Domain I

Discuss the maturity assessment component of the pre-participation examination.

A maturity assessment should be part of the preparticipation examination for children and adolescents to determine their level of sexual, dental, and skeletal maturity. Only a physician or physician's assistant may assess an athlete for sexual maturity. Skeletal maturity is usually assessed by measurements of the hand and wrist as well as weight/height for age. Skeletal maturity and chronological age may differ. For example, if the chronological age is 14.3 and the skeletal age is 15.5, this would be expressed as 15.5-14.3% = SA + 1.2. Another method is to divide the skeletal age by the chronological age: a score greater than one indicates advanced skeletal maturity and a score less than one indicates a delay in skeletal maturity. The most common assessment tool for sexual maturity is Tanner's 5 stages of assessment. This tool assesses maturity for both males and females, based on direct observation of breasts and genitals: Females: breast development, onset of menses, and pubic hair distribution. Males: Penis and testes development and pubic hair distribution.

Describe an effective warm-up, cool-down, and explain the purposes of each

A warm-up is performed to gradually increase muscle temperature, elasticity, and stimulate the cardiorespiratory system. A dynamic, sport- specific warm-up of five to twenty minutes in length should be performed. The warm-up can include bounding, footwork drills, active stretches, and should encourage continuous movement. The exercises selected and the intensity of the warm-up is dependent on the age and physical conditioning of the group. Right after the warm-up, activity should begin. After the activity has concluded, a gradual cool-down should be performed to bring the body slowly back to its resting state. Cool-down should last five to ten minutes in length and can include light jogging followed by walking. After gradually slowing down the exercise intensity and heart rate, stretching exercises should be performed. Stretching should start with standing stretches, move to seated stretches, and can end

What is a wellness screening, what is its function, and what types of questions are on this screening?

A wellness screening is a tool athletic trainers can use to help gauge if participants are taking proper measures to ensure wellness in all areas of their lives. Wellness screenings can assist the athletic trainer in identifying individuals that may need education or a referral to other healthcare providers to develop and maintain a healthy lifestyle. Wellness screenings commonly include questions about proper diet, adequate exercise, and avoidance of drugs, alcohol, and tobacco. Other topics include safe practices in all areas of life such as driving, care when dealing with dangerous materials, and safe sexual behaviors. Stress- control habits are also addressed to ensure participants have adequate coping mechanisms so that they can effectively respond to stressors in life and in sport.

Discuss the dangers of amphetamines and cocaine use, including symptoms and treatment.

Amphetamine toxicity: may be caused by intravenous injection, inhalation, or sniffing of various substances (methamphetamine, methylphenidate), and ephedrine and phenylpropanolamine. Cocaine may be ingested orally, IV or by sniffing, while crack cocaine is smoked. Amphetamines and cocaine are CNS stimulants that can cause multi- system abnormalities. Symptoms may include chest pain, dysrhythmias, myocardial ischemia, myocardial infarction, seizures, intracranial infarction, hypertension, dystonia, repetitive movements, unilateral blindness, lethargy, rhabdomyolysis with acute kidney failure, perforated nasal septum (cocaine), and paranoid psychosis (amphetamines). Crack cocaine may cause pulmonary hemorrhage, asthma, pulmonary edema, barotrauma, and pneumothorax. Swallowing packs of cocaine can cause intestinal ischemia, colitis, necrosis, and perforation. Athletes should be referred for immediate diagnosis and treatment. Diagnosis includes clinical findings, CBC, chemistry panel, toxicology screening, ECG, and radiograph. Treatment includes: Gastric emptying (1 hour or more) and charcoal administration. IV access and supplemental oxygen. Sedation for seizures. Haloperidol for agitation. Hypertension: Nitroprusside, phentolamine 2.5-5mg IV. Cocaine quinidine-like effects: Sodium bicarbonate.

Describe signs and symptoms of anxiety disorders to include panic attacks and phobias. List appropriate treatments for these conditions.

Anxiety disorders account for about 20% of all medical conditions for which Americans seek care. Panic attacks and phobias are both classified as anxiety disorders. A panic attack is characterized by unanticipated feelings of terror with a physiological reaction similar to one who feels their life is in danger. Around 30% of young adults experience panic attacks. Panic attacks are more likely to be experienced at night and can be genetic. A patient who suffers from suspected panic attacks should be referred to a mental health provider. Treatments include behavioral modifications and medications that repress fear. A phobia is an unfounded fear that persists over time and leads to the person avoiding the situation or object that causes them fear. Common phobias are fear of heights, social interactions, and fear of flying. Symptoms of this condition can include an elevated heart rate and troubles breathing. A patient who suffers from a suspected phobia should be referred to a mental health provider. Treatments can include and desensitization, which is a technique in which the patient is antianxiety or antidepressant medications, behavioral modifications, gradually exposed to their phobia to overcome it.

Discuss the vulnerability of athletes to heat-related illness, and list some preventive measures.

Athletes are at particular risk of heat-related illnesses (hyperthermia) and must learn preventive steps and be advised to monitor other team members. About 65% of heat is lost through evaporation during exercise, but heat dissipates less readily in, hot humid environments and when the athlete is wearing wet, sweaty clothes. There are a number of steps to prevent heat loss: Utilize the wet bulb globe temperature index, which monitors the effects of humidity, temperature, and solar energy to determine risks. Identify athletes at high risk, such as those with diabetes mellitus or who are overweight. Provide adequate hydration: 16 oz of fluid (sports drink, not sodas) before activity and 8 oz every 20 minutes during activity to prevent thirst. Pre-and post-activity weight measurement, with 16 oz of fluid taken for every 1-pound loss of weight. Allow time for acclimatization (7-10 days). Monitor for signs of hyperthermia. Provide 10 minute breaks at least every hour. Promote evaporation: Change wet t-shirts. Provide shelter.

Discuss how athletes can prevent keratoderma (callus formation).

Athletes are prone to the development of keratoderma (callus formation), caused by hypertrophy of the stratum corneum layer of the epidermis, on the palms of the hands and on the bottom of the feet, depending upon the type of sports activity. Calluses on the feet are a particular problem if they become very thick and interfere with elasticity of the skin, because cracks may form, which may be quite painful, and blisters may form beneath the calluses. Preventive methods include: Soaking feet and using callus files to reduce the thickness of existing calluses. Wearing double socks to cushion the sole of the foot. Wearing properly fitted shoes. Applying emollients to feet and hands to prevent friction and keep skin supple. Wearing protective gloves, tape

Describe hypothermia, including the basic symptoms.

Athletes who participate in sports or training during cold weather are at risk for frostbite and hypothermia and should be educated about signs of hypothermia and preventive safety measures. Hypothermia occurs with exposure to low temperatures that cause the core body temperature to fall below 95°F (35°C). Hypothermia may be associated with immersion in cold water, exposure to cold temperatures, metabolic disorders (hypothyroidism, hypoglycemia, hypoadrenalism), or central nervous system abnormalities (head trauma, Wernicke disease). Many patients with hypothermia are intoxicated with alcohol or drugs. Symptoms of hypothermia include pallor, cold skin, drowsiness, alteration in mental status, confusion, and severe shivering. Any numbness requires immediate attention. The patient can progress to shock, coma, cardiac abnormalities, and cardiac arrest. Frostbite occurs when the tissue begins to freeze, usually signaled by burning pain and numbness in the affected area, while hypothermia usually begins with shivering as the body's core temperature drops.

Discuss the safety hazards associated with buffer zones

Buffer zones are the open spaces surrounding areas of sports activity within a sports facility. Buffer zones are needed because athletes often leave the playing area at a high speed (especially in sports like basketball) or may not be looking where they are going. There are standards for buffer zones for all sports, such as the distance from windows to prevent breaking glass from injuring athletes. Sometimes danger arises when coaches or trainers use "found" space for practice activities rather than the gymnasium. Buffer zones should always be adequate, and should not be used for any other purpose, such as activities should be used for practice, and these areas should always be equipment storage or scoring tables. Only spaces intended for athletic supervised.

Discuss the dangers of chlamydia for athletes.

Chlamydia is a sexually-transmitted disease (STD) caused by Chlamydia trachomatis and is often co-infected with gonorrhea. It may be transmitted by oral, anal, and vaginal sex. It is the most common STD in the United States. Symptoms of chlamydia include: Males: urethritis, epididymitis, proctitis, or Reiter's syndrome (urethritis, rash, conjunctivitis). Many cases are asymptomatic. Females: Mild cervicitis with vaginal discharge and dysuria, but complications can lead to infertility and pelvic inflammatory disease (PID). Any athlete presenting with evidence of chlamydia should be referred for diagnostic testing and treatment. Diagnosis is most reliable from nucleic acid amplification test (NAAT) (Amplicor®, Probe TEC®). Treatment includes: Azithromycin 1 g orally in one dose OR Doxycycline 100 mg orally twice daily for 1 week. Avoidance of sexual contact for 1 week. Treatment of the infected person's sexual partner is very important to avoid reinfection after treatment.

Discuss the risks associated with frostnip and frostbite (Part II).

Discuss the risks associated with frostnip and frostbite (Part II). Cold injuries, frostnip and frostbite (Part II): Full-thickness and into sub-dermal tissue freezing with cyanosis, hemorrhagic blisters, skin necrosis and "wooden" feeling, severe burning, throbbing, and shooting pains. Freezing extends into subcutaneous tissue, including muscles, tendons, and bones, with mottled appearance, non-blanching cyanosis and eventual deep black eschar. Prognosis is poor for 3rd and 4th degree freeze injuries. Determining the degree of injury can be difficult because some degree of thawing may have occurred prior to hospital admission. Treatment includes: Rapid rewarming with warm water bath (40-42°C, 104- 107.6°F), 10-30 minutes or until the frostbitten area is erythematous (red) and pliable. Treatment for generalized hypothermia. Treatment after warming and debridement of clear blisters: Aloe Vera cream every 6 hours to blistered areas. Dressings, separation of digits. Tetanus prophylaxis.

Explain how identifying risk factors through assessments, pre-participation exams, and the review of injury surveillance data is beneficial for an athletic trainer.

Identifying risks to the physically active population is beneficial because it provides the athletic trainer a way to recognize potential injuries before they occur and devise ways to prevent them. For example, assessments can identify biomechanical errors patients may be making such as lifting with straight legs and a bent back, which leads to back injuries. Pre-participation exams can identify patients' preexisting injuries, areas of weakness, and inflexibility. After recognition, the athletic trainer can address and correct these areas of concern with therapeutic exercises before the patient develops a new injury related to these biomechanical limitations. Reviewing injury surveillance data allows the athletic trainer to be cognizant of common injuries in different physical activities. Preventative actions can then be taken such as developing specific physical training and conditioning plans and ensuring a safe training environment to prevent those injuries from occurring.

