You’ve Earned It: Time to Ask for a Pay Raise

Posted October 20, 2016

Beth Wolfe

By Beth Wolfe, CAGS, ATC

Asking for a pay raise can be a daunting, intimidating and lonely process. However, with the right tools, advice and support, the pay raise process can be easier than you might think. In her article, Carolyn O’Hara provides several tips to ponder before asking for a pay raise, and below are 3 adapted pieces of advice that can be useful in preparing to ask for a pay raise.

1. Do your homework. How much of a raise should you ask for? Are you making the same as your peers in the area? One thing you must also keep in mind is that sometimes pay raises aren’t possible for certain positions due to circumstances beyond your control. Ask your employer if they provide merit based pay raises or if your salary is predetermined by another source such as grant monies or contract agreement via outside provider. If your institution does not provide merit-based raises, you could still ask for a raise based on what others in your area are being paid. However, if your salary is predetermined by an external source it may be difficult to obtain a raise unless the funding source agrees to a higher salary. Utilize a national salary database such as Glassdoor, Indeed or US Department of Labor to see what other people with your same job title are making in your area and across the country.

2. Take a moment to reflect on your value.  Why should your boss give you a raise? What is your worth or value as a healthcare provider? Do you offer a special talent or skillset that warrants a pay raise? From these questions gather evidence and formulate a list of facts, contributions and patient care statistics. Statistics could include hours worked, overtime worked, patient feedback and outcomes, and number of patient encounters by day, week and month. Be confident in your list of evidence and be sure to provide examples for each item on your list.

3. Ask for advice from others in your industry. If you are the only employee at your organization, ask a mentor or peer in your area how they navigated asking for a raise. Each organization will handle pay raises differently, but at least you can gain some relevant and real-time advice instead of asking blindly. Additionally, ask this mentor or peer if you could practice your “ask for a raise speech” with them so that they can provide you with constructive feedback. A practice session can help alleviate nervousness, jitters and anxiety you may have going into the discussion.

What happens if you are denied or don’t get a raise? Don’t get discouraged; it is okay! Have a back-up plan in place so you could compromise with your employer. For example, could you have additional flex-time for extra hours worked? Or you could discuss how you could take on more responsibilities that could lead to a future pay raise. Make note of the reasons for why you weren’t offered a raise this time so you can continue to build your case for a raise in the future.


O’Hara, C. (2015). How to ask for a raise. Harvard Business Review. March 5. Retrieved from

About the Author

Elizabeth “Beth” Wolfe is the Injury Prevention Coordinator and Research Assistant for the Tufts Medical Center Division of Trauma and Acute Care Surgery in Boston, Massachusetts. Wolfe received her undergraduate degree from the University of South Carolina (2010) and master’s in Health Education (2012) and CAGS in Sport Psychology (2013) at Boston University. Wolfe is currently pursuing a Doctorate of Health Science in Healthcare Administration and Leadership at the Massachusetts College of Pharmacy and Health Sciences. A few of her research interests include bike and pedestrian safety; fall prevention; concussion/head injury documentation and coding; and performance/quality improvement programming for the profession of athletic training. Wolfe is an active medical volunteer for the Boston Athletic Association and numerous other races/events throughout the greater New England area. In her free time, Beth loves to ride her bike around Boston and participates in local rugby and softball leagues.



Osteoarthritis Prevention and Wellness Protection Strategies

Posted October 18, 2016

By Jeffrey B. Driban, PhD, ATC, CSCS

How many Athletic Trainers (ATs) can remember a patient who tore an anterior cruciate ligament (ACL), returned to visit a few years later and described chronic knee pain and limitations with their favorite activities?

The Bone and Joint Health National Awareness Week is a great time to focus on injury/illness prevention and wellness protection strategies that can help preserve long-term health. This is particularly relevant if we consider that 37 percent of ATs think osteoarthritis – a chronic painful and disabling condition – is not a major health concern.1 Furthermore, only approximately 70 percent of ATs discuss with a patient their risk for osteoarthritis and strategies to mitigate this risk.

