Hey, this is Sandy. And Randy?
And we're here on AT Corner. Being an Athi trainer comes with
ups and downs, and we're here to showcase it all.
Join us as we share our world in sports medicine.
Welcome back to another episode of AT Corner.
For this week's episode, we are going to be talking about an
evaluation that is all about getting the most efficient
information as quickly as possible and that is the on the
field evaluation. You know what?
I don't think before you're in the profession of athletic
training you realize how many different evaluations you do.
Yes, yes, that is very true. Like you have your on field
eval, your sideline eval, your clinic eval, your clinic eval
when someone comes in and you're like, oh, I think I know what's
going on with you and I don't have that much time.
But I also have like 50 other people behind me that I have to
take care of, right? Yes.
So for clarity, we are defining on field eval as the eval where
someone goes down. Typically in this setting, we're
talking about an athlete that goes down on the field and you
are evaluating them on the field before you get to the sidelines.
So we're not talking about anything that happens after
this, after you get them off the activity field, yes, or whatever
they're doing. Yes I know in my world it's the
on court eval. You do have a lot of on court.
You know what I said the other day?
I was referring to the water as in a pool and I called it the
water field. I was actually just about to say
you don't hear too many in the OR yeah, in the water evals.
I guess only in an emergency, yeah.
Right. Yeah.
But then again, that's kind of like lifeguard, like not.
Necessarily AT right. I mean, unless, unless you are
also lifeguard certified and you did actually get in the water,
then yeah, that would be a unique one.
I want to talk to some water a TS and see if they have, if
they're like, 'cause I mean, I, I imagine you are poolside.
Yeah, you're right. Poolside.
I I've actually never done an on field, I guess water eval.
Anytime I've had to do anything in the water, they've come out
to me. That's that's what it would be
for me. Interesting.
See, look at that. Got a good question there.
So if you're not on the water field, what do you ask on the
field? For me, I ask like what happened
right? Even if you saw it.
Yeah, even if I saw it and want to get their feel of what
happened, where are their pains at?
I mean, a lot of times they're already kind of like hovering
around that spot, so I have an idea of where it's at, but I
still want them to tell me so I know exactly where I'm going to
be looking. Yeah.
And then that's kind of where I go go into it.
A lot of like Palpation and stuff from there.
So I did ask this on our stories is one of the first things I
asked on our polls this week. And most people said that they
asked for the mechanism of injury or what happened.
I think the first thing I asked is where, because obviously as
you're running out, you have an idea of of where, but it might
not be exactly right. So like, I had a baseball
athlete who got hit in the shoulder with a ball and it
bounced off his shoulder and apparently hit his thumb.
And I asked him where it hurt, And he was talking all about his
thumb. And I'm like, checking out his
shoulder. And I'm like, OK, I'll check out
your thumb. His thumb was fractured.
Had no idea that the ball even hit his thumb.
Yeah. Or like because I was so focused
on his shoulder. Yeah.
And also too, like sometimes like how their response to the
injury or pain could be sometimes misleading, like you
might be going out there thinking it's a groin injury
because their hands are in between their legs.
But then it ends up it was a hand injury, right?
You know, so or vice versa, you think, oh, maybe it was their
hand but end up being a groin injury as stuff like that.
You know, sometimes just depending on the response could
kind of mask what which structure might actually be
truly injured kind of like that. Right.
And you could have really good field vision, but if you have
someone under a football pile like.
Who knows? Right, right who?
Knows what happened under there. So anyway, the the I don't think
I said this one, but then the third most was did you hear a
pop or crack? Yeah, I mean, I'll, yeah, I
asked that. But again, that kind of, yeah, I
guess even muscular I'd I'd, I'd ask that too.
Yeah, that's true. Those are kind of the things
that you start with and then I broke this episode into kind of
like by body part. So I first go into like ankle.
We talked about when you get an athlete off the field, also
calming an athlete down. We're going to talk about that
Knee on field evals, evals by sport or position thigh, hip
evals torso, abdomen, spine, shoulder we.
Got some good stuff. So let's see how much of this we
can get through for an ankle eval.
Now I I started with this one, obviously because I feel like
ankle's the first thing you think of like it's.
Common. Injuries, right?
And it's kind of the first thing you go over when you're in
school. But also I feel like ankle is so
interesting when I think about it.
The very first thing I was wondering was how many people
actually do special tests on the field?
Like does your ankle eval include special tests?
Most time on the field now. See like what do you do on the
field like palpations? Yeah, mostly just technically
auto ankle rules. Oh yeah, yeah.
So auto ankle rules palpations kind of like rule out your
fracture. Yeah, I'm just making sure I can
get them up. Right.
And then you get them off. Yeah, you're not really doing
too much right. Yeah, if it's if it's sometimes
like not too bad, I'll throw in the special test to get an idea
of how like how much pain there is.
Like, OK, are we gonna, is this part of the thing where maybe
the kid just kind of like tweaked it kind of thing?
You know, my basketball guys tend to like to like walk it off
and like, oh, they'll be OK. Or am I going to have to tape
this real fast? Right, right.
So so that sometimes I'll do my special tests on the field just
like really quick, like just do a tailor tilt and like anterior
drawer real quick. But if it's like really
significant, it's mostly just palpations.
And then I'll take, I'll take a look at the rest later, like
off, off the field, off the court.
