Tell us about your research project for ATR 462. Why are you interested in this topic? What have you learned so far?
For my research topic for 462, I decided to look again at blood flow restriction training, or BFR training. I feel as if I still didn’t get a great idea of the clinical implications of BFR training thorough my clinical questions, and wanted to continue research on it. Hopefully in the future I will be able to use this in clinical practice, or at least be able to know exactly how well it works and what the indications for BFR training are. I am interested in this topic for a few reasons. The first reason is the way it was brought to me. One of my coaches asked me about BFR training a little while back, probably sometime during my first semester junior year. I really had no idea about it so I decided to give it a google. Everything that I found on BFR training was related to bodybuilding. Body builders were using it claiming that it rapidly increased strength and hypertrophy. At this point I am thinking, if this works for body builders, why would it not work for injured athletes. The second reason I wanted to continue this research sort of builds on the first. I noticed after completing the first round of research on BFR training, that pretty much the entire bodybuilding community was using this technique wrong. They would pretty much completely cut off blood supply to the extremity being trained, and do multiple sets, without letting the blood flow back into the extremity. From everything that I had seen and read about the rehabilitation side of BFR, this seemed way wrong. So for reason two, I wanted to continue the research on BFR training in order to hopefully find what implications this treatment has on health issues such as a blood clot, etc… The third reason I wanted to continue this research is to hopefully become somewhat of an expert on this topic. I want to do this just so that I can use this type of training in the future and have something that everyone else doesn’t have. I like the idea of some type of certification in BFR training, just so people would realize that there are potential dangers when someone does this without prior knowledge or the incorrect way.
This week my clinical experience was pretty exciting. I was able to clinical for a basketball game as well as some practices and just some treatment/rehab time. On the day that I was able to do the general treatment and rehab time slots, I was able to complete 2 evaluations. One of them really stuck out to me just from the results and the diagnosis that I was able to formulate from my examination findings. The athlete came into the clinic with knee pain that was pretty severe at times, especially when running. The athlete reported that they felt their knee pop while kicking a soccer ball, and that they had felt this same pop with pain a couple weeks before while doing a specific stretching exercise (crossover knee pull). During my evaluation the athlete had noticeable but minor deficits in active knee flexion range of motion, but showed equal strength in all knee ranges of motion with slight pain during knee extension. The athlete’s pain was located just under the medial patellar tendon. Due to the location of pain, and the athlete reporting that the pain felt like it was coming from deep in their knee, I was generally worried about the meniscus or the ACL having suffered damage. After a battery of tests, I determined that it was neither the ACL nor the meniscus, and kept doing other tests for the MCL as well as the LCL, without getting any positive tests. I then went back and did more palpations on both knees without finding any differences in actual palpations, but finding a location that seemed to elicit pain, right over the medial patellar tendon. At this point I was kind of stumped, mostly due to the athlete’s mechanism and their report of where their pain was located. I called over Chaypin to look over the things I had done, and do some special tests of her own just to see what we thought. After we briefly talked about my findings compared to hers, we came up with a diagnosis of patellar tendonitis. This evaluation really reminded me that I always have to keep an open mind about whatever I am evaluating. Even though the athlete could be reporting pain in a slightly different location that where the injury has occurred, I need to keep in mind that the athletes perception of pain location could be somewhat flawed, due to multiple factors. The athlete has been doing rehabilitation for the patellar tendonitis and is showing signs of improved pain levels, so at this point it looks like I have done a pretty good job with the evaluation and diagnosis of this athlete’s injury.
For your journal, you should reflect on your experiences.
You can select from either of the following prompts:
I do believe that trust is one of the most important factors between the patient and the clinician. Trust affects multiple things, if not, everything and every part of the healthcare system. Trust can effect how effective a treatment is, due to the fact that without trust, the patient may have negative thoughts about the treatment they are receiving, and that could render the treatment less effective just because of the power the brain has in the healing process. I believe one of the best ways to gain trust with a patient is to be fully honest with them, as well as all of your other patients. Especially in the Athletic Training setting, our patients often talk to each other about going into the clinic for rehabilitation or treatment because they are sometimes on the same team. If they are talking to each other, and I as a clinician were to treat one differently in terms of honesty about whatever is going on, and about their treatments, whoever was getting the short end of the stick would definitely have some apprehensions about seeing me again when something went wrong. Another good way to gain a patient’s trust is to treat everyone the same way, and in a good way. When people start seeing that a clinician is treating them differently, they will again have apprehension toward that clinician. When I am in my clinical experiences, I try to treat everyone the same. It doesn’t matter if they are one of my good friends, or if I don’t even really know their name. I always try to treat everyone the same way. One more way to gain a patient’s trust is to have meaningful conversation with them when they are in the clinic for evaluations, therapy, or rehab. This is one of the best ways to increase a patient’s trust. Overall, patients that trust their clinicians will have better results with treatments, evaluations and rehabilitation. I believe that this is one of, if not the, most important part of a patient-practitioner relationship, and without trust, the patient will never have the best outcome with whatever intervention is performed.