In contrast, over 80 percent of adults after an ACL injury believe that knee osteoarthritis would be a major health concern and only 27 percent recalled having a conversation with their health professional about osteoarthritis risks associated with their knee injury.2 While many patients focus on short- and medium-term goals like return to play, it is vital that ATs provide patients with information about what they can expect after an injury. Let us consider some key questions.

What is osteoarthritis?

Osteoarthritis – the most common form of arthritis – is a progressive disease that affects all the tissues in a synovial joint. Osteoarthritis reflects a failed attempt to repair joint damage that is caused by stress on a joint. Osteoarthritis can be thought of as a disease, which is defined by the structural changes in a joint like bone spur formation or cartilage damage. It can also be thought of as an illness, which is defined by a patient’s reported experience like joint pain or other symptoms.3

Is osteoarthritis a major health concern?

Over 30.8 million million adults in the United States have osteoarthritis.4 Osteoarthritis is among the top 15 causes of disability.5 Osteoarthritis causes over $10 billion in annual absenteeism6 and more than $185 billion/year in healthcare expenditures.7 Unfortunately, a patient is at risk for early-onset osteoarthritis after a joint injury. This is troubling because adults 20 to 55 years of age with hip or knee osteoarthritis are 4 times more likely to be psychologically distressed compared with their peers. Furthermore, 67 percent of these patients report osteoarthritis-related work disability and approximately 40 percent report reduction in quality of life.8

Which physically active individuals are at risk for osteoarthritis?

Most adults who take part in physical activity and sports are safe and possibly even protected against osteoarthritis.9 However, men in soccer and certain elite-level sports may be at greater risk for hip or knee osteoarthritis.10,11 It remains unknown if these specific sports cause osteoarthritis or if other factors are the culprits (for example, the amount of training the athlete performs, the types of injuries that occur or how we manage an injury). Among our patients, one of the strongest risk factors for osteoarthritis is joint trauma. Individuals with a history of knee injury are 3 to 6 times more likely to develop osteoarthritis.12 Within the first decade after a knee injury, 1 in 3 patients develop osteoarthritis.13,14 Hence, a 20-year-old athlete who tears her ACL is at elevated risk for osteoarthritis by 30 years of age, which could lead to knee symptoms and then have a major impact on her work and quality of life for decades.

What can we do to prevent osteoarthritis?    

An injury prevention program can reduce the risk of injury by 35 to 68 percent.15,16 Furthermore, lower limb injury prevention programs can improve performance, keep athletes on the field and be easily implemented in a team warm-up. Recently, the Osteoarthritis Action Alliance, of which the NATA is a member organization, released a Consensus Opinion on the Best Practice Features of Lower Limb Injury Prevention Programs (Executive Summary). The task force identified 6 core components that should be included as part of a training program for prevention of major joint injury among youth athletes:

1. lower extremity and core muscle strength training

2. plyometric - jump training

3. balance training (as part of a program)

4. continual feedback on proper technique

5. sufficient dosing and compliance

6. minimal to no extra equipment

Unfortunately, we are unable to prevent every injury. Hence, we need to educate our patients about their risk for osteoarthritis and secondary prevention strategies that could help delay or prevent the onset of osteoarthritis. Secondary prevention strategies include regular exercise and weight management. These concepts will be expanded upon in the Athletic Trainers’ Osteoarthritis Consortium’s review and recommendations on the role of ATs in preventing and managing post-traumatic osteoarthritis in physically active individuals. The article will published by the Journal of Athletic Training in Spring 2017.

It is important to recognize that ATs are in a key position to help prevent this chronic disabling disorder and have a lasting effect on a patient’s long-term health and wellness. So next time you treat an injury, think long-term and talk with your patient about their future risk of osteoarthritis and how they can help reduce their chances of getting it.


1.  Pietrosimone BG, Blackburn JT, Golightly YM, et al. Certified Athletic Trainers' Knowledge and Perceptions of Posttraumatic Osteoarthritis After Knee Injury. Journal of athletic training. 2016.

2.  Bennell KL, van Ginckel A, Kean CO, et al. Patient Knowledge and Beliefs About Knee Osteoarthritis After Anterior Cruciate Ligament Injury and Reconstruction. Arthritis Care Res (Hoboken). 2016; 68(8):1180-1185.

