Hot Springs Arkansas is the place to be in July 2024. Keith Shireman and the Arkansas Athletic Trainers Association will host SWATA outside of Texas for the first time in years.
SWATA is the largest attended district meeting.
Next year Keith and the team in Arkansas hope to make SWATA 2024 the newest record holder for SWATA attendance.
QCollar seems like just another gimmick…but this could really be a life-changing tool. Dr. David Smith, inventor of the Q-Collar joins me to discuss the story, how it works, and his book When Heads Come Together.
Where did the idea for the Q-Collar start?
Dr. Dave was presenting at the Army Research Lab in 2008 where they threw down the gauntlet complaining that clever people should “figure out Traumatic Brain Injury.”
I was working on wound care.
When presented with the woodpecker I immersed myself in the anatomy and physiology of cavity animals.
During a yawn, you are occluding your jugular.
When getting FDA clearance, what were some of the harder questions you had to answer?
42 patents
We are the only FDA-approved TBI prevention device.
Is there any concern with extended use, like several hours at a time?
FDA recommends 4 hours.
We lay down to sleep for 8 hours at a time and occlude our jugulars.
When Heads Come Together – this is a more detailed story about your journey to “solve” TBI…discuss the book.
Julian Bailes listened to me and encouraged me
Discuss the rebreather and how you can reverse TBI.
We looked at how a giraffe breathes
In the first 10 minutes after a concussive event, there is a critical issue
We partnered with Dr. Jedd Hardings at Cinncinatti
Spreading depolarization
I told him CO2 was the trigger for the depolarization
They raised the CO2 levels of a legally brain-dead patient in a coma. The family agreed to try this and 4 hours later he awoke from his coma.
Youth Sports Safety is Jim Mackies passion project. With over 50 years working as an AT, he can sit back and turn the profession over to the younger crowd, but instead, he continues to give time and effort to help improve healthcare for all athletes
Mr. Mackie have you ever had to perform CPR?
Had a coach drop dead on the goal line after a game.
As I am headed that way I see the firetruck pulling out, and this was before we AEDs readily available.
Jim, What is happening in Youth Sports Safety?
Florida is # 1 in sport safety but much to be done. Laws re Concussion, CWI, AED, EAP, etc. but much education and compliance are needed.
There are a lot of causes or task forces, why did you choose Youth Sports Safety?
Obviously, there was a big void legislatively & in the knowledge base. Allows me to put many years of experience back into the community to advocate and educate.
Where is it headed?
Progress is being made but we have to see more implementation of best practices done consistently. With many schools without an AT there requires more district education, especially in our rural communities.
What roadblocks are we seeing?
Resistance and slow to change the culture, especially in youth leagues. Many are volunteer-driven and they rely on what their personal experience was and not best practices as well as the effort it takes to implement.
We have discussed social media a lot recently, what role does it play in Youth Sports Safety?
Podcasts can help to educate and influence the public. They see a lot of situations that happen and yet are dismissed or diminished in a 24-hour news cycle.
We have been opportunistic and gotten some really high-profile doctors and Athletic Trainers.
Call to action:
Take the time to educate kids, parents, and coaches on the best practices. Raise the expectations of those you entrust your child to at their sports venue. Take the steps to create a venue-specific EAP, learn CPR, have AEDs accessible everywhere, and connect with an AT.
Tyler Knight shares some Soccer Specific Return To Play or RTP tips and tricks. With nearly a decade of soccer experience, he has seen a lot of growth in sport-specific rehab plans.
What is the least soccer specific rehab exercise you have seen?
Almost everything we do…discuss the importance of understanding the ‘why’ of what we do, as well as never forgetting components of movement.
Isometrics because the patient can’t perform much more
Eccentrics once able
Stretch-shortening cycle
Unloaded → supported → unsupported
“Train movement not muscles”
What do we need to consider in on-field RTP?
In order to get to the field, you have to get out of the Athletic Training room first.
Treat the person, not the athlete or the injury (reference all that people have going on in their lives). Ron Corson-ism
Good communication, setting expectations, and appropriate planning are MUSTs.
