Everything you need to know about concussions

Over the last 2 decades, there has been a lot of talk about the injury known as concussion. There has been a growing body of research about concussions—what they are, what causes them, and how we can better treat them. For this reason, the clinical management of concussion care has significantly changed in recent years; however, not all health care providers have been informed about these changes.  

My name is Logan Curry. I am a physical therapist at Advanced PT’s Appleton North location with advanced training in treating and managing concussions. I frequently get questions from patients or their parents about these injuries. Here are the answers to some common questions that I get about concussions. 

What is a concussion?

A concussion is a traumatic injury to the brain, which causes a cascade of events leading to inflammation, blood flow restriction, and a depletion of energy needed for normal neurological function. This is a functional injury to the brain without visible structural tissue damage to the brain. It causes signs and symptoms (such as dizziness, headache, fatigue, etc.) which can occur immediately or over time. Although these symptoms can be quite severe, typically we expect them to resolve in days or weeks following the injury.  

How do you diagnose a concussion?

A clinical assessment performed by a health care provider is necessary to formally diagnose a concussion. Assessment may include but is not limited to testing for cognition, eye control and vision, posture, gait, balance, and neck motion.  

Do you need to get imaging after a concussion?

No, it’s not necessary, but sometimes it may be appropriate. Currently, diagnostic imaging for clinical use cannot identify people who have sustained a concussion, so CT scans and MRIs will show no signs of tissue injury. If a person sustains significant head trauma and their symptoms progressively worsen or create an unstable condition, they should receive a CT scan to rule out something more serious. In other cases, a person may receive an MRI to assess for structural injury to the brain in cases where symptoms persist longer than expected.  

What do you do after a concussion to help recover?

Initially, a period of relative rest (reducing daily activities and limiting screen time) for the first 24-48 hours following injury is recommended. After this period of time, it’s important to gradually return to physical and cognitive activity with minimal increase in symptoms. Sometimes people want to avoid all stimulation that provokes symptoms following their injury. Unfortunately, this doesn’t help their brain adjust to the stimulation that comes with daily activities. After a concussion, the brain needs to be gradually exposed to normal stimuli as part of the recovery process.  

How does someone return to school, work, or sport?

Often after these injuries, people need to receive modifications or accommodations to their school or work day to allow them to return to those activities at a sub-symptom threshold level (with minimal increase in symptoms). This they can do with the assistance of a healthcare provider. Returning to sport should occur in a gradual manner under the direction of an athletic trainer or physical therapist. Returning to full participation in sport should occur after fully returning to school/work activities. 

How long does it take to recover?

The majority of concussions recover fully in a relatively short amount of time (14 days or less for adults and 30 days or less for children). Unfortunately, there are cases and situations where concussion symptoms can persist because the brain needs some additional help to get back to normal function. 

Should someone receive care or treatment after a concussion? I

t is important to have oversight by a medical provider to assist in helping a patient who has sustained a concussion return to normal activities. ER doctors, primary care physicians, and athletic trainers are often the first health care providers to see people following a head injury. In some cases, they may recommend that a patient receive care or treatment from other health care providers such as a physical therapist, occupational therapist, speech and language pathologist, neurologist, concussion doctor, neuro optometrist, and neuro psychologist. Their recommendation will be based upon the provider’s experience and the patient’s symptoms following an injury. Sometimes providers may not be aware of some options that may be available to help get their patient better faster. 

How does physical therapy help people who have concussions?

The main goal of physical therapy following a concussion is to help gradually retrain the brain to process information and return to normal activity and function. Every concussion is going to present differently, so treatment can vary from one injury to another. The physical therapist will perform a comprehensive assessment and determine the most appropriate treatment strategy to help each patient address their impairments and deficits as well as work towards achieving their specific goals. Physical therapy may include aerobic activity, treatment for the neck, exercises for the eyes, interventions for the inner ear, balance training, reaction training, and sports/job specific activities.  

Concussions are a very complex injury and not fully understood. Despite our limited knowledge on the subject, there are many great things that can be done to help people feel better faster and to assist in managing symptoms. If you have any additional questions about concussions or are curious about what physical therapy can do for treating concussions, feel free to contact me at lcurry@advancedptsm.com or 920-991-2561. 

Patricios JS, Schneider KJ, Dvorak J, et al. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport-Amsterdam, October 2022. Br J Sports Med. 2023;57(11):695-711. doi:10.1136/bjsports-2023-106898 

National Athletic Training Month Recap.

