- Sprain vs strain
- A sprain injures a LIGAMENT (bone-to-bone); a strain injures a MUSCLE or its TENDON.
- Transtheoretical Model — 5 stages
- Precontemplation → Contemplation → Preparation → Action → Maintenance (Stages of Change for behavior).
- Motivational interviewing
- Collaborative, patient-centered counseling that helps an athlete resolve their own ambivalence about change (uses OARS).
- OARS (motivational interviewing)
- Open questions, Affirmations, Reflective listening, Summaries — the core MI skills.
- Primary prevention
- Stops injury/illness before it occurs (protective equipment, conditioning, education).
- Secondary prevention
- Early detection to limit severity (pre-participation exam, baseline concussion testing, screenings).
- Tertiary prevention
- Manages an established condition to restore function (rehab after an ACL reconstruction).
- Pre-participation physical exam (PPE)
- Screening exam to identify conditions that may predispose an athlete to injury or illness before sport.
- Health literacy
- The ability to obtain, understand, and use health information to make appropriate decisions.
- Critical health literacy
- The highest level — critically appraising health information and acting on social determinants of health.
- Risk reduction strategy
- Lessens the probability or impact of a harmful event without eliminating it (vs risk avoidance).
- Heat acclimatization
- Gradual physiologic adaptation to exercising in the heat over ~10–14 days; reduces heat-illness risk.
- WBGT
- Wet-Bulb Globe Temperature — environmental heat index used to modify or cancel activity for heat safety.
- Female athlete triad
- Low energy availability (±disordered eating), menstrual dysfunction, and low bone mineral density.
- Wellness dimensions
- Physical, emotional, social, intellectual, spiritual, and occupational wellness.
- SMART goals
- Specific, Measurable, Attainable, Relevant, Time-bound — framework for behavior-change goals.
- Proper hydration guidance
- Match fluid intake to sweat losses; monitor body-weight change and urine color to prevent dehydration.
- Protective equipment fitting
- Equipment (e.g., helmets, mouthguards) must be properly fitted and maintained to reduce injury risk.
- Disordered eating red flags
- Weight loss, preoccupation with food/weight, dental erosion, fatigue, and menstrual changes warrant referral.
- Tobacco/substance education
- Risk-reduction counseling addresses tobacco, alcohol, and supplement/PED use using evidence-based education.
- HOPS evaluation
- History, Observation, Palpation, Special tests — the systematic injury-evaluation sequence.
- SOAP note
- Subjective, Objective, Assessment, Plan — standard clinical documentation format.
- Lachman test
- Most sensitive test for an ACL tear — anterior tibial translation, knee flexed 20–30°, soft endpoint = positive.
- Anterior drawer (knee)
- Tests the ACL — anterior tibial glide, knee flexed 90°; less sensitive than the Lachman.
- Posterior drawer (knee)
- Tests the PCL — posterior tibial glide with the knee flexed 90°.
- McMurray test
- Screens for a meniscal tear — pain/click with tibial rotation as the knee is extended from flexion.
- Valgus stress test
- Tests the MCL of the knee; performed at 30° of knee flexion to isolate the ligament.
- Varus stress test
- Tests the LCL of the knee; performed at 30° of knee flexion.
- Thompson test
- Squeeze the calf — NO passive plantarflexion = positive for an Achilles tendon rupture.
- Anterior drawer (ankle)
- Tests the ATFL — anterior talar glide; the ATFL is the most commonly sprained ankle ligament.
- Talar tilt test
- Tests the calcaneofibular ligament (CFL) of the lateral ankle.
- Empty can (Jobe) test
- Tests the supraspinatus — resisted abduction in the scapular plane with the thumb pointing down.
- Neer / Hawkins-Kennedy
- Provoke subacromial impingement of the shoulder (passive elevation / internal rotation).
- Apprehension test (shoulder)
- Tests anterior glenohumeral instability — apprehension with the arm abducted and externally rotated.
- Phalen / Tinel sign
- Reproduce median-nerve paresthesia in carpal tunnel syndrome (wrist flexion / tapping the nerve).
- Straight leg raise (SLR)
- Screens for lumbar nerve-root irritation — radicular pain at ~30–70° of hip flexion.
- Special test purpose
- Special (stress) tests confirm the injured structure after history, observation, and palpation.
- Grade I sprain
- Microscopic tearing; mild pain/swelling; NO laxity; firm endpoint; minimal loss of function.
- Grade II sprain
- Partial tear; moderate pain/swelling/bruising; SOME laxity with a definite endpoint.
- Grade III sprain
- Complete rupture; gross instability; soft or ABSENT endpoint; marked loss of function.
- MMT grade 3 (Fair)
- Full range of motion against gravity with NO added resistance — the antigravity pivot grade.
- MMT scale
- 0 (no contraction) to 5 (full ROM vs gravity + maximal resistance), on the Oxford scale.
- Goniometer
- Instrument to measure joint range of motion in degrees; axis over the joint, arms along the segments.
