Archive for July, 2016

Olympics Swim Competition: 3 Common Injury Risks and Preventative Approaches

Friday, July 29th, 2016

Posted July 29, 2016

Tim Koba, MS, ATC
Twitter @timkoba

By Tim Koba, MS, ATC

As the Summer Olympics approach, athletes and fans prepare for the athletic contests. One of the most popular sports in the summer games is swimming. With that in mind, we will take a look at 3  common injury risks and preventative approaches.

1. Shoulder

When we think swimming injuries, the shoulder comes to mind as the most commonly involved joint. In fact, the term swimmer’s shoulder was coined to discuss the unique anterior shoulder pain that swimmers experience as a result of their sport. This results from the triad of swimming biomechanics, muscular overuse and fatigue and glenohumeral laxity and instability. The typical swim stroke of shoulder adduction and internal rotation leads to hypertrophy of the pectoralis major and latissimus dorsi, as well as the under recruitment or over exertion of the teres minor, pectoralis minor and serratus anterior. As the arm is in constant overhead motion, the inability of those muscles to provide adequate stability can lead to increased pain and pathology.

2. Knee

Symptoms involving knee pain would not necessarily be thought to occur in swimming, but it is the second most common complaint amongst swimmers. The breaststroke is the most likely to result in pain, and the usual area of concern is the medial knee compartment with some anterior pain. The unique whip-like kicking motion of that stroke in conjunction with water resistance can lead to a variety of medial knee pathology including MCL tenderness, pes anserinus or hip flexor and adductor strains. The patella may also be overloaded if swimmers are constantly kicking and maintaining tension on their patella tendon.

3. Back

As swimmers propel themselves underwater they rely on hyperextension of their spine in order to streamline their bodies. Constant hyperextension can lead to developing extension based low back disorders, spondylolysis and degeneration over time. The breaststroke and butterfly tend to place the most strain on the low back.


The common denominator in developing an injury as a swimmer is stroke mechanics. If the stroke movement deteriorates due to fatigue, muscle imbalance or stress, pain will ensue.

As Athletic Trainers, our job is not to change their stroke mechanics, but rather, to work with the coach and athlete to identify overload leading to pain. Once identified, the coach can correct the movement and reinforce proper stroke mechanics. To help swimmers increase their strength, endurance and shoulder stability, simple exercises can be performed as a prehab strategy. Exercises that address the external rotators, rhomboids, lower trapezius and serratus muscles can effectively stabilize the head of the humerus and decrease strain as a result of their sport. Incorporating a core stability training program can help avoid low back pain and degeneration.

When athletes improve their underwater form, strengthen their shoulders and stabilize their core, they can better handle the high training loads that lead to success. Working with swimmers to address these areas can also keep them under the water and out of the athletic training facility.


Wanivenhaus, F., et al. (2012). Epidemiology of injuries and prevention strategies in competitive swimmers. Sportshealth.

About the Author

Tim Koba is an Athletic Trainer, strength coach and sport business professional based in Ithaca, New York. He is passionate about helping others reach their personal and professional potential by researching topics of interest and sharing it with others. He contributes articles on injury prevention, management, rehabilitation, athletic development and leadership.


Work-Life Balance: Finding Ways to Compete, May Just Save Your Life

Thursday, July 28th, 2016

Posted July 28, 2016

By Paul LaDuke, ATC

Living a balanced life is a key strategy for Athletic Trainers (ATs) to prevent professional burnout. Burnout will happen when a busy AT allows their career to completely overtake every other aspect of their personal life. I believe it is vital for an AT to spend time on their fitness, spiritual life, nutrition and interpersonal relationships outside of athletic training. Time away from the profession and invested into living a balanced life will improve your time at your job.

One strategy to consider to help you live a balanced professional life is to compete in an athletic event.  There are many opportunities to compete in 5k and 10k community races, triathlons, swimming, adult recreation leagues, etc. Personally, I have competed in weightlifting and had recent success as a master at the national and international levels. For me, competing in a sport has aided in my personal motivation to stay fit. It has also helped me to live a balanced life, stay in tune with the athlete’s mentality and manage life’s stresses in a healthy manner. The process of preparing to compete can carry over into every aspect of life and help an AT to live a more balanced life.

Why compete?

Lisa Simpson, Head Athletic Trainer for Camp Hill High School in Harrisburg, Pennsylvania, says, “I compete because I thrive on competition. I like to set goals for my events and love trying to reach them. I'm the most competitive person I know.”

