What is an Athletic Trainer?

By: Oscar Mallory, ATC

Many times in my career I have heard questions from the general public that usually sound like this: “What exactly do you do?”; “Are you like a Personal Trainer?”; “Are you like a Sports Medicine Doctor?”; ” Are you like a coach?”; “Are you one of those guys that run on the field or court when the athletes get hurt?”

These questions arise a few times a year and many of you are asking this as well; the answers are simple.

First, we need to define a Certified Athletic Trainer (ATC).  An ATC is a skilled allied health professional that specializes in prevention, recognition, assessment, and management of athletic injuries. He or she is also trained in therapeutic exercise (rehabilitation) and the use of modalities, such as electrical stimulation, ultrasound, heat, ice, along with various others.¹ The ATC works closely with licensed medical professionals to provide care for various athletic populations such as local middle and high schools, as well as colleges and universities. He or she will occasionally refer athletes to physicians or collaborate with team physicians in order to manage injured athletes.

As for Personal Trainers, their primary job is to guide their client’s through exercise routines that they create for them to reach their fitness goals. They also perform routine fitness assessments to help determine how their clients can move forward and increase physical fitness.² We are not Personal Trainers, although our athletes could benefit from their skills in pre- and post-season exercise programs.  After explaining the difference, the reply I commonly get is “Aw man, I was hoping you could show me how to lose some weight!” Even though we have the capability to help people lose weight, we usually focus those efforts on the athletic population.

Although we are often referred to as “Doc”, we are not Sports Medicine Doctors.  After residency, doctors interested in sports medicine complete a fellowship program which allows them to further their interests in either general practice in sports medicine or orthopedic surgery.  Sports medicine doctors in general practice treat patients with athletic injuries.  Depending on the nature of the injury, the doctor will either refer the patient to an orthopedic surgeon for corrective measures or to a physical therapist or athletic trainer for rehabilitation.  As athletic trainers, we work under their supervision most of the time. On many occasions, the doctors are present at games, and some practices, to follow up on past patients.  This increases their accessibility should a medical emergency arise or if an on the spot diagnosis is needed. If their expertise is not needed at that time, the Athletic Trainer will handle all situations that present themselves.

Coaches and Athletic Trainers have one key thing in common; both want their athletes to be healthy and prepared to play.  That is where the similarity ends.  Coaches are responsible for training athletes in proper game play and conditioning athletes for strength and endurance.  They also organize practices and plan for games.  Most coaches are former athletes and they build on their knowledge through seminars or clinics.  There are also many coaches that have earned degrees in physical education and have completed course work in coaching and officiating. Though most coaches have first aid training, they do not take care of injuries unless an ATC is not available.

To address the final question, we are those guys and gals who run on the field when people are hurt.  However the unseen portion of our job is just as important. We perform concussion testing at each of our home schools, coordinating with the school’s athletic director to ensure all athletes have a baseline test.  We are in constant contact with the athletic directors to stay informed of game and practice schedule changes, along with severe weather alerts. Another unseen duty is coordinating with the school’s Principals, Teachers, and Nursing staff to ensure that injured athletes receive any necessary accommodations to aid them throughout the school day. Injuries that may require accommodations can range from joint injuries to concussions.  Of course, athletes can also get sick from a number of things, just like everyone else. As ATCs we are on the lookout for other conditions such as blood disorders, heart conditions and asthma, most of which are revealed during pre-participation physicals.

So as you can see, Certified Athletic Trainers are a specialized medical care group, primarily serving the athletic community, with the ability to administer preventative, acute and rehabilitative care. ATCs also use a lot of the same manual testing methods that sports medicine doctors use in the field and the athletic training room. These tests help determine the nature of an injury and help the ATC come up with a plan of action that may involve taping, bracing, rehabilitating, or referring to a physician for diagnosis. The athletic trainers at CHKD are a dedicated group of people that enjoy working with young athletes, as well as the many sporting events we cover in the community.