Right. So I asked if you always do
special tests, if you sometimes or never and we got the kind of
an even spread, 18% they said they always do special tests,
18% said they never do special tests and the remaining 65 said
sometimes. And I think that was kind of
like so, so telling of athletic training that like really it
depends is a big answer. You know, I did ask like what
special test? And there was a super big
variety. Some people only do squeeze
tests for like a fibular fracture, which is what I start
with. So like usually I'll run on the
field, I'll ask them, you know what happened slash if they
heard a popper crack, I'm calming them down at the same
time. Then I'm doing squeeze test 1st
and then I add So I start at the top and I'm squeezing down and
then I move into my auto ankle rules malleoli and then if I
could get to the foot depending and then I get them.
Some people also do bump test. Some people do tilt test Kleiger
anterior drawer. But also, so I thought it was
interesting because a lot of people said they do bump test,
but I'm thinking like cleats, you can't really do a bump test
with cleats. So I mean, that's another sport
specific thing, right? Also, I was wondering how much
of this is also sport specific, If you're doing all those things
on the field, for example, like for a baseball athlete or a
softball athlete, if you take them off right, there's not
depending on on your conference and your rules and everything,
they might not be able to go back in, right?
Yeah, I know. Well I know softball has some re
entry rules but. Like after the 5th or something
for softball? Yeah, I'm not 100% sure on how
there's work. Chris C says depending on
substitution rule for baseball and softball, if you come off
the field you are subbed out and may not be able to re enter the
game. So I do a quick eval and then
have them test it to see if they can possibly finish the inning
before more depth in depth eval later.
Yeah, yeah. And I think that's why like you
get why it was fine. I think we brought this up when
we talked to the candid guys when we did the baseball episode
about that's probably the only sport that you see functional
testing on the field, on the field during the evening.
Actually I asked, I did ask about the sport specific
question, Megan M says. I work rugby and they have been
often when the play is still going on.
Same by position but the rules of the game are very different.
Often running on during live play.
What the? Heck, I know for example an
ankle I'll rule out fracture and dislocation, then jump to
function on the field. For knee I'll do ligamentous
eval, range of motion, strength, quick function again on the
field. Interesting.
For thigh hip, I'll roll out deformity, check range of
motion, strength function, same process.
Basically for all parts, if they feel function I take them off
the field. Once they're subbed they're done
and they're limited Subs per match.
Interesting. Only exception is head injury
assessment and blood time. That's interesting.
OK, so there is another sport where you can see an on field
functional testing. Right.
I mean, usually, like, you know, you, you get some like
especially like a pitcher, a catcher.
Yeah, right. Like just just throw, throw a
little, throw a little. See a couple pitches how you
feel, right? You don't see that in
basketball. OK, Why don't you go hit a layup
real quick? Let's see if you can do that.
That's interesting. Right.
I forgot about that. So yeah, I could see.
Well, I mean, you do on the side, not like on the court.
You don't ask them to do it. Yeah, but that's what I'm
saying, you know, like baseball is just so unique that that you
literally have the Ave. Softball, right?
But I think it is because of that aspect, like if they're out
off like they're done right, at least I know for sure in
baseball, like I said, for softball, I know they do have
pre entry rules, but I'm not familiar with those right,
right. So I wouldn't take the chance.
Exactly. If I'm working I'd.
Still try to. Say, hey, can you finish the
ending? And so that's The thing is like
you can take so much more time on the field when you're at like
baseball or softball versus some of your other sports.
Yeah. Yeah, I'm trying to think of
anywhere else, like football. Get them up.
I don't work soccer. What?
Anything about soccer, specifically tennis, you have a
2 minute rule. Yeah, I don't.
I don't like sports like that. Yeah, I like wrestling.
Wrestling. Yeah, I mean soccer is kind of
the same, right? If you go out there, they have
to come off, but a lot of times like they can be subbed in.
Like if you get them off, they can re enter pretty quickly.
Like so that's not, I mean it can be a huge deal, especially
because if they're going to come in real quick, they're probably
not going to sub them. So in that moment they're going
to be short handed. So a lot of times the coach will
be asking do I need to sub? Right.
So that's why you're kind of like depending on the severity
of the injury. If it's not, if it's just a it's
not too, too bad kind of deal. Like you can get them in pretty
quick where they probably won't have to make that sub.
They just got to get the ref's attention like hey I'm good and
they'll let them re enter. In performing arts, they stop
the show. Does the curtain come down to
block everything? Or it depends on the contingency
plan, but and where they are in the show.
And sometimes, depending on the theater, they have some
contingencies that will close the curtain and then get like,
evacuate everyone and they'll just stop the show.
OK, that's interesting. Basketball.
They either come off or they have to burn a time out.
That kind of. That's a bummer.
I know, I know, I'm so scared of that.
I do not want to ever have especially.
How valuable timeouts are in basketball, right?
We get a million of them. So, Haley L says cleats or shoes
make a difference first. Some have easy access to palpate
malleoli, others don't. This is also like when they spat
and you're like can you not please because you're you're
just harming yourself when I'm trying to do an ankle eval on
you. Well shoot this is like shoes
are getting like tighter yes like especially like soccer
boots like especially like like the Nike ones 'cause they have
like that like conforming like like fly knit material for like
the. Angle the sock.
Yeah, basically the sock like it's like super tight now and
it's like it's making it almost impossible to get these shoes
off if there is an injury. Well, that's what shares it for.
Yeah, seriously. It's always useful to consider
the sport in position they're playing when going through the
evaluation because their sport slash position demands are
slightly different as well as the surface they are playing on
in additional forces. For example, a baseball player
sliding into second base and jamming the ankle into the bag
is different than stepping on the bag awkwardly while running
the bases. In football, lineman has
different levels of forces and often wait than a position
player moving freely around the field.
There are considerations in the back of my mind.
