Podcast Archives - Page 17 of 84 - The Sports Medicine Broadcast

March 10, 2021February 23, 2021

Snocross – Amy Metiva

Amy Metiva did not ride snocross, or even really know about the sport. She is a really good AT and busted it to be the best wherever she was working. Check out some of her story below.

Start us with a crazy/awesome story

Fargo, North Dakota and it’s negative 39 degrees. The propane tanks froze so the trailer stayed around 42 degrees the whole weekend.

Most race weekends we work 15 hour days.

We had to backboard in the snow…in the negative 40-degree snow. There were 2 sleds stuck together and a rider underneath the sled.

Knowing he needed advanced care quickly we carried him right to the ambulance.

Hunter was in an accident in a tight corner.

“We are basically waiting for a car accident to happen and then being ready to pounce.”

We had a racer get hit by a spindle and had an arterial bleed from the nose and he was not breathing when we got to him.

By divine intervention, he came back.

He was buried under the snow and we had to dig him out of the snow. Ended up breaking every bone in his face and had 97 stitches in his face.

He got to race about 3 weeks later.

Hunter, discuss your previous interactions with ATs

Hunter grew up playing football and had the high school AT.

He did not have much interaction with her.

Got hit with a spindle and tried to shake it off.

Once he could not move his arm he needed to go see medical.

Amy always seems to know when you are going to be hurting and ready to take action.

Racers are tougher than nails, so how have you softened them up?

Do not go up to the racers when they are focused and in the zone.

I communicate beforehand and set up some signals to know they are all good.

Build trust before they are injured

They come to know if I can get them back into the race safely I will.

If I can help them hit their goal and dream…that is the most amazing thing

Discuss your journey to becoming an AT.

Middle School athlete and was told she had swelling and could not play anymore. She went to an Athletic Trainer and he helped her rehab.

In 7th grade she went to a camp and found a book by Arnheim and started reading it on her own.

By high school, she was the self-proclaimed medical person.

Went through the internship program at Lake Superior State and was assigned tennis.

Her parents told her to be the best tennis AT there was even though she did not like tennis.

She then moved onto wrestling and loved being the only female AT. That led her to volunteer in lots of places.

She stopped the Harlem Globetrotters bus to speak with the AT.

This conversation changed Amy’s direction for her career.

A year later he called her and brought her to the court to meet the first female Harlem Globetrotter.

I have had a lot of jobs between now and then including a ten-year sabbatical to raise my two boys.

How did you get into snocross?

Someone randomly sent her an offer to help with snocross and she went for it…with no previous knowledge of the sport.

“After the first race I was hooked.”

Then I got the “call” to the major leagues.

She was grilled for 13 hours about how she would handle the job.

“God has a plan for me and he wanted me in that place at that time to care for those Snocross athletes.“
– Amy Metiva

Talk about the FXR Snocross medical trailer

It is an ER

It is a mobile medical clinic

We do a lot of taping since they can not fit a brace on with the clothes

Sutures, ultrasound, xrays but no medications

Everything in the trailer is free for everyone with a “hard card”

Family members and crew members as well

Expect the unexpected and be ready for anything

Obviously, it’s cold, what are your go-to “stay warm” items

Klim is a sponsor and provides great gear.

Hunter tries to wear almost the same thing each race day whether it is negative temps or just below freezing.

Amy does not change her routine either

Lots of FXR on the outside

3-4 layers of tights

FXR boots wearing 1-3 pairs of socks

Gloves with hand warmers

I know from 6-10 pm I am going to be on the track for the night show.

Discuss how you work with the EMS crews to coordinate care.

We use the Polaris rapid response that has treads and is equipped with basically everything we need.

If they need a higher level of care than we can provide then we do a hot transfer and get them to the ambulance.

I have to coordinate my movements with the track boss.

“Amy to 4” is her call to go back to the trailer for medical.

We have 3-4 people on track most times unless there is an injury.

They are allowed to call a red flag for a medical stop if needed.

How have you used supplies in random or odd ways in Snocross.

Amy uses a lot of RockTape, but it comes down to knowing your riders.

Riders get blisters on their throttle hands.

They love colored pre-wrap so it matches their uniform better.

Amy sometimes modifies braces for the snocross racers.

It is hard to get anything else underneath their uniform so we can not use a lot of braces.

Can ATs volunteer?

COVID had eliminated the volunteer options

It is cold

You are in the trenches

Just reach out with plenty of time as she has to get permission.

You have to be serious because you are standing in the line of fire.

Nutrition:

I love HOIST hydration for staying hydrated, but what do professional Snocross riders use?