National Athletic Training Month is held every March in order to spread awareness about the important work of athletic trainers (ATs). The care provided by these experts, whether to middle, high school, collegiate or professional athletes or the industrial athlete, can be life-altering. The athletic training ranks teem with stories of current ATs drawn to the profession through their interaction with an AT who helped them through a devastating injury when they were young. Such profound encounters contribute mightily to the next generation of ATs so vital to the health and well-being of athletes of all ages and disciplines.

As providers of front-line care, ATs offer wide-ranging skill sets that go well beyond the physical aspects of sports medicine. Their ability to connect with patients is perhaps the true hallmark of the AT. Another characteristic shared by many ATs is their slightly annoying reluctance to highlight their own skills.

As it’s National Athletic Training Month, we asked them the following question:

What unique value do you feel athletic trainers offer their patients?

And forced them to answer.

Lynsey Hansen – 11 year in athletic training, previous experience with youth, high school, and collegiate athletics. Past year and a half with Industrial and Tactical Medicine.

“AT’s have the unique opportunity to get to know their patients before they get injured in most cases, which can help improve the patient's outcome, and the AT also gets to watch them successfully return to their career, hobby they love, etc. Having that sort of relationship can help keep the small things small, but also incorporate techniques to aid the mental and emotional aspects when those injuries are more severe.”

Joe Hanel – 8 years in athletic training. All in Industrial setting.

“I think the general public is starting to understand that AT’s have a very broad range of knowledge about all kinds of injuries, human anatomy, kinesiology and more. When it comes to the front line of care, AT’s seem to be most knowledgeable in whole-body care. Most LAT’s need to be ready to treat any injury so our continuing education is not often specialized, allowing us to stay current on a wide spectrum of healthcare issues. I believe this really helps us stand out.”

Heidi Bohl – 13 years in athletic training, previous experience in youth and high school athletics. Past 4 years in Industrial and Tactical Medicine.

“Athletic trainers offer multiple skillsets that dabble in a variety of healthcare spectrums including physical care as well as emotional wellbeing. The range of training allows us to guide and address the whole body.”

Traci Tauferner - 17 years in athletic training, previous experience in youth, high school, collegiate and semi-professional athletics. Past 15 years in Industrial and Tactical Medicine. APTSM’s Director of Industrial and Tactical Medicine.

“I work mostly in the tactical setting. So for me athletic trainers bring valuable expertise to police and fire departments by offering specialized injury prevention, rehabilitation, and fitness training tailored to the physical demands of their jobs. Our knowledge of sports medicine principles can also help in managing and preventing work-related injuries, ultimately promoting the overall health and well-being of police officers and firefighters.”

Sean Gough – 12 years in athletic training, previous experience in high school and collegiate athletics. Almost 1 year with APTSM in Industrial and Tactical Medicine

“Athletic trainers excel in being the go-to, that trusted face due to the long-term relationships we build with patients—especially in the athletic setting but also now in the industrial and tactical space. Not only do we get to see our patients at a time where they are vulnerable, hurt, or uncertain about their future, but we also get to see them at their best.”

Marc Viergutz – 8 years in athletic training, previous experience in high school, collegiate, and professional athletics. Past 3 years with Lawrence University.

“AT’s offer a truly sport-specific view which is unique in the world of medicine. From the way we are educated to the way we approach things. It’s always from a view with the athlete’s sport in mind. We have the opportunity to work every day with that sport and provide tailored treatment plans.”

Megan Werner – 14 years in athletic training, previous experience in youth, high school, and collegiate athletics. Past 6 years in Industrial and Tactical Medicine and as Sports Medicine Coordinator.

“I feel athletic trainers offer a huge value to our patients because of our dynamic skill set. With our roots in athletics, we naturally learn to be flexible and are quick to adjust based on the needs of our patients and clients. We are always looking for ways to help our patients recover from injury or continue to improve their performance, no matter if their “playing field” is an actual field or court for an athlete, a manufacturing facility for an industrial worker, or a burning building for a firefighter.”

So if you see your friendly (or even somewhat laconic) athletic trainer, invite them to chat about their chosen profession as well as their national organization’s tagline for the month-long celebration: “From Head to Toe.”

Actually, once the ATs got going they couldn’t resist answering our second question (“How does ‘From Head to Toe’ encapsulate what you and Advanced PTSM do in athletic training?”), which we combined into a tidy paragraph that represented the group’s thoughts nicely:

“As athletic trainers, we are ready to address almost anything our patient might need. Our education includes emergency care, evaluating and treating orthopedic injuries, injury prevention, as well as concussion care, nutrition, and hydration. We’re also typically in environments like working with a team or company where we get the chance to develop strong relationships with our patients and get to know them as a person, not just their injury.”

