Chronic Back Pain is probably the least favorite for most clinicians, but it is one of the most reported reasons for office visits. Brent Ness joins the Sports Medicine Broadcast to discuss how Aclarion is helping provide imaging that can identify biomarkers and find where the pain is actually coming from.
Brent, recall your earliest interaction with Athletic Trainers.
My kids played sports in high school and had injuries that the AT Staff took care of.
Give us the highlights of NOCIScan
Taking info from an MRI, measures the quantity of different biomarkers within the spine and disc.
Compares the biomarkers to other discs within the patient's spine. Structural integrity and acid levels
Disc material can be filled with acids, which can cause pain
MRI can look normal if these acids are present.
Nerves can grow into the disc with a herniated disc or degeneration.
Disc degeneration is not just in “old” people, but also in people in their 20s, 30s, early 40s, and volleyball players
Gives the treating physician more information
Spectroscopy: same machine as MRI, different sequence that the tech would use. 1.5 or 3 T works
Proteoglycans levels
Result reports usually take just a few minutes
Currently in 23 markets in the US, still a cash pay service at the moment or done through clinical trials. Working on coming to Houston
How does this apply to the currently active athletic population?
Football, hockey, pole vault, volleyball
Ben likes to look at all of the options for Athletic Trainers. Are there any Athletic Trainers currently employed by Aclarion?
Always looking for motivated people. Yes
Lower-income high school Athletic Trainer – How do you feel I can best help my patients with back pain?
Start with the traditional treatments, rest, ice, NSAIDs. If very painful for a long period of time, if they move on to get an MRI, ask for MRSpectroscopy or NOCIScan to see more. They get with the imaging center to ensure the tech can get a single voxel spectroscopy setup on the machine.
What is keeping more surgeons from adopting this type of MRI?
Still new, working on moving into more hospitals. Cash pay vs. insurance is a big roadblock that many surgeons face.
Hopefully, one day we can work toward also being used on the knee
$1450 list price (usually discounted as well) – patient pay model on the website, acquire through info@aclarion.com first
Contact Us:
Aclarion – aclarion.com
Brent: info@aclarion.com
Ben –
Shelby – Shelbyngaytan@gmail.com
Jeremy – info@sportsmedicinebroadcast.com
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Learn about scoliosis rehab with Lauren Ferrante, PT, DPT, OCS. Explore home exercises, manual therapies, and AT tools for scoliosis.
Q: What are the most important home exercises for scoliosis?
A: Key home exercises focus on spinal mobility, especially for those who sit frequently. Cat-cows and thoracic rotation are crucial. Depending on comfort level, core activation exercises like supine marches or dead-bug isometrics are beneficial. When supine, tactile cues help maintain spinal symmetry. Bridges or modified side planks are good starting points, with progression as needed.
Q: Which scoliosis treatment method is best for high school age, considering the Schroth Method helps the 10-15 age group?
A: The Schroth Method can be used for older populations, but it is generally less effective for high school age individuals compared to younger ones. For this age group, focusing on functional core strengthening can also be beneficial.
Q: Are Pilates or yoga safe and recommended for young athletes with scoliosis?
A: Yes, Pilates and yoga are highly recommended for individuals with scoliosis, including young athletes. These activities promote continued mobility and strength, which are vital for managing scoliosis. The most important aspect is to find an activity they enjoy and consistently engage in it.
Q: What manual therapies are effective for scoliosis, and is dry needling helpful?
A: Effective manual therapies include thoracic gapping and rib mobilizations, particularly in a side-lying position to encourage rib expansion. The specific therapy depends on the patient's individual needs and curve patterns. Dry needling is not frequently utilized for scoliosis treatment according to the provided information.
Q: How often are lordotic curves seen in individuals with thoracic scoliosis?
A: Lordotic curves are quite common in individuals with thoracic scoliosis. If a person has a mid-thoracic curve, their body often adjusts by developing a compensatory lordotic curve. Therefore, this presentation is observed frequently.
Q: How do current trends, such as phone and gaming use, contribute to setbacks or overcorrection in scoliosis?
A: The impact of phone and gaming trends on scoliosis setbacks depends on individual patient motivation and activity levels. For athletes, it's often less of an issue, as it's unrealistic to maintain one position for extended periods. For minimally active individuals, parental encouragement to move around every hour, regardless of the activity, is important.
Q: How often are active populations braced for scoliosis?
A: Braces for scoliosis are typically prescribed by pediatric orthopedic specialists. For junior high and high school-aged children, as they mature, the need for braces often decreases, and they may not be in them very much.
Q: What are the three most important practical tools for Athletic Trainers (ATs) regarding scoliosis?
A: The three most important practical tools for Athletic Trainers when addressing scoliosis are observation for signs of scoliosis, implementing exercises on a mat or table, and utilizing a wall for exercises with minimal equipment.