Discuss standard protective equipment for the lower extremities.

Injuries to the knees and ankles are the most common sports injuries of the lower extremities. Protective equipment may be required or discretionary. Equipment for the lower extremities includes kneepads, shin guards, knee and ankle braces, and shoes. Large-scale studies of high school athletes have shown that the use of discretionary equipment reduces injuries by about 9%, but the biggest advantage related to knee pads, which correlated with a 56% decrease in knee injuries. Interestingly, the use of ankle and knee braces markedly increased the incidence of injury, with knee injuries 61% more likely and ankle injury 75% more likely. Shoes should be fitted properly and should be the correct type for the sports activity.

Explain the importance of flexibility and describe various stretching techniques.

It is generally accepted that having good flexibility prevents injuries because there is more range-of-motion available to the muscle before it is at risk of strain. Further, any impedance of normal range-of-motion can produce altered movement patterns that may lead to injuries, especially overuse injuries. There are many techniques to improve flexibility. Static stretching is a stretch-and-hold technique in which a muscle is held in a position of maximum stretch for an extended period. Dynamic stretching uses functional movements to stretch the muscle such as a butt-kick for stretching the quadriceps muscle group. Dynamic stretches are considered more functional as the movements performed for the stretches more closely mimic the movements required of the activities. Ballistic stretching uses a bouncing motion to stretch the muscle. Proprioceptive neuromuscular facilitation (PNF) is a stretching technique that can achieve great gains in flexibility but requires a partner for the stretch. There are different variations of PNS stretching but all include an active contract phase and a passive relax phase. During the active contract phase the partner provides resistance as the partner brings the athlete into a stretched position while they relax the person being stretched contracts the muscle. In the passive relax phase, the muscle being stretched.

Discuss the safety hazards associated with lightning. (Part I)

Lightning, which kills about 100 people a year in the United States and injures 400-500, poses a serious safety hazard for athletes. Storms can arise and become dangerous in a very short time, less than 30 minutes, especially in areas of the country with frequent thunderstorms. While lightning often accompanies rainstorms, it can occur without rain as well. The athletic trainer usually monitors weather conditions and advises the coaches and other staff when hazardous conditions arise, or when changes in weather conditions suggest a potential hazard may occur. There are a number of steps that should be followed to minimize risk: Check weather report daily. Use portable (SkyScan or Thorguard) detection system if possible to detect lightning, and use the Internet to check weather changes. Identify safe shelters prior to sports activities, and gauge the length of time needed to access the shelter: Buildings grounded with electrical wiring or plumbing OR vehicles with hard metal roofs and windows closed. Avoid sheds, which are usually not secure or grounded.

Discuss the safety hazards associated with field conditions.

Many sports injuries (for example about 25% of soccer injuries) are caused by poor field conditions, such as holes in the field from poor maintenance, gophers, or other burrowing animals, or damage caused by sports activities. There may be pooled water, broken glass, rocks, raised sprinkler heads, or items that have been thrown onto the field, all of which pose a potential hazard. In many cases, there is no clear responsibility for checking the field prior to activities. Referees may be responsible at some institutions, but the reality is that they rarely walk the entire field and often arrive shortly before game time. Coaches are usually busy with the athletes. The athletic trainer should ensure that a procedure is in place to check the field before use. This may include groups of athletes walking the field before play or volunteers, such as athletic supporters or parents. Various approaches may be used: A group may walk from one end to another or the field may be divided into grids for inspection.

Describe the safety measures that can be taken against hypothermia.

Safety measures to prevent hypothermia include: Wearing clothes that are appropriate for the environment, temperature, and chill index, as wind and humidity increase heat loss. Doing warm-up exercises to increase circulation. Beginning exercises slowly and avoiding slippery surfaces. Removing any wet clothes promptly and replacing with dry clothes. Avoiding accumulation of moisture in clothing by overheating. Wearing clothes in layers that allow for ventilation. Ensuring that the head and neck are well covered, as 50% of heat loss is from the head and neck. Wearing mittens or gloves appropriate for the temperature and conditions. Wearing moisture-wicking socks, such as those made of wool or polypropylene, to keep feet dry. Avoiding alcohol, which results in vasodilation, increased heat loss and impaired reasoning.

Explain ten principles of conditioning that can be applied to all exercise programs to lower the risk of injury.

Safety: Ensure the area is free of safety hazards, and conditioning equipment is functioning properly. Athletes should be educated how to properly perform exercises and how to recognize normal and abnormal sensations when exercising. Warm-up and cool-down: Prior to the workout, the athlete's blood flow to working muscles should be gradually elevated by performing a dynamic warm-up routine. At the conclusion of the workout, exercise intensity should be gradually reduced and stretching should be incorporated. Motivation: Integrate variety into the training program using sport-specific periodization training to alleviate boredom and increase compliance. Overload: The body must be overloaded within a safe realm to respond to those demands and get stronger. The SAID (specific adaptations to imposed demands) principle is directly related to the overload principle. Consistency: Exercises must be done regularly and repeatedly to make and maintain improvements. Progression: Increasing demands should be placed on the body as appropriate to advance physically. Intensity: Exercise intensity should be stressed over an unnecessarily long workout. Specificity: Exercises should be chosen to improve athletes' specific sport and position performances. Individuality: Exercises should be selected based on the needs and preferences of the individual. Minimal stress: Be cognizant of stressors in athletes' lives and allow time away from conditioning as needed.

Discuss the safety hazards associated with strength training and weightlifting.

Strength training and weightlifting utilize the same equipment, such as free weights and weight machines, but the goals are different. Strength training aims to improve physical conditioning, while weightlifting (not recommended for children or adolescents) is a competitive sport that involves lifting maximal amounts of weight. There are a number of steps that should be taken to reduce safety hazards: - Exercise equipment should be checked daily and cleaned to ensure it is safe.; - Instruction in lifting techniques and supervision should be provided.; - Athletes should be advised to do warm-up and stretching exercises before using equipment.; - Use of weights and equipment should be based on age- and size-appropriate standards to prevent injury.; - Weightlifting requires a spotter at all times.; - One or more spotters must assist with free-weight exercises in which the bar passes over the face or head, the athlete is positioned on his back, or the bar is racked in front of the shoulders.

Discuss how commercial and custom-made male genital protective devices can minimize the risk of injury and illness.

Studies have indicated that about half of male athletes, especially in middle school and high school, do not routinely use genital protection while playing sports, sometimes because traditional cups are uncomfortable. Additionally, males often do not report painless testicular swelling, so educating athletes about the danger of injury to genitals is necessary to ensure compliance with safety guidelines, especially since about 20% of genital injuries result in permanent damage. Injuries include hematoma of a testis or of the scrotum; lacerations of the penis or scrotum; torsion; and hernia. Genital protection devices include: Genital cups, held by a jock strap: There is a wide variety of cups, from flat to contoured, designed to absorb impact. They must be large enough to comfortably fit over the genitals and minimize movement, or else they can be uncomfortable. Compression shorts made of nylon and spandex to limit movement and provide support. Running shorts combine shorts and briefs, but don't provide sufficient protection from cold.

Discuss the risks associated with near drowning.

Submersion asphyxiation caused by near drowning can cause profound damage to the central nervous system, pulmonary dysfunction related to aspiration, cardiac hypoxia with life-threatening arrhythmias, fluid and electrolyte imbalances, and multi-organ damage. Hypothermia related to near drowning has some protective effect, because blood is shunted to the brain and heart, but this is not likely to occur in a heated swimming pool. Preventive methods include: Forbidding roughhousing in the pool area. Never swimming or diving alone. Never swimming or driving while under the influence of drugs or alcohol. Securing pool facilities to prevent unauthorized access. The person should be removed from the water and CPR begun immediately while awaiting emergency transfer. Even those who recover promptly and are breathing independently should be taken to an emergency department for evaluation, as physiological responses may be delayed. Initial treatment includes: Establishment of airway, breathing and circulation (ABCS). High flow 100% oxygen with facemask. Monitoring for at least 72 hours for respiratory, cardiac, or neurological deterioration.

Discuss safe sex practices.

While abstinence is the only sure way to avoid sexually-transmitted diseases and pregnancy, the reality is that many teenagers and most adults are sexually active. Athletes should be advised of safe sex practices in order to prevent unwanted pregnancies and sexually- transmitted diseases. There are a number of safety guidelines. Males should use a latex condom for each sex act, and females should demand that their partners use condoms. Females should practice appropriate birth control, including the use of a female condom, IUD, diaphragm or birth control pills or patch. Males and females should avoid multiple sex partners and sex with people they don't know well. Males having sex with males and others who have engaged in unsafe sex practices should be tested for HIV and hepatitis before engaging in sex with new partners. Males and females should seek medical advice after any sign of pain, difficulty urinating, discharge, or lesions.

Discuss the importance of diet: basic elements.

A basic understanding of the elements of a good diet is necessary for the athlete. The energy for the body is supplied by: Fats = 9 calories per gram. Fats provide the slowest but most efficient form of energy, requiring 5 hours to metabolize. Fats should comprise 30% of the diet. Carbohydrates = 4 calories per gram. Simple carbohydrates (sugars, fruits, dairy products) are the fastest source of energy, requiring about 30 minutes to metabolize. Complex carbohydrates (whole grains, vegetables) convert more slowly to energy, taking about 2 hours. Carbohydrates should comprise about 55% of the diet. Carbohydrates provide more energy per unit of oxygen expended than other food components. Proteins = 4 calories per gram. Protein, including meat and fish, metabolizes more slowly (3 hours) but provides a longer- lasting source of energy. Protein should comprise about 15% of the diet. Athletes expend 2200-4400 calories daily. In order to prevent dehydration, athletes must also consume adequate amounts of water, approximately 2 1/2 liters per 2400-calorie energy output.

Explain how to develop an athletic training clinic's policies and procedures manual and what should be included.

A policies and procedures manual should be developed in cooperation with all stakeholders and based the organization's vision and mission statements. The policies state rules and principles the organization abides by while the procedures articulate how processes will be done. Policies and procedures manuals should be very thorough and include both program operations and human resources issues. Program operations that should be developed are objectives for the program, how the organizational structure will be laid out, the scope of practice, accepted referral procedures, documentation protocols, budget expectations, and emergency planning. Human resources issues to include in the policies and procedures manual are job descriptions, how employee evaluations will be conducted, expected dress code, hiring procedures, and firing practices.

Explain why a spotter should be used for free weight training and describe proper spotting techniques.

