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

Working with High Performance Minor Athletes - Part 2

Please check out part one of Working with High Performance Minor Athletes

It does not matter if the athletes are male or females, hormones are going to effect your interactions with them each and every day.  They effect their moods, their body, how they recover from injuries both physically and emotionally, how they react to their teammates, training partners and coaches.  I will break the myth right now, it is not only girls who cry and not only boys who want to hit things.  If you are dealing with young elementary aged children, they are still learning how to deal with disappointment, loss and success.  As the athletes grow older they are starting to discover who they are, and are having more expectations put on them.  Their role in sport can start to define them, if this role is suddenly changed, they may find it hard to cope.  You typically become their ally or enemy. If this role change occurs due to an injury, they see you as an enemy because you are what is holding them back.  If it is a coaching choice that changes their role you become the ally, they see you as someone to turn to who understands what is going on.  Typically at this age their relationships with their parents are changing and they may not feel they can go to them, you become their constant who they can trust.  It is this trust that will help you get through the enemy stage.  If you have built the trust when the time comes for you to remove them from play you remain their ally.  When removing an athlete from activity be prepared for anything.  As I said earlier girls hit and boys cry, you are messing with their identity in their minds, and they each have their own way of showing it.

At times you feel like a glorified babysitter.  You are the first one there, the last to leave, you pick up after the athletes, find out who's parents are always late, and do the room checks because the coaches are having strategy sessions.  Due to all this you become the gate keeper, you learn which athletes like to toe the line, which ones like to step over the edge a little and the ones who will ask you later "what line?"  Many coaches like to think they have their finger on the pulse of their athletes, but truly it is the Athletic Therapist.  We see all, here all and usually end up cleaning up the mess.  With minor aged athletes you try to help them keep the messes to a minimum, you become the teacher again in guiding them as to right and wrong.  You would be amazed at what these young minds can come up with to do on road trips.

For everyone involved in minor sports at a high level, we all must remember that these athletes are still kids.  Even as an Athletic Therapist it is hard.  We are trying to give them the structure and guidance they need to succeed.  Nutrition plans, treatment schedules, and expectations of how to act in the clinic or treatment room.  Let the kids be kids.  They will try to eat poutine before a game, use your athletic tape for their sticks and you will go through about ten sets of nail clippers each season.  It all becomes worth it though when they do something to show they have been listening, or when the truly show they care by carrying the treatment table and medical kit.  No matter the age of your athletes it is important to treat them all with respect and have their long term health and wellness in mind, because at times you will be the only one worrying about that.

Please follow us on Twitter @EliteInjuryMgmt  and our webpage at www.eliteinjury.com

Exercise - What is the Perfect One?

I would like to thank Freakonomics for the inspiration for this article and for Dr. David Geier for introducing me to the Three I's.

For many the desire to improve their health via exercise can be a long, tiresome journey.  One of the reasons is the need to try and find the perfect exercise.  Walk into any gym and you will see line ups for treadmills, ellipticals and bikes, yet not everyone is seeing the same results.

Intensity High intensity work outs are all the rage right now and for good reason.  By increasing the intensity of each individual work out you can decrease the time needed to work out and lets face it the majority of us do not have the time or desire to spend hours of each day in the gym.  A good example of intensity training would be to run for a minute as hard as you can, then rest (key here is active) for a minute.  You complete more work in 15 minutes than you would in double that time by doing continual exercise.

Indvidualized We all move in our own way.  Not everyone is a runner or a swimmer.  Some people have the ability to move gracefully in dance or yoga, were others feel more comfortable hitting a heavy bag.  Due to injury, physiology, anatomy or access to equipment can effect how well an activity works for you.  High intensity training works great for those who do not have access to much more than their running shoes and a pair of shorts.  Exercises such as high knees, bear crawls and jumping jacks can all be done in your living room.  Even those who enjoy running can employ the principals of intensity.  For some traditional exercises such as running, swimming and biking work well for them and produce ideal fitness gains.

I Like to Do It The best exercise for anybody is the one they will do.  If you don't like to run, don't.  Sink like a rock, don't enter the pool.  I quite enjoy Zumba, while my husband has recently discovered DDP Yoga.  Within a 30 minute Zumba session I work more muscles, burn more calories  than I do in a 30 minute jog.

