Paul R. Geisler

Management of a stage III Lisfranc ligament injury in a collegiate football player: a case review

The diagnosis and management of the Lisfranc joint injury is a complicated and sometimes frustrating endeavor. Some con- sensus exists on the diagnosis of Lisfranc injuries; however, the proper management of these subtle injuries is still debated and poorly reported. This case review highlights a unique manage- ment of a stage III Lisfranc injury, in that the athlete was able to successfully return to full participation after 3 weeks of rest and conservative, nonsurgical treatment.

The Elephant in the Room: Adequate Supervision, Not Direct Supervision

● Graduate educators and supervisors reporting that newly certifi ed graduate assistants need considerably more time, experience, and mentorship to improve their decision-making skills and autonomic performance.1 Enter the sound of an elephant trumpeting—at this point, loudly. We all hear the trumpet call and fully see the elephant in our midst, yet we often fi nd it easier to pretend we don’t, and we typically resign ourselves to water cooler talk, private exchanges, and tepid whispers in the hope that the elephant will quietly go away with minimal suffering or collateral damage. But if left alone in a room to its natural curiosities and needs, an elephant can—and will—do considerable damage. Ignore the elephant just enough, and it is sure to do some unforeseen yet signifi cant destruction to the environment and its occupants. It is time to pay stern attention to the large pachyderm in our midst making considerable noise in our collective rooms; it’s time we stop skirting the diffi cult conversation that this contentious issue deserves. My friends, it is time to address the elephant known as the “direct supervision standard” in athletic training education before it makes an untenable mark on our educational process and thus, by extension, on our profession. Regardless of the professional position you currently hold, you undoubtedly know by now that according to the most recent accreditation standards of the Commission on Accreditation of Athletic Training Education (CAATE),2 athletic training students must be “directly supervised” at all times during their clinical education. However, you may be surprised to know that a defi nitive follow-up edict was passed down in spring 2012 that effectively outlawed any variation of “fi rst aider” policies that many athletic training education programs had developed in good faith to satisfy the needs of their instiG U E S T E D I T O R I A L

On the Need to Move Toward an Evidence-Based Athletic Training (EBAT)

Evidence-based practice (EBP) is now a well-known paradigm for the athletic training (AT) profession. The Commission on Accreditation of Athletic Training Education accredited programs have require...

Current Concepts in Hip Preservation Surgery Part II—Rehabilitation

Context: Successful treatment of nonarthritic hip pain in young athletic individuals remains a challenge. A growing fund of clinical knowledge has paralleled technical innovations that have enabled hip preservation surgeons to address a multitude of structural variations of the proximal femur and acetabulum and concomitant intra-articular joint pathology. Often, a combination of open and arthroscopic techniques are necessary to treat more complex pathomorphologies. Peri- and postoperative recovery after such procedures can pose a substantial challenge to the patient, and a dedicated, thoughtful approach may reduce setbacks, limit morbidity, and help optimize functional outcomes. Evidence Acquisition: PubMed and CINAHL databases were searched to identify relevant scientific and review articles through December 2014 using the search terms hip preservation, labrum, surgical dislocation, femoroacetabular impingement, postoperative rehabilitation, peri-acetabular osteotomy, and rotational osteotomy. Reference lists of included articles were reviewed to locate additional references of interest. Study Design: Clinical review. Level of Evidence: Level 4. Results: Hip preservation procedures and appropriate rehabilitation have allowed individuals to return to a physically active lifestyle. Conclusion: Effective postoperative rehabilitation must consider modifications and precautions specific to the particular surgical techniques used. Proper postoperative rehabilitation after hip preservation surgery may help optimize functional recovery and maximize clinical success and patient satisfaction.

Evaluating Evidence-Informed Clinical Reasoning Proficiency in Oral Practical Examinations

Clinical reasoning is the specific cognitive process used by health care practitioners to formulate accurate diagnoses for complex patient problems and to set up and carry out effective care. Athle...

Validation of the Quantitative Diagnostic Thinking Inventory for Athletic Training: A Pilot Study.

Context: The cognitive process of making a clinical decision lies somewhere on a continuum between novices using hypothetico-deductive reasoning and experts relying more on case pattern recognition. Although several methods exist for measuring facets of clinical reasoning in specific situations, none have been experimentally applied, as of yet, to the profession of athletic training. The Diagnostic Thinking Inventory (DTI) has been used with medical doctors and medical students to determine their level of clinical reasoning as it applies to diagnosis making. Objective: To validate the DTI for Athletic Training (DTI-AT) and associated interview questions for use in the field of athletic training. Design: Mixed methodology. Setting: Online inventory and Skype-based interviews. Patients or Other Participants: Convenience sample of 25 senior-level athletic training students. Main Outcome Measure(s): Participants completed an online version of the DTI-AT which rated clinical reasoning tendencies on a 6-point L...

