Really?..."the best day of your life?"

Dang, that's a small picture? But the news is still BIG...

How many people can honestly say they remember the "best day in their life?" I believe this is mine. If you haven't heard, I passed the Board of Certification (BOC) Exam today. If you're even reading this blog, then I'm pretty sure you already know what I'm talking about, since becoming a Certified Athletic Trainer was the very premise of this whole thing in the first place!

Now that I am reflecting back on it, I am so glad I did this! My mother would occasionally ask me, "do you have any regrets?" in which she'd be referring to the major I chose to study, and the school I chose to attend, etc., and every time, I would respond with a stern "No, I don't have any regrets." However, when she would ask me this, I would sometimes slip into a daydream where I would fantasize about what my life would have been like had I chose a different path.

I always wanted to study music, or be involved with the musical artist/writer scene in some way, and I think those that know me see how that reflects in my personality. I've always said if I couldn't do music, or science, I would love being a Director. Not so much music videos or anything, but more along the lines of short films or documentaries. I think that shows with my sort of love for photography. Why I never pursued these things? Well, I did -- or, I do! I still do all of the things I love to do, which is why my favorite saying is "only boring people get bored." My particular needs are always met. There is never a moment when there is not something I can be doing. Call me "too busy" if you want, but I call it just having fun. Just being me.

When I took the exam back on April 7, 2010, I was nervous as all hell. Admittedly. It is natural to be nervous, as this will potentially decide the course of your future. At least in the short term. Prior to taking the test, the biggest motivation for me was Sean, AJ, and Eric, whom all passed on their first attempts. For the last two years, we've been hearing nothing but how hard the test is, and how the test is set up to weed out the weak, and how it is intentionally designed to trick you, etc. But, I remember the morning when hearing the news that these three guys passed, and I immediately thought, "Hey, I know every bit as much as they do," in the notion that we were taught by the same instructors, read from the same books, exposed to pretty much the same things, etc. It was not so much of me comparing myself to them, it was moreso a cohort that was able to overcome what most people assumed to be the truth about a "test." So, I cracked open the books!

I stuck to a study schedule of 2hrs of straight study, and 1hr of a break, which was mainly video games. Then, 2hrs of some more studying, and yet again, another 1hr of break-time. I kept this schedule during Spring Break -- while most people were on the beach, I was in between the sheets -- of the textbooks, that is! I sacrificed a lot over the last two years. Went through a lot of stuff that many people, except those involved, don't even know about. Not even those closest to me. And I am suddenly overjoyed with such elation, now that I have passed the test. Nice!

As you can tell, I am in a really great mood! Like AJ says, "Life's good," and yes, it feels great to be me right about now. I wish everyone can get a chance to experience the type of unbelievable emotion that I felt once I found out the results. But, before I get too sentimental, I have to gloat a little (as if I wasn't already) and smash on one particular person. I'm not the type to hold grudges, but this moment is especially bitter for none other than USF Professor Gary Stevens, who once advised me to change my major after not performing well on an Anatomy exam. I have heard of things like that happening to other people, maybe in the movies, but I never thought it would happen to me. I couldn't believe this person would say something like that. Until this point, I have never revealed these details, but I held it in just for this moment! And all I have to say to him is, HOW GREAT AM I?

I am certainly proud of where I come from, proud of what I have developed into, proud of what I am; education is truly a gift that no one can ever take from you, and is truly able to lift communities to higher levels. The knowledge I have amassed over the last two years is unmatched and I will never forget the people I've met along the journey, especially my lifetime bros. (and sis) from the c/0 2010. The ride has come to an end, but the fun is just getting started. I hope and pray that I can continue to live as fulfilling of a life as I have been living, especially leading up to this point.

Now in regards to celebration, where is the cake?

-The Dreamer, ATC

Knee Arthroscopy Rehab Protocol - Phase 2

A few of the new exercises added to the knee rehab program. The other exercises have since been progressed, or discontinued, depending upon evaluation, and largely the level at which the patient completes them.

Multi-Hip - An exercise typically seen performed on machines, but can be changed if a machine isn't available. Most exercises are that way; can be modified as such to perform the actions you are trying to accomplish. The tubing is of moderate resistance and is affixed to his uninvolved leg. The involved leg then becomes the stabilizer, thus improving his proprioception, strength, and balance. In early stages, using a stick or some type of device is helpful in preventing your patient from falling.

Working hip abductors

Working hip adductors, primarily

Working hip flexors

Lateral Cup Slides - Being a basketball player, sliding from side-to-side is important for defensive stances, as well as getting your body low. This exercise replicates those movements. At this stage, only 4 cups were used; mainly as distance markers for him to meet.

