Rear Foot Pain

In this case we view different diagnosis of rear foot pain. This blog post will cover rear foot impingement that is often misdiagnosed. Another thing that it covers is a high index of suspicion that is needed when determining rear foot pathology and a detailed history. The final topic it will cover is the treatment for rear foot pain.

 

Rear foot impingement is often misdiagnosed.  This happens when a therapist or athletic trainer does not consider doing a broad range of possible causes prior to attributing the pain to the impingement.Inspection of the rear foot should be very throw. Although the pain can be tolerated by athlete it can also become worse. The injury can lead to osteoporosis overtime.

When diagnosing rear-foot pain high index of suspicion is needed. Many times physicians asked questions that may not be appropriate to the cause. This can result to misinterpretation of the injury. Other times the information derived from questioning is not sufficiently through. The patient should be allowed sufficient time to think. Some good questions would be “where is the most pain?” and “How bad is the pain on a scale of 1-10?”.

 

It is important to always give the proper treatment.  These specific injuries are unique and not always the same. One of most common non surgical method is taping. Taping is most successful because it helps with : infections,firm-soled shoes,and/or immobilization. If nonsurgical treatment is not effective surgical extension will be needed.

In conclusion rear foot pain  is often misdiagnosed because  the therapist or athletic trainer does not consider a broad range search.  Also a high index of suspicion is needed when encountering these injuries. A detailed history is critical in this field of injuries. I think that the treatment of the real foot pain is very important. This article will help us evaluate our skills with all the information it provides. Now we know that we must diagnose rear-foot pain very carefully.

Pregnant Athletes

Authors: Melissa Her, May Xiong, Christina Chagolla, Sabrina Chavez

The anatomy and physiological changes of a pregnant women are complex. For the pregnant athlete, or just any pregnant women in general, there is no black and white guideline as to how they should exercise and maintain healthy behaviors. Pregnancy has a series of steps and changes involving both the anatomic and physiologic functions of a human body. Physically, the process and changes of pregnancy is very visible, but what happens inside is not visible to the naked eye.

https://www.youtube.com/watch?v=6TO1GJfKRAo

There are many different physical changes that occur while an athlete is going through the process of her pregnancy. The first notable one is gestational weight gain; the woman on average gains around twenty-two to thirty-five pounds. At this time, the abdomen grows as well as the breasts; this causes for the center of gravity (COG) to get altered. According to an article from “The Pregnant Athlete, Part 1: Anatomy and Physiology of Pregnancy,” how much weight you gain depends on a few factors: your age, body mass index(BMI), pregnancy activity level, and socioeconomic status. Another physical change is the extension of the trunk, but distinctly in terms of the lumbar spine. The body mass changes to where its above the area that is supported, and can cause elongation (decreased tone of abdominal muscles). During an athletes pregnancy, weight gain increases that amount of force that is put on the joints. This weight gain and altered postural alignment could also lead to problems in postural balance. Women experience a numerous amount of physically changes during the process of their pregnancy.

There are many physiologic changes that happen and the hormones are the most common to cause the changes inside the body. The main source of pregnancy sustaining hormones is the corpus luteum, which is a mass of cells that forms on the ovaries, stimulates glandular tissue, and ducts in the breasts. The corpus luteum can also increase mobility of the joints, and the ligament laxity alterations are affected during the first trimester of pregnancy. The high levels of progesterone, a steroid hormone involved in the female menstrual cycle or pregnancy, directs the action on a smooth muscle of the lung and increases the heart rate, stroke volume, and blood volume. Also, decreases airway resistance, thereby reducing breathing effort and facilitating a greater airflow in pregnancy. This change in the size and shape of the abdomen, residual capacity that are the volume of air present in the lung and overall lung capacity but instead the vital capacity that are the amount of airs the pregnant woman can take. Pregnant females make a postural adjustment, which changes muscles tone to decrease and increase the back pain. They are likely to gain weight due to the amount of nutrition they need for the body to maintain the changes inside the body. The extra energy or food inside the body will become fats that increase of maternal red blood cells and possibility of increase in back pain. This fluctuates of hormones made changes inside the pregnant female’s body.

