The Art of Taping

As an Athletic Therapist one of the things that we do on a regular basis and by regular I mean multiple times daily is taping.  Be it an ankle, thumb, knee or wrist we have to know that exact place to put the tape and what way the that piece of tape needs to go to prevent and stabilize the joint.  

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Recently I was instructing a class of high school students on various tape jobs.  There were varying degrees of experience with taping as well as degrees of interest in doing them properly.  One of the first steps we went over was reviewing the motions of the joints we were going to tape.  Before you even can touch a roll of tape you have to know what way the joint your going to tape moves.  It would be very detrimental to tape an ankle inversion sprain and pull the ankle into inversion instead of eversion.

Learning to tear tape is another skill that needs to be mastered prior to applying tape to the body.  Poor tears cause wrinkles and tight spots which are both huge no-no's with any tape job.  The use of scissors or tape sharks to cut regular white taping tape is not efficient nor practical.  

You may be asking by now why is this post called the Art of Taping.  It may seem more technical than artistic.  As much as you need the technical knowledge as to the body and its motions, taping is truly an art.  No body part is the same.  For example no arch in the foot is the same.  Being able to recognize this and know the difference, while taping essentially on the fly is part of the artistic aspect. 

 Many of you may not think so but tape jobs are pretty.  They should be viewed like a sculpture.  The absence of wrinkles and windows (where skin shows through between two pieces of tape) makes for a smooth, flawless tape job.  This combined with the ability of the strength of the tape to prevent injury is beautiful.  

If you still doubt how taping can be art.  Watch an Athletic Therapist at work.  The fluidity of their motions as they move the roll of tape around the body of their athlete or patient is at times as graceful as a ballerina or pianist.  

I hope that after reading this you have gained a little more appreciation for those of us who tape.  It is not as simple as throwing on a piece of tape as though it is a bandage.  Each piece is in its place for a reason and put there purposefully, as a painter puts each brush stroke on their masterpiece.  

Please follow us on Twitter @EliteInjuryMgmt and check out our website www.eliteinjury.com for more tips and services that we offer in keeping everyone in the sport of life.  

Fatigue in Athletes

Many athletes become fatigued during the season.  With the prevalence of year round sport, young athletes are becoming fatigued more often that before.  As a coach and parent there are two main ways you can help deal with athlete fatigue.  Firstly you must plan a schedule that will help prevent athlete fatigue, secondly you must be able to recognize the signs and symptoms of athlete fatigue.  

Signs to look for when seeing if your athlete is becoming fatigued come as both physical, mental and emotional.  Physically athletes may become more prone to sickness.  Missing practices, games and competitions due to illness more often than normal is an easy sign for parents and coaches to see.  An increase in pain as well as slower recovery from work outs or injuries occur as athletes become more fatigued during the season.  As the body uses its energy to try to keep up with normal daily activities, It finds it harder to find the energy to heal, compete and learn new skills.  Skills that were once automatic become harder to complete.  

Mental and emotional fatigue can end up leading to depression, so it is imperative that early recognition occurs.  Athletes may appear moodier or more emotional.  The happy go lucky athlete who cheers everyone on, soon becomes withdrawn and irritable.  You may notice an increase in irritability.  Snapping at parents, siblings or teachers without cause or over reacting to situations can be early indicator of fatigue.  

Altered sleep patterns, both a increase or decrease in the amount of sleep is a sign of both mental and physical fatigue.  When or wear an athlete chooses to sleep as well.  You may find that an athlete is falling asleep during dinner or needing naps after school.  If this is typically abnormal and becomes more than an occasional occurrence, further investigations as to the cause need to occur.  

One of the major clues or signs to look for is a decreased enthusiasm for their sport.  Not wanting to attend practices or competitions, coming up with excuses as to why they don't want to go or wanting to leave early are all signs of this loss of enthusiasm.  This type of fatigue is associated with burnout and is typical with athletes involved in sports with early specialization and year round sport.  

Prevention of fatigue as with all types of injuries is simpler than dealing with it after it occurs.  When organizing an athletic year follow the principles of periodization.  Both physically and mentally the athlete can not be at peak performance all the time.  There must be highs and lows of training and competition. 

As parents, coaches and teacher-coaches; a balance between school, sport and social life must be achieved.  When scheduling practices and games allow time for both the body to recover as well as time for your athletes to complete homework and spend time with friends and family.  

Communication is pivotal for both recognition and prevention of fatigue.  Talking and listening to your athletes to both verbal and non-verbal actions will allow you to take any steps needed before it is too late.  

Athlete fatigue is more than just being tired and can lead to long term health problems.  Preventing and recognizing this before it becomes severe is important in truly making the athletes health a priority. 

Follow us on Twitter @EliteInjuryMgmt and check out our website at www.eliteinjury.com 

Emergency Action Plan

An athlete goes down, they are hurt and not getting back up.  What do you do?