Individualization (based on person, position, and injury)
Consider our two biggest protective capacities and build upon those early: strength and endurance
Programming based upon working zones (importance of ESD)
Quantifying internal vs. external load
To do that, we have a few basic rules at Charlotte FC:
1. Create a safe environment.
2. Don’t hurt the person.
3. Be aggressive without breaking rules 1 and 2.
KPIs to provide direction and accountability to the process
Additional principles of rehab to accelerate and enhance what we do on the field:
Move early, move often.
Highlight BFR and isometrics.
Don’t mess it up.
Consider tissue healing times.
Periodize manual therapies, incorporate things the person believes in
Break down the phases of healing (acute, subacute, remodeling), as well as the places of healing: table, Athletic Training room, gym, field, and everything in between.
Create time for mental or psychological recovery
KPIs
Mobility
Stability
Function
Power
On-Field
Consider position, individual needs, team tactics, and demands of the sport…and MAKE IT FUN
Players have the ball only 3% of the time, a good reason to emphasize the incorporation of the ball and fitness/drill exercises that place focus on getting into the right spaces
In 2019/2020 EPL season, the highest average number of passes per game was 688 (Man City; approx 62. per player) and the least was Burnley at 333 (approx. 30 per player).
Paul Bradley research
Consider control – chaos continuum
Reverse engineer and use the prospective loading document
When we have elevated AC ratios, did the majority of that come from a more controlled environment or chaotic environment
By using fatigue, you can increase chaos (for those athletes limited in what they can perform)
How are you going to account for one of the most unique facts of the game: limited substitutions and, potentially like many other sports, the pace of the game is only increasing
Actual loading
Link load with the context of how it happens in a session/match
TD, HSR, sprint, ACC/DEC, HMLD or explosive efforts
Intensive vs. extensive days (can you match what the player is doing with you to what the team is doing; team schedule, RPExduration)
Density of high intensity actions (repeated sprint ability and repeated high intensity efforts in 1, 3, and 5 min blocks)
In the secondary setting, we may not be out on the field for practice. How can we help coordinate RTPs?
“It takes a village.” Educate, incorporate, and empower those around you. If we all understand the why, we will know how to do it, and what we need to use to get there. Trust is a major factor here.
Create a PowerPoint document, have illustrations, don’t be afraid to do the math ahead of time, use a stopwatch.
Let's talk through a RTP plan you use and why:
The war is won and lost in the mind
Briefly recap where we are and where we’re going
What can we do to prepare, potentiate, desensitize, or address other movement qualities before we hit the pitch; build time and trust with people
Individualization:
Needs assessment to construct rehab or movement plan:
Current injury
Previous hx of injury
Quality of movement (identify areas to fine-tune)
Training history (gym)
Movement and ability restoration
Major proponent of push-pull movements or complex training (plyo-like), also appreciate avenues to incorporate lumbopelvic hip stability (core transferring F)
External load
Average weekly load in training
Average match load
These are BUDGETS, it’s science AND art
If they aren’t close to being on the field, what are we going to do to reduce that gap (RPE x duration; off legs conditioning, gym, etc.)
On-Field
4 levels
1: high control
Band 1 ACC/DEC, no HSR/sprint
2: medium control
Band 2 ACC/DEC, add HSR, no sprint
3: low control to low chaos
Band 3 ACC/DEC; add sprint
4: medium to high chaos
Add density to exposures
Drill selection
Technical
Tactical/passing
Position specific
**all interspersed with position specific running**
MAS, ASR, or loading focused
How can we get players out of rehab the same care and joy others get from playing the game
Revisit the plan often to show progress
Change the setting
Make it fun, do what you can with them
Week
Monday: introductory day
Tuesday: small to medium space
Wednesday: large space
Thursday: treatment only
Friday: small to medium space day, slightly more than re-intro
MOBO is a single myofascial release tool designed and created by Dr. Christie Powell. Her inventor story is different than the ones we have heard previously.
MOBO is only offered in blue…why blue?
I have scaled back the company and product offering
We got a huge verbal order before COVID that wanted blue.
Happy accident since we had to order 10,000 units
How did you get started?
