No running, no hiding from concussions (AT student blog term 2)

See below for my “I haven’t had time to write anything so here is a copy and pasted school blog post to fill time until I actually write…” Post. Enjoy that.

“So far my winter term has began with more concussions then my stint with football in the fall term did. And I’m only working in clinic…?

Over the holidays I did some work with my alumni varsity basketball team (Carman Collegiate), the coach had me design a few conditioning programs for the girls- which was a blast! The girls soon grew to love/hate me, it seems I have a fantastic imagination when it comes to designing sport specific work-outs to compliment practices. I attended one pre-season tournament with them in January, in which the coaches got confused as to what to call me (trainer? assistant coach? therapist? old player?) and at one point were planning on throwing a jersey on me and seeing if I could still play. However, I did come in somewhat handy with a couple small injuries. One player came up to me after the first game complaining of pain just inferior to her lateral malleoulus. She had no history of trauma (hadn’t rolled or landed funny on that foot in the last game) except for she had sprained that ankle a few years ago. After my assessment, I came up with a mild strain to the peroneals. She didn’t have any laxity in the joint, and didn’t really want tape (besides I wasn’t sure how I was going to tape to help that anyway– and the med kit there is pretty lacking). She was just happy to have some sort of reason as to why her foot kinda hurt.

After her, athletes started to get a little more liberal with actually coming to talk to me. Later on that day, conveniently 15 minutes before the start time of their second game in the day, the star player came to me complaining of knee pain (that she’d been experiencing for the last 4 months or so, but didn’t know what to do about it- so she just continued to train on it). I soon learned that during soccer season she had been hit with a valgus force and the knee had been “weird” since then. Okie dokie. So after running a quick assessment, I was slightly confused. While her MOI from soccer would suggest the medial aspect of her knee to be the problem, all of her pain and positive tests were on the lateral side. With ligament tests, there was no laxity, but the end feel was extremely painful. She only experience pain during play after she became fatigued and during lay-ups or jump-shots. She had a positive Ober’s and Nobel’s. So I came up with the possibility of the lateral ligaments still being a bit upset from the soccer incident, plus a little bit of ITB friction happening now during basketball. She, too, was quite happy just to know what was wrong and I said I could try taping for a little extra support (again, no laxity so wasn’t really worried about her going back to play if she was okay with it). At first, she said no to the tape (in my head I was going “thank god” as the game was due to start in about 5 minutes now). I ran through my warm-up with the team, and then, of course, said player comes back requesting I try tape. Of course!

So I slapped on a collateral ligament support (what else could I do for that??), had her do some functional testing which got a: “wow! my knee feels so amazing! Like, it doesn’t hurt at all anymore!”. Wasn’t expecting that response, but okay. I should mention that our med kit at Carman Collegiate only really has zinc oxide tape in it (and a few other necessary first aide supplies). No pro-wrap (unless it’s in the players’ hair), no toughener, no leuko tape or elasticon, legitimately only white tape. Thumbs up. This was the first time this player had ever been taped, so I wasn’t too surprised when I noticed she wasn’t playing as aggressively in the first quarter. After the buzzer rang for that quarter, I found her getting tangled in a mess of sweaty tape trying to get it off. I helped her take it off, and found that as soon as she started playing again she was back to her old self. Until she got elbowed in the face and I had to go onto the court (FIRST TIME GOING ONTO A FIELD/COURT AS A THERAPIST!!!) as she stayed down for a while. Not an injury I could real do much for, except for check her teeth. Just a nice cut on the inside of her lip, to which I advised rinsing with salt water later to prevent infection. She was back on the court in a few minutes.

What else did I do over the holidays? Well, about a week before Christmas my mom concussed herself by falling on the curling ice. I wasn’t home when this happened, so I got the stress inducing text saying “don’t panic,…. but your mom is in the emergency room because she hit her head on the ice…” WHAT. Tell me I’m not the only one out there who would go into full fledged OMG mode? Luckily, it wasn’t as serious as the scenarios my mind took me to. The emerg. doctor, unfortunately, obviously hadn’t done much continuing education on concussions- sending her home with a “mild” concussion, not checking her for fractures (the only thing that hit the ice was her head… the sound alone stopped every sheet of ice in the rink) with the reasoning “we only really see fractures in car accidents.. so you’re probably fine”, telling her that there was no need for someone to check on her throughout the night as “we don’t really do that anymore” (my mom was alone at this point, her husband was away and I was stuck in the city because of weather), and then sending her with two kinds of painkillers for the headache (isn’t this the one thing we’re never supposed to do??).

