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ABSTRACT PRESENTATION 
 

 

1 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                        Volume 6 – Issue 3s – January 2024 

Southwest Athletic Trainers’ Association Free Communications 
Abstract Presentations  
 

The following abstracts were accepted and presented at the 68th Southwest Athletic Trainers’ Association (SWATA) 
Symposium, 2023.  
 

 
The Association of Vitamin D, Bone Mineral Density, and Injuries among Acrobatics and Tumbling 
Athletes 
Lee K, Gallucci A, Forsse J, Cherpe de Souza L, Irvin L, Boyer E, Funderburk L: Baylor University, Waco, TX  

Introduction: Acrobatics and Tumbling (A&T) is an emerging sport incorporating various elements of 
gymnastics and competitive cheerleading. Anecdotal evidence suggests that the sport presents with high 
injury rates potentially due to the high impact nature of the activity. Due to the potential aesthetic sport 
related concerns, bone mineral density and risk of injury presents a concern for patients, athletic trainers 
and stakeholders. Increased understanding of the relationship between bone mineral density, serum vitamin 
D status, and injury incidence in A&T may be useful to athletic trainers, registered dietitians, and others 
working with these athletes. The objective of this study was to evaluate the relationship between bone 
mineral density, serum vitamin D, and injury among A&T student athletes. Methods: Cohort Study at a 
NCAA Division I University Sponsored Athletic Department. Forty-two participants on the active A&T roster 
consented to participate. Average age was 19.69 ± 1.199 years. Positional composition: 19 tops, 23 
bases. Serum vitamin D was analyzed at two timepoints 8 weeks apart. Injury history data was collected 
between timepoints by team athletic trainer. Routine DXAs performed as standard of care. Outcome 
measures included serum vitamin D (ng/ml), injury incidence, and bone mineral density (femur, lumbar 
spine). Descriptive statistics were utilized in addition to t tests and ANOVAs to determine if significant 
differences existed in injuries based on bone mineral density, or athletic position (i.e., top, base). Poisson 
regressions were completed to analyze the relationship between bone mineral density and injuries. Results: 
Between week 1 and week 8, participants experienced a significant loss of vitamin D (6.093 ± 10.973, 
p<.001). Average bone mineral density Z score for the femur was 1.836 ± 0.842, and of the spine was 
1.952 ± 0.999. Bone mineral density of the spine was significantly greater in bases than tops, but no 
difference existed in the femur. There was no significant difference in injuries sustained based on bone 
mineral density of the femur or spine. Clinical Application: No significant differences were found in injuries 
related to differences in bone mineral density of the femur or lumbar spine. However, differences were 
found among bone mineral density by position group, with bases having higher bone mineral density in 
their spine than tops. This may be important due to the requirements of the base position compared to 
tops. Although a direct relationship between serum vitamin D and high average bone mineral density was 
not identified, significant decreases in serum vitamin D and high average bone mineral density in the 
sample may provide interesting insight for healthcare providers working with A&T. Athletic trainers, 
strength staff, and dietitians working with A&T should consider the impact of changes in serum vitamin D 
and activity when monitoring for factors related to injury. 

  



ABSTRACT PRESENTATION 
 

 

2 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                        Volume 6 – Issue 3s – January 2024 

Attitudes Toward Implicit Bias Among NCAA Medical Support Staff 
Warner BJ*, Jacobsen AP†‡, Decker M§, Cage SA?: *Grand Canyon University, †UT Health East Texas, 
‡The University of Texas Health Science Center at Tyler, §The University of Texas at Arlington, ?The 
University of Texas at Tyler 
 
Introduction: Implicit biases are unconscious attitudes, emotions, or stereotypes that have the potential to 
negatively affect behaviors, actions, and decisions. Recent research has shown that healthcare workers do 
not provide equitable care to patients from different demographics. When patients are receiving different 
levels of care, there is a potential for different patient-related outcomes. One of their first steps in many 
implicit bias interventions for healthcare professionals is identifying one’s implicit bias. The purpose of this 
study was to describe the attitudes toward implicit bias among non-athletic training healthcare 
professionals who provide care to collegiate student-athletes. Methods: An electronic survey was sent to 
every National Collegiate Athletic Association (NCAA) team physician, mental health care professional, 
and nutrition and dietetics professional whose email address was publicly available on their institution’s 
website (n = 623). A total of 116 (age = 40 ± 13 years, experience = 12 ± 11 years, 71 females, 45 
males, 33 team physicians, 27 mental healthcare professionals, 56 nutrition and dietetics professionals) 
participants opened and completed the survey for a response rate of 18.6%. Participants were asked to 
provide demographic information, including age, years of experience, gender identity, and race. 
Following the demographics section, participants completed questions taken from the Attitudes Toward 
Implicit Bias Instrument. Pearson’s correlations were used to determine relationships between age, years of 
experience, and attitudes toward implicit bias. Independent samples t-tests were performed to determine 
differences in attitudes toward implicit bias between races, gender identities, and professions with 
significance set at p < .05. Results: The majority of participants (n = 109, 94.0%) agreed that implicit 
biases have the potential to impact patient care, and need to be addressed during education and 
professional development. There were no significant correlations between age or years of experience with 
attitudes toward implicit bias. Females were significantly more likely to believe that implicit bias could 
impact patient care and needed to be addressed than males (t(114) = -3.068, p = .003). Participants 
from racial minorities were significantly more likely to believe that implicit bias could impact patient care 
and needed to be addressed than white participants (t(114) = -2.131, p = .035). Mental healthcare 
professionals were significantly more likely to believe that implicit bias could impact patient care and need 
to be addressed than team physicians (t(114) = -3.222, p = .002) or nutrition and dietetics professionals 
(t(114) = 3.017, p = .003). Clinical Application: Despite some differences between groups, the 
overwhelming majority of healthcare professionals agreed that implicit bias has the potential to impact 
patient care and needs to be addressed. These findings suggest that NCAA healthcare professionals may 
be receptive to interventions designed to identify and address implicit biases. 

  



ABSTRACT PRESENTATION 
 

 

3 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                        Volume 6 – Issue 3s – January 2024 

Does Pressure from Coaches Affect the Eating Habits of Male Collegiate Athletes?  
Bynum C*, Long M*: *Abilene Christian University 

Introduction: Research has shown that eating disorders tend to be most seen in females and athletes. The 
research on the prevalence of eating disorders in males is low compared to the research on females. This 
study examined male athletes at Abilene Christian University and determine if the pressure about weight 
from coaches and teammates could influence the eating habits of these athletes. The purpose of this study 
is to determine if pressure about weight from coaches or teammates affected eating habits of male 
collegiate athletes at a NCAA Division 1 institution. Methods: This study employed a cross-sectional survey 
design. Participants included NCAA division I male student-athletes. The survey was sent out electronically 
to the participants via school email. The survey includes informed consent, demographic information (age, 
school classification, and ethnicity), and the questions from the Weight Pressures in Sports Scale in Male 
Athletes survey. A higher score for a question indicated that there are more weight-related pressures for 
that topic. This scale had instructions for how to calculate the total score for the different subscales. There 
was a total score, the coach/teammates subscale, and the appearance subscale. Results: The score for the 
coach/teammate pressures subscale was 4.09 out of 6, the score for the appearance pressure subscale 
was 2.55 out of 6, and the total score with all the questions was a 3.32 out of 6. It was found that over 
half of the total score came from the coach/teammate pressure on the players. It was also shown that 
there was a higher score from the coach/teammate pressures compared to the appearance pressures. In 
each of the subscales, the coach /teammate subscale (α =0.87) and the appearance subscale (α = 0.84) 
included seven questions, so the total scale was made up of all 14 questions (α = 0.90). Each question was 
scored on a six-point Likert scale that ranges from 1 (Never) to 6 (Always). The total score was determined 
by adding up the scores for each question and then averaging that number by dividing it by 14. Each 
subscale was totaled and divided by seven. The dependent variables were the coach/teammate subscale 
and the appearance subscale. Translation to Practice: The results indicate that the pressure from coaches 
can have an influence on their athletes' eating habits. While this can be an awkward topic, it is an 
important topic, especially for athletic trainers to keep in mind when working with athletes. When working 
with athletes on the daily, athletic trainers should make sure to check in with athletes who could possibly be 
struggling with disordered eating. Knowing the signs and symptoms of disordered eating can lead to 
earlier interventions for student-athletes. 

