I feel that this semester I have progressed tremendously in a few areas at my clinical site. I have been with Kris, mainly working with baseball players this semester. I have learned so much about general athlete maintenance. For example, there are a couple of baseball players who frequently use the athletic training clinic in order to feel at their best for the season. Some of the general things they do include flexibility work, trying to relieve muscle soreness, dealing with nagging muscle tightness unilaterally due to the nature of baseball, as well as other small things. A good way to work with athletes on maintaining flexibility is PNF stretching. I have been able to experiment with PNF stretches for multiple areas of the body with many baseball players this year. A great way to relieve muscle soreness is a cold whirlpool. There are a few of the guys on the baseball team who love a cold whirlpool after double headers. They claim that it really helps to decrease soreness in the days after a couple games. A great way to deal with muscle tightness is using the dolphin to do instrument assisted myofascial release. There are many athletes who love scraping because it helps them loosen up and increases blood flow to the area. I do enjoy working with the guys on my team. Working with these guys that I know well has really helped me with my confidence in the clinic. They are always joking around with me while I am completing any kind of treatment with them and this has helped me tremendously to be confident when I am trying new things. But that is also a double-edged sword. Since I am always with the baseball team I don’t get the chance very often to work with athletes in other sports. I think the worst thing about working baseball is how difficult it is to get my clinical hours while being with my team for the semester. I also do not get to clinically experience the games like the other students are able to, since I am playing at that time. This experience has been pretty similar to what I imagined it would be in January.
After taking my second BOC practice exam, I feel that I am making good progress. According to our clinical coordinator, Beth Funkhouser, everyone in the junior class is doing well for this point in the athletic training program. My scores in every category went up, and I actually did very well in three of the categories. There is one category that is giving everyone trouble right now, and that is rehabilitation. I think the reason rehab is so tough on everyone is the fact that all the questions that deal with rehab are very nit-picky. They are also the weird questions that have you match up certain exercises with certain stages of rehab, and these could be interpreted differently depending on who is taking the test. For example, one person might like to do one exercise with very little resistance early in a rehab, and another person might like to do the same exercise with more resistance later in the rehab. Technically both aren’t right, but according to this practice BOC, one of them is right and one is wrong. These types of questions are very hard for me, because somehow I tend to be the person that picks the wrong way to interpret questions like this (funny, but not funny). Overall I do like taking these practice tests, especially since we students do not have to pay for them. These practice tests are great in helping me and my professors determine where I am at in comparison with my classmates, and it will help my professors know what to focus on in class as we get closer to the day that I take the real BOC.
During my clinical experience this week I was able to work with one of the baseball players who fouled a ball off of his shin a couple weeks ago. By this time much of the swelling was gone but there was still some swelling hanging around that I was trying to get rid of. I decided that we should do ultrasound and laser to try and get some of the swelling off of his shin. It’s like there is a small little capsule just medial to his shin where all the swelling is located. The swelling would still not change at all with just ultrasound and laser treatments. I tried cupping after that. The cupping looked like it worked some, but still not as much as I would have liked for it to. I was taking the cup and suctioning right over the swelling, and moving the cup up the athletes leg and around to the back of the knee to try and get some of the swelling closer to a more lymphatic site. The athlete had to go to class right after this.
The next day the athlete came in and we tried to see if massage would help move the swelling. I massaged over the swelling and did the same thing as I did with the cupping, tried to bring the swelling up the athlete’s leg and to the knee. I saw that this was working pretty well so I continued for around 7 minutes. After I was finished with the massage I took another closer look at the swelling. It looked to me like almost half of the swelling was gone. The massage treatment must have worked well! I haven’t gotten the chance to work with the athlete anymore since then so I am not sure how he is progressing with this, but I will be excited to see how the athlete’s leg looks this coming week.
This specific occurrence kind of put another tool in my Athletic Training tool belt. I now know that if this type of injury ever happens again, I have a way to combat the stubborn swelling that will come with the injury.
One of my goals this semester is to become more knowledgeable about baseball arm care by researching and helping Kris Johnston plan a daily arm care protocol for our baseball team.
