Past Episodes - The Sports Medicine Broadcast

March 29, 2023November 7, 2022

Cryotherapy Research with Sean Kennedy

Cryotherapy Research discussion with Sean Kennedy, live from the Memorial Hermann Sports Medicine Update. What is current science telling us?

Cryotherapy – What do you tell them?

We have a lot of interpretations, so it makes it hard for there to be clear guidance

Cryo after injuries – there is no hard science about dosing for ice

Think about the messaging (chemical and nerve) that may be delayed

There is a place to allow the swelling to do its job.

Evidence shows compression edges out ice but can be used together easily.

Listen to the theories and allow your mind to be open. Do not be a stagnant clinician.

Cold water emersion

We used to believe it would send them into shock and the heat would stay in the core

All position statements say full body immersion is the standard to lower core temperature

Joint application only could take 80 minutes to cool the body

It could be 3-5 minutes with cold water immersion

Cryotherapy Recovery from workout

What is the value of reducing the perceived soreness from the damage that was done?

If you are trying to mask the fatigue by ice bath you are increasing the risk of injury.

Jeremy Jackson

Shawn Ready – shawnreadyatc@gmail.com

Ray Olivo – rayolivo1@gmail.com

Dr. Mark Knoblauch – maknobla@Central.UH.EDU

Dr. Layci Harrison – lharris5@Central.UH.EDU

Bob Marley – Bob.Marley@uth.tmc.edu

Dr. Josh Yellen – jbyellen@central.uh.edu

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March 25, 2023March 24, 2023

Supply Chain Concerns for 2023

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Supply chain issues are still causing problems for Athletic Trainers. Thankfully Paul Calloway has the inside scoop to help us stay ahead of it.

Supply Chain Concerns 2023 with Paul Calloway

AEDs – there has been a shortage for a little while.

Shortage in components and an uptick with purchasing after Damar Hamlin incident

Hospital suppliers have more access than sports medicine suppliers

Aerosols

Tough to get – QDA, Tuff Skin, Adhesive, Cold Spray

All are unavailable for the foreseeable future possibly until 2024.
Magic spray and stick em’
May not be available in as many varieties

Shortages cause price increases

M-tack from Mueller is a pump spray

Gatorade chews

Still in short supply

They have basically taken those out of the options

Cliff bar energy chew is an alternative

Foam

There has been a bit of pressure in the foam market.

Pre-wrap and under wrap continue to be problems for sourcing

Price increases should be expected

Looking at about $1 per roll

OTC meds

More so with Medique brand products

They have been struggling for about 2 years to get things leveled out.

You may need to buy in the bulk bottle

Athletic Tape

Coach tape from J&J was bought by BSN Medical

The price has gone up but it is back and available again.

Elasticon has been brought back as well

Zonas 1-inch box tape is back in production as well.

Other concerns

There tends to be consolidation of SKUs…like there may be fewer options for ankle braces

Mueller has discontinued some of the medkit lines.

Not a whole lot of new products out this year

Prices will continue to generally increase

Freight

We are paying more in freight now than last year. Even if it says free shipping, it still has to come out of the costs.

Tips

If there are a few sacred items put no substitutions but be willing to consider alternatives on most other products.

Andover was bought by Millican…they are the same, but just now switching branding

They did discontinue some of the niche items

Contact us:

Jeremy Jackson

Paul Calloway – Twitter or Facebook

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March 15, 2023March 1, 2023

Patellar Instability

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Patellar Instability is a specialty for Dr. Jeremy Rush's orthopedic practice in San Antonio.

Tell me about the first patellar instability you remember seeing.

Chronic instability up to dislocation

It is a very heterogeneous group

Patella dislocation and patella subluxation

And patella instability

Addressing the first-time dislocator

Be super aggressive with the rehab

Step one: reduce the dislocation

Brace them for a week but then get them moving

Try to get started in PT within one week

See them back about 6 weeks and then again at 3 months

At 6 weeks with effusion makes you think there is a loose body.

Ability to do straight leg raises

Apprehension with manual pressure

Instability vs dislocation.

Dislocation = all the way out – 95% are lateral

Usually traumatic events
Some are from anatomic risk factors

Subluxation is partially out of the groove

Instability is a chronic form of Subluxation

First timer tips

Get them to relax

Move them into extension

Calm them and even cover the dislocation if needed

Maybe get them up and it could self-reduce

Top patient complaints/ indicators of patellar instability

Knee feels unstable or it is slipping

Or my knee just hurts

Buckling

Recurrent effusion

Anterior knee pain

Start with rehab

Target

Positive patellar apprehension

J-Sign

Predisposed to instability

Patella alta

Women are at higher risk due to q-angle hyperlaxity

Rotational abnormalities

On exam

J-sign

Apprehension

Lateral pressure

MRI on chronic instability

MPFL damage

If the injury is unclear then I get an MRI to rule out any sort of cartilage or loose body.

