Injuries in Gymnastics

Tim Koba, MS, ATC
Twitter: @timkoba

By Tim Koba, MS, ATC

If you’ve been watching the Olympics, you may have been mesmerized by the physical abilities of the gymnasts competing. Their ability to run, jump, leap, twist, twirl and flip is awe-inspiring. It may also leave you wondering how prone to injury they are given the skills they need to perform and the training required to reach this elite level.

Different studies cite different overall injury rates, but gymnastics generally has a greater risk of injury than many other sports.  Injury rates differ between male and female gymnasts, the events and the various apparatus.

Female gymnasts are more likely to suffer lower extremity injuries while their male counterparts have higher levels of upper extremity injury. Due to the upper body dominant skills of the male events, they are much more likely to suffer wrist and hand injuries. Women are more likely to have ankle and foot injuries. For female gymnasts, the most commonly suffered injury is an ankle sprain on 3 out of 4 apparatus, except for uneven bars which is upper body injury of the shoulder or wrist.

As young gymnasts progress in skill and hours training, their risk of injury goes up since they spend more time under load practicing higher level skills. As they produce more force with their maneuvers, the risk of having an injury increases. Younger athletes are also prone to wrist injuries at the growth plate. As their wrists extend under a load, the forces are transmitted to the growth plate and can result in pain and injury. This is most pronounced in athletes aged 10 to 14. Care should be taken to assess total volume and pain at this level to avoid wrist injury or manage it early.

Injuries in competition are more common as a result of performing the high level skills at higher speeds and greater heights without the benefit of crash pads and landing pits utilized in practice. Unfortunately, traumatic knee injuries, including ACL tears, are the most common cause of long term time away from the sport, surgery and medical disqualification from participation. Injuries as a result of floor routines are the most common mechanism for ACL injury in gymnastics.

Because of the nature of the sport, and the extreme flexibility needed to perform, gymnasts also sustain other injuries. Rates of back pain differ, but low back pain is one of the top 5 most common injuries. The main concern with gymnastics is developing a stress related fracture from constant extension. With the extreme range of motion in the hip, there have been case reports of hip instability and impingement syndromes of that joint. The hours required to learn and master a maneuver can lead to gradual overload and overuse injuries.


• Rates of injury in gymnastics differ, but the most commonly injured areas are the ankle and foot for females; wrist and hand for males

• Knee sprains are the most common cause of time lost from sport and injuries requiring surgery

• Injuries are more likely to occur in competition than in practice and when progressing from one level to another

• There are some unique injuries as a result of participation including wrist growth plates, low backs and hips

Understanding common injuries associated with participation and specific apparatus can help to develop prevention and rehab programs geared toward helping gymnasts successfully participate at their desired level.


Kerr, Z. et. al. (2015). Epidemiology of National Collegiate Athletic Association women’s gymnastics injuries, 2009-2010 through 2013-2014. Journal of Athletic Training: 50(8).

Kox, L. et. al. (2015). Prevalence, incidence and risk factors for overuse injuries of the wrist in young athletes; a systematic review. British Journal of Sports Medicine: 49.

Saluan, P. et. al. (2015). Injury types and incidence rates in precollegiate female gymnasts. Orthopaedic Journal of Sports Medicine: 3(4).

Tirabassi, J. et. al. (2016). Epidemiology of high school sports related injuries resulting in medical disqualifaction: 2005-2006 through 2013-2014 academic years. American Journal of Sports Medicine: 20(10).

Weber, A. et. al. (2014). The hyperflexible hip: managing hip pain in the dancer and gymnast. SportsHealth: 7(4).

Westermann, R. et. al. (2014). Evaluation of men’s and women’s gymnastics injuries: a 10 year observational study. SportsHealth: 7 (2).

About the Author

Tim Koba is an Athletic Trainer, strength coach and sport business professional based in Ithaca, New York. He is passionate about helping others reach their personal and professional potential by researching topics of interest and sharing it with others. He contributes articles on injury prevention, management, rehabilitation, athletic development and leadership.


Consensus Statement on Injury Prevention

Posted August 11, 2016

Tim Koba, MS, ATC
Twitter: @timkoba

Tim Koba, MS, ATC

The American College of Sports Medicine (ACSM) recently released a consensus statement on injury prevention geared to the team physician. Their conclusions, however, are beneficial for coaches, athletes, parents, Athletic Trainers (ATs) and other healthcare professionals.

In the statement, the authors focus on ankle, patella femoral syndrome, ACL, shoulder, elbow, head and neck injuries in high school and college athletes. They also touch upon sudden cardiac death, heat illness and skin infections. The article systematically addresses the mechanisms of injury and injury reduction strategies of each injury. I will include a brief summary with action items of the statement and refer those interested to the complete article.

Ankle: Ankle sprains have a high risk of repeat injury and are the most commonly suffered injury in athletics. Key prevention strategies include balance training; neuromuscular training to include jumping, landing and cutting exercises; and technical training. Once an ankle is injured, bracing is an effective way to provide support while the athlete is performing rehabilitation.

