Posts Tagged ‘athletic training’

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.

 

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. 

 

In-Depth Look: Assistant Athletic Trainer for The Original Harlem Globetrotters

Monday, December 19th, 2016

Posted December 19, 2016

Austin Burns, ATC is the Assistant Athletic Trainer for The Original Harlem Globetrotters. The Harlem Globetrotters are an exhibition basketball team that combines athletics, performing arts and comedy.

Describe your setting:

I work in a setting with a mixture of professional sports and performing arts.

How long have you worked in this setting?

I have worked in this setting for a little over a year and will be beginning my second tour this holiday season.

Describe your typical day:

Depending on the city we are playing in and how far we have to travel to the next city, my day will typically begin around 6:00am. We are usually on the bus by 8:00am and then off to the next location. After traveling for roughly 4 to5 hours, we check into our hotel and grab a quick lunch.

Afterwards, I head to the arena to meet up with our production and equipment truck. I’ll start by meeting with the arenas facility manager to locate the locker rooms and familiarize myself with the layout of the building. I’ll then help the truck driver unload all of my equipment and supplies; this is usually in a hallway somewhere.

The players, coaches and remaining staff arrive to the arena around 4:00pm and hold a walk through practice. At 5:00pm, I begin all of the pregame routines including stretching, taping, prehab exercise, and various other treatments depending on the needs of the athletes. At 6:45pm, the pregame entertainment begins so I’ll end all treatments and get changed for the show. The show starts at 7:00pm and runs for 2 hours.

During the show, my primary focus is no different than any other Athletic Trainer (AT). I manage acute injuries, perform wound care, make sure the athletes are hydrated and stay alert for anything out of the ordinary. Following the end of the show, the athletes have an autograph session for 20 minutes. I use this time to make ice bags, pack my equipment, load the truck and perform any additional treatments.

By 10:00pm, we are back on the bus and on our way to the hotel. Once in my room, I enter in the medical notes for the day and try to get to bed by 12:00am so I can repeat it all the next day.

What do you like about your position?

What I like most about my position is how creative and adaptive I have to be when working on location. Not having a designated room to perform treatments and exercise can be very challenging. Most days, I find myself performing corrective exercise and prehab on the bus, manual and soft tissue therapies in the hotel room and ice baths in the hotel room tubs. This can be difficult when working with athletes who are all over 6 feet 5 inches tall and can’t fit in the seats, beds or tubs.

What I also love about my position is getting to see the joy people experience when coming to one of our shows. So many children and adults leave the game smiling and laughing. To know you helped make that happen is really rewarding.

What do you dislike about your position?

The hardest part about the position is being on the road for 5 to6 months at a time. Being away from friends and family can start to take a toll on you. Fortunately, you begin to develop a small family with the athletes and staff involved in the production, which helps with the home sicknesses.

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

The advice I would give to any young AT looking at this setting would be to go for it!

Don’t think because you have only worked in football, baseball or basketball your whole career that you can’t tackle performing arts or any other setting. I have become a more well-rounded AT because I chose to challenge myself by working in new and different settings.

I was very nervous when I started in this position but am grateful I made the decision to take on this role.

 

 

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In-Depth Look: Athletic Trainer for the United States Soccer Federation

Monday, November 21st, 2016

Posted November 21, 2016

Steven Bagus, ATC, NASM-PES is an Athletic Trainer for the United States Soccer Federation.

Describe your setting:

I work with the United States Soccer Federation (USSF). In this setting, I work with a variety of national soccer teams at a variety of locations. This setting allows for a great deal of travel and the opportunity to work with athletes of different ages.

The diversity of coaches, athletes and staff members provides a constantly changing atmosphere. This setting forces me to use all of the tools in my athletic training box. Learning the health history of the players, their needs during training camps or tournaments and the expectations of the coaching staff in a short time frame and an unfamiliar environment helps me to be a more dynamic Athletic Trainer (AT).

How long have you worked in this setting?

My first experience working with the USSF was in 2009, but I entered my current role in January 2016.