Eat small – grapes, raspberries, lots of water

Avoids energy drinks, some coffee with collagen

Amy eats small meals and drinks Starbucks black ice tea

Soup and crackers are always great.

Almost everyone eats a bigger meal after the shows at night.

Watch Snocross with Amy Metiva on Facebook

Contact Us

Amy Metiva – email – amymetiva@yahoo.com

IG – AmyMetiva10

David – redinger3@gmail.com

Hunter – For the races: snocross.com click live stream

IG – @hunterpatenaude

Jeremy – IG – SportsMedicineBroadcast

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March 2, 2021February 11, 2021

Auto Racing Medicine – Julia Hines

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Dr. Julia Hines has connected her passions and works with Auto Racing Medicine because her dad took her to races growing up. She joins us to discuss her story of becoming and AT and PT as well as how she is helping make racing safer.

Julia hines; Motorsports PT; Auto Racing Medicine

Julia, What is your favorite race event and why?

Going to Monaco would be a bucket list item

What is your experience in driving racecars?

I have done some courses

Dr. Hines’s husband is a racer

I get in the racing go-karts now and then.

How did you get into Athletic Training and Physical Therapy?

Dad is an amateur racer and started going to the track at 3 or 4 years old.

He got a concussion in her senior year of high school.

They basically did not treat him at all

He drove the pacecar the next day

He had symptoms for about a year including BBPV

I grew up close to Limerock park and love all those events

Went for PT school but ended up doing the combined AT PT program.

I got injured a lot as a dancer growing up

There are ATs with racing, but they are few and far between.

Showed up at races and talked to everyone I could

My doctoral thesis was on returning the motorsports PT.

Talk about the evolution of concussions in Auto Racing Medicine.

This is not a team sport. If the drivers are not driving, they are not earning their money and they are potentially out of the industry.

The big teams, NASCAR, INDY, F1 they have traveling medical teams

The “arrive and drive” guys do not have any sort of consistent medical care.

Julia is currently working with more of the endurance events where they are driving for 24 hours.

NASCAR has been focusing on improving the health of the pit crews and a lot of ATs

Back in the 90s they would grab the guy from the local oil shop to be part of your pit crew.

Do you have experience treating Pit Crews with random injuries?

They have medical personnel in the pit..and everywhere.

If there was an emergency we would work as a team, allowing the emergency medical crew to lead and then being the primary on the follow-up or continuation of care.

Talk about the marathon races…how do you prepare them?

Anytime a driver exits the car after 2 hours…something is going to be sore. Low back, foot, hand.

Rule out red flags.

What can I do in this instant to help them get back in the car in a few hours?

As a PT I avoid passive therapies

As a MotorsportsPT we utilize a lot of the passive therapies because they are not really done with their event.

If it is the night time you are trying to allow them to get treatment and get rest.

Letting them know you have a plan in case treatment one does not work

Do you ever have to “talk” them back into the car?

I had a driver with a torn ACL who was concerned about driver changes. We had to work through the process of what causes pain and what does not.

But never really had to convince anyone to get back onto the track

What is the least understood aspect of a motorsports athlete?

These are extremely high performing athletes.

Heart rate, respiratory rate and effort have been shown to be very high during the duration of the event.

Going back to the concussion in motorsports…it was hard to recreate the situation.

The heat

The helmet

G forces

Incline

Vibration

Tons of visual stimulus

What is the RTP for motorsports?

Every racing environment is different

Use multiple monitors to simulate the environment

Get as close as you can without putting them at danger

What lessons stand out the most that you took into motorsports?

Reaching out to your network – Sarah Brown at BU had multiple brainstorming sessions with Julia

Professor worked with her to create higher value questions and prepare answers.

If you do not try then you always wonder “what if”

For 4 years I showed up at racetracks and talked to people…4 years I worked on building the network.

What is an adaptation you have used for race teams? (creative ways you used theraband to for support, brace you had molded…)

Things are too bulky usually for them.

So almost everything has to be minimalist.

The ACL patient had a brace that he could not wear so they had to try several options to make it work for him. Ace wrap ended up too bulky, so they went to KT tape for the proprioceptive feedback.

What types of injuries do you see in auto racing medicine?

Mostly chronic issues

Strangest?

The driver was getting in the car and was struggling with forearm stiffness. They came to the pits for treatment and she was almost on the interview with him.

A neuroma in his foot from driving for 20 years.

Fun Stories?

The first AT in racing was a rodeo AT back in the 70s or 80s

Most of the rescue crews are fireman and EMTs

ATs can and do belong in those positions with proper training.

