The Great Shin Splint Debate

One of the inevitable things that none of us looks forward to in the spring is the plague of shin splints.  Your athletes are changing surfaces and not a one of them has purchased new shoes.  We've been practicing outside for a week and I'm looking out my office window as I write at four track athletes hanging around my ice bath waiting their turn to ice their shins up.

Over the years, I've encountered a lot of different opinions on what the best way to treat shin splints really is.  We all have our own methods and opinions on it, and tend to settle into a pattern when we find something we think works.  Two years ago I decided that instead of settling on a pattern, I would experiment and see for myself whose way really is the best.  The results of my experiment?  Pretty much everyone's methods work!  Not every treatment will work on every athlete, so it is best to keep your mind open when you encounter some of the sillier ones, because they might surprise you.

• Pre-practice moist heat - I try to avoid this in more acute cases, for obvious reasons.  For an athlete who comes in halfway through the season complaining that he or she has been having a nagging problem with shinsplints all year however, this can be a lifesaver.  The heat will loosen up the anterior tibialis and take pressure off of the insertion where the pain is located.  I find that this is best used in combination with taping or wrapping treatments, and should always be followed up with ice after practice.

• Shin taping - How many of my readers just groaned?  Yes it's an old method, but we're still using it so there has to be something to it.  moving the muscles across the leg with tape takes pressure off of the insertion point where the pain is coming from, relieving the pain.  For some athletes, I've found that this is the only solution.  I can stick arch supports in their shoes until the cows come home, but nothing seems to work for them like a good old tj.  The downside to shin tape is that you may need to get your male athletes to shave their legs.  I've tried this method using underwrap, but it just does not work the same. 

• Neoprene calf sleeves - An interesting spin on several taping methods, calf sleeves work much the same way as a heat treatment does, except their effects last all the way through practice.  Not only do you get the heating effects of a MHP, you also get the compression effects of a tape job.  The downside to neoprene is that it gets extremely sweaty during practices, especially on hot days and needs to be cleaned frequently.  Sleeves run about $10-15 a piece depending on the brand.  If I have them available, I loan out one pair and recommend to the athlete that they purchase a second pair.  This cuts down on the laundry they have to do, and ensures that your athlete will (hopefully) have cleaner gear.

•  Toe tap exercises - I was flabberghasted when I heard about this one, but as a high schooler with terrible shin pain I was ready to try anything.  My athletic trainer recommended that I try an exercise where I just tap my toe on the ground to build up the muscles in my lower legs and relieve some of the pressure on my shins.  Believe it or not, this does actually work for some athletes!  It can be done at any time of the day, so kids will do it while they're doing their homework or sitting in class as something to do.  Keeping the heel on the ground, lift the toes and tap your foot on the ground, that's it.  Use in combination with other treatments.

• Flexiwrap taping  - I know what you're thinking, that stuff is for taping on ice bags, what good is it going to do for shins?  This is another method that it's best to keep an open mind about.  Flexiwrap can be used to take the place of neoprene sleeves if you don't have the funds for them.  It acts the same as the neoprene would, keeping the heat in the muscle while adding a push to keep the pressure off of the muscle insertion.  If you're feeling extra ambitious, you can even put a product like Biofreeze or Cramergesic on the skin before taping for a little extra feeling of heat.  If you're doing this however, make sure to test it on a small area for a practice first - some athletes are more sensitive than others!

•  Arch taping  - This is my current go-to treatment, as it appears my current set of athletes are rather biomechanically unsound in the arch department.  Correcting leg position by adding support to the arches should take the pressure off of the shins and hopefully help prevent other problems further up the leg into the season.  The downside to arch taping is that some people are more sensitive to changes in their feet than others are and athletes might not be willing to try and get used to arch tape if it is uncomfortable.

• Insoles or arch supports - Insoles are expensive, so I tend to wait until I've tried a few other things before recommending their use.  Store bought arch supports will work for some athletes however, so it isn't a bad idea to consider their use if an athlete has feet that can be corrected using a softer insert like the ones found at the drug store.