This goal has been going pretty well so far. Kris and I have looked over multiple arm care protocols, throwing programs, and training programs to help pitchers take care of their arm, and hopefully help them be at their best for every game they appear in. We have looked at a couple resistance band and throwing combination programs from Crossover Symmetry and a custom protocol that was created by the Baltimore Orioles Head Athletic Trainer. Kris was able to speak with him at a NATA convention and pick his brain about the Orioles pitching staff and their recovery and care protocol. He gave Kris a copy of his starting pitcher protocol since they are on a set schedule to throw around once every 6 days. Basically on day one the pitchers are on strict orders to not throw anything, or complete any upper body exercises, only lower body. Day two the pitchers have very light recovery training with resistance bands. Day three the pitchers can throw a flat ground bullpen with proper warm up. On day four the pitchers can throw a light bullpen off the mound. Day five is pretty much active rest with very little upper body work, and then day six is of course their start.
Obviously this can be very tricky when talking about relief pitchers, especially closers since there is a possibility that they could throw 5 games in a week. The good news here is that they are normally limited on pitches due to the fact they only throw one inning a game. For these players almost all of their arm care during the season is done on off days, and what is not done on off days is very low intensity and duration.
The crossover symmetry program is much broader and can be manipulated more just due to the vagueness of the program. Basically this program lets the coach or AT decide when it would be a good time to throw a bullpen, and only focuses on the resistance band exercises, and which exercises should be used on what days. There is a recovery exercise set, a warm up exercise set, and a strengthening exercise set for the shoulder. This program also does a good job of incorporating exercises that benefit the muscles around the elbow.
Overall I feel like I am accomplishing this goal. I have learned a great amount of information about how to help pitchers take care of their arms. The only problem now is putting it into action with the baseball team.
Athletic Training is more than just filling up water bottles and checking to see if the “star athlete is o.k.” This week’s journal prompt discusses the NATA slogan. “Your Protection is Our Priority” How does this promote AT? This slogan promotes athletic training an a couple ways.
First, the slogan includes the word protection. The main job of an athletic trainer is to prevent and protect from injury. Whether this involves prescribing someone an ankle brace or doing preventative exercises for back pain this is still the main focus of athletic trainers. Without injury prevention, there would be more athletes hurt, more athletic programs suffering, and multiple unhappy coaches. In my opinion, most coaches and athletic programs have no idea how much athletic trainers do to hold together every team and every athletic program. In my opinion, the majority athletic trainers are not recognized enough for what they do. Overall, protection and prevention are our main focus.
The next part of the slogan “our priority” is pretty self-explanatory. Our job as athletic trainers is injury prevention, injury management, and rehabilitation for the most part. Many programs, athletes, and coaches do not realize that this really is the main priority to athletic trainers. Athletic trainers do help all kinds of athletes in various ways. From what I have seen so far in my clinical experience, the priority of an athletic trainer or student is to protect people.
I believe that this slogan promotes athletic training very well. It gives the community around us an idea of what our goal is. It gives athletes a feeling of peace that we are there for them, and to make sure that they are physically at their best for every contest. It gives coaches the confidence that if anything does happen during a game or match that we will be there to assist the best that we can, and hopefully resolve or diagnose anything that could happen at a game. It gives an athletic department faith in their athletic training staff.
This is a great slogan for the NATA. I feel that athletic trainers and athletic training students can apply this slogan to their clinical practice and hopefully use its meaning to become better clinicians.
This week during my clinical experience, I was able to work with a few of the baseball players on either their rehab, or preventative conditioning. There is one person that stands out to me that I have been working with lately. The athelte has been doing great with his rehab since his ACL surgery and has finally gotten back all of his extension and much of his leg strength. This week Kris kind of put me in charge of the athletes rehab for a couple days because we were scheduled at the same time. I decided that the athlete needed to continue to strengthen his quads as well as his hamstrings and glutes, as well as work on some balance exercises and maybe mix up some of the monotony of his rehab. The athlete’s physician also cleared him to start doing some running work so he was pretty happy about that, which is completely out of character for him! Thursdays rehab looked a little bit like this.