Current Concepts in Rehabilitation After Hip Preservation Surgery Part II

Context: Successful treatment of nonarthritic hip pain in young athletic individuals remains a challenge. A growing fund of clinical knowledge has paralleled technical innovations that have enabled hip preservation surgeons to address a multitude of structural variations of the proximal femur and acetabulum and concomitant intra-articular joint pathology. Often, a combination of open and arthroscopic techniques are necessary to treat more complex pathomorphologies. Peri- and postoperative recovery after such procedures can pose a substantial challenge to the patient, and a dedicated, thoughtful approach may reduce setbacks, limit morbidity, and help optimize functional outcomes. Evidence Acquisition: PubMed and CINAHL databases were searched to identify relevant scientific and review articles through December 2014 using the search terms hip preservation, labrum, surgical dislocation, femoroacetabular impingement, postoperative rehabilitation, peri-acetabular osteotomy, and rotational osteotomy. Reference lists of included articles were reviewed to locate additional references of interest. Study Design: Clinical review. Level of Evidence: Level 4. Results: Hip preservation procedures and appropriate rehabilitation have allowed individuals to return to a physically active lifestyle. Conclusion: Effective postoperative rehabilitation must consider modifications and precautions specific to the particular surgical techniques used. Proper postoperative rehabilitation after hip preservation surgery may help optimize functional recovery and maximize clinical success and patient satisfaction.

Current Concepts in Hip Preservation Surgery

Context: Successful treatment of nonarthritic hip pain in young athletic individuals remains a challenge. A growing fund of clinical knowledge has paralleled technical innovations that have enabled hip preservation surgeons to address a multitude of structural variations of the proximal femur and acetabulum and concomitant intra-articular joint pathology. Often, a combination of open and arthroscopic techniques are necessary to treat more complex pathomorphologies. Peri- and postoperative recovery after such procedures can pose a substantial challenge to the patient, and a dedicated, thoughtful approach may reduce setbacks, limit morbidity, and help optimize functional outcomes. Evidence Acquisition: PubMed and CINAHL databases were searched to identify relevant scientific and review articles through December 2014 using the search terms hip preservation, labrum, surgical dislocation, femoroacetabular impingement, postoperative rehabilitation, peri-acetabular osteotomy, and rotational osteotomy. Reference lists of included articles were reviewed to locate additional references of interest. Study Design: Clinical review. Level of Evidence: Level 4. Results: Hip preservation procedures and appropriate rehabilitation have allowed individuals to return to a physically active lifestyle. Conclusion: Effective postoperative rehabilitation must consider modifications and precautions specific to the particular surgical techniques used. Proper postoperative rehabilitation after hip preservation surgery may help optimize functional recovery and maximize clinical success and patient satisfaction.

Part II Current Concepts in Rehabilitation After Hip Preservation Surgery

Context: Successful treatment of nonarthritic hip pain in young athletic individuals remains a challenge. A growing fund of clinical knowledge has paralleled technical innovations that have enabled hip preservation surgeons to address a multitude of structural variations of the proximal femur and acetabulum and concomitant intra-articular joint pathology. Often, a combination of open and arthroscopic techniques are necessary to treat more complex pathomorphologies. Peri- and postoperative recovery after such procedures can pose a substantial challenge to the patient, and a dedicated, thoughtful approach may reduce setbacks, limit morbidity, and help optimize functional outcomes. Evidence Acquisition: PubMed and CINAHL databases were searched to identify relevant scientific and review articles through December 2014 using the search terms hip preservation, labrum, surgical dislocation, femoroacetabular impingement, postoperative rehabilitation, peri-acetabular osteotomy, and rotational osteotomy. Reference lists of included articles were reviewed to locate additional references of interest. Study Design: Clinical review. Level of Evidence: Level 4. Results: Hip preservation procedures and appropriate rehabilitation have allowed individuals to return to a physically active lifestyle. Conclusion: Effective postoperative rehabilitation must consider modifications and precautions specific to the particular surgical techniques used. Proper postoperative rehabilitation after hip preservation surgery may help optimize functional recovery and maximize clinical success and patient satisfaction.

Deep Vein Thrombosis in a Collegiate Female Soccer Player: A Case & Evidence- Supported Review

Deep Vein Thrombosis in a Collegiate Female Soccer Player: A Case & Evidence- Supported Review An otherwise healthy, 20-year-old, collegiate female soccer athlete presented in our athletic training room complaining of deep and diffuse knee pain after a non-contact, weight bearing and torque producing mechanism while playing indoor soccer. Her past medical history revealed a successfully reconstructed anterior cruciate ligament following an ACL tear in the right lower extremity status post three years.