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Caught In The Middle

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This past week a good strength coach friend of mine from a major BCS school called me complaining about the Athletic Trainer that cared for the team that she coordinated the performance training for asking me if I thought teaching and training a body weight squat was contraindicated in an athlete’s progression back to sport after ankle surgery.  Apparently the athletic trainer told her that the athlete was not to do ANY lower extremity work in the weight room, even though she was weight bearing without crutches and performing about 100 heel raises daily in her rehab plan. 

I told her I didn't think so but then asked her if she had ever put on an in-service for the athletic trainers on what exercises and progressions they used in the weight room to safely return athletes back to activity.

…. Long pause….. “But that’s not my job.”

A few days later an old athletic trainer friend emailed me asking me how many female soccer athletes we had with stress fractures this season. I told him none and he went off about how the strength coach at his institution “just didn’t get it and was causing all the stress fractures.” I asked him if he evaluated the soccer team for hip and ankle dysfunction prior to the year to see if they were “qualified” to do take on the training program.

….. long pause…… “But that’s not my job.”

If it’s not your job, then whose job is it?

Unfortunately, when we make it someone else’s job and fail to make the initial investment needed to help our athletes we only end up making more work for ourselves.  You may 'lose' the argument with the athletic trainer or strength coach that day, but the only one that really ends up losing is the athlete stuck in the middle.


Art Horne is the Coordinator of Care and Strength & Conditioning Coach for the Men’s Basketball Team at Northeastern University, Boston MA.  He can be reached at

Excuse me. That's my daughter you're caring for

everything basketball

Do you treat your each patient as if they were your daughter?

Do you listen attentively while taking an injury/illness history as if you were listening to your grandmother?  Do you welcome each patient into your treatment room with a smile and thank them for stopping in? Do you call your patients after surgery just to make sure they are doing ok – you know, just the way your mother used to with you?

I remember being an athletic training student at Canisius College when I was challenged by my mentor, Pete Koehneke, to treat every patient as if they were his daughter or a family member. 

Boy, did my attention to detail quickly change.

How would the quality of your patient care change if you were treating your daughter/son or better yet your boss’ child?

Would you still be texting on your cell while performing that ultrasound treatment? How about the “advice” of rest and ice you gave the long distance runner without examining them first?

Would that change?

What if that track athlete was a family member? Your sister? Your child?

How would you treat your patient then?


Art Horne is the Coordinator of Care and Strength & Conditioning Coach for the Men’s Basketball Team at Northeastern University, Boston MA.  He can be reached at

Standing on the shoulders of giants

"If I have seen farther than others, it is because I was standing on the shoulders of giants"

- Albert Einstein

shirley sahrmann


The Boston Sports Medicine and Performance Group is proud to announce a speaking engagement with Dr. Shirley Sahrmann, June 3/4 2011 in Boston.  Complete details to follow.

Mental toughness training meet your good friend Rhabdo

Just in case you missed it, earlier this week 19 Oregon Football Players were hit with a “very weird” illness after a  workout session.  One doctor called it a compartment syndrome, I’m guessing this one smells a bit more like Exertional Rhabdomyolysis (RAB-DOE-MY-O-LIE-SIS) or Rhabdo. 

What is this strange animal you may ask? Simply stated, Rhabdo is a rapid breakdown and destruction of skeletal muscle resulting in the release of muscle fiber contents or myoglobin into the bloodstream. Symptoms include:muscle pain, weakness and swelling along with cola colored urine.

No problem right? That’s how you build big muscles, you tear um down first to then build them bigger and better! What doesn’t kill you makes you stronger!

dunk shot
Well, not exactly. You see, Rhabdo can ultimately lead to death via kidney failure.

So what causes Rhabdo?

The list includes but not limited to:

• muscle trauma or crush injury
• severe burns,
• physical torture or child abuse
• prolonged lying down on the ground (people who fall or are unconscious and are unable to get up for several hours)
• prolonged coma,
• severe muscle contractions from prolonged seizures
• cocaine use with related hyperthermia (increased body temperature),
• extreme physical activity (running a marathon),
• low circulating phosphate, potassium, or magnesium levels in the blood (electrolytes)
• prolonged drowning or hypothermia (low core body temperature)
• lack of blood perfusion to a limb

Pretty extreme stuff isn’t it?  Here is some more info:

Other contributing factors include: initial fitness level at the beginning of a training program, extreme heat and levels of dehydration.

Now I wasn’t in Oregon this week, nor do I have any additional information regarding the type of training these young men were doing and for the purpose of this rant it doesn’t matter.  My only goal is to provide a basis for conversation between your Sports Medicine and Performance Departments on how to recognize the onset of Rhabdo, and better yet avoid it all together.  And although there’s plenty of football and hockey dads out there that pay good money to coaches around the country to make their kids puke during workouts, I hope that a culture of “superdiscipline” and common sense instead becomes the standard conditioning test this fall.

Now drop and give me 500!


Art Horne is the Coordinator of Care and Strength & Conditioning Coach for the Men’s Basketball Team at Northeastern University, Boston MA.  He can be reached at

What's your definition of evidence based medicine?

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On line resources define Evidence Based Medicine as the following:

ev•i•dence-based med•i•cine


treatment based on reliable evidence: the use of clinical methods and decision-making that have been thoroughly tested by properly controlled, peer-reviewed medical research.

Now that we got that out of the way we can move forward with your definition?

The same?

You sure?

No other phrase has infiltrated both sports medicine and strength and conditioning more in the past decade, and for good reason. It guides clinical practice and allows us to allocate resources, time, and personnel towards obtaining best practice.  The problem is not with evidence based medicine but with individuals providing “their own definition” in defense of the work they are conducting.

So the next time your co-worker starts ultra-sounding an entire thigh simply ask them what their definition of evidence based medicine is.  Hint: we are not allowed to each have our own definition.

Art Horne is the Coordinator of Care and Strength & Conditioning Coach for the Men’s Basketball Team at Northeastern University, Boston MA.  He can be reached at


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