Thursday, March 19, 2015

Communication: The Key Component in Athletic Training by Mark Stephens

What is the one word that we think of when we hear the word communicate?  Talk. Well, sometimes it may not be so simple.  You often have trouble finding the right words.  Talk to whom exactly?! Talk to your friends, your parents…your colleagues?  And, tell them what?!  It’s hard enough to talk to those who are close to us like our family and friends but what do we do when we have a superior?   We must be open and honest.  Regardless if what we have to say is good or bad, more of than not the truth overrides falsehoods. 

Do you ever remember your parent’s tell you “As long as you tell us the truth, you won’t get in trouble”.  I know what you’re thinking. “Uh huh, sure”. Well in this case it’s the truth.   As health care professionals in the career of athletic training, communication is the key component to establishing a successful and effective working relationship with your superior.  If you think about it, what is the one thing that we are asked as by the coach and athletic staff when we witness an injury?  “Is he /she okay”? or “how bad is it”…” do you know when they will be back to full status”.    When this happens, we get a little nervous and become apprehensive on what to say.  It’s during this time when I remember that as long as I speak the truth, I will not get into trouble.  I’m sure we can all agree that we if we are honest and up front with our coaches and athletic staff about an injured athlete, we do them a service.  Often at times we think we may hurt the coaches feelings and make them upset by not telling them what they want to hear. However, I defy anyone to tell me otherwise. 

Tuesday, February 24, 2015

Manual Therapy in the Secondary Setting- Friend or Foe? By Cat Webb

Personally I have been using manual therapies in my secondary setting for a couple of years now. At first I was hesitant in my career and soon realized the benefit they had to offer. My top 3 go to manual therapies are: Positional Release Technique (PRT), Muscle Energy Technique (MET) and Mulligan manual therapies with mobilizations. Each of these techniques did require additional certifications and education. Nevertheless, as an athletic trainer in the secondary setting I am improving my overall treatment time by reducing my clinical treatments from an average of 5 days (5 treatments) to 2 days (2 treatments). I am also able to perform all of these manual therapy treatments on the field and return patients to play pain free immediately.
I have had great success using PRT with headache patients including concussion patients, neck pain/soreness and low back pain/soreness.  Positional release technique (PRT) is a unique method that has been gaining popularity as a manual therapy technique with lasting effects by decreasing muscle tension, fascial tension and hypomobility, in turn increases range of motion (ROM) and decreases pain.1   PRT is a method that uses a total body screening evaluation to locate tender points (TP) while placing the patient in a position of comfort (POC) to resolve dysfunctional tender points.  This indirect technique involves positioning the patient away from resistance and towards the direction of greatest ease, opposite that of stretching.   Theory behind PRT,  is that by placing the compromised tissues into a position of  relaxation for a period of time you will decrease gamma gain and facilitate restoration of normal tissue length and tension.1,3,4  The application of PRT by the clinician relaxes the muscle-spindle mechanism and breaks down the contraction,3  allowing the clinician to provide biofeedback while palpating the TP and breaking the chain of muscle contraction that causes pain or weakness from the point of dysfunction. 
On the other hand, I have had great success treating patients with MET that complain of pain or soreness along the following muscles-sartorius, rectus femoris, iliopsoas and quadratus lumborum.  MET is a direct mobilization technique that uses voluntary contraction by the patient to treat soft tissue restrictions.1 MET was developed based on the principles of proprioceptive neuromuscular facilitation (PNF).  MET has been found to normalize joint ROM,2 increase joint mobility, increase flexibility,3 strengthen muscles and relax hypertonic shortened muscles.  Exact theories are unclear as to why MET works, one theory suggest that MET releases restricted joints through isometric muscle action known as autogenic inhibition.4  This theory addresses treating postural and phasic fibers through MET.  In order to isolate both fibers the patient contraction must occur between 10 and 30 percent.  This allows for avoidance of fatigue which can occur during a more vigorous contraction, such as in PNF.  The second theory addresses only the postural muscles, also known as non-fatiguing muscles.  This type of contraction occurs with less than 30 percent to avoid the stretch reflex.  MET works during this type of muscle contraction by resetting the gamma gain of the muscle spindle and possibly creating a voluntary contraction of the opposite muscle. Muscle energy techniques can be applied in two different methods based upon the patient’s pain.  Patient’s reporting with tightness should be treated with a post isometric relaxation technique where the agonist muscle is being isolated.  This isolation increases the neurofeedback through the spinal cord during the isometric contraction.  This in turn causes re-education in the muscle tone.  This is very similar to PNF with relaxation after an isometric contraction however performed with less intensity.  If the patient reports pain then the clinician would choose the method of reciprocal inhibition muscle energy techniques.  Reciprocal inhibition treats the antagonist and is used for acute injuries that are painful.  This allows the clinician to treat in mid-range instead of end-range and avoid pain by treating opposite of the injured muscle.2
Mulligan Mobilization with movement (MWM) is a system of manual therapy interventions developed by Brian Mulligan that I have had great success treating lateral ankle sprains, tennis/golf elbow, loss of supination/pronation, loss of interphalangeal joint movement and tight hamstrings.  This manual therapy combines a sustained manual ‘gliding’ force to a joint with concurrent physiologic (osteokinematic) motion of the joint, either actively performed by the patient, or passively performed by the operator. The manual force, or mobilization, is theoretically intended to cause repositioning of ‘bony positional fault’. The intent of MWMs is to restore pain-free motion at joints which have painful limitation of range of movement (ROM). Therein lies one of the key aspects of the mobilizations with movement system: a trial of MWM at the time of the initial patient examination will determine whether MWM is an appropriate therapeutic intervention for that patient’s dysfunction. If a trial of MWM is able to eliminate the pain associated with an active movement, then MWM is an appropriate intervention; if not, then MWM is not an appropriate intervention. In the event that a trial of MWM is not able to eliminate the pain associated with an active movement, the therapist should not employ the MWM, and other therapeutic interventions should, therefore, be explored.