As a smaller person performing myofascial release on large D1 athletes.
I kept having to McGyver things together to teach the patients how to do the work at home.
At a huge CrossFit event, the contestants all had 10+ devices and that was a huge inspiration.
I wanted one device that could replace most of those.
I reached out to an engineering friend and we worked together.
You mentioned getting funding for MOBO…can you share?
It is so complicated, I am a PT and I just want something for my patients.
We had to create CAD drawings
Film videos
Pay someone to listen to your idea
The very first prototype was $1000 to produce.
We connected with a producer that worked out in our gym and he was our first funder.
$10,000 seemed like so much but that went through really quickly
He hooked us up with the filming studio.
We launched a Kickstarter to produce about 1000 units.
All my friends were product models and my gym was always the setting for photo shoots.
We did a “Meet and Greet” and the people donated about $20,000 which allowed us to make our first order.
We had trouble sourcing the materials in the US so we had a big process of finding the materials that were responsible.
We got another couple hundred thousand dollars from customers. This was a personal loan-type investment.
I had to bring on some business partners and there was much more stress.
So much time lapsed between a problem and a solution because they were being made overseas.
The last round of funding happened right at COVID. We had put in all the work and fine-tuned the process.
We took away all of the moving parts to limit the possible breakages.
We simplified the tool, but of course, that costs money and time.
We got 1.5 million dollars from one investor and that was in January 2020…right before COVID.
We now have to spend all this time filming and creating a website and an online shop.
Discuss the MOBO licensing deal
I felt like I was letting my baby leave the house.
Our deal was with DICK’S Sporting Goods.
We actually shared their manufacturing facility and they felt our tool would help them reach the adventure sports crowd.
We had to negotiate so many things to produce the product cheaper.
We knew there were certain areas we could not compromise on certain components.
What would you do differently if you were starting over?
Everything got me to where I am now with the product and company.
I could not have done this by myself. Surrounding myself with the best possible fit and people that have the same values.
I allowed anyone who showed interest to help instead of vetting them and picking the “right” person
What do you see going forward?
I am going to lots of places to do a demo for a running group and a yoga studio.
Alex Bray is a young professional that grew up with social media and smartphones. She uses it to make an impact in her sports medicine practice.
Why do you use social media for sports medicine?
Started in grad school as a way to network, turned into a way to advocate for our profession & athletes, share things I struggle with as an AT to help others, and learn from other ATs in areas that I’m weaker in.
What have you taken from Social Media?
It can be helpful or hurtful. I’ve created some friendships because of it, but I also see toxic, negative things in the AT Social Media world every day. I tend to scroll past those & ignore them as best I can.
How has it helped?
I’ve learned things to help my athletes (@ Zach’s incredible shin splint program, patellar tendon treatments, etc), learned about jobs, and gotten involved more in my state association because of it.
Has it been harmful or negative for you at all?
The most “harmful” thing for me is more of my personal anxiety struggles. I feel like I’m a part of the first generation that ever grew up with social media and playing competitive sports we always hear “Everyone is watching what you post,” so I tend to overthink if my content is portraying what I want to, or if someone will take it out of context. When I start to overthink things and feel like my mental health is struggling, I usually delete the apps for a while.
How do you manage Twitter?
I try to go by the rule I grew up with using social media: Don’t post anything you wouldn’t want your grandma to see! There are certain hot takes that I avoid sharing opinions on. I also tend to ignore any of the toxic, negative comments/accounts.
Which platforms do you use and why?
Twitter – a huge opportunity to network with other ATs, learn from other ATs, and also share things with parents/athletes that they may not learn otherwise.
Facebook – From an AT perspective, mainly to connect with my athletes’ parents/encourage other parents to understand what ATs do for their kids. For example, I had the opportunity to go to the state capitol this year, so of course I’m going to share that and make sure parents see ATs do so much more than stand on the sidelines!
TikTok- I use TikTok in waves. I’ll download it, post some content, and then get anxious with it (afraid something is taken out of context for example) and delete it for a while. I try to take “social media breaks” anytime I start to feel like they’re affecting my mental health.
What has your HR or legal department given you for guidelines?