Call to action: Network but do not give your services away for free

Watch Auto Racing Medicine on Facebook

Contact Us:

Dr. Julia Hines – https://www.motorsportspt.com/contact

Mike – @McKenneyATC

Jeremy – @MrJeremyJackson

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Go through the schools RevTracker system and make a donation.

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February 24, 2021February 7, 2021

Profesional Cutman Jovan Means

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Jovan Means is an Athletic Trainer and a professional cutman. It would seem that these jobs conflict each other but Jovan shares how these professions work together for him.

Where does your Cutman story start?

16 years as an AT

DC native

Currently working in the same school system, he graduated from (not at the same school though)

Jovan has always been a fan of boxing and MMA and thinking “I always wanted to expand my skill set.”

One day he was watching a fight with his son and he said “Dad, that is similar to what you do.”

Light bulb moment.

Started reaching out to cutmen in the area and Mike Rodriguez reached out to him and serves as his mentor.

Being a cutman is an inside job. You have to know someone to get your foot in the door.

Mike Rodriguez invited him to a cutman workshop and they sparked a friendship.

What about taping?

It takes Jovan takes 12 minutes to wrap one hand

Different classes and commisions have requirements for the amount of tape per hand.

Make gauze pads for knuckles.

Tape must be 1 inch from the knuckles.

Monitored by an official and the opponent’s team.

There are a lot of rules to follow.

Back to cutman business

You got 60 seconds to get in the ring, handle swelling, overheating, and out of the ring.

He has learned how to anticipate what injuries will be coming and how he will handle it.

2019 Jovan was in Las Vegas for NATA and there were a few fights in Las Vegas that he was able to shadow him.

Mike is really big in boxing; it was really a blessing for him to be connected with such a big name.

Chris Colbert allowed Jovan to walk out with him

Mike reminded him you gotta start in the trenches. The Las Vegas week was pretty “big-time” but definitely solidified Jovan’s desire to grow in this field.

Jovan does a lot of volunteer work at a local boxing club.

Some cutmen do not tape hands…so for Jovan's fighters it is a bonus.

Ringside you get a 10-second heads up to jump into action.

Keep the “Enswell” tool on ice.

Jovan also uses an ice cream scooper to help with swelling.

Wound care is something we obviously know how to do as ATs.

What is your priority as a cutman?

Over the eye first – blood

Swelling before under the eye-bleeding

Nose plug

How do you stop the bleeding?

Dog ear cleaner q-tips

You are allowed some medicines, but you gotta know the rules.

Adrenaline chloride 1:1000 and other coagulants

Petroleum jelly

Horror Story

First time with a fighter and knew he had been whacked and would not have been allowed to play sports if at the high school

He went back in and got knocked out.

The fighter was out for a few minutes before coming to.

When have you been “star struck?”

Charlo brothers were at the ring hanging out were there. There were also their trainers and cutman.

What courses, training, or certificates would be good for an AT interested in being a cutman.

Relationships

Work with the “losers”

Do your research

Reach out

Start putting in work

Jovan has been rejected more than once as they did not know what an AT is.

Favorite experience as a cutman?

Met two guys from Dallas the day before the fight.

His brother asked him to coach him as well.

This guy is 1-5 fighting a 6-0 guy

Jovan really got to coach this guy to a victory

Mike is part owner of WARTAPE

Shoutout to Dr. Donita Valentine

Watch Professional Cutman on Facebook

Contact Us

Jovan Means

Jeremy Jackson

These people LOVE Athletic Trainers and help support the podcast:

Frio Hydration – Superior Hydration products.

Athletic Dry Needling – Save up to $100 when registering through our link.

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February 10, 2021January 27, 2021

AT Dads 3 – The Wife

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The wife is the greatest source of growth. I trust my wife and if she tells me I need to be kinder, slower, more active with my kids then I usually listen.

Ryan Stevens asked a few of his colleagues and their wives to join us and see what makes a good AT Dad…and what does not.

The Wife; AT Dads; Kevin Briles; Kim Briles; Annie McCune; Dave McCune; Ryan Stevens; Sports Medicine Broadcast;

How did you meet?

Dave and Annie McCune – Annie was a PA and took a sports medicine course at Rutgers where she met Dave. They waited until she finished her rotation to start dating of course

Kevin & Kim Briles – Kim was coaching at the same school and came in to ask why her kids did not have water setup.

Kevin Blew up on her, set her straight about the role of the Athletic Trainer, and then the rest was history.

Sarah and Jeremy – We were at a college dance with other people and kept checking each other out. We started hanging out after that and now almost 16 years and 3+ kids later we are here.