Chrissy Wojnarski, Athletic Trainer for Sonoraville High School in Georgia, writes, “Running is me time. With how crazy work can be, I just need something I can do to tune it all out. I just plug in the headphones and go, and I’m no longer thinking about the senior who tore his ACL, or the parent who can’t understand why their student athlete can’t play in the game the next day after getting a concussion, or the coach who wants his star athlete back this week. I also run for the very simple fact that I can. I am physically capable of putting one foot in front of the other for 13 miles, which when you think about it is pretty cool, especially given the amount of people who can’t, whether from illness or injury, or some other factor. For this reason, I also choose to run for those who can’t. For every race I run, I pick a charity to also raise funds for in hopes that my efforts will get them one day closer to being able to do the things they can’t because of whatever it is that afflicts them.”

The common theme among the responses I received was that competing motivates fitness goals. Striving for these fitness goals carries over into other areas of life as well. It is important to understand competing as an adult has a completely different focus than competing at youth levels. It becomes about the personal struggle to push yourself and reach your own goals.

What are the positives and negatives of competing as an AT?

Chuck Yasinski, Athletic Trainer for Palmyra High School in Pennsylvania says,  “Positives are challenging yourself to be your best, and to set a personal record. Negatives are risk of injury if you push yourself too hard.”

Steven Kramer says, “Positives: sense of accomplishment, something not many people can say they have done. Knowing I set a goal and have met that goal. Pushing my body to a physical limit and succeeding. Negatives: many races are on Sunday so the first few days back at work are rough when soreness kicks in.”

ATs know all too well the risk of injury with any physical movement. I’ve treated athletes who were injured getting off the bus for their game. So there is risk in competing but the personal rewards well outweigh the risks.

Want some more motivation?

Life has a way of being completely unpredictable and no one has the ability to foresee future events. Simpson told me this inspiring story of how competing helped her battle with cancer, not just physically but also psychologically.

Simpson writes, “In July of 2013, I was diagnosed with and had surgery for ovarian cancer.  In December of 2013, all of my tests and scans came back clean. I was told at that time that I had beaten the cancer, but my body wasn't fully recovered from surgery or chemo until at least a year later. I fought through some discomfort from the surgery, fatigue, headaches and some general blood count issues from chemo. I remember trying to go on a run in September of 2013, and I struggled mightily to get to one mile. Prior to my diagnosis, I was running upwards of 7 miles at a time, so only being able to get to a mile was depressing. There is an ovarian cancer walk and 5k every September at Harrisburg Area Community College, but I wasn't ready to compete in 2013 so I set my sights on 2014. September 2014 was the first 5k I competed in since my diagnosis just over a year earlier. Although my time wasn't like it had been prior to my diagnosis, crossing the finish line meant I had definitely beaten cancer in my mind. So ever since then, each time I compete it feels like I'm crushing cancer all over again. I wanted to be able to run during my struggle, but the thought of running and competing when I was better definitely kept me motivated and still does.”

The ability to recover after injury, illness or even cancer is a part of our profession I have always found to be personally inspiring. Being with an athlete throughout the process from devastating injury through rehabilitation and back to participation, seeing what the human spirit can overcome and living what we live every day is inspiring. I would challenge each and every AT to adopt the mentality of the patients we treat and train for competition. You never know what event may come your way, but by living a balanced life, including finding ways to compete, may just save your life.




In-Depth Look: Athletic Trainer for the US Air Force Special Operations

Thursday, July 21st, 2016

Posted July 21, 2016

Steven Koch

Steven Koch, MS, LAT, ATC, CKTP, is Program Manager/Head Athletic Trainer for the Versatile Injury Prevention and Embedded Reconditioning (VIPER) Clinic for the United States Air Force. He currently works with Air Force Special Operations.

Describe your work setting:

The military setting is a unique setting to say the least. As an Athletic Trainer (AT), there are many opportunities to think outside the box. Not only are there your typical acute athletic injuries including sprains and contusions, but you’ll also see chronic/overuse injuries or stress-related injuries. These injuries include stress reactions and stress fractures that will mimic other injuries ATs really won’t see in a typical athletic setting.

On the flip-side, we see muscular injuries that are also compensating for a stress injury and evolving from a stress reaction into a stress fracture. As an AT in the military, the focus is geared towards injury prevention. A lot of the injuries we see are lower extremity injuries. Most of these can be mitigated by teaching something as simple as proper running form, rucking form, stretching techniques or correcting biomechanics during exercise.

