Unit 1 EXPLORATION OF THERAPEUTIC CAREERS Lecture notes

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1 Unit 1 EXPLORATION OF THERAPEUTIC CAREERS Lecture notes I. Sports medicine is a term that has many connotations, depending on who or what group is using it. A. Sports Medicine is multi-disciplinary, including the physiological, biomechanical, psychological, and pathological phenomena associated with exercise and sports. B. The clinical application of the work of these disciplines is performed to improve and maintain an individual s functional capacities for physical labor, exercise, and sports. It also includes the prevention and treatment of diseases and injuries related to exercise and sports. II. Sports Injuries A. An injury is defined as damage to the body that restricts activity and/or causes disability. B. When considering athletes in all sports, recreational and organized, who participate in sports in one year s time, there is a 50% chance of their sustaining some injury. i. Fifty percent of all sports injuries require only minor care and involve no restriction of activity. ii. Ninety percent of these minor injuries are muscle contusions, minor joint sprains, and muscle strains. iii. Ten percent of sports injuries lead to complications and eventually to severe, chronic conditions in later life. C. For sports injuries that must be medically treated, sprains or strains, fractures, dislocations, and contusions are the most common. D. For both males and females, the most commonly injured body part is the knee, followed by the ankle. Males do have a much higher incidence of shoulder or upper arm injuries than females. E. Types of Sports i. Collision Sports 1. In collision sports, athletes use their bodies to deter or punish opponents. (Remember to consider the true intent of the sport.) Collisions may occur in other sports but are accidental and not part of the actual intent of the game. 2. American Football, Ice Hockey, and Rugby are the most common collision sports in the U.S. 3. Football is the most injurious sport in the U.S. a. Most injuries occur during practice and offensive linemen sustain 20% of all reported football injuries. Defensive linemen sustain 19%. Most injuries result from direct impact (44%). Unit 1 Exploration Of Therapeutic Careers 1 draft copy

2 b. The body part most commonly injured in football is the knee. Concussions also seem to be a frequent injury. c. Head, neck and internal injuries account for the majority of fatal injuries in football. Sudden heart failure and heat stroke also account for football fatalities. 4. Ice Hockey a. The highest percentage of hockey injuries occur in games, most commonly in the second half. b. The most common ice hockey injuries are incisions, lacerations, and contusions. c. The most common cause of death in hockey is being hit by a stick or a hockey puck. d. The hockey stick is responsible for over 1/3 of all hockey injuries, almost twice the number caused by the hockey puck. 5. Rugby a. The highest incidence of injuries in rugby occurs to the shoulder, followed by injuries to the head, the neck, and the knee. ii. Contact Sports 1. Contact sports include basketball, baseball, field hockey, lacrosse, rodeo, soccer, softball, water polo, and wrestling. 2. Basketball a. Basketball has the second highest rate of injury in competitive sports in the U.S. b. Most of the injuries in basketball are to the knee, followed by ankle sprains, and contusions. 3. Baseball and Softball a. Most injuries in these sports are caused by the ball, which is not only hard but travels at an extremely high rate of speed. b. Injuries to the hand, wrist, and forearm are the most common c. Fatalities do occur in baseball and softball, usually the result of being hit by a bat or ball. 4. Soccer a. Soccer is played by more individuals than any other sport in the world. It is the most popular sport in over 135 countries. b. The main causes of deaths in soccer are from collision with another player or the ground, being hit in the head with a ball, and hitting a goalpost. c. Injuries to the lower extremity seem to be the most common soccer injury with ankle sprains being most frequent. Fractures and contusions are also commonly seen. Unit 1 Exploration Of Therapeutic Careers 2 draft copy