Jog 10 min. treadmill
Wall sit with ball squeeze 5x1 min, 30 second break
Leg extension machine 3x10
Hamstring curl machine 3x8
Leg press 3x8
Squat free throws (will explain later) 2x15
Balance pad ball toss (with baseball) 5x1 min.
Hamstring PNF stretching
With the leg extensions we went up in weight each set as tolerated. The athtlete finished at 120 lbs. and said he was finally feeling like he had most of his quad strength back. Leg curls were the same; we finished at 120 on the machine. For the squat free throws, I made him do 5 deep squats every time he missed a free throw, which he missed quite a few, He ended up doing 60 squats there. The athlete did well with the Balance pad tosses so we will have to progress that some more here this week. I enjoy doing this athlete’s rehab with him because I feel like I know him very well and I know how to push him to just the right point. Towards the end of the athlete’s rehab he sometimes gets to where he is trying to find ways to cheat reps, or he gets tired and doesn’t do them to his full ability. I feel like adding the free throws and baseball toss at the end of his rehab gave him something to push toward and look forward to at the end of his rehab. Overall, doing this and knowing how to change someone’s rehab to help them push themselves harder will help me and my athletes in the future because it may cut down on recovery time.
I completed 12 attempts this week in my clinical packet.
Compare and contrast your clinical placement from last semester to the one you are experiencing now. What do you enjoy about each, what makes each unique? What challenges have you faced at each? How have these experiences affected you?
Last semester I was placed with Bre Davenport, Washington County Schools head athletic trainer. This semester I am placed with Kris Johnston here at Emory and Henry College. Last semester was really fun, being in a different setting rather than being at Emory. I got to see the high school side of things, which included some major differences such as team managers, a much smaller budget, many more athletes for just one athletic trainer, and many more games going on at one time. In the high school most of what we experienced were games for volleyball, football, wrestling or basketball. It was really neat to get to be a part of all the different sport’s games, and to see how each differed from the other in terms of injury management and things of that nature. It was also pretty neat to be with someone that was not affiliated with Emory and to see how they do things differently. For example, Bre was in charge of 4 athletic training rooms total, even though they were small. We would be in any of those 4 rooms at any given time, depending on which school we were at and what games we were covering. It was a great experiencing how Bre was able to keep up with this many places and athletes at one time, with only one assistant athletic trainer. With all of the teams having a manager, we never had to fill up coolers or cater to disrespectful players who wouldn’t put their water back where they got it. I feel like here that is an issue. For some reason I feel like a lot of the athletes do not respect all of what the athletic training students or the certified athletic trainers do for them. We also got to see a different side of the rehab part of athletic training at the high schools. Often with more serious injuries, the athletes would go to a physical therapy clinic to do their rehab, and Bre would work with the physical therapists to make good decisions regarding practice load and return to play for these athletes. Overall I have enjoyed my experience both off site, and here at Emory. They have both taught me many things about the profession.
The occurrence I am going to talk about for this journal will involve something I saw and discussed this past weekend while playing baseball at Covenant College. This past weekend while I was playing first base our pitcher picked over to first to try and pick off the runner. The ball was overthrown and out of my reach and hit the base runner about 8 inches under his arm pit, right on his ribs. The runner was having trouble breathing and my immediate thought was that he just got the wind knocked out of him due to the ball hitting him at a pretty high velocity in a relatively unprotected area. After no more than 10 seconds the athlete began coughing, and began spitting out blood. Their Athletic Trainer came over to assist the athlete. The athlete’s rib compression tests did not cause any pain so the chance of a broken rib was ruled out. The Athletic Trainer then took the athlete out of the game and took him to the sideline.
This past fall at a football game we had an athlete that got hit by someone’s helmet in a similar area, and began coughing up blood. Initially this athlete was coughing up more blood than the one at the baseball game this past weekend. Bre began evaluating the athlete and called the paramedic over to assist. After listening to the athlete breathe the paramedic determined that the athletes ribs were fine, and there was no concern that the athlete had a punctured lung. The paramedic and Bre determined that the athlete had suffered a ruptured alveoli. At the time I had never heard of this injury. The paramedic and Bre agreed that this injury wasn’t too much to worry about at that specific time unless the athlete’s condition deteriorated after he was taken out. This brings me to the occurrence that happened this past weekend at Covenant.
