The BOC Exam...

In order to be licensed as an Athletic Trainer, you have to take the Board of Certification exam. It is a very rigorous exam, or so I'm told. In order to be eligible to take the exam you have to meet the following requirements:

• Endorsement of the exam application by the recognized Program Director of the CAATE (Commission on Accreditation of Athletic Training Education) accredited education program

• Proof of current certification in Emergency Cardiac Care (ECC) or proof of enrollment in an approved ECC course

A sample exam question would be like this:

Which modality would BEST control pain in a two-day-old Grade I (mild) lateral ankle sprain in a 25-year-old male with Raynaud’s phenomenon? Choose only one.

Continuous 3 MHz ultrasound

Electrical stimulation - biphasic continuous current

Ice massage

Paraffin bath

Warm whirlpool (100 degrees Fahrenheit/38 degree Celsius)

(Continuous 3 MHz ultrasound should have a bubble by it as well.)

ECC Certification includes:

• Adult and Pediatric CPR
• AED (Automated External Defibrillator)
  
• 2nd rescuer CPR
• Airway obstruction
• Barrier devices (e.g., pocket mask, big valve mask, etc.)

I just got kind of worried. On the 2009-2010 exam, only 38.2 percent of people passed. However, Ithaca College has a 97 percent pass rate, so that makes me feel a little better.

I found all of this information at http://www.bocatc.org/index.php?option=com_content&view=article&id=10&Itemid=8

Injuries and Statistics

According to the U.S. Consumer Product Safety Commission Report, sports injuries in baby boomers increased by 31 percent from 1991 to 1998. About 276,000 emergency room cases were for people aged 35-54 in 1991. In 1998, that number skyrocketed to 365,000. In 2006, the NEISS (National Electronic Injury Surveillance System) reported over half a million injuries associated with basketball alone.

Baby boomers suffered over 1 million sports related injuries, which ended up costing $18.7 billion in medical costs in 1998.

Basketball is the sport with the highest number of injuries. I didn't realize there weren't hat many injuries associated basketball. It makes sense though, between the colliding and the jumping involved with basketball, there is a high possibility of injury. One might think that football and lacrosse and other contact sports would be right up there. They are, but you have to remember when thinking about this issue, that with lacrosse, football, etc. the players are wearing pads. In basketball, they aren't.

I've looked, but I couldn't find any statistics about rugby. On this website rugby is combined with lacrosse, and they had relatively few injuries, but I think that that would be a sport that is pretty high as well. There is all of the intense contact of soccer and football, all the collisions, but no padding like in football. I guess I'll just always wonder.

NEISS put out predictions based on 2006 data. Here is what they said

bold=sport
italics=number of projected injuries

Basketball-529,837 These injuries are mainly cut hands, sprained ankles, broken legs, eye and forehead injuries
Bicycling-490,434 These injuries are mainly feet caught in spokes, head injuries from falls, slipping while carrying bicycles, collisions with cars
Football-460,210 These injuries are mainly fractured wrists, chipped teeth, neck strains, head lacerations, dislocated hips and jammed fingers
ATV's, Mopeds, Minibikes-257,123 Riders of ATV's were injured when they thrown. Along with this there were also fractured wrists, dislocated hands, shoulder sprains, head cuts and lumbar strains
Baseball, Softball-274,867 These injuries were mainly head injuries from bats and balls or ankle injuries from running bases or sliding into them
Exercise, Exercise Equipment-269,249 These injuries were mainly twisted ankles and cut chins from tripping on treadmills. Head injuries from falling backward from exercise balls, ankle sprains from jumping rope
Soccer-196,544 This injuries were mainly twisted ankles or knees after falls, fractured arms during games
Swimming-164,607 The injuries were mainly head injuries from hitting the bottom of pools, and leg injuries from accidentally falling into pools
Skiing, Snowboarding-96,119 These injuries were mainly head injuries from falling, cut legs and faces, sprained knees or shoulders
Lacrosse, Rugby-85,580 These injuries were mainly head and facial cuts from getting hit by balls and sticks, injured ankles from falls

This is a comparison of injuries associated with 16 popular sports between 1991 and 1998.















http://www.scientificpsychic.com/fitness/sport_injuries.html

Torn ACL

There are 4 ligaments that stabilize the knee. The four are the MCL, LCL, PCL and ACL. The MCL is the medial collateral ligament; the LCL the lateral collateral ligament. These are the two that run down the sides of your knee, the MCL is on the inside, the LCL the outside. Contrastingly, the PCL is the posterior cruciate ligament and the ACL the anterior cruciate ligament. The PCL runs down the back of the knee, and the ACL runs down the front.

