Introduction and Exploration of Therapeutic Careers

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Introduction and Exploration of Therapeutic
Careers
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Sports Medicine

• A term that has many connotations, depending on
  who or what group is using it.
• Sports medicine is multi-disciplinary, including
  the physiological, biomechanical, psychological,
  and pathological phenomena associated with
  exercise and sports.
• The clinical application of the work of these
  disciplines is performed to improve and maintain
  an individuals functional capacities for
  physical labor, exercise, and sports. It also
  includes the prevention and treatment of diseases
  and injuries related to exercise and sports.

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Sports Injuries

• An injury is defined as damage to the body that
  restricts activity and / or causes disability

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Sports Injuries

• When considering athletes in all sports,
  recreational and organized, who participate in
  sports in one years time, there is a 50 chance
  of their sustaining some injury.
• 50 of all sports injuries require only minor
  care and involve no restriction of activity.
• 90 of these minor injuries are muscle
  contusions, minor joint sprains, and muscle
  strains.
• 10 of sports injuries lead to complications and
  eventually to severe, chronic conditions in later
  life.

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Sports Injuries

• For sports injuries that must be medically
  treated, sprains and strains, fractures,
  dislocations, and contusions are the most common.
• For both males and females, the most commonly
  injured body part is the knee, followed by the
  ankle. Males do have a higher incidence of
  shoulder or upper arm injuries than females.

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Sports Injuries

• Types of sports
• Collision
• Contact
• Non-contact

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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.
• American football, ice hockey, and rugby are the
  most common collision sports in the U.S.

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Collision Sports

• Football is the most injurious sport in the U.S.
• Most injuries occur during practice and offensive
  lineman sustain 20 of all reported football
  injuries. Defensive lineman sustain 19. Most
  injuries result from direct impact (44).
• The body part most commonly injured in football
  is the knee. Concussions also seem to be a
  frequent injury.
• 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.

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Collision Sports

• Ice Hockey
• The highest percentage of hockey injuries occur
  in the second half.
• The most common ice hockey injuries are
  incisions, lacerations, and contusions.
• The most common cause of death in hockey is being
  hit by a stick or hockey puck.
• The hockey stick is responsible for over 1/3 of
  all hockey injuries, almost twice the number
  caused by the puck.

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Collision Sports

• Rugby
• The highest incidence of injuries in rugby occur
  to the shoulder, followed by injuries to the
  head, the neck, and the knee.

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Contact Sports

• Contact sports include
• Basketball
• Baseball
• Field hockey
• Lacrosse
• Rodeo
• Soccer
• Softball
• Water polo
• Wrestling

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Contact Sports

• Basketball
• Basketball has the second highest rate of injury
  in competitive sports in the U.S.
• Most of the injuries in basketball are to the
  knee, followed by ankle sprains, and contusions.

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Contact Sports

• Baseball and Softball
• Most injuries in these sports are caused by the
  ball, which is not only hard but travels at
  extremely high rate of speed.
• Injuries to the hand, wrist, and forearm are the
  most common.
• Fatalities do occur in baseball and softball,
  usually the result of being hit by a bat or ball.

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Contact Sports

• Soccer
• Soccer is played by more individuals than any
  other sport in the world. It is the most popular
  sport in over 135 countries.
• 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.
• 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.

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Non-Contact Sports

• 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.

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Non-contact Sports

• Track and Field
• 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.
• Heat injury is significant as are overuse
  injuries. Strains, sprains and abrasions are
  probably the most common musculoskeletal
  injuries.
• Structural abnormalities, types of running shoe,
  running surface and running intensity are
  commonly attributed to causing running injuries

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Non-contact Sports

• Skiing
• Three factors stand out when considering the
  injury rate of skiing the skier, the ski
  equipment, and the environment.
• The most common skiing injury today is to the
  knee (20). Ankle sprains have recently been
  significantly reduced due to changes in ski
  equipment
• The usual causes of reported fatalities are head
  injuries, or internal hemorrhages caused by
  lacerations to the spleen or liver.

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Non-contact Sports

• Tennis and Other Racquet Sports
• Elbow and wrist injuries are commonly seen in
  racquet sports. Overuse injuries are also very
  common.
• Poor technique is believed to contribute to many
  tennis injuries

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Sports Medicine

• 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.

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Sports Medicine

• Besides the physical aspects, the psychological
  and emotional aspects of competition must be
  addressed.

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Sports Medicine

• 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

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Health Professions in Therapeutic Careers

• Skills and Personal Qualities for Individuals in
  Therapeutic Careers
• Stamina and ability to adapt
• Empathy
• Sense of Humor
• Ability to communicate
• Intellectual curiosity
• Personal ethics

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Health Professions in Therapeutic Careers

• Certified Athletic Trainer (A.T.C.)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.