A spotter is essential when performing free-weight exercises, especially when the weights are extremely heavy. Without proper spotting, weight lifters can lose control of heavy weights and put themselves at risk for injury. If this occurs without a spotter, the weights could fall on the lifter's head or neck causing severe injury or even death. The spotter should know their physical limitations and use a second spotter if the weight being lifted exceeds their capabilities. Not only should the spotter be able to protect the lifter from injury, they should also provide guidance on proper lifting form, and offer encouragement. There are many techniques for proper spotting. The spotter should ensure the lifter knows how to get out of the way of a failed lifting attempt, especially when the weight is overhead. The spotter must ensure the lifter is in a stable and biomechanically correct position with a proper grip before attempting the lift. The spotter should stand behind the lifter and should always be in a position to protect the lifter and themselves. The spotter should monitor the lifting speed, range of motion of the lift, the lifter's breathing, and repetitions performed.

Discuss how commercial or custom-made ankle supports can minimize the risk of injury and illness.

Ankle sprains are common in almost all sports. The ankle comprises 3 bones and 3 groups of ligaments that stabilize the joint. The talus bone connects in a hinge joint with the distal tibia and fibula, stabilized by anterior and posterior tibiofibular ligaments. The medial aspect of the ankle is stabilized by the deltoid ligament. Most sprints are inversion injuries with tearing of lateral ligaments. Because sprains may weaken the ankle, taping helps to stabilize the ankle and prevent further injury. However, studies of the effectiveness of taping vary from no results to decreased injury, and it's better to focus on strengthening exercises. A good program is as follows: Taping using 1.5-2 inch porous athletic tape or moleskin. High-top shoes with inflatable support to protect the ankle. Semi-rigid orthotic stabilizers that fit about the ankle. Shoes with adjustable straps providing semi-rigid support to the ankle.

Discuss anabolic steroids, including side effects.

Athletic organizations must take a firm no-use stand on anabolic steroids as they have been widely used among athletes. Athletes must be educated about the dangers of the drugs. Anabolic steroids, such as cypionate and testosterone enanthate, are used to increase muscle mass and improve athletic performance, but they have serious side effects and have no place in sports: Liver disorders (especially oral anabolic steroids). Cardiovascular disorders. Increased aggressiveness and libido. Males: Decreased sperm count, atrophy of testes, and erectile dysfunction. Gynecomastia (breast development) in males. Females: Inhibition of formation of follicles and irregularities of menstrual cycle, including amenorrhea. Hypertrophy of clitoris. O Acne. o Hair loss and male pattern balding with increased facial hair. Breast atrophy. o Masculinization of body, features, and lowering of voice. o

Describe how to minimize the risk of heat and cold injuries and illnesses.

Athletic trainers must take many steps to minimize the risk of heat illnesses in the physically active population. Necessary steps include educating all stakeholders on prevention, ensuring a gradual acclimation is followed over a period of 7 to 14 days, proper hydration, unrestricted access to fluids, and selecting clothing for activity participation that is light-weight and light in color. High-risk individuals should be identified and closely observed and the heat index should be monitored and activities adjusted accordingly. Weight records should also be kept to ensure participants are rehydrating appropriately. To prevent hypothermia, there are several steps the athletic trainer must take. Education should be provided to all stakeholders on proper attire, hydration, how to recognize and treat potential cold illnesses, along with education on the risks inherent with participation in cold weather. High-risk participants should be identified and monitored. Clothing selected should be lightweight, layered, waterproof, windproof, and allow for movement and sweat to evaporate. Wearing a hat should be encouraged and participants should properly warm-up prior to activity and wear warm-up suits when not competing. If the temperature falls below freezing, an extra layer of clothing should be added for every 5 mph of wind.

Discuss exclusion from sports based on the pre- participation examination.

Based upon the finding of the preparticipation exam, an athlete may be excluded from participating in sports activities, as the purpose of the exam is to establish the athlete's fitness to play. Exclusion can be based on any of the following: Injuries. Latent conditions, such as cardiac abnormalities, which may cause harm. Physical disabilities that pose a danger to the person or others. Renal disease. Uncontrolled hypertension. Health conditions that pose a risk to others, such as an acute Staphylococcus aureus/MRSA infection and, in some cases, HIV and hepatitis infections. Disagreement among physicians regarding the safety of allowing the athlete to participate in sports activities. The failure of reasonable accommodations to eliminate risk. Contagious diseases that pose a risk to others. In addition, athletes with one eye should be excluded from boxing, wrestling and full-contact martial arts, because adequate eye protection gear is unavailable.

Discuss the importance of diet: modifications for exercise.

Carbohydrate loading and protein diet modifications are often used to increase the storage of glycogen before endurance sports, and to prevent energy loss and anemia: Intake of simple carbohydrates immediately before an event may increase dehydration and cause an increase in insulin, thus lowering blood sugar. If activities last longer than 90 minutes, then stored glycogen is adequate. If activities last more than 2 hours, then sports drinks that are 6-8% glucose may be used during the event. While high carbohydrate diets (70%) should not be used for prolonged periods, carbohydrate loading diets are often used for 3 days before endurance events. Shorter durations (1 day) may cause water retention and muscular stiffness. Exercise increases the need for protein, and insufficient intake may result in anemia. Endurance activities require 1.2-1.4 g protein/kg of body weight. Resistance and strength activities require 1.6-1.7 g protein/kg. Protein supplements should be avoided. Pre-event meals should be 500-1000 calories 3-4 hours before the event.

Explain cardiorespiratory endurance, its importance, and list techniques to improve it.

Cardiorespiratory endurance is the ability to perform activities that require large-muscle movements of the entire body over an extended amount of time. Cardiorespiratory endurance is important because it enables oxygen to be effectively delivered throughout the body to the working tissues. If an individual has a low-level of cardiovascular endurance, they will be unable to sustain their activity, will be more likely to fatigue early on, and are at a greater risk of injury. To improve cardiorespiratory endurance, aerobic activities should be performed three to six times per week for a period of twenty to sixty minutes. Competitive athletes should perform aerobic exercises at least four times per week for a minimum of 45 minutes. Examples of aerobic activities include jogging, swimming, cycling, elliptical, and skipping rope.

Discuss aerobic endurance training (part II)

Continuation of endurance training (Part II): While most activities are aerobic, building anaerobic endurance is an important part of fitness: Anaerobic endurance activities: During anaerobic activity, the demands for oxygen and energy exceed that available so the body burns stored energy and lactic acid begins to accumulate. As energy stores are depleted, usually within about 4 seconds, activity ceases and the muscles react with pain. Endurance activities are classified as short (<25 seconds), medium (25-60 seconds), or long (1-2 minutes). Short-distance running, such as 200 meters, is about 5% aerobic and 95% anaerobic. The longer the distance, the greater the shift to aerobic: a 5000 meter run is 80% aerobic and 20% anaerobic. Marathon running is only 2% anaerobic. The goal of anaerobic activity is to increase anaerobic endurance through high-intensity repetitive exercises with a short recovery period.

Discuss speed and strength endurance training.

Continuation of endurance training (Part III): Speed: The goal of speed endurance is to increase the athlete's ability to run repeated high-speed sprints of short distances, improving coordination of muscle contractions. Repetitive running is used to increase endurance, including competitive running and participation in timed trials. Strength: The goal of strength endurance is to improve and maintain muscle contractions and force. Strength is essential for all athletes. Exercises to increase strength include weight training, hill and harness running, and Fartlek training, during which athletes run with varying the speed and intensity. For example, they may jog for 10 minutes, and then do a 2 mile hilly course, running up hills and jogging between, followed by a final 10 minute jog. Alternately, the coach may use a whistle to signal a change in раce.

Discuss high-altitude sickness (Part II).

Continuation of high altitude sickness (Part II). Typical changes that occur during acclimatization include: Hyperventilation to increase oxygen uptake (hypoxic ventilatory response). • Increased urination and dehydration. • Increased heart rate. Frequent awakening during the night and Cheyne-Stokes respirations. • Increased blood pressure. Preventive methods should begin below 10,000 feet, but a gradual ascent with a few days of planned rest before exertion is optimal: Immediately stop ascent with any signs of AMS until symptoms subside. • Always descend immediately for emergency treatment when signs of HACE or HAPE emerge. • Increase elevations above 10,000 feet at the rate of 1000 feet daily, with one day rest for each 1000 feet. • If flying/driving to high elevation, avoid exertion or more ascents for 24 hours. Drink copious (4-6 liters/day) amounts of to keep urine clear or pale. Avoid exercises and over-exertion until acclimatized, and sleep only at night. • Eat a 70% carbohydrate diet. Avoid use of alcohol, tobacco, or depressant drugs.

Discuss how the maintenance of clinical and treatment areas can minimize the risk of injury and illness. (Part II)

Continuation of maintenance of clinical and treatment areas (Part II): Treatment areas should have access to a clean and functioning ice machine in case cold packs are needed. Hydrotherapy area should have elevated outlets (5 feet) to prevent splashing of outlets and/or electric shock. Athletes should be required to shower before non-emergency treatment. Equipment, including cleats, should be left outside treatment area. Shoes should not touch treatment tables. Telephones must be accessible in case emergency assistance is required. Smoke detectors and fire safety information must be available. The athletic trainer should be sure at all times to operate within the scope of practice when supervising and providing treatment to athletes.

Discuss the safety hazards associated with lightning. (Part II)

Continuation of safety hazards, lightning (Part II): Utilize "flash-to-bang" method to estimate the proximity of lighting: count the seconds from the flash to the bang of thunder and divide by 5 to arrive at the distance in miles. Stop all activity when "flash-to-bang" nears 30 seconds or lightning detection system indicates increasing storm activity. Advise spectators to seek shelter and exit metal bleachers. Seek shelter away from lone objects, tall trees, standing water, or open fields, avoiding metal structures. Avoid the locker room, showers, and indoor pools or tubs. Open area: crouch low with only feet touching the ground. Avoid the use of telephone landlines, which can transmit electrical charges. Ensure that CPR-certified individuals are available.

Discuss how the maintenance of clinical and treatment areas can minimize the risk of injury and illness. (Part I)

Depending upon the size of the organization or facility, the clinical and treatment area may be shared by a number of different staff and athletes. The area may include office space, examining rooms, taping area, wound care area, rehabilitation area, electrotherapy (ultrasound, diathermy) and hydrotherapy tubs and pools. The clinical and treatment areas are ideally located within close proximity to training areas, such as adjacent to locker rooms or gymnasiums. Not only the space but also the equipment within must be maintained in accordance with accepted standards: A schedule for use should be maintained and updated weekly to avoid conflicts. Athletic trainers are usually responsible for cleaning equipment and maintaining floors and environmental surfaces. Treatment tables should be cleaned daily and after each use. Hydrotherapy equipment should be disinfected daily following manufacturer guidelines and using EPA-approved disinfectants.

