Sports Medicine Broadcast

Learn about scoliosis rehab with Lauren Ferrante, PT, DPT, OCS. Explore home exercises, manual therapies, and AT tools for scoliosis. Q: What are the most important home exercises for scoliosis? A: Key home exercises focus on spinal mobility, especially for those who sit frequently. Cat-cows and thoracic rotation are crucial. Depending on comfort level, core activation exercises like supine marches or dead-bug isometrics are beneficial. When supine, tactile cues help maintain spinal symmetry. Bridges or modified side planks are good starting points, with progression as needed. Q: Which scoliosis treatment method is best for high school age, considering the Schroth Method helps the 10-15 age group? A: The Schroth Method can be used for older populations, but it is generally less effective for high school age individuals compared to younger ones. For this age group, focusing on functional core strengthening can also be beneficial. Q: Are Pilates or yoga safe and recommended for young athletes with scoliosis? A: Yes, Pilates and yoga are highly recommended for individuals with scoliosis, including young athletes. These activities promote continued mobility and strength, which are vital for managing scoliosis. The most important aspect is to find an activity they enjoy and consistently engage in it. Q: What manual therapies are effective for scoliosis, and is dry needling helpful? A: Effective manual therapies include thoracic gapping and rib mobilizations, particularly in a side-lying position to encourage rib expansion. The specific therapy depends on the patient’s individual needs and curve patterns. Dry needling is not frequently utilized for scoliosis treatment according to the provided information. Q: How often are lordotic curves seen in individuals with thoracic scoliosis? A: Lordotic curves are quite common in individuals with thoracic scoliosis. If a person has a mid-thoracic curve, their body often adjusts by developing a compensatory lordotic curve. Therefore, this presentation is observed frequently. Q: How do current trends, such as phone and gaming use, contribute to setbacks or overcorrection in scoliosis? A: The impact of phone and gaming trends on scoliosis setbacks depends on individual patient motivation and activity levels. For athletes, it’s often less of an issue, as it’s unrealistic to maintain one position for extended periods. For minimally active individuals, parental encouragement to move around every hour, regardless of the activity, is important. Q: How often are active populations braced for scoliosis? A: Braces for scoliosis are typically prescribed by pediatric orthopedic specialists. For junior high and high school-aged children, as they mature, the need for braces often decreases, and they may not be in them very much. Q: What are the three most important practical tools for Athletic Trainers (ATs) regarding scoliosis? A: The three most important practical tools for Athletic Trainers when addressing scoliosis are observation for signs of scoliosis, implementing exercises on a mat or table, and utilizing a wall for exercises with minimal equipment. Contact Us Jeremy Jackson Benjamin Stephenson Layci Harrison Mark Knoblauch Ashlyne Elliott Leslie Bennett Sponsor List Frio Hydration – Superior Hydration products. Xothrm – Best heating pad available – Use “SMB” or email info@xothrm.com and mention the Sports Medicine Broadcast. Donate and get some swag (like Patreon but for the school) HOIST – No matter your reason for dehydration, DRINK HOIST MedBridge Education – Use “TheSMB” to save some money, be entered in a drawing for a second year free, and support the podcast. Marc Pro – Use “THESMB” to recover better. Athletic Dry Needling – Save up to $100 when registering through our link.

ACL Reconstruction, Repair or Regrowth…which is right for you? Chris Antonelli has worked with a lot of BEAR implant patients for several years. Thank you, Miach Orthopedics, for pushing progress. Chris Share your AT Story?   Purdue for undergrad Baseball injuries led me to discover sports medicine Worked with a bunch of sports in college  During undergrad   Offer outreach AT services Bare bones: What is BEAR, and why should an athlete choose it? It is not a reconstruction; it is a repair technique. Decreased pain Less swelling Earlier function Feel better earlier The Ben version: Is skeletal maturity a strict requirement? How does it look in adolescents? It is now approved for skeletally immature Exercises? Any differences in 0-6weeks? First 4 weeks, they are partially weight-bearing instead of full weight-bearing The ligament is weaker at first Limit the flexion range of motion They will be braced for 6 weeks, and then a functional brace Does it affect quad inhibition? They feel really good, really early. Quads are fantastic, really on. What does the evidence say about timelines and re-tear compared to autografts? After the first 12 weeks, it is pretty much the same as others, with a 9-12 month full return to participation. Slower, more conservative. BFR and NMES for the first 8 weeks Once they have a good ROM, load them with an open kinetic chain. LAQ with BFR. 12 weeks, I do some isometric testing Patient education –  Educate and measure swelling Unable to get to full TKE It looks like meet boiled spaghetti, but we want it to become unboiled What about 5-10 years out? We still need more cases and research,h but it looks good with what we have What research is lacking that we should keep an eye on? Specific ACL autograft techniques vs BEAR Is BEAR becoming more accessible? Does insurance affect who can get it? No insurance issues with BEAR implants It is being sought out by a lot of people, and until recently, it was not available for high school students. More surgeons are learning the technique and process. Contact: Chris Antonelli cantonelli42@gmail.com Miach Ortho –  Ben Stephenson Jeremy These people LOVE Athletic Trainers and help support the podcast: Frio Hydration – Superior Hydration products. Xothrm – Best heating pad available – Use “SMB” or email info@xothrm.com and mention the Sports Medicine Broadcast Donate and get some swag (like Patreon but for the school) HOIST – No matter your reason for dehydration DRINK HOIST MedBridge Education – Use “TheSMB” to save some money, be entered in a drawing for a second year free, and support the podcast. Marc Pro – Use “THESMB” to recover better. Athletic Dry Needling – Save up to $100 when registering through our link.

Contact Us Jeremy Jackson Benjamin Stephenson Layci Harrison Mark Knoblauch Ashlyne Elliott Leslie Bennett Sponsor List Frio Hydration – Superior Hydration products. Xothrm – Best heating pad available – Use “SMB” or email info@xothrm.com and mention the Sports Medicine Broadcast. Donate and get some swag (like Patreon but for the school) HOIST – No matter your reason for dehydration, DRINK HOIST MedBridge Education – Use “TheSMB” to save some money, be entered in a drawing for a second year free, and support the podcast. Marc Pro – Use “THESMB” to recover better. Athletic Dry Needling – Save up to $100 when registering through our link.

