What is your most challenging class so far this semester? Why do you find it challenging? How are you coping?
So far my most challenging class this semester is definitely physiology. The reason that it is so challenging is because of the depth that the class goes into, as well as the service learning project hours that are required outside of the class. I think that the depth is so difficult for me because I really haven’t had a class that goes this deep into the biological and chemical processes that the body goes through constantly. Some of the hardest things to remember are the things that are involved at the cellular level such as cellular respiration, integration at nerve synapses, and the neurotransmitters that are involved in this process, as well as the endocrine system. The endocrine system is VERY complex, and anything that happens in terms of release of a hormone, has an effect elsewhere in the body, and also has an effect with another endocrine organ and what hormones they release or stop releasing. With neurotransmitters, it is just hard to remember everything they do within the body and within the brain. My grade in this class at that time isn’t really where I want it to be; despite the amount of time I spend studying every week. I think that this is just because of the difficulty of the content and materials learned in this class, and applying them on the tests we are given. So far I am coping but not very well. I find myself stressed about this class very often, and the only way I can really cope with it is to do things that get my mind off of the class. The bad thing about this coping method is that I really don’t have time to do all those things between classes, clinical hours, baseball, and multiple other things going on at school. I am hoping that after all grades are added in and the final is completed, I can achieve a B in the class. As of right now, things are just going rough with all of the things I have going on, I just try to not think about the difficulty of my schedule. I have been just putting my head down and doing the best I can.
Describe your clinical question and what lead you to chose to research that topic. Include the selection of your group, committee members and what have you learned about your topic so far.
For my clinical question, I am teaming up with Brittany Litchford to find some information and research on the following question; Does the implementation of blood flow restriction training improve rehabilitation outcomes in athletes with acute soft tissue injuries?
The reason we chose this question goes back to a couple of years ago. Coach Chip Schaffner, the assistant baseball coach here at Emory & Henry College, brought this topic to my attention about two years ago through a body building article that was found on a well known bodybuilding website (that just happens to be a pretty unreliable source). The article explained how body builders were using blood flow restriction techniques in order to rapidly increase hypertrophy while completing their training session for the day. Since then there has been some research on this topic pertaining to rehabilitation of soft tissue injuries, and I thought that if there is some credibility to this rehab technique, this could have many implications during rehabilitation sessions with patients. For my committee members I chose Assistant AT Cole Ross, Clinical Coordinator and Professor Beth Funkhouser, and Coach Schaffner. I chose Cole Ross because of his extensive knowledge on eccentric exercises during rehabilitation. He completed his masters Thesis on eccentric overload training. I chose Beth Funkhouser for my faculty advisor because she seems to be the only person that I am in contact with that knows any information pertaining to this topic from a rehabilitation perspective. I chose Coach Schaffner as my content expert because he has done some research on how it effects body builders, so he could possibly relay some information and techniques to me and Brittany as we research this question. So far I have seen that body builders are trying to complete this technique for hypertrophy, and they are doing it in completely the wrong way. Some of the information I have seen and videos show that they are completely cutting off blood supply during an exercise through the use of a belt or a tourniquet, instead of restricting blood flow properly, with the use of the correct equipment, and without completely cutting off blood supply. Overall I want to see if blood flow restriction training should be much involved in various soft tissue rehab programs, and to see if the outcomes are better than just conventional rehabilitation programs alone.
were evaluating an initial injury/condition, or
were performing a specific therapeutic intervention
This weekend at the football game, during my clinical experience, there was an athlete that went down for the other team. From the way he went down, it looked like he really did something bad to his knee. The athlete was tackled low, around the ankles, and he slipped one leg out of the tackle. He planted that leg and tried to push off in order to free the other, but when he pushed off he couldn’t free his other leg. It looked like the knee was flexed, and slightly internally rotated, and you could tell as soon as the athlete tried to get away from the tackle, that something happened to his knee, it kind of just moved in a way that it shouldn’t have. It looked as though his knee just kind of separated. Dr. Hannula completed the on field evaluation on the athlete after their athletic trainer had requested that he do so. One thing that was amazing to me was that the athlete seemed like he wasn’t in any pain. He didn’t have any bad facial expressions, and he was calm when he talked. He didn’t roll around on the field, and didn’t scream or anything. We splinted the athlete with an air cast, and put him on the spine board to be transported to the emergency room.
After everything calmed down, I asked Dr. Hannula what he thought about the injury, and he told me he was pretty sure that the Athlete had dislocated his knee, and that it had self-reduced before we were able to get out there. Dr. Hannula also said that it was kind of hard to test because the athlete was guarding pretty bad, and swelling was already accumulating, but he was pretty sure that there was extensive ligament damage in the knee. Dr. Hannula said that he decided to send him to the emergency room due to the fact that there could be some serious vascular damage, and nervous damage in the knee. He said that the emergency room would have better equipment to do a thorough vascular examination.
Really during this occurrence, and after, I am still wondering how the athlete wasn’t in more pain. It seems to me that this injury typically produces a very high amount of pain, and I am just confused as to why the athlete wasn’t showing more pain.
Describe an evaluation opportunity you have had this semester. How will this event influence your future clinical actions or clinical decision making?
