Last semester, I said that I felt least confident when asked to perform an evaluation alone. This has greatly improved this semester. I feel more confident in my knowledge of common injuries and how they present, and I feel that has had a tremendous impact on how I feel while performing an evaluation. I believe that I have improved greatly in my palpations, and this is partly because I have just been exposed to it more. I believe that palpations are something that you can only improve in by practicing it and familiarizing oneself with them. Being able to perform more trigger point work on athletes has played a big role in my comfort level with palpations. By performing trigger point, I have been able to practice feeling for abnormalities within the muscles, feeling where one muscle begins and the other ends, and practicing how hard I need to feel during palpation. Additionally, I have learned to not freak out when the athlete presents with something unfamiliar to me. It’s very rare that an athlete presents with textbook symptoms for an injury, and that is okay. I have learned to take it one bite at a time, and that it is okay to ask for help when I am faced with something challenging.
This past semester, I was not able to experience many rehabs, but I enjoyed those that I was involved in. This semester I was able to be involved in a lot more rehabs, and I still feel the same way about them. I love to see the athlete improve and work hard (most of the time) to get better. I am thankful that I was able to be a part of the rehab process more this semester. Overall, I feel that I have grown as an AT student and in my skill set; however, there have been quite a few problems as well. I feel like I have lost my excitement for the process, and sometimes feel like I do a lot, perhaps too much, learning on my own. I oftentimes have to be “re-taught” things in the clinic because I still do not know the information from class. There have been quite a few times that I have wondered whether or not that this is the best academic track for me, and have done a lot of praying about it. However, I will continue doing my best to keep learning in the AT program as long as I am still here.
This week we had a head and face practical where I received approximately 19 attempts, some of which will hopefully be mastery.
Now that I am back with my primary preceptor, I realize that a lot has changed since the beginning of the semester. However, I do not believe that the changes are just with the rotation that I am on; I believe that the changes translate throughout all of the rotations with all of the different preceptors. Now that I am almost through all of upper and have complete lower, the expectations of me have risen. I have the opportunity to perform more evaluations now than I did in the beginning of the semester, and I believe my preceptors feel as if they can trust me without having to “hold my hand” per say throughout the entire evaluation.
A tremendous change has occurred regarding rehabs. Now I am entrusted with running many rehabs on my own, whether it is in the weight room or in the clinic. This area is one in particular that I have enjoyed because I love being able to see the athletes back in an athletic atmosphere where they are getting to push themselves to be better. Additionally, Chaypin allowed me to create my first rehab this past week. It made me feel as if she trusted me enough to be able to put one of her athletes in my care. Of course she checked over it and gave me feedback, but being able to create a rehab on my own was a huge milestone for me.
Unfortunately, one thing that has not changed throughout the semester is my confidence in the clinic. My confidence level is about the same as when I started this semester despite the knowledge that I have gained in the past 3-4 months. I feel as if the information that I am learning in the classroom has trouble translating to actual application in the clinic. However, once someone in the clinic explains to me the situation that I am struggling with, I can learn from it and am able to apply it to other situations that are similar.
This week I had approximately 3 attempts this week during our head and face evaluation. A lot of the tests for the head and face section are tests that we have covered before in previous sections, so I am unsure of whether or not we will cover them in class. We participated in a concussion debate in class, so my attempts for this week are lower than normal.
This week I have had the opportunity to run many of the rehabs for women’s soccer players. Many of these rehabs have been ankle related, but many have been ACL related as well. A specific ankle rehab that sticks out to me is a one for a soccer player who has struggled with chronic ankle instability and reoccurring ankle sprains. She has been coming in for rehab for almost two weeks and seems to be making good progress concerning strength; however, her balance is a big area of weakness. She often has trouble while performing activities on the BOSU ball, such as cup pick-ups and cup touches. She especially has trouble doing tasks on the blue foam pad that is used to help with balance.
During a specific rehab, she had particular issues with keeping her balance while closing her eyes and standing on one foot on the BOSU ball. It was in the rehab plan to try to keep her eyes closed while moving her head from side to side while doing the same exercise as before. She seemed apprehensive about the task, but tried to do it anyway. She had to catch herself many times and couldn’t seem to keep balanced for more than just a couple seconds at a time. Because she could not perform the activity in an efficient manner, I told her to keep her head still on the second try to see how she would do. She still had a few issues, but overall she was able to perform better. From there on, I told her to alternate between moving her head and keeping it still every two times until she finished the designated number of sets. By doing that, she was able to spend a lot more time on the BOSU ball instead of catching herself or having to reposition back onto the BOSU ball. She was able to do the rest of her exercises in the rehab without alteration. I hope to be able to follow her through the rest of her rehab, to see the improvements that she makes. Additionally, this was a great experience because I was able to implement what I have learned in therapeutic rehabilitation in the clinical setting. What happened during this rehab is not something I have experienced very often, so it was definitely a unique learning experience.
