Archive for March, 2016

Sodium’s Role in the Hydration Practices of an Active and Healthy Population

Thursday, March 31st, 2016

Posted March 31, 2016

Mike McKenney

By Mike McKenney, MS, ATC

In a previous blog post, I briefly mentioned sodium ingestion plays a significant role in the application of hydration strategies. This is a topic often met with some confusion as there are many different recommendations available to healthcare providers. These recommendations can have a direct effect on the fluid balance of an athlete, such as those from the CDC1 and the FDA.2 With that said, this post is not intended to refute the CDC and FDA recommendations, or downplay potential health risks of excessive sodium ingestion, but rather provide a more refined context on the role sodium plays in the hydration practices of an active and healthy population.

Sodium should not be actively avoided by athletes. It is the primary electrolyte that helps drive thirst and maintain appropriate fluid balance in the extracellular fluid space.3 Repetitive bouts of exercise with insufficient sodium replacement can lead to decreases in plasma volume due to an athlete's inability to retain water. This further reduces an athlete's performance as well as the ability to tolerate exercise in hot environments.4 Exercise-associated muscle cramping (EAMC) is a condition commonly assumed to be the result of decreased sodium levels. However, recent investigations indicate there is no reliable, scientific link between EAMC and sodium loss.5 But if athletes should be ingesting sodium, how much is appropriate to ingest?

According to the CDC1,consuming excessive amounts of sodium will have negative effects on the human body to include increased risk of heart disease and high blood pressure. However, similar to general hydration recommendations, sodium recommendations are made to be broadly applied to the general population. The FDA2 agrees with the aforementioned statement, but adds a caveat to their recommendation (added emphasis is mine): "Sodium is an essential nutrient and is needed by the body in relatively small amounts (provided that substantial sweating does not occur)." As Athletic Trainers (ATs), we often find ourselves in settings where substantial sweating is not only a normal occurrence for our patients, but a daily one, which places them in a population who have different needs.

It should not be assumed that a typical diet will be sufficient to replace sodium in athletes. Sweat sodium concentrations and sweat rates can vary widely6, resulting in the need for individual replacement plans. In situations where fluid loss is great, sodium losses can far exceed standard nutritional recommendations. Currently, it is recommended adults 14 and older should consume about 2.3g of sodium per day.7 However, it has been demonstrated athletes can easily exceed this recommendation in a single training session or game:

- Ice-hockey players can lose 5.7g in a single game8

- Soccer players can lose 2.4g in a single training session9

- Football players can lose up to 17.5g following a two-a-day practice6

Likewise, due to large variations in sweat rate and sweat sodium concentrations, some athletes are perfectly fine with their diet alone. Knowing how much an athlete needs is necessary in order to make an appropriate recommendation, and this can be accomplished with minimally invasive sweat testing services offered by a number of companies. Additionally, replacement can be achieved with the sodium consumed as part of a meal, such as chicken noodle soup,10 or with a number of commercially available products. However, care needs to be taken to understand an athlete’s medical history prior to making any sodium supplementation recommendations in order to account for medical conditions where this practice is potentially contraindicated.



2. (Know Your Numbers)

3. Shirreffs S, Maughan R. Volume repletion after exercise-induced volume depletion in humans: replacement of water and sodium losses. Am J Physiol. 1998;274(5 pt2):F868-875.

4. Shirreffs SM, Sawka MN. Fluid and electrolyte needs for training, competition, and recovery. J Sports Sci. 2011;29(S1):S39-S46.

5. Murray D, Miller KC, Edwards JE. Does a reduction in serum sodium concentration or serum potassium concentration increase the prevalence of exercise-associated muscle cramps? J Sport Rehabil. 2015 [Epub ahead of print]. 

6. Fowkes-Godek S, Peduzzi C, Burkholder R, Condon S, Dorshimer G, Bartolozzi AR. Sweat rates, sweat sodium concentrations, and sodium losses in 3 groups of professional football players. J Athl Train. 2010;45(4):364-371.


