The Sports Medicine Broadcast

Driving Healthy helps us lead by example, and take advantage of time off. Shawn gave me lots of tips before we took our 3800-mile 4-week road trip across the country. Longest road trip: well over 1000 miles Average Road trip: some days working outreach I might drive 350 in a day Eating Healthy - nutrition is huge Know your body’s needs and what causes problems. I stay with simple things that I can extend throughout the day. Meat cheese and nuts work great for me. Drink things that help you hydrate and feel better Stop and do your lunch break and bring a game, frisbee, or soccer ball. Pee breaks also help to get you up and moving Bring a cooler of healthy snacks and food with you. Staying fit - Donnie Thompson bowtie for postural correction Keep exercises - band pull-a-parts Doing the old rocky routine with the lat pulldown machine in the truck Use a lacrosse ball in a tube sock for mobility Lifting heavy before starting a long drive gave me soreness that encouraged me to move. Mile markers: I would see a mile marker and think for this mile I am going to focus on getting a really good core contraction. Then I would squeeze the butt for the next mile. Staying Awake - Get up and move Changing what I listen to helps me. Contact Us:

Collagen is everywhere right now. It is in coffee and everything, but we need to be more strategic in our implementation. Meredith Sorenson Joins Dr. Yellen to discuss how we can should and should not be using it. Where is the evidence? It can help increase the collagen in structures and joints in the body. A lot of athletes are using it as a preventative measure which is where the most evidence is. We want to make sure that we are loading the tissue when we are consuming the collagen. Is it safe? NSF certification means you get what it says and there are no banned substances. VitalProteins, SIS, Klean Athlete, Live Momentus Or you could go to the grocery store and grab some Jello…well gelatin Glucosamine and joint and bone health. Collagen is probably the better option. Bad information is really easy to come by. Pain Patterns The studies were measuring subjective pain Are there biomarkers? P1NP is a direct biomarker Dosage of Collagen 15 mg Dosage is probably the minimum It is a pretty low-risk supplement. Most of the indicators are in research…we are not going to remove someone's tendon to measure the collagen. Why would I recommend it? They have the resources to purchase it The athlete is actively working in rehab They are struggling to get enough protein in as is. More of a need for explosive movements Possibly more for females to encourage tendon and ligament strength Contact Us: Meredith Sorenson - @MeredithDarcyRD

Dr. John Gallucci discusses Five Things that Athletic Trainers can do as clinicians to help prevent injury. John, what is your Athletic Trainer story?  Wrestler and baseball player in high school A local PT company had an outreach AT His family owned a supply company that connected him with PTs. Through high school and college, he had several great interactions with ATs that lead him down that path to becoming an AT. Five things we are doing wrong that could cause injury: Providing self-care * We understand biomechanics and how the body works. * Use proper biomechanics * Appropriate nutrition I learned this lesson about 15 years ago when I was feeling unhealthy.  I was not fit enough to get across the field and do CPR. I could not run to get the AED if needed.   We are givers but sometimes we as Athletic Trainers need to TAKE a little. We never get enough sleep * This causes soft tissue injuries and cramping Biomechanics * PNF patterns cause the clinician not to use the legs and strength of the chain * Put yourself in a de-risk situation * Outpatient is the PT of choice * 8-12 patient loads - consider the height of the table and use proper leverage and bracing When I was day to day with redbull as their AT, I got there early to stretch and run to be ready for the day. Are you ready for the demands of the day? The Industrial ATs are teaching the workers how to be ready for the job.  Take some of that and internalize it. Stress Causes Harm * Think about your responsibility each day * Think bout the communication chains between medical professionals * Make sure the EAPs are clear, written, communicated, and practiced * We have to make decisions as healthcare professionals that can impact the lively hood of the patient * Vent or decompress in a safe place - internalizing the stress is a big problem. Proper lifting techniques * Lifting techniques are important for high shelves * Use the tools to provide the best mechanical advantage * Do lifting drills as a team * Practice lifting technique  Time with the RedBulls: In the 90s I had the opportunity to work with the local team that only had one AT / medical professional Spent 7 years working in the professional soccer realm. Became the player care coordinator I currently help the MLS ID good AT candidates Medical coordinator I have been lucky to see the league evolve from 10-12 teams up to 31 teams in the next few years. Santa Monica PEP program

