Monday, November 24, 2014

Blog by Kimber Rodgers

I had a patient this week that really made me think.  He has a low grade ankle sprain… something I’m sure most athletic trainers deal with on a weekly basis.  His strength and ROM were normal, but he was not able to complete functional tests. 

I will admit… I don’t like to be wrong.  I’m competitive and I like to be right.  But with this patient, I was at a loss.  I threw everything I had in my arsenal of tricks at him.  But it seemed no matter what I did, he didn’t show improvement. 

I woke up yesterday and remembered: an Airrosti Certified Chiropractor, who moved to my area this summer, met with me in late July and offered his services and conveyed his interest in treating athletes.  So, I called him; I explained the situation, gave him some history on the patient, and he happened to have an appointment available that morning.  With a few tests and a couple of new corrective exercises, he discovered a muscle strain secondary to the ankle sprain I had not even thought to consider.  After one treatment, the patient’s pain was 60% better and his functional status was dramatically improved.

I am so fortunate to have such a talented group of health care professionals in my area!  I would definitely encourage everyone out there to use all of the tools you have at your disposal.  Whether it’s an Airrosti Certified Provider, sports massage therapist, someone with certifications in manual therapy or other alternative techniques, etc. make contact with other healthcare professionals in your area and develop relationships with them.   Those relationships can help improve patient outcomes and help us to become better athletic trainers by learning new “tools” from other healthcare professionals.

Monday, November 17, 2014

Developing a Student Aid program in the Secondary School Setting

I’ve had several friends and colleagues, even coaches at my school, ask me how I find and keep so many good student aids.  We treat our student aid program just like we would if we worked at the college level or if these students were employed through us.  We have high expectations of our students and hold them to a high standard.
I think there are several things that contribute to developing and sustaining an effective student aid program.  These are things we do at the high school where I work; there definitely is not a right or best way to do it… but this has been working for us over the past 5 years, and interest in our student aid program continues to grow. 
I think the first step is evaluating the needs of your athletic programs to determine how large, or small, you would like your staff.  We start the year with around 20 student aids, and typically have an additional 3 or 4 students in class that do not have obligations after school.  Inevitably, you will have student aids quit.  They either don’t know what they are truly getting in to, decide they want to spend their time doing other things, or move; but for whatever reason you will lose at least one student aid every year.  The extra students who start the year with no obligations can serve to fill those spaces, in the eventuality you have a student aid leave your staff.
Next, we have an application that all students interested in the student aid program complete.  The application includes a summation of duties and expectations, a brief questionnaire, and a grade report to be completed by the student’s current teachers.  We evaluate each application before contacting students for an interview.
During the interview, we go into more detail about what will be expected and required of the student aids in our program.  We stress the amount of time that is required to become a student aid, and try to reiterate that point several times during the interview.  We get to know each student to determine if they would be a good fit with our current staff.  Then, we answer questions the student may have for us.
Upon completion of the interviews, we send a letter to each student informing them whether we are offering them a position on our student aid staff, desiring them to take our class with no extracurricular obligations, or (in rare cases) saying “Thank you for your interest, but….”  I believe by treating the process of selecting our student aids as a professional application, we emphasize the importance we place on our program and give students selected a sense of pride and accomplishment.
Before the school year begins, we hold an in-service with our newly selected student aids to teach them basic skills we want them to know early on (e.g. CPR and First Aid, basic taping techniques, etc.), and then another with our entire staff to go over rules and procedures, brush up on basic skills, and prepare the athletic training room for the coming season.  Throughout the year, we hold monthly meetings to inform student aids on upcoming events and to discuss any issues that may have occurred.

We also try to have fun with our students. We carve pumpkins together at Halloween, have a Christmas party, and several other things throughout the year to show our student aids that we appreciate their hard work and dedication.   I know our students look forward to having homemade lasagna and Secret Santa at the Christmas party every year.
While this has worked for my school, you have to find something that works for you and your situation.  However, I encourage you to expect more from your student aids; if you hold them to a higher standard, they will begin to do the same for themselves and may surprise you with what they are capable of.