  



ABSTRACT PRESENTATION 
 

 

4 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                        Volume 6 – Issue 3s – January 2024 

Knowledge of and Attitudes Toward Native American and First Nations People Among NCAA 
Division I Athletic Trainers 
Trail LE*†, Warner LK‡, Warner BJ§, Decker M?, Cage SA* : *The University of Texas at Tyler, †UT Health 
East Texas, ‡Creighton University, §Grand Canyon University, ?The University of Texas at Arlington 
 

Introduction: Current literature shows that Native Americans people experience more health care 
disparities relative to other ethnic and racial groups. Previous research has also shown that these 
healthcare disparities are present in pediatric and young adult Native American populations. As 
healthcare professionals who will potentially treat these populations, it is important to understand the 
knowledge of and attitudes toward Native Americans people among athletic trainers. The purpose of this 
pilot study was to describe the knowledge of, and attitudes and opinions of National Collegiate Athletics 
Association (NCAA) Division I athletic trainers toward Native Americans. Methods: An electronic survey 
(Table 1) was sent to every NCAA Division I athletic trainer whose email address was publicly available on 
their institution’s website (n = 3,016). A total of 253 (age = 34 ± 11 years, experience = 11 ± 10 years, 
61 females, 42 males, 1 non-binary) athletic trainers opened and completed the survey. Questions asked 
participants to provide demographic information, including age, years of experience, gender identity, 
race, and ethnicity. Participants also completed questions related to comfort providing equitable care for 
Native American patients, attitudes toward Native Americans and knowledge of contemporary, historical, 
and sports medicine issues specific to Native Americans. Pearson’s correlations were used to determine 
relationships between age, years of experience, attitudes toward Native Americans, and knowledge of 
contemporary, historical, and sports medicine issues specific to Native Americans with significance set at p 
< .05. Results: The majority of participants reported generally favorable attitudes toward Native 
Americans. There were significant, very weak negative correlations found between attitudes toward Native 
Americans and age (r(251) = -.258, p < .001) and years of experience (r(251) = -.223, p < .001).  
There were also significant, very weak positive correlations found between knowledge of Native American 
sports medicine issues and age (r(251) = .275, p < .001) and years of experience (r(251) = .277, p < 
.001). When asked about providing equitable care for Native American patients, 94.4% (n = 239) 
participants expressed some level of comfort with providing equitable care. However, participants had 
mean scores of 26.4% for knowledge of contemporary Native American issues, 33.4% for knowledge of 
historical Native American issues, and 64.6% for knowledge of sports medicine Native American issues. 
Clinical Applications: While the majority of participants expressed generally favorable attitudes toward 
Native Americans people, there appears to be a gap between attitudes and knowledge of issues facing 
Native American patients. Professional masters in athletic training curricula and continuing education 
offerings should provide information about providing equitable healthcare for Native American patients. 

Table 1: Knowledge of and Attitudes Toward Native Americans Scale 
Attitudes 

Prompt Answer Choices 
1. Native Americans tend to live in a way 

that is in tune with nature (e.g., live off the 
land, hunt for food, etc.) more than other 
Americans* 

2. Native Americans hold on to their 
traditions more than they should in this 
day and age.* 

3. Native Americans tend to treat others with 
kindness. 

4. Native Americans tend to work harder 
than most other racial groups. 

5. Native Americans tend to be more 
spiritual than other social groups. 

a) Strongly Disagree 
b) Disagree 
c) Somewhat Disagree 
d) Somewhat Agree 
e) Agree 
f) Strongly Agree 



ABSTRACT PRESENTATION 
 

 

5 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                        Volume 6 – Issue 3s – January 2024 

6. Native Americans tend to be more cliquey 
than other minority groups.* 

7. Native Americans have been treated 
poorly given their inherent worth as 
humans. 

8. Native Americans should have more rights 
than they currently do given their status as 
the original Americans. 

9. Using a Native American as a mascot is 
acceptable with permission from the 
associated tribe. 

10. Using a Native American as a mascot is 
acceptable without permission from the 
associated tribe.* 

Contemporary Issues (Correct Answers bolded) 
What percentage of the United States population 
is Native American? 

a) 0.5% 
b) 0.9% 
c) 1.2% 
d) 1.5% 

How many Federally recognized Native American 
Tribes are in the United States? 

a) 574 
b) 484 
c) 267 
d) 654 

Which of the following tribes does NOT have a 
federally recognized reservation in the state of 
Texas? 

a) Apache 
b) Tigua 
c) Kickapoo 
d) Alabama-Coushatta 

How many Native Americans/Native Hawaiians 
were elected to the United States House of 
Representatives in 2020? 

a) 1 
b) 8 
c) 6 
d) 4 

How many Native American Tribes have treaty 
rights to send non-voting delegates to the United 
States Congress? 

a) 2 
b) 4 
c) 6 
d) 7 

Historical Issues (Correct answers bolded) 
Which of the following tribes is not part of the 
Plains culture? 

a) Crow 
b) Blackfeet 
c) Hopi 
d) Comanche 

Which of the following was not a primary crop 
grown by sedentary farming tribes in the 
Southwest culture? 

a) Corn 
b) Carrots 
c) Beans 
d) Squash 

What housing structure was primarily used by the 
Navajo tribe? 

a) Teepee 
b) Wigwam 
c) Pueblo 
d) Hogan 

Before European contact, which region of the 
United States had the largest population? 

a) Modern-Day California 
b) Modern-Day Texas 
c) Modern-Day Florida 
d) Modern-Day New York 



ABSTRACT PRESENTATION 
 

 

6 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                        Volume 6 – Issue 3s – January 2024 

The ancestors of Native Americans are thought to 
have arrived in North America over _____ years 
ago. 

a) 6,000 
b) 1,000 
c) 12,000 
d) 10,000 

Sports Medicine Issues (Correct answers bolded) 
True or False: All Native American tribes require 
consent from a medicine man for a sports medicine 
professional to provide care. 

a) True 
b) False 

Which of the following Native American tribes 
generally does not allow blood transfusions? 

a) Navajo 
b) Hopi 
c) Mohawk 
d) Seminole 

What percentage of Native Americans people use 
peyote for spiritual and medicinal purposes in 
modern society? 

a) 10% 
b) 20% 
c) 30% 
d) 40% 

Which of these sports was invented by Native 
American? 

a) Football 
b) Lacrosse 
c) Golf 
d) Tennis 

Which Native American Olympian won the 
decathlon and pentathlon in 1912? 

a) Billy Mills 
b) Jesse Rinick 
c) Jim Thorpe 
d) Andrew Sockalexis 

 

 

 

 

  



ABSTRACT PRESENTATION 
 

 

7 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                        Volume 6 – Issue 3s – January 2024 

The Effects of Dry Cupping Therapy on Touch Pressure Threshold in Collegiate Baseball Players. 
Cage SA*, Peebles RL†‡, Volpi JD†‡, Trail LE*†, Warner BJ§: The University of Texas at Tyler, †UT Health 
East Texas, ‡University of Texas Health Science Center at Tyler, §Grand Canyon University 
 