In conclusion, we learned that some of the physical changes include increases in the specific hormones that mediate the the process of fetal development and sustain essential functions for both mother and fetus. We have informed ourselves on the woman’s body and we can recognize when the athlete is pregnant. We can give advice and guidance in matters pertaining to the health of a pregnant athlete.

Perilunate Dislocation in a Collegiate Football Player

Authors:
Julian Cazares, Matt Lor, Juana Cervantes, Victor Alvarez

Overview:
In this case review, a 20 year-old African American football cornerback hit his dorsiflexed wrist on the opposing player’s helmet. Different procedures were given in order to help the healing process. X-rays were taken to diagnose the situation.  Anesthesia was injected to reduce the pain, but it was unsuccessful.  Physicians used finger trap splints to create traction for a successful closed reduction, confirmed by a radiographer. The athlete was then splinted and referred to an orthopedic hand and wrist specialist.  According to the MRI scan, the ligament was torn. The ECRB tendon weave procedure with K-wine reinforcement.  They need support and protection so they applied a short-arm cast on him.  Lastly, thermoplastic splints were worn by the athlete to limit motion and he was recommended to continue range of motion exercises.  “Although perilunate dislocation is not a career-ending injury, the method of treatment varies and its long-term prognosis is not highly predictable.”(Waugh, 2009)

Development:
Perilunate dislocation is a low risk injury, but it is extremely uncommon making up only 3% of all carpal injuries and is incredibly rare in athletics. Perilunate dislocation usually occurs when someone falls from extreme heights. In order to avoid a perilunate dislocation to progress into a serious injury, it is essential to seek immediate care. Perilunate dislocation is an uncommon injury so quickly diagnosis if necessary. (Waugh, 2009)

This article helped us find out about perilunate dislocation and its symptoms of this particular injury. As athletic trainers this got us thinking about perilunate dislocation this increased our awareness about this very rare injury. In order to decrease severe injury it is essential to limit  range of motion as much as possible in order to keep it in place and to replenish the injury to avoid any further dislocation. The bright side to this injury is that the athletic can still perform with this injury. Unfortunately, the athlete will need to play with support for example a brace or any other type of protection to keep on performing. (Waugh, 2009)



Conclusion:
In conclusion, perilunate dislocation is pretty difficult to diagnose by just inspecting. Fortunately, it could quite simply be diagnosed by palpating the carpals to check if their is a gap somewhere in the carpals. Gladly, it is it is not a very severe injury and classified as a minor injury if treated in time and correctly. Athletes can still perform and initiate their daily practice. The cost of performing with a perilunate dislocation is the requirement to wear support in order to prevent any further damage. As athletic trainers we will be observing the sign of permulate dislocation which is a slight dislocation in the carpals. This injury is extremely rare in athletics and their is a huge chance that we might not get to observe this injury for ourselves. On the bright side, if we see this injury we could spot it right away with this information granted to us. To further get more information about this injury, we need to look at x- rays and how the injury progresses over time. To further have more knowledge about this injury, we need more research. (Waugh, 2009)

Work Cited:
Waugh, A.M., Johnson D.L., Branam B., Madaleno J.A., Boland M., and University of Kentucky (2009). Perilunate Dislocation in a Collegiate Football. Athletic Therapy Today, 14(1), 41-13.

Perilunate Dislocations. (n.d.). - Wheeless' Textbook of Orthopaedics. Retrieved March 19, 2014, from http://www.wheelessonline.com/ortho/perilu.

Trans-scaphoid perilunate dislocation. (2011, February 28). YouTube. Retrieved March 19, 2014, from https://www.youtube.com/watch?v=m1KzlJSYGPw.

Barefoot Performance

Throughout many years, athletic shoe designs have evolved to fit society's personal needs. Therefore , many top brands only focus on the comfort , performance , fit , and cushion of athletic shoes. The two primary components that need focus are the sole, which is the bottom of the shoe and the cushion. Shoe designers also focus on trying to decrease shoe injuries.

