Managing the Asthmatic Athlete

Understand asthma in athletes, including environmental triggers, gender disparities, and symptom differentiation.

Ryan Brown, DO, CAQSM
Managing the Asthmatic Athlete

Q: Is there a correlation between working in an area with chemical plants and developing asthma?

A: Living near chemical plants, such as Pasadena High School, can lead to a higher incidence of asthma due to pollutants. These pollutants can damage tissues and cause respiratory issues, mimicking asthma symptoms. It's not typically an age-related development but rather an environmental factor.

Q: Why do boys seem to have a higher incidence of asthma and injuries in athletics compared to girls?

A: It is possible that the higher incidence of asthma and injuries in boys is due to a greater number of boys participating in athletics. We often diagnose asthma in children who are going to be athletes, and this demographic tends to be more boys than girls. A true genetic cause for this difference is not currently known.

Q: Is there a reason why Black individuals have a higher incidence of asthma?

A: A 2008 study indicated that Black individuals have higher incidences of asthma, followed by White individuals, and then Hispanic individuals. The specific reason for this disparity is not fully understood at this point.

Q: Among triggers like exercise, allergens, and pollution, does one impact asthma more significantly than others?

A: The impact of asthma triggers varies by individual. All of these factors can trigger asthma. For example, some individuals with allergic asthma may experience more severe reactions in rural areas due to pollen, while others may be more affected by industrial air quality problems in urban settings. Allergen tests can help determine an individual's specific triggers.

Q: How often are upper respiratory infections (URIs) confused with asthma?

A: URIs are likely to be confused with asthma, especially in younger patients who have not been tested for asthma. In emergency room settings, albuterol is often administered due to its low risk and typical effectiveness. If a patient improves with albuterol, it can lead to a presumption of asthma or bronchial hyper-responsiveness.

Q: How would you encourage an athletic trainer (AT) if they are unsure whether an athlete truly has asthma or is just out of shape?

A: It is challenging to differentiate between an athlete being out of shape and having asthma, as the symptoms can be very similar. Increased access to medical professionals for diagnosis is encouraged. Athletic trainers should promote education about asthma. It can be a difficult situation, particularly if a coach suggests a student is feigning asthma to avoid participation.

Q: How much does an asthmatic baseline cost, and how beneficial is it for an athletic trainer?

A: An asthmatic baseline device can be beneficial, especially for younger athletic populations, and can be purchased from retailers like Amazon. These devices can be reused if properly cleaned between athletes. Establishing a baseline helps athletic trainers objectively assess an athlete's lung function, determining if intervention or rest is needed before play.

Q: When establishing a baseline for an athlete, should it be tested daily, or only when the athlete feels slowed down?

A: An asthmatic baseline should be established out of season, before the season starts when the athlete is having a normal day and not experiencing symptoms. It should be retested approximately once a year to account for changes in fitness levels and lung capacity as the athlete grows and develops. It is not necessary to test daily, only at the beginning of the season to gauge their baseline.

Q: How does acid reflux mimic asthma symptoms?

A: Acid reflux can mimic asthma, especially in younger individuals who may not be able to articulate their symptoms precisely. They might point to their chest, similar to how they would for cardiac issues, instead of explaining the burning sensation associated with acid reflux. This can lead to a misinterpretation of their discomfort as asthma.

Ashlyne Elliott

Leslie Bennett

Sponsor List

Frio Hydration – Superior Hydration products.

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Donate and get some swag (like Patreon but for the school)

HOIST – No matter your reason for dehydration, DRINK HOIST

MedBridge Education – Use “TheSMB” to save some money, be entered in a drawing for a second year free, and support the podcast.

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

Preparing the Athlete for Surgery

Ashlyne Elliott

Leslie Bennett

Sponsor List

Frio Hydration – Superior Hydration products.

Xothrm – Best heating pad available – Use “SMB” or email info@xothrm.com and mention the Sports Medicine Broadcast.

Donate and get some swag (like Patreon but for the school)

HOIST – No matter your reason for dehydration, DRINK HOIST

MedBridge Education – Use “TheSMB” to save some money, be entered in a drawing for a second year free, and support the podcast.