Describe your typical day:

A typical trip working for the USSF involves meeting the team at an airport to travel together for international trips or traveling to the location of a domestic camp.

The camp begins with setting up your athletic training facility, typically an empty hotel room. A typical camp has an average of 12 boxes of athletic training supplies. Once your functional athletic training facility is set up, it is important to review the physicals for each athlete. Each day of camp can be different depending on the needs of the team.

As the AT, I am expected to join the team for all team meals, prepare the athletes for practice and games and evaluate and treat the athlete’s post-activity. Each day is exciting, challenging and demanding but can be a very rewarding experience as an AT.

What do you like about your position?

I love that this position allows me to travel all over the world with the highest level of athletes.

What do you dislike about your position?

The biggest challenge of this job is learning the needs and expectations of different athletes and coaches on a regular basis.

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

My advice to young professionals looking for this setting is to be very flexible and excited to help the team accomplish their goals. If you are interested in working for a national program, seek out the medical administrator and see where you can help.

 

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/.

 

Self-Care for Athletic Trainers: How to deal with stress, long days and an intense work environment

Tuesday, October 25th, 2016

Posted October 25, 2016

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

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

For years researchers have been interested in methods to help combat stress and burnout in healthcare fields. Studies have shown that an increase in fatigue, insomnia, depression, heart disease and other psychological and physiological ailments can be attributed to stress in the workplace. Other byproducts are decreased patient satisfaction and reduction of a clinician’s attention and concentration, which can reduce their decision-making skills and concentration.2 Obviously, to us in the healthcare field, reduced decision-making skills and decreased patient satisfaction are detrimental to our jobs. However, the physiological and psychological effects on the clinician are detrimental to our health and well-being.

So what are some ways to combat this stress in the workplace? The research is clear that exercise is one of the best ways to combat stress.1 Not only does exercise release hormones that are mood boosters, but it helps you expel aggression and focus your mind on something other than work. Other proven ways to combat stress include seeking outside help, broaching the subject at work to create a better work environment and meditation. Let’s take a deeper look into these less utilized options.

Outside help: There is a stigma in our society that, “only crazy people go to psychologists.” This stigma is false! In fact, a high percentage of those seeking advice from psychologists do not suffer from any diagnosed medical condition. Many employers offer the services of mental health and wellness to their employees. You should take advantage of this great opportunity! If you still feel uneasy about a mental health counselor, seek out a friend, family member, significant other, clergy or other trusted individual to speak to about stressors or struggles at work. Sometimes the best way to combat your stress is to talk it out. Another great resource could be a sport psychology consultant who specializes in sub-clinical issues. They would not only be beneficial to us as professionals but also a useful resource for athletes during the recovery process.

At work: ATs struggle at 2 major things in the athletic training profession, including saying no and asking for time off. We all know that our field is highly stressful. We don’t dictate our own schedule a majority of the day, and sometimes are left out of the loop. This can lead to burnout. So how do we address it? Speak to our supervisor. Companies want to retain their employees, but there is a direct link between burnout and its effect on retention.3 Odds are good you are not the only one suffering from stress, and maybe there is a way to incorporate a stress reduction program into your work day. Another option is to look into classes being held at a local fitness center, which may offer a short lunch time yoga class.

Meditation: Yoga is an ancient form of exercise; its goal is to connect mind and body. Studies show links between yoga and reduction in stress and anxiety levels.4 Apart from yoga, meditation can help reduce stress. In our profession, we need to take the time to sit in silence. A simple practice of setting aside 5 minutes of your day to quiet your mind free of counterproductive thoughts, to-do lists and stress will do wonders for not only releasing stress but increasing your positive outlook on the rest of the day.

As healthcare professionals, we put the focus on others and sometimes forget about ourselves. If you find yourself suffering from increased amounts of stress at work or in general, that could be a sign to make more time for yourself. We cannot be at our best for others, if we are not at our best for ourselves.

Resources

1. Gicaobbi, P. R. (2009). Low Burnout and High Engagement Levels in Athletic Trainers: Results of a Nationwide Random Sample. Journal of Athletic Training, 370-377.

