Archive for the ‘Athletic Trainer Stories’ Category

Exercise Associated Muscle Cramps

Monday, March 6th, 2017

Posted March 6, 2017

By Michelle Snow, MA, AT, CSCS

Muscle cramps are often associated with heat and dehydration. A 2003 study looked at the number of heat related illnesses during a football season. Seventy-three percent of these illnesses were related to muscle cramping.1  Dehydration has long been blamed as the cause of exercise associated muscle cramps (EAMC). The most common theory places blame on salty sweat removing electrolytes from the body.

However, if EAMCs are heat and dehydration related, why do people experience cramping during cold weather events or while swimming in cold water? And, why does stretching almost immediately relieve the EAMC?

Unfortunately, to date, very little evidence and research has found a cause for EAMC. Two theories have been developed to help explain what may contribute to cramping, the dehydration and electrolyte imbalance theory and the altered neuromuscular control theory.

Initially, it was believed fluid and electrolyte disturbances may cause EAMC. This theory hypothesized that sweating caused a loss of fluid and electrolytes. This would lead to contraction of the interstitial space and a loss of interstitial volume. The increase in surrounding ionic concentrations and mechanical deformation of the nerve endings leads to a hyper-excitable motor nerve and a spontaneous contraction.

The theory was based on observation that athletes who experienced EAMC would often have significant fluid and electrolyte losses at the time of the cramp.4 However, it has been shown that losses in fluids and electrolytes, plasma, blood volume and body weight are similar in individuals who experience EAMC and those who do not experience cramping. Even when given a sports drink that reflected individual fluid losses, approximately seventy percent of participants still experienced EAMC.2

Due to these discrepancies, the second theory regarding a neuromuscular etiology has the strongest support from current research. This theory hypothesizes that neuromuscular fatigue alters the reflex control mechanisms of both the muscle spindle and golgi tendon organ, eliciting muscle cramping.4

The muscle spindle responds to length changes in the muscle. As length increases, the muscle spindle increases impulses to the agonist muscle to contract and decreases impulses to the antagonist muscle so it relaxes. The golgi tendon responds to length changes in the tendon and causes the agonist muscle to relax. Both work together to protect the muscle from over stretching. However, with fatigue, it has been noted that the muscle spindle activity increases while the golgi tendon activity decreases.2 This may explain why muscle cramps occur later in activity once the muscle has fatigued.

In most studies, fatigue has been the most common contributing factor to muscle cramping. This may be caused by an increase in exercise intensity and/or duration. It has also been found that those who have a history of EAMC are more likely to cramp again during other bouts of exercise. Current injury or previous history of injury may also play a role in EAMC. And, it has been found that male athletes are more likely to cramp than female athletes due to the greater proportion of fast-twitch fibers4.

The most effective treatment for acute fatigue-induced muscle cramps is static stretching of the affected muscle. It is thought that static stretching activates the golgi tendon organ by increasing tension in the tendon, causing increased afferent reflex inhibition.4  While the old method of using pickle juice may not change the blood plasma concentrations of electrolytes, it has been found that the acetic acid in pickle juice may trigger a reflex that increases neurotransmitter inhibition to cramping muscles.3 This has been found to effectively shorten the duration of EAMC.

However, it may not be an effective treatment for athletes who develop stomach duress or acid reflux after consumption. Even though there is little evidence to support the dehydration-electrolyte theory, it is still recommended that athletes remain hydrated to prevent heat illness. It is important to continue to recommend athletes to consume enough fluid so that not more than two percent of body weight loss occurs due to perspiration.

Other treatments have been recommended, however, little research has been completed to determine how effective they may be. Plyometric exercises and eccentric exercise may be incorporated for athletes who chronically experience muscle cramps. One study looked at strengthening the gluteus medius to help an athlete who struggled with hamstring muscle cramping. With the agonistic relationship of the hamstring and the gluteus medius, it was proposed that the weak glut might increase the amount of work the hamstring needed to do,  fatiguing the hamstring more quickly. The athlete targeted in this study was able to complete 3 triathlons without EAMC following 3 weeks of the targeted strengthening.4

Further research is needed to explain what causes exercise associated muscle cramps. Fatigue plays a significant role in muscle cramping. However, it does not explain how some athletes experience cramps, while others do not. The most effective treatment is static stretching of the affected muscle.

Resources

1. Cooper, E. R., Ferrara, M. S., Broglio, S. P. (2006). Exertional Heat Illness and Environmental Conditions during a Single Football Season in the Southeast. Journal of Athletic Training, vol. 41, 332-336.

2. Miller, Kevin. The Neurological Evidence for Muscle Cramping. NATA Symposium, June 2011, New Orleans Convention Center, New Orleans, LA. Conference Presentation.

3. Miller, K. C., Mack, G. W., Knight, K. L., Hopkins, J. T., Draper, D. O., Fields, P. J., Hunter, I. (2010). Reflex Inhibition of Electrically Induced Muscle Cramps in Hypohydrated Humans. Medicine and Science in Sports and Exercise, vol. 42, no. 5, 953-961.

4. Nelson, N. L., Churilla, J. R. (2016). A Narrative Review of Exercise-Associated Muscle Cramps: Factors that Contribute to Neuromuscular Fatigue and Management Implications. Muscle and Nerve, vol. 54, no. 2, 177-185.

 

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2017 NFL Pro Bowl Concussion Symposium and Health Screening

Tuesday, February 21st, 2017

Desi Rotenberg
MS, ATC

Posted February 21, 2017

By Desi Rotenberg, MS, ATC

The 2017 NFL Pro Bowl is a tradition that stems back to its inception in 1938. While the teams have changed drastically since then, the NFL Pro Bowl has become a tradition of competitive fun and entertainment for players, NFL front offices and fans. 2017 was the first year since 1980 (minus 2009) that the game was held within the continental United States. This venue change hoped to bring more fans, more attention and enhanced exposure of the game itself.

