Jan 29, 2015
On With The Show …

For the second year in a row, T&C Managing Editor Greg Scholand blogged at the NATA Annual Meeting. Check out Greg’s take on the educational sessions and panel discussions he attended, as well as other observations he had from the convention floor.


5:30 PM: The convention has just wrapped up, and I need to go pack for the long trek back to upstate New York. But before I sign off, I’d like to say a big THANK YOU to all the presenters and panelist at this year’s annual meeting, all the readers who stopped by our booth to share their thoughts on the magazine, and everyone who visited this blog. I welcome your feedback, and as always, your thoughts on how we can improve T&C–just send me an e-mail at [email protected].

See you next year in Philadelphia!

3:50 PM: Most of us under age 35 remember being told as children that playing video games was a waste of time. I strongly disagreed, as it was the only way I could see the Seahawks win the Super Bowl. But now, there are even more reasons why mom was wrong–the latest generation of video game systems offer challenges that emulate real workouts, and gaming consoles are finding their way into rehab facilities and athletic training rooms around the country.

At the session entitled “Utilization of Video Gaming Among Athletes for Rehabilitation,” presenters from the University of Maryland, Hope College, and the University of South Carolina talked about the many ways they’re using games like Nintendo Wii Sports and Dance Dance Revolution (DDR) to add a new twist to their rehab programs.

For example, DDR involves standing on a pressure-sensitive pad that contains several directional arrows. Following on-screen prompts and guided by the rhythm of a song, the player must step on specific arrows in specific patterns to score points. In athletic training applications, the game can be modified: The athlete begins on an elevated surface, so they’re performing forward, backward, or lateral step-down and step-up movements with each “dance move.” Or, an athlete can begin in a push-up position with their hands in the center of the pad and perform the moves with their hands instead of their feet–this provides a non-loaded upper-body workout and a core stabilization challenge at the same time.

One important question still needs to be answered about “Wii-hab” exercise: How much value does it really have? Since the latest-generation gaming systems are still fairly new, there’s not much research on things like degree of muscle activation, aerobic output, and other factors of physical performance. But that’s changing–session presenter Stacy Fritz, PhD, PT, recently received a $100,000 grant to study the rehab benefits of video game-based exercise. In the meantime, anecdotal evidence suggests that it holds real promise, especially for athletes in the early stages of rehab who have movement limitations or can only tolerate limited exertion.

And, not to be ignored, these activities are fun! The presenters noted that athletes are eager to comply with Wii-based exercises, especially if a game allows them to compete against teammates. Some athletes even schedule their rehab sessions together, to ensure they’ll have the chance for frequent rematches.

12:30 PM:
Everyone who works with high school and college athletes understands that mood swings, emotional outbursts, and odd behavior sometimes come with the territory. As they progress into adulthood and adjust to new settings and responsibilities, it’s normal to have days when they feel depressed, overwhelmed, or stressed out. How do you know when it’s a normal, healthy, temporary emotional response, and when it might be the sign of a mental health issue requiring treatment?

Windee Weiss, PhD, Assistant Professor at the University of Northern Iowa, talked about that challenge at a great session on mental health issues in athletes. She began by explaining that this is a sensitive topic in the athletic community, since many people perceive a stigma attached to mental illness. A long-established culture in most sports emphasizes “toughing it out” through any personal struggles, and an athlete may feel it’s an admission of weakness to seek help for a mental health issue.

For that reason, it’s important for athletic trainers to understand and watch for the warning signs of clinical depression and anxiety disorders. Weiss suggested that duration of symptoms is a valuable indicator: An athlete who has a few days of abnormal behavior, persistent sadness, uncharacteristic apathy, or profound anxiety might just be having a “bad week.” But if you notice those signs for several weeks in a row, or if the bad weeks become more and more frequent, some form of intervention is needed. When in doubt, Weiss said that referring an athlete to a counselor or physician is a prudent first step.

Not surprisingly, some athletes will go to great lengths to hide a mental health issue. In those cases, an ATC might be able to notice physical symptoms that frequently accompany depression and anxiety disorders. These might include headaches, muscle and joint soreness, unexplained chest pain, dizziness, digestion problems, chronic fatigue, and changes in appetite and/or weight. Those signs are obviously linked to many other conditions as well, but if they’re persistent and it’s difficult to pinpoint their source, a mental health issue should be considered. Trained counselors have several screening tools that can help make a diagnosis.

Weiss stressed how important it is to tell athletes that mental illness is treatable, often without medication. Just as they wouldn’t ignore a sprained knee or pulled muscle that limits their performance, they shouldn’t ignore a mental health issue that can hamper their athletic success and seriously affect their quality of life.