ACL: Although not a very common injury, it does account for significant time lost from activity and long term joint health. In high school, the sport with greatest risk of injury is football. In college, it is women’s soccer, with female athletes being at increased risk of injury in general over their male counterparts. Adopting an injury prevention program that addresses strength, core strength, neuromuscular control, cutting, jumping and landing can effectively reduce the risk of injury. Bracing is not an effective means of reducing injury risk.

Patellofemoral pain: Patellofemoral pain is characterized as pain around the front of the knee. Contributing factors include muscle weakness, previous injury, training error and improper movement patterns. Injury prevention techniques include assessing and training for proper jumping and landing form and implementing a structured training program to minimize muscle imbalances with an emphasis on quadriceps, hamstring and hip abductor strengthening.

Shoulder pain: The disabled throwing shoulder is a term to describe pain and dysfunction with overhead sports. Risk factors are muscle imbalances, previous injury and training error. Prevention is focused on following recommended pitch counts, optimizing form for throwing and serving, balancing activity with rest and strengthening the upper body to correct any imbalances in the shoulder, arm and scapula.

Elbow injury: There are no injury prevention programs developed for reducing elbow injury in throwing athletes. The main focus currently is on monitoring fatigue, incorporating adequate rest periods, monitoring total throwing volume to reduce overload, not throwing too many months out of the year and undertaking a general strength program to improve strength and reduce any imbalances.

Sudden cardiac death: Luckily, sudden cardiac death is a rare phenomenon and occurs for several reasons, including genetics. From a prevention standpoint it is important that all athletes have a physical to determine their risk factors and follow-up testing as indicated by their doctors. All athletic sites and sports should have a written and communicated emergency action plan in the event of a catastrophic injury. Access to an AED is essential, and one should be close by to provide care to a fallen individual within 3 minutes of collapse. Chest protectors do not prevent death from sudden impact, also known as commotio cordis, but using a softer ball in youth sports might. It is also not recommended that athletes step in front of a shot due to risk of having a commotio cordis event.

Exertional heat illness: The main risk factors for exertional heat illness are environment, previous injury and some heritable traits such as sickle cell. The main prevention strategy is acclimatization. Ideally, athletes prepare for the environmental conditions that they will be playing in. Coaches can monitor and modify practice and equipment needs depending on the weather. In preparation for weather, athletes can pre-hydrate, stay hydrated during activity and monitor weight loss between practice sessions. Having an emergency action plan in place in case of emergency is essential to management of heat illness.

Skin infections: College wrestling has the greatest incidence of skin infections. Other risk factors include previous skin infection, reduced immune function, body shaving, facility cleanliness and sharing personal care items. Some general rules are important for reducing risk of skin infections and include good hygiene, immediately laundering of uniforms and practice garments, facility cleaning, not sharing equipment or care items and promptly reporting any wounds or lesion to the team AT or your physician.


While this statement is geared for the team physician, the information is very valuable for those working in athletics to understand and implement.

- Pre-participation physical exams to identify risk factors and assess health history prior to participation.

- Instituting a school wide or at least team wide training program to improve strength, neuromuscular control, balance and technique is an effective means to reduce risk of injury.

- Monitoring athletes to provide adequate recovery and early intervention can delay time lost from competition for musculoskeletal injuries and heat illness.

- Crafting an emergency action plan that is easy to understand and implement, in conjunction with quick access to an AED, can provide the best chances for survival in the event of a catastrophic injury.


Special Communications. (2016). Selected issues in injury and illness prevention and the team physician: a consensus statement. Medicine and Science in Sports and Exercise, 48 (1).

About the Author

Tim Koba is an Athletic Trainer, strength coach and sport business professional based in Ithaca, New York. He is passionate about helping others reach their personal and professional potential by researching topics of interest and sharing it with others. He contributes articles on injury prevention, management, rehabilitation, athletic development and leadership.

Olympic Athletic Trainers Prepare for the Zika Virus with Complex Prevention and Early Detection

Posted August 8, 2016

Erin Chapman

By Erin Chapman, MS, LAT, ATC

The summer months for Athletic Trainers (ATs) are often a time to re-energize, visit with friends and family or work summer camps. However, since it is an Olympic year, some of our fellow ATs have traveled to Rio de Janeiro, Brazil to assist the United States elite athletes.

The location of the Summer Olympics has brought unique challenges to ATs. Many ATs have spent a lot of time learning and preparing to keep the athletes safe. One of these challenges is the current Zika virus outbreak in parts of South, Central and North America. The best defense ATs have against Zika or any contagious disease is to know more about it. Here is some important information medical professionals should know about Zika.

The Zika virus is a flavivirus (Petersen et al., 2016) and is transmitted from mosquito to human, human-mosquito-human, mother to fetus during pregnancy and sexual transmission (male to partner). Patients testing positive for Zika virus have reported the following symptoms: conjunctivitis, rash, arthralgia, fever, myalgia, headache, retro-orbital pain, edema, vomiting or a combination of symptoms. The adverse fetal outcomes from mother to fetus transmission are not completely known; however, Zika virus RNA has been found in the amniotic fluid of fetuses and newborns with microcephaly.  An unknown incubation period makes the diagnosis and prevention of Zika virus challenging.