One of the attention grabbers for me during the Pro Bowl weekend occurred off the field. This year, The University of Central Florida (UCF) hosted the 2017 Pro Bowl Concussion Symposium and Health Screening. The purpose of this symposium was two-fold. First, retired NFL players were invited to partake in health screenings for free to help identify any neurological, cardiovascular or other issues plaguing them due to their playing time in the league. Second, the NFL Players Association partnered with the UCF Psychology Department to present all of the latest research and treatment options related to concussions in the world of sports, and more specifically, the game of football.

Here are a few of the highlights:

Following the U.S. Supreme Court settlement regarding previous NFL players and head injuries, the science has gained a significant amount of traction. As new empirical data emerges and technology continues to develop, more funding is becoming available to allow athletes to have increased access to neurological assessment and professional evaluation following head trauma. Interestingly, the Supreme Court settlement included a 65-year plan that will give retired NFL players and their families financial support if they experience symptoms of amyotrophic lateral sclerosis (ALS), dementia or any other life-altering behaviors or symptoms that may arise secondary to traumatic brain injury.

Furthermore, baseline testing is being made available to all retired NFL players and will be done immediately upon retirement. This will allow the players’ medical teams to identify any behavioral, cognitive or neurological changes that may arise over the remainder of the individual’s life.

The overarching goal is to have every college, high school and middle school offer some form of baseline testing in at least one sport for all student athletes. We are slowly, but surely, making our way towards that goal. However, there still remains room for improvement when it comes to baseline testing.

The areas of deficiency that were identified was a lack of baseline testing within recreational sports and ease of administration within middle schools and high schools. If we want to ensure the safety of all athletes, we must do what we can to have concussion education, a concussion protocol and return to play protocol in place.

At the academic levels, we must also ensure that we have a return to learn protocol in place. The question that acts as a defense for medical professionals responsible for the return to play decision is, “If you cannot learn new information, should you be returning to play?”

Emerging Technology

To this point, there are 2 questions that remain: 1) How do we diagnose Chronic Traumatic Encephalopathy prior to death, and 2) How do we avoid the high cost of imaging when it comes to concussion diagnostics?

There is by no means an answer to the first question as of yet, but I am hopeful due to the emergence of Diffuse Tensor Imaging (DTI). DTI has been around for roughly 20 years and has been mainly used in the diagnosis of strokes and other ischemic disorders of the brain.1 Within the past 10 years, research has shown that DTI can also be used to assess the integrity of the white matter in the brain.2 The goal of physicians at the symposium was to make DTI more streamlined and allow patients access to this form of diagnostic following head trauma.

In the image below, the varying colors represent the orientation of various white matter within the brain. In the second image, neurological specialists have the ability to zoom in on a specific location and can visualize a physical abnormality or disruption in neuronal activation due to a disturbance in neuronal integrity.

Images Obtained from Journal of Neuroradiology

So how do we lower the cost of imaging?

We start by locating private medical companies that offer this type of imaging. There were several speakers at the symposium who owned businesses that focused on the neurological diagnosis and treatment of individuals who suffered traumatic head injuries. The businesses offer consultations and diagnostics at a fraction of the cost of normal imagining techniques.

Cognitive and Behavioral Effects of Head Trauma 

Neuropsychologists want to make one thing very clear to all health practitioners: There is no such thing as the average TBI patient. While there are several concussion treatment protocols, it is paramount that each case be treated on an individual basis according to the needs of the patient and the underlying symptoms present. Cognitive changes following head trauma occur on a varying spectrum, and can include, but are not limited to: changes in vigilance, reaction time, mental tracking, verbal retrieval, mood and information processing.

Common symptoms that can be seen are the emergence of anxiety, depression, inability to focus and difficulty sleeping. Each symptom can lead to frustration, impatience and social disconnect. There is one congruity with all of these cognitive and behavioral changes: a concussion is a physiologic injury of the brain, where normal cerebral flow has been altered and the normal “algorithm” of information input and output has been compromised.

Unfortunately, head injuries cannot be cured; however, there is hope for individuals seeking refuge from this life-alerting injury. There are many clinics that exist, such as the UCF Psychology Clinic that can help patients learn to cope with the inhibiting effects of head trauma. Treatments include consultations with neuropsychologists, who walk patients through cognitive rehabilitative exercises and various forms of talk therapy. These treatments can help an individual compensate for the mental, emotional or physical deficiency that has arisen. The goal of treatment is to help the individual learn how to live within this new reality, and how to improve their overall quality of life.

The central message of the symposium is concussion research and concussion management are constantly changing. Unfortunately, policy change happens at an even slower rate. Due to this constant evolution, this is a topic All medical, fitness and cognitive specialists need to stay up to date on this topic due emerging information and the constant evolution of the topic. This can be accomplished by staying up to date on the latest research and emerging trends, in order to be able to follow “best practices” and avoid liability.

Resources

1. Hagmann, P., Jonasson, L., Maeder, P., Thiran, J. P., Wedeen, V. J., & Meuli, R. (2006). Understanding diffusion MR imaging techniques: from scalar diffusion-weighted imaging to diffusion tensor imaging and beyond 1. Radiographics, 26(suppl_1), S205-S223.

2. Le Bihan, D., Urayama, S. I., Aso, T., Hanakawa, T., & Fukuyama, H. (2006). Direct and fast detection of neuronal activation in the human brain with diffusion MRI. Proceedings of the National Academy of Sciences, 103(21), 8263-8268.

3. Rutgers, D. R., Toulgoat, F., Cazejust, J., Fillard, P., Lasjaunias, P., & Ducreux, D. (2008). White matter abnormalities in mild traumatic brain injury: a diffusion tensor imaging study. American Journal of Neuroradiology, 29(3), 514-519.

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. 

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NATM in New York City

Wednesday, February 8th, 2017

Posted February 8, 2017

By Lauren Stephenson, MA, ATC

“Athletic Trainers Save Lives.”

“Every Body Needs an Athletic Trainer.”

“We’ve Got Your Back.”

“We Prepare You Perform.”

“A Safer Approach to Work, Life & Sport.”

“Your Protection is Our Priority.”

