The Important Role of an Athletic Trainer

Most people would agree that having a healthcare provider on the sidelines at sporting events and practices is advantageous, especially for when an injury occurs. More and more schools, locally and around the country, are hiring athletic trainers to support athletes, coaches, sports teams, and school district athletic programs. Although their presence is increasing and their impact is tangible, there are still a good number of people who do not know what athletic trainers are, nor what they do. Certified Athletic Trainers (ATCs) are health care professionals who collaborate with physicians to provide preventative services, emergency care, clinical evaluation, therapeutic intervention, and rehabilitation of injuries and medical conditions.  

In order to become a Certified Athletic Trainer, an individual must graduate with a bachelor’s or master’s degree from an accredited athletic training education program. In addition to classwork, the athletic training student must complete a series of clinical rotations at various high schools and colleges, as well as pass a comprehensive test administered by the Board of Certification for the Athletic Trainer. Once an individual is certified, they must meet ongoing continuing education requirements in order to remain certified, and they must also work under the direction of a physician.

Athletic training is often confused with personal training. A personal trainer is a fitness professional who has the knowledge, skills and abilities to provide safe and effective exercise and fitness programs. An athletic trainer, whose education includes strength and conditioning classes, focuses primarily on sports medicine services, such as injury assessment and management, in addition to general fitness. Returning the injured athlete back to sports as quickly and safely as possible is the top priority of the athletic trainer.  

Justen Lopez, is the current Certified Athletic Trainer for Pleasantville Schools. He works with athletes before, during, and after practices and competitions. Justen works roughly 25 hours a week at the school, making sure all athletes receive the best and fastest care possible, in order to keep them healthy and playing on the fields and courts. His daily routine begins with pre-practice/game treatment, including assessment, taping, and rehabilitation of injuries. After doing rehabilitation exercises with athletes across all sporting teams, Justen provides sports medicine coverage during practices and games. He is present on-site in the event of an athlete injury, making him the first person to assess, evaluate and determine what the proper medical care and course of action should be. It goes without saying that there are huge benefits to having a trained healthcare professional present immediately following an injury. Additionally, having an athletic trainer on-site can take pressure off coaches. It allows coaches to focus on coaching, and not have to manage injuries.

Common minor injuries and issues that Justen treats include hamstring strains, shin splints, mild ankle sprains, IT band syndrome, and patellofemoral pain syndrome. He utilizes different techniques and methods (like hands-on massage therapy, stretching, and taping) to aid the injury recovery process, and to get athletes ready to perform and compete. Justen also coordinates with other healthcare professionals when necessary, in order to get the injured athlete the appropriate care.

Another advantage of having a Certified Athletic Trainer on staff and on-site at the secondary school level is that they can assess and treat more minor injuries, without the need for medical referral. This helps prevent a minor injury from turning into a more serious injury, and also allows students to receive care without breaking up their normal routine (of having to go to different doctors at varying times). The Certified Athletic Trainer provides medical support built-in during the school day and practice time, saving precious time and resources. Certified Athletic Trainers also implement and oversee concussion policy/ procedures, to provide proper management for concussed athletes, both in the athletic and educational environment.
The value of having Certified Athletic Trainers present during sporting events and practices is becoming more and more evident as the number of people playing sports and getting injured increases. Educating the general public, as well as school officials, will help raise awareness and ultimately help athletes everywhere, no matter what age or skill level.

Preventing Back and Knee Injuries This Winter

Winter brings snow, ice, wind and frigid temperatures, and with the cold weather comes the arrival of knee and back injuries across the northeast. The most frequent injuries that we see in our physical therapy practice over the winter months are low back pain from shoveling, anterior cruciate ligament (ACL) tears and patellofemoral pain syndrome in knees from winter sports.

Lower back injuries are very prevalent once the snow begins to fall. Shoveling and snow blowing can both put a lot of strain on the muscles of the lumbar region, especially if some easy precautions are not taken. Shoveling snow tends to require people to lean over for prolonged periods of time, while lifting potentially heavy weights that are far from the center of their body. While doing this for a few minutes may not be problematic, shoveling snow for 30 minutes may lead to muscular or potentially disc-related issues.

Generally speaking, the muscles of the lumbar spine are not trained to perform repetitive heavy lifting. They are endurance muscles designed to maintain our upright posture all day. By constantly leaning over while carrying additional weight, undue stress is placed upon the lumbar musculature, which can cause them to fail, resulting in a strain. When a muscle is strained, it can become spastic, which is an involuntary contraction of the muscle. Muscle spasm can be quite painful, especially in a central region of the body, such as the lumbar spine. To alleviate a muscle spasm, various stretching and soft tissue techniques are performed and typically symptoms resolve within a few weeks.

Snow shoveling can also lead to posterior disc herniation, which may cause sciatic nerve aggravation. If a disc does begin to press against one of the nerve roots in the lumbar spine, often times a tingling or numbness is felt throughout the leg, typically in the gluts, hamstrings or foot. As a preventative measure, it is recommended to perform standing lumbar extensions before, during and after shoveling snow, as this movement helps to counteract leaning forward. To perform a standing lumbar extension, simply place your hands on your hips and lean backwards, trying to create a large arch in your low back, hold for a few seconds and repeat 10 times.

