Archive for November, 2013

The Athletic Trainer’s Role in Caring for Athletes with Diabetes

Tuesday, November 26th, 2013

November is American Diabetes Month—a time to come together and raise awareness of this ever-growing epidemic that is facing our nation. According to the American Diabetes Association, nearly 26 million children and adults in the United States have diabetes. "Diabetes doesn't stop," states the American Diabetes Association. "It is 24/7, 365 days a year.

Athletic Trainers (ATs) play a critical role in the prevention, recognition and immediate care of athlete with diabetes.  ATs work to provide perspectives on proper exercise and nutrition, counsel athletes on proper hydration and help them keep track of the intensity of exercise sessions, so they can adjust glucose and insulin levels accordingly.

Based on current research and literature, the National Athletic Trainers’ Association (NATA) suggests guidelines in their position statement for management of athletes with type 1 diabetes. These recommendations are organized into categories: diabetes care plan; supplies for athletic training kits; preparticipation physical examination (PPE); recognition treatment, and prevention of hypoglycemia; insulin administration; travel recommendations; and athletic injury and glycemic control.

According to the statement, athletes with type 1 diabetes can benefit from a well-organized plan that allows them to compete on equal ground with their teammates and competitors. This plan should include the following seven elements:

* Blood glucose monitoring guidelines: These should address the frequency of monitoring as well as pre-exercise blood glucose levels where beginning exercise could be unsafe.

Insulin therapy guidelines: These should include the type of insulin used, dosages and adjustment strategies for planned activities types, as well as insulin correction dosages for high blood glucose levels.

List of other medications: Make sure to include medicines used to assist with blood glucose control and/or to treat other diabetes-related conditions.

Guidelines for low blood glucose (hypoglycemia) recognition and treatment: These guidelines include prevention, signs, symptoms and treatment of hypoglycemia, including instructions on the use of the hormone glucagon to metabolize carbohydrates.

Guidelines for high blood glucose (hyperglycemia) recognition and treatment: These guidelines include prevention, signs, symptoms and treatment of hyperglycemia and diabetic ketoacidosis, a condition where insufficient levels of insulin lead to hyperglycemia and the buildup of ketones (by-products of fat metabolism which can reach toxic levels) in the blood. Diabetic ketoacidosis can be life threatening.

* Emergency contact information: Include parents’ and/or other family member’s telephone numbers, physician’s telephone number and consent for medical treatment (for minors).

Medic alert: Athletes with diabetes should have a medic alert tag with them at all times.

Since travel is also often a part of life for those on sports teams, athletes with diabetes are also advised to carry pre-packaged meals and snacks in case food availability is interrupted. If travel occurs over several time zones, insulin therapy may need to be adjusted to coordinate with changes in eating and activity patterns.

The primary goal of diabetes management is to maintain blood-glucose levels consistently in a normal or near-normal range. Strategies to recognize, treat and prevent hypoglycemia (low blood glucose) typically include blood-glucose monitoring, carbohydrate supplementation and insulin adjustments.

Here is an interesting PowerPoint called the Diabetic Athlete that was presented at the March 2013 Great Lakes Athletic Trainers' Association.

Athletes are likely to see their AT more often than any other healthcare professional. This frequent contact means ATs have an opportunity and a responsibility to develop a plan for their patients with diabetes – a plan that empowers ATs to prevent and recognize problems, as well as treat problems when they occur. As an AT, how do you plan your care for diabetic athletes?


Written By:
Brittney Ryba


An In Depth Look with… Tim Koba, ATC, CSCS, PES, CES, CMT

Friday, November 22nd, 2013

An In Depth Look with… Tim Koba, ATC, CSCS, PES, CES, CMT

Describe your setting:

I am an Athletic Trainer and strength coach working in a sports medicine clinic, seeing patients with physicians in my role as a physician extender. I also work with local high schools holding outreach injury clinics and consulting with teams on injury prevention, speed, agility and strength development for their sport. I also provide staffing for football games in the fall and other events throughout the year.                                                                                                                  

How long have you worked in this setting?

I have worked there for about 6 years.

Describe your typical day:

I come to work at 8:00am and prep for the day. Then I see patients alongside the physicians until 5:00pm. On days that I travel to a school I will leave after the morning patients are completed.

What do you like about your position?

Seeing a lot of patients coming in over the years has improved my ability to take a pointed history, see trends in injury patterns and recognize the injury .

What do you dislike about your position?