8. Godek, S.F., Godek, J.J., McCrossin, J., and Bartolozzi, A.R. 2006. Sweat and sodium losses in professional ice hockey players during a pre-season practice and a game. Med Sci Sports Exerc. 38: S218–S219.

9. Maughan R, Merson S, Broad N, Shirreffs S. Fluid and electrolyte intake and loss in elite soccer players during training. Int J Sport Nutr Exerc Metab. 2004;14(3):333-346

10. Ray ML, Bryan MW, Ruden TM, Baier SM, Sharp RL, King DS. Effect of sodium in a rehydration beverage when consumed as a fluid or meal. J Appl Physiol. 1998;85(4):1329–1336.

About the Author

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

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

Why Should Athletic Trainers Get an NPI?

Tuesday, March 29th, 2016

Posted March 29, 2016

By Kathy I. Dieringer EdD, ATC, LAT

District VI Director

You’ve heard it before, but now it is even more important. As Athletic Trainers (ATs), we are at a crucial time in the history of our profession, positioned to be a leader in healthcare since our team-based approach is the model on which the future is based. ATs are the experts in injury prevention, and healthcare is moving in the direction of emphasizing prevention. We have worked for years to improve our status in healthcare and have made incredible strides, but our work is not done!

So why don’t some ATs take the 5 to 10 minutes to get their NPI? We’ve all heard the reasons: I’m in the (fill–in-the-blank) setting so it doesn’t apply to me; I will never bill for my services; I don’t like how we’re categorized; or it doesn’t help me.

Let’s take the I and me out of it, and think we, as in we, the athletic training profession. It doesn’t matter where you work, it doesn’t matter if you are seeking reimbursement and categories can be changed. What matters is representing yourself as a healthcare provider with an NPI. We were recognized by the American Medical Association over a decade ago, and while that recognition was important, we must continue to progress.

When any entity is trying to assess market penetration of healthcare providers, they use one common tool: the NPI database. This is true of legislators, regulatory agencies and insurance companies.  This occurs on the state level as well as the federal level. Imagine the powerful representation we would have if all ATs were represented during this search. There is definitely strength in numbers. Using NPI statistics gives ATs more power in legislative, regulatory and healthcare initiatives, increasing our value as allied healthcare providers.

The most commonly understood reason to have an NPI is its necessity when billing third party payers for services performed by a healthcare provider. Any claim submitted to an insurance company must identify the AT by an NPI or the claim will be rejected. Is third party reimbursement important to our profession? Absolutely! Is it THE most important reason to get an NPI? In my opinion, no.

The most important reason for all ATs to get their NPIs is to increase the representation of our profession in the healthcare market. We are stronger together, and this most definitely pertains to market penetration of our profession.

I implore every AT to take the time and get your NPI. The process takes all of 5 to 10 minutes, and your NPI follows you for the rest of your career as a healthcare provider.

Follow this link to learn more about how easy it is to obtain an NPI, as well as step by step instructions:


Wrestling Weight Management: Safe Practices for Weight Loss and Weight Gain

Thursday, March 17th, 2016

Posted March 17, 2016

By Claudia Curtis, MS, ATC, LAT

Gone are the days of wrestlers using rubber suits to condition in order to lose weight. The wrestling community recognizes now how unsafe this practice is and that there are more appropriate ways to manage weight. So why is it that as Athletic Trainers (ATs), we continue to hear our wrestlers are running themselves ragged just hours before weigh-ins to make weight? Why is it that with all of the resources we have about nutrition, we still hear of athletes eating bizarre things or starving themselves to make weight? Don’t these practices go against everything we know about hydration and nutrition’s contributions to performance?

The National Collegiate Athletic Association (NCAA) and many high school associations require hydration and body fat testing to determine the minimum weight safe for an athlete to participate, calculated at the beginning of the season. While this is a great way to establish a baseline for safety, many wrestlers are uninterested or uneducated in the safest way to achieve, and more importantly, maintain a weight throughout the season. There is no requirement to maintain hydration status throughout the season, so frequently the first thing athletes do to lose weight is to restrict water intake. Losing even 2 percent of body weight due to dehydration is enough to show performance deficits.1 Continuing beyond that level increases the effects on multiple body systems, leading to losses in strength and endurance.2 At 5 percent dehydration, research indicates the body’s capacity for work output can decrease by up to 30 percent.1 Hydration is encouraged in many sports; it is important that it be viewed the same way in wrestling.

