works:
What I really like about this is not just the way it's explained, but the process by which it's promoted/defended/marketed (I do not mean to use those terms negatively at all; it's simply necessary when pitching any product to consumers). Dr. Kerr sums up the anatomical implications quite nicely here. He clearly has paid close attention to allowing neck extension to still occur (something it's predecessors limited). This is very important, as you don't want to create an axial load to occur. Key Point: Disperse Forces Imposed over a Greater Area. Check out his site: It's incredibly self explanatory and about as user friendly of a site as I've seen. If nothing else, watch it for a fantastic video of a mannequin getting hit.
Preventing Horse Collar Tackles
Does anyone remember this play a few years back? Not long ago, the "horse collar" tackle was actually a legal means to bring stop your opponent. As you can see, it was very easy for the player being collared to suffer a serious injury. The feet remained planted while momentum keeps the upper ody moving...aNd something's gotta give; be it a ligament, tendons, bones, etc.
Well, a new device has been recently approved for use . The X Collar which provides a tear-away component to the outer part of the football pad. It's a nice little snippet, first developed as a science project, which has since evolved into a product which is currently being marketed. Be sure to check out the schematic design and short video at the end of the article. Good stuff
Let's face it, while an opponent might not want to hurt someone, it can be hard to teach them NOT to try and grab any available part of the the opponent in the middle of gameplay. I love this. Simple, and likely pretty effective. We'll see if it catches on. At less than $30, it can be a nice inexpensive way to help limit this, especially in the beginning or middle levels of football.
Anybody have any thoughts on the possible limitations or negative consequences of these devices?
So many times, I hear AT's and students upset that public perception is that we tape ankles and get ice. Not sure why, but it's never really bothered me. Yes, we do much more than that, but I'd be more concerned if we had NO public perception. At least we are being noticed.
Anyway, a co-worker of mine is adamant about applying a clean, neat and functional taping technique. He describes taping as an "ATC's signature". I love that! Take pride in it; make sure it works and don't try to rush it.
When teaching traditional taping techniques to university students, I seem to find that while there are hundreds of variations and personal preferences on taping. That said, the instructor HAS to teach one method for the student to capture the basics and learn the skill. I frequently hear from clinical instructors questioning the technique involved when students displays their skills at a clinical site. While I do teach one method; it is just that; one method. I fully expect each student's taping to evolve as they progress clinically, and even encourage it. However, there are several taping basics which can easily be lost or discarded over time. We should be sure that the evolution is one of sound clinical reasoning and not just clinician preference. This can potentially decrease the effectiveness of the tape itself, delaying rehabilitation or even exacerbating the injury.
Some general rules on taping: The first assumption here is that I am discussing taping an injured ankle, not simply taping a healthy one.
1. Avoid continuous tape. This means don't wrap with one or two long strips of tape completely circling the joint. Use smaller, shorter strips for greater tensile strength. An added danger with continuous tape is that it may only provide compression, not support.
2. Know what you are taping for. In this video, we are taping to help lock the talus into the ankle mortise. I am applying a basic variation of the closed basket weave taping technique.
3. Overlap the tape by half all the time, and you will have both a neat AND functional taping.
4. I've heard colleagues say for years that taping with white tape is going out the door. This, coupled with the proliferation of over the counter braces and advances such as Kinesio tape (among others) certainly would lend credence to that argument. However, I think that sometimes nothing beats regular tape. In addition, much like anything in health care, I think it's more damaging to completely discard something when a) it still works for some athletes and some injuries, and b)it's the athlete's preference. At the end of the day, I think that's what drives the discussion for me.
5. Make sure it's latex free. Most, but not all tape is nowadays. Be sure to ask and double check before applying directly to your athlete!
Lastly, I'm not against other styles of taping, nor am I against bracing. As an educator I believe that all are beneficial when used correctly, and it's up to the ATC, athlete and injury to determine which is the best specific tool for that specific scenario.