Ryan and Jamie met in an AOL chat room, stayed in touch and 15 years and 4 kids later

What does your life look like now?

Annie –

Craziness –

We just moved back for Dave’s job at Rutgers.

I was doing door dash

Staying home with their son

Dave has to be at school early for testing

One 6 year old together

Dave was living in a dorm for a little while when he was transitioning jobs.

Was able to come back to Virginia during COVID

Kim

Ships passing in the night

We kind of have opposite schedules

15/17/20-year-old kids

We have a son that hasn’t left his pajamas in 10 months

It is a good crazy, we are used to it.

Jeremy, what about your wife Sarah?

Sarah is a stay at home mom and works part-time at the church. She is the primary caregiver to our kids both biological and foster.

3 boys under the age of 10 and a foster daughter under 1

Ryan and Jaime

Wife stays home with the 4 young kids

Ryan says “I could not make it without her.”

Paint a picture of the relationship you have with your children now.

Briles: the wife gets up at 4:30 to get the kids to daycare on time.

Kids ride the bus home

We had to orchestrate the entire fall season of who was picking the kids up from school. We had grandparents and family that we trusted.

We use to take them to school and the teams would automatically babysit for us

There was a time I needed a break. It was Christmas time, we were supposed to go to this event – I told Kevin “Get everyone out of this house and do not come back until I tell you”

Kevin called the wife a few times to see if he had permission to come home.

McCune: I used to take them to school with me all the time pre-COVID

Annie says she needs that time alone. As the mom and the wife everyone needs something and she just needs some time alone.

If it was written on the wall, what would be your mission statement for your family?

Jackson Family: To raise Men (and maybe women) who honor God and positively impact the world around them.
Briles Family:
- Driven
- Compassionate
- Kind
McCune Family:
- Be relaxed in the situation
- Trust
- Always be kind to everyone you meet
Stevens Family:
- You will be loved and you will love

“Keep Doing / Stop doing /Start Doing”

One key to successfully maintaining your family dynamic?

McCune – spend time together when we are off

Briles – just be quiet & Say yes more to friends and family

Jackson/ Stevens – prioritize family

What will you “STOP” doing which may lead to more stress upon the family?

McCune – stop trying to help when I get home

Briles – stop saying yes to everything

Jackson – The wife says I need to STOP being on my phone during the evenings

What do you hope to start doing/do more of moving forward to further build your family?

McCune – more fun things as a family

Briles – make the remaining moments count

Jackson – I apparently need to start listening more as I can not remember what the wife told me

Funny Stories?

Briles – Kim was pregnant with Liz, our first, we were warming up for the varsity football game.

I was in the old school locker and I got a message on my beeper…911

That was the code for it is time

I sprinted out and knocked over two band members trying to get the keys and get to the hospital.

Meanwhile the wife was headed to the hospital where she waited 8 hours for the baby to come.

Jackson: Sarah was having a rough day and my oldest decided to shoot at me with the nerf gun. So we had a battle that later turned into a shooting alley as we laid on the floor and shot nerf guns at the 2 youngest boys while they walked back and forth trying not to get hit.

Leave us with one action step:

Dave and Annie – focus on your relationship with your spouse

Kim – you get to going through the motions but these conversations remind us to focus

Kevin – put the phone down

Jeremy – Date Your Wife

Ryan – invest in yourself

Resources from AT Dads 3 – The Wife:

www.cATalyzingATs.com

Date Your Wife Book

Watch AT Dads 3 on Facebook

Contact Us:

Dave – @RUTrainerMcCune @RUAthletics

Kevin – @kbriles @ATSNJ

Ryan – @CatalyzingATs

Jeremy – @MrJeremyJackson

These people LOVE Athletic Trainers and help support the podcast:

Frio Hydration – Superior Hydration products.

Athletic Dry Needling – Save up to $100 when registering through our link.

Frio Hydration – Superior Hydration products.

Athletic Dry Needling – Save up to $100 when registering through our link.

February 3, 2021January 20, 2021

AT Dads 2 – Goals

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John Ciecko is a goal setter, so in AT Dads 2 we discuss the end goals and how we can work backward from that to make all 940 weekends count.

Ryan, give us an intro to your family.

3 boys and a girl

10 and under

What does the end of your career look like as related to your family?

John – For a goal setter the end of my career has always been saved for… the end of my career. Now I’m focusing on financials more, planning and goal setting for 4 rather than just 1. Is there a career change, job change. I’m now more aggressive in my job responsibilities and worth at my current job.

