Yo Bartender! Jobu Needs a Refill!

I love movies.  I love baseball.  An obvious conclusion? I've seen all of the movies in the Major League series multiple times.  Not always the most baseball accurate films (Eddie Harris' pitching mechanics MIGHT get the ball to the plate) they are quotable, hilarious and have withstood the test of time so far.  My roommate in college would constantly hit me with one of Harry Doyle (Bob Uecker) or Rube Baker's quotes.  The other night, I put the original on before bed.  An hour and 45 minutes later, there was a smile on my face and a ton of excitement for baseball season to be here.  Like I said, I've seen these movies countless times so I knew everything that was in there but this time I did happen to notice there are quite a few instances of an Athletic Trainer making an appearance or times when an Athletic Trainer is needed.  Let's take a look at a few...

As we all know, Charlie Sheen is a stand up guy and a moral citizen.  He'd never do anything to end up in jail...  ummm.... However, his character Rick "Wild Thing" Vaughn was signed from the California Penal League and is having a little problem controlling his high 90s fastball.  Just as he is about to be sent down, manager Lou Brown stumbles upon the source of this problem.  Rick has horrible vision.

Willie Mays Hayes might have a point, but they do solve Rick's control issue.  While a yellow legal pad with 4 letters scribbled on it got the job done here, it's not the most scientific approach to determining an athlete's visual acuity.  What they need here is a Snellen eye chart.  Most Athletic Training rooms have one of these and the lucky ATC's can book a same day appointment with an optometrist or ophthalmologist.  Sometimes we might not have the best facilities or may be traveling and might need to come up with our own solution similar to Lou.  There is a chart for making your own Snellen eye chart based on the height of the letters and the correlating distance. You can find that grid many places, including here.

Continuing with the Wild Thing example, think about this.  We should always be searching for and treating the cause of problems.  Yes it is important to break the pain cycle and treat the symptoms but that won't solve the problem.  In the real world, before the vision problem was found, this athlete's pitch counts would be exceptionally high due to throwing so many balls.  He probably wouldn't stay in the game long, but these Indians were a sad bunch so maybe that's not true.  The Athletic Trainer would likely have been seeing Rick about some overuse conditions soon.  You might not think that poor eyesight could cause shoulder or elbow problems but it is our job to find the cause, no matter how unrelated or bizarre it may seem.

I had one pitcher who came to me early in his time with this team complaining of diffuse shoulder pain.  This particular exam revealed a lot.  Poor posture and upper cross syndrome were present.  Positive Hawkins-Kennedy and Impingement sign tests were elicited.  Manual Muscle Tests revealed weakness in most planes.  Already this seemed a daunting rehab but I jumped right in and began postural correction exercises, scapular stabilizing and rotator cuff strengthening programs.  In my excitement to get started tackling all of these problems, I forgot to truly figure out the cause.  Being a former pitcher myself, I've had lots of training regarding pitching mechanics and its intricacies.  After watching this young man throw, it appeared to me that he was rushing and was inconsistent at his balance point.  I had him do some basic single leg stands which showed incredibly poor balance.  After working with the pitching coach to correct and fine tune his throwing mechanics and correcting his other issues with me, he went on to have some success and remained healthy.

Let's take a look at one more clip for today.  As I mentioned before, there are a lot of these little instances in these film (including one where they mount an outboard boat motor in a whirlpool. not safe but funny)  This article would be too lengthy to go over them all so I'll hit the one that covers the hot topic of 2010 and continuing into 2011, concussions.

While no research will show voodoo magic as a cause of concussion, 'tis very bad to steel Jobu's rum. 'Tis very bad.

This weekend featured a couple of all star games.  We had the laughable NFL Pro Bowl and the NHL All-Star Game.  Defense was not present much in either game.  Unfortunately, the NHL's biggest star, Sidney Crosby, wasn't present at all.  Crosby is still recovering from a concussion.  This NFL season brought a lot of attention to the issue and now Crosby's All-Star absence is making the NHL pay more attention as well.  Athletic Trainers and Team Physicians have been paying attention to these serious injuries for a lot longer.

