This week I was able to perform another evaluation on a patient in the clinic. The patient came in with a complaint of pain on the side of her foot that had been persisting since her most recent ankle sprain on August 22 of this year. She had a bad sprain in April of this year which took six weeks to heal, but healed completely with no lasting issues. While squatting in August, she lost her balance and felt immediate pain go through her foot and ankle. She tried to give it time to heal, assuming that it was another sprain, until weeks later she went to the doctor. She had a negative x-ray, and that is when she started coming to the physical therapy clinic. She presented with palpable tenderness on her styloid process of her right ankle at the insertion of her peroneus brevis. She had pain with joint mobility of her metatarsals, and complained of pain that occurs consistently throughout the day. The patient stated that the pain resides at about a four out of ten consistently throughout the day, and higher on days when she is on her feet more often. There were no obvious deformities or discoloration, and the patient had been wearing a brace when working out since the injury.
At first, I thought that the patient had point tenderness at her calcaneofibular joint, but after further examination, I decided that is was primarily pain along her peroneus brevis. After talking it over with Matt, I was right in my assumption that the patient was experiencing peroneal tendinitis that began after her sprain in August. In the AT clinic, we have had some athletes experience tightness in their peroneals; however, I have not seen a patient that presented quite like this one. It was very encouraging to be able to complete an evaluation and feel confident about what the patient was experiencing. Additionally, one of my goals for the year is to better my rehabilitation programming, and I have been able to plan this patient’s program which has been going really well. She already reports feeling less pain throughout the day. In the future, thinking back to this experience will help to trust in my knowledge that I have gained thus far to make good evaluation and rehabilitation decisions.
This week I had nine attempts from Beth’s PBL and one attempt in the clinic.
This week I was able to have a very unique evaluation opportunity. I received multiple phone calls from my sister and my mom while I was clinically experiencing with Hannah. When I checked my phone, I immediately called them back and tried to figure out what was wrong. My sister had had an accident at her gymnastics class where she thought her spotter said to do two backhand springs, but he only told her to do one. He spotted her on the first one, but did not expect her to keep going and did not spot her on her second backhand spring. When she went back the second time, her arms gave out and she landed directly on her back. She had bruising on her spinous processes from the impact, but had intense shoulder pain. There was no bruising or obvious deformity along her shoulder or upper back, but she had pain in the midrange of her range of motion that was relieved when she got to the top of her range of motion. She could not bring her arm across her chest due to pain. I instructed her on how to do an empty can test which was positive. She was point tender in the middle of her deltoid.
When my mom arrived home, I instructed her through FaceTime on how to perform an anterior apprehension test, which was negative. I also instructed my mom on how to perform active and passive range of motion. The active ROM was very painful, but the passive ROM caused no pain at all. I checked back again with her later that night, and she had pain with shoulder flexion around 30 degrees, when before the pain began around 45 degrees. My first concern was that she had injured her rotator cuff muscles; however, that next morning she was still in some pain but was able to function fairly well. She took volleyball off for the rest of the week, and is now ready to play again after some good rest and stretching.
This experience showed me that it is important to keep a level head. I am very protective over my sister, and my first instinct was to advise my mom to take her to the hospital because of her pain level. However, after asking her lots of questions and finding signs as well as I could through the phone, I had to go against my instinct and advise my mom to not take her to the doctor just yet. Luckily, I believe that it was a minor muscular injury that was able to quickly heal with rest. This experience helped to remind me that it is important to be rational, even when the first response tells you otherwise.
This week I had three attempts from the PBL that we did for Beth’s clinical class on head and face injuries.
I have been lucky to be able to clinically experience with a bunch of different preceptors, some who are still at Emory and some who are not. Each preceptor has been unique in their personalities and treatment styles, so I have been able to adopt a lot of their quirks as my own quirks.
The first preceptor that comes to my mind when reflecting on influence is Zach James. I always noticed that Zach never appeared stressed out and would take time with each individual who entered into the athletic training clinic for treatment. Zach made every person feel heard when they were telling about him about what was wrong with them. Additionally, Zach was always encouraging during rehabs with athletes. There was always a positive vibe during the rehab, which made the process much more fun and enjoyable. Now and in the future with whatever job or activity I am involved in, I hope to implement the same kind of positivity, empathy, and ability to stay calm in stressful moments the same way that Zach did during his time at Emory.
Secondly, I think of Hannah. Hannah relies a lot on manual therapy, which is something that I am also a big fan of. I admire that she would choose to do manual therapy over a treatment that may be easier or less time consuming. Her choice to pursue manual therapy over other types of treatment has encouraged me to practice massage therapy and trigger point more, making me much more comfortable performing this treatment on athletes and those in the physical therapy clinic. Additionally, Hannah also presents with a very positive attitude whether she is having a good day or a bad day. I admire the type of care that Hannah shows the athletes. For example, when a volleyball player had a season ending injury a week or so ago, it was evident how much Hannah really cared and how much she wanted to help her athlete. I hope to show these attributes when I am practicing in my profession.
Lastly, I would like to mention Melissa. Melissa truly cares about her athletes, but she refuses to get pushed over or disrespected. Sometimes I have trouble asserting myself to people I do not know very well, but watching Melissa has shown me that there is no reason that I should be disrespected or talked down to. Each preceptor has had an unique impact on how I practice/would like to practice athletic training, and I would have to write a book to speak of it all.
