A Day in the Life…

There are so many places where an athletic trainer can work. I thought it would be fun to share a glimpse into my typical day as an athletic trainer! Some of what I do is very unique and new to the profession.With that said this is a day in my life…

MONDAY:

7 am-12 pm: Observe Surgery

  • On surgery days I assist in prepping the patient for surgery. I do not scrub in so I help the surgical nurses, PA, and surgeon tie up their gowns. I then watch the  surgery and learn different techniques and procedures. Once the surgery is complete I help transfer the patient to the recovery area. I also help clean and sanitize the operating room for the next case.
  • or

2:30-7ish pm: Work at Ponderosa High School

  • At the high school I assist in evaluations of any injured athlete. I help cover all in season sports teams. I design rehab protocols for injured or post operation athletes. My other responsibilities include mentoring the student athletic           trainers and help teach them about the athletic training profession.
  • phs

 

TUESDAY:

8:30-12:30pm: Assist in Clinic @ Steadman Hawkins Clinic

  • On clinic days I assist in rooming patients, taking their medical histories, and ordering proper imaging. I also assist in dressing changes and suture removals for post operation patients.
  • stead-door
  • xray

2:30-7ish pm: Work at Ponderosa High School

  • Some of my basic responsibilities include setting up water and Gatorade for every team that is practicing. As well as I perform daily duties such as laundry and keeping the athletic training room a clean medical facility.
  • phs-atr

WEDNESDAY:

8:00-12pm: Observe Surgery

scrub

2:30-7ish pm: Work at Ponderosa High School

  • As an athletic trainer we have to document any injury or treatment that is given to an athlete. This is done when we have down time in between seeing athletes.

THURSDAY:

8:30 am- 12pm: Assist in Clinic @ Steadman Hawkins Clinic

pt-room

room

2:30pm-7ish pm: Work at Ponderosa High School

FRIDAY:

2:30pm- 10pm: Work at Ponderosa High School

  • Typically Friday nights in the fall includes covering the varsity football game. The head athletic trainer travels to all home and away games but I will assist in coverage during home games.

SATURDAY:

8:00 am- 12 pm: Work at Ponderosa High School

  • During the fall season this includes covering JV and Freshman football games. I also will see any injured varsity athlete for treatment. In the winter Saturday morning I am covering basketball practice.
  • atia

In the evening when I finish at Ponderosa I come home and work on completing my master’s degree.

An athletic trainer in the physician setting is a relatively new profession. The NATA (National Athletic Trainer’s Association) has some great resources explaining the position and the financial benefit an athletic trainer can bring to an orthopedic clinic (1).

http://www.nata.org/professional-interests/emerging-settings/physician-practice

  1. Physician Satisfaction With Residency-Trained Athletic Trainers as Physician Extenders

 

 

The tale of two or three ligaments…

Most people have heard of the dreaded ACL (Anterior Cruciate Ligament) tear. It used to be a career ending injury, but now thanks to modern technology and the advance of sports medicine in most cases it is only a 6-9 month road block and athletes can sometimes comeback even stronger. There are 4 major ligaments the comprise the knee joint; ACL, PCL, MCL, & LCL. The ACL prevents anterior translation of the tibia helps with rotational stability of the knee.

Over recent years there has been an emerging debate on what is the best way to reconstruct the torn ligament. The patient has three main choices; hamstring autograft, patella tendon autograft, or a cadaver graft. Each have their own pros and cons. For the sake of this post I am going to eliminate the cadaver ligament as it is mainly only chosen as for patients over 40 as a second or third choice. The pros and cons of the hamstring and patella grafts are relative to each and patient and there is just a difference of a couple of percentage points in regards to the re-rupture rate between the hamstring and patella tendon grafts. This blog post also is not to debate if the hamstring is better than the patella. It is about the “discovery” of a new-found knee ligament.

In 2013 an article in the Journal of Anatomy (1) made comments and brought to light the potential impact of a widely unknown ligament called the Anterolateral ligament. At first the media portrayed that this was a new discovery but this ligament has indeed been documented since the 19th century.

(http://www.sydneyknee.com.au/wp-content/themes/ypo-theme/images/anterolateral-ligament-knee.jpg)

The ligament is on the outside part of the knee, tanish in color.

Another article came out a couple of weeks ago in Bottom Line (2) alerting consumers to orthopedic surgeons who have started repairing the anterolateral ligament along with the reconstruction of the ACL. This is alarming and should be definitely be brought up with your surgeon if you are having ACL surgery. It is alarming because there is no evidence that supports it is beneficial to the patient to repair the anterolateral ligament. Research is on going and it will be interesting what conclusions they will find and if it’ll have any benefit in eventually repairing it along with the ACL ligament. This is also a controversial surgery because there is no info on how to exactly perform the surgery! Make sure you are talking with your surgeon to get all the details possible and do your own research to make sure you make an educated decision in regards to the reconstruction of your ACL. My best advice is just to have an open and honest conversation with your doctor.

1.Claes, S., Vereecke, E., Maes, M., Victor, J., Verdonk, P., & Bellemans, J. (2013). Anatomy of the anterolateral ligament of the knee. Journal of anatomy, 223(4), 321-328.

