Managing Hamstring Strains

By Tim Koba, ATC

Hamstring injuries are one of the most common injuries in sports. Time lost from competition can be substantial, and there is a high risk for re-injury.

One of the reasons that the hamstring is so susceptible to injury is that it crosses both the hip and knee joints. During running, the hamstring works to decelerate the knee at ground contact and then assist the glutes to accelerate the hip into extension. This change in function is believed to be one of the reasons that the hamstring is injured.

Risk factors for injury include a previous hamstring injury and weakness in the hamstrings.

Currently, there is a lack of systematic research on effective hamstring prevention, treatment and rehabilitation programs. Stretching has not been shown to decrease injury risk, and our current knowledge on prevention has been primarily performed on soccer athletes utilizing Russian/Nordic hamstring exercise as an eccentric training technique. This exercise has been effective in reducing the rates of hamstring strains in soccer athletes. However, due to the eccentric action of the exercises, it does cause DOMS, so starting a program should be progressed accordingly. While not studied for prevention, Romanian deadlifts activate the hamstrings eccentrically, and they can be an adjunct to a prevention program.

If a hamstring is strained, the location can affect the time lost from competition. Proximal hamstring injuries, avulsions and larger lesions all increase the time to heal. If you have access to a physician doing corticosteroid injections, this can assist in decreasing the healing time without an increased risk for re-injury.

Rehabilitation of hamstring injuries follows the same guidelines as other rehab programs including decreasing pain and inflammation; restoring range of motion and neuromuscular control; and strengthening and progressing to higher speed and higher functioning sport specific drills. A more holistic rehab program focusing on core stability, hip strengthening and neuromuscular control is more effective than an isolated strengthening and stretching program in return to sport and re-injury rates. Adding in eccentric exercises in the late strength phases can assist with injury prevention as well as incorporating agility and running drills to improve proprioception and stride mechanics.

While the evidence for the most effective treatment of hamstring injuries continues to be developed, we know that eccentric training is beneficial at preventing initial strains and recurrent strains. The added benefit of eccentric hamstring strengthening is that they can also help decrease ACL injuries in certain populations.

What have you found to be effective in preventing and rehabbing hamstrings?

Planting the Seeds for Athletic Training Awareness

“What do you want to be when you grow up?” This is the question posed to children by adults from a very early age into young adulthood.

Often children will respond with professions they hear about, see on TV or interact with on a daily basis including police officer, teacher, firefighter or doctor to name a few.  But how do you give a name and face to the athletic training profession?

In the new children’s book, “Do you want to be an Athletic Trainer?” author Marsha L Grant-Ford and contributor Jonathan Ford help to plant the seeds of athletic training awareness in children by offering a glimpse into the exciting world of the certified Athletic Trainer (AT).  This non-fiction book includes descriptions of ATs who work with doctors to keep active people healthy.  ATs are featured in businesses, hospitals, physician offices, sports teams and the rodeo.  The book also mentions ATs working in the military, law enforcement, NASCAR and NASA.

With its colorful pictures and detailed descriptions, children are given a face and name to the ATs they see in their daily lives.  Professional tasks are introduced and explained in captions including patient education; taping and bracing; orthopedic and general medical examination; therapeutic interventions; emergency skills and concussion management.  This book is just one way for children to see a realistic view of the importance of ATs in keeping active children and adults healthy at work and at play.

For more information or to purchase a copy, please visit the following link.

Rehabilitation for Patellofemoral Syndrome

By Tim Koba, ATC

There was a new article published in the Journal of Athletic Training that compared the outcomes of two separate treatment protocols on patellofemoral syndrome (PFS).

The potential patients were screened and then enrolled in either a hip strengthening protocol or knee strengthening protocol. Patients met with the Athletic Trainer three times a week for six weeks and were instructed to do their home exercises six times a week.

At the end of the six weeks, both groups showed improvement in pain and dysfunction associated with PFS. The hip strengthening group had resolution in symptoms prior to the knee group, but the overall improvement was not statistically significant.

Adopting a hip or knee strengthening program, or a combination of both, is an effective way to treat PFS. For a link to the article click here.

What protocols do you currently employ?

Long Term Athletic Development

By Tim Koba, ATC

There is some buzz in the athletic performance and strength and conditioning industry regarding ‘long term athletic development’ (LTAD), but what exactly is that?

The main process behind LTAD is the realization that youth athletes have a lot of years to play sports, grow physically, socially and emotionally, and develop skills at each stage in their athletic career. A lot of current programs, for all ages, promise quick results, fast gains and reaching your peak in a short period of time. LTAD involves taking a step back, looking at the athlete as a whole and developing a process to make them a better athlete globally.

