Joe Paterno's firing, a good thing for Athletic Training?

Joe Paterno the legendary coach at Penn State University was recently fired because of a sexual abuse scandal.   I am not going to talk about the scandal as it is being covering in intimate detail throughout the country by a  legion of writers. I do want to address a little know fact about Penn State Football and the profession of athletic training. You can turn on a college football game being played anywhere in the country and if you watch the sidelines close enough you are bound to see either female athletic training students, female certified athletic trainers or both working the game. This is pretty much a given. If you do not, it most likely a military academy or a school that just does not have an athletic training program. Even many schools without programs have females enlisted to help the certified athletic trainers. This is not the case at Penn State. If you watch their sideline you will not see any female athletic training students nor male student athletic trainers. This is not because Penn State does not have a program. They do.

At one time male athletic training students worked with the football team. Unfortunately, Joe Paterno did not allow females to work during the season. He did allow a limited number of females to work spring football.  This was only after he personally interviewed and approved them. One time Athletic Training Program Director, Craig Denegar decided that this was not a very fair arrangement. In a meeting with Coach Paterno, Mr. Denegar tried to convince him to allow females the same opportunity as the males. Coach Paterno refused.  Sticking to his principles Mr. Denegar had no choice but to withdraw all  athletic training students from a clinical rotation with Penn State football. The football team scrambled and filled the lose of student with graduate assistant athletic trainers.

Coach Paterno's reason for denying females an opportunity was because he did not want to offend their sensibilities with the kind of language that can be heard on a football field. It is a shame he did not share that  protective attitude when it came to young boys.

Gear Review - Rescue Hooks

While these product have been in use in the military and emergency setting in the past they were only introduced at the 2010 National Athletic Trainers' Association Convention.  These knives were developed to cut clothing, shoes, seat belts, etc. in emergency situations.  The Benchmade Knife Co. exhibited these to athletic trainers as a different tool to remove tape and in worse case scenarios to remove clothing in an expedient manner.

I had a chance to evaluate these products at the exhibits and actually purchased one.  The one I choose is the Houdini Pro which which works like a pocketknife.   The hook blade folds out of the way. It also has a LED  light and a spring loaded glass punch for breaking glass.  While my need to break glass is not something I have run into in my 25 years as an athletic trainer, I did find a use for the punch end.  Newer version of  Riddell helmets have a quick release component that allows faster removal of the facemask.  All that is needed is a pointed object to press the release pin.  The punch on the Houdini Pro fits this bill.

  

Houdini Pro - Benchmade Knife Co.

Here is a video of a hook knife in action.

I had a chance to use this tool throughout the last year and have a very favorable impression.  It cuts the tape off with no problems, including the heaviest tapings that athletic trainer devise for maximum support.  A tool that is design to cut through leather combat boots has no problems with moleskin, Elastikon, etc.  The one caveat with all these hook knives is that it is important to do your cutting with the blade perpendicular to the skin surface.  I would advise letting your athletes use these knives as they could end up slicing their skin if used improperly. 

Here is a picture of the various styles that they offer. I also have the 8 EOD and the 8 Hook.  Out of the three I still prefer the Houdini Pro.

Benchmade has a well earned reputation in their industry for high quality knives.  They come with a lifetime warranty and a lifetime free sharpening. They run aroung $40.00 apiece, but last year they offered an NATA member discount.  Enjoy!

Unethical?? Illegal??

In the April 2011 edition of Training & Conditioning there is an article entitled "Triple Trouble", written by a former Division I College Athletic Trainer now working at the high school level.  http://www.training-conditioning.com/2011/04/11/triple_trouble/index.php  It is the story of an athletic trainer's efforts to keep an athlete on the field after three separate injuries.  While I applaud the effort, I do take exception to some of the methods. In particular, the athlete sustains a a tear of the flexor tendon on the fourth finger. He is taken to the ER and eventually sees one orthopedist, who then refers him to a hand specialist. The hand specialist decides surgery is not warranted but the athlete will be out 6-8 weeks until the tendon heals.  Now comes my issue.


"I realized I would be going against what the specialist said, but he was a young physician and did not have much experience in sports medicine. I had treated several flexor tendon injuries and felt confident that I could devise a protective device and get Justin back on the field. I would not recommend a novice athletic trainer or one who hasn't dealt with this type of injury before do this, but I talked about my idea with Justin and his parents, and they had faith in my skills."


Any Athletic Trainer who takes it upon them-self to disregard a physician's instructions is in violation of their state's practice act and is crossing ethical boundaries. Parents consent or not it is outside the scope of our practice.  Other than the obvious scenario that the athlete suffers a long term disability from the actions of the athletic trainer, what precedent does it set?  What if the athlete suffers a concussion?  They are evaluated by a physician who says no play.  The parents and the athlete want to play.  What are you going to say?  The physician ruled him out?  You have already established that you can ignore the physician's direction. 