3.  Lane NE, Brandt K, Hawker G, et al. OARSI-FDA initiative: defining the disease state of osteoarthritis. Osteoarthritis Cartilage. 2011; 19(5):478-482.

4. Cisternas MG, Murphy L, Sacks JJ, et al. Alternative Methods for Defining Osteoarthritis and the Impact on Estimating Prevalence in a US Population-Based Survey. Arthritis Care Res (Hoboken). 2016; 68(5):574-580.

5. Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2013; 380(9859):2163-2196.

6.  Kotlarz H, Gunnarsson CL, Fang H, Rizzo JA. Osteoarthritis and absenteeism costs: evidence from US National Survey Data. J Occup Environ Med. 2010; 52(3):263-268.

7.  Kotlarz H, Gunnarsson CL, Fang H, Rizzo JA. Insurer and out-of-pocket costs of osteoarthritis in the US: evidence from national survey data. Arthritis Rheum. 2009; 60(12):3546-3553.

8. Ackerman IN, Bucknill A, Page RS, et al. The substantial personal burden experienced by younger people with hip or knee osteoarthritis. Osteoarthritis Cartilage. 2015; 23(8):1276-1284.

9. Urquhart DM, Tobing JF, Hanna FS, et al. What is the effect of physical activity on the knee joint? A systematic review. Med Sci Sports Exerc. 2011; 43(3):432-442.

10. Driban JB, Hootman JM, Sitler MR, Harris K, Cattano NM. Participation in certain sports is associated with knee osteoarthritis: a systematic review. Journal of athletic training. In Press.

11. Michaelsson K, Byberg L, Ahlbom A, Melhus H, Farahmand BY. Risk of severe knee and hip osteoarthritis in relation to level of physical exercise: a prospective cohort study of long-distance skiers in Sweden. PLoS One. 2011; 6(3):e18339.

12. Muthuri SG, McWilliams DF, Doherty M, Zhang W. History of knee injuries and knee osteoarthritis: a meta-analysis of observational studies. Osteoarthritis Cartilage. 2011; 19(11):1286-1293.

13. Harris K, Driban JB, Sitler MR, Cattano NM, Balasubramanian E. Tibiofemoral Osteoarthritis After Surgical or Nonsurgical Treatment of Anterior Cruciate Ligament Rupture: A Systematic Review. Journal of athletic training. 2015; In Press.

14. Luc B, Gribble PA, Pietrosimone BG. Osteoarthritis Prevalence Following Anterior Cruciate Ligament Reconstruction: A Systematic Review and Numbers-Needed-to-Treat Analysis. Journal of athletic training. 2014; 49(6):806-819.

15. Sugimoto D, Myer GD, Barber Foss KD, Hewett TE. Specific exercise effects of preventive neuromuscular training intervention on anterior cruciate ligament injury risk reduction in young females: meta-analysis and subgroup analysis. Br J Sports Med. 2014.

16. Emery CA, Roy TO, Whittaker JL, Nettel-Aguirre A, van Mechelen W. Neuromuscular training injury prevention strategies in youth sport: a systematic review and meta-analysis. Br J Sports Med. 2015; 49(13):865-870.

About the Author

 Jeffrey B. Driban, PhD, ATC, CSCS is an Assistant Professor in the Division of Rheumatology at Tufts University School of Medicine and Tufts Medical Center. The goal of his research is to explore novel biochemical and imaging markers to gain a better understanding of osteoarthritis and potential disease phenotypes. Dr. Driban received his Bachelors of Science in Athletic Training from the University of Delaware. He received a Masters of Education and Doctor of Philosophy in Kinesiology with an Emphasis in Athletic Training from Temple University. He completed a post-doctoral research fellowship in the Division of Rheumatology at Tufts Medical Center where he continued his osteoarthritis focus. Dr. Driban also aims to raise awareness about osteoarthritis and promote primary and secondary prevention strategies for physically active individuals as the Chair of the Athletic Trainers’ Osteoarthritis Consortium and by serving as a National Athletic Trainers’ Association’s representative in the Osteoarthritis Action Alliance and Chair of the Alliance’s Osteoarthritis Prevention Work Group. Dr. Driban is also co-founder of Sports Medicine Research Company, which provides a blog and podcast focused bridging the gap between research and clinical practice related to sports medicine.