This week I had 3 attempts in my clinical book from the vignettes in our PBL in Beth’s class.
This week I was able to work on my personal clinical goal of gaining a better understanding of the different populations and age ranges that I could potentially be involved with as an athletic training student. This week I was back in the athletic training clinic because of the inability to be at the physical therapy clinic. Because of this, I was back to helping and clinically experiencing with athletes instead of the older, non-athlete population. The difference is exponential, and I feel like I was able to learn from being back in the clinic, as well as apply what I had learned in the PT clinic to the athletic training setting. This week I gained a new appreciation for the athletic training setting because of the upbeat and more rigorous atmosphere. Sadly, it is easy for me to become almost uninterested from time to time in the PT clinic because of the nature of the injuries and the different goals that people in the PT setting have set for themselves. I believe that all the goals set, regardless of the setting, are important, and it has been so beneficial to see the difference in goals between the two settings.
For example, most of the time the main goal for an athlete who is hurt is to get back to competition to play at 100% of their ability. In contrast, some examples of goals in the PT clinic are to be able to walk up a flight stairs without difficulty or to be able to get into a bathtub without assistance. Both of these examples in my eyes hold equal importance in relation to the individual that they belong to, but the path to reach these goals are often times very different. In the AT clinic on Friday, I lead a shoulder rehab on a shoulder injury. The athlete was ten weeks out and was expected to be throwing a baseball again within the next thirty-eight days. However, in the PT clinic, I am assisting with some rehab with a man who had his shoulder surgery in April, and he still has very minimal range of motion. I feel like I have gotten a lot better at reading the patient and understanding the importance between the individual and their wants and needs.
This week I had seven attempts from the PBL #1 that we completed for clinical class with Beth.
This week, I got to evaluate my first patient at the PT clinic. The patient was a 17 year old male soccer player who had a history of hip pain. He had been to the clinic once before for rehab on his ankles; however, hip pain was never mentioned. The patient claimed to have hurt it last spring when he was in season for his high school team, but never saw his athletic trainer or took time to recover. He said that he “just played through it”. He found that the only thing that helped the pain after his high school season ended was to rest. Unfortunately, each time he would try to practice after that, he would experience the pain again. He is taking some time off from his club season because of the pain in his hip/groin area. The patient stated that he feels the pain when he does a deep squat, sprints, walks up stairs, does “over the gate” stretches, and spreads his legs apart as if he were in a butterfly stretch. After completing an initial evaluation, I spoke to Matt and suspected hip flexor tendinitis. He confirmed my diagnosis and we began looking at treatment options. I was able to decide what stretches he took home to do, and the stretches and treatment he had done that day. Additionally, Matt let me decide his treatment for his following visit (with his guidance, of course).
I think that his experience really helped me find my footing in the PT clinic. Thus far, I have felt somewhat uneasy while clinically experiencing at my off-site. I do not feel like it is because of the atmosphere or the people, but because of the difference in populations from the PT clinic to the AT clinic. With that being said, I felt much more confident with this patient though, most likely because of his age and that he is an athlete. I believe this helped towards one of my goals because I have been able to work on rehab progressions. This patient was a good stepping stone into the PT clinic because it was somewhat in my comfort zone, but my limits were still pushed by having to think about how to progress his rehab. Overall, I feel like it was a beneficial step in my learning journey that I can use in the future to gage my progress as I move forward in the PT clinic.
This week I only had one attempt to put in my clinical packet, unfortunately.
This pre-season experience has gone fairly different from last year, but in a good way. This pre-season I spent a lot less time with football, and I was able to begin promptly with my clinical experience at the PT clinic with Matt. However, when I was with football during this pre-season, I felt much more confident in everything I did. I remember my first day last year, and I was very timid and unsure of myself because everything was so new. That is very different, and the feeling of just being thrown into the mix did not happen this time around. I feel like last pre-season I got to see many more acute injuries and perform a lot more wound care than this year, but I have been able to see more chronic injuries and rehabs this time. I remember during my second football practice that I asked Morgan if I could take care of a football player with turn burn who was bleeding because I “hadn’t seen any action”.
The thing that has helped me the most is by far my previous experience. By being hands on in the past, I feel much better about how I perform currently. My hindrances however, are the areas that I still haven’t been as hands on with. For example, a back injury really makes me uneasy and the same goes for creating a rehab or understanding rehab progressions. Because I have less experience in those areas, I feel like they are difficult for me to do well in. By being in the PT clinic this semester, I believe that I will receive a lot more hands on experience doing the things that I have not had as much experience doing in the AT clinic.
My growth as an AT student has made me become aware of how important the relationships with the athletes really are. The athletes can sense whether or not I am sure of myself, which can affect how much they trust my treatment. Growing as an ATS has made me realize that I need to be on the up-and-up with athletes. If treating them is something that I feel confident in, then I need to make sure that I appear confident. However, when I am unsure of what I am doing or what I need to do, then I have found that being upfront with the athlete was the best way to handle the situation.
Lastly, my goals for the semester are to complete eight or more masteries per week, gain knowledge and confidence concerning rehab progressions, and to develop a better understanding of the different populations of people that I could possibly treat. I picked these because I feel like these goals would be the best ones to truly take advantage of my opportunity in the PT clinic.
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.
Write something about yourself. No need to be fancy, just an overview.