Subjects Of Athletic training Philosophies (SOAP) Notes

Hello everybody, I have not written much about myself personally on this website because that is not what this is about. That being said, for those of you who don't know me personally, the community I live in was in the direct path of hurricane Florence. I am blessed to say I didn't suffer any damage to my properties, but sadly that is not the truth for many people in my community. Weeks have gone by and many still need help recovering from the devastating storm. If you're interested in helping the recovery here are some opportunities to get involved. If a financial contribution is not something you can engage with right now, please consider just spreading the word. Just because the national news coverage ends does not mean the wounds have healed. Also many of these organizations are involved with the recovery for victims of Hurricane Michael as well. American Red Cross - Hurricane Florence Relief https://www.redcross.org/donate/hurricane-florence-donations.html/ ...

Good morning! Today I want to talk about accountability and how it applies to athletic training. We all know there are an unlimited number of ways to achieve the same set of rehab goals, so I don’t believe accountability can relate to our individual treatment philosophies and approaches. In my opinion, I see two qualities that can measure the “success” of an athletic trainer in their dealings with patients. Those two qualities being; patient relationship & trust, and the ability to effectively progress a patient back to unrestricted activities. Each of those qualities exist on a spectrum. You can have great relationships or you might struggle to make strong connections with your patients. At the same time you could resolve all injuries effectively and quickly, or you might have patients who keep coming back for the same old thing. For the benefit of our patients, I would think we all strive to make positive connections and get them back to being healthy as effectively as possi...

Today’s article is going to resemble a bit of a nostalgic love letter. In the chaotic environment of athletic training it is easy to get bogged down under volumes of insurance paperwork or reach the end of your patience with demanding coaches. Not to mention those difficult athletes we’ve all had the pleasure of working with. Despite all of that, I’m still here on the “front lines”, many of you are here with me. But why? The hours can be grueling, the money is often abysmal, and we generally are greatly underappreciated. Despite everything athletic training might’ve deprived me of through years of study and work, it has paid back its debt twofold. Since starting my journey into athletic training, I have had the pleasure of several once in a lifetime experiences. All of which were unique to opportunities provided by my profession. Without divulging my entire resume, athletic training has sent me to other countries, the sidelines of international competitions, travel all across the ...

When I was growing up, nobody in my immediate family had much of a medical background. So when I got into athletic training, everything was new and foreign to me as I was learning about the human body. One of the greatest lessons I've learned about the body is how little we actually know! I think this article discussing lower-crossed syndrome (LCS) is a good example of that. Or maybe I just still have a lot to learn, but either way I'd like to start this discussion. Let me start by saying, I know what lower-crossed syndrome is. Well I know what the concept is and I know how the textbook describes it. My confusion lies in the pathology and reasoning for LCS. The textbook definition of LCS goes something like this "Tightness of the thoracolumbar extensors on the dorsal side crosses with tightness of the iliopsoas and rectus femoris. Weakness of the deep abdominal muscles ventrally crosses with weakness of the gluteus maximus and medius." See the image below for clari...

Good morning! Welcome back to SOAP Notes! After a long hiatus, I have another article to share! I'm sure many of you can relate to how crazy things get towards the middle/late parts of a season. With NATA convention starting this week, I felt this topic would be appropriate. Those of you who are athletic trainers know that our profession has been pushing towards more evidence-based practice (EBP) methods. This has been reinforced by the added requirement of 10 EBP credits on our biannual continuing education reports. Unfortunately, in my opinion many of these EBP continuing education units (CEUs) are accomplished through online quizzes that rarely have an obvious correlation to the clinic. Today I want to talk about EBP, how it can directly impact clinical practices, and how it might possibly be addressed differently. My understanding of the idea behind evidence-based practice is that we must hold ourselves accountable to standards set by the most recent research availab...

Hello Everybody!  Today we have a very special article on the subject of athlete recovery. It is a special article because it was written by my friend and colleague, Graham Joseph. Graham and I had an interesting conversation on the topic of athlete recovery and he offered some great ideas on the subject. I asked if he was interested in writing an article for this site, and here we are! Enjoy!  ---- “Recovery” is one of the many catch-all terms that is widely used across the sports medicine, performance, and coaching world. However, what does this term “recovery” really mean for athletes, and how does this translate to what strategies you implement in your clinical practice? With this post I will try and limit the cliché terms and explain how I consider recovery when dealing with patients and athletes. I ask myself, what are we recovering from? I like to break this into three groups; 1) Central Fatigue, cognitive fatigue, or plain tiredness 2) Peripheral fatigue, ...

Good morning! Today I am going to introduce a slightly different format. This article will be the first in a new style/series of articles that I hope to produce once a month. The format will be based on the medical acronym SOAP. In this series, I will provide 2-4 research articles that have evidence to support opposing opinions (subjective). Then I will add my own personal experience or lessons I’ve learned from others relating to the topic, perhaps on both sides of the argument (objective). I will then offer my personal stance and consideration of the presented information (assessment). Finally, the community response from all of you will provide the “plan”! The first topic of this new SOAP series will be kinesio-tape (K-Tape). SUBJECTIVE: I have two articles cited below. The first one used the application of kinesio tape on the forearm and measured grip strength and force sense in healthy collegiate athletes. In an overview, the study concluded that K-tape had no effect on gri...

