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
John Ciecko has been hesitant, mostly about what it looks like to go fully digital, so we set up a meeting of the minds.
Have you been thinking about moving from paperwork to an EMR in your athletic training practice?
If you answered yes, you will want to listen to today’s show. Both Danny Barringer and Christopher Dean recently switched to EMR’s and today on pod they will highlight the benefits and help you navigate the roadblocks.
Why should AT’s move to this fully digital model?
Ease, portability, security, and accessibility. As AT’s we are often not seated at our desk during the day. Moving to an EMR allows us to access information as well as enter information whenever and wherever we need to.
How did you decide which EMR to utilize?
It’s important to research the available EMR’s but before you even get to that point identify what is important to you and your stakeholders in the EMR’s capabilities.
Danny researched and found that DragonFly Max offered everything he needed as an outreach director at a hospital with multiple schools and sports.
Chris was introduced to NextGen when the orthopedic practice merged with a hospital that already utilized an EMR. While NextGen didn’t have a lot of what he felt AT’s needed, the IT department was able to customize NextGen to make it more useful for the athletic trainer.
How do you get buy-in or navigate roadblocks with implementing an EMR?
Communicate the why, talk about liability and the lack of protection paper offers and remind them that one HIPPA violation would cover the cost of an EMR.
What is one thing you both love about the EMR’s you are using?
One thing both Danny and Chris agreed upon is the dictation feature that is found in both DragonFly Max and NextGen. They both appreciate the ability to dictate a note or eval info no matter where they are.
Can EMR’s assist with the PPE collection?
Absolutely! In DragonFly Max you can take a photo of the PPE and upload it into each student-athletes profile. NextGen allows you to internally or externally upload a PDF of the PPE into a student athlete’s file.
What’s one recommendation for AT’s who are wanting to make the switch to EMR’s.
Research all the EMR’s available and find one that has everything you need. Remember that Standard Of Care is EMR now. EMR’s can help AT’s prove relevance and value.
Ever wondered how to explain the rotator cuff as a secondary stabilizer in the GH joint to either your athlete or their family? Dr. Simonich has the perfect analogy.
He tells his patients that it is like if I were to take a big exercise ball in my right arm and pull it into my chest. My chest would be the socket, the exercise ball my humeral head, my arm would be the rotator cuff and my hand the tendons of the cuff. That demonstration can help show how difficult it is for the rotator cuff to stabilize the joint.
What are the two types of shoulder dislocations, where do you see them and how should we treat them?
TUBS (Traumatic Unilateral Bankart Surgical) and AMBRI (atraumatic multidirectional bilateral rehab rarely inferior capsular shift) are the two types of dislocations.
You will see TUBS is most often in contact or collision sports like football or rugby. AMBRI is seen often in swimmers especially at the end of a long season.
Post a TUBS dislocation and relocation Dr. Simonich likes to use the apprehension test as an indicator of further treatment. He also uses athlete age (young athletes have a high rate of recurrence) individual goals, sport played and level of participation as indicators for surgery. Surgery reduces the high rate of recurrence in young athletes.
What are the types of AC joint separation and how do you treat them?
AC joint separations are relatively easy to see and cause biplanar instability. There are 5 types with Type I and II requiring conservative treatment, Type III going either way but trending non-operatively and Type IV V VI requiring reconstruction with a joint tie-down.
Clavicle fracture treatments have changed throughout the years due to research. What does the current research say?
Prior to 06’-07’ most clavicle fractures were treated non operatively. Research was introduced in two studies in those years that saw a better union rate with fixation in the clavicle post-fracture and surgeons began to surgically treat and fixate.
In 2017 a new study showed that while the rate of union is still higher in clavicle fractures with fixation, fixation doesn’t improve shoulder function nor does it decrease limitations in the shoulder. Dr. Simonich will put a plate to fixate the clavicle on an athlete with shortening, displacement, or comminution because they get faster healing rates, are more predictable and can get them back to their sports.
Watch the Athletic Shoulder 2019 presentation on Facebook
Today on the podcast Robbie Jenkins from Rapid Reboot talks all things compression therapy in our Compression Roundtable.
What is Rapid Reboot?
Rapid Reboot is a company that specializes in dynamic compression technology that gives you more value for your money.
Robbie and the team at Rapid Reboot felt like there was a unique opportunity to add more to the market of compression therapy. They worked to offer more applications and educate on the many opportunities compression therapy has to benefit our athletes.