ACL Reconstruction, Repair or Regrowth…which is right for you? Chris Antonelli has worked with a lot of BEAR implant patients for several years. Thank you, Miach Orthopedics, for pushing progress.
Chris Share your AT Story?
Purdue for undergrad
Baseball injuries led me to discover sports medicine
Worked with a bunch of sports in college
During undergrad
Offer outreach AT services
Bare bones:
What is BEAR, and why should an athlete choose it?
It is not a reconstruction; it is a repair technique.
Decreased pain
Less swelling
Earlier function
Feel better earlier
The Ben version:
Is skeletal maturity a strict requirement? How does it look in adolescents?
It is now approved for skeletally immature
Exercises? Any differences in 0-6weeks?
First 4 weeks, they are partially weight-bearing instead of full weight-bearing
The ligament is weaker at first
Limit the flexion range of motion
They will be braced for 6 weeks, and then a functional brace
Does it affect quad inhibition?
They feel really good, really early.
Quads are fantastic, really on.
What does the evidence say about timelines and re-tear compared to autografts?
After the first 12 weeks, it is pretty much the same as others, with a 9-12 month full return to participation.
Slower, more conservative.
BFR and NMES for the first 8 weeks
Once they have a good ROM, load them with an open kinetic chain.
LAQ with BFR.
12 weeks, I do some isometric testing
Patient education –
Educate and measure swelling
Unable to get to full TKE
It looks like meet boiled spaghetti, but we want it to become unboiled
What about 5-10 years out?
We still need more cases and research,h but it looks good with what we have
What research is lacking that we should keep an eye on?
Specific ACL autograft techniques vs BEAR
Is BEAR becoming more accessible? Does insurance affect who can get it?
No insurance issues with BEAR implants
It is being sought out by a lot of people, and until recently, it was not available for high school students.
More surgeons are learning the technique and process.
AT the end of the Bench by Dr. Robert Bradley is a good read for prospective and new Athletic Trainers to the profession. With 32 years of experience as an AT, Dr. Bradley has some advice and wisdom for those who are not so new to the profession as well.
Robert, what is one of your favorite stories to share from your AT career?
When I was a student, the sidelines were muddy, and it was pouring rain. SE Missouri University
Assisting a softball player after recovering from a stroke at the age of 19. She was able return to play eventually.
Take us back to the very beginning. What is your first memory of an Athletic Trainer?
I was cut from the basketball team as a junior in high school. I went to a cramer first aider camp and the rest is history.
What made you become an Athletic Trainer?
My father was a coach, and I understood that side of the game.
I did not enjoy the competition part.
This was the best of both worlds for me.
How long until the “honeymoon” period was over for you?
Worked at a high school in Saint Louis
Then went to college athletics
When I stepped into the administrative role, things changed for me.
How do we stay in the “honeymoon phase”?
Depends on your desires
If you just want to be in the traditional role and avoid the admin work, then you may stay in that phase forever.
Why did you switch?
I had a talent for organization and administration.
I still cover sporting events at the local college.
What do you wish you knew going into AT?
The chapters that were most fun to write
Coaches – I want ATs to understand the coach's perspective
Learn about sudden cardiac death in athletes, including screening, return-to-play, misconceptions, and insights for athletic trainers.
Q: What is one key takeaway for athletic trainers regarding sudden cardiac death?
A: It is crucial for athletic trainers to utilize available screening tools. When an athlete provides positive answers during screening, it's essential to follow up thoroughly to ensure appropriate medical evaluation occurs. This approach helps identify potential cardiac issues early.
Q: What are the clearance and return-to-play criteria for athletes diagnosed with or being treated for a heart condition?
A: Clearance and return-to-play criteria vary based on the individual patient and the specific cardiomyopathy and its severity. While many athletes may face sport restrictions, some cases allow for participation if evaluations are thorough. Each situation requires careful consideration, as there is no universal “cookbook” approach.
Q: What are the most common misconceptions about sudden cardiac death in athletes?
A: A common misconception stems from fear regarding athletes collapsing on the court. It's important to understand that it's impossible to guarantee 100% prevention. Comprehensive workups are necessary to identify rare factors contributing to sudden cardiac death, as some issues might not always be immediately apparent.
Q: What are the updated incidence values and trends in male and Black athletes regarding sudden cardiac death, and what explains these patterns?
A: Multiple factors contribute to these patterns, including genetics and predisposing health conditions. Socioeconomic status, affecting access to healthcare providers and cardiologists, also plays a significant role. Often, primary care physicians manage a large population due to limited access to specialists, and missed family screenings for cardiomyopathy can impact these variables.
Q: What are the barriers when younger athletes are unable to explain what is happening to them?