References:

NATA, board of directors, (2013, January). Terminology. nata.org/athletic training/terminology

Earl, Roger (2004). NCSA’s Essentials of Personal Training. NCSA Certification Commission.  pp. 162, 617.

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Core Exercises for Runners

By: Tim McDonald, PT, ATC

The Oregon Project Stability Routine

Key exercises that keep some of the world’s best runners healthy.

Here is an article from Running Times magazine written by Matt McCue regarding exercises done by Oregon Project runners.  The Oregon Project is a distance running team coached by Alberto Salazar, former Boston Marathon winner and American record holder.  Two of his runners, Mo Farah and Galen Rupp, medaled in the 2012 Olympics; Farah with a gold in the 5K and 10K, Rupp with a silver in the 10K. As the strength coach for the Oregon Project, David McHenry, PT, is tasked with keeping 2012 Olympians Mo Farah, Galen Rupp, Dathan Ritzenhein, and Matthew Centrowitz healthy.  For each movement, do 2 sets of 20 repetitions, 3 times per week.

Hot Salsa

Step into a wide lunge and reach a weighted ball as far out in front of you toward the ground as you can. Keep your back as straight as possible. Shift your weight forward on your front foot. While keeping the ball forward, lift your back leg off the ground and rise up to a perfect running position.

Runner Touch

Strike a pose in perfect running position with one leg in high knee position. Balancing on the one leg, bend at the hip and touch the toe that’s on the ground with the opposite hand while the leg in the air rotates under and back. Make sure the standing leg remains stable and as straight as possible while enabling you to touch the ground. Be sure to prevent the moving knee from crossing midline while that leg straightens out behind you. Come back up to running position quickly without losing balance, pause for a second or two, and repeat. Switch legs and repeat.

Side Plank Knee to ChestBegin in a side plank. Let your shins rest on a BOSU ball and balance on the ground using your lower arm. Keeping your body level to the ground, drive your top knee toward your chest while moving your upper arm back in a running motion. If your left elbow is on the ground, your right knee will move forward in a “high knee” position and the right arm will swing behind, parallel to the ground. The motion recruits the core, scapular stabilizers and muscles down the leg. Repeat on the opposite side.

The Clamshell

Lie on your back and bend your knees to 90 degrees, keeping your feet on the ground. Then hold that position and roll onto your side. Keeping your feet together and your femurs slightly in front of the midline of your body, lift the top knee away from the bottom knee using the glutes to drive the action. The upper foot will turn down to “stand” on the other foot and the motion will engage the external hip rotators.

Reverse Clamshell

These may feel like they’re the same as the clamshell, but they control the hip in a different way. Whereas the clamshell opens on the front side of the body, this exercise opens on the backside. Lie on one side with your knees bent and your lower legs behind you at a 90-degree angle. While keeping your knees together, lift your top foot away from the bottom foot as high as you can, hold it for a two-count and then bring it back down slowly. The target muscle is the deep internal hip rotators.

Mountain ClimbersDrop to a plank position with your forearms on a medium-sized stability ball. Keeping your core tight, bring a knee to the ball. Try to keep the ball and torso as steady as possible. Alternate knees to the ball throughout the exercise. The movements integrate muscles used during a stride.

The Jane Fonda

Lie on your side and place your bottom hand behind your head. Put your top hand on your upper hip, pressing your pelvis forward to make sure it does not rotate back during the exercise. Use your core muscles to stay steady. Keeping the top leg straight, lift it up and then back using your glutes to lift the leg. By keeping the outside of your foot level to the ground, you should feel the fatigue in your gluteus medius.

Runner Pulls

Balance on one leg and grab a pulley system or elastic band in front of you with the opposite hand. Raise the free knee up toward your waist while simultaneously pulling the weight down 90 degrees and rotating toward your opposite leg. These should only be undertaken after you have mastered the previous drills, as any lingering hip or core weakness or control deficiency will reinforce the wrong movements here.