How long have you worked in this setting?

I have spent a little more than 5 years working in a military setting. I first started off doing my graduate degree at the 377th Medical Group (MDG) out at Kirtland Air Force Base in Albuquerque, New Mexico. After that, I worked in the Army for close to 3 years with Basic Combat Training and Army Sapper School.

After a brief hiatus from the military, I was brought on to work in the Navy Seal/SWCC pipeline up at Naval Station Great Lakes at the Naval Special Warfare Preparatory School. I’m now in San Antonio, Texas to work with Air Force Special Operations including Pararescuemen/Combat Rescue officers; Tactical Air Control Party, Combat Control, and Special Operations Weather Team specialists; and Special Tactics officers.

Describe your typical day:

My typical day starts around 6:00am. I go out to early morning physical training and observe the airmen completing exercises to ensure they have proper form.

After physical training is complete, I perform musculoskeletal sick call. This means if anyone is hurt or injured, I perform a complete neuromusculoskeletal evaluation and diagnose the injury. From there, I educate the airman about their injury, perform manual therapy as well as give them therapy exercises to help decrease their pain, heal them and keep them in training. Performing sick call keeps the airman in training and decreases training time lost, which increases on-time graduation rates.

Depending on the injury, I may have to keep the airman from performing or modify certain training exercises or events in order for the injury to heal a little faster. If needed, I refer the airman to our sports medicine physician if I suspect any type of evolving stress injury so they can receive further evaluation and appropriate imaging, which is usually an x-ray or stress fracture MRI.

Once musculoskeletal sick call is complete, I attend training events, whether it is an obstacle course, ruck march or other physical training event. Just in case someone gets injured, the AT is normally on site to evaluate the injury. Most of the time, the AT also performs some of the training events going on. Being side-by-side with the airmen or instructors during the training events is a good way to get to know the airmen and gain their trust.

After the day is complete, I perform one final sick call to see if any airmen need further treatment. On any given day, the airmen have the chance of going through 2 to 3 musculoskeletal sick calls. This ensures they have the opportunity to get any injuries evaluated and treated accordingly.

What do you like about your position?

First off, I work among some of the military’s most elite airmen. I never did sign the dotted line to serve the military myself, so I thought, the least I could do would be to provide them with immediate medical services. Just like any other AT, I like to see the airman fully recover from an injury and join back with their team like they were never injured.

Second, I work with an excellent team of 3 other ATs and a sports medicine physician, who together, make for a great team and provide unparalleled medical services. Unlike sports, every day is game day for these individuals, and they really don’t have any down time. When they eventually get to their team, they have to be ready with little to no notice and have to perform at 110 percent at any given time.

What do you dislike about your position?

The hardest part of my job is evaluating an injury and knowing the airman might have a stress-related injury. That injury will keep them from continuing on with their team who they have built a strong relationship with. It’s kind of like having an injured athlete watch their team from the sidelines.

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

The best advice I can give to a young AT looking into the military setting is to reach out to those who already work in the military setting. Look for internship opportunities to gain hands-on experience. The military is still an up-and-coming setting for ATs. It isn’t your typical setting – there aren’t any games to prepare for, no overnight travel and no time away from your family. The military setting is challenging to break into to say the least. All branches usually require a bachelor’s degree with 5-8 years’ experience, or a master’s degree with 3-5 years’ experience. Having additional credentials is also very helpful in setting yourself above other ATs who are applying for the same position.



Baseball Nostalgia and Common Elbow Injuries

Tuesday, July 12th, 2016

Posted July 12, 2016

Desi Rotenberg,

By Desi Rotenberg, MS, LAT, ATC

Baseball is woven into the fabric of America’s national consciousness and offers participants from diverse background the opportunity to put aside their differences and play a friendly game of catch. Like many of you, some of my greatest memories as a child were going to the ball park with my dad, throwing, hitting and through it all, learning invaluable life lessons. Whether playing in a competitive environment, or playing a casual game of toss, baseball offers us an opportunity to connect with earlier generations and continue the legacy of American nostalgia and pride.