In order to achieve ongoing results, you first have to know the athlete: what their goals are, what their strengths are, what their weaknesses are, how they move, how they perform exercises and what is the process in which to create global improvement. This global improvement is not geared toward one sport. Playing a single sport does develop motor skills, coordination and specific movements for that sport, but it can also limit total development of the athlete and stunt their potential. An athlete who only plays soccer can be predisposed to hip injuries and never develop any throwing skills or quick start and stop skills that could improve their game and make them a better athlete.

LTAD is the foundation used to make athletes better. It involves a systematic program to introduce exercises, progress those exercises and tie those exercises into a sport. Many programs focus on only one facet of a program and neglect the other pieces. There are speed schools, agility classes, core classes and strength programs for athletes of all ages, but few places take all of those components and put them together in a larger framework to create well-rounded athletes. That is LTAD. It is understanding that athletes need a combination of strength, power, speed, reaction, acceleration, deceleration, agility, endurance and recovery and then creating a program that systematically addresses each component in an organized manner to deliver consistent results over time. Does this mean that a youth player will experience significant growth in six weeks? No. It means that the youth player will develop a foundation for ongoing engagement and learning that will lead to improvement and growth this year, next year, the year after that and so on.

The best way to have healthy, happy athletes is to expose them to different sports and challenge their ability to improve in a consistent manner over time.

FAQ: What Approved Providers Need to Know About EBP Program Approval

As a current or aspiring BOC Approved Provider, you may have questions about how to offer BOC Approved Evidence Based Practice (EBP) Programs. Here are a few frequently asked questions with answers to help you through the application process.

Q: How do I apply for EBP program approval?

To be eligible for approval as an EBP event, the program must adhere to at least one of the following application formats: 1) Clinical EBP and/or 2) Foundations of EBP. There are three applications, one for each format and one for an integrated format that includes both clinical and foundations of EBP. Diversity among topics is encouraged in order to provide appropriate content for all clinicians relative to their level of expertise with EBP.

Q: What is the difference between Clinical EBP and Foundations of EBP Programs?

A: Clinical EBP programs are organized around a clinically oriented topic. Examples: Glenohumeral assessment, ACL rehabilitation, sport-related concussion. Foundations of EBP programs promote EBP within the profession by enhancing a clinician’s ability to find and evaluate evidence and apply it to their clinical practice; by defining EBP and how to use it; and by suggesting methods of integrating EBP into practice or teaching.

Q: How long does the EBP approval process take?

A: Providers will be notified of the initial application outcome within 10-16 weeks, depending on the length of the program and/or number of applications pending review.

Q: When does an EBP course expire?

A: Clinical EBP courses expire after two years. Foundations of EBP courses expire after five years. Course expiration date is always December 31st.

Q: What is considered “contemporary” experience on the EBP Faculty Qualification Form?

A: The term “contemporary” is not defined by dates. Qualified speakers must demonstrate current or recent examples of expertise.

Q: What format is required for the EBP home study course assessment?

A: As long as the evaluation activities demonstrate measurement of all learning outcomes of the course, the assessment can be varied and administered in an assortment of formats. For example:

  • - An exam using multiple choice questions and or other question formats. Questions would be based upon learning outcomes/content of the course.
  • - An EBP case study where students are asked to answer various questions based upon the case. Questions are related to course learning outcomes. These questions could be in a multiple choice or open-ended format.
  • - An assignment such as the following: The purpose of this assignment is three fold: 1) to demonstrate the ability to develop a clinical question using the PICO format, 2) to demonstrate the ability to search the CSR and other databases to find literature related to the clinical question and 3) to analyze, synthesize and create an outline of findings that answer the clinical question based upon the literature.
  • - Cochran Systematic Review/other databases: Participants will each develop a clinical question on a topic and research it using the Cochran library system and other databases. Students will develop an outline of their findings based upon the evidence.

Two New BOC Board Members Named for Upcoming Term

The BOC is pleased to announce two incoming members of the Board of Directors. Patrick J. Sexton, EdD, ATC, will serve as an Athletic Trainer Director, and Douglas B. Gregory, M.D., will serve as Physician Director. The two new board members will begin their terms January 1, 2016, and will begin attending meetings in February of next year.

Patrick J. Sexton, EdD, ATC

Patrick J. Sexton, EdD, ATC

Douglas B. Gregory, M.D.

Douglas B. Gregory, M.D.

Dr. Sexton served as Head Athletic Trainer on his arrival in 1993 and now currently serves as a Professor and Director of Athletic Training at Minnesota State University, Mankato. Prior to this position, he worked as Head Athletic Trainer, curriculum director and instructor at University of Wisconsin La Crosse and as an Athletic Trainer at University of Wyoming, Laramie, and at Pima Community College, Tucson.