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Certified Athletic Trainer

• 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.
• Career settings College/University athletic
  departments, High School athletic departments,
  Professional Sports Teams, Sports Medicine
  Clinics, and Physical Therapy Clinics

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Certified Strength and Conditional Specialist
(C.S.C.S)

• Strength and Conditioning Specialists educate and
  train athletes in proper strength and conditional
  practices. They design and implement safe and
  effective strength and conditioning programs.
• Education Bachelors degree in a health or
  sports related field, and successful completion
  of NSCA exam.
• Career settings College/University athletic
  departments, Professional Sports Teams, Private
  practice, Gyms/Fitness Facilities.

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Chiropractor

• 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.

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Chiropractor

• Education Bachelors degree in a health related
  field and completion of an accredited 4-year
  chiropractic program
• Career settings Most commonly in private
  practice, can be affiliated with a professional
  sports team

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Dietician (R.D.)

• Dieticians are responsible for assessing
  patients 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.

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Dietician (R.D.)

• Education Bachelors or Masters degree in
  Nutrition/Dietetics, successful completion of ADA
  exam.
• Career settings Hospital, private practice,
  college or university, research facility

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Exercise Physiologist

• 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.

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Exercise Physiologist

• Education Bachelors, Masters, or Doctorate
  degree in Exercise Physiology. No licensing is
  currently available.
• Career settings Private practice, gyms/fitness
  facilities, human performance labs, research,
  corporate fitness programs, and rehabilitation
  clinics and programs

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Massage Therapist (L.M.T.)

• Massage Therapists provide hands-on manipulation
  of the soft tissues of the body including
  muscles, connective tissue, tendons, ligaments
  and joints. Massage therapy provides and
  alternative health option to help alleviate the
  soft tissue discomfort associated with everyday
  and occupational stresses, muscular over-use and
  many chronic pain syndromes.

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Massage Therapist (L.M.T.)

• Education successful completion of an
  accredited program and state licensing exam.
• Career settings private practice, hospitals,
  hotels, resorts, sports medicine clinics,
  professional sports teams, gyms/fitness
  facilities.

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Occupational Therapist (O.T.)

• Occupational Therapists help people with physical
  or emotional difficulties to overcome, correct or
  adjust to their particular problems. OTs 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

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Occupational Therapist (O.T.)

• Education masters degree in Occupational
  Therapy and successful completion of state
  licensing exam.
• Career settings rehabilitation clinics,
  hospitals, private practice, and public schools.

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Orthopedic Surgeon (M.D.)

• 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

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Orthopedic Surgeon (M.D.)

• Education - Doctorate degree in medicine
  (successful completion of medical school),
  internship, residency, and optional fellowship to
  specialize further. Successful completion of
  multiple board examinations.

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Orthopedic Surgeon (M.D.)

• Career settings - Hospitals and Clinics.
  Specialties available sports medicine, hand
  surgery, general orthopedics, spine, pediatrics,
  and geriatrics.

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Performance Enhancement Consultant

• 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
  performances.

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Performance Enhancement Consultant

• Education college degree in a sport discipline
  with training in sports psychology, exercise
  physiology, nutrition, etc.
• Career settings private practice, teaching in
  college / university

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Personal Trainer

• 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.

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Personal Trainer

• Education Completion of a certification exam,
  however further education is recommended.
• Career settings Private practice, gym and
  fitness facilities.

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Physical Therapist (P.T.)

• Physical Therapists provide treatment to improve
  mobility and prevent or limit permanent
  disability of patients with disabling injuries or
  diseases. PTs assess patients, design treatment
  programs and promote proper exercise and activity.

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Physical Therapist (P.T.)

• Education Masters degree in Physical Therapy
  and successful completion of state licensing
  exam.
• Career settings Rehabilitation clinics,
  hospitals, and home health.

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Sports Psychologist

• 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 individuals
  psychological health and well-being throughout
  their lifespan.

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Sports Psychologist

• Education Masters or Doctorate degree in Sports
  Psychology.
• Career settings Private practice, research
  facilities, college / university program,
  professional sports teams.