•  Ice cup massage - If you have a freezer in your training room, you should have a backstock of ice cups waiting to be used.  For shame if you don't.  Slapping an ice bag on the shin doesn't have the same cooling effect as an ice massage does.  You get greater contact time, and the rubbing motion across the muscle and shin area can help to relieve pain too.  

• Ice bath - Seriously, don't put an ice bag on shin splints.  Personally, I love the ice bath.  Sure it takes a little more time out of your day to fill and empty and clean, but the treatment is so much more effective than a simple bag of ice, why not use it?  Don't have a whirlpool or a tub?  Get a party bucket, they're less than ten dollars.

 Good luck this spring everyone, and stay on top of those shin splints!  When left untreated, those shin splints can and will turn into a stress fracture that will end the season.

Gearing up for Spring Sports

For most of us, winter sports are over and done with and we're rapidly flying into spring seasons.  Time for baseball, softball, track, lacrosse, and rugby!  Spring is easily the most hectic season, as it sees most teams spread out, practice schedules at odd times, and games squeezed in whenever it isn't raining. 

Our athlete's safety is still number one on our minds in the spring, so consider a few of these ideas to keep your head on and make sure that everyone stays safe and happy:

• Daily or weekly email updates to coaches - If your school is anything like the four I've been at, your spring sports fields are spread out all over the place.  If I'm having a high injury week, I might go days between seeing some of my coaches for more than two minutes.  Sending out email updates on injured athletes and whatever else you may need to share takes five minutes and is a good way to keep up with your coaches if you haven't had an opportunity to track them down.

• AEDs with far away sports - Before working at my current high school, this was never an option that I considered.  All of your coaches have (or should have) CPR and AED training, but if something should happen at practice and you aren't there at a far away field or facility it is a good idea to have an AED available.  Ours were purchased through a grant, since it is somewhat impractical cost-wise to purchase four or five separate AEDs and accessories.

• Contact/emergency action sheet in all med kits - Not everyone likes to do this because it makes it a lot easier for those pesky teenagers to apprehend your phone contact information, but there are any number of situations where it can be beneficial to keep the number for your cell phone or pager on a small emergency card in each med kid.  Along with this, I tape a small card with a basic emergency plan for the team's venue to the inside top of each kit.  It might seem like extra work now, but the few minutes that it can save in an emergency might save a life; plus it never hurts to be prepared!

• Walkie talkies - They're relatively inexpensive, they're a one time purchase, and they're a super easy way to stay connected with your coaches and teams while you're off at other fields.  You're as far away as the push of a button for all of your coaches, easy!

• Weather reminders - If you're above 8 on the 1-10 boredom scale in the spring then this one is for you.  Write up the day's weather conditions (including of course humidity and heat warnings) and post it outside of your athletic training room.  Add pictures, put comics on them, put out a list of delinquent athletes from winter season that still haven't turned their equipment in, put out a fact of the day, do something!

Have fun this spring, and stay safe everyone!

Should girls be allowed to play football with the boys?

The hot button topic for sports bloggers today is Mo Isom, star goalie for LSU's women's soccer team, as she begins her attempt at trying out for kicker on the football team. Personally I don't think that her trying out should be such a big deal.  Girls have been playing on boys teams for years now, and she is not the first female to try out for a D1 football team. 

Speaking from the experience of a woman who plays in a men's lacrosse league, I can definitely say that Mo (or any girl looking to play with the boys for that matter) will likely face some adversity at first.  It can be difficult to penetrate into the "boys club" that many male teams become, but if Mo is made up of as strong of stuff as she seems to be she should be fine.  Actions speak louder than words, especially where sport is concerned.  If a girl can prove herself on the field then she will generally be accepted by a team with no problems. 

If anything, I believe the greater challenge that faces not only Mo but any girl going out for a boy's football team at any level is acceptance of the public and the media.  While a lot of male athletes are more than ready to accept that some women can in fact compete on their level, the public is less willing.  Listening to discussion on the radio today, the main concern appeared to be that Isom wouldn't be able to take a hit or try for a tackle after kickoff.  I am inclined to disagree.  While she may be of a lighter build than the other guys, aren't most kickers?  As long as she's doing the same things in practice that the other kickers do (which, let's be honest, isn't a lot) she should be fine.