We would love to hear your stories of Dr. Josh Yellen’s impact on your life and career. Help support the future of Athletic Training. Contact Amari – Ammercad@cougarnet.uh.edu

AT the end of the Bench by Dr. Robert Bradley is a good read for prospective and new Athletic Trainers to the profession. With 32 years of experience as an AT, Dr. Bradley has some advice and wisdom for those who are not so new to the profession as well. Robert, what is one of your favorite stories to share from your AT career? When I was a student, the sidelines were muddy, and it was pouring rain.  SE Missouri University Assisting a softball player after recovering from a stroke at the age of 19.  She was able return to play eventually. Take us back to the very beginning. What is your first memory of an Athletic Trainer? I was cut from the basketball team as a junior in high school.  I went to a cramer first aider camp and the rest is history. What made you become an Athletic Trainer? My father was a coach, and I understood that side of the game. I did not enjoy the competition part. This was the best of both worlds for me. How long until the “honeymoon” period was over for you? Worked at a high school in Saint Louis Then went to college athletics When I stepped into the administrative role, things changed for me. How do we stay in the “honeymoon phase”? Depends on your desires If you just want to be in the traditional role and avoid the admin work, then you may stay in that phase forever. Why did you switch?  I had a talent for organization and administration. I still cover sporting events at the local college. What do you wish you knew going into AT? The chapters that were most fun to write Coaches – I want ATs to understand the coach’s perspective Contact: Robert Bradley – rlbatc@gmail.com Benjamin Stephenson – @_benstephenson on IG These people LOVE Athletic Trainers and help support the podcast: Frio Hydration – Superior Hydration products. Xothrm – Best heating pad available – Use “SMB” or email info@xothrm.com and mention the Sports Medicine Broadcast Donate and get some swag (like Patreon but for the school) HOIST – No matter your reason for dehydration DRINK HOIST MedBridge Education – Use “TheSMB” to save some money, be entered in a drawing for a second year free, and support the podcast. Marc Pro – Use “THESMB” to recover better. Athletic Dry Needling – Save up to $100 when registering through our link.

Learn about sudden cardiac death in athletes, including screening, return-to-play, misconceptions, and insights for athletic trainers. Q: What is one key takeaway for athletic trainers regarding sudden cardiac death? A: It is crucial for athletic trainers to utilize available screening tools. When an athlete provides positive answers during screening, it’s essential to follow up thoroughly to ensure appropriate medical evaluation occurs. This approach helps identify potential cardiac issues early. Q: What are the clearance and return-to-play criteria for athletes diagnosed with or being treated for a heart condition? A: Clearance and return-to-play criteria vary based on the individual patient and the specific cardiomyopathy and its severity. While many athletes may face sport restrictions, some cases allow for participation if evaluations are thorough. Each situation requires careful consideration, as there is no universal “cookbook” approach. Q: What are the most common misconceptions about sudden cardiac death in athletes? A: A common misconception stems from fear regarding athletes collapsing on the court. It’s important to understand that it’s impossible to guarantee 100% prevention. Comprehensive workups are necessary to identify rare factors contributing to sudden cardiac death, as some issues might not always be immediately apparent. Q: What are the updated incidence values and trends in male and Black athletes regarding sudden cardiac death, and what explains these patterns? A: Multiple factors contribute to these patterns, including genetics and predisposing health conditions. Socioeconomic status, affecting access to healthcare providers and cardiologists, also plays a significant role. Often, primary care physicians manage a large population due to limited access to specialists, and missed family screenings for cardiomyopathy can impact these variables. Q: What are the barriers when younger athletes are unable to explain what is happening to them? A: Effective communication with younger athletes is key. Teenagers, for instance, may be reluctant to express their symptoms clearly in a clinic setting, especially if they fear being told they cannot play. Instead of general questions like “Have you experienced chest pain?”, ask specific questions about the type of pain (e.g., sharp, moving). It is also the healthcare provider’s responsibility to perform thorough exams and order proper tests, such as EKGs or ultrasounds, to avoid missing critical information. Q: Is there a commonly overlooked response when screening athletes? A: A significant red flag is when athletes, for various reasons, fill out screening forms themselves and then change their answers, or when forms are left blank or show erasures. Following up with specific questions about why they changed or erased an answer, and providing education, is crucial. Q: What inspired you to focus on sudden cardiac death in athletes? A: My personal experience as an athlete growing up in a small Texas town, where sports were integral, profoundly shaped my life, teaching me multitasking, leadership, and competitiveness. As a mother with multiple children involved in competitive sports, I understand the physical and mental benefits. My inspiration stems from wanting to ensure their safe participation. Q: What ethical dilemmas arise when individuals refuse genetic testing? A: When requesting genetic testing, it’s vital to explain to families why the test is necessary and how it can help. Many are more receptive when they understand it’s a narrow test, not a full genetic profile, and how it can benefit their children. Ultimately, respect their decision and use available information to provide the best care without undue pressure. Q: Is there anything else athletic trainers should know about sudden cardiac death? A: I am highly impressed by the athletic training field, particularly athletic trainers’ knowledge, dedication to children, and proficiency in CPR and AED use. While physicians have the support of nurses and other healthcare professionals, athletic trainers often perform life-saving interventions on the field independently, which is truly commendable. Q: What management or monitoring strategies are suggested for children removed from sports due to cardiac conditions? A: Be mindful of athletes who are removed from sports, as they may feel a sense of loss after being part of a team. If time permits, maintain contact and explore new ways to keep them involved, possibly in a different role within the team or organization. Collaborate with other team members to help the athlete transition and remain connected. Contact Us Jeremy Jackson Benjamin Stephenson Layci Harrison Mark Knoblauch Ashlyne Elliott Leslie Bennett Sponsor List Frio Hydration – Superior Hydration products. Xothrm – Best heating pad available – Use “SMB” or email info@xothrm.com and mention the Sports Medicine Broadcast. Donate and get some swag (like Patreon but for the school) HOIST – No matter your reason for dehydration, DRINK HOIST MedBridge Education – Use “TheSMB” to save some money, be entered in a drawing for a second year free, and support the podcast. Marc Pro – Use “THESMB” to recover better. Athletic Dry Needling – Save up to $100 when registering through our link.

