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.
This past week an athlete came into the clinic complaining of sharp back pain after a lifting session and a shuttle run. Laura and I were the students in the clinic and Melissa gave us the opportunity to perform the initial evaluation. Laura and I were both skeptically at first about doing this particularly evaluation because both of us felt a little uneasy about the lumbar spine. Soon into the evaluation, we saw that it was most likely a hip condition that was referring pain into his lower back. This suspicion would have been more evident in the beginning of the evaluation; however, the athlete left out a key event in the progression of his injury. He explained that the pain first presented during front squats in the gym, but then worsened during the shuttle run once he bent down to touch the line. Halfway into the objective portion of the evaluation, the athlete revealed that he also fell during the shuttle run which is what actually caused the onset of his sharp pain. This piece of the history then lead me to suspect an up-slip of his left pelvis. After further testing using the Long-sitting test, the standing flexion test, and Gillet's test, my suspicion was confirmed. His hips were then realigned with instructions from Melissa which alleviated much of his sharp pain leaving mostly soreness afterwards. We then applied STIM and ice to help with his pain, and instructed him to come back the next day.
This was an awesome moment to have, especially just coming back from break. It was encouraging to be able to put to use the information that I have learned, but have not been able to practice on an actual incident. During the moment it was tempting to run to Melissa when we were stumped, but I believe it was more beneficial for us to work it out on our own. When listening to how this athlete described his pain, I used my own personal experiences to relate to him. The pain he was describing sounded very similar to the pain I feel when my hips are out of alignment. Because I had experienced something similar to him, it was easy to be empathetic to what he was feeling and experiencing. This occurrence helped me work toward my goal of improving my evaluation skills. Unfortunately, I did not get to perform as many evaluations as I would have liked this semester, so it was great to be able to perform one so early in the semester. In the future, I will attempt to make it known to the athlete that every piece of the injury's history is important. This will hopefully save me and the athlete time and it will help avoid unnecessary special tests.
This week I have had eleven attempts in my clinical book. They consist of ROM and MMT of the cervical spine during upper and a variation of the McConnell tape on a basketball player.
I feel less confident as an ATS when asked to do an evaluation alone. I feel okay until I receive an answer from the athlete that I do not expect. For example, I recently did an ankle evaluation on a female basketball player and she complained of pain being on the medial side of her ankle and some on the medial malleolus. I did not expect this; therefore, it was harder for me to try to decide what exactly was wrong. While preforming evaluations, I believe that I am least confident in my palpations, and I often worry if I am checking all the different ROMs that should be checked. I believe this is because I am very inexperienced in evaluations, palpations, etc.
On the other hand, I feel most confident as an ATS when helping with rehab or taping. Because I have made a point to do as much taping as possible, I believe that it has greatly influenced my confidence level. I feel as if I am a perfectionist in regards to taping, and do not mind taking extra time to ensure that everything fits and looks correct. Also, I have not been able to help with many rehab sessions, but the ones that I have attended, I have loved to help with. I get a lot of happiness from seeing the athletes work hard and accomplish things that they couldn't do the day before. I enjoy encouraging them and pushing them to get better. I think I feel confident in rehab, especially when it is in the weight room, because I really like to pay attention to form and the quality of movements. I think because of my own experience in the weight room, it has been able to translate into my confidence level when helping others in a similar setting.
I performed massage therapy on a volleyball player's back and shoulders in the clinic as a therapeutic intervention. I selected this treatment because she was complaining of tightness and knots in her shoulders that were causing her pain. I am partial to this treatment because I know how effective it has been for me as an athlete. I intended for this treatment to remove the tightness that she was experiencing and to provide pain relief from the knots that were in her shoulders. I hoped that this would increase her ROM and better the quality of that ROM. I used the effleurage technique with petrissage and trigger point. After performing the treatment, I assessed the effectiveness by asking the athlete about her pain levels. The pain levels had decreased along with some of the tightness she had been experiencing. Despite the pain that accompanied the treatment, the athlete experienced immediate relief post treatment. This will effect my future clinical decision making by recognizing the effects that massage therapy have on athletes and utilizing it the best I can. I favor the immediate effects that massage have on the athlete and strongly believe that the athlete also receives beneficial psychological effects from the manual therapy as well. It causes athletes to relax in that moment which may be something that they do not get to do very often. Therefore, while receiving treatment, the athlete also receives a mental break, which may increase their athletic and academic performance.
One of my clinical goals was to refine my taping skills by practicing a minimum of two tape jobs per week with my preceptor. I believe that this goal has gone very well, and that my taping skills have improved tremendously since the beginning of the year. I feel much more confident when taping now, and am not so hesitant to offer my help when taping needs to be done. My preceptors have done an awesome job of taking time to teach my taping jobs that are not as common, and they make sure that I do them correctly. I have learned how to do a spiral tape job, a figure eight thumb spica, use moleskin stirrups, offer an alternative to a spiral wrist tape, and others on top of making my ankle taps better by reducing wrinkles and being able to alter the tightness of the tape to best suit the athlete.
My clinical packet has been getting a lot more love recently than earlier in the semester. Early on, the clinical packet really just made me frustrated because I had already gotten masteries for the things that I knew how to do, which wasn't a whole lot, so it became sedentary for a while. However, once we really got into the swing of the semester, I started realizing that it was time to bring it back out. I am fairly pleased with the progress I have made in it so far, even though I am not meeting my goal every week. With that being said, during weeks that we have practicals, I am exceeding my goal which is hopefully making up for the weeks that I do not have as much luck. I am missing a few signatures for what we have had tests on to get a mastery and have a plan to get those this week to catch up so that I can get a numerical idea of the progress I have made so far. Because I am only a couple hours short of meeting the minimum hours needed for clinical, I am hoping that I can get more times during day treatments and rehabs instead of pre- or post-practice treatments to try to focus on skills within the clinical packet that are not as common as others.
My favorite part of clinical experience so far is definitely the relationships I have been able to make. I have made some great relationships with my preceptors, and I believe that has influenced how comfortable I am in the clinical setting. Being comfortable with my preceptors has made it easier for me to learn and ask questions. Additionally, I have been able to make some really good friendships with the athletes that I am around on a weekly basis in clinical. This has made it easier for me to help treat them, and in relation it has made it easier on the athletes to be more comfortable and relaxed when I am treating them in the clinical setting. I believe that a good environment makes the AT clinic a much more effective place.
Outside of the AT world, these relationships are special to me because I love people and investing into them as much as possible. I believe that one of my main purposes here is to create relationships with others, so that makes this major perfect for what I enjoy. I have learned so much not only about athletic training, but also about communicating with others and putting myself in others' shoes. The clinical setting requires that the AT's and AT students try to understand what the athlete is experiencing, which is a skill that I will be able to translate into other areas of my life to better my communicating skills with others. Overall, I have enjoyed so much about clinical experience, but the people I am surrounded with is my favorite part.