Prevention/Care Exam 1

Athletic Training (definition)

Healthcare profession in which professionals collaborate with physicians on injury risk reduction, injury/illness evaluation and diagnosis, rehab and performance enhancement, emergency care and planning, and therapeutic modalities/techniques

BOC exam

Board of Certification exam; must graduate from a CAATE-accredited program to be eligible to take it

CAATE

Accrediting body for athletic training programs; accredited programs are now at the Master's level

NATA

National Athletic Trainers' Association, the professional organization for athletic trainers (founded 1950 — check your slide, which lists 1850, against your professor's stated date)

AT settings

Traditional/sports, industry-occupational, corporate, performing arts, physician extender/clinic/hospital, armed forces/public safety, private sport performance

What do ATs do?

Prevent death via emergency policies/procedures, ensure standard of care, reduce risk, perform pre-participation screenings, fit protective equipment, manage medications, assess/evaluate/diagnose, manage critical incidents, and provide therapeutic interventions (modalities, rehab, IV, sutures)

Evidence-based practice (in AT)

Combines clinician-centered outcome measures, patient-rated outcome measures, and research-based continuing education

Liability

The state of being legally responsible for the harm one causes to another person; assumes a person acts with ordinary/reasonable prudence within their scope of practice

Negligence

Failure to use ordinary or reasonable care

Standard of Reasonable Care

The expectation that a provider is thoughtful and careful relative to the situation and operates within the limits of their training and scope of practice

Jordan McNair case

Real-life negligence example: heatstroke symptoms went unrecognized/untreated (no cold tub, no rectal thermometer, delayed EMS call); he died of multi-organ failure; case illustrates 100% survivability of heatstroke if temp is lowered to 102°F within 30 minutes

HMO (Health Maintenance Organization)

Insurance plan requiring in-network providers and a PCP referral; lower premiums/copays and no deductible, but least provider freedom and financial penalty for going out of network

PPO (Preferred Provider Organization)

Insurance plan with a larger provider network and more freedom to manage your own care; higher premiums and a deductible, but out-of-network care is still covered (at a lower rate)

POS (Point of Service)

Hybrid of HMO and PPO — designates in-network MDs like an HMO but allows going out-of-network like a PPO; best for those who travel frequently

HDHP with HSA

High-Deductible Health Plan paired with a Health Savings Account; allows tax-free HSA funds to cover the deductible, covers care at 100% once out-of-pocket max is met, but has the highest deductibles

Deductible

The amount a patient must pay before the insurance company takes responsibility for claims; resets annually and incentivizes patients to only incur necessary costs

Premium

The monthly payment for insurance coverage, usually deducted from payroll and often paid in part by the employer

In-network vs out-of-network provider

In-network providers accept a contracted reimbursement rate from the insurer (patient pays less); out-of-network has more limited benefits and greater patient financial responsibility

NPI (National Provider Identifier)

Unique 10-digit ID number that identifies who provided services on a claim; fulfills HIPAA requirements

CPT codes (Current Procedural Terminology)

Codes used by healthcare providers to identify medical, diagnostic, and surgical services performed

HCPCS

Healthcare Common Procedure Coding System; Level I = same as CPT codes, Level II = identifies products/supplies/services not in the CPT set

ICD-11 codes

International Classification of Diseases codes used for diagnoses on billing claims and in Electronic Medical Records

Explanation of Benefits (EOB)

A statement from the insurance company showing what was billed/covered — this is NOT a bill

Medicaid

Federal program administered by individual states based on financial need and/or disability

Medicare

Federally funded health plan for patients 65+ or those with a documented disability

Workers' Compensation

Insurance coverage provided and paid for by employers to cover work-related injuries

Kinetic chain

Concept that movement at one joint/segment affects proximal and distal segments during motion

Gait cycle — stance phase

Initial contact to toe-off; makes up about 60% of the gait cycle

Gait cycle — swing phase

Toe-off to initial contact; the remaining ~40% of the gait cycle

Walking vs. running gait

Running burns ~2x more calories/min, is higher impact, uses a midfoot (walking = heel) strike, has a flight phase (walking always has a foot in contact with the ground), and uses bent arms with longer strides

Windlass mechanism

Mechanism activated by dorsiflexion of the toes at toe-off that tightens the plantar fascia, turning the foot into a rigid lever for propulsion

Supinators

Runners who run on the outside of their foot

Pronators

Runners who run on the inside of their foot; benefit from flexible, cushioned footwear

Pes cavus

High arch foot type

Pes planus

Flat foot / no arch foot type

Foot injury prevention basics

Appropriate footwear, correcting biomechanical deficiencies with orthotics, and good foot hygiene

Foot hygiene practices

Trimming toenails correctly, shaving down excess calluses, keeping feet clean and dry, and wearing clean, correctly-fitting socks and shoes

Morton's toe

An abnormally short first metatarsal causing the second toe to bear more weight, appear longer, and risk stress fracture; managed with a medial wedge if structural forefoot varus is present