Explore a complex case of Thoracic Outlet Syndrome, double crush, & triple crush injuries. Learn about diagnosis, treatment, & patient support. Q: Overview of Neck, Nerve, or Both? A: My wife experienced numbness in her upper extremities. As an athletic trainer (AT), I initially suspected Thoracic Outlet Syndrome (TOS). She eventually sought medical attention and was diagnosed with TOS. Conservative treatment, including medication and a home exercise program, was recommended. However, therapy seemed to worsen her symptoms. An MRI of the vascular system came back normal, except for a benign thyroid mass. A cervical MRI revealed stenosis in C5, C6, and C7, which, when combined with her other symptoms, provided clarity. I consulted a spine surgeon, who advised exhausting conservative options before considering surgery for insurance coverage. My wife, who has a fear of anesthesia, opted for pain management and received injections. An EMG to rule out carpal tunnel syndrome indicated 70% carpal tunnel involvement. An upper extremity specialist diagnosed a double crush injury, meaning nerve compression at two sites. She underwent left-side carpal and cubital tunnel release, followed by a two-level cervical fusion. Post-surgery, she regained sensation in her pinkies. The right side was subsequently treated. She experienced relief for about a year before numbness recurred. Another round of CT, MRI, and EMG scans returned normal. Pain management suggested a shoulder issue, leading to an MRI of the shoulder. While the report mentioned a slight rotator cuff tear, a physician who reviewed the scans deemed her shoulder pristine. This doctor’s examination of her neck, however, exacerbated her symptoms, leading to a diagnosis of lower brachial plexus TOS. Despite my initial concern about the previous treatments, the doctor affirmed that the cervical fusion was necessary. A C8 nerve block did not provide relief but offered further diagnostic information. We were then referred to a specialist in Dallas, where a diagnostic nerve block in the scalenes provided immediate relief. Months later, Botox injections were administered for extended relief. The doctor’s words, “How does it feel to not be crazy?” significantly validated her experience. She then underwent a first rib removal on the left side, which resulted in an 11-day hospital stay with complications including two chest tubes, a needle aspiration, and 100cc of fluid in the pleural cavity. Upon returning home, she began physical therapy but developed shortness of breath with deep breaths due to a costochondral fracture, likely from the chest tube or aspiration. She is currently awaiting a consultation for ultrasound injections to address this. The journey continues. Q: What inspired you to share this story? A: The primary motivation was to share the complex journey and its takeaways. This case involved a “triple crush” — compression at the first rib, cubital tunnel, and carpal tunnel. A key takeaway is the importance of acknowledging when you “don’t know, but know the next step.” In healthcare, we often focus on obvious issues, but a broader perspective is often needed before returning to specific concerns. It’s also crucial to acknowledge the psychological toll on patients without answers, highlighting the profound impact of chronic pain. Q: You mentioned how emotionally draining the journey was. What advice do you have for clinicians to support patients? A: Remind patients that recovery is an “ultramarathon, not a sprint.” Reinforce this message, as other healthcare professionals will likely echo it. Sometimes, when my wife is in pain, she doesn’t want to discuss it, and that’s acceptable as long as I am there to support her. The doctor’s validation, “How’s it feel to not be crazy?” significantly improved her emotional well-being. Supporting patients in seeking further opinions is also vital. Q: Overlapping issue on a personal level, how did you navigate the multiple diagnoses? A: My ability to navigate this well stems from my access to top medical professionals through my profession. My connections as an athletic trainer allowed me to consult doctors and seek referrals. While they may not know specific TOS treatments, they can guide us to the appropriate specialists. Q: Any difficulties separating the Athletic Trainer (AT) role from the husband role? A: There were no difficulties in separating the AT from the husband role. My wife knew me as both from the beginning of our relationship, so there was no separation or conflict. Contact Us Jeremy Jackson Benjamin Stephenson Layci Harrison Mark Knoblauch Ashlyne Elliott Leslie Bennett Sponsor List Frio Hydration – Superior Hydration products. Xothrm – Best heating pad available – Use “SMB” or email info@xothrm.com and mention the Sports Medicine Broadcast. Donate and get some swag (like Patreon but for the school) HOIST – No matter your reason for dehydration, DRINK HOIST MedBridge Education – Use “TheSMB” to save some money, be entered in a drawing for a second year free, and support the podcast. Marc Pro – Use “THESMB” to recover better. Athletic Dry Needling – Save up to $100 when registering through our link.

