This semester I have been grateful for the progress I have seen. My junior year I really struggled with finding motivation to continue in athletic training with zeal because I knew that this field was not where I wanted to spend the rest of my career. Even though I still want to go to physician assistant school, I have been able to be content this semester. This isn’t particularly an example of educational progress; however, this has been the progress that I have been most proud of this semester. As I have mentioned in previous journals, I am very thankful for Cole and Alex for investing into me like they have. In addition to the preceptors I had this semester, I really enjoyed the other students that I was placed with this semester. I feel like they care for athletes similarly to me. They place a lot of emphasis on getting to know the athletes and creating a relationship with them, so it created a fun and fruitful atmosphere in the AT clinic this semester.
Outside of gaining some of my passion back for the profession, I feel like I have been able to fine tune some areas of my clinical practice. I have become much more confident in doing my evaluations, and I have been able to grow in understanding what parts of the evaluations are most relevant to the current problem. In retrospect, I feel like it has taken me more time to find the information that I needed to make a diagnosis. Now it is much easier for me to filter through the information that I receive from the athletes to coax the conversation to the areas that I need. I also feel much more comfortable in creating rehabs. This semester, Cole would allow me to look at previous rehabs for an athlete and create a rehab on the spot that would flow well with the previous exercises. This pushed me in terms of my comfort zone, but I know this has definitely made me a better clinician. Additionally, Cole would ask me why I was doing what I was doing, which pushed me to think about the in’s and out’s of my practice. Overall, I feel like I have been able to not be so high strung in the clinic which I know has been able to relate back to the athletes that I am around.
This past week I had the opportunity to start a freshman football player’s rehabilitation from a previous fibula fracture. The athlete had a contact injury that resulted in a fibula fracture, which then required two surgeries to fix the surgery. Unfortunately, his rehabilitation was scheduled to begin during Thanksgiving Break, so upon his return to school, he was already behind. I was somewhat unfamiliar with his case, so before we started rehab that day, we went over everything that had happened. I found out that over Thanksgiving Break, he had done small amounts of running. He has been cleared for activity, but is still experiencing mild discomfort while walking for long periods of time and complains of numbness on the top of his foot from the surgery.
The first rehab we did was very successful, and I was able to make many conclusions about his current state. He did not physically appear as if he had suffered from a lot of muscle atrophy, but the strength difference was extremely noticeable. This was highlighted during single leg squats to a box. His unaffected leg was so simple and effortless for him, while the affected leg was very difficult to perform the exercise on. Additionally, he complained of a lot of increased stiffness in the affected leg, which may have increased the difficulty of this particular exercise. I also had him perform some balance exercises to find a baseline of where he was ranged on proprioception. He was pretty impressive balance wise and worked very hard to perform well, specifically on balance exercises. After a few more exercises, we ended the session with a light jog because he really wanted to run some more since he had worked on that some over break. However, during the jog, he obviously favored his injured leg much more than the other.
Through this rehab, I was able to keep the session very informal and lighthearted, while also being able to get a really good idea of where he was in the process. Something that I had not put much thought into previously was the level of insight that the athlete had to where he or she was in rehabilitation or their abilities to perform. After speaking a lot about level of insight in my abnormal psychology class, I have tried to incorporate that more into my clinical practice. This athlete in particular does not have very good insight into the depth of his condition; he believes that he is much farther along that he is, even though he is performing fairly well. In the future, I plan to look much more into how the athlete thinks he or she is doing, and base some of the rehabilitation techniques off of that answer.
This week, I was able to design a rehab day with a football player who is six months post-op from his ACL reconstruction surgery. He was cleared to start cutting this week, but was still struggling with feeling unstable on his affected leg. We began rehab with a warm up on the stationary bike, and then we took out the ladder. I wanted to get his heart rate elevated and perform movements that would prepare him for the cutting movements he would be performing later in the rehab. Additionally, I wanted to take advantage of this time to get him moving while also making him think about his movements. I had him start by doing four sets of each exercise starting with two feet in each block for speed. Then we moved into lateral movements for four sets, and then we started doing cutting like movements. He performed 4 sets of ickey, then we moved onto doing two ickey steps forward then one backward. He seemed to have considerable trouble with these exercise, not because of the physicality of it, but because of the mental portion of the exercise. I would like to see exercises like that incorporated into his rehab more often to help prepare him mentally for coming back to play. We ended the ladder with a backwards ickey.