Marc Pro – Use “THESMB” to recover better.

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

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Are We Worrying Too Much About Electrolytes During Exercise – Brett Singer

brett singer; electrolytes

Ashlyne Elliott

Leslie Bennett

Sponsor List

Frio Hydration – Superior Hydration products.

Xothrm – Best heating pad available – Use “SMB” or email info@xothrm.com and mention the Sports Medicine Broadcast.

Donate and get some swag (like Patreon but for the school)

HOIST – No matter your reason for dehydration, DRINK HOIST

MedBridge Education – Use “TheSMB” to save some money, be entered in a drawing for a second year free, and support the podcast.

Marc Pro – Use “THESMB” to recover better.

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

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Words Matter with Bubba Wilson

mitigating secondary loss

Ashlyne Elliott

Leslie Bennett

Sponsor List

Frio Hydration – Superior Hydration products.

Xothrm – Best heating pad available – Use “SMB” or email info@xothrm.com and mention the Sports Medicine Broadcast.

Donate and get some swag (like Patreon but for the school)

HOIST – No matter your reason for dehydration, DRINK HOIST

MedBridge Education – Use “TheSMB” to save some money, be entered in a drawing for a second year free, and support the podcast.

Marc Pro – Use “THESMB” to recover better.

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

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Preceptor Reflections with Leslie Bennett

Discover Leslie Bennett's insights on being an exceptional athletic training preceptor, her passion for the profession, and advice for aspiring ATCs.

Leslie Bennett
Preceptor Reflections

Q: What makes you an exceptional preceptor, and why do students consistently choose to learn from you?

A: I’ve been practicing since 2009, having graduated from TXST and then joining MHH. I became a preceptor in 2016 when I joined UST, where I now serve as the Director of Sports Medicine and Senior Woman Administrator. This allows students to experience both the hospital and university aspects of my work. I aim to teach them how to advocate for the athletic training profession.

Q: What is your favorite aspect of being a preceptor?

A: My favorite part is the daily interaction with students. I enjoy watching them grow throughout their athletic training careers, from start to finish. It keeps me active and engaged, always moving and lifting equipment alongside them.

Q: What inspired you to become an athletic trainer (AT)?

A: My journey began in high school; I was a student seeking an activity before basketball season. I've always wanted to work in healthcare as a “giver at heart,” specifically with an active and motivated population. What truly drives me is the opportunity to inspire athletes to become their best selves. I also focus on imparting life lessons and common sense, helping them mature into adults.

Q: Amanii, what made Leslie a good preceptor for you?

A: Amanii stated that my personality made me a good preceptor. I am very welcoming and provide a safe space for students to be hands-on and make mistakes. I added that I aim to give students ample opportunities to practice and learn before they are on their own, without overwhelming them.

Q: Amanii, is there anything Leslie could have done better to help you?

A: Amanii reflected that she is quiet and reserved and needs more one-on-one discussions to talk through things. She also acknowledged that she needs to be more verbal and proactive in asking for help when she needs it.

Q: What is the most valuable lesson you've learned as a preceptor from students?

A: Teaching and conducting skills checks with students is the best thing I've learned as a preceptor. This process keeps me fresh, on my toes, and ensures I stay current with the latest practices and information in the field.

Q: Jackson, what are the differences in expectations between your first and second-year students?

A: As Jackson, I believes in a hands-on approach from the start, as students might not get such opportunities at other sites. First-year students receive more guided practice; for example, I'd bring them along for a concussion evaluation to observe and ask questions. By their second year, I expect them to lead first-year students and attempt any evaluation, acting as mentors.

Q: What are your general expectations for first-year and second-year students?

A: For first-year students, my main expectation is willingness to work. If you're comfortable with ankle evaluations, I'll provide those opportunities, and we'll build from there. For second-year students, I expect them to mentor first-years and be ready to attempt any evaluation. I added three expectations: be ready for anything, be a sponge, and be flexible. I also stressed not to complain about menial tasks, as students are paying to be prepared.