Introduction: Cupping therapy is a therapeutic modality that uses negative pressures to achieve therapeutic 
benefits. Various published studies report that cupping therapy decreases pain, increases range of motion, 
and improves blood flow. Previous studies also report an effect on tissue tenderness. However, there do 
not appear to be any studies assessing the effects of cupping therapy on touch pressure threshold, which 
measures skin sensitivity. Changes in touch pressure threshold may provide more information on the 
neurological effect cupping therapy has on treated tissues. The purpose of this study was to compare the 
effects of cupping therapy on touch pressure threshold with a control condition in collegiate baseball 
players. Methods: We recruited and consented ten apparently healthy college baseball players (21.50 ± 
1.18 yrs, 185.93 ± 6.21 cm, 89.16 ± 7.23 kg). Subjects received treatment on the left side of their lower 
back while the right side of their lower back served as the control and received no treatment. Touch 
pressure threshold, in grams of force measured by Semmes-Weinstein Monofilaments, was the primary 
outcome measure. Measurements were taken three times on the left side followed by three times on the 
right. The treatment site was prepared by applying coconut oil to the skin. One plastic pneumatic cup was 
applied to the left side, placed 5-cm lateral to the spinous process of the L4 vertebra. Two pumps of air 
were withdrawn from the cup, and the cup was left in place for 20 minutes. Following removal of the cup, 
touch pressure thresholds were taken for both sides again. A paired samples t-test was performed to 
determine if cupping therapy had a significant effect on touch pressure threshold, and an independent 
samples t-test was performed to determine differences in changes between the treatment site and control 
site, with significance set at p < .05. Results: Within group measures for touch pressure threshold produced 
significant increases post cupping therapy treatment (3.06 ± 0.50 to 3.73 ± 0.58 , p < .01). When 
compared with the control, cupping therapy resulted in a significant increase in touch pressure threshold 
(F(1,19)=10.902, p < .01). Clinical Application: Cupping therapy applied for 20 minutes to the lower 
back appears to increase touch pressure threshold. This suggests that cupping therapy may influence 
cutaneous sensory nerves, in addition to the previously reported effects on treated tissues. Further studies 
should be conducted to confirm the effect of cupping therapy touch pressure threshold. Clinicians should use 
discretion when selecting a therapeutic modality if attempting to increase skin sensitivity. 

  



ABSTRACT PRESENTATION 
 

 

8 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                        Volume 6 – Issue 3s – January 2024 

Acute Management of an Abdominal Cavity Perforation in a Collegiate Baseball Pitcher: A Case 
Report. 
Gallegos DM*†, Jacobsen AP†‡, Galbraith RM†‡, Peebles RL†‡, Warner BJ§, Cage SA*:  
*The University of Texas at Tyler, †UT Health East Texas, ‡University of Texas Health Science Center, 
§Grand Canyon University 
 
Background: A 21-year-old male collegiate baseball player was performing warm up exercises when he 
tripped backwards onto one of the team’s pitching machines that had been laid on its side. Upon falling 
backward, the patient sustained a puncture wound through the left buttock from one of the machine’s 
handles. Unaware of the injury, the patient’s teammates lifted him off of the machine and retrieved the 
athletic trainer. Evaluation revealed a deep wound with visible adipose tissue and musculature. At this time, 
the patient was immediately transported to the emergency department of the local hospital, and team 
physicians were informed to alert the hospital of the patient’s impending arrival. Differential Diagnosis: 
Puncture wound of the left buttock, abdominal organ injury, anal laceration. Treatment: Upon arrival at the 
hospital the patient was admitted for evaluation. Initial inspection of the wound revealed the anal sphincter 
was intact. A CT scan was ordered due to the possibility of perforation of the abdominal cavity. The CT 
scan revealed that the handle of the pitching machine had perforated the patient’s abdominal cavity to a 
depth of 14 cm. The handle traveled through the sciatic notch of the pelvis, anterior to the bowel and 
posterior to the bladder. During the penetration and subsequent removal, the handle did not come in 
contact with any blood vessels or nerves. While the CT scan showed evidence of the handle making contact 
with the bladder, the bladder was intact. The wound was then flushed and debrided, and closed with eight 
sutures. The patient was administered intravenous antibiotics while in the hospital. After performing a 
bowel movement and urinating, the patient was discharged the same day of admittance with a 
prescription for oral amoxicillin and hydrocodone. Two days following the injury, the patient was 
evaluated by the team physician in clinic. Evaluation found the wound to be healing well with no signs of 
infection. The team physician and athletic trainer reiterated the need to monitor for signs of infection, and 
reinforced the need to report any blood with bowel movements or urination. Seven days post injury, the 
patient was re-evaluated by the trauma surgeon who had treated him in the hospital. The wound was 
continuing to heal well, and the patient was instructed to return at 14 days for suture removal. After the 
sutures were removed, the patient was allowed to begin progressing into light physical activity consisting 
of resistance band training and light throwing. 28 days post injury, the patient returned to full team 
activities, including full intensity practice and weight lifting. Throughout the healing process, the patient 
experienced constipation no complications in the form of infection or issues with urination. Uniqueness: The 
nature in which the patient was injured does not fit with a typical mechanism of injury found in sport. 
Additionally, given the location of the injury the lack of neurovascular or organ damage is noteworthy. 
Lastly, the patient did not require pelvic floor therapy to return to activity even though the handle of the 
pitching machine damaged the muscle wall of the abdomen.  Conclusions: When caring for an acute 
traumatic injury, timely and appropriate referral is paramount to ensuring optimal patient outcomes. 
Emergency action plans should incorporate a chain of communication that includes the team physician in 
order to make sure that proper healthcare professionals are informed prior to the arrival of a patient. 
Evaluation and reevaluation of healing injuries is critical to ensuring timely referral to therapy specialists if 
needed. 

  



ABSTRACT PRESENTATION 
 

 

9 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                        Volume 6 – Issue 3s – January 2024 

The Impact of Bracing on Kinesiophobia and Recovery in ACL Reconstruction Patients: A Case Study 
Valdecanas N*†, Neelon K*, Braunreiter K*†: *Houston Methodist Sugar Land Orthopedics & Sports 
Medicine Sugar Land, TX, †FBISD Stephen F. Austin High School Richmond, TX 
 

Introduction: With 100,000 to 200,000 cases reported in the U.S. yearly, the anterior cruciate ligament 
(ACL) is a commonly torn structure in the knee among contact and non-contact sports. As medical research 
on ACL injuries grows, ACL reconstruction (ACLR) continues to be the preferred surgical intervention. Due to 
extensive rehabilitation timeline requirements,  ACLR patients may face physical and psychosocial 
circumstances affecting their overall recovery. At any point in rehabilitation the patient may experience 
kinesiophobia, or an irrational fear relating to further injury from participation in physical movement, 
especially with return to running, jumping, and sports-specific programs. Functional bracing has been an 
option for intervention to decrease fears of buckling and instability. However, they are argued to foster 
reliance, creating muscle atrophy and decreased knee extension velocity. As best evidence based practice 
develops on ACLR patients and effective interventions, functional bracing is currently challenged as an 
assistance or hindrance to overall recovery. Patient Information: Athlete is a 16-year-old softball catcher 
who underwent isolated bone patellar tendon bone ACL reconstruction in June 2022. She not only 
experienced the physical complications of recovery, but also faced ongoing psychosocial factors from 
early to late stages of her rehabilitation. From fears of engaging in physical activity without her brace to 
the financial burdens of the equipment, the athlete poses a significant case regarding bracing use and 
kinesiophobia levels. Interventions: Post-surgery, the athlete was taken through a standard rehabilitation 
protocol focusing initially on extension mobilization and quadriceps activation with progressions. She 
received clearance from her physician to run and jump at 4 months and to begin softball-specific activity 
at 6 months. Her physician instructed her to use the functional brace for running, jumping, and softball 
activity during the first season of play. At months 4, 6, and 10, the athlete completed hop testing and ACL-
RSI measurements to track her progress in return to sport. To gradually prepare the athlete for softball 
catching, a deep knee flexion squat was also used to gauge her symptoms and abilities with therapeutic 
interventions. Outcomes: While the athlete successfully returned to sport for softball hitting and as first 
baseman after 6-7 months, she continued to report psychosocial uncertainties that affected her 
performance. At 4 months, her baseline ACL-RSI was 44.2%. With each re-evaluation, this score slowly 
progressed to 64.2% at 6 months and 82.5% at 10 months. Additionally, her overall hop test outcome that 
allowed return to sport at 6 months was 91.6%. However, this score was achieved with her brace. The 
athletic trainer noted the athlete’s kinesiophobia with non-braced activity, so she was slowly weaned from 
functional brace outside of softball participation. At 10 months, hop testing was performed again without 
her brace with an overall score of 80%. Clinical Bottom Line: Functional bracing usage has been highly 
debated in ACL reconstruction patients. While clinical practice has shifted away from using them, some 
clinicians and patients may prefer to use them in reintroduction of sports activity. Although functional 
braces have shown to be disadvantageous in patient’s progressive tissue loading, comfortability, finances, 
and self-efficacy with long-term use, it is appreciable to consider the proprioceptive effects the external 
support may give patients with higher kinesiophobia levels when reintroducing running, jumping, and other 
sports activity. In doing so, the patients may address psychological hesitancies and build confidence in 
physical movements. However, it is crucial that if a functional brace is incorporated into therapeutic 
intervention, the rehabilitation team must work to wean the patient out of the brace to aid appropriate 
strength, neuromuscular control, and self-confidence in his or her abilities apart from the brace. 