5:10 PM: Every year, one of the biggest highlights of the NATA convention is the Hall of Fame induction ceremony. This year was no exception, as five outstanding athletic trainers were honored for their long careers of service to athletes and to the profession as a whole.

Michael Ferrara, PhD, ATC, FNATA, of the University of Georgia, explained that each day presents a new challenge, and he has continued meeting those challenges because he loves the many diverse aspects of the job–treating athletes, solving problems, working with colleagues, and educating the next generation of athletic trainers.

Joe Iezzi, MA, ATC, PES, of Downington (Pa.) West High School, quoted baseball icon Jackie Robinson to put his career into perspective: “A life is not important except in the impact it has on other lives.” He also encouraged young athletic trainers to seek out mentors among older members of the profession: “I guarantee you, the experience and knowledge you’ll learn from them, you’ll value for life.”

Thomas E. Koto, Jr., ATC, LAT, who has worked everywhere from the Olympic Games to the NFL to a ski resort, joined his fellow honorees in pointing out that induction into the hall of fame is not an individual honor. It’s made possible by co-workers, colleagues, family members, and many others who support and enrich the lives and professional journeys of every successful athletic trainer.

Bill Lyons, ATC, Athletic Training Program Director at the University of Wyoming, was praised by colleagues for possessing a rare combination of gifts: the ability to perform his job duties with excellence, and the ability to teach others with equal talent and care. He drew laughs by concluding his remarks with a bit of Texas-themed advice: “Don’t squat with your spurs on.”

Chad Starkey, PhD, LAT, ATC, FNATA, Associate Professor and Coordinator of the Graduate Athletic Training Program at Ohio University, noted that his position on the stage was quite humbling: Behind him sat the full roster of Hall of Famers, the men and women who built the profession, while in front of him sat the association’s membership, who will carry it forward to new heights.

All of us at Training & Conditioning would like to offer a hearty congratulations to this year’s inductees. So here goes: Congratulations!

12:05 PM: This morning, at the session entitled “Medical Case Studies in the NFL,” we heard from professionals on the leading edge of sports medicine. With practically unlimited resources, pro football athletic trainers do whatever it takes to get injured athletes back onto the field as quickly as possible.

Paul Sparling, MEd, ATC, Head Athletic Trainer for the Cincinnati Bengals, presented the case of a 28-year-old quarterback who injured his elbow during the 2008 regular season. (The name was omitted for privacy reasons, but here’s a hint: It was Carson Palmer). He’d been hit in the arm by a blitzer while in mid-throw, and while he stayed in the game, he reported significant elbow soreness the next day.

An MRI revealed no torn ligaments, but some edema around the ulnar collateral ligament (UCL). The player received anti-inflammatory drugs and sat out the next game, then returned two weeks post-injury, only to experience more pain. Another MRI revealed a “peeling” (partial tear) of the UCL, and the player sat out the remainder of the season.

Here are a few interesting nuggets from the subsequent treatment and rehab:

• The Bengals consulted several orthopedists to decide whether surgery was needed on the UCL. Five said no, one said yes–and that one was a physician for an MLB team. Sparling noted that it’s important to work with physicians who fully understand the context surrounding an injury. A baseball pitcher with the same partial UCL tear might well have required surgery based on the functional requirements of that position, but for a quarterback, non-surgical treatment proved successful.

• The athlete’s rehab structure was highly progressive. After several weeks of no throwing, he began with short throws using Nerf footballs, and gradually worked up to longer throws, a real football, and more reps. He did not throw to actual receivers running routes until 12 weeks post-injury.

• Patience proved to be a virtue in this case. Despite only being a partial ligament tear, it took a full six months from the date of injury before the athlete was cleared to resume full activity.

Also speaking at this session was Ryan Grove, MEd, ATC, Assistant Athletic Trainer for the Pittsburgh Steelers. Citing his extensive athletic training experience rehabbing Steelers who have suffered knee injuries, he explained how damage to the medial collateral ligament (MCL) heals more quickly with help from an innovative treatment based on Autologous Conditioned Plasma (ACP).

ACP treatment involves drawing a small amount of the athlete’s blood, then centrifuging it for five minutes to separate the plasma from the red blood cells. The plasma is then drawn into a syringe and injected directly into the injury site. Blood plasma contains platelets and special molecules called growth factors that promote cell migration, stimulate blood vessel and collagen formation, and essentially speed up the healing process.

A few months ago, we reported on a similar treatment based on platelet-rich plasma (PRP). Compared with PRP, ACP is less expensive and easier to perform (it requires less blood and fewer syringes), making it an attractive option for clinicians with limited resources who are interested in employing a cutting-edge treatment technology.