Ryan – I am not a goal setter, I set priorities and work towards making those good.
I want them to be functioning and contributing members of society.
All my kids will be adults by then
We want them to always feel welcome to come back and spend time in our house

Let’s work backward from there to make a plan.

20 years

Jeremy – approaching retirement
All Bio kids out of college; Possibly grandkids.
I want to know my grandkids the way my mom and Sarah’s parents do. I want to be an actively involved part of their life. This doesn’t happen if I am absent from my kid’s life now.

John: As Jenny says, in 20 years, I’ll be close to 100! – I’ll be approaching retirement or onto my “second” career in retirement. I will be focusing on Davids’s post-college and Cece's college years. These are very important years for them, where advice and communication are important to their adulthood. I’m building capital and “collecting coins” now so that my words then will have more of an impact on them when they need it.

10 years

Jeremy – I will have 2 out of high school and at least one to go.

Dating my Wife

Intentional conversations and interactions with my kids.

Ryan: I’ll have 4 teenagers…

I want them to be safe

Foster a relationship that allows them to tell you the bad stuff too.

John: in 10 years David will be getting ready to try out for the basketball team at my high school…if that is what he chooses.
I look forward to dealing with “father/son/patient/medical provider scenarios”
I want them to fail so they can learn, but not fall.

Next year

Jeremy – adopting MJ, attending school events, taking them to school and events with me.

It is not about the big events, but the daily interaction.

“Dating my kids” – giving them individual time to invest in our relationship

DATING MY WIFE

John: Focusing on my relationship with Jenny so that our relationship with our children is meaningful. We are intentional with our words and actions throughout our relationship.

How are we as AT Dads going to get there?

John – Pulling on inspiration and examples from my ATDads/Men mentors like Jeremy, Tom Ford, Larry Cooper etc.

Call to action:

“Dad can you look at this or are you too busy (with your phone)”…if you are hearing this look at why and respond appropriately.

Make a plan for how you will hit your target.

Watch AT Dads 2 on Facebook

Contact Us

Ryan

John

Jeremy

These people LOVE Athletic Trainers and help support the podcast:

Frio Hydration – Superior Hydration products.

Athletic Dry Needling – Save up to $100 when registering through our link.

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Athletic Dry Needling – Save up to $100 when registering through our link.

January 27, 2021January 19, 2021

AT Dads 1 – Relationships

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AT Dads are similar to dads in every other profession: great, average, or awful. Dads are one of the biggest influences in the life of a child for both good and bad.

Meet our AT Dads

Ed, what is the one question you want answered by the end of the episode?

What were some of the biggest challenges you faced balancing being a father and an athletic trainer?

Prioritize and set non-negotiables

Were you able to increase the amount of quality time throughout their childhood and adolescence? And if yes, how?

Friday Pizza Nights

Driving to school with altered schedules

Joel?

How understanding does your significant other need to be in order to find the balance?

Larry’s wife was non-athletic so she does not fully understand the lifestyle.

Larry used to hold a team meeting to discuss the week and expectations and schedule.

Has the balance ever brought you to consider changing settings/roles in the profession?

Jeremy:

As an AT Dad, How do I foster a lifetime relationship with my children?

Larry, let’s start back in the beginning.

When did you meet your wife and marry?

Wrestled in high school and in community college

Left and went to Pitt

Wanted to be an architect, then an accountant. Realized he could not stay inside all day every day

Larry’s uncle introduced him to athletic training

Was a student teaching and doing field experience at Baldwin high school.

One of the team members introduced him to his wife.

Went to Sugarbowl with Pittsburgh and spent a lot of money on alcohol and she possibly saved his liver and his life.

First Job in Arlington VA as a certified AT

Got married over Thanksgiving in his first year as a teacher.

His wife attended a lot of the games and they became friends with one of the coaches and his spouse.

Moving 6 hours away from his parents brought him closer to his wife.

Waited 5 years to have kids and spent a lot of time investing in each other.

Larry’s wife got a job at Larry’s school so they got to work together.

The first kid

Sarah born in April 1990

The most rewarding job I have ever had was being a dad.

They moved back to Pennsylvania and worked at a clinic. He used this time to spend with family.

Larry would take his daughter to pre-school daily and work on the counting skills while in the car.

The Second Kid

Molly was born in 1993

Another AT joined Larry on staff that allowed him some more time off

Third time is the charm…

Delaney was born in 1997 and they had 3 full-time ATs on staff at that time

Larry was involved in the state association and coaching soccer..life was busy, but life was good.

All 3 played Volleyball, cross country, soccer.

