Bull's Eye and Shot Guns

As a high school athletic trainer, you are faced with hundreds of patients at any given moment.  During the day of chaos this leads us to triage our patients as quickly as possible.  Yes, some of us have figured out an appointment schedule or hired a 3^rd assistant, but we are still stuck in the traffic jam of the high school setting.  It is during this traffic jam that I wonder how other athletic trainers evaluate their patients. We are all taught how to evaluate in our own respective programs, some use the bull’s eye approach, others use the shot gun approach. I, now, use regional interdependence or the SFMA (Selective Functional Movement Assessment).

The bull’s eye approach is where the patient comes into the clinic complaining of issue A and the athletic trainer evaluates issue A and then treats issue A.  The athletic trainer may evaluate above and below immediate to issue A but do they evaluate the entire patient. This is coined the “bull’s eye” approach because all the athletic trainer sees is one issue at a time.  

Some athletic trainers may use the shot gun approach, where the patient comes into the clinic complaining of issue A and the athletic trainer shoots several treatments at them such as, ice bag, heat pack or e-stim, without a proper evaluation.  Both of these strategies could be used, but are they treating the entire patient or even the root of the patient’s complaint? All athletic trainers should evaluate with a standardized method of some nature, this could be a check-list in their head, a cheat sheet in a program or the SFMA.

While being in the doctoral program at the University of Idaho I have learned several new and exciting techniques that have been very beneficial to my tool box.  These techniques are not time consuming and can be used with high school patients.  One of these techniques is the SFMA (Selective Functional Movement Assessment) by Gray Cook.

The Selective Functional Movement Assessment (SFMA) is a series of 7 full-body movement  tests designed to assess fundamental patterns of movement such as bending and squatting in  those with known musculoskeletal pain. When the clinical assessment is initiated from the  perspective of the movement pattern, the clinician has the opportunity to identify meaningful  impairments that may be seemingly unrelated to the main musculoskeletal complaint, but   contribute to the associated disability. This concept, known as Regional Interdependence, is the  hallmark of the SFMA.

The assessment guides the clinician to the most dysfunctional non-painful movement pattern,  which is then assessed in detail. This approach is designed to complement the existing exam and  serve as a model to efficiently integrate the concepts of posture, muscle balance and the  fundamental patterns of movement into musculoskeletal practice. By addressing the most  dysfunctional non-painful pattern, the application of targeted interventions (manual therapy  and therapeutic exercise) is not adversely affected by pain.

SFMA offers healthcare professionals a new approach to the treatment of pain and dysfunction.  Our standardized clinical model ensures isolating the cause of injury and efficient care.

http://www.sfma.com/site/

I have been using the SFMA for the past year with amazing results.   Instead of a bull’s eye approach or a shot gun triage I have had success in using regional interdependence.  This approach has allowed me to really treat the whole patient with an evaluation that last less than 2 min.  For an athletic trainer on a time crunch being able to evaluate the entire patient knowing that you have considered all the issues and possible issues that could be presented, is priceless. 

This standardized evaluation has a fool proof breakout session that allows you as a clinician to evaluate your patient thoroughly while monitoring their movement patterns and defining their pain or dysfunction.  It is also a wonderful and useful tool to quantify when the patient has overcome their pain or dysfunction. I could write pages about the SFMA, show my outcomes data, patient testimonials etc. but in a nutshell I believe the SFMA has changed my patient care tremendously and I believe all athletic trainers should give it a try.

So I ask you, which type of evaluation do you perform? Are you interested in treating the whole patient in less time than evaluating one bull’s eye or are you stuck in the traffic jam refusing to change?

~Cathlene Webb MS, ATC/LAT

Policies and Protocols

Athletic trainers are professionals that work to prevent injuries and illnesses.  Everyday we are introduced to new ways to recognize deficiencies in our patients by develop stretching, strengthening and nutritional programs to help minimize injury.  We work to maintain clean and safe practice and competition environments all in the name of prevention.

This fall my school district wanted to get emergency Epi-Pens at each school following a South Texas school incident that made national news (link below).  Getting the emergency medication was simple thanks to our team physician and a company that provides two free pens to every school that applies with a prescription.  I then found out that a new policy had to be written and be approved by the school board, and an existing policy needed some revamping.
Once in this process, I started to review all of our policies and realized there were some policies I did not know existed and some that needed some updating.  Not being aware of all safety and medical policies is my fault. When I joined this district four years ago, I only asked to review high school policies and the athletic department policies, not those that pertained to the nursing staff or other campuses within the district.  


In most cases this means that a policy, protocol or procedure has been developed, approved, and then upheld in order to stay current with new research and laws.  In the secondary setting, the total number of policies, protocols and laws that must be followed are at times overwhelming, and that list keeps getting longer every academic year.