There is a lot of attention and new research into concussion right now.  I'd say that most ATCs are keeping a close eye on this and some are doing the research themselves.  There were two such articles in the latest edition of the Journal of Athletic Training.  As important the research is, I think that most of our focus should be on properly dealing with the concussions that we could see at any moment while on the job.  While this article isn't here to rehash evaluation protocols, knowing your concussion evaluation protocol is a must.  Hopefully it entails more than a bag of ice on the head like our friend Eddie Harris.

At the PBATS conference in January, I got to see a good presentation on emergency care.  Richie Bancells, the Orioles Head Athletic Trainer touched on some generalities and some of the new equipment they had.  His focus was on being prepared though.  He reiterated several times the importance of practicing your emergency action plans and taking an honest look at what your strengths and weaknesses are.  I'd like to convey that here as well.  Take out your concussion evaluation form tonight and look it over.  Go through it in your head a few times and even ask the questions out loud.  Make some changes if necessary.  I will be doing the same.

Smooth Professional

I'm working on a few things to put together for a pretty big post sometime next week.  I don't want to give too much away but if you're a fan of the Major League movies you'll probably appreciate it more.

In the mean time I have a few links for you to check out.  I bet most of the Athletic Trainers have seen this video but I want to use it to prove a point.  A couple of AT students at JMU put this together for a class project.  I've seen it probably about 10 times and love it more each time.  It's funny, well put together and most importantly brings positive attention to AT.

http://www.youtube.com/watch?v=qw3RHKTkBMk

Although this is undeniably cool and the most viewed video related to AT by far, it is still only at 73,000 views.  Respectable? Yes.  About 72,750 more than my awesome blog!  However, that 15 year old who lip-syncs has 73,000,000 views.  I refuse to share a link to him.  Admittedly, I did chuckle the first time I saw it but couldn't even finish one of his "songs".  Got to hand it to the kid though, he's way more well known than any of us.  It is a sad, sad reality but hopefully more people like those JMU students will join in the effort of promoting AT's and increasing awareness of what it is we do.

Rhabdomyolysis at Iowa

There's a lot of things I want to write about but when things are in the news, it seems more appropriate and relevant to go off of that.  The breaking news last night came from the University of Iowa, where 12 football players developed cases of "exertional rhabdomyolysis".  Apparently, these athletes were participating in the football team's winter workouts.  A bunch of athletes coming down with muscle soreness after a winter workout isn't that rare. Many of them probably took it relatively easy or completely rested over their holiday break and jumped into a high level strength training session.  However, this case caught my eye as a bit strange.  First, rhabdomyolysis is not regular muscle soreness or DOMS.  Rhabdomyolysis is rare and is a very serious condition that can cause kidney damage and other serious complications. It was actually discovered during World War II in bombing victims that had muscles crushed. Over 70 years, there has been extensive research so I won't go into all of the details but you can read more about it here.  Secondly, this past fall, 19 members of a high school football team in Oregon were stricken with the same disease.  Within 6 months, 2 football teams have had several young, healthy athletes suddenly develop a very serious muscle condition.  After the first scenario there was some debate about if creatine supplementation was a factor.  It appears that the jury is still out on that one. I'm guessing there will be more investigating about what exactly is causing this now that a second case has occurred.  I'll keep an eye on it but if you have more information or research please share it with us all in the comments.

While I am definitely interested in the findings there's a few other things going on here.  Nowhere in these articles is "Athletic Training" or "Athletic Trainer" mentioned.  As someone who has worked Div. 1 football, I can assure you that this directly affects the Athletic Trainer.  When these football players were having trouble walking, who do you think was getting called at midnight or later? The Athletic Trainer. Who do you think is visiting these guys in the hospital and contacting their families? The Athletic Trainer.  A lot of these issues they are likely dealing with in Iowa today falls under the area of the hypothetical course I want to teach some day, The Things They Don't Teach You in College. 

One thing that this originally made me think of was my old medical terminology class.  It was something I reluctantly decided to take as an elective but it has proved useful time and time again. In this case, Lysis = breakdown and Rhabdomyo = striated muscle.  If you're a student reading this, I can't encourage you to take a medical terminology course enough.  It's helped me figure a lot of things out as a trainer and answer a lot of questions on Jeopardy!