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Lightning Safety

By: Christine Minor, MSEd, ATC, VATL

VTLightningLightning is the most frequent weather hazard that affects athletic events. Since 2006, lightning has caused an average of 32 deaths a year in the United States and about 10 times as many injuries.  The National Weather Service’s data from 2010-11 shows 48% of lightning casualties occurred during organized sports and 62% of lightning fatalities were attributed to recreational activities.  June, July and August are the peak months for lightning activity, as well as the peak months for outdoor sports and recreational activities.  On average, 25 million lightning flashes strike the ground each year in the United States.  It is very important that during outdoor activities those in charge are aware of the risks of being outside in a thunderstorm and take the appropriate actions to prevent lighting strike injuries.

It is important to monitor the weather report before and during activities occurring outside in times when thunderstorms are common, most typically late afternoon to early evening.  Portable weather radios are available for monitoring developing weather conditions, as well as smart phones and tablets equipped with weather monitoring applications.  Lightning can travel up to 8-10 miles, so if you can hear thunder you are within 10 miles from the lightning strikes.  If lightning is seen and/or thunder is heard, outdoor activities should be postponed or suspended until 30 minutes after the last strike of lightning is seen or thunder is heard.

Upon suspension of activities, participants and spectators should move quickly to a safe building until the storm is over.  The safest place during a lightning storm is a fully enclosed building that has wiring and plumbing.  If there is not a safe building nearby, a fully enclosed vehicle with a metal roof provides a similar amount of protection.  It is important to note that structures often identified as shelters are not safe. These include: rain, sun, bus, picnic, and park shelters, storage sheds, dugouts and tents, as well as structures with open areas like gazebos, press boxes, porches, and concession stands.

In the event of a lightning injury, it is important that emergency medical services be contacted immediately by calling 9-1-1.  It is a common myth that lightning strike victims carry an electrical charge, they do not, and it is safe to provide first aid and cardio-pulmonary resuscitation (CPR) if necessary.    Rescuers should first make sure the area is safe for them to enter and, if needed, move the victim to a safer location before beginning care and resuscitation efforts.  It is common for lightning strike victims to be found unconscious, with cold extremities, and in cardiopulmonary arrest.  If an automated external defibrillator (AED) is available, it should be used with victims who are unconscious or may be in cardiac arrest, but locating an AED should not delay CPR.  CPR and first aid should continue until more advanced healthcare personnel arrive and take over care.

For information on the Virginia High School League’s Lightning Policy visit: http://www.vhsl.org/sportsmed.lightning-safety

 

References:

Lightning Safety. National Weather Service. http://www.lightningsafety.noaa.gov/fatalities.htm. Accessed August 7,2014.

Walsh KM, Cooper M, Holle R, Rakov VA, Roederll WP, Ryan M. National Athletic Trainers’ Association Position Statement: Lightning Safety for Athletics and Recreation. Journal of Athletic Training. 2013; 48(2):258-270

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Minimalist Running vs. Traditional Heel Striking… Does it Even Matter??

An Update in Running Medicine from the 2014 Running Medicine Conference at the University of Virginia

By Dana Strozier, DPT

By this point, anyone even remotely interested in running is probably well aware of the continuing trend towards minimalist or barefoot running. Minimalist running encourages more of a midfoot or forefoot strike as opposed to the traditional heel strike, and it continues to be quite a hot topic in the running community. Will Cowling, CHKD Sports Physical Therapist, wrote a blog post here back in December of 2012 where he discussed some of the research behind the various striking patterns (i.e. heel striking, midfoot striking, forefoot striking) as well as some of the potential benefits and disadvantages of each pattern. In today’s blog post, I will first review some of the basics regarding striking pattern and injury risk. Then we can jump in to discussing some of the newest research on these topics as presented at the 2014 Running Medicine Conference at the University of Virginia this spring.

