This semester I have not had the opportunity to do a very in-depth therapeutic rehabilitation or plan for a patient. This semester I was supposed to have had the opportunity to help design and carry out a rehab plan for an athlete with a shoulder injury, but said athlete decided to do his/her rehab at an offsite physical therapy clinic. The best example of carrying out something such as this probably comes from my strength and conditioning project with our client. Though the project is for Advanced Strength and Conditioning and is supposed to be focused on the aspects for the class, a huge part of our project has been on the rehabilitation side for his injury. We created a plan to address his hamstring issues that includes strengthening, stretching, mobility work, and anaerobic capacity in order to address the issue. We are constantly reevaluating and tweaking as we go in order to make the fastest progress possible. The overall goal of the project for us is to allow our client to return to his competitive running time and speed without any hamstring pain. We did baseline testing to determine what areas we wanted to work on and decided to focus on glute and core strength while working on overall flexibility (mostly in the posterior chain). As of now, we are exactly in the middle of the project and will be performing our tests again to assess our progress thus far. We have a daily journal that we and our client post to in order to keep things very up to date. As of now, it appears that we have made great progress, but still have a lot of work to do and some variables to shift. Our goal at the end of the next 3-4 weeks is to completely negate the pain and have him back to his competition speed. When the project is all said and done, I will be able to use it in similar future cases as well as how I will go about future rehabs such as this in order to produce the fastest and best outcome that is physiological process.
I would like to reflect on my goal of: expanding my knowledge of evaluation skills and executing of special tests in order to become more accurate in diagnosing injuries. I feel like I have definitely made a lot of progress in this category of my goals. Being with the football team has allowed me to have a ton of opportunities to perform clinical evaluations. In doing so, I have gotten a lot of practice with the special tests and diagnosing a variety of injuries with accuracy. I have also gotten comfortable with the hip, a section that i struggled with severely last year and was nervous about coming into this year. I believe the independence with evaluations has pushed me to be more analytical and pick situations apart more in order to come up with my ideas and how I should proceed in an evaluation. As for my other goals, I am on track with my goal of completing my clinical question research in the Month of November. My goal of completing 10 masteries per week has slacked as of late. I started off strong early in the semester with filling out everything I did and getting signatures, but I have not been doing so well with it lately. I have a lot of attempts and masteries that I can get credit for from both clinical experience and PBL's, but I need to fill them out and get them signed. I feel like I am in a more comfortable position with attempts and masteries this semester than the past two, despite slacking as of late.
My favorite part of clinical experience this year has been the independence and being able to be with one sport and really learn the team and their tendencies. Last year when we rotated, it was very hard to keep up with injuries from week to week and to be able to read the athletes. We were also watched closer by our preceptors and supervised in evaluation situations more. This year we have been able to perform evaluations more freely and been able to make more decisions and voice our opinions in the clinic. Being with one team gives us the opportunity see the athletes injuries and know what they each need from week to week. Also, constantly being around the same athletes allows us to get to know them better, which, in turn, allows us to read them better when they are injured or sick. Being with football has also given me the opportunity to see a lot of injuries I typically would not see in other sports and a higher volume of injury evaluations due to the contact nature of the sport. I feel like this will experience will translate well to my next clinical sight and feel that I will be more prepared wherever I go.
The inspiration for this clinical question came from one of the members of my investigation team. Originally I was thinking about doing a question involving turf research, but once my team member came forward with this idea I found it much more interesting. I am always excited to learn more or partake in research regarding the field of strength and conditioning and how we can benefit athletes better in the setting. Brittany, Chandler, and I agreed to work together as we know we can depend on each other and all have a deep interest in the topic. I am looking forward to how the research will show us whether supervised workouts or unsupervised workouts produce better results. I am interested to see if the unsupervised produce results that may seem better, but produce more injuries as well due to the fact that there is not a coach present. A side piece that could be explored, but is not a specific part of our research would be looking at one on one sessions with coaches vs. group workouts.
I have shared quite a few pieces of advice with the sophomores this year, so it would be very difficult to say everything on here. One of the first and best pieces I have offered is to not procrastinate on the clinical packets and clinical assignmnets. I presonnaly did this my first semester in the program and it made the last week of the semester very miserable and added a lot of tress to finals and conpetncy exams.