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Legal Concerns

• Legal terminology
• Assumption of Risk a person who voluntarily
  exposes him / herself to a known and obvious
  danger.
• Battery touching someone without permission
• Civil a private right as opposed to a criminal
  action

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Legal Terminology

• Compensatory Damages Money awarded equivalent to
  the actual value of damages
• Criminal act that is punishable by written state
  or national laws
• Duty to Act a legal obligation
• 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

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Legal Terminology

• Improper Release of Medical Information
  releasing any medical information without written
  permission
• Informed Consent being informed of all
  procedures and the potential risks and benefits
  of each
• Liability the legal responsibility to act in a
  reasonable and prudent manner makes you legal
  liable

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Legal Terminology

• Litigation carry on a legal contest through the
  judicial process
• Malpractice when an individual commits a
  negligent act while providing care
• Negligence doing something (commission) or
  failing to do something (omission) a reasonable
  person would or would not do under similar
  circumstances
• Punitive Damages compensation awarded for
  subjective damages

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Legal Terminology

• Reasonable and Prudent Care quality of care
  given that would be given by another person with
  similar training
• Release of Liability intentional release of
  known rights
• Risk Management management of potential dangers,
  preventing loss

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Legal Terminology

• 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)

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Legal Issues

• Negligence in order to prove negligence, four
  basic elements must be shown
• There must be legal duty of care.
• There must be a breach of that duty.
• There must be some injury. The mere threat of
  harm is not sufficient.
• That breach of duty must be the proximal cause
  (the direct result) of the resulting injury.

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Legal Issues

• 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 individuals negligence contributed to
  that injury, then liability is still a
  possibility.

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Legal Issues

• Foreseability 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 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.

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Legal Issues

• Title IX an addition to the 14th Amendment made
  in 1972. 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.

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Athlete/Patient Rights

• All athletes/patients have the following rights
• The right not to be discriminated against, for
  race, religion, gender, etc.
• The right to privacy and confidentiality of
  medical records and information.
• The right to have access to his/her own medical
  records.

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Athlete/Patient Rights

• The right to understand his/her medical status in
  his/her own language
• The right to refuse treatment.
• The right to be fully informed about the care and
  treatment he/she receives and the potential risks
  and benefits of each.
• The right to be free from verbal, physical,
  mental, or sexual abuse.
• The right to prompt and prudent car

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Legal Safeguards

• It is important that sports medicine
  professionals be aware that they are legally
  obligated in carrying out their professional
  responsibilities.

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Legal Safeguards

• In order to protect themselves, sports medicine
  professionals should follow the safeguards listed
  below
• Carry liability insurance.
• Keep accurate records/documentation.
• Be informed and up to date in changes in the
  standard of care through continuing education.
• Be familiar with the medical histories of
  athletes, clients, or patients.

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Legal Safeguards

• Maintain qualified and adequate supervision of
  facilities, employees, and equipment.
• Always stay within your scope of practice.
• Have a good rapport with athletes, parents,
  coaches, physicians, clients, and colleagues.
• Follow the orders and recommendations of
  physicians at all times.

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Documentation

• 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.

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Documentation

• Documentation concerning pre-participation exams,
  insurance forms, personal data information,
  accident reports, rehabilitation programs and
  progress charts, and clearance for participation
  are essential.

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Documentation

• In a legal situation, if it wasnt written down,
  it didnt happen!

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Documentation

• Injury reporting forms and injury tracking
  software are available on line.

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Documentation

• SOAP Format
• The recognized system for documentation is the
  SOAP method.
• S Subjective information that the patient
  reports
• O Objective information that can be measured
  and expressed in a standard format.
• A Assessment what decisions are made with the
  subjective and objective information gathered.
• P Plan course of treatment to be carried out

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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

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Scenario 1

• 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 laterally and medially.
  During passive knee extension, the patella
  laterally deviates from the grove. 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

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Scenario 1

• 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.

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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 the 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 referred to an emergency room.

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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 resolves. The examiner rechecks neck
  and shoulder ROM, strength of the shoulder and
  arm muscles and grip strength. All appear to be

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Scenario 3

• normal. The examiner believes this athlete has
  had a brachial plexus injury (stinger). Since the
  athletes 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.

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Ethical Issues

• 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.
• 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
  guidelines for professionals.

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Ethical Issues

• In health care, ethical principles include
• Never compromise the health and safety of any
  patient / athlete
• Respect the rights, welfare, and dignity of all
  individuals
• Comply with the laws and regulations governing
  the practice of the profession
• Accept responsibility for sound judgment
• Maintain and promote high standards in the
  provision of services
• Do not engage in any form of conduct that
  constitutes a conflict of interest or that
  adversely reflects on the profession

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Ethical Issues

• Ethics Committees are established in many
  hospitals to assist health care professionals in
  making ethical decisions.
• Ethical issues in sports often deal with some of
  the following areas
• Fair play and sportsmanship
• Cheating
• Winning at all costs
• Performance enhancing drugs

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Ethical Issues

• Drug testing vs. privacy
• Gender equity in sports
• Public admiration of athletic heroes
• Accommodation of disabled athletes
• Sports and its effect on society
• Violence in sports

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The End

• Any Questions???