Sigh.

If anybody else out there has had the joyous experience of trying to give a injured family member advice.. you know how frustrating it can be. Having gone through the concussion experience first hand, and, you know, being educated on the matter- you’d think I’d have a little more influence with her. Thankfully, her husband sided with me, and over the next two weeks we managed to keep her laying low and mostly brain resting. She refused to not watch tv, and having a concussion over Christmas has to be the worst, because there is no avoiding busy social gatherings. Against my advice, she tried to go back to work after New Years- even after a sport med doctor I made her see told her to wait a couple weeks due to persisting symptoms. Can we guess what happened? More symptoms returned, and she started to get frustrated, irritable, and a little depressed. The back of her head (impact site) was still throbbing (3.5wks later) so I suggested she see another doctor. She listened, and this local doctor strictly told her to take another 2 weeks off before even thinking of working. My mom’s job consists of a lot of computer work, writing, editing, and thinking, interviewing, and critical analysis. Aka, a lot of brain work. This doctor also said that she had to come back to see her before she went back to work. (Btw, this is the exact same advice I gave her, the previous doctor gave her, and Robyn from the clinic at school gave her). Finally, she is listening. Somewhat. I woke up this morning to find her snow-blowing our driveway with a push blower. She comes inside saying “.. my head ache is back..”. WONDER WHY.

In rehab the other day we were talking about building a pts confidence back up to eventually return to play is a big part of it. I can see that now with my mom’s injury, she’s expressed many times that getting back onto the curling ice is terrifying to think about, and thinks that her fall was because of something she did wrong. She has been a curler for her entire life, many years as a competitive curler. She has even began to lose her nerve over small tasks that were once second nature to her (for example, working with our horses in the barn). As we know, a lack of confidence in one’s abilities often can cause more injury due to hesitation in actions. While the immediate challenge for her is just recovering from the actually injury, I can see down the road how there will be a lot of confidence building to do.

Okay so that covers my holidays…

I’m doing my clinic with Claude at MORfit, who I worked with before and throughout the holidays as well. The first thing he had me do once we both got back from holidays in the clinic was, wait for it…. a concussion assessment. His reason for having me do this (besides being his student)? “I haven’t done one in like 5 years…. so you have more experience with it then I do”. Inspiring. The next week I also did a full assessment for him on a new patient. He presented with pain just medial to his bicipital groove. He initially injured himself about a month ago when doing lateral DB raises, hearing a pop at end range and having severe pain around the insertion of pecs. Interesting. So I ran through my assessment, finding he had pain in all ranges of motion, except internal and external rotation. This changed when I went to IROM, internal caused great pain and external much the same. Definitely suspecting pec strain at this point. No weakness in any ranges though. I should also mention that during postural assessment, he had significantly anteriorly rotated shoulders. For special tests I did empty can (positive with pain), and speeds (positive with pain). Combined those with resisted cross flexion/extension (very painful) and I concluded a pec major strain likely because of the anteriorly rotated shoulders and the MOI.

What else have I done in clinic? A lot of pnf-ing, and massaging. Massaging was real fun after weeks off, the first time Claude had me do more then one in a shift, my hands were done for the rest of the day. I’ve also continued to work with the Older Adults program, and continue to love it.

I’ve noticed that I’m much more confident in my assessments now then I was last term, which is nice. I don’t panic anymore and as a result don’t forget what comes next. It’s much easier to come to some sort of conclusion when your brain isn’t experiencing stage fright!

To summarize, working with family members is frustrating, I have a knack for designing conditioning programs that make teenagers dislike me, my assessment skills are improving, and my hands are out of shape.

What are my goals for the upcoming couple weeks?

I’d really like to come up with a few new exercises for the older adults. I try to have new balance challenges for them every week, but I really need to think up some brand new ones. I also hope to do a few more assessments over the coming weeks, to continue to improve my skills in that area. I’m also hoping to give my mom some relief, by trying out my new christmas gift of a massage table, and working on her neck.

That’s all for now, folks!”

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