Where did your state rank in votes for BOC Athletic Trainer Director?

Posted October 17, 2016

During the election for BOC Athletic Trainer Director, we have been keeping track of the percentage of Athletic Trainers in each state who voted during the election. Online voting closed on Thursday, October 13, 2016 at 11:59pm ET.

Congratulations to Montana for taking first place! Texas was in second place, and Nebraska was close behind in third place. New Mexico, Wyoming, Pennsylvania, South Carolina, Indiana, Oklahoma and North Dakota all made the Top 10 list. Thank you to everyone who voted in this election!

The BOC is pleased to announce the election of 2 new Athletic Trainer Directors to the Board of Directors. Michael Carroll, MEd, LAT, ATC, and Neil Curtis, EdD, LAT, ATC, will take office in January 2018, following a year of mentorship and learning as AT Directors-elect. Learn more at


Is Cupping the New “Fad” Therapy?

Posted October 14, 2016

By Mackenzie Simmons, ATC

If you watched the Olympics this summer, you likely saw many Olympic athletes covered in perfectly circular red spots. These red spots are left by a therapeutic tool, known as cupping. Cupping is an ancient therapy, most prominently used in Middle Eastern and Asian countries.  Cupping has recently started to become popular in the United States over the past few years.

The process of cupping involves heating glass suction cups and placing them on the treatment area. The suction cups are usually left on the skin for around 5 minutes before they are removed. As the suction cups cool down, a partial vacuum is formed with the skin. The number of cups that are used is dependent upon the size of the treatment area; the bigger the area, the more cups that are used.

Cupping is believed to relieve pain by stimulating the muscles while increasing blood flow. It has also been shown as a form of deep-tissue massage that helps with the relaxation of sore muscles. Unfortunately, there has not been much research conducted that shows the positive effects of cupping.

Cupping might be the new “fad” therapy for Olympic, professional and collegiate athletes. Over the past 10 years, Kinesiotape, cryotherapy chambers and power bands have all become well-known and are used by professional athletes. With the limited research on cupping, time will tell  if this therapy will be around in 4 years for the next Summer Olympics.




Medical Therapeutic Yoga: A New Movement in Healthcare

Posted October 10, 2016

Desi Rotenberg

By Desi Rotenberg, MS, LAT, ATC

Medical therapeutic yoga is a new movement within the rehabilitative realm that is quickly becoming more widely accepted as a pragmatic route to improving physical, emotional and mental well-being. There has been a paradigm shift within the medical field, as yoga therapy becomes more and more integrated into healthcare. Furthermore, yoga therapy is becoming more popular in the treatment of musculoskeletal injuries.

The core premise and philosophy behind medical therapeutic yoga is to understand your own limitations to be able to deliver the safest and best care possible. This includes a comprehensive understanding of the human anatomy and the treatment of specific diseases, disabilities or disorders. Additionally, in order to become a yoga therapist, a medical professional must have knowledge of indications and contraindications for safe breathing practices, as well as a strong knowledge base in various yogic practices to ensure patient safety.1

In 2012, the International Association of Yoga Therapists (IAYT) advisory board approved the educational standards for the training of yoga. This approval opened the door for medical therapeutic yoga to be held to competency-based educational standards. Although, Yoga Therapy is not governed nor regulated by the IAYT. The focus is on entry-level requirements for the training of yoga therapists and includes a definition of yoga therapy and training requirements. The goal for any organization when developing competency-based standards “is to define the foundational knowledge and skills required for the safe and effective practice of yoga therapy.”2

The Scope of Practice for yoga therapy can be found here:

The Professional Yoga Therapy Certification can be a post-certification option for Athletic Trainers who are interested in furthering their knowledge base. The Professional Yoga Therapy Institute (PYTI) is one of several institutes who offer both continuing education courses and a full professional certification.

