In this past week, I did a follow-up evaluation on an ACL injury and he was about 5 months post-op. He was weight bearing for awhile now and started functional activities as tolerated in the athletic training room. Although, he has not made it to many of his rehabilitation sessions he has been playing basketball lately which could affect his return to play time. We noticed during the evaluation he has more laxity in his involved knee than the uninvolved one. During this time of rehabilitation, the ACL is at its weakest point and it needs to continue to be strengthened. The physician said that when he gets 90% strength back in his leg then he will be cleared to play but needs to continue strengthening. It would be ideal for him to take it seriously because football season is right around the corner and he could miss out on another season if he continues to stress the ligament and not strengthen it. This is making it a challenge because as an athletic trainer we can only help the ones that come to us. As much as we want to help him out and educate him on what the right thing to do is, we can’t control his actions when he leaves the room.
This experience will impact my future patient interactions because I do not want to see any athlete think they can return to early. Returning to activity to early will increase the risk for re-injury or an injury to one of the surrounding structures. I will educate my patients on what the importance of rehab is and why they need to continue strengthening the surrounding muscles. When someone is cleared to play again, I want them to return with more confidence then they did before the injury. This will help prevent any others from happening as well. Also, I noticed that every minute with your athlete during the rehabilitation process is a time to improve or educate them on the importance of why they need neuromuscular control, proprioception, and continue strengthening even when we are not around.
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My primary preceptor this semester is Cole who is the athletic trainer for the men’s basketball team and football team at Emory & Henry. I feel great about this clinical placement because I work well with Cole. He has helped me a lot over the few years he has been here, and I have learned a lot. Cole and I are always looking for new ways to do things in the athletic training room because athletic training is always about thinking outside the box. Especially in the rehabilitation process when there are only so many resources to use or for the athlete to use to help them strengthen and regain their functional mobility to return to play. I hope to find other ways to do things and innovate to see what fits me, so I can become a better clinician no matter what resources I have surrounding me. I also hope to gain better tapping and wrapping skills from this experience because between basketball and football, there are a lot of athletes that need their ankle, wrist, or shoulder taped before participation. I feel like that is another skill I need to improve on this semester that Cole and other preceptors can help with. I cannot say I am nervous about anything because I know what needs to be done and what Cole and others want me to have done. Throughout my years at Emory & Henry I have become a lot more confident in what I do personally, so I can be prepared for any situation. Yet, there is always room to build so that is what I am trying to continue to shape this semester. I am looking forward to this semester with Cole and hope to end this semester as an even more well-rounded athletic trainer.
Over Christmas break I have had to study for my exit exam retake which has kept me on a steady school schedule which will help me start this semester. I want to get ahead of my classes from the beginning, so I don’t have to worry about cramming everything at the end of the semester. In the previous semesters, I felt like have had trouble keeping up with my work, so I am taking that as a lesson into this spring to do my best to stay on top of everything. Everything being homework, projects, clinical hours, and studying. When I begin to get behind, it just causes more stress and for me and causes me to continue to fall back. Keeping up with all my work will relieve any stress I have and will allow me to stay focused on what’s ahead than what’s in the past.
Here are the goals I set for myself this semester to help me become a better clinician. I feel like I am weak in some places such as modalities, rehab, lumbar/pelvic region of the body, and can do better going through the evaluation process. I have talked to my preceptors and teachers about my weaknesses and plan to review and gain experience in these areas. Keeping up with these goals will help me retain things better than when I learned about them in class. Especially with experience, I plan to be able to understand everything to a point where I can teach it to an injured patient that has no idea why they need rehab and modalities after their injury.
My toughest class this semester is biology because it has a lot of material compared to the other classes I am taking. Most of my classes this semester, including biology, are review of material I have already been over. The reason biology is so challenging is there are a lot of processes I have to know and the exams have a lot of material on them so the usually take over an hour. For classes such as nutrition and strength and conditioning, the exams are shorter and it is over a lot of material I will need to know for my career so I do not have trouble with them. Those classes correlate with each other as well so it makes it a little easier to retain that information. I am interested in all my classes this semester but biology is just a lot of material I do not see in other classes. To stay on track and progress in biology I have been reviewing my notes and material after class. Also, I make study guides for the exams a week before so I have something to study throughout the week when I get a chance during the day. It has seemed to help me over the last two exams and better understand the material. I plan to continue this throughout the rest of the semester because I know class is going to keep adding knew processes in later chapters. In my other classes, I have been doing the same thing to prepare for exams and better retain the information. I have found in college that looking over the material right after class helps me retain the information more so I will continue to do so till graduation. What helps me retain the information very well in biology is working in a group with the extra time of class we have after lectures. This is when we draw out the processes so we know exactly what we need to put on the test. My group works very well together and our professor helps us throughout class which is why our class average has continued to rise throughout the semester.