Dr. Sexton has been active with professional associations at the state, district and national levels. He has served on the Joint Review Committee on Athletic Training Education Programs (JRC-AT), as vice-chair on Commission on Accreditation of Athletic Training Education (CAATE) committees, the NATA Professional Education Committee and others. As a volunteer for the BOC, he has served as an exam model and examiner.

“I have been so involved in the profession for two simple reasons,” Dr. Sexton said in his personal statement. “First because all of my mentors were very active in the profession so I learned the importance of being involved, and second because I believe that if you disagree with how something is being done or if you think there is a better way to do something, it is much better to put your efforts into working toward changing things than it is to sit back and just talk about how things should be.”

Dr. Gregory specializes in general pediatrics and primary care sports medicine at Lakeview Medical Center, in Suffolk, Virginia, where he serves as Medical Director for Quality. He has been the team physician for a local high school for 30 years. In 2010, he was awarded by the Academy of Pediatrics for his long-term dedication to the development of primary care sports medicine.

As an advocate and supporter of athletic training, Dr. Gregory has mentored numerous Athletic Trainers and has been actively involved with athletic training education and certification. He served as the American Academy of Pediatrics representative for JRC-AT and then CAATE. In addition, he has served on several NATA committees and task forces.

After learning of his appointment to the BOC Board of Directors, Dr. Gregory said he sees this role as a part of his long-term commitment to athletic training, which began in 1993.

“This position is a continuation of my involvement with athletic training education as a preceptor for young Athletic Trainers, site visitor for CAATE and a CAATE commissioner,” Dr. Gregory said.

The BOC looks forward to working with Dr. Sexton and Dr. Gregory. Both men will serve three-year terms, with the possibility of appointment for a second consecutive term.

Task Force and Panel Begin Work on Practice Analysis Study

Members of the Practice Analysis Task Force and the Practice Analysis Panel

Members of the Practice Analysis Task Force and the Practice Analysis Panel met in Omaha in October to review the practice standards for BOC Certified ATs.

By Amanda Webster, ATC

For three days, a group consisting of six Practice Analysis Task Force members and 17 panelists met at the Board of Certification headquarters in Omaha, Nebraska, with the objective of reviewing practice standards for Certified Athletic Trainers (ATs).

It was the intention of the BOC to form a group that would represent ATs in a variety of settings and geographical locations. Panelists and task force members were selected based on their experience, education and the region in which they practice. Members of the group would have the knowledge of experienced ATs as well as the fresh perspective of newly-minted ATs.  ATs in the high school, college, military, hospital, physician practice, therapy clinic and performing arts settings were represented.

Under the guidance of James Henderson, a psychometrician, the group debated previous existing domains, tasks, knowledge and skills.  A psychometrician (in case you have never heard the term) designs, administers and interprets quantitative tests.  Dr. Henderson served as a mediator for discussions, recorded agreed-upon statements and aided in defining terminology.  When all is said and done, he will use the information gathered to help develop the next step in the process of the practice analysis study.

The task proved tedious at times with respect to discussions about the growth of our profession and advancements in sports medicine.  The last practice analysis study was performed six years ago.  Major topics of discussion were traumatic brain injury management, Evidence Based Practice and patient population.  We were able to reach a consensus on domains, terms and definitions by respecting everyone’s background and maintaining a professional and team-oriented view.

As a panelist, my biggest takeaway from this meeting was the vast knowledge and skills a Certified Athletic Trainer is required to have.  When you put it on paper, the list seems endless! Working in the company of distinguished ATs was truly encouraging.  I have no doubt I will be applying to participate in future BOC events, and I encourage young professionals like myself to do the same.

Even if you were not a part of the meeting, you will have the opportunity to be involved in the next step of the practice analysis study.  The newly established domains and task statements will be validated by an online survey, which a stratified random sample of Certified ATs will be invited to participate in.  This will serve as the blueprint for the BOC exam as well as for continuing education program development.

NCAA Health and Safety Guidelines for Independent Medical Care

By Erin Chapman, MS, LAT, ATC

As an Athletic Trainer (AT) working in an athletic model, I was interested to the read the guidelines released by the Safety in College Football Summit.  However, are these guidelines reachable for an institution that is currently in an athletic model? How can these guidelines be incorporated into an athletic model? Will it result in a higher cost to the institution? Money and resources seem to be obstacles many institutions are facing with the current economic status.

In an athletic model the Athletic Director often supervises ATs.  Discussions regarding promotions, hiring and firing are often not made by those with a background in healthcare, but rather athletic administration.  Athletic Directors may have a better understanding of what an AT does on a daily basis compared to other administrators, but they often do not have the healthcare expertise to make decisions related to the effectiveness of healthcare professionals.  Many may feel that a conflict of interest between the safety of the student-athletes and winning can be blurred in this model.

The Princeton Model was established years ago by Princeton University.  I often go back to the article in the NATA News from March 2011 to see how this model would be appropriate and feasible for my setting.  I often ask why it took so long for the NCAA to establish these guidelines.