After the game I walked over to their Athletic Trainer and told him that I was an Athletic Training student at Emory and we spoke a little about the injury. I told him about the occurrence that happened while I was experiencing the football game this fall, and he seemed pretty appreciative about my ideas. He told me that this had never crossed his mind as a possibility in the baseball player’s injury. This occurrence truly made me realize how much I have learned so far during my Clinical Experience. It made me feel pretty good about my education on this subject. It was also great to help someone in the same field as me with a possible diagnosis. I gave the AT my email address so that he could maybe let me know what happened with this athlete, and to see if the information I provided was accurate.
Discuss your Therapeutic Interventions Case Study. How do you feel about this challenge? What excites you? What worries you?
My therapeutic interventions case study is with a volleyball player that is post-surgical from a rotator cuff and labrum injury. The athlete is 5-6 weeks post-surgical. I have been creating her daily rehab program as well as trying to instruct her while she is doing her rehab when I can be there. Lately it has been tough to be at her rehab sessions because we both have classes around the same time during the day, and she usually schedules her rehabs in the middle of baseball practice. Hannah and I have been trying to find a time at least a couple days a week that the patient can come in to do rehab when I am not practicing or in class. So far this has been the only problem I have had with the case study. I feel like this will be a good challenge for me, and I feel that I will learn a whole lot more about shoulder rehab techniques and programs from doing this case study. I think the patient will be good for me because she seems to be motivated to complete her rehab sessions and get back to playing volleyball. I am excited about doing this project because I feel like it will help me in the future, as well as help me understand some of the methodology behind a labrum and rotator cuff injury rehab. I am also excited to pretty much be doing this study on my own. I really like being “let loose” to do something that I come up with. I feel like that is a great way to learn the correct way to do things. Even though I am pretty much on my own with the rehab design, Hannah is always there to correct me on anything that may not be correct during the patient’s rehab. I am not really worried about too much at this time. As of right now I’m only worried about possibly pushing the athlete too hard, or not progressing quickly enough. I don’t want the athlete to take too long to recover because the rehab program isn’t challenging enough, but I also don’t want to push the athlete too hard and cause set backs.
I did not complete any attempts or masteries this week, but I did do quite a few things that I will be able to write down in my book.
Who is your primary preceptor this semester? How do you feel about your placement? What are you excited about, nervous for, etc? What do you hope you will gain from this experience?
My primary preceptor this semester is Kris Johnston. I really like my placement, especially since I get to experience with basketball, and I will even get to have some experience with baseball when we have split practices. I really like being with Kris. He is very good with various manual therapy techniques and different taping methods, which was part of my goals for this semester anyway. I also like Kris being my primary preceptor because he is easy to work with. If something comes up he always understands and doesn’t fly off the wall about small things. Kris is also always willing to take the time to teach me and other students about various new things that we may have not learned yet in class. Kris also always provides good feedback while I am doing an evaluation or when I am doing some type of therapy with someone, which is helpful for learning the proper way to do things. Kris also lets me do many things on my own in the clinic, while watching from a distance, and gives me feedback. This helps me make my own decisions in the clinic. He is also very good about letting me get more hours when I need them. For example, on Saturday’s basketball game, he let me come in for an extra hour to help out with baseball treatments. It doesn’t sound like much but everything helps during baseball season when sometimes he can’t schedule me in the afternoons due to baseball. I am very excited to work with Kris because it seems like I learn something almost every time I get to experience with him. He is always giving me feedback when I am in the clinic and it really helps me build my skillset. The only thing I am nervous about is not getting enough hours during the semester due to Kris being my preceptor, and him covering baseball. I am sure it will all work out though. I hope that during this semester I will be able to learn a few things. The first being more things about taping and tape modification in specific circumstances. Another thing I hope to learn more about is various manual therapy techniques. The last thing I really want to get out of this semesters clinical experience is to learn more about upper extremity injuries, as well as methods to prevent them.