Probably more than I can remember. Honestly, living by the “don’t post anything you don’t want your grandma to see” is my general guideline for social media use. I definitely have certain opinions that are different than Select Physical Therapy, but I try to disclose that my opinions are my own, not the company I work for.
What connections have you made through social media?
Friendships/relationships more than anything!
Call to action:
Use social media to share positive things about the profession / where it’s going / what we do. Feeding into the toxic negativity spiral doesn’t help anyone! Use that same energy to reach out to people who can make a difference at the state and national levels!
Andrea Kovalsky uses Twitter a lot as an Athletic Trainer.
Why do you use social media for sports medicine?
I was professionally socialized by Boomer ATs, so I’m a bit old school. But working on a relatively nontraditional DAT, I’ve learned that we have to embrace change and make it work for us before we get left behind. If social media is how future generations consume information and interact with the world, then it has to be a part of how we advocate and move the profession forward. Otherwise, we’re losing out on engaging with a huge audience.
There is just so much information out there, it’s impossible to read & digest everything coming out of sports medicine today. I like the short snippets that social media provides so that I can decide whether I want to read the whole article/study later
Journal subscriptions are expensive! I’m completing a DAT at FIU right now, but I joke that I’m only there for access to the university’s library databases (PS: If we want preceptors to encourage clinical students to practice EBP, we must give preceptors access to the university library databases as a form of payment for the work they do!)
What have you taken from Social Media?
Like the disclosure slide that no one pays attention to in CEU presentations: my opinions may not be those of my employer, and use this information with caution!
Take everything with a grain of salt: Who is the speaker? What’s their background? What’s their motivation for posting this? Are they blowing off steam, subtweeting someone, or looking for genuine engagement? If they are looking to engage, are they open to learning, or will any discourse make them dig in further? Know when to disengage.
We have such a diverse community on #ATtwitter. There are a lot of positives as well as some challenges. It’s also helpful to bring those connections to the real world, though. The life we present online is often much rosier than real life, but real life is where things get done. Advocating on social media and living it are two different things. I try to be the same person online as off.
How has it helped?
Probably wouldn’t have survived lockdown without finding AT friends online
Learning new clinical techniques, hearing about research before it’s published
Another avenue to get questions answered & reach people in power
Got our new practice act language passed!
Helps me survive as a solo AT: venting, troubleshooting, connecting with others who get my jokes
Has it been harmful or negative for you at all?
There will always be trolls and misinterpretation of context, which is how messages get blown out of proportion
Probably mildly addicted, but who isn’t? (It’s also kinda my job to be on socials, so I use that excuse)
How do you manage Twitter?
Tweetdeck is a lifesaver, but there are dozens of paid and free social media managing apps out there
Add relevant images as much as possible, it boosts your visibility
Use a link-shortener like bit.ly when you reach a character limit
Don’t just post a link to other content, post a quote or short explanation
Ask a question, and state something poignant if you want people to engage
Best engagements happen when you post in the morning
My NATM is often not the theme: 2022 was #ATgratitude, and 2023 was #auscultATe. IATA’s 2022 was #FlatAT (had so much fun with that!)
I do use ATCAnonymous, but only when I need to reach a wider audience than what I have, with a legitimate question. Not a fan of anonymous accounts. Why? Listen to Kutz & Konin’s Leadercast episode 15: Anonymity & leadership
Socrates said: “Is it true? Is it kind? Is it necessary?” There’s enough shit in the world. Be kind.
Eleanor Roosevelt said: “Great minds discuss ideas; average minds discuss events; small minds discuss people.”
Which platforms do you use and why?
Fewer and fewer nowadays! The real world is too busy (FT job, FT doctoral student, serving on 2 boards & a committee, and like to cook and run)
Facebook, b/c I'm a millennial
Twitter for AT stuff
I assist in managing the IATA Instagram, but I don’t have a personal account
I had a Snapchat for a week, and didn’t get it, so I deleted it
Personal social media account vs. AT department account:
Make sure you’re posting on the right account!
Know & stick to that account’s goals & mission
But don’t rely on that account solely to convey information (ATR hours, for example)
What connections have you made through social media?