2. Irving, J. A., & Park-Saltzman, J. (2009). Cultivating mindfulness in health care professionals: A review of empirical studies of mindfulness-based stress reduction (MBSR). Complementary therapies in clinical practice, 61-66.

3. Mazerolle, S., & Eason, C. (2016). A Longitudinal Examination of Work-Life Balance in the Collegiate Setting. Journal of Athletic Training, 223-232.

4. Smith, C., Hancock, H., Blank-Mortimer, J., & Eckert, K. (2007). A randomised comparative trial of yoga and relaxation to reduce stress and anxiety. Complementary Therapies in Medicine, 77-83.

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.

 

You’ve Earned It: Time to Ask for a Pay Raise

Thursday, October 20th, 2016

Posted October 20, 2016

Beth Wolfe
CAGS, ATC

By Beth Wolfe, CAGS, ATC

Asking for a pay raise can be a daunting, intimidating and lonely process. However, with the right tools, advice and support, the pay raise process can be easier than you might think. In her article, Carolyn O’Hara provides several tips to ponder before asking for a pay raise, and below are 3 adapted pieces of advice that can be useful in preparing to ask for a pay raise.

1. Do your homework. How much of a raise should you ask for? Are you making the same as your peers in the area? One thing you must also keep in mind is that sometimes pay raises aren’t possible for certain positions due to circumstances beyond your control. Ask your employer if they provide merit based pay raises or if your salary is predetermined by another source such as grant monies or contract agreement via outside provider. If your institution does not provide merit-based raises, you could still ask for a raise based on what others in your area are being paid. However, if your salary is predetermined by an external source it may be difficult to obtain a raise unless the funding source agrees to a higher salary. Utilize a national salary database such as Glassdoor, Indeed or US Department of Labor to see what other people with your same job title are making in your area and across the country.

2. Take a moment to reflect on your value.  Why should your boss give you a raise? What is your worth or value as a healthcare provider? Do you offer a special talent or skillset that warrants a pay raise? From these questions gather evidence and formulate a list of facts, contributions and patient care statistics. Statistics could include hours worked, overtime worked, patient feedback and outcomes, and number of patient encounters by day, week and month. Be confident in your list of evidence and be sure to provide examples for each item on your list.

3. Ask for advice from others in your industry. If you are the only employee at your organization, ask a mentor or peer in your area how they navigated asking for a raise. Each organization will handle pay raises differently, but at least you can gain some relevant and real-time advice instead of asking blindly. Additionally, ask this mentor or peer if you could practice your “ask for a raise speech” with them so that they can provide you with constructive feedback. A practice session can help alleviate nervousness, jitters and anxiety you may have going into the discussion.

What happens if you are denied or don’t get a raise? Don’t get discouraged; it is okay! Have a back-up plan in place so you could compromise with your employer. For example, could you have additional flex-time for extra hours worked? Or you could discuss how you could take on more responsibilities that could lead to a future pay raise. Make note of the reasons for why you weren’t offered a raise this time so you can continue to build your case for a raise in the future.

Reference

O’Hara, C. (2015). How to ask for a raise. Harvard Business Review. March 5. Retrieved from https://hbr.org/2015/03/how-to-ask-for-a-raise.

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.

 

 

Osteoarthritis Prevention and Wellness Protection Strategies

Tuesday, October 18th, 2016

Posted October 18, 2016

By Jeffrey B. Driban, PhD, ATC, CSCS

How many Athletic Trainers (ATs) can remember a patient who tore an anterior cruciate ligament (ACL), returned to visit a few years later and described chronic knee pain and limitations with their favorite activities?

The Bone and Joint Health National Awareness Week is a great time to focus on injury/illness prevention and wellness protection strategies that can help preserve long-term health. This is particularly relevant if we consider that 37 percent of ATs think osteoarthritis – a chronic painful and disabling condition – is not a major health concern.1 Furthermore, only approximately 70 percent of ATs discuss with a patient their risk for osteoarthritis and strategies to mitigate this risk.