Encouraging high school and collegiate wrestlers to focus on an appropriate diet to maintain a healthy weight can be more challenging. Wrestlers frequently look at the quantity of what they’re putting into their body as a way of management, not the quality. Not all calories are created equal, and focusing on nourishment that will leave the athlete feeling full and allowing their body to recover from the rigors of a very demanding sport is an important key to success. The Cleveland Clinic’s tips for athletes include focusing on a diet filled with lean protein (chicken and fish), paired with healthy fats (found in many seeds, nuts and avocado) and high fiber fruits and vegetables. Blood sugar remains more stable and the body feels full for longer. Other tips include looking for unneeded sources of sugar in the diet and focusing on refueling the body within an hour after a workout.3 Making sure to refuel after workouts keeps the body from wanting to overindulge at the next meal. When athletes are looking to lose weight, they need to be encouraged not to restrict calorie intake, as they often over restrict. This can lead to decreases in metabolism, and eventually decreases in training intensity and performance.4

The most important thing to remember is the majority of the wrestling population is still developing, both physically and cognitively, and the things these athletes put in their body have a direct effect on their ability to fully develop. Not only does diet have an effect on their physical performance, but also on their ability to remain alert in the classroom. As ATs, we realize we are not dietitians, but we can encourage them to find the most appropriate ways to manage their weight, avoiding yo-yo diets and dehydration, to allow for proper weight management and optimal performance.


1Excerpt from Sports Nutrition 2nd Edition, accessed at:

2 The Wrestler’s Diet: A Guide to Healthy Weight Control. Accessed at:

3 “6 Do’s and Don’ts for Athletes Losing Weight.” Accessed at:

4 “Safe Weight Loss and Gain for Young Athletes.” Accessed at:


Strategies in Pro Sports to Encourage Sleep and Promote Recovery When Traveling

Monday, March 14th, 2016

Posted March 14, 2016

Kurt Andrews

By Kurt Andrews MS, ATC, PES, CES

The National Sleep Foundation kicks off its #7Days4BetterSleep in this year’s Sleep Awareness Week from March 6-13. Sleep is part of everyone’s daily routine, some more than others, but is often how we spend one-third of our existence on this planet. It’s been reported through the years that sleep is closely related to physical and mental health, cognitive processes and metabolic functions (Samuels, 2008).

For the athlete population, sleep serves as one of the most significant factors to ensure the appropriate amount of recovery from training sessions and games. Research indicates athletes generally sleep less than non-athletes and often have difficulty sleeping (Walters, 2002). Sleep serves multiple purposes. It has been emphasised that sleep helps with physical and psychological restoration and recovery, conservation of energy, memory consolidation, discharge of emotions, brain growth and maintenance of the immune system (Samuels, 2008). Sleep loss or a lack of sleep could lead to a general decline in athletic performance.

In professional sports, athletes and staff can expect to spend half of the team’s regular season games on the road. The figure pictured here is an example of the first half of the 2015 season for the Los Angeles Galaxy. A constant struggle with east to west or west to east travel is athletes and staff tend to battle fatigue during and after the long journeys. This more than likely is due to the cramped conditions; dehydration as a result of the low humidity on board the airplane; air turbulence; reduced barometric pressure; vibration; noise; flight anxiety and whole body stiffness due to relative inactivity while traveling (Reilly et al., 2005).

The rapid transition across time zones leads to the appearance of a number of undesireable side effects, collectively known as jet lag.  Jet lag is the psychophysiological impairment of well being and performance. It occurs when the athletes’ circadian rhythms are disturbed by trans meridian travel because the time in the new environment no longer matches the body’s internal circadian rhythm (Reilly et al., 2005).  Jet lag symptoms include but are not limited to an inability to sleep at the local time, bowel irregularities, increased incidence of headaches, irritability and moodiness, fatigue, reduced cognitive skills and poor psychomotor coordination (Brooks et al., 2005). The severity of jet lag is directly related to the direction of flight (it can be worse after flying east compared to west) and the number of time zones crossed. The general rate of adjustment is traditionally seen as one day for each time zone crossed (Reilly et al., 2005).