Monday, October 27, 2014

ATC’s and Impact: Not just Cognitive Recall

Often the world of athletic training, we hear the word “impact”.  There can often be a common misconception of what the true word of “impact” means.  Any athletic trainer will tell you that when they hear the word “impact”, they automatically think of ImPACT testing.  An ImPACT test was developed by clinical experts who pioneered the field of helping treat concussions.  ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) is the most-widely used and most scientifically validated computerized concussion evaluation system.  ImPACT provides trained clinicians with neurocognitive assessment tools and services that have been medically accepted as state-of-the-art best practices -- as part of determining safe return to play decisions. Though this is appealing and VERY important in decision making regarding athlete’s return to play protocol, I prefer to think of impact as something that we ensure as health care professionals…something that we choose to do.  Here is how we can make an ImPACT of our own in the profession of athletic training:

 Get involved!! – How often do we see those people just “sitting” on a job?  One thing comes to mind…supervisor.  Yes, we all know that CEO’s and big Whigs of major corporations are apparently making the “big bucks”.  But what is it that they really do? Sure, they might be a pencil pusher and big “high man on the totem pole” who calls the shots.  BUT, are they actually teaching you anything?  What is it that you are learning from your superior?  Are you learning anything at all?  If you commonly find yourself stuck between a rock and a hard sport regarding the “day in and day out” normal work grind of the run of the mill job, you are spinning your wheels.  I challenge you all to broaden your knowledge base of sports medicine and to get involved in an organization in some way or another. Reach out and join a committee, or volunteer to help others.  You’d be surprised how much this would make a difference. Even if you don’t learn anything new, there is always the chance you could educate someone else and become a teacher!

Vote!!-  Every couple of years, there is always the opportunity to elect new board members into new organizations.  Some of which you may have heard of: SWATA, NATA, GHATS, YPC…etc. The list is endless.  How are we able to broaden our base of knowledge and implement knowledge construction in place of knowledge reproduction if we don’t elect new leaders or teachers of our own?  Remember that old hag you had in grade school who was mean to everyone.  20 years later, you realize that she’s still around and now it’s not you dealing with her, only your children are.  Sound familiar?!  Need I say more?  I rest my case!

Stay abreast on current research!!-  Yes, yes, yes.  I know. Last thing that we all want to hear are the words “statistically significant” or “the null hypothesis showed that p is less than 0.5….” blah blah blah.  I myself hated statistics and am NOT a research person. But let me ask you this: The first time you ate some of grandma’s cookies that were dry and tasted like chocolate chip corn bread, did you ask for more?  No!!  You found a way to bake something better right?! Why? Because who wants to eat something that tastes atrocious?  I sure don’t. So, does it make sense to keep “spinning” our wheels? I think you can answer that one. 
There are new trends of research and medicine that are evolving every day.  As health care professionals, how are we to treat the hurt and wounded if we aren’t up to speed on current research and medicine? 

These are just a few of what I can think of off the top of my head.  The list goes on and on.  Like I said, athletic trainers are some of the most unnoticed and disregarded professionals in their line of work.  However, we are called on to help those in times of dire need and emergencies.  If we lose focus for just a second in this line of work, than we too start to spin our wheels. Only then do we make an impact on others, but in a negative way. 

Thursday, October 16, 2014

Life of an ATC: Is It in You?