Providing Experiences for the Next Generation of Professionals

Getting people back to what they love is the job of an athletic trainer. Ensuring there are plenty of high-caliber graduates ready to serve active populations is the job of universities and colleges, whose programs provide interactive learning environments that will prepare students to enter the profession.

Advanced Physical Therapy & Sports Medicine (APTSM) plays a vital role in the process.

“It’s important we offer internships and job shadowing opportunities for those on the path to becoming athletic trainers,” said APTSM’s Traci Tauferner. “The field is projected to grow 25% by the end of the decade.”

While there is a broad range of settings for the athletic trainer—physician practices, professional sports, clinics specializing in sports medicine, occupational health, and performing arts, to name a few—the vast majority of graduates will enter the field’s most traditional setting: schools.

That’s where Tauferner started out after earning her athletic training degree at UW-Oshkosh. With a robust resume developed since her graduation—she’s the Director of Industrial & Tactical Medicine at Advanced—Tauferner now devotes time both to her administrative duties as well as to the onsite therapy services she delivers at multiple locations.

Tauferner is committed to bringing attention to industrial athletic training, especially as the need for athletic trainers to prevent, evaluate, manage, and rehabilitate conditions faced by workforces—directly at companies and municipalities—continues to grow.

“Achieving injury prevention and cost control in this day and age for the industries and tactical groups we serve is not just a desired outcome,” said Tauferner. “In many cases, it’s a matter of survival.”

More than 55 Wisconsin companies and organizations utilize Advanced PT’s hallmark program of onsite wellness solutions. APTSM’s dedication to workplace health and safety has contributed to recognition at local, state, and national levels.

That kind of focus includes providing learning opportunities for those interested in pursuing a career in the field, and Tauferner is passionate about students understanding the paths available to them.

“It’s important for us to provide these experiences for the next generation, especially so in the bourgeoning industrial and tactical realms, as fewer than 5% of graduates are going into those sectors,” she said.

The connection between APTSM and Tauferner’s alma mater remains strong, as evidenced by UW-Oshkosh student Cade Littleton’s recent experience.

Littleton, a senior in the Masters of Athletic Training Program, spent the summer working through four specific rotations: clinical, hospital, professional team, and industrial/tactical.

Littleton said a few football injuries (“some hip and shoulder pain, but nothing huge like a blown ACL”) led him to seek treatment. Though his high school didn’t have a traditional athletic trainer, a nearby orthopedic group supplied the small school with a physical therapist, and Littleton found himself fascinated by the PT’s skills.

“I was just very interested in what he did, so much so that I actually job shadowed him for one of my classes,” said Littleton. “That set me on the PT path, but once I got to school and got a little more experience with athletic training, I became drawn to that, to work with a younger and highly active population.”

To meet the requirements of the program, one of Littleton’s rotations had him paired with Tauferner.

“This was actually the third time I had met Traci,” said Littleton. “I met her following a presentation she did on mental health, then at the WATA (Wisconsin Athletic Trainers’ Association) conference this year.”

For two weeks Littleton followed Tauferner’s schedule (“yeah, she starts early”), which included stints with the tactical groups she services.

“It was cool to see the firefighters and police officers and how they handle things at their own facilities,” said Littleton. “It was a lot different than my traditional experiences.”

With those tactical groups, Tauferner gave Littleton the opportunity to do full evaluations; she provided guidance, talking Littleton through treatment options and giving him the chance to “do his own thing.”

“Traci allowed me to do a lot more hands-on than I expected, so that was really cool,” he said.

He also learned about Tauferner’s use of and advocacy for modern cupping techniques.

“Just how she used cupping and explained it so it made sense to the client was very interesting,” said Littleton. “That helped me a lot because I’m still a student trying to figure this stuff out.”

Asked about key takeaways following the rotation, Littleton doesn’t hesitate.

“The experience pushes me to continue to learn, to ask questions, and to demand respect as Traci does.”

Littleton admitted he’d like to replicate the demeanor Tauferner exhibited throughout their time together.

“Traci’s vibe is straight confidence,” said Littleton. “The setting doesn’t matter.”

Summer rotations are complete, Littleton is now working with UW-O’s athletic trainer for 2023 football season. Set to graduate next May, Littleton is currently leaning towards working in the high school or college setting, but he’s not ruling anything out.

“I’m not 100% sure yet,” said Littleton.

If uncertain about his job setting, Littleton expresses a clearer view in the geographic sense.

“I’m up to moving,” he said. “I’m not a huge fan of winter.”

—

If you or a student you know is interested in experiencing what Advanced does every day, contact us today!.