I would like to be more hands-on with evaluation and treatment of patients. While it is nice being able to identify what is wrong, I would like to be able to work with them on rehab and returning them to their desired level of activity.

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

Working in a clinic is a great way to gain exposure to injuries, seeing commonalities in how injuries present and working on taking a pointed history in order to streamline the diagnostic process.

Dehydration Precautions in Winter Weather

Friday, November 15th, 2013

Frostbite and hypothermia are not the only health hazards associated with frigidly cold temperatures. People lose a great deal of water from the body in the winter due to respiratory fluid loss through breathing. The body is also working harder under the weight of extra clothing and sweat evaporates quickly in cold, dry air.

Dehydration can occur when athletes don’t take in enough water to compensate for the water lost during routine processes or exercise. Awareness, recognition and education are the ways to help prevent dehydration during cold weather training. The goal is to replace 100% of sweat and electrolytes lost during exercise outdoors. Read more about dehydration and performance and cold weather nutrition and hydration from Jeffrey A. Kline, ATC, NASM-PES.

During warmer weather we are very aware of water loss because of the sweating mechanism our body uses to keep cool, but it is harder to recognize when there is cold weather. Shifting temperatures and not having enough water can cause cramping and increases injuries.

Drinking water or sports drinks before, during and after sports is especially important for children and pre-teens because they have special fluid needs compared to adults, or even teenagers. A good way to monitor proper hydration is to examine urine output - the color should be nearly clear.

As a parent or coach, make sure you take precautions to prevent heat illnesses in children and that they follow recommended sports hydration guidelines. Review the Youth Sports Hydration Guidelines reviewed by Susan Yeargin, PhD, ATC, on

Written By:
Brittney Ryba

Return to School Post-Concussion

Thursday, November 14th, 2013

As a follow-up to a recent BOC blog post, Pre-Concussion Screening of Children and Adolescents, I found a recent Position Statement by the American Academy of Pediatrics, which highlights some guidelines for returning concussed students to the school setting. You can view it here.

In it, they state the majority of concussions resolve in 3-4 weeks and may require some initial modification but no longer-term adjustments to students’ class schedule. For symptomatic students with concussions lasting longer that 3-4 weeks, accommodations may need to be put in place limiting their overall school load, including the use of a 504 plan, or individualized education program (IEP).

They also suggest the use of a concussion team that can help return students to school involving the school nurse, psychologist, physician, family, counselor or Athletic Trainer (AT). The authors say that the AT can be a great resource for the school and the physician in working with concussed athletes. Effort should be made by pediatricians to collaborate with ATs.

How much input do you as an AT have on return to school decisions? Are you being consulted by the school to help students become reintroduced to a school setting, whether they are athletes or not? How many of you have been able to meet with a school physician who has been receptive to your suggestions and ability to help with concussion education and management at the school? Do you have recommendations for the rest of us?

Written by:

ETHICS IN ACTION: Fitting In Isn't Always Easy

Tuesday, November 12th, 2013

Ethics education has evolved over the years.  In medicine, it was originally structured content delivered via formal courses on ethical theory.  Through the years, it has transformed to informal education gained through the socialization process.  Young professionals were exposed to mentors who guided their socialization, thereby shaping their moral compass.  In high stakes situations where the mentor holds “power” over the trainee, the student is inclined to “go with the flow” to protect his or her image and status within the organization.  Recently, medical education has been shifted back to a more formal ethics education protocol – but one that emphasizes ethics across the curriculum rather than ethics in one theoretical course.  The advantages of ethics across the curriculum is that it integrates ethics into all academic courses rather than delivering all ethical content in a sterile, theoretical course.  We know that ethics is best learned when students and professionals grapple with the ambiguities of ethical dilemmas.

In light of the transformation of ethics education, how would you advise the student in the following case?

As a young professional in your first job, you are faced with the challenge of working with a team of far more experienced clinicians than you.  Part of this challenge is that, based on your formal educational program, you observe what you believe to be breeches in professional behaviors relative to the articulated code of ethics for your profession.  One of the most disturbing behaviors you observe involves “derogatory comments about patients, their history, their injury/condition, and/or their family situation” when the clinicians are discussing cases in the lunchroom.  They do not refer to the patients by name, but it is quite clear about whom they are talking.  Is this unethical behavior?

  1. What would you recommend the student do in this situation?  Why would you recommend he or she act in this way?
  2. What is at stake here relative to professional values?
  3. If the patients are not being named, what is the problem?
  4. What could the possible consequences be for the young professional if he or she addresses this behavior from his or her moral framework?
  5. What values are present in this particular case?
  6. Is this a violation of the NATA Code of Ethics?