Q: How do you balance your professional and personal life as an athletic trainer?

A: As a single AT, my life is simpler, though my lifestyle might be a reason I'm single. Initially, it was challenging to advocate for myself, but now I set strict boundaries with athletes and coaches. My Athletic Director is supportive and helps enforce these boundaries. Jackson emphasizes communication with all parties, especially his wife, using a shared calendar to manage busier seasons and ensure understanding.

Q: What are the unique aspects of navigating the athletic training profession as a Black woman?

A: As a female AT, I must be prepared to stand my ground against those who doubt my capabilities. It's important to demonstrate competence in all aspects of the job. Being a Black female AT also means representing diversity and understanding the unique challenges some athletes face, allowing me to advocate for those who cannot. A downside is that my directness can sometimes be perceived as abrasive. It was tougher initially, and challenging moments still occur, but it's crucial to document incidents as perception is key.

Q: What advice would you give to aspiring athletic trainers starting their first year as ATCs?

A: I advise networking extensively, as your current professional pool is small. Seek out mentors and build relationships with people at different levels and settings. Attend medical timeouts and district meetings to connect with others. Never assume you know everything; it's okay to say, “I don't know, but I will find out.”

Ashlyne Elliott

Leslie Bennett

Sponsor List

Frio Hydration – Superior Hydration products.

Xothrm – Best heating pad available – Use “SMB” or email info@xothrm.com and mention the Sports Medicine Broadcast.

Donate and get some swag (like Patreon but for the school)

HOIST – No matter your reason for dehydration, DRINK HOIST

MedBridge Education – Use “TheSMB” to save some money, be entered in a drawing for a second year free, and support the podcast.

Marc Pro – Use “THESMB” to recover better.

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

AJ Duffy – The Future of Athletic Training

Care You Can Count On is the theme for National Athletic Training Month (NATM). AJ Duffy joins my UH MAT students to discuss the future of Athletic Training.

AJ Duffy the future of Athletic Training

This episode of the Sports Medicine Broadcast, hosted by Jeremy Jackson and joined by student medics Ben Stephenson, Caroline Hayes, and Katie Gibson, features NATA President AJ Duffy discussing the future of the Athletic Trainer profession and leadership.

AJ Duffy‘s treasured memories from his Athletic Trainer career are not specific injury recoveries, but rather the lasting relationships built over 42 years with student-athletes, coaches, and colleagues. He stresses that these connections enhance the medical care provided, especially in embedded settings like military, performing arts, and athletic environments, where professionals may work with individuals for long periods.

The Path to Leadership and NATA Membership

Career Start: AJ Duffy‘s interest in becoming an Athletic Trainer began in high school and was cemented on a recruiting trip to the University of Michigan, where he was mentored by figures like Lindsey McLean, the “father of the certification exam”.

First Leadership Role: His leadership journey started as a state liaison officer, where he initiated the creation of the first national directory of leaders in the profession due to the lack of an easy way to connect before the internet. He describes volunteerism and leadership in the NATA as a “vortex” that moves the profession forward.

Value of NATA: Duffy explains that NATA membership is crucial for continuing education and, more importantly, professional advocacy. As an example of advocacy, he cited the NATA's successful federal effort to prevent the suspension and eventually expand the Army's holistic health program, which utilizes embedded Athletic Trainers. Additionally, the NATA establishes guidelines to enhance compensation and positions across all career sectors.

Advice for Future Athletic Trainers

International Career Pathways: For those seeking international opportunities, AJ Duffy noted that international athletic therapy is a growing field. Opportunities exist in places like Britain, Ireland, and Spain (which has two CAATE-approved programs). He advises new professionals to put in the “legwork” to find openings in various international sports and secondary schools.

Focus and Communication: Duffy's primary advice for young Athletic Trainers is to be a sponge, be unafraid, and put the phone down to stay focused on the conversation or the injured individual. He emphasized the critical nature of communication and having “conversations that matter,” noting two quotes: “Are you prepared to have a conversation that matters?” and “Buried feelings Never Die”. He encourages students to ask questions, but only at appropriate times, not during a critical moment like an injury evaluation.