As many of us enter the working world as a young aspiring professional in our field, we tend to wonder what it would be like first rattle out of the cage.  We are afraid, excited, and yet somewhat apprehensive of it all.  Prior to entering the world of young professionals, our lives as young adults in college are spent in burning the late night oil trying to accomplish our one goal: graduating.  Afterwards, we seek out what we think would be the easiest thing-securing the job. But, we are still unsure of what to expect once we begin our career. I use to think that a day job would be easy. Though athletic trainers don’t really follow the typical 8am-5PM protocol of work, there is still a lot to say for what we do.  Here are a few reasons why I love being an athletic trainer:

1)  Every day is something new- In this line of work, you can expect the unexpected.  Whether it’s being on the sideline at a football game, sitting under a tent at a soccer match, or getting up close and personal on the basketball court, every day presents it’s own challenges.  I personally have witnessed a variety of injuries and issues that have been personally challenging for me.  At the end of the day, you have dealt with or seen an injury, a psychosocial issue with an athlete, dealt with a parent, or witnessed that big “W” from your favorite team. 

2) It keeps me young- It takes a special kind of person to do what we do. Being a former athlete myself, I couldn’t get enough play time.  Whether it was for myself, or for my father, there was never enough time for me to obtain all the play time that could satisfy me.  Sometimes I reflect back on what times where like when I was a kid- often wishing that I could go back in time and relive those glory days on the field.  I often watch kids catch the hail mary that allows them to score the winning touchdown in a game that separates the men from the boys. Seeing young student athletes achieve something that I would not consider a small feat, makes me feel like I’m a high school kid again.  Not to mention being around student athletic trainers who are half my age.  They alone keep me on my toes.

3) Personal satisfaction- I hate to admit it but there are those times when we all witness an athlete go down on the field. Whether it’s a sprained ankle, a subluxed shoulder, or a torn ACL, we are called on as a confidant and health care professional to use our skills and knowledge and utilize it to the fullest, so we can return that particular student athlete or “all star” back to full player’s status.  For me, there is nothing more rewarding then having a student athlete bounce back from such a horrific injury, only to score the highest percentage points in a district game.  Not to mention, there is always that  big “thank you” from the parent themselves J

4) You become a mentor-  Yes, yes, yes. I hate to admit it too, but I did have ill feelings towards school counselors and mentors when I was in school.  We used to think that all of those health and nutrition classes we took wouldn’t be necessary. Little did I know, I was wrong.  I cannot tell you how many times I have been asked about nutrition, health, or even weight training.  You will soon realize that after you develop a rapport with athletes, you will be the one that they come to in dire needs of advice. 

As you can see, there is a lot more to athletic training that just taping and give the typical “ice water” treatment.  Athletic trainers are what I always consider the step children of the athletic program.  Like musical composers, we are the ones who remain in the background and wait in the wings in case we there is a medical emergency.   We are underpaid and overworked but to me, there is nothing in the world like sitting in the dugout eating sunflower seeds and watching the game from an up close and personal view. In  my opinion, sometimes as the bench warmer, you not only get the best seat in the house, but also hold the most important position on the team.  

Tuesday, October 7, 2014

Annie's Advice

One group of young professionals that we like to give advice to are the recently graduated, and recently certified/licensed athletic trainers. We all remember our first year on the job, and the challenges we faced. I quickly learned that everything I learned in the classroom, was just a foundation for what was going to be thrown at me. Having a mentor with some tips to help along the way is a saving grace for many fresh athletic trainers. Below I have complied a list of “tips and tricks” to help the new athletic trainer get through the first few years in the profession.
-Get or Stay close to a mentor from the HS setting
-Know and learn your limitations
-Utilize fellow ATCs
-Be confident in your abilities
-Communicate with your team physician
-Evaluate the whole athlete, not just the suspected injury
-Don't be afraid to refer when necessary
-Work to educate your student athletes and others
-Be honest and straightforward with your athletes, parents, and coaches
-Don't be afraid to say NO
-Take time to have some fun
-Think of it as a marathon, not a sprint. Take everything one-step at a time
-Listen to the Kids
-Get to know the janitors and secretaries
-Set up reasonable protocols
-Introduce yourself to the other team's ATC
-Don't be afraid to a risk
-Listen to those that have more experience than you, but also your students
-You're not going to get everything right 100% of the time. Failing is a part of it. 
-Try not to take work home with you
-Don't be afraid to ask for help
-Talk to the kids like they are adults
-Get to know your AD

Good luck on your career as an athletic trainer! Take it one day at a time, lean on others for advice and assistance, and most importantly, Have FUN! Welcome to the best profession out there. 

