Do you personally have a Diagnostic Accuracy cutoff in terms of diagnostic factors to determine if you would use the test?
No, but if there are multiple tests available I look at the most accurate ones. I do not really like it when clinicians do every test available just because.
Are we image happy?
X-ray, MRI, Ultrasound – it is visual, so it gives us something to see
But blood tests do not really give us that. It has to be done against controls.
Having every injury get an MRI would be great, but it is cost-prohibitive for a lot of people
“If we are sending every patient to get an ultrasound image, then why are we there?”
Talk about treating the patient vs treating the image or diagnostic test.
In Athletics, the nice thing is most injuries are life-threatening.
But for internal injuries MRIs are lifesavers.
It is hard to argue with an x-ray showing a fracture
What is the conversation you would have with parents before the season begins about your confidence in your evaluations and role at the school?
If I think we can treat them here we will if I think they need imaging I will refer them to our team doctor and he can order the images.
Mention this though: “a non-sports medicine doctor will likely default to out two weeks” once they do that we are obligated to follow that before beginning rehab and return to play work.
Is there any uncertainty in using diagnostic accuracy values in Athletic Training?
YES! There is untold value – the new ATs have learned this but it is a new development in AT education.
How do we make Diagnostic Accuracy Language more universal?
It is growing as we have more and more ATs learning about it as part of their education.
More talks at conventions with catchy names
When would you not focus on diagnostic accuracy measures?
In short, yes you can go with your gut and try a few other tests when things seem off.
How do you get students to buy-in?
This is how you win arguments.
If someone questions you and your evaluation you Have numbers and research to back it up…this usually will end the argument.
Make them understand it is not just statistics.
Some orthopedic tests have minimum research or no reported value, where does proof of the value come in?
Yes, you can still do the test if there is a value that is not reported.
Diagnostic Accuracy” – Mark Knoblauch, PhD, LAT, ATC, CSCSAsk your questions LIVE from the Memorial Hermann Sports Medicine Update 2019 in Katy, Texas. We hope to include your questions in the follow up interviews that will be edited and released later.
NATA Presidential candidates Kathy Dieringer and Katie Flanagan join Cari Wood in answering some member-driven questions.
Jill A. asks – Licensing in California – what’s the plan?
Katie Flanagan (KF): We need to pull back, circle the wagons and reconsider it
Kathy Dieringer (KD): It has gotten to the Governor’s desk multiple times…then vetoed but it does not pass due to politics. There is no lack of effort, but there are organizations working against us.
Continue to be persistent
Chris P – How will we work to expand Diversity in our field?
KF: Tripled our membership in 20 years but only increased diversity 3%
Diversity wins
KD: Diversity makes us stronger
NATA membership stat is about 80% caucasian
Other than the board our leadership does not reflect this number
Jeff K – What suggestions do you have for ATs to sustain viable employment due to the lack of sports?
KF: The secondary setting is hugely important and is a portion of what we do.
Your 2020 NATA Candidates join the SMB for a round of answering your questions.Submit your questions here, via messenger, or via email to info@sportsmedicinebrodcast.com
ALWAYS do a neurovascular assessment. Every single dislocation should experience this before reduction.
With the Shoulder there is a risk of axillary nerve entrapment
Typically if the nerves are intact distally then they are intact all the way up the nerve, therefore do your nerve tests at the distal end of the limb.
A dysvascular limb becomes a medical emergency so do a pulse check on both sides. double and triple check if there is no pulse as some are harder to palpate
Dr. Mundluru also recommends having the functional tests distal to check nerve and muscle function
OK sign
Thumbs up
Cross fingers
Scratch test
Repeat the scratch test at the deltoid and check bilaterally having the patient note any difference in sensation
A good motor assesment for dislocation management is having the patient press backwards at the elbow into the examiners hand. most other ROM tests will be limited or elicit pain.
They also discuss:
Brachial Plexus Crush
Transient symptoms after dislocation
Self-Reduction
Sports Specific RTP
When does it become surgical?
Elbow Dislocations
Hip Dislocations
Patella and Knee
Whenever possible treat young patients non-operatively.
Have stories of Dislocation Management gone well or poorly?
It has been widely recommended that athletes partake in multiple meals throughout the day in order to maintain the energy necessary to participate in athletic events. Most Muslims will automatically adjust their meal frequency to two meals in a 24 hour period, the Suhoor (early breakfast) which takes place at dawn and the Iftar which takes place just after sunset. The challenge is created as student-athletes find it more difficult to eat healthier meals as each Iftar is generally composed of meals that are high in fat, sugar, and salt. It should be noted that meals at both Iftar and Suhoor generally meet the daily caloric needs for student-athletes they may lack proper nutrients that are essential for optimal performance.