A huge effusion indicates a loose body.

Contact:

Dr. Jeremy Rush – IG @satxsportsmedicine

Jeremy – @jhjacksonlat

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March 1, 2023November 3, 2022

Eccentric vs Tempo

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Eccentric contractions have long been known to improve muscle hypertrophy. Ryan Collins joins Clayton Berrang to discuss Eccentrics vs Tempo training and how to implement both.

Where in the timeline are the athletes?

Once they can move without bracing

Strength Deficit Eccentric training benefits

Supermaximal load and trying to move that through the eccentric motion

A load that can not move through the concentric movement

How would you recommend emphasizing eccentric training?

Tempo training is a safe place to start but it affects the muscle adaptations

Most ATs and PTs are probably already doing this.

EX: single leg squat – box progression –

Reverse engineer sprinting

Brakes are going to be important to anything we move

But eccentric training offers so much more than just the brakes

Triphasic training

When do you transition from eccentric training?

Time of year and sports demands

Talk about the cycles for football

Summer is great for super maximal loads for the experienced lifters

Beginners lifted should be doing triphasic

The full stretch-shortening cycle would be in season

Tempo training is one of the easiest forms of progression for an athlete's body

Most adaptations from the eccentric load

Increased reps give some adaptations

Tempo is the lowest ROI

Box squats example

Tempo training and progress through the tempo training

4×5 with a 3 sec – 4-5 and up to 8-second tempo

Now we use slightly heavier weight with about a 2-second tempo

5 – 7 – 10 – 12 reps progression

Progress through load

4×5 and increase the load over the next 4 weeks

How do we set up a supermaximal eccentric?

Rack setup with safety catches and partners or team lift it back up

We are looking at 5/10% above our maximal level

We can do 5 sets of 1

Is there a tempo in this eccentric?

Move it as slowly as possible

The nordic hamstring curl is an example

“What works works”

If you move slowly you will move slow, move fast to move fast”

Late RTP 6 months out ACL?

Overload plays in

Their body is avoiding positions needed for power due to injury.

Post activation potentiation

Bands are a great tool

Apply them in multiple planes of motion.

You can pull them into an overloaded position

Forward-backward lunge with the band

Clayton Berrang – Email cberraang@athleteth.com

Dr. Josh Yellen – jbyellen@central.uh.edu

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February 15, 2023November 3, 2022

Mobilization of the Athletic Spine

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Mobilization of the Athletic spine with Brian Duncan and Shawn Ready live at the Memorial Hermann Sports Medicine Update

Who is worried about spine manipulation?

My fear is always the lack of proper evaluation

You need all the myotomes, dermatomes, mobility, and descriptions.

You are not going to manipulate someone who just went in for a tackle and is now having pain.

Red flags are more obvious, but what about yellow flags of mobilization?

Going through your 5Ds

Dysphasia

Dysarthria

Dysoplia

Dizziness

Drop attack

3Ns

Nystagmus

Nausea

Manipulation is a skill similar to any special test we do… it's like an anterior drawer

HVLA manipulations

High-Velocity Low Amplitude

Knowing your anatomy is crucial if you are going to do mobilizations.

Contact Us

Brain Duncan – 214-632-6784

Dr. Josh Yellen – jbyellen@central.uh.edu

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February 8, 2023January 11, 2023

How It Ended

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Jamie shares How It Ended, an amazing partnership between AT and AD to transform the culture of sports medicine in a community.

Jamie, go back over the timeline.

DME – I wanted to be in the high school setting so I knew DME was short term

A&M Consolidated – 2 years, then I left to be the head AT, open a new school, and work alongside my husband.

Rudder in Bryan ISD 11 years – AT and public health mirror each other in the area of prevention. I felt called to go into public health and work with low socioeconomic status. We housed a few homeless students during our time there. During the master's, I got connected with HR and the school safety department. Felt like I hit a ceiling and thought it may be because we were married and did not want to put a spouse in charge of the other.

The move to Brenham would really challenge me to grow.

Assistant AD of Sports Med in Bryan ISD

Brenham – 4 years

Waller ISD

Coach Allen, where are you now?

Giddings Texas – DC / Head AT

Houston Stratford HC/CC – 16 years

Head AD in Benham because we wanted to retire

Bastrop allowed me to be just the AD not a coach anymore.

What is the legacy y’all left?

Coach Allen – Do what is best for kids, even if it is tough for adults.

Jamie – I would hope people would see how deeply I care about making the whole system.

I hope that through my work, people would see that we win when there is a team approach.

You discussed the talks at SWATA and NATA, what do you want to clarify?

The AT department needed a lot of tender loving care.

When I got into I realized how much prep work I needed to do.

