Rowan University



Michael Boisselle

Prevention and Care Observation Packet

Spring 2008

Assignment #1

Observe a certified athletic trainer complete 4-wrapping/taping procedures. Find out the following information.

1. Name the wrapping/taping

2. Why was the wrapping/taping done

3. Explain how to do the wrapping/taping procedure

4. How long will the person wear this (number of weeks)

Closed Basket Weave

Taping was done to prevent an inversion ankle sprain.

1. QDA/tough skin

2. Heel and lace pads

3. Pre-wrap

4. Anchors

5. Stur-up / horseshoe x3

6. Figure-eights x2

7. Ankle locks x2

8. Close up

The individual will wear this as desired.

Quadriceps Contusion Compression Wrap

Taping was done to control swelling of the quadriceps.

1. Start distal of the thigh with ace bandage later medially overlapping half way each time around in a weaving pattern

2. Creating the greatest amount of tension over the inflamed area.

3. Finish the wrap over the proximal thigh

4. Anchor with 1 ½ non-elastic tape

The individual will wear this for about 2-4 weeks or as desired by the individual athlete.

Patellar Tendon Strap

The patellar tendon strap was used as a treatment for patellar tendinitis.

1. Apply a decent layer of pre-wrap

2. Roll pre-wrap up so that it forms a thick band of wrap

3. Position the roll over the mid portion of the patellar tendon

4. Wrap over with a layer of pre-wrap

5. Apply non-elastic white tape medial laterally to anchor the strap

The individual will wear this strap as long as the individual athlete desires.

Hip Flexor Strain Wrap

This wrap was used to provide compression and moderate support to the hip flexor.

1. Taping block

2. With six inch double elastic wrap, start mid medial thigh and proceed in a lateral direction around the thigh

3. At the proximal thigh, apply the wrap in a medial-to-lateral direction across the lateral hip with a moderate upward pull. Continue to encircle the waist with mild roll tension and return to the proximal thigh

4. Apply one circular pattern around the mid-to-proximal thigh, across the lateral hip with a moderate upward pull, encircle the waist, and return to the proximal thigh. Repeat this pattern one or two times

5. Anchor with non-elastic white tape

The individual will wear this wrap for about 2-4 weeks, or as desired by the individual athlete.

Assignment #2

Observe two injury evaluations; write a one-page paper on each evaluation, which includes the history, what was done during the evaluation, what the diagnosis was, and what you learned in observing the evaluation.

Evaluation

A female athlete came in with pain in her left shoulder. The history for the individual was not entirely thorough she informed the athletic trainer that the pain started the week prior, and hurts during activity. When asked how painful it was on a scale of one through ten she indicated that it was a seven, more of dull pain rather than point tenderness with extreme pain. After asking about the history, the observation did not give any clues to the diagnosis. There was no noticeable deformity in the shoulder nor was there any discoloration or swelling.

The athletic trainer then examined the individual’s range of motion, during active range of motion the individual felt pain and discomfort through extension and flexion. Through passive range of motion pain did not occur during flexion but did however occur during extension. Following the evaluation of range of motion and bilateral comparison, the athletic trainer then went on to strength test, which once again was compared bilaterally. During both flexion and extension the individual experienced pain and was weak to the point where it needed to be taken into consideration in the diagnosis. During bony palpation the individual showed pain at the scapular spine, and the AC joint.

Circulation and neurological tests were within the normal limits. And thus the examiner continued by performing special tests. These special tests included; Hawkins Kennedy(+), O’Brians(+), Speeds(+), Neer(-), apprehension internal rotation(+), Crank(-), and grind(-). After taking into consideration the entire evaluation the final diagnosis for the individual was rotator impingement.

In observing this evaluation I learned what questions to ask the individual, and the proper order in which to assess the injury to prevent pain from lagging into the proceeding test or evaluation. I also learned that it is important to let the injured athlete tell you as much as they can in their own words, rather then just jumping out and saying things that they agree to. Though it is usually necessary to ask the specific questions and explain what is meant by the question in order to get a accurate assessment and correct diagnosis.

Evaluation

A female athlete came into the athletic training room complaining of pain along the lateral side of the knee. Upon the assessment the examiner asked the athlete the basic history questions. As can happen many times, in this particular situation the individual did not know a specific time the injury occurred or a possible mechanism that could of caused it. The individual was feeling fine in the morning practice, but is now experiencing pain while walking, the lateral side of her right knee in particular.