What benefits does compression therapy offer?
Most often people think of compression therapy in terms of recovery. Robbie explains that there are many more uses for dynamic compression. Compression can be beneficial to fluid replacement, lymphatic drainage, injury prevention, and pre-workout, pre-game.
How do you educate on the treatment of the lymphatic system since it is a delicate system that doesn’t require a great deal of pressure?
The lymphatic system is unlike other systems in the body in that it doesn’t pump. Evidence doesn’t support using tight as possible to treat it. Robbie recommends that you use well below 100mmHG of pressure if there is a lymphatic issue. However, for healthy individuals that don’t have lymphatic issues you can have 200-300mmHG of pressure combined with sped-up cycle times.
Are there contraindications for the use of dynamic compression therapy?
Yes. DVT, blood clots, as well as post-cancer patients, are contraindications to utilizing compression therapy. DVT is a different scenario as compression therapy is contraindicated if a DVT is present, however, compression therapy has been shown to prevent DVT’s. Surgeons often prescribe compression therapy immediately post-op to prevent the formation of them.
Robbie reminds us that Rapid Reboot is FDA approved and regulated for over the counter use.
What research is available or what is the best practice for the use of compression therapy?
Physicians that Rapid Reboot has spoken to highlight how dynamic compression can help with venous return and how important that is to the cyclical nature of our vascular system.
Robbie finds that with the fluid gathering that tends to happen in our lower extremities due to gravity that the Lower Extremity boots are most beneficial to the entire body, though he loves the hip attachment, as well as probably most beneficial to athletes as all utilize the lower body.
What is one thing Robbie wants AT’s to know regarding dynamic compression therapy?
Don’t put it into one box. Dynamic compression therapy has many benefits, can be used multiple times per day and is safe to use for as long as you want. Pre/post workout and games, prevention as well as post-injury, tight muscles or DOMS are many of the uses for this therapy.
We have been testing the units and now Brandon Hearn – Product Guru for Compex – joins the Sports Medicine Broadcast to discuss Compex live. We have lots of questions and he has lots of answers.
“The Compex is not Complex” – Brandon Hearn
Do you have a Compex Unit?
We plan to have another discussion down the road but what tips, tricks, or uses have you found for helping athletes (yourself included) to recover and heal using NMES units like Compex?
What questions do you need answers to?
Want a sweet deal?
During our Compex live podcast, Brandon extends a pretty sweet deal towards the end of the show for podcast listeners. You can get one of the upper-level units for a base unit price.
Buying through an approved vendor?
MioTech has great prices and great customer service.
Current prices for the units discussed:
Fix Massage Gun – $165
Theragun G3Pro – $599
Marc Pro – $655
Compex Edge 2.0 – $140
Best use ideas to get started?
If you are brand new to (or taken an extended break from) exercise then START SLOW…
John, Sofia, myself and Coach Caballero all went way too heavy to start.
We were struggling to walk, tie shoes or do most things normally. SO BE WARNED!!!
Using squats as an example:
Hook the pads up as shown on the Compex website for the area you are trying to target.
Turn the device on
Select Resistance
Select the muscle group
leave the radiator image on
The top 2 uses for the devices:
Clearing of lactic acid in 7 minutes or less on the blood flow or warmup setting.
Increase muscle recruitment to improve training sessions.
Another great use for the device is pre and post-surgery. hooking the device up quad and hamstring simultaneously. This way they are all firing at the same time without movement. Decreasing muscle atrophy and improving long term outcomes.
Compex pads are expensive…
DON'T buy cheap ones on amazon. Brandon says the pads are more expensive to provide a better product and provide more safety. The cheap pads can actually cause burns to the skin if the adhesive is missing.
I bought some and we are going to test it out on ourselves…not on patients.
Two other safety features we learned about during the Compex Live session:
Biphasic current means the electricity goes into and out of the body through the pads.
You can not charge the device while operating it.
John, Sofia, Coach Caballero and I really tested these things out.
Thrower’s elbow is an injury that AT’s and coaches deal with frequently. What do we need to know as we interact with young throwers?
The more you throw and the higher velocity you throw at increases your risk for injuries. As AT’s and coaches, we need to not only be aware of the rules that are in place to protect these young athletes we need to follow them and encourage parents who may have their kids participating in multiple leagues to stay within the guidelines. The bottom line is the AMOUNT MATTERS.
