This week I was at a volley ball match at Virginia high school. Things were going smoothly until the JV team started their match. Right after the first play, a girl comes limping over to the side line. My preceptor had just stepped out for a minute, so I had another student go get him while I started my eval. I didn’t see her fall, but she reported she inverted her ankle and fell while going for a ball. She had never had an injury before so she was pretty worked up. I tried to calm her down and explain everything I was doing to so that she wouldn’t get scared or caught off-guard. Her ankle was really swollen around her lateral malleolus and point tender over the deltoid ligament, ATF, CF, and PTF. She had mildly limited AROM with pain. Next I did special tests. I did: (-) compression, (-) Kleiger, (-) bump, (+) anterior drawer, (+) inversion and eversion talar tilt. I didn’t believe she had a fracture, nor did my preceptor, but he gave them the option of going to get an x-ray. Our conclusion was that she had a grade I inversion ankle sprain. We iced, and elevated her foot for the rest of the game. Then after, we put a horse shoe pad and ace wrap to help push out swelling. We also put her in a walking boot. I was expecting to put her on crutches, but my preceptor said he prefers walking boots to begin mobility as soon as possible. This also makes sense because of Wolff’s law which states, “tissue will respond to physical demands placed on them, causing them to remodel or realign along lines of tensile force.” I felt very confident doing this eval and I feel like I am still working towards my goal of becoming more accurate with the assessment of injuries.
This week I had 5 attempts.
This week I did an eval on a soccer player who was complaining of hip and back pain. Something I found interesting in her history is that the head of her femur is too small for her acetabulum which she says causes various types if muscle a joint pain. She first noticed her pain when she went for a goal shot. She reported a sharp pain 7/10 when she kicked and 4/10 when running. She also reported pain with trunk rotation. I then went on to my inspection where there was no redness, no swelling, no bleeding, and no obvious deformity. Then I began my palpations. I started with her mid back. There was palpable tightness and knots on the left lateral side of her mid back and along para spinals. I also palpated her sacrum and PSIS where there was palpable tenderness and reported pain of 7/10. Her PSIS were also out of alignment. Next I did Range of Motion. I did active, passive, and resisted for hip flexion, hip extension, trunk flexion, and trunk extension. I also had the patient do active trunk rotation. From the ROMs I was able to rule in an oblique and possible para spinal strain. Her strength was a 5/5 hip flexion and 4/5 for hip extension. I then continued to special tests. I found a (+) Long sits, (+) SI compression, (+) SI distraction. Due to her strength, positive special tests, and palpation findings, I believe she had SI dysfunction. My immediate treatment for her was to correct the malalignment and to give her Ice. I feel like this eval was a good step for reaching my goal of becoming more accurate with my evaluations. I felt very confident with my findings and that I was able to flow easily from one section of an eval to another. I did use my special test book to remind me of special test. Although it is acceptable to use a resource while doing an eval, I would like to be at a point where I wouldn’t have to use one as often, especially for simple tests like compression and distraction.
This week I had two attempts, one was performed to mastery.
Now that I have nearly finished my first year in the program, I feel like I have gained so many new experiences and relationships. This week I was back with my primary preceptor and I feel like our relationship and work ethic has improved. At the beginning of the semester Melissa and I were pretty decently friendly and worked well together. Now, I consider Melissa a great friend and an amazing teacher. I wouldn’t have survived this semester without Melissa. She has been the biggest help for me when studying for tests and practicals. She gives me the most freedom in the clinic. All the evaluations I have done this semester were under Melissa’s supervision. It was my goal to improve my evaluation skills, and even thought I did not accomplish that in the way I said I would, I know I am much better at them. I think the only thing that has changed from the begging of the semester to now is that I don’t feel like a student. Previously I felt like everything I did, the preceptors were hand holding, which may have been necessary at the time. Now the preceptors let us have more freedom. They let us decide how to treat patients, and let us modify exercises, and let us create rehab programs. I think it is nice and respectful that the preceptors have given us these responsibilities.