During inspection of the injured knee, there was no deformity that stood out. There also was no discoloration or swelling. As the examiner started to test the range of motion, (which was able to be compared bilaterally) the examiner noticed the iliotibial (IT) band was significantly tight. Through the total passive range of motion the individual was able to perform it fully though through it she experienced pain. A notable observation during the passive range of motion was the knee clicking at 90 degrees of flexion. The examiner then tested the individual for strength mainly at her hamstrings and quadriceps. Both appeared to be fine.

During bony palpation the athlete experienced pain over the lateral femoral epicondyle. Upon further palpation, the individual experienced pain over the lateral collateral ligament (LCL) and lateral meniscus. The following special tests were then performed: Obers(+), Renees(+), Knobles(+), Apleys compression(-), and McMurrey’s(-). Following the assessment and keeping in consideration the tight IT band that was detected earlier on, a diagnosis was made. The examiner diagnosis the individual with IT band friction syndrome and possible injured meniscus. Observing this evaluation taught me how important it is to take all tests into consideration and even if pain occurs in one area, it may be due to an injury that is elsewhere on the individual.

Assignment #3

Observe three treatments, write a one page paper on each treatment, that includes, what the treatment was, why it was being done, and what you learned about the treatment and corresponding injury.

Cryotherapy

Cryotherapy is a common term to describe multiple types of cold application that uses the type of electromagnetic energy classified as infrared radiation. When cold is applied to the skin heat is moved of lost. This process of removing the heat is known as abstraction.

The most common mode of heat transfer with cold application is conduction and evaporation. Cold application for less than fifteen minutes causes immediate skin cooling, cooling the subcutaneous tissue after slight delay, and after a longer delay, cooling muscle tissue. The greater the temperature gradient between the skin and the cooling source, the greater the resulting tissue temperature change. The deeper the tissue there fore varies directly to the duration of application. Cryotherapy is usually applied for 20 to 30 minutes for maximum cooling of both superficial and deep tissues. As I have now learned, the use of a barrier between the ice application and the skin should not be used in treatments with duration less than 30 minutes. The barriers have an affect on heat abstraction.

Cold application leads to vasoconstriction at the cellular level and decreases tissue metabolism, which reduces secondary hypoxia. Capillary permeability and pain are decreased, and the release of inflammatory mediators and prostaglandin synthesis is inhibited. The gate theory of pain hypothesizes that cold inhibits pain transmission by stimulating large diameter neurons in the spinal cord, acting as a counterirritant, which blocks pain perception.

Because vasoconstriction leads to a decrease in metabolic rate, inflammation, and pain, cryotherapy is the modality of choice during the acute phase of injury. Ice application is continued during the first 24 to 72 hours after injury, or until acute bleeding and capillary leakage has stopped. Methods of cryotherapy include ice massage, ice and cryo packs, ice immersion and cold whirlpools, commercial gel and chemical packs, controlled compression units, and vapo-coolant sprays. With each of the previous methods, the individual experiences four progressive sensations: cold, burning, aching, and finally analgesia. I observed this modality used on a number of athletes with various injuries during my observation hours.

Ultrasound

Ultrasound uses high-frequency acoustic waves, rather than electromagnetic energy, to elicit thermal and nonthermal effects in deep tissue to depths of 3cm or more. This transfer of energy takes place in the deep structures with out causing excessive heating of the overlaying superficial structures. The actual mechanism of ultrasound, produced via the reverse piezoelectric effect, converts electrical current to mechanical energy as it passes through a piezoelectric crystal housed in the transducer head.

The vibration of the crystal results in organic molecules moving in longitudinal waves that move the energy into the deep tissues to produce temperature increases, and mechanical and chemical alterations. Thermal effects increase collagen tissue extensibility, blood flow, sensory and motor neuron velocity, and enzymatic activity, and decrease muscle spasm, joint stiffness, inflammation, and pain. On the contrary, non-thermal effects decrease edema by increasing cell membrane and vascular wall permeability, blood flow, protein synthesis, and tissue regeneration, thus promoting the healing process.

Sound waves can be produced as a continuous or pulsed wave. A continuous wave is one in which the intensity stays constant, and a pulsed wave is intermittently interrupted. Continuous ultrasound waves provide both thermal and nonthermal effects, and are used when a deep, elevated tissue temperature is advisable. Pulsed ultrasound and low intensity, continuous ultrasound produces primarily nonthermal effects and are used to facilitate repair and soft tissue healing when a high increase in tissue temperature is not desired.

In the case of my observation ultrasound was being used as a treatment for tendinitis. And another athlete was using to help reduce the swelling in his elbow.