Use the PASS or SSSA to guide you and make sure you evaluate your program

I was in the middle of getting my hands dirty and realized I did not have sinks. Coach Allen came in and made it happen within a few days.

Coach Allen, speak to the AT, how do they start the process of building what y’all built?

A lot of times there is a natural divide between the 2

Athletic Trainers are fearful the coach won’t listen and follow instructions

Coaches are fearful every player will be set out.

Be willing to pitch in and do the extra things.

Build trust

Call to action:

ATs – try not to take on responsibilities that are not yours and then let it become your job or expected of you.

If I did someone else's job, I would remind them to take care of it.

Jamie is one of the most efficient people I know. She handles people and situations really well.

She went out and earned the changes and I was able to go in and ask for it.

Contact us:

Jeremy Jackson

Eliot Allen – dallen2@bisdtx.org

Jamie Woodall – jwoodall@wallerisd.net

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January 31, 2023January 27, 2023

Medical Screening with Dr. Laura Purdy

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Dr. Luara Purdy goes over what we know at this point about Damar Hamlin and the importance of accurate medical history.

Dr. Purdy, what do we know at this point about Damar Hamlin?

Has a background of sickle cell trait

Almost no commentary of known information about his heart.

He suffered sudden cardiac death and was resuscitated

Usually, the athlete has something leading up to an episode with hypertrophic cardiomyopathy

Underwent induced hyperthermia and was put into a coma

If there are not any problematic findings he could be cleared to play again and perform rehab.

Any inaccurate info out there we can help correct?

COVID virus and vaccine – causes mild carditis

COVID is not the only virus or vaccine that causes this.

The heart is a muscle and our bodies are filled with muscles from head-to-toe

Most viruses cause inflammation of muscles.

The flu makes your whole body hurt…muscles.

Myocarditis hurts every time your heart beats

A colleague had a kid turn in a physical without documentation of being insulin dependent. What are your thoughts?

This is so dangerous – everyone involved needs to be aware and know how to deal with the possible complications.

They need to have insulin available and food available all the time.

WE WAN YOU TO PLAY…safely

Dr. Purdy, what are some non-reported medical conditions that cause problems?

Asthma

Anaphylaxis

Any history of previous injury

Head injuries

Vision

Discuss the sports physical versus a routine / developmental physical.

Most athletes are going to feel healthy

A routine annual physical is designed to take a look at your health head to toe and risk factors.

We have limited time with them during this.

By having a sports physical we give two opportunities for the doctor to see the patient. And the sports physical would be scheduled for more time.

Telehealth –

The physical exam would change the outcome

We do have smart stethoscopes but we are not there yet.

Still get your sports physical in person if at all possible

Offload the other visits to telehealth and free up the doctor for more in-person time

Athletic Trainers are the first line of defense in protecting the athletes.

If you see something please say something.

Contact us:

Jeremy Jackson

Dr. Laura Purdy –

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January 25, 2023January 11, 2023

The Good Life

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The Good Life, relationships are built, trust is established and culture is changing. Jamie and Eliot discuss what the AT / AD relationship looked like once they got past the rough spots.

Coach Allen, what has been your favorite part about working with Jamie?

She is such a problem solver. She anticipates problems that are going to occur.

Jamie, Your favorite part about working with Coach Allen?

Very patient and graceful when things do not go his way.

He did not shut down when I came on too strong.

“Is it best for the kids?” is a driving force for him

What was your biggest sports medicine victory together?

When I first got into it I wanted to do a lot but I had to clean and organize everything first.

I knew I was going to forget something big like AEDs.

Bart Peterson had a checklist he shared with Jamie that was part of the PASS system.

This really helped us prevent compliance slip-ups.

We changed the culture of healthcare in Brenham. The ripple effect.

The overall respect our community and school had for ATs

We built up to having 4 ATs.

Parents and students were asking for it.

What are some of your smaller wins?

I needed a window door if I had to have a closed-door conversation.
Hydration systems – moved away from trash cans
Radios
Lockers for student ATs
We shut down the gym AT and moved everything to the field house AT Facility.

Having the plan written out on the whiteboard allowed us to collaborate more.

Any regrets?

Coach Allen – Not really, have not worked with anyone I trusted as much as Jamie.

I came in too strong.

When I left Brenham it was an unexpected change. It was not something I was looking for and therefore was a little unprepared.

There were some organizational things I had not prioritized because of the bigger issues.

Talk about the Master’s Degree

I got my degree in public health because I was ready to leave the profession.

Through the master’s I learned how happy I was in the profession

In Brenham, I did not have time for all the school health stuff while we were making adjustments.

The pandemic was really a blessing for an AT with a degree in public health. Being married to Josh Woodall helped us really sit down and work side by side and help set up procedures to get stuff back to the school and back to athletes.