Tuesday, September 30, 2014

How to cruise through speed bumps and avoid traffic jams of the secondary school ATR

I cannot emphasis enough my passion for the secondary setting however it often comes with professionals in the early phases of burn-out. When I see these professionals I want to shake them and help them speed through the chaos of the secondary traffic jams that usually occur from 6:30-9am and 1:30-9pm. I have found that when speaking to my colleagues that are in this situation they often times refuse to change their ways and believe burn-out, stress and extreme tiredness are all part of our profession that we have to accept. This is not true!
A close classmate of mine realized this the hard way. In a classroom setting round table discussion a group of Athletic Trainers from across the nation drilled him with questions often beginning with why, such as “why do you put out water”, “why do you work on Sundays”, “why are you juggling patients” after the intense questioning he broke down. His simple answer was, “I don’t know why, maybe it’s because I have always done it.” This response got me thinking, how could I help him…….?
After collaborating with dozens of secondary athletic trainers from across the nation here is a short and simple map to beginning the steps of avoiding burn-out, lowering your stress level and enjoying your job once again-
1. Make your presence known- yes it may take more time at the beginning however in the end you’ll stop chasing your tail
  a. Speak at booster club, PTA or open house meetings- parents need to know who you are and what your title is.
    i. This is the perfect time to correct vocabulary and emphasis our title as “Athletic Trainers NOT Trainers.”
    ii. Explain your treatment protocol, concussion policy, referral policy etc.
    iii. Communicate with parents, if they have a child that is an athlete they should know you just as if you where the Head Coach
  b. Speak to the faculty- Ask your principle for a 20 minute time slot during your teacher in-service. This again gives you the upper hand in informing the staff of your title and policies
  c. Speak to each of the sports teams- This step is crucial! Do not allow a coach to speak to their athletes about your treatment policies, title, and overall athletic training room procedures. When you allow someone else to inform the athletes you give room for error
2. Make the ATR a clinic- when speaking to your parents, faculty and athletes inform them that they will be treated in a clinic not a “room”. This helps the individuals understand what you are expecting such as:
  a. Schedule appointments with your patients- have your athletes sign an appointment book when they walk in, first come first serve mind-set.
    i. Require all patients to attend am clinical treatments and if needed they can schedule an additional appointment for lunch, athletic period or after school. This gives you the opportunity to create a schedule and provide space between each treatment.
    ii. Require a sense of etiquette within the clinic- low voices, no cell phones, no food, no shoes etc. This will help the athlete understand the importance of their treatment and provide a calming environment
    iii. Slow down- yes you have too many patients for the amount of time you have with them and yes you might not be able to do the entire treatment that you would like or would be beneficial, however you must slow down
1. Learn to prioritize your patients and their treatments- try to see your patients twice a day so that you have the opportunity to do two different treatments. This will provide you time between the treatments to reflect on your patient notes and research any new treatments you would like to do in the second treatment time
2. Stop running around the ATR like a crazy person, it freaks out your patients and causes them to become anxious. Instead take your time with each patient, ask about their day, the upcoming game etc.
3. Give away hydration- yes, this has been a part of our profession forever but when you are treating 30 athletes in a 45 minute window at a 6A high school, water should be the least of your worries. Your focus should be to treat, care, prevent and rehabilitate your patients like the medical professionals we are.
  a. Most high school sports have a manager, spend one class period teaching them how to clean coolers, location of all supplies and process of setting up for practice vs. games.
    i. This allows for more responsibility from the manager which is a skill all teenagers should learn and provides you time to treat patients. This allows for the coach to communicate any schedule changes to a student whom they already have in their class instead of calling you or you worrying about what practice will be like today.
4. Be a professional- This one is going to be the hardest but will make the most impact.
  a. Dress like a professional- Don’t dress like a coach, you are not a coach, you are a medical professional with an extensive background in sports medicine. Don’t be scared to wear something other than khakis. I choose a few years ago to start wearing scrubs in the clinic and for inside sports. I have them in school colors with a monogram of the schools logo and my title. I found that the patients, parents and faculty’s attitude changed remarkably in a positive way. I am treated with respect and curiosity because I have made my presence known that I am a medical professional. This curiosity comes from patients, parents and faculty wanting to know more about athletic training and our skills.
With these 4 easy steps I hope you are cruising through your day and avoiding all traffic jams that occur in the secondary setting. Of course there are countless ways to improve our setting however these have made the most impact on my setting and many others. Please pass along any other ideas that have worked in your setting so I can add them to the list, we are only as good as our weakest link