Hello everybody! Today’s SOAP Note will be focused on the blend of the weight room and the athletic training room. I have previously talked about the role of the strength coach being focused on enhancing movement through force production compared to the sport coach who teaches skill. Then there is the athletic trainer/physical therapist who aim to restore mobility in injured athletes through the means of efficient movement. Today I hope to explore both the division and the deep connections between the weight room and the athletic training room. Please note, I do not personally believe all athletic trainers and strength coaches operate this way, nor am I speaking of any specific person. I am only analyzing the demands of each job in a general sense. Let’s begin with the commonalities. Between the three departments of athlete development (medical, performance, and sport) there is really only one goal; to optimize athletic potential in an individual. For each department, that goal me...

Hello Everybody, Today’s SOAP Note is going to be about injury rates in sports. The field of athletic training is generally moving towards more injury prevention instead of a reaction approach to injuries. The first step in injury prevention is to identify how they happen. I’ve had some recent thoughts I want to share on how and why injuries occur (in a general sense, not a specific mechanism of injury) and my role as an athletic trainer in their prevention. Anytime injury rates are discussed, football always dominates the conversation. Football, ice hockey, lacrosse, soccer, basketball, rugby, these are all high contact sports. When it comes to athlete-athlete collisions, injuries are near impossible to prevent. You can build the perfect athlete with no compensation patterns, ideal muscle balances, incredible strength-to-weight ratio, etc. and as soon as that athlete is hit by another those measurables go out the door. A “perfect athlete” may be able to withstand more forces, but...

Hello Everybody! Lately, I've given much thought about working with the perfect athlete. In that situation, what role does the athletic trainer play? What role is the strength coach? What about the sport coach? I’ve talked about coaches’ roles before in my “Internal vs. External cues” article. This time I have a slightly different way to look at it. Imagine a group of buddies going on a road trip. The athlete is the vehicle; some are sports cars, some are pickup trucks. In this scenario the pedals and steering wheel are separated in the two front seats. The strength coach controls the gas pedal and brake pedal. They decide how fast or slow the athlete advances. As the road changes (games, practices, time of the season) the strength coach might need to adjust the speed of the car. To consider the body’s ability to adapt and develop I will add that after a while of traveling at certain speeds the car can change. A minivan that continues to run “pedal to the metal” will eventua...

Hello Everybody! Today I am going to focus on Instrument Assisted Soft Tissue Mobilization (IASTM). Full disclosure, I am M1 Graston Technique certified. I frequently use instrument assisted soft tissue mobilization in my treatments. There are three treatment goals I use IASTM for; 1) increase localized blood flow to the target tissue, 2) increase neural proprioception of a joint or muscle, and 3) decrease myofascial adhesions/malaligned fibrous tissue. Working a lot with baseball athletes leaves my practice prone to “routine treatments”. These are treatments I end up doing just about every day usually with pitchers as part of their process to get ready for sport activity. This often means I will perform Graston Technique on the same target tissue for one guy multiple days in a row. I started to notice that from one day to the next or even one week to the next I could not detect a difference in tissue quality on the athlete. Every time I performed IASTM on the same athlete in the ...

Hello Everybody, In today’s SOAP Note I will discuss routine treatments or as I often call them, “the feel good stuff”. I would classify these as treatments that are performed almost daily on an athlete, or treatments that the athlete asks for based on what they like. Typically with the intent of just making the athlete “feel good” prior to activity without relation to any particular injury. I work mostly with baseball athletes, so most of my discussion will use baseball specific examples but this topic fits with any sport. In my undergrad studies, one thing that was consistently imposed on me was being able to answer the question “why?” this is also something I always reinforce to my students. Part of answering “why” for treatments is being able to justify what treatments you decide to use based on sound medical science. Godforbid you find yourself in court, they will judge you against decisions made by a prudent athletic trainer faced with the same information. This is the reaso...

Hello everybody! I’ve previously mentioned Gray Cook and some of his thoughts on how the body moves. Today I am going to discuss how his thoughts mixed with those of Douglas Heel relate to cueing a movement. One thing Gray Cook includes in his FMS program is a pyramid that looks like this: His ideas are that we need to install quality movement before reinforcing that movement by increasing performance. Finally once we have a solid base we can properly teach (sport) skill. After I saw this pyramid, I instantly thought about Douglas Heel’s three body zones presented in his Be Activated series. I created a similar pyramid with Heel’s zones, which looked like this: Notice any similarities? These two pyramids are almost talking about the same thing but from two different approaches. Quality movement begins with zone 1. Power (performance) is produced in zone 2, and skill exists in zone 3. This progression also mimics the relationship between a sport coach, strength coach, and the...

Hello Everybody! I’d like to discuss one basic treatment philosophy today; cookie cutter protocols. What role, if any, do they play in our treatments? I’ll start by saying in an ideal setting I would prefer to assess every athlete’s health and quality of movement then address not only the injured tissue but any imbalances they may have as means of injury prevention. Unfortunately this is rarely feasible due to time constraints as I’m sure many of you can relate. It’s my impression that cookie cutter protocols often get a bad reputation as being unspecific and impersonal, but is there some sense to using them? First let’s get on the same page and define what a “cookie cutter” protocol looks like. I consider a cookie cutter protocol to be a “one size fits all” type of rehab. It doesn’t matter what sport/position you play, if you suffer a lateral ankle sprain you will complete exercises XYZ over the next 2-4 weeks. Second, we should make a distinction between macro-protocols and micr...