Archive for September, 2013

Featured BOC Approved Provider

Thursday, September 26th, 2013

Featured BOC Approved Provider: University of Florida’s Department of Applied Physiology and Kinesiology

It is critical that Athletic Trainers (ATs) are able to identify BOC Approved Providers when looking at advertisements or attendance certificates. The BOC recognizes BOC Approved Providers who follow the guidelines to help identify the BOC in continuing education event materials. A BOC Approved Provider is featured in each issue of the AP Update. The spring issue’s featured BOC Approved Provider was the University of Florida’s Department of Applied Physiology and Kinesiology.

The University of Florida has been a BOC Approved Provider since July 2009. As you can see in the advertisement below, the university adheres to the policies found in the BOC Approved Provider Guidebook. Recently, the BOC asked Patricia Tripp, University of Florida Undergraduate AT Program Director, to comment on the benefits of being a BOC Approved Provider. This is what she had to say:

“We value the educational contribution of our clinical preceptors and find it rewarding to provide them with quality continuing education options at no cost. Our interdisciplinary collaboration with the College of Medicine’s UF Running Medicine Conference demonstrates the positive support our department shares with colleagues across campus.”

If you would like to be considered for recognition as a Featured BOC Approved Provider, please submit your advertisements, evaluations and certificates of completion for review. You can email your electronic promotional materials to or mail your printed promotional materials to:

Board of Certification
Attn: Professional Development Coordinator
1415 Harney St, Suite 200
Omaha, NE 68102-2205

Muscles, Movement and Pain: September Pain Awareness Month

Tuesday, September 24th, 2013

Muscles, Movement and Pain

The term “joint play” refers to the small amount of movement in a synovial joint that is independent of voluntary muscle movement, whereas “joint centration” describes the optimal alignment of joints.

Loss of joint play and/or joint centration is often initially expressed by periodic twinges of pain or discomfort. It may also lead to more joint fatigue and greater pain after use. Eventually it may amount to ongoing nagging discomfort or pain during use. So what should Athletic Trainers and manual therapists do first: stabilize or mobilize? Both have significant positive clinical benefits, so it is most advantageous to do both – during the same treatment session if possible.

To reduce wear and tear on joints, functional movement specialists assess and correct aberrant muscle imbalance patterns, allowing forces to be transferred in the most efficient way possible. Think of joint centration like the wheel on a car. If the center of rotation is aligned with the center of the hub, it will deliver the most efficient performance. But when this neutral position becomes misaligned, the wheel spins incorrectly and may lead to future mechanical problems. We commonly see this in "Upper Crossed" postures where slumped shoulders lead to “decentration” of the glenohumeral joint and subsequent rotator cuff impingement syndromes (Fig 1).

Commonly, joint play dysfunction is the cause of secondary muscle changes. The secondary muscle changes are mainly atrophy and spasm. Muscle spasm is the brain's way of preventing painful joint movements. Of course, this whole process is interlinked with the actions of the nervous system. Whatever the reason for the loss of joint play, when a joint is not free to move, the muscles that move it cannot be free to move, and compensations occur (Fig 2).

Of course, all muscles can act as stabilizers or mobilizers depending on joint position and coordinated motor control. Balance of mobilizers and stabilizers acting at a joint results in optimal joint centration. Loss of centration occurs when phasic (mobilizer) muscles are forced to stabilize. Non-optimal joint centration can lead to whole body stress, and, conversely, stressful activities can cause loss of proper joint centration. This is why we must help down-regulate our clients’ sympathetic nervous systems by keeping them moving correctly through specifically designed joint centration corrective exercises. 

Erik Dalton, Ph.D. founded the Freedom From Pain Institute™ and developed Myoskeletal Alignment Techniques® for manual and movement specialists. Dr. Dalton is the author of Advanced Myoskeletal Alignment and Dynamic Body. He offers BOC approved continuing education credits through live workshops and home study courses worldwide. Visit to review courses and read published articles about myoskeletal alignment.

