Rehabilitation for Anterior Cruciate Ligament Reconstruction (ACLR) has for years followed the time-based approach progressing athletes to the next step based solely on how far they are out from surgery. Research has shown that criteria based protocols, where each athlete only progresses once they reach a specific goal improves outcomes in patients, specifically athletic populations. (cited research) In this course, participants will learn and discuss different methodologies for athletic trainers to use determining rehabilitation advancement for patients returning from ACLR.
Outline
Why do we say that at 6 weeks every ACL should be able to do a partial squat and be at 90 degrees flexion?
Adrian Peterson only needed 6 months…he rehabbed 25 hours per week
Navarro Bowman had Failure To Thrive and was 12 months +
Normal rehabilitation is about 9 months but often they athlete still lacks full function at this point and they are not totally comfortable with their knee
Let’s look at it similar to school…you pass the test you move on…you fail the test you get held back.
150,000-200,000 ACL surgeries per year.
How are we doing a disservice to our patients using a time-based rehab program?
NFL bases their timeline on RTP for week ONE readiness
What are the parameters for RTP?
Each phase should have criteria before advancing:
Physician approval
Published research
Biological healing
Tissue healing – know the biological clock and tissue remodeling for each surgery
Long-term adult smokers may have secondary psychosis due to use, and long-term smokers may accrue damage to lungs
With patients that we are working with, the use of THC/CBD would be more for the short-term benefits
More information about the use of Cannabis?
11-12:15 min
The advocation of these products to minors should not be done because of the lack of research, although there are specific laws for minors and medicinal use
Literature suggests these products should be used for people 25 yrs or older so that the brain is fully developed
Laws are being driven by consumers who are electing pro-cannabis officials
Laws are changing rapidly in favor of cannabis use (decriminalization)
How do we know which CBD products are legitimate?
12:15-14 min
CBD products are similar to supplements as they are not federally regulated
There have been studies that prove some products on the market are 100% illegitimate
It’s legal for companies to say products are “90% proprietary” meaning we only know 10% of what’s actually in the products
Everything on the market could be a hybrid, so there’s no guarantee that a CBD product does not contain THC
Hybrids in the sport world may be problematic, and as a medical professional our recommendations should be conservative
What are some of the uses of Cannabis?
14-15:10 min
There are legal drugs on the market approved by the federal government
There are medications for epileptic seizures and for cancer patients to help reduce nausea and vomiting due to chemotherapy
There’s ongoing research on use for post-concussive patients, patients with diabetes, MS, ALS, etc.
Informally (subjective feedback) Cannabis reduces inflammation, localized pain, and anxiety
The challenge for athletes and where to go for information on Cannabis
15:10-19 min
Athletes and medical staff need to be aware of laws nationally and internationally
33 states in the US have approved cannabis use, but all the laws vary (possession in person, travel, etc.)
There’s a need for a resource athletes and all sport related personnel can go to for information on cannabis
When you Google search “Cannabis” you need to be able to decipher whether or not the site you are on has a 3rd party objective or a hidden agenda
Government sites may have limited information because it’s still an illegal drug
Laws and regulations are changing daily so you should find a resource with active information
Secondary school message to students? 19:10-21min
Cannabis is a plant but is a serious substance especially in a developing brain
Use of cannabis can cause a loss in the ability to calculate, learn and understand new languages in developing brains, it can also affect emotions
From the CBD aspect, it’s “GNC Round 2” you just don’t know what’s actually in the product
Speak with a physician prior to use (preferably an open-minded physician), and/or have the product compounded (information from a pharmacy)
Summary
As an Athletic Trainer, we need to be able to educate our athletes, parents, and coaches by researching cannabis to the best of our ability
At Dublin City University they normally run an injury and rehab clinic for athletes and students. The AT students participate in the clinic as part of their rotations as well as sports team affiliation.
Bolton University in England looks similar to the program run by Aoife Burke in Ireland. They have a clinic for students and athletes and sports rotations. They use the term Sport Rehabilitation instead of Athletic Trainer.
Valerie Pelleck feels the majority of her programs students were done with their practical portions and have been able to transition to online easy enough. In Canada they go by Athletic Therapist instead of Athletic Trainer.
Luzita Vela at UVA us the clinical coordinator for what most Americans know as a 2-year master's degree.
What are the benefits to transitioning to online learning?
Adam Naylor thinks we have to re-assess efficiency.
the switch has likely helped students focus on their knowledge and understanding as well as the utilization of literature.