Every March Athletic Trainers (ATs) are dedicated to promoting National Athletic Training Month (NATM) and the athletic training profession. At Stony Brook University (SBU), we began a NATM tradition in 2012 with an inaugural trip to the “TODAY Show” in New York City to help kick-off NATM. The first year, there were a total of 30 students, faculty and staff attending all wearing university attire and carrying signs promoting the NATM slogans.  The trip was a huge success!  We received recognition from the hosts of the show and enjoyed some great group activities. The activities included breakfast at Ellen’s Stardust Diner on Broadway and a visit to the Body Worlds exhibit. The trip made such an impact that we decided to continue the tradition the following year.

In 2013, our group of now almost 50 including alumni (and we thought 2012 was huge), made the very early-morning, and much colder, trek into New York City for another amazing day. Our group filled an entire side of the “TODAY Show” corral with ATs and AT students. We followed this with breakfast at Ellen’s Stardust Diner s and a tour with Jim Ramsay, head AT for the New York Rangers at Madison Square Garden.

With a couple of years’ experience under our belt, we decided to make an even bigger impact in 2014 by inviting our colleagues from all of District 2. This was the biggest success yet with over 200 ATs and AT students lining the entire “TODAY Show” corral.  We held signs with our new NATA logo and were proud to represent all regions of District 2, now this was huge.  Our breakfast at Ellen’s Stardust Diner became a networking event for students from varying institutions. Then, the SBU crew followed that with a custom mouth guard workshop at New York City dental school.

In preparing for our 2015 event, we wanted to make our NATM kick-off tradition have an even greater impact Let’s get the word out that March is National Athletic Training Month! So we decided to not only attend the “TODAY Show”, but to also include the audience of “Good Morning America.” In addition, we invited District 1 to join us. In 2015, we gathered 100 ATs and students at each location and gained recognition from Robin Roberts at “Good Morning America.”  Our breakfast networking continued at Ellen’s Stardust Diner and several schools attended the Body World Exhibit together.

In 2016, we continued this tradition of attending 2 shows and set an all-time record of over 250 ATs and students! After breakfast, the SBU crew enjoyed an amazing experience with performing arts ATand SBU alumnus, Monica Lorenzo, MS, ATC at Radio City Music Hall. Lorenzo is an ATfor The Radio City Rockettes.

2017 marks our sixth year for NATM in New York City. It has become a tradition, not only for SBU, but for many ATs and AT programs in the northeast. We have over 13 institutions throughout Districts 1 and 2 represented and are looking forward to promoting this year’s slogan: “Your Protection is Our Priority.”

Every year we receive snap shots from people watching their TVs all over the US. They are always excited to see friends and colleagues and our NATA logo plastered across their morning news screens.  It has always been our goal to promote our profession. However, our event has evolved into an experience of camaraderie among all those in attendance, sharing an unparalleled experience of professional pride.

Being in New York City, we are lucky we have access to some of the largest morning news shows in the country. However, we recognize that travel to New York City in March is not feasible for ATs across the US. We have found this type of NATM event to be very rewarding, and we hope you join us in seeking out your local morning news show to help promote the athletic training profession in March. Here are some tips for making a successful local event:

1. Find out if your local news station allows visitors for a live audience.

2. If they allow visitors, check in with other local AT programs and ATs to see if they want to attend.

- Local AT associations also can send out a mass email with your contact info.

- The more people the greater the impact.

3. Make a spreadsheet that includes one contact for each interested institution.

4. When you a have general idea of how many will be in attendance, use the NATA PR Toolkit for NATM to create a press release and send it to the news station. You can find the NATA PR Toolkit at  https://www.nata.org/advocacy/public-relations/national-athletic-training-month.

5. Create an itinerary for the day and make sure you arrive very early to get a good spot.

- Be detailed so everyone knows where to go and who to direct questions from the producers to.

- Breakfast or a fun event afterward is always a bonus.

6. If you can’t get a large group together, just get started with your own group and it will grow from there.

If you’re interested in attending NATM in New York City or would like some guidance on starting your own event, please contact lauren.stephenson@stonybrook.edu. You can follow our event on Facebook at www.facebook.com/NATMinNYC  or on the “TODAY Show” or “Good Morning America” on March 3, 2017.

Happy National Athletic Training Month!

 

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Patient Reported Outcomes in Clinical Practice

Tuesday, January 17th, 2017

Posted January 17, 2017

Beth Druvenga
M.S. Ed, LAT, ATC

By Beth Druvenga, M.S. Ed, LAT, ATC

As athletic training pushes to the forefront of healthcare professions, it is necessary for us to also change with the times. The Institute of Medicine urges healthcare educational programs to incorporate outcomes that are reported by the patient into their curriculum as to enhance clinicians’ decision making processes and drive forward patient centered care.1 Patient reported outcomes (PROs) are a valuable tool for Athletic Trainers (ATs) to add to their arsenal of evaluating their patient as a whole. With the addition of PROs into educational programs,1 this gives the student a chance to learn how and when to utilize these outcomes. It also makes it easier to analyze and interpret the results.

Many clinicians are hesitant to use PROs, especially in the fast-paced world of athletic training. Some of the greatest barriers to using PROs are time, comprehension and independence. Most clinicians and patients, report that it takes too much time to complete the surveys, and therefore, do not want to include them in their plan of care. Others report that patients don’t understand the questions and cannot properly fill out the survey without dependence on the clinician.1 How can we break through these barriers?

Initially, it may take time to walk the patient through the survey, but after they understand it, they can independently complete it at subsequent times. On the patient’s side, they can complete the survey while they are hooked up to electrical stimulation, icing or heating. This breaks down the time, comprehension and dependency barriers. It could be easily argued that recording PROs is as important to the patient’s rehab as recording objective measures of range of motion, strength and flexibility.

Once you’ve decided to use PROs, there are some things to consider for picking the correct outcome measure to use. First is to select the type of PRO. There are PROs to record the overall health related quality of life, the patient’s whole body health or information that focuses directly to one area of the body. The PRO that focused directly to one area of the body will be best suited for the outcomes most ATs will want to measure.

