Athletic Training Room

Mission

The Punahou Athletic Training Room provides first aid and health care to all Punahou students, specifically those participating in interscholastic athletics.The Punahou Athletic Training Room strives to establish itself as a model of excellence in sports medicine care.

The health and welfare of our athletes is our first concern.We provide services that are consistent with the highest standards of quality outlined in the National Athletic Trainers' Association (NATA) Code of Professional Practice (APPENDIX D). The Punahou Athletic Training Staff adheres to the NATA Code of Ethics (APPENDIX A) and the Athletic Training Educational Competencies (APPENDIX B) as established by the NATA. We are committed to utilizing the best technology available for the prevention and treatment of athletic injuries and upgrade equipment and supplies whenever necessary.We continually evaluate our program to ensure that our practices and programs are current.

Athletes competing for Punahou, but have sustained an injury in a situation unrelated to their Punahou team activities, will be responsible for their own medical care. The staff will assist with emergency care and treatment of non-athletes who sustain an injury at school.However, responsibility for rehabilitation will be that of the individual student and his/her family.

Functions of the Punahou Athletic Training Room Staff

  1. Provide efficient and timely care of athletic injuries that are incurred by Punahou athletes during their competitive season
  2. Enable injured athletes to return safely to competition as soon as possible
  3. Reduce the risk of athletic injury for our student-athletes
  4. Educate student-athletes about athletic injuries so they are empowered to lead healthier, injury-free lives
  5. Coordinate with the strength and conditioning program, the coaches, the athletic support staff, school administration, physicians and other healthcare providers to provide the best possible healing environment for our student athletes
  6. Facilitate a safe return to school and sport for student athletes after a concussion by coordinating care between teachers, school administration, counselors, the health center, parents, coaches, and the student athlete

Services are Categorized into the following Areas

  1. Injury Prevention
    a.Monitor injury trends via collection and analysis of Punahou athletic injury data and recommend appropriate changes in team training to reduce injury risk
    b.Select, apply and modify prophylactic and protective equipment and other custom devices for patients/clients to minimize the risk of injury or re-injury
  2. Management of Athletic Injuries
    a.Emergency Care
    b.First Aid
    c.Injury Evaluation
    d.Referral
    e.Practice and Competition Coverage
  3. Rehabilitation of Athletic Injuries
    a.Design and implement therapeutic exercise program
    b.Utilize therapeutic modalities in treatment plan

Injuries

Concussion Management Program

Punahou School has instituted a Concussion Management Program (CMP) to ensure student athletes return to athletic participation safely.
View more information

Anterior Cruciate Ligament

Anterior Cruciate Ligament (ACL) Sprain

The anterior cruciate ligament (ACL) is one of the most commonly injured ligaments in the knee. Approximately 150,000 ACL injuries occur in the United States each year. ACL knee injuries can cause many problems for kids who play sports. Besides the likelihood of having to sit out an entire season, they have a higher chance of developing osteoarthritis (a painful joint condition) later in life. Female athletes participating in basketball and soccer are two to eight times more likely to suffer an ACL injury compared to their male counterparts.

Why do ACL injuries occur in kids?

Most ACL tears do not occur from player-to-player contact.The most common causes of noncontact ACL injury include: change of direction or cutting maneuvers combined with sudden stopping, landing awkwardly from a jump, or pivoting with the knee nearly fully extended when the foot is planted on the ground. More information

How can ACL injury be prevented?

Several prevention programs have been developed in an attempt to decrease the incidence of noncontact ACL injuries. The focus of current prevention programs is on proper nerve/muscle control of the knee. These programs focus on plyometrics, balance, and strengthening/stability exercises. More information.

Cervical Spinal Cord Injury

Spinal Injuries

Each year, approximately 12,500 new cases of spinal cord injury (SCI) are reported in the United States. Nine percent of these SCI are a result of sports and recreation. Among all US sports, the greatest number of catastrophic SCI occurs in football.

Catastrophic SCI occurs when there is structural distortion of the cervical spinal column associated with damage to the spinal cord. The SCI that carries the greatest risk of sudden death for the athlete happens when the damage is at the C4 level or above and severe enough to affect the spinal cord's ability to transmit respiratory or circulatory control from the brain.