FooBag is Craig's other child. He created the product to keep his AT gear dry after a coach accidentally soaked his whole med kit. Many hours have gone into creating the product that you see today. 5 words to describe FOObag: Innovative Necessity Driven Family Committed FOO - I have ten siblings and we were the jocks in the neighborhood We were nicknamed the egg rolls Where did the idea start? Hofstra University where I met my wife We were founders of the student AT organization Summer intern with the New York Jets I have worked at each level of sports Got my masters from Hofstra in 2003 Stepped down as the coach/AT to follow my daughter's college sports careers I passed the stadium on a rainy day where I always kept my gear on the back of the cart The coach borrowed the cart to move gear but did not keep my kit out of the weather, it soaked everything in my medkit. At that moment I knew I needed a solution I spent about a year or two looking at all the kits to design and create the bag to fit my needs and the other ones on the market. I wanted to find a local manufacturer so I could make trips there as needed. The manufacturer showed him a bag they use when onboarding inmates at the penitentiaries After a few weeks, we had a prototype. Then we tweaked it several times. And then adjusted the sizes. We have grown with feedback. What “version” of the FOObag are you on now? We now have the 2.0. Who was your first sale to? Marissa, a local AT here on Long Island and a long-time friend. Your biggest haters? I do not remember anyone giving me a hard time or telling me that it wouldn't work Other ATs were a little “jealous” of me thinking of it first. If you were to start over what would you have done differently? I would have learned more about social media and online marketing and online sales. I would like to have switched and delved into other markets earlier. Contact Us Craig - craigatc14@aol.com Foobag - @FooBagFoo Jeremy - @MrJeremyJackson

Connecting PTs and ATs to create a high-performance sports medicine team is part of the mission Dr. Eddis Smith is accomplishing with Ellie Roenig. As an AT I want people to know why we should collaborate. We need to move things forward in creating high-performance teams PT, AT, Team Doc, Mental Health, Sports Science. We send our residents 4 days a week to the AT Facility And available after school and on Saturday Load management - How do you do it? Create high-performance teams Communicate Close those gaps Athletes need to be weight room ready when they leave your care How else are we connecting PTs? PT asked the manager how they can work it out. Find a company that values the community integration It has created a significant increase in referrals Eliana Roeing Contact Us: eddiePTATC

Up to 90% of eye injuries in sports can be prevented with proper eyewear. Dr. Alireza Somji, OD joins me, Jeremy Jackson to discuss some of what he sees and how we can help prevent eye injuries. International sports vision association - eye safety awareness program WileyX are ballistic rated Sportsvision.pro Protect prevent play Over half of the brain is dedicated to visual processing. But we almost never train the visual performance Alexander Arnold from the redbull documentary Steph Curry, Matt Ryan. First step should be getting a full eye evaluation. Make sure they have an examination and not a screening.

Females Athlete Care is not the same as male athlete care. Dr. Jill Moschelli is making a career specializing in it. Megan Smith, the chairperson for Women In Athletic Training, leads the interview. https://mm.linkedin.com/posts/cassie-monaco-2803b3202_flathead-valley-high-school-students-win-activity-7034338310130974721-xSV0 Looking into your bio, you specialize in Female Sports Medicine. Can you share with us what that entails? Female athletes are just different than men Female athlete triad. Concussion recovery is different Predisposed to different types of injuries How popular is being a female sports medicine-specific doctor? It is not really common, but some of it is due to comfort level. There has been an increased discussion about women training on their menstrual cycles and understanding how each phase affects your training. When someone is looking into this- do you have any recommendations on how to get started or a basis of understanding while training during different phases? Educating in general is the biggest first step Educate them about their own body and their cycle Know what is normal for you and be aware of what changes look like. Some of those changes can be due to oral contraceptives for whatever reasons. Basic menstrual tracking app. Perceived performance scales but nothing has been clear or consistent…so more research is needed. How do we ask: are you on your period? Make it not taboo…make it part of their general health I am going to ask a lot of questions and if you feel like you can't or do not want to answer that is fine. “How has your menstrual cycle been?” “Are you on any medicines that would impact it?” We bring up topics like that at the beginning of the season so it is less taboo and breaks through the barrier. Over the years I have taken many female-specific continuing eds, but one stood out to me which was pelvic floor dysfunction in female athletes. Is this something that you’re seeing in the clinic or refer out to a pelvic floor PT? Can you share how this can affect the training of our female athletes? It happens more than we are aware of.  It is not discussed as much.  Up to about 30% of elite female athletes experience incontinence. Impact sports have a greater incidence. Bringing up the conversation more often helps teach people about it. Finding a pelvic floor therapist can be difficult Stress Incontinence: Inability to control the flow of urine during stress. How can Athletic Trainers bridge that gap? The more we talk about it the more it normalizes it. You can be the first line of defense for those athletes. Maybe set up a regular schedule to discuss it so they know to expect it. Have the resources available or posted for them.  Are there areas of female patient care that you believe would be beneficial for athletic trainers to be better versed on? What are those areas? Is there training that you recommend?