All in all, manual therapies are your friend. They reduce your patient load by decreasing your overall treatment time and accurately treating the patient’s pain instead of using a band-aid. I hope they become your friend as they are mine and you begin the research process of finding the best ones that fit your practice. Hopefully the 3 listed above are a good starting point.

Monday, February 9, 2015

Calling all young professionals to NATA!

The Young Professional’s Committee has some new and exciting tricks up their sleeve for this year’s convention in Saint Louis. 
For starters, be on the lookout for registration information about our career session that will be held on Wednesday afternoon.  We will be blasting out an announcement in the next issue of NATA News and ROM.  Our session will feature mock interviews where YP’s can be both the interviewer and interviewee.  Want to touch up those skills prior to a big interview this summer?  This is the session for you!  Want to start working on your skills so you can help with the interview process for that new assistant position at your job?  This session has something for you as well!
The Young Professionals and Cramer will be teaming up once again to host the YP lounge event.  Be on the look out for the announcement in the programming guide.  Last year’s lounge event in Indianapolis was so successful- we had almost 500 people present!  Come out and enjoy meeting the hall of fame members, the YP committee members, and many others within the profession.  Grab a drink with your free ticket, and rub elbows with the professions’ finest.
Lastly, do not forget to look for the YP stamp on the programming guide.  This stamp indicates the sessions that are geared towards the young professional.  Go check them out!

See you in St. Louis!

Tuesday, February 3, 2015

Where's The Money by Julie Ellena

As most of you may of seen in the January edition of the NATA news, a new Athletic Trainer Salary survey has been released. As a profession our salaries have increased steadily since 2011. The national average for full time position in 2014  was $55,036. In District 6 the average salary  reported was $64,126 which is six thousand dollars above and beyond the previously reported salary. Across the nation salaries increased, the largest increase in salary over the last 3 years was the young professional group (1-5) years of experience, improving more than 12 percent.

As the profession moves forward with this knowledge, we are look forward to continue success showing our value. With the current healthcare model in America the athletic trainer is receiving increased value. Our skill set is unlike any other, various health care professionals and community health organizations are stating to take notice. Our efforts are being helped by medical issues occurring in the spotlight (concussions, heat illness and unfortunately, the death of athletes)  and being talked more and more in the mainstream media. We are seeing parents, realize what an assets an athletic trainer is and parents are taking action to save AT jobs and create new ones.

As our profession continues to change and grow with the nation's health care needs, we expect the salaries will continue to increase as more and more individuals are taking a proactive approach to healthcare, rather than a reactive one. Let continue to improve and show our value, it's working.

For more information on the salary survey, there is a free interactive salary database

Friday, January 23, 2015

On the Cutting Edge of Everything, by Julie Ellena

As Athletic Trainers we are expected to on the cutting edge of health care, as individuals we are expected to be in the know about new trends and technology, but at what point does one decided they can not be on the cutting edge of everything. There will always be the new rehabilitation exercise or routine, a new tape technique, the latest phone update, injury tracking program, etc. So how do we decided what to filter in and what to filter out in the flow of information we process daily. One of the best athletic training resources I have found to keep me informed is an email called "Athletic Trainer Weekly" Its a weekly email that collects articles from around the web that relates to the athletic training profession. It's a great addition to the emails I receive from the NATA Blast and NATA Monthly (both which are great benefits of NATA Membership!) According to the Athletic Trainer Weekly website ( "Athletic Trainer Weekly is a free, weekly curation of the best information for athletic trainers from the web and from experts in the field."  Personally, I enjoy reading the Athletic Trainer Weekly. It is organized and published by a fellow Athletic Trainer and it's divided up by subject matter: In the News, For the Kit, From the Field, Hit the Books, Sage Advice, Up the Ladder, and they typically have a funny story or video at the end.  Go Check it out! It's free and not many things in life are free. Happy Reading!