- Capsular pattern
- A characteristic proportional limitation of ROM that suggests whole-joint capsule involvement.
- End-feel
- The quality felt at the end of passive ROM (firm, hard, soft, empty) — helps localize the limitation.
- Dermatome
- Area of skin supplied by a single spinal nerve root — maps sensory loss to a level (e.g., L5 = great toe).
- Myotome
- Muscles innervated by a single spinal nerve root — tested by resisted movement (e.g., S1 = plantarflexion).
- Review of systems
- Screening across body systems to detect non-musculoskeletal causes and red flags requiring referral.
- Compartment syndrome — Dx
- Suspected by pain out of proportion and paresthesia; confirmed by compartment pressure measurement.
- Functional Movement Screen
- FMS — screens basic movement patterns for asymmetries and limitations, not a diagnostic test.
- Special test sensitivity/specificity
- Sensitive tests (when negative) rule OUT (SnNout); specific tests (when positive) rule IN (SpPin).
- Differential diagnosis
- Systematically narrowing possible conditions using history, exam findings, and special tests.
- Concussion assessment tools
- SCAT and balance/cognitive testing (e.g., baseline comparison) help evaluate a suspected concussion.
- Emergency Action Plan (EAP)
- A written, venue-specific plan defining roles, equipment, communication, and EMS activation for emergencies.
- Exertional heat stroke — definition
- CNS dysfunction + core temp >~104–105°F in an exercising athlete; a true medical emergency.
- Heat stroke — gold-standard temp
- RECTAL thermometry is the only valid field measure; oral/tympanic/axillary/temporal devices are inaccurate.
- Cool first, transport second
- For exertional heat stroke, begin cold-water immersion immediately and cool BEFORE transporting.
- Cold-water immersion
- Immerse in ~35–59°F water with continuous stirring; fastest whole-body cooling for heat stroke.
- Heat exhaustion
- Heavy sweating, fatigue, headache, normal/mildly elevated temp, intact CNS — cool, hydrate, rest.
- Suspected cervical spine injury
- Activate EMS/EAP, manually stabilize the head/neck in neutral, jaw-thrust airway, minimize spinal motion.
- Equipment removal (spine)
- Generally remove the helmet AND shoulder pads together as a unit, by trained rescuers, keeping the spine aligned.
- Sudden cardiac arrest
- Athlete collapses without contact → start CPR and apply an AED immediately; SCA is a leading cause of death.
- AED use
- Apply as soon as available; early defibrillation is the strongest determinant of survival in SCA.
- Concussion — remove from play
- Any suspected concussion is removed immediately and not returned to play the same day ('when in doubt, sit out').
- Anaphylaxis management
- Severe allergic reaction with airway swelling/breathing difficulty → epinephrine + activate EMS.
- Severe asthma attack
- If unresponsive to the rescue inhaler, support breathing and activate EMS for emergency care.
- Arterial bleed — first step
- Apply direct pressure to the wound first to control bleeding.
- Open fracture
- Cover with a sterile dressing, control bleeding, immobilize, and activate EMS; do not push bone back in.
- Shock management
- Lay the athlete flat, elevate the legs (if no contraindication), maintain warmth, monitor, and activate EMS.
- Penetrating chest wound
- Seal with an occlusive dressing to prevent air entry; monitor for tension pneumothorax; activate EMS.
- Lightning safety
- 'When thunder roars, go indoors' — seek a substantial building or hard-topped vehicle; resume after 30 min.
- Suspected neck injury — avoid
- Do NOT have the athlete move the neck or remove a helmet improperly; restrict spinal motion.
- Stroke recognition (FAST)
- Sudden Face droop, Arm weakness, Speech difficulty → Time to call EMS immediately.
- Wound care / bloodborne pathogens
- Use standard precautions and PPE for any blood exposure; control bleeding, clean, and dress wounds.
- Exertional sickling
- In sickle-cell trait athletes, exertional muscle cramping/weakness — stop activity, cool, oxygen, monitor.
- Hypoglycemia (conscious athlete)
- Give fast-acting carbohydrate (glucose, juice) for a conscious diabetic athlete with low blood sugar.
- Triage principle
- In multiple casualties, manage life-threatening airway, breathing, and circulation problems first.
- Cryotherapy effect
- Vasoconstriction — decreases metabolism, inflammation, pain, and nerve conduction; used in acute injury.
- Cryotherapy contraindication
- Cold hypersensitivity / Raynaud phenomenon, impaired sensation, and poor circulation.
- Thermotherapy effect
- Vasodilation — increases blood flow and tissue extensibility; used in subacute/chronic conditions.
- PRICE / POLICE
- Protection, Rest/Optimal Loading, Ice, Compression, Elevation — early acute-injury management.
- Therapeutic ultrasound
- Deep heating (continuous) or non-thermal tissue healing (pulsed); 1 MHz penetrates deeper than 3 MHz.
- Iontophoresis
- Uses direct current to drive medication (often anti-inflammatory) through the skin into tissue.