In contrast, over 80 percent of adults after an ACL injury believe that knee osteoarthritis would be a major health concern and only 27 percent recalled having a conversation with their health professional about osteoarthritis risks associated with their knee injury.2 While many patients focus on short- and medium-term goals like return to play, it is vital that ATs provide patients with information about what they can expect after an injury. Let us consider some key questions.

What is osteoarthritis?

Osteoarthritis – the most common form of arthritis – is a progressive disease that affects all the tissues in a synovial joint. Osteoarthritis reflects a failed attempt to repair joint damage that is caused by stress on a joint. Osteoarthritis can be thought of as a disease, which is defined by the structural changes in a joint like bone spur formation or cartilage damage. It can also be thought of as an illness, which is defined by a patient’s reported experience like joint pain or other symptoms.3

Is osteoarthritis a major health concern?

Over 30.8 million million adults in the United States have osteoarthritis.4 Osteoarthritis is among the top 15 causes of disability.5 Osteoarthritis causes over $10 billion in annual absenteeism6 and more than $185 billion/year in healthcare expenditures.7 Unfortunately, a patient is at risk for early-onset osteoarthritis after a joint injury. This is troubling because adults 20 to 55 years of age with hip or knee osteoarthritis are 4 times more likely to be psychologically distressed compared with their peers. Furthermore, 67 percent of these patients report osteoarthritis-related work disability and approximately 40 percent report reduction in quality of life.8

Which physically active individuals are at risk for osteoarthritis?

Most adults who take part in physical activity and sports are safe and possibly even protected against osteoarthritis.9 However, men in soccer and certain elite-level sports may be at greater risk for hip or knee osteoarthritis.10,11 It remains unknown if these specific sports cause osteoarthritis or if other factors are the culprits (for example, the amount of training the athlete performs, the types of injuries that occur or how we manage an injury). Among our patients, one of the strongest risk factors for osteoarthritis is joint trauma. Individuals with a history of knee injury are 3 to 6 times more likely to develop osteoarthritis.12 Within the first decade after a knee injury, 1 in 3 patients develop osteoarthritis.13,14 Hence, a 20-year-old athlete who tears her ACL is at elevated risk for osteoarthritis by 30 years of age, which could lead to knee symptoms and then have a major impact on her work and quality of life for decades.

What can we do to prevent osteoarthritis?    

An injury prevention program can reduce the risk of injury by 35 to 68 percent.15,16 Furthermore, lower limb injury prevention programs can improve performance, keep athletes on the field and be easily implemented in a team warm-up. Recently, the Osteoarthritis Action Alliance, of which the NATA is a member organization, released a Consensus Opinion on the Best Practice Features of Lower Limb Injury Prevention Programs (Executive Summary). The task force identified 6 core components that should be included as part of a training program for prevention of major joint injury among youth athletes:

1. lower extremity and core muscle strength training

2. plyometric - jump training

3. balance training (as part of a program)

4. continual feedback on proper technique

5. sufficient dosing and compliance

6. minimal to no extra equipment

Unfortunately, we are unable to prevent every injury. Hence, we need to educate our patients about their risk for osteoarthritis and secondary prevention strategies that could help delay or prevent the onset of osteoarthritis. Secondary prevention strategies include regular exercise and weight management. These concepts will be expanded upon in the Athletic Trainers’ Osteoarthritis Consortium’s review and recommendations on the role of ATs in preventing and managing post-traumatic osteoarthritis in physically active individuals. The article will published by the Journal of Athletic Training in Spring 2017.

It is important to recognize that ATs are in a key position to help prevent this chronic disabling disorder and have a lasting effect on a patient’s long-term health and wellness. So next time you treat an injury, think long-term and talk with your patient about their future risk of osteoarthritis and how they can help reduce their chances of getting it.

References

1.  Pietrosimone BG, Blackburn JT, Golightly YM, et al. Certified Athletic Trainers' Knowledge and Perceptions of Posttraumatic Osteoarthritis After Knee Injury. Journal of athletic training. 2016.