The highlight of this week was when I was clinically experiencing softball practice on Friday. The team was doing their throwing warm up and the all the sudden a player was bent over. A ball had taken a bad bounce and hit her straight in the nose. It started bleeding immediately. We all ran out with the kit and Melissa determined it was broken. One of the AT’s drove her to the hospital where they confirmed her nose was broken. About 20 minutes later the players were doing a scrimmage type scenario and a player hit a line drive straight between the first and second basemen. The right fielder was going for it. The ball finally bounced and hit the right fielder in the jaw. Again we ran out to check her out. She was fine that time. But then this same player was batting. She fouled a ball and it hit her straight in the foot. When she came into the AT room after practice we did a bump test and used a tuning fork on her which were both positive. We gave her a walking shoe and we are sending her for an X-ray soon. Finally, another player comes into the AT room and is complaining of shin and ankle pain. Melissa did ROM and Kleiger’s and none of them had pain. Then I did a bump test, and she nearly jumped off the table because it hurt so bad. So we gave her a walking boot and we will be sending her for testing as well. Needless to say it was a very eventful day of practice.
This week I did not get any masteries or attempts, but I am filling out my clinical packet and so far, I seem to be on track.
My athletic training student mentor is Lauren. At the beginning of me being in the program she showed me a lot of techniques and helped me a lot, but now that I am able to do so much, I don’t feel like I need to rely on her to show me things. I think we work well as a mentor-mentee relationship because I can have my independence, but I know if I need help with anything she will be there for me. The one big thing I learned from Lauren is how to be a graceful clinician. She makes everything look so easy and gentle and it’s amazing to watch her in action. I think Lauren is going to be a great physical therapist because of that quality. One thing Lauren really helped me out with was studying for some of my Upper and Lower practical’s. I think she specifically helped me with the cervical spine practical. She showed me a way to remember some special test and it was very helpful. Also, a big help was when I asked her how she was doing her clinical question last semester. For some reason our whole sophomore class didn’t know there was an outline we had to follow and were about to submit our work in the wrong format. Because I asked her how she was formatting it, not only did that save me, but she saved the whole sophomore class once I told them about it.
A highlight from this week is that I did my Imaging rotation. I saw some pretty cool stuff there. I will talk more about it on my Clinical Experience page. We had and In-service with Dr.Handy and he talked about alternative treatments. One of the things that stuck with me was the yoga breathing exercise he taught us. I have been using it a lot to wake myself us when I feel tired in the middle of the day, and when I am stressed out because I have a million of papers to write that I can’t get myself to stop procrastinating on. Finally, I observed a tennis match over the weekend and I had a good time watching it this time since I wasn’t freezing to death. There was this one girl on the other team who I couldn’t stop looking at because of her shoulders. I wanted to take a picture because it was so strange, but that is just rude. Her AC joints were stick out so much, that at first when I looked at her, I thought she has some kind of large cyst on her shoulder. That was until I noticed it was Bilateral, and then I noticed I could prominently see her humeral heads. She seemed to be a healthy weight so I was very confused to see her shoulders looking like that. I assume it doesn’t have any functional effects on her considering she and her partner won their doubles match.
This week I had a hand and wrist practical. After I receive my test back I will have a definite number, but I estimate I got about 25 masteries this week.
This week’s blog prompt is,” Reflect on your progress on one of your unique clinical goals, other than completion goal.” So I will talk about my goal on evaluation proficiency. My goal is, “I will become proficient at doing evaluations by attempting or practicing at least 1 a week.” I most definitely have not done an eval a week. I guess it wouldn’t be impossible to do, but it would be difficult to find a teacher or upperclassmen to do this with once a week. That being said, I feel fairly confident in doing an eval. I have done 2 real clinical evals and several practice evals in my upper extremities class this semester. Each time I do one I feel like I do it better and more accurate. Thinking back to last semester, I remember one day in the clinic when the AT asked me to do a lower back eval and my class hadn’t even covered the knee yet; I kind of freaked out, and did not know what I was doing. I can compare that to the first eval I did this semester on the hip and even though I got stuck at some point, I was much better off. I can continue to compare this to the Elbow practical I took this Friday, and think that have been my best practical so far. I feel like I was actually palpating this time around instead of just poking a pointing to areas. Although I am not necessarily following through with my goal, I think the purpose of having this goal is still being achieved. Evaluations are a skill that builds up over time, and I can only see myself continuing to progress.