Expert insights on athlete nutrition timing: GI issues, RED-S, PCOS, and fueling strategies. Learn about tailored snack recommendations. Q: What recommendations do you have for athletes experiencing amenorrhea or relative energy deficiency in sport (RED-S)? A (Dr. Curtis): While not a typical GI condition, amenorrhea and RED-S require a multidisciplinary approach. Often, medication is prescribed to induce a period, but this does not resolve underlying hormone imbalances or decreased bone density. These conditions frequently arise from an athlete’s energy deficiency, such as a marathon runner not increasing fuel intake to match activity, leading the body to prioritize survival over non-essential functions like menstruation. Q: How can athletes add more fuel to help resolve amenorrhea? A (Poole): It’s a myth that athletes should not get their period; it is not normal. Addressing overall energy intake is crucial. In severe cases, decreasing activity while increasing fuel might be necessary. We often work with athletes who are injured or returning to sport, which provides an opportune time to address their fueling needs. Q: How do you address athletes dealing with PCOS and stress fractures? A (Dr. Curtis): The culture of sports often pressures athletes toward specific body images or weight classes, which is unhealthy. We must educate athletes that a balanced diet is acceptable and that restrictive diets are not always necessary. Coaches also play a role in fostering a healthier environment. Q: How do you approach discussing sensitive topics like nutrition and body image with athletes? A (Dr. Curtis): As a former pediatric sports medicine doctor, I learned the importance of creating a trusting and safe environment. While it’s harder to have parents leave the room now in full sports medicine, fostering trust is key. A (Poole): We focus on the athlete’s performance goals, as health often isn’t the primary motivator for adolescents. We seek out what truly motivates them to achieve their best performance through proper nutrition. Q: What are the best snack recommendations for athletes? A (Bri Poole): Snack recommendations are highly individualized based on what works and what an athlete enjoys. Simple, easily digestible options like GoGo Squeez are generally safe choices. Q: Are there specific snacks you recommend for gastrointestinal (GI) comfort during exercise? A (Dr. Curtis): I don’t have specific go-to snacks; the focus is on what an individual athlete likes and what doesn’t cause GI distress. Suggesting foods they are unwilling to eat can lead to non-compliance. A (Poole): Simple carbohydrates are typically easy on the GI system around exercise. It’s best to stick with foods the athlete has consumed before. Liquid carbohydrates can be a good option as they may sit better for some. While many believe “sugar is bad,” simple sugars are the body’s preferred fuel source during exercise. Q: Should athletes track their food intake? A (Poole): Some athletes have higher or different energy needs, even if they aren’t playing intensely. Athletes generally have elevated caloric demands. It’s perfectly fine for them to eat snacks, especially when readily available, such as on the sidelines. Q: How do you approach nutrition planning for athletes from diverse cultural backgrounds or those who observe religious practices like Ramadan? A (Poole): Always approach with an open and curious mindset. Ask questions to understand cultural practices better, especially regarding fuel timing within non-fasting windows. Work closely with the athlete to create a tailored plan. A (Dr. Curtis): Meet athletes where they are; you cannot simply forbid them from fasting. I am willing to write letters to coaches if training times need to be adjusted to accommodate an athlete’s practices, ensuring they can continue to play safely. Q: How does pre-exercise nutrition differ for a morning lift versus a morning run? A (Poole): Many runners prefer not to eat before a run. For shorter runs (e.g., 5 miles or 3k), it can be acceptable if the athlete had sufficient fuel the day prior and will refuel adequately post-run. However, for exercise lasting 50-90 minutes or longer, pre-exercise fuel is essential, particularly for running due to its impact on bone resorption. The specific goals of the runner (e.g., marathon training) also influence recommendations. Contact Us Jeremy Jackson Benjamin Stephenson Layci Harrison Mark Knoblauch Ashlyne Elliott Leslie Bennett Sponsor List Frio Hydration – Superior Hydration products. Xothrm – Best heating pad available – Use “SMB” or email info@xothrm.com and mention the Sports Medicine Broadcast. Donate and get some swag (like Patreon but for the school) HOIST – No matter your reason for dehydration, DRINK HOIST MedBridge Education – Use “TheSMB” to save some money, be entered in a drawing for a second year free, and support the podcast. Marc Pro – Use “THESMB” to recover better. Athletic Dry Needling – Save up to $100 when registering through our link.

Learn about emergency preparedness in youth sports, focusing on cardiac safety, the Project Adam initiative, and the status of the “Heartsafe” program with Tom Woods. Q: What is the 10-second version of focusing on cardiac emergency preparedness? A: Review statistics on sudden death in young athletes. Sudden cardiac arrest is the leading cause of death. Target the most likely areas where incidents occur and prioritize time and equipment-sensitive responses. Q: How did the Damar Hamlin incident negatively impact perceptions of youth sports safety? A: Some may falsely believe youth athletes are inherently safe because a highly prepared incident was effectively managed in the NFL. However, youth settings lack the extensive resources and numerous providers available in professional sports. This incident highlights the need to increase effective response capabilities and empower more individuals to provide care. Q: Is youth sports a bigger industry or does it bring in more money? A: When including grassroots sports, the financial investment in youth sports is substantial. It is crucial to make reasonable investments in equipment, procedures, and policies that maximize safety and efficient use of time to ensure overall safety. Q: Do club sports typically have athletic trainers (ATs) or automated external defibrillators (AEDs)? A: This is a critical point; clubs should invest more in youth safety. Efforts like Bob Marley’s network aim to bring ATs to these settings. More needs to be done beyond large tournaments, extending to daily operations, especially given that larger clubs may have many teams practicing simultaneously. Q: What steps are needed for club sports to align on safety protocols? A: Project Adam and recent legislation offer programs specifically designed to make youth sports cardiac safe. These initiatives provide a framework for clubs to enhance their emergency preparedness. Q: What are the specifics of Project Adam? A: Our school became involved with Project Adam after recognizing areas needing attention in our setting. It offers a systematic approach to achieving cardiac safety. Texas Children’s Hospital (TCH) is an affiliate site for Project Adam, providing numerous resources. Q: Why might Project Adam not be widely known? A: The exact reason is unclear. However, presentations like this provide an opportunity to spread the message. Discussions with directors at TCH and Cook Children’s indicate that some areas, like Dallas-Fort Worth (DFW), are more involved. We need to disseminate this information, especially with increased requirements for cardiac responsiveness. Q: How do schools or districts achieve “Heartsafe” program status? A: Achieving “Heartsafe” status involves a step-by-step process through Project Adam. Organizations register, complete a checklist, and consult with directors and affiliate contacts for questions. Upon completion, they receive “Heartsafe school/program/district” designation. Q: Is the “Heartsafe” program similar to SafeSport and currently in process? A: Yes, it is similar to SafeSport and is an ongoing process. Q: What legislative action is impacting emergency preparedness? A: House bills have been passed and are expected to take effect on September 1st, following the governor’s signature. This legislation aims to enhance cardiac responsiveness. Contact Us Jeremy Jackson Benjamin Stephenson Layci Harrison Mark Knoblauch Ashlyne Elliott Leslie Bennett Sponsor List Frio Hydration – Superior Hydration products. Xothrm – Best heating pad available – Use “SMB” or email info@xothrm.com and mention the Sports Medicine Broadcast. Donate and get some swag (like Patreon but for the school) HOIST – No matter your reason for dehydration, DRINK HOIST MedBridge Education – Use “TheSMB” to save some money, be entered in a drawing for a second year free, and support the podcast. Marc Pro – Use “THESMB” to recover better. Athletic Dry Needling – Save up to $100 when registering through our link.