Explain how designing and following plans to minimize risks from the physical environment and equipment benefits the athletic trainer.

Designing and following plans to minimize risks from the physical environment and equipment benefits the athletic trainer by preventing a wide array of injuries from occurring. For example, following the standard operating procedures for weight training equipment can prevent many catastrophic injuries, minor injuries, and everything in between. Designing and implementing an education plan to teach and reinforce the proper utilization of football equipment can prevent death, paralysis, and many other injuries. Being aware of risks involved with athletes who compete on turf fields, and providing education and techniques to lower those risks can prevent various sprains and abrasions. There are many different types of athletic equipment and multiple physical environments in which athletic trainers provide coverage. Therefore, athletic trainers should be well versed in the proper use and dangers of misuse for all equipment and physical environments in which their athletes compete. Further, athletic trainers should proactively design, implement, and reinforce injury prevention plans for all physical environments in which they provide coverage and all equipment their athletes use.

Discuss ranges of movement

Each part of the body has a range of movement. Exceeding the normal range can result in strains or sprains. The basic movements are as follows: Flexion: bending, as the back flexes bending forward Extension: movement drawing two ends of a jointed part or extensor in separate directions, as when the arms stretch straight; Abduction: drawing away from the medial plane of the body, as when the arm lifts away from the side of the body; Adduction: drawing toward the medial plane of the body, as when a leg crosses inward; Rotation: turning around the medial line, as when standing still and turning the upper body from side to side; Pronation: positioning face down while lying on the back or palms down Supination: positioning face up when lying on the back or palms up; Elevation: raising upward, as in lifting shoulders forward; Depression: lowering, as in pulling shoulders backward; Circumduction: circular movement of limb or eye, as when moving arms in circles; Inversion: turning inward; Eversion: turning outward

Discuss sport-specific protective equipment.

Each sports activity requires specific types of safety protective equipment, and students should be aware of necessary and discretionary equipment: Baseball: (Not always worn) batting helmets with mouth guards. Catchers: mouth guard, shin guards, chest protector, and protective mitt. Football: Football helmet and mouth guard; shoulder, hip, and tailbone padding; and thigh guards. Basketball: Basketball shoes (medium tops providing ankle support) and mouth guards. Gymnastics: Wrist guards, handgrips, and soft gymnastic footwear; floor pads should be in use and equipment properly padded. Skateboarding: Helmet, knee and elbow pads, and slip- resistant shoes with closed toes. Soccer: Shin guards and special molded cleats or ribbed-sole shoes; goal posts should be padded to prevent head injuries. Volleyball: Kneepads, protective pants, and shoes with ankle/arch support.

Discuss the dangers of eating disorders for athletes.

Eating disorders are a health risk for athletes, especially females although males sometimes also have eating disorders, often presenting as excessive exercise. Different types include: Anorexia nervosa affects 0.5-3.7% of females; it is characterized by profound fear of weight gain and severe restriction of food intake, often accompanied by abuse of diuretics and laxatives, which can cause electrolyte imbalances, kidney and bowel disorders, and delay or cessation of menses. Anorexics may become emaciated and die. Bulimia nervosa affects 1.1-4.2% of females and includes binge eating followed by vomiting, often along with use of diuretics, enemas, and laxatives. Gastric acids can damage the throat and teeth. While bulimics may maintain a normal weight, they are at risk for severe electrolyte imbalances that can be life threatening. Binge eating affects 2-5% of females and includes grossly overeating, often resulting in obesity, depression, and shame. Early intervention can prevent physical damage, but hospitalization and intense therapy for long periods of time may be required.

Explain the science of ergonomics, what an ergonomic risk assessment (ERA) is, and potential recommendations an athletic trainer would make following an ERA.

Ergonomics combines knowledge of muscular activity and human measurement to design workplaces that increase functionality and decrease the risk of injury. An ergonomic risk assessment (ERA) reviews different jobs, identifies which jobs have the highest risk of injury, and address those first. This is done by reviewing the history of injuries, worker complaints, and performing a physical-demands analysis. After performing an ERA, the athletic trainer would make appropriate adjustments to the workstation, educate about injury prevention techniques, and demonstrate appropriate stretches and strengthening exercises. Recommendations should be made to the worker, the supervisor, and the manager so that all involved parties know what preventative steps should be taken. Common factors that contribute to workplace injuries and are corrected during the ERA are repetitive movements, improper workplace setup, vibrations, twisting, reaching, bending, and other problematic body positions.

Discuss the dangers of alcohol (ethanol) for athletes.

Ethanol is the form of alcohol found in alcoholic beverages, flavorings, and some medications. It is a multisystem toxin and central nervous system depressant. Teenagers and young adults frequently use ethanol as the drug of choice, but binge drinking can lead to serious morbidity or death. Ethanol has direct effects on the central nervous system, myocardium, thyroid, and hepatic tissue. Ethanol is absorbed through the mucosa of the mouth, stomach, and intestines, with concentrations peaking about 30-60 minutes after ingestion. About 90% of ethanol is metabolized in the liver, and the rest excreted through the pulmonary and renal systems. Ethanol overdose affects the central nervous system as well as other organs in the body. If people are easily aroused, they can usually safely sleep off the effects of ingesting too much alcohol, but if the person exhibits an altered mental status, nausea and vomiting, or is semi-conscious or unconscious, emergency medical treatment should be initiated.

Discuss the importance of diet: concerns for female athletes.

Female athletes often believe that they should lose weight to compete better, but they run the risk of inadequate nutrition, which can impair performance instead. At least 1200-1500 calories/day are usually required for most girls and women, but female athletes may require many more calories. Female athletes often require increased iron in their diets because they lose iron through menses. Many female athletes develop amenorrhea as their bodies attempt to conserve stores of iron. Amenorrhea or excessive exercise can lead to bone loss and osteoporosis, so a diet with sufficient iron, from sources like red meat and pork; is advised. Adequate calcium intake may counteract the bone loss, but calcium supplements of 1500 mg/day may be required to avoid stress fractures, especially for participants in activities that require running and jumping. Additionally, vitamin C, which helps with the absorption of iron, is necessary.

Discuss how commercial and custom-made breast support devices can minimize the risk of injury and illness.

Females engaged in sports are particularly vulnerable to breast injuries, with the nipple the most commonly injured because of sensory stimuli causing erection of the nipple tissue and subsequent friction from clothing, resulting in pain and bleeding. Breasts may also have contusions, abrasions, and lacerations from impact, especially in contact sports and sports in which balls or other items are hurled at high speeds. Breast injury has been shown to increase the risk of cancer. Breast protective devices should support Cooper's ligaments, which suspend the breasts: Polyurethane nipple and breast cups (worn under a sports bra). Seamless sports bras made of non-abrasive, hypoallergenic material. Compression sports bras are usually used for females with breast cup sizes of A or B. Encompassing sports bras are more appropriate for females with larger breasts, as they support each breast separately. Careful measuring should be done to ensure correct fitting. Polyurethane chest shields, usually placed over a sports bra and fitted snugly to the individual.

Discuss the Q angle assessment component of the pre- participation examination.

Females often differ biomechanically from males, putting them more at risk for injury. For example, females tend to have a wider pelvis than males, resulting in an increased Q (quadriceps femoralis) angle. When the athlete is standing, an imaginary straight line is drawn from the anterior superior iliac spine down the anterior thigh (femur), through and past the center point of the patella. A second line is drawn from the center point of the patella to the tibial tubercle, and then the angle between the two lines is measured at the point of the tibial tubercle. Normal angles: Male 13°; Females 15°. An increased Q angle can result in increased knee stress. Female athletes experience 2-4 times the number of injuries to the anterior cruciate ligament (ACL) than male athletes. If an increased Q angle is found, the athlete may need flexible custom orthotics to prevent pronation of the foot, knee support, and a program of strength-building exercises for quadriceps and hamstrings.

Discuss the safety hazards associated with floor mats.

Floor mats pose a potential hazard to athletes, such as wrestlers, who come in skin contact with the mat. Mats should meet the standards and specifications of the particular sport so that they provide adequate cushioning to prevent injury. Mats should be: Examined regularly and replaced if cushioning deteriorates. Checked to ensure they are smooth, without surface cracks, prior to each event. Cleaned thoroughly, following manufacturer's guidelines, and disinfected before each session. Protected from people walking on them without proper footwear, as this may damage the cushioning and the surface of the mat. Installed away from walls or protrusions that might injure the athlete during activities. If not left in place, stored according to manufacturer's guidelines to prevent damage to the mat.

Discuss the risks associated with frostnip and frostbite. (Part I)

Frostnip is a superficial freeze injury that is reversible. Frostbite is damage to tissue caused by exposure to freezing temperatures, most often affecting the nose, ears, and distal extremities. As frostbite develops, the affected part feels numb and aches or throbs, becoming hard and insensate as the tissue freezes, resulting in circulatory impairment, necrosis of tissue, and gangrene. There are 3 zones of injury: Coagulation (usually distal) is severe irreversible cellular damage. Hyperemia (usually proximal) is minimal cellular damage. Stasis (between other two zones) is severe, but damage is sometimes reversible. Symptoms vary according to the degree of freezing: Partial freezing with erythema and mild edema, stinging, burning, throbbing pain. Full thickness freezing with elevated edema in 3-4 hours; edema and clear blisters in 6-24 hours; desquamation with eschar formation and numbness; and then aching and throbbing pain. Prognosis is very good for 1st degree and good for 2nd degree frostbite.

Describe functional strength and core stability training. How can they be used to prevent injury?

Functional strength training is a technique to strengthen the body in functional movement patterns. It looks at the body as a kinetic chain, multiple body parts working together to create motion. For a proper movement pattern to occur, all the parts within the kinetic chain must be strong and functioning properly. With functional training, all the links in the kinetic chain are strengthened in ways that mimic the movements used in activity. For example, when a pitcher throws a pitch, he or she is not only using the strength of the shoulder, but also the core, hips, and legs. By using this strengthening technique, the athlete gains strength for the physical activities in which they participate in all three planes of motion. An example of a functional strengthening exercise is a standing diagonal rotation with TheraBand resistance. Core stability training is a technique to improve the muscular strength, endurance, power, and neuromuscular control over the muscles of the abdomen, lower back, and hips. Strengthening of the core is essential for injury prevention as a weak core leads to improper movement patterns and injuries. Examples of exercises for core stability training are planks, bridging and various exer

Discuss the dangers of gonorrhea for athletes.