2.  Bennell KL, van Ginckel A, Kean CO, et al. Patient Knowledge and Beliefs About Knee Osteoarthritis After Anterior Cruciate Ligament Injury and Reconstruction. Arthritis Care Res (Hoboken). 2016; 68(8):1180-1185.

3.  Lane NE, Brandt K, Hawker G, et al. OARSI-FDA initiative: defining the disease state of osteoarthritis. Osteoarthritis Cartilage. 2011; 19(5):478-482.

4. Cisternas MG, Murphy L, Sacks JJ, et al. Alternative Methods for Defining Osteoarthritis and the Impact on Estimating Prevalence in a US Population-Based Survey. Arthritis Care Res (Hoboken). 2016; 68(5):574-580.

5. Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2013; 380(9859):2163-2196.

6.  Kotlarz H, Gunnarsson CL, Fang H, Rizzo JA. Osteoarthritis and absenteeism costs: evidence from US National Survey Data. J Occup Environ Med. 2010; 52(3):263-268.

7.  Kotlarz H, Gunnarsson CL, Fang H, Rizzo JA. Insurer and out-of-pocket costs of osteoarthritis in the US: evidence from national survey data. Arthritis Rheum. 2009; 60(12):3546-3553.

8. Ackerman IN, Bucknill A, Page RS, et al. The substantial personal burden experienced by younger people with hip or knee osteoarthritis. Osteoarthritis Cartilage. 2015; 23(8):1276-1284.

9. Urquhart DM, Tobing JF, Hanna FS, et al. What is the effect of physical activity on the knee joint? A systematic review. Med Sci Sports Exerc. 2011; 43(3):432-442.

10. Driban JB, Hootman JM, Sitler MR, Harris K, Cattano NM. Participation in certain sports is associated with knee osteoarthritis: a systematic review. Journal of athletic training. In Press.

11. Michaelsson K, Byberg L, Ahlbom A, Melhus H, Farahmand BY. Risk of severe knee and hip osteoarthritis in relation to level of physical exercise: a prospective cohort study of long-distance skiers in Sweden. PLoS One. 2011; 6(3):e18339.

12. Muthuri SG, McWilliams DF, Doherty M, Zhang W. History of knee injuries and knee osteoarthritis: a meta-analysis of observational studies. Osteoarthritis Cartilage. 2011; 19(11):1286-1293.

13. Harris K, Driban JB, Sitler MR, Cattano NM, Balasubramanian E. Tibiofemoral Osteoarthritis After Surgical or Nonsurgical Treatment of Anterior Cruciate Ligament Rupture: A Systematic Review. Journal of athletic training. 2015; In Press.

14. Luc B, Gribble PA, Pietrosimone BG. Osteoarthritis Prevalence Following Anterior Cruciate Ligament Reconstruction: A Systematic Review and Numbers-Needed-to-Treat Analysis. Journal of athletic training. 2014; 49(6):806-819.

15. Sugimoto D, Myer GD, Barber Foss KD, Hewett TE. Specific exercise effects of preventive neuromuscular training intervention on anterior cruciate ligament injury risk reduction in young females: meta-analysis and subgroup analysis. Br J Sports Med. 2014.

16. Emery CA, Roy TO, Whittaker JL, Nettel-Aguirre A, van Mechelen W. Neuromuscular training injury prevention strategies in youth sport: a systematic review and meta-analysis. Br J Sports Med. 2015; 49(13):865-870.

About the Author

 Jeffrey B. Driban, PhD, ATC, CSCS is an Assistant Professor in the Division of Rheumatology at Tufts University School of Medicine and Tufts Medical Center. The goal of his research is to explore novel biochemical and imaging markers to gain a better understanding of osteoarthritis and potential disease phenotypes. Dr. Driban received his Bachelors of Science in Athletic Training from the University of Delaware. He received a Masters of Education and Doctor of Philosophy in Kinesiology with an Emphasis in Athletic Training from Temple University. He completed a post-doctoral research fellowship in the Division of Rheumatology at Tufts Medical Center where he continued his osteoarthritis focus. Dr. Driban also aims to raise awareness about osteoarthritis and promote primary and secondary prevention strategies for physically active individuals as the Chair of the Athletic Trainers’ Osteoarthritis Consortium and by serving as a National Athletic Trainers’ Association’s representative in the Osteoarthritis Action Alliance and Chair of the Alliance’s Osteoarthritis Prevention Work Group. Dr. Driban is also co-founder of Sports Medicine Research Company, which provides a blog and podcast focused bridging the gap between research and clinical practice related to sports medicine.

