Why Proper Injury Management is Important

I recently treated a young dancer who hurt her leg at school.  The story of how she hurt her leg and her subsequent recovery is a perfect example as to why safety recognition and proper injury management is key. 

Now her mechanism of injury is somewhat amusing but totally preventable.  While at school she slipped on a pencil and awkwardly caught her balance.  She was unable to extend her leg fully and was walking around on her tippy toes when I saw her.  She complained of pain in her upper calf.  She had no swelling or deformity.  Her hamstring and calf were in spasm which was causing her pain.  I sent her home with instructions to RICE (rest, ice, compress & elevate).  This is where the story turns ugly.  She went to school the next day feeling better, that was until she was not allowed to ice during recesses and lunch.  When her mother arrived home, her ankle was swollen, bruised and sore.  She was in so much pain, you could not touch her leg without her crying.  Click here to see her ankle.  After one day of ice, elevation and rest the swelling had gone down and by day five full range of motion had returned and she is back to dance.

  

Her injury was totally preventable, making sure that things are not left on the floor and encouraging kids to be aware of their surroundings.  However, kids will be kids and that can't always happen.  What could have happened is the proper management post injury.  As was seen by her recovery once the RICE principle was initiated, if this had been done the day after injury then the swelling, pain and bruising would not have been so severe. 

Basic injury management principles are just that basic and simple.  The RICE principle has been around for many years and does not require much advanced knowledge of injury management.  Correct management obviously creates a more ideal situation for healing, which is in the best interest for everyone.  A similar situation is a friend of mine who hurt her knee during soccer.  Her husband told her to heat it that night.  These two situations show the importance of more education on basic injury management.  

As health professionals we may feel that everyone knows how to deal with acute injuries, but everyday athletes both young and old are getting improper advice which in turn prolongs their injury and taking them away from being active and achieving success. 

For more information on injury prevention and management 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. 

Balancing the Scales: Sport, School and Life

Being a student athlete is hard work.  The amount of time and dedication it takes to compete at any level can at times leave little room for anything else.  Finding time to schedule in school work, friends and family soon leaves many athletes overwhelmed and unsure of how to deal with all that is on their plate.  The majority of young athletes that excel in their sporting venue also excel in school because of their internal drive to succeed.  It is also what makes them say yes to student council, yearbook and many other school activities.   Creating an environment for the athletes to succeed is job held by many and each of them have specific roles.

As the parent you are the master conductor and scheduler.  You shuttle the kids from school to practices and games and back home again, watching them do homework in the back seat or in the stands while waiting for their siblings to be done.  You see them texting their friends or talking to them after school.  Part of your job as master scheduler is to put time in each day for your children to complete their school work.  Try to give them uninterrupted time and space to complete their homework for the day.  When planning for weekends away, have the children speak to their teachers in advance to get their assignments and reading for that period.  Schedule time each week for them to have friend time, family time and down time. It is very easy for everyone to get caught up in the rat race of classes and sport, even young athletes need time to spend with their friends.  It may be they end up playing street hockey, a pick up game of basketball or doing cartwheels in the basement but it needs to unstructured socialization time with their friends.  Family is important, as you will be who they fall back on when things get tough in life.  Spend at least one night a week together as a family to reconnect, turn off the phones and find out how everyone's week has been.  Each person needs some me time, so let them have it.  This time will be useful as your athletes will discover how they are feeling both physically and mentally when the world slows down around them.

Coaches need to remember that sport is not their athletes full time occupation, school is.  Schedule enough time for your athletes to rest, do school work and have fun.  Athletes who are both mentally and physically fatigued will not be able to focus on the skills expected of them.  You should encourage your athletes to excel at school, as the problem solving and critical thinking skills they gain there will help improve their on field performance.

As an athlete you may feel the pressure to say yes to every request you get.  Learn to say NO and to find a way to schedule time for yourself.  Using a day timer or calendar to organize and write down when assignments, tests and games are will allow you to manage your time wisely.  You don't want to have to worry about doing the ten page essay after family supper on Sunday night.  Talk to your friends, find time to hang out with them away from school or gym.  Your friends and family will help you out when you start feeling like everything is too much, keep them close so they are their for you when it happens.

Usually as a teacher you are probably doubling as teacher during the day and coach at night.  Be understanding of your student athletes when they let you know they will be away, let them know what work they will miss so they don't fall behind. Students who exercise typically do better in class, help them excel at both school and sport.

Everyone involved in student athletes lives needs to pay attention to how much pressure they are putting them under to complete everything asked up them.  We all need to be realistic in our expectations of them and to pay attention to the signs of burn out.  If they are getting burnt out, be there for them and help them adjust as need to so they can live that balanced lifestyle where they gain the full benefits of school, sport, family and friends.

Symptoms of Burn Out
low motivation, decreased energy, concentration problems, loss of desire to play, lack of caring, sleep disturbances, physical and mental exhaustion, lowered self-esteem, negative affect, mood changes, substance abuse, change in values and beliefs, increased anxiety, highs and lows.