Zika virus is diagnosed using the RT-PCR and IgM-capture enzyme-linked immunosorbent assay. Currently, the treatment of Zika virus is focused on symptoms since there is no Zika virus vaccine. Thus, prevention and control measures center on avoiding mosquito bites, reducing sexual transmission and controlling the mosquito vector.

Ultimately, it is a complex prevention and early detection approach that will help protect the Olympic elite athlete community. Such steps will most likely be taken to reduce the chances of being infected with Zika virus; however, more research still needs to be done in this area to understand this virus better.

As healthcare professionals, we should have a good foundational knowledge regarding different illnesses especially while traveling to other countries. Zika may not affect us; however, the unknowns of this virus and its effect on us here in the United States should influence professional learning behavior. The athletic training profession emphasizes prevention and the steps to prevent, diagnose and treat; thus Zika virus prevention and treatment ought to be our approach to new challenges in our clinical settings.

The Centers for Disease Control and Prevention provides up-to-date recommendations for those traveling to Brazil. These recommendations are constantly updated as more information is gathered and should be checked frequently for any changes.

What can travelers do to prevent Zika?

As mentioned previously, there is no vaccine or medicine that can prevent Zika virus. Travelers can protect themselves by preventing mosquito bites

- Cover exposed skin by wearing long-sleeved shirts and long pants.

- Use EPA-registered insect repellents containing DEET, picaridin, oil of lemon eucalyptus (also known as OLE, para-menthane-diol or PMD) or IR3535. Always use as directed.

- Pregnant and breastfeeding women can use all EPA-registered insect repellents, including DEET, according to the product label.

- Most repellents, including DEET, can be used on children older than 2 months.

- OLE should not be used on children younger than 3 years.

- Use permethrin-treated clothing and gear such as boots, pants, socks and tents. You can buy pre-treated clothing and gear or treat them yourself.

- Stay in places with air conditioning and window and door screens to keep mosquitoes outside.

- Sleep under a mosquito bed net if air conditioned or screened rooms are not available or if sleeping outdoors.

- Mosquito netting can be used to cover babies younger than 2 months old in carriers, strollers or cribs.

- Sexual transmission of Zika virus from a man is possible. If you have sex (vaginal, anal or oral) with a man while traveling, you should use condoms.

Petersen, L. R., Jamieson, D. J., Powers, A. M., & Honein, M. A. (2016). Zika virus. New England Journal of Medicine, 374(16), 1552-1563

About the Author

Erin Chapman started working for The College at Brockport as an Athletic Trainer (AT) in March of 2010.  She completed her bachelor’s degree in Athletic Training/Exercise Science at Ithaca College in 2007, and her master’s degree in Human Movement at A.T. Still University in 2009.  She is working toward a doctorate in Athletic Training at the University of Idaho.  Chapman's research interests are in breathing pattern disorders in the physically active population and concussion education in intercollegiate athletics.

As an AT, Chapman assists Golden Eagles athletes by working with field hockey; men’s and women’s basketball; men’s and women’s indoor and outdoor track and field; and men’s lacrosse. Prior to working for The College at Brockport, Erin spent two-and-a-half years as the Head AT and biology teacher at the Winchendon School in Winchendon, Massachusetts.  Chapman is a BOC Certified AT and licensed in New York state.


In-Depth Look: Athletic Trainer for the USA Women’s National Volleyball Team

Posted August 5, 2016

Jill Wosmek, ATC

Jill Wosmek, ATC is Head Athletic Trainer for the USA Women’s National Volleyball Team. She has been working in this setting for over 7 years.

Describe your setting:

I work with the Women’s National Volleyball Team and Olympic level athletes.

How long have you worked in this setting?

I started working in this setting in May of 2009.

Describe your typical day:

My day starts early. I like to get in a morning workout prior to the day starting so am up at 4:30am. I’ll then start admin and prep work for the morning session with the team. The athletes start to arrive around 7:00am for pre-practice treatment and therapy. The team trains from 8:30am to 11:30am. I will do a variety of things during that time including admin tasks, rehab with post-op athletes or watch practice. We’ll then preform post-practice treatments, and afterwards, go to lunch.

In the afternoon, we prepare for a second session. This may be more court work, yoga or weightlifting depending on the day and the athlete’s needs. We end the day with lots of recovery and individualized treatment plans. At some point, we normally have a staff meeting, so there is always time to strategize with our team.

USA win first Women's World Championship title.

What do you like about your position?

I like working with elite level athletes and having the responsibility of being an influencer to this unique group. I also like having a leadership role that goes beyond a typical Athletic Trainer position.  I’m lucky to feel fulfilled and challenged in my role and have the ability to provide selfless service that goes beyond just a sport.

What do you dislike about your position?

Like any athletic training position, time management can be challenging. It can be hard to find time for yourself outside of work.

What advice do you have about your practice setting for a young AT looking at this setting?

My advice would be to gain as much experience as you can! We all have so much to learn, and I still feel overwhelmed at times when I come across things I’d like to know more about. It can be tough to fit it all in.