The Health and Safety Guidelines for Independent Medical Care are considered just that, guidelines, and many ATs might have an interest in learning how other institutions have implemented these guidelines in their clinical settings. Being at an institution that has a strong athletic history and a limited budget, the idea behind implementing these guidelines is not as easy as one might think.  While I have never had an issue with a coach trying to impose demands on a medical decision or established recommendations, creating a barrier between the medical staff and coaches would ultimately eliminate any risk of this occurring in the future.

Athletic Trainers are healthcare professionals but are not always viewed as such when established within athletics; rather, they are seen as support staff.  Often they are at the mercy of a coach’s decision, which often disrupts scheduling and medical coverage. Placing ATs in a medical model would require coaches and medical staff to discuss scheduling and guidelines for changing practices and/or games so that adequate healthcare services would be provided.

While creating these guidelines will get sports medicine professionals talking and brainstorming, further research into implementing these guidelines is essential in producing positive outcomes in providing individual healthcare that separates sports medicine from athletic administration effectively as stated in the guidelines.

4 Steps to Getting the EBP Credits You Need

We’re already nearly halfway through the current reporting period. Are you on track to meet your continuing education (CE) requirements? More importantly, do you know how to meet your CE requirements?

The new Evidence Based Practice (EBP) category deserves a second look as you work through your CE plan. As you may know, the BOC added the EBP requirement just this year, so Athletic Trainers must now complete a certain of continuing education units (CEUs) in this new category. These requirements must be met and reported by December 31, 2015.

Fortunately, fulfilling your EBP continuing education requirement is just like completing any other CE program. Simply make sure that, out of your total CEUs due, you have completed the minimum amount required from the EBP category.

So … how many CEUs is that?

How Many EBP CEUs Do I Need to Do?

The number of EBP CEUs required depends on when you were certified. Let’s break it down:

  • If you were certified in 2013 or before, you must complete 50 total CEUs. Of those, at least 10 must be in EBP
  • If you were certified in 2014, you must complete 25 total CEUs. Of those, at least 5 must be in EBP

Great! Now let’s go find some EBP CEUs.

Where Do I Find EBP Programs?

On the BOC website!

The BOC has approved more than 210 CEUs in the EBP category. Approved CEUs include both live and home study courses, so there are plenty of opportunities for you to check this requirement off your to-do list.

Here is how to get the EBP CEUs you need:

  1. Use the BOC’s online program listing to browse current courses. (Hint: You can filter by several criteria by clicking the column headers)
  2. Click on the provider name for contact information for the program you want to take. Some course titles also contain links for additional information
  3. Begin with a Foundations of EBP program if you’re new to EBP principles
  4. Then, or if you are already familiar with EBP principles, move on to Clinical EBP programs in your areas of interest

That’s all there is to it! Just don’t forget to record your CE in BOC CentralTM by December 31, 2015.

Questions? Comments? Leave your thoughts below or send us a message via Facebook or Twitter.


Athletic Trainers Expand their International Reach

Pictured are, from left, BOC President Susan McGowen, CATA President Richard DeMont and ARTI President Paul Berry.

Pictured are, from left, BOC President Susan McGowen,
CATA President Richard DeMont and ARTI President Paul Berry.

Athletic Trainers and Athletic Therapists from the US, Canada and Ireland will now be able to obtain credentials in each other’s countries more easily, thanks to an agreement signed last week by the BOC and its Canadian and Irish peer organizations.

Representatives from the BOC, Canadian Athletic Therapy Association (CATA), Athletic Rehabilitation Therapists of Ireland (ARTI) convened at a Dublin conference to sign the international mutual recognition agreement (MRA) September 4, 2014. Under the agreement, the national certification bodies for athletic training and athletic therapy in all three countries will recognize each other’s education and certification standards.

“We have very strict standards by which we certify our Athletic Trainers,” said Susan McGowen, President of the BOC. “ATs’ skills are in demand worldwide and this just makes it easier for them to work where they want to go. We are working collaboratively by removing barriers for qualified professionals to reach the top of their profession.”

The MRA, signed at the Joint Ireland Faculty of Sports Exercise Medicine and World Federation of Athletic Training and Therapy (WFATT) Conference, allows for a certified professional in one country to practice in another signatory nation following the successful completion of the respective nation’s examination.

Expanding upon a mutual recognition agreement signed in 2005 by the BOC and the CATA, this new agreement ensures common recognition among those organizations and ARTI, their peer organization in Ireland.

“As standards continue to align globally, the Board of Certification, in cooperation with our current partners and the World Federation of Athletic Training and Therapy, look forward to future agreements with other organizations of like-minded professionals around the world dedicated to the prevention and care of injuries to the physically active individual,” McGowen said.