Competence in the sport and bio mechanics or forces of that
sport can be helpful to evaluate an injury and possibly a go or
no go call. But sports where time stops, I
might take a little bit more time to check them before
getting them up because there is less pressure.
Yeah. I did ask this also on our
stories, 61% of people said they have a generally same eval per
sport, but 39% of people said they do vary they're on field
eval by sport. I I think too, it's a lot of
just understanding the lingo of the sport, like just how
athletes talk and describe what happened makes a big difference
because then you can kind of visualize what they're talking
about. Right, right.
So going back to the ankle, Christina S says biggest thing
is where the pain is and if there's any chance of fracture,
I always check the fib before getting them off.
If that's good, I'll let them off the field to be more
thorough. Yeah.
Do you want to read from Marissa S?
Yes, Marissa S says mostly palpation.
Are the bones in the right places, No deformities?
Then Great, let's move them. Sometimes they're not calming
down or not willing to try standing yet and I'll do more.
I'll have them planner and dorsiflex so they trust it's
still working and if we're still sitting there then I'll do
inversion, E version and anterior drawer.
I feel like this is a good like in between those like, OK, I
don't like always do these things, but like if we're just
sitting there and they're really just need another minute, like
at least I can continue my eval. Yeah, yeah, I hear you.
I like I let them know. Hey, take your time.
We're in no rush. I say that too.
I usually, even though like I don't like to be on the field
very long, like I usually like, OK, let's get up.
Like we're good, everything stable, let's get up.
But I do verbalize we can take as long as you need.
Yeah. Most of the time they don't.
Yeah, yeah, most of the time they they get up pretty quick
and even when I say, OK, there's no rush, I'll give it like
another minute or two. OK, You ready?
Yeah. But a lot of times too like ref
will be trying to rush us and I I honestly don't even listen to
the ref. Yeah.
Like they'll be saying something good, Good.
I'm like, I didn't hear a word you said, buddy.
I I haven't had a rough a ref rush.
In a while, I feel like it hasn't happened in a long time,
but every now and then you'll get one that wants to try and
keep the game moving. You know, sometimes it like,
well, again, I worked a lot of soccer, but again, a lot of
times it's a soccer ref. Maybe that's why I don't work
soccer. Yeah, the soccer ref just didn't
want to put extra time on. So something I was trying to do,
something that I really liked from Josie, he said.
A lot of my preceptors taught me to be thorough enough because
you have a whole stadium and crowd watching.
Obviously take your time and do your job, but there is so much
more that you can do on the sideline.
If it's safe to move and the athlete is ready, let's move to
begin the next steps. I really liked that, yeah.
For sure. It's like you're not trying to
figure out what is wrong on the field necessarily.
Yes, you're trying to rule out the big things and make sure
that you can get them off. Yes, all it's doing is like I
said, making sure they're safe to move and then just trying to
set the table for the on the off the field eval.
Yeah, you don't need to decide your you don't need to let
coaches know what is going on. Yeah, we don't.
We don't like OK. And you don't need to debrief
your dock right after your 32nd on field eval.
Yeah, yeah. I don't think we need to do
active passive range of motions and then manual muscle test on
the field. We can, right?
We can get those done off, right.
That is one thing I notice every time I have students who've
never done on field eval. I feel like their very first
thing they want to do is range of motion.
Oh, interesting. It's very common that I'm
finding that they come on and they're like, oh, let's just see
if you can move it. I'm like whoa, whoa, whoa, whoa,
whoa, whoa, whoa. Hold on.
I don't know if this is a thing but like I feel like students
now are doing that first before like palpation.
It is. They do.
It's crazy. I'm not sure if they're learning
it that way or like. I feel like that's I'd rather do
palpation first. I always so my what I teach is
obviously calm them down like once we've we've gotten them to
a point that you're evaling right, the process that you need
to do for every single injury, not just ankle is start with
what is the biggest thing that you're worried about?
Well, obviously life threatening, like we're past
that, right? We're talking about orthopedic
eval. So bones, you got to check for
fracture. So usually that means a some
sort of palpation, some sort of axial load fulcrum test, if you
like, depending on like what the limb is, what you know.
So you rule out fracture, right? Then you move into so bone.
Then the next structure you look at is joint.
So you're looking at stability, you're looking at ligaments,
you're looking at special tests, you're looking at at at that
point, if you've already ruled out fracture, you can then go
into range of motion if deemed necessary that you feel like it
needs it on the field, right. Yeah.
And then you can move into like muscle.
So and honestly, I'm not usually testing muscle on the field.
The biggest, I think the closest I get to doing that is like grip
strength and that's like softball, baseball.
If I'm really doing an on field eval, I'm kind of jumping ahead
because we do talk about shoulder, but we're really not
you're not really doing an on field eval for upper.
You're just kind of like get off, like hold it, get off.
We can take care of this on the sideline, you know, but if it's
like baseball, softball, they're not going to get up or they're
not going to get off the field, right.
So like grip strength? I think that's the only time I
really off the top of my head that I do something muscular.
Yeah, I'm trying to think. I don't.
It's definitely lower extremity. I'm not doing anything muscular
like like manual muscle testing, like motion stuff.
I'm just going to make sure, can we walk right?
Because I'm thinking like hamstring or quad, OK, how
difficult are we going to be able to walk?
Right. So again, just like like biggest
to smallest bone joint muscle. Yeah, Yeah, I thought, yeah, I
don't think I really do much manual muscle doesn't I guess.
Yeah, baseball soft would be different because they are going
to be on the field. You can keep them on the field,
right, Right. So you want to make sure like
hey, can you actually stay on the field effectively?
OK, Yeah, I think all my sports I probably wouldn't.