Recreating the Unthinkable: The Stevens Point Mass Casualty Event

Even when you know it’s a simulation, you’re a bit on edge. Maybe it’s because everyone is.

Or it might be the card they handed you to identify your role in the simulation, which reads “ACTIVE SHOOTER MOCK VICTIM INFORMATION.”

Advanced Physical Therapy’s Lynsey Hansen was ready for her role as a shooting victim nonetheless.

“I was hit but still responsive,” Hansen said. “I just followed what was on the card and did my part.”

The mock disaster, held in Stevens Point for Central Wisconsin first responders, required that exact mindset from everyone involved: be prepared to do your part.

The active shooter event is known as Rescue Task Force Training (RTF). Conducted annually by the Stevens Point Fire Department, Police Department and Emergency Medical Services Team, RTF provides the training ground for multiple agencies to respond to a simulated disaster scenario. The collaborative effort identifies opportunities for enhanced coordination among the agencies tasked with stabilizing a complex situation and triaging victims at a time when every second matters.

While this was Hansen’s first participation in the event as a member of Advanced PT, her boss has been there a few more times.

“Advanced has been working with Stevens Point Police and Fire for 13 years, so this was my 13th,” said Traci Tauferner, Director of Industrial & Tactical Medicine. “I go every year to RTF training, and every year I learn something new.”

Often assisting as a victim in the dress rehearsal, Tauferner recently has taken a step back to view things as an observer.

“As the provider of onsite rehabilitation for Stevens Point Police and Fire Departments, it’s a perfect time for us to educate ourselves about the physical aspects required by personnel to effectively do their jobs in a high stress mass casualty event,” said Tauferner. “With that knowledge, we will understand how we can best rehab them if they have an injury.”

In previous drills, Tauferner focused on her role as victim, viewing the triaging interactions she had with first responders tending to her injuries. This year’s perspective afforded her the opportunity to see department interactions, triage tools, deployment, and the results of public safety partners who have planned and trained together.

Scrutinizing the approach of first responders in managing a large-scale crisis assists Advanced onsite tactical providers.

“We aren’t police officers or firefighters,” said Tauferner. “If we don’t study how they do their work, we won’t understand how to strengthen them, condition them, rehab them, and protect them if they have an injury.”

Hansen, fresh from her first acting stint, appreciated the combined efforts of those who pitched in to coordinate the event.

“You’ve got staff members and groups from multiple locations—Stevens Point, Plover, Portage, etc.—that participate, which is so important because each situation will be unique and you’re going to need to pull from every available area,” Hansen said. “So getting that experience is so beneficial for all parties.”

Afterwards, departments held debriefing sessions, both individually and jointly; those wide-ranging conversations help drive next year’s training. All participants acknowledge the intricacies of fine-tuning the rapid deployment of resources among multiple groups, but their overarching goal is simplicity itself:

To create a unified response that saves lives.

Quick Access to Quality Care

The Zoom connection was spotty.

“So you said you’re from the Twin Cities? I love Minneapolis,” I stated.

“Not Minneapolis,” she said. “Leopolis!”

Wait, what?

“And now I live in Pella.”

After the reconnect, I had Sally Egan of Advanced Physical Therapy & Sports Medicine (APTSM) begin anew.

“As an onsite provider at three companies and a municipality in Northeastern Wisconsin, it’s my job to help create and maintain healthy environments for employees,” said Egan. “And the best way to do that is to provide quick access to quality care.”

Egan is a veteran of APTSM’s industrial rehabilitation team, a group of licensed athletic trainers and physical therapists dedicated to keeping employees healthy, safe, and on the job. Like many of her colleagues from the athletic training world, she began her career in the high school setting, as the athletic trainer at nearby Shawano High School (about 15 minutes away from what she refers to as the “Twin Cities”) for nearly a dozen years.

She stresses the similarities between the two environments.

“What we do as industrial athletic trainers is bring the sports medicine model of immediate, consistent care to the workplace,” said Egan. “And we do this at no cost to the employee.”

Which is so important to her clients, everyday people who are just trying to make a living and put food on the table.

Egan understands that concept well.

“I grew up in this area on a very small dairy farm. I know what it's like for a family to live paycheck to paycheck and not able to get healthcare when you really should, because you just can't afford it,” said Egan. “So being able to provide that service—literally in my hometown—is just an amazing opportunity for me.”

Interesting that she and her chiropractor brother (“two tiny farm kids”) both pursued careers in health care. It makes complete sense, though, as she describes it as a simple transition from fixing tractors or boards on a wall to fixing people.

The similarities don’t end there, as Egan quickly points out.

“You have to be adaptable and inventive because you don't usually have the resources. That's what onsite rehab is. You don't have a lot of equipment, so you have to work with what you have,” she said.

