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.
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
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.
What are stem cells and how are we using them in the knee?
Today on the SMB, we are joined by Dr. Evan Meeks who helps educate us on stem cells and their use.
Dr. Meeks explains that stem cells are found within the body and they can change into other types of cells. They can be used to treat musculoskeletal injuries (ie regrow muscle, ligament or cartilage) However, Dr. Meeks cautions us that stem cells are a “new and budding area that has theoretically huge potential for the future but the science is still in the early stages.”
What can make you a good candidate for stem cell therapy?
Type and degree of injury are important factors when considering stem cell treatment as well as the patient’s age.
How are patients prepped for this procedure?
The best preparation we can give a patient is to educate them and to manage their expectations.
Are there ethical issues regarding stem cell treatment?
The main ethical concern is embryonic stem cells. However, currently, it is illegal to use embryonic stem cells for treatment. They are only used for research. Dr. Meeks cautions that embryonic stem cells are unsafe right now. They can turn into any type of cell and we can’t control it.
As secondary school athletic trainers will we encounter this often?
Dr. Meeks explains that it is pretty rare since or population is younger and still heals well. He does say occasionally it can be used to help surgical outcomes with meniscus repair or bone stimulation.
What is Dr. Meeks’ prognosis for stem cell usage for the next 10-20 years?
“It will be the new frontier for musculoskeletal medicine.”
What one thing should AT’s know regarding stem cell treatment?
Dr. Meek’s feels stem cell treatment is the new pitch count in athletic training. We must educate and disseminate the correct information.
Dr. Evan Meeks is an assistant professor in the Department of Orthopedic Surgery at McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth).
Dr. Meeks specializes in sports medicine with an emphasis on arthroscopy and minimally invasive techniques to treat injuries of the shoulder, hip, and knee. During his training, Dr. Meeks worked extensively with professional and college teams in the Houston area, including the Houston Texans, Houston Rockets, Houston Astros, Houston Dynamo, and the University of Houston athletic program.
As a former college athlete, Dr. Meeks has the unique ability to see injuries from the perspective of both the athlete and the physician.
Dinner etiquette means starting with the outside and working your way in with the silverware. Social Media Etiquette is an everchanging environment but certain truths hold solid.
Is Social Media important for the Sports Medicine Professional?
YES! – there is so much to learn. Find a good knowledge stream on twitter or facebook and you will be completely filled. It can be a source of customers and advocacy as well as connection and mentoring.
CAUTION!!! – Social media can also become a breeding ground for decay if you choose to follow and engage with “dead fruit.”
Do these things
Know your WHY
Start with ONE
Know your LIMITS
be YOURSELF
Remember there are real people reading these
CHECK your spelling and grammar
PROTECT patient privacy
Don't do these things
Use foul/inappropriate language
Use inappropriate pictures
Share pictures of videos with ANY injury details
Think “permission to post” clears you legally
Forget there are real people on the receiving end
Be too serious
Forget your WHY
Tips and Tricks
Be a sponge first
If you are new to Social Media start with one platform and be a creeper for a little while. Read posts, watch others and see what is normal for that platform.
Use different apps for different accounts
TweetDeck for Personal and Twitter app for Bussiness or
Hoot suite for all personal accounts and native apps for professional
Tools to check that spelling
Grammarly – checks spelling and grammar
PhraseExpress – allows me to type “SMB” and it automatically gets expanded to “Sports Medicine Broadcast”
Christina Curry-King joins Ray Olivo to discuss her presentation on Identification & Implication of Relative Energy Deficiency in Sport (RED-S) at the Memorial Hermann Sports Medicine Update.
Baseline tools to ID REDs
Relative energy deficiency in sport (RED-S) is a syndrome in which disordered eating (or low energy availability), amenorrhoea/oligomenorrhoea, and decreased bone mineral density (osteoporosis and osteopenia) are present.
Sit down and get a 24-hour recall of what they are doing and eating. – Could be inadvertent due to scheduling – Or people who are struggling do to eliminating certain foods.
What about the subjective portion of the evaluation?
Athletes struggling with relative energy deficiency may report still being tired ad lethargic.
Try these things:
getting some good nutrient-rich food in around those training times
Ask about sleep
probe deeper
Are you fearful of certain foods?