So far this semester my most challenging course has been physiology. It is my first senior level course in college and also happens to be one of the toughest courses in any science department. I believe it has been very challenging for me due the fact that it has been almost four years since I took biology 117/118 and two years since I took chemistry 111/112. The parts of the class that involve things learned in exercise physiology and modalities are coming easy to me, but a lot of the basic concepts from biology and the chemistry aspects as a whole in the course are difficult. The course has a lot of biochemistry, microbiology, and cell biology material, all classes I have not had. The class is very intriguing though as I love studying the physiology of humans and learning about the biological pathways of the body. I am definitely having to study more for the course than I have for any other science course due to the detail and volume of what we learn. We also have an offsite project we must obtain hours for which can be very difficult to do around our class schedules and clinical schedules, so balancing that has also been a challenge. But as I said, I am studying more frequently and more in depth than usual for the course and trying to stay ahead as much a possible. So far the course is going well for me and is very interesting. It also plays into a lot of my course material for other athletic training classes as well!
Everything that we do in clinical class parallels our clinical experience in one way or another. Many of the things we have covered in our clinical course this semester has been review from what we learned last year and it is really helpful as we do not always get to practice what we have learned in our clinical experience. The nice thing about the review is knowing that if a situation does happen, we know how to go about taking care of it. Many of the pbls have helped me in my clinical experience with football, especially in the in-game scenarios when we run to the field. Picking apart the scene and determining what needs to be done is a great skill that has become easier to use from our clinical course review. One example I can think of was with the dummy last week d our "worst scenario possible" practice. Taking on situations like that in class make us better prepared to handle situations in in clinical experience, but hopefully none quite as extreme as that one anytime soon. Our discussion of clinical experiences for the week is also useful as we can relate to each other on the same level and discuss situations that can potentially benefit us all as a class. This week, I also dropped off on my attempts and masteries gaining only two attempts. I believe it is time to start running some scenario examples as the quantities of injuries coming in with football seems to be going down, or at least the ones that are happening are repeats of ones already seen.
A few weeks ago I had a very challenging evaluation with a football player. The athlete came in complaining of shoulder and arm pain after practice. The pain was limiting the athletes ability to actively move his arm. I cannot remember every detail of the evaluation, but I do recall my thought process as I moved throught. The athlete was saying he was in a good amont of pain and that he felt a pop as he fell on the arm. One problem I ran into was that the story of his mechanism of injury changed from the beginning of the evaluation to the end which gave me a false interpretation of what had happened. From previous experiences with the athlete, we knew he has some issues dealing with pain and is prone to coming in for injuries. As I tried to move the patients arm for mmt, rom, and special tests he said it was too painful to mive his arm more than 30 degrees in any direction. I wanted to rule out an AC joint injury, rotator cuff, and labrum, but was unable to even get him into the positions to rule these injuries out with special tests. Outside of palpation I could not figure out what to do and became very frustrated. His pain was all centered on the anterior aspect of the shoulder and "radiated" down the arm, It just so happened to be the night that Dr. Hannula was doing consulations so I took him to the clinic to see him. After his evaluation, he determined it to be a proximal clavicle fracture, which I had not even suspected. This made me even more frustrated. However, after talking to Melissa and discussing my frustration, I realized that a lot of people may have not checked for the injury based off of the symptoms he presented with. My take away from this was to realize that, even though I have a good knowledge base already, I am still a student and I still am exoected to make errors. Yes I still expect the best from myself and expect to be on target with my evaluations, but I still must allow for room for error and learning from mistakes in order to e the best clinician I can be.
Through my clinical experience over the past year and couple of months I have had a chance to see the characteristics of my preceptors in clinical practice and determine which of these I think are appropriate to adopt. One of the most important characteristics I have seen and adopted is having confidence when doing anything with the athletes. I have seen first hand that if a student acts timid or nervous around the athletes that it tends to make them very uncomfortable. This makes any situation harder to deal with as they are less likely to trust you or cooperate. I have also learned that is important to be straightforward with the athletes and not beat around the bush when it comes to injuries. One of the most important things I think I have picked up is explaining what you are doing as you go through an evaluation. Many of the athletes are interested in what you are doing and even if they are not it can beneficial to explain what you are doing and why. It is also important to not let the athletes walk over you and disrespect you. In some cases the athletes act as if we are their servants. It is crucial to let them know quickly that you are there to help, but not to wait on them hand and foot. Perhaps the most valuable thing I have picked up that will help me throughout my education and career is to always try to have a positive attitude or mood. Even when you are having a bad day, having a positive attitude while you are in clinical experience makes everyone's time more bearable. Everyone is tired and stretched thin, so it does nothing to come in and act like a brat.