1/27/11
Here is the latest: http://sports.espn.go.com/ncf/news/story?id=6065314

Sounds like they are going to try and blame the Strength & Conditioning staff for the workout. The workout has been reported by the players themselves to be 100 squats at 50% of their max and then pushing sleds. Is this a difficult workout? Yes, but don't kid yourself to think that this is out of the ordinary in high level collegiate athletics.  If it was just one case I might believe this to be a "freak" occurrence. 13 cases makes it seem that there is still something else playing a big role in this.

Anything but Jay Cutler

Every other person with an opinion and a computer or microphone is sharing their opinion on this.  I'm not delusional enough to think that I can add anything that hasn't already been said.  Even Charles Barkley is weighing in. Let me guess Charles... "It's turrible to criticize him"

It's starting to remind me of those times when the evening news comes on and the first 15 minutes is nothing but murders, thefts, stocks falling, and even a bad weather forecast.  I doubt that I'm the only one that thinks "Isn't there any good news in the world?" Well, believe it or not, there are good news stories and things going on involving sports medicine that don't have to do with Jay Cutler's knee.  I've even found a couple of them and will share them with you all.

I know that I wrote extensively about the Steelers yesterday but this is a well-written and relevant article.  As someone who was part of a graduating Athletic Training class that was 75% female, this topic often came up.
http://espn.go.com/espnw/blog/_/post/6050787/pittsburgh-steelers-female-orthopedist-part-team
I think that the Steelers deserve all of the praise they receive regarding their efforts in diversity.  Most people know that the Rooney Rule (where a minority candidate MUST be interviewed for all open coaching positions) came from Pittsburgh's owner.  They also were the first and are the only NFL team to employ a female athletic trainer, Ariko Iso.



Now, some shameless alma mater promotion...
http://www2.wilmington.edu/news/3-Peat-Athletic-Training-Quiz-Bowl-Team-Wins-Third-Ohio-Title.cfm

Want to Play a Role in Winning a Super Bowl? Become an Athletic Trainer.

Like over 100 million other people, I will be watching the Super Bowl in 2 weeks.  We all have our different things that we like about Super Bowl Sunday.  If you are lucky enough to be a Steelers or Packers fan, then obviously you will be intent on watching the game.  If you are a fan of one of the other 30 teams that didn't make it, you'll likely have other interests.  Plenty of folks just enjoy the spread of pizza, wings, etc.  Others might have some money on the game. One friend has a bunch of side bets that include an over/under for the length of the national anthem, who will have the most commercials, the color of the Gatorade poured on the winning coach and several other humorous wagers.  As for me, it's some combination of those things, but I will be very interested in watching one particular Steeler.

In the Steelers first drive yesterday, Maurkice Pouncey, was injured as another player rolled up on his leg.  My Dad (a big Steelers fan) asked me what I thought.  After just a few replays, it was pretty evident that it was at least a syndesmosis (high ankle) sprain. Although seeing him loaded on to the cart a few moments later made it evident, I had to break the news to Dad that he was likely done for at least the rest of this game.  As the game progressed, it was clear that the Steelers were missing their Pro Bowl center. Reports today confirm the injury as a high ankle sprain.

Their chances against the Packers will certainly be higher if Maurkice will be healthy enough to play.   Depending on the severity, these injuries tend to take 3-4 weeks or more to heal. The Steelers' physicians and trainers will have to cut that time in half.  I have no doubt that treatment began immediately and will continue as much as possible over the next two weeks.  These are the exciting but nervous times of being an Athletic Trainer.  They are also the most rewarding. This situation is a great microcosm of one of my favorite parts of this job (rehab) and one of the most stressful (deciding if an athlete is cleared to play).

Granted a Conference USA baseball game is on a slightly smaller stage than the Super Bowl, I've been there before.  With just about a week remaining in the season, our Senior shortstop suffered a high ankle sprain after stepping awkwardly while rounding 3rd base.  My initial impression and the early diagnosis made the idea of him playing in the final series doubtful.   With family and friends coming to town for Senior day, it was greatly important to this young man to play in his last game.  After consulting with the physician and coach, we set a goal of having him available as a pinch hitter and potentially a DH.  I remained skeptical but did everything in my power to get him on the field.  Lesson number one was never underestimate a determined, stubborn and tough athlete.  We both put in a lot of hours and I know it wasn't easy for him, but it was clear that the idea of sitting on the bench for his last game hurt worse than his ankle.  With an ankle tape job and bracing that took easily 10 minutes to apply, he was able to do enough to make the roster for the weekend. The first two games didn't go well. Pinch hit strikeouts and slow limps back to the dugout were all he could manage. Then on Senior Day he was slotted as the DH. In a key situation he was able to rope a single and "run" down to first base.  It was a long and unsuccessful season for the team but at the moment, I was as proud as any other moment in my life in sports.