Post Exercise Recovery Nutrition is one of the topics Brett Singer addresses with high school, college, and professional sports in Houston as part of the Ironman Sports Medicine team. Doubling carb intake prior to an event Cliff Bar and Gatorade Gatorade and a banana Applesauce and Gatorade Gummy bears or Fruit snack Choose any two of them and that should get you to the right amount. Is there a chart for glycemic reference? Brett uses the USOC recovery chart Glycemic Index Chart by National Library of Medicine Post-exercise nutrition can minimize the NEED after for a recovery drink Milk is more effective at rehydration than just water. If you are eating then you probably do not need the recovery drink Electrolyte drink vs Gatorade Situations dictate different needs. The 10-year-old kid will likely need less than an adult Sodium and Chloride are the most important components of the recovery drinks Professional soccer players may lose 6-7 pounds during the course of practice A meal and water with an electrolyte drink between meals. Youth bodies can handle the heat better? 2% of body weight loss shows visible effects of performance In general, water should suffice if trying to recover 12 ounces (kid) versus 72 ounces (adult) What are some dehydration signs to look for in Youth Sports? Losing abnormal amounts of sweat Headaches  Nausea Fatigue Cramping Weighing in and out should be done with caution. High School and Rec athletes - Are there ideal mixes?  There is not one that has all of the needs of an athlete. Most products are insufficient for high-level athlete carb needs 3 to1 or 4 to 1 ratio is ideal for carbs/protein but needs to look at the big picture. 20-40 grams of protein High-glycemic foods in recovery are OK Creatine and Post Exercise Recovery Nutrition I do not push it for high school athletes but it is safe. Following the guidelines is important The benefit is really for the high-level athletes It also helps with glycogen replenishment Whey vs casein protein? It does matter how much protein you take in? As far as protein synthesis goes 20-40 grams is the general window Adding glycogen to protein does not improve glycogen uptake Focus on carbs if there are small windows between competitions or training sessions.

Don't be that preceptor who is just trying to get CEUs or the one who only uses MAT students as grunt labor. Being a Mentor is a choice.  A choice to give of yourself for the good of others.  So is adoption.  DJ tell me some of your adoption story. Taylor has been such a fantastic part of our life.  She is a part of my life as an Athletic Trainer and my life as a preceptor and mentor. Worst preceptor story you have heard? Worst mistake I made as a preceptor was right out of Grad School. * My responsibility is to the team and athletes, not the students. * I did not want to invest in the students * I did not want to give up control * I only allowed them to set up the field * It is finally my time to be the Licensed Health Care Provider and make decisions * It is about me now Communicate the roles and expectations Some other bad examples? I am not getting any feedback I am doing what they ask but I am not getting any feedback How to avoid being average as a preceptor: Do not complain about students on social media What are some of the struggles for preceptors? Accountability Set expectations * Have an orientation * What can the program cover before the kids get to you * What do you need to cover Dress code Look at this as a semester-long interview process. For scheduling purposes * We try to keep a really structured process * Immersion should be a minimum 40 hours per week * 85 hours /2 weeks * 1 day off every 7 * And at least 8 hours between shifts Shout out to my administrators and my co-worker for giving us the opportunity to be preceptors for U of H MAT. JP: I felt like my hands were being held the whole time… I was either setting up the field or observing.