This week we had a wrist, hand, and finger practical. By having the practical, I received approximately 50 attempts, and some of these will turn into masteries (hopefully).
We have made considerable progress on our little clinical question research. Together with the help of our committee, we have found some extremely useful information in discovering whether or not a mineral deficient is the primary cause of muscle cramping in athletes. With the information that we have discovered, we have realized that we may need to change our question. Instead of comparing three minerals, potassium, sodium and magnesium, and their effects on muscle cramping, we may need to begin looking at the comparison between a mineral deficit and muscle overloading. The thought of changing our question this late into the process has definitely been a challenge, but we want to have the best clinical question that we can have that is the most beneficial in the long run. Additionally, in regards to research on our current question, it is very difficult to locate information on each separate mineral. We have found one article that solely mentions a sodium deficit, but no articles yet on magnesium or potassium deficits. This is really surprising to me because of how the majority of people tell those who are cramping to eat a banana due to the potassium in it.
I have been very surprised at some of the information that we have found so far. One article we found mentioned that there was no evidence stating that a deficit in a particular mineral could cause muscle cramping during competition. I also found it interesting that another article states that it is difficult to distinguish the difference between an overload muscle cramp and a mineral deficit cramp. Lastly, one of our articles stated that if the muscle cramp is a result of overloading that muscle, only that muscle and the muscles in that muscle group would be affected by the cramping. On the other hand, if it were a mineral deficit that is the source of the cramping, the cramp would travel across muscle groups to cover a wider area of the body.
Moreover, meeting with Beth about our question really helped us in focusing our research on specific questions that we had. I felt a little frazzled when looking prior to the meeting because I was really unsure of what I was looking for. Now that we have specific question, I believe that we will be able to find better information to attempt to answer our question.
This week I had approximately 42 attempts in our clinical book. We began the wrist, hand, and finger section in upper with Brianne, and received attempts in ROM, MMT, and special tests.
This past week I was able to work on my evaluation skills. Being on Kris’ rotation, I have gotten a lot of experience in regards to the rotator cuff and back muscles. Many baseball players come into the clinic with pain in their infraspinatus, lattisimus dorsi, pectoralis, and supraspinatus. I have been able to do a lot of trigger point on these muscles, and become very familiar with palpating these muscles. This has worked toward my goal of studying anatomy, studying signs and symptoms, and working on my evaluation skills, which cover all of my clinical goals for this semester. The most prevalent of these goals in my opinion is working on my evaluation skills. With the repetition of the same problems in the clinic with the baseball team, I have been able to learn a lot about what muscles are affected by specific motions. For example, I know that the infraspinatus is often irritated during the deceleration phase of a pitch because of the nature of the muscle to slow down the arm. Kris has also done an excellent job with explaining to me why the baseball players are having the signs and symptoms that they are experiencing.
A specific instance when I was able to put this knowledge to use was when a tennis player came into the clinic over spring break. She was complaining about shoulder pain, and Chaypin was not there to perform the evaluation. Kris was finishing a treatment on one of his athletes, and he asked me to perform the evaluation on this athlete. She was complaining of pain in the posterolateral portion of her shoulder, so I asked her at what time in her serve does she experience pain. She continued to explain that her follow through causes her the most pain. Using what I had learned through baseball, I palpated her infraspinatus and was able to determine that it was the source of her pain. Kris confirmed my suspicion, and we were able to perform some trigger point as treatment in the time that we had left in the clinic. I was apprehensive about performing the evaluation at first because I still feel unfamiliar with the shoulder, so it was encouraging to make the correct diagnosis with this patient.
This week I performed approximately 24 attempts during my elbow and forearm practical test with Brianne. These ranged from ROM to MMT to special tests.
