FWATA 2008 Clinical Symposium

General Session Topics and Faculty*

Friday, April 4, 2008

9:00am-10:00am How to Scope an Elbow

Kenneth Akizuki, MD
Sportsmed Orthopaedic Group, Inc. & St. Mary’s Medical Center;
Team Physician, San Francisco Giants Baseball Organization

Join us during an exploration of the elbow. A cadaver elbow will be dissected. Such technique as a Tommy John procedure will be demonstrated.

10:00am-12:00pm Exhibits Open to Certified Athletic Trainers Only (Coffee provided)

10:10am-11:00am Debunking the Grief Models: Contemporary Understanding of the Psycho-emotional Response to Sport Injury

Dawn K. Lewis, Ph.D., Assistant Professor
Department of Kinesiology, California State University, Fresno

The use of stage models, such as Kubler-Ross’ (1969) stages of death and dying, to explain injured athletes’ response to sport injury has become popular in the sport injury rehabilitation literature. These models assume that when athletes become injured they experience a predictable sequence of psychological responses. However, some researchers (e.g., Morrey, Stuart, Smith, & Wiese-Bjornstal, 1999; Lewis, 1999) have argued that there may be significant differences in the experiences of terminally ill patients and injured athletes and have questioned the validity of the Kubler-Ross model for athletic injury. Furthermore, recent work has concluded that there is little empirical evidence to support the use of stages of grief models for injured athletes (e.g., Brewer, 1994; Evans & Hardy, 1995). Instead, researchers and theorists who study the sport injury response suggest that cognitive appraisal models or stress and coping perspectives may be more appropriate. Therefore, the purpose of this symposium is to describe contemporary models for understanding athletes’ psycho-emotional response to sport injury and their resultant intervention strategies for minimizing psycho-emotional trauma and enhancing physical rehabilitation.

11:00am-11:50am The Cramer and NATA Connection - the Evolution of Athletic Training into Sports Medicine

Ed Christman,
Vice President of Marketing, Cramer Sports Medicine

This valuable information will focus on the history of the National Athletic Trainers Association and Cramer Products. Discussion will be on the role of Chuck and Frank Cramer in the formulation of the NATA.

12:00pm-1:00pm Lunch Break and Exhibitor Break (Exhibits open to all)

1:00pm-2:00pm Drug-Dispensation and Drug-Administration in the Traditional Athletic Training Room Setting

Leamor Kahanov, EdD, ATC,
Director, Graduate Athletic Training Program
San Jose State University Department of Kinesiology

Adherence to federal regulations and guidelines regarding the dispensation of OTC and prescription medications has been poor based on past research, and athletic trainers may have engaged in drug distribution practices which violated state and federal statutes. The purpose of this presentation is to present the latest research and revisit drug dispensation and administration laws relevant to athletic training room practices. Since the initial Drug Dispensation study in 2001 regarding ATC adherence to state and federal drug laws, some problem areas still persist. In general drug distribution adherence scores remain low across the country. Correlations between the adherence scores and institution athletic division, gender, employment setting, age, and additional certifications were weak. Athletic trainers appear to have progressed regarding adherence to state and federal statutes on prescription drug regulation from 5 years ago, yet an understanding of administration of OTC medication still appears to be less than desirable. A review of federal and state laws and regulations will be provided. ATCs in collegiate environments should seek out exemplary athletic training room drug policies, and revise institutional drug policies and procedures to comply with federal and state laws.

2:00pm-3:00pm Effective Uses of Recovery; Reducing the Inflammation and Pain Cycles

Bernd Friedlander, DC, BS

Many athletic trainers and team physicians after an injury prescribe anti-inflammatory Ibuprofen, aspirin, and cortisone shots to stop the pain. While these therapies meet the goal of providing pain relief in the short-term, long-term use of these medications can have harmful effects at the expense of continually weakening the ligaments and tendons, and the eventual loss of the individual's ability to participate in their chosen sports. Inflammation is the process by which the body heals soft tissue injuries, including injuries to connective tissues, ligaments, and tendons. After minor injuries or repetitive motion injuries, the ligaments and other connective tissue may not heal properly. What recent studies have shown is inadequate healing, not inflammation, is the problem. An athlete, to effectively heal, needs to let the inflammatory process occur around their damaged ligaments and tendons. It is by doing this that the injured ligaments, tendons, and connective tissue have an opportunity to heal. This presentation explores a new natural therapy that meets the goal of providing short-term pain relief, while supporting the proper immune response to injury and restoring joints, ligaments and tendons.