Contrary to the other professional sports in the United States, teams within Major League Soccer travel commercially for all road games throughout the entire regular season. Each club deals with the headaches  everyone else tends to have when traveling domestically, including weather delays, long lines at security, aircraft mechanical issues, the middle seat saga, lost baggage and the general negative mood level of some airline personnel. Arriving into the new city can be a hectic experience.  As the medical staff looking after athletes, it is imperitive we have protocols in place to ensure each individual is able to maximize their recovery from the flight and activity from the day. Athletes are normally expected to be fully prepared to participate at a high level inless than 24 hours after travel. Listed below are some strategies taken to allow athletes to get to sleep in order to promote recovery and ultimately achieve maximum performance with a minimal amount of travel side effects.


- Nap on the flight. A 20-minute nap about 8 hours after nocturnal sleep has positive effects on performance (Postolache et al., 2005).

- Recommend that athletes get 9 to 10 hours of sleep per day, with 80-90% of it during the night (Bompa & Haff, 2009).

- Encourage a bedtime ritual to develop a winding down routine to serve as a cue to the mind and body to get ready for sleep.

- Researchers recommend flight schedules be arranged to allow athletes to arrive at their destination as close to their recommended sleep time as possible. East-bound flights should be made during daylight hours with an earlier start for the longer flights. West-bound flights should be late in the day to arrive as close to the athlete’s sleep time as possible (Brooks et al., 2005).


- Try to keep the temperature of the room as close to what is normal and most comfortable for the athlete. Research suggests that the ideal temperature for males to promote deep sleep is 68 degrees and for females it is 73 degrees (Pan et al., 2012).

- Keep the lights low or off in the hotel room when preparing to fall asleep, usually starting an hour before going to sleep. The alteration of light and darkness is seen as the most important factor that can be used to reset the body clock (Arendt, 2009).

- Avoid using electronics (phone, TV, etc.) prior to going to bed to maximize the darkness in the hotel room.

- Massage prior to bed to allow the body to calm down and relieve any tension built up in the musculature.


- Drink water on the flight and upon arrival in the new city, as dehyration makes it difficult to adjust to a new circadian rhythm.

- Consume food sources containing tryptophan for dinner. Such foods include nuts, seeds, tofu, cheese, red meat, chicken, turkey, fish, oats, beans, lentils and eggs. Tryptophan serves as a precursor for the rest-inducing hormones serotonin and melatonin and ultimately leads to the synthesis of melatonin in the brain (Peuhkuri, 2012).

- Minimize spicy and acidic foods at dinner which can increase the risk of heartburn.

- Drink a chamomile tea after dinner. Chamomile has been valued as a digestive relaxant and has been used to treat various GI distubances including flatulence, indigestion, diarrhea, motion sickness, nausea and vomiting (Srivastava et al., 2010).

- Consume a snack before bed that contains carbohydrate. Carbohydrate can raise plasma tryptophan levels, promoting the synthesis and release of serotonin, a precursor of melatonin (Reilly et al., 2005). Research indicates that certain fruits such as tart cherries or kiwi fruits promote sleep (Peuhkuri, 2012).

- Drink a glass of chocolate milk before bed. Melatonin is a natural compound in cow’s milk(Peuhkuri, 2012)

- Avoid drinking caffeine or alcohol before going to bed.

- Take a night-time supplement with magnesium and zinc (ZMA pills). Magnesium is an essential mineral that can improve length and quality of sleep. Magnesium supplementation close to bed has been shown to improve brain activity readings associated with deep sleep and lower late-night cortisol levels (Held et al., 2002). Zinc, particularly in combination with magnesium and possibly melatonin, can promote better sleep, particularly for people who struggle with insomnia (Rondanelli et al., 2011).