I just take them off the off the water.
So I did also talk about the calming down process for like an
on field eval. I asked when people calm someone
down. So the three options were I
don't start my eval until I calm them down.
I will calm them down as as I am palpating and evaluating and my
focus is the injury. Coaches will calm them.
Most people said they do it simultaneously.
They'll calm them down as they're palpating slash
evaluating I. Don't know how I I have to be in
the the first category right? I will not start until because
like. I mean, it's, it's almost evenly
slit. We have 52% people saying they
do it at the same time, 46% of people say they have to calm
them down ahead of time, which only leaves 2% of people saying
like the coaches or someone else will calm them down so they
could focus on the injury. I think we're mostly in the same
like, mindset that we have. And I think it also depends on
if you're by yourself or if you have students or if you have
another athletic trainer with you, you know, what that process
looks like as far as calming them down and also your
philosophy. Yeah.
Or your rapport with the athlete.
For sure. Yeah, I, I mean, obviously like
while I'm calming them down, I am observing like I'm seeing
like, I mean, if things are twisted the other way.
You're as stabilizing as you're like, like.
There's things pointing the way they shouldn't be anymore.
Like, obviously I'm doing that part of the eval, but yeah, most
of my energy is going to go to calming them down because I'm
not going to get anywhere. No, you are.
It's going to take forever. Yeah, they're going to roll
around. And I'm going to ask them
questions they're not going to answer and like it really, it's
a really test of patience at that point.
So that's why it's just let's just calm them.
Down. It's not good for anyone.
Yeah, let's just calm them down and then then I'll start my
eval. My oldest favorite though is
when I ask what happened and it's like it's my knee.
Why other? OK, So what happened?
My knee. That at that point I hit them
with whatever their name was, like, I need you to talk to.
Them yeah, I know what happened. My knee, my knee.
I know that's a body part, but what happened?
That is, you know, people did submit talking about making a
joke, like making jokes, Yeah, to kind of like, lighten the
mood. I think it for me it depends on
who. It is who it is.
And the context, Right, right. Like, if they're in a lot of
pain, I'm not gonna jump to the joke.
Right, right, right. To try and lighten it.
But you're right, that does help sometimes.
Especially if you know the personality of the athlete and
you have pretty good rapport, then you can get away with it.
A joke in there. Right, right.
I think just the other day I had someone who had like a really
big hit and I came over and I was like a hit like that gets a
visit from me and they just laughed.
That's pretty. Funny, Cat L, So I did ask about
like how you calm them down and Cat L said keeping it simple.
I call them by name, I tell them to look at me and then I
instruct them to breathe in through their nose and out
through their mouth. I think giving them something to
focus on. Honestly just focus on your
breath looking at something right.
Yeah, and I just validate what they're feeling like.
I know it hurts and I know it sucks.
So just validating that. And then same thing, kind of
going with their breathing and just kind of focus on that.
I usually like to try and look at them and look at their eyes
for a second just to so I can see what's going on in there.
You know, you can get a lot from their face if they're able to
look at me, if they're not able to look at me, if they're able
to focus and open their eyes or if they're kind of like in La La
Land or somewhere else. Not with us, right.
And just again, that that breathing is usually what I
mean. If I get them at least through
like one cycle of breath, then I can start, you know, and then I
usually remind them like, hey, keep with that breathing.
Keep with that breathing. Chrissy says if the athlete is
freaking out slash screaming, etcetera, I'll do what I can to
calm them down. But I also don't want to delay
care. So as I begin an e-mail, I'll
try to use affirmation and start off with palpation and testing.
That shouldn't cause any pain. And then I give them positive
wording to help calm them down more before I get to palpating
and testing that may increase their pain.
Nice, nice. That's nice.
I know I really like that that's usually off of I've I've never
really thought about that for on the field.
I think for off the field, I definitely start where it
doesn't hurt and then so they get used to like my palpation
and then I move to the area. But I think especially like I'm
thinking ankle, like I, I jump straight into the malleol,
squeeze test and then malleoli. Yeah, I think I, I, I tend to
start where where I know it's probably not hurting.
Like it'll still be in the opposite same area.
Like it's an ankle. I'm not starting at the knee,
right, Right. So like if it's an ankle, right,
I'll probably start my auto ankle rules like, oh, with the
navicular tuberosity, right. I mean, how often does that
really hurt? Inverting ankle sprain.
So I'll start there just because they're already in pain.
I just calmed them down. I'm not trying to press the spot
that I know probably really hurts.
And then we're just back into now.
I'm trying to calm the kid down so it does kind of add more time
of being calm. So I think I tend to do that
too. That makes sense, yeah.
What about for a knee on field eval?
What do you do for your knee? Somewhat the same, like I for
sure still start with Palpation, but that one tends to be really
quick just to make sure again, everything's like in place and
we're not looking at anything too crazy.
And then I will try to jump into a lockman 1st.
I don't even think I really do Varus Valgus anymore.
That was my question about the knee eval the.
Yeah, I mean, honestly, no, I think I just do a Lochman and
then that's kind of it. I think it also depends on your
sport. Yeah, because I feel like the
only. Well, again, if they're staying
out there, that might make a difference.
Well, I mean, at at football, I'll do a Lochman and Valgus
Ferris unless they're wearing a knee brace.
If they're wearing a knee brace, then I just get them up because
I'm not going to take the knee brace off on the field.
Yeah, Yeah, I palpate if I can. Honestly, sometimes I don't if
they're in a knee brace. I have.
I guess that is kind of and I haven't, yeah, because.
I mean, it's kind of in the way. One time I got APCL in a knee
brace and I was able to do a posterior drawer in the knee
brace on the field before getting them off.