The PYTI defines medical therapeutic yoga as “the practice of yoga in medicine, rehabilitation, and wellness settings by a licensed health care professional who is completing or has graduated from the Professional Yoga Therapy Institute program and has been credentialed as a Professional Yoga Therapist-Candidate or Professional Yoga Therapist.”4

Becoming a medical yoga therapist is not for everyone. While knowledge is essential to a medical professional’s success as a practitioner, the journey of accruing wisdom holds an even greater weight. The uniqueness of this new field focuses on the well-being of the patient, while also ensuring the individual who practices medical therapeutic yoga is able to achieve a balance within every aspect of their life, both professionally and personally.

More information on medical yoga therapy and becoming a professional yoga therapist, can be found at the following websites:

International Association for Yoga Therapy-

Professional Yoga Therapy-

Medical Therapeutic Yoga-


1. Garner, G. (2007). The Future of Yoga Therapy and the Role of Standardization. International Journal of Yoga Therapy, 17(1), 15-18.

2. Educational Standards for the Training of Yoga Therapists. (2016). Accessed September 27, 2016.

3. Scope of Practice for Yoga Therapy, (2016). INTERNATIONAL ASSOCIATION OF YOGA THERAPISTS. Revised: September 1, 2016.

4. Professional Yoga Therapy Institute, (2016). Accessed September 27, 2016.

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. 




Discussion and Research on Concussion Management

Posted October 6, 2016

Diane Sartanowicz,

By Diane Sartanowicz, MS, LAT, ATC

With the start of the fall athletic season, much has been written about concussions. In the news and media, concussions are referred to as a public health crisis due to the increase in the number of diagnosed cases.  As Athletic Trainers (ATs), we are called upon as experts in the field of concussion management and are driving the research and discussion around this very hot topic. So why are there so many unanswered questions?

Some of it has to do with the definition of a concussion. The term concussion (or commotio cerebri) has been used for centuries to imply “a transient loss or alteration of consciousness without associated structural damage.”1 It is also known as a mild traumatic brain injury (mTBI) and can cause a variety of physical, cognitive and emotional symptoms. In recent years, concussion has been used most frequently in reference to sport-related head trauma.

Along with the struggle to come to a unified definition of concussion, another set of questions relates to the diagnosis of a concussion and the reporting rates. An estimated 1.7 million concussions occur each year in the United States as a result of sport and physical activity, and of those, 80 percent  are seen in an emergency room department. These numbers are staggering when almost half a million visits for mTBI are made annually by children aged 0 to 14 years.2  Many more concussed youth seek treatment through physicians’ offices or not at all.  So are these statistics accurate? We need to understand exactly what we are diagnosing in order to collect and track the data. Education on the signs and symptoms of a concussion is the key to successful outcomes for the athlete.

As a consequence of the multi-faceted issues facing youth sports concussions, programs like the Massachusetts Concussion Management Coalition (MCMC) are being established to address this issue.  MCMC is a group of individual stakeholders who are dedicated to the health and safety of our student-athletes. The broad range of groups like the Massachusetts Interscholastic Athletic Association (MIAA), Massachusetts School Nurse Organization, Athletic Trainers of Massachusetts (ATOM), Department of Public Health and the Brain Injury Center of Boston Children’s Hospital are represented and their top priority is to prevent and manage concussions.

MCMC is a pioneer in concussion research and education outreach bringing everyone together to collaborate on the best way to tackle the many issues surrounding concussions. Due to the generous funding by the NHL Alumni Foundation, MCMC has been able to provide free ImPACT™ neurocognitive testing to all MIAA member schools that enroll in the program. Along with the free testing, MCMC provides secondary schools with concussion education presentations to their communities. It is our goal to ensure tools are readily available for all secondary schools to be knowledgeable in the recognition, management and treatment of concussions. We hope to create a legacy of concussion education in the Commonwealth of Massachusetts which reflects these goals. For more information on our program or how to get involved, please visit our website at

As I write this blog, we have just completed a successful Concussion Awareness Week in Massachusetts. It is through the collaborative efforts of the Think Taylor Foundation and the MIAA that 86,000 student-athletes have become more engaged in the discussions surrounding concussions. Think Taylor was founded by Taylor Twellman, star forward for the New England Revolution soccer team. His career-ending concussion left him seeking answers and wanting to make an impact on the lives of student-athletes.