After the ladder, I wanted to work on glute activation before moving into running. I had him perform 2 down and back duck walk with two black mini bands. He has done this often, but this time I asked him to walk forward on the way down, and then walk backwards on the way back. I wanted to make sure that it was targeting different parts of the glutes with each movement. He gave me positive feedback that it was challenging and that he felt it in a different place than just when moving forward. After that, we moved our session to outside. He explained that he had trouble with adding additional, non-necessary movements when he was cutting while running, so we tried to focus on correct mechanics for the majority of the rest of the session. We started with slow running and cutting to ensure that he felt comfortable, then increased the speed. He consistently performed much better as the speed increased, which I believed allowed him to stop overthinking so much about what he was doing and just performed. Overall, I think it was a successful rehab where he was challenged without overdoing it. I felt more confident pushing him a little harder than I usually feel comfortable with, so I'm learning the correct level of how much to push someone and when to lay off.
The clinical goal that I have focused on the most is my first goal: I will practice my use of therapeutic modalities by reviewing parameters weekly with my preceptor. Therapeutic modalities is one of the most difficult portion of being in the clinic for me, right behind designing creative rehabs. I believe that it is difficult for me to remember many of the modalities and their parameters, especially for ultrasound, because it is an area that I am not very interested in. It is easy for me to remember general medicine protocols, emergency care, and diagnoses because those are things that I am very interested in. I have found a trend in my practice where I have a much more difficult time being excited about and remembering areas of practice that don’t easily keep my attention. Additionally, I think this area is a challenge for me because in the back of my mind, I know I will not be using modalities for very much longer in my career. When I travel to China for athletic training, I will not be given the same resources that we have in America, and I will have no choice but to be creative in my treatments. Also, when if or when I get the opportunity to go to PA school, I will not have to apply these treatments very often if at all.
However, after bringing this up to Cole and explaining my struggles with ultrasound and e-stim, he was been very intentional about reviewing parameters with me. He offered me a sheet that helped him in his graduate research on the effectiveness of ultrasound which has been very beneficial to me during treatments. Additionally, he allows me to set up multiple ultrasound treatments, each needing different parameters so that I am exposed to multiple different scenarios in which a modality can be used. I think that this practice and being “forced” to recall the information on a weekly basis has helped me so much this semester. I have also never been much of a fan of using modalities because of the results I have received on myself and the reports I have heard from other athletes, but my preceptors have done a great job at explaining what each modality treatment was for and why it works well for that situation. It has also been really helpful that they understand that I have a hard time remembering and that I would ultimately prefer a different treatment type, but still encouraging to continue to learn about the modalities that I struggle with while also discussing different treatment options with me.
My favorite part of clinical experience this fall has definitely been my rotation with Dr. Handy. Over the course of the athletic training program and its classes, I have found that I am particularly interested in the general medicine portion of what we do. For me, gen med is like a big puzzle - I ask questions to get all of the pieces, and then when I have all the pieces of the puzzle then I can figure out what the puzzle actually makes. I don’t get as much experience with general medicine in the athletic training program, so it was very exciting to me to be able to get 20 hours full of clinical experience that was flooded with general medicine.
This is especially exciting and meaningful to me because it gives me a glimpse into my future. Sometimes I struggle with spending so much time in the athletic training clinic because I sometimes spend whole days doing things I’m not AS passionate about, even though I still take pride in what I do there. However, spending hours upon hours and staying late in the clinic with Dr. Handy was never a struggle for me. I was constantly wondering what was going to be in the next room, writing down different medications and what they do, trying to fit the pieces of the puzzle together for each individual patient, and even at one point, getting moved to tears by a patient suffering from Parkinson’s Disease. I loved that Dr. Handy allowed me to participate in auscultation in most of his patients, and he always asked me what I heard which allowed me to try to work through all the different sounds and the knowledge that I had to put the heart sounds together with the conditions that I knew. It seems like such a small aspect of the whole evaluation, but it was so exciting for me.
Looking back on all of my rotations, they have helped me navigate where my passions are and where they do not. I loved being in the emergency room and experiencing the energy that constantly was flowing during that rotation, especially when running down the halls when the nurse I was shadowing was called for a code blue. I being in family practice with Dr. Handy and experiencing something different in each room that I walked into. But on the other hand, I did not at all enjoy my rotation in the wound care clinic, not because it wasn’t interesting, but because I couldn’t stomach it. Additionally, I thought I was going to fall in love with the PT clinic, but I was surprised when I didn’t have the spark I thought I would have for it. All of these experiences have continually affirmed me that I am headed in the right direction for my future career.