Elbow Injury Prevalence

Baseball, like any sport, offers its share of injury risk. According to a study by Hootman et al. in Journal of Athletic Training, 45% of all injuries sustained in Major League Baseball (MLB) from 1988-2005 were related to the upper extremity.1 Furthermore, the highest volume of baseball injuries to the upper extremity (21.7%) were related to the elbow (compared with 17.1% of injuries related to the shoulder).2  Concurrently, according to an article by Forbes Magazine, pitchers accounted for 58.6% of MLB injuries in 2015.2 These 2 statistics do have relative correlation, as pitchers with elbow injuries seem to make up the majority of the disabled list throughout any given season.

Elbow injuries seem like an inevitable consequence to overhand sports. In a year-long study that followed youth baseball players from the start of the season to the end of the season, Matsuura et al. found 30% of youth baseball players will have elbow pain each year, and nearly 60% of players with elbow pain will show radiographic abnormalities.3

Common Elbow Injuries

Baseball at any level requires high level velocities that place rotational and shearing forces on the joints and ligaments required for those movements. The elbow has 6 degrees of motion: flexion/extension, pronation/supination and valgus/varus. The 3 main mechanisms of elbow injuries are valgus force, posterior translation and posterior-lateral translation.4 However in baseball, the most common mechanism of injury is associated with overload. The varus/valgus motion of the elbow can only articulate up to 3-4° before the forces begin to overload the articulating structures and the chronic forces compromise the integrity of the joint.4

Andrews reviewed 72 baseball players who underwent arthroscopic or open elbow surgery and found 65% were diagnosed with a posterior olecranon osteophyte and 25% were diagnosed with an ulnar collateral ligament injury.5


Below is a chart showing frequency of Tommy John Surgery, or ulnar collateral ligament (UCL) reconstruction, from 2000-2014 in Major and Minor League Baseball:

Source: Sporting Charts- Disabled List Data for Major and Minor League (MLB)6


































































1. Hootman, Jennifer M., Randall Dick, and Julie Agel. "Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives." Journal of Athletic Training 42.2 (2007): 311.

2. Maury, B “Infographic: 2015 Baseball Injuries, Broken Down By Position And Body Part”; (2015).

3. Matsuura, Tetsuya, et al. "Elbow Injuries in Youth Baseball Players Without Prior Elbow Pain A 1-Year Prospective Study." Orthopaedic journal of sports medicine 1.5 (2013): 2325967113509948.

4. Inagaki, K. (2013). Current concepts of elbow-joint disorders and their treatment. Journal of Orthopaedic Science18(1), 1-7.

5. Andrews JR, Timmerman LA. Outcome of elbow surgery in professional baseball players. Am J Sports Med. 1995;23:407–13.



About the Author

Desi Rotenberg, originally from Denver, Colorado, graduated with his bachelor's degree in 2012 from the University of Northern Colorado. He has been a BOC Certified Athletic Trainer since 2012 and earned his master's degree in Exercise Physiology from the University of Central Florida in 2014. He currently is a high school teacher, teaching anatomy/physiology and leadership development. Along with being a teacher, he wears many hats, such as basketball coach, curriculum developer and mentor. He has been a contributor to the BOC Blog since the summer of 2015. 




From Capitol Hill Day to NATA Clinical Symposia & AT Expo

Friday, July 8th, 2016

Mike McKenney, MS, ATC

Posted July 8, 2016

By Mike McKenney, MS, ATC

Every year, thousands of Athletic Trainers (ATs) travel to the NATA Clinical Symposia and AT Expo for many reasons that include continuing education, networking, committee meetings, advocacy and interviews. I was fortunate enough to attend the NATA 67th Clinical Symposia & AT Expo in Baltimore, Maryland this year and want to share my experience of a week filled with athletic training events.

Capitol Hill Day

My trip began with Capitol Hill Day, where over 400 ATs traveled to Washington D.C. to petition Congress for support of The Sports Medicine Licensure Clarity Act (HR 921/ S 689) and The Secondary School Student Athletes’ Bill of Rights (H RES 112/S RES 83). This was my first time visiting Congress on behalf of the athletic training profession, and it was a rewarding experience knowing  the efforts put forth by hundreds of ATs will positively impact our profession and patients. Both pieces of legislation have bi-partisan support in Congress, but still need the support of ATs across the country in order to advance through the legislative process. Please contact your elected representatives to support this legislation, and urge them to co-sponsor it if they have not yet done so already:

NATA 67th Clinical Symposia & AT Expo

The annual conference allows NATA leadership to update the membership on what is new and upcoming in the profession of athletic training. This year, NATA President Scott Sailor, EdD, ATC announced a new public awareness campaign for athletic training with the launching of This is a website dedicated to educating the public about the roles of ATs, and the first step of a multi-year advocacy campaign designed to impact the many different athletic training settings. Additionally, the NATA announced the ATs Care: Peer-to-Peer Support Program, which is designed to support ATs who have experienced a catastrophic event. This is in response to a survey that indicated a large percentage of ATs were not prepared to cope with the psychological impacts of such events. The tentative launch schedule for this program is set for the spring of 2017.