Gonorrhea is caused by Neisseria gonorrhoeae and should be suspected with urinary infections. Symptoms include: Males: Dysuria and purulent discharge from the urethra, epididymitis, and prostatitis. Females: Many women are asymptomatic or may have lower abdominal pain, cystitis, or mucopurulent cervicitis; if untreated it can result in PID and chronic pain. Rectal infections are common in women and homosexual males. Untreated, gonorrhea can become a systemic infection, resulting in petechial or pustular skin lesions, arthralgias, tenosynovitis, fever and malaise, and septic arthritis. Athletes with urinary infections or other signs of gonorrhea should be referred for diagnosis and treatment. Diagnosis is by cervical or urethral culture or NAAT. Gram stains of urethral smears are more accurate for males than females. Cultures of multiple sites may be needed to confirm disseminated disease. Treatment includes: Cefixime 400 mg orally in one dose OR Ceftriaxone 125 mg Im in one dose OR Ciprofloxacin 500 mg orally in one dose OR Levofloxacin 250mg orally in one dose.

Explain how implementing risk-reduction plans in accordance with current guidelines benefits the athletic trainer.

Implementing risk-reduction plans that follow current guidelines benefits the athletic trainer by ensuring that the best plans for injury risk reduction are utilized. This can be achieved by examining the risks in advance, researching best practices to reduce these risks, planning preventative strategies, and implementing steps to reduce the incidence of injuries. For example, to reduce the risk of cervical neck injuries in football, a preventative plan including education on proper tackling technique should be implemented to reduce the incidence of these potentially catastrophic injuries. Additionally, in sports with a high risk for ACL sprains, a risk-reducing conditioning program should be incorporated that works to strengthen appropriate musculature and teaches techniques to reduce the risk for ACL sprains such as proper jump-landing form. By studying the risks for injuries and guidelines to risk reduction programs for all athletes for which they provide services. manage these risks, athletic trainers can implement sport-specific, injury

Discuss jet lag, including some helpful remedies.

Jet lag is caused by a disturbance in the Circadian rhythm of waking and sleeping when traveling from one time zone to another, especially over multiple time zones. Jet lag may result in lethargy, dizziness, insomnia, dehydration, drowsiness, and impaired athletic performance. Travel from west to east seems to cause more problems than travel from east to west. Some believe that it takes one day to compensate for each time zone crossed. There are some steps an athlete can take to minimize the effects of travel: Sleep well the night before. Hydrate well prior to boarding the plane, avoiding alcohol. Avoid drinking juices, sodas, caffeinated beverages, and alcohol during the flight. Try to eat and sleep on a schedule that coincides with home time if possible, when an extended period of adjustment is not possible. Remove shoes, stretch, and walk about periodically to improve circulation. Schedule rest time during the day if necessary.

Discuss Marfan syndrome assessment in a pre- participation examination.

Marfan syndrome is a genetic disorder of the connective tissue that may put athletes at risk. Connective tissue, such as tendons, ligaments, heart valves, and blood vessels, are often defective and weak. Depending upon the severity of the disorder, athletes may be restricted from team sports, especially contact sports that may result in chest trauma, or isometric exercises, such as weightlifting. Symptoms of Marfan may be noted on the PPE and the athlete must be referred to a specialist. Traits can include: Tall, thin stature with loose joints, with the long bones disproportionately long. Scoliosis. Flat feet. Pectus carinatum (pigeon chest) or pectus excavatum (funnel chest). Long, narrow face with high-arched roof of mouth and crowding of teeth. Dislocation of lenses of eyes and sometimes retinal detachment, myopia. Aortic dilatation (with risk of dissection). Cardiac valve disorders with heart murmur. Stretch marks. Abdominal/inguinal hernia.

Discuss mononucleosis, including symptoms and treatment.

Mononucleosis is an infectious disorder caused by the Epstein-Barr virus. It is spread through saliva and airborne droplets and occurs most often in teenagers and young adults. The incubation period is 4-6 weeks. Symptoms are usually similar to an upper respiratory infection or flu, with adults affected more than children. The following symptoms may persist for weeks: Weakness. Headaches. Fever. Persistent sore throat. Enlarged lymph nodes in neck and axillae. Enlarged tonsils. Generalized red macular rash. Enlarged spleen (rupture may occur in rare cases). Diagnosis may include clinical examination, antibody tests (such as Monospot®), and CBC. Treatment is primarily supportive, as there is no treatment for the virus, and includes: Rest and restricted activity to avoid spleen rupture. Acetaminophen or ibuprofen. Adequate fluid intake.

Discuss muscle contractions

Muscles usually contract (shorten) to create force, but there are a number of different types of contractions that must be understood by the athlete and by trainers: Isotonic (concentric and eccentric) contractions involve movement of the muscle as when pushing or pulling. Isotonic exercises usually balance concentric and eccentric contractions. - Concentric contractions cause the muscle to shorten, as occurs when the muscle is used to lift a weight, as with a bicep curl. - Eccentric contractions cause the muscle to lengthen, as occurs when lowering the weight.; Isometric contractions occur without muscle movement, as when attempting to push or pull an immoveable object, tightening the muscle, or holding an object out in front of the body so that the weight pushes down but the muscle's opposing force keeps the object stable.; "Passive stretch" contractions result in stretching when the muscle lengthens without stimulation to contract, such as the pull on the hamstrings when bending over to touch the toes.

Describe physiological changes that occur from strength training.

Muscular strength training brings about in various physiological changes Ca within the muscle tissue. Hypertrophy, an increase in muscle size, occurs re in response to strength training as myofilaments within the individual ar muscle fibers increase in size and number. This results in an increased ei cross-sectional diameter of the muscle fibers which makes the muscles themselves appear larger. Strength training also improves e neuromuscular control of muscles. This is achieved as more motor units li are elicited to fire for muscular contraction which creates a more efficient and stronger contraction of the muscle. Another physiological change resulting from strength training is non- contractile tissues such as ligaments and tendons are strengthened. Stronger ligaments and tendons will decrease the risk for sprains and strains respectively. Also, bone mineral density is increased making the bone stronger and therefore less likely to fracture. Finally, if the heart rate is elevated to a training level during strength training, the cardiorespiratory system simultaneously receives training and becomes more efficient as well.

Discuss the ways overweight athletes can prevent injury.

Overweight athletes are often engaged in sports that require large size and mass, as for instance football, basketball, and wrestling. These athletes should be carefully assessed for risks. In addition, these athletes should have their body masses double-checked, since individuals with extreme muscle mass are often inaccurately categorized as overweight. The overweight athlete is more likely to suffer from injury. Overweight athletes should be advised to: Avoid any use of performance-enhancing supplements, steroids or stimulants in trying to lose weight or convert fat to muscle, because these may result in hypertension, cardiac abnormalities, or other health problems. Avoid high-volume, high-intensity plyometric exercises, which can result in joint damage. Acclimatize to heat and to exercise by staying hydrated and staying alert for signs of heat-related illness. Maintain a nutritious diet.

Discuss pediculosis assessment in a pre-participation examination.

Pediculosis is infestation with lice, transmitted by direct contact with someone who is infested. It includes the following: Head lice (most common in children). Body lice (most common in transient populations). They feed on the body but live in clothing or bedding and are spread by sharing bedding, clothes, or towels. Pubic lice spread by sexual contact or, rarely, sharing clothes or bedding; may infest the genital area, eyebrows, eyelids, lower abdomen, and beard. Symptoms include persistent itch (usually worse at night), irritation, excoriation, and sometimes secondary infection. Diagnosis is by clinical exam and finding of lice or nits. Treatment includes: Permethrin 1% (Nix) (treatment of choice): This is a cream rinse applied after body or hair is washed with a non-conditioning shampoo and towel dried. It is left on for 10 minutes and then rinsed off, leaving residue designed to kill the nymphs emerging from eggs not killed with the first application. Treatment is often repeated in 7 to 10 days. Nits should be removed manually.

Explain what periodization training is, why it is used, and list conditioning goals that should be achieved during each cycle.

Periodization training is a technique that considers the entire training period and sets appropriate conditioning goals to meet the needs of athletes during different phases of the season. Specific training goals will be set for off- season, preseason, and in-season. Periodization allows for peak performance during the competitive season, reduces overuse injuries, and offers variety in conditioning. A macrocycle is the complete training period. The length of a macrocycle depends on the sport. For a seasonal sport, such as basketball, the macrocycle would be one year. However, for Olympic competition, the macrocycle spans a four-year period. Macrocycles are broken down into mesocycles, smaller units such as off-season, preseason, and in-season. The off-season is broken even further down depending on how far away the competitive season is. The goals and exercises of the off-season are then adjusted accordingly. The off-season starts with the transition period in which the athlete should perform recreational activities for their enjoyment to provide a mental and physical break from the stress of the season. Then endurance is achieved during the preparatory/hypertrophy phase, followed by the strength phase in which weight training focuses on sport-specific activities. During the preseason power is developed. During the competitive season the goals switch to maintenance of muscular strength and power already developed.

Describe plyometric exercises, why they are used, and safety precautions.

Plyometric exercises start with a quick, eccentric contraction followed immediately by a rapid, forceful concentric contraction. A box jump would be an example of a plyometric exercise. The athlete would quickly squat down prior to jumping, causing an eccentric contraction of the quadriceps muscle group. Then the athlete would jump up onto the box by quickly and powerfully producing a concentric contraction of the quadriceps muscle group. The speed of stretch during the eccentric phase is more important than the length of the stretch. Plyometric exercises are used to improve muscular power, which is a combination of muscular strength and speed. They can also develop eccentric control during activity, which can prevent injuries. Plyometric exercises strengthen the muscles in biomechanically correct ways, and they also strengthen the tendons and ligaments. To keep athletes safe while performing plyometric exercises, it is important to teach and monitor proper form and tailor the exercises to the age of the athlete and their level of ability.

Discuss the safety hazards associated with pollution.

Pollution can pose a considerable risk to the health of athletes. In many areas, especially urban or industrial, playing areas or fields are located in high traffic areas, increasing the risk of exposure to particulate matter (fumes and soot) from automobile exhaust. Additionally, in some areas ozone levels and pollen counts are of concern: Practices/games should be held after rush hour, usually in the late afternoon. Pollen counts and ozone levels should be checked daily and outdoor activities should be cancelled or delayed when appropriate. Exercises may be done in the early AM when it is cooler and ozone pollution levels ore lower, because heat combines with some compounds to produce ozone. Aerobic exercise, such as jogging, increases the use of mouth breathing and the intake of particulate matter and may require modification, movement to a less polluted area, or to an indoor facility.

Explain how prioritizing wellness for individuals and groups helps the athletic trainer.