In clinical, we have started diagnosing injuries and conditions from the head and have made it down to the shoulder so far. When I am at my clinical placement, I can apply what we have learned in class for patient care. I have seen several athletes come to the sideline with nosebleeds or signs of a concussion we have had to assess throughout the high school football season. We also started off the class talking about fractures and the different mechanisms of how they happen. In the past two weeks I have experienced two compound fractures on the field during a high school football game. The first one was right above the epicondyles which I talked about last week in my journal. The second one was this past friday night in warm-ups when a wide receiver fell on an outstretched arm (foosh) and had a compound fracture of the radius and ulna. We had to call EMS because it was about fifteen minutes before the game started. We tried to splint but the athlete was in so much pain we could only stabilize until EMS arrived. Now we have moved onto the shoulder and cervical area in class this past week. Coincidentally, today was with an orthopedic doctor and he evaluated a softball pitcher who had supraspinatus tendonitis. She got tendonitis during the past season from the repetitive throwing motion. Studies have shown that underhand throwing is actually more natural and less harmful to the shoulder girdle than overhead throwing. During her evaluation, we were able to see the difference in angles each arms internal and external rotation. While the doctor performed went through range of motions on the patient and special test we were able to see how much pain it has been causing her overtime. Her injury was not severe enough to have surgery quite yet but down the road the patient will continue to have the pain. What the doctor recommended ways to limit overhead throwing because it caused more pain. As a softball pitcher, this is possible for the patient to primarily throw everything underhand. She will also be going through rehab to strengthen her supraspinatus before the spring season begins.
The material we have covered in class relates to my clinical experience very well. I have used or experienced many skills from class either in the clinic or on the football field. The only thing different than class and my clinical experience is the patient is has usually been screaming in pain during the severe injuries which is hard to simulate in class. I had an opportunity on Friday to see a high school football player break his femur. When we got to the player on the field, he was lying prone and his leg was in external rotation while he was in excruciating pain. When we palpated the back of his leg, he said everything hurt which made me first think he tore his hamstring but there was a lot muscle guarding. That is when I knew that his hamstring was still intact and he had to of broke his femur. This happened in the first five minutes of the game and EMS had not arrived at the scene yet. We had someone call and the officer there had called three different EMS agencies and two helicopters but they were busy at the time but said they will be at the scene soon. While we were waiting for EMS to arrive we had to keep the athlete calm and control his emotions. When there were enough paramedics from the stands to help we rolled him over and made sure his leg was stabilized by using our med kits and I had to keep his femur in place. We were checking vitals because he did pass out from shock twice before EMS had arrived. One of our next steps was to cut off his cleat and his pant leg so we can see his skin around the injury. It was not an open fracture or else we would have had to do this earlier to control the bleeding. Luckily, the officer on site had an emergency kit so he could start an IV and give him morphine to control his pain. After thirty minutes or so, EMS had arrived at the scene and we first splinted his leg. They did not have a traction split so we used two rods and taped them around his leg for stabilization. While we were doing so, others started to get the spine board ready so we can get him up on the gurney. Finally, we got the athlete off the field and resumed play. There was family that rode with him in the ambulance and the coaches had his paperwork.
This situation will influence future clinical decision making because we must make sure that we have all the materials we need at the field in case of another emergency like this. Materials that could have helped the athlete and reduced time on the field would be more splints and a spine board at the high school game. EMS should have been there at the time of the injury as well which could have reduced a lot of time. As hurricane Florence been approaching, the weather around here has been questionable. It has been very humid and rains at least a few times each day. These weather conditions have affected football practice and game times due to lightning, humidity, and obviously an increase in rainfall. Hurricane Florence caused many colleges and high schools in its path to cancel or reschedule there games such as Emory & Henry College and Patrick Henry High School. E&H had to cancel their game and Patrick Henry moved there game to Thursday so they can play it before the hurricane hit this area. At the Patrick Henry game, the humidity was around 45 but did not affect the athletes play because of the wind and lower than usual temperatures at this time of year. I have only had limited practice towards my goals this semester because of the inclement weather. I have been able to practice using the digital psychrometer and the risks of lightning so far. The other day Patrick Henry’s practice had to be canceled halfway through because we spotted lightning in the distance. It was close enough to harm the athletes in the next few minutes so for the safety of the team we brought them inside.