3 iii. Non-Contact Sports 1. A great number of sports are classified as non-contact, including archery, badminton, bowling, crew/rowing, cross country running, curling, fencing, golf, gymnastics, skiing, squash, swimming, diving, tennis, track and field, and volleyball. 2. Track and Field a. Taking into account the high number of participants in the U.S., track and field has relatively few fatalities and a relatively low injury rate. b. Heat injury is significant as are overuse injuries. Strains, sprains and abrasions are probably the most common musculoskeletal injuries. c. Structural abnormalities, types of running shoe, running surface and running intensity are commonly attributed to causing running injuries. 3. Skiing a. Three factors stand out when considering the injury rate of skiing the skier, the ski equipment, and the environment. b. The most common skiing injury today is to the knee (20%). Ankle sprains have recently been significantly reduced due to changed in ski equipment. c. The usual causes of reported fatalities are head injuries, or internal hemorrhages caused by lacerations to the spleen or liver. 4. Tennis and Other Racquet Sports a. Elbow and wrist injuries are commonly seen in racquet sports. Overuse injuries are also very common. b. Poor technique is believed to contribute to many tennis injuries. III. Sports Medicine A. The risk of injury is inherent in all sporting activities. It is important to reduce the risk of injury through a program of prevention that includes physical conditioning, good nutrition, and careful attention to the selection and fitting of gear and equipment. B. Besides the physical aspects, the psychological and emotional aspects of competition must be addressed. C. Although injury prevention is of primary concern, when injuries do occur, they must be cared for in the most efficient manner possible. The sports medicine team (including professionals in many different therapeutic careers) must work closely together to ensure that all injuries are properly managed. Unit 1 Exploration Of Therapeutic Careers 3 draft copy

4 IV. Health Professions in Therapeutic Careers A. Skills and Personal Qualities for Individuals in Therapeutic Careers i. Stamina and ability to adapt. ii. Empathy. iii. Sense of humor. iv. Ability to communicate. v. Intellectual curiosity. vi. Personal ethics. B. Certified Athletic Trainer (A.T.,C.) i. Athletic trainers are responsible for injury prevention, recognition, and evaluation; and the management, treatment, rehabilitation, education, and counseling of athletes. ii. The athletic trainer is the major link between an athletic program and the medical community for the care and safety of the athlete. Communication between the athletic trainer, parent, athlete, coach and other therapeutic professionals is essential. iii. Education Bachelors or Masters degree in Athletic Training/Sports Medicine with 800 to 1500 practical hours of direct supervision in a curriculum approved program. Successful completion of NATA exam. iv. Career settings College/University athletic departments, High School athletic departments, Professional Sports Teams, Sports Medicine Clinics, and Physical Therapy Clinics. C. Certified Strength and Conditional Specialist (C.S.C.S.) i. Strength and Conditioning Specialists educate and train athletes in proper strength and conditioning practices. They design and implement safe and effective strength and conditioning programs. ii. Education Bachelors degree in a health or sports related field, and successful completion of NSCA exam. iii. Career settings College/University athletic departments, Professional Sports Teams, Private practice, Gyms/Fitness Facilities. D. Chiropractor (D.C.) i. Chiropractors diagnose and treat patients whose health problems are associated with the nervous and muscular system, especially the spine. They employ postural and spinal analysis, manipulate and adjust the spine. They can specialize in athletic injuries, neurology, orthopedic, nutrition and internal disorders. ii. Education Bachelors degree in a health related field and completion of an accredited 4-year chiropractic program. iii. Career settings Most commonly in private practice, can be affiliated with a professional sports team. E. Dietician (R.D.) i. Dieticians are responsible for assessing patient s nutritional needs, planning menus, and teaching nutritional principles with the goal of improving nutritional health. Dieticians may specialize in a particular area of clinical nutrition such as diabetes, cardiovascular disease, or pediatrics. Unit 1 Exploration Of Therapeutic Careers 4 draft copy