Random Question: When did we start calling these "Ankle Tape Jobs"? Does "Nice ankle taping." not suffice? Does anyone know the origin of the phrase "tape jobs"? It is so awkward sounding; both to type and speak.
This has been one tough summer; but I am finally looking forward and able to get back to blogging. Here are some miscellaneous thoughts/tips/experiences I've had throughout, and hopefully back to some blogging normalcy. I returned this week from another trip to the Dominican republic, my 11th trip in the past six years. It's difficult for me to encapsulate the service learning experience concisely, but I'll give it a shot.
1. First time bitten by a centipede. I hope it never happens again.
2. While writing a SOAP note on a patient, an AT student asked "how do you spell machete"? How many educators have heard that before?
3. Watching students educate injured patients on proper posture, lifting techniques, and making on the fly adjustments to improve quality of life is one of the most beautiful things I've ever seen. I will never tire of it.
4. Don't think that just because your patient doesn't walk with a limp (antalgic gait) that they don't have significant pain and/or dysfunction in their lower extremity. Some people make subtle adjustments without even knowing it. Fully evaluate with a careful history, palpation, range of motion and manual muscle testing and then special tests before you complete your assessment. 5. Look your patient in the eyes directly when they are speaking to you, and LISTEN. Sometimes listening and expressing compassion is the best care you can give someone.
Haven't blogged in awhile, because I haven't seen much that I considered blogworthy. Happens I guess. I stumbled upon this article while reviewing potential collaborations, and this will immediately become required reading in my sophomore level AT course. In our field, we often speak of working collaboratively with other disciplines, and in fact, on clinical rotations students will often witness/participate in discussions/debates with other health care professionals addressing the student athlete. While learning to practice interdisciplinary care is in my opinion the best option for athletes, it can admittedly be at times difficult and/or frustrating.
Some key points prior to reading the article:
1. Understand that most everyone is coming from an angle in which they believe that their plan of care is the BEST way for the athlete to heal and return to activity in a safe and expedient way.
2. Listen. Listen to counterpoints; often times we tend to "zero in" on orthopedic or gen med issues as they are presented from faculty or textbooks. As we all know, unfortunately cases do not always present this way, and we can learn much from other professionals who have experience in dealing with those issues.
3. Share knowledge. Don't be afraid to speak your mind in a calm and professional demeanor. Emotion tends to force others into a defensive stance, which can alter the level of care for the athlete.
4. More is more. I love this adaptation to "less is more". The more information you and your colleagues have, the more informed decisions can be made, and outcomes can be enhanced (read: improved standard of care).
I have been fortunate enough to work closely with nurses and nursing students the past several years during our coursework in the Dominican Republic, and the exchange of knowledge in both directions has made me much more informed regarding general medical conditions; including signs, symptoms and overall management. Working side by side on real patients has incredible benefits, including my own progression as a clinician.
This group you see above are the 2012 graduates of the University of Southern Maine's Athletic Training Education Program. One of my favorite times of year are watching the next group of seniors move on to the next stages of their life. I had the privilege yesterday of watching this group of men and women at our graduation. They were a great group, and are going on to do great things; some as Graduate Assistant Athletic Trainers at Auburn University, University of North Carolina, Thomas University, Providence College; some onto obtain their Doctorates of Physical Therapy and Physician Assistants degrees. Either way, a heartfelt congrats to an amazing class. Great Job Gang!
Watching the exciting UEFA semi-finals, I was struck by a concussion and it's management during the game.
Check out the video here first:
It should also be noted that after a quick evaluation he was allowed back on the pitch and, eventually, several minutes later, subbed off. Watching this left me with some questions.
1. Does UEFA have specific rules regarding this? For instance, if this were the NHL/NFL, etc., he would be out of the game immediately, right? Why isn't unconsciousness grounds for immediate removal from game play? Perhaps the rules are different? Lastly, how does this align with the Zurich Protocol?