This year’s NATA slogan, “Your Protection is our Priority”, I think accurately describes our profession very well in just five words. This slogan can be interpreted a couple different ways, each pertaining to a different area of athletic training. One of these interpretations being putting the athletes first. That is the whole reason that we do what we do. Everything that is seen and everything that is done behind the scenes works toward the protection of the athlete. Even ensuring that the athletes have water or making sure that there is sunscreen available work towards the protection of the athletes, as small as they may seem. On the other side of the spectrum, the “big” things that we do work towards the athlete’s safety just the same. All of the complex tape jobs, the modalities, the rehabs,learning as many injuries as possible, and the outside research conducted in hopes of injury prevention help protect the athlete.
Another way this slogan can represent our profession is through privacy of the athlete. It is our job to protect the athlete as well as his or her own personal right to their privacy concerning any of the medical history or any other information that they entrust us with. We are held responsible under the law to ensure that all of the information that we either are told by an athlete or that we diagnosis or discover concerning the athlete are handled appropriately and professionally.
I think this slogans help remind us and others of the importance of this profession. It is easy to get caught up in a routine, but once reminded of why we do what we do, it is also easy to remember that it is definitely worth it. It takes an individual with a servant’s heart to be involved in athletic training, and one can see this plainly when in the clinic. I think that the slogan for this year also helps portray that one of the most important aspects of the profession is putting other people first. Remembering this makes me very proud of what ATCs and ATSs are known for and what they are responsible for doing.
This week we continued working on the elbow unit and started the wrist, hand, and finger unit. I had nine attempts for nine different elbow special tests, including the varus and valgus stress tests, radioulnar stress test, hyperextension test, golfer’s elbow test etc. We began learning palpations for the wrist, hand, and finger unit.
This semester, I am feeling very good about the semester clinical packet. I have slacked off within the last week, but up until then I have stayed on top of what we have been doing in class. It has been hard so far to practice some of the skills in actual practice in the clinic because we have complete the cervical spine, and we just finished the shoulder. Now that I feel more confident about the shoulder, it will be nice to get some real practice in the clinical setting. I have yet to go through the packet with my practical tests from Brianne’s lower extremity class to finalize all of my masteries, but that is something I am hoping to accomplish over spring break so that my masteries are ready for signatures. It has been very different than last year for me because last year I struggled the most with remembering to write down dates as we went along in class. It was difficult to try to remember when we did what in which class when filling out the packet. However, I learned from last semester and have been making notes of dates on which day we practice the tasks in class beside the list of competencies in the front of the clinical packet. I have also found that by filling out my packet as we go, it makes me reflect on what I learned in that class period and helps me to remember the special tests much for efficiently.
I know that the packet is a source of stress for me and many other of my classmates; however, it is very encouraging when i look through the packet and am able to see progress within its pages. By adding the dates of attempts beside the list at the beginning, it shows me how much progress I have made and some sort of gauge as to how much farther we have to go. So not only I am saving myself from heartache in the future by filling out the packet in a disciplined manner, I am also helping myself to stay encouraged and positive concerning the semester.
This week we started working on the elbow in Lower Extremity, so we have just went through the elbow palpations and ROM this week. This means that I have four attempts which are constituted of the ROM for the elbow motions. Even though we have not specifically covered manual muscle testing for the muscles associated with the elbow, we discussed where to find the muscles and what motions that they are responsible for.
This semester I wanted to pick a topic that was very different than the topic we picked last semester; therefore my group and I chose a topic that had to do with nutrition in a sense. Sam, Am, and I chose to investigate which supplements help diminish muscle cramping in athletes. Sam, Am, and I chose to work together again this year because last year we worked really well together when doing our Little Clinical Question. We all have a strong work ethic and strive to get assignments done in a timely and efficient manner. Each of us also does a good job of carrying our own weight for the group. We have decided to look into how magnesium, potassium, and sodium effect muscle cramping in athletes. Ideally, we will find multiple studies that work with solely one of those three options and examine their effects on muscle cramping during/post competition. We will then hopefully be able to determine which of the three supplements works best in the reduction or ceasing of muscle cramping due to competition. We are still undecided if we will be adding a time to our PICO format. This may be determined based on the information that we find in our articles.