I am adding Inspire even if you love the exercise if it does not inspire you to get off the coach, push your chair away from your desk then it still won't do you any good.  I love swimming but I have no desire to find a babysitter just to go workout for an hour, plus it's hard to get inspired to go into a cold pool during our Alberta winters.  A good test as to whether an activity is inspiring would be this.  If you see someone doing it, and you want to join, I suggest you do.

Not everyone has to start competing in triathlons once they start their journey to better health like TriFattyTri but you may enjoy it.  If you are starting your own journey to better health and incorporating exercise follow the Three I's, remembering that the most important is do you like it.

Please visit our website at www.eliteinjury.con and follow us on Twitter @EliteInjuryMgmt

Why Ice?

As you can gather from the name of this blog, I fully believe in icing injuries.  Any athlete or patient will tell you that I don't believe in heat only ice when it comes to treatment of musculoskeletal injuries.  There has been a lot of new information coming out saying that icing an acute injury is detrimental to healing.

When dealing with an acute injury the use of cryotherapy (application of cold) to the area is important for the first 24-48 hours.  The use of ice decreases pain and muscle spasm as well as blood flow, inflammation and edema.  This is due to the stop of tissue hypoxia and additional tissue injury.  When managing an acute injury the reduction of all of these aids in recovery and rehabilitation.

Reviews of research done on cryotherapy shows that more detailed studies need to be completed.  The research has proven that the application of ice on acute injuries does decrease pain, which will decrease spasm caused by the pain-spasm cycle.  Since muscle spasm decreases range of motion, this decrease in pain will lead to earlier improvement in range of motion and subsequent earlier start to rehabilitation.

The principle of RICE is still the standard when dealing with acute injuries.  Rest, ice, compress and elevate the injured area for the first 24-48 hours.  When icing on average for topical application the ice should be applied for around 20 minutes depending upon the size of the area needing treatment and the depth of soft tissue.  Topical application will reduce tissue temperature to a depth between 2 - 4 cm.

When applying ice, no matter the mode there are 4 sensations that you will experience.  Starting with cold, progressing to burning, achy/dull and finally numb.  When determining how often to apply the ice, the area needs to come back to normal body temperature before reapplying.

No matter the type of soft tissue injury, be it sprain, strain, contusion or post operative the application of ice is the still the best way to decrease pain and inflammation without the use of medications after an acute injury.

Articles used
Hubbard, T.J & Denegar, C.R. Does Cryotherapy Improve Outcomes with Soft Tissue Injury? Journal of Athletic Training. 2004 Jul-Sep; 39(3): 278-279
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC522152/

Nadler, S.F, Weingand, K, Kruse, R.J. The Physiologic Basis and Clinical Applications of Cryotherapy and Thermotherapy for the Pain Practitioner Pain Physician.  2004;7:395-399, ISSN 1533-3159
http://www.painphysicianjournal.com/2004/july/2004;7;395-399.pdf

Injury Prevention - Athletic Therapist at the Ready

To continue on with our What is an Athletic Therapist series, we will be focusing on their role in injury prevention.

Injury prevention is a major role for all athletic therapists, be it for initial injury or re-injury.  There are many aspects to injury prevention.  Two of the most important are physical preparedness and education.

Physical preparedness.  Athletic Therapists play a major role in helping ensure that their athletes can withstand the physical demands of their sport, both daily and from season to season.

Proper strength and conditioning involves everything from ensuring proper muscle balance, flexibility as well as proper aerobic and anaerobic conditioning for sport and position.  Their knowledge of biomechanics, anatomy and physiology enables each Athletic Therapist to work with each athlete on an individual basis to improve their performance.

On a daily basis the preparation for practice, game or event can range from stretching or muscle work, injury rehab, or taping and strapping all help prevent injuries.

Part of physical preparedness is also ensuring that the body is being provided with the proper nutrients and energy.  Ensuring that athletes have readily available nutritious food that will supply them with the proper energy reserves for their sport as well as educating all athletes in the area of nutrition.

Each day Athletic Therapists are educating athletes, coaches, parents and administrators.  Any time that as an Athletic Therapist you get to educate someone you are working towards injury prevention.  Even during the rehabilitation stage the knowledge you are passing on can help prevent further injuries.  From nutrition, injury care, concussion recognition, injury recognition, and beyond your Athletic Therapist is there to ensure that you have the knowledge and skills to stay healthy and in the game.