5 ii. Education Bachelors or Masters degree in Nutrition/Dietetics, successful completion of ADA exam. iii. Career settings Hospital, private practice, college or university, research facility. F. Exercise Physiologist i. Exercise Physiologists develop exercise routines and educate people about the benefits of exercise. They often teach at colleges and universities and perform research regarding the effects of exercise on the body. ii. Education Bachelors, Masters, or Doctorate degree in Exercise Physiology. No licensing is currently available. iii. Career settings Private practice, gyms/fitness facilities, human performance labs, research, corporate fitness programs, and rehabilitation clinics and programs. G. Massage Therapist (L.M.T.) i. Massage Therapists provide hands-on manipulation of the soft tissues of the body including muscles, connective tissue, tendons, ligaments and joints. Massage therapy provides an alternative health option to help alleviate the soft tissue discomfort associated with everyday and occupational stresses, muscular over-use and many chronic pain syndromes. ii. Education successful completion of an accredited program and state licensing exam. iii. Career settings private practice, hospitals, hotels, resorts, sports medicine clinics, professional sports teams, gyms/fitness facilities. H. Occupational Therapist (O.T.) i. Occupational Therapists help people with physical or emotional difficulties to overcome, correct or adjust to their particular problems. OT s use various activities to assist the patient in learning new skills for daily living or for preparing to return to work. Treatments are designed to help the patient acquire independence and regain lost functions. ii. Education Masters degree in Occupational Therapy and successful completion of state licensing exam. iii. Career settings rehabilitation clinics, hospitals, private practice, and public schools. I. Orthopedic Surgeon (M.D.) i. Physicians examine patients, order tests, make diagnoses, treat diseases and disorders, and teach preventive health. Orthopedic surgeons are physicians who specialize in the surgical treatment of orthopedic (bones, muscles and soft tissue) injuries. ii. Education Doctorate degree in medicine (successful completion of medical school), internship, residency, and optional fellowship to specialize further. Successful completion of multiple board examinations. Unit 1 Exploration Of Therapeutic Careers 5 draft copy

6 iii. Career settings Hospitals and Clinics. Specialties available sports medicine, hand surgery, general orthopedics, spine, pediatrics, and geriatrics. J. Performance Enhancement Consultant i. Performance Consultants work with coaches and athletes to achieve maximum sports performance. They generally work with both physical and mental techniques designed to enhance athletic performance. ii. Education college degree in a sport discipline with training in sports psychology, exercise physiology, nutrition, etc. iii. Career settings Private practice, teaching in college/university. K. Personal Trainer i. Personal Trainers provide individualized exercise and fitness programs, as well as providing motivation and ensuring proper exercising methods to their clients. They provide instruction in the many facets of fitness and must have a basic understanding of the principles of human physiology and anatomy. ii. Education completion of a certification exam, however further education is recommended. iii. Career settings Private practice, gym and fitness facilities. L. Physical Therapist (P.T.) i. Physical Therapists provide treatment to improve mobility and prevent or limit permanent disability of patients with disabling injuries or diseases. PT s assess patients, design treatment programs and promote proper exercise and activity. ii. Education Masters degree in Physical Therapy and successful completion of state licensing exam. iii. Career settings Rehabilitation clinics, hospitals, and home health. M. Sports Psychologist i. Sports Psychologists study and treat the psychological factors that are associated with participation in sport, exercise and other types of physical activity. They help athletes through psychological treatment methods to achieve optimum mental health and enhance sporting performance (often involving techniques like visualization and relaxation); and they conduct research to understand how participation in sport/physical activity affects an individual's psychological health and well-being throughout their lifespan. ii. Education Masters or Doctorate degree in Sports Psychology. iii. Career settings Private practice, research facilities, college/university programs, professional sports teams. V. Legal Concerns A. Legal Terminology i. Assumption of Risk: a person who voluntarily exposes him/herself to a known and obvious danger. ii. Battery: touching someone without permission. iii. Civil: a private right as opposed to a criminal action. Unit 1 Exploration Of Therapeutic Careers 6 draft copy