Well no matter if you are an Athletic Therapist/Trainer or coach the most important thing that you have already done is have your Emergency Action Plan (EAP).  The EAP is simply the plan that you as an association, club or team have set out in case an emergent situation may occur.  It is important to remember that not all emergent situations may be an injury.  An athlete may have a medical episode as well as someone in the stands.

It is really simple to think that if an emergency does occur everything will fall into place and there will be no complications.  However during an emergent situation, there is chaos.  No matter the level, no matter the expertise of the medical staff or coaching staff, everything going on is chaos.  If you check back to any of the videos from the post Athletic Therapists/Trainers in Action  even though all the ATs are working in the professional ranks, what goes on around them is chaos.  The biggest thing to notice is that it is organized chaos.  Each person knew their role and that by completing their role, that was what would guarantee the athlete getting the best, quickest care possible.

It is very important to note that if as a coach you are unable to have an Athletic Therapist on staff you still need to have an EAP and may find it more important as you will be taking control and charge of the situation.  You as a coach need to have this written plan that you share with your coaching staff and inform your parent group that you have one.  This will help with efficiency in care and will ease any concerns that your parent group will have in case something were to happen to their child.

So what makes up a good EAP.  There are three major roles.  Charge Person, Call Person, Control Person.  The focus will be on if you do not have an AT on staff and will be managing the emergency as a member of the coaching staff.  Time is of the essence during an emergency, so making sure that everyone knows what to do is very important.

The Charge Person's only concern is the care of the injured athlete.  They are to decide whether or not further care is needed beyond what they are trained to do.  This can include finding someone more qualified in the stands and activating EMS.  It is recommended that this person does possess some level of first aid and CPR training that way they have the knowledge base to know if more care is needed and can do some basic interventions.

The Call Person has at times the most simple job, they need to discuss with the charge person what the extent of the players injury is and if they want EMS contacted.  Never rely on a cell phone during this time as depending on the location service may be intermittent.  The call person should know the location of a land line or pay phone at the venue and have the address for each.  They should also know the best location for the ambulance to come to to ensure adequate access, the closer the ambulance can get to the playing field can at times be critical.

The Control Person can be likened to the bouncer.  They must ensure only the people needed to help with the emergency have access to the athlete.  As much as spectators and parents feel they will be of assistance, the more bodies in the way can impede the care of the injured athlete.

So how does all this start.  Once the charge person enters either the competitive surface, both the call and control person need to be at the ready.  A simple set of easily identifiable signals can get the ball rolling.  You can choose which signals work best for you and your EAP team, but some standard rules should apply.  The signal for activating EMS should be one handed, as your other hand could be stabilizing the head and neck.  All signals should be large ie. arm straight up in the air, hand on the head ect.  That way someone on the sidelines or stands can easily distinguish what is going on.  You can have a signal not only to activate EMS, but to ask for assistance from the sidelines.

Depending on the EAP sample you look at, it can be either the call person or control persons job to talk to the facility staff.  The facility staff are a huge asset during this time.  They know the layout of the venue and will assist in ensuring the ambulance can get to the athlete quickly and uninhibited.  You can also decide who will retrieve the Automated External Defibrillator (AED), it can be the call or control person or you can designate someone who's job is solely to do that.  As soon as the charge person shows the need to activate EMS the AED needs to be retrieved.

Use the officials of the game or event, they can help greatly in dealing with crowd control including the other team.  Once they charge person has decided that EMS needs to be activated they can assist the control person and facility staff in ensuring quick access to the athlete.

Time is of the essence during an emergency, be it your athlete or a spectator or even an athlete from another team, you want to ensure they get the quickest access to advanced medical care.  In rural areas your average time for an ambulance to arrive can be upwards of half an hour, even in the city you may be looking at a wait of ten minutes or more.  The sooner that you as the charge person decide that is what is needed, the sooner that ambulance is on its way.  Never assume that someone else more qualified will be there to make that determination and know that unlike professional sports Paramedics are not waiting in the wings to take over.  A well organized EAP runs smoothly like a well choreographed dance, each person moves independently of each other but all working towards the same goal.  This goal is the safety of the athletes and having an EAP is one of the first steps in ensuring that for them.

Please follow us on Twitter @EliteInjuryMgmt and check out our website at www.eliteinjury.com

Athletic Therapist in an Occupational Setting

We would like to thank Mat Bonneau, Certified Athletic Therapist for giving us this insight as to what it is like to work in an occupational setting. 

So I’ve been working in occupational testing for 2 years now, and it’s something I never thought that I’d be working in coming out of school. The opportunity has been good thus far although the job definitely comes with its own set of challenges.