Tuesday, January 6, 2015

Advocating to Secondary School Administration by Michelle Vryhof Holt

No matter what situation we are in or where we are working at we should be advocates for ourselves, each other and our profession. I have recognized that even our biggest allies in our workplace can still benefit from conversation and understanding of what it is we really are able to do and what we should be responsible for. It is vital to clarify realistic expectations with those that we must answer to in order to preserve that providing quality medical care to student-athletes or patients is the most important thing we do and must be made priority over all else.
I have been very fortunate to be in company with those who exemplify this. I currently get to witness and assists behind the scenes with the process of proposing another full-time athletic trainer for each school in our district to the chain of command in administration. It is a great experience for a young professional growing in my career and equips me for the tools to effectively move a motion like this one forward myself if the future presents the opportunity. I want to share some tips I have learned to others who may find themselves alone in such a position.
1)      Education is always the first crucial step in order to see actions made in our favor. School or district administration professionals will not understand the need to act if they don’t understand how important our role is and how well we fulfill the needs they might not even realize they have by doing what we are skilled and trained to do as medical professionals.
2)      Plan a way to present that keeps them engaged, perhaps a powerpoint could help. Try to say what you need to say in as few words as possible and keep the information organized so it flows.
3)      Numbers talk. Try including a graph or chart to document points that can help support the need. Ideas may be injury rates in seasons, season overlaps including “off-seasons” that still compete, coaching staff growth rates vs. support staff growth, and change in athlete/athletic trainer ratio over time.
4)      What are the most important athletic trainer’s responsibilities related to care and what are the “other duties as assigned” that could take away from that quality of care?
5)      If you bring up the amount of hours you work, try to frame it in a different light. Others work long, long hours too but how could it affect someone’s life? It may help to focus on fatigue’s potential effect on skills and judgment in critical injury situations, especially at the big events at with high injury potential at the end of the week.
6)      Stay positive! It can be easy to list out the complaints. If the tone can somehow stay positive with energy focusing on the goal of helping the student athletes, there is a much better chance that your important information doesn’t fall on deaf ears.
7)      Be prepared with alternative ideas that could still benefit you and rebuttals to potential questions. Is it appropriate for a head coach or coordinator be your direct supervisor? Maybe an open line of direct contact to administration is a key that helps the seed spread.
8)      Don’t let the conversation stall. It will take time to pass through the levels for consideration, so keep stimulating the topic with your admin. Also, try to plan for proposal at the beginning of administration’s budget planning process so that timing works in your favor.

9)      Most importantly, don’t give up! Keep trying different ways to help those above you understand, and when personnel changes occur realize the opportunity for a recharge in your advocacy efforts.

Monday, December 22, 2014

Energy Bus by Michelle Vryhof

We know that the inevitable factor of change keeps life interesting, but also challenging. When I consider the past few years of my own life, the situations have been fluidly changing but my “to-do” list is almost always a constant in length. The encouraging thing in my mind is that my never-die work ethic to be productive and be involved hasn’t wavered. The struggle, however, is teetering the line of burnout when trying to balance work and life. Also, keeping upbeat and having a positive attitude toward the daily aspects of the grind can become more difficult as the sport seasons or responsibilities go on and on without rest for the weary athletic trainers.
If you are feeling a little worn out and perhaps not quite your usual self, let me suggest that you take the time to read a small book that that could possibly change your life forever. I know, I know…why am I asking you to do then one more thing that takes up time from busy life? It’s a very short, easy read and the story demonstrates the pearls of wisdom in a way that keeps you interested to read it from cover to cover in one sitting. The book is titled The Energy Bus by Jon Gordon. The 10 valuable rules to fuel your life are:
1.       You’re the driver of the bus.
2.       Desire, vision and focus move your bus in the right direction.
3.       Fuel your ride with positive energy
4.       Invite people on your bus and share your vision for the road ahead.
5.       Don’t waste your energy on those who don’t get on your bus.
6.       Post a sign that says “No energy vampires allowed” on your bus.
7.       Enthusiasm attracts more passengers and energized then during the ride.
8.       Love your passengers.
9.       Drive with purpose.
10.   Have fun and enjoy the ride.

These rules make perfect sense when you read the whole book and find the ways to apply these principles. But here are some additional thoughts of how to keep up the positivity in your daily life, things that I try to remind myself all the time. First, in order to balance energy with work and life, we have to let go of some things in our work life. As athletic trainers, we wish we could do it all and we sure try to. We have to accept and then let go that we perhaps didn’t get to everything on our to-do list or didn’t finish a task quite as well as we would have liked. Do your best, but when it is time to say “no” you are helping yourself and those around you by not stretching yourself too thin and jeopardizing the quality of care you give. Second, stay positive by celebrating the smallest successes or improvements in others. It really spreads enthusiasm and encourages patients in dealing with their pain or struggle. I share this with you in hopes to help anyone who needs a little positive energy pick-me-up as we look ahead to a fresh new year full of great potential!!