7 iv. Compensatory Damages: money awarded equivalent to the actual value of damages. v. Criminal: act that is punishable by written state or national laws. vi. Duty to Act: a legal obligation. vii. Failure to Warn: failing to inform a participant of potential risks and dangers. When dealing with minors, failing to warn parents and obtain parental consent. viii. Improper Release of Medical Information: releasing any medical information without written permission. ix. Informed Consent: being informed of all procedures and the potential risks and benefits of each. x. Liability: the legal responsibility to act in a reasonable and prudent manner. Failure to perform in such a manner makes you legally liable. xi. Litigation: carry on a legal contest through the judicial process. xii. Malpractice: when an individual commits a negligent act while providing care. xiii. Negligence: doing something (commission) or failing to do something (omission) a reasonable person would or would not do under similar circumstances. xiv. Punitive Damages: compensation awarded for subjective damages. xv. Reasonable and Prudent Care: quality of care given that would be given by another person with similar training. xvi. Release of Liability: intentional release of known rights. xvii. Risk Management: management of potential dangers, preventing loss. xviii. Tort: a civil wrong, intentional or unintentional. Anything a person can be sued for, either act of commission (committing an act which is not legally theirs) or act of omission (failing to carry out a legal duty). B. Legal Issues i. Negligence in order to prove negligence, four basic elements must be shown. 1. There must be a legal duty of care. 2. There must be a breach of that duty. 3. There must be some injury. The mere threat of harm is not sufficient. 4. That breach of duty must be the proximal cause (the direct result) of the resulting injury. ii. Assumption of Risk the law recognizes that there are some risks inherent in all activities. It is assumed that an individual who participates in an activity and is injured as a result of the ordinary risk associated with the activity will not have grounds for negligence. However, if another individual s negligence contributed to that injury, then liability is still a possibility. iii. Foreseeability of Harm exists when danger is apparent, or should have been apparent, resulting in an unreasonably safe condition. Equipment, facilities, and conditions should be regularly inspected for Unit 1 Exploration Of Therapeutic Careers 7 draft copy

8 threats to safety. Unsafe conditions should be identified, reported in writing to appropriate personnel, restricted from use, and repaired or replaced as soon as possible. iv. Title IX an addition to the 14 th Amendment made in Title IX states that no person in the United States shall be excluded on the basis of sex or be denied the benefit of any education program or activity receiving Federal financial assistance. VI. VII. VIII. Athlete/Patient Rights A. All athletes/patients have the following rights: i. The right not to be discriminated against, for race, religion, gender, etc. ii. The right to privacy and confidentiality of medical records and information. iii. The right to have access to his/her own medical records. iv. The right to understand his/her medical status in his/her own language. v. The right to refuse treatment. vi. The right to be fully informed about the care and treatment he/she receives and the potential risks and benefits of each. vii. The right to be free from verbal, physical, mental, or sexual abuse. viii. The right to prompt and prudent care. Legal Safeguards A. It is important that sports medicine professionals be aware that they are legally obligated in carrying out their professional responsibilities. B. In order to protect themselves, sports medicine professionals should follow the safeguards listed below: i. Carry liability insurance. ii. Keep accurate records/documentation. iii. Be informed and up to date in changes in the standard of care through continuing education. iv. Be familiar with the medical histories of athletes, clients, or patients. v. Maintain qualified and adequate supervision of facilities, employees, and equipment. vi. Always stay within your scope of practice. vii. Have a good rapport with athletes, parents, coaches, physicians, clients, and colleagues. viii. Follow the orders and recommendations of physicians at all times. Documentation A. One of the most important responsibilities sports medicine professionals must do is develop and implement a comprehensive record-keeping system. Accurate records are critical in litigation and serve to improve communication between all members of the sports medicine team. B. Documentation concerning pre-participation exams, insurance forms, personal data information, accident reports and injury management, daily Unit 1 Exploration Of Therapeutic Careers 8 draft copy