Dr. Josh Yellen presented Leadership in Crisis at the Memorial Hermann Sports Medicine Update. Shawn ready had some questions to follow up on his talk. Leadership in COVID -  Planning in athletic - speaking to your AD, your coaches, school leaders…this is one setting. How do we as qualified healthcare providers help function in the world? I am Head FOOTBALL Athletic Trainer or I am an AT with a lot of experience with football. Compare primary care vs AT There is a shortage of primary care physicians. The definition of Athletic Trainer and primary care doctor is almost identical Practicing Scared -  We as directors need to understand the CAATE standards, the state practice acts, and the BOC requirements. We need to keep pushing into the village of medicine. PA is a master's degree program but is much more respected. We were comfortable staying in the sports setting for many years. To have direct access to patients you have to have a physician oversite. Bachelor's degrees will not be reimbursed by CMS. WHY DO WE USE OTHER PROFESSIONS TO EXPLAIN OUR PROFESSION? Medical Model's effect on Leadership In Crisis -  The Physician is the top and we are all extensions of the physician. If we do not move into a better role and stake our ground then someone is going to take our role. Sports Medicine Student Aides - appropriate vernacular is important This gives the impression that a high school student without training can do your job Watch the presentation on the SMB Facebook

Preceptors are an important part of the MAT program for future Athletic Trainers. Dr. DJ Gilliland shares what makes a good Call out by name a few of the best preceptors you have known. David Stuckey at Hardin Simmons - instilled in us the desire to give back to the profession. It was our responsibility to mentor someone David Colt or DC hired me out of undergrad. He guided us on how to teach and interact with our students. Kyle Southall at Briarwood Christian in Alabama 48 local preceptors Dustin Rush - What you see is what you get He does a great job of letting students take chances and risks. Dustin has a fantastic debrief with the students. Frank Perez - He is a tough preceptor with a ton of experience.  He is really good. He spent several years with Cirque De Soleil and brings dance medicine into the equation He has a large administrative component to his site. * Great communication skills with coaches and admin, and team docs * He is an alumnus * Always an ear to listen or a shoulder to guide them…we need to guide them more Administrative work: * Documentation practices are on par with what is needed for professional communication * Team management - day-to-day injury report presentations * Working alongside the nutritionist for the team * Physician referrals * Scheduling * Second-year students should be involved with scheduling and communicating with the opponents' medical staff. * 5% of the BOC is now about Administration * Allow the MAT students to schedule the student coverage * Teach them how to manage the student aides * Allow them to create an evaluation system * Have them look at and update the policies and procedures. * Have them look at and update the EAP * Teach them to be a mentor to the kids * Understanding professional boundaries Mike Ramirez -  * “You can not work in the NFL unless you work at a college” * Great with organization and teaching the students what to expect. * He puts students in charge of making sure the gear is ready * They learn inventory * Real-world problem solving * Writing rehab plans Brenna Ellis - She transformed the experience for our students. They leave feeling like they have grown as an individual and professionals. AT is a family. Supervised Autonomy -  The preceptor should be the patient's advocate Build up the student's trust and confidence by having mock scenarios in downtime. The really good preceptors take advantage of that time.

Cryotherapy Research discussion with Sean Kennedy, live from the Memorial Hermann Sports Medicine Update. What is current science telling us? Cryotherapy - What do you tell them? We have a lot of interpretations, so it makes it hard for there to be clear guidance Cryo after injuries - there is no hard science about dosing for ice Think about the messaging (chemical and nerve) that may be delayed There is a place to allow the swelling to do its job. Evidence shows compression edges out ice but can be used together easily. Listen to the theories and allow your mind to be open. Do not be a stagnant clinician. Cold water emersion We used to believe it would send them into shock and the heat would stay in the core All position statements say full body immersion is the standard to lower core temperature Joint application only could take 80 minutes to cool the body It could be 3-5 minutes with cold water immersion Cryotherapy Recovery from workout What is the value of reducing the perceived soreness from the damage that was done? If you are trying to mask the fatigue by ice bath you are increasing the risk of injury. Instead of Icing try MarcPro