2. Bottom Line Link

AT’s Have your Back…Literally

I am a huge fan of college football and love watching games all day on Saturdays. Watch enough football and you’ll unfortunately be a witness to some rather gruesome injuries. For example this past Saturday Seth Russel (QB for Baylor) dislocated his ankle and was carted off the field (praying for a speedy recovery bud). Other times you’ll see a player be spine boarded when there is a suspected cervical spine injury. Usually this is done for precaution and it is always good to be prepared for this type of injury. With that being said there has been some recent debates over the best way to spine board someone or even to spine board someone at all with a suspected cervical injury. The National Association of EMS Physicians (NAEMSP) and the American College of Surgeons Committee on Trauma (ACS-COT) have published a new position paper on “EMS Spinal Precautions and the Use of the Long Backboard.”

The change in protocol comes from lack of research support for using the long backboard technique. The position statement outlines the benefits and risks for using a spine board. The side effects for using the spine board include increasing pain, pressure ulcers, patient agitation and comprised respiratory system. People who are recommended to be spine boarded include someone with:

  • Blunt trauma and altered level of consciousness
  •  Spinal pain or tenderness
  • Neurologic complaint (e.g., numbness or motor weakness)
  • Anatomic deformity of the spine
  • High-energy mechanism of injury and any of the following:
    • Drug or alcohol intoxication
    • Inability to communicate
    • Distracting injury

People who are no longer needing to be spine boarded include someone with:

  • Normal level of consciousness (Glasgow Coma Score [GCS] 15)
  • No spine tenderness or anatomic abnormality
  • No neurologic findings or complaints
  • No distracting injury
  • No intoxication
  • Patients with penetrating trauma to the head, neck, or torso and no evidence of spinal injury should not be immobilized on a backboard

(EMS Spine Boarding Position Statement)

The National Athletic Trainer’s Association (NATA) has also done some research into spine boarding techniques. A study published in the Journal of Athletic Training compared the different spine boarding techniques with the amount of spine movement. The lifts the study looked at include the traditional Log Roll, Lift and Slide technique, and the  6+ Person Lift. Researchers measured axial rotation, flexion-extension, lateral flexion, anteroposterior displacement, distraction, and medial-lateral translation at the C5-C6 spinal segment.The results from this study concluded that the there is ultimately going to be some spinal movement regardless of the lift technique. The researchers also concluded that the 6+ Person technique minimized the extent of motion generated across a globally unstable spinal segment (1). There was also significantly more lateral flexion and axial rotation during the log roll technique when compared with the two others.

Sport medicine is constantly changing and more research is occurring daily to help make sure the best possible care is available for athletes. The new spine boarding techniques should start being visible within the next year if they haven’t been seen already. As an athletic trainer I am going to do everything I can to help make sure the athlete is cared for safely. Spine boarding is an intense situation for everyone involved and ultimately can save someones’ life and/or limbs! AT’s have your back…literally!

This is only one of many life and limb saving stories! Tommy was indeed back boarded and had a full recovery. His story could have ended very differently had the right protocol not been taken by his athletic trainer!

*Disclaimer: Please use this information only for personal use and only perform actions within your scope of practice*

  1. Del Rossi, G., Horodyski, M. H., Conrad, B. P., Di Paola, C. P., Di Paola, M. J., & Rechtine, G. R. (2008). The 6-Plus–Person Lift Transfer Technique Compared With Other Methods of Spine Boarding. Journal of Athletic Training, 43(1), 6–13.

High Intensity Interval Training

So what is the science behind Orange Theory Fitness (OTF)? Most OTF members have heard of the E.P.O.C principle or the Energy Post Oxygen Consumption rate. This is the “after burn” effect and the reason calories are still burned even the following day after a workout. While this is a great benefit of an OTF workout there is even more science behind an OTF workout than just the after burn concept. There are numerous other benefits that come with a high intensity interval workout

OTF is based on high interval training or HIIT. HIIT is defined as a workout consisting of short duration high intensity interval bouts performed between 80-95% of the exerciser’s maximum heart rate followed by an interval at a lower intensity. Some of the other benefits of HIIT include an increase of fat and carbohydrate burning enzymes, increase fitness level, and a high adherence rate to the workout program.

(https://andreellison.files.wordpress.com/2014/02/orangetheoryfitnessseattle001.jpg)

Subjects who participated in high intensity interval training showed an increase in fat and carbohydrate oxidation (Perry, Heigenhauser, Bonen, & Spriet, 2008). Fat oxidation is the mechanism the body uses to break down fats into energy for the body. Carbohydrate oxidation is the breakdown of glucose and fructose in the tissues of the body to be able to use as energy. This means that the body is able to breakdown fats and carbohydrates faster with the effects of high intensity interval training.

HIIT was also found to be to reduce body mass index, body fat percentage, decrease blood pressure and increase peak oxygen pulse. This means that HIIT is extremely effective in reducing cardiovascular risk factors that lead to chronic diseases such as cardiovascular disease, Diabetes, and Metabolic Syndrome. HIIT leads to a greater quality and longer life. Thanks to an Orange Theory workout you are receiving these incredible benefits with every workout!

Perry, C. G., Heigenhauser, G. J., Bonen, A., & Spriet, L. L. (2008). High-intensity aerobic interval training increases fat and carbohydrate metabolic capacities in human skeletal muscle. Applied Physiology, Nutrition, and Metabolism, 33(6), 1112-1123.