9 treatment or status reports, rehabilitation programs and progress charts, and clearance for participation are essential. C. In a legal situation, if it wasn t written down, it didn t happen! D. Injury reporting forms and injury tracking software are available on line. E. SOAP Format i. The recognized system for documentation is the SOAP method. 1. S = Subjective: information that the patient reports. 2. O = Objective: information that can be measured and expressed in a standard format. 3. A = Assessment: what decisions are made with the subjective and objective information gathered. 4. P = Plan: course of treatment to be carried out. ii. Scenarios 1. Using the following scenarios, have the students prepare a basic SOAP Note, as per the performance skills checklist. Or use your own scenario. 2. Scenario #1 A female distance runner is complaining of a deep, aching pain in the knee during activity. She cannot recall any injury to her knee. She has increased her running distance from 4 miles/day to 6 miles/day in the past week and has been running on varied surfaces. She also complains of pain during ascending and descending stairs. After practice, she has been applying ice to her knee and taking ibuprofen. Observation reveals no postural abnormalities other than slight joint effusion. As the examiner palpates the patella, the athlete reports pain and tenderness when the patella is pushed downward. She also reports discomfort when the patella is moved medially and laterally. During passive knee extension, the patella laterally deviates from the groove. Pain increases during resisted knee extension, and crepitus occurs under the patella. She cannot perform a duck walk or squat test without pain. You believe that this athlete may have Chondromalacia (a degenerative condition in the articular cartilage of the patella). You decide to design a rehabilitation plan for this athlete including quadriceps and hamstring flexibility and strengthening, specialized taping, and other appropriate procedures. 3. Scenario #2 A hockey player was taking a shot on goal when his stick hit the jaw of the player who was guarding him. That player comes off the ice bleeding from the mouth, complaining of pain in his lower jaw and an inability to close his jaw (malocclusion). Upon palpation by the examiner, deformity and swelling are noted. Discoloration around the jaw and facial distortion are observed. The examiner suspects this athlete may have a fracture of the mandible. The bleeding is controlled, the jaw is immobilized, and the athlete is immediately referred to an emergency room. Unit 1 Exploration Of Therapeutic Careers 9 draft copy

10 4. Scenario #3 A quarterback is charged by the defense as he is preparing to throw a pass and is struck in the throwing arm, forcing it into external rotation, abduction and extension. He reports an immediate burning sensation traveling down his arm and now his thumb is tingling. The examiner notes muscle weakness involving the shoulder and arm muscles and pain above the clavicle. No deformity or swelling is palpated. Within 10 minutes, the pain and burning sensation resolves. The examiner rechecks neck and shoulder range of motion, strength of the shoulder and arm muscles, and grip strength. All appear to be normal. The examiner believes this athlete has had a brachial plexus injury (stinger). Since the athlete s symptoms have all cleared and returned to normal, the athlete is allowed to return to the game. An additional exam to recheck this athlete will be conducted at the end of the game. IX. Ethical Issues A. Sports medicine professionals must act at all times with the highest standards of conduct and integrity. Ethics can be defined as a system of moral principles or standards governing conduct and knowledge of right and wrong. B. Ethics are held on an individual level. What one person considers right or wrong may not be the same as another person. However, many professional organizations establish ethical principles as guidelines for professionals. In health care, ethical principles include: i. Never compromise the health and safety of any patient/athlete. ii. Respect the rights, welfare, and dignity of all individuals. iii. Comply with the laws and regulations governing the practice of the profession. iv. Accept responsibility for sound judgment. v. Maintain and promote high standards in the provision of services. vi. Do not engage in any form of conduct that constitutes a conflict of interest or that adversely reflects on the profession. C. Ethics Committees are established in many hospitals to assist health care professionals in making ethical decisions. D. Ethical issues in sports often deal with some of the following areas: i. Fair play and sportsmanship. ii. Cheating. iii. Winning at all costs. iv. Performance enhancing drugs. v. Drug testing vs. privacy. vi. Gender equity in sports. vii. Public admiration of athletic heroes. viii. Accommodation of disabled athletes. ix. Sports and its effect on society. x. Violence in sports. Unit 1 Exploration Of Therapeutic Careers 10 draft copy