Once the type is determined, it’s time to decide on the quality of the PRO. In determining the quality, a clinician should look at the reliability and validity of the measure. This is to make sure that the outcome measure accurately shows change over time for the intended population and evaluates items which are important to the clinician and the patient. 2 Other elements to look at are the stability of the measure to reproduce a same score when a patient’s health status has not changed and responsiveness to detect how true the change in the score is over time.2

Along with the internal elements of the outcome measure, the measure also should be patient and clinician friendly, easy to use and score and support the goals that have been made for the patient. If you are interested in adding PROs into your practice but are still not sure where to go, http://www.orthopaedicscores.com/ is a valuable website. This resource has PROs grouped into specific categories as well as offers printable excel files.

One of the best reasons to use patient reported outcomes is to increase communication with the patient and to direct the patient’s care plan.1 Utilizing PROs in conjunction with clinician reported outcomes can enhance the rehabilitation process. Imagine the scenario of a patient returning from ACL surgery. By utilizing PROs, they will be able to see their progress from day 1 to present. As ATs, we watch our patients go through the highs and the lows of their rehabilitation process, including days where they feel like they haven’t made any progress. PROs, in conjunction with clinician reported outcomes, are valuable tools to utilize in helping patients reach their goals.

Resources

1. Snyder Valier, A. R., Jennings, A. L., Parsons, J. T., & Vela, L. I. (2014). Benefits of and Barriers to Using Patient-Rated Outcome Measures in Athletic Training. Journal of Athletic Training, 674-683.

2. Valier, A. R., & Lam, K. C. (2015). Beyond the Basics of Clinical Outcomes Assessment: Selecting Appropriate Patient-Reported Outcomes Instruments for Patient Care. Athletic Training Education Journal, 91-100.

About the Author

Beth Druvenga is an Athletic Trainer currently living in northern Virginia. She has experience working in both a collegiate and high school setting. Druvenga is originally from Iowa where she earned her Bachelor of Arts degree in Athletic Training from Central College in 2012. She graduated from Old Dominion University in 2014 with a Master of Science in Education. Her professional interests include patient-reported outcomes, psychology of injury and rehabilitation as well as using yoga to increase flexibility.

 

Prevent Cold Weather Illnesses This Winter

Wednesday, January 11th, 2017

Posted January 11, 2017

By Mackenzie Simmons AT, MSEd, ATC

Throughout winter, it is important to be aware of the signs and symptoms of cold weather illnesses, as well as the risk factors and preventative methods. While heat illness usually seems to be on the forefront of environmental issues, cold weather illnesses can cause the same catastrophic results. Athletic Trainers (ATs) and other healthcare professionals need to be knowledgeable in differentiating and diagnosing hypothermia, frostbite, chilblains and trench foot in athletes. A short summary of these cold weather illnesses are listed below.

Hypothermia (mild, moderate or severe) is caused by prolonged exposure to cold, wet or windy conditions, usually during endurance events or outdoor games.

Mild

- Core temperature 98.6F to 95F

- Cold extremities

- Shivering

- Pallor

Moderate

- Core temperature 94F to 90F

- Slowed respiration and pulse

- Cessation of shivering

- Dilated pupils

- Impaired mental function and motor control

Severe

- Core temperature below 90F

- Rigidity

- Severely depressed respirations

- Bradycardia

- Usually has fallen into a coma

Frostbite (mild or superficial) occurs when there is an exposure to cold temperatures, often in conjunction with wind or touching cold surfaces

Mild

- Area is firm or cold to the touch

- Limited movement

- White or blue-gray colored patches in skin

- Tingling or burning sensation

Superficial

- Area is hard or cold

- Burning, aching, throbbing or shooting pain

- White, gray, black or purple skin

- Tissue necrosis

Chilblain (or pernio) is caused when the body has prolonged exposure to cold, wet conditions.

- Red or cyanotic lesions

- Tissue necrosis

- Skin sloughing

- Swelling

Trench foot comes from prolonged exposure to cold, wet conditions; it usually occurs with the continued wearing of wet socks, wet shoes or both.

- Burning, tingling or itching

- Loss of sensation

- Cyanotic or blotchy skin

- Blisters or skin fissures

Sometimes, cold weather illnesses cannot be prevented in athletes, but there are risk factors that can predispose an athlete to getting hypothermia, frostbite, chilblain or trench foot. Listed below are a few of the risk factors for cold weather illnesses:

- Lean body composition

- Lower fitness level

- Females

- Older age

- Issues such as cardiac disease, Raynaud’s phenomenon and anorexia

- Previous cold injuries

- Low caloric intake

- Dehydration

- Fatigue

While most risk factors are genetic, there are a few that can be controlled. An AT can encourage athletes to stay properly hydrated and nourished before activity to ensure the body has enough nutrients to efficiently function. Also, make sure the athletes are at the necessary fitness level to perform the event in the cold weather. It is important to encourage the athletes to get a full night of rest leading up to the event so the body is not fatigued.

In addition to controlling the risk factors, the AT can also provide guidance on the proper clothing to wear to the event. When possible, the athlete should keep their hands, feet, toes and ears covered. Also, dressing in layers is essential to keeping warm—the first layer of clothes should allow sweat evaporation, the middle layer for insulation and then the outer layer being water and wind resistant. The AT should also monitor the wind chill before and during the event to make sure the weather is safe for activity.

Resources

Cappaert, Thomas A., et al. "National Athletic Trainers' Association position statement: environmental cold injuries." Journal of athletic training 43.6 (2008): 640-658.

 

 

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Utilization of Sport Psychology in the Rehabilitation Process

Monday, January 9th, 2017

Posted January 9, 2017

Beth Druvenga
M.S. Ed, LAT, ATC

By Beth Druvenga, M.S. Ed, LAT, ATC

“Sports are 10% physical, 90% mental,” this common phrase used in sports is easily transferred into the world of injury rehabilitation. Sport psychology has started to be incorporated into the sports medicine realm.  Athletic Trainers (ATs) are required to participate in some type of psychological or behavioral classes as part of an athletic training program curriculum. Many people have heard of collegiate or professional athletes using psychological techniques such as imagery, stress reduction and positive self-talk as part of their pre-game regimen. They have credited these techniques as helping their game excel, but what if we transferred these techniques into the athletic training facility?