- Ingest oral melatonin 30 minutes prior to going to bed. Melatonin is known to decrease the time taken to fall asleep, and is thought to promote more restful sleep based on its circadian rhythm functions (Macchi & Bruce, 2004). Research shows that daily doses between 0.5 and 5mg were similar in effectiveness, except that on the higher dose people fell asleep more quickly. High-dose melatonin prompts sleep induction and decreases the fatigue the next day more than low-dose melatonin (Herxheimer & Petrie, 2001).


Arendt, J. (2009). Managing jet lag: Some of the problems and possible new solutions. Sleep Medicine Reviews, 13: 249-256.

Bompa, T.O. & Haff, G.G. (2009). Periodization: Theory and methodology of training (5th ed.). Champaign, IL: Human Kinetics.

Brooks, G.A., Fahey, T.P., & Baldwin, K.M. (2005). Exercise physiology: Human bioenergetics and its applications. (4th ed.) New York, NY: McGraw Hill.

Held, K., Antonijevic, I. A., Kunzel, H., Uhr, M., Wetter, T.C., Golly, I.C. … & Murck, H. (2002). Oral Mg (2+) supplementation reverses age related neuroendocrine and sleep EEG changes in humans. Pharmacopsychiatry, 35(4), 135-143.

Herxheimer, A. & Petrie, K.J. (2001). Melatonin for preventing and treating jet lag. Therapeutics, 6: 186.

Macchi, M., & Bruce, J.N. (2004). Human pineal physiology and functional significance of melatonin. Frontiers in Neuroendocrinology, 25(3): 177-195.

Pan, L., Lian, Z., & Lan, L. (2012). Investigation of gender differences in sleeping comfort at different environmental temperatures. Indoor and Built Environment, 21(6): 811-820.

Peuhkuri, K., Sihvola, N., & Korpela, R. (2012). Diet promotes sleep duration and quality. Nutrition Research, 32: 309-319.

Postolache, T.T., Hung, T.M., Rosenthal, R.N., Soriano, J.J., Montes, F., & Stiller, J.W. (2005). Sport chronobiology consultation: From the lab to the arena. Clinics in Sports Medicine, 24(2): 415-456.

Reily, T., Waterhouse, J., & Edwards, B. (2005). Jet lag and air travel: Implications for performance. Clinics in Sports Medicine, 24(2): 367-380.

Rondanelli, M., Opizzi, A., Monteferrario, F., Antoniello, N., Manni, R., & Klersy, C. (2011). The effect of melatonin, magnesium, and zinc on primary insomnia in long term care facility residents in italy: A double blind, placebo controlled clinical trial. Journal of the American Geriatrics Society, 59(1): 82-90.

Samuels, C. (2008). Sleep, recovery and performance. The new frontier in high performance athletics. Neurologic Clinics, 26: 169-180.

Srivasta, J.K., Shankar, E., & Gupta, S. (2010). Chamomile: A herbal medicine of the past with bright future. Mol Med Report, 3(6): 895-901.

Walters, P.H. (2002). Sleep, the athlete, and performance. National Strength and Conditioning Association, 24(2): 17-24.

About the Author

Kurt Andrews, originally from the metro Detroit area, graduated with his bachelor’s degree in Exercise Science in 2008 from Oakland University. He has been a BOC Certified Athletic Trainer since 2011 where he earned his master’s in Athletic Training from the entry level master’s program at the University of Arkansas. He currently is in his fifth year as an assistant Athletic Trainer for the Major League Soccer (MLS) club LA Galaxy. He currently holds memberships with NATA, CATA and PSATS where he serves on the sponsorship, continuing education and research committees and was presently serving as the Western Conference senator.



How did we start off National Athletic Training Month (NATM)? With an annual visit to the “TODAY Show!”