Explore expert tips for post-operative ACL rehab, including avoiding pitfalls like lacking extension & recommended biofeedback units. Q: What is your favorite phase of post-operative care for ACL repair? A: Phase 2 is a favorite because the athlete is getting off the table, which is exciting both mentally and physically. During this phase, significant gains are made, and progress continues toward returning to running. Q: What is your biggest tip to avoid pitfalls, such as lacking extension, in post-operative care? A: Consistently checking and actively feeling for extension daily is crucial. Make it a habit and an integrated part of the treatment flow to catch any issues early. Even a little bit of load when athletes start doing more of their daily activities can affect extension, so early detection is key. Q: Is lacking extension from one treatment to the next a red flag? A: It is not necessarily a red flag, but it should definitely be noted. This observation prompts consideration of what might have changed between sessions that could have caused the lack of extension. For example, it might indicate that too much activity was introduced. Q: Should fibular head mobilizations be immediately used for lacking extension? A: No, one should not immediately jump to using fibular head mobilizations. However, they can be a successful intervention in certain cases. Q: Can this ACL rehabilitation program be used for other surgeries? A: The framework of this ACL rehabilitation program can definitely serve as a guide for other knee surgeries. However, modifications are necessary based on the specific structures that have been surgically altered. For example, a meniscus repair would require avoiding weight-bearing, unlike an isolated ACL reconstruction. Q: What biofeedback units do you recommend? A: I recommend Mtrigger. It’s an app-based unit with an easy setup, and it can be used more functionally beyond just table exercises. Additionally, it is versatile and can be applied in various other post-operative cases. Contact Us Jeremy Jackson Benjamin Stephenson Layci Harrison Mark Knoblauch Ashlyne Elliott Leslie Bennett Sponsor List Frio Hydration – Superior Hydration products. Xothrm – Best heating pad available – Use “SMB” or email info@xothrm.com and mention the Sports Medicine Broadcast. Donate and get some swag (like Patreon but for the school) HOIST – No matter your reason for dehydration, DRINK HOIST MedBridge Education – Use “TheSMB” to save some money, be entered in a drawing for a second year free, and support the podcast. Marc Pro – Use “THESMB” to recover better. Athletic Dry Needling – Save up to $100 when registering through our link.

Get insights on chest injuries & emergencies from ER physician Dr. Dacia Ticas. Learn about red flags and vital info for athletic trainers. Q: What drew you to emergency medicine, particularly regarding chest injuries and emergencies? A: I liked everything and wasn’t sure what to commit to. Emergency medicine allowed me to experience a bit of everything, including a wide range of chest injuries. Q: As an ER physician, what makes you nervous, especially concerning severe chest injuries in children? A: Pulseless children are concerning. Severe cases with children, such as swelling or edema of the airway where a cricothyrotomy might be necessary, are also very serious. Q: For athletic training, what are red flags indicating something is truly wrong with an athlete, beyond just being out of shape, regarding potential chest injuries? A: Being out of shape typically presents as shortness of breath without actual struggle or severe chest pain. Red flags for chest injuries include pale or cyanotic appearance, complaints of severe chest pain, and a visible struggle to breathe. Q: Is an on-field ultrasound something athletic trainers can perform, or is a physician required for assessing chest injuries? A: A physician would be required. While we wish it were seen more often, on-field ultrasound has tremendous value in clarifying life-threatening chest injuries. Q: As athletic trainers are the initial contact for chest injuries, what essential information do you need from us? A: We will conduct our routine workup regardless. Key information includes what actually happened—e.g., getting hit in the throat versus the chest—whether they collapsed or lost consciousness, and how the patient initially presented and communicated their complaints. Q: What kind of chest injuries might take a day or two to fully manifest or be definitively diagnosed? A: Cardiac and pulmonary contusions can take time to develop. Life-threatening issues are typically identified through labs on the day of the incident. Q: Can you explain Commotio cordis in the context of chest injuries? A: Commotio cordis involves the ventricles going out of whack due to a flux of ions being disrupted, which is a chemical issue. This happens in a fraction of a second, as highlighted by the Damar Hamlin incident, which brought athletic training to the forefront for chest injuries. Q: When an athlete experiences chest pain after a hard tackle, when is immediate removal necessary, and when can we “wait and see” for bigger issues related to chest injuries? A: Often, if you ask an athlete if they can return to play a few plays later, they might indicate they cannot or develop a specific spot of noticeable pain. Lingering pain for a few plays, rather than generalized pain, may be a sign for removal due to a bigger issue, particularly with chest injuries. Q: Could you share a surprising ER story related to chest injuries? A: There are many stories. Early in my career, seeing a 4×4 through a chest wall, yet the internal organs were intact, was shocking. As I progressed, medical mysteries became more enticing. DJ Harden’s aortic injury after a chest hit, and assessing patient consciousness and bilateral pulse equality, are all crucial in emergency medicine for chest injuries. Contact Us Jeremy Jackson Benjamin Stephenson Layci Harrison Mark Knoblauch Ashlyne Elliott Leslie Bennett Sponsor List Frio Hydration – Superior Hydration products. Xothrm – Best heating pad available – Use “SMB” or email info@xothrm.com and mention the Sports Medicine Broadcast. Donate and get some swag (like Patreon but for the school) HOIST – No matter your reason for dehydration, DRINK HOIST MedBridge Education – Use “TheSMB” to save some money, be entered in a drawing for a second year free, and support the podcast. Marc Pro – Use “THESMB” to recover better. Athletic Dry Needling – Save up to $100 when registering through our link.

Guided practice was the theme for Chris Greenleaf and Mary Williams as they joined Ben and Jeremy at the Sports Medicine Update. Being a preceptor is a growing experience, and the best way I know to grow is to ask experts how they do it. Contact Us Jeremy Jackson Benjamin Stephenson Layci Harrison Mark Knoblauch Ashlyne Elliott Leslie Bennett Sponsor List Frio Hydration – Superior Hydration products. Xothrm – Best heating pad available – Use “SMB” or email info@xothrm.com and mention the Sports Medicine Broadcast. Donate and get some swag (like Patreon but for the school) HOIST – No matter your reason for dehydration, DRINK HOIST MedBridge Education – Use “TheSMB” to save some money, be entered in a drawing for a second year free, and support the podcast. Marc Pro – Use “THESMB” to recover better. Athletic Dry Needling – Save up to $100 when registering through our link.