All Athletic Therapists are prepared to deal with any injury that may come their way, however their goal is to help you prevent those injuries from even occurring or reducing the time you are away due to injury.  Your success is always what every Athletic Therapist wants.

What I Have Gotten Back

To give more of an insight as to why I do what I do, I thought I would give you a glimpse inside.

The athletes have always been my reason?  As an athlete I suffered through injuries that effected my performance and still effect my day to day life.  I had an amazing Chiropractor who helped me through so many of my injuries and led me to becoming an Athletic Therapist.  I wanted to be there for other athletes, to help them achieve their best.

As an Athletic Therapist you are there with your athletes through everything.  We see them at their highs and lows, both on the playing field or in their personal life.  It is not only the physical injuries that can cause devastating blows to athletes.  The loss of a girlfriend or boyfriend, family member or even teammate can effect athletes in so many ways.  Getting to know my athletes both on a physical, mental and personal level has helped me gain a better understanding of what makes them "tick".  Developing these relationships is what makes me good at what I do.  Knowing that I have been there for my athletes in their time of need means a lot.

The relationships that continue after athletes have graduated help me realize that I did make a difference in their lives.  Getting to watch my athletes get married and have babies, graduate from college or university, get drafted into the NHL and even play professional hockey gives me great joy.  Even greater joy is watching my children be able to enjoy the benefits of their mom being away for long hours and for all the time put in before they were born.

Being able to have my 6 week old son meet Nail Yakupov was pretty cool.  I know at the moment this picture means nothing to him but give it a few years and I think he will thank me.  I am also very grateful to Nail for being so wonderful and willing to hold him.  I am also grateful for C being so good at hanging out at the rink with me that weekend for the Stollery event.

The other picture is now one of my favorites.  Jaynen is a former athlete of mine who now plays for the Calgary Hitmen.  Q has decided that he is her favorite player and her Christmas present was getting to meet him.  For so many reasons I am grateful that this could happen.  Being able to watch Jaynen grow into an amazing young man who I am proud that my daughter looks up to is great.  The smile on both their faces says it all.

I hope that I have at helped all my former and current athletes in some way but mostly I would like you all to know that I am thank full for all of you.  You have all taught me something in some way, be it due to an injury, something you were studying on the bus or what music I should be listening to, you have taught me something.  Thank you.

This has been a short list of what I have gotten back because I truly have to be thankful for so many things in my life that I have gotten from sport and being an Athletic Therapist. Being able to help athletes achieve their goals, working through the physical struggles of injuries is just the tip of the iceberg as to what I have gotten back.

Female Athlete - Their Why

The why.  This is extremely important to all who participate in sport.  It is what gives athletes their drive and purpose.  They why can change from beginning to end but performance can be effected if it is not truly from within.  With the female athlete, their reasons to start participation vary especially from their male counterparts.

Friends are one of the greatest reasons for females to start sport participation.  The adage if your friends jumped off a bridge would you?  Holds true in this case.  Many young female athletes either start participating in sport as a group of friends or because their friends are already involved.  Compared to their male counterparts females are not inclined to join a sport group or team by themselves.  They also are more likely to quit if they no longer have friends at sport or if they become bullied in any way.

Both male and female athletes feel a lot of pressure from family to participate, the female athlete however more so.  Females see it as a sense of duty to their family to participate, whether they are happy or not.

Females will choose to participate in sport as a means of exercise and weight loss, especially as they grow older.  This is one of the main reasons for females past their teenage years to restart or start participation in sport.

Another difference between males and females is the desire to compete.  Females will continue in sport participation not due to the competitive drive of beating their opponents but the internal drive of accomplishing the task and improving themselves.  This is one of the main points that keep females involved.  They want to continually improve themselves.  The sense of accomplishment over weighs that of besting their opponent if there is one.

One thing that everyone involved with female athletes needs to keep in mind is that their is a higher drop out rate compared to males.  We need to remove boundaries that interfere with female participation in sport.  Be it gender biases, the emphasis on the body or sport stereotypes, we need to encourage females to participate in sport.