Effleurage Massage

An individual came in with a bad case of DOMS (delayed onset muscle soreness), which seemed to cause excessive swelling of the elbow and forearm. DOMS is a result of starting a new strenuous workout program or just a new workout regiment in entirely and causes extreme muscle soreness in the days following. In this particular case, the individual initially had an extreme decrease range of motion and was instructed to thoroughly stretch particularly while in the shower with hot water. The individual returned with a significant better range of motion and completely pain free. Though swelling continued to increase over four days with out any pain in movement. To help control the inflammation a massage treatment was performed. Massage incorporates manipulation of the soft tissues to increase cutaneous circulation, cell metabolism, and venous and lymphatic flow to assist in the removal of inflammation. As a result massage can help increase range of motion, relieve pain, and reduce edema. To reduce friction, a lubricant is applied to the individual, especially if area of massage contains hair.

The specific type of massage used with this individual was effleurage massage. The gliding motion over the skin is superficial, and involves longitudinal strokes to relax the patient. Applying the technique towards the heart reduces swelling and aids venous return. As compared to other therapeutic massages this variation avoids any attempt to move deep muscles. Following the massage ice was applied.

Assignment #4

Observe a rehabilitation program; write a one page paper on the rehabilitation program. Explain what the injury is, what was part of the rehabilitation program, and what you learned in observing the rehabilitation program.

Rehabilitation Program

An off-season athlete came into the athletic training room complaining about soreness right at the joints of his elbows. After asking a few basic history questions, the main stand out response was that the individual had just started a new weight lifting regiment in the gym three days prior to pain. The athlete had not worked out in some time and was starting back up to get fit for the upcoming season. The diagnosis for the individual was that he had DOMS (delayed onset muscle soreness) and that it was a common effect of the body’s reaction to the new work out regiment. To help relieve the pain and help regain range of motion, the individual was instructed to do proper stretching techniques before and after the lifting. For specifically the elbows, the individual was told and instructed on some techniques on how stretching should be done. These techniques included having an individual assist him on the stretching or to just use a bookcase or desk as leverage for the stretch. Another piece of advice to help facilitate this painful time starting the work out program was to do these stretches while in the shower or after warming up the muscles.

The individual came back and explained that his range of motion has greatly increased, and the pain had subsided. Towards the end of the week he stopped in again with swelling at the elbow. After going to the school infirmary, they sent him to the hospital to rule out infection. X-rays were taken and showed no broken bones or fractures. The conclusion was that it was a part of DOMS and that the swelling just needed to be controlled properly.

This meant that a rehabilitation program would be necessary for the individual to continue to work out and hopefully prevent any injuries that the future may hold. The athlete came in each day and worked on stretching the arm, and did effleurage message to help control the swelling. After the message the individual went through ultrasound. Which was then followed by ice for twenty minutes.

This routine went on for about a week. Throughout the week several strengthening exercises were incorporated. These exercises involved using the putty for five minutes at a time kneading the putty in the palm of the hand constantly squeezing and making a fist. Another exercise technique involved a five-pound dumbbell weight and was curls.

Swelling had completely subsided and complete range of motion was regained in the next week. The individual continued his weight lifting program and has yet come back with any further complications that I know of. The most interesting thing that I took out of this injury was the history questions that were asked. Because at first the reason for swelling was unknown; the athletic training student asked the individual everything he did in the past week, including any new food, drink, or hygiene products. Which was surprisingly detail that would in some cases be beneficial to choosing the correct diagnosis.

Assignment #5

Write a daily log that records your hours and what you observed on a daily basis in the athletic training room.

Day 1:

Today during observation in the athletic training room, I went to baseball practice upstairs in the gym. While I was up there, Mr. Whedon went over PNF exercises with a few of the upper classman. I learned how to manually do the PNF exercises, why they are done, and when it takes place in the rehabilitation program. After watching and learning the technique, I got to actually experience the exercises by being the “patient” for an upper classman, and then vice versa, I got to perform the PNF motions on them. Down in the athletic training room I observed how to make a heel pad for the bottom of the shoe for lacrosse players that had been experiencing shin splints. The day in the athletic training room ended with practicing the numerous taping that were learned in our prevention and care class, and even got advise from some of the upper classman and certified athletic trainers on “tricks” or techniques that they use and find are more helpful to the athlete.

Day 2:

Today was an interesting day in the athletic training room, I observed many things for the first time and learned a lot. I was able to observe a rehabilitation program for a softball player who had just came back from ACL surgery, and was starting rehab. I was able to see what the knee looked like post surgery and was also able to observe how small the incisions were, but also was explained on how they did the surgery. I learned about each ACL surgical technique, allograph and autograph. In this case the individual used the autograph technique and there fore had more swelling. As well as the ACL rehab program, I also observed a few other programs, and watched friction, and effleurage massage. The day ended with a review of the tapings that we were preparing to be tested on in prevention and care.