Learn about facial injury red flags, CSF identification, EAP essentials, and return-to-play guidelines for athletes from Dr. Rehal Bhojani. Q: What are the red flags for hematomas? A: Protocols from SCAT6 and other guidelines for hematomas or hemorrhages emphasize watching for loss of consciousness (LOC), altered mental status, and vomiting. Quickly identify these signs to avoid missing late concussions or other critical issues. Ensure the mechanism of injury (MOI) aligns with the trauma; diagnosis is challenging if it doesn’t. Q: How can CSF be identified, and what is the “halo sign” red flag? A: The halo sign, also known as the ring sign, remains the best indicator for identifying cerebrospinal fluid (CSF). CSF is distinct: it has a clear-to-mucous color, is super thin, lighter than water, and does not mix with other fluids. For instance, a soccer player initially diagnosed with a concussion showed a bloody nose and consistent halo sign post-game, necessitating immediate emergency room referral. Q: What essential elements should be added to an Emergency Action Plan (EAP)? A: EAPs are becoming more comprehensive, focusing on three key areas. First, ensure resource accessibility by including contacts for ENTs, dentists, and eye doctors. Second, review the EAP regularly, two to three times a year, rather than just annually, using past injury knowledge to proactively improve it. Third, if using AI to draft EAPs, meticulously verify all listed resources. Q: What items should be included in kits for eye and tooth injuries? A: For eye and tooth injuries, kits should include 4×4 gauzes, an otoscope, a “Save a Tooth” system, eyedrops, nasal tampons, and Afrin. Physician-approved medications should also be added, along with an ENT kit, which is available online. Q: What are the risks and benefits of athletic trainers performing sutures on the field? A: On-field suturing depends on the location and type of laceration, with the cause (e.g., metal object) being crucial due to potential tetanus considerations. Athletes often return to play the same day with sutures. For facial lacerations, specific types and sizes of sutures are used, but caution is advised near the eye. Eyebrows and the skull are generally suitable for suturing if no underlying fracture exists. Control bleeding and inform athletes of the risks associated with playing with sutures; safety is paramount. Q: When can athletes return to play after tooth injuries? A: For primary (baby) teeth, if no secondary tooth injury is suspected, return to play (RTP) is generally straightforward. However, secondary tooth injuries involving complex factors can lead to lasting effects. It is important to document whether the injury involves primary versus permanent teeth. For younger children, involve parents to understand the mechanism of injury and the potential for future crown and root fractures. Q: What current sports medicine trends should recent graduates be aware of or learn in the classroom? A: Sports medicine is constantly evolving, with increased pressure for accurate decision-making. Recent graduates need to be proficient in current literature and comfortable with shared decision-making and escalating care. As athletic trainers often serve as primary sports medicine providers, they require broad skills across various domains. Q: How can these emerging sports medicine competencies be effectively taught? A: Teaching these competencies is challenging due to the need for comprehensive exposure. Educational methods vary by setting, and the field has expanded significantly. Training provides a broad scope, so it’s important not to be narrow-minded. Past experiences remain relevant, and post-training, continuous reading and skill refinement are crucial. In a controlled educational environment, students should learn as much as possible, as quickly as possible, to prepare for real-world practice. Q: What topics are covered in today’s breakout session? A: Today’s breakout session focuses on facial injuries, incorporating practical eye, ear, and nasal examinations. The session emphasizes that history-taking accounts for 80% of a diagnosis, with the physical examination comprising the remaining 20%. Contact Us Jeremy Jackson Benjamin Stephenson Layci Harrison Mark Knoblauch Ashlyne Elliott Leslie Bennett Sponsor List Frio Hydration – Superior Hydration products. Xothrm – Best heating pad available – Use “SMB” or email info@xothrm.com and mention the Sports Medicine Broadcast. Donate and get some swag (like Patreon but for the school) HOIST – No matter your reason for dehydration, DRINK HOIST MedBridge Education – Use “TheSMB” to save some money, be entered in a drawing for a second year free, and support the podcast. Marc Pro – Use “THESMB” to recover better. Athletic Dry Needling – Save up to $100 when registering through our link.

Dr. Dominic Maneen shares insights on OMT in sports medicine, covering his AT to DO transition and OMT applications for common conditions. Q: How did you transition from an Athletic Trainer (ATC) to a Doctor of Osteopathic Medicine (DO)? A: I transitioned to practicing sports medicine without surgery, as that field didn’t align with my interests. I explored osteopathic medicine, identifying the core difference between DOs and MDs as a dedicated course in osteopathic principles. I maintained my athletic training certification to foster understanding and collaboration with ATCs, and a second course focusing on the musculoskeletal system further ignited my passion. During medical school, I also pursued an MBA, gaining insights into medical billing. Q: Can you describe your athletic training (AT) experience at HBU? A: I completed my undergraduate studies at UT, then worked as an ATC for baseball and softball at HBU. I entered the profession serendipitously, drawn by the phrase “sports medicine.” It required rapid maturation, as I assumed an adult role despite being only slightly older than the athletes. I collaborated with Richy Valdez and several GAs, and student athletic trainers were indispensable since it was impossible to simultaneously oversee both baseball and softball. I recall an incident involving twin softball players: one sister not playing, the other on deck, with an accidental practice swing hitting the sister, necessitating a golf cart ride to the adjacent facility. Q: Why is low back pain a significant health concern, and how is it related to depression and lifestyle? A: Low back pain is the second most common reason people visit the doctor, with depression being the first. Patients typically present with symptoms that indirectly lead to a depression diagnosis, rather than overtly stating “depression.” A sedentary lifestyle is often termed “the new smoking” in medicine, leading to tight, unused muscles. Hands-on manipulation therapy can be beneficial, and simple exercises like push-ups can improve posture by strengthening the neck muscles that support the head. Many individuals struggle with core muscle activation; focusing on proper technique and guiding them to engage their core will lead to increased strength over time. Q: How do you address flat feet in patients? A: Patients often present with concurrent back and knee pain. Structural analysis can reveal the cause, leading to recommendations for inserts or corrective devices for arch support, rather than immediate surgical intervention. Subsequent efforts focus on improving knee mechanics to alleviate symptoms. Q: What is your approach to concussion management? A: Myofascial release may sometimes require trigger point injections. However, most concussion cases can be effectively managed with muscle energy techniques. In older patients, some form of osteopathic manipulation may be necessary. Q: What are the key anatomy considerations for the neck? A: It is crucial to understand that the neck’s complexity extends beyond superficial muscles like the scalenes and deltoids; smaller, deeper muscles also play a significant role in neck function. Q: What are your tips for the Athletic Training Room? A: Prioritize hands-on manipulation therapy and muscle energy techniques with athletes, rather than solely relying on stationary bikes or treadmills for warm-up. Contact Us Jeremy Jackson Benjamin Stephenson Layci Harrison Mark Knoblauch Ashlyne Elliott Leslie Bennett Sponsor List Frio Hydration – Superior Hydration products. Xothrm – Best heating pad available – Use “SMB” or email info@xothrm.com and mention the Sports Medicine Broadcast. Donate and get some swag (like Patreon but for the school) HOIST – No matter your reason for dehydration, DRINK HOIST MedBridge Education – Use “TheSMB” to save some money, be entered in a drawing for a second year free, and support the podcast. Marc Pro – Use “THESMB” to recover better. Athletic Dry Needling – Save up to $100 when registering through our link.