Last year, I sprained my PCL in dance. It is much more difficult to do that than to sprain or tear the ACL. However, it is much more difficult to repair the ACL and to rehab it than it is to work with rehabbing the PCL.

The ACL is crucial to knee stability. It helps to prevent excessive motion. Most people who have torn their ACL will complain of a feeling that their knee is "giving out" from under them.

An ACL tear is usually sports related, but can happen in motor vehicle accidents, falls and work related injuries as well. Approximately 80% of sports related ACL tears are non-contact tears. This means that they don't involve another athlete in the injury. Most of them are from landing from a jump or from pivoting on the leg while running. Interestingly, women are more prone to injury involving the ACL than men are, but it is unclear as to why this is.

Symptoms
People who have a torn ACL often complain of hearing or feeling a pop in their knee at the time of the injury. The loudness of the pop surprises a lot of people; people can usually hear it from the sidelines of a game. Even if you don't hear the pop, you will usually feel the shift in the joint. There are always those people though who have no idea that they've sustained an injury. It has been known that people don't always feel the tear. People have gotten hurt, not realized it, felt fine and continued with the game. It has happened.
Other symptoms include the giving out that was mentioned earlier and swelling and pain in the knee.

Surgery?
People can get surgery done to reconstruct their ACL, however it might not be necessary. If you don't do a sport routinely that requires the use of your knee, and you don't have knee instability, then you probably won't need to have surgery to reconstruct the ACL. There is also a debate over whether to perform surgery on a partial tear. Some say that you can, but others say that it's better not to do it. Most people start feeling better after a few weeks, but problems with instability might continue.

At Ithaca High this year, we've had three ACL tears. Two guys and one girl tore their ACLs this year. One was in soccer, one in football, and one in lacrosse. ACL injuries are also more common in younger people. There is a debate in the health professions about what to do when the ACL injury happens to somebody who is not only younger, but a child. Some people say that it is better to repair the ACL before skeletal maturity, however, the other side says that problems that arise may lead to growth plate closure or alignment deformities. Who knows what's going to happen?

Mentor Meeting

In my mentor meeting today, I taped my friend Courtney's ankle to show how much better I've been getting since I went to Ithaca College and had them teach me. It was nerve-wracking because I didn't know what to expect. I wasn't sure if I was going to do everything correctly, and I didn't want to waste the tape that I had, because that was ALL the tape that I had. But it went quite well I thought. I'll let you decide, here it is:

It proved to be helpful. YES!!

So, my WISE project has officially proved to be helpful to my well being. I stepped on a hammer the other day and I bruised the muscle on the bottom of my foot, either my flexor digitorum or my flexor hallucis, I'm not sure which. The flexor digitorum is the muscle that runs down the back of the tibia, under the foot and flexes the foot for the final push off while you are walking. The flexor hallucis flexes the big toe.

How has it proved helpful you might ask? Well, I am able to tape my foot so that it is stable when I walk. Naturally, it still hurts, but I am able to take care of it and not put as much pressure on it while I walk or dance. This is a VERY good thing. I have a dance competition in about three weeks, in which I NEED to perform, so having the pressure off of the foot has been a major bonus, and I can do it myself which is even better! yay!!

Yawn

Oh my gosh, today was the most boring day of my WISE project thus far. Chelsea, the final student from IC finally came in today. She is a gymnast, so they were still in season, so she couldn't come down to the high school until today. Since she's going to be working with Kara doing Lacrosse or Track, Kim said that maybe it was better if I did a different sport. I have been changing it up like I mentioned before, but I don't have as many choices now. She doesn't want me working with Lacrosse as much as I have been recently. So, I changed sports. Remember how I mentioned that Girls's Lacrosse was the most boring thing? Yea, I had to work with Girl's Lacrosse today. John and I spent most of the time trying to stay awake...soooo boring.

In better news, during my WISE mentor meeting today, I taped my best friend's ankle. The video is going to be posted as soon as I find my cord. That will hopefully be tonight, but I don't know for sure if I know where my cord is, so at the earliest possible time, I will upload that so you can see it. It was really weird to be doing a tape job without anybody explaining it to me. I talk to Mr. Heurich, and tell him, and the camera what I am doing. I'm not used to that, it was kinda cool. :)

I guess that's all for now, hopefully you will see the video soon. bye!

Spreading Out

So, I started working with other practices other than just guy's lacrosse. I liked it and all, but I thought if I was going to get the full impact of this project, than maybe I should branch out and get the experience working with sports other than just lacrosse. Since I started with this idea, I've worked with the Track and Field athletes as well as the baseball players. I think I still like guy's lacrosse the best. I've also worked with John Dale (a student from IC) on girl's lacrosse, and I don't think I've ever seen anything more boring than girl's lacrosse.