Celebrate National Rehabilitation Awareness Week

Tuesday, September 17th, 2013

Since 1976, National Rehabilitation Awareness Week has been celebrated annually across the United States. This observance, falling on the third week of every September, promotes the value of rehabilitation, highlights the capabilities of people with disabilities, salutes the professionals who provide services to this community and renews our commitment to meet the needs of people with disabilities.

Rehabilitation helps minimize physical or cognitive disabilities and restore those affected by potentially disabling disease or traumatic injury to health and productivity. Rehabilitation is the single most effective treatment available to persons with brain injury.

In the athletic training profession, treatment and rehabilitation is one of the five practice domains. Athletic Trainers (ATs) are healthcare professionals who collaborate with physicians. The services provided by ATs comprise prevention, emergency care, clinical diagnosis, therapeutic intervention and rehabilitation of injuries and medical conditions.*

Why not take a moment this week to say "thanks" to your favorite ATs, rehabilitation researchers, counselors, therapists and technicians? The BOC thanks ATs for their dedication to the profession.

*This definition is approved by the NATA's nomenclature work group and the NATA Board of Directors, January 2013.

Written By:
Brittney Ryba


Program Director Highlights: Valerie W. Herzog

Monday, September 9th, 2013

Program Director Highlights from the August 2013 PD Update
Program Director - Valerie W. Herzog, EdD, LAT, ATC
Weber State University

1) How long have you been a PD at Weber State University?

I have been a PD here for eight years.

2) How many students are currently in your program(s)?

There are 40 undergraduate students and 31 master’s level students.

3) Do you teach any classes? If so, which one(s)?

Yes, I teach Basic Rehabilitation for Musculoskeletal Injuries, Advanced Rehabilitation for Musculoskeletal Injuries, Research Methods II and III, Administration and Management in Athletic Training, and our BOC exam prep courses (undergraduate and graduate).

4) Do you use the BOC Self Assessment Exam(s) as tools to assist your students in preparing for the exam? How?

Yes, I encourage the students to take the exams online to identify their weaker areas.

5) How do you prepare your students for the BOC exam?

In the BOC exam preparation class, students complete a set of practice questions each week. I encourage students to create a running list of every word, phrase and/or concept that they are not fully confident about. I then ask them to use that list to study from, by researching and reading about everything they were unsure of. I explain that one of the mistakes students make is to continually study the content they already know well. Instead, I encourage them to focus on the content they don’t know.

Completing large amounts of practice questions helps them identify things they don’t know well. In class each week, we review the questions that they were assigned to complete and discuss the content as needed. The students then have a week to take a quiz on the same content areas, although they see different questions. During the following wing class period, we review the quizzes in class.

The students also go through all of the Athletic Training Education Competencies and rate their level of confidence/knowledge on each on a scale of 1-10. I tally all of the scores together to determine the weakest areas for the class as a whole. Students are then assigned two to four competencies that were rated the lowest overall to research and create digital flashcards (using the app, “Flashcards Deluxe”) for study tools that are used by the whole class.

6) What study materials do you recommend to your students?

We have tried a variety of exam prep books with varying success. In the fall, we’re going to try a newer book, Athletic Training Exam Review: A Student Guide to Success, by Lynn Van Ost.

7) Please provide some tips for how you prepare your students for entering the real world (e.g. completing the BOC paperwork post-exam; state licensure/registration/ certification; NPI numbers).

In the BOC exam prep class, I have a day set aside to discuss how to complete the certification process, how to get licensed/registered/certified in the state where they get hired, and NPI numbers. We also review continuing education requirements so that they understand how to maintain their credentials, as well as the disciplinary procedures. During the same semester, they are typically enrolled in our athletic training management course, where they are also discussing legal issues, ethics, career skills and a variety of other topics related to management in athletic training.