This week I did my Physical Therapy Out-patient clinic observations in addition to my normal clinical hours. I thought this was pretty fun. It was kind of like our clinic x10. I saw a variety of different patients from, post total joint surgery to stroke patients learning how to walk again. I think the highlight of being there was when the PT was showing me a model of the total knee repair, and I asked what the surgeons do with the ACL and PCL and she did not know so we had to look it up. Apparently, the product the surgeons put on the knee is secure enough to where the joint does not slide all over the place. I’m not going to lie; I was pretty proud of myself for asking a question they didn’t know. All in all, it was a good experience to go to the PT clinic. I’m not sure if it clarified if I would want to work there myself. Parts of it seem fun and interesting, but I also like the more live action that happens when working in a college setting. I think working in a PT clinic is something I would do after I lived my happy glory days in a college setting.
For more detail on the PT clinic, I will be posting another post on my Clinical Experience tab.
Like I said earlier, I took an elbow practical this week. Once I get my score back I will have an official number of masteries, but I could guess I got about 25 masteries.
This year the NATA slogan is, “Your protection is our priority.” This promotes Athletic Training because it lets our athletes know they are important. If our athletes think they are important they are more likely to appreciate us and tell other people about how important we are to them. Therefore, helping spread the word about how awesome athletic trainers are. This slogan is significant because it sets a mindset for AT’s to achieve.
This week I got 2 attempts.
This semester I feel like I am doing pretty good at keeping on top of my clinical packet. Every time I take a test I fill out the attempts and masteries I have completed. A lot of the skills I am learning are from the evaluation of the upper extremities course which we take a test about every 3 weeks. This gives me a minimum of 30 masteries when we get the tests back. We have taken 2 tests so This gives me nearly 80 masteries. I have an additional 10 from tapping skills. In total I have close to 100 masteries out of 173. I didn’t realize how well I was doing until I just counted while writing this post. I feel like I don’t have to worry as much as I did last semester because of the way I have been entering in my attempts. Last semester, I waited up to the last 4 weeks before the packet was due to fill out a majority of the packet. That was a seriously hellacious experience that I hope to never experience again. Although It would be simple to just do the skills from Upper Extremities, I do want to get masteries from other classes in order to better prepare me for the comprehensive exit exam at the end of the semester. I feel like last semester, even though I had a good range of skills I didn’t truly retain this knowledge. I think this is because I didn’t take notes in my clinical book. I have been trying to write notes on a lot more pages this go around because I think it will be easier to study at the end of the semester. Instead of having to go searching into several different text books I will just be able to look into my clinical packet and have all the information. The only downfall is that the packet is collected at the end of the semester and it goes into a deep dark abyss of a filing cabinet in which I will never see it again. So in order to avoid putting all this work into having a mini textbook and never getting to keep it, I have been typing some of the notes into a document which I will build up over the semesters. I think it will be pretty cool to look back on when I am a senior.
This week I got 10 attempts.
This semester my clinical question is, “do athletes have more endurance running when listening to music with ear buds or background audio?” I came up with this question one day when I was running on an elliptical and I had forgotten my ear buds. There was music on in the background, but it was pretty quiet. That day I was only able to run for 15 minutes opposed to my usual 30. I don’t know why that happened. My body wasn’t tired previously to working out, nor were any muscles sore. 10 minutes into running I felt like death. It didn’t make sense to me. Even though I was tired after a short run, at least I had a good idea for this project. I suspect people are able to have more endurance because they are distracted, and are not focusing on how tired they are or how their muscles feel. I want to know if people really have more endurance when they listen to music or if it is just a distraction. The people on my team so far are Melissa Davis as my AT advisor, Josh Bullock as my content expert, and Joseph Vess and my Ampersand Center Rep. I’m working to get another content expert. I have been reaching out to some psychology professor and haven’t been able to secure one yet. I think a psychology professor would be very helpful in investigating this question because they will be able to aid me in understanding mentality and information on how the brain works. Josh Bullock is Emory & Henry’s strength and conditioning coach. I think he will be helpful in understanding endurance and human capacities. As for my other team members, I think they will be able to help me find resources and review my progress and final product. One thing I typically struggle with in writing and in research is conveying 100% of what I am saying. Because I am doing all the research clearly I know what I am talking about, but a reader might not fully comprehend. This is where I think my other team members will be the most helpful, especially because they are all very good at asking questions.
This week I took my Shoulder practical. After I get my sheet back I will have 30+ attempts and masteries for this week.
A basic medical kit would include: 2-inch tape, power flex, pre-wrap, scissors, heel and lace pads, alcohol wipes, gauze, non-adherent pads, Band-Aids, gloves, cotton swabs, neosporin, a CPR mask, and hand sanitizer.