What should we do when a throwing athlete begins to complain about pain?
When complaints begin we need to take them out. Shut them down from throwing and begin evaluating what might be going on. Remember that in developing youth, growth plates are the weakest link. Rest when the pain starts to prevent an injury in the growth plate.
We hear about the dreaded curveball and why it shouldn’t be thrown by young athletes. Is this accurate?
We need to change how we think about the curveball. Any speed off-speed pitch will decrease the forces on the elbow and shoulder. The more you throw at an increased speed the higher your risk moves. It’s not the curveball that is the problem, it is the fact that most young people don’t have the correct mechanics to throw it.
What about asymmetry? We are told to expect it in throwing athletes. At what point should we be concerned?
When you see a greater than 15-20 degree difference between the throwing and non-throwing hand there is a significant increase risk of injury.
If the athlete has this significant difference but isn’t experiencing pain or throwing mechanics haven’t changed, you don’t have to shut them down but you should be working to get them around 10 degrees of motion between their throwing and non-throwing arms. It’s also important to remember that throwing slows down progress on the range of motion games.
Should we change our thinking on surgical vs non-surgical treatment of shoulder injuries and thrower's elbow?
It really is a case by case basis. Young athletes with acute large tears probably should get a surgical consult. More chronic injuries in a little bit older throwers might choose rest to get them pain-free or to finish out their career. It’s not cut and dry one way or the other but needs to be evaluated case by case.
What are the biggest barriers to recovery post-injury?
The number one barrier is compliance with treatment. Staying on top of them and encouraging them to continue with the rehabilitation even once they’ve become pain-free. Compliance with prevention is also difficult. They need constant reminders and encouragement to follow through.
Are there any prehab thoughts from athletes awaiting UCL repairs?
Braces that prevent valgus and restrict 10-100 degrees are recommended. Controlling pain and inflammation pre-surgery and reducing the stiffness in the joint is helpful. The athlete can continue to exercise if they are pain-free and using symptoms as their guide.
Is there anything else AT’s should know regarding throwing injuries?
Young kids are at increased risk because of their growth plates and mechanics. Be their advocate, and follow the rules.
Ever been the only white person in the room? How about your college program?
Eva Martinez says as a brown woman in Athletic Training she longs to see more diversity and inclusion in leadership. She wants to see people like her in leadership.
What is your Diversity and Inclusion story?
Have you been excluded from conversations because you did not fit the mold for the current leadership style?
Are you like Sofia and never really felt excluded or like there was a ceiling to your ability?
Do you get fired up when someone makes an off-color comment, let it slide or find a way to educate?
Find the Similarities
Sometimes people make comments because they are intentionally hurtful, but sometimes they are just ignorant.
I said something about going to a polish festival and used the word “polak” while talking to my wife. I read a book where the main character was Polish and referred to himself as a “Polak” so I thought it was normal…until she told me the word is derogatory.
If I had said this to a polish person it may have ended very differently.
Continuing to use the term after learning the meaning would be intentional. I have only used the term to tell the story since that day.
In your quest for Diversity and Inclusion be quick to extend grace and offer a chance for education and change.
Secondary school AT? Then you should be familiar with and completed the ATLAS Project survey.
Today on the podcast John Ciecko catches Larry Cooper and Rob Huggins for an update on the ATLAS (Athletic Training Location and Services) program which started in 2015 as a joint initiative between the Korey Stringer Institute and the NATA.
The ATLAS project is designed to track to AT services, improve communication between athletic trainers and produce research for the advancement of the profession of Athletic Training in the secondary school setting.
What are the updates from ATLAS?
Rob reports that ATLAS has had a successful year. Over 13,488 schools are reporting AT services in the US and that is 66% of schools. Over 16,000 AT’s have completed surveys in the last 2 years and they are finding an increased response rate from AT’s and schools.
Why the increased response from Secondary AT’s?
Larry believes that the BOC adding a reminder at the end of our reporting document is aiding in more AT’s taking and re-taking the survey. State levels continuing to push it at the grassroots level are also helping.
The state of Florida is only 70 schools away from 100% participation, and the goal is for every state to reach that level.
How does ATLAS help AT’s in the secondary setting?
Data collected and reported from ATLAS to the individual states is helping push legislation through for things like AT presence at every school and cold water immersion tubs.