8) Do you have any tips, suggestions or questions for other PDs?

We weren’t sure about creating or requiring a BOC exam preparation course, but we are SO glad we did. It gives the students some structure while they study, with deadlines to study content areas. Students often think that they can study on their own, but it is always easier to put off studying for real deadlines in other courses where they receive grades. We have seen a much higher pass rate on the exam for students who took the course, and we are now requiring it of all students in both programs.

If you are a PD who would like to be considered for inclusion in the Featured Program Highlights, please submit an email with your interest to

An In Depth Look with… DeDe D’Orsi, ATC

Friday, September 6th, 2013

DeDe lecturing at the Marshall Center for International Peace Talks in Garmisch,Germany.

An In Depth Look with… DeDe D’Orsi, ATC

Describe your setting:

DeDe D’Orsi has been a lot of things in her life: a professional skier, a U.S. Olympic Team Athletic Trainer (AT) and a physical education teacher, as well as a sports educator of military children, athletes and coaches in Europe. Her career launched as a Fulbright Scholar in 1989 in Minden, Germany, where she was a teacher and an AT for a professional soccer team for one year. Her career has evolved in various ways to involve international work, consulting and working with people in the military.

D’Orsi began lecturing at all possible conferences to promote AT awareness. She was sent to University of Arizona to be on a task force to rewrite its physical education curriculum with recommendations to have a certified AT in all  Department of Defense Dependents Schools (DoDDS) high schools worldwide.

About two years later, D’Orsi was one of 10 people chosen to go to San Antonio to become certified in coaching principles and sports education.  She also teamed up with an instructor who taught the coaching part of the two-day course, and she taught the sports injuries portion.  The entire course was set up by the American Sports Education Program. All coaches had to pass classes in both coaching and sports injuries, plus have CPR certification, before being able to coach for DoDDS (DoDDS has since become Department of Defense Education Activity, or DoDEA).

She also worked with a German physical therapist, from whom she learned a great deal of European approaches to sports injuries. She began lecturing internationally in locations such as Innsbruck, Vienna, Scholoss Pitkin, Austria, Garmisch, Germany, Italy and Spain. She certified all coaches in the Bavarian Region of Germany in Sports Injuries before it went to online certification.

While doing so, she would lecture and write articles, reading journals for continuing education (CE). It became difficult to maintain her certification and find CE so she applied and became a BOC Approved Provider in Germany.

She conducted taping workshops for coaches at the AAHPERD annual conference, where she brought stateside colleagues over to lecture with her, including Dr. Sue Shapiro LAT, ATC, Associate Professor/Program Director of Athletic Training at Barry University. She also conducted a five-day Cramer type course in Oberammergal, Germany, with guest lecturer Steve Cole from the College of William & Mary.

The Department of DoDEA called D’Orsi to be on a new task force only when a heat illness charge was brought against them or if a head injury protocol needed to be written.

With the tightening of security after the Gulf Wars, D’Orsi had difficulties for attendees coming to her workshops. She had to change her business model. She became more involved with military athletes after being engaged to a soldier, which launched her interest in the Wounded Warrior Program.

How long have you worked in this setting?

D’Orsi has been a BOC Certified Athletic Trainer since 1982. She was a professional skier before she blew out her knee. The first injury, known as the unhappy triad, ended her skiing career. Her interest in athletic training began while she was getting treated in an athletic training facility. She already had earned a master’s degree at the University of Virginia, so her only option was to go the internship route to becoming an AT.

DeDe using Kinesio Taping for a TBI on a Wounded Warrior.

She took on many roles. Currently she is in Cocoa Beach, Florida, at Patrick Air Force Base transitioning to a stateside environment and working on getting her Florida AT License.  After a three month waiting period, D’Orsi was permitted to be a Red Cross volunteer with the Bamberg, Germany Base PT at the PT clinic after her daily work. This began her interaction with the Wounded Warriors. She found this extremely rewarding, and it has become her calling.

