My most interesting and mildly challenging evaluation I have ever done was on a middle school basketball player’s wrist. He had tripped and fallen on an out-stretched hand. He came in really calm and his complaint was that his wrist would click every time he bent it and that it hurt to move. Immediately I knew I had to rule out a fracture. I did palpations and felt crepitus around his lunate. I then did Range of motion and a mobility for all of his carpals. His range of motion was normal, but as he stated, there was a pop every time he flexed and extended his wrist. At this point I was a bit confused. I thought there may have been a dislocation because of how mobile his carpals were, but then I checked them bilaterally; while there was a bit more mobility on the injured side, it seemed relatively normal for him. Then I went into some special tests. I did a couple of percussion tests, but it was hard to isolate the carpals. I also did a squeeze test on his forearm which was positive. I was stuck between a radial ulnar sprain, a lunate fracture, and a lunate dislocation. At this point is when my preceptor helped me think through the process. He reminded me of his age and how we need to be worried about growth plate injuries and greenstick fractures. He also stated how when we are young our joints are very loose which explains the amount of mobility I saw in his wrist. What I learned from this evaluation is that sometimes there are parts of the history you don’t ask, but you need to take into account. In this instance, obviously I see a young boy and an injury around the joint, but I didn’t think of it as a factor that would play into the evaluation. Maybe because I’m more used to an older population, this just slipped my mind. Now I know for the future I will need to be more cognizant of age and other factors that are implied but not asked.
This week I had 12 attempts and 0 masteries in my clinical packet.
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As a student, I have always felt like I have good time management skills and a good gauge of what is truly important. I feel like in most instances I balance my responsibilities well. A challenge I typically face is staying 100% motivated to do everything to the fullest and not getting behind. When I feel like I am behind I feel it is important to do a personal check on myself. Am I dedicating enough time to accomplish this task? Am I prioritizing something less important? When I feel like I am behind the first thing I do is talk to my class mates and see where they are standing. If I find someone just as behind as I am, I will usually try to work with them and we will pound some work out together until we are caught up. If this option isn’t available, I always find it helpful to talk to a professor to get a real sense of where I am and what I can improve on. Another good option is to talk to the preceptors and see if they have any advice or tips. We are lucky to have an Emory & Henry Graduate as one of our preceptors. She is well aware of how to make it in the program and is a good source to talk to when I feel like I am struggling or behind. My final resource if I feel seriously behind or lacking motivation is to give a call home to Dad. This is mostly what I do and need when I feel like I’m losing motivation. My dad gives me new perspective and is a sounding board for what I experience. He helps me find solutions I may not have thought of yet. If I’m lucky when I call he will tell me a silly story about something my cat did which always makes me happy and motivated to start working hard again.
This week I had 6 attempts in my clinical packet What I learned from last semester is that I need to be more proactive about my education especially when it came to my clinical packet. I felt like I had everything under control and that I was on pace but until the last few weeks when I realized I was very far behind. The way I will combat this is by actually committing to my goal of attempting 8 tasks and completing 6 to mastery a week. The most important part of this is to be simulating attempts. A large portion of this semester is general medical conditions. While I may have experiences with some conditions in the clinic, there are very many tasks that are not so likely to come into the clinic for an examination. Another way I plan to be proactive is by reading new research more often. I feel like this will expose me to a lot of new and interesting things in the athletic training profession. This brings me to my next goal, “I will develop my knowledge of therapeutic exercises by conducting research every 2 weeks on the best 2 exercises for each injury per body region throughout the semester.” I decided to make this a goal because I feel very comfortable in examining injuries, but now I believe it will be important for me to know how to effectively treat them. I feel like my classes this semester are fairly subdue in the level of difficulty, therefore, I will have time to be able to do research and progress my knowledge as a student. My final goal is to be able to present my research. This goal is not yet formed into a SMART goal, but I plan on accomplishing this goal by working with our ampersand center and attending sessions in order to prepare to present my clinical question. I really want to present my research because I enjoy talking about interesting things in the medical field. It will also be a good opportunity to push myself and meet some new professionals who may be pertinent to being successful after I graduate
AT this point of the semester I am behind in my clinical packet. I believe half of this is due to me not realizing that the semester was ending so quickly; and the other half was me not keeping up with my goal of attempt 10 tasks and perform 5 to master each week. I have 50 attempts with 30 masteries. I still need 80 more mastery within 2 weeks. This is mildly frustrating because this semester I felt like I stayed on top of actually writing in the attempts and masteries as they came up. I suppose I needed to do more simulations with my preceptors throughout the semester because I feel that I didn’t have very many opportunities to do evaluations. This being said, my goal for next semester is to do more simulations just in case I don’t have as much actual experience as I need. Especially if I am with a sport that is prone to having injuries in only one area of the body, I will need to make up by doing simulations on other parts of the body. If I really push for more simulations throughout the semester rather than being like everyone else at the end of the semester trying to force their clinical packets to be done, this will be a lot less stressful and annoying to me and my preceptor.