Skiing is the cause of a significant number of winter injuries, including ACL tears. The ACL can tear by being struck from the front, forcing the knee into hyper-extension, or it can be torn when a rotational force is applied to the knee when it is planted on the ground. Generally in skiing, the tear occurs when a ski boot does not dislodge from a ski during a fall, causing the rotational force. Unfortunately, there isn’t anything that can be done to ensure that a boot will disconnect properly other than wearing proper footwear. In general terms, the likelihood of having an ACL tear can be lessened if a person has strong hip musculature and good stability through the knee. This can be achieved by performing strengthening exercises targeting the gluts, as well as doing exercises on unstable surfaces, such as on balance boards, BOSU balls and physioballs. If an ACL tear does occur, the recovery time following surgery is typically 9-12 months, assuming full return to sport participation, including skiing, is the goal.

Lastly, most winter sports, including skiing, snowboarding, hockey and ice-skating, put a lot of pressure on the knees, as these sports require the participant to maintain mini-squat positions for extended periods of time. This can be an issue if the participant has weakness in the hip and/or thigh musculature. Hip weakness typically manifests itself with knee genu valgum, also known as knocked knees. Genu valgum is an issue, as it places a lot of stress on the medial structures of the knee, especially the medial collateral ligament (MCL). The iliotibial band (ITB) can also become very aggravated, because this position can increase friction between the ITB and the lateral femoral condyle, causing pain along the lateral side of the knee. These issues can both be addressed with strengthening of the gluts and quadriceps, as well as stretching of the ITB and gluts.

Not all winter injuries are preventable, but there are some simple strengthening exercises, as mentioned above, that can help assist in building up areas in the knee and back which can avert or lesson injuries that might otherwise slow you down this winter.

Helping People with Diabetes Get Moving in the Right Direction Through Physical Therapy

What is Diabetes?  Diabetes is a condition in which a person’s body does not properly produce or use insulin. Insulin, a hormone produced by the pancreas, is necessary for glucose to enter the cell and be converted to energy to perform daily activities.  Since glucose is produced from the majority of foods that we eat, when a person has diabetes and is unable to properly break it down, these sugars build up in their blood.  This may lead to serious health complications including heart disease, stroke, blindness, kidney failure, reduced muscle strength, sensation issues, and lower-extremity amputations.  Diabetes is the seventh leading cause of death in the United States.

There are three categories of diabetes: type 1, type 2, and gestational.  Type 1, previously known as juvenile or insulin-dependent diabetes, is typically diagnosed in children and young adults.  In type 1, the body does not have the ability to produce enough insulin, reducing the amount of glucose that can enter cells for energy.  Type 2 is the most common form of diabetes, often referred to as hyperglycemia or insulin resistant diabetes.  In individuals with type 2, their glucose levels rise above normal.  At first, the pancreas produces extra insulin to compensate, but eventually it is unable to maintain the work output and cannot make enough insulin to keep their blood glucose levels normal.  Gestational diabetes occurs in women who are pregnant and have never had diabetes prior to pregnancy.  During pregnancy, the placenta produces hormones that may cause a buildup of sugar in the mother’s blood.  If the mother’s pancreas is unable to produce enough insulin to handle the excess sugar, her blood glucose levels will rise.   

Physical therapists are extensively trained to evaluate and assess pre-diabetic and diabetic patients. They are able to design individualized exercise programs that will improve their quality of life and reduce risk factors.  Often, people wish to exercise, but they don’t know where to begin or what their limit is.  Physical therapists have a great understanding of the body as a whole, being able to design safe and effective exercise programs based on each individual person.  These programs will include aerobic exercise, strength training, flexibility enhancement, and balance training to cover all the bases.

No matter what type of diabetes an individual suffers from, one action proven to help is exercise. The American Diabetes Association recommends 30 minutes of moderate exercise at least 5 days per week, but no more than 2 consecutive days.  Moderate intensity exercises are described as intense enough to make you perspire and raise your heart rate, but still engage in conversation.  Aerobic exercises allow your body to use insulin more efficiently while relieving stress, improving your heart, and promoting blood circulation.  Strength training 2 days per week can also lower your blood glucose levels by maintaining strong muscle and bones.  Strong muscles improve one’s ability to burn calories even while at rest.  Think about it, your heart is a muscle!

Physical therapists are also equipped to treat areas that may have pain or sensory issues such as numbness and tingling.  Along with providing appropriate exercises, physical therapists perform manual therapy techniques that help relieve pain.  Assistive devices are often used to aid with walking as a result of pain, a sore on the foot, or post-stroke symptoms resulting from diabetes.  Physical therapists can help improve your strength and balance in order to make your walking pattern more safe and efficient.

There is always a way to make time to better your health and exercise.  Here are some helpful tips to get you started on a daily basis: get up once per hour and walk; moving helps maintain an appropriate blood glucose level.  If you have the option to take the stairs instead of an elevator, climb away! Use speakerphone; you can pace while on the phone.  Get involved in sporting events and play dates with your kids in the neighborhood.  When doing homework or watching television, stop for a few minutes and stretch.  If you’re taking public transportation, get off a stop early and walk; it will start your day off right. These are simple ways of fitting in exercise without taking time away from responsibilities and life.  

The impact that physical therapy can have on diabetic individuals is significant. Every case is unique, and physical therapists are best suited for tailoring specific plans to help each individual. With November being American Diabetes Month, now is as good a time as any to seek a physical therapist to help get moving in the right direction.