Nice. Did you feel positive?
Uh huh. It's interesting.
I wonder if it's because like most of those like was it kind
of like one of those like Hinge? Like it was a lineman brace.
It was, yeah. I wonder if like you know,
because like a lot of those are like geared towards ACI, wonder
how much posterior protection there is on those.
I'm trying to remember which one he was wearing because we do
have a We do have two different kinds.
We have one that has a bar in the back and we have one that
just has straps in the back and it was not recent.
I don't, I don't remember which that was interesting. 1 he was
wearing. I know he was wearing a knee
brace though. I want to say it was the one
with the IT was. No, you're right, it was not the
one with the bar in the back, only straps in the back.
Which actually is interesting because you'd think him because
he did land on it, you'd think him landing on it would like
landing on the bar, the metal bar in the front.
Actually, maybe that's what caused the injury.
Maybe. Yeah, maybe.
Interesting. 56% of people said they do ACL tests and a valgus
varus test. So most people, 29% said they
sometimes include valgus varus, 14% said they never do valgus
varus, and 1% said they only do valgus varus.
I think these one percent, 2% are funny 'cause we actually get
a few votes for them. Yeah, that's interesting.
Which is kind of interesting. I wonder in what context you
only do values varys. That's what I Yeah, that's what
I was wondering. So Jenna W says she rolls out
fracture of the femur, tib fib, especially the fibular head, the
patellar location, which no one, no one else talked about this
patellar location. I think that's so important.
That's one of the first things I do is figure out where that
patellar is. And I think it's because we
talked about this a couple episodes ago is the very first
emergency eval I did as an athletic training student.
It looked like the Patella was dislocated, but it was actually
the fibular head. So that Patella location is
something and I've heard some people like when I've never seen
it, but when you snap your patellar tendon like that,
patella's going to move, right? So I've heard that some people
miss that too. So looking for that Patella.
Then she tests the ACLPCLMCLLCL, same routine every time, every
knee injury. Nice.
Yeah. Knees are very straightforward.
And then do you want to read the one from Christina's?
Yes. So Christina says palpate for
location base test off of that, but I typically will go through
all knee ones quickly. Valgus, ferrous anterior drawer,
lockmans, Lelli's and Mcmurray's.
Only if it seems severe. If not, I'll palpate where, ask
if they can get up and then finish off the field.
We did get a few, few people who included like a couple of
meniscus tests or like a couple of different ACL tests, which I
thought was interesting. Like some people said they did
do like pivot shift on the field or like Mcmurray's or like some
people go through the whole knee, which I don't know
specifically like what sport. Yeah, some people just do, like
I just do palpation, Lachman, valgus, varus for the most part.
Yeah, yeah. I really don't test the meniscus
on the. No, yeah, on the field.
But I could see pivot shift like if you're already doing like
valgus, it's a nice little transition into pivot shift.
Maybe it's more efficient? Maybe.
Just saying here, you're already
kind of there. Unless your M sales gone and
then pivot shift is not really useful.
Yeah, I'm saying instead of like going lockman, then you have to
switch your hand, like slide your hands differently for a
valgus. I can see it.
I feel like you have to get the lockman first.
Also that is another thing that I noticed.
That's why I like this. I have like the students who
come through, they learn that Lachman doesn't go first.
I don't know if the if now let me clarify.
I don't know if they learn an A specific order or if omittedly,
they do not learn that Lachman goes first.
What do? They do first.
They do like anything else like valgus virus or like to me it's
I'm like you are about to make them guard if if you cause them
pain. You only get one Great.
Shot yeah, you really, you have to do that Lockman and then and.
I'm going to be honest man, every time I do it, like I feel
like they're already guarding by the time I am able to do it.
The Lockman. Yeah.
So I'm like, Dang it, yeah. I think I haven't had an acute
guarding situation in a while. I feel like most of the time I
get guarding like the next day. Really.
Uh huh. Interesting.
Yeah, I feel like I get it. I feel like like my last couple
have been like even I can get them off the field and they're
not guarding yet. Weird, yeah I feel like mine are
always guarding like right away. Could also be sport.
Yeah, because like I'll do like a anterior drawer to just like
kind of confirm what I kind of felt.
And I also do like to see if they truly do guard.
I feel like Andrea Drawer you could really tell if they
they're guarding because you can feel the hamstring.
I found, yeah, I found pretty good success with like, if
they're guarding like something's really wrong in the
knee and like if I just, like, barely start moving, I feel
those hamstring tendons pop out. I know.
Oh boy, bad things are happening in there.
Right. Yeah, Honestly, I'm trying to
remember the last time I felt guarding in the knee that was on
the sideline and I feel like it hasn't been in in a while.
Yeah, so that's good. I just that's just luck I think.
Yeah, must be. What about a thigh hippie, Val?
I can't really think of too many thigh hippie valves that I've
done, except for the one that comes to mind is I had a
baseball athlete who was, it was a visiting athlete.
They ran, they were running to first base and they felt a pop
in their hamstring. And so then they were just like
on first base, like laying on first base.
That's a bummer. Yeah.
I mean, it's the same. It's just palpate.
What happened? What do we feel?
Right. It's kind of like weird to
palpate a hamstring on the field like when everyone's watching.
Yeah, I don't know what like track like that was, right?
That was the big deal, especially with like sprinters.
I mean, it's it's almost as it's almost as their version of like
an ACL, right? That season's going to be pretty
much toast or you're going to miss most of it, right because
of it. So it there's, there's a lot of
emotions. I come with a a hamstring issue
but. Hamstrings are my least favorite
injury. I'll at least try to at least
feel where their pain is to see what it feels like if there's
like a divot. Oh, well, you do that on the
field and track like, I guess they're done already.