I found that there were some policies that were written with the school nurses in mind, but not the athletic trainer. This obviously was not a problem, but it showed further that there should be constant communication among all professionals and departments in the district. How can you be compliant and provide best care for all students if you don't know a policy in place? 

We, as medical professionals, must ensure that we are staying current on all policies within our organization as they tend to change more often than our state and national laws.  We should be reviewing all medical policies on a regular basis to ensure that they work for all people responsible for upholding the policy within the organization. It is another opportunity for collaboration throughout. I am grateful for the nursing staff that I work with we try to work with each other to provide the best care for all students.

EpiPen Story: http://www.nbcnews.com/health/texas-boys-death-reignites-debate-over-epipens-schools-4B11194403

-Stephanie Nelson

Remembering All the Aspects of Evidence-Based Practice

I have to give a shout out to my volleyball coaches. They have helped cut down on the amount of volleyball injuries we normally have in one season by simply adding a variety of workouts to their team's practices.  Since taking the job two years ago, they have added in mobility training, yoga, meditation, and probably a few other things that I do not know about.  They required each player to buy their own foam roller over the summer, and they all roll out on a regular basis after practices.  

Other coaches think they are crazy.  I mean, why would you need to do anything besides practice your sport and lift weights, right?  Luckily, I have been able to see all the benefits these changes have produced.  We used to have a variety of upper and lower body injuries we dealt with all year long.  This year I can think of one injury, and it resolved quickly with a little help from our athletic training staff.

This change has helped me see that sometimes we need to step out of our comfort zones and try new things.  This summer I attended a session at the NATA Annual Meeting addressing evidence-based practice (EBP).  When I think of EBP, I mostly consider what the research supports.  At the meeting, I was reminded EBP is not just what is supported by original research; it also factors in the clinician’s own knowledge and experience, along with the patient’s goals and values.

Before I may have joined in with the other coaches, thinking our volleyball coach was doing some crazy stuff.  There probably is not a lot of research out there correlating the specific combination of activities my volleyball coaches use with a decrease in team injuries.  However, I have seen the outcomes and I have observed the improved quality of life my players have now. That alone is evidence in my evidence based practice.  Could it be coincidence? Sure, but I’m going to support my coaches new additions to practice, until I am proved otherwise.

Even though I am a young professional, I still find myself get stuck in my ways, but, thanks to my volleyball coaches and a NATA Annual Meeting session this summer, I have been open to trying new things.  We, as health care professionals, should be anxious to learn and try new methods.  Instead of doing what we have always done, let’s be willing to apply our EBP methods and add a little creativity in order to achieve better outcomes for our athletes!

-Shaya Hancock

Life Balance As A GA

Good Afternoon America! I hope all is well and the Fall semester has been good to you. Football season is going strong (Go Baylor Bears!) and midterm exams are on the horizon (yikes!). For the majority of young professionals out there, you have some stories of when you were a graduate assistant. I hear from a good number of “seasoned” ATCs about how “back in the day” they covered all types of sporting events AND worked their way through graduate school. For those who were able to navigate the waters of being a GA without any hiccups, I salute you. For the rest of us who had a nice “adjustment period” before they got it perfect, I also salute you. 

Being a GA in the current workforce is tough. Graduate school work is tougher than it ever has been. The profession is in a transition period. Collegiate athletics is a booming business where universities are measured on the success of their athletic programs. It’s bananas.

My path to being a Graduate Assistant at Baylor University began at the University of Texas at Arlington. I was a 400m Hurdler for a year and then began working on my degree as an athletic trainer. I interned my senior year at Southern Methodist University and got motivated to continue my education as a graduate assistant. I ultimately chose Baylor because of the program I was working for (shout out to Baylor Track and Field) and the Christian atmosphere. I have had a blast working as a GA with multiple sports and adding more skills to my skill-set. I also had the opportunity to go to Puerto Rico this summer to work for the United States Virgin Island Basketball Federation for their U17 team. Huge blessing.

So…to the good stuff…during my time as a GA I have found some tricks that have allowed me to balance all of the duties associated with current GA positions. Now…(imagine I’m sounding like Dr. Phil when I say this)…if you follow these 10 steps, I promise you will ease into the real world much more efficiently, have a greater overall experience, and actually ENJOY being a GA (yes…it can happen).

1. Get to know your full time athletic training staff and coaching staff. Actually ask about their careers and what they like to do. These relationships will add the “human touch” to your time at your respectable university.

2.  Get a planner. If you don’t have one yet, go ahead and make the trip to Walmart and get one. It will change your life. Adding all practice times and dates in one place will allow you to not be caught off guard.

