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.
The sport that I am currently with is tennis, so by personal experience, I know for sure that wound care items should definitely be in a well-stocked med kit. The courts are not conducive at all with the players’ skin, and it is so very easy to get caught up in your own feet while playing so falling is definitely a hazard. Those wound care items would include things such as saline solution, cotton swabs, gauze pads, bandages, antibiotic ointment, gloves, powerflex, and any other cleaning or bandaging materials. Additionally, ankle sprains are quite common in tennis, so taping materials are definitely a must in a well-stocked med kit. These taping materials would include items such as pre-wrap, heel and lace pads, and tape. If there were room in the kit, adhesive spray would be a plus. As with any sport, I believe a well-stocked med kit would need to include medicines such as anti-histamines, ibuprofen, and like medicines just in case an athlete had an allergic reactions or was in pain. In my med kit, I always like to have a good supply of hand sanitizer, cough drops, Blistex, and sunscreen. As random as those items sound together, they are each of equal demand. I never imagined that so many athletes would come to ask for chap stick (and Blistex seems to be a favorite). With tennis specifically, it is a good idea to have sunscreen on hand even though most of our games are played in the cold. I know that sunscreen is something I often forget to bring with me on tennis trips; therefore, it is something I ask for often from others.
Outside of the traditional items found in the med kit, I believe that it is important to have sugary items on hand with tennis. I know that myself and quite a few others that I have encountered have trouble with maintaining their blood sugar levels during competition. Most of the time it is a known issue that the athletes can keep under control themselves, but it can quickly get out of hand. I am lucky enough to have a coach that struggled with the same thing previously who understands what goes on when I have a hypoglycemic episode and does an excellent job of making sure that I’m taken care of by keeping an arsenal of carbs (usually awesome bagels) near the area where I am playing. Moreover, I believe that having anything on hand to help elevate an athlete’s blood sugar is an integral part of a med kit for an AT or ATS with tennis.
This week I attempted twenty-seven competencies in my clinical packet. These attempts consisted of the special tests for the shoulder ranging from the AC/SC compression test to the ER lag test in our books.
This week I spent my clinical hours clinically observing in the clinic because I was unable to work a sports team practice because I am Hannah and Chaypin for tennis right now. This week a swimmer came into the clinic for treatment on her low back pain. Hannah was hooking her up to STIM when the athlete complained of pain that radiated from her low back into her glutes with a sharp pain presenting over her sacroiliac joint. That is when I asked Hannah if we should check her hips for an up slip. We had the swimmer turn onto her back, bridge up, and then checked the alignment of both her ASIS. The left ASIS was higher than her right. Hannah then proceeded to align her hips by having her squeeze her legs together and then apart to try to fix the up slip. When she finished, the alignment of her hips had not changed. Hannah and Chaypin then discussed what to do next to attempt to fix the problem, and they were discussing which way was the correct way to pull the ASIS back into alignment: was she to push up or push down with the left leg? I had recently reviewed this with Melissa, so I asked if I could take over from that point. They said it was okay, so I started from the beginning by having her bridge, squeeze my fists then pull apart, and then had her push up with her left leg while pulling down with her right leg. We repeated this three times and checked her alignment again and it had improved tremendously. We then followed with STIM and ice over the areas she had been having pain.
This situation was similar to my first evaluation of this semester that I wrote about in a previous reflection; however, a difference occurs because once the issue was diagnosed, I did not have to be walked through of how to fix the problem. The previous learned knowledge that I had received from that situation and the review sessions afterwards helped give me enough confidence in my ability to fix it without any more guidance. I am thankful that there was guidance available to me when I needed it and how beneficial it was and is to me now that I can perform it on my own.
This week I had twelve attempts in the shoulder unit that included all the shoulder ROM competencies.
Before entering the athletic training program, I wasn’t even sure of the knowledge that athletic trainers were responsible for knowing (probably something I should have looked into before making it my major). It is not until you are submerged into the field that you give it the respect that it deserves. Regarding taping and bracing, it is extremely underrated. I remember how floored I was at the difficulty of an ankle tape when I first attempted it in Intro. Taping and bracing isn’t a skill that someone can just decide that they are going to learn that day; it takes a lot of practice to get it to be effective and pretty. Taping and bracing demands an understanding of the anatomy of the body part that is being protected, stabilized, etc. It is also important to understand where the tension on the tape needs to be placed or what directional the tape needs to be pulled. For example, if I pull my stirrups on an ankle tape from medial to lateral instead of lateral to medial, I am potentially increasing the athlete’s risk of an ankle sprain, thus defeating the purpose. Lastly, it is important to understand the nature of the athlete’s injury or condition to be able to successfully help the patient. Despite my lack of knowledge in bracing, I would assume that the same concepts of taping apply.
I try not to hold it against other people when they assume that all we do is tape ankles and get water because I was once in their shoes and did not understand how difficult a profession it was. However, when I do hear that comment being made, it’s hard to not become slightly offended. I believe that those in the athletic training profession can help change this persona by always explaining to the athlete what we are doing while helping them and why they are receiving the treatment that they are receiving. By doing so, we are increasing the trust that the athlete has in our abilities and showing them that our knowledge extends farther than knowing how to tape an ankle, make an ice bag, or fill up a cooler.
This week I had my cervical spine practical, so I had approximately 35 attempts. These included cervical spine ROM, special tests, and a neurological assessment. When I receive the test back with my grade, some of them will turn to mastery.
This semester I have been placed with Melissa as my primary preceptor, and my group members are Colin and Laura. It has been a really awesome experience so far, and I can already tell we are going to learn so much together if we take advantage of the opportunities that are presented to us. Both Colin and Laura are very serious about their studies and how they perform, so that is a good common ground that we all have. Despite only having us all together once since classes started back, I can tell that we are going to have a good time together. We are all very light-hearted, but we also know when it is time to be serious. Laura and I work very well together to accomplish everything that needs to be completed while in the clinic together. In addition to accomplishing tasks, we also work together when trying to learn new things and when we are just studying in general. There was a particular instance when we were in the clinic and no athletes were in there, and we quizzed each other with BOC practice questions. We worked together to figure out the answers to various questions, and learned from the ones that we couldn’t figure out. Also, Laura and I worked together to diagnosis our first injury on our own. This was the instance that I mentioned in the last reflection concerning the athlete with a pelvic up-slip. Since this injury experience, we have had many conversations on the correct way to realign pelvic rotations. Today I believe there was a breakthrough in that understanding when I got to realign a patient’s hips on my own. I have not been able to work much with Colin due to our schedules; however, Colin and I work very well together in regards to our classes. We work well together when we are studying, and it is beneficial that we often times have different strengths. Both Colin and Laura have a natural curiosity for learning about the profession, so I am excited to see what we will be able to learn together as the semester progresses.
This week I have had eighteen attempts in the cervical spine and thoracic evaluation section of the clinical packet. All of the attempts have happened in Upper Evaluation with Brianne. They consisted of testing the integrity of the C4 -T1 spinal nerve roots and special tests.