We can be more directive in the online learning process
In Ireland, Aoife Burke feels it has increased the availability of health care as their system is not as robust or developed.
Some of the other issued discussed:
How are students being encouraged and enabled to be hands-on?
What have been the chief concerns expressed by your students?
Discuss options are your programs considering to make up for lost contact-hours?
What is your national organization doing to accommodate for certification exams given the anticipated delay in graduation?
How is your institution managing to assess practical competencies if face to face opportunities are no longer available?
Amidst COVID 19 and all the shutdows everyone has had a season cut short.
Cari Wood has been monitoring mental health for a few years at Redmond High School. In a recent podcast, we discussed what this looked like for her.
Cari also has a high school senior who is living out all of the things we are discussing.
Now with COVID 19 Robert Andrews has been releasing some articles on how we can help deal with this as parents, athletes, Athletic Trainers, and coaches.
Here are the Season Cut Short talking points:
1)Normalize the first week or two. Look at this as a holiday for the first week or so. Athletes suddenly find themselves at home with little to no schoolwork, no structured workouts, and no competitions.
Let them sleep in for a while. I see so many athletes who are sleep deprived of their rigorous schedules. The grind of training, school, homework, and competitions has left many athletes with serious sleep deprivation. I see athletes that are 40 to 60 hours a month behind in their needed sleep! And we wonder why athletes seem to struggle so much with anxiety and get overwhelmed so easily.
Give them time to get caught up. You will see they will be able to better handle the curveball they have been thrown. They will handle stress, downtime, the experience of being disconnected from their sport and lack of exercise much better with adequate sleep.
2) Have regular family meetings to discuss how everyone is doing, where are they doing well, where are they struggling and where they need help.
Your kids will resist at first, but if you do a good job of modeling openness and vulnerability and lead a structured meeting, they will learn to value this time together.
The family meetings are also good times to discuss expectations around chores, schoolwork, training and any other topic the family needs to focus their attention on.
3)Help your kids create a written planner for their schoolwork and training schedules. Our athletes are used to structure. They need structure and discipline in their lives. Especially now! In this planner have them lay out their training schedule. You might ask, “what training schedule?” Find out the most important strengths they need to conserve to be ready to get back in the gym or on the court or in the pool.
Some might need flexibility, others strength and conditioning. It is time to get creative.
I spoke to a gymnast the other day who committed to do an hour and fifteen minutes of stretching at 2:00 p.m. six days a week. Her mother ordered her a rug to use since they have hardwood floors. I have seen videos of kids doing conditioning work on the roofs of apartments in New York City. Go for walks, bike rides, play tennis.
4)Empower them to take responsibility. There are two key traits that determine what level of development we obtain in our lives. One is the capacity to experience empathy and the other is the ability to take personal responsibility for our lives. This is a great time for them to step up and learn personal responsibility and accountability.
Another suggestion is to have your athlete find an “accountability partner”. This is someone that they can check in with every day to discuss how their workouts are going, if they did them or did not, and why, and if they need support or need to be challenged to stay committed to the agreement they made with themselves and others.
I can guarantee you that the athletes that take responsibility for themselves mentally, emotionally, physically and spiritually will be the ones who make the best comebacks when their respective sport fires back up again.
5) Connect with others. Today more than ever, we have the ability to connect with each other. Have your kids step beyond texting and set up Join Me or Vimeo groups with their friends and teammates. This will go against their nature to communicate via text, but it is critical that they learn how to reach beyond that and make meaningful attempts to reach out in ways that they can see a smile or a laugh.
They need to be able to see when a friend is upset. Connection is critical during this time.
Text messaging is not enough. I have been using FaceTime, Skype or JoinMe with some of my friends on my Mac.
The bigger the screen the better the connection. It is amazing how our faces light up when we see each other.
It has made for a much richer conversation. I hang up filling emotionally full and connected to them. If they set up a team or group list, make sure and include EVERYONE! I have worked with far too many athletes who have been left out of group chats and text groups. They need this connection just as much as anyone else.
6) Try new things to stimulate your mind, body, and emotions as a family. Try a family game night, movie night, bike rides or walks, reading time, family cookouts, or karaoke. These might get your family out of your comfort zones.
This is a time we must get out of the boxes we live in mentally and emotionally. Challenge your family to get uncomfortable with new experiences.