At this point, my future professional goals are to become a certified athletic trainer and go to grad school to get my master’s degree in either kinesiology or exercise science. I’m hoping to find a GA program that will allow me to work as an athletic trainer at the same time as getting my master’s degree. I decided I want to get my Master’s degree immediately after undergrad because the whole field of athletic training is moving to a master’s degree and I want my degree to stay competitive. So far the schools I am interested in are Penn State University, James Madison University, and University of Texas. I decided to look into these schools because their programs seem advanced and enjoyable.
My dream work setting is in the performing arts. One in particular is Drum Corp International. My background of being in band in high school and my love of athletic training has been my main motivators to want to work with this kind of population. I feel like it would be so fun to travel with some of the most intense marching band in the United States. This summer I will be eligible to apply for an internship to work and study with athletic trainers in DCI. If I get this internship I will be ecstatic. This would be a stepping stone from leaving college and entering the work force. I would be able to make connections that hopefully would lead me to a job in this field after I graduate. Another field of athletic training I would like to work in is the military, specifically for government contractors in the D.C., Maryland, and Virginia area. I would like this a lot because I would be able to live in the area the I have grown up in most of my life. This week I had 15 attempts with 7 masteries. As an ATS I feel most confident when I am organized, and on top of all my work. This allows me to have more time to think about the application of what I learn in class and contribute it to what I am doing in the clinic. I also feel confident being able to participate fully in class. That being said, when I am disorganized I feel like I am behind and scatter brained. I feel like it is harder to participate in class which is disappointing and frustrating because I feel like I should know the information, or at least be able to contribute of conversation. When I’m disorganized and stressed it completely throws off all of my work ethic and it can be challenging to get back on track. The best way I have found to combat this is to buckle down on the weekends and try to catch up the best I can. This semester has been difficult in this sense because I feel like I’m in a constant cycle of being on top of my work, then being behind, then having to catch up, but then because I pushed so hard to get back on top I relax and fall behind again. I have to find a way to break this cycle, but I’m not sure how yet. This used to not be a problem for me so I’m not sure what has changed and how to fix it. However, once I do, I know I will be as confident as I can be and I feel like my class participation will be much better, which in the end will make me happier.
This week I had 5 attempts. My favorite part of clinical this semester is being off site. Being at high school is a lot different than being at the college level. In years past we always have joked around what it is like to have to be creative on make things on the spot, but in the high school this is a reality because they don’t have as much of a budget as the college. At the high school level I notice a dramatic decrease on pre-performance rehab and interventions. I know the reason why this is different is because they have to either come straight from the end of the day to the clinic or they will not have pre-treatment because time is so limited. That being said, I don’t believe many of the athletes are aware they can have pre-treatments. I know when I was playing softball is high school I had no clue who or what an athletic trainer was, let alone what they were able to do.
Another part of this semester that I have enjoyed is being what I like to call a “Freelance ATS”. On weeks where I am not able to travel down to the high school I can do hours with my secondary preceptor on campus. I am primarily with women’s soccer when I can’t go to Bristol, but there have been many times where I have done clinical hours with other preceptors. I really enjoy this because I like the preceptors we have here and I also get to help them out when they don’t have students. There is always one preceptor that doesn’t have sophomores on their rotation and typically that is who I help if I’m not with soccer. I believe this allows me to have more experiences, but also keeps me aware of what is going on with campus athletics so that when I come back to on-site I will be more aware of who has what injuries and such. I also really look forward to next semester. I feel like I have a lot of experience with lower extremities from this semester and last year. I really hope to be able to clinically experience baseball because I have helped with one of the player’s post-surgical rehab and I would like to continue seeing his progress and ultimately get to see his return to play. This week I had 5 attempts in my clinical packet. The advice I would give to the freshman and sophomore is to stay on track with their clinical packet and to figure out the way that they need to study. Being new to the program can be difficult if they are not good at time management and organization. Having both of these skills is important in finishing the clinical packet. If they are able to stick to their goals, then they will easily be able to finish their clinical packet on time. Another important thing the freshman and sophomore should know is how they need to study. I found the best way to study for me is with one other person because that person will keep me focused on the task at hand. They should also utilize their VARK test scores to figure out what methods of studying they should do. The final piece of advice I would give to the underclassmen is to ask the upperclassmen about anything. The upperclassmen are very willing to help so long as they ask.