So far I have been doing a couple of things to prepare for my BOC exam. First, the practice BOC exams that have been scheduled, and the one that I have already taken have helped me learn the areas that I am pretty strong in, as well as the domains that I need to improve. I feel that I did fairly well on the first practice exam that I took. Even though the results were pretty good, I would like to be a few points higher in each section just to feel more confident about the exam. I think that writing down the problems that I had trouble with on the practice exam have also helped me study. It is nice that we can take out those notes that we wrote down and discuss them in class with our professor, as well as take them to our clinical sites and discuss them with our preceptors, just to get a couple different points of reference about how to answer those types of questions in the future. Another way I have been studying is by doing about 10 of the practice problems out of my BOC prep study book every day, and comparing my answers to the correct answers for those questions. Overall I feel that these two study methods are great because I have some instant feedback with both, and I am able to make corrections as well as learn how to answer the types of questions that I missed in the future. I feel that I am almost ready to sit for the BOC exam, and have great results after taking it. I believe that the Emory & Henry Athletic Training Program has prepared me very well to become a certified Athletic Trainer.
a) Look back and reflect on your years in the Athletic Training Program...what are you taking forward to your final semester?
How will this change your approach to your clinical and classroom experiences? What goals are you setting for yourself?
Over the years in the Athletic Training program, many things have happened that have been tough, but yet they have also been educational and helpful. I can remember the multiple evaluations that I have completed, where I felt like I had no clue what to do next, or like the condition just completely stumped me. I remember being the young class in the AT program, looking to try and learn many things from the older students, trying to figure out how to do evaluations and just try to learn the swing of things. Now most all of this has past. Now the freshmen are looking up to me, some of my preceptors ask me to check and make sure the freshmen are doing their evaluations right, and they ask me to help some of the younger kids with their evaluations. I am really looking forward for starting to apply for future jobs. Hopefully I will be able to get some type of entry medical sales position, and in the next 3 years, be able to secure a job as an Orthopedic Sales Representative.
Overall all of this put together will change the way I approach this semester. I feel that when looking at actual difficulty of the classes I am taking, I have a relatively easy semester. I am only taking 12.5 hours since this is all that I need to graduate. I feel as if I will be able to spend more time on each individual class this semester instead of having to allocate more or less time to specific classes based on how important I believe they are. Overall I should make better grades in general this semester. I also believe that since this is my last semester, I will know more than ever, and I will be the most confidant I have ever been in the AT clinic. Overall, I feel that this semester will be the best that I have had so far. My goals for this semester are really just to do well in all of my classes, and begin applying for jobs, and hopefully getting an interview scheduled for shortly after I leave here for the summer.
Reflect on your progress with the completion of your clinical packet? Was the goal you set achievable? Realistic? Will you approach your clinical packet differently next semester of have you found a system that works?
This semester I have been pretty behind on filling out my clinical packet. As of right now I have written up 55 attempts, 11 masteries, but still need signatures on many of them. I think the goal that I set, to complete 6 masteries a week, was reasonable, but I was not diligent enough to do what my goal states. I believe that a lot of it had to do with the rigor of this semester for me. I am taking 4 classes that require much time outside of class and clinical. Those classes are Connections, Human Anatomy, Physiology (which also requires us to complete a service learning project on top of all the clinical hours I am required to get each semester), and Art. Art takes up a ton of time. In order to keep a good grade in there, I would say that I spend 8-10 hours per week working on various assignments, and often more than one at a time. Another reason that the attempts number is so low is because we are supposed to be getting quite a few attempts from organization and administration projects, but the class is WAY behind, and we haven’t turned in any projects yet (there are 5 pretty large group projects that are due in… about 2 weeks…). The goal was very realistic if I would have kept up with it better during the semester. I will definitely approach the clinical packet differently next semester because I cannot afford to get behind. With 40 baseball games in one semester, getting behind would cause me to do very poorly in my classes, and in baseball, and even could effect whether or not I graduated on time. Overall I have learned one big thing from my clinical packet goal… follow it, and don’t get behind!
What domain of AT (5 domains) do you feel most confident with, which one do you consider to be your weakness? What do you think would help you to strengthen your weaker domains?
I feel that I am the most confident in the injury prevention domain of Athletic Training. I am good at detecting movement patterns that could potentially cause someone to be at a higher risk for injury. I also feel that I am good at crafting things such as braces that can help an athlete prevent injury. I am also the most interested in this domain of Athletic Training. I feel that some of the best insight I have had was during my clinical rotation with Kris Johnston. We spent a lot of time looking at risk factors in baseball players, specifically pitchers and arm injuries. Some of the things I learned from this included; proper strength ratios between anterior upper body muscles and poster upper body muscles, how arm slot and “springiness” can affect a pitchers risk for injury, how band and weighted ball programs can decrease risk of injury when used properly, and many more things. Overall I believe that injury prevention is my best domain of the 5 in Athletic Training.