7) Some parents say that no matter what they do their kids won’t get off of their phones or video games. They just sleep and play games or are on their phones. There is a concept called “escalation of leverages”. It goes like this: If your kid won’t get off of their video games or phone, take something that they value away. Limit their data or take their phone away for a few hours a day. If that doesn’t work raise the leverage that you have on them. Take their TV out of their room for a few hours or day. Take their phone away.
When they buy into the structure that they need to hold themselves to, then the reward is that they get the data, the phone, the video controller or the TV back. Sometimes we have to be the wall with our kids. They won’t like it, but as I said earlier, they need structure now more than they quite possibly ever have.
I hope these tips help. It will take time and you will struggle. Keep at it. If your kids aren’t frustrated or angry at you at times, then you aren’t holding them accountable enough. These are trying times for all of us. When kids get stressed, they look for something to push up against as a way of feeling safe. If they don’t find it, they keep pushing. Some will end up getting in trouble with their behaviors. You can be that something that they push up against. It will be good for all of you and it will help them stay on track in their schoolwork and in their respective sport.
Searching for a career people consider The Places You Will Go as a determining factor.
That may be upward along the corporate ladder or it may be outward around the country or around the world.
Josh and Jamie share the places you will go with AT service
John Ciecko does a lot of traveling. Some of it is personal, some is business. Some trips are, of course, both.
He talks to Josh and Jamie Woodall about the places that AT service has taken them.
Here in this 30-minute podcast, we do not get to discuss all of the places they have gone but their favorites are:
Talledega for Josh
Superbowl in Atlanta for Jamie
Hit the Hill day in Washington DC
How can AT take you places?
Josh says it is simply through service and volunteering. Becoming part of the local, state or national governing bodies is a great way.
Jamie got roped into being the PR person becauseJohs needed help. She has now completed her full term as PR chair for the NATA as well as serving on other committees both locally and nationally
Time to Advocate Far and Near I'm An Athletic Trainer and This Is My Life Buckle Up, Cause I Work All Day and All Night We Start In The Concussion Clinic And This Will Take A Minute Tell Me What Happened? When Did The Symptoms Start? There's Voms, Sway, Impact, and Some Other Parts Then Off To The School Lots To Be Done Tie Your Shoes, It's Time To Run Basketball, Wrestling, Swimming, Baseball, Track, and softball Give Me Some Coffee For The Long Haul Evals, treatments, education Injury Prevention and documentation It's All Healthcare It's What Athletic Trainers Do Happy National Athletic Training Month From Me to You
Sarah Baulch and Herd Sports Medicine
Fall in Texas is hot Spring in Texas is quite cold One thing that is constant, ATs are on the go From the football field to the basketball court to running circles on the track There’s one thing you can count on, ATs will have your back We can splint your broken elbow, diagnose your concussion too, rehab that sprained ankle and get you back to play It doesn’t matter what jersey you wear, or what sport you want to play, Athletic trainers truly care, and might just save the day
Megan Mormile
March is a great month for many reasons: Spring sports, sunshine, it comes with the season. But for Athletic Trainers it means one thing: National AT Month is here, and it’s time to sing! What is an AT, you ask? Don’t know? Let me tell you: We’re allied health professionals, but I’m not through: We cover, we watch, we listen, we care We’re known for taping ankles, but it doesn’t stop there: We help prevent injuries, in all sorts of ways. Through preventative rehabs, and keeping up with the craze. We’re trained in evaluation, assessment, and diagnosis Of pretty much anything that comes with a prognosis. Injury on the field? No worries, don’t fear: Athletic trainers can handle emergency situations with care. Rehab? No problem. Modalities? No sweat. Athletes get care, and are ready to jet. Last but not least, the professional part: ATs handle admin and organization with heart. We’re here for your athletes, day in and day out: Hopefully now, you know of our clout. So come check us out, and see what we do: Ask us some questions, and maybe bring some coffee, too. HAPPY NATM!!!!!
Dr. Mark Knoblauch shares the mic as we are live in Katy, Texas learning.
What is a normal day like for radiologists?
Most are sitting in front of a computer looking at images, coming up with a diagnosis, and sending them back.
Dr. Nicks has a unique set up as he has a viewing room in the middle of the ortho floor. He regularly gets out of the office to interact with doctors and patients.
He, at times, even scrubs in with the surgeons to help and learn.
How much info are you usually given with the images to make a diagnosis?
Usually one or two lines at most. This is part of the reason he gets out of the office to see and interact with the doctors.