Learn how to optimize hamstring recovery for peak performance with insights and key Q&A from Brian Duncan, PT, DPT, OCS, SCS. Q: Is fascial length more critical than strength for hamstring recovery? A: Fascial length is not necessarily more important than strength, but the body adapts from training, loading, and sprinting. However, sprinting alone is insufficient for optimal hamstring recovery. Q: How can fascial length be tested in athletic training (ATR)? A: Currently, there is no way to palpate fascial length. It can only be observed on MRI or ultrasound as imaging techniques improve. An NFL-funded trial is ongoing, examining hamstring injuries and investigating various factors with imaging across several colleges. Q: How does adjusting knee positioning impact hamstring rehabilitation? A: Varying the amount of knee flexion or extension can increase hamstring length and load depending on the specific area of the hamstring. Training hip extension can place more load on the proximal hamstring tendon. Most hamstring injuries occur at the myotendinous junction (proximal), while injuries within the muscle belly tend to heal better. Q: What are the challenges in hamstring rehabilitation for high-level athletes? A: The higher the level of competition, the more complex the situation becomes, often involving “more cooks in the kitchen.” This raises questions about collaboration between different coaches and the athletic trainer. Communication and planning can be challenging in these scenarios, impacting hamstring recovery. Q: Is high-intensity sprinting the most important aspect of hamstring recovery, and what are the considerations for progression? A: High-intensity sprinting is considered most important, but a lack of planning may be an issue. There is a significant load difference between an 80% sprint and a 100% sprint, with a substantial increase in eccentric load at maximum effort. The length the hamstring travels between 80% and 100% sprint is no different. A gradual progression back into previous activities is often necessary for effective hamstring recovery. Running more than nine sprints in a session can lead to further hamstring injury. Q: Can AI, such as ChatGPT, replace athletic trainers? A: AI is only as effective as the user and the questions asked. For example, it can build a maintenance program. When asked to include high-speed running and eccentric loading, it then asked if a weekly microcycle was needed. Hopefully, it will not replace athletic trainers’ jobs but instead help them to excel at them, especially in optimizing hamstring recovery. Q: What are the key takeaways for athletic trainers from this presentation on hamstring recovery? A: Athletic trainers should start eccentric training early (at a pain level less than 4/10) and incorporate sprinting (running) as soon as possible. It is also crucial to communicate with coaches to target at-risk position groups with maintenance plans throughout the season and to incorporate banded Nordic hamstring curls to maximize range of motion. Q: What is the role of maintenance programs in athletic training, especially concerning hamstring injuries throughout a season? A: Maintenance programs are vital throughout the season to prevent recurrences and soft tissue injuries. During SAC camps, the key is to prevent overtraining and identify athletes who don’t self-regulate. Sprint training should occur early in SAC camp or during the day’s workout before lifting. For in-season maintenance, hamstring work should be incorporated on match day and two days after, ideally 3-4 days before the next match day. Contact Us Jeremy Jackson Benjamin Stephenson Layci Harrison Mark Knoblauch Ashlyne Elliott Leslie Bennett Sponsor List Frio Hydration – Superior Hydration products. Xothrm – Best heating pad available – Use “SMB” or email info@xothrm.com and mention the Sports Medicine Broadcast. Donate and get some swag (like Patreon but for the school) HOIST – No matter your reason for dehydration, DRINK HOIST MedBridge Education – Use “TheSMB” to save some money, be entered in a drawing for a second year free, and support the podcast. Marc Pro – Use “THESMB” to recover better. Athletic Dry Needling – Save up to $100 when registering through our link.

Limb Alignment & Leg Length Discrepancies: Key Takeaways Guest: Brennan Roper, MD Discussion Points: Magnet-Based Leg Lengthening: Explore cutting-edge technology utilizing rods implanted in bone and an at-home magnet for non-invasive leg lengthening. This innovative approach allows for daily progress monitoring by providers, offering a minimally invasive alternative to traditional manual methods. Precision in Magnet Use: Understand the critical importance of using the correct magnet, placement, and parameters for effective leg lengthening outcomes. Understanding Leg Asymmetry: Learn that some degree of leg length asymmetry is normal. However, significant discrepancies warrant prompt medical attention, as early intervention can lead to less invasive treatment options. When to Seek Medical Advice: Recognize the importance of consulting a physician for any concerns regarding limb alignment, especially if a discrepancy exceeds 5mm or 1 cm. Specialized Care for Discrepancies: Discover why seeking a specialist for limb length discrepancies is crucial, rather than relying on general clinics or ready clinics. Supplementation for Teens: Discuss the role of Vitamin D supplementation, particularly for teenagers, due to potential dietary deficiencies. Calcium supplementation may also be considered based on laboratory findings. Long-Term Prognosis: Examine how the long-term impact of limb length discrepancies is influenced by the degree of the discrepancy and treatment goals. Even small differences, like 2mm, can allow for a quick return to sports after incision healing, with “guided growth” being a viable option for minor discrepancies. Miserable Malalignment Syndrome: Gain insight into this condition, characterized by knee or hip pain and a feeling of being “off,” despite a seemingly neutral external appearance. This syndrome often involves internal rotation of the femur, knee valgus (knock-knee), and external rotation of the tibia. Tolerance for Differences: Understand that small leg length differences (2, 3, or 4mm) are generally well-tolerated, while angular discrepancies tend to be less so. Shortlink:SportsMedicineBroadcast.com/LimbAlignmentWebsite: http://utphysicians.com/provider/brennan-roper/