The companies and organizations she works with rely on Egan to deliver services known as “rapid response,” where direct access to care means employees will be seen in 24-48 hours for an evaluation. That kind of quick care creates the opportunity for an improved healing timeframe, as the onsite provider can swiftly address and manage issues that, if left untreated, could become a recordable injury.

“We can prevent that from occurring,” said Egan. “So you’re keeping the employee healthy and keeping them at their job, and you’re saving the employer money by reducing direct and indirect costs that result from such an injury.”

Again, she leans on her sports medicine background.

“One domain of athletic training is about reactive and emergency care, which in industry is rapid response and OSHA first aid. So we're there for that assessment, and occasionally wound care and emergency care,” said Egan. “For injuries, we’re able to assess and make appropriate decisions if this is something that you can rehab or treat, or make that decision for a proper referral and guide them to where they should go for the best quality and line of care.”

Developing a relationship and a rapport with her employees is crucial.

“Well, it’s on me to get out on the floor and make connections,” said Egan. “You need to show them that you're there to know them as a person, not just a patient.

Forming such bonds requires a level of trust, something Egan says comes naturally when employees get treated right away and feel better. Whether it’s Egan making the rounds on a factory floor or working with a patient who scheduled an appointment in a (usually) small treatment room, the brief interactions are the sources of the best kind of marketing there is word of mouth.

“One employee will say, ‘Sally has done great things for my shoulder. Go see if she can help you.’ And that keeps my days full,” said Egan.

Egan highlights additional services she can provide if companies so choose. One company, for instance, wanted to offer their office personnel some strategies to improve general wellness. So, every week at the scheduled time, staff members stop what they are doing, grab a chair, and join Egan at the center of the office, where she leads them in fifteen minutes of stretching and body mechanics.

“It’s just a special need that the company felt strongly about, and we can do those types of things,” said Egan. “We individualize services based on the company. I meet with HR every single week at my companies just to keep the lines of communication open. We’re there to prevent health issues as much as possible, so that kind of collaboration ensures their needs are being met.”

The stability of the Wi-Fi connection notwithstanding, someone needed to get going. Technically her “day off,” Egan was headed to a side gig, teaching chair yoga to retired adults. But she wanted me to know she hadn’t looked at list of questions I had sent her prior to the interview.

“I wasn’t going to prep for this. Because what works in this field is that we're ourselves. We're not scripted. You get the real me,” said Egan.

The small-town country girl paused, and before signing off acknowledged one final similarity between her job as an industrial rehabilitation specialist and her work with high school athletes in a previous life.

“We’re in healthcare for a reason, and that’s to help people. I get to make those personal connections with industry clients just like I did in sports medicine. And the best part is when I get somebody that comes in and says, ‘Thank you so much for helping me. I feel so much better, and I didn't know if I was ever going to feel better.’

“That’s the best part of my job.”

—

Click Here to learn more about our Industrial and Tactical Medicine and Wellness programs.

What is Modern Cupping Therapy?

Modern Cupping Therapy is a form of alternative therapy that has gained popularity in recent years. It involves the use of cups made of glass, silicone, or plastic that are placed on the skin to create suction. This suction is believed to increase blood flow to the area and promote healing.

Cupping therapy has been used for centuries in traditional Chinese medicine, and its modern iteration has evolved to become a non-invasive and safe therapy.

Here's what you need to know about this popular alternative therapy:

How does Modern Cupping Therapy work?

During a cupping session, a therapist places cups on the skin and creates suction. The suction is created using a handheld pump. Once the cups are in place, they are left on the skin for several minutes before being removed. Sometimes, they are moved in a very specific pattern or sequence depending on the desired effect.

The suction created by the cups is believed to stimulate blood flow to the area and promote healing. It can also help to relax the muscles, reduce pain, and improve overall circulation.

What conditions can Modern Cupping Therapy help with?

It can be used to help many different conditions including, but not limited to, those listed below:

• Back pain

• Neck pain

• Shoulder pain

• Knee pain

• Migraines

• Arthritis

• Fibromyalgia

• Lymphedema

Is Modern Cupping Therapy safe?

Yes! It is generally safe when performed by a qualified healthcare professional. Minor side effects may include mild discomfort, bruising, or skin irritation. It is important to seek the advice of a qualified healthcare professional before using cupping therapy.

Conclusion

Modern Cupping Therapy is a popular alternative therapy that has gained popularity in recent years. It involves the use of cups placed on the skin to create suction, which is believed to stimulate blood flow and promote healing. The therapy is generally safe when performed by a qualified healthcare professional and can help with a variety of conditions. However, it should not be used as a replacement for conventional medical treatment. If you are interested in trying Modern Cupping Therapy, call today and we can chat further to determine if cupping is right for you and how to work it into your treatment program.

