3rd Matthew Gfeller Sport Related Neurotrauma Symposium

This past week, I traveled to the University of North Carolina (not for the "game", but for continuing education.  Continuing education can be many things to professionals; costly, convenient, enlightening, repetitive, etc.  In this case, it was superb.  Simply put, this was one of the best symposiums I have ever had the opportunity to attend.  I would strongly recommend this to any health care professional looking for the most recent and up to date information regarding concussion research and implementation.  The symposium offered a variety of presenters, including researchers, athletic trainers, engineers, lawyers, epidemiologists, optometrists, neuropsychologists, to name a few.  I will do my best to keep this concise, even though my notes alone were well over eleven pages, covering the 30 presentations we heard over the course of two days.

                               Panel discussion of clinical dilemmas in concussion management.

The Matthew Gfeller story is a powerful one.  His parents gave a very emotional speech, entitled "From Tragedy to Advocacy".  If you'd like to learn more about Matt, and the foundation which bears his name, I encourage you to visit: http://www.matthewgfellerfoundation.org  There is a short video as well which succinctly describes their difficult, yet valiant path.

Some highlights:

Former U.S. Women's Soccer Team member and Olympic Gold Medalist Cindy Parlow-Cone offered a very raw and honest take on her own personal experiences with concussion and symptom persistence afterwards.  She spoke of her difficulty since her career ended and gave a unique perspective that despite what current evidence states, you can be concussed when heading a ball.  She called for more in depth research in this area, specifically in youth soccer, where she currently serves as  a coach.

Dr. Dirk Keene had some interesting comments regarding CTE which certainly educated this clinician.  Chronic Traumatic Encephalopathy (CTE) is a clinical diagnosis (by definition), not a pathological one.  Simply stated, a pathologist cannot diagnose this condition.  To date, all cases of CTE neuropathology described in the literature are derived from a highly selected, non-random, non representative group of mostly former athletes who suffered untimely deaths.  What does this mean?  It means that it's application in an unbiased population base needs to be studied.  Effectively, if you only study one group, it is difficult to draw definitive comparisons and extrapolations.  That's not to say a link doesn't exist, but further research is needed.

Dr. Steven Rowson from Virginia Tech and it's Star Evaluation System (similar to NOCSAE, but definitely different) describing that as little as 5-7mm of movement cause brain injuries stood out to me.  You can find their recommendations for helmets here.  His slides describing the differences in helmet performance in testing were quite eye opening: not all helmets are created, nor perform equally.  If you are looking for a helmet to purchase, whether you are a parent, athlete or coach, you should really check out the link.

Concussion Vital Signs, a computer based neurocognitive assessment tool, made an announcement which will have a substantial effect:  As of April 15, they will offer their tools for free.  No charge.  They cited the desire to provide appropriate care to all, and more specifically "to do the right thing."  If you are interested, you can FMI at http://www.concussionvitalsigns.com

A mock trial was presented based on actual athletic training.  I thought this was very well done, and quite unique.  The level of detail was interesting, and too in depth to delve into here, but some main points were document everything, and make sound clinical decisions devoid of influence, or as Eugene Egdorf more distinctly put it "It will be very easy for me to make you look bad."  Of interesting note, he was also the lawyer who served on the EA Sports settlement case (regarding the unauthorized use of athlete likenesses/names by the NCAA)  as well as the wrongful death settlement against the NCAA, which resulted in all student athletes being required to test for sickle cell.

Dawn Comstock, an epidemiologist who tracks (thanks to the help of ATC's around the country) high school injury data to identify patterns of sports related injury had some interesting data.  You can actually view some of it here.  What a fantastic way to acclimate oneself with a particular sport with which they may have little familiarity.  Perhaps with this information, we can better predict and prevent!

