How did you get into the field of Sports Medicine?
Like many in the profession of athletic training I was introduced to the world of sports medicine through my own personal injury. I was a high school athlete that tore my ACL while playing in a football game as a sophomore in high school (1993-94). I had all the classic signs and symptoms of a typical torn ACL, but unlike today I had no help as to what the “pop” was in my knee at the time of injury. At a young age I became determined to find out if there was a better way for assessment of injury on the sideline of a sporting event. I started the process of researching professions. I started out with shadowing physical therapists. It was interesting to see all the assessment skills and rehabilitation techniques but it lacked a certain luster I was after. I continued with my research and came upon the profession of athletic training. I found a local athletic trainer to go shadow and it became my passion from that day on. I was impressed by the advanced assessment skills of the athletic trainer and also the rehabilitation skills. The rehabilitation skills that begin at the time of injury and continue through to the return to play. I began reading articles in the Journal of Athletic Training and visiting undergraduate institutions that supported a bachelors of science in athletic training.
Since graduating from Canisius College in 2000 with my BS in athletic training and University of Kentucky in 2002, my passion for the profession has not stopped. I am continuously searching for new ideas and techniques that can progress me to the status of a great athletic trainer. Most of my clinical skills come from evidence based medicine to help to make a precise and effective health care provider. As we all know time is a valuable thing to an athletic trainer and the athletes we treat and rehabilitate. As with everything in the health care setting my skills are constantly in the evolution process. I like to think that I am constantly changing and adapting my assessment and rehabilitation skills to match the needs of athletes today.
How has your philosophy changed in the past three to five years?
Three areas that have changed are first my assessment of function in my initial evaluation. In the past I tended to have an athlete lay passive on the treatment table as I went through my assessment techniques. While palpation of anatomy is extremely valuable, and focusing in on the area of pathology, following my assessment of each athlete they rise off the table and I assess function. Assessing for muscular dysfunction and inactivation, through several closed kinetic chain movement patterns either upper extremity, lower extremity, or an integrated upper and lower body movement. Having the patient rise off the table and be part of the assessment is engaging for both the athlete and the athletic trainer. Upper extremity I might see scapular dysfunction and determine an appropriate rehabilitation, while lower extremity I might detect a gluteal dysfunction that might need to be addressed with an appropriate muscular activation.
Second, I have changed my approach to the rehabilitation of the core musculature. This change came two years ago when I attended a lecture series hosted by advisory board member Art Horne. The lecture series brought in Stuart McGill from the University of Waterloo. His evidence on core training was ground breaking in my mind. After seeing Dr. McGill lecture I now had great new techniques to assess muscular activation in the core. I also now understood we need to take an injury prevention approach through developing endurance in the core. I cannot emphasis enough how much more successful I have been in rehabilitating the core and then developing injury prevention techniques in the athletic population through following Dr. McGill’s evidence. Whether the patient is post surgical or fully functional the core is always assessed and appropriate activation techniques are utilized to ensure this area is never compromised. A must read for every athletic trainer is Dr. McGill’s textbook: Low Back Disorders. This text never acquires any dust on my bookshelf!
The last area that has changed in recent years through current evidence is my approach toward closed kinetic chain functional training. I now use the term integrated training when reaching the final stages of rehabilitation. I like to integrate several different systems of the human body while rehabilitating an injury. This includes using proper muscle activation, joint and muscle range of motion, joint mobility, and balance. This approach uses both upper and lower extremity in the process of rehabilitation. While using both upper and lower body activation we must include the core to progress the athlete properly. My techniques of an integrated rehabilitation can include thera-band or my favorite the Russian kettlebell. The Russian kettlebell when incorporated properly and with proper weight for rehabilitation can be an extraordinary in incorporating all areas described in an integrated rehabilitation approach. With proper activation of the core through integrated rehabilitation we give the upper and lower extremity a strong stable base to perform. This also, in theory, can lead to improved time of rehabilitation, which can lead to quicker, healthier, and more efficient return to full activity of the athlete. A valuable read for all athletic trainers to begin the process of learning the movement patterns with Russian kettlebells is: Enter the Kettlebell! by Pavel Tsatsouline.
Please discuss your philosophy on taping/bracing. Does this cause problems elsewhere? What are the advantages of taping/bracing?
Currently my philosophy on taping and bracing is that I implement it on each player. In the past year I have switched to Power Tape and it seems to be holding up to the claims it made as compared to conventional taping methods. First off, the product has evidence to prove its supportive abilities do hold up during and after athletic events. Athletes like the product and are more compliant to come in and get taped up. The product does hold up to a three hour practice with the most profuse sweating of an athlete, and in fact seems to have better breathe-ability for the athlete also.
I do not believe that taping and bracing causes problems elsewhere.
I believe the advantages of taping or bracing include supporting of the ankle in an athlete with previous history of inversion ankle sprains, compressive abilities against the foot, ankle and lower leg to possibly increase the activation of the musculature in the area to help prevent or control an ankle injury better.
How do you address knee pain the basketball athlete?
It begins with a detailed history of the injury. Things such as when and where the pain is? Are there specific activities of daily living that cause pain? Are there specific athletic activities that cause pain? Was there a specific time when you remember doing something that caused the pain to begin in the knee. I then proceed to take a comprehensive look at the knee both orthopedic evaluation and functional evaluation. My functional evaluation is sometimes where we get to the root of the knee pain. I will assess ankle mobility, knee stability, hip mobility, and finally core stability all through functional movement patterns. These areas must be working in conjunction with one another to help solve the athlete’s history of knee pain. There may be a anterior and posterior core activation issue, that leads to improper firing of the glute complex, which causes the knee to drop in a valgus pattern, and then causes a drop in the arch of the foot. You start at the top and address each issue and the athlete will get significantly better on the court and in life.