The administration was supportive and family-oriented when his daughter was born.

His wife stayed home with the kids.

Larry was able to take 2 weeks off and then proceeded to juggle and balance.

Pizza Friday – they would come up for dinner each Friday night and eat together.

His kids still carry on that tradition with their own.

Eat dinner together whenever possible

During summer Larry would plan camping trips and travel the country. One trip was 7.5 weeks with a family camper.

“We are going to be in this area, what do you want to do?”

Watch the AT Dads 1 Facebook video

These people LOVE Athletic Trainers and help support the podcast:

Frio Hydration – Superior Hydration products.

Athletic Dry Needling – Save up to $100 when registering through our link.

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Athletic Dry Needling – Save up to $100 when registering through our link.

AT Dads; Hands Free
Water, — We freaking love these hands free units from FrioHydration

January 20, 2021January 20, 2021

Emerging Setting with Max Mahaffey

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An emerging setting is the non traditional roles, athletics, an Athletic Trainer is employed in.

The Physician Practice Setting only makes up around 2% of Athletic Trainers currently.

About Max:

He played football and graduated from Louisiana College
Worked in Alexandria, Louisianna for 2 years with an independent minor league team and as a physician extender
Went back to Lousianna college to work as an AT

Went back to school and got his masters at the University of Houston
Worked as the Baseball AT after graduating
Got hired by Memorial Hermann to work with the Sugarland Skeeters

What do you need to work in the PPS?

DME – Durable Medical Equipment – need to be able to communicate how and why to use these devices

Casting and splinting – both removal and application.

Communicating the goals and expected outcomes.

Physician Practice Value Model

Manual for what ATs do in this role

What does max do in this emerging practice setting?

HPI
Exam
Initial assessment / DDx
- Answer questions
Confer with Doctor
Plan
- Imaging
- HEP vs PT
- RTP protocol
- Orthos referrals
- In-office procedures

Pros and Cons of Physicians Practice Setting

Pros

Work closely with doctors
Set schedule vs athletics
Had freedom to pick “regular AT” per diem
Wide variety of patients
- Pediatric
- Youth
- Geriatric
A lot of concussions

Cons

Public’s lack of knowledge of an AT
Difficult/ rude patients
They are not there to see Max
A lot of concussions
A lot of the same stuff
- neck/back

CPT Codes

ICD vs CPT
97110 Therapeutic Exercise for 15 minutes
- Codes are not profession-specific

Financial Impact

Worth and Value
- Worth – the monetary cost of the service
- Value – is the perceived worth
ATs can increase efficiency by performing the non-billable tasks and freeing up the Doc for the billable tasks.
Pecha et al study
- Increase of $200-$1200 per day increase
In Max’s clinic study over 6 months, this value would have been about $16,000
Patient satisfaction survey

Sugarland Skeeters experience:

He has been there since the inaugural season
Mostly veteran players trying to get back to affiliated ball

Facebook video

Max

Jeremy

Financial Supporters

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January 13, 2021December 24, 2020

BFR in Adolescents

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It is the ultimate biohack, but is BFR in adolescents a good idea?

Devin Kielur DAT, LAT, ATC joins Kyle Kimbrell PT, MPT to discuss procedures, protocols, outcome measures…not just hey this is cool…

Blood Flow Restriction: What contraindications are there?

It is like a hybrid car – there are two ways two produce energy for movement

With BFR you are limiting the ability to produce aerobic energy.

Too much load can be problematic post-surgery

Open wounds – no BFR

With any clotting issues, there should be a doctors clearance
Post-op is the target time
The first teaching was: wait until the wound was closed
With use, there has been less concern with waiting until the wound was closed.

Hypertension

Who is administering it?

What methodology? – you need to have the means to measure the pressure

Do you need it at all?

Encourage the behavior of “Is this going to outweigh the risk?”

Athletes that do not like having their BP taken.

Sickle cell and diabetes could cause problems.

Clotting disorders

ORS has trained over 8,000 people in the US alone.

What is the main goal or purpose in using it?

Devin likes to focus on good sleep, nutrition, hydration, and body awareness.

How do you decide what load is used?

We use an RPE scale

Then use our rep scheme and by the end of the exercise, we need you to be exhausted.

We found the analgesic side very beneficial – the cuffs seem to settle the pain down

Tissue flossing produces a similar effect on the ischemic area and reduces pain…but it should not be counted as occlusion training

Do these goals change in adolescents?

Reduce pain

Limit muscle atrophy

Repeated inflation and deflations of the cuffs change the hydration of the cell and trick the body into “feeling normal”

This would need to occur frequently

Cuffs allow for movement and walking.