3:00pm-3:30pm Exhibitor Break

3:30pm-5:00pm From Beginning to End: The Nature and Course of Concussion in High School and Collegiate Sports

Tony L. Strickland, PhD, MS, Director and CEO of the Sports Concussion Institute, Marina Del Rey, California

The CDCP estimates that 1.6 to 3.8 million sports-related MTBIs, or concussions, occur in the USA each year. Football injuries associated with the brain occur at the rate of one in every 5.5 games. Approximately 10% and 20% of college and high school players, respectively, sustain brain injuries during the course of a season. Concussions, however, remain an underreported injury because it is more difficult to detect (than ligament, muscle, or orthopedic injuries) and because of the “tough guy” mentality that is pervasive through sports culture. Lack of proper diagnosis and clinical management may result in long-term consequences, including Second Impact Syndrome and other neurocognitive ailments. As such, the serious nature of head injury requires that concussions be managed by trained experts for assessing, diagnosing, and treating each player individually. We will discuss the current state of concussion in high school and collegiate sports, the importance of professional clinical care for mild traumatic brain injuries, and the proper methodology for managing concussion.

5:00pm-6:15pm Exhibitor’s Social

Saturday, April 5, 2008

8:00am Exhibits Open (coffee available)

9:00am-9:50am Clavicle Fractures to Rod or not to Rod

Louay Toma, M.D., Muir Orthopedic Specialists

Fractures of the clavicle are common and comprise 45% of all shoulder girdle injuries. Eighty percent of all clavicle fractures occur at the middle 1/3, where the bone curves. Traditionally, clavicle fractures are treated conservatively with immobilization in a figure-of-eight wrap or a sling. Conservative treatment of non-displaced clavicle fractures typically results in radiographic union of the bone ends in 12 weeks and symptom relief at six to eight weeks. Surgical treatment of displaced fractures is controversial due to poor patient outcomes that have been reported in the literature. Another highly debated topic regarding the surgical repair of displaced clavicle fractures is which surgical procedure will produce the best outcome. Common surgical management of the clavicle involves the use of plates or screws, in which the literature reports a high occurrence of persistent nonunions and other complications. A relatively new surgical approach using an intramedullary rod may produce more promising results in decreasing pain and improving anatomical alignment. This session will cover appropriate use of intramedullary rods in the treatment of clavicle fractures.

10:00am-12:00pm Poster Presentations

10:00am-10:50am The National Honor Society of Sports Medicine for Secondary Schools: Promoting Academic Excellence

Eli Hallak ATC, EMT, Head Certified Athletic Trainer, St. Francis High School
Cindy Kramer, MS, ATC, CSCS, Head Certified Athletic Trainer, Notre Dame High School

We have begun to build an exciting new association for high school students and educators by creating the first secondary schools healthcare honor society in the nation. In June 2007, The National Honor Society of Sports Medicine was founded by Eli Hallak ATC (St. Francis High School, La Canada) and Cindy Kramer ATC (Notre Dame High School, Sherman Oaks). The purpose of this organization is to “Create enthusiasm for scholarship in the area of sports medicine and other fields directly related to sports medicine, to stimulate a desire to render service in the community, to promote leadership, and to assist in the development of character in the students of secondary schools”. Join us for an informative talk regarding the vision, direction, and opportunities for educators and secondary school students within this new organization.

11:00am-12:00pm Getting and Nailing Your Interview

Leamor Kahanov, EdD., ATC, Director, Graduate Athletic Training Program, Department of Kinesiology, San Jose State University

Discuss powerful Cover Letter, Resume writing and Interview techniques. Learn how to get the interview, and what to do when you get the interview.

12:00pm Exhibits Close

12:00pm-1:00pm Lunch Break

1:00pm-4:00pm New Insights for Evaluating External Rotation Injury Mechanisms of the Shoulder