My second goal for the year is to improve my knowledge of evaluation skills and execution of special tests in order to become more accurate in diagnosing injuries. I definitely feel like this is progressing as the semester goes. With each evaluation I am becoming more comfortable with moving through them smoothly. I have also been spending some time looking over my special tests and making some new notes as I perform them and feel some of the different results. With each evaluation, I notice it becoming easier to focus more on moving through the process without having to stop and think and gather my thoughts. It seems as though finding one thing quickly leads me to another thing to try. These sequences are also leading me to more accurate assessments.
So far I feel like I am meeting my packet goals better than I have before. This past week I definitely slowed down on my attempts as I did not get to see very many injuries, whereas the previous weeks I had been seeing a ton. I feel like now I can do better and it is time to start practicing my skills through some scenario based situations in order to make up for not seeing actual injuries. I am still wanting to obtain ten masteries per week and will more than likely have to use the scenarios to hit that mark.
There were a lot of cool things that I had the chance to do this week, but I chose the course objective of demonstrating reliability, dependability, and initiative for something interesting, or at least that I think is interesting, that happened at Ferrum. This falls under the initiative for the most part. When we arrived at Ferrum on Saturday we found out that we only had one taping table/station for all of our athletes. There were two Athletic Trainers and three students, including myself, that were going to have to tape in the space. While we were figuring out our plan for getting everyone through, I noticed a conditioning room next to our space that was full of equipment. I got the idea of building a taping station out of what I saw. I ended stacking some box jump platforms and some flat platforms that they had and making a two sided taping station in a narrow hallway. I know it may seem kind of strange that I wrote about this over an evaluation or injury, but it's the cool ingenuitive things such as this that makes Athletic Training so much fun. Many times on our road games we are not always in the best situation to get athletes the pre-treatment that they need, but we always figure out a way to do it. The athletes got a big kick out of it and I did as well. On top of that I would like to add a part about responsibility and dependability. Between the Athletic trainers and AT students who traveled, I was the only male. This meant I was in the locker room post-game doing a lot of things by myself. I was originally in there to give out water and cut tape, but in the midst of that an athlete got a sever cramp in his leg and I got to help him out by myself. These situations influence me by building my confidence and ingenuity in ways that other normal scenarios do not. It teached me to be creative and to make the best of the situation as well as to be independent in many situations. Again, I know these may not be the most exciting things to some, but I thought they made for a neat little story.
I can honestly say that this years preseason experience does not even begin to compare to last years. Last year I was timid and nervous early on about my knowledge and skill level which led to me sitting back and not actively trying things during EMS training, practices, and other situations. I was proactive I feel, but not like I could have been or should have been. This preseason I feel right at home with my skills and experience and feel as though I am right on track with where I want to be. I feel that having had upper and lower evaluation classes has made the biggest change to who I am as an ATS. It has given me the confidence I need to perform evaluations as well as find correct diagnoses and be more confident in my assessments than I would have been last year doing an ankle evaluation. Being with football has also helped me a lot as I have seen many injuries and gotten to practice my evaluation skills. I have also seen many of the injuries many times over giving more exposure and a better understanding of each. One thing that has hindered me is medical abbreviations and remembering special test names. I need to look back on medical terminology book/packet as knowing the abbreviations would greatly increase my productivity on my evaluations as well as save me some time. During the evals I have done, I have been doing the special tests and know what to look for in order to rule in/out and injury, but I have not been able to think of the names at times. I have had to ask Melissa or Tayler. This was particularly an issue with the patella as I was carrying out the tests and correctly using them, but simply could not think of the name. This can be remedied by looking back in my eval book as well as studying the skills from last semester during clinical. I am much more confident in my evaluation and talking to patients and also much more confident in relaying information to my preceptor as well as feeling more confident in my judgment on a diagnoses. one example would be directly saying what I believe an injury to be instead of beating around the bush and giving two or three things it could "possibly" be. I am right o track with my goals at this point as I want to achieve 10 masteries per week. Through the two weeks I have had 30 attempts, many of which have come from injury evaluations. Some examples have been plica syndrome, hamstring strains, sciatica, jones fracture, lumbar muscle strain, concussions, etc with many of these having multiple recorded attempts. I have even seen what was a suspected AC joint injury, which turned out to be an avulsion fracture of the clavicle, which oddly enough turned out to be a shadow on the X ray and was finally ruled to be myositis ossificans of the clavicle. All in all preseason was very good to me I feel and I look forward to a good semester!
Each week, the students in our Athletic Training Program are required to post a journal entry. These can be typed our video recordings. Each week we focus on a different topic relating to clinicals, research, EBP, classes, or life in general. We are also graded through our websites, so if you notice any weird notes or things that do not make sense it is probably part of an assignment. Take a minute to check them out!