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.
As of right now, I know that I eventually want to pursue physician assistant studies. I feel like that field is something that the Lord has definitely called me to, and I am always interested in general medicine, so I feel confidently about pursuing this field. I can also get involved with medical missions, which would be a dream for me to be able to do. Originally, I wanted to be a pediatric physical therapist, but that quickly changed when I did my rotation in the physical therapy clinic last Fall. I am so grateful that I was placed there despite it not being my favorite rotation because it made me realize that PT was not what I wanted to study. I had a hard time with staying excited and eager to learn in the physical therapy, my interest was just not spiked in that setting. I was comparing my PT experience with my rotation in the emergency room when I was a sophomore, and it was completely different. Even though I was at the ER until 2:00 AM, I stayed continually intrigued by everything that was going on and still remember that rotation today. Additionally, I shadowed a PT the summer before my junior year, and I feel like I learned so much information in such a short period of time. The majority of that information I can still recall because I was just so genuinely interested in what was going on. I can’t imagine how excited I would be to shadow in a specialty that I am leaning towards, such as cardiology or pediatrics. I am taking the first steps in making connections with PAs right now to look into some more shadowing experience in different fields.
When I graduate, there are few PA programs that I could get accepted into because I am missing two classes that are required for the majority of programs. I am looking into what schools offer these classes over the summer so that I can get them out of the way and focus on applying to schools. I have also invested into a study manual for the GRE to ensure that I am preparing properly to get an adequate score for the PA programs that I am interested in. Lastly, because I am getting married next year and don’t know where my fiance and I will be located geographically, I am researching programs all across the U.S. to prepare for any place that we could land.
Going into my senior ATS year, my strengths and weaknesses have become something that I ponder often. I believe that partially comes from the prompting of my preceptors and many of my professors, but it also may come from a desire to be more introspective as I get older and gain maturity. Many of my flaws have been revealed through introspection, which usually results in me trying to grow and work through those shortcomings both by myself and with the help of others. I believe that my communication and relational skills with the athletes has consistently been one of my strengths. It is so easy for me to create relationships with the athletes that are definitely friendships, but also hold the adequate amount of professionalism in the clinic. For the majority of the time, there is a mutual respect that is between the athletes and me while in the clinic; they respect me and my knowledge, and I respect their privacy, preferences, and modesty. Another strength that I have this year compared to years past is the motivation to stay busy in the clinic. I want to be the first person to offer my help as an athlete walks through the door, I want to be the person who runs out on the field, and I want to be the first one to join in on cleaning the coolers or stocking the shelves in the clinic. As mentioned in my previous journal, I believe this is largely due to the leadership that I am under. I feel that this fact can highlight how good leadership can pull out others’ strengths, and I hope to be a leader like that in the leadership roles I am in now and in the one’s I will be given in the future.
On the other hand, I am struggling this year with being confident in my rehabilitation choices. I have always struggled with rehabilitation progressions, and it is quickly becoming real to me that it is time to buckle down and start growing in this area. I recognize how important it is to be able to plan a successful rehabilitation that will create buy in from the athletes, but also ensure that they are getting better. I was thinking today while running a rehabilitation for a football player with a sprained ankle that there could potentially be a problem with creating rehabs because I struggle with creativity. I have a desire to be innovative and offer exciting, new exercises to rehab patients, but I find it very difficult. To improve this weakness, I plan on pushing the borders of creativity and trying to grow my confidence in what I can create.
Write something about yourself. No need to be fancy, just an overview.