There are some athletes who still feel the stigma of psychosocial help and may not see it as the ATs “place” to employ sport psychology theories into the rehabilitation program.1 However, these interventions have been shown to have positive effects on athlete compliance to rehabilitation programs, better rates of recovery and may help alleviate stress or anxiety.4,3

As ATs, we are put into the unique role, which allows us to control many aspects of the rehabilitation process such as; creating a positive atmosphere, maintaining athlete compliance and providing social support for the injured athlete. We can easily facilitate the discussion with the athlete about how they feel regarding their injury, refer them to another healthcare professional or help them cope with their injury. ATs are on the front lines of student-athlete wellness. Having awareness and knowledge about the psychosocial aspects of the sport allows ATs to take greater care of the athlete, which will hopefully reduce injury recovery time.

Use your tools of the trade! As a professional, it is intrinsic to give our athletes feedback and cues on how to do their exercises correctly. We help set achievable goals in their rehabilitation and lift them up when they’re having a rough day in rehab. All athletes have some part of their identity associated with being an athlete. Being aware of any changes in this identity can be useful for an AT to help in identifying any issue that may appear. These are all subtle psychological interventions!1 Though subtle is sometimes best, there are some more direct ways that can be beneficial to the athlete.

Start by having the athlete write down goals for each week in a journal or on a rehab sheet. The ability to see these goals daily during rehab will ingrain in the athlete’s mind about what they have set out to do for the week and will motivate them to make progress.2 They can acknowledge their goals while doing specific exercises and visibly see their progress written out. Talking with the athlete about their motivation for recovery can also be helpful. By understanding the athletes “why” early in the recovery process, you can help remind them of this “why” during the difficult days.

Add imagery into their program. Imagery is a process which involves three steps: vividness, controllability and self-perception.5 Especially with post-surgical cases and prior to the exercise, have the athlete imagine the muscles they use to do a specific exercise (vividness). After they have done this for a few minutes, have them move on to imagining going through the exercise and completing it successfully and pain free (controllability). Then, after doing this step for a few minutes, finally have the athlete think about a time where they were performing at their best, what emotions they had and what it took for them to feel that way.5 Imagery can be used in pain management as well. Having the athlete view the pain as a “hot” color like red and change it to a “cool” color like blue, which can help reduce pain.6

Teach them positive self-talk. Athletes are quick to get down on themselves if they aren’t performing the task perfectly. Have the athlete use “I can”, or “I will” statements before tackling a tough exercise. This practice will positively engage the brain and give the athlete the boost to achieve their goal. Another way to enhance confidence is to view the setback or injury as a challenge and obstacle to overcome rather than a threat to athletic identity. Changing the perception will help the athlete remain optimistic during a potentially difficult period of life.

Create a peer to peer group.2 A peer to peer group can be led by a sport psychologist or qualified mental skills coach, which can meet to discuss the “boo’s and yay’s” of that day’s session. Athletes need to know they’re not the only one struggling with certain things. When they can dialogue with others in a controlled setting, they may find it beneficial to talk with others going through similar situations. They can also share techniques which have helped them and may  help other athletes.

Many ATs do not feel adequately equipped to walk athletes through the psychological aspects of return from injury. If this is the case, search for local sports psychologist or qualified mental skills coach, who work with adolescents or young adults. A great resource is the Association for Applied Sport Psychology, they have information for consultants in your area, as well are plenty of resources on injury/rehabilitation.

In the college/university setting, seek out your psychology or kinesiology professors. They may have an interest in the area of sport psychology and would be willing to provide guidance and expertise. Seek out workshops, lectures and continuing education that touch upon applying psychology into the athletic training facility. As ATs, we are uniquely taught and equipped to handle many different and difficult facets of injury, rehabilitation and return to play. We have an overflowing toolbox, but adding sport psychology training may prove to be a welcome addition.

**Huge thank you to my brother Joel Druvenga, a Master Resilience Trainer-Performance Expert with Comprehensive Soldier and Family Fitness at Fort Riley Army Base. He has a Bachelor of Arts in Psychology, Master of Education in Counseling with an emphasis in Sport Psychology.  He is also working toward a Doctor of Education in Kinesiology. He provided me with valuable insight into the realm of sport psychology and utilizing it in the sports medicine world, and added some great edits to this blog post.**

References

1. Arvinen-Barrow, M., Massey, W. V., & Hemmings, B. (2014). Role of Sport Medicine Professionals in Addressing Psychosocial Aspects of Sport-Injury Rehabilitation: Professional Athletes' Views. Journal of Athletic Training, 764-772.

2. Granito, V. J., Hogan, J. B., & Varnum, L. K. (1995). The Performance Enhancement Group Program: Integrating Sport Psychology and Rehabilitation. Journal of Athletic Training, 328-331.

3. Hamson-Utley, J. J., Martin, S., & Walters, J. (2008). Athletic Trainers' and Physical Therapists' Perceptions of the Effectiveness of Psychological Skills Within Sport Injury Rehabilitation Programs. Journal of Athletic Training, 258-264.

4. Heaney, C. A. (2006). Recommendations for Successfully Integrating Sport Psychology Into Athletic Therapy. Sport Psychology & Counseling, 60-62.

5. Richardson, P. A., & Latuda, L. M. (1995). Therapeutic Imagery and Athletic Injuries. Journal of Athletic Training , 10-12.

6. Taylor, J., & Taylor, S. (1997). Psychological approaches to sports injury rehabilitation. Gaithersburg: Aspen Publishers.

About the Author

Beth Druvenga is an Athletic Trainer currently living in northern Virginia. She has experience working in both a collegiate and high school setting. Druvenga is originally from Iowa where she earned her Bachelor of Arts degree in Athletic Training from Central College in 2012. She graduated from Old Dominion University in 2014 with a Master of Science in Education. Her professional interests include patient-reported outcomes, psychology of injury and rehabilitation as well as using yoga to increase flexibility.