A: Effective communication with younger athletes is key. Teenagers, for instance, may be reluctant to express their symptoms clearly in a clinic setting, especially if they fear being told they cannot play. Instead of general questions like “Have you experienced chest pain?”, ask specific questions about the type of pain (e.g., sharp, moving). It is also the healthcare provider's responsibility to perform thorough exams and order proper tests, such as EKGs or ultrasounds, to avoid missing critical information.
Q: Is there a commonly overlooked response when screening athletes?
A: A significant red flag is when athletes, for various reasons, fill out screening forms themselves and then change their answers, or when forms are left blank or show erasures. Following up with specific questions about why they changed or erased an answer, and providing education, is crucial.
Q: What inspired you to focus on sudden cardiac death in athletes?
A: My personal experience as an athlete growing up in a small Texas town, where sports were integral, profoundly shaped my life, teaching me multitasking, leadership, and competitiveness. As a mother with multiple children involved in competitive sports, I understand the physical and mental benefits. My inspiration stems from wanting to ensure their safe participation.
Q: What ethical dilemmas arise when individuals refuse genetic testing?
A: When requesting genetic testing, it's vital to explain to families why the test is necessary and how it can help. Many are more receptive when they understand it's a narrow test, not a full genetic profile, and how it can benefit their children. Ultimately, respect their decision and use available information to provide the best care without undue pressure.
Q: Is there anything else athletic trainers should know about sudden cardiac death?
A: I am highly impressed by the athletic training field, particularly athletic trainers' knowledge, dedication to children, and proficiency in CPR and AED use. While physicians have the support of nurses and other healthcare professionals, athletic trainers often perform life-saving interventions on the field independently, which is truly commendable.
Q: What management or monitoring strategies are suggested for children removed from sports due to cardiac conditions?
A: Be mindful of athletes who are removed from sports, as they may feel a sense of loss after being part of a team. If time permits, maintain contact and explore new ways to keep them involved, possibly in a different role within the team or organization. Collaborate with other team members to help the athlete transition and remain connected.
Explore a complex case of Thoracic Outlet Syndrome, double crush, & triple crush injuries. Learn about diagnosis, treatment, & patient support.
Q: Overview of Neck, Nerve, or Both?
A: My wife experienced numbness in her upper extremities. As an athletic trainer (AT), I initially suspected Thoracic Outlet Syndrome (TOS). She eventually sought medical attention and was diagnosed with TOS. Conservative treatment, including medication and a home exercise program, was recommended. However, therapy seemed to worsen her symptoms. An MRI of the vascular system came back normal, except for a benign thyroid mass. A cervical MRI revealed stenosis in C5, C6, and C7, which, when combined with her other symptoms, provided clarity.
I consulted a spine surgeon, who advised exhausting conservative options before considering surgery for insurance coverage. My wife, who has a fear of anesthesia, opted for pain management and received injections. An EMG to rule out carpal tunnel syndrome indicated 70% carpal tunnel involvement. An upper extremity specialist diagnosed a double crush injury, meaning nerve compression at two sites. She underwent left-side carpal and cubital tunnel release, followed by a two-level cervical fusion. Post-surgery, she regained sensation in her pinkies. The right side was subsequently treated.
She experienced relief for about a year before numbness recurred. Another round of CT, MRI, and EMG scans returned normal. Pain management suggested a shoulder issue, leading to an MRI of the shoulder. While the report mentioned a slight rotator cuff tear, a physician who reviewed the scans deemed her shoulder pristine. This doctor's examination of her neck, however, exacerbated her symptoms, leading to a diagnosis of lower brachial plexus TOS.
Despite my initial concern about the previous treatments, the doctor affirmed that the cervical fusion was necessary. A C8 nerve block did not provide relief but offered further diagnostic information. We were then referred to a specialist in Dallas, where a diagnostic nerve block in the scalenes provided immediate relief. Months later, Botox injections were administered for extended relief. The doctor's words, “How does it feel to not be crazy?” significantly validated her experience.
She then underwent a first rib removal on the left side, which resulted in an 11-day hospital stay with complications including two chest tubes, a needle aspiration, and 100cc of fluid in the pleural cavity. Upon returning home, she began physical therapy but developed shortness of breath with deep breaths due to a costochondral fracture, likely from the chest tube or aspiration. She is currently awaiting a consultation for ultrasound injections to address this. The journey continues.
Q: What inspired you to share this story?
A: The primary motivation was to share the complex journey and its takeaways. This case involved a “triple crush” — compression at the first rib, cubital tunnel, and carpal tunnel. A key takeaway is the importance of acknowledging when you “don't know, but know the next step.” In healthcare, we often focus on obvious issues, but a broader perspective is often needed before returning to specific concerns. It's also crucial to acknowledge the psychological toll on patients without answers, highlighting the profound impact of chronic pain.