Written By:
Kimberly Peer, EdD, AT, FNATA

Dr. Peer is an Associate Professor at Kent State University.  She holds a Doctorate in Higher Education Administration with a Cognate in Health Care Management.  Kimberly was recently appointed as the editor-in-chief for the Athletic Training Education Journal and serves on the Commission on Accreditation of Athletic Training Education Ethics Committee as well as the NATA Committee on Professional Ethics.  Her national contributions include service to the BOC, NATA, JAT and REF in multiple capacities.  Her statewide service includes the Governor’s appointment to the Ohio licensure board and over 12 years service to the OATA.

Peer received the NATA Fellow Award and OATA Hall of Fame Award in 2012 and has been lauded with other national, regional, and state level awards for her contributions to the profession and athletic training education. Dr. Peer has published and presented extensively on the international and national levels about ethics education and pedagogy and has co-authored with Dr. Gretchen Schlabach the first textbook on ethics in athletic training.


Pre-Concussion Screening of Children and Adolescents

Friday, November 8th, 2013

Sports injuries have been the subject of intensive media coverage over the past few years, with lawsuits between players and sports organizations and injuries to high school athletes getting major attention. This has increased the level of concern that parents, schools and coaching staff have when children and adolescents engage in contact sports. Often the schools and coaching staff are mostly concerned with limiting their liability. Parents are more likely to be concerned regarding the potential for their child to be injured, whether it is a broken bone or a concussion. Schools will often manage their concerns by conducting sideline assessments, and pulling the individuals out of play if they display any indications of injuries. Other concerns include the appropriate treatment of a concussion, and what are the potential impacts of cumulative blows to the head.

However, it is often important to document the extent of an individual’s cognitive deficits when he or she has suffered an injury. This can be difficult to establish in children and adolescents since they are continuing to develop. At times, athletes may test in the average range, but this may not reflect their true deficit if they were functioning in the high average to superior range prior to the injury. This is the reason that it is important to establish a pre-concussion level of functioning that can be used as a point of comparison should individuals suffer a concussion or traumatic brain injury. This baseline can be established using a basic neuropsychological screen, or a more comprehensive neuropsychological evaluation. By taking this step, individuals can be better served when they require treatment following a concussion or brain injury, and a true determination can be made regarding their return to a premorbid level of functioning.

Written By:
Kevin O’Keefe, PsyD
Program Director
Licensed Psychologist
Florida Institute for Neurologic Rehabilitation

About The Florida Institute for Neurologic Rehabilitation

Founded in 1992, FINR is a nationally-recognized leader in delivering high quality, clinically relevant and cost-effective brain injury rehabilitation.  FINR has developed a comprehensive brain injury rehabilitation continuum of care offering specialized inpatient evaluation and treatment for both children and adults. FINR maintains both CARF and Joint Commission accreditations.  FINR’s Pediatric rehabilitation and education program is accredited by the Association of Independent Schools of Florida. For more information, visit

November's National Blog Posting Month Blog Roll

Wednesday, November 6th, 2013

Since November is National Blog Posting Month, we thought we would take the opportunity to share some blogger love. This list collects some of our guest writers’ favorite sites, as well as their own blogs. Also included are blogs maintained by BOC Approved Providers.

Do you have other favorite blogs that can help inform, enlighten or inspire fellow Athletic Trainers? Tell us in the comments! Or, would you be interested in being on the BOC blog team and writing posts about your areas of interest? Learn more about this opportunity.

Allied Health Education Blog

Allied Health Education is a therapist owned continuing education company based in Raleigh, NC.

Athletic Training Education Blog

Written by Stacy Walker, ATC, this blog is dedicated to educational theories and topics.

Athletic Training and Fitness

Michael Hopper, ATC, works for Monroe Physical Therapy & Sports Medicine and is an outreach Athletic Trainer at Waterloo High School. He has special interest in ACL injuries in female athletes, the relationship between hip dysfunction and knee injuries, and concussions.

The Concussion Blog

Dustin Fink, ATC, has more than 14 years of professional experience with concussions and TBI in athletics. “Having sustained multiple concussions and beginning to feel the effects years later, and seeing kids at the high school level report concussions on a more frequent rate, this has become his passion,” according to his blog. “Add to that he would like to see his three kids grow up and play full-contact/collision sports (if they choose) in a safer environment.”