Plantar fasciitis — description

Common "catchall" term for pain in the proximal arch and heel, linked to heel spurs, plantar fascia irritation, and bursitis; the plantar fascia stabilizes the foot and braces the longitudinal arch

Plantar fasciitis — etiology

Increased tension on the fascia (esp. during push-off in running), switching from rigid to flexible footwear, poor running technique, leg length discrepancy, excessive pronation, inflexible arch, and tight gastroc-soleus complex

Plantar fasciitis — signs/symptoms

Pain in the anterior medial heel or along the arch; worse in the morning and eases after a few steps; increased pain with forefoot dorsiflexion

Plantar fasciitis — management

Extended treatment (8-12 weeks): night splint/brace to maintain static stretch, arch taping, vigorous Achilles/great toe dorsiflexion stretching, NSAIDs, occasionally steroid injection

Jones fracture

Fracture at the base of the fifth metatarsal from inversion/plantar flexion, direct force, or repetitive stress; high nonunion rate; managed with crutches/immobilization, possible surgery, return in ~6 weeks

Metatarsal stress fracture

Tiny bone cracks from repetitive forces/overuse, training changes, or nutrition deficits; dull ache progressing to pain at rest; managed with partial weight bearing, rest, and gradual return with orthotics

Bunion

Bone growth of the first metatarsal head associated with forefoot varus or narrow/pointed shoes; causes lateral malalignment of the great toe and joint inflammation

Sprained toe

Injured ligaments of the toe from kicking a non-yielding object; managed with buddy taping and gradual return to weight bearing

Turf toe

Hyperextension sprain of the first metatarsophalangeal joint; managed by stiffening the shoe's forefoot, taping to prevent dorsiflexion, and rest

Subungual hematoma

Blood trapped under the toenail from direct pressure or shearing forces; managed by sterile relief of pressure (drilling the nail) within 12-24 hours

Foot orthotics — purpose

Control abnormal foot mechanics, maintain neutral foot position, prevent compensation, and provide a platform that relieves stress on the foot

WBGT

Wet Bulb Globe Temperature; used to guide heat-stress management decisions during activity

Heat storage equation

S = M ± K ± C ± R - E (heat Stored = Metabolism ± Conduction ± Convection ± Radiation - Evaporation)

Conduction (heat exchange)

Heat transfer from direct contact with a cooler (or warmer) surface

Convection (heat exchange)

Heat lost or gained from air or water moving past the body

Radiation (heat exchange)

Heat lost or gained via infrared exchange between the skin/clothing and surroundings

Evaporation (heat exchange)

Heat loss through sweat evaporating from the skin

Hydration guidelines

Begin activity well hydrated (starting 24 hrs prior), drink at regular intervals, replace fluid losses, and monitor urine color (light yellow = hydrated, dark = dehydrated)

Dehydration signs/symptoms

Thirst, dizziness, dry mouth, irritability, excessive fatigue, possible cramps; treated by moving to a cool environment and rehydrating to normal weight

Daily fluid recommendations

Males ~3.0 L/day, females ~2.0 L/day during minimal activity; an adult can lose ~1.5 L/hour during exercise

Exercise-Associated Muscle Cramps (EAMCs)

Painful muscle spasms (calf/abdominal) once called "heat cramps," caused by excessive water/electrolyte (sodium) loss and neuromuscular fatigue; prevented with fluids/electrolytes, treated with fluid intake and light stretching/ice massage

Heat exhaustion

Inability to sustain adequate cardiac output; symptoms include profuse sweating, vomiting/diarrhea, pale skin, hyperventilation, dizziness, muscle cramps, nausea, and loss of coordination

Exertional heat stroke

Life-threatening condition with sudden onset, core temp >105°F, and CNS dysfunction

Heat stroke — gold standard treatment

Measure core temp rectally, cool rapidly within 30 minutes of collapse via full-body cold water immersion (35-59°F, circulating) up to the neck, remove once temp reaches 102°F, then transport ("cool first, transport second")

Why cool first, transport second?

The amount of time the brain stays above the critical temperature threshold (105°F) drives morbidity/mortality, so on-site cooling before transport improves outcomes

Reasons heat stroke deaths occur

Misdiagnosis (no/inaccurate temperature reading), no or delayed care, and inefficient/too-slow cooling method

Barriers to rectal thermometry use

Resistance from parents/guardians/administration, need for more information, comfort level, liability concerns, lack of equipment/expense, and lack of knowledge on when/how to use it

Hypothermia

Core temperature drop below 95°F from heat loss exceeding heat production, impairing neuromuscular function; risk increases with wind, dampness, and inadequate clothing

Windchill

Effect of wind speed combined with air temperature that increases the risk/speed of cold injury (e.g., frostbite)

Cold-weather injury prevention

Suitable, waterproof/windproof apparel worn in layers (adjusted for activity level) and good hydration, which supports blood volume and heat maintenance