This allows PTs to space out the sessions

RPE –

Omnires scale

“I do not want to make your pain worse, but do not tell me your pain.”

I do not tell them what number I am looking for.

They give me the number they feel fits

30/15/15/15 rep scheme with 30-second intervals

***use the patient as the guide***

Initial BFR goal: I want them to be mesmerized by it.

This means I have set the load up and it seems really low at first.

We need a continual push for growth to occur

What procedures or policies would you recommend before beginning to use it.

Measure LOC
1. Prescribe pressure based on that number
2. Some companies have not
Document the number for full occlusion
Document the pressure for each session
Document the length of time the cuff was on
Document the load used
interventions should be supervised with the AT

Consider the timing of using the devices.

We are basically lifting heavy so plan with the fatigue levels of the day.

What is the variability of using the device between clinicians?

Experience can play a role in the use of BFR.

This is about equal parts perceived and real
Confidence and comfort are kinda contagious

Have I done enough? – did they complete the 75 reps 2x in a row? Then I need to increase

How is the person moving?

Are they really sore?

What are they reporting about the interventions?

Kyle takes girth measurements – within a month I should see some increase in girth size. This allows me to check their attendance and level of exertion

We also use this to discuss nutrition and protein intake.

Watch BFR in Adolescents on Facebook

https://www.facebook.com/980579115403772/videos/1597911170390829

Contact Us

Kyle – kyle@ors.io

IG: @kylekimbrell

Twitter: @kylekimbrell1

Devin: Twitter: @kielur_devin

Jeremy Jackson – MrJeremyJackson on Twitter and Facebook

Goal Setting for Patients

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Goal Setting can be awkward…”What do you mean what do I hope to get out of coming here today?”

I am trying to have a more Patient-Centered Approach to Athletic Training Services, but I have not found a good way for me to ask the questions that the students understand.

As a licensed AT and practicing PT Daria Oller knows the value of goal setting. She joins Ray Olivo and John Ciecko to try and make me less awkward…Good Luck.

What is “patient goal setting in rehab”?

Looking at objective measures

ROM
Strength parameters
Rep or weight count
Pain is an important measure – you can include subjective measures

Do not say “the patient will be better”
Use the SMART concept
- Specific; Measurable; Attainable; Realistic; Time-Bound

Working on them together

Recognizing them as a total person

Continually listening

How is it affecting the quality of life?

What is not “patient goal setting in rehab”?

If you take the patient out of the equation you are showing your ego… “I want the patient back playing in two weeks..”

A big failure is removing the patient from the equation

Having coaches dictate when an athlete or parent can return to play.

Daria: LongCOVID – I want to get back to running, walking, dancing. I am stubborn and would do them but then was just crashed out.

How I have asked:

“What is your goal for today?”

“What are you hoping to get out of coming in today”

“What are you wanting to hear after the evaluation?”

Thoughts on asking these goal-setting questions?

With kids, it may just be awkward because they are answering them for themselves the first time

There are therapy goals and then daily goals
They should still tie into what the overall goals are

John: Relationship building

A majority of people will not know what their goals for the day are.
What is the real question?
- Realistically you are talking about the history
- “How are you doing today?”
- “What have you learned today?”
You use those things as clinicians to help them define their goals.

Remember the history and relationship with the kid and consider that as you are asking the “goal” question.

We do not use a lot of objective goals because we do not have to report it, but they can be useful in motivating.

“How can I help you today?”
Ray Olivo – on helping patients set goals for their healthcare

Continue to ask questions to figure out who they are as a person rather than an injury

“How can we work together to get you to your goal?

Daria – the psychosocial is such a huge piece as well.

Some goal-setting is defined by statements such as: “I want to get on the floor with my kids/ grandkids and play but the pain is preventing it.”

Trying to document for insurance forces Daria to put all of the pieces together.

Are there stairs in your apartment
It sounds like you are saying this, this, and this. How can we work together to get better?

Example of “Goals” for athletes

Ankle sprain

Walk pain-free
Jog pain-free
Run pain-free
Practice pain-free
Return to play

Instead of “Here is what you are going to do today.”

Maybe try:

“Here is what I feel like we need to work on how do think we can accomplish that?

John – I like to look at it as a department view

“What are our professional goals”

We write them out and put them on the wall and it leads everything we did

You still need to have a goal as an AT to guide the patient’s recovery.

Celebrate small goals

In the secondary setting where we potentially see them every day, what should this look like?