Advancements in Cartilage Repair: Insights from Dr. Raj Shani Cartilage damage is a common issue, particularly among athletes. Understanding the latest repair and preservation techniques is crucial for both medical professionals and those in sports medicine. We recently had the opportunity to discuss these topics with Dr. Raj Shani, a leading expert in the field.Favorite Technique: ACI (MACI) Dr. Shani highlighted Autologous Chondrocyte Implantation (ACI), specifically MACI, as his preferred technique due to its immediate positive impact on patients. This procedure offers a faster, easier, and less burdensome recovery for the patient. Looking ahead, advancements may allow for cartilage harvesting and growth to occur in a single setting, eliminating the current two-stage procedure.Why Athletic Trainers (ATs) Need to Know For athletic trainers, a general understanding of these techniques is invaluable. ATs are often the first point of contact for athletes and see them daily. Their knowledge fosters comfort and trust, allowing for more effective discussions about injuries and treatment options with athletes.Exosomes vs. Gene Therapy: The Future of Growth When considering future growth, Dr. Shani believes exosomes hold more immediate promise. The ability to directly introduce exosomes into the knee makes them a more practical option than gene therapy, which presents significant challenges in modulation.Cartiheal: A Natural Solution Cartiheal, derived from coral, is a fascinating naturally occurring and biologically inductive material. Bone can grow into it, making it a valuable substitute for allografts, which can be expensive or unavailable.The Meniscus: Protecting Cartilage It’s important to differentiate the meniscus from the articular cartilage that deteriorates with arthritis. The meniscus plays a vital role in protecting the articular cartilage by increasing the surface area for weight-bearing. Without a healthy meniscus, the cartilage on the bone experiences less surface area for load distribution, making it more susceptible to damage and issues. Cartilage Lesions in Athletes: Sports at Risk Approximately 30% of athletes experience cartilage lesions. Sports involving cutting and contact, such as basketball, are particularly prone to these injuries. While data may be biased due to a higher male participation rate in sports, male athletes generally show a higher incidence of these lesions. Contact Us Jeremy Jackson These people LOVE Athletic Trainers and help support the podcast: Frio Hydration – Superior Hydration products. Xothrm – Best heating pad available – Use “SMB” or email info@xothrm.com and mention the Sports Medicine Broadcast Donate and get some swag (like Patreon but for the school) HOIST – No matter your reason for dehydration DRINK HOIST MedBridge Education – Use “TheSMB” to save some money, be entered in a drawing for a second year free, and support the podcast. Marc Pro – Use “THESMB” to recover better. Athletic Dry Needling – Save up to $100 when registering through our link.

Recovery Specialist, Club Sport Athletic Trainer, former industrial AT…Vander Castillo has created his own place to excel as an Athletic Trainer. What is your Athletic Trainer story? As an avid NBA follower, I saw the Athletic Trainers and wanted to be those guys. Full-time job working with club sports…please explain. I like wearing many hats My office is inside of the club volleyball facility. I have a mobile recovery unit I see athletes one on one for a care plan Appointment based during the week Event coverage during the weekends. I do a lot of education so the athletes know what they are doing. Parents and players spend so much time on performance but neglect recovery What drew you to club sports? Much of my AT experience was in the industrial setting Disney Beer Coca-Cola This helped me grow into an autonomous AT I started as VSix industrial AT but that changed.  I found a niche in hotels. I was the MIPP program for the hotels in California. We had bi-weekly appointments set up. Being a business owner, what should ATs know? Social Media is great for an AT to break off and do your own thing. Creating your own brand is simple but not easy. Get to know sales: yourself, your brand, your product. I do a complimentary resume/ interview session during NATM each year. People will pay for good care Best growth tool? Who do you follow? Mike Stella ProMotion Krystal Tyree PTBiz ATVantage KCAT – Jessica  Compex vs Marc Pro vs Twitch? Which do you prefer? MarcPro is my favorite  Twitch is second and more affordable.  What makes up the majority of your business? Event coverage, practice, recovery, private evals? About equal thirds Tournaments Recovery AT services Most underrated recovery tool? Sleep Contact Us Vander Castillo – VSixAT

Joseph Eberhardt and Dawson Sports Medicine were preparing for a 3-peat at the time of this recording. Spoiler alert they placed 3rd in the 2025 state championships. For those of us who may not know what is GHATS? And what is it all about? Chris Shaddock brought me into Sports Medicine as an eighth grader GHATS hosts a workshop for student Athletic Trainer Aides. The workshop is to educate and expose students to the profession. Numerous courses and rotations provide students with opportunities to learn and explore their interests. I was uncoordinated and unathletic, and I needed people who understood me. My sophomore year was the first year of the QuizBowl in GHATS. Chris told them: Do not embarrass me, watch the quiz bowl, and learn. Learn it, love it, win it. My senior year, I wanted to keep competing and so we were doing speed drills, we acquired a quiz bowl buzzer, we did scrimmages…And we finally won. I went on to college and came back to GHATS to recruit the student AT aides from Houston. We won 5 championships and have been in the finals 7 times. I began developing the program so that we as a staff, are involved. We start studying for them in August. As part of our student AT workshop, before school starts. If we win this year, we will be the leading state title holders in our entire district. We study one 30-minute session each week starting from week one. 13 students were at each of these sessions I write 200 new questions each year so the students can not just memorize them.  I introduce them only at the scrimmage. Region 6 has created a clause that requires the question to be fully read before the students can buzz in. The quality of competition has increased  What did that look like through college? 1 year at Texas A&M Corpus Christi we competed. It was a different style quiz bowl that was more like Kahoot. What does the state quiz bowl competition look like? The last two years was at Tarelton State.  We came in early Sunday to settle in Then they host the AT Olympics. Monday morning they start the state competition like a track meet.  Multiple events and your points total place you. This year there is a rubric that enables the student to learn exactly what is being required. After lunch was the quiz bowl just like GHATS. Tournament style with buzzers, head to head. They have a skills requirement list that they must learn and have signed off on by the professionals. How do you keep kids motivated and engaged? Are they intrinsically motivated? Both I push hard but it’s because they show up and want to be there. Give us your tips for success. ENJOY IT – the whole process Ernest Shackleton – Difficulties are obstacles to be overcome These people LOVE Athletic Trainers and help support the podcast: Frio Hydration – Superior Hydration products. Xothrm – Best heating pad available – Use “SMB” or email info@xothrm.com and mention the Sports Medicine Broadcast Donate and get some swag (like Patreon but for the school) HOIST – No matter your reason for dehydration DRINK HOIST MedBridge Education – Use “TheSMB” to save some money, be entered in a drawing for a second year free, and support the podcast. Marc Pro – Use “THESMB” to recover better. Athletic Dry Needling – Save up to $100 when registering through our link.