Having been to many a Cleveland Fusion game to watch my best friend play, I can absolutely say that there is no reason girls shouldn't play football.  The women who play in the Women's Football Alliance are tough and strong, and I could easily see most of them playing right alongside the guys. 

This all said, I do not believe that teams should have to give up spots that would have been going to better players if there is pressure to "allow" a female to play on the team.  Title 9 allows girls the option to try out for the football team if they so choose if their school does not have a comparable female sport.  Try out does not necessarily mean make the team.  If someone goes out for a team and is a good enough athlete to merit a position, it shouldn't matter what their gender is.  If they're able to compete at the appropriate level then they should be allowed to compete, period.

I've seen girls play at or better than the boys in wrestling, ice hockey, lacrosse, and yes even football.  Once a girl proves herself on a team, there is no need to be concerned about distractions or problems, she and the rest of the team are there to win games.  In short, yes, I think that not only should girls be allowed to play football with they boys, they should be encouraged.  Don't like it?  Then encourage enough girls to play football that we form all-female teams at the high school and college level.  We need more girls in sports!

You Pulled What Out of Your Athlete's Where Now?

I've been around the athletic training room for ten years now, first as an athlete and student and then as a certified, and I can say with some certainty that I have seen some pretty weird things.  Some of the strangest stuff has been things I've had to extract from athletes.  You'd think by the time they're teenagers they would stop putting erasers up their noses but no, that's not the case.

2003 - "Oh whoops, they're stuck..."

Most kids don't like the nose plugs.  Honestly, who likes shoving a scratchy cotton tampon up their nose?  Not me.  The day after a game where I had plugged a player's nose, he came to the training room to get taped and began to play with the box of nose plugs we had on the table.  Suddenly the bright idea came from his teammates - how many can you fit in your nose?  I turned my back to tape an ankle and then heard the fatal words "Oh whoops, they're stuck..." Four nose plugs up one pretty normal sized nostril.  FOUR.  Fifteen minutes and a hefty scoop of skin lube later my player had the use of his nostril back. 

2004 - "Can you look at my eye?"

When a player says they've been having itching in their eye all day usually my first guess is pink eye, allergies, or a corneal abrasion.  Not even close with this lacrosse player.  Peeling back his eyelid with a cotton swab I noticed the problem immediately but was still pretty foggy on the cause - how on earth did he get a half centimeter long piece of mechanical pencil lead in his eye?  How I didn't immediately come to the answer I got I'll never know - "Oh, we had a lead fight yesterday afternoon."  Clearly I should have thought of that one right from the start.

2005 - "...well they gave me five bucks!"

We adults know it's a bad idea to put things in our noses, they're fragile.  For some of my football players, this lesson hadn't yet been learned by the age of 18.  This particular individual came in to the athletic training room with tears in one eye and blue mucous emerging from his nose.  I pointed at the tissue box and asked no questions.  There's a point where you just don't want to know - but I got to know anyhow of course.  My football player snorted an entire pixie stick.  If you're not familiar with this particular confection, I can tell you that they're on the sour side and completely sugar.  If you've ever been making a ten gallon cooler of Gatorade and gotten the powder dust up your nose then you know how uncomfortable this is.  After flushing him through with saline, I finally had to ask why he did it.  Personally I'm not sure it was worth the five bucks!

2008 - "My foot is killing me, I think I have a blister"

Soccer players are prone to blisters, it's a fact of life, so when one comes in complaining that they think they have a blister that's usually what it is.  Normally I don't lance blisters unless an athlete is in a lot of pain or they're looking like they're going to get infected.  This one looked bad, like a blister had somehow developed under several layers of skin.  So we got out the callus shaver, shaved him down, then went to work with a scalpel.  Without going into detail, it was pretty obvious after the first cut that this was no blister.  A splinter then?  Sort of.  It was buried so deeply that it took three athletic trainers and close to 40 minutes to extract the half centimeter long shard of wood.  After puzzling over it for a minute, the athlete was able to identify it and how it got in there - over a month ago he had popped a blister using a toothpick, part of it must have broken off in his foot.