Use of Blood Flow Restriction Training with a Collegiate Baseball Player Following Hook of the 
Hamate Excision 



ABSTRACT PRESENTATION 
 

 

10 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                        Volume 6 – Issue 3s – January 2024 

Goza JP*, Galbraith RM†‡, Jacobsen AP†‡, Warner BJ§, Cage SA?:  
*Collin College, †UT Health East Texas, ‡University of Texas Health Science Center, §Grand Canyon 
University, ?The University of Texas at Tyler 
 
Background: A 21-year-old male collegiate baseball player underwent successful excision of the hook of 
hamate of the left hand. Following two weeks in a padded splint to allow for appropriate scar healing, 
the patient’s sutures were removed and rehabilitation was initiated. Initial rehabilitation consisted of 
passive range of motion exercises progressing to active range of motion exercises. After one week of 
range of motion exercises and improvement of range of motion, resistance training with blood flow 
restriction was initiated. Differential Diagnosis: Hook of the hamate excision. Treatment: Week 3: Prior to 
beginning resistance training with blood flow restriction, grip strength was assessed using a handheld 
dynamometer. The average of the patient’s three trials for his surgery hand was 60.6 pounds. The 
average for the non-surgery hand was 145.8 pounds. The average Resistance exercised consisted of 
theraputty gripping, resisted pronation and supination, and resisted wrist flexion and extension. All 
exercises were performed with 50% blood flow restriction for one set of 30 repetitions followed by three 
sets of 15 repetitions with 30 second breaks between repetitions and 60 second breaks between 
exercises. Exercises were performed five days during the week. Week 4: The average of the patient’s 
grip strength trials for his surgery hand was 82.4 pounds, and 144.5 pounds for his non-surgery hand. 
Level of resistance for exercises was increased to tolerance with sets, repetitions and frequency remaining 
the same. Week 5: The average of the patient’s grip strength trials for his surgery hand was 121.4 
pounds, and 145.6 pounds for his non-surgery hand. Level of resistance for exercises was increased again, 
and the patient began sport specific activities including hitting and catching. Given the increase in sport 
specific activity, resistance training frequency was decreased to three times during the week. Week 6: The 
average of the patient’s grip strength trials for his surgery hand was 130.8 pounds, and 145.2 pounds for 
his non-surgery hand. The patient returned to full participation in team activities, with a plan to continue 
therapeutic exercises three times a week. Uniqueness: While the patient’s return to play following hamate 
excision was consistent with current literature, recent data has suggested that patients undergoing hook of 
the hamate excision experience a reduction in grip strength post-surgery. In this case, the patient improved 
his grip strength by 115.8% within four weeks of splint and suture removal. This case provides an example 
of a successful therapeutic exercise protocol for increasing grip strength using blood flow restriction 
following hook of the hamate excision. Conclusions: When developing a therapeutic exercise protocol for a 
patient after injury or surgery, it is important to explore all possible options to ensure optimal patient 
outcomes. As this report describes only one hook of the hamate excision patient’s outcomes following 
therapeutic exercise with blood flow restriction, larger scale studies are necessary to provide more 
generalizable recommendations. 

  



ABSTRACT PRESENTATION 
 

 

11 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                        Volume 6 – Issue 3s – January 2024 

Hook of the Hamate Fracture in a Collegiate Baseball Player Preceded by a Hamate Stress Fracture 
Parker HN*†, Galbraith RM†‡, Jacobsen AP†‡, Hodges C†, Warner BJ§, Cage SA*:  
*The University of Texas at Tyler, †UT Health East Texas, ‡University of Texas Health Science Center, 
§Grand Canyon University 
 
Background: A 21-year-old male collegiate baseball player reported to the athletic training staff 
complaining of pain along the hypothenar eminence of the left hand. The patient’s pain was intensified 
when swinging a bat but remained constant even at rest. The patient reported symptoms beginning 
approximately three weeks prior to being evaluated by the athletic training staff, but delaying reporting 
symptoms in order to continue playing. Physical exam revealed tenderness over the hook of the hamate 
and hypothenar eminence, decreased active wrist extension, decreased grip strength, and pain with 
resisted pronation and supination. At this time, the patient was removed from activities involving gripping 
or putting axial force on the wrist and referred to the team physicians. Differential Diagnosis: Hook of the 
hamate fracture, triangular fibrocartilage complex injury, wrist flexor tendinopathy. Treatment: Day 2: 
Initial exam by the team physician furthered the suspicion that the patient may have experienced a hook 
of the hamate fracture. X-rays were ordered for further evaluation, including a carpal tunnel view to 
evaluate the hook of the hamate. X-rays did not reveal a fracture, leading to the physician placing the 
patient in a volar wrist brace for two-weeks based on the tentative diagnosis of a hook of the hamate 
stress reaction. Day 16: Upon discontinuing the volar wrist brace, the patient attempted to return to 
activities, but experienced a similar magnitude of symptoms. At this time, the decision was made to obtain 
an MRI to evaluate the patient’s hand further. Day 18: Upon receiving the results of the patient’s MRI, it 
was determined that the patient had suffered a hook of the hamate fracture. The MRI also revealed that 
the patient was suffering from a stress fracture of the hamate bone. The patient was then referred to an 
orthopedic hand surgeon for consultation. Due to the nature of the patient’s health insurance, he was forced 
to return to his home state for his consultation. Day 28: Upon physical exam and review of the MRI 
findings, the orthopedic surgeon suspected the patient had been predisposed to the hook of the hamate 
fracture due to the stress fracture in the hamate. The patient was consented for surgery, with the goal of 
excising the fractured portion of the hamate. Day 29: The patient underwent successful surgery to excise 
the fractured portion of the hook of the hamate, and was discharged with instructions to follow up with the 
athletic training staff and team physician upon returning to his institution. Uniqueness: The nature in which 
the patient was injured is typical of hook of the hamate fractures in baseball players. However, the 
presence of a stress fracture of the body of the hamate bone is an uncommon predisposition to a hook of 
the hamate fracture. Stress fractures of the body of the hamate are not well described in the literature, 
making it an unlikely consideration when forming a differential diagnosis. Furthermore, the patient’s health 
insurance status made timely diagnosis and treatment difficult. Conclusions: When caring for a traumatic 
injury, early diagnosis is often critical to optimal patient outcomes. In the event a clinician is caring for a 
patient with restrictive health insurance, patient education on the potential ramifications of maintaining such 
an insurance plan is crucial. Should a patient with a restrictive insurance plan suffer an injury warranting 
advanced diagnostic testing and therapeutics, clinicians must work to expedite access to care as quickly as 
possible. 