Supply chain issues are still causing problems for Athletic Trainers. Thankfully Paul Calloway has the inside scoop to help us stay ahead of it. AEDs - there has been a shortage for a little while. Shortage in components and an uptick with purchasing after Damar Hamlin incident Hospital suppliers have more access than sports medicine suppliers Aerosols  Tough to get - QDA, Tuff Skin, Adhesive, Cold Spray * All are unavailable for the foreseeable future possibly until 2024. * Magic spray and stick em’ * May not be available in as many varieties Shortages cause price increases M-tack from Mueller is a pump spray Gatorade chews  Still in short supply They have basically taken those out of the options Cliff bar energy chew is an alternative Foam There has been a bit of pressure in the foam market. Pre-wrap and under wrap continue to be problems for sourcing Price increases should be expected Looking at about $1 per roll OTC meds  More so with Medique brand products They have been struggling for about 2 years to get things leveled out. You may need to buy in the bulk bottle Athletic Tape Coach tape from J&J was bought by BSN Medical The price has gone up but it is back and available again. Elasticon has been brought back as well Zonas 1-inch box tape is back in production as well. Other concerns There tends to be consolidation of SKUs…like there may be fewer options for ankle braces Mueller has discontinued some of the medkit lines. Not a whole lot of new products out this year Prices will continue to generally increase Freight We are paying more in freight now than last year.  Even if it says free shipping, it still has to come out of the costs. Tips If there are a few sacred items put no substitutions but be willing to consider alternatives on most other products. Andover was bought by Millican…they are the same, but just now switching branding They did discontinue some of the niche items Paul Calloway - Twitter or Facebook

Patellar Instability is a specialty for Dr. Jeremy Rush's orthopedic practice in San Antonio. Tell me about the first patellar instability you remember seeing. Chronic instability up to dislocation It is a very heterogeneous group Patella dislocation and patella subluxation And patella instability Addressing the first-time dislocator Be super aggressive with the rehab Step one: reduce the dislocation Brace them for a week but then get them moving Try to get started in PT within one week See them back about 6 weeks and then again at 3 months At 6 weeks with effusion makes you think there is a loose body. Ability to do straight leg raises Apprehension with manual pressure Instability vs dislocation. Dislocation = all the way out - 95% are lateral * Usually traumatic events * Some are from anatomic risk factors Subluxation is partially out of the groove Instability is a chronic form of Subluxation First timer tips Get them to relax Move them into extension Calm them and even cover the dislocation if needed Maybe get them up and it could self-reduce Top patient complaints/ indicators of patellar instability Knee feels unstable or it is slipping Or my knee just hurts Buckling Recurrent effusion Anterior knee pain Start with rehab Target Positive patellar apprehension J-Sign Predisposed to instability Patella alta Women are at higher risk due to q-angle hyperlaxity Rotational abnormalities On exam J-sign Apprehension Lateral pressure MRI on chronic instability MPFL damage If the injury is unclear then I get an MRI to rule out any sort of cartilage or loose body.   A huge effusion indicates a loose body. Contact: Dr. Jeremy Rush - IG @satxsportsmedicine Jeremy - @jhjacksonlat

Eccentric contractions have long been known to improve muscle hypertrophy. Ryan Collins joins Clayton Berrang to discuss Eccentrics vs Tempo training and how to implement both. Where in the timeline are the athletes? Once they can move without bracing Strength Deficit Eccentric training benefits Supermaximal load and trying to move that through the eccentric motion A load that can not move through the concentric movement How would you recommend emphasizing eccentric training? Tempo training is a safe place to start but it affects the muscle adaptations Most ATs and PTs are probably already doing this. EX: single leg squat - box progression -  Reverse engineer sprinting Brakes are going to be important to anything we move But eccentric training offers so much more than just the brakes Triphasic training When do you transition from eccentric training? Time of year and sports demands Talk about the cycles for football Summer is great for super maximal loads for the experienced lifters Beginners lifted should be doing triphasic The full stretch-shortening cycle would be in season Tempo training is one of the easiest forms of progression for an athlete's body Most adaptations from the eccentric load Increased reps give some adaptations Tempo is the lowest ROI Box squats example Tempo training and progress through the tempo training 4x5 with a 3 sec - 4-5 and up to 8-second tempo Now we use slightly heavier weight with about a 2-second tempo 5 - 7 - 10 - 12 reps progression Progress through load 4x5 and increase the load over the next 4 weeks How do we set up a supermaximal eccentric? Rack setup with safety catches and partners or team lift it back up We are looking at 5/10% above our maximal level We can do 5 sets of 1 Is there a tempo in this eccentric? Move it as slowly as possible The nordic hamstring curl is an example “What works works” If you move slowly you will move slow, move fast to move fast” Late RTP 6 months out ACL? Overload plays in Their body is avoiding positions needed for power due to injury. Post activation potentiation Bands are a great tool Apply them in multiple planes of motion. You can pull them into an overloaded position Forward-backward lunge with the band Clayton Berrang - Email cberraang@athleteth.com