Dr. Erik Swartz also presented on his HuTT(R) helmetless tackling system, which is an interesting approach.  We tend to hear a lot about the need for helmet design advancement to reduce concussions, but, what if we had athletes perform more drills without helmets?  This obviously would reduce the number of "head to head" collisions in practice, while also simultaneously teach proper form.  More on that (along with a good short video) here.  Definitely an intriguing idea.
He also presented on the new EMS spine injury standards, and implications for athletic trainers.  Basically, the new guidelines will not require the use of a backboard.  Stated simply, there is no real data to support their continued use.   Why do we continue to put suspected injuries on a flat, rigid board when the body is neither of those two things? Once they are placed on a backboard (spine board), they then go on a gurney, which is a bit redundant. I blogged about this awhile back. In Europe, for instance, I have seen body vacuum splints being used, which, while certainly inhibitory, appear to be more comfortable.

Dr. Grant Iverson had a fascinating presentation describing the negative effects of rest...and how it's not really a great prescriptive tool for many maladies (back pain, etc.)  Maybe it's not a good idea for a concussion?  He even showed that not one study has shown that rest is beneficial; even going so far as to explain that abrupt cessation of exercise can actually cause headaches.  I really enjoyed his presentation style for sure, and it was SO REFRESHING to hear this presented (especially to AT's).  It's something I think many clinicians have navigated away from, but  many still adhere to, perhaps unnecessarily.  In addition, he stated that suicidality has not been clinically proven to be a symptom of CTE (no studies to support).  Perhaps more surprisingly, he referenced data which stated NFL players actually have a lower mortality rate than that of the general population.  This seems to be contradictory to mainstream media reports...absolutely fascinating stuff.

Honestly, there were many more fantastic topics, including the utilization of a Biopsychosocial model for the treatment of concussion, patient referrals, evaluating visual deficits following concussion and visual rehabilitation.  This post barely scratches the surface of the information presented, but I feel I need to keep it at an appropriate length.  As both an educator and a clinician, I need this information to not only practice at a high level, but to properly inform future health care providers of the latest evidence in clinical practice.  This symposium delivered.

All in all, a tremendous array of information and an absolute top tier, professional event put on by Dr. Jason Mihalik, Dr. Kevin Guskiewicz, and Dr. Johna Register-Mihalik.

Saved by the...suit?

I've been watching a lot of Winter Olympic sports on TV lately...can't get enough.  Maybe it's because  it's winter, but mostly I think it's simply because I love the sports.  One segment caught my eye because I couldn't quite believe it...but I found it fascinating.  A company named Dainese has engineered a skiing suit which inflates if/when a skier crashes.  Check out the article here. 
You can read the article itself...pretty cool stuff.  I'm sure engineers had a difficult time designing this, especially when they had to deal with forces exerted when a skier goes airborne.  I did a little digging, and found the company website, which posts a few mini-infographics (be sure to scroll down the page a bit) of a similar (but not exact?) design for motorsports.  Cool stuff.
Here is video of actual inflation:

Turns out, this company has worked with motorsports, but has been branching out.  

Upon further review, check it out this video...I know, it's not english, but body language is body language. 

At any rate, just some really interesting technology that might someday play a role in other sports...and increase safety.    Hope you enjoy!

EMS Evolution: Relaxation of Spine (Back) Boarding Rules Ahead?

Not sure if anyone has noticed or not, but the National Athletic Trainers' Association has a new blog directed to professionals and students in the field.  Content is generated via professionals from around the country, and a couple of days ago one was brought to my attention.
You can read it here.

While the post doesn't delve into specifics, it does state that several protocol changes are occurring in the area of spine boarding...most notably the prospective omission of the use of spine boards with suspected cervical injuries.  EMS appears poised to begin transporting certain cases (I am unsure at this point as to which ones) with a cervical collar only.   As Dr. Swartz points out, this should really spur ATC's to meet with their local EMS provider(s) to discuss their current protocols and how it might affect your overall management.    I'll certainly be looking forward to the upcoming position statement...