Describe your typical day: There is no typical day. She sees various individuals who open up a new world of sports medicine to her. For example, she saw a soldier in his 20s who could hardly do 20 curl-ups or five minutes on the bike due to flight or fight syndrome, or battle fatigue, which he faced every day in a combat zone. D’Orsi took a course in Kinesio taping and lectured on it. She also utilizes Tai Chi and relaxation techniques when working with individuals for their stress. She also used Kinesio taping to treat warriors with traumatic brain injuries, long range sleep disturbances and continuous headaches.

D’Orsi has a passion for supporting individuals in the military and helping them get back on their feet. She also enjoys lecturing and learning new applications constantly.

What do you dislike about your position?

D’Orsi was inspired by her mentors Joe Gieck and the late Dr. Frank C. McCue III, as well as Gene Bayliss and Kathy Ortega to keep spreading the word of athletic training in Europe. ATs were thought of as coaches in Europe, which brought many problems in recognizing what the profession actually does for the athlete. Presently working with the Army in Germany as an AT, one is just thought of as a glorified sports event planner for the Wounded Warriors, and that wasn’t what she was interested in.

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

Go out and make your way over there – internationally. Europeans think of an AT as a coach. You have to think outside of the box.

She also learned that if you give it away, they’ll keep on taking it. So she created her own source of getting the word out through workshops as a European consultant. And if you can speak the language, it is a huge asset. D’Orsi studied Spanish first and then found a private tutor while in Germany. She taught and skied with Austrians so she needed to learn German. Learning the language helps you to understand the culture that you are living in.  D’Orsi has certainly left her footprints in the sand for young professionals to follow.  It is now their turn to pick up the ball.

AAN Releases New Guidelines for Managing Concussions

Wednesday, September 4th, 2013

The American Academy of Neurology (AAN) has released its first update on concussion management in 15 years, basing its findings on data gathered through intensive research. With a growing firestorm around the issue of misdiagnosed concussions in professional athletes and an alarming rise in concussions in younger athletes, the study brings to light much-needed information about the risks and recommendations for managing concussions. The study has been endorsed by some heavy-hitters in the world of neurology and athletics, including the American Football Coaches Association, the National Academy of Neuropsychology, the National Athletic Trainers’ Association, the National Football League Players Association, the National High School Coaches Association and the Neurocritical Care Society.

The AAN aims to answer four crucial questions when it comes to dealing with concussions, particularly in athletes. The findings can be boiled down to a few salient points, including the most important one: Suspect a concussion? Get off the field and tell your Athletic Trainer. Following is a breakdown of the questions the AAN study answered and its best-practice recommendations.

1. What factors increase/decrease concussion risk?

Based on the ratio of males to females in contact sports, it's no surprise that males register the highest number of concussions. But that doesn't mean female athletes are less likely to suffer a concussion. In fact, females who participate in soccer or basketball probably face a higher risk of concussion. For male athletes, the higher risk sports are football and rugby, with no data to support the effectiveness of one type of football helmet over another.

2. What diagnostic tools identify those with concussion and those at increased risk for prolonged issues?

The AAN recommends several diagnostic tools for licensed health care professionals (LHCP) to use to assess potential concussions, including the Post-Concussion Symptom Scale, the Balance Error Scoring System and the Sensory Organization Test. The AAN has even developed a free mobile app for use by coaches, athletes and medical staff lacking in concussion experience. The "Concussion Quick Check" is a quick reference app that helps identify the common signs of a concussion, finds a neurologist using the current location or by doing a city/state search, and provides state specific concussion laws. A neurologist or physician with the proper medical training should always be consulted before an athlete returns to play (RTP). It can literally mean the difference between life and death – and should never be left up to the coach, parents or an inexperienced LHCP.