Nancy Clark’s Blog

Nancy Clark, MS, RD, CSSD “is an internationally respected sports nutritionist, weight coach, nutrition author, and workshop leader. She is a registered dietitian (RD) who specializes in nutrition for exercise, health, and the nutritional management of eating disorders.”

Eric Cressey’s Blog

Eric Cressey specializes in applied kinesiology and biomechanics as they relate to program design and corrective exercise; maximal relative strength development; and athletic performance enhancement.

Vern Gambetta’s Blog

Vern Gambetta is the Director of Gambetta Sports Training Systems. He has been the a conditioning coach for several teams in Major League Soccer as well as the conditioning consultant to the US Men’s World Cup Soccer team. Vern is the former Director of Conditioning for the Chicago White Sox and Director of Athletic Development for the New York Mets.

Home CEU Connection Blog specializes in continuing education for Athletic Trainers and other healthcare professionals.

I Train Therefore I Eat

Stephanie d'Orsay MS, LAT, ATC, CSCS, shares her thoughts, knowledge and experience in the world of nutrition and strength training. Her goal is to motivate and inspire her readers “and to hopefully help people lead healthier, happier lives.”

Mike Reinold’s Blog

Michael M. Reinold, PT, DPT, SCS, ATC, CSCS, “is considered a world-renowned leader in the field of sports medicine, rehabilitation, fitness, and sports performance . . . Mike uses his background in sport biomechanics, movement quality, muscles imbalances, and manual therapy to specialize in all aspects of human performance.  He has worked extensively with a variety of professional athletes with emphasis on the care of throwing injuries in baseball players.”

PirateATC Blog

Brad E. Morgan, ATC, covers topics related to athletic training and sports medicine for high school and middle school athletes. He focuses on his hometown in Lake County, Ohio.

Promote the Profession

Paul LaDuke, MSS, CSCS, ATC, USAW Level I, promotes the athletic training profession. He advocates for the presence of an AT in every high school to protect student athletes and their health.

Resource Exchange Center’s Blog

The Resource Exchange Center (REC) “exists to provide up-to-date, confidential and accurate information on dietary supplements, dangerous and/or banned (prohibited) substances, and provide educational materials to empower athletes to make healthy and responsible decisions.”

Sports Medicine Blog

Mike Ryan, ATC, PT, PES, is in his 25th season as a full-time AT and registered physical therapist in the National Football League. His blog says he “has outstanding first-hand sports medicine experience in the fields of injury prevention, injury rehabilitation and performance enhancement of elite athletes.”

Sports Medicine Research: In the Lab & In the Field

The mission of SMR is to bridge the gap between research and clinical practice related to sports medicine. Topics address brain/concussions, bones, injury prevention, evaluations, rehabilitation, pediatrics, patient-reported outcomes and more.

The Teaching Professor Blog

The Teaching Professor Blog features a new weekly post from Dr. Maryellen Weimer, professor emerita at Penn State Berks, on such topics as: the scholarship of teaching and learning, student engagement, classroom policies, active learning, assignment strategies, grading and feedback and student performance.

Trust the Evidence

Funded by the Centre for Evidence Based Medicine at Oxford University, this blog explores “up-to date relevant material from multiple sources of evidence as well as horizon scanning for information likely to change practice today.”

WSJ Health Blog

The WSJ Health Blog offers news and analysis on personal health, new research and health news.

Written By:
Melissa Breazile

Assess Your Professional Development

Monday, November 4th, 2013

As a reminder, ATs certified prior to 2013 need to complete their continuing education (CE) and recertification fee requirements by December 31, 2013.  The BOC offers a FREE service that can help you identify what areas you may need more knowledge and skills in to determine your CE needs before the deadline approaches.

The BOC’s Professional Development Needs Assessment (PDNA) is a tool intended to empower ATs of all experience levels to engage in self-reflection with the goal of assessing professional development needs across the domains of athletic training, as defined in the BOC Role Delineation Study/Practice Analysis, Sixth Edition (RD/PA6).  PDNA results are for personal use only and in no way impact current certification status.

If ATs need assistance with determining if a particular CE activity may be eligible for continuing education units (CEUs), the BOC has the free tool called the Individual Activity Review. This tool is a resource which can be used by all ATs, newly certified or experienced, to determine if CE activities meet BOC recertification requirements and fall within the domains of athletic training as defined in the RD/PA6.

Be Certain.™ to stay on target with your recertification goals. Read more about your certification information in the winter Cert Update, which will be in your mailbox this week.

Written By: Brittney Ryba