The leadership team was meeting and Coach Allen knew Jamie would be a great asset. He pressured the admin to let her in.

Delivery is key

Respect is built and given, not taken

We did Character Talks with our athletes to help grow the respect for the AT staff. Jamie spoke at some of them.

Contact:

Jamie Woodall – jwoodall@wallerisd.net

Eliot Allen – dallen2@bisdtx.org

Jeremy – @MrJeremJackson on Twitter

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January 18, 2023November 2, 2022

Abdominal Injuries in Sports

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Abdominal Injuries in Sports with Dr. Benedict Ifedi and Shwan Ready live from the memorial Hermann Sports Medicine Update

How are we going to see this on the field?

PQRST –

Provoking – what is making it worse?

Qulity – sharp, ripping

Radiating – diaphragm

Severity – 0-10

Timing – constant, coming and going

All ATs need to have a stethoscope and BP cuff in their kit to monitor for vitals

PulseOx in your pocket

What do we need to carry with us?

Stethoscope

PulseOx

BP Cuff

Pneumothorax cover

Possibly needle decompression – 18 gauge needle

Reflex Diaphragm evaluation

Whats going on

Where are yo uhurting

How is it hurting?

Keep it simple with yes or no questions

PulseOx for Oxygen

Walk them off and continue to monitor if things are trending upward.

Trending downward – call EMS and send them

Let’s try to loosen up everything so there is not compression from equipment.

It can also be a lung contusion – where the athlete is spitting up blood.

If it clears in a few minutes then still sit them out and have them follow up with an ER visit and imaging

Rib Fracture – Evaluation

Posterior to anterior allows you to check the spine first.

Having a systematic routine is important.

Pneumothorax

Spontaneous – taller thinner athletic male

Traumatic- comes witha hit to the ribs

If you are looking at the athlete and they are just struggling then elevate yoru care to the next level.

Use your vital sign measuring tools.

Comotio Cordis

Sudden collapse

Non-responsive

Activate EMS and provide care

Aortic Rupture

ABC

Pulses were weak

Legs felt like they were going numb

Spleenic Laceration

Mono increases the spleen 30-50% increase in size

Flank pain from a blow

Monitor vital signs – PulseOx and BP

Practice your abdominal palpations on non injuries so you know the difference.

Liver Laceration

Rare

Usually non emergency

Painful breathing

Outpatient follow up most likely

Looking at the PQRST

Rigidity in the abdomen is something we need to know what it feels like.

Kidney

Kidney punch

Tenderness in CVA area

May have radiating pain that wraps around to the bladder area

Blood in the urine

Where can we go to learn normal abdominal feel and sounds?

Youtube is a great resource

Dr. Josh Yellen – jbyellen@central.uh.edu

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January 11, 2023January 11, 2023

How It Started

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How It Started is not how it ended. Jamie and Eliot Share their stories and motivation for changing the culture of Sports Medicine in Brenham ISD.

Eliot, before Jamie Woodall, what was your take on Athletic Trainers?

I was a head football coach for 20 years in Houston

We had ATs that were old school and then a series of newer ATs that really opened my eyes

I wanted to move to the model of “head and assistant” vs male and female

Jamie, What was your take on Athletic Directors?

I have had some great experiences and some bumpy ones

Many of those belong to me as being young in my career and lacking the finesse in my conversations.

Why did you interview for the job with Eliot?

I am happy where I am but I was willing to look.

It sounds like Rudder is a situation that someone can walk into and keep the machine running. We need someone to take care of our kids like that.

I lost the Assistant AD title, I had to commute…I was losing a lot.

Tell me about your “List of Demands”

Calibration

Radio

Hydration units

Water access on one of the practice fields

Jamie, you got your master's to leave the profession of AT. Why did you stay?

I got a master's in public health and was really ready to leave.

I could not go to work every day and be happy.

I loved the AT-specific aspects of my job.

Some of those things were my mental decisions, it was my mindset.

Eliot, how did you help Jamie become a little more palatable?

Jamie’s resume was really outstanding

We needed a lot of help.

She really came in guarded, even stating all coaches are A**holes until proven otherwise

I had a plan to get it all started, but those got changed.

Physicals are starting to come in and I do not have a filing system.

We hired a second AT and I pushed for a second female. I wanted to remove the male-female divide.

I wanted someone who already knew my personality.

We wanted physicals every year and not just odd years.

In the coaches' meeting, Eliot stole my show.

I am protective by instinct. I knew I needed to push the coaches so she didn't take the blame.

“It was my job to stand on her own two feet.”

The relationship between the AT and coach can be really tough. Try to see the best in each other.

Being able to relax and trust them

Contact us:

Jeremy Jackson

Jamie Woodall – jwoodall@wallerisd.net

Eliot Allen – dallen2@bisdtx.org