I'll continue to work on other sports just to get an idea of what it will be like to work with other teams. I think sticking with one sport doesn't really get me to see what it is like to be an Athletic Trainer. Being an AT, unless you are specifically working with one team, and most people don't do that, you work with all different teams. For instance, Kim works with soccer, football, hockey, baseball, softball, track, lacrosse, and all the other teams, so that it what it is really like to be an Athletic Trainer, not just focusing on one sport in particular.

Sprained Ankles

Another injury that seemed common on the Lacrosse Injuries Forum was sprained ankles.

Oh, here's the link to that forum if you want it...

http://forums.insidelacrosse.com/showthread.php?t=39299

Anyways, like I said, sprained ankles seemed common among the list of injuries commonly sustained by a lacrosse player.

A sprained ankle, or a twisted ankle, is the stretching or tearing of ligaments. The most common kind of ankle sprain is an inversion sprain. When this happens, the bottom of the foot faces inwards, which damages the ligaments on the outside of the foot.

A medial ligament sprain rarely occurs. This would be when the bottom of the foot is facing outward. When it does occur, it is usually in conjunction with a fracture.

The most common ligament injured in an ankle sprain is the anterior talofibular ligament. This ligament connects the talus (ankle bone) to the smaller bone in the calf, the fibula.
However, if the sprain is severe, there could be damage to
the calcaneofibular ligament which connects the heelbone to
the fibula.

In addition to ligament injuries, tendons, bones, and other tissue might also be damaged. Because of this, it is important to get an x-ray of the ankle if sprained, because small fractures are not uncommon.

With a severely sprained ankle, there can be complete ruptures of the anterior talofibular, calcaneofibular, and posterior talofibular ligaments. These can result in a dislocation of the ankle joint which is often associated with fractures.

There are three stages of ankle sprains.

Stage 1:

• some stretching of the ligaments, possible minor tearing of the lateral ligaments
• little or no joint instability
• mild pain
• mild swelling around the bone on the outside of the ankle
• some joint stiffness while walking or running

Stage 2:

• moderate tearing of the ligaments
• some instability of the joint
• moderate to severe pain, and difficulty walking
• swelling and stiffness in the ankle joint
• minor bruising

Stage 3:

• total rupture of the ligament(s)
• major instability of the joint
• severe pain initially followed by no pain later
• severe swelling
• extensive bruising

There are two parts to rehabilitation of an ankle sprain: immediate and long-term.

Immediate:
RICE

R: Rest. This helps to reduce pain and prevent further damage. Many therapists say to have some moderate weight on the foot as soon as possible-it is thought to accelerate rehabilitation.
I: Ice. Applying ice and compression can reduce pain and swelling and encourage blood flow. Apply an ice pack immediately for 15 minutes and repeat every 2 hours.
C: Compression. This reduces bleeding and swelling.
E: Elevation. Elevation uses gravity to reduce swelling and bleeding by allowing the fluids to flow away from the injury.

Later on, strengthening things such as ankle circles can get the ankle moving again and reduce swelling even more. After a sprain, the calf muscle often tightens up so protect the joint, so slowly strengthening the calf can also help get the rehab done quicker.

The steps to taping an ankle.

So, when I went to IC on Friday and learned how to tape an ankle better, I wrote down the steps that I will be talking through when I tape somebody's ankle next Tuesday. These are the steps I learned from the person who taught me.




The only difference was that I was taught the two figure 8s before the medial heel locks and then 1 more after the lateral heel locks. I was also taught to do an anchor between each stirrup.

At IC...

I had an appointment on Friday, so I didn't end up going to school. My mom and I went to Ithaca College. She had to get an allergy shot, but I didn't really want to sit through that, so I went to the Training Room. I met Courtney Gray, one of the Trainers. She is super sweet. I was talking to her about how I am going to Ithaca College to study Athletic Training. However, I also told her that I wanted to learn how to better tape somebody's ankle. Mr. Heurich and I talked about having me tape somebody's ankle during our mentor meeting the Tuesday we come back. In order to do that, I needed to get a better understanding.

I met a guy in the Athletic Training program. I feel bad, I don't remember his name, but he taught me how to tape an ankle better than before. It was nice because it was one-on-one. It was a little difficult for him though because he was teaching me on himself, and I've since tried doing that and it isn't easy. The thing I love the most about Ithaca College is how accommodating everybody was. When I left, they gave me pre-wrap, and three rolls of tape to practice with. They just invited me in and taught me in the spur of the moment, then they invited me back later in the week. I don't know if I'll be able to make it back up, I might on Friday, we'll see. I just thought it was amazing that they were so welcoming. They were so nice.