During Concussion Awareness Week, all student-athletes were encouraged to turn their school orange, the color of healing, and to take the TT Pledge. This pledge states, “I will become more educated on the signs and symptoms of concussions, I will be honest with my coaches, and Athletic Trainers, parents and teammates, and that I will be supportive of anyone with a concussion.” These 3 words – education, honesty, support – are what ATs embody every day. Our combined efforts lead the way to increased awareness and expanded concussion education across the state. I would encourage each of you to get involved in a movement like ours.


1 Charles H. Tator. Concussions and their consequences: current diagnosis, management and prevention, CMAJ. 2013 Aug 6; 185(11): 975–979

2 Faul M, Xu L, Wald MM, Coronado VG. Traumatic brain injury in the United States: emergency department visits, hospitalizations, and deaths. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2010.

About the Author 

Diane Sartanowicz, MS, LAT, ATC is the Director of the MCMC.  She was president of ATOM from 2006-2008, past-president of Eastern Athletic Trainers’ Association from 2011-2012 and is currently the NATA District One Treasurer.

Who is the Current BOC Board?

Posted September 29, 2016

Athletic Trainers have the opportunity to vote for 2 new Athletic Trainer Directors to join the BOC Board of Directors. As you consider the candidates you might wonder, who is the current BOC Board? Take a look below to see who makes up the current BOC Board and their responsibilities. For more information on the BOC Board visit

Then, don’t forget to vote! Online voting opens September 6 and closes October 13, 2016, 11:59pm ET. Learn more about the candidates by visiting





In-Depth Look: Athletic Trainer Who Works in an Industrial Setting

Posted September 26, 2016

Rosalina Cintron, MS, ATC, CEAS has worked as the FedEx Express on-site Athletic Trainer, and is now working on-site at O'Hare International Airport.

Describe your setting:

I am on-site at O'Hare International Airport providing service to an array of departments.

How long have you worked in this setting?

I have been on-site  for a little over two months.

Describe your typical day:  

On a typical day, I attend leadership meetings, perform injury evaluations and conduct symptom intervention services. The services I provide is an effort to keep each employee safe and productive within their workplace.

What do you like about your position?

As an industrial athletic trainer,  I focus on the whole person. This method of patient care provides me with the opportunity to build relationships that make an impact. The satisfaction of helping someone become pain free and stronger is the most satisfying feeling. It makes me strive to be the best I can be at my profession!

What do you dislike about your position?

There isn’t anything that I dislike about my position!

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

The best advice I can provide for a young AT is to never work in seclusion, and most importantly, love what you do!








Return to Sport Post ACL Reconstruction

Posted September 21, 2016

Tim Koba, MS, ATC
Twitter: @timkoba

By Tim Koba, MS, ATC

ACL injuries continue to be a hot topic in the sport world. A big reason is that even though they are still not very common, percentage wise, they have a large impact on long term joint health, recovery, cost and ability to return. As reconstruction techniques continue to evolve, athletes are able to return to play, but how successfully?

After surgery, the treatment consists of rehabilitation to regain motion, function, proprioception strength and control. Once athletes have completed about 6-9 months of rehab, they return to sport. Here’s the sobering news: Of those who suffer an ACL reconstruction, only 65% return to their pre-injury level of sport, with only 55% returning to competitive play. Even more discouraging is the fact that of those who return to sport, up to 1 in 5 will suffer a tear to their reconstructed knee, or the ACL on the non-reconstructed side.

In order to determine what risk factors existed, and ways to modify them, researchers looked at elite soccer players who had their ACL reconstructed and then followed them. They looked at the type of surgery they had, their rehabilitation process and their return to sport. What they discovered was that athletes who did not meet certain bench marks in rehab were 4 times more likely to have another ACL injury. The following table shows the exercises and the discharge criteria that were deemed successful.

Discharge tests and criteria used during the study period

6 part return to sport tests Discharge permitted when criteria was met
Isokinetic test at 60, 180 and 300 degrees/sec Quadriceps deficit <10% at 60 degrees/sec
Single leg hop Limb symmetry index >90%
Triple hop Limb symmetry index >90%
Triple crossover hop Limb symmetry index >90%
On field sport specific rehab Fully completed
T test <11 sec

In addition to the tests above, athletes who had lower hamstring-to-quadriceps strength ratios were also more likely to injure their ACL. Since strong hamstrings act as an assistant to the ACL, weakness there can mean more stress on the ligament.