Was it from reading an article
Weight gain
Hesitant to eat before or after the event
Not being able to perform
Bad experience with certain food
Recommendations for AT involvement with cafeteria
Something is better than nothing
Add color
Bring some fruit and veggies from home
Pre-activity quick snack
Some sort of granola bar
Or banana
Applesauce
Shelf-stable and portable
Even juice like apple or orange on the way out the door
What about the fast-food budget family
Is there a grilled option or fruit and yogurt option?
Thoughts on supplementation?
You will get more bang for your buck by buying real food…you will get more energy in food then you will ever get in a supplement
Certain supplements have a place if the other standards are met first.
Sleep calculations –
Hands down top recovery tool
8-9 hours per night sleep minimum is critical for injury prevention.
Watch the presentation on Relative Energy Deficiency
I am not talking about your in-laws being challenging parents. We are not even discussing the relationship you have with your own parents.
Challenging parents and family members of patients can ruin your day and cause some serious headaches for Athletic Trainers.
Charlotte Koenig works for Memorial Hermann in risk management and knows a few things about dealing with challenging patients and family members. Today on the podcast she gives us some great steps to follow when dealing with a challenging athlete, parent or coach and also helps us set and follow through with boundaries.
Are you someone who says, “I’m sorry,” often?
Charlotte believes that is a phrase that is empty and doesn’t have much substance She recommends changing the “I’m sorry,” to “I apologize.”
Use the 5-minute rule speaking with a challenging parent?
When Charlotte is engaged in a face to face or phone conversation with someone who is challenging she makes sure to wrap things up in about 5 minutes.
Active listening and repeating back to them what you think they are saying can diffuse situations.
One phrase she uses often is, “What I hear you saying is...”
When do you ditch email and talk to someone face to face?
“Compassion can’t come through text or email.” Every person can insert there own emotion when reading a text or email so Charlotte believes that it is always best to communicate verbally when you are dealing with someone who might be upset.
How do you de-escalate a situation that has gotten heightened?
“Don’t throw fuel to the fire,” when dealing with someone that is challenging. Remain calm, meet them where they are and see the whole person not just this incident.
Have questions about infections??? Joins as we discuss Skin with Kathy Nguyen
Who is Dr. Kathy Nguyen?
Dr. Kathy Nguyen is a primary care/sports medicine physician. She is a team physician for multiple high schools, helps with colleges in the Houston area and is the team physician for the Houston Dash soccer team.
Do you know what is considered best practice and recommended by research?
As athletic trainers, we routinely see a variety of skin issues happening with our athletes.
Blisters: do you pop it or not?
Today on the podcast Dr. Nguyen relays to us the best practice in issues as common as blisters and as serious as tinea issues that may be resistant to topical antibiotics.
For example
At minute 2:10 on the podcast, Dr. Nguyen says she always recommends leaving the blister if possible.
Around 4 minutes on “Skin with Kathy Nguyen”, she discusses wound care specialist opinion on new skin growth and scarring.
What are truths and what are myths?
Through research and discussion with other wound care specialists, she helps us sift through what are considered old wives tales and gives us concrete reasons to refer a skin issue or lesion to a doctor.
A Tool for identifying the potential for injury due to limitations in specific movements. It was developed by Gray Cook
Getting certified is a good idea and can really help you take advantage of the tests and results but it is not mandatory o use the tests to help identify potential issues.
What is the key to Reducing Injury Risk with FMS?
Protect before you correct
What tests does it involve?
Deep Squat
Hurdle Step
Tight Hip flexor may cause limitations in testing
In-Line Lunge
Active Straight leg raise
Rotary Stability- probably the hardest one
Shoulder Mobility- Hard to access
Trunk Push up
Scoring the movement screens
0-pain in any movement 1- no pain but unable to do the movement 2- Complete movement but show some compensation 3- Complete movement no pain or compensation A score of 14 or less equals a more likelihood of injury. 21 is a perfect FMS score
My research interests include functional movement and how movement is related to balance ability. Specifically, I am interested in ways to improve functional movement and the effects of improved functional movement scores on injury risk.
I am also studying how the effects of balance training can be crossed from the trained limb to the contralateral limb following lower-body injuries as a way to expedite the injury rehabilitation process
Dr. Harrison was also on the Sports Medicine Broadcast…