Thursday, March 10th, 2016

Posted on March 10, 2016

Beth Wolfe

By Beth Wolfe, CAGS, ATC

Dark and early on March 4, a group of about 100 Athletic Trainers and students from District 1 and District 2 volunteered to stand in the snow and 30 degree weather to show their support for our profession. Due to the weather and national news headlines, the celebrities of the “TODAY Show” spent very little time outside on the plaza. However, Al Roker did take the time to shake hands and talk to a group of Hofstra athletic training students off camera, after reporting the weather from the plaza. Regardless of the limited live coverage from outside on the plaza, many of our posters made it on live TV during the interview with the United States Olympic gymnasts Mary Lou Retton, Carly Patternson and Nastia Liukin.

This year is special, as there are 2 chances to join the NATM in New York City events! We are going back to New York City on March 18 to be on “Good Morning America!” Be sure to set your DVRs and take pictures of your TVs and tablets as over 200 Athletic Trainers and students will be present to support NATM.

Each year this event continues to grow and become a spotlight for celebrating NATM. A special thanks to Lauren Stephenson and the Stony Brook Athletic Training Program as this event would not be possible without their efforts and support. The NATA is appreciative of your time and efforts to run this great event each year!

Would you like to join us next year? Follow the event on Facebook for the latest updates and news on NATM in NYC 2017:

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.

"TODAY Show" interview with the United States Olympic gymnasts.

National Athletic Training Month signs as seen on the "TODAY Show!"



















In-Depth Look: Athletic Trainer working as an Associate Professor

Thursday, March 3rd, 2016

Posted March 3, 2016

Kellie C. Huxel Bliven, PhD, ATC works in higher education, primarily in graduate post-professional education at A.T. Still University of Health Services (ATSU). 

Describe your setting:

ATSU is named for the founder of osteopathic medicine, Andrew Taylor Still.  The university is a graduate, health professions university with 2 campuses located in Kirksville, Missouri and Mesa, Arizona.  I’m located in Mesa, where there are a variety of health professional programs including athletic training, dental, osteopathic medicine, physician assistant, physical therapy, occupational therapy and many more.  I am fortunate to work with and teach in several of the programs on campus and online, which allows me to interact with, work alongside and learn from a variety of health professionals.

Currently, my primary position is in the online, post-professional kinesiology program. The students enrolled in this program come from a variety of health and fitness backgrounds.  I also have adjunct positions in athletic training and dental programs.

While teaching is a large component of my job, it is not what I spend most days doing.  I currently serve on many institutional and professional committees, which requires time for meetings, and work on projects for the organization.  I also am working on several research projects, which requires concentrated time for reading and writing.

How long have you worked in this setting?

I began working in higher education after earning my PhD in 2005.  I started at Indiana State University and was there for 3years as a faculty member in the athletic training department working with both undergraduate and graduate accredited programs.

In 2008, I moved to ATSU.  For 3 years, I was an assistant professor for anatomy in the Arizona School of Health Sciences.  In this position, I was responsible for teaching the physician assistant and audiology anatomy courses.  In 2011, I had the opportunity to become involved in online education and transferred from anatomy to the kinesiology program, formerly known as human movement.  All along, I’ve been fortunate to remain connected to the athletic training programs, where I’ve taught several courses and served as a thesis adviser.

Describe your typical day:

I gauge my schedule and typical day according to the academic calendar and the current quarter.  As much as I try to structure my schedule, it inevitably is changed!  In general, I like to get into the office early – I consider it my uninterrupted time – to read, respond to emails and grade.  Most days, by 9:00am, are filled with committee and student meetings.  I also carve out time to interact with students in the online courses I teach and work on projects, such as research and course development.

What do you like about your position?

I like working with people, so the interaction I have with colleagues and students is something I really enjoy and value.  I also like that I have flexibility in terms of how I use my time to complete tasks. I also have a variety of courses, projects and committees in which I am involved.

What do you dislike about your position?

Sometimes there are too many opportunities to get involved, and I am not the best at saying no to things!

Recently, I have begun to miss the clinical setting and am exploring how to integrate that back into my work.

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

There will be many opportunities that come to you so learn to be judicious in what you agree to do so you do not overcommit yourself.  I am still trying to take this advice!  I also think learning time management and life balance early in your career is important to continued success and enjoyment in this setting.