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.
What are your goals for this semester? Why did you select those areas to focus on? What do you hope to achieve from those goals?
My goals for the semester are as follows:
1. Become more proficient at upper extremity evaluations by completing at least one upper extremely evaluation each week, and asking for helpful feedback.
2. Become more knowledgeable about baseball arm care by researching and helping Kris come up with a daily arm care protocol for the pitchers on the Baseball and Softball teams.
3. Become familiar with different taping methods, as well as being proficient when having to modify a tape job by completing at least 2-3 each week.
4. Complete at least 6 masteries each week in order to complete my clinical packet.
I chose the first goal because sometimes I feel a little shaky when looking at various upper extremity injuries. For example I feel as if it is tough to evaluate the shoulder because there is so much going on up there, and I believe the elbow is just as tough because there are only a few special tests that I have learned, and many of those special tests will cause a false positive. This has been my experience, with the baseball players I have worked with that have shoulder and elbow problems. From this goal I hope to achieve confidence, as well as more knowledge of upper extremity injuries and the anatomy of these injuries. I would also like to be more efficient when evaluating upper extremity injuries, and I believe this goal will put me on track to do all of these things.
The second goal is just a project that Kris and I have sort of dove into, due to the amount of arm problems on the baseball team that I believe could be solved with the proper arm care. We have sort of been looking at various arm care programs out there and trying to put together something that will be best suited for our athletes. This will also help me in the future when working with baseball players.
My third goal is simply so that I will be able to complete a tape job for any injury or prevention of an injury that will require one. I also enjoy altering taping methods to suit athletes and the specific problems they are having.
The fourth goal is just a way for me to complete my clinical packet on time and will keep me on track pertaining to studying for the exit interview.
This past week I have not completed any masteries toward my clinical packet.
Reflect on your progress this semester.
What was good? What was bad?
What was your favorite thing you experienced as an ATS?
How will your experiences from this semester influence your start of next semester?
I feel like I have progressed tremendously this semester. There are alot of things that I feel I have become better at since the beginning of this semester.
I feel like some of the good progressions I have made this year mostly have to do with confidence. I feel more confident doing various types of evaluations in various settings. I feel like my biggest progression with my evaluations has been with evaluations during a game. I have learned that you have to diagnose an injury faster than in the clinic. This may also mean applying tape or bracing during a game. I have overall become faster with sideline evaluations as well as on field evaluations. I also feel like my decision making has become better than it was before this semester when it comes to conditions and injuries. Honestly I really haven't had any bad experiences this semester. I feel like if I do get an evaluation wrong or miss something I get more upset about it than before, but this is because I feel like I should be able to accurately diagnose anything.
The best thing I have experienced as a student is definately high school football in general. I have seen some pretty cool injuries, and I like being able to watch some high school football every friday night. The really cool thing is that it makes me feel like a part of the community, like I am doing something that is helping this community by my clinical experience.
I believe that this semester's experiences will better prepare me for what ever spring sport I will be covering.
when do you feel less confident as an ATS? Compare that to when you feel the most confident.
Sometimes I feel less confident evaluation of an athlete that is screaming in pain. This makes me less comfortable because I do not want to further injure the athlete, and sometimes I'm not sure how far to push them during certain parts of an evaluation. For example I'm not sure how far to push someone to try and move when they have an injury that they are afraid to move.
I am most confident while doing relaxed evaluations in the clinic. I feel as if these evaluations go much smoother, and I have an easier time determining what to do next and determining a diagnosis.