3.  At the beginning of each semester, add your syllabi to your planner. REMEMBER: YOU ARE HERE TO GET A DEGREE AAAAAAAAAND WORK A SPORT ASSIGNMENT. Don’t underestimate the time you’ll need to get homework done. Keeping all assignments and exam dates in one place will keep you on track.

4. Take things one day at a time. Don’t get too caught up in everything going on around you. Focus on what you have to do one day at a time. I look at things in weeks. Each Monday, I sit down at an eating establishment of my choice (More times than not it’s fast food. Ballin’ on a budget.), and I see what I have to do that day and what is on the horizon that week.

5. Create your own routine. For instance, Monday and Tuesday are homework nights. Wednesday is “Career Night” where I sit down and work on career building items. I will look up something I want to learn and integrate to my practice or read a book that will motivate me to do more in the workplace. Thursday night is “Hoop Night”. I’m in our gym doing my best Kobe Bryant impression (no Achilles jokes people). Friday night is “Social Night”. No books, no homework, no work. Just hanging out with friends and family. By establishing a consistent routine each week, you give your week balance and feel more at ease with all of the craziness going on.

6. WORK OUT (begins playing LMFAO’s “Sexy and I Know It”). Don’t forget to take care of your body. The pounds add on as we get more busy in our jobs. Athletic trainers usually eat horribly as well (I’m guilty). Try to get 3 workout sessions in a week. It will make you happier and gives you a stress release.

7.  Reach out to other professionals for guidance. Be sure to tap into those who have done what you are looking to do. This gives you wisdom in how you can navigate your career and GA time.

8.  Jam out! Find some music that can relax you while you’re in the athletic training room. I’m a huge Christian Hip-Hop fan, so I’ve been playing Lecrae and Trip Lee any chance I can. Music helps keep you relaxed and is a nice topic of discussion with your athletes.

9.  Go out to other sporting events. I work track and field/cross country and baseball. Whenever I get the chance, I go out to our volleyball and football games to support my university and have fun with friends (Dressed in normal human clothes. No khakis.).

10.   HAVE FUN!!  This is the beginning of an amazing part of your career. Make the most of it. Be encouraged. Two years passes faster than you think. Enjoy the people, enjoy your teams, enjoy your job and I promise you, it will all pay off. 

-Roger Sancho

It's Award Season!

No, I'm not talking about that Award Season, but nominations are now open for the athletic training world's version of the Grammys.

ATs, in general, have a problem with patting ourselves on the back. The Honors and Awards Reception held annually at the SWATA meeting is one of the few times our profession gathers to acknowledge the excellence of our colleagues.

As athletic trainers, hard work is a given, and excellence and professionalism among our health care peers is on the rise. ATs who go above and beyond this norm, deserve to be honored for doing so. I have never fully agreed with the old school motto that "athletic trainers should be seen and never heard," but I definitely don't agree with that when it comes to our own awards. Let them be heard!

Everyone knows someone who is great at their job, and now would be the time to nominate that athletic trainer for an award that recognizes greatness in the profession. I challenge everyone to nominate one person for one of the six SWATA awards. It doesn't take that much time. It doesn't require that much effort. It is easy to do! Don't let your favorite AT stand in the background; bring them to the stage to honor their commitment to our profession.

Deadlines to submit nomination packets to the Honors and Awards Committee is November 15. All nomination packets can be found on SWATA.org

-Tiffany McGuffin

Do you hear what I hear?

On my first day of Fall football practice, there was a different atmosphere on the field as music played in the background. I thought this was just something to kick off the start of the season, to get the athletes pumped up,but as practiced progressed through the week, the music stayed. Music has now become an essential element in my teams' workouts.

Whether at they gym or in a spinning class,  the mood of the workout is typically set by the kind of music playing. Every team out there has a game day warm-up playlist to get kids hyped up. Some colleges and universities who once only played music during their team stretching and warm-ups have now started to incorporate it throughout the duration of practice. Now some high school coaches are jumping on the bandwagon.

Coaches believe that by adding music to practice, they are producing an environment much like what the athletes will see on a game day. They hope that the music will boost productivity and increase the athletes' focus. The athletes also enjoy having music while they practice because it gets them pumped up between plays and reps on the football field. Another reason some coaches have added music to practice is because their athletes need to get used to their coaches signing the plays since some teams run a no-huddle offense and they have to rely on watching the signals that are being used.  After several weeks of football practices with music in the background, our coaches and athletes feel like there is a more positive work environment and a good tempo out at practice. All the while accomplishing the necessary tasks to prepare for the big game at the end of the week.

Could this be a growing trend? I'm not sure, but I'm enjoying it.

--Kristin Salinas

In case our last post wasn't convincing enough...

Let the BOC fill you in!

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