References:

1. Wang, Sz., Lu, Yh., Wu, M. et al. Cupping Therapy for Diseases: An Overview of Scientific Evidence from 2009 to 2019. Chin. J. Integr. Med. 27, 394–400 (2021). https://doi.org/10.1007/s11655-020-3060-y

2. Mohamed, Ayman A., Zhang, Xueyan, and Jan, Yih-Kuen. ‘Evidence-based and Adverse-effects Analyses of Cupping Therapy in Musculoskeletal and Sports Rehabilitation: A Systematic and Evidence-based Review’. 1 Jan. 2023 : 3 – 19.

The impact of Athletic Trainers in Industrial Medicine

Heidi demonstrates a simulated pull during a post-offer test to assess the employees ability to perform their job duties.

Advanced PT’s Heidi Bohl had the opportunity recently to share her experiences as an industrial athletic trainer to college students on the AT track in South Carolina. The college seniors who comprised her audience have been the beneficiaries of a number of presenters who highlighted a variety of topics related to pursuing a career in athletic training, but this was their first exposure to industrial athletic training.

While there are many paths open to those earning an athletic training degree, the majority make their debut in organized athletics (secondary schools, colleges, etc.). Already employed at the YMCA when she joined Advanced Physical Therapy & Sports Medicine, Bohl was initially hired for on-call work, covering for full-time athletic trainers to provide care to high school and middle school athletes as well as to club team participants.

Bohl enjoyed the work but made clear to her audience the importance of considering options and thinking about what is most important to each individual as they continue their education and pursue their career goals

“The schedule of a high school athletic trainer isn’t necessarily conducive to raising a family,” Bohl said. “My husband and I knew we wanted kids, and I wanted to be home for them.”

Bohl continued with part-time efforts at both jobs until her position at the YMCA was eliminated due to COVID; to replace those missing hours, she looked to the bourgeoning field of industrial rehabilitation, where companies hire providers to deliver healthcare services onsite to their employees.

It just so happened her current employer was a leader in the delivery of industrial onsite services. And because of the growth in that area, Advanced was looking for additional providers.

“Rob Worth (President of Advanced PT) knew me through the PRN work I had done, and we discussed the kinds of services Advanced was performing at companies,” Bohl said. “We both thought it would be a great fit for me.”

Advanced PT works with over 60 industrial companies, who employ physical therapists, physical therapy assistants, occupational therapists, occupational therapy assistants, and, of course, athletic trainers from Advanced to deliver the services necessary to keep employees at their best. The idea driving the model is simple yet profound: reduce the time and money lost to a company by reducing employee injury.

“We look at the employees at our companies as industrial athletes,” said Bohl. “Our presence onsite allows them to work safely at their job and enjoy life outside of work.”

Bohl’s skill set is vast, and good thing, as there are a multitude of areas on which to focus, including early intervention services, job testing, injury prevention, ergonomics, and wellness initiatives, to name a few. Programs are customized by the employer; they choose what best fits their needs and objectives.

After three years in industry, Bohl now dedicates all her hours to a single employer. She’s available onsite, naturally, but she’s also available by phone, text and email when not onsite to discuss injuries and determine plans of care.

“We promise opportunities for access to care within 24 hours if we aren’t onsite, which includes access to orthopedic providers we partner with,” said Bohl. “That kind of rapid response is a win-win scenario for employees and the employer.” Typically, companies utilizing the onsite model will see a reduction in OSHA recordable injuries by at least 50%, along with significant reductions in healthcare costs from both work-related and non-work related injuries. Bohl covered a lot of information in her thirty-minute presentation, but she saved a few minutes at the end for questions.

“Can you discuss the importance of developing rapport with the employees and understanding the company culture?”

“It’s vital,” said Bohl. “You have to know your employees and know how to interact with them. I provide services at a concrete and construction company. My dad was a general contractor. My uncle does concrete for a living. This is just a natural fit for me.”

If students didn’t understand the concept of variety in the world of industrial athletic training at the beginning, they sure were on board at the end.

“You’ll be on the floor, moving from area to area, employee to employee, encouraging people to come talk to you if they have questions, then you’ll head back to meet with the employees who made appointments to see you. Afterwards, you’ll be at a safety meeting sharing data and ROI; following that, it’s time to perform a jobsite analysis and then an ergonomic evaluation,” said Bohl.