  



ABSTRACT PRESENTATION 
 

 

12 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                        Volume 6 – Issue 3s – January 2024 

Twelfth Rib Avulsion Fracture in a Collegiate Baseball Pitcher: a Case Report. 
Warner LK*, Jacobsen AP†‡, Galbraith RM†‡, Hodges C†, Warner BJ§, Cage SA?:  
*Creighton University, †UT Health East Texas, ‡University of Texas Health Science Center, §Grand Canyon 
University, ?The University of Texas at Tyler 
 
Background: A 21-year-old male collegiate baseball player reported to the athletic training staff after 
experiencing acute pain in his left side following throwing a pitch. The patient experienced immediate 
difficulty with active lateral flexion and trunk rotation. Palpation revealed spasm and tenderness along the 
internal and external oblique muscle. The patient reported having subluxed a rib on a previous occasion. 
While the pain experienced was similar, the patient stated that there was more pain along the muscle 
bellies of the internal and external oblique muscles compared to the previous injury. No difficulties with 
breathing, bowel movements, or urination were reported. Differential Diagnosis: Oblique strain, subluxated 
rib, intercostal cartilage irritation. Treatment: At the time of the initial evaluation, the patient was 
diagnosed with a strained oblique. The patient was instructed to avoid vigorous physical activity, throwing, 
deep stretching, and any other painful activities until symptoms began to improve. The patient began a 
rehabilitation program centered around core and hip strengthening. Treatment was initiated using cupping 
therapy and electrical stimulation Following a week of relative rest and rehabilitation, the patient 
reported no improvement in pain or range of motion. At this time, the patient was referred to the team 
physician for diagnostic ultrasound. Musculoskeletal ultrasound revealed edema consistent with a high-
grade external oblique strain. Given the amount of edema the patient had, the physician opted to 
postpone an MRI until edema had begun to resolve. Ten days after the previous evaluation, the patient 
was seen again in clinic to be consented for an MRI. A second musculoskeletal ultrasound was performed, 
revealing a cortical disruption at the 12th rib. Given the new finding, the physician ordered a CT scan for 
further evaluation. The CT scan confirmed an avulsion fracture of the distal aspect of the 12th rib as a 
result of the previous oblique strain. These findings provided context for the patient’s delay in decreased 
symptoms and healing. The patient continued relative rest and combined with treatment and rehabilitation 
for the following four weeks, at which point the fracture was confirmed to have healed. At this time, the 
patient began a return to throwing protocol, and was able to return to full activity with no complications. 
Uniqueness: While avulsion fractures of the ribs have been previously reported in athletic populations, 
there appear to be no documented cases of an avulsion of the 12th rib. Additionally, previous documented 
injuries have primarily involved the serratus anterior avulsing seventh through ninth ribs. Conclusions: When 
providing care, clinicians must consider all patient reported signs and symptoms. In the event that a 
patient’s symptoms do not follow an anticipated progression, clinicians should use all available resources to 
obtain a diagnosis. Evaluation and re-evaluation of patient progress is critical to ensure optimal outcomes 
following injury. 

  



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13 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                        Volume 6 – Issue 3s – January 2024 

Slowing it Down: The Impact of a Core Stabilization Program of Hypermobile Sprinters 
Spears, T* †, Gonzalez-Pons J †, Debose J †: *Houston Methodist Sugarland Orthopedics & Sports 
Medicine Sugarland, Tx, † Fort Bend George Bush High School Richmond, TX 
 
Background: Low back pain (LBP) is a common complaint in sprinters, and it can present itself in many 
ways. One study published in 2019 surveyed 2539 runners; 22.6% of them reported LBP of some kind at 
least once within that year.5 LBP can occur in sprinters for many reasons. One study noted that muscle 
weakness, imbalance, and improper recruitment of hip and/or core musculature are a few sources of LBP 
in athletes.4 The aim of this study is to examine the effectiveness of a core stabilization program on 
athletes suffering from lumbar facet hypermobility. Differential Diagnosis: Conditions that are typically 
prevalent in sprinters include but are not limited to: hypomobility, hypermobility, disc herniations, and 
spondylosis. Treatment: Lumbar hypermobility was the final diagnosis based on the patient’s presentation 
and characteristics. For the plan of care, stabilization exercises while incorporating sport-specific activities, 
manual therapy and patient education were initiated. Evidence suggests that this program along with 
proper manual therapy techniques should begin to improve the patient’s symptoms over time.2 The manual 
therapy techniques included and were L3 segment gapping maneuver, paraspinal stripping, and a psoas 
release. Manual therapy was to continue as needed throughout the patients’ rehab. Uniqueness: Patient is 
a 17-year-old male, 200-meter sprinter who showed up in the athletic training room with complaints of 
LBP that began after doing squats in the weight room at 165 lbs the previous day. Patient complained of 
unilateral pain (7/10) left lower back that had gotten worse after sitting in class all day and reported 
being unable to participate in sprinting/jumping activities. Patient demonstrated reproduction of symptoms 
with end range extension, left posterior quadrant test, palpation of L4 segment, and with prolonged static 
postures. He also showed hinge point at L4 with back extension and positive aberrant motion which leads 
to a high probability of having lumbar hypermobility. Conclusion: Following 5 treatment sessions over 10 
days, the patient returned to his usual sport-like activities. Upon discharge, the patient was pain-free with 
daily activities as well as with range of motion. This patient was instructed to continue with his home 
exercise program and was actively monitored for the following 2 weeks to ensure no relapses or setbacks 
to occur after treatment sessions concluded. This case demonstrated the positive effects of a core 
stabilization program, coupled with a manual therapy approach on sprinters who are suffering from a 
hypermobility issue of the lumbar spine. The patient was issued a personalized rehabilitation protocol that 
was followed carefully for two weeks, this program allowed us to see major improvements. The patient 
was able to recognize symptoms early enough for us to start making quick progress, and consistency 
allowed us to maintain progression over time. 

  



ABSTRACT PRESENTATION 
 

 

14 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                        Volume 6 – Issue 3s – January 2024 

The Diagnosis, Rehabilitation, and Treatment of Posterior Impingement in a High School Baseball 
Pitcher  
Tisdale K*†, *Houston Methodist Orthopedics and Sports Medicine at The Farm League Spring, TX, 
†Tomball High School Tomball, TX  
 