In the meantime, consider my curiosity piqued.  Two questions linger for me:
Are backboards even effective?
Are cervical collars even effective?
So, I did a bit of searching and this is what I found.

This article challenges conventional wisdom (perhaps a better term is conventional practice) regarding the blanket use of cervical collars.  In fact, validation for challenging the efficacy of cervical collars was studied a decade ago.  Which ultimately lead me to this article, which was a real eye opener.  There are a number of valid points the article raises, and one of them is the topic of patient comfort.  Having seen a full body vacuum splint used when I was in France a few years ago, I can honestly say it makes a lot of sense to potentially use one of those as compared to a traditional spine board.  It seemed far more comfortable compared to it's stiff counterpart.

So after becoming  more convinced evidence is lacking, I stumbled upon  Neurosurgery PreHospital Cervical Spinal Immobilization After Trauma, which states virtually the exact opposite of what other studies are saying. 

Needless to say, it will be very interesting to see how this situation develops, both regionally and nationally.  While I fully realize I'm not answering any definitive questions here, I am trying to illustrate the difficulty clinicians face when attempting to best care for their patient.  That headache, neck and/or back pain may be exacerbated by the very tools we use to "safely" care for them.   

PowerPlay Cold & Compression Product Review

Earlier this month, I was contacted to complete a product review for PowerPlay Portable Cold & Compression systems.  I replied that I would be more than happy to do so.  Before we begin, I offer  that I am not receiving reimbursement of any kind, and offer my objective and unbiased view of the product. 

I was shipped the PowerPlay Standard Kit, which included the Cold and Compression Ankle Wrap and the  Knee Wrap.  The entire contents of the system, which was shipped in a convenient and small bag (14" x 10.5"), weighed less than 10 pounds.  My initial thoughts were that this is a fantastic, lightweight, portable system which would travel easily.  As an ATC who travels, this would certainly be very easy to toss into my checked baggage.  The product was clearly designed with efficiency and portability in mind.  That said, it would work very easily in a standard sports medicine clinic as well.
 

The directions for each "unit" came with easy to read instructions, which included both written and diagram instructions.  The instructions were quite simple and straightforward, covering everything from contraindications to battery life, true to electrical modality form.  Set up only took 3 minutes, but I was fiddling around with it.  By the third time I used it, I could set it up in under a minute and a half.  Ease of use is a tremendous bonus with this product. 

For the compression unit itself, these items were included:
1. PowerPlay Pump

2. Cloth Sleeve (this serves as a protective area for exposed skin)
3. Gel Pack (one each for ankle and knee)
4. Compression Wrap (one each for ankle and knee)

Prior to applying,  the gel packs must be frozen for a minimum of one hour, remove from the freezer and then attach them to the inside of the Compression Wraps.  This is done via velcro attachments, which fit quite snugly inside.   You simply had to fit the patient, then attach the hose to one of the three ports on the PowerPlay Pump, which you then turned on.  I love the fact that there were three different ports, as you can treat multiple regions/body parts at once. The pump is small, but very efficient and easy to use.  It only has four buttons, a Power On/Off, and one each for the port of choice. 

Once attached, you press the port of attachment, and choose a level of compression both appropriate and comfortable for the athlete.  I did notice a discrepancy here, as the instructions indicate you can choose between 30 mmHg and 70 mmHg of pressure, however the pump only displays 50-70 mmhg, in 5 mm increments.  Not a huge deal, but a discrepancy nonetheless.  Once you set the pressure, the unit will automatically turn on and provide intermittent compression for a 20 minute time period, automatically shutting off at the conclusion.  Again, the design is so convenient and easy to use, I could see myself utilizing this product on a very regular basis. 

During it's first trial run, I kept getting a "HI" message on the LED screen, which upon further inspection revealed cord compression (the athlete's leg was compressing the cord, impeding airflow).  Simply moving the chord was not difficult, as each compression wrap has a 5 foot long air hose, which I thought was well thought out.  Not everyone likes to have a compression unit buzzing on their chest during treatment! If you needed a longer one, an additional 5 foot extension was located in the bag as well.