For the last set, we incorporated an additional cup for him to pick up, and then place back down, in order to add more knee flexion; making sure to watch for all bending motions to come from the knee, and not so much at the hip.

Modified Squat - There is added resistance with the use of his arms, which are forced in a downward (palms down) swinging motion while squatting, and an upward motion (palms up) while returning to start position.

Downward motion

Upward motion

Jogging - For a patient that is 6'10" you can imagine this would be somewhat difficult for such a small hot tub.

Marching - Marching was actually more difficult than light jog. In the picture, the patient is shown with his knee somewhat out of the water, but this is only for demonstration purposes, as this is a practice we do not want to make a habit of. The patients' knee should be submerged under water at all time. They can bring their knee up as close to the surface as possible, but avoid lifting it any further.

If the patient is not tired by the end of the workout/exercises, think to increase the level of intensity, or volume, depending on the stage of their rehab. Dealing with Div. I athletes, one would expect them to be in top physical form, but that is not always the case, so it is always important to treat every case with specificity and be careful not generalize. Usually we will end most exercises with a 15 minute bike ride, or a minimum of 5 minutes out on the track, then finally, end with cryotherapy. Some individuals like to be challenged more than others and it is great working with those types, but also understand not everyone heals the same, so different people will be at different stages after certain amounts of time.

Knee Arthroscopy Rehab Protocol - Phase 1

Patient Profile: 19 year old basketball player suffered what was initially thought to be an ACL partial tear, and combination tears in the posterior horn of the medial and lateral meniscus of his left knee. On April 2, 2010, once the Docs went in to scope his knee, they found the ACL to still be intact, also minimal damage to the meniscus; at which point they just cleaned up and any scarring that took place along the ligamentous attachment sites. Below are a few of the exercises we are working on in order to restore the patients' full range of motion, strength, and confidence in the use his knee.

1. TKE (Terminal Knee Extensions) 2 x 15 - I am actually on the opposite end providing the resistance. This can modified in a number of ways. Some like to affix the end to an attachment wall, or via pulley-system. But since I did not have those items available to me at the time, one must get creative

(START position)

(END position)

2. Cup Walking 10x - This is also another exercise that can be highly modified. Some are more comfortable with using larger cones, but for the purposes of this rehab, I use a stack of cups (again, resources available) because partially, this is only Day 2, and your patient may not be as comfortable with that much hip flexion at this point. So, a 4" obstacle vs. a 8" obstacle makes a huge difference.

3. Total Gym mini squat - Patient performs a partial squat in a limited range that is to be predetermined in your evaluation. In this particular case, the patient was able to actively flex his knee to about 45 degrees without pain. Allowing pain to be his guide, we asked the patient flex his knee to his end point, and from there, flex it slightly beyond the point of pain, but no further than that.

4. Calf raise 2 x 15 - This is a great exercise I like to do because not only does it incorporate gastroc strengthening, but it provides physical and tactile feedback to the body about its positioning in space. From the initial evaluation, the patient complained of placing as low as 35% of weight on the involved leg. So this is a great exercise to address both strengthening and confidence concerns.

(START position) Patient stands close to a stable, depending on stability, and raises up off the floor to the metatarsal heads, or the ball of the foot. For patients with patellar grafts, or any one who has undergone a procedure involving the patellar tendon, raising to their toes may provide an unwanted strain on the tendon at this point in the rehab.

(END position) Simply return to the flat-foot position

5. Quad Sets 10 x 10 secs - A standard exercise in most knee rehabs, patient actively contracts their quadriceps muscle group while playing close attention to the firing order of each muscle. Most importantly, we want to focus on the neuromuscular control of the vastus medialis oblique; allowing it to contract first, while the others follow. Having the patient place their hand over each muscle is an easy way to determine if this is being accomplished.

6. Straight Leg Raise (5 way) - The SLR is also a common exercise found in many rehab protocols. It is an excellent way to build strength and range of motion, especially during the early phases of rehab. Pictured below is the patient performing SLR's with a 2lb. weight, which he progressed to after exhibiting good technique and control with no weight attached. Many reading this already know the 4-way direction in which the hip moves, but may ask about the "5th direction?" Nope, it is not "rotation," it resembles a 90-90 hip extension that T. Solley coined the "donkey kick," which sorry to say, is not pictured. It is patent-protected ;-)

Overall, we have had good success with these rather simple exercises. They are easily progressed for difficulty and easily modified for future phases. Within one week, the patient has shown tremendous improvement, going from 11o degrees of knee flexion, to 130 degrees in essentially 5 days. His uninvolved side was last measured at 148 degrees, so there is 18 degrees to go. Although his swelling has subsided significantly, it is still noticeable, which is why every session is completed with 5-10 mins on the bike in order to flush out any remnant substances from the workout, and a cryotherapy treatment for residual swelling.