It's not like they're going to go back, no.
No, they're at that point. They're done.
And and and some of it is to like, yeah, honest, yeah.
If I'm having to respond on the track, they're probably going to
be done. The ones that are the Gray area
are if they come off and like, oh, my hamstring's hurting or
like, oh, it feels like it's tightening up, Those are the
Gray area ones. Like how could they go?
Could they not? Which most of the time they're
going to be conservative and just be like, Nah, you don't
need to run that next race. But yeah.
For like, I'm, I'm trying to think like basketball.
I don't think I've ever had like a thigh hip except for like they
fall on it. But most of the time like I if
they fall on it, I just kind of like wait for them to get up if
I see it, you know, and then I'll check them off.
If they're really not getting up and I get called on.
I don't think I've ever got called on for thigh, hip for
basketball. Actually, I'm thinking about
too. I don't think I have.
Either for football, I definitely palpate because if
they took contact to the thigh or hip, like I had one that I
thought was a femur fracture because he took a helmet
straight to the thigh and he was in so much pain and he couldn't,
he couldn't put any weight on it.
My fulcrum test was positive, so I was like, yeah.
But really that's kind of what I did on the field.
Like I put my hand underneath his femur and I just kind of
like tried to like, quote UN quote, like bend the bone to
like stress it because obviously like I'm not going to be able to
do that from the top where it got hurt hit because that's
going to hurt. And then other than that, I just
kind of like, OK, let's get you off and then.
I'm trying to think for like the hip joint.
There's really not much you're going to do on the field.
I'm not going to sit there and do like a scowl.
Right. Unless unless you think it's
dislocated. Like OK get you off but.
Again, that's more observation because it's not like you can
necessarily feel it because it's pretty deep and there's a lot of
big muscles around it, right? So you'd have to see their
position. Right.
Also, especially for like football, they have the thigh
pads. Yeah, thigh pads.
So you're just kind of like, don't they have a girdle deal?
So you're like, OK, can you get up or can we get you up?
Put your leg on, put put all your weight on this other side.
Just this last weekend I had. So usually I just have the the
teammates help get each other up.
I don't know what the heck happened, but Oh yeah, we we ran
out for an injury and like all the guys got off the field and
we weren't out there for very long.
So I don't, I do not know why. So like, I got up and then I
look around and I realized there's literally no one on the
field anymore. And so I was like, OK, so then
my two students helped the helped the athletes start
getting off. But like this, yeah.
I mean, he he wasn't a big kid, luckily, but like, he's taller
than us. Yeah.
Which is very easy to do, actually.
So I did ask about about how you get people off the field, like
tips and tricks. Literally every single answer
was about height. Like, oh, I'm taller than all my
athletes. They're like, oh, I'm really
short or like, this is my height.
Like I got I know all of your guys's heights now by the way.
But anyway, Natasha N says, since I'm 5 four and work with
all males taller than me, I have them use me like a crutch with
their arm across my shoulders to walk off the field.
If they can't walk with their good leg then I carry them off
supporting the injured side and have a teammate support the
other leg. Hockey is easy because I have
them single leg balance on the good side and just walk them off
the ice while they glide. That's pretty funny.
I thought that was pretty cool about hockey because I didn't.
I mean, I've never wore toffee, right?
That's pretty. Funny.
I usually just like, hey, can like, hey, those two guys.
And usually I don't even have to ask.
Like I'll just turn around and be like, yeah, actually, I don't
have to ask who I should say. I usually just say, guys, can
you help me get them up? And then everyone rushes over
and. Yeah, the only drawback I have
is basketball. Oh my gosh, they're so tall.
Yeah. They're way taller than me.
And most of the time they're so sweaty.
My team's small SO. They're so sweaty.
Yes, but I mean I worked cross so.
That's true. That doesn't scare me anymore.
Yeah but like I'd rather someone sweaty hold someone sweaty
instead of me in my homeostasis non sweaty.
For sure. You know what I mean?
And then I'm, I'm dressed up, right?
You too, for indoors. So yeah.
And then they get sweaty on your nice clothes.
Right. No thanks.
I think the one that gets me is like, at a certain point you
might as well just carry them. We'd sometimes my athletes will
be carried off the field by their teammates.
Because there's sometimes like we are not like this.
We're not moving. We're going to a snail's pace
like we got and like, obviously like they're in pain.
And the longer they're they're the more difficult of a time
that they're having, right? The longer it's going to take,
the more they're just sitting in pain, the more they're getting
frustrated. So it's just easier just to
make, let's just carry them right.
Then you got got to make sure you it's always tough because
especially if it's not like if it's a coach or someone that's
helping you, they don't, they don't know the best way to carry
them. And the next thing you know,
we're carrying this person awkwardly.
So I have to tell them, OK, grab my arm, right.
So then we'll interlock arms and then have the athletes sit and
then we can lift and then go. But if you don't like if, if
they don't understand you right away, like I don't know, you're
carrying someone awkwardly. And I'm like, OK.
Most of the time. This is awkward.
Most of the time I just have the guys pick each other up,
whatever they do. But for like an ankle or a knee,
especially with football, it's really easy to grab their knee
pad. And especially because 99% of
the time it is above their knee anyway.
So I just grabbed their knee pad and I walk with them and I'm
like basically like it's a sling.
Like I'm holding their knee pad as we're walking.
It was funny the story that you brought up about the your guys,
just everyone left. Yeah, I look up and I'm like,
what the hell, guys? As they're getting off field,
one of the coaches came to help and just literally just like
grabbed this. Kid and just carry like over
over his shoulder it. Was pretty funny.