 

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Medical Therapeutic Yoga Series: A New Movement in Healthcare

Monday, October 10th, 2016

Posted October 10, 2016

Desi Rotenberg
MS, LAT, ATC

By Desi Rotenberg, MS, LAT, ATC

Medical therapeutic yoga is a new movement within the rehabilitative realm that is quickly becoming more widely accepted as a pragmatic route to improving physical, emotional and mental well-being. There has been a paradigm shift within the medical field, as yoga therapy becomes more and more integrated into healthcare. Furthermore, yoga therapy is becoming more popular in the treatment of musculoskeletal injuries.

The core premise and philosophy behind medical therapeutic yoga is to understand your own limitations to be able to deliver the safest and best care possible. This includes a comprehensive understanding of the human anatomy and the treatment of specific diseases, disabilities or disorders. Additionally, in order to become a yoga therapist, a medical professional must have knowledge of indications and contraindications for safe breathing practices, as well as a strong knowledge base in various yogic practices to ensure patient safety.1

In 2012, the International Association of Yoga Therapists (IAYT) advisory board approved the educational standards for the training of yoga. This approval opened the door for medical therapeutic yoga to be held to competency-based educational standards. Although, Yoga Therapy is not governed nor regulated by the IAYT. The focus is on entry-level requirements for the training of yoga therapists and includes a definition of yoga therapy and training requirements. The goal for any organization when developing competency-based standards “is to define the foundational knowledge and skills required for the safe and effective practice of yoga therapy.”2

The Scope of Practice for yoga therapy can be found here: http://www.iayt.org/news/308692/IAYT-Updates-Scope-of-Practice.htm.3

The Professional Yoga Therapy Certification can be a post-certification option for Athletic Trainers who are interested in furthering their knowledge base. The Professional Yoga Therapy Institute (PYTI) is one of several institutes who offer both continuing education courses and a full professional certification.

The PYTI defines medical therapeutic yoga as “the practice of yoga in medicine, rehabilitation, and wellness settings by a licensed health care professional who is completing or has graduated from the Professional Yoga Therapy Institute program and has been credentialed as a Professional Yoga Therapist-Candidate or Professional Yoga Therapist.”4

Becoming a medical yoga therapist is not for everyone. While knowledge is essential to a medical professional’s success as a practitioner, the journey of accruing wisdom holds an even greater weight. The uniqueness of this new field focuses on the well-being of the patient, while also ensuring the individual who practices medical therapeutic yoga is able to achieve a balance within every aspect of their life, both professionally and personally.

More information on medical yoga therapy and becoming a professional yoga therapist, can be found at the following websites:

International Association for Yoga Therapy- http://www.iayt.org/

Professional Yoga Therapy- http://proyogatherapy.org/

Medical Therapeutic Yoga- http://www.gingergarner.com/therapies/medical-yoga/

Resources

1. Garner, G. (2007). The Future of Yoga Therapy and the Role of Standardization. International Journal of Yoga Therapy, 17(1), 15-18.

2. Educational Standards for the Training of Yoga Therapists. (2016). http://www.iayt.org/?page=AccredStds. Accessed September 27, 2016.

3. Scope of Practice for Yoga Therapy, (2016). INTERNATIONAL ASSOCIATION OF YOGA THERAPISTS. http://c.ymcdn.com/sites/www.iayt.org/resource/resmgr/docs_certification/scopeofpractice/2016-09-01_IAYT_Scope_of_Pra.pdf. Revised: September 1, 2016.

4. Professional Yoga Therapy Institute, (2016). http://proyogatherapy.org/about-pyts/. Accessed September 27, 2016.

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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