I would also say to appreciate other disciplines and rely on their insight as well. The best service you can provide to your athletes and staff is a comprehensive approach to sports medicine and performance along with humility.



Concussion Baseline Assessments: What Should Clinicians Capture?

Posted August 1, 2016

Nicole T. Wasylyk,

By Nicole T. Wasylyk, MSEd, LAT, ATC

Traumatic brain injuries (TBIs) are an ever-prevalent topic in our society today, in part due to their high incidence rate. It’s estimated that 1.7 million Americans sustain a TBI each year.1 Diagnosing and managing TBIs can be a complex pathway. Clinical assessment of patients is key to diagnosis since there is currently no objective diagnostic tool to identify whether a patient has sustained a TBI.  Assessing a patient’s baseline is also key in the post-injury assessment and management process.

In order to craft the best clinical assessment to identify TBIs, we need to understand the key components that make up the assessment toolkit. A baseline assessment should consist of the following key components.2

Clinical History and Self-Reported Symptom Assessment

There are many useful tools clinicians can use to assess symptom number and severity. The most frequently used and researched tools include the Standardized Assessment of Concussion (SAC), Head Injury Scale, Graded Symptom Checklist, Brief Symptom Inventory 18 (BSI-18), Sport Concussion Assessment Tool Version 3 (SCAT3)3 and the Concussion Symptom Inventory. The SCAT, now in its 3rd version, is a useful tool that incorporates more than just a self-reported symptom scale. In 2012, a consensus statement was released by the International Conference on Concussion in Sport4 supporting the use of the SCAT3 and the Child SCAT3 (ages 5-12). 5

Physical Motor Control Testing

Assessing motor control can include any number of functional tests to assess gait, postural control, fine motor control or hand control and proprioception. Most commonly utilized tests include simple heel-toe gait observation and the Balance Error Scoring System (BESS). The BESS is a quick, portable and cost effective way to evaluate motor control. Although there is variability, the BESS has been found to be both a valid and reliable tool to assess motor control.6

Neurologic Exam

A neurologic exam should certainly be completed post injury. Baseline assessments most often do not demonstrate deficits but are helpful to perform for completion and practice’s sake.

Neurocognitive Testing

Computerized testing is the most frequently utilized form of neurocognitive testing. This type of testing is a comprehensive evaluation of specific domains such as memory, attention, problem solving, language, visuospatial and motor processing speed. Commonly used tests include the ImPACT test, Wisconsin Card Sort and King-Devick. There are numerous computerized tests to assess patients; it’s important to review and understand each of the domains the test seeks to evaluate and ensure it meets your patient population needs.

This leads us to the following question: What makes up the best baseline concussion assessment?

We do not yet have strong evidence to suggest the gold standard for clinical assessments. However, we do know that a combination of assessment tools, such as the SCAT3, which incorporates both a clinical history and self-reported symptom assessment and physical motor control testing, along with ImPACT testing is a robust way to evaluate patients. Almost all of the tests, aside from the computerized ones, are low cost, reliable, valid and easily implemented. They also carry little burden on both the clinician and the patient.

Recently the National Collegiate Athletic Association (NCAA) and the Department of Defensehave partnered together on a comprehensive study of concussions. This multi-center center study titled Concussion Research Initiative of the Grand Alliance7 will seek to answer questions on the etiology, evaluation, diagnosis and prevention of concussions. The study has 3 aims: to create a sustainable framework to achieve clinical and scientific research, to investigate the natural history of concussions, and to conduct advanced research that will integrate biomechanical, clinical, neuroimaging and genetic markers of injury to advance our understanding of TBIs.8

Hopefully there will be more information in the coming years regarding evidence based management of concussions. Currently, best practice is to utilize a multimodal approach to assess and manage concussions. This includes symptom assessment, physical motor control testing, neurologic exam and neurocognitive testing if available.


1. Daneshvar DH, Nowinski CJ, McKee AC, Cantu RC. The epidemiology of sport-related concussion. Clin Sports Med. 2011 Jan;30(1):1-17, vii.

2 .

3. 4. SCAT3:

5. McCrory P, Meeuwisse WH, Aubry M, et al. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. Br J Sports Med. 2013 Apr;47(5):250-8.

6. Child SCAT3:

7. Bell DR, Guskiewicz KM, Clark MA, Padua DA. Systematic review of the balance error scoring system. Sports Health. 2011 May;3(3):287-95. PubMed PMID: 23016020;



About the Author

Nicole Wasylyk works as an Athletic Trainer in a physician practice at Dartmouth-Hitchcock Medical Center (DHMC) in Lebanon, New Hampshire. Prior to DHMC she resided in Madison, Wisconsin and was an Athletic Trainer in a physician practice at Meriter-Unity Point Health. Wasylyk obtained her Bachelor of Science in Athletic Training from Boston University and Masters of Science in Education from Old Dominion University. She has completed a residency program for healthcare providers who extend the services of a physician at UW Health. Wasylyk also obtained her orthopedic technician certification. Her professional interests include injury surveillance and prevention, standardization of best practices and patient reported outcomes collection. 