As an athletic therapist, I am responsible for assessing a person’s medical history to help make a determination if they are able to complete our lifting test. We hold our clients to pretty strict standards to help ensure that they do not injure themselves while doing the test or something that could be potentially harmful on the job site. Occasionally we also run the physical portion of the test depending on how busily our day gets booked up. We see everybody from the lean 18 year old heading out for his first job on the rigs who’s never had so much as a cold to the overweight 55 year old type 2 diabetic, hypertensive operator who’s looking for a job to take them to retirement. We get quite a range of characters coming through. For the most part things run smoothly but occasionally we run into people who are more difficult to deal with. Like any service type job, how our day goes depends a large part on who companies send us each day.

Typically, a client goes through a brief pre-medical screen before coming to see us. We take a few measurements such as height, weight and blood-pressure to make sure there are no concerns with a client taking the test. We then go over their medical history with them, making sure to highlight and talk more in depth about any health conditions that may be red flags. Every once in a while I’ll come across a condition which I’m not as familiar with. We have a medical review team of medical doctors, chiropractors, physiotherapists and athletic therapists that help us to discern what may need to be looked at by another health professional or can continue through our testing without any restrictions. All of our files are reviewed by this team to make sure that everything is covered. Any type of medical clearances or restrictions are take care of by this department.

After going through a client’s medical history, we typically review their injury history looking for dislocations, fractures, sprains and strains. This can be challenging because clients may try to hide or not disclose information that they feel may hinder their opportunity to find a job. We check a client’s joint range of motion, muscle strength and ligament laxity to determine if a candidate is fit enough to not only complete the test, but also safely work at the job site without putting them at risk of further injury. We tend to focus on problem areas such as shoulders, low backs, knees and ankles throughout our assessment, while also keeping in mind common workplace injuries such as medial/lateral epicondylitis or carpal tunnel syndrome. The most difficult part of the job comes when you have to stop somebody from performing the lifting portion of the exam. Sometimes a person understands why we have a concern about the injury or medical condition in question and sometimes they don’t. We see people who have had a rotator cuff tendonitis for years but feel it is just part of getting old and don’t ever seek treatment for it. Other times they've had surgery and we just want proof that a surgeon feels that they are safe to go back to work without any restrictions. It can be a very touchy subject because a person feels if they don’t get through all their testing on the first day that they won’t get the job. It does put us in an awkward situation sometimes but we do our best to try and explain everything to our clients to the best of our ability.

Each physical test is set for a company based on a site analysis done by one of our assessors. The test doesn't change much from company to company but we vary the weight of the test based on what the person will be doing on the job site. The test is always run by a person with an exercise background, whether it’s a PFT, Kinesiologist or one of our assessors to ensure client safety. The test takes about 30 min to run for each group. We start with a brief cardiovascular test and proceed to a lifting test. Throughout the physical test, we are looking for a person’s ability to safely perform the lifting portion of the test using proper lifting technique for each lift. Clients are closely monitored to ensure that we are not putting them in danger throughout the testing. People will try and push themselves past their limits sometimes in order to attempt to secure a position within a particular company, so we do our best to prevent them from causing any injuries throughout our testing.

Overall it’s been an enjoyable experience working in occupational testing. It’s a really good chance to be exposed to different medical conditions and it’s a good chance to work on your assessment skills. On a busy day you can assess 25-30 people so it’s a good opportunity to be hands on with your muscle testing and special tests. I’m grateful for the opportunity to work in this field and appreciate being stretched outside the box of a typical athletic therapy setting.

Please check out our website at www.eliteinjury.com  and follow us on Twitter @EliteInjuryMgmt

So You Made a Resolution

How many of us have made to lose weight by exercising more.  A great way to better yourself and improve your health.  We are half way through January and are starting to reach the point where people are faltering with that resolution.

One of the keys to maintaining a lifestyle change such as working out is to ease into it.  Not only will it easier to have this change be a lasting one, it will be more beneficial to the body.  When you push yourself too fast to soon you put yourself at risk of injury and not maintaining your exercise program which can lead to fluctuating weight.  We are going to focus on the injuries that can occur by doing to much to soon.

There is an increased risk of musculoskeletal injury when taking on a new exercise program to quickly.  Moderation is a key when starting out or changing your exercise program.  The exertion that you are putting on your body is more than it is used to which can lead to injury.  Typical injuries that you may experience when starting out with an exercise program are muscle soreness, muscle strains and depending on your choice of exercise you may see ligament sprains.

Muscle soreness is typical with physical exercise and typically is called DOMS - delayed onset muscle soreness.  DOMS is normal with workouts, and occurs one to two days after exercise.  If the pain is severe or lasts for longer than two days, you have progressed from normal muscle soreness to muscle damage.  If the pain is so severe that you our unable to complete daily tasks such as walking or lasts longer than the normal two days, you need to make a change to your program.  This also applies to any time you make a change to your work out.  For treatment of DOMS the best way to reduce pain is to continue with moderate exercise.  Stretching, cryotherapy and massage therapy have not shown to be beneficial in the reduction of pain from DOMS.  One of the best ways to deal with DOMS is to alternate your work out, by giving the muscle groups a day or two of rest before training them again, you allow the body to heal/repair from the prior work out.