“ATLAS supports the policy initiatives that are making even bigger impacts in this country than this project is.”
Aside from the numbers of which schools have AT’s, what else do we learn from these surveys?
We are learning about how socioeconomic status affects the likelihood of an AT being at a high school. In the EATA Districts 1 and 2, there are 10 times greater odds of AT services in upper-class areas versus lower class and a 4 ½ time greater odds in middle versus lower class areas.
This information can help states or districts get AT services in those areas and present to those who have high stakes in youth athletics (NFL, NBA, NHL, MLB) and together we can come up with creative solutions to manage this public health crisis.
Has ATLAS had a direct effect on legislation?
Absolutely! Recently in Arkansas, there was legislation brought forward threatening the practice act in that state for AT’s. Jason Cates used that data while sitting with his legislator to show him the actual numbers of students, teachers, and families that would be affected if this law was passed and that data helped the legislator block the bill.
What is the future goal of ATLAS?
We would like to have 100% participation in the ATLAS survey and we would like the data we collect to drive AT services throughout the country so that every school has an AT.
Rob encourages everyone in the secondary setting to please complete and update the survey each year. He believes that ATLAS “can make the biggest impact in what is arguably the largest area for growth in our profession, secondary schools.”
Ever wondered if every athlete should get an EKG? Or if caffeine is really as bad for the heart as you thought?
Today on the podcast, Dr. Mark Knoblauch sits down with pediatric cardiologist Dr. Elizabeth Wang and talks about any other information surrounding pediatric cardiology.
Dr. Wang is a born and raised Texas girl who did her undergrad at Texas A&M and got her medical degree from The University of North Texas. She did her pediatric residency and fellowship at UT Houston and is still there today.
Dr. Wang enjoys Pediatric Cardiology and refers to herself and others in this field as glorified electricians and plumbers. She is particularly interested in the athletic population because of the physiologic response to exercise.
When should an athlete see a pediatric cardiologist?
If there is no family history and the athlete is otherwise healthy and not reporting any symptoms then I educate them to remain hydrated drinking at least ½ their body weight in water per day and more if they are exercising, I encourage them to get 9-11 hours of sleep per night and to eat well including vegetables.
If symptoms are present, (ie deep pressure in chest, dizziness, passing out or palpitations) or symptoms appear or worsen with exertion then I recommend parents seek out a pediatric cardiologist.
Pediatricians and other general practitioners are vital in finding and referring abnormalities. Good physical examinations along with screening for hypertension and other abnormalities help differentiate who needs a referral to a pediatric cardiologist.
Are there drinks and other substances you recommend athletes avoid to help their hearts?
Dr. Wang absolutely recommends that athletes avoid caffeine, energy drinks, vape pens and other drugs. “If I go out of business because everyone stopped drinking caffeine and vaping then I am okay with that and I have done my job!” An otherwise-normal heart can go into arrhythmia with substances found in drugs and/or caffeine, so Dr. Wang recommends all her patients stay away from these and get more sleep.
What is your response to the thought that every athlete should get an EKG especially since there is a study sighting that Italy requires it?
Dr. Wang explains the particular study stating this is out of a small region in Italy that is very homogenous. This doesn’t apply to the US which is a large and very diverse population. EKG’s are a valuable tool but it doesn’t catch everything. There are false positives on EKG’s that can cause immense stress and thousands of dollars of follow up tests that eventually show a healthy heart, and there are normal EKG’s that aren’t followed up with the right questions about symptoms and exertional symptoms that can have a problem. There are rare abnormalities that don’t show up on a routine EKG and require a very well trained eye on an echocardiogram to diagnose. EKG’s are useful but we need to follow the guidelines for what does and does not require more testing.
If an AT suspects a cardiac issue and is worried about oxygen saturation is it best to check the lips and nail beds for capillary refill?
Dr. Wang believes that best practice is to check the gums and the tongue instead of the lips and nail beds. She explains that if an athlete is panicked or worried it can stimulate the parasympathetic nervous system and that can produce the blue lips or decreased capillary refill. “The gums and the tongue are most indicative of what your central oxygen saturation is.
Are there any closing thoughts you’d like to share?
“Please don’t be a stranger. I love interactions so please get a hold of me if you have any questions.” You can email Dr. Wang at Elizabeth.W.Wang@uth.tmc.edu