The compression was uniform and quite comfortable, as opposed to say, plastic wrap around an ice bag on a joint, which can be effective but also uncomfortable.  It was also surprisingly cold (in a good way), which surprised me.  Sometimes feedback from athletes is that it's not cold enough when compared to ice, but with this product, it was definitely not an issue. The gel packs themselves were designed well, and I was particularly fond of the knee wrap, which left a horizontal opening in back, allowing for a comfortable treatment of the knee not only in extension, but stages of flexion as well.

The unit is powered by an internal NiMH battery, which according to the manufacturer will run the system for 4-6 hours prior to needing a charge.  A wall charger is included in the package.  Of interesting note, it is recommended that the battery be charged every 60 days while NOT in use, and will last for roughly 500 recharges in between replacements.   Translation:  this should last you a long time.

In terms of price, it is very comparable to similar systems.  It is more expensive than traditional CryoCuff systems, but much less expensive than a Game Ready, both of which require water and ice. While cold therapy has had it's knocks over the past few years, I do still believe that it has a place in treatment, and can plainly see the advantages to using this.  In my opinion, this is a sound product and investment in the care of your patients and athletes. 

Two Months on the Road...A Sochi Recap

As I type, it has been two months since I've set foot in the United States.  I had the pleasure of working with the United States Bobsled and Skeleton Team both prior to and through the Winter Olympics.  The experience was awesome... but it's always good to be home. Our travels took us through Germany, Switzerland, Austria, and onto Russia.  The following are some musings I've had both during and after this experience. While difficult to capture concisely, I'll do my best to keep a bullet item style entry list.   The list is random and in no particular order of importance.

The US Bobsled and Skeleton Federation was very successful at the Olympics, garnering at least one medal in each event.  Congrats to the following medalists whom I had the humble honor of working with:
Matt Antoine:  Bronze Men's Skeleton
Noelle Pikus-Pace:  Silver Women's Skeleton
Steve Holcomb & Steve Langton: Bronze Men's Two Man Bobsled
Steve Holcomb, Chris Fogt, Curt Tomasevicz & Steve Langton: Bronze Men's Four Man Bobsled
Elana Meyers & Lauryn Williams: Silver Women's Two Man Bobsled
Jamie Greubel & Aja Evans: Bronze Women's Two Man Bobsled

I would be remiss if I did not mention the rest of the athletes who competed at the highest level; there are many that were on the World Cup team who didn't make it to the Olympics, just as there were Olympic athletes who didn't garner a medal. Simply getting to that point is a feat in and of itself; they are all shining examples of devotion to their sport and truly embodied the Olympic ideals...my heart ached for them when they didn't achieve what they desired to.  Just because an athlete doesn't medal, doesn't mean that they aren't giving their all, and I think that can be easily dismissed.

Apologies to the Dos Equis Guy, but fellow ATC Byron Craighead (pictured above) may truly be the most interesting man in the world.

The Olympics were an emotional roller coaster.  I teared up more times in the past two months than in the past two years.  OK, that's not true. I tear up a lot.  But the moments were raw, real, emotional, and to be a part of that, even a bit part, will leave an indelible mark on this athletic trainer.

Regarding those who complained  the facilities/hospitality were subpar, my advice is simple.  Gain some perspective, or come travel with me to some parts of the world where everything isn't tailored exactly to one's lofty expectations.  In many ways the region reminded me of my travels in the Dominican Republic.  Applying "first world" logic to all parts of the world simply doesn't work.  I took the experience for what is was; brand new infrastructure that went up in the blink of an eye.  Was it perfect?  No...but I've yet to find perfect anywhere.  The lodging was fine; the volunteers were amazing!  Their spirit was palpable on all levels.  I'm not sure I could ask for much more considering the region we were in.  Of course, to be fair, this was my first Olympics, so if I were only comparing to other Olympics, my perspective or expectations may have been different.  The people were great, and they did their job...plain and simple.  They deserve our gratitude, not our complaints.