Contact Us

AJ Duffy – President@NATA.org

Jeremy Jackson – SportsMedicineBroadcast.com

Benjamin Stephenson

Carolin Hayes

Katie Gibson

These people LOVE Athletic Trainers and help support the podcast:

Frio Hydration – Superior Hydration products.

Xothrm – Best heating pad available – Use “SMB” or email info@xothrm.com and mention the Sports Medicine Broadcast

Donate and get some swag (like Patreon but for the school)

HOIST – No matter your reason for dehydration DRINK HOIST

MedBridge Education – Use “TheSMB” to save some money, be entered in a drawing for a second year free, and support the podcast.

Marc Pro – Use “THESMB” to recover better.

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

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Safer Sidelines – Stephanie Kuzydym

Stephanie Kuzydym shares some of the background before becoming known as Safer Sidelines on Twitter (X).

Stephanie, where did the Safer Sidelines journey start?

I was a high school tennis player and visited the AT often.

My mom spotted the signs of overheating.

I started to train for marathons and learned more about heat illness.

I took a storytelling class in college and heard the story about a Louisville kid who died from heat exhaustion.

It was always a topic at the back of my mind.

When I moved to Houston and learned about the heat and humidity.

A baseball player with commotio cordis really was the tipping point.

Damar Hamlin was a huge catalyst for the improvement of the database.

We were working on SaferSidelines before he collapsed.

Scott Anderson and Dr. Steve Horwitz had their own databases, and together we created the Deadly Games Database.

What is one of the most eye-opening things regarding athletics?

Why is nobody seeing this thing???

Why are we so bad at reporting this?

Is anyone asking for the details?

Was there an AT, an AED?

Matthew Mangine collapses June 16.

Mike Quinn tells his daughters' girls' soccer league that they need to learn CPR.

A short time later he was running during their practice and collapsed.

Had Damar Hamlin not collapsed, they would not have been trained in CPR.

The Damar Hamlin incident activated a major push for CPR/AED training

Contact:

Stephanie Kuzydym

Bubba Wilson

Benjamin Stephenson

Jeremy

These people LOVE Athletic Trainers and help support the podcast:

Frio Hydration – Superior Hydration products.

Xothrm – Best heating pad available – Use “SMB” or email info@xothrm.com and mention the Sports Medicine Broadcast

Donate and get some swag (like Patreon but for the school)

HOIST – No matter your reason for dehydration DRINK HOIST

MedBridge Education – Use “TheSMB” to save some money, be entered in a drawing for a second year free, and support the podcast.

Marc Pro – Use “THESMB” to recover better.

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

McDonald; Dermoneuromodulation; Medbridge; CEUs Online CEUs; affiliate link

Chronic Back Pain with Aclarion

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

These people LOVE Athletic Trainers and help support the podcast:

Frio Hydration – Superior Hydration products.

Xothrm – Best heating pad available – Use “SMB” or email info@xothrm.com and mention the Sports Medicine Broadcast

Donate and get some swag (like Patreon but for the school)

HOIST – No matter your reason for dehydration DRINK HOIST

MedBridge Education – Use “TheSMB” to save some money, be entered in a drawing for a second year free, and support the podcast.

Marc Pro – Use “THESMB” to recover better.

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

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Scoliosis-Specific Rehabilitation

Learn about scoliosis rehab with Lauren Ferrante, PT, DPT, OCS. Explore home exercises, manual therapies, and AT tools for scoliosis.

Lauren Ferrante, PT, DPT, OCS
Scoliosis-Specific Rehab

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.

Ashlyne Elliott

Leslie Bennett

Sponsor List

Frio Hydration – Superior Hydration products.

Xothrm – Best heating pad available – Use “SMB” or email info@xothrm.com and mention the Sports Medicine Broadcast.

Donate and get some swag (like Patreon but for the school)

HOIST – No matter your reason for dehydration, DRINK HOIST

MedBridge Education – Use “TheSMB” to save some money, be entered in a drawing for a second year free, and support the podcast.

Marc Pro – Use “THESMB” to recover better.

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