Olympics Swim Competition: 3 Common Injury Risks and Preventative Approaches

Posted July 29, 2016

Tim Koba, MS, ATC
Twitter @timkoba

By Tim Koba, MS, ATC

As the Summer Olympics approach, athletes and fans prepare for the athletic contests. One of the most popular sports in the summer games is swimming. With that in mind, we will take a look at 3  common injury risks and preventative approaches.

1. Shoulder

When we think swimming injuries, the shoulder comes to mind as the most commonly involved joint. In fact, the term swimmer’s shoulder was coined to discuss the unique anterior shoulder pain that swimmers experience as a result of their sport. This results from the triad of swimming biomechanics, muscular overuse and fatigue and glenohumeral laxity and instability. The typical swim stroke of shoulder adduction and internal rotation leads to hypertrophy of the pectoralis major and latissimus dorsi, as well as the under recruitment or over exertion of the teres minor, pectoralis minor and serratus anterior. As the arm is in constant overhead motion, the inability of those muscles to provide adequate stability can lead to increased pain and pathology.

2. Knee

Symptoms involving knee pain would not necessarily be thought to occur in swimming, but it is the second most common complaint amongst swimmers. The breaststroke is the most likely to result in pain, and the usual area of concern is the medial knee compartment with some anterior pain. The unique whip-like kicking motion of that stroke in conjunction with water resistance can lead to a variety of medial knee pathology including MCL tenderness, pes anserinus or hip flexor and adductor strains. The patella may also be overloaded if swimmers are constantly kicking and maintaining tension on their patella tendon.

3. Back

As swimmers propel themselves underwater they rely on hyperextension of their spine in order to streamline their bodies. Constant hyperextension can lead to developing extension based low back disorders, spondylolysis and degeneration over time. The breaststroke and butterfly tend to place the most strain on the low back.


The common denominator in developing an injury as a swimmer is stroke mechanics. If the stroke movement deteriorates due to fatigue, muscle imbalance or stress, pain will ensue.

As Athletic Trainers, our job is not to change their stroke mechanics, but rather, to work with the coach and athlete to identify overload leading to pain. Once identified, the coach can correct the movement and reinforce proper stroke mechanics. To help swimmers increase their strength, endurance and shoulder stability, simple exercises can be performed as a prehab strategy. Exercises that address the external rotators, rhomboids, lower trapezius and serratus muscles can effectively stabilize the head of the humerus and decrease strain as a result of their sport. Incorporating a core stability training program can help avoid low back pain and degeneration.

When athletes improve their underwater form, strengthen their shoulders and stabilize their core, they can better handle the high training loads that lead to success. Working with swimmers to address these areas can also keep them under the water and out of the athletic training facility.


Wanivenhaus, F., et al. (2012). Epidemiology of injuries and prevention strategies in competitive swimmers. Sportshealth.

About the Author

Tim Koba is an Athletic Trainer, strength coach and sport business professional based in Ithaca, New York. He is passionate about helping others reach their personal and professional potential by researching topics of interest and sharing it with others. He contributes articles on injury prevention, management, rehabilitation, athletic development and leadership.


Work-Life Balance: Finding Ways to Compete, May Just Save Your Life

Posted July 28, 2016

By Paul LaDuke, ATC

Living a balanced life is a key strategy for Athletic Trainers (ATs) to prevent professional burnout. Burnout will happen when a busy AT allows their career to completely overtake every other aspect of their personal life. I believe it is vital for an AT to spend time on their fitness, spiritual life, nutrition and interpersonal relationships outside of athletic training. Time away from the profession and invested into living a balanced life will improve your time at your job.

One strategy to consider to help you live a balanced professional life is to compete in an athletic event.  There are many opportunities to compete in 5k and 10k community races, triathlons, swimming, adult recreation leagues, etc. Personally, I have competed in weightlifting and had recent success as a master at the national and international levels. For me, competing in a sport has aided in my personal motivation to stay fit. It has also helped me to live a balanced life, stay in tune with the athlete’s mentality and manage life’s stresses in a healthy manner. The process of preparing to compete can carry over into every aspect of life and help an AT to live a more balanced life.

Why compete?

Lisa Simpson, Head Athletic Trainer for Camp Hill High School in Harrisburg, Pennsylvania, says, “I compete because I thrive on competition. I like to set goals for my events and love trying to reach them. I'm the most competitive person I know.”

Chrissy Wojnarski, Athletic Trainer for Sonoraville High School in Georgia, writes, “Running is me time. With how crazy work can be, I just need something I can do to tune it all out. I just plug in the headphones and go, and I’m no longer thinking about the senior who tore his ACL, or the parent who can’t understand why their student athlete can’t play in the game the next day after getting a concussion, or the coach who wants his star athlete back this week. I also run for the very simple fact that I can. I am physically capable of putting one foot in front of the other for 13 miles, which when you think about it is pretty cool, especially given the amount of people who can’t, whether from illness or injury, or some other factor. For this reason, I also choose to run for those who can’t. For every race I run, I pick a charity to also raise funds for in hopes that my efforts will get them one day closer to being able to do the things they can’t because of whatever it is that afflicts them.”