I felt euphoria marching during opening ceremonies.  Not sure I deserved to be there as much as others, but it's certainly how I felt walking into that stadium.  I heard many thought the sweaters were ugly, but I have to tell you, walking in wearing the letters USA on your back, amidst a sea of your fellow teammates instills a sense of pride that transcends fashion.

I may be a teacher, but this experience was a strong reminder that I am still a student; I learned a multitude of information on this journey.  I need to be better at maintaining this mindset on a more permanent basis.  Speaking of which, I have yet to find the book that explicitly guides me on how to remain a confident, assertive practitioner while also remaining open to new ideas, proven or not.  If you find one, let me know.  Better yet, maybe I should start writing it.  I should be ready by the time I'm 90.

Dry needling is not acupuncture.  But it kind of is?  I need to learn more about it, but it does fascinate me.

Athletic Training does not have to be reactionary practice (post-injury); it can be performance enhancing.

Athlete's often know their body better than coaches/therapists.  LISTEN to them.
Coaches/Therapists often know an athlete's body better than the athlete.  DISCUSS with them.  The problem that can arise is a LACK of, or complete omission of communication and open mindedness which can impede athletic performance.  We can all learn from each other if all parties knock down traditional walls of professions.  It's a complicated dance at times, but quite lovely when all parties collaborate equally on the finished product. 

Message to ATC's:  If you haven't already, learn Kinesio Taping.  Learn manual therapy skills.  Practice them often.  Be open to new ideas, but don't be afraid to voice your own thoughts...through careful collaboration, the most positive outcome for the athlete can be attained.

Contrary to some colleagues, I would argue that classic taping with 1.5 inch white tape is not a dying breed...in fact I utilized it quite regularly throughout.

My thanks to the USOC, USBSF and USM for a wonderful experience!

New Ligament Discovered in Human Knee...No Biggie

Fascinating news out of Belgium...researchers have located and identified the existence of a new ligament within the knee.  The ALL or Anterolateral Ligament (seen here).  So why is this so interesting?  A phenomenon that many of us have experienced are those athletes who have trouble with stability AFTER successful ACL reconstruction.  The ligament is repaired, strength is full and equal bilaterally, and yet,  some athletes still experience occasions when their knee will "give way", or as we know it in our field,  the Pivot Shift. 


                                                                      Classic example of Pivot Shift Test

This issue of chronic, unpredictable knee instability presents numerous problems for those injured, and those responsible for rehabilitating them.  The identification of this ligament could potentially pave the way in terms of surgical techniques, rehabilitation, etc.  Very interesting stuff...I'm both baffled and impressed that a ligament has been "discovered" in 2013.    Kudos. 

Urinalysis via Smartphone?

Wow.  No other way to describe it.  While reading BBC online via my app this a.m., I came across this little treat:
http://www.bbc.co.uk/news/technology-21586082

A couple of items which struck a chord with me:
1.  The term "consumer based health care".  I love this, and have been using it for years in my classes.  Be a savvy consumer; shop around, and collect information.  Never a bad thing at all.
2.  While the app won't be available until the end of March, and they discuss using it in developing countries, I think this could be incredibly useful in our country

Random Sidebar:  I love TED conferences.  Great info, and possibly the second most used app I use, behind Netflix of course.  If you haven't explored TED Talks yet, check them out here.  A good buddy of mine turned me onto them. 
While it's early yet, and nothing is completely substantiated, this could have a huge impact on urinalysis in the AT setting. Essentially, this has the potential to take our urinalysis test strips to the next level.   I surmise that most ATC's now own a smartphone (I could be wrong here, but it seems that way to me).  How easy would it be to download this app (at a marginal cost, mind you), and run the test strips!  This could make the referral and management process much smoother and more efficient.  