Day 3:

Today in the athletic training room I I continued the observation of the post ACL surgery athlete do her rehab. Some of the other athletic training students were preparing for a test in there advanced emergency care class, and went over copious scenarios and had to perform the treatment for each. In observing these scenarios I got a glimpse of what to prepare for as I take the class in my future. After the multiple scenarios, we all practiced our tapings; we did this for a good amount of time, until we were comfortable with each. During the taping, it was nice to see how each student was willing to help other classmates. Tonight was a basketball game for the girls, but one player would not make it out to the court, she is waiting for the doctor to come and administer a cortisone shot for her knee. This would be a first for me, and so even though the doctor was running late I had to wait it out to see the procedure done. The doctor came and gave the athlete her cortisone shot for her knee, and gave her instructions to follow for the next few days. I was excited to witness the shot, but once the needle came out I was shocked to see the size. The most interesting thing about the shot was the injection. To see the doctor pin point the area of pain and inject it and around the point was really neat. The wait was well worth it.

Day 4:

Today in the athletic training room I witnessed the numerous lacrosse players come in with shin splints. When I say numerous I mean several girls were in complaining about shin splints. In my time in the athletic training room I witnessed what seemed to be nearly every treatment for shin splints imaginable. Arch tapings were being performed on a few of the athletes, and others were getting heel pads for there shoes. It was interesting to see how different girls responded to different treatments. Some of the girls preferred the arch tapings while other liked the heel pad, and some of them used both. It occurred to me that shin splints is really a tough injury to get rid of and it needs to be taken care of properly the first time or it can become chronic and reoccur often leading to stress fractures. And speaking of stress fractures, one of the athletes with a history of shin splints was a perfect candidate for a fracture. She had a pinpoint localized pain in her shin and was advised to get x-rays. I look forward to seeing the results.

Day 5:

Today was a rather slow day in the athletic training room. The students went to work straightening up the tape and supplies, just to use them while practicing their tapings. The usual athletes came in for their rehabilitation programs and did their treatments. Coleen told us to go over spine board procedure. Many of the other students had learned the proper technique in there classes, but I was not one of those who had learned it. I took the time to talk to Coleen and she helped explain what I was supposed to do. We did this several times, students switching roles each time so that it was not always the same person in charge of the neck brace or stabilizing the neck. It was a true learning experience for me and I learned a lot. After the spine board practice, the students practiced using the vacuum splint on each other and discussed which scenarios it would be necessary to use the splint.

Day 6:

Today in the athletic training room I observed the cybex machine. One of the upperclassman gave a “little seminar” on how the machine is run. He went over all the different things that the cybex can be used for and showed us how to enter athletes information into the computer system so that it would be possible to track there progress. It was really neat when we ran the machine on a student and got to see the charts come up on the computer screen, it was interesting how the chart was a “lie detector” it was able to let the athletic trainer know if and when the athlete was cheating or not trying their hardest. After we went through some of the different exercises that can be performed, we went over the calibration process. I was able to take part in this process and make the adjustments on the seat and the weights to calibrate the machine. I am fortunate to have access to this machine and be able to observe the different ways in which it is useful in the rehabilitation progress. And I even got a chance to try it out, it is no easy task, especially when there is no way to cheat without the instructor knowing.

Day 7:

Today in the athletic training room, observation started with basketball athletes coming in for the pre-practice treatments. A few of the athletes had their ankles taped. The taping was closed basket weave to prevent inversion ankle sprains. After the basketball players got their treatments we went over some tapings before heading upstairs to the practice. Once upstairs, I “tested” the students assigned to basketball and asked where to find each piece of equipment in their kit, in doing so I learned about each essential part of the kit and learned under what circumstances each treatment would be done. We then went over how to take blood pressure; there were a few of us with only the one kit so we took turns for the time being. After the mini lesson on taking blood pressure, we all headed down stairs and went over some special tests. Each of these special tests were fairly new to me, and therefore an excellent learning experience.

Day 8:

Today in the athletic training room a number of athletes came in for treatment for their sports. We had one individual that was recovering from ACL reconstruction surgery, and others with minor injuries. Many athletes stopped in to get stretched and in observing I learned proper technique to insure that the athlete gets the most out of the stretches. Once again we went over taking blood pressure, but this time I was able to get more time in practicing it, and was thoroughly educated on how to take the readings. I was then able to practice multiple times on other students. Many of the seniors were reviewing for there BOC exam and thus I got a chance to listen in on some of the different questions that may be asked during the exam and I was even able to answer some of them correctly. The observation ended with practicing each taping that I have learned this semester and meeting the expectations of Coleen for each before proceeding to the next taping. Following the completion of each taping we cleaned up the tables shut everything down and called it a night.

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