Of course, I had the benefit of TV and countless replays, while this medical staff was in a pivotal moment at a crucial match. I would never question the decision made, as I was not present personally, but as a teacher, I have to understand to better explain why some injuries are managed differently from our position statements to the clinical world.
Looking further into this, I found an interesting blog which seems to be neat resource for all things concussion. You can check it out at http://theconcussionblog.com/
Each spring I get fired up, sign up for a few 10k's, maybe a sprint tri, and try to get going again. I guess it's my way of breaking out of winter hibernation in Maine. Last night I came across this video which was both emotional and inspiring. Amazing stuff.
I teach an online course each summer called The History of Athletic Training, The premise behind it is that in order to better appreciate the present, we need to examine the past. It's easy to look at today and complain where we are at, but if you look a bit closer, and further back, even a few decades, you can see we've come quite far in a number of areas. In addition, it's nearing the start of triathlon season (yes!). With those thoughts in mind, I devoured this article posted online a few weeks ago.
Some prevailing thoughts at the time (keep in mind this was the 80's):
1. Glycogen runs out
2. Electrolyte levels didn't change
Boy, has that changed over the years!
Triathletes have always fascinated me; the sacrifice of training in three separate disciplines certainly requires diligence and a level of self experimentation that is intriguing. At any rate, if you are interested in working at one of these events, this article is a must read.
After a discussion in class the other day regarding cardiac issues in sport, a student had asked if I had seen the following video.
One, I'm glad he is OK, and back on the pitch. Two, I can't believe I didn't see this before (thanks Devon), but it is a tremendous testament to modern technology and athletics. In the AT world we often talk about managing cardiac events with an automated external defibrillator (AED) and CPR, but seldom how best to manage this situation. It's a good reminder that appropriate emergency transport and testing should be completed prior to return to competition (which likely goes without saying, but there it is anyway). It is highly likely future ATC's will be seeing more of these as both testing and technology advance.
Recently, the NCAA issued guidelines which required mandatory sickle cell testing of athletes. This was seen as taking a proactive step in insuring the overall health and well being of student athletes.
However, other reports are a bit contradictory., Additional read here. NPR (yes, I'm getting old) reports here that the American Society of Hematology suggests that the NCAA integrate coping (read, counseling) services along with their testing. Their additional suggestion? That the NCAA models their program after the US Army. The Army does not require testing (as of 1996), but does closely monitor a number of areas during physical activity, including acclimatization to heat, physical exertion and hydration status. They also have mandatory rest periods. Those specific areas are exactly within the domain of athletic trainers; and one would hope that all ATC's work closely with their athletic teams in providing practice guidelines in adverse and normal conditions. I have been unable to find any documentation of sickle cell associated deaths within the Army, but it certainly begs the question, if the ASH recommends it, they must have a solid track record, right? Let's hope so.
So what do you think? Good move by the NCAA, or is more (or less) intervention needed?
I was reading one of my favorite sites here, and came across an interesting link to the NFL which is a fun interactive historical timeline of "Health & Safety" in the NFL. Of particular interest to me was the evolution of the football helmet and pads. It has always fascinated me. Check it out at http://evolution.nfl.com/#
You can either click on the faux football field on the bottom of the screen and jump around, or in a more fun way, simply move your cursor to the right of your screen and it seamlessly scrolls laterally. If you click on the red dots near each topic, it will take you to videos, screen shots and narratives which more fully explain. Nice touch.
While many fans banter about the changes of the game, it's very interesting to see the simultaneous timeline of the evolution of playing surfaces and in particular, penalties. It certainly puts into perspective the safety aspect of the game. Check it out!