A couple weeks ago, I was able to evaluate a knee injury that had occurred on a football player. The athlete had already been evaluated by the Football Athletic Trainer the day before, and he asked me to evaluate it just so I could get the experience. The athlete was having some pain in the anterior knee, and the knee was a little swollen. I palpated a variety of structures, and it seemed like the athlete didn't have a whole lot of pain, just some pain on the superior and inferior border of the patella. The athletes ROM was lacking in flexion and extension, and MMT was 3/5. After a barrage of special tests, the patellar glide test caused pretty intense pain for the athlete. From this I determined that the athlete had suffered a subluxed patella. I reported my findings to Cole and he said that his evaluation yielded the same diagnosis. He asked about some of the things that had happened during the evaluation like pain locations and ROM results. Turns out that the athletes ROM was slightly less than the day before. This will influence my future clinical actions because of the change from day to day. This instance makes me think that it wouldn't be a bad idea to periodically evaluate the athlete during the rehabilitation process just to make sure that the condition is getting better, and to determine the effectiveness of the rehabilitation program. Overall this experience will make me think about doing multiple evaluations on a single injury to determine severity of the injury as well as effectiveness of rehabilitation.
One of my clinical goals this semester is to learn more about blood restriction training, and learn the implications in the rehab setting for this type of training. In the past, about three years ago, I had read an article that wasn’t really from a relatively non-credible source about this type of training. I thought the article was pretty interesting at the time so I attempted to research some things about this type of training. During my research I found that there wasn’t much information about blood restrictive training when talking about using it in the rehabilitation setting, only using it in the bodybuilding setting. According to a group of bodybuilders, blood restriction training allowed them to see huge gains in strength and muscle size, in much less time training. So instead of spending literally half the day training, they were able to reduce their training to 3-4 hours per day. There was no explanation of the science behind this type of training really, just an explanation that pretty much said that it worked. Now I’m not sure how much of this was placebo effect, or if there is any credibility to their statements, but it did peak my interest. From this, I have decided to do my clinical question research on this topic, and possibly pursue this topic for my senior research project. I have talked to some people in the strength training realm about this and it seems as if they are not really sure how this works either, so I feel that research on this type of training could be beneficial in terms of rehabilitation and strength training. Through my clinical question I would like to find out if there is any credibility to this training, and figure out if there is a way to implicate this into rehabilitation programs and possibly get athletes back on the field sooner, with better rehabilitation results.
As a senior ATS, what do you perceive to be your greatest strengths and weaknesses?
As a senior Athletic Training Student, I feel that I am pretty in tune with my strengths and weaknesses as of right now. A few of my strengths include Evaluation of injuries, understanding patients concerns regarding an injury, and communicating with patients and my preceptors. I have done many evaluations in my time in the Athletic Training Program and I am thankful for all of the opportunities I have had to complete these evaluations. For example, I was able to do a couple evaluations this past Saturday at the Emory & Henry football game. For one of them the athlete came to me during the middle of the game and was describing to me that he had hurt his hand. By using my evaluation skills I was able to determine that the athlete had suffered a grade 1 UCL sprain of his 5th PIP joint. I confirmed this with my preceptor and then discussed with the athlete that he could finish playing the game, but I would like to apply buddy taping to the finger in order to reduce the movement of the joint. I also instructed the athlete to come into the clinic after the game so that we could get a better evaluation. Even after this evaluation by Cole, he told me that my sideline evaluation was good. I felt that this instance also shows my strengths in understanding patients. I kind of had to do this evaluation on the fly and the athlete didn’t really know exactly what happened. I had to piece this puzzle together with the little information that the athlete provided. I think this example also shows how I am able to communicate with my preceptors in a positive way.
I believe that my main weakness is always wanting to voice my opinion when speaking to a preceptor or an athlete. I feel like sometimes this makes my preceptors a little angry with me. One way I could improve this is to take in the whole situation before I interject what I think into the conversation. This has happened a couple times in the past when speaking about evaluations, one happened this past Saturday. Overall I feel that my strengths far outweigh my weaknesses.
Reflect on your "final" pre-season experience. Compare it to your previous years.
How do you feel different as a senior ATS? What has helped you so far? What has continued to be a hindrance?
How has your growth as an AT student influenced your interactions with patients and preceptors? Give an example.
Wow, senior year already! I cannot believe my time at Emory & Henry is almost over. Anyway, back to the journal prompt. My final pre-season experience was pretty good. I learned many new things this year during administration time. For example, I was able to work a lot with filing paperwork for old and new athletes, and making sure that they had everything they needed in order to compete in collegiate athletics this year. I completed tasks like filing physicals, and going through various teams’ paperwork and determining whether or not all of the athletes on the team needed to submit more paperwork. I think this was a good experience for me because I feel that I haven’t completed a whole lot of administration type duties in the past, and it gave me an idea about good ways to file paperwork, and how to communicate with athletes that still needed things.
I feel different as a senior this year because all of the other students have been looking at me as a role model and asking me various questions about how and why I do certain things. This has helped me further my confidence with athletes and with other various things such as general knowledge about how an entire Athletic Training staff works together to run smoothly. So far this semester I truly believe that all of the administration duties have helped me grow as I stated above. I think the main thing that has hindered me is one of the new staff members that is with football. We have had a few clashes this pre-season and I feel that it has kind of made me a little testy at times. I am open to changes in staff and even changes in the way things are done, but in this particular circumstance I feel that the changes haven’t benefitted me or any of the other students for that matter. We haven’t been able to do things that increase our knowledge in the clinic very often such as doing evaluations or rehabs, because it seems like we are always stuck doing all of the cleaning, or filling up all of the water bottles. Overall this has been my biggest hindrance.
I feel that I have grown into a pretty knowledgeable student in the ATP, and it has enabled me to question preceptors, and interact with patients more confidently. I feel like I can do things in the clinic now without asking if that is the right thing to do. I am able to make many decisions on my own, and my preceptors almost always agree with me that these decisions are the correct ones.
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.