Prioritizing wellness for individuals and groups helps the athletic trainer by promoting overall well-being for all involved parties and preventing a multitude of injuries and illnesses that may occur because of various aspects in the lives of the individuals. Promoting wellness goes beyond the field of play and athletic performance. It addresses and promotes healthy lifestyle behaviors in all aspects of the athlete's life such as good nutritional choices, stress management, getting adequate amounts of sleep, proper exercise, implementing safety practices, and avoidance of drugs, alcohol, and tobacco. Athletic trainers can use wellness screenings to monitor the wellness of individuals and groups and detect possible areas of concern. If an area of concern is noted, the athletic trainer can offer assistance either through referral, education, or encouragement depending on the type of wellness concern and the needs of the individual.

Describe proper hand hygiene and the proper way to remove gloves.

Proper hand hygiene is essential to preventing the spread of diseases and illnesses. To properly wash hands one must wet hands under running water, lather with soap being sure to scrub the back of the hands, between the fingers and under the fingernails. Hands should then be scrubbed together for at least twenty seconds, then rinsed under running water, and dried with a paper towel or air dried. Athletic trainers should wash their hands before and after caring for a patient with a wound, after treating each patient, and immediately after coming into contact with blood or bodily fluids. If it is not possible to wash hands right away, then an alcohol-based hand sanitizer should be used. To properly use hand sanitizer, apply the sanitizer to one hand and then rub both hands together until dry. Gloves protect the athletic trainer from possible exposure to bloodborne pathogens. The proper way to remove gloves is to take one glove off by turning it inside out. Once the first glove is removed, it is placed it in the gloved hand and the second glove is removed by turning it inside out. The ungloved hand must not touch the soiled surface of the glove. The gloves should then be thrown away and the athletic trainer should wash their hands immediately.

Explain how providing education about the appropriate use of personal equipment is beneficial to an athletic trainer.

Providing education about the appropriate use of personal equipment benefits the athletic trainer because this helps to prevent injuries due to misuse of equipment. If protective equipment is misused it can cause injuries to the athlete, their teammates, and their opponents. For example, educating football players on proper use of helmets can prevent serious injuries. Avoiding helmet-to-helmet contact and spearing can prevent concussions and cervical spine injuries. Explaining the proper use of protective padding such as shoulder pads and shin guards can ensure that athletes understand the intended protective use of the equipment and wear it properly to avoid injury. Educating softball and baseball athletes about the dangers of batting without a proper helmet will increase compliance of the use of protective gear. Providing education on the proper use of braces and other protective devices will ensure that the protective equipment is used properly to protect the patient's injured area and will prevent the patient from reinjuring the area or causing a new injury due to misuse of the equipment.

Discuss protective equipment for the feet.

Quality athletic shoes are made with proper cushioning and ankle support for specific types of sports activity, and guidelines about shoes should be provided to athletes. Additionally, athletes should be advised to wear the type of socks they will wear during the sports activity when fitting the shoes Additional supportive devices may be used as well: Insoles: These may be simple foam padding or rigid orthotics, which provide the best support. Arch supports: These are used to prevent pain in the arch or forefoot. Heel cups: One type of heel cup is firm plastic and essentially compresses fat in the heel to provide a cushion. Another type is padded and rubberized, compressing as the heel pushes downward and preventing the heel from contacting the shoe. Some padded heel cups have rubberized waffle-designs and others have cutouts (U-shaped) below the heel. Heel pads: These provide less support than heel cups but may relieve discomfort.

Explain the Strength of Recommendation Taxonomy (SORT) ratings and how they can be used determine the reliability of research.

Research of various qualities are available, so rating systems have been devised to help medical professionals more easily identify the quality of the research. The Strength of Recommendation Taxonomy (SORT) rating scale has been accepted for use by the NATA. The SORT rating scale evaluates research based on validity and the level of evidence the research provides. This scale gives grades of either A, B, or C to research. A SORT rating of an A means that the research is consistent, of good quality, and focuses on the needs of the patient. A rating of a B indicates research is inconsistent while still being focused on patient-outcomes. Finally, a rating of a C indicates that research is disease-oriented, based on expert opinion, or may be a case-study.

Discuss the dangers of Rohypnol, including symptoms tre and treatment.

Rohypnol ® (flunitrazepam) is a type of benzodiazepine, commonly referred to as the "date rape drug" or "roofie" because it causes anterograde amnesia. Rohypnol® is popular with teens and young adults and is often taken with alcohol, which potentiates its effects. Rohypnol® is a CNS depressant that causes muscle relaxation, slurs speech and reduces inhibitions. The effects occur within 20-30 minutes of ingestion but may persist for 8 to 12 hours. Repeated use can result in aggressiveness, and withdrawal may cause hallucinations and seizures. Overdoses cause hypotension, altered mental status, vomiting, hallucinations, dyspnea, and coma. Females are the most common victims, and may not remember the event except for a perception of lost time or physical discomfort. Diagnosis is by history and clinical examination. Treatment includes: Assessment for rape and STDS. Gastric emptying (less than 1 hour). Charcoal. Monitoring for CNS/respiratory depression. Supportive care. Counseling referral for rape.

Discuss the skinfold measurement component of the pre-participation examination.

Skin-fold measurement using special calipers is a way to estimate body fat and may be performed on the triceps, biceps, suprailiac, and- subscapular areas. For example, for the triceps skinfold thickness (TST) measure, the midpoint between the axilla and elbow of the non- dominant arm is measured, with the skin grasped between the thumb and index finger about 1 cm above the midpoint by grasping at the edges of the arm and moving the finger and thumb inward until a firm fold of tissue is observed. The calipers are placed around this fold at the midpoint (right below the fingers) and squeezed for 3 seconds, and then a measurement is taken to the nearest millimeter. Three readings are taken to achieve an average. The TST is a percentage of standard age- adjusted measurements for males and females: Males (Adult) TST 12.5 mm; Females (Adult) TST 16.5 mm. The actual measurement is divided by the standard measurement and multiplied by 100. Thus, if a male's TST measured 11.8: 11.8 12.5 0.944 x 100 =94.4%

Explain the uses of injury surveillance data and name organizations that report this data.

Sports injury data is collected by multiple organizations and athletic trainers can use this information for many purposes. Injury surveillance data can be used to recognize injury trends and compare the injury statistics of the athletic trainer's organization against national statistical norms. It can also be used to educate all stakeholders about the inherent risks in sports, and has been used to make rule changes to make sports safer. There are many organizations that collect injury data but the ones most frequently used are the National Safety Council, the NCAA Injury Surveillance System, the National High School Sport-Related Injury Surveillance Study, the Annual Survey of Football Injury Research, the National Center for Catastrophic Sports Injury Research, and the National Electronic Injury Surveillance System. Athletic trainers are the primary reporters of injury data for both the NCAA Injury Surveillance System and the National High School Sports-Related Injury Surveillance Data.

Discuss the general issues related to standard protective equipment.

Standard protective equipment must be provided to athletes to minimize the risk of injury or death. Studies have shown that athletes who participate in high- risk sports often underuse protective equipment and engage in other high-risk activities, such as drinking and using tobacco, so educating athletes about the importance of safety equipment is important. Often athletes, especially young adolescents, do not understand the need for safety equipment, or they complain that the equipment is uncomfortable, so clear explanations and proper fitting of equipment may improve compliance. Additionally, the Certified Athletic Trainer and the organization/institution must establish clear inflexible guidelines for the use of safety equipment, and then check to ensure that the equipment is in use. Information about the need for safety equipment should be provided to parents to enable them to better reinforce the safety guidelines. A wide variety of protective equipment is available; the choice of equipment depends on the athlete's size, skill level, physical maturation, strength, and the activity.

Discuss the dangers of syphilis for athletes.

Syphilis is caused by the spirochete Treponema pallidum and has increased in incidence over the last ten years, associated with risk- taking behavior such as drug use. There are 3 phases to the disease, with an incubation period of about 3 weeks: Primary: chancre (painless) in areas of sexual contact, persisting 3-6 weeks. Secondary: General flu-like symptoms (sore throat, fever, and headaches) and red papular rash on trunk, flexor surfaces, palms, and soles; lymphadenopathy occurs about 3-6 weeks after end of primary phase and eventually resolves. Tertiary (latent): Affects about 30% and includes CNS and cardiovascular symptoms 3-20 years after initial infection. Athletes with evidence of syphilis should be referred for diagnosis and treatment. Diagnosis is by dark-field microscopy (primary or secondary) or serologic testing. The CDC provides treatment protocol for different populations. Treatment includes: Primary, secondary, early tertiary: Benzathine penicillin G 104 million units IM in one dose. Tertiary: Benzathine penicillin G 2.4 million units IM weekly for 3 weeks.

Discuss standard protective equipment for the eyes.

The American Society for Testing and Materials (ASTM) sets the standards for eye protection for racquet sports as well non-racquet sports (like baseball, basketball, field hockey, and skiing) to reduce the risk of eye injury. Protective eye gear is intended to dissipate the force of impact from the eye/face to the skull without leading to intracranial injury and without interfering with the playing of the sport. Most eye protection is formed of polycarbonate plastic, which is very resistant to force. Lenses are 2mm for low-risk sports activities and 3-mm for higher risk activities. Eye protection can be made with prescription lenses if necessary. Protective eye gear must include both frames and lenses, and frames must meet impact-resistant standards. For some sports, such as hockey, a full-face cage of polycarbonate or wire is required. All athletes who have lost an eye should wear protective eye gear at all times.

Describe the NOCSAE certification, warning, and how the athletic trainer can use these to minimize the risk of injury.

The National Operating Committee on Standards for Athletic Equipment (NOCSAE) has developed safety standards that football helmets must meet for certification. Football helmets must be NOSCAE certified for use and helmets must have the NOCSAE warning label affixed. The warning states that helmets cannot prevent all head injuries or neck injuries and must not be used to spear or ram an opponent. Failure to heed this warning could result in serious injury, paralysis, or death. Each player should read this warning aloud and sign a form stating that they understand the warning. Athletic trainers should educate athletes, parents, and coaches on the risks for concussion that still exist even when wearing helmets. Education should also be provided on the proper use of football helmets that prevents head-down contact, spearing, and helmet-to-helmet collisions. With proper education, many serious and potentially life-threatening injuries can be prevented.

Discuss standard protective equipment for the head and face.

The National Operating Committee on Standards of Athletic Equipment (NOCSAE) researches and establishes standards regarding protective equipment. Protective equipment for the head and face is especially important to prevent serious injuries: While batting face guards are rarely used, they can prevent many facial injuries and should be recommended, especially for younger athletes. Mouth guards should be made of flexible material by a dentist to fit the individual's jaw and upper teeth, or fit-checked to make sure that they provide maximum protection and comfort. Helmets should fit snugly, so that they don't move if they are rotated, turned, or tilted. The helmet should be pressed down at the crown to check for fitting of the jaw pads and chin straps. Football helmets may be air/fluid-filled or padded. Flak jackets (padded vest-like snug protective gear) are intended to protect the thoracic area after rib injuries.