I have a feeling that Maurkice Pouncey will be in uniform on Super Bowl sunday.  The news reports today make me think that he fits into that determined, stubborn and tough athlete category.  If he does play, with every snap that isn't fumbled and every little block that goes unnoticed, there will be a bunch of people on the sidelines wearing khaki pants and Steelers polo shirts with smiles on their face, imagining what their next Super Bowl ring might look like.  The commentators will undoubtedly talk about Aaron Rodgers' poise, James Harrison's intensity and maybe even Maurkice Pouncey's determination and toughness. You can color me surprised though if a Steelers' Athletic Trainer is mentioned.  The funny thing is, that's fine with most trainers I know.  We're happy to be the guy in the background of the picture like Jerry Maguire.  Although I hope to see this changed someday, the reward of seeing our athletes competing because of our efforts and the thanks we receive from them are almost always enough.

If you are interested in seeing the video of the injury (about 1:20 into the video) or seeing what Maurkice is saying here is the link:
http://www.nfl.com/news/story/09000d5d81de2959/article/pouncey-plans-to-play-in-super-bowl-despite-ankle-sprain

Ah Hah Moments and Their Close Relative, the "Doh!"

Everybody loves when they have one of those "Ah Hah!" moments. Some people may call it something different, but when you are able to put two and two together and get a grasp on something it can be very rewarding.
On the other hand, these are closely related to the "Doh!" moments, when you feel rather stupid for not knowing or not being able to remember something.  Some of you who know me probably know how much I love game shows. While Wheel of Fortune isn't one of my favorites it does provide great examples of each!

Ah Hah: http://www.youtube.com/watch?v=pMzNeTVCNIM&feature=related

Doh!: http://www.youtube.com/watch?v=NLdZ9AhPCEQ

No matter which of one of these paths you take to realizing something, to me it seems like all that matters is that you do know the answer.

The first case in Athletic Training that I can personally remember something like this happened over the span of my first fall semester at Memphis and culminating at a conference I was attending that Winter. At first, I had my "Ah Hah" moment but I was quickly hit with my "Doh!" moment.

All throughout fall baseball season, I kept noticing a lot of my athletes were coming in with complaints of shoulder pain.  Being a freshly certified trainer, I was more than happy to get to practice all of my shoulder special tests. (For those of you reading who may not be an AT, there are a LOT of shoulder examinations)  After a few lengthy exams resulting in not a lot of clear answers, I was admittedly frustrated. I knew that something was causing these athletes to have repeated cases of impingement and rotator cuff tendonitis, but I couldn't figure it out.  One day during treatment, 3 of my pitchers were in for treatment when I realized they all looked a lot alike.  Rounded shoulders? check.  Forward Head? Check.  Tight Pectoralis groups? check.  I thought that I had discovered this major combination of postural conditions that would lead to shoulder pain and injury. Now maybe I wasn't paying attention as well as I should have back in Upper Extremity Eval class one day because it turns out I was simply noticing the very common "Upper Cross Syndrome".  When I saw a presentation on this syndrome that Winter, I thought to myself "Not as brilliant as you thought? Huh Scott?".  But as Lee Corso would say... Not so fast my friend!  While I did not immediately recognize a phenomenon first described in 1979, I recognized common signs, symptoms and conditions and then used what I knew to make a logical and educated conclusion about the cause of our team's problem.    We were able to treat the effected athletes and begin a preventative course of action for the rest of the team.  Most trainers and coaches will put that in our proverbial win column.

If you're working with or plan on working with athletes, you will probably see Upper Cross Syndrome. Obviously, I know baseball the best and it can cause a lot of negative effects in the rotator cuff in those athletes.  However, I became even more versed in it's causes, effects and treatments this summer working with a Titelist Performance Institute trainer. Upper Cross Syndrome adversely effects many golfers as well.  A quick search will also bring back results relating Upper Cross Syndrome to MMA Fighters, Swimmers and even a cause of headaches.  Even if you think you know about this condition, take a few minutes to research it and read about it's potential effects.  I was rather astonished at how much it plays a role in.