The Mark D’Anza story: LT hoodie
Road trip to Rock Island, IL: Augustana, Shakespeare in the park, and Denise
Crashed at Hopper’s on the way home from an epic road trip a few summers ago; got some amazing Texas BBQ
Downstate IL ATs….who got me the job I have now
SSATs: I have helmet stickers from at least a dozen states. I’ve gotten beer & tea from Ohio, a poker chip from Vegas, and lapel pins from New York
How I decided to do a DAT!
Call to action:
My mantra: Lead with Compassion.
Lead: Don’t follow. Don’t do it just because everyone else is doing it. Do it because it means something to you. And don’t be afraid to do something that no one else is doing!
Lead: when there’s so much coming at you at once and you don’t know where to start, start with compassion. Don’t start with aggression or frustration or anger.
…with compassion: Have compassion for not only others, but yourself. Everyone is going through or has gone through stuff, even the ones that look like they have it all together. If someone is mean to you, it’s a reflection of who they are, not you, so give them the compassion they need. There are enough “-isms” out there (racism, sexism, ableism, ageism, etc.). Try compassion instead!!!
Favorite twitter accounts to follow (besides sports medicine broadcast): MadamAthlete, California AT Association, NATA_SSATC, Washington State DNR (@waDNR) @EDACNATA, @SimonSinek
TikTok always ended up showing me stuff I did not want to see, so I deleted the app. Meanwhile, KP, AKA Kyle Parkison, is amassing quite a following and positively impacting the world using TikTok.
Why do you use social media for sports medicine?
Started it for fun and advocacy
A lot of students and people did not know All of the things we do as Athletic Trainers.
TikTok has a lot more random followers
TikTok would be the only one if I had to choose.
Those videos are about ten seconds to a minute long.
A lot of people know and follow me…
It is kinda weird
I am outgoing but people outside of my circle following and recognizing me was just weird.
What have you taken from Social Media
I have been using it for about 6 years.
I have taken a lot of ideas from others
How has it helped?
Free stuff for the kids
Advocacy
Has it been harmful or negative for you at all?
My wife and I have had a few conversations about it, but she actually is pretty helpful in making videos.
How do you manage a video per day?
Some are 1.5 hours
Some are 30 seconds
Some are 6 seconds
I keep the app open while recording the long videos and just lock the phone until it is time to record again.
Which platforms do you use and why?
I use:
Twitter
IG
TikTok
Facebook
YouTube shorts
TikTok is easily my favorite
What has your HR or legal department given you for guidelines?
Our admin team was 100% supportive
None of them really knew what is going to happen
Make sure you ask and keep open communication.
I ask parents before posting ones with student-athletes
What connections have you made through social media?
Several brands have sent me things or given me discounts for making videos.
Lots of student-athletes in the surrounding area have connected with me.
Growth Plate Injuries are hard to identify unless you know what to look for. Dr. Lindsay Crawford specializes in Pediatric Orthopedics and shares some of her wisdom with the Sports Medicine Broadcast.
The location of the pain is an indicator
Is it at the joint itself or on the bone adjacent?
Dr. Crawford likes to have xrays before doing a lot of special tests on athletes with swelling
How can they verbalize?
Take your time
Look all around
Break it down and say words they understand
Use your normal system for evaluating
Give them a distraction – maybe close their eyes
I try to not clue them into what I am looking at.
Little league elbow – what tips do you have?
Year-round baseball is huge in the southern states where you can play all year long.
You need to have a feel for the parents and kid and know if you can say rest or not throw anything at all other than in a life-threatening situation.
Return to throwing instructions are complex and have a lot of steps.
After they begin their program require them to come back into the clinic to re-evaluate
Speak to the Mental Health of the kids that get shut down.
Know what the patient's goal is, and form a plan that works and they can follow.
Do we have an end point or goal
The curveball and growth plate injuries?
If there was no pain, and then they started throwing the curve ball and pain started, we need to cut out the curve.
If you have mysterious knee pain then check the hip.
Growing pains are real
Some kids have growing pains
3-6-year-olds, typically have pain in their calf or knee