- TENS
- Transcutaneous electrical nerve stimulation — pain control, often via the gate-control mechanism.
- NMES
- Neuromuscular electrical stimulation — elicits a muscle contraction for re-education or strengthening.
- High-volt pulsed stimulation
- Used for pain, edema, and wound healing; main risk if misused is a skin burn.
- Tissue healing — inflammatory
- Days 0–~6: swelling, pain, redness, warmth — PROTECT and control inflammation.
- Tissue healing — proliferation
- Days ~3–21: collagen/granulation forms — begin gentle, controlled loading to align fibers.
- Tissue healing — remodeling
- Week 3 to a year+: collagen matures along stress lines — load progressively toward function.
- Eccentric loading
- Lengthening under tension (e.g., heel-drops) — cornerstone of chronic tendinopathy rehab.
- Tendinopathy is degenerative
- Chronic tendon problems respond to controlled loading, not rest alone.
- PNF stretching
- Proprioceptive neuromuscular facilitation — contract-relax techniques to enhance flexibility and coordination.
- FITT principle
- Frequency, Intensity, Time, Type — the variables of an exercise/rehab prescription.
- SAID principle
- Specific Adaptation to Imposed Demands — rehab must mimic the athlete's sport-specific demands.
- Overload principle
- Adaptation requires demand beyond the tissue's current capacity, applied progressively.
- Reversibility
- Training gains are lost when the stimulus stops ('use it or lose it').
- Closed-chain exercise
- The distal segment is fixed (e.g., squat) — more functional and joint-stabilizing for lower-extremity rehab.
- Open-chain exercise
- The distal segment moves freely (e.g., leg extension) — isolates a muscle but is less functional.
- Proprioception / balance training
- Restores joint position sense after injury (e.g., balance-board work) to reduce re-injury.
- DOMS
- Delayed-onset muscle soreness — peaks 24–72 h after unaccustomed eccentric exercise; self-limiting.
- Joint mobilization grades
- Maitland grades I–II for pain, III–IV for stiffness, and V (thrust) for manipulation.
- Convex-concave rule
- Convex-on-concave: glide OPPOSITE the bone motion; concave-on-convex: glide the SAME direction.
- Therapeutic exercise progression
- Restore ROM → strength → proprioception → power/agility → sport-specific function, guided by healing.
- Modality screening
- Always screen for impaired sensation, poor circulation, malignancy, and DVT before thermal agents.
- Return-to-play criteria
- Pain-free full ROM, near-symmetric strength, restored function, and medical clearance before clearance.
- Scope of practice
- Defined by the STATE practice act where the athletic trainer works — not by BOC certification alone.
- BOC vs state credential
- BOC certification = national competency; state licensure/registration = legal right to practice.
- HIPAA
- Protects identifiable health information held by covered health-care entities.
- FERPA
- Protects student education records at federally funded schools — often covers athletes' school medical records.
- Standard precautions
- Treat all blood and body fluids as potentially infectious; use hand hygiene and PPE.
- Hand hygiene
- The single most effective measure to prevent the spread of infection in health care.
- Informed consent
- A patient with capacity voluntarily agrees to care after being told risks, benefits, and alternatives.
- Mandatory reporting
- Most states require athletic trainers to report suspected child abuse or neglect.
- Documentation standards
- Accurate, timely, confidential records — essential for continuity of care and legal protection.
- Negligence
- Failure to provide the standard of care that a reasonable clinician would, causing harm.
- Duty of care / standard of care
- The legal obligation to act as a reasonably prudent athletic trainer would in similar circumstances.
- BOC Standards of Professional Practice
- Define the practice and disciplinary standards required of every certified athletic trainer.
- Evidence-based practice (EBP)
- Integrates the best research evidence, clinical expertise, and patient values/preferences.
- PICO question
- Patient/Problem, Intervention, Comparison, Outcome — frames a focused clinical question for EBP.
- Levels of evidence
- Systematic reviews/meta-analyses of RCTs sit at the top of the evidence hierarchy.
- Reliability vs validity
- Reliability = consistency of a measure; validity = whether it measures what it intends to.
- Sensitivity vs specificity
- Sensitivity rules OUT when negative (SnNout); specificity rules IN when positive (SpPin).
- Type I vs Type II error
- Type I = false positive (α); Type II = false negative (β).
- MCID
- Minimal clinically important difference — the smallest change a patient perceives as meaningful.
- Patient-reported outcome measures
- Standardized tools (e.g., disablement/quality-of-life scales) that track patient-centered progress.
- Risk management audit
- Systematically identifies and controls risks in athletic facilities, activities, and policies.
- Continuing education (CEUs)
- BOC certification is maintained through ongoing continuing-education requirements and standards.
- Therapeutic-use exemption
- A documented exception allowing a needed prescribed medication under a drug-testing policy.
- Confidentiality
- Athlete health information is disclosed only with proper authorization, per HIPAA/FERPA.