Have there been any times in your career or studies when you had a similar situation?
Know of a good treatment for Upper Cross Syndrome?
Please share in the comments.

Dream Jobs and Where I've been

Somehow, as a 17 year old high school senior, I made a decision about what I wanted to do with my life. That decision has certainly been the right one so far. I consider myself lucky.  However, getting to do what you love everyday isn't the same kind of luck as hitting the lottery.

"Luck is when preparation meets opportunity." - Seneca, Roman Philosopher 5 BC - 65 AD

I saw this quote a while back in a great article by Mike Reinold about landing his dream job on his website.  If you are an ATC, PT or CSCS and don't know about Mike and his work, you are missing out.  Mike is the Head Athletic Trainer for the Red Sox and has done an extensive amount of work and research on the athlete's shoulder.  He's a pretty big inspiration for me and this tiny endeavor you are reading.  I see him as a pioneer in our field because he is using the technology we have today to educate ATCs and PTs and foster discussion on hot topics in our field.  Here is the link to that article: 5 Tips for Landing a Sports Medicine Job in Professional Sports 

I'd certainly echo everything he discusses in that article. As for me personally though, I'll share some extra info.

My #1 piece of advice that I could give based on my experience is to be willing to step out of your comfort zone. Personally, I've done this 3 times and it has worked out each time.  As a member of a graduating HS class of 175, I could have went to one of many colleges with a lot of classmates and friends.  However, I went to the small, yet highly respected, Wilmington College.  People still think I went to school in Delaware or North Carolina.  False.  Now, I know I'm not the first kid to go to college knowing nobody, but at the time it was a big step.  I can't speak highly enough about Wilmington.  I'm very proud to be an alumnus and would recommend it to anyone interested in Athletic Training.  It surrounds its students with great faculty and puts them in many career growing opportunities. It has great internships available including one with the Cincinnati Reds. Easily, this was their selling point to me and it was the highlight of my undergrad experience.

The next time was also a choice of college.  Graduation was fast approaching and I needed to make a decision about where to go next.  A very big part of me wanted to take one of a few opportunities to stay in Ohio. It was a complicated and difficult decision but in the end I decided to head south to Memphis, TN because of the chance to be the sole ATC with a Div. 1 baseball team. Once again, it worked out.

While at the University of Memphis, I saw Coach John Calipari give a speech.  He was a captivating and charismatic speaker.  It's not hard to see why he is a great recruiter in NCAA Basketball.  He was talking about his life and how it wasn't always as good as it was for him then (and now...) His main advice was when you feel stuck and aren't sure what to do, ask for help.  The timing of this was pretty good as I was nearing the point of having to do a summer internship as part of my Master's program and was having some difficulty.  At the time, my advisor and the other faculty were hoping to have me do an internship in the compliance department or somewhere else internally in the Memphis athletic department.  While those were more applicable to my degree (Sport & Leisure Commerce), I did not see it as a step toward my goal of being in pro baseball.  At that time, I reached out to one of our team physicians, Dr. Barry Phillips, who was also the team physician for the Cardinals' AAA team, the Memphis Redbirds.  Dr. Phillips got me in touch with their trainer, Chris Conroy.  I'm now happy to call Chris a good friend and a colleague with the Cardinals.

Another graduation was coming quickly and the fact that I didn't have anything in mind for what to do next was staring me in the face.  Enter the Cotuit Kettleers of the Cape Cod Baseball league.  I was offered the position and accepted.  I would definitely put leaving on a two-day drive with no idea about my housing situation outside of the comfort zone.  As a fan of baseball alone, it would have been worth it.  4,000 educated, opinionated and enthusiastic baseball fans is a sight to see.  As a bonus, it was good experience too.  I had the opportunity to have my first intern.  It is easy to see why so many people love being an AT instructor and working in an ATEP.

While there are a lot of important details and personally influential people left to tell, I don't mean for this to be my life story.  At the recommendation of a good friend, I just wanted to share a little about where I'm coming from.  I'll work on some applicable things to post tomorrow.

As always, comment or send me a message with ideas of things you'd like to see in the future.