Muscle strains occur when the muscle is taken beyond its normal capacity be it load capacity or range of motion.  These typically occur when using too much weight or performing a move that requires flexibility that you have not gained.  If you have taken up strength training, yoga or classes such as Zumba, you may be more prone to a muscle strain if you do not pay attention to your body.  Slow and easy is the best rule of thumb when starting a strength program. When doing exercises that involve flexibility or doing a movement that goes beyond your norm, pain is your guide.  If the movement hurts, stop.  Find a way to modify the movement, but continue to work on building towards completing the movement properly.

A ligament sprain can occur during weight lifting, running, or during activities such as Zumba, dance, soccer or even yoga.  You typically will not see them if you are cycling, running on a treadmill, rowing or using an elliptical machine.

As part of a complete exercise program, you need to have a flexibility and propioception portion.  A full body stretching program will help alleviate any muscle imbalances caused by improper posture.  Propioception is knowing where you body is in space.  By working on balance and proper positioning you reduce the chance of injury. Think of a volleyball player coming down from a block, if as they land their ankle starts to roll, an athlete with propioception training body will notice this and activate the muscles to avoid the injury.

Setting the goal and resolution of losing weight is an admiral one that will only be of full benefit if you are able to continue with it and avoid injury.

What is an Athletic Therapist?

I am pretty sure when I told my parents I was going to be an Athletic Therapist my dad had a heart attack.  He had no clue what it was but was pretty sure he didn't want his baby girl being one.  Since that moment I have spent a major part of my life explaining what it is I do and what an Athletic Therapist is, even to those who think they know.

So what is an Athletic Therapist?  Well we are health care professionals who are trained in the areas prevention, immediate care and rehabilitation of musculoskeletal injuries.  We work with athletes from the young hockey player and the weekend warrior to the professional and Olympic level athletes.  No matter the level or sport we are there.  Be it at the rink, field, court, studio, gym or clinic we want to support athletes in achieving their goals.  Not only do we treat athletes we can work with general public helping them overcome injuries that they receive either at work or home.

So what do we do?  Everything.  We can help with equipment, tape any joint you prefer, assess your injury on site and rehab you from there to return to play.  We are the first ones there and the last ones to leave.  The best analogy I have heard to describe us is "mom".  We know when our athletes are hurt before they do, if they are having a bad day and how to fix it.

My daughter says I fix football players owies by putting bandaids on them.  My husband laughs because I love the smell of a hockey rink.  I can fix anything with a roll of athletic tape, and hate being called "trainer".  I have slept on treatment tables, numerous buses and even bags of equipment.  The long hours, endless bus rides are worth it.  Being able make a difference in my athletes lives is worth it, because that is what we do.  

For more information on what Certified Athletic Therapists can do please check out www.eliteinjury.com and www.athletictherapy.org.

Intro to the Female Athlete

The female is a complex being turn that female into an athlete and you have made her even more complex. The female athlete provides many challenges to the coach, parent and athletic therapist.  To fully understand the female athlete will take more than this one post.  Today will be an overview of future topics and if you feel I am missing one or want me to talk about something specifically let me know as not all athletes are the same.

Female Athlete Triad, simply it is the combination of disordered eating, amenorrhea, and osteoporosis.  It is a vicious cycle that starts with disordered eating and progresses.  No sport is exempt from this as it is typically seen as an aesthetic or performance sport issue.

Anterior Cruciate Ligament Sprains, this ligament helps prevent anterior translation of the tibia relative to the femur.  In more simplified terms it stops the lower leg from moving forward compared to the upper leg.

Disordered Eating,  detrimental effects on energy levels do not require an athlete to have a diagnosed eating disorder such as Anorexia Nervosa or Bulimia Nervosa, the slightest change in energy intake for the athletes energy output will place unnecessary strain on their body.

Physical characteristics, the differences between males and females can predispose females to injuries that their male counterparts may not experience.  These characteristics may also predispose the athlete as to what sport or position they may participate in.

Why the participate?  The reason for female participate in sport varies depending on the individual however there are some constants.  Friend participation both effects the reason to start sport participation as well as when females decide to no longer be involved.

One of the new areas of study on the female athlete is in the area of concussions.  Still in its infancy we are learning a great deal about how females react to a concussive injury and if there is differences from their male counterparts.

As a parent or coach it is important to understand how to deal with the female athlete.  Learning how to deal with them will give both you and them an advantage on their path to success.