This is the main example of “society’s needs’ because it shows you the overuse of cushion  and thicker soles.

     In our opinion, a lot of work is put into creating a comfortable and fashionable shoe . Majority of the focus is pointed towards injury prevention which covers areas of the shoe like the arch, cushion, sole and performance. From the article, there are personal opinions about how a show should perform an how many injuries are prevented during barefoot running. Adding more cushion to a shoe would probably cause more injuries than less cushioned shoe. the closet your barefoot is to the ground, the better you would and probably perform. Top brands are providing shopped and sizes of peoples feet. This will give people a wider option to choose a comfortable shoe that will allow for better performance.

There are six different areas that are very important to the performance of your feet. If any of these issues listed in the picture are reduced , this will most likely help you run better and prevent less injuries.

     

“No footwear comes closer to recreating this natural sensation than Vibram FiveFingers®. It allows you to land on your forefoot, directly below your center of gravity, resulting in optimum balance, increased stability, less impact and greater propulsion. Running in FiveFingers delivers sensory feedback that improves agility and equilibrium and allows immediate form correction. In addition it stimulates and strengthens muscles in the feet and lower legs”

- http://www.vibramfivefingers.com/barefoot-sports/barefoot_running.htm

      We learned that the way our shoes are created or formed are not really beneficial to the human skeleton. As an athletic trainer/student , it is our job to know what is best for the athlete. The sole provides stability and cushioning at the interface, which is between the foot's plantar surface and the ground. Many researchers believe the humans musculoskeleton is at its best performance when barefoot walking and running.

Liver Laceration Sustained by a College Football

Authors: Julian Guzman, Jose Luis De La Cruz, Alexis Carrillo, Enrique Gonzalez, Henry Clark

In this case study a college football player sustained an injury to the liver. The highest percentage of abdominal injuries occurs in contacts sports. Return to full competitive sports should be determined by the team physician on an individual. The athlete was cleared to resume all football activity at seven weeks.

The football player obtained this injury when he was hit in his right abdomen by the helmet of his opponent. Internal injuries are rare but the consequences can be very dangerous on the athlete. His breathing became more labored and he continued to exhibit a tachycardia heart rate. CT scan revealed the presence of a 3.4 x 1.5 cm non-perforating tear of the liver. Laboratory test failed to demonstrate any evidence of internal bleeding.

The highest percentage of abdominal injuries occurs in contact sports. Sports classified as contact sports are football, rugby, soccer, and hockey. These contact sports can cause internal damage. When you have internal damage it feels tenderness, ridged and has bruising. Direct trauma is more severe. The kidney’s are the most commonly injured.

The return to a full contact competitive sports should be determined by the team physician on an individual basis. The athlete should be cleared by his team physician. It allows the physician to be sure that the athlete is fine and will not hurt himself or the team. The way they evaluated this particular athlete was perform an ultrasound and a CT Scan at eight weeks.

In conclusion we learned that the liver self heals. Abdominal injuries are rare. Whenever an athlete wants to go back to the sport the athlete must be cleared by his team physician like this athlete did. We would like to know if once a player sustains a liver laceration is their career over. Also what is the normal recovery time for a lacerated liver to heal.

Brett, J. (2009) Liver Laceration Sustained by a College Football Player. Athletic Therapy Today, 14(2), 23-26

The Comeback

Overview:

Each year in the United States about seven million children and adults sustain injuries playing sports. People who sustain serious injuries have to go to rehabilitation. Rehabilitation is very important to every athlete in order to get them back on the field, court, or wherever they play sports. In Rehabilitation performance goals are set and they are very important for recovery. Although performance goals are always going to be the main focus, Mental imagery should be included and practiced more in the rehabilitation of an athlete. Mental Imagery used in the rehabilitation of an athlete would be very useful. Most athletes are scared of getting injured again and imagining themselves playing again would be a big contribution to the rehabilitation of an athlete. Athlete’s will become more eager to get back to what they like doing.