A more detail kit would additionally have elasticon, leuko tape, adherent spray, bio-freeze, ace bandages, triangle bandages, ibuprofen, benadryl, saline solution, cough drop, and glucose/ hard candy.
Side line emergency supplies are AED, splint bag, and a spine board with straps.
The items in the basic medical kit are important because it has basic first aid equipment and the essential taping supplies. This is the minimum any of us athletic training students should have on our body’s during events.
The items in a more detailed kit are important because it allows the athletic trainer to do more and different types of tape/ wrap jobs. Additionally, it has items to treat athletes on site for pain and illnesses.
The side line emergency supplies are important to have because if something catastrophic does happen athletic trainers are prepared to treat broken bones, cardiac conditions, and spinal/ head traumas.
While clinicaling with Chaypin and Hannah, I had the opportunity to experience a lot of rehabs this week. I did a ACL rehab and lumbar rehab. The ACL rehab was pretty cool because it was a pool rehab. She ran laps, did squats, used resisting flippers and did hip 4 ways. It was interesting to lead her on these exercises. I sat and watched for the most part, but I also tried to encourage her too since this was her first time doing a pool rehab. The Lumbar rehab was a bit different. The AT had warned me that this patient sometimes slacks in form and might give attitude if told to correct something. So going into this rehab I didn’t really know what to expect. I watched her pretty closely checking her form. Despite a few bad reps here and there I didn’t think she was slacking. She definitely didn’t give me an attitude either. Again, I just tried to encourage her to keep doing good reps, and she ultimately finished pretty fast. I think it was good to experience these rehabs because I got to work with two different personalities, but ultimately still achieve a good outcome.
This week I got 15 attempts.
Taping. It’s both the bane and reason for an athletic trainer’s existence. Many people believe all ATs do is tape and give out water, but what many people don’t realize is that there is a lot of effort that goes into perfecting a tape job. First of all, there has to be a reason for the tape job which requires lots of research. Second, the AT must know the anatomy and physiology of the body in order to apply it properly. If an AT pulled ankle stirrup lateral to medial, you can bet he or she should be expecting a lawsuit. Third, tape has a mind of its own and the AT must obey its demands otherwise you bet there’s going to be a wrinkle. Wrinkles lead to friction which will lead to a callus or blister which will lead to the AT having to cut it off. This all could have been avoided it the AT obeyed the tape. Finally, I can almost guarantee anyone criticizing ATs for only taping and giving out water has never tried to rip tape. Ripping tape is a struggle that will leave you very disappointed in yourself if you don’t know how to do it correctly.
On a more serious note, it can be hard to beat the stigma that all athletic trainers do is give out water and tape, especially since that’s often times all people will see. What really matters is that the athletes know we are more than just water boys and girls. If they understand we come from an intense program and do everything we do with the athlete’s best interest in mind, then I think we are doing our job correctly and Athletic trainers shouldn’t worry too much about the stigma. If athletic trainers do run into people who don’t understand what we do, we have to make sure we educate people so they know we are more than what they think, but not act offended. If they are being jerks about it then hand them a roll of tape and tell them to try it out and see how wrong they are about us.
This week I got 5 attempts.
This week’s journal topic is: Review the list of course objectives & outcomes from one of your ATR 340 course syllabus. Relate one of these course objectives to something you experienced this week. How has this experience enhanced your learning in that course? So when I looked at the syllabus I found this objective, “Use clinical reasoning skills to formulate an appropriate clinical diagnosis for common illness/disease and orthopedic injuries/conditions.” On Thursday I was clinically experiencing with Men’s basketball. After practice I was waiting for the men to come back, but the softball team came in first. A lot of girls came in so I decided to help them with getting ice. A girl asked me If I would look at her foot, and I thought I was going to have to do an evaluation, but it was just a bruise. I told Melissa, and she said it was fine, just give her ice which is what I figured I should do. I was ready to do a full ankle eval, so this experience change my view on clinical injuries. If it’s obvious, I should just use my best judgment to correct and help the situation.
This week I wrote a paper for exercise physiology on if fast twitch muscle fiber transplants are ethical. I said the procedure is not ethical due to no evidence based research on the procedure. There is also a high risk of injury and infection due to little to no physician certified to do the procedure. Finally, I compared the transplant surgery to blood doping that happened a lot in the 1960’s. I stated how the procedures both theoretically gave the person a physical advantage, while still technically using their own body tissue. Then I went on to talk about how the International Olympic Committee banned blood doping and set out rules and regulations. I said those rule should be applied to muscle fiber transplant surgery.