After a busy day that included many of the aforementioned tasks plus the Zoom presentation to prospective industrial athletic trainers located a thousand miles away, Bohl was back at her full-time job, the primary focus of which revolves around getting her children to and from a plethora of practices, games and competitions.

She has a vast mom skill set too.

Trail Blazer to Trailblazer

Ray Mack is inducted into the St. Francis High School Hall of Fame by Dr. Deborah Kerr, Superintendent of Schools, on December 9, 2022

Many physical therapists have an injury story that contributes to a career path.

But most don’t include a connection to a legendary Wisconsin team whose mad dash to a national championship helped make March Madness what it is today.

Ray Mack of Advanced Physical Therapy & Sports Medicine vividly recalled a high school football injury from six decades ago that led him from athlete to athletic trainer.

“As defensive end, it was my job to get crushed first on a student body left,” Mack said. “Hurt my back and that was it. To continue participating in sports, I decided to become a student athletic trainer.”

And the rest, they say, is history. A history that includes the improbable journey with the Marquette Warriors basketball team from 1973 through 1977.

Understand that at the time of Mack’s injury, circa 1970, athletic training was in its infancy: it was the coaches who primarily handled injuries to their athletes. Outside of football hotbeds like Texas, the presence of athletic trainers was few and far between.

The year after Mack’s injury, he became the student trainer at St. Francis High School and would continue for the remainder of his high school career.

“I wanted to continue participating in sports and I had the aptitude for the health and medical stuff,” said Mack.

As a result of his performance, the St. Francis football coach obtained a scholarship for Mack to Marquette University as a student athletic trainer, which also allowed him to attend physical therapy school there. He covered multiple sports at the university including soccer, wrestling and cross country/track. Ray was also one of the first student athletic trainers for the new Marquette University's Title IX women’s sports program.

It was Division 1 college basketball, however, that powered the engine that was Marquette sports.

“I was blessed to be part of the national championship at Marquette in 1977 under legends Al McGuire, Hank Raymonds, Rick Majerus, and Bob Weingart,” said Mack. “All Hall of Fame members.”

While many know the names of the coaching legends, Mack highlighted Weingart’s impressive resume, which included 38 years as Marquette’s head athletic trainer as well as trainer for the USA track team in the 1972 Olympics.

“He was the man at Marquette,” said Mack. “Working with Bob was both an honor and an opportunity.”

It was during Mack’s senior year stint as the Warriors student athletic trainer when he was told he couldn’t continue with the basketball program during his second semester, as he was being sent to New York for his physical therapy residence—exactly when Marquette would make their run to college basketball’s ultimate prize.

Though Mack didn’t exactly appreciate the timing of the move, he later came to appreciate the wisdom of the choice his advisors made, sending him to areas that took him well beyond his identified niche in sports medicine.

“As a function of that experience, I became through my VA tenure an amputee specialist and a medical surgical clinic specialist,” said Mack. “It broadened my horizons dramatically.”

After 45+ years as a physical therapist, Mack continues to treat patients, specializing in the non-operative treatment of orthopedic-related injuries of the spine/pelvis and extremities. His personal interests are as vast as his medical pursuits and include photography, website development, history, learning theory and aquatics.

Oh, throw in mustaches and Hawaiian shirts too.

Mack described his work as an athletic trainer and physical therapist not as an occupation but a vocation, something he was meant to do in life. And while there is plenty to look back upon, there’s much more ahead.

“I'll do this for as long as I feel like I can contribute and make a difference.”

Baseline Concussion Testing

Ben Benesh, PT, SCS

What is a concussion?  The Center for Disease Control and Prevention (CDC) definition:

“A concussion is a type of traumatic brain injury—or TBI—caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells.”

According to a Pediatrics study from 2016, it was estimated that between 1.6 and 3.8 million sports concussions occur annually in the United States. Concussions can happen in sport during a violent head to head collision in football or taking a charge and hitting the back of your head in basketball. They can be sustained during a whiplash-type injury in a flyer during a competitive cheer stunt or when a young athlete takes a volleyball spike to the head or face. Besides the obvious appropriate post-concussion management for these athletes, a proper baseline concussion test is key in the successful return to school and sport.

High school-age athletes are baseline concussion tested as a Freshman and again as a Junior. They are usually tested in school by their athletic training team. The group that needs the most attention are the elementary and middle school-aged children, that do not have access to athletic training staff, and do not have school-based concussion baseline testing. These kids are still playing sports, including collision type sports that put them at risk for a concussion. Over the last 7 years of treating patients following a concussion, I have seen plenty of soccer and football athletes, but have also treated basketball players, volleyball players, wrestlers, competitive cheer athletes, and even swimmers! In order to treat these patients as effectively as possible following a concussion, baseline testing is crucial.