OK, So what about torso, abdomen eval?
Same thing. It's just palpate.
This is like like someone got the wind knocked out of them,
someone taking contact to a rib, like stuff like that.
Yeah, a lot of it's just palpate and then yeah, palpate, you
know, like make sure we're doing OK.
Breathe. Yeah, make sure, make sure we
can breathe, make sure we get deep breaths in all right,
because that's something really quick, like for ribs and stuff.
And then I'll make sure like organs are pretty good, like
real, like real quick. And I'll make sure there's
already not like any guarding in an area or rigidity.
Usually I put my hand on their on their like abdomen, I guess
like either on their ribs or like on their stomach.
And I, and sometimes if I'm like, wow, I'm calming them
down, I'll, I'll tell them to like breathe into my hand or
like, which is just like sitting right on top or like while I'm
like, just so I can like have them feel like, you know, that
contact is sometimes necessary. Kirsten M says.
I look at the skin where they had contact, watch the rise and
fall of the ribs, make sure they're equal bilaterally and
make sure there's no sudden tenderness or rebound pain, and
possibly get out my stethoscope if I'm not seeing recovery in
the 1st 30 seconds to a minute. Nice.
Albert T says life limb little was something I learned as a
student and I still use today to prioritize my on field
evaluation decision and care. Having an established process is
important to rely on, especially during stressful situations.
We need to have control of a situation if we are able to
provide the best care possible. Overall, have good preparation
and execute with confidence. OK, I got a couple more.
What do you include in your spine eval?
Do you get a lot of Spine I? Mean not as much as you.
I get moments that are close. Like when I see two volleyball
athletes diving in the same general direction, I'm like, oh.
I'm like. Oh.
Or like when they're. Going to the.
Stand baseball softball home plate.
Yeah. But yeah, like, or if they're
like diving for a ball and they're going towards the stands
and gets a little dicey, right. I mean for the spine, like it's
kind of the same like all the all the way down, right,
Obviously palpation and then I'll check sensation, right,
like even lumbar, right, like a forward.
Like I had an athlete I was covering USA event athlete fell.
Dude this is pole vault athlete fell and like literally landed
in the box sitting down. So basically like compressing
lumbar spine and stuff? I was actually just thinking
about that. And had like low back pain,
right? So I treat it the same way I
would like C spine, right, just OK.
We he was just sitting there. So I just basically went up to
him and like, because I was looking at him, he was facing
me. So I went around the back and
was palpating lumbar spine to make to see if there's any
tenderness and then obviously sensation right down.
So I think for the spine it's the same way, especially if
we're talking like on the field, on the court, like because more
than likely it's an acute injury.
So I have to rule out any fracture to the spine.
So I think it'd be the same palpation.
And then yeah, like sensation dermatomes and then myotomes if
the dermatomes are OK. That's it.
I think spine you you can take the longest with and I think
people understand it well. Not that it matters what people
understand or not, but like I think it's not a rush on
anybody's part to do a spine eval.
Rushed usually no matter what. Like I had an athlete who was
completely blindsided by a HIT and it he just took like a body
to his head, neck region and he like it looked like he passed
out and then kind of got up to sitting or like kneeling.
I don't know how he got up to kneeling from that like so
quickly. But and also it was like way
across the field for me, but but like I went over immediately and
just while he's kneeling, like obviously it's a good thing that
he was able to get up to kneeling, but like I still have
to check his spine. So then immediately I went into
the same thing that you were talking to talk about where like
I'm facing him, but like my hands around his neck so that my
fingertips are on his spine, his processes and I'm able to
palpate while I'm like looking at him and I'm stabilizing.
So even though he's not like on the floor, that we all learn in
class, right? The nicely laying down.
Yeah, yeah. I did not have the one actual
spinal injury that I've had, two spinal injuries.
But actually, no, the two spinal injuries that I've had, neither
of them were laying down. One of them walked in and the
other one was, I don't even know how to explain the position he
was in. He was.
He fell with his butt in the air.
Yes. Yeah.
Like knees on the floor, butt in
the air, head on the floor. Yeah.
So, you know, I mean, you got to practice different ways for
sure. But, yeah, mostly just
palpating. And then once you're able to
rule out that that's fine, then you can assess that, like,
active range of motion. So like Kirsten M puts it a
really good way. My key point with this one is I
take cues from the athletes. Do they not want to move their
head and have palpable neck pain?
Fine. We cervical collar and check
extremity dermatomes and myotomes and call EMS if the
patient clears that and still doesn't want to move.
Yeah, yeah, I think. Apprehension's a big, big kind
of deal. One of my friends who I know
who's broken their neck said that he felt like his neck was
was going to fall off, like his head was going to fall off, like
he had to like hold up his head. Oh, that's a that's a key
complaint in high cervical fractures like AC2, like the
sensation that it feels like your head's going to fall off.
Not a good feeling. No, that sounds really weird.
I no thank you. No, no, no, no, thank you.
OK, so moving into shoulder eval, what do you include in
your shoulder eval on the field? Do you even do a shoulder eval
on the field? Yes, I'll do quick palpations
like AC joint clavicle. I think it depends.
For me, I mean I can see my shoulders.
What? What are you?
What? What sport are you thinking
right now? Almost anyone of mine because I
I don't have equipment so I can see him so I know if it's out or
not for the. Well, OK, but like basketball,
they're going to, they have to come off right.
Yeah, but if I'm still out there, I'm at least going to get
an idea real quick. Have you ever done a basketball
on like go down with the shoulder?