My other goals were to become more proficient in lower extremity evaluations and go over various conditions with preceptors. I have seen some minor ankle sprains at my off site location but nothing serious. I will be working on doing more evaluations throughout the rest of the semester. Although, when I am at football games and volleyball matches, I do talk to my preceptor about any conditions or illnesses she has ran into over the years. One illness we have been over is impetigo because at one of the high schools she covers had a small case of it recently. We talked about how it was spread and the importance of cleaning clothes, cuts, and other wounds to help prevent the illness. We have talked about many other illnesses throughout the games we have watched and we plan to talk even more about the dangers of contagious diseases that can spread at the high school level. One course objective I can relate to this semester is explain the principles of environmental illness prevention programs to include: acclimation and conditioning, fluid and electrolyte replacement requirements, proper practice and competition attire, hydration status, and environmental assessment (eg, sling psychrometer, wet bulb globe temperatures [WBGT], heat index guidelines). I have been at a few high school football games this semester and it has either been humid and hot or storming. Before each game we would use a digital psychrometer and we almost had to stop the game because the humidity made the heat index close to 100 degrees. The referees were stopping the game frequently for water breaks and watched closely for athletes looking dehydrated or cramping. There were many athletes during the first scrimmage to go down with cramps so we gave them electrolyte tablets. Also, we made sure the athlete was drinking plenty of water since the temperature was 89 degrees at kickoff with around 45 percent humidity. Another incident of dehydration we ran into this weekend was actually not on the field. Before the game started, the band was getting off the field and a student was looking pale and nearly collapsed. The parents that helped the band saw him and carried him into the stands while I got water and Catherine got EMS. We made sure his parents were contacted as EMS came by and put him on the stretcher to help him. The reason we believe he got so dehydrated was obviously not enough fluid intake but also his clothing. The band were all in full uniforms causing everyone in the band to have a greater risk of heat illnesses with the high humidity from the distant storms. After the student was taken to EMS, the whole band took off their jackets to reduce that risk of illnesses. Along with that, the Friday night game had to be delayed an hour and a half because of the constant lightning causing us to add 30 minutes every time it struck. This caused the game to end closer to midnight but it gave the athletes a safe playing environment as the temperature dropped after the storm past.
At the beginning of pre-season last year, I felt like I could not help athletes on the field as much. I was primarily making water coolers, wound care, and taping because that was all I was cleared to do. During the pre-season, there was some review and I learned a lot of new skills. I knew there was a lot more to learn throughout the year and my role would increase as the year went on.
When we started this pre-season, I thought it would be a lot of review from last year but we did a lot of new things. As an ATS this pre-season, I was able to do evaluations and treatments as I played a bigger role on the sidelines and in the clinic. I feel different as an ATS going into this semester because I can relate to more situations that have happened. Last year, I was only looking for simple cases I can do such as ankle evaluations and simple wrapping while I had to observe all other problems. This pre-season I was presented with a lot of different injuries from hip strains to bicep tendon strains. What has helped me this semester is being more confident and looking for different cases of injuries while keeping an open mind. This year, I feel like I know about various injuries but do not know the full process on how to evaluate and treat the athlete. I usually need to double check with a preceptor to make sure what I am doing is correct which I think is what slows my patient contacts down. This year I plan to work on knowing everything that needs to done after an injury and how I plan on taking care of it. I will do this by spending more time on specific injuries and illnesses outside of the classroom as we go over them in clinical. My growth throughout my first year as an ATS has influenced me to talk more in depth about injuries and illnesses with my preceptors and understanding what is being explained. I can relate to some of these cases they have told me because I have seen the whole rehab process of some injuries. My interactions with patients has changed as well because now athletes know I can help them if something does not feel right. Athletes can rely on me to help them using proper care and I think that's what helps me see various injuries and illnesses now from the start of the program. Semester goals:
I chose these goals because I feel like I needed become more proficient in lower extremities and heat illnesses because it was material I learned in earlier classes in the program. I did not study very well for them and I want to improve that knowledge so I do not lose it. I chose my last goal because I needed to go more in depth when explaining what I am doing in my exit and become more proficient at performing them. At the end of the year I was told I should do this so I chose to make it a goal to push me to gain the skills I need to become a great Athletic Trainer. During this spring semester I have set goals in order to complete my clinical packet on time and also learn about the most common injuries in the winter/spring sports. In the spring, baseball and softball are the main sports which you could imagine being a lot of arm/shoulder injuries. Over this semester, I have seen that labral tears are the long term and overuse injuries most common in these sports but actually a lot of injuries are from direct contact to a ball/person. At softball, it seems more common to see a player get hit in the face or arm with a ball or run into the catcher which causes many injuries that could get bloody. Also, in baseball and softball a common injury I have seen is hip flexor strains from not only the first baseman. Several players on both teams have needed ace wraps during play to help their stretch. To treat these strains I have yet to figure out the solution to which way the ace wrap should be put on. I have learned it depends on the athlete whether to help with hip flexion or restrict it in order to make the athlete more comfortable during play.
This semester I have also been with basketball which was very healthy until near the end of the season. I noticed that several ankle injuries from stepping or landing on someone’s foot hurt the team later in the season. It was important for many of the players to get their ankles taped before the game and even practice to keep their ankle stabilized. Also, many players suffered from shin splints but it could have been caused by the lack of support from the shoes the team was wearing. Some other injuries I have noticed are contusions on the head or face from falling on the ground and from violent elbows that can injury the eye, nose, or mouth. There were not many of these injuries but it was something to always look for during play. Some other injuries I have also learned to keep an eye out for is falling directly on the knee or on an outstretched arm because the hardwood floor is not very forgiving to an athlete. With tennis and spring football practice in my next rotations to finish the semester, I am curious to see what injuries are common to keep a watch for. Also, I am interested to see how injuries from spring football differentiate from the common injuries during the season since there are no pads or helmets. |