In addition to the above, I volunteered as a moderator for the NATA, as well as attended numerous presentations discussing new findings in malignant hyperthermia from the Korey Stringer Institute; neuroplasticity following musculoskeletal injury; hyponatremia; neurodynamics; and blood flow restriction training and clinical reasoning from Journal of Athletic Training Editor-in-Chief, Craig Denegar, PhD, PT, ATC, FNATA.

Mike McKenney, ATC and Kristin McKenny, ATC holding the 2016 Dan Libera Service Award for Paul Bruning, ATC.

One particular highlight was being able to see multiple friends present their original research. It was also great to catch up with ATs I haven’t seen in some time and maintain those connections as our professional lives take us in a hundred different directions. On the other side of the coin, I also took advantage of the opportunity to meet new ATs who are just as excited about the profession.

BOC Volunteer Reception

Another highlight of my trip was being able to attend the BOC Volunteer Reception, which allowed me to meet a number of individuals who provide an enormous service to not only the BOC, but to the athletic training profession. The reception included presentation of the Dan Libera Service Award. My undergraduate Head Athletic Trainer and mentor, Paul Bruning DHA, ATC, was honored with this award for his service to the BOC. Unfortunately, Paul was not in attendance. However, BOC Executive Director Denise Fandel was kind enough to take a picture of my wife and me holding his award, which was an honor due to the positive impact he had on our athletic training education.

In conclusion, I think the planning committee put on a great event this year. There were many great moments that made it a very beneficial to me and to the athletic training profession. I look forward to my next opportunity to attend!

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.







In-Depth Look: Athletic Trainer who Works with a Reality TV Show and Live Action Entertainment

Friday, July 1st, 2016

Posted July 1, 2016

Kelly Hudson, MS, ATC, with the cast of Universal Studios Hollywood’s “WaterWorld.” The cast is pointing to the parts of their body that hurt!

Kelly Hudson, MS, ATC, is the Lead Athletic Trainer for NBC’s “The Biggest Loser” and the Head Athletic Trainer for Action Horizons Stunts.

Describe your setting:

“The Biggest Loser” is a reality television film set.

Action Horizons is located at Universal Studios Hollywood and works with live action shows including: “WaterWorld,” “TriWizard Tournament,” “Raptor Encounter” and “Special Effects Show.”

How long have you worked in this setting?

I have been a Certified Athletic Trainer (AT) for 21 years and have been fortunate enough to spend the past 17 years working in performing arts.

Describe your typical day:

Truly, there is no typical day in reality TV or live stunt shows. I am certainly never bored!

On the set of “The Biggest Loser” our team is in constant motion. First and last chance workouts, extreme challenges and location shoots keep us on our toes. Much like the cast, we never know what surprises are ahead.

Backstage at Universal Studios Hollywood, I care for 120 professional stuntmen and stuntwomen. Water skiers launched through the air, 45-foot fire dives, knock-down-drag-out-fights and near-miss jet ski chases are all in a day’s work.

What do you like about your position?

Hands down, my fellow ATs on the set of “The Biggest Loser” are the best part of my job. They are excellent at what they do. They are colleagues and friends, and I am so fortunate for the team we have created.

When I am working for Action Horizons Stunt Shows, I am on my own in an open air training room with only a portable table and a kit. I am also surrounded by Hollywood’s hardest working performers.  It is incredibly rewarding to be part of a company that puts such value on the health and wellness of their cast.

What do you dislike about your position?

As the old saying goes, “Choose a job you love, and you will never have to work a day in your life.”

I chose wisely and haven’t worked since. I can honestly say that I love every part of what I do!

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

First, find what you love and then create opportunities for yourself and our profession.

Second, never pass up an opportunity that crosses your path. Big or small, good or bad, they are all stepping stones to your ultimate goal.

Third, surround yourself with incredible people and you will thrive.