The common theme among the responses I received was that competing motivates fitness goals. Striving for these fitness goals carries over into other areas of life as well. It is important to understand competing as an adult has a completely different focus than competing at youth levels. It becomes about the personal struggle to push yourself and reach your own goals.

What are the positives and negatives of competing as an AT?

Chuck Yasinski, Athletic Trainer for Palmyra High School in Pennsylvania says,  “Positives are challenging yourself to be your best, and to set a personal record. Negatives are risk of injury if you push yourself too hard.”

Steven Kramer says, “Positives: sense of accomplishment, something not many people can say they have done. Knowing I set a goal and have met that goal. Pushing my body to a physical limit and succeeding. Negatives: many races are on Sunday so the first few days back at work are rough when soreness kicks in.”

ATs know all too well the risk of injury with any physical movement. I’ve treated athletes who were injured getting off the bus for their game. So there is risk in competing but the personal rewards well outweigh the risks.

Want some more motivation?

Life has a way of being completely unpredictable and no one has the ability to foresee future events. Simpson told me this inspiring story of how competing helped her battle with cancer, not just physically but also psychologically.

Simpson writes, “In July of 2013, I was diagnosed with and had surgery for ovarian cancer.  In December of 2013, all of my tests and scans came back clean. I was told at that time that I had beaten the cancer, but my body wasn't fully recovered from surgery or chemo until at least a year later. I fought through some discomfort from the surgery, fatigue, headaches and some general blood count issues from chemo. I remember trying to go on a run in September of 2013, and I struggled mightily to get to one mile. Prior to my diagnosis, I was running upwards of 7 miles at a time, so only being able to get to a mile was depressing. There is an ovarian cancer walk and 5k every September at Harrisburg Area Community College, but I wasn't ready to compete in 2013 so I set my sights on 2014. September 2014 was the first 5k I competed in since my diagnosis just over a year earlier. Although my time wasn't like it had been prior to my diagnosis, crossing the finish line meant I had definitely beaten cancer in my mind. So ever since then, each time I compete it feels like I'm crushing cancer all over again. I wanted to be able to run during my struggle, but the thought of running and competing when I was better definitely kept me motivated and still does.”

The ability to recover after injury, illness or even cancer is a part of our profession I have always found to be personally inspiring. Being with an athlete throughout the process from devastating injury through rehabilitation and back to participation, seeing what the human spirit can overcome and living what we live every day is inspiring. I would challenge each and every AT to adopt the mentality of the patients we treat and train for competition. You never know what event may come your way, but by living a balanced life, including finding ways to compete, may just save your life.




In-Depth Look: Athletic Trainer for the US Air Force Special Operations

Posted July 21, 2016

Steven Koch

Steven Koch, MS, LAT, ATC, CKTP, is Program Manager/Head Athletic Trainer for the Versatile Injury Prevention and Embedded Reconditioning (VIPER) Clinic for the United States Air Force. He currently works with Air Force Special Operations.

Describe your work setting:

The military setting is a unique setting to say the least. As an Athletic Trainer (AT), there are many opportunities to think outside the box. Not only are there your typical acute athletic injuries including sprains and contusions, but you’ll also see chronic/overuse injuries or stress-related injuries. These injuries include stress reactions and stress fractures that will mimic other injuries ATs really won’t see in a typical athletic setting.

On the flip-side, we see muscular injuries that are also compensating for a stress injury and evolving from a stress reaction into a stress fracture. As an AT in the military, the focus is geared towards injury prevention. A lot of the injuries we see are lower extremity injuries. Most of these can be mitigated by teaching something as simple as proper running form, rucking form, stretching techniques or correcting biomechanics during exercise.

How long have you worked in this setting?

I have spent a little more than 5 years working in a military setting. I first started off doing my graduate degree at the 377th Medical Group (MDG) out at Kirtland Air Force Base in Albuquerque, New Mexico. After that, I worked in the Army for close to 3 years with Basic Combat Training and Army Sapper School.

After a brief hiatus from the military, I was brought on to work in the Navy Seal/SWCC pipeline up at Naval Station Great Lakes at the Naval Special Warfare Preparatory School. I’m now in San Antonio, Texas to work with Air Force Special Operations including Pararescuemen/Combat Rescue officers; Tactical Air Control Party, Combat Control, and Special Operations Weather Team specialists; and Special Tactics officers.

Describe your typical day:

My typical day starts around 6:00am. I go out to early morning physical training and observe the airmen completing exercises to ensure they have proper form.

After physical training is complete, I perform musculoskeletal sick call. This means if anyone is hurt or injured, I perform a complete neuromusculoskeletal evaluation and diagnose the injury. From there, I educate the airman about their injury, perform manual therapy as well as give them therapy exercises to help decrease their pain, heal them and keep them in training. Performing sick call keeps the airman in training and decreases training time lost, which increases on-time graduation rates.

Depending on the injury, I may have to keep the airman from performing or modify certain training exercises or events in order for the injury to heal a little faster. If needed, I refer the airman to our sports medicine physician if I suspect any type of evolving stress injury so they can receive further evaluation and appropriate imaging, which is usually an x-ray or stress fracture MRI.