Describe the mechanism for catastrophic neck injuries in tackle football and list steps the athletic trainer must take to prevent these injuries.

The most common mechanism for catastrophic cervical spine injuries (CSIS) is axial loading to the head. This can occur in tackle football with head-down contact, when the athlete leads with the crown of the head. It is this improper and illegal technique that causes CSIS, not football equipment worn. Therefore, proper education and rule enforcement is essential to prevent CSIS. All athletes participating in football must be taught the catastrophic risks of head-down contact, be instructed on proper tackling techniques, and have ample time to practice correct tackling form. Athletes should be taught to make contact with their chest and shoulders, while keeping their heads up so they can see their opponents. All stakeholders should reinforce safety rules that prohibit head-down contact to include coaches, officials, athletic trainers, administrators, parents, and athletes.

List the normal pulse, respiration rate, blood pressure, and temperature for adults and children. Explain possible reasons for abnormal findings.

The normal pulse for adults is between 60 to 100 beats per minute and 80 to 100 for children. Athletes may have a slower pulse rate due to physical conditioning. A faint, fast pulse could signify shock, heat exhaustion, bleeding, or a diabetic coma. A hard, slow pulse could signify stroke or a skull fracture. The normal respiration rate for adults is between 12 to 20 breaths per minute and 15 to 30 for children. Shallow breathing could signify shock while coughing up blood signifies a chest injury such as a punctured lung. The normal resting blood pressure is below 120mm mercury (Hg) for the systolic blood pressure and below 80mm Hg for the diastolic blood pressure. Females generally have a lower blood pressure than males of 8-10mm Hg for both systolic and diastolic measurements. A low blood pressure could signify bleeding, shock, organ injury or a heart attack. The normal body temperature for both adults and children is between 98.2 and 98.6 degrees Fahrenheit. A rise in temperature could indicate an infection or a heat illness. A lowered body temperature could signify hypothermia.

The pre-participation examination consists of several different types of health examinations. List and briefly describe the purposes of each.

The pre-participation examination consists of the following components: Medical history: Contains questions about medical conditions, family history, and is used to recognize conditions that may predispose athletes to injury. The medical history should be completed prior to the physical and orthopedic screenings and with assistance of parents if the athlete is a minor. Physical examination: Consists of height, weight, body composition, pulse, and blood pressure. Cardiovascular screening: The physician reviews the medical history as related to the heart and listens for abnormal heart sounds using auscultation. Orthopedic screening: An examination used to recognize musculoskeletal conditions in which the patient performs movements as instructed by the examiner while the examiner observes the quality of movements. General medical screening: A physical screening performed by the physician to include examination of the eyes, ears, nose, throat, abdomen, lymph nodes and skin. A maturity assessment should be performed as well as a review of all medications and supplements. Wellness screening: Contains questions that assess healthy behaviors related to nutrition, alcohol, drugs, stress control, and safety measures the patient takes.

Describe how the pre-participation examination can be used to detect medical conditions that would disqualify an athlete from participation in sports, how a legal basis for sport disqualification is determined, and list some medical conditions that would disqualify an athlete from participation in contact sports.

The pre-participation examination screens athletes for potentially life- threatening conditions by asking pertinent medical questions and providing a thorough physical examination. Most conditions that warrant disqualification from sport participation should be identifiable during the pre-participation examination. The physician and organization have a legal basis to disqualify an athlete from participating in a sport if the decision to disqualify is specific to the patient, reasonable, and based on proficient medical evidence. This was determined by the case Knapp vs. Northwestern University. The Committee on Sports Medicine recommends disqualifying an athlete from participation in contact sports if they have one of the following medical conditions; atlantoaxial instability, cardiovascular carditis, an enlarged liver, poorly controlled compulsive disorder, and an enlarged spleen. There are many other medical conditions that could be disqualifying based on the specific history of the patient.

Discuss aerobic endurance training

The purpose of endurance training is to increase the production of energy to meet demands of athletic activities, such as running, swimming, and cycling. One of the goals of endurance training is to increase the maximal volume of oxygen uptake (VO2 max) and the lactate threshold. The VO2 max is primarily determined genetically, but with endurance training it can be increased about 20%. The lactate threshold level, at which aerobic activity becomes anaerobic and produces an abundance of lactate acid, is around 65% of maximum heart rate, but may be 80-90% in athletes: Aerobic endurance activities: Body's supply of oxygen and energy can keep pace with demands. Waste products are carbon dioxide (expelled through expiration) and water (expelled through sweating). Endurance activities may be short (2-8 minutes), medium (8-30 minutes), or long (30 minutes or longer). Exercises that increase aerobic endurance include continuous running (20-30 minutes) to increase oxygen uptake and interval training (three to five 10-minute periods with 2-3 minute rest intervals) to strengthen the heart muscle.

Describe the following types of heat-related illness: heat stress, heat exhaustion, and heat stroke.

There are 3 types of heat-related illness: Heat stress: Increased temperature causes dehydration. Athletes may develop swollen hands and feet, itchy skin, sunburn, heat syncope (pale moist skin, hypotension), and heat cramps. Treatment includes removing from heat, cooling, hydrating, and replacing sodium. Heat exhaustion: Involves water or sodium depletion; this condition is common in children and teenagers who are not acclimated to heat. Heat exhaustion can result in flu-like aching, nausea and vomiting, headaches, dizziness, and hypotension with cold clammy skin and diaphoresis. Temperature may be normal or elevated but less than 106°. Treatment to cool the body and replace sodium and fluids must be prompt in order to prevent heat stroke. Careful monitoring is important, as reactions may be delayed. Heat stroke: Involves failure of the thermoregulatory system with temperatures that may be greater.than 106°F; may result in seizures, neurological damage, multiple organ failures and death. Exertional heat stroke often occurs in young athletes who engage in strenuous activities in high heat. Treatment includes evaporative cooling, rehydration, and immediate emergency transfer.

Describe different eating disorders, how they can be recognized, and proper care for each.

There are eating disorders that the athletic trainer should cognizant of to provide proper care to patients. Bulimia nervosa is characterized by the consuming of extreme amounts of food in a very short amount of time after a period of self-starvation. After consumption, the individual then attempts to purge the calories consumed with self-induced vomiting, laxatives, or diuretics. This cycle goes on repeatedly and can cause damage to the stomach, heart, liver, teeth, throat, and mouth. All individuals with suspected eating disorders should be approached early on, empathetically, and referred to mental health professionals.

Describe behavioral risks involved with physical activity to include overtraining, nutrition, and substance abuse.

There are many behavioral risks athletic trainers must be aware of to provide the best available care to the physically active population. Overtraining can occur when the physiological and psychological stresses placed on an individual outweigh their coping mechanisms, which can lead to staleness and burnout. Athletic trainers should be aware of signs and symptoms of each and be able to offer referrals and coping mechanisms as needed. The nutritional needs of the physically active population must be met for patient safety and optimal performance. Athletic trainers must be aware of signs and symptoms of various eating disorders such as anorexia nervosa and refer patients as required. Athletic trainers must also be able to offer sound general nutritional advice as well as pre-game meal recommendations. Substance abuse is a concern athletic trainers must be aware of and be ready to provide immediate care and refer patients as required.

Explain how emotional stressors affect the risk of injury.

There are many emotional stressors that can increase athletes' risks for injury. Unrealistic expectations, worry, anger, discouragement, and frustration all lead to an increased state of negative stress, predisposing an athlete to injury. Negative stressors decrease focus, flexibility, coordination, and efficiency of movement patterns. Negative stress also increases muscle tension and activates the fight-or-flight response. Without appropriate coping mechanisms, negative stress can become a chronic condition. Athletic trainers can offer many techniques to help patients manage stress such as imagery, negative thought stoppage, and cognitive restructuring. Athletic trainers must also refer patients to psychologists and psychiatrists as needed.

Explain possible reasons to refer athletes for further evaluation following a pre-participation physical examination.

There are many possible reasons to refer an athlete for specialized care following a pre-participation physical examination. For example, patients with signs and symptoms of eating disorders should be referred to a mental health practitioner. Athletes with heart arrhythmias should be referred to a cardiologist. Athletes with body asymmetries or abnormalities that may lead to injuries should be referred to the appropriate healthcare provider who could work to correct the asymmetry. For example, athletes with flat feet or leg-length discrepancies could be referred to a podiatrist for orthotics. Athletes with a history of severe head traumas should be referred to a neurologist. Athletes who report symptoms of psychological concerns should be referred to a mental health provider.

Describe reasons to refer athletes for psychological concerns.

There are many psychological concerns athletic trainers should be aware of that require referral to mental health professionals for proper care. These include the following: Depression: Signs and symptoms include feelings of helplessness, alterations in eating and sleeping habits, and thoughts of hurting oneself. Paranoia: Individuals suffering from paranoia are extremely suspicious about certain things and over time develop bitterness and rage towards the object or person of their paranoia. Posttraumatic stress disorder: After a psychologically traumatic event such as abuse or surviving a life-threatening situation, some develop posttraumatic stress disorder. Individuals may relive the traumatic experience in nightmares or be easily startled. Eating disorders: There are various eating disorders such as bulimia nervosa, anorexia nervosa, and anorexia athletica. All evidence of eating disorders is reason for referral to a mental health provider. They have various signs and symptoms such as a distorted body image, purging one's food, starving oneself, and participating in overly excessive physical activity.

What cleanliness policies should be followed in the athletic training clinic?

There are many rules that should be enforced in the athletic training clinic to protect the clinic from unnecessary exposure to dirt and germs. No cleated shoes should be allowed in the clinic and shoes should not be allowed on treatment or exam tables. Sports equipment should not be brought into the clinic and athletes should shower before receiving treatments. Athletic trainers should work together with the custodial staff and équipment managers to ensure that all areas of the athletic environment are constantly maintained for cleanliness to prevent infection and injury. The athletic training clinic should be swept, sinks disinfected, and trash emptied daily. Athletic trainers should clean and disinfect treatment tables, hydrotherapy modalities, and equipment daily. Other areas that athletes are exposed to should be kept clean and sanitary as well as locker rooms, showers, water fountains, wrestling mats, and gear for practices and games.

Describe how to minimize the risk of lightning, altitude, and jet lag injuries and illnesses.