As a senior athletic training student, it is getting easier for me to imagine what my “real life” job is going to look like when I graduate. It has also really helped me by going to any off-site clinical placement to understand what professionalism looks like in places other than the collegiate setting: the emergency room, the wound care center, the outpatient physical therapy clinic, and the family practice rotation. By modeling how other professionals act in their workplace and by implementing what I have learned about professionalism by experience and in class, I try to lead by example. However, I also make sure that I am able to maintain my personality and sense of humor while maintaining professionalism. I would never want to work in a place that requires me to lay down who I am as a person for my job - I want to pursue relationships with my patients, have comedic relief during treatments, and have an appropriately relaxed environment to help patients feel at ease when they are under my care.
Having said all of this, there are no students younger than me on my rotation at the moment, but I do have many freshmen approach me and ask for my advice concerning majors, career paths, experience and shadowing, patient care hours, etc. Because we are all pretty close, I try my best to show them what hard work, professionalism, and other good practices in the workforce look like. It is very important to me that I am punctual not only for my clinical experiences, but in all areas of my life if I can help it. Additionally, I never share patient information with anyone, including my best friends and younger “mentees”, and I make sure to share with them why I can’t do that. They respect that I take that part of my profession seriously. Lastly, I try to educate those younger than me on everything that I have learned and experienced throughout my time at Emory. I wish that I had had an older student that was pursuing the same career path that I wanted so that I could learn about prerequisites, patient care hours, application necessities and deadlines, the importance of class planning, and how helpful it is to have useful experience under your belt when thinking about future possibilities. It is one of my passions to invest into people younger than me, so I take a lot of pride in being as helpful as I possibly can to those who are walking where I once walked.
This semester, my most challenging class is physiology with Dr. Fleet and abnormal psychology with Dr. Qualls. I feel like physiology is one of my most difficult classes because Dr. Fleet’s teaching style is very different from my learning style. She shows us a lot of diagrams, charts, and pictures, and writes the majority of our notes on the chalkboard during class. I have issues with retaining the information as she teaches off of the picture on the powerpoint presentation. Additionally, the way her notes are structured makes it difficult for me to remember and absorb while in class. I prefer lists and notes that are separated by subheadings depending on related topics. I realized that her teaching style was not working for me when I started reviewing for the first test because I had retained very little information from the class periods. This class is also difficult for me because of the relationship to chemistry. I find it hard to talk about ions, channels, gradients, etc. because it is hard for me to visualize them. I enjoy anatomy and my AT classes because I can physically see and touch what we are learning about; therefore, making it easier to make connections while I learn. I’ve always had a hard time learning about what I couldn’t see or visualize. Because of these obstacles, I have spent a considerable amount of time thinking about how to improve my learning. I have found that when I relate what we are learning about in class to real life situations, such as diseases, injuries, and everyday life processes, I can understand the concepts much easier. Additionally, I plan on going through my notes and rewriting the information in class in ways that I can comprehend it better.
Abnormal psychology is hands-down my favorite class that I have taken so far, despite it being difficult. I retain the information well in class, and I haven’t been this excited about a class since I got to college. I stay engaged during class (and it’s an 8am class, so that’s big news), write detailed notes, participate when I can, and actually enjoy reading the textbook each week. The part of the class that makes it difficult is the amount of information that we are supposed to know. I feel almost behind in the class because the majority of the class has had multiple psychology classes, so their background of psychology is more extensive than mine, but that only pushes me to do better. For the next test, I plan on reviewing my notes much more frequently and rewriting information multiple times when I have trouble remembering it. I would also like to watch videos of mental illness interviews to practice diagnosing the patients. This class requires a lot of work, but I know it will be helpful to my future career.
The little clinical question for this semester is: In endurance athletes, what is the most effective program to prevent medial tibial stress syndrome?
My partner, Laura, was the mastermind behind this question, and it originated from her past experiences with athletes that she has worked with. Even though she had the original idea for this question, it resonated with me in a different way. My roommate’s boyfriend had a chronic injury that put his future career at risk. He was training to be an officer in the Marines when he was in college, and thankfully is now continuing to pursue that career now after his graduation. He had quite a scare for his future while running cross country in college. He had experienced leg pain for quite a while, but did not think it was too much of an issue. Eventually he went to get the pain evaluated, and it turned out to be a stress fracture in his femur. This stress fracture lead to the finding of a tumor in his femur. Thankfully, the stress fracture healed and the tumor has not proven to cause many more issues since its original finding, and the doctors say at the moment that it does not need to be removed. Stress injuries hit a soft spot for me, partly because of watching my friend become so worried, regardless of how related the stress fracture and tumor. Additionally, at the beginning of football season, we tried to implement a program to help prevent ankle injuries. For most of the preseason, the athletes were showing up to participate in the prevention program and the numbers were high. Unfortunately as practices went on, fewer and fewer people would show up to complete the steps of the program. It was very difficult to create buy-in from the athletes. I believe it would be extremely helpful to look at a program and its effective, while also digging into how to create buy-in from the athletes, so they do not become weary and burn out from the program.