Once musculoskeletal sick call is complete, I attend training events, whether it is an obstacle course, ruck march or other physical training event. Just in case someone gets injured, the AT is normally on site to evaluate the injury. Most of the time, the AT also performs some of the training events going on. Being side-by-side with the airmen or instructors during the training events is a good way to get to know the airmen and gain their trust.

After the day is complete, I perform one final sick call to see if any airmen need further treatment. On any given day, the airmen have the chance of going through 2 to 3 musculoskeletal sick calls. This ensures they have the opportunity to get any injuries evaluated and treated accordingly.

What do you like about your position?

First off, I work among some of the military’s most elite airmen. I never did sign the dotted line to serve the military myself, so I thought, the least I could do would be to provide them with immediate medical services. Just like any other AT, I like to see the airman fully recover from an injury and join back with their team like they were never injured.

Second, I work with an excellent team of 3 other ATs and a sports medicine physician, who together, make for a great team and provide unparalleled medical services. Unlike sports, every day is game day for these individuals, and they really don’t have any down time. When they eventually get to their team, they have to be ready with little to no notice and have to perform at 110 percent at any given time.

What do you dislike about your position?

The hardest part of my job is evaluating an injury and knowing the airman might have a stress-related injury. That injury will keep them from continuing on with their team who they have built a strong relationship with. It’s kind of like having an injured athlete watch their team from the sidelines.

What advice do you have about your practice setting for a young AT looking at this setting?

The best advice I can give to a young AT looking into the military setting is to reach out to those who already work in the military setting. Look for internship opportunities to gain hands-on experience. The military is still an up-and-coming setting for ATs. It isn’t your typical setting – there aren’t any games to prepare for, no overnight travel and no time away from your family. The military setting is challenging to break into to say the least. All branches usually require a bachelor’s degree with 5-8 years’ experience, or a master’s degree with 3-5 years’ experience. Having additional credentials is also very helpful in setting yourself above other ATs who are applying for the same position.



Baseball Nostalgia and Common Elbow Injuries

Posted July 12, 2016

Desi Rotenberg,

By Desi Rotenberg, MS, LAT, ATC

Baseball is woven into the fabric of America’s national consciousness and offers participants from diverse background the opportunity to put aside their differences and play a friendly game of catch. Like many of you, some of my greatest memories as a child were going to the ball park with my dad, throwing, hitting and through it all, learning invaluable life lessons. Whether playing in a competitive environment, or playing a casual game of toss, baseball offers us an opportunity to connect with earlier generations and continue the legacy of American nostalgia and pride.

Elbow Injury Prevalence

Baseball, like any sport, offers its share of injury risk. According to a study by Hootman et al. in Journal of Athletic Training, 45% of all injuries sustained in Major League Baseball (MLB) from 1988-2005 were related to the upper extremity.1 Furthermore, the highest volume of baseball injuries to the upper extremity (21.7%) were related to the elbow (compared with 17.1% of injuries related to the shoulder).2  Concurrently, according to an article by Forbes Magazine, pitchers accounted for 58.6% of MLB injuries in 2015.2 These 2 statistics do have relative correlation, as pitchers with elbow injuries seem to make up the majority of the disabled list throughout any given season.

Elbow injuries seem like an inevitable consequence to overhand sports. In a year-long study that followed youth baseball players from the start of the season to the end of the season, Matsuura et al. found 30% of youth baseball players will have elbow pain each year, and nearly 60% of players with elbow pain will show radiographic abnormalities.3

Common Elbow Injuries

Baseball at any level requires high level velocities that place rotational and shearing forces on the joints and ligaments required for those movements. The elbow has 6 degrees of motion: flexion/extension, pronation/supination and valgus/varus. The 3 main mechanisms of elbow injuries are valgus force, posterior translation and posterior-lateral translation.4 However in baseball, the most common mechanism of injury is associated with overload. The varus/valgus motion of the elbow can only articulate up to 3-4° before the forces begin to overload the articulating structures and the chronic forces compromise the integrity of the joint.4

Andrews reviewed 72 baseball players who underwent arthroscopic or open elbow surgery and found 65% were diagnosed with a posterior olecranon osteophyte and 25% were diagnosed with an ulnar collateral ligament injury.5


Below is a chart showing frequency of Tommy John Surgery, or ulnar collateral ligament (UCL) reconstruction, from 2000-2014 in Major and Minor League Baseball:

Source: Sporting Charts- Disabled List Data for Major and Minor League (MLB)6


































































1. Hootman, Jennifer M., Randall Dick, and Julie Agel. "Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives." Journal of Athletic Training 42.2 (2007): 311.

2. Maury, B “Infographic: 2015 Baseball Injuries, Broken Down By Position And Body Part”; (2015).

3. Matsuura, Tetsuya, et al. "Elbow Injuries in Youth Baseball Players Without Prior Elbow Pain A 1-Year Prospective Study." Orthopaedic journal of sports medicine 1.5 (2013): 2325967113509948.