Introduction: Posterior impingement, also known as internal impingement, is a type of secondary 
impingement that is caused by overuse and repetitive movements of the shoulder overhead during motions 
such as throwing, spiking, etc. A combination of shoulder abduction and external rotation produces 
impingement of the infraspinatus and/or of the supraspinatus against the posterior-superior glenoid. 
Posterior impingement is common in overhead athletes, and this mechanism is usually seen during the 
cocking phase of throwing. Someone suffering from posterior impingement may complain of posterior 
shoulder pain, posterior stiffness and decline in performance. Patient Information: In this case study, a 15-
year-old male high school baseball pitcher seeks medical help after dealing with posterior shoulder pain, 
elbow pain, and tingling in his elbow to 4th and 5th fingers for 3 weeks. The athlete complained of feeling 
weak while throwing. He states that does not recall doing anything specific to his shoulder, such as falling 
on it or subluxing/dislocating it. The pain is the highest during throwing and after throwing but eventually 
would cease as he rested. The symptoms he is experiencing are not isolated just from pitching but arise 
when throwing any ball. He also has pain from reaching overhead to grab things from shelves or stretching 
with his hands overhead. Differential diagnoses include posterior impingement, SLAP tear, rotator cuff 
tendonitis, UCL tear, and cervical radiculopathy. These diagnoses have similar signs and symptoms, so the 
objective examination was important in determining the diagnosis. Cervical radiculopathy was tested to 
rule in or out the paresthesia symptoms he was experiencing. Posterior impingement was ruled in through 
location of pain and when he was getting pain. Additionally, I tested multiple tests for the same condition 
to aid in ruling. Intervention: The athlete was removed from participation to prevent further damage to 
structures and decrease pain and tingling symptoms. Rehabilitation focused on shoulder stability, rotator 
cuff strength, serratus anterior strength, and proper scapulohumeral rhythm and throwing mechanics. 
Posterior mobilizations, scapular framing, and scapular upward rotation mobilizations were utilized before 
exercises to help decrease pain and improve shoulder and scapular joint mobility, and soft tissue massages 
were done on the biceps, upper traps, forearm, rhomboids, and lats to help release tension. Return to Play 
protocol is broken up into phases. Phase 1 is general stabilization and strengthening, phase II is advanced 
stabilization and strengthening, phase III is plyometrics, and phase IV is sport specific activities (return to 
throw). The athlete progressed through the program based off location of pain, type of pain, and change 
in symptoms. The throwing motion was also utilized to gauge progress. The goal for the athlete was to be 
able to return to strength and conditioning camp in 6 weeks. Outcomes: The patient made progress through 
his program. He was re-tested on MMTs for IR, ER, flexion, and protraction, specifically the serratus 
anterior. He reported no pain through the first two weeks with any of the exercises. General muscles 
soreness is expected as he continued to increase strength gains. He has not been cleared to participate at 
this time, and he is currently continuing in phase II. Clinical Bottom Line: This case report demonstrates how 
posterior impingement goes beyond the shoulder musculature and glenohumeral joint. There are many 
impairments that can arise due to the impingement. Muscle imbalances and improper scapulohumeral 
rhythm are expected in overhead athletes. One may note scapular dyskinesis as a sign of muscle 
imbalances often presented with posterior impingement. The current research harps on evaluation of the 
glenohumeral joint, scapulohumeral joint, and humeroulnar joint, including the cervical spine, and how to 
rule in and out their involvement. 



ABSTRACT PRESENTATION 
 

 

15 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                        Volume 6 – Issue 3s – January 2024 

A Case Study on Treatment Of Subcoracoid Impingement in an Overhead Athlete With Manual 
Therapy  
Mennell M†, *, †: *Houston Methodist Willowbook Orthopedics & Sports Medicine Spring, TX, †Tomball 
Memorial High School Tomball, TX  
 
Introduction: Subcoracoid impingement of the shoulder is a condition that occurs when the tendons or soft 
tissues in the shoulder are compressed or pinched between the coracoid process and the humeral head. It is 
also suspected that subcoracoid impingement can occur when the humerus translates anteriorly, decreasing 
the subcoracoid space. This impingement can cause pain, inflammation, and limited mobility in the shoulder 
joint. All kinds of impingement are typically multifactorial, and have several areas that need to be 
addressed. The purpose of this case report is to examine the effects of therapeutic exercise as well as 
manual therapy on subcoracoid impingement in an overhead athlete. Patient Information: Patient is a 16-
year-old third baseman who began seeking treatment for increased shoulder pain toward the end of a 
baseball game. Patient reported sharp pain in the anterior aspect of his shoulder when throwing during 
the cocking phase. He reported pain during warm ups that gradually got worse throughout the game when 
throwing, and was unable to continue by the bottom of the 5th inning. He reports no neurological symptoms 
such as numbness or tingling. He reports no history of shoulder pain. Differential diagnoses included 
subcoracoid impingement or rotator cuff strain. Rotator cuff strain was ruled out as the rotator cuff muscles 
were strong and not painful, but subscapularis manual muscle testing was weak and painful along with 
positive impingement tests such as Hawkins-Kennedy test, O’Brians test, and Bear hug test. Interventions: 
Treatment options for subcoracoid impingement may include rest, physical therapy, anti-inflammatory 
medications, and in severe cases, surgery. The treatment for this patient included manual techniques along 
with therapeutic exercise over the course of about 6 weeks, followed by a return to throwing progression. 
Manual techniques included soft tissue mobilization of the pecs as well as a poster glide of the shoulder. 
Following manual therapy the patient would stretch internal and external rotation, and then complete a 
series of exercises targeting the subscapularis as well as overall rotator cuff strength. Outcomes: Once the 
patient was pain free and internal and external range of motion was normalized, he was cleared to begin 
a return to throwing progression with his coach. Patient felt strength and range of motion improved and 
reported being ready to return to play. Following the completion of the throwing progression the patient 
will be cleared to return to play as tolerated. Patient discussed and agreed to continuing a maintenance 
program to be done 2-3 times a week either in the athletic training room or at home to maintain the 
strength needed to play baseball. Clinical Bottom Line: Overall this case met expectations of implementing 
a good posterior cuff strengthening therapeutic exercise plan along with introducing manual therapy to 
address subcoracoid impingement in an overhead athlete. Based on the positive results of this treatment 
for this athlete, who had no shoulder injury prior, it would be interesting to see if introducing a posterior 
cuff strengthening program to overhead athletes as a warm up would prevent similar injuries in the future. 

  



ABSTRACT PRESENTATION 
 

 

16 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                        Volume 6 – Issue 3s – January 2024 

A Case Report of the Evaluation and Management of Low Back Pain in a High School Basketball 
Player  
Leveston, K*†, Neelon K*, Ephran E †: *Houston Methodist Sugar Land Orthopedics and Sports Medicine 
Sugar Land, TX, †Fort Bend L.V. Hightower High School Missouri City, TX  
 
Background: Low back pain can be a tough injury to endure, especially in the growing high school 
athlete.3 LBP in a high school athlete can be caused by various factors, such as structural deformities, 
mobility deficits, and so much more. The majority of LBP in adolescents is nonspecific LBP, which is defined 
as LBP that does not cause systemic or structural changes.5 Nonspecific LBP is often a result of other 
etiologies such as hypermobile or hypomobile segments of the spine, hip mobility deficits, gait, sleeping 
positions, or improper weightlifting form. Differential Diagnoses: Other possible diagnoses of LBP in 
adolescents could be spondylolysis, spondylolisthesis, slipped vertebral apophysis, or fractures of the 
thoracolumbar spine.1 High school athletes who are diagnosed with hypermobilty of the lumbar spine can 
be treated conservatively by being prescribed stability exercises and manual techniques. Treatment: A 17-
year-old male basketball player came to the athletic training room complaining of left lower back pain of 
3 weeks. He reported pain with prolonged sitting, pain while getting dressed, and pain while lifting 
weights. The patient reported feeling this same type of pain during previous basketball seasons as well. 
The athlete did not seek treatment for his low back pain in the previous seasons as he reported it was 
intermittent. During examination, it was discovered that the patient had limited lumbar range of motion in 
left side bending and left rotation at end range. The patient also had an upslip of the left innominate and 
the left quadratus lumborum had increased muscle tone. A combination of manual techniques and 
strengthening of the hip and lower back muscles were used to improve the patient’s pain and stabilize the 
patient’s hypermobility at L4-L5. 6 After completing 12 rehab sessions over 4 weeks, the athlete was able 
to perform at his maximal level with no pain. The athlete’s asterisk signs, a squat and full court sprints, had 
significantly improved and no longer caused the athlete any pain. Uniqueness: The athlete presented with 
LBP that was a result of a hyper mobile L4-L5 segment. The athlete’s age and activity levels were large 
factors in the athlete’s diagnoses. The athlete responded well to stability exercises, as well as manual 
techniques performed by the clinician. Conclusion: This case shows that a combination of manual therapy 
and stabilization exercises are best to manage non-specific LBP.6 The patient responded well to attending 
rehab 3 times a week for 4 weeks and was able to perform at his maximum level with no pain. 