There are many steps the athletic trainer must take to ensure the safety of all participants and staff when there is a threat of lightning. An emergency action plan should be established that dictates how lightning will be monitored, who will monitor, and who makes the decision to suspend and' resume activity. Weather should be closely monitored with the National Weather Service, commercial lightning detection services, or lightning detectors. If thunder is heard, a lightning strike is seen, or weather-monitoring services report a lightning strike within 5.75 miles, activity should be stopped and not resumed until 30 minutes has passed since the last thunder, lightning strike, or reported strike within 5.75 miles. To prevent altitude sickness, acclimation to high altitudes should be achieved. The amount of time recommended for acclimation varies with some experts recommend 3 days, while others recommend 2 to 3 weeks. To prevent jet lag (circadian dysrhythmia), the participant should attempt to become adjusted to the new time zone before departing. They can do this by adjusting their sleeping, eating, and exercise schedules. Also, plenty of fluids should be consumed and alcohol should be avoided.

Describe common musculoskeletal risks involved with physical activity and steps the athletic trainer can take to prevent these.

There are many types of musculoskeletal risks involved with participation in physical activity and athletic trainers must be able not only to recognize and treat these injuries, but also work to prevent them. Muscle strains occur when a muscle is stretched forcefully beyond its anatomical limits, or contracts against a resistance that is beyond its capabilities. These forces result in excessive stretching and tearing of the muscle fibers. Ligament sprains occur when a force is placed on a joint beyond its anatomical limits, resulting in excessive stretching and tearing of the ligaments. Sprains and strains can be prevented in many ways. A proper warm-up should always be incorporated with physical activity, flexibility exercises should be performed, strength training should be included, and athletes should be offered education on proper body positioning to prevent strains and sprains.

Discuss tinea cruris (jock itch) and tinea pedis (athlete's foot), including symptoms and treatment.

Tinea cruris (jock itch) is a fungal infection of the perineal area, penis, inner thighs, and inguinal creases, but may also occur under breasts in women and beneath abdominal folds where skin is warm and moist. It rarely occurs before adolescence. Symptoms include: Scaly, itching, erythematous rash that may contain papules or vesicle and is usually bilateral and symmetrical. Treatment: Selenium sulfide shampoo wash of area before applying medication. Topical antifungal (clotrimazole, miconazole, tolnaftate, naftifine, terbinafine) 2 times daily for 4 weeks. Tinea pedis (athlete's foot) is a fungal infection of the feet and toes. It is rare before adolescence and more common in males. Symptoms include: • Severe itching with vesicles or erosion of instep and with peeling maceration and fissures between toes. • Dry, scaly, mildly erythematous patches on plantar and lateral foot surfaces. Treatment: • Same as tinea cruris.Keep feet dry with absorbent talc. • Allow feet to air dry and use 100% cotton socks, changed twice daily.

Discuss body planes.

Understanding the planes of the body is helpful when describing the motions and the body parts used by an athlete. Also, knowledge of body planes can help a trainer ensure that the athlete utilizes his or her body properly to avoid strain. The three major planes with examples are listed below: - Frontal (coronal): Divides the body or parts into anterior (front) and posterior (rear) sections: Arm during backstroke in swimming; - Transverse (horizontal): Divides the body or parts into superior (upper) and inferior (lower) sections: Bat swing in baseball, Movement of criterion arm in basketball jump shot, Movement of criterion arm in forehand drive in tennis; - Median (Mid-sagittal/ lateral): Divides the body or parts into right and left sections: Movement of criterion arm during serve in tennis, Pulling arms upward

Describe catastrophic risks involved in physical activity to include commotio cordis and exertional heatstroke.

Various catastrophic risks exist when participating in physical activity. The athletic trainer must be cognizant of all catastrophic risks, work to prevent them, and be prepared to provide immediate and appropriate care should a patient suffer from a catastrophic injury or illness. Commotio cordis is a catastrophic injury that can occur to apparently healthy individuals and, unfortunately, about half of patients who suffer from commotio cordis suffer immediate death. The mechanism of injury for commotio cordis is a blow to the chest that occurs at a specific point in the repolarization phase of the cardiac cycle, 15 to 30 milliseconds before the peak of the T wave occurs. Usually, this blow results in ventricular fibrillation, making immediate defibrillation and resuscitation essential to reduce mortality rates. Exertional heatstroke, caused by physical activity performed in a hot. environment, is a serious heat illness that can lead to death. Exertional heatstroke requires immediate and appropriate care to increase patients' chances of survival. The patient's body temperature becomes extremely elevated, inhibiting the body's thermoregulatory system. If a patient is suspected to be suffering from exertional heatstroke, they should be immersed in a cold-water bath immediately until their body temperature is lowered to 102 degrees Fahrenheit. Once their body temperature is lowered, they must be transported for immediate, advanced medical care.

Discuss the vision assessment component of the pre- participation examination.

Vision is particularly important to athletes, and a thorough vision assessment should be done to determine if there are any abnormalities or disorders of the eye. The examination should include: Test for visual acuity. Pupillary response to light and accommodation. Extraocular muscle motility assessment. Test of peripheral vision. Ophthalmoscopic examination of inner eye. Common refractive disorders of the eye include: Myopia: nearsightedness. Hyperopia: farsightedness. Astigmatism: Distortion of vision. Athletes with refractive disorders may require referral for corrective lenses, including contact lenses, which can be worn with protective goggles. Special sports contact lenses (both prescription and non- prescription) are now available and are used increasingly by athletes to block certain wavelengths and remove glare. These specialized lenses are intended primarily for outdoor use.

Discuss warm-up exercises

Warm-up exercises, performed for 15-30 minutes, should be the first part of any training exercise or participation in sports activities in order to increase circulation and muscle elasticity and prevent injury. Warm- up should begin slowly and then proceed systematically to involve all parts of the body. There are different types of warm-up activities: - Passive: for example, massage and warm showers; - General body-wide: for example, jogging; - Specific stretching motions: While it's important to stretch and warm-up all muscles, special attention should be paid to the muscles most used in the sports activity, such as swinging the arm and throwing a ball in preparation for pitching. Stretching should be bilateral, held 10-30 seconds, and static rather than ballistic. Warm-up activities often include a combination of exercise activities, such as slow running for 3-5 minutes to increase muscle circulation, 10 minutes of general stretching to improve muscle elasticity, and 10 minutes of specific pre-conditioning exercises for the particular sport. Athletes should be wearing proper clothing and footwear during warm- up exercises.

Discuss how commercial or custom-made running shoes can diminish the risk of injury.

Wearing improperly fitted or worn running shoes is a major cause of foot injuries. Running shoes should be constructed of breathable material with a soft but sturdy midsole, good forefoot flexibility, and a strong heel. Running shoes should be purchased from a reputable dealer who can advise the athlete. Most good quality running shoes support 350 to 550 miles of running, but shock absorption weakens with time, so shoes may need to be replaced before obvious wear occurs. Subtle changes in wear patterns may help to determine the need for a particular type of support, so the athlete should wear the old shoes so they can be examined when purchasing new ones. During the selection process, shoes should be worn for at least 10 minutes to ensure comfort, and some stores may allow the purchaser to do a trial run up and down the street if requested. New shoes should be broken in slowly (3-mile runs) and should never be worn in a marathon or other long race immediately after purchase.

Describe recommendations for healthy weight loss and weight gain.

Weight loss: For safe and effective weight loss, a combination of diet and exercise is recommended. Calories consumed may be reduced by 500 to 1,000 calories per day. However, females should consume at least 1,000- 1,200 calories per day and males should consume at least 1,200 to 1,400 calories per day. Exercises should be performed for 30 to 45 minutes, 3 to 5 days a week. Weight loss goals should be 1-2 pounds per week and focus on long-term lifestyle changes. Weight gain: The goal of a weight-gaining program is to increase lean muscle tissue, not body fat. This is achieved through an increase in muscle work with an increase in caloric intake. It is recommended to increase caloric consumption by 500-1,000 calories per day to gain 1 to 2 pounds of muscle tissue per week. Weight training must be included in the weight-gaining program, or the extra calories consumed will be stored as fat, not lean muscle tissue.

Discuss high-altitude sickness (Part I).

When ascending to high elevations, most people experience some degree of shortness of breath from the change in altitude. While air is still 21% oxygen, the atmospheric pressure is lower, so the oxygen molecules are further apart, so people take in less oxygen with each breath. There is a 17% decrease in oxygen at 5000 feet and a 31% decrease at 10,000 feet. Between 20 and 30% of the population develop a degree of high altitude sickness when ascending above 8000 feet, and 75% gets sick when above 14,000. Athletes training or competing at high altitudes must be aware of the dangers of high altitude sickness and preventive measures. There are 3 main types of high altitude sickness: Acute mountain sickness (AMS), which indicates failure to acclimatize; may be mild to severe and often presents with headache, lethargy, nausea, confusion, unsteady gait, and dyspnea. Occurs 6-24 hours after ascent. High-altitude cerebral edema (HACE), which can lead to acute neurological damage, causing seizures, coma, and death. High-altitude pulmonary edema (HAPE), which can lead to acute respiratory distress and death.

List and briefly describe five components that should be included in a risk management plan.

When developing a risk management plan, the athletic trainer must include the following five elements: Security issues: Security of the athletic training clinic must be maintained for many reasons, one of those being to protect the privacy of medical records. Only those who need access to the clinic should have keys to the facility. Athletic trainers and team physicians should have access to the facility and any others with access must be determined by the needs of the organization. Fire safety: A fire evacuation plan must be developed and posted in the athletic training clinic. Smoke alarms should be present and tested systematically to ensure proper function. Electrical equipment safety: Ground fault interrupters (GFIS) must be installed in areas where water and electricity are used together such as whirlpools, electrical stimulation, and moist heat packs. Malfunctioning electrical equipment should be removed immediately and electrical equipment must be inspected annually. Emergency action plan: A plan to properly manage emergency situations must be developed in collaboration with emergency responders working in the community. The emergency action plan should detail procedures for calling advanced medical care, transportation considerations for all facilities, and proper management of patients wearing athletic equipment. Crisis management plan: A plan to properly manage potential crises that originate from weather, public health, or acts of terror must be developed. Crisis management plans must detail action steps all personnel will take in the event of these emergencies.

Explain how ensuring safety by observing and acting in response to environment conditions benefits the athletic trainer.

When the athletic trainer ensures the'safety of all people involved in athletic events by monitoring and responding appropriately to environmental conditions, many injuries and illnesses are prevented, of which several are life threatening. The athletic trainer must be able to recognize various environmental conditions that pose threats to the physically active population and can readily offer safety recommendations to prevent those from occurring. There are many examples of environmental conditions that threaten the health and wellbeing of those exposed to these elements. For example, lightening poses great risk for catastrophic injuries and the athletic trainer must be prepared to immediately respond to protect all involved parties from risk of injury. Heat, especially when combined with high humidity, poses a risk for heat illnesses. Cold weather poses a risk for hypothermia, high altitude poses risks for multiple injuries and illnesses, and air pollution is another environmental condition that athletic trainers must be cognizant of and be ready to offer injury-preventing advice.