Because here's here's what I'm thinking.
So like I've never had a outside of football.
I've never had a shoulder that has stayed on the field except
for baseball. I had a someone take a, our
pitcher took a comebacker to the shoulder and so I just did an on
field eval real quick. But that like I don't really
count that. But in football I have had some
people who have like dislocated their shoulder and they're on
the floor or they, I don't even remember there was one.
I can actually remember the eval and I can remember exactly where
it was on the field and which field it was.
I don't remember what happened, though, but they were laying on
the field and they couldn't get up.
It was a shoulder thing. So I had to do a shoulder eval
kind of on the field, which was interesting because I was like,
OK, well, you can get up, right? Yeah, most of the time I'm just
going to get them up. Yeah.
I mean, I like I said, I do a quick palpation and then that's
about it, right. And then we just do the rest.
Right. I mean, unless you're really
worried about and even like a clavicle fracture, like you're
going to get them at least sitting and then up, right,
there's not really anything you have to like stabilize on the
field for upper extremity. Same thing like elbow.
You're just gonna, I did have an elbow eval in softball that I
did a little bit more because she was on the base.
So then she was going to continue running the bases.
So I mean, but with an elbow I was like, are you going to be
able to slide? Like, is this your like, which
arm is this? You know, it's not like she had
to throw right then, Yeah, or had she didn't have to catch.
I think really everything else like fingers, wrists, you can
get them off. Yeah.
Shoulders 9 times out of 10 you're going to get them off I
think. Just weird ones.
Yeah, real funky ones. Yeah.
And again, I I kind of said this before, but like athletic
training doesn't really operate in blanket statements.
So obviously we talked about these outlines, but these should
just guide. Yeah, it's always a depends.
It depends. Depends.
You never know what you're going to see, no?
Do you have any other on field eval tips?
I think, I think for most of it's for like students because
like students like freak out about the on field.
Like they put so much emphasis on, oh, I got to do it or I've
never done it before. And just like, I don't know,
they put so much stress on it and then they get out there and
it's like they feel like they have to go 1,000,000 miles an
hour. So I always tell mine, take your
time because I know they're not going to like I know that like I
tell them we're not going to take an hour.
Right, right. But.
Take your time. I try to slow them down, right?
Because like, we have been allowed this time out, right?
There is a time out for us to go out there and understand what's
happening and what we need to do with this athlete.
Slow down, take your time, all right, I think that's the
important thing is, is just for that for students, just not
feeling rushed, like take your time, get a good get an I make
sure you're comfortable that this person can move right.
So if you have to take some time, take some time, all right,
That's that's how I do it. When I go out there, I'm I'm
taking my time, right. So like I said, I even if the
refs trying to rush me, I just ignore them, right.
I'm not taking an hour, like I'm moving pretty quick, but I can't
think of myself moving quick or I'll move too quick.
So that's my thing with like students is just slow down.
Like this is a time out for you to just let's get an idea of
what's happening to this person. I think my the first thing that
comes to mind for me is that you should get a good idea of
calming them down. Yes, that is the very first
thing. I know some people say they do
it at the same time. I think if you are able to calm
them down that is 99% of your on field and then you got to rule
out fracture and then you can kind of most the time get them
up depending on what it is even like a knee like calm them down,
rule out fracture, Lachman get them up.
Yeah, that's nothing too. It's like if you feel like
you're being rushed and you know, you're rushing through
stuff, right? It may not make the athlete feel
super calm, you know? Something that I Something that
I really admire that I've started to take into my on field
evals as well that I've noticed in my Co head, Lorena, when she
does an on field eval, she is smiling and I don't know why.
Like it just makes such a difference to see like I think
I'd like for example, I think I do a good job coming athlete,
but I'm not really thinking of what they're seeing.
But when she comes athlete like because she's smiling, like it
really makes it just, it just makes it a lot calmer.
And I feel like like she has such a good rapport with her
athletes that that also like shines through.
And I think that's something that I've been trying to take
into like, it really like, take a breath, be present, be calm,
calm them down, and then you can move on.
Yeah, good point. You know what I think now when I
go out there, instead of asking what happened, I'd be like, hey,
what's good? Someone said they make a dad
joke. I mean, those, those are always
well placed. Well, now, now I think I'm gonna
do that. I'm gonna try that.
Hey, what's good? What's cooking?
Yeah, hey, what you got cooking over here, man?
Or just hit them with what the hell did you do?
I mean that. One will go well.
I have been sassy to them like that before.
Depending on who it is, I. Could probably do that with my
basketball. Or sometimes like if I have to
go out for another for like the same person again, I'm like why
am I here again? Depending on who it is, you
can't do that to everyone you. Can't do that.
Yeah, yeah, yeah. That is funny though.
Yeah, I could see certain. Athletes like you miss me.
Yeah, bro, what are we doing? What's up?
Did you just need a breather? Yeah, sometimes I'll hit them
with that. Like if it's like like they're,
they're kind of like they're fine, right?
And but it was something where you have to go out there and be
like, you didn't need to do all that, just catch a break.
Right. Just get get a time out.
Usually That is another thing I do though too.
I do do some gamesmanship, like depending on what what point of
the game. If I know my team needs a little
bit of a little bit of a breather, I might take my time.
I might go a hair slower. I do it for the.
Kids, you do it for the athletes.
Yeah, that's right. I do it.
For the kids, I will in baseball, softball, if they're
running the bases and I like do my eval and I'm like, OK, like
I'm done with like this. I'm going to go back.
I I usually do tell them like, I'll see you after you get back
home. That's good.
Yeah. I like that.
It's my little one liner. You got anything else?
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