This week I evaluated football player who was complaining of knee pain. He said he fell on his knee and it hurt on the spot of impact, but it also hurt on the back of his knee in the popliteal space. I started with history. The player said he fell on his knee, but it didn’t hurt on the back of his knee until later. The pain gradually got worse as he continued to play. He also mentioned it hurt to squat only in the first few degrees, and when he plants and cuts. Next I did an observation. There was a little bit of swelling over his patella, but I deduced it was from when he fell, and it was nothing more than a bone bruise. There was no deformity, swelling, or discoloration in the popliteal area. Then I palpated over the patella, the patella tendon, the quads, the hamstrings, the IT band, and the boney landmarks. There was point tenderness over the patella, lateral hamstring area, and around the insertion of the IT band. The IT bands also felt every tight. ROM was within normal limits, however there was pain with active knee flexion and extension. Strength for knee flexion and knee extension was 4/5. Then I started doing special tests. At this point I was between a hamstring strain and IT band friction syndrome. I had (+) Rene’s test, (-) Obers test, (-) Nobel’s compression test. I had the player do some functional tests, like the squatting and planting so he could show me when and where it hurt. At this point, I still felt stuck between IT band friction syndrome and Hamstring. I asked the preceptor to double check me and see what she thought. When I palpated I didn’t feel any roping or deformity between his two hamstring tendons. This was because I palpated on and then palpated the other, so I wasn’t able to differentiate the difference. When the preceptor palpated the hamstrings, she did both at the same time, and then had me feel it. It was obvious then that there was some serious roping and tearing of the tendon. AT this point, it was obvious he had a hamstring strain. What I learned from this evaluation was that I need to take my time when palpating and do a better bilateral comparison. I did palpate bilaterally; the only difference was I should have palpated them at the same time. This would have made my eval go a lot smoother.
This week I got 2 attempts and 1 to mastery Think about the preceptors you have had, what characteristics did they exhibit that you have adopted or hope to utilize in your career. Explain why.
Melissa has been my life saver in many classes. I have learned many things from her, but the most important thing I have learned is administrative duties. Half the time I ever see her in the clinic she is on the computer doing some kind of paper work. This gives me insight to how being a certified ATC will be very different from being an ATS. I hope to be able to manage paperwork in a organized timely fashion to the best of my abilities when I am an ATC. Chaypin exhibits a desire to learn more as she works. I feel like this is important in athletic training because the field is always changing and new studies are coming out daily. This is something I hope to utilize in my career after I am graduated. She also enjoys and take constructive criticism very well which, while I feel I did this well prior to being an ATS, I have a greater appreciation of because of Chaypin. Hannah has a sense of finesse that blows my mind for her being a recent graduate. She never seems to do too little or too much of anything, and everything has a nice flow. Finesse is usually something that is built up over time, but Hannah’s just comes off so natural. I have learned a lot from Hannah. Particularly when she does certain treatments slightly different from how I learned. I am always interested in what she learned different at her college. I hope to be able to incorporate her differences into my style. Cole is a new preceptor and I haven’t experienced him too much in the clinic, but it is very clear he has a very different way of doing things than any other preceptor I have been with. Something I find interesting is the way he uses modalities. He doesn’t uses stim nearly as much as the other preceptors and when he uses ultrasound he calculates a specific heat for an injury. This is different from how I was taught and I want to do more research and find more information that supports his way of using modalities. Randy is my current preceptor, and once again very different from others that I have experienced. One thing I really like about what he does is that he explains the injury and what is going on to the athlete. This is something I have started doing myself. I believe it helps the athlete have a better understanding and it may lead to better treatment out comes, and prevention of similar injuries. 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. |
This is where I do my weekly clinical blog assignment. There is either a prompt I am responding to, or I just talk about something exciting I saw during the week.
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April 2019
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