3:45 PM: Ankle sprains are among the most common athletic injuries, and studies have shown that standard taping and bracing are effective treatment methods. After a brief overview of those techniques, Jay Hertel, PhD, ATC, FNATA, from the Exercise & Sport Injury Laboratory at the University of Virginia, focused the bulk of his presentation on prevention strategies. In particular, he discussed research demonstrating that progressive balance training programs are very useful for avoiding sprains.

The key word above, Hertel says, is progressive. Balance training, whether or not athletes have a history of sprains, must add new challenges as the ankle musculature and neurosensory system adjust to various drills. A few specific aspects of balance training that can be made progressive include:
• Visual input: eyes open to eyes closed
• Surface: stable to unstable (e.g. floor to wobble board)
• Predictability: expected to unexpected stimuli
• Difficulty: increasingly larger jump/hop distances

1:30 PM: I just spent the lunch hour at our booth talking to some readers. Matt, an ATC who works at a clinic here in Texas, told me about how a couple years ago, his clinic director’s son was having a problem with dehydration after exercise. He would feel sick and sometimes vomit after workouts. Matt found an article in T&C about hydration strategies and gave it to the athlete, and it made a huge difference for him. It’s always great to hear that our magazine is helping ATCs do their job better!

Have you ever used one of our articles as a source of advice or ideas when treating a specific athlete? If so, I’d love to hear about the case, and get your feedback on what you’d like to see us cover in the future. Feel free to send me an e-mail at [email protected] to share your story and any thoughts on the magazine. Thanks!

11:50 AM: I just left an excellent session on Deep Vein Thrombosis (DVT), the potentially fatal condition in which a blood clot (often in the leg) forms in a blood vessel, and could then travel to the lungs and form a pulmonary embolism. Why are some athletes at special risk for DVT? Look at this partial list of risk factors:
• Air travel
• Partial immobilization
• Obesity
• Recent acute trauma
• Recovery from surgery

It’s not hard to imagine an athlete having several of these factors at the same time. In fact, a football lineman who’s overweight, recovering from injury, and traveling by plane with his team might be batting 1.000 on the list above.

The typical signs of DVT in the leg are swelling, pain, and redness, but it’s important to note that a high percentage of DVTs are completely asymptomatic, so the absence of these signs isn’t enough to exclude a DVT diagnosis if an athlete reports tightness or discomfort in the leg. Ultrasound imaging is a common and reliable method for detecting DVTs, and if a thrombosis is found, an athlete will typically be placed on an anticoagulant drug and withheld from activity.

As for prevention, a few simple steps include walking around frequently during long bus or plane rides, keeping partially immobilized limbs moving as much as possible, and staying well hydrated. I’m now going to take that advice myself, and go on brisk walk to the exhibit hall to pick up some free sports drinks…

10:15 AM:
It’s Thursday and the convention is finally in full swing. In this morning’s USA Today, there’s an article on the NATA’s new heat safety guidelines for high school preseason training. The article quotes Doug Casa, Director of Athletic Training at the University of Connecticut, who co-chairs the association’s heat illness task force.

A major focus of the new guidelines is acclimatization–letting the body gradually adjust to workouts in hot weather. For instance, in the first five days of preseason football practice, they call for no more than one practice per day, with no more equipment than a helmet for the first two sessions. On days six through 14, the guidelines recommend following each two-practice day with a one-practice day.

In the upcoming July/August issue of T&C, you’ll find an excellent roundtable discussion on heat illness, in which we talk to several ATCs with expertise on the topic, including Doug Casa.

I also checked out USA Today‘s sports section, and found it failed to mention the tennis match I played yesterday with T&C‘s Advertising Materials Coordinator, which I won in straight sets. If you’re at the show and you’d like to console him in person, stop by our booth in the exhibit hall, #14033. You can pick up a show packet, renew your subscription, and enter to win some great prizes!

PRELIMINARY: Greg has fired up his Buick and is heading west through parts unknown with one destination in mind: San Antonio. When he finally reaches the Annual Meeting, his mission is to bring our readers the finest informational nuggets the show floor has to offer.

If you’ll be at the show, feel free to e-mail Greg with your own convention notes or stories, and you may see them up on this page. If you won’t be there in person, follow the blog all convention long to read about what you’re missing.

In addition, convention attendees are invited to visit T&C in the exhibit hall at booth 14033, where you can pick up your free show packet, renew your subscription to the magazine, and enter our drawing to win a car GPS unit and a $100 gas card!

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