Q: You mentioned how emotionally draining the journey was. What advice do you have for clinicians to support patients?
A: Remind patients that recovery is an “ultramarathon, not a sprint.” Reinforce this message, as other healthcare professionals will likely echo it. Sometimes, when my wife is in pain, she doesn't want to discuss it, and that's acceptable as long as I am there to support her. The doctor's validation, “How's it feel to not be crazy?” significantly improved her emotional well-being. Supporting patients in seeking further opinions is also vital.
Q: Overlapping issue on a personal level, how did you navigate the multiple diagnoses?
A: My ability to navigate this well stems from my access to top medical professionals through my profession. My connections as an athletic trainer allowed me to consult doctors and seek referrals. While they may not know specific TOS treatments, they can guide us to the appropriate specialists.
Q: Any difficulties separating the Athletic Trainer (AT) role from the husband role?
A: There were no difficulties in separating the AT from the husband role. My wife knew me as both from the beginning of our relationship, so there was no separation or conflict.
Expert insights on athlete nutrition timing: GI issues, RED-S, PCOS, and fueling strategies. Learn about tailored snack recommendations.
Q: What recommendations do you have for athletes experiencing amenorrhea or relative energy deficiency in sport (RED-S)?
A (Dr. Curtis): While not a typical GI condition, amenorrhea and RED-S require a multidisciplinary approach. Often, medication is prescribed to induce a period, but this does not resolve underlying hormone imbalances or decreased bone density. These conditions frequently arise from an athlete's energy deficiency, such as a marathon runner not increasing fuel intake to match activity, leading the body to prioritize survival over non-essential functions like menstruation.
Q: How can athletes add more fuel to help resolve amenorrhea?
A (Poole): It's a myth that athletes should not get their period; it is not normal. Addressing overall energy intake is crucial. In severe cases, decreasing activity while increasing fuel might be necessary. We often work with athletes who are injured or returning to sport, which provides an opportune time to address their fueling needs.
Q: How do you address athletes dealing with PCOS and stress fractures?
A (Dr. Curtis): The culture of sports often pressures athletes toward specific body images or weight classes, which is unhealthy. We must educate athletes that a balanced diet is acceptable and that restrictive diets are not always necessary. Coaches also play a role in fostering a healthier environment.
Q: How do you approach discussing sensitive topics like nutrition and body image with athletes?
A (Dr. Curtis): As a former pediatric sports medicine doctor, I learned the importance of creating a trusting and safe environment. While it's harder to have parents leave the room now in full sports medicine, fostering trust is key.
A (Poole): We focus on the athlete's performance goals, as health often isn't the primary motivator for adolescents. We seek out what truly motivates them to achieve their best performance through proper nutrition.
Q: What are the best snack recommendations for athletes?
A (Bri Poole): Snack recommendations are highly individualized based on what works and what an athlete enjoys. Simple, easily digestible options like GoGo Squeez are generally safe choices.
Q: Are there specific snacks you recommend for gastrointestinal (GI) comfort during exercise?
A (Dr. Curtis): I don't have specific go-to snacks; the focus is on what an individual athlete likes and what doesn't cause GI distress. Suggesting foods they are unwilling to eat can lead to non-compliance.
A (Poole): Simple carbohydrates are typically easy on the GI system around exercise. It's best to stick with foods the athlete has consumed before. Liquid carbohydrates can be a good option as they may sit better for some. While many believe “sugar is bad,” simple sugars are the body's preferred fuel source during exercise.
Q: Should athletes track their food intake?
A (Poole): Some athletes have higher or different energy needs, even if they aren't playing intensely. Athletes generally have elevated caloric demands. It's perfectly fine for them to eat snacks, especially when readily available, such as on the sidelines.
Q: How do you approach nutrition planning for athletes from diverse cultural backgrounds or those who observe religious practices like Ramadan?
A (Poole): Always approach with an open and curious mindset. Ask questions to understand cultural practices better, especially regarding fuel timing within non-fasting windows. Work closely with the athlete to create a tailored plan.
A (Dr. Curtis): Meet athletes where they are; you cannot simply forbid them from fasting. I am willing to write letters to coaches if training times need to be adjusted to accommodate an athlete's practices, ensuring they can continue to play safely.
Q: How does pre-exercise nutrition differ for a morning lift versus a morning run?
A (Poole): Many runners prefer not to eat before a run. For shorter runs (e.g., 5 miles or 3k), it can be acceptable if the athlete had sufficient fuel the day prior and will refuel adequately post-run. However, for exercise lasting 50-90 minutes or longer, pre-exercise fuel is essential, particularly for running due to its impact on bone resorption. The specific goals of the runner (e.g., marathon training) also influence recommendations.