Beth Funkhouser was selected as one of our committee ATCs, Joe Lynch was selected as an ATC, and Mike Caro, CSCS, was also selected. All the members of this committee are heavily involved with current literature, and I believe that they will have very insightful and up to date information to offer. I am excited to see what helpful information can be found and hopefully implemented to Emory’s athletic training setting.
When thinking about what we have learned in textbooks, I try to remember that that condition is the perfect example of its kind. The history, mechanism of injury, observations, palpations, special tests, will all point directly toward that injury if it is a textbook injury. Typically in a textbook, the author will not mention other signs or symptoms the patient may have from other pathologies because we are being taught about just that injury. This is the reason we speak of “textbook answers” because the textbook presentation of an injury or condition is perfect, without any doubt. However, in reality those cases are few and far between. It reminds me that it is necessary to treat the individual, not the injury.
Through my experience in the program, I have learned that an injury will hardly ever look the same between two different patients. Each patient has different anatomy, different prior conditions, different skill and experience levels, and all of these factors can effect how the injury presents itself. I believe this concept is also hard with illnesses, not just injuries. Some individuals can present with only a few symptoms of an illness, while another patient will have all of the symptoms. Additionally, pain tolerance plays a role in reconciling textbook information with real life situations. For example, a football player this year experienced a grade 2 hamstring strain on the first day of practice will eccentrically contracting his hamstrings. That individual had never had an injury before, and his reaction to the injury was much more intense than other reactions to hamstring strains I have seen during my clinical experience.
Overall, I think the most important thing I have learned from reading the textbook to personal experience is that we don’t treat injuries, as I mentioned early. The person is of utmost importance, not just treating a specific pathology like the textbook suggests. A patient consists of that injury, but also an emotional component, pain tolerance, past medical history, other pathologies, etc. My goal is to help the patient become better than he or she was before they walk into the clinic in whatever area I can help with, injury related and also not injury related. I believe making relationships with the athlete helps us understand that the person we are treating isn’t just a scenario from a textbook or from class, but they have become our friend (with professional implications, of course).
This semester I was able to do an on field evaluation for a football player who landed on his shoulder during practice. Once he got off the ground, he kneeled for a while holding his arm. As I started walking over to him, he got up and started making his way to the opposite sideline. I ran to catch up to him and finally caught him at the sideline to ask what happened. He said that he landed directly onto his shoulder after a tackle, and he was experiencing fairly intense pain towards the back of his shoulder. We struggled to remove his shoulder pads to get a better evaluation of the injury, but when we did, he said his pain had moved from the back of his to the anterior portion of his shoulder along the biceps tendon. He was tender along the short head of the biceps tendon, but was not at all tender in the posterior portion of the shoulder. I went through manual muscle testing for both the rotator cuff and biceps, and he was only experiencing some muscle weakness with testing of the biceps. Additionally, he was positive for pain and some weakness during special testing for the biceps. After the on field evaluation, the initial diagnosis was biceps tendinitis that was irritated from the fall.
The next day when I arrived for practice, the initial diagnosis had changed. It had shifted to shoulder impingement, and he was experiencing pain in the posterior portion of his shoulder again. It was not severe enough to keep him out of practice that day. I was surprised at the change in diagnosis because he insisted the pain was in the anterior shoulder and he was not at all tender near the end of the acromion. I also learned that the football player had a history of prior shoulder injuries and impingement. If I could go back and do the on field evaluation again, I would ask many more questions about the athlete’s history. If I had been aware of the past shoulder injuries, I would have also performed more special tests for impingement and rotator cuff injuries. I learned that no matter where I am, whether it be in the field house or on the field, that I should take the time to ask the important questions. If on the field, I should keep the questions clear and specific to what I need to know to be efficient, but I should not cheat myself the past medical history to make an accurate diagnosis.
Write something about yourself. No need to be fancy, just an overview.