2009 - "My ear hurts, help!"

Swimmers are usually pretty good about not getting into too much weird trouble (aside from ridiculous injuries stemming from their inability to ambulate properly on dry land) but this one made the wall of fame, mostly because of how ridiculous it was.  A swimmer with ear pain probably has swimmer's ear, so you get your otoscope and take a look, find the swelling, send them to the doctor.  Or it could be a tiny wad of paper shoved way back in their ear.  How did it get in there?  "Oh... it might be a spitball."


2011 - "I just wanted to see what it felt like..."

In my old training room, I had my taping tables pretty far away from my office, so I didn't pay much attention to what was going on in there while I was taping.  A lacrosse player limped out while I was taping one of his teammates, and I noticed a small amount of blood running down his leg.  Naturally (in my best parent voice) I had to ask, what did you do?  Pulling up his shorts, he revealed three staples embedded in his mid thigh.  I held out a pair of forceps silently, and our conversation was about as follows:

Athlete: Can you do it?  It really hurts!
Me: Duh, but you put them in there.
Athlete:  I can't just seriously pull them out, ok?

At this point I rather unceremoniously yank all three staples out and proceed to scrub the area with an alcohol pad, much to the young man's displeasure.

Me: That's what you get for being a dumb ass.
Athlete: It hurts bro!
Me: What did we learn?
Athlete: [short pause] Don't be a dumb ass?
Me: Good boy.

I can't be the only one that this happens to.  Got a story about weird things you've removed from your athletes?  Share it!!!

Happy National Athletic Training Month!

It seems hard to believe that it's March already, but here we are, and this is our month!  I thought I would kick it off by throwing up some ideas on how to celebrate and spread the word about how awesome Athletic Trainers are!!!

1.  Posters or a bulletin board

Sure it's old school, but posters or bulletin board decorations are perfect for any area, be it clinic, classroom, or athletic training room.  They're easy and can be made to fit your audience.  You can put up something more serious in your clinic and then make something more fun in your athletic training room, or whatever you feel like!  The theme for this year is "Athletic Trainers Save Lives" so you may want to consider that as a theme for your board or poster. 

Tips:

• Start with a dark background so that you can use white printouts that are easy to read.  Red or blue for the NATA, or use your school colors!
• Keep it simple, people are more likely to read short fun looking things.
• Highlight areas of interest with bright colors, cutouts, or arrows.
• Use pictures if you have them!  I always put up pictures of me and my student aides at work.
• Have multiple ATCs?  Do a "meet your ATCs" section with pictures and short interviews!

2.  Raffle for ATC themed prizes

One of my favorite things that I do every year is a raffle for various prizes.  This year I'll be giving out three "I <3 my Athletic Trainer" t-shirts, NATA and GLATA post-it notes and pens, and a gym bag with our mascot on it!

Tips:

• Combine this with other things that you've got going on.  One great idea is to make a quiz to go along with your bulletin board or posters - in order to enter the raffle you have to score 100%
• Need extra money for your budget?  You can make your raffle a fundraising event!  Sell tickets  and use your proceeds to get something you need for your athletic training room like new small rehab equipment!

3.  Fact-a-day posts

You've got Facebook or Twitter or Google Plus or some sort of social networking media, use it!  Every day this month, post a fact about Athletic Trainers, who we are, what we do, how we operate, etc.  Need facts?  Check out the NATA website for materials!

4.  Funny pictures - when you're clearly too cool for the rest of this stuff

The internet savvy ATC might find all of the other options boring.  The obvious solution to this particular problem is to use those internet skills to create a mass of amusing ATC related macros and motivational posters.  For example, exhibit A:

 

By the way, I actually am Wonder Woman.  To quote this year's "Not a Trainer" poster, "We're trained in fitness, sports, computer applications - even parenting."  That sounds like a superhero to me!

Regardless of what route you decide to go, remember to have fun with it and if appropriate, really emphasize this year's theme.  Athletic Trainers DO save lives every day.  Whether you're getting people back to work, helping someone establish good nutritional and fitness habits, providing emergency care to an athlete, or just sitting and being an ear for a student, YOU are a life saver.