Thursday, September 25, 2014

Concussions- question your surroundings

This blog post is a challenge to you to enhance your practice of evidence based medicine and learn to question your surroundings-
Unlike most sports injuries, concussion are often referred to as an invisible injury1. Concussions are defined as a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces2. An estimated 300,000 sports related concussions occur annually in the United States, which is nearly 20% of the 1.5 million head injuries recorded3. This invisible injury can occur with several symptoms, many that are subjective in nature. Typical symptoms of a concussion may include somatic complaints (e.g., headache, dizziness, and fatigue), neurocognitive deficits (e.g., concentration and attention problems, information processing, and memory dysfunction), and emotional signs and symptoms (irritability, anxiety, low motivation).4,5 The presentation of concussion symptoms varies considerably patient to patient and without a formal way to identify the patient reported symptoms clinicians are unable to treat the patient accordingly6.
In recognition of the need for better concussion management strategies, the International Ice Hockey Federation (IIHF), in conjunction with the International Olympic Committee (IOC) and the Federation Internationale de Football Association (FIFA), convened in Vienna in October of 2001 to evaluate the current status of concussion management guidelines and to draft practical recommendations for making return-to-play decisions (Aubry et al., 2002). It was during this conference that the recognition of utilizing a symptoms scale during return to play protocols and the importance of documenting the self-reporting symptoms of the concussion patient became evident. It became clear that symptom reporting scales where important in treating the patient and that several scales addressed the same symptoms, but there was not one scale that was viewed as the golden standard. To identify these symptoms the post-concussion symptom scale (PCSS) was developed to provide a formal method of documenting post-concussion symptoms, as perceived and reported by the patient7. The PCS scale items were constructed to reflect actual player reports rather than medical jargon7. The PCS scale measures the severity of patient reported concussion symptoms on a 0-6 Likert scale, while providing the clinician a formal way of documenting these post-concussion symptoms8-10. The PCSS includes the following 22 items: headache, nausea, vomiting, balance problems, dizziness, fatigue, trouble falling asleep, sleeping more than usual, sleeping less than usual, drowsiness, sensitivity to light, sensitivity to noise, irritability, sadness, nervous, feeling more emotional, numbness or tingling, feeling slowed down, feeling foggy, difficulty concentrating, difficulty remembering, and visual problems. The PCSS was developed to provide an adjunct to other tools, such as neuropsychological testing, and is commonly found within on-field concussion assessment tools (e.g., Sport Concussion Assessment Tool 2 [SCAT2]) and post-acute computerized neurocognitive tests (e.g., Immediate Post-concussion Assessment and Cognitive Test [ImPACT], CogSport)6.
The PCSS is found to be broken into four factors: seven cognitive symptom factors (e.g., concentration, attention, memory and reaction time), three sleep disturbance symptom factors (e.g., sleeping more or less than usual) four emotional symptom factors (irritability, nervousness, sadness, more emotional than usual) and eight somatic symptom factors (e.g., headache, dizziness, fatigue, nausea)6. This scale is scored as a total overall score that includes all four of the factors. The instrument is documented as having a low score if the patient reports 0, a borderline normal score if the patient reports 1-5, a borderline score if the patient reports 6-12, a very high score if the patient reports 13-26 and extremely high if the patient reports 27+. It is not understood or well researched what these different scores mean or how they should be treated. Kontos 2006, reports that as clinicians we should