“Garbage in gets garbage out” plays true in imaging and sports injuries too.
Are there specialties in radiology as well?
Absolutely, If Dr. Kumaravel were to get a neuro MRI he would be sending it right along.
Where are we headed with Imaging and sports injuries?
Clinical Skills need to be an emphasis in radiology education. We are moving away from using clinical skills and he believes it is showing in the results.
Continued improvement and growth. we are now able to see bone marrow edema with CT scans
Ultrasound is the next big wave in the United States. It is becoming an extension of the physical exam.
The hardest part about an AT using the US machine is knowing what it means and interpreting the results.
The World Federation of Athletic Training and Therapy or WFATT exists to ensure access to athletic healthcare is a global phenomenon.
The World Federation Mission Statement
The WFATT provides leadership to advance the international interests of its members for the common goal of optimal health care for physically active populations.
Vision Statement
Athletic Training & Therapy will be recognized as an essential part of multidisciplinary healthcare teams worldwide.
About Dr. Glen Bergeron
He started at the University of Manitoba in 1970 with a PE degree and went on to masters of exercise science with a focus on Athletic Training.
Dr. Bergeron was one of the first people to write the certification exam for Canada Athletic Trainers / Therapists
He worked at the University of Winnipeg and again at Manitoba. He later returned to the University of Winnipeg to become their program director.
The World Federation is an “organization of organizations”
If you are a member of one fo the organizations that are currently members, then you can be a part of it too.
Anyone with skills or talents they think may benefit the organization should contact the organization and see how they can help.
What about the WFATT World Congress?
The World Congress exists to disseminate info and promote the world federation.
The 2019 congress had over 350 attendees in Tokyo Japan.
The focus is to help empower the community to see what effect and impact Athletic Training and Therapy can have on your community. How can it help move the profession forward?
Doctor Angie Curtis, MD, MPT fits into the Minority Women Doctors category but has a unique path.
Her original plan was to be a doctor.
Obstacles arose and she chose Physical Therapy school.
Before she could get established as a PT she knew she needed to go after her dream of becoming a Sports Medicine Doctor.
Challenges facing Minority Women Doctors
Doctor Curtis did not present on becoming a doctor as an African American woman. But a previous conversation in the hallway sparked an interest in me to learn more and help grow to understand.
I know I have preset judgments and biases based on where and how I was raised.
I also know that I am responsible for my actions and choices. I can not blame anyone else for the way I view or treat others.
Have you judged Minority Women Doctors too soon?
Dr. Curtis has been overlooked and ignored because she is a black female, dressed like a doctor, carrying clipboard and stethoscope. The nurse in scrubs was a male so he was obviously more “doctorly”
She has not allowed this to make her bitter but continues to grow and improve patient care and open doors for the women behind her.
Biologics may decrease the epidemic of Tommy John surgery
Dr. Eric Makhni discusses how biologics have shown up to 67% efficiency in repairing the UCL and preventing reconstruction or repair.
Team physician for the Detroit Lions, Bloomfield Hills High School, and Oakland University as well as a consultant for the Angles, Dr. Makhni knows the body and injuries.
One of his best traits is his ability to talk to patients and help them understand the injury and healing process. Being a great physician is important, but communicating that to patients is equally valuable.
What common injuries are we seeing in youth-related to sport specialization and overuse?
Tommy John surgery is the big one – a partial or full-thickness tear of the Ulnar Collateral Ligament (UCL).
Pitchers are the most frequent but catchers are right behind them in the frequency of UCL injuries.
Stress fractures are also common among middle-school-age (10-13) athletes
What do you think are some contributing factors?
YEAR-ROUND SPORTS (single sport) are by far the worst culprit for overuse injuries.
Kids are throwing harder at younger ages.
Poor mechanics.
CORE ACTIVATION
Weighted ball routines
Discuss the evaluation process
Look at the age of the athlete
Listen to their complaints
is it fatigue or pain
constant or only after pitching
Ask more questions
Determine the patient's goals
Perform any manual tests needed
What new surgical procedures are being used?
If possible the surgeon should try to repair the UCL with internal bracing. The recovery time is significantly decreased.
Biologics such as PRP and Amniotic stem cells can be used in partial tears.
The use of Biologics, for the most part, is not covered by insurance, so if you are going to travel that road make sure you discuss it with your doctor and find one who knows baseball and the demands.
Watch the Biologics and Surgical repair of the elbow Facebook live