This study highlights a couple of key points when rehabilitating ACL injuries.

- Prior to return to play, athletes should be fully recovered with equal strength bilaterally

- They should be able to seamlessly perform multidirectional drills

- Athletes should have adequate hamstring strength. Most of us do not have access to isokinetic testing, but spending time having athletes perform hamstring strengthening during their rehabilitation is essential.


Kyritsis, P. et. al. (2016). Likelihood of ACL graft rupture: not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture. British Journal of Sports Medicine, 50.

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.


Heat Illness Safety: How to Prepare for Rising Temperatures

Posted September 15, 2016

Desi Rotenberg

By Desi Rotenberg, MS, LAT, ATC

With the summer months coming to a close, the likelihood of heat related illnesses still remains a hot topic in the athletic population. While to some this topic may seem redundant and like a broken record, we must always remind ourselves that with outdoor participation comes the threat of a heat related incident.

In addition to a constant awareness of the negative outcomes that can arise from poor hydration in the heat, we must also acknowledge that global temperatures continue to rise. According to the National Weather Service, 2014 through 2016 showed the hottest increase in average temperature over a 2-year span since the late 1800s.1 Furthermore, according to NASA, the 10 warmest years for global surface temperature have all come since 2000.1

Now, the intention of this editorial is not to throw global warming statistics at you and inform you that you should all head for your nearest bunker. The purpose of this editorial is to bring further awareness to already prevalent issues in sport and exercise. Further precautions should be taken to ensure all players remain safe and understand proper hydration techniques required on a daily basis to ensure safe and optimal athletic performance. As Athletic Trainers (ATs), we must  continue to educate coaches, athletes and parents and to enforce hydration policy adherence.

Heat illness and rising temperatures are now becoming a hot topic outside of the athletic population as well. As of 2015, the Occupational Safety and Health Administration issued a statement saying, “Under OSHA law, employers are responsible for providing workplaces free of known safety hazards. This includes protecting workers from extreme heat. An employer with workers exposed to high temperatures should establish a complete heat illness prevention program.”2 This attention to heat related injuries has come in response to a 2015 study by the U.S. Department of Labor that concluded, “In 2014 alone, 2,630 workers suffered from heat illness and 18 died from heat stroke and heat related illness on the job.”2 The fact of the matter remains that being outdoors in the heat for prolonged periods of time requires a concrete prevention and treatment plan.

According to the NATA, fluid replacement should approximate sweat and urine losses so that athletes lose no more than 2% body weight per day; on average, this equates to consuming 200-300 mL fluid every 10-20 minutes during exercise.3 In addition to monitoring fluid loss and fluid replacement, it is recommended that the AT or coaches check the temperature and humidity prior to the start of a practice or a game. NATA guidelines suggest a temperature of 90°F at 20% humidity could be suitable for conducting football practice with full protective gear, whereas a temperature of 90°F at 80% humidity could create a dangerous environment for which activity and equipment use should be limited.4

The guidelines are in place and will only change slightly every few years; however, we must do everything we can to educate our population, whether athletic, commercial, industrial or any other group working or exercising outdoors. Whether the temperature on Earth continues to heat up or average temperatures in specific locations continue to rise, our awareness should always be towards safety and hydration education. The best treatment is always a good preventative plan and the best preventative plan always requires a conscientiousness of your surroundings.



2.     United States Department of Labor. Occupational Health and Safety Administration, Heat Illness Safety and Prevention.

3.     Casa DJ, Armstrong LE, Hillman SK, Montain SJ, Reiff RV, et al. National Athletic Trainers' Association position statement: fluid replacement for athletes. J Athl Train 2000;35:212--24.

4.     Binkley HM, Beckett J, Casa DJ, Kleiner DM, Plummer PE. National Athletic Trainers' Association position statement: exertional heat illnesses. J Athl Train 2002;37:329--43.

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.