Athletic Trainer on the Mountain

Back when I was in graduate school (was that really 10 years ago?), I completed a project for an Administration course in which I mock "proposed" a fictional ski resort hire an athletic trainer.  My reasoning?  Concussions and Rehabilitation. Back in 2000, the only options a resort-goer may have is basic first aid, or a trip to a hospital.  Why not increase the standard of care on-site I say?! During the proposal, the question was posed if ski patrol should be threatened by the addition of another healthcare provider.  My response: absolutely not.  The ATC could have space near or in the base lodge; ski patrol could bring a skiier/boarder to them, or perhaps they may  have simple walk in visits.  And whom better to evaluate a concussion "in the field" or "on the slopes" than an ATC?  They could then make a referral and begin a well informed, injury management decision.  It seems to me that this would be a welcomed addition of services. 

Today's article in USA Today has brought all of this back to me.  I haven't been able to watch the documentary (apparently it will be on HBO later on), but here are a a few related clips which may help.

In fact, this idea might fit in quite nicely with the progression of interprofessional education and healthcare delivery.  

If you're interested in some good concussion stuff, check out the Head Games trailer here (the full movie is available if you have Netflix).

Back from a Looooooong Break

It's good to be back, both literally and figuratively; I just returned from Sochi, Russia working with our US Bobsled and Skeleton teams, and it was a tremendous experience, as always. Great to see the USBSF family.  To learn more about Bobsled & Skeleton, check out: http://www.teamusa.org/USA-Bobsled-and-Skeleton-Federation.aspx   

A couple of quick hits to start the week:
This link comes via Kyle Gilson, Head Athletic Trainer at MCI.  Really interesting audio about the "Brain Bang Theory".  Check it out here, and weigh in!

Did you hear about the cut achilles tendon in the NHL?  Well, here's something I never knew existed...a sock designed to prevent such an injury from occurring.   Insight on that located here  and even more here.

Have a great Monday!

AED's and Athletic Trainers

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. 

MATA, Symposium & AT News Ticker

Fantastic whirlwind of a weekend that began at the Annual Fall meeting Friday for the Maine Athletic Trainers' Association (MATA).  We were treated to an unorthodox topic, which was well provided by NATA Hall of Famer Marjorie King. 

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...

In a very interesting move, the Australian Football League (AFL) will require their sports trainers and medical staff to wear neutral colors next year during games.  Is this a step towards separating medical staff from the team?  Would this catch on over here?  Hmmmmmmm.  The short article actually gives a brief history of clothing worn by sports trainers in the sport throughout the years.  Before you get mad at me for calling them "sports trainers", that is what they refer to themselves in Australia.    Very rare and scary injury; football player tears vena cava on field and survives.  A bit more information on spontaneous vena cava tear here...Let's wish him luck.  Been meaning to share this for awhile, but here is a great video and article on how universities are looking at concussions and head injuries.  A must watch is information on the  system  which starts around the 1:30 mark.   A fascinating look at utilizing technology and real time data to assess athletes.  Think an MRI is always the best way to diagnose?  Maybe not.

Service Learning in Haiti

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.

At any rate, keep up the great work Kevin!

Instant Replay for ATC's?

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

Breast Cancer Awareness Month: Conflicted

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. 

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New Safety Devices for Football Players

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?

Classic AT: Taping an Ankle

Students: You asked for it, here it is.

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.  

I'm back baby!

 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.

That's it for now,  but look for more coming soon!

Athletic Trainers & Nurses: A Healthy Collaborative

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.

The article itself, published in the May 2012 edition of the National Association of School Nurses (NASN), can be found here:  http://nas.sagepub.com/content/27/3/136.full.pdf+html?ijkey=xo5hF791ez6E6&keytype=ref&siteid=spnas

I really believe this can serve as a nice informational piece when either creating or modifying the Emergency Action Plan (EAP).    Hope you enjoy!

Congratulations to the Class of 2012!

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!

Concussion Management

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/