4. Inagaki, K. (2013). Current concepts of elbow-joint disorders and their treatment. Journal of Orthopaedic Science18(1), 1-7.

5. Andrews JR, Timmerman LA. Outcome of elbow surgery in professional baseball players. Am J Sports Med. 1995;23:407–13.



About the Author

Desi Rotenberg, originally from Denver, Colorado, graduated with his bachelor's degree in 2012 from the University of Northern Colorado. He has been a BOC Certified Athletic Trainer since 2012 and earned his master's degree in Exercise Physiology from the University of Central Florida in 2014. He currently is a high school teacher, teaching anatomy/physiology and leadership development. Along with being a teacher, he wears many hats, such as basketball coach, curriculum developer and mentor. He has been a contributor to the BOC Blog since the summer of 2015. 




From Capitol Hill Day to NATA Clinical Symposia & AT Expo

Mike McKenney, MS, ATC

Posted July 8, 2016

By Mike McKenney, MS, ATC

Every year, thousands of Athletic Trainers (ATs) travel to the NATA Clinical Symposia and AT Expo for many reasons that include continuing education, networking, committee meetings, advocacy and interviews. I was fortunate enough to attend the NATA 67th Clinical Symposia & AT Expo in Baltimore, Maryland this year and want to share my experience of a week filled with athletic training events.

Capitol Hill Day

My trip began with Capitol Hill Day, where over 400 ATs traveled to Washington D.C. to petition Congress for support of The Sports Medicine Licensure Clarity Act (HR 921/ S 689) and The Secondary School Student Athletes’ Bill of Rights (H RES 112/S RES 83). This was my first time visiting Congress on behalf of the athletic training profession, and it was a rewarding experience knowing  the efforts put forth by hundreds of ATs will positively impact our profession and patients. Both pieces of legislation have bi-partisan support in Congress, but still need the support of ATs across the country in order to advance through the legislative process. Please contact your elected representatives to support this legislation, and urge them to co-sponsor it if they have not yet done so already:

NATA 67th Clinical Symposia & AT Expo

The annual conference allows NATA leadership to update the membership on what is new and upcoming in the profession of athletic training. This year, NATA President Scott Sailor, EdD, ATC announced a new public awareness campaign for athletic training with the launching of This is a website dedicated to educating the public about the roles of ATs, and the first step of a multi-year advocacy campaign designed to impact the many different athletic training settings. Additionally, the NATA announced the ATs Care: Peer-to-Peer Support Program, which is designed to support ATs who have experienced a catastrophic event. This is in response to a survey that indicated a large percentage of ATs were not prepared to cope with the psychological impacts of such events. The tentative launch schedule for this program is set for the spring of 2017.

In addition to the above, I volunteered as a moderator for the NATA, as well as attended numerous presentations discussing new findings in malignant hyperthermia from the Korey Stringer Institute; neuroplasticity following musculoskeletal injury; hyponatremia; neurodynamics; and blood flow restriction training and clinical reasoning from Journal of Athletic Training Editor-in-Chief, Craig Denegar, PhD, PT, ATC, FNATA.

Mike McKenney, ATC and Kristin McKenny, ATC holding the 2016 Dan Libera Service Award for Paul Bruning, ATC.

One particular highlight was being able to see multiple friends present their original research. It was also great to catch up with ATs I haven’t seen in some time and maintain those connections as our professional lives take us in a hundred different directions. On the other side of the coin, I also took advantage of the opportunity to meet new ATs who are just as excited about the profession.

BOC Volunteer Reception

Another highlight of my trip was being able to attend the BOC Volunteer Reception, which allowed me to meet a number of individuals who provide an enormous service to not only the BOC, but to the athletic training profession. The reception included presentation of the Dan Libera Service Award. My undergraduate Head Athletic Trainer and mentor, Paul Bruning DHA, ATC, was honored with this award for his service to the BOC. Unfortunately, Paul was not in attendance. However, BOC Executive Director Denise Fandel was kind enough to take a picture of my wife and me holding his award, which was an honor due to the positive impact he had on our athletic training education.

In conclusion, I think the planning committee put on a great event this year. There were many great moments that made it a very beneficial to me and to the athletic training profession. I look forward to my next opportunity to attend!

About the Author

Mike McKenney is an Athletic Trainer (AT) at Northeastern University in Boston, Massachusetts, where he is the Medical Coordinator for their Division I men’s ice hockey program.  Prior to Northeastern University, he served as an AT in multiple settings including secondary schools, Division I athletics and professional cycling; additionally, he worked as an AT who extends the services of a physician for a large orthopedic group.  He has also provided services for many organizations to include the Boston Marathon, USA Cycling and USA Volleyball.

McKenney is a hydration and electrolyte replacement consultant for the Atlanta Hawks of the NBA.  His professional interests include hydration, electrolyte replacement, thermoregulation in sport and postural restoration.  McKenney completed his athletic training education at Gustavus Adolphus College in Saint Peter, Minnesota and master’s degree at North Dakota State University in Fargo, North Dakota.  His graduate research was published in the February 2015 edition of the Journal of Athletic Training.