  



ABSTRACT PRESENTATION 
 

 

17 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                        Volume 6 – Issue 3s – January 2024 

Low Ferritin Count in Female Collegiate Soccer Player Presents as Concussion 
Nelson EN*, Pitcock TD†, Knoblauch MK*, Harrison LJ*: *University of Houston, Houston, TX, †Rice University, 
Houston, TX  
 
Background: Women’s soccer leads the National Collegiate Athletic Association for having the highest 
number of concussions in female sports. Common symptoms of concussion can include light headedness, 
headaches, and dizziness, but these symptoms are not exclusive to concussions. Female athletes may 
experience nutritional deficits that can lead to a wide range of symptoms mimicking those commonly 
experienced with a concussion such as headaches, dizziness, and fatigue. The patient in this case is a 21-
year-old female soccer athlete who presented with sensitivity to light, light headedness, nausea, and 
fatigue after experiencing repeated ‘headers’ as well as a collision during a match. Upon evaluation, she 
reported a long-standing history of hyperhidrosis, eating disorders, and migraines. The athletic trainer 
evaluated the patient for a concussion, but all results were within normal limits. As a precaution, the patient 
was removed from play and any further activity pending evaluation from the team physician. Two days 
later, the patient was seen by the team physician who also ruled out a concussion and was cleared to 
return to play. Nine days after the initial injury, the patient collided with an opponent while participating 
in a match. During halftime the patient complained of feeling ‘off’ but assumed it was due to dehydration. 
The athletic trainer treated the patient with water, a salt tablet, and electrolytes which relieved symptoms 
prior to the start of the second half of the competition. Two minutes into the second half of the match the 
patient was removed from play due to dizziness, lightheadedness, headache, and nausea. The team 
physician referred the patient to the team’s concussion specialist. Differential Diagnosis: Initial suspicions 
were centered around a concussion due to the collision sustained nine days prior. Treatment: After 
examination, the concussion specialist ordered bloodwork. The blood panel revealed a low ferritin count, a 
protein responsible for iron storage.  Based on her blood panel, it was determined the low ferritin count 
secondary to hyperhidrosis was contributing to headaches, nausea, lightheadedness, and dizziness. The 
physician prescribed ferrous sulfate tablets to treat low levels of iron. The physician also recommended 
meetings with both the athletic trainer and registered dietitian for neck strengthening and meal planning. 
The registered dietician provided several food adjustments to incorporate higher levels of iron into the diet 
such as adding more leafy greens, proteins, and potatoes. She also advised the patient to keep a daily 
food and symptom log. The athlete was allowed to fully participate but was instructed to check in with the 
athletic trainer before and after any physical activity. After following the recommendations, the patient 
noted an immediate decrease in the severity and frequency of symptoms. She completed the season 
without any further incidents. Uniqueness: Nutritional deficits in female athletes are often missed due to 
high hormone intricacy and the lack of research on women. In this case symptoms caused by a low ferritin 
count mimicked those of a concussion. Conclusion: The patient presented with a mechanism and symptoms 
that align with a concussion diagnosis. After ruling out a concussion, bloodwork confirmed a nutritional 
deficit which commonly presents with symptoms similar to a concussion. After changing her diet, the patient 
was able to resolve her symptoms.  By collaborating with experts such as registered dieticians, athletic 
trainers can further their knowledge in the unique components of food and how important of a role it plays 

 

  



ABSTRACT PRESENTATION

18 
Copyright © by Indiana State University            Clinical Practice in Athletic Training 
All rights reserved. ISSN Online 2577-8188        Volume 6 – Issue 3s – January 2024 

Athletic Trainers in Physician Practice Society Free Communications 
Abstract Presentations
The following abstracts were accepted and presented at the 6th Athletic Trainers in the Physician Practice Society  
Annual Conference in 2023.  

Figure-8-Reconstruction of Posterior Sternoclavicular Joint Dislocation 18 Days Post Initial Injury 
Suri M, Bunemann S: Ochsner Sports Medicine Institute, New Orleans, LA  

Introduction: Traumatic sternoclavicular joint injuries account for less than 3% of all traumatic joint injuries1. 
Although rare, posterior dislocation of the sternoclavicular joint has the potential to be life-threatening due 
to the proximity of vital structures posterior to the manubrium. This injury typically requires a high-energy 
force applied through the joint2. SC dislocations become increasingly difficult to reduce after 24 hours, so 
timely diagnosis and treatment are important. Glass et al. found mediastinal compression occurred 30% of 
the time with posterior dislocations. If left untreated, prolonged pressure on the superior mediastinum can 
cause erosion of the great vessels, tracheoesophageal fistula, brachial plexopathy and thoracic outlet 
syndrome1. An open reduction is indicated once a closed reduction has failed. Case Presentation: 74-year-
old, Caucasian male, who had a possible syncopal episode and fell onto a metal table from ground level 
sustaining a left posterior sternoclavicular dislocation. He was initially seen at the ER at the region’s level 1 
trauma center on 8/5/2022. His chief complaint was left clavicle pain with 10/10 pain on VAS. Xray 
were negative for left clavicle fracture and patient was released with a sling. He was referred from his 
primary care provider to a local Orthopedist, who ordered a CT scan which showed a posterior 
sternoclavicular joint dislocation with the sternal end of clavicle imbedded in mediastinum. Thirteen days 
post-injury closed reduction was attempted by an Orthopedic trauma team at a local trauma hospital. 
Follow up imaging showed persistent posterior dislocation. Due to failed closed reduction. Subsequently, an 
open reduction of the sternoclavicular joint was indicated. Eighteen days post-injury, the patient underwent 
an open reduction of the left sternoclavicular joint with figure-of-8 reconstruction utilizing a semitendinosus 
allograft. A cardiovascular consult was obtained to assist with retro-manubrium dissection.  A successful 
reconstruction of the sternoclavicular joint was achieved without adverse incident. Discussion: This case 
illustrates the importance of accurate diagnosis and prompt treatment. Posterior dislocations accompanied 
with symptoms of mediastinal compression can achieve satisfactory results with both closed and open 
procedures if the dislocation is reduced as close to the time of injury as possible. Clinical Practice 
Recommendations: Symptoms of mediastinal compression accompanied posterior dislocations 30% of the 
time although patients still achieve excellent to good results regardless in the choice of treatment. For 
patients treated by open reduction, the failure of an initial closed reduction resulted in the in functional 
outcomes no worse than for patients treated without an attempted closed reduction. Based on the low 
number of reported open reduction cases in the literature, tenodesis, suture fixation and ORIF have the 
largest proportion of excellent/good results without frequently associated high-risk complications. K wire 
and pin fixation is associated with dangerous complications including wire and pin migration or breakage.  



