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.
As a senior ATS, how do you model professionalism as a student and mentor younger ATSs? Do you feel you are a mentor/ role model/ resource for other students?
I model professionalism to the younger Athletic Training Students in a few ways. The first way I do this is by treating my athletes in a professional way. I believe that everybody has seen, at some point during their clinical experiences, athletes being treated differently based on how their athletic trainer or their athletic training student likes them. I try to treat all of my athletes the same, because I believe that one person should not receive better care just due to how much they are liked by the athletic training staff. I also model professionalism by always being on time. I believe that in my “career” in the athletic training program, I have only been late one time. I think that being on time is one of the most professional things that someone can be in control of. It is also one of my pet peeves. I hate not being on time. Most of the time I show up to events or anything like that at least 15 minutes early just to make sure I am on time, and to account for any delays. Another way I show professionalism is by always following the dress code. Even though I wear a hat almost everywhere, I never wear it in the clinic. I always wear clean clothes that follow the dress code to practices and games. There are certain instances where I have seen a couple of the girls in the program wear clothes that are provocative, mostly wearing shorts that are too short. I really don’t have any control over that, but I feel that the older girls do a good job of wearing clothes that are not provocative. I feel that in the dress aspect of being professional, all of us seniors set good examples of professionalism. I am always respectful to my preceptors, and I always talk to them when I have problems or questions with anything. Overall, I feel that this shows more professionalism than anything. Openly communicating with preceptors and professors helps build professionalism in the long run by showing how to approach and speak with them.
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.