Also this week, I took a cervical thoracic eval practical. I feel like I did really well. This is going to give me about 30 masteries when I get the test back. I also got a mastery for lower extremity taping this week.
Katie, Colin, and I are in a rotation group together this semester. When our placements came out, I was excited to see that we are in a group together. All three of us are the uber nerds of our class. We are always finding new ways to study and keep everyone on top of the game. Other schools and classes are competitive and have people who are trying to be the best in their class. What is great about our class is that we all want to see each other succeed, so we help everyone out the best we can. Katie and I are called “mom” in our class because we look out for everyone to make sure they are keeping up with assignments, and are understanding concepts and techniques. Colin is always getting study groups together, and making everything a group effort. I believe having us three together is going to bring forth a new level of excellence. In clinical, of course we joke around with each other, but we also study together and go over difficult topics from class. During this week, Katie and I were reading over a practice BOC book. This week we were learning special test for the cervical and thoracic spine. Katie and I came up with a memorization tool to remember Allen’s test. It is up up and away with Tim Allen which stands for arm up head up and away, then Tim Allen plays buzz light year, so it was fitting. That could stand as a testament for how nerdy we are. Our class is always encouraging each other to achieve greater things, and that is what makes our rotation group and our class so special.
Below is a picture of our group. Just to prove how super awesome we are, we didn’t even plan to match that day. It just happened.
Not too much happened when I was clinically experiencing this week. It seemed our schedules were messed up a bit because one day our preceptor had 6 of us scheduled for just men’s basketball practice. With that being said, there were not too many opportunities to do much. I wrapped a support brace onto a player.
In class I made a model sarcomere that could actually move. My partner and I geeked out over us getting it to move. I put a video of that below as well. Hopefully, us geeking out will bring good grades on tomorrows test.
This week I got 17 attempts.
This week I was able to do my first non-simulated evaluation. This was on the first day I was back and I felt like I had forgotten a lot of evaluation skill. I made myself do it anyway because I knew it would be good for me. The patient was complaining of lower back pain. He said it was so bad that he had to stop doing his work out and the strength and conditioning coach made him go to the athletic training room. I took a history and did the observation which I felt confident with, but when I got to special tests, I realized I had forgotten a lot. At this point with the history I was between a muscle strain and SI dysfunction. I consulted with the ATC and we decided to start with special tests for SI dysfunction. I did the compression and distraction test which was positive, then I did gillet test and the stand and bend over test, and only one of them was positive. Then I did the long sitting test which was crazy positive. I felt like I had pretty good proof for SI dysfunction by then. I reported back to the ATC, and she told me I was going to realign his hips. Maybe I’m just a nerd, but I was really excited to learn how to do this. She said first I have to determine which side of the hip is raised and which side was lowered. We did this by checking the alignment of the iliac crest, ASIS, and PSIS. Then we did a method where the patient placed his foot on my shoulder and I pushed down on his other leg and he pushed against both resistances. I checked the progress by doing another long sitting test and the results were a lot better. I felt pretty cool for being able to do that. I then hooked him up to IFC and gave him ice to help with the pain and soreness he was feeling. I felt like the process was very slow, but I am glad that I was able to come up with a diagnosis and be able to fix it.
In addition, I have re-stated my goals for this semester. My first goal, I will complete my clinical packet by attempting at least 10 tasks a week. Second, I will become proficient at doing evaluations by attempting or practicing at least 1 a week. Third and final, I will become proficient at doing tape jobs by attempting or practicing at least 3 a week.
This week I have attempted 14 tasks.
This first semester in the program has been the most intense change I have ever gone through in my entire academic career. I feel like I have learned so much new information, yet I know I have so much more to learn. The best part of this semester was doing Emergency Room observations. I really liked the energy in there and I got to see some crazy things too. The toughest part of the semester was time management issues. I have always been proud of my time management skills, and I am very strict about staying on schedule, but for most of this semester I felt like I was just floating in the wind and I couldn't get control of nearly anything. I found myself living one second at a time which is very different for me to do. Finally, my favorite part of the semester was becoming good friends with the other kids in the program. When I felt like nobody understood what I was going through, there were 8 other peers going through the same thing as me and we could come together to make a plan for all of us to succeed. As stressful as this program has been at times, I know it will be worth it when I have my degree. I'm looking forward to the new content I will learn next semester.