ABSTRACT PRESENTATION 
 

 

19 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                        Volume 6 – Issue 3s – January 2024 

Second Victim Syndrome and Organizational Support for Healthcare Providers: A Scoping Review 
Petryszyn KR*, Young JP*, Neil ER‡, Benedict JE†, Eberman LE*: *Indiana State University, Terre Haute, 
Indiana; ‡ Temple University, Philadelphia, PA; †Henry Ford Health System, Jackson, MI 

Introduction: Healthcare providers may experience critical incident, medical error, or other adverse patient 
events in their clinical practice. Those that do encounter such events, may experience second victim 
syndrome (SVS), a condition in which providers feel psychological, cognitive, or physical reactions 
rendering care in these instances. Those with SVS may experience symptoms such as anxiety, depression, or 
burnout. Organizational support may mediate the impacts of SVS after an adverse patient event. We 
conducted a scoping review to explore and synthesize the literature on the support strategies implemented 
by healthcare organizations in the United States, for healthcare providers, after adverse patient events. 
Methods: The initial search strategy yielded 244 articles, 84 of which were removed for duplication. The 
3-person review team completed title and abstract screening, reference screening, and full-text review, 
reaching 2-person consensus for article inclusion at each phase. To be included in analysis, studies had to 
have taken place in the United States, and had to include real or perceived outcomes of organizational 
support strategies for healthcare providers related to adverse patient events. During title and abstract 
screening, 144 articles did not meet inclusion criteria. The references of the remaining articles (n = 16) 
were screened and 6 articles were added to the review pool. Twenty-two articles were included in the full 
text analysis, during which 16 articles were removed for not meeting the inclusion criteria. Six articles were 
included in the final extraction and analysis. Results: The studies included in the final analysis, assessed SVS 
and organizational support across a variety of healthcare work settings and professions, using several 
strategies, both quantitative and qualitative, to measure provider experiences. The Second Victim 
Experience and Support Tool (SVEST) (n = 2/6, 33.3%) and the Medically Induced Trauma Support 
Services Staff Support Survey (n = 2/6, 33.3%) were the most commonly used tools to measure SVS 
experiences. Our findings indicate that healthcare providers believe organizational support after adverse 
patient events was or would be beneficial for minimizing SVS. Despite the perception of its value, the 
frequency of perceived organizational support given to healthcare providers differed across studies, 
ranging from 43 – 94% of the participants believing they received some form of support. Our findings 
also demonstrated a discrepancy in the types of support strategies healthcare providers preferred or 
desired after an adverse event, as the level of agreement differed between sampled populations. 
Conclusion: Healthcare providers believe support from their organization is important after experiencing 
an adverse patient event, but support strategies may not be universal. Certain support strategies may be 
contextual, with potentially different preferences for support based on organization or profession. 
Organizations should establish provider support systems for adverse events, but first need to assess 
provider preferences to implement the strategies most desired. That being said, little is known about the 
effectiveness of the discussed organizational support strategies, outside of their perceived value. Athletic 
trainers in physician practice are situated among a variety of healthcare providers, all of whom are 
susceptible to SVS. As organizations develop their support systems, they should consider the 
interprofessional nature of their staffs to aid in collective support following a crucial incident.  
  



ABSTRACT PRESENTATION 
 

 

20 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                        Volume 6 – Issue 3s – January 2024 

The Impact of Video-Assisted Education on Knowledge and Retention Compared to Paper Education 
Material   
Nance KM, Drescher MJ, Eberman LE, Rivera MJ: Indiana State University, Terre Haute, IN 
 
Context: When educating patients, clinicians must be effective to assure patients understand their 
treatment plan and abide by such to achieve optimal outcomes. Teaching methods that stimulate more than 
one sense more positively impact learning outcomes. The purpose of this study is to compare paper and 
video-assisted education at the point-of-care with the aim of changing patient education and local 
practice in a system for individuals undergoing total hip arthroplasties (THAs). Methods: We used a 
randomized cohort design to explore patient knowledge and retention and educational method at the 
point-of-care. We compared the current education method (paper) to video-assisted materials using pre 
and post-education surveys. Both surveys included three demographic questions and a 10-item survey that 
covered the protocol for THA pre and post-operative care. The post-education survey included an 
additional three items regarding how often they referred to the material, perceived effectiveness, and 
accessibility. These questions were ranked on a Likert Scale (1 = strongly disagree to 5 = strongly agree) 
for perceived effectiveness and accessibility, and (1 = never to 5 = very often) for frequency of material 
referencing. The protocol items were graded on correctness, receiving one point for each correct answer or 
a zero an incorrect answer with a maximum score of 10. The tool was content validated by physicians in 
the clinic to ensure questions were accurate and aligned with the patient population. Pre and post-surveys 
were collected approximately 1 month apart. Patients were randomly assigned to their education group. 
In total, 12 participants (age = 70+11 years) were included in the analysis, 6 received paper education, 
and 6 video-assisted. The majority of patients identified as men (58%, n = 7), and achieved an annual 
salary of $35,100+26,163. Demographic data and pre- and post-education surveys were analyzed using 
descriptive statistics. A Wilcoxson Signed rank test was used to compare pre and post-knowledge scores 
and education group. Chi-squared analysis was calculated to determine the correlation of frequency of 
access, effectiveness, and accessibility and education group. Results: The average pre- and post-survey 
scores were 7+1/10 and 7+1/10, respectively. There no significant difference between education group 
and post-survey scores (p > 0.05). There were no significant correlations between education group and 
frequency of use (p =.39), perceived effectiveness (p = .29), and accessibility (p =.55). Conclusions: 
There was no differences in knowledge and retention between education materials. However, beyond the 
similar knowledge and retention scores, video-assisted material was found to be more accessible. Due to 
this finding, the paper education material will be revised to assure patients are able to access these as 
well, as they are just as effective at sharing and retaining patient knowledge. Other healthcare facilities 
should consider exploring various modes of education to determine which is most preferred and accessible 
to their patient population. 

  



ABSTRACT PRESENTATION 
 

 

21 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                        Volume 6 – Issue 3s – January 2024 

Clinical Athletic Trainers Decrease Orthopedic Physician Clinical Burden 
Barloon, A. ATC BCS-O, Meadows, K. ATC, Pennuto, A, ATC BCS-O, Petrachaianan, K., Glass, N., Hogue, M., 
MD: University of Iowa Hospitals and Clinics, Iowa City, Iowa 

Introduction/Context: More than half of physicians in the United States are reporting symptoms of burnout. 
These symptoms lead to increased risk to patient safety and overall physician health. The use of Certified 
Athletic Trainers (ATCs) is increasing in popularity, especially in Orthopedic clinics. ATCs in the clinical 
setting have been shown to allow physicians to focus on patient care and less on clerical and 
documentation tasks. The goal of this study is to assess if ATCs in the physician practice setting influence 
physician work-life integration, burnout, and work engagement. Methods/Intervention: Approval obtained 
by IRB at University of Iowa. An observational, nonrandomized study with data collected from physicians 
at two time points, 6 months apart. This information included: overall quality of life question, two item 
burnout survey, work-life balance scale, and physician job satisfaction survey. In addition to data collected 
from physicians, monthly EPIC ™ signal data was collected and blinded by a research team member. Each 
provider was divided by use of ATC or no ATC in clinic. These two groups were compared using 
independent, two-sample t-tests. Analyses were performed using RStudio statistical software. Results: 
Clinics with ATCs have decreased order contribution for providers as well as decreased portion of notes 
authored by provider. The average “In Basket” time is significantly lower with ATCs. Additionally, 
providers who utilize ATCs have significantly less time working in EPIC™ outside of clinical hours per 
person than those who do not. No significant difference was found between ATC and no-ATC groups in 
physician work-life balance, job satisfaction, or overall quality of life at time of initial survey and 6-month 
survey. There was noted to be decreased work engagement scores for those who use ATCs. Discussion: The 
use of ATCs in physician practice is increasing in popularity with studies demonstrating decreased provider 
need for clerical and documentation tasks and increased time for providers to focus on patient care. It 
demonstrated lower amounts of time spent in EPIC ™ outside of clinical hours for those providers who 
utilize an ATC. In addition to time outside clinical hours, our study found providers have decreased order 
input and documentation proportions with ATCs. Our study did not show any statistically significant 
differences in physician work-life balance, job satisfaction, or overall quality of life with use of ATC or no 
ATCs. Clinical Bottom Line: In this study, the use of ATCs in the orthopedic clinical setting demonstrated 
decreased amounts of time spent in EMR software outside of clinical hours, decreased order input for 
physicians, and decreased documentation burden for physicians. 

 

 