To summarize without getting too technical, the research has shown that heel striking produces greater stress on the body due, in part, to the high loading rate of the ground reaction forces (GRF). Think of GRF’s as the amount of force being transferred through your joints as a result of your feet hitting the ground, and think of loading rate as how quickly that force is applied to your body. It is commonly accepted that the GRF produced by running is about 2.5 times your body weight, regardless of which striking pattern you use. Since we cannot change the GRF’s (without altering body weight), the difference in the various striking patterns is in how quickly this force is applied to your body. Obviously, a more gradual increase in forces applied to our bodies will be less stressful than applying these same forces very quickly.

When these forces are displayed on a graph (see below), heel striking has been shown to produce what is referred to as an “impact peak” as a result of applying a high amount of force very quickly (i.e. a high loading rate). You can see this represented as a steep line leading up to this peak. This, in turn, has been shown to contribute to a multitude of running-related injuries.

Dana 1

Forefoot or midfoot striking, however, has been shown to produce lower loading rates. Although you still reach that “2.5 times your body weight” GRF, you do so more gradually, therefore putting less stress on the body and theoretically reducing injury risk. Take a look at the graphs below that compare a heel striker (presumably in traditional running shoes) to a barefoot or minimalist runner.

Dana 2

You can see that the barefoot runner does not even produce that initial peak in the graph (the impact peak), and the increase to the maximum force is more gradual, though they both reach the same maximum force. As Will discussed in his post, the research supports the idea that heel strikers seem to be injured more frequently than forefoot or midfoot strikers. In an effort to streamline this information, the media seems to have simplified this idea into the following significantly over-simplified conclusions:

1.) Heel striking is bad and leads to injuries.

2.) Forefoot or midfoot striking is good and will decrease your chance of injuries.

As a physical therapist, a runner, and a heel striker, these ideas have made me wonder, “Is the solution to injury-free running really just a matter of changing how your foot strikes the ground?!”

Some new research presented by physical therapist and researcher Jay Dicharry at the 2014 Running Medicine Conference suggests it is slightly more complicated than simply looking at the position of the foot when it first hits the ground while running. In fact, Dicharry’s research has shown that a heel striker can actually produce a relatively low loading rate (as represented by a graph with no impact peak, like in the graph shown above of the barefoot runner) while a midfoot runner can produce a graph that looks like the top one shown above with the steep impact peak and high loading rate. But how is this possible?

As it turns out, where your foot strikes the ground in relation to the rest of your body may actually be more influential than the actual position of your foot when it hits the ground.

While heel strikers will typically produce a graph with that initial impact peak and a high loading rate, and a mid or forefoot striker will typically produce a graph with a lower loading rate and no impact peak, Dicharry’s research has shown that this doesn’t necessarily have to be the case. His research has shown that the problem is likely not actually the heel hitting the ground first vs. the mid or forefoot hitting the ground first. The problem may actually stem from the fact that heel strikers are more likely to over-stride, meaning they reach their leg out too far ahead of their body while running.

Dana 3

This means their foot will hit the ground far ahead of their center of mass (see the red runner in the picture above). Not only is this highly inefficient (like hitting the brakes with each step you take!), but it is also what leads to the high loading rate and increased stress to the body. Conversely, forefoot or midfoot strikers are less likely to over-stride, meaning their foot typically hits the ground closer to their center of mass (see the green runner in the picture above). Not only is this running pattern more efficient, but it produces a lower loading rate, which essentially means less stress to the body. This research suggests that maintaining a more “pendulum-like” stride instead of over-striding (thus, essentially taking shorter steps) can result in a lower loading rate, reduced stress to the body, and decreased injury risk regardless of your actual striking pattern.

To summarize, addressing strike pattern is not necessarily the best way to decrease loading rate and minimize the stress running places on the body. Adjusting stride length may actually be more beneficial than attempting to change how your foot strikes. So for all those injury-prone heel-strikers who are looking to improve their running form, this research shows that it may be possible to decrease the stress to your body and increase efficiency by simply decreasing stride length and striking closer to your center of mass.