 

 

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Nutrition, Recovery and Injury Prevention for Basketball Players

Tuesday, January 3rd, 2017

Posted January 3, 2017

Desi Rotenberg
MS, LAT, ATC

By Desi Rotenberg, MS, LAT, ATC

Basketball is a sport that requires several complex movement patterns, both within the individual and the team. Before an exercise specialist can create a training and nutrition program for any sport, it is important to first fully understand the game as a whole. This includes, but is not limited to, the specific movement patterns required to optimize performance as well as how to decrease overall time to fatigue in-game and during off-court training. Coupling movement patterns with a deliberate hydration plan and nutrition plan can optimize performance, while ensuring the athlete’s body can handle the strenuous mental and physical demands of the sport itself.

Nutrition

Basketball requires a combination of movements that include strength, endurance, power, agility, quickness and proprioception. While a single game lasts between 32 and 48 minutes, depending on the level, the actual exercise time may only be a fraction of that time. A single player will undergo 1 high intensity run every 21 seconds and spends nearly 60 percent of their playing time undergoing low intensity activity .2

In order for each player to maximize their performance on the court, they must ensure they have properly fueled the energy systems needed. The training needs of the sport will also need to be taken into consideration: the average basketball player trains between 2-3 hours per day, 4-6 days per week.2 Additionally, it is estimated that the average basketball player runs between 1 and 3 miles per game. These values have only been confirmed at the professional level with state-of-the-art tracking technology. Currently, the record belongs to Jimmy Butler, who ran an average of 2.74 miles per game during the 2015-2016 NBA season.

Nonetheless, a basketball player’s diet must reflect that of the short-term, high intensity movements coupled with long-term low intensity energy demands. The table below illustrates the nutritional requirements for basketball players at the high school and post-secondary levels:

  Men Women
Calories

2,500-3,000 (High school)

3,000-3,500 (Post-Secondary)

2,200-2,700 (High School)

3,500-4,000 (Post-Secondary)

Protein

1.4-1.7 g/kg

1.4-1.7 g/kg

Carbohydrate

2.7-4.5 g/kg

2.7-4.5 g/kg

It is recommended athletes eat a high carbohydrate, low fat meal roughly 3-4 hours prior to the start of a practice or competition. A small snack should be consumed 1-2 hours prior to the start. This snack should be relatively high in carbohydrate (juice, cereal bar or bagel) and have some protein (peanut butter, milk, cheese or yogurt) in order to prepare the athlete’s body for the energy need required. The protein will help initiate the athlete’s muscle recovery following completion of the practice or competition. Less than 1 hour prior to the start of the practice or competition, the athlete should consume a sports drink. This will help prime the athlete’s short-term energy system and contribute to hydration, which will help prevent fatigue.

During the practice or competition, it is recommended the athlete drink water or colored sports drinks that are kept at a cool temperature. This will prevent dehydration and exercise-induced hypoglycemia. Basketball players should be taking breaks and consuming either water or a sports drink roughly every 15-20 minutes during play.1

Injury Prevention

According to a 2016 study by Bird and Markwick published in the International Journal of Sports Physical Therapy, injury prevention within the basketball population is a combination of the ability to recognize poor movement patterns and the theoretical likelihood to predict future injury incidents.3  A meta-analysis of basketball injury prevalence showed amongst high school basketball players, an injury will occur 2.08 times per every 1,000 exposures in boys  and 1.83 per times per 1,000 exposures in girls.3 An exposure being an opportunity for an injury to occur within practice or in-game. Concurrently at the collegiate level, the injury rate substantially rises: 9.9 times per 1,000 exposures in men and 7.68 times per 1,000 exposures in women.3

Furthermore, as expected, the lower extremity was the most common region of the body to have sustained injury amongst basketball players. Ankle sprains during landing accounted for nearly 45 percent of all lower extremity injuries. In females, knee injuries that occur during a cutting or rotational movement account for nearly 30 percent of all injuries amongst high school and collegiate basketball players.3

As mentioned above, given the knowledge we have about the specific injuries that occur within the sport, we can begin to predict future injury occurrences. Bird and Marwick explain it as “injury prevention through prediction; an approach that is used to assess fundamental movement qualities in order to identify and predict overall injury risk.”3

Recent research suggests that movement screens are moving away from the traditional isolated muscle strength assessment tests. They are moving towards an integrated approach that evaluates fundamental movements related to the assessment of “an athlete’s movement competency, or the fundamental mechanics required over a period of time within a specific sport.”3 In simple terms, the assessment should focus on the fundamentals, which can then be continuously trained to ensure a safe, yet effective improvement in overall sport performance.

Below are a few of the functional assessment tools utilized by this study and their practical applications. Each test is scored on a scale of 1-3 (1 being can not complete without major flaws; 2 being can complete but with some flaws and 3 can execute with technical proficiency).3

1. Hop and Jump Variation Assessment

a. A good way to assess neuromuscular control using single leg hopping, hopping for distance and timed hop.

b. Practical Application: These assessments will allow the practitioner to visualize any neuromuscular control deficits, muscular strength deficits or imbalances, knee position and trunk position/compensation.3

2. Landing Error Scoring System

a. Known as the “Drop Box Vertical Jump test;” evaluates 17 jump-landing characteristics

b. Practical Application: Considered a reliable screening tool in the identification and prediction of non-contact ACL injuries through the evaluation of landing mechanics.3

3. Tuck Jump Assessment

a. Allows for evaluation of the ability of the hip, knee and ankle to absorb force during take-off and landing, specifically targeting the stretch-shortening cycle.

b. Practical Application: The ability to identify and predict lower extremity dysfunction such as high risk landing patterns, knee loading patterns and neuromuscular control within the hip, ankle and knee in conjunction with the trunk.