In healthy athletes, baseline concussion testing includes concussion education, past head injury medical history, baseline ImPACT neurocognitive computer testing, baseline vestibular/oculomotor screening and assessment, and baseline balance assessment. These objective measurements will be saved and used following a concussion to determine if your athlete is back to “normal” following injury and can safely return to their sport they love to do.

In this crazy time dealing with the COVID-19 pandemic, sporting events are delayed or canceled and then rescheduled without notice. The training schedule may not be as consistent or as intense as previous years as kids are quarantined or had exposure to COVID-19 or coaches are unable to secure facilities to practice. Parents are often not even able to watch their children play sports because of spectator restrictions in gyms. All of these reasons make this year unique. But the truth is, concussions still happen during a pandemic and we need to be best prepared to give our young athletes the best care possible if they sustain a concussion.

Please contact us for more information or to schedule your Baseline Concussion Test at our Appleton North or Community First Champion Center clinics!

References

https://www.cdc.gov/headsup/basics/return_to_sports.html

McCrory et al. Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. BJSM April, 2017

Elbin et al. Removal From Play After Concussion and Recovery Time. Pediatrics August, 2016

Speed and Agility Training

David Reybrock, MPT

Speed and agility are primarily associated with athletes training for sport; but it also occurs in our everyday activities. We are all athletes in one form or another. Whether you are in a sport, involved in recreation, participate in regular exercise, walk a dog, or play with your children; speed and agility training can help enhance your movement skill acquisition and functional mobility.

As movement specialists, Physical Therapists can use speed and agility training to provide stability by varying speeds of motion and body position.  Everyone can benefit from improved balance, quicker feet, and faster reaction time.  Speed and agility in youth can be used for injury prevention, promote exercise participation, and improve physical fitness.  Speed and agility in elderly can be used to improve coordination, prevent falls, and maintain independent living.  Adding speed and agility to an exercise routine or treatment program can help you move more efficiently and effectively.  

What is Speed, what is Agility?

Speed is defined as the ability to move the body in one direction as fast as possible. Training for speed requires strength in the arms and legs to propel your body forward. The muscles in the back of the thigh and leg create triple extension- forceful extension of the hip, knee, and ankle joints. The gluteus maximus muscle of the hip; hamstring muscles of the knee; and gastroc-soleus muscles of the ankle are the muscles used to run faster.

Agility on the other hand, is the ability to accelerate, decelerate, stabilize, and quickly change directions with proper posture. Agility training focuses on performing a variety of movements in a quick manner. It is not simply going as fast as you can, but rather adjusting movements while going as fast and as steady as possible. Training for agility requires good balance and a strong core to support the body as it moves through all three planes of motion.

The combination of speed and agility training should be used to develop movement skills that include acceleration, deceleration, dynamic balance, and change of direction. In developing these skills, appropriate stability, mobility, and sequencing of movement patterns is important for training athletes and treating patients in physical therapy.

Here are some examples of speed and agility drills that can be used to train athletes and treat patients to be able to speed up, slow down, and change direction more efficiently:

Sprints or walking. Run or walk as fast as possible from a standing still position. The distance will vary based on ability and sport specificity. Add change of speed, stop and pivot turns, head movement, inclines or declines to incorporate agility.

High knees wall drill. With arms extended forward and hands on a wall for stability, alternate knees to hip level up and down as fast as possible. For agility, remove hands from the wall and perform with opposite arm swing and change of speed.

Static balance. Sit on a stability ball, stand with a wide or narrow BOS, or single limb stand.

Dynamic balance. Seated balance with arm and leg movement. Tandem forward walking, side-stepping, and carrying objects while walking.

Cone drill example:

Pro-Agility: 20-yard line sprint, 5-10-5
Purpose: Improve the ability to change direction by enhancing footwork and reaction time.
Procedure: Place each cone 5 yards apart. Start in a two-point stance at the starting line, the center cone. Sprint to the end line and touch with your hand. Turn back and sprint to the far cone (10 yards) and touch the line. Turn back and sprint 5 yards through the start line to the finish.

Image- https://mishockpt.com/speed-and-agility-training/

Agility Ladder drill example:

2 feet out, 1 foot in.

Image- https://i.pinimg.com/564x/97/db/15/97db15d22b150e4585a1caa89056b39a.jpg

Plyometrics: Jump, leap, and hop.

References:

Clark, M.A., Sutton, B.G., Lucett, S.C. (2014). NASM Essentials of Personal Fitness Training, 4th Edition, Revised. Burlington, MA: Jones and Bartlett Learning.