John – The target – “what is your bullseye?”
Work backward from the outer rings to see how they get to the bullseye.
We keep soap notes and rehab sheets out for all of our athletes. Rehab charts are on the back of the soap notes.

WRITE THINGS DOWN

Daria – know the target and work out from there
8 weeks walking pain-free
So what steps can we use to get you there at 2 weeks, 4 weeks, and 6 weeks?

Ray– having them see their goal is important
Let’s take a picture of your ankle daily and compare it
Or lets video you walking and running
Each athlete is by appointment currently and they have an agenda for the day.
Ask them what their plan is

Other tips for implementing the patient goal setting in rehab?

Daria: Long-standing pain – the goal is not being pain-free, but finding distractions to keep his mind off his pain.

Certain hobbies and activities and helping him build those into their life and improving the ability to perform those tasks.

Ray: There are many ways to do goal setting.

IT’S ALL ABOUT THE PATIENT

John: Practice what we preach.

How are your goals going to help your patient population?

If you are good at setting your own goals it will show in your practice

https://www.facebook.com/980579115403772/videos/411065410067494

Got tips for us?

Daria Oller – @OnTapPhysio

Ray Olivo

John Ciecko

Jeremy Jackson

Goal Setting Resources

Setting Quality Goals – use the promo code “1FreeCourse” to earn some 2 CEUs related to the discussion.

Financial Supporters

Frio Hydration – Superior Hydration products.

Athletic Dry Needling – Save up to $100 when registering through our link.

December 31, 2020December 24, 2020

Path to Leadership

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Rick Cox has used the Sports Medicine Broadcast on his path to leadership. Through John's Leadership series Rick has been able to strengthen and improve as a leader in Athletic Training and at home.

An interesting fact: Rick was wearing his Sports Medicine Broadcast shirt when he dislocated his elbow rock climbing.

“The world is always full of the sound of waves. The little fishes, abandoning themselves to the waves, dance and sing and play, but who knows the heart of the sea, a hundred feet down? Who knows the depth?”

Why did you choose that line from Musashi?

Well it illustrates a person's path to their given occupation or specialty. (Musashi)

We may see the outside but do we ever really know the true path that person took to get where they are now and more importantly, where they are going in the future?

Who is Rick?

Year 3 at Suffolk Head AT
was satisfied for a while as an assistant
Realized that just being part of the staff was not going to be good enough, but he knew he needed to learn.
I am constantly questioning “what could I be doing better”

What started Rick on his path to leadership?

Had no experience
Did a lot of reflection and questioning himself
Makes small changes

How did he do it?

A lot of reading, but not focusing on a single person
Simon Sinek
Ryan Holiday
Military tends to lend itself to leadership

“Football (soccer) is life sped up”

Life / Athletics and war are not the same thing but lessons can be learned

You realize people have gone through some tough situations and you are not alone.

What have been some of the leadership lessons you have realized?

There are examples everywhere

The election is an example

What are some of the universal truths you have learned?

Not placing blame

Honesty

“Take the blame and give out credit” – Rick Cox

In my path to leadership, building relationships has been one of my strengths and it has grown our influence with our athletes and coaches.

Honesty with harshness

When have you had to relearn the lessons?

Year on we had a baseball player in the clinic and our Ortho wanted the athlete to go to the ER.

We were busy and did not communicate with each other and the coach.

The following day the baseball coach was pretty upset.

Rick’s first instinct was to place blame, but before he spoke he remembered the lessons…”You are right, we messed this up”

Have you seen improved relationships on your Path To Leadership?

Not to the point of being “buds” but there have been improvements

John busted his butt to build relationships, made progress but then for some reason it reset once the season was over

It is like building a garden. You have to replant each year

What have been other benefits to your Path to Leadership?

I am still struggling with this at home and have not been able to transition this to home

What has been the outcome?

I have become a better clinician
I am better as a leader due to this.

What would you tell a Young Rick Cox?

Humility

Books?

Anything by Jocko

Simon Sinek’s Leaders Eat Last and Start with WHY

Ryan Holiday’s The Obstacle Is The Way and Ego Is The Enemy

Dare to Lead – Brene Brown

https://www.facebook.com/sportsmedicinebroadcast/videos/340721383694562/

Contact Us

Rick Cox – rcox2@suffolk.edu @Suffolk_AT

John Ciecko – @John Ciecko

Jeremy – @MrJeremyJackson

Encourage them to buy more shirts for you…

Frio Hydration – Superior Hydration products.

Athletic Dry Needling – Save up to $100 when registering through our link.

Armed Forces Athletic Trainer Michael Hooper; path to leadership; John Ciecko