Development:

The three key points of this article are (1) rehabilitation of athletic injury should include both physical and psychological components, (2) goal setting will be more effective in producing the desired outcome if the athlete is involved, and (3) mental imagery can promote healing, decrease pain, and improve both self-motivation and adherence. The key point I found most interesting was the third point which talked about mental imagery and how this can help an injured athlete recover more quickly by promoting healing, decreasing their pain, and improving both their self-motivation and adherence.

The treatment given were two main treatments: goal setting and mental imagery. The goal setting treatment has two steps to it, which are short-term goals and long-term goals. Short-term goals are often daily goals that motivate the athlete by allowing them to see immediate progress. Long-term goals provide the athlete with directions and motivation to return to play in the future. Including the injured athlete in the goal setting process can help them by creating personal ownership of their rehabilitation goals. The other treatment, mental imagery, helps an injured athlete during the rehabilitation process by maintaining a positive outlook, controlling stress, improving self-confidence, managing pain, and promoting healing by imagining the injured ligaments or bones repairing themselves. This technique can improve concentration on exercise and can lead to an increase in effort throughout the rehabilitation process.

This article has influenced me in thinking deeply about these two specific treatments the next time I have an injury or when I’m helping an injured athlete trying to recover. With this information and knowledge I now know how to motivate an athlete with mental imagery and setting goals to keep them in track to recovering. It has shown me that the physical treatment isn’t the only way that will help an injured athlete recover, it’s also psychological. The athlete has to think about them recovering in order to motivate them to keep going with their physical treatment.

Conclusion:

In conclusion, mental imagery and goal setting, is a proper way of helping an athlete during rehabilitation. By using the goal setting process it helps an athlete that has an injury. This process helps motivate an athlete. By using mental imagery it can help athletes look at the results in a positive view. We can tell our athletes to picture themselves back on the field, court, or ect.  Mental imagery is a skill that comes natural to an athlete. As a student Athletic Trainer, i want to gain more knowledge about the psychological rehabilitation. I can make use of this knowledge when i become a Athletic trainer in my future. I can use the goal setting and mental imagery when I’m helping someone who's injured or whose going through the process of their comeback. I've gained experience already in the mental and physical process by when i had my own injuries. The outcome is always something I looked forward to accomplishing. I know as a student athletic trainer i can encourage and help other athletes prepare and conquer their injuries during their comeback.

Hamson-Utley, J. Jordon, PhD, ATC, LAT (2008). The Comeback: Rehabilitating the Psychological Injury. Sports Psychology & Counseling, 35-37.

Facial Fractures

Facial fractures usually occur in automobile collisions,and sports related injuries. In automobile collisions rough contact when collision happens can cause damage to the frontal skull. In sports there are various causes like contact with equipment and environment, direct contact with body and between players.Complications in facial fractures vary from vision loss, diplopia, and severe facial deformity. In severe fractures you can even have the loss of smell and taste.

The therapy give for RTP was a liquid diet and 6 week normal diet. The rehab process took a little longer than therapy. The first 3 weeks the athlete only did walking and biking. At 5 weeks the athlete was able to run,sprint, and weight lifting. At 11 weeks passed by the CT scans were made to see if the athlete was able to play or practice their sport.

I've learned to recognize the injury. I can tell when because, of a deformity when the face doesn't have a normal form. When there is too much bleeding and when they can't stand the pain. For the return to play they need a face shield. Its evenly molded for the face. Its evenly distributes pressure around the area of the fracture. The face shield has to be worn for a year.

As a student athletic trainer I have discovered a variety of things. Some things I have learned were taping specific areas of our bodies. I’ve also learned how to identify injuries and cuts, such as abrasions, lacerations, punctures, fractures, etc. Knowing this could help me in my future career as a doctor, I know that I'll learn it later on so it'd be a review. I could expand all of my knowledge by paying more attention to all of the curriculum we've been taught. Also I could go further detail in facial fractures, such as how to fix them or what to do when there is a facial incident. I believe that i should take all of this into consideration and try more as a student athletic trainer.