Frostnip

Superficial cold injury to ears, nose, chin, fingers, toes from high wind/severe cold; skin appears firm and cold but not permanently damaged; treat with firm pressure or warm air — do not rub

Chilblains

Redness, swelling, and tingling pain in fingers/toes from 1-5 hours of exposure to poor peripheral circulation as blood shunts to the core

Frostbite

Occurs when outside temp is below 28°F; skin appears pale, hard, cold, waxy, and gray; requires gradual re-warming (100-110°F, water submersion ≤98°F); deep frostbite requires hospitalization

Skin cancer from sun overexposure

Major types: basal cell carcinoma, squamous cell carcinoma, malignant melanoma; fair-skinned individuals are more susceptible; 95% cure rate with early detection

Lightning safety rule

"When thunder roars, go indoors" — and wait 30 minutes after the last thunder before going back outside

Weather watch vs. warning

Watch = risk of hazardous weather has significantly increased; Warning = hazardous weather is occurring or imminent

Flash-to-bang method

Estimates lightning distance by counting seconds between the flash and the thunder and dividing by five to get miles away

Lightning detector (handheld)

Inexpensive device that can detect storms within 40 miles; should not be the sole method used to decide when to seek shelter

Muscle strain

Stretch, tear, or rip of a muscle or adjacent tissue, often from eccentric contraction/overloading; ranges from minor tissue separation to complete rupture

Muscle strain grades

Grade I: fibers stretched/slightly torn; Grade II: several fibers torn, painful active contraction; Grade III: complete rupture of muscle or musculotendinous junction

Tendon

Connects muscle to bone; made of wavy, parallel collagen fiber bundles; breaking point occurs at 6-8% increase in length

Tendinitis

Inflammation of a tendon from repeated microtrauma; gradual onset with diffuse tenderness, swelling, pain, and crepitus; key treatment is rest

Contusion

Result of a sudden blow to the body; can be deep or superficial; chronic inflammation/contusion can cause calcium deposits (myositis ossificans)

Sprain

Result of traumatic joint force stretching or tearing a ligament (which connects bone to bone)

Sprain grades

Grade I: some pain, mild point tenderness; Grade II: pain, swelling, instability; Grade III: extreme pain, severe instability/swelling, loss of function

Subluxation

Partial dislocation with incomplete, temporary separation of a joint

Dislocation

At least one bone in a joint is forced out of alignment and must be reduced manually or surgically; most common in fingers and shoulder; X-ray is the only absolute diagnostic method

First-time dislocation protocol

Should always be treated as a fracture until a fracture is ruled out

Osteoarthritis (OA)

Wearing away of hyaline cartilage causing joint mechanic changes and degeneration; symptoms include pain, stiffness (prominent in the morning), localized tenderness, and creaking/grating; commonly affects weight-bearing joints

Bursitis

Inflammation of a bursa (fluid-filled sac in areas of friction); repeated trauma can calcify/degenerate the bursa lining

Bone fracture types

Closed: little movement/displacement; Open: displaced fractured ends breaking through surrounding tissue

Stress fracture (bone)

Caused by overload from muscle contraction/fatigue, altered stress distribution, surface changes, and repetitive stress; bone is most vulnerable early in training due to remodeling/resorption

3 phases of the inflammatory/healing response

1) Inflammatory response phase, 2) Fibroblastic (proliferation) phase, 3) Maturation (remodeling) phase

Inflammatory response phase

Begins immediately; vasodilation causes swelling/redness; leukocytes/phagocytes react; goals are to protect, localize, decrease injurious agents, and signal repair

Fibroblastic (proliferation) phase

Scar formation through resolution (little tissue damage, normal restoration) and regeneration (tissue replaced by same tissue type); pain/tenderness gradually subside

Maturation (remodeling) phase

Long-term process of collagen realignment along tensile force lines; continued collagen breakdown/synthesis increases strength; may take several years for tissue to appear normal

Factors that impede healing

Extent of injury, edema, hemorrhage, poor vascular supply, tissue separation, muscle spasm, atrophy, corticosteroids, keloids/hypertrophic scars, infection, humidity/climate/oxygen tension, and health/age/nutrition

Skeletal muscle healing

Initial bleeding, then proliferation of ground substance/fibroblasts; myoblastic cells regenerate new myofibrils; collagen matures along tensile force lines; healing takes 6-8 weeks

Tendon healing

Requires dense fibrous union of separated ends (often needs surgery) and abundant collagen for tensile strength; strength isn't solid until 4-5 weeks

Bone healing — 5 stages

Hematoma formation, cellular proliferation, callus formation, ossification, and remodeling

Cartilage healing

Limited capacity to heal due to chondrocyte and matrix disruption, leading to variable healing outcomes

Nerve healing

Nerves cannot regenerate the cell body after injury, but regeneration can occur within a nerve fiber at ~3-4 mm/day; peripheral nerves heal faster than central nervous system nerves