4. Weight Bearing Lunge Test

a. Correct landing technique can be visualized through ankle dorsiflexion range of motion

b. Practical application: can be a predictor of ankle injuries caused by poor force absorption within the ankle due to a lack of ROM.3

5. Star Excursion Test

a. Used to assess static and dynamic balance and neuromuscular control that involves single leg balance in 8 different directions. This will allow for the assessment of “ankle dorsiflexion, knee flexion, overall knee and hip range of motion, and proprioception.”3 Considered a reliable and predictive measure of lower extremity injuries within high school basketball players.4

b. Practical application: The ability to identify and/or predict chronic ankle instability, ACL deficiencies and patellofemoral pain.

Sleep and Recovery

Furthermore, a 2011 study by Mah, et al. out of the Stanford Sleep Disorder Clinic, investigated the effects of sleep extension on specific measures of athletic performance as well as the effect of sleep on reaction time, mood and daytime sleepiness in collegiate basketball players. It was noted an athlete who receives 79.7 additional minutes of sleep (~1.2 hours) per night, can see substantial improvements in performance in strenuous physical requirements, cardiorespiratory functioning and psychomotor tasks that include memory, learning ability and reaction time.5

Sleep extension will be predominantly critical within the collegiate and professional athletic population. This is due to the frequent travel across several time zones and into several different locations within the United States in a relatively short period of time. It was noted in this same study that collegiate basketball players travel on average of 2-3 times per month, with trip duration lasting anywhere from 3-5 days.5  This study reinforces the notion that at any level and within any sport, athletes require additional sleep in order to ensure optimal performance.

Through the use of a predictive model, the practical application of nutritional requirements, injury prevention and sleep extension can ensure optimal performance within the sport of basketball at any age level. Often times these aspects of athletic competition go unnoticed and only come to the forefront following an injury, burnout, nutrient deficiencies or an incident that is secondary to 1 of these occurrences. While there are specialists geared towards nutrition, sleep and injury prevention at the professional and collegiate levels, it will be important for high school athletic coaches and staff to understand the correlation between proper nutrition, proper sleep, injury prevention and overall performance and success within the sport in general.

Resources

1. Academy of Nutrition and Dietetics, (2016). “Fueling Basketball Players.” https://www.nutritioncaremanual.org/vault/2440/web/files/SNCM/Client%20Education%202014/Basketball%20Players-4-2014.pdf. Accessed: December 5, 2016.

2. McInnes, S. E., Carlson, J. S., Jones, C. J., & McKenna, M. J. (1995). The physiological load imposed on basketball players during competition. Journal of sports sciences, 13(5), 387-397.

3. Bird, S. P., & Markwick, W. J. (2016). Musculoskeletal Screening and Functional Testing: Considerations for Basketball Athletes. International Journal of Sports Physical Therapy, 11(5), 784.

4. Plisky, P. J., Rauh, M. J., Kaminski, T. W., & Underwood, F. B. (2006). Star Excursion Balance Test as a predictor of lower extremity injury in high school basketball players. Journal of Orthopaedic & Sports Physical Therapy, 36(12), 911-919.

5. Mah, C. D., Mah, K. E., Kezirian, E. J., & Dement, W. C. (2011). The effects of sleep extension on the athletic performance of collegiate basketball players. Sleep, 34(7), 943-950.

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. 

 

Choosing the Correct Continuing Education Program

Tuesday, December 13th, 2016

Posted December 13, 2016

Brian Bradley,
MS, LAT, ATC, CSCS

By Brian Bradley, MS, LAT, ATC, CSCS

Obtaining continuing education units (CEUs) can be a frustrating task, but it can also be very rewarding if done correctly. Start by changing your attitude about continuing education (CE). Don’t think about CE as an annoying, time-consuming tasks you are required to do in order to maintain your certification. Try to think of CE as an opportunity to improve your skills and become a better Athletic Trainer (AT).

1. Know what specific CEs you need for your certification and license

If you are an AT who was certified in 2015 or before, 50 CEUs (including at least 10 CEUs from the EBP category) are required by December 31, 2017. If you were certified in 2016, 25 CEUs (including at least 5 CEUs from the EBP category) are required by December 31, 2017Some states also require CEs with each license renewal, sometimes those including medical errors programs or attending live events. Make sure you account for these when scheduling your CE programs.

2. Find CEs that are aligned with your interests or position

For example: If you work with athletes who have prolonged symptoms after concussions, it may be beneficial to attend a seminar in which they cover sub-maximal graded treadmill exercise.

3. Look for CEs that may make you more marketable in the future

Consider taking CE programs that add to your resume and clinical tool kit. Not only may it make you a better clinician, but it may help you land a job in the future.

4. Look for CEs that may satisfy requirements for multiple certifications

If you are an AT certified as a strength and conditioning specialist, look for a class you can use for both certifications.

5. Don’t wait until the December 2017 of a reporting period to get your CEs

Don’t wait to get your CE completed. The danger of waiting until this last minute is that there may not be any classes that fit into your schedule.

6. Look for CEs your employer will reimburse

Paying for CEs can get expensive but sometimes employers will provide their employees a CE budget.

7. Use CEs as a chance to network

Think about attending a seminar that offers CEs for multiple professions (RN, PT, EMT, etc.). This will help other professionals get to know the athletic training profession.

8. Attend a National or Local Athletic Training Meeting

Get to know other ATs in your state or district. Usually these meetings offer a lot of CEs and cover topics that directly impact you.

9. Use CE Course as an Excuse to Travel

Attend a seminar or course in someplace you have never been. Plan your trip to add a day or 2 to sightsee and experience a new location.

If you’re struggling with CEUs, remember the BOC website has a list of live events and home study programs to help you meet your CE requirements. Find CEUs on the BOC website at www.bocatc.org/findCE. You can also check the career education section of the NATA website at https://www.nata.org/career-education/education/online-ceu-opportunities.

Resources

www.bocatc.org/findCE

https://www.nata.org/career-education/education/online-ceu-opportunities

About the Author

Brian Bradley has been a BOC Certified Athletic Trainer since 2008. He is originally from Lawrence, Massachusetts but now live in Orlando, Florida. Bradley earned his undergraduate degree at Merrimack College in North Andover, Massachusetts and his master’s degree at the University of Florida. Bradley has worked in a variety of settings including professional, collegiate and secondary schools and in a physical therapy clinic. He currently works at Orlando Orthopaedic Center in the durable medical equipment (DME) department.  In his spare time, Bradley spends time with his wife, Izzy, and his daughter, Abigail.  He is also a big Boston/New England fan and enjoys running.