I have other issues with the article as well.  Particularly, this athlete suffered two separate tears of his plantar fascia on each foot with no mention of a physician's evaluation. Hopefully, that information was left out by the editors for the sake of brevity.


This story sends the wrong message to the public about the ability of athletic trainers to look out for the health and welfare of their athletes.  The obvious solution to the dilemma would have been to see another Orthopod for a second opinion who would agree with your plan for handling the injury. If they still do not agree, then the athlete sits, end of  discussion.   


     

Antibacterial properties of copper

Did you know that the metal Copper has antimicrobial properties? I came across an article a couple of years back when Methicillin Resistant Staphylococcus Aureus (MRSA) was in all the headlines. I was amazed at how effective this metal is and wondered why I hadn't heard more about it. As you can see by the graph below MRSA cannot live more than one and half hours on the metal. Copper alloys e.g. bronze and bronze (bronze containing more copper) with lesser amounts of copper also have antimicrobial properties but are not as efficient and need longer contact times to be effective. Stainless steel has no effect on MRSA nor any other infectious microbe.

Graph depicts survival times of Methicillin Resistant Staphylococcus aureus on three copper alloys and stainless steel (C304) at room temperature. C19700 (99% copper) limited survival to 1.5 hours. C24000 (80% copper) showed a significant reduction after 3 hours and complete inviability after 4.5 hours. C77000 (55% copper) showed significant and continuing reduction after 4.5 hours. Survival time on stainless steel continued up to 72 hours.

Wikipedia offers the following information on the effectiveness of copper:

E. coli
The bacterium produces potent toxins that cause diarrhea, severe aches and nausea in infected persons. Recent studies have shown that copper alloy surfaces kill E. coli O157:H7. Over 99.9% of E. coli microbes are killed after just 1–2 hours on copper. On stainless steel surfaces, the microbes can survive for weeks.
MRSA
Methicillin-resistant Staphylococcus aureus (MRSA) is a dangerous bacteria strain because it is resistant to beta-lactam antibiotics. In 2008, after evaluating a wide body of research mandated specifically by the United States Environmental Protection Agency (EPA), registration approvals were granted by EPA in 2008 granting that copper alloys kill more than 99.9% of MRSA within two hours.
Clostridium difficile
Clostridium difficile, an anaerobic bacterium, is a major cause of potentially life-threatening disease, including nosocomial diarrheal infections, especially in developed countries. C. difficile endospores can survive for up to five months on surfaces. The pathogen is frequently transmitted by the hands of healthcare workers in hospital environments. C. difficile rivals MRSA as the most common organism to cause hospital acquired infections in the US
The antimicrobial efficacy of various copper alloys against Clostridium difficile was recently evaluated. The viability of C. difficile spores and vegetative cells were studied on copper alloys C11000 (99.9% copper), C51000 (95% copper), C70600 (90% copper), C26000 (70% copper), and C75200 (65% copper). Stainless steel (S30400) was used as the experimental control. The copper alloys significantly reduced the viability of both C. difficile spores and vegetative cells. On C75200, near total kill was observed after one hour. On C11000, near total kill was observed after 3 hours. On C70600, near total kill was observed after 5 hours. On C26000, near total kill was achieved after 48 hours. On stainless steel, no reductions in viable organisms were observed after 72 hours (3 days) of exposure and no significant reduction was observed within 168 hours (1 week).
Influenza A
Influenza, commonly known as flu, is an infectious disease from a viral pathogen different from the one that produces the common cold.
After incubation for one hour on copper, active influenza A virus particles were reduced by 75%.  After six hours, the particles were reduced on copper by 99.999%. Influenza A virus was found to survive in large numbers on stainless steel.


As you can see by the quotes above copper is a very effective antimicrobial.  So how can this help the athletic trainer?  We need to examine any frequently touched surface that have a copper or copper alloy version.  This could include doorknobs, light switch plates, faucets, pens, or countertops.  


The idea of a copper countertop peaked my interest since it is a large, frequently touched area that is a reservoir for microbes. Being that copper counter tops are expensive I decided to look into making one myself.  I have a 20 foot long counter in one of our facilities.  After searching the internet I came across Storm Copper. They specialize in a variety of copper products and I settled on copper roofing flashing. I order a 24" by 25' roll which arrived rolled up in a wooden crate.  I unrolled it  and placed weights on it so that it would take a more flattened shape.  I then sanded the old formica countertop to roughen up the surface.  I attached the sheet using an adhesive like liquid nails, used a rubber mallet to bend over the edges and tacked and glued the edges down.  It wasn't the most professional job, but it turned out okay. Certainly no one has stated that it is hideous.  I feel the benefits outweighed the aesthetics. 


