So Your the One who Runs Onto the Ice?

First of all I don't run onto the ice, that isn't safe, I walk quickly.  You may be thinking that all our concentration is on not falling, even though that may be part of what is going on in our head, we are already starting assessing the scene.

When you are working on the bench or the sideline as an Athletic Therapist you are always at the ready.  I have heard coaches say it is like we have eyes in the back of our heads we can know something is wrong even if we are not looking at the playing surface.  Adam Oates commented that when he started as a coach in the NHL he noticed one of his players was hurt and turned to Athletic Trainer Greg Smith to point it out and Smith was already moving down towards the end of the bench the player was coming off at.  This is a typical reaction for any AT working with a team.

I have been asked what we do while on the bench.  When working lacrosse and hockey I did work the gate but for me that just helped me see the ice and floor better, it also helped me get to know my athletes.  You could tell what they were like coming off from each shift, what was normal and what wasn't.  You would also be amazed at what they will tell you while you are both standing there.

So a player goes down.  You get an initial shot of adrenaline, I have told coaches who do not have access to ATs on their bench that the first thing you need to do when entering the playing surface is to take a deep breath and calm down, it is because that is what I do. As I am on my way to the injured athlete, many things are running through my head.  I am assessing what position they are in, are they lying still or rolling around in apparent agony?  I am going over what I saw the last few seconds of the play, based on this I already have an idea of what body part might be injured.  I quickly run through their medical history, was that the same knee that they had surgery on two seasons ago?  I may talk to another player or official to see if the noticed anything.

Once I arrive at the athletes side, the hands on work begins.  Always start with A, B, C - Airway, Breathing, Circulation.  Hopefully the athlete is talking to you and that solves A & B, you still need to check their heart rate.  Have them take some deep breaths before you start to assess, what is wrong, what hurts, what happened?  What I saw might not be what they are complaining of, however when I start my physical assessment I am going to make sure we both aren't right.  As long as it is not a suspected spinal injury, a quick physical assessment occurs and once the athlete is ready we move the athlete safely.

The pressure that is on during the on field assessment is huge.  Deciding if it is safe to move the athlete and how to do so.  Officials, other players are over your shoulder trying to help and wanting to get the game moving.  The coaches are wanting you to find out what is wrong so they know if they have lost a player or not.  Then there is the fans.  Parents, grandparents, family, friends, scouts, everyone is watching your every move, at times if feels like they are waiting for you to mess up.

I may not have eyes in the back of my head, but I do use my senses during injury assessment.  Initial injury assessment begins on the sideline, by watching and listening to the game or sport.  Once the physical assessment begins we add the sense of touch but always continue with my eyes and ears.  The use of the 6th sense is almost the most important, however that is a whole other post in itself.

So yes I am the one that goes onto the ice or field, but my job doesn't start or end there.  I've been watching to make sure if anything happens, making sure any of the prevention techniques used are doing their job, checking in with athletes as to their status of a healing injury.  When an athlete does get hurt, getting them off to the sidelines safely is just the start, a further assessment and decision about care must occur prior to anything else.  No matter what the safety of the athlete is key.  Getting them back to play is the goal, that is why we do what we do.

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

Where do Athletic Therapists Work?

In honor of National Athletic Training Month in the States this entry will be an overview of all the different areas that an Athletic Therapist works in.

Sport:
All the major professional sports in North America have associations for their Athletic Therapists/Trainers (ATs), the NFL, NHL, NBA, MLB and MLS all have highly qualified personal on their sidelines to ensure the safety of their athletes.  Many of the national sport programs in Canada and the United States carry ATs to help lead their medical teams.

It is not just mainstream sports that employ ATs.  There are ATs working with major dance and performing arts groups such as Cirque du Soleil, Radio City Music Hall Rockettes, Disneyland and Disney World.  Many ballet companies employ ATs to keep their dancers in top form through rehearsals and performances.  In both Canada and the US you will find ATs working and supporting pro rodeo athletes, working in the NLL, and the PGA.  You will find that ATs work with cheerleaders, gymnasts and figure skaters.  No sport is immune to us being there to help the athletes, coaches and parents be safe.