For our ATC committee member, we chose Chaypin Buchanan because of her experience with women’s soccer this past season. There was a particular athlete that suffered from chronic muscle cramping in both of her legs, so we knew Chaypin would have experience working with athletes that struggled with muscle cramping. We asked Beth Funkhouser to be our faculty advisor for our committee because of her experience in sports where athletes typically struggle with muscle cramping and because of her knowledge in general. Lastly, we have asked Coach Josh Bullock to be our content expert. We chose him because there have been many athletes come to him with questions about supplementation and nutrition. There is a new program designed to help educate athletes about nutrition (macronutrients, micronutrients, supplementation, etc.), so we think he will be a valuable asset to us in our research. Moreover, I am very excited to research this topic because I have a genuine interest in nutrition and its effects on athletes and their performance.
This week I had my shoulder practical, so I got many attempts. I had approximately 64 attempts, some of which will be turned into masteries when I receive my graded practical back.
My rotation at the outpatient rehab clinic with Matt Harris was very beneficial for me. I want to be a pediatric physical therapist, but have never been able to observe a physical therapist. I was uncertain about how I would feel about working with the geriatric community, but this rotation has proved to me that I would not mind it at all. The first patient that I was able to observe at the rehab clinic was an elderly man who was having trouble walking due to his long hospitalization. For his rehab session, we walked with the man around the clinic when he first arrived and made our way to the parallel bars. This was where he just used the bas for support instead of his walker and just worked on taking big steps instead of the smaller ones that he was talking. After many sets of that, he began swinging his leg from adduction into abduction while supporting himself on the bars. He had a lot of trouble with his left hip during this exercise. To end his session, Matt stretched his hamstrings and hip flexors and then ended with joint mobilization in his hips. It was very interesting to look at this rehab compared to the rehabs that we perform in the AT clinic because we are much more aggressive with rehab in the clinic. It opened my eyes to just how different the rehab process in with different populations of people.
While at the rehab clinic, I also got to see Matt meet a patient for the first time and evaluate her. She was having burning, tingling, and pain in her biceps. It was a good experience to watch him conduct his evaluation because I realized that it is the exact same way that we have learned to conduct an evaluation. By the end of the evaluation, I had guessed that she was experiencing biceps tendinitis and/or shoulder impingement, which ended up being what he had diagnosed her with. It was encouraging for me to know that I am on the right track to establishing a sound foundation for what I want to do in the future. It also gave me clarity that I was learning what was expected of me.
I was at the Outpatient Physical therapy first on January 31, from 10:00am – 12:00pm, February 1, from 2:45pm – 4:30pm, February 2, from 10:30 am – 11:35pm and from 1:30pm – 2:45pm.
This rotation was by far my favorite rotation yet. I thought that being able to see everything so clearly was extremely interesting. I spent my entire time in MRI, and the majority of what I saw was brains. The most interesting was a man who was being checked for MS plaques. When looking with Stacy at the images, she explained to me that MS plaques show up as white on the screen that we were looking at. Thankfully, the only plaques that could be seen on these images were two very small places. Once contrast was added for the pictures, we received even better news because the contrast images showed that the MS plaques were inactive. Later on when there was a little bit of a dead period, I was shown old images of a woman in her upper thirties who had two strokes in her lifetime. Stacy explained to me how the colors of the abnormalities change depending on what type of imaging you are observing. So one set of images for this woman showed a huge stroke in the left inferior portion of her brain. After looking at a different set of images with different a different shading code, she soon figured out that what she thought was a massive stroke in the left inferior portion of her brain was actually her old stroke. She was experiencing another stroke in the right superior portion of her brain. I thought it was very interesting how the MRI uses the different colors to tell us about what is going on within the person.
Even though I mostly saw brain scans, I also saw some scans of a shoulder, some knees, and a few lumbar spines. The scan of the shoulder showed what appeared to be a torn supraspinatus tendon. To show me how to find the pathology, the radiology technician showed me a normal scan where I could see where the supraspinatus inserted into the greater tubercle. After seeing the old scans, it was obvious that the supraspinatus tendon was nowhere on the scan. Additionally, there were three people getting scanned for future knee replacements. The technicians explained to me how in depth the process was and how specific the scans needed to be because the company that makes the knee replacements made them custom fit for the patient. Lastly, there was a man that can to get a scan because of chronic back pain. It took a long time to get his scans because he could not quit moving because of his pain. Once he was administered some pain medicine, he was able to lay still long enough to get the MRI. His images showed that he had a bulging disk in his lumbar spine that was causing his pain. Moreover, I thoroughly enjoyed my time in the imaging department and was able to get a better understanding of anatomy through the pictures that I was able to study.
I was at the imaging department on February 14 from 10:00am - 1:00pm and on February 17 from 9:30pm - 12:30pm.