I believe that my two worst domains are organization and administration, and rehabilitation. I think that organization and administration makes me less confident because I am still in that class, and I really feel like I am not learning all that much in organization and administration right now. We haven’t really even turned in any assignments in there other than ones that just felt like busy work, and now since we are just getting assigned 4 LARGE projects at one time with really no time to complete them properly. With that said, I feel that I have the least amount of knowledge in the organization and administration domain. I think that my second largest weakness is rehabilitation. Honestly I don’t really know why I feel this way about rehab. I had a pretty good project and outcomes with my case study last semester, even though the patient’s compliance was terrible. I feel that I can design a pretty good rehab program. Sometimes I just get a little confused on how fast to progress the athlete. I believe that part of this is due to the fact that everyone heals differently in different time frames. But even so, sometimes I have a little less confidence in this domain.
Describe a treatment you performed/designed. Why did you select that? What was your intended outcome? How did you assess its effectiveness? How will that experience influence your future clinical decision making?
I performed an ultrasound on a football player about 2 weeks ago that had been having some distal hamstring pain and tightness. Every day we had been stretching the athlete before practice and according to the athlete it didn’t really help him that much during practice. The problem was that the athlete never came in during rehab and treatment hours according to Cole. I was sitting there wondering how the athlete ever expected to get any better without ever showing up to treatment in order to address the issue. I decided to try continuous ultrasound in order to try and loosen and heat the tissue that had been giving the athlete trouble during practice just to see if we could do something different that had better outcomes. Immediately after finishing the treatment the athlete said that it felt better than when I began the treatment. The athlete went out to practice and said that he had very little trouble out of the hamstring that day, just a little bit of tightness. So overall I would say this is the way I assessed the outcome. The athlete preferred the ultrasound over the stretching before practice to relieve pain. Now it would be great if the athlete would actually come in during rehab and treatment hours in order to do some flexibility training and to really get the hamstring to 100%, but of course, that doesn’t happen all the time. Overall I think that I will begin to think about ultrasound and stretching for athletes that have hamstring issues, before games or practices, along with flexibility training every day during treatment hours.
Reflect on your progress on one of your clinical goals.
One of my clinical goals are to “learn more about blood restriction training and rehab by studying this topic, and completing my little clinical question. So far I haven’t done a whole lot with this goal other than begin to look at some things related to it. So I have been looking at some videos and online forums that discuss this topic, mostly in the bodybuilding world. I have talked with coach Wyatt Briggs, our new strength coach, about some of the things he has heard about this topic. He showed me a website that has the proper equipment and teaches how to use blood restriction training properly. The site is Kabuki strength. They sell the cuffs that are used to restrict blood flow as well as books that talk about how to use this training method properly to achieve maximum size and strength gains. Still, most of the information I have found has not been related to rehabilitation, just to hypertrophy and strength gains. It is kind of funny to see all of the videos of people doing it online and doing it improperly. Many people will use some type of large rubber tubing or band to restrict the blood flow, and even completely stop the flow of blood, which is completely wrong. They are literally setting themselves up for massive injury and even blood clots. There are even people that are shown using modified belts, and they will tighten them as tight as they can get. Even with all these improper techniques, I still haven’t found any massive or extensive injuries that have occurred due to people doing the wrong things while utilizing this type of training. Often people will completely cut off blood, or make a tourniquet like restriction for 5 minutes or more at one time. My big question is how do these people think that this is helping them, and how do they not see the potential for injury in this situation? I am sure before long since this technique is slowly gaining popularity, someone will have a massive injury that can be attributed to doing this improperly.
What has been your favorite part of your clinical experience so far? Why? What makes that special for you? Is it helping you reach a semester clinical or personal goal?
So far my favorite part of my current clinical experience is definitely the bonds I have made with some of the athletes that are on the football team. Although there are quite a few athletes on the football team that are disrespectful and ungrateful, there are a few that really appreciate all that we athletic training students do during our clinical rotations. I think that the athletes that actually do try to make bonds with us are very conscious and understanding of how much we do for them. For example, one of the players always talks to me when he sees me, and he always says thank you for anything that I do for him. On his senior day, he said and I quote “thank you for all that you do man, I know there are some of us that don’t respect you guys, but just know that I appreciate everything you do. Don’t let anyone stop you from being you.” This really meant a lot to me coming from an athlete that I would consider being my friend. I realize that the athlete that stated this will probably never see this blog post, but I want to make it known that I really appreciate them saying that to me. It has helped me cope with football, and has helped me to try to see the good in the whole football situation. Overall football has kind of been a nightmare for me. I have seen a lot of disrespect from the coaching staff and many of the players, and even disrespect from preceptor to student, and from student to preceptor. Personally I try my best to be as respectful as possible while stating my concerns. I believe one of my clinical goals last year was to begin to be more comfortable around my athletes. This semester that has been one of the best things I have gotten out of this clinical rotation. I believe that even though this hasn’t been the greatest clinical rotation I have had, I am still learning things and getting to be more comfortable around the athletes.