From secondary schools to major universities and colleges ATs are the driving force for player safety.  Many are required to teach classes or do research during the day and then start treating and preparing athletes for practices and games.  For those in secondary schools they are the sole person in charge of all their schools athletes which can range in the hundreds.  Those working at major post secondary institutions might be lucky enough to have a group of assistant therapists/trainers as well as a group of student trainers/therapists.  They become administrators and teachers on top of their normal AT tasks.

Occupational:
As discussed in our post So You Only Work with Athletes Right? ATs do not only work with athletes.  Though many work in a clinical setting where they help rehab athletes from injuries, they also will treat the general public.  ATs are employed in hospitals, as occupational health and safety experts and with the military.  Many private companies are using the skill sets of ATs to help reduce on the job injuries and improve the overall health of their employees.  One of the motos of the Canadian Athletic Therapist Association is Rapid Return to Work and Play.

General Public:
The skill sets of prevention and rehabilitative care are not only for those in the areas of sport and work settings.  Anybody who suffers from a musculoskeletal injury can benefit for seeing an AT.  If you have been in a motor vehicle accident, fell on the ice and broke your ankle, strained your back shoveling snow or hurt your shoulder doing yard work, ATs will get you back on track quickly and safely.

All Athletic Therapists/Trainers are trained in the areas of injury prevention, rehabilitation and emergency care.  We work with all levels of athletes, different types of occupations, and all ages of the general public.  Our goal no matter what our occupational setting is to help you get back to either work or play safely and quickly.  We truly are AT4All.

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

Proper Concussion Management

Gone are the days of returning to the game the same day you suffered a concussion.  Well it is supposed to be.  Even with all the media attention and front line education on concussions; coaches, parents, officials, athletes and trainers are still missing the message.  After a concussion has been diagnosed it is extremely important to have the athlete rest.  Not only physical rest but cognitive as well.  No matter the age of the athlete it is important to offer them this rest.

I has amazed me over the years that parents, athletes and coaches have tried to circumvent the return to play protocols because the concussion occurred in another sport. It is the parents role to inform teachers and other coaches of their child's concussion.  Concussed athletes may need to take time off work or school, to give the brain the rest it needs.  Student athletes need to be given the chance to fully recover before returning to full mental and physical activities.  Having athletes refrain from attending school while still suffering symptoms will aid in their recovery.  It may be required for the student athlete to remain home from school until symptom free as the level of concentration at school is too much.  Gradually introduce them back into school and homework.  Consultation with their teachers is important, ask for extra time to complete assignments and tests.  The other major part of cognitive rest is to take away screen time.  Put down the phones, turn off the computer, TV and video games.  That scream you just heard was every young athlete having a minor heart attack due to this.  The bright lights, sound and concentration needed for these activities do not help the brain heal.

Right after injury it is imperative that you do not give the athlete any pain medication.  Advil, Tylenol, Aspirin and Ibuprofen will only mask the signs and symptoms of the concussion.

Your qualified health care provider will complete a concussion test and compare it to the athletes baseline evaluation.  Only when an athlete is sign and symptom free do they progress onto step two of the return to play process.  A minimum of 24 hours is required between each step where the athlete must remain symptom free.
Step 1 - Rest until 24 hour symptom free.
Step 2 - Light aerobic exercise such as biking or jogging for 20-30 minutes.
Step 3 - Sport specific exercises such as skating in hockey, running drills in soccer or football.
Step 4 - Non-contact training drills such as passing drills.
Step 5 - Full contact training drills upon medical clearance 
Step 6 - Return to normal game play.

An athlete should remain at step 5 until both the athlete, parent and coach feels that the athlete is able to keep up with the play both physically and mentally.

Key points to remember are:

• Return to learn before return to sport
• No difference in management between elite and non-elite athletes.
• Younger athletes may require longer to recover.  

Rushing any athlete back to sport to quickly can cause serious damage both to the brain and other areas of the body. Following proper concussion management may help to decrease the long term effects of concussions.