not only look at the total score of reporting symptoms but the individual score of each of the four factors2; this would allow clinicians a more in depth way of a multidisciplinary clinical management approach, rehabilitation treatments and return to play protocols6.
Researchers have found, through factor analysis of the PCSS scale and multiple other symptom scales, that the emergent four factors may reflect different subtypes of concussions6. Researchers report that, as clinicians, we should not only look at the total score of reporting symptoms but the individual score of each of the four factors. This would provide clinicians with a more in-depth approach of analyzing and controlling rehabilitation treatments and return to play (RTP) protocols6.
So…….… My question to my colleagues is this- Have you ever researched the tools given to you and may be required of you to use with your patients? Have you or do you understand the foundation of the numerous concussion scales, test or policies you are treating your patients with? I understand that concussions are a hot topic, however I feel this line of questioning should be utilized in all areas of athletic training. I know that being in the secondary setting myself we become comfortable and I find myself stuck, not able to explain a treatment method on a foundational scientific level or concussion scale with supporting research evidence. Once I realized this speed bump I began questioning everything, as I challenge you to do as well.
Which brings me back to the PCSS that I find absolutely fascinating. I have watched numerous sports medicine professionals ask the symptoms check-list and leave the patient with a mindset of “yes they have symptoms” or “no they do not have symptoms”. Did you ever stop to think what each of those symptoms mean or where those symptoms are located in the brain? Did you stop to think of what the difference of somatic and cognitive symptoms could mean for your patient? I know I didn’t at first and then it all became clear. These symptoms mean something and that something is crucial for their return to play or return to learn. So I CHALLENGE you to take a closer look at your patients symptoms and figure out what they truly MEAN.
~Cathlene Webb MS, ATC, LAT
University of Idaho Doctoral Student
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2. Meehan WP, d’Hemecourt P, Comstock RD. High School Concussions in the 2008-2009 Academic Year. The American Journal of Sports Medicine. December 1, 2010 2010;38(12):2405-2409.
3. Kelly JP, Nichols JS, Filley CM, Lillehei KO, Rubinstein D, Kleinschmidt-DeMasters BK. Concussion in sports. Guidelines for the prevention of catastrophic outcome. JAMA : the journal of the American Medical Association. 1991;266(20):2867-2869.
4. Barr WB, McCrea M. Sensitivity and specificity of standardized neurocognitive testing immediately following sports concussion. Journal of Neurophysiology. 2001;7:693-702.
5. McCrea M, KM G, SW M. Acute effects and recovery time following concussion in collegiate football players: the NCAA Concussion Study. JAMA : The Journal of the American Medical Association. 2003;290:2556-2563.
6. Kontos AP, Elbin RJ, Schatz P, et al. A Revised Factor Structure for the Post-Concussion Symptom Scale: Baseline and Postconcussion Factors. American Journal of Sports Medicine. 2012;40(10):2375-2384.
7. Lovell M, Iverson G, Collins M, et al. Measurement of Symptoms Following Sports-Related Concussion: Reliability and Normative Data for the Post-Concussion Scale. Applied Neuropsychology. 2006;13(3):166-174.
8. Iverson GL, Gaetz M, Lovell MR, Collins MW. Cumulative effects of concussion in amateur athletes. Brain Injury. 2004;18(5):433-443.
9. Echemendia RJ. Assessment and Management of Traumatic Brain Injury. Sports Neuropsychology. 2006.
10. Iverson GL, Lange RT. Examination of "Postconcussion-Like" Symptoms in a Healthy Sample. Applied Neuropsychology. 2003;10(3):137.