Since the daily caloric value is generally met by student-athletes it is important to pay particular attention to the macronutrients (fats, carbohydrates, and protein) consumed. It has been recommended that foods high in both fat and protein are consumed during Iftar and that foods high in carbohydrates and low in glycemic index are consumed during Suhoor in order to provide adequate fuel for the day.
Hydration
Lack of fluid intake throughout the day can create significant risks for those who participate in physical activity during Ramadan as most athletic events take place while Muslim student-athletes are fasting. A common occurrence for student-athletes is to ingest large quantities of fluids during hours of allowed fluid intake. This practice can prove ineffective as it will induce urine loss as well as disrupt sleep. It is recommended to drink water frequently in shorter intervals with solid foods during meals to aid in digestion and water retention. Another recommendation is to drink water with a marginal amount of salt and/or electrolytes prior to dawn to improve water retention and stores. Sugary and caffeinated drinks should also be avoided as they can cause further dehydration.
Sleep
Disruption in sleep will cause daytime fatigue and poor concentration. Coupled with a new fasting cycle, student-athletes may find it difficult to maintain a level of physical performance prior to Ramadan. Student-athletes are recommended to maintain a minimum of 8 to 9 hours of sleep a night. Since meals that break the fasts can often disrupt sleep cycles, student-athletes are encouraged to partake in naps in which they can obtain between 1.5 to 2 hours of sleep in the afternoon when able to in order to negate the effect of nocturnal sleep loss.
Considerations for Coaches and Medical Emergencies
Coaches and staff must always be aware of and sensitive to all student-athletes needs both religious and non-religious. It is important during this time that coaches routinely collect feedback from student-athletes but not to do so in a way that draws attention to a student who is practicing a religious observation. It is also important for the student-athlete to make the coaches aware of their practice, as fasting during Ramadan without knowledge can be misconstrued as a lack of effort or performance without the knowledge of these recommendations.
One consideration to keep in mind is the early days and weeks of a new fasting cycle, is the disruption of a student-athletes ability to self regulate their body temperature during activity without the use of fluids. Student-Athletes will have access to cooling towels during athletic events as well as small cooling tubs in the Athletic Training Room. Student-Athletes are able to rinse their mouths with water in an attempt to stave off thirst but in the event that a medical emergency is believed due to dehydration and/or increase in body temperature, it is allowed to give fluids to the student-athlete and activate the Emergency Action Plan. In any instance, regardless of religious views or practices, all student-athletes should be treated equally as to not draw attention to their needs.
Please inform booster families that student-athletes may attend, but will not be able to participate in pasta or pizza parties that take place during the season. In addition please inform banquet planning families to consider providing a take-home option during the postseason banquets. Even though there will be plenty of food for them at home, the notice and consideration will not go unnoticed by the student-athlete and their families.
Internet dropped so we have part one and part two on FB
We are approaching the Ramadan season again.Two RDs in the Gatorade fellowship program have joined us today as well. Melanie Battalagia and Kayla Cross. They are working with Brett Singer out of Memorial Hermann's Ironman Institute.Interesting enough we may not even need to consider what is required in treating the atletes observing Ramadan as COVID`9 has pretty much shut down all athletics across the country.
We are approaching the Ramadan season again.Two RDs have joined us today as well. Melanie Battalagia and Kyla Cross. They are working with Brett Singer out of Memorial Hermann's Ironman Institute.Interestingly enough we may not even need to consider what is required in treating the athletes observing Ramadan as COVID`9 has pretty much shut down all athletics across the country.
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?
Making a switch to online learning in a hands-on intensive course is not an easy task.These Clinical Coordinators join to share their struggles and successes.Luzita Vela, Ph.D. (University of Virginia)Valerie Pelleck, MSc., CAT (University of Winnipeg)Adam Naylor, Ph.D. (University of Bolton)Aoife Burke, CAT (Dublin City University)SportsMedicineBroadcast.com/InternationalClinicalCoordinator
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.
Robert Andrews has shared some tips on parenting and guiding athletes whose season has been abruptly cut short.Cari wood has been monitoring the mental health of her students for a few years. She has revamped her survey and tips to fit our current world pandemic.Todd Sabol just knows how to connect and serve others.Join the conversation or share your success and struggles.
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!!!!!
Putting her creativity to work Megan wrote a poem about Athletic Training to encourage you.Compex partnered with us to send out some free units to help ATs improve their practice.