The price of metals has increased drastically the last few years, a less expensive alternative would be the 0.10" (30 Gauge).  There are various widths and lengths to choose from. 


The copper will tarnish with time especially when in contact with certain chemicals like tape remover.  A good metal polish will bring it back to its original shine.  Below is a picture of a section of my counter.  It is nice to know that every couple of hours this counter is disinfected without any effort at all. 

Budget Taping with PowerTape

I received an email from Andover Healthcare, makers of PowerFlex and PowerTape.  I have spoken about these products before and am a big fan. Andover Healthcare's latest pitch to get people to use their products is cost savings.  Since PowerTape only sticks to PowerFlex or itself you need to use PowerFlex in place off underwrap.  While I have found PowerTape to be less expensive than J&J Coach, the additional cost of using PowerFlex as an underwrap is cost prohibitive.  Andover touts the use of a modified ankle taping in order stretch the amount of tape used and thereby saving money.  


See the flyer below. The link for the video of the technique is here: http://andoverhealthcare.com/videos/budget_taping.html. Basically, they recommend starting your top anchors only 2-3 inches above the malleolus.   While this cuts down on the amount of tape used you immediately question the amount of support provided.  Personally, I would only use this technique while taping prophylactically, otherwise I would revert to the more traditional technique.  I have developed my own technique combining both white adhesive tape and PowerTape.  See below for my explanation.

http://andoverhealthcare.com/videos/budget_taping.html to view video of technique

My technique combines the traditional white adhesive tape with the combination of PowerTape. I call this a hybrid. Apply the anchors and stirrups in the traditional method using your favorite white adhesive.  From here on, using only PowerTape, start with a figure eight.  This gives you the base for all subsequent strips to adhere to. After the figure eight, apply your horseshoes working your way up the ankle filling it in as you finish over your previously applied adhesive tape anchors. Now that you have a solid foundation of PowerTape, you then apply your heel locks and any other strips you prefer. To recap:

1. White adhesive tape
1. anchors and stirrups
2. PowerTape
1. horseshoes, filling in up to the top
2. heel locks
3. additional strips to your liking

This is my technique for using PowerTape on a limited budget.

Open Basketweave

The open basketweave has been around for many years and is still taught in many athletic training programs and texts. It is used to control swelling in an acute ankle injury situation. While still being taught you will very rarely see it in use.  Actually, the only time I have ever seen it applied to an athlete was while visiting the Naval Academy for a contest and I saw the legendary athletic trainer "Red" Romo apply it to a cadet using 1 inch white tape.  It was a work of art and it has stayed with me all these years.  

I have always been disillusioned with compression wraps for acute ankle sprains.  You spend you time working to reduce swelling or prevent it from occurring in the first place.  You then apply an elastic wrap with a horseshoe and send them on their way.  They return the next day either wrap in hand or reapplied in a fashion that affords no compression.  All your work is for naught as the ankle is swollen and you are back to square one.  The most common reason for athletes taking their compression wrap off is the need to shower.  

The introduction of Powertape offers a tape that does not absorb water.  It is a man made material that does not degrade when wet.  With this in mind, I began applying open basketweaves to acute ankle sprains and have been very pleased with the results.  The taping is applied after treatments are finished. It provides support by the use of stirrups, compression by the use of Powertape and PowerFlex.  You can adjust the amount of compression by how tight you apply the PowerFlex.  The taping is kept on until the next treatment session.  It is left on for showering as it is basically waterproof. The athletes do like it as it provides support throughout the day that an elastic wrap does not offer.  We have made it a standard part of our acute ankle sprain care.

Refresher on the Open Basketweave

Materials Needed:
3” PowerFlex (Andover Healthcare)
1” or 1 ½” PowerTape (Andover Healthcare)

PowerFlex is applied to the ankle for use as compression to the injured area. It is important to allow some stretch to remain to account for additional swelling. A horseshoe may be applied under the tape for additional compression to the injured area. 

 

PowerTape is a cohesive product that sticks to itself and PowerFlex. Three 1 ½” stirrups are applied for either lateral or medial ligamentous support. 

1” PowerTape is applied in the traditional fashion leaving the center open to allow for expansion.

 Four 1” strips are placed lengthwise over the tape ends.

The advantage of this method over an elastic wrap:

1. There is no need to remove this for the purpose of showering as the tapes do not absorb water. 
2. Support is provided to the injured area in addition to compression. 
3. Continuous compression and support are achieved throughout the day since the tape is not removed for bathing. 

Excellent results have been achieved since the tape is not removed until a return to the athletic training room. This allows for removal, treatment, and reapplication.