Robert W. Pettitt, Ph.D., ATC, CSCS, California State University, Fresno

Forced-shoulder external rotation, with eccentric resistance imparted by the subscapularis muscle, occurs in contact and combative sports. Conversely, high external rotary moments, from contraction of the external rotator cuff, occurs during the cocking phase of overhead throwing motions. Each of these external rotation mechanisms often leads to distinct pathologies. The forced-external-rotation-injury mechanism has been linked epidemiologically to subluxations/dislocations of the long head of the biceps tendon (LBT). The pathomechanics of this injury has been defined better over the past decade. Anatomists recently have questioned the existence of a distinct transverse humeral ligament. Rather, protection of the LBT within the bicipital groove is largely because of a fibrous extension from the subscapularis. Thus, when the forced-external-injury- mechanism is suspected, the subscapularis muscle should be examined thoroughly. Conversely, the cocking action of overhead throwing motions can bowstring the LBT, and this action, combined with external rotary moment, has been suggested to cause a peel-back effect leading to a superior labrum anterior posterior (SLAP) lesion. Moreover, to adduct the shoulder from above to below a 90-degree abduction angle, while maintaining a specific angle of external rotation, requires higher force output from the external rotator cuff (i.e., higher external rotary moments). Arthokinematically, a greater peel-back effect, therefore, is produced when the elbow drops during the cocking phase of throwing (i.e., when the shoulder abduction angle is less than 90-degrees). When this mechanism is suspected, the clinician should thoroughly examine for the SLAP lesion. This presentation reviews the physical examination procedures for these two distinct external rotation injury mechanisms.

Shoulder Injury Update 2008

Michael Oberlander, MD, East Bay Sports Medicine and Orthopaedic Associates
Michael Chisar, MPT, ATC, SCS, CSCS, Program Director/Instructor, Sports Medicine, Personal Training and Coaching Programs, Diablo Valley College

This talk will focus on the medical / surgical management and rehabilitation principles of shoulder injuries. A variety of shoulder pathologies will be discussed, including shoulder instability, internal and external impingement, rotator cuff tears and labral tears. Particular emphasis will be placed on understanding the current medical / surgical decision making processes and the most up to date procedures utilized to treat these injuries. A comprehensive approach to rehabilitation of shoulder injuries based on this discussion of pathologies and treatments, as well as current literature, will also be presented.

4:00pm-4:55pm FWATA Business Meeting and Open Forum

5:00pm-5:55pm State Meetings (CA-TBD; NV-TBD; HI-TBD)

6:00pm-7:30pm Far West Athletic Trainers’ Association’s Hall of Fame and Awards Dinner

Sunday, April 6, 2008

8:30am-9:20am Runner’s Clinic 101: Identifying and Making Sense of Pathomechanics

Monique Mokha PhD, ATC, Lecturer, California State University, Long Beach and Fullerton

Runners are unique! And, managing their injuries takes a comprehensive approach that includes an assessment of running gait. Additionally, those who perform running as part of their sport training or cross training typically need an assessment of running gait as well when pain and dysfunction arise. During this session, we will go through a complete running gait analysis that includes aspects of (a) static and dynamic posture/alignment evaluation, (b) pertinent strength assessment, (c) pertinent flexibility assessment, and finally, (d) running technique evaluation. We will put the pieces together in order to design the appropriate intervention for our runner/performer. The speaker will share a full library of running video in order to illustrate normal and pathological running patterns as well as provide samples of anonymous reports from her former Runner’s Clinic clients. You will leave knowing what to look for, how to look for it, and what it all means for intervention!

9:30am-10:20am NMES Application: It is More Than 10 Seconds On and 50 Seconds Off

Mack D. Rubley, PhD, ATC, LAT, CSCS,
Director, Athletic Training Education Program,
Department of Kinesiology, University of Nevada Las Vegas
William R. Holcomb, PhD, ATC, LAT, CSCS*D, FNCSA,
Associate Professor, Athletic Training Education Program, Department of Kinesiology, University of Nevada Las Vegas

The goal of this presentation is to review the current research regarding the clinical application of NMES techniques. We will discuss the impact of combined current techniques, rest intervals, pain associated with treatment, the impact of adipose thickness and how the sexes seem to tolerate different magnitudes of current. Topics covered in the presentation will also include appropriate treatment times based on current literature, review of physiology of contraction and how the use of NMES can supplement rehabilitative exercise. Finally, the topic of what we as clinicians need to see from future studies will be discussed.

10:20am-10:35am Coffee Break

10:35am-11:25am Hip Problems in Athletes - The New Frontier in Sports Medicine

Marc R. Safron, MD, Professor & Associate Director, Sports Medicine, Department of Orthopaedic Surgery, Team Physician, Stanford University

Hip and pelvis injuries are common in most sports. Due to the high susceptibility and prevalence of injuries, this discussion will address problems related to this region. Topics will focus on the differences of adolescent and adult type injuries. Injuries of discussion will include but are not limited to avulsion fractures and those of bony and soft tissue nature. In order to correctly evaluate injuries, the use of better imaging may be discussed. Due to the increasing incidence of hip injuries, interest and awareness for those that deal with such injuries needs to rise.