Alcock's Syndrome, Pudendal Nerve & Obturator Internus

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

Tick Season

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

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

Deep Vein Thrombosis in Athletes

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

Orthopedic Special Tests

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

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

Student Resources

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

Supplements: Are you keeping up?

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


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

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

History of Athletic Training

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

Football Helmets

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

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

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