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.