One step that can assist in identifying and assessing possible concussions is the presence of a Certified Athletic Trainer (AT). ATs are equipped with skills that allow them to block out the distractions that exist during games and focus on the athlete. They're also educated and trained to be 100% objective when evaluating athletes, meaning they are less prone to overlook suspected symptoms in favor of allowing the athlete to return to the field.

3. What clinical factors identify those at increased risk for severe or prolonged post-concussion impairments, recurrent concussions, or chronic neurobehavioral impairment?

The study concluded that there is a high likelihood that a history of concussions can cause longer and more severe symptoms and cognitive deficits. Further, returning to play (and the classroom) too soon after a positive diagnosis can have severe and lasting repercussions, especially within the first 10 days. Currently, as many as 40 percent of high school athletes who suffer concussions return to action too soon, raising the risk for more severe injuries.

4. What interventions enhance recovery, reduce recurrent concussion risk or diminish long-term ramifications?

The AAN study could draw no conclusions regarding the effects of post-concussion activity on the recovery from a sports-related concussion or on the likelihood of developing chronic complications.

AAN Practice Recommendations

Pre-participation Counseling

School staff, parents and athletes should be educated by an LHCP about the risks of concussions. There are more and more resources to be found for educating everyone involved in an athlete’s life, including "Heads Up: Concussion In Youth Sports" from the CDC, and a "Summary of Evidence-based Guideline for Patients and Their Families" from the AAN*.

Suspected Concussion

  • Sideline staff, including coaches and LHCPs, should make use of the standardized sideline assessment tools and report the results to a clinical LHCP, who will be evaluating the affected athlete, paying particular attention to the results of at-risk athletes.
  • Team personnel should immediately remove the athlete from play. Not after a few minutes or another run... immediately. And personnel should not let them return to play no matter how hard they insist they are "just fine.”
  • Neuroimaging only needs to be used to rule out more serious traumatic brain injury (TBI) such as an intracranial hemorrhage.

Management of Diagnosed Concussion

  • The athlete should never be allowed to RTP until an LHCP judges that the concussion has healed completely. Athletes should also not be allowed to RTP until they are asymptomatic (without symptoms) and off any medications.
  • Due to younger athletes facing higher risks, they need to be managed more conservatively, with careful attention being paid to preteen and younger athletes.
  • Clinical LHCPs can use additional information, like neurocognitive testing, to more accurately assess the athlete's recovery before allowing RTP.
  • Activities that don't aggravate symptoms and don't carry the risk of a repeat concussion may be started but only if recommended by a LHCP.
  • When athletes are deemed ready to return to physical and cognitive activity, the AAN recommends a gradual increase to regular levels with careful monitoring. The AAN also recommends cognitive restructuring. It found that using this intervention for TBI has shown benefits in decreasing the proportion of athletes who develop chronic post-concussion syndrome.
  • Retirement from play is a serious judgment that an LHCP hates to make but must take into account, specifically when the athlete has suffered multiple concussions. If, after careful assessment, retirement is the best option, this needs to be communicated to the athlete, helping the athlete to understand the dangerous ramifications should he or she decide to return to play after being advised not to.

The bottom line is you've only got one brain. Take care of it and it will take care of you for the rest of your life.

About the Author:

Amy-lynn Engelbrecht is the Online Content Specialist at offers quality online continuing education courses for Athletic Trainers, Certified Strength and Conditioning Specialists, Massage Therapists, Physical Therapists, Physical Therapist Assistants, Occupational Therapists, Occupational Therapist Assistants, and Speech Language Pathologists.


*This statement is provided as an educational service of the American Academy of Neurology. It is based on an assessment of current scientific and clinical information. It is not intended to include all possible proper methods of care for a particular neurologic problem or all legitimate criteria for choosing to use a specific procedure. Neither is it intended to exclude any reasonable alternative methodologies. The AAN recognizes that specific patient care decisions are the prerogative of the patient and the physician caring for the patient, based on all of the circumstances involved.