The research by Jay Dicharry discussed in this blog post was presented during the 2014 Running Medicine Conference.  Dicharry discusses this research in a series of 2 blog posts linked below:

1) http://anathletesbody.com/2011/02/07/loading-rate-part-1-what-does-it-mean-for-you/

2) http://anathletesbody.com/2011/02/08/loading-rate-part-2-forefoot-midfoot-rearfoot%e2%80%a6%e2%80%a6-who-cares/?relatedposts_hit=1&relatedposts_origin=187&relatedposts_position=0

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Preventing Skateboarding Injuries

By: Chris Bertani, PT, DPT, MS, OCS, CSCS

Skateboarding 1

 

Summer is in full swing and the groms are hitting the streets and boardwalks with their skateboards.  Skaters skate for fun, transportation, and sport.  While some might argue skateboards are “useless wooden toys”; skateboarding is invigorating, but does carry some inherent risk.  Skateboarding injuries accounted for an estimated 78,000 emergency department visits in 2011.1  The most common injuries include injuries to the ankle, wrist, or face.2,3  Concussions, fractures, and dislocations are some of the more serious skateboarding injuries.2,3  These injuries typically occur with falls or during collisions.  Although not all injuries can be prevented, heeding some basic advice can help to reduce the potential for injury.

Skateboarding 2SAFETY FIRST!!4 The American Academy of Pediatrics2,3 (AAP) recommends children less than 5 years old should not ride skateboards, and children younger than 10 years old require close supervision. Some basic advice includes not skateboarding in or near traffic or when holding onto a moving vehicle.  So NO “skitching” a ride from your sister’s bike or neighbor’s mini-van!  The AAP also strongly recommends kids wear protective gear when skating.2,3  Equipment should include a quality skateboard, helmet, wrist/hand guards, elbow pads, knee pads, and appropriate shoes.  The helmet should be of good quality and comply with the U.S. Consumer Product Safety Commission (CPSC) or guidelines set forth by the Snell Memorial Foundation.1-4  The helmet should fit snug and not move around when you shake or move your head.1,4  A proper fitting helmet should not interfere with your vision or your hearing.1,4

Skateboarding should take place in designated, supervised skate parks to improve overall safety.  Skateboarding should not be performed on wet, rough, uneven surfaces, or surfaces with debris.1-5

Skateboarding 3

More than 50% of skateboard injuries occur among those younger than 15 years old, and 85% of these kids are young boys.1,6  Novice skaters account for nearly one-third of the injuries.4  Kids tend to have reduced balance and coordination, muscle imbalances, and tend to overestimate their abilities.1,4,6  Inadequate protective equipment, attempting tricks beyond their skill level, using homemade ramps and obstacles, in addition to the above mentioned factors, can lead to increased risk of minor and more serious injury.4

Before attempting switch 360˚ kick-flips or McTwists, kids should really learn the basics. Learning how to slow down and come to a controlled stop and learning how to turn properly should be emphasized in the beginning.  Also, learning how to control a fall is important because every skater falls once in a while.  Like any other sport, fitness is important and staying or getting in good shape with conditioning exercise is recommended. Of course if an injury occurs seek proper medical attention.  For more information about skateboarding safety and how-to advice, check out the resources below or talk to someone at your local skate shop or skate park.

Resources:

  1. http://orthoinfo.aaos.org/topic.cfm?topic=a00273
  2. Skateboarding and Scooter Injuries. Committee on Injury and Poison Prevention. Pediatrics 2002;109;542. DOI: 10.1542/peds.109.3.542
  3. AAP Publications Reaffirmed or Retired. Pediatrics 2014;133;e799.  DOI: 10.1542/peds.2013-4154
  4. http://skateboardsafety.org
  5. http://hss.edu/onthemove
  6. Skateboard Injuries. Committee on Injury and Poison Prevention. Pediatrics 1995;95;611
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