 

 

 

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Medical Therapeutic Yoga Series: Yoga as a Therapeutic Intervention

Tuesday, November 8th, 2016

Posted November 8, 2016

Tim Koba, MS, ATC
Twitter: @timkoba
Blog: www.timkoba.blogspot.com

By Tim Koba, MS, ATC

As research continues to improve and advance, it is important to stay abreast of current trends. One of those trends is the development of yoga as a therapeutic intervention. While yoga has been practiced for thousands of years, its popularity for fitness has increased worldwide. In conjunction with this increase in practice comes an increase of research evaluating the therapeutic effectiveness of yoga on different diseases and populations.

There have been some recent literature reviews that evaluate the state of the current research and can help practitioners gain an understanding of alternative and complementary forms of treatments. Yoga has been routinely associated with breathing, movement and mindfulness that can improve stress levels. Indeed, one of the benefits of yoga is the ability to decrease stress. This reduction in stress has additional health benefits including the regulation of breathing; decreasing hypertension; and potentially modulating post-traumatic stress disorder (PTSD), anxiety and depression. It has also been shown to be an adjunctive therapy for asthma.

The focus on the breath with yoga helps to regulate breathing and improve lung capacity. Recently, a study looked to see if this improvement in breathing ability transferred to actual physical performance. A small sample of matched female participants were measured for cycling performance before, during and after being in a yoga group or a control. The practice group showed improvements in lung regulation and capacity at rest, but no improvement in cycling performance or VO2max. So, while yoga may help with regulating breathing, it is still important to undergo training modalities to achieve physiological adaptation.

Another common reason to perform yoga is to improve balance and flexibility and both of these outcomes are achieved with routine practice of yoga. Athletes have even seen improvements in these areas compared to those who did not practice yoga. Unfortunately, no study has evaluated the on-field transfer, prevention or rehabilitation potential of yoga on injury risk and performance measures. It still remains to be seen if yoga is a viable standalone prevention or rehab strategy.

An area of rehabilitation that does show promise is chronic low back pain. One of the main reasons for participants to choose yoga relates to low back pain (20 percent). Yoga practice has demonstrated effectiveness in decreasing the pain and dysfunction associated with chronic low back pain. Yoga also improves the symptoms and function of those suffering from knee arthritis. Yoga can help to decrease the pain, swelling and stiffness associated with osteoarthritis (OA).

While the use of yoga is showing promise as a therapy, there are definite opportunities to learn more. It is important to note a few things regarding its effectiveness as a therapeutic modality. The range of yoga styles and instructors makes it very difficult to standardize yoga therapies, and thus, hard to compare outcomes to traditional therapies. The differences of the styles, instructor, location, class level and overall vigor of practice all have an effect on how a client will respond to the intervention. As studies regarding yoga become more robust, we can make better recommendations to athletes and clients regarding its use, but currently our knowledge is limited.

Conclusion

- Yoga can improve pain and stiffness of OA and improve chronic low back pain

- Yoga can improve balance, flexibility and strength

- Yoga can decrease stress, including the regulation of breathing and decreasing hypertension

- Yoga may have a positive benefit on PTSD, anxiety and depression

- Yoga may be useful as a complementary practice for treatments, but more standardization and research is required to make specific recommendations

Resources

Beutler, E., et al. (2016). Effect of regular yoga practice on respiratory regulation and exercise performance. Plos One, 11(4).

Chang, D., et al. (2016). Yoga as a treatment for chronic low back pain: A systematic review of the literature. Journal of Orthopedic Rheumatology, 3(1), 1-8.

Field, T. (2016). Yoga research review. Complementary Therapies in Clinical Practice, 24, 145-161.

Jeter, P., et al. (2015). Yoga as a therapeutic intervention: A bibliometric analysis of published research studies from 1967-2013. The Journal of Alternative and Complementary Medicine, 21(10): 586-592.

Park, C., Braun, T., & Siegel, T. (2015). Who practices yoga? A systematic review of demographic, health related and psychosocial factors related to yoga practice. Journal of Behavioral Medicine, 38, 460-471.

Woodyard, C. (2011). Exploring the therapeutic effects of yoga and its ability to increase quality of life. International Journal of Yoga, 4(2), 49-54.

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.

 

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Athletic Trainers Provide Psychological First Aid

Friday, October 28th, 2016

 

Posted October 28,2016

By Mackenzie Simmons, ATC

The theme for World Mental Health Day this year was Psychological First Aid. This theme ties directly to the care Athletic Trainers (ATs) provide on a daily basis to patients. Whether an athlete has suffered a season-ending or career-ending injury or has lost a loved one in their life, the AT will be there to assist with their mental and emotional well-being.

Mental health issues can affect athletes in a variety of ways. High school and collegiate athletes struggle with the stress of homework, practice and games. Professional and collegiate athletes spend a lot of time on the road, making it hard to see their families and loved ones on a daily basis.  At any level of sport, an athlete may suffer a serious injury and feel like they are losing a part of their identity. These factors can negatively impact the mental health of any athlete, causing serious and long-term issues if they are not handled in an appropriate manner.

The next time you are providing care to your patients, make an effort to look past the musculoskeletal injury of your athlete. Take a moment and look deep down to see how they are handling an injury or their overall participation in the sport emotionally. Many athletes are experts at masking their pain and appearing strong to continue with competition. However, deep down, they may be fighting some emotional battles that they are afraid to show.

By establishing a strong relationship with your athletes, they will likely begin to trust you more, thus allowing them to share their emotional and mental problems with you as well. We, as healthcare providers, need to bring mental health issues out of the shadows, and help our patients be physically well, as well as mentally and emotionally strong.

World Mental Health Day was celebrated worldwide on October 10 to help bring awareness to a variety of mental health topics while gaining support for these serious issues. Learn more about World Mental Health Day at http://www.who.int/mental_health/world-mental-health-day/en/.