A common questions posed by students is "Are we supposed to treat every wound with anti-bacterial product(s)?" My response (opinion) is most of the time, no. In a normal, healthy athlete, an abrasion or small laceration not requiring stitches (usually defined as anything under one inch in length, although depth can skew this a bit) doesn't necessarily need an antibiotic or anti bacterial treatment. Please keep in mind I'm talking about small cuts and scrapes here. Treatments should be utilized only when certain signs or symptoms call for them; I like to use the example of headaches. Is is safe to take an analgesic or anti-inflammatory (for example Tylenol or Motrin) just because you may get a headache at some point during the day? Of course not;. My guess is the problem lies here. Perception.
I think the first place to start is to understand who the intended audience is for recommendations. Hospital workers? General population? Then we can really dive into the material.
Now, in the case of an athlete who has a weakened immune system or other dermatological/medical condition, that may be required treatment, but for most of our day to day, it seems like overkill. Not everyone agrees though. For instance, the Mayo Clinic states here that a thin layer of antibiotic cream should be applied to minor cuts and scrapes. This fascinates and confuses me, as I've read articles/protocols which state that cleaning small wounds with clean drinking water and soap (or simple saline solution) often will be the correct management plan. However, this literature review also points to confusing evidence. At least I'm not alone.
Take Home Point: Just because it's an OTC (over the counter) medication, doesn't mean it's safe and can be used at will; it needs to be used correctly at the appropriate time. For instance, it has been suggested that use of Povidine/Iodine and Hydrogen Peroxide actually delay the healing process. When we were younger, my mother used to practically bathe me in hydrogen peroxide and slather on Neosporin on everything. We know a little better now though that it may not be the best choice. So what to do? Let me further muddy the waters. The FDA published "The Benefits of Topical OTC Antimicrobial Products" which states they provide a great advantage to the general public. Really? What about the healthy population? I should also note here that these products do a great job of killing bacteria; there is no questioning that. However, all bacteria may be killed (good or bad) which can have unintended consequences. Now let's flip it around. This blog in Scientific American alludes to the fact that we may be going way overboard in our usage here, even suggesting (citing research) that it makes sick people worse. For those who want the cliff notes version, studies by both Aiello and Larsen showed no advantage in using anti bacterial soap over regular hand washing.
Now I know what your thinking. What about MRSA? Great question. The NATA offers our protocol right here and a position statement here. Now of course, this is not your normal, run of the mill cut or scrape. This would and should require more. Furthermore, it recommends following standard infection control precautions. My question is...which ones? And also, should we enact "standard infection control precautions" before or after we know what we are dealing with? I think it is easy for someone to read this statement and immediately believe it applies to everyone, everywhere. Is it possible that we are all interpreting that we should use these products on everything, all of the time? Diving deeper in, the NATA document references the CDC's Hand Hygiene Task Force (for real) which created the Guideline for Hand Hygiene in the Health Care Setting. Again, count me as confused and fascinated; so in order to combat pesky dermatological conditions, we should bathe in anti-microbials; but wait, didn't MRSA originate in health care facilities where these exact precautions were taken? On top of that, community acquired MRSA is now on a furious rise. So I ask; Are we doing the right thing?
This of course bleeds into (sorry) how we define prevention. Some would argue that prevention begins when you treat the wound, so throw everything you have against it. My definition starts prior to that; make sure you know your athlete, their specific medical history and let them know the signs of infection prior to utilizing a shotgun approach. Watch closely and educate your athlete. And before I forget, most importantly, wash your hands. Practice good hygiene and basic wound care. Wash your hands in soap in water, sing the ABC's and be happy. One more thing; wash your hands even after you've used gloves treating someone. Your opinion?
Anyone who has enrolled in one of my courses has heard me say numerous times "Don't be afraid to apply yourself. Put yourself out there." Well, one of our current students is doing just that, and on his long drive from Maine to Florida for his internship at the ESPN Sports Complex, made a number of stops at some institutions along the way. He gained some great information and tours about some storied athletic programs. Thankfully, he kept a short blog, which you can check out here. Good luck John!
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