In football, axial loading is the primary mechanism for catastrophic SCI. Axial loading occurs as a result of head-down contact and spearing. The incidence of quadriplegia in organized football has remained relatively low since rule changes by the National Collegiate Athletic Association (NCAA) and the National Federation of State High School Associations (NFHS) against helmet to helmet contact and spearing have been enforced. However, dangerous head-down contact remains a common occurrence on the football field.

An athlete risks paralysis anytime he or she initiates contact with their head down. When the head is up, the cervical spine is in a position where it has maximum flexibility to endure impact without injury. When the head is down, the natural curve of the cervical spine is reduced, the vertebrae of the neck align in a straight column, which increases the potential for an impact resulting in a serious spinal injury.

During a head-down hit the head is stopped at contact, the trunk continues to move and the spine is crushed between the two.

Whether intentional or unintentional, head down contact results in axial loading and is the primary cause of cervical spine fractures and dislocations in football. Football equipment, such as helmet and shoulder pads, do not prevent axial loading injuries of the cervical spine.

Prevention

Football hitting technique is the critical factor in preventing axial loading. When contact is made with the shoulder and chest while keeping the head up, the risk of serious head and neck injury is greatly reduced. When the head and eyes are up, the athlete can see the impact before it happens.Whether they are the ball carrier or the tackler, they can prepare their neck musculature accordingly for protection where the force of the hit can be absorbed by the neck muscles, intervertebral discs, and the cervical facet joints.

In an effort to prevent SCI many organizations promoting child safety in sports have created instructional videos on safe tackling and safe blocking, including the National Athletic Trainers' Association (NATA) and USA Football.

NATA Heads UP – Reducing the Risk of Head and Neck Injuries in Football

Proper football hitting technique
How to tackle
How to block

Growth Plate Tendonitis

Sever's Disease:

Also called Calcaneal apophysitis. It is an irritation to the calcaneal growth plate due to tightness of the Achilles tendon while the body is in the growth phase

Symptoms:

  1. Pain, swelling, in one or both heels
  2. Tenderness and tightness in the back of the heel that feels worse with compression
  3. Pain with walking, running or jumping and increases with activity.
  4. The pain may be especially bad at the beginning of a sports season.
  5. Pain increases with cleated shoes and shoes with limited heel padding.

Sever's is more commonly seen in males during their growth spurt from ages 10-15. For girls the growth spurt is generally from ages 8-13.

Treatment:

  1. Ice the heel for 20 minutes pre and post activity.
  2. Add heel cushioning to shoes or change to shoes with more heel padding for the majority of the practices.Save cleated shoes for games.
  3. Limit running during practice regardless of shoes worn.
  4. Give periodic rest during activity to allow heel to rest.
  5. Can use a compression pad taped to the calcaneus to provide some mild relief.
  6. Pain will not go away until the athlete can rest the heel for several weeks.
  7. Modify cardiovascular activity – bike or swim when possible to reduce repetitive trauma to the calcaneus.

For additional information about Sever's Disease, please look at the following video:

Osgood Schlatter's

This is typically a sports-related complaint due to repetitive micro trauma resulting in traction to the apophysis at the tibial tuberosity and the distal patella tendon.

Symptoms:

  1. Knee pain
  2. Tenderness
  3. Swelling at the anterior tibial tubercle

Osgood Schlatter's is more commonly seen in males during their growth spurt from ages 12-15 and for girls in their growth spurt from ages 8-12.

Treatment:

  1. Ice the knee for 20 minutes pre and post activity.
  2. Add heel cushioning to shoes or change to shoes with more heel padding for the majority of the practices.Save cleated shoes for games.
  3. Limit running during practice regardless of shoes worn.
  4. Give periodic rest during activity to allow knees to rest.
  5. A patella strap, placed between the patella and the tibial tuberosity may give some relief.The strap changes the primary tension and moves it from the tibial tuberosity to the strap sight.
  6. Pain will not go away until the athlete can rest the knee for several weeks.
  7. Modify cardiovascular activity – bike or swim when possible to reduce repetitive trauma to the knees.

Sinding-Larsen-Johansson
Knee pain is located at the origin of the patella tendon at the inferior patella pole.

Symptoms and Treatment
Identical to Osgood Schlatter's. except that knee pain is on the distal patella and proximal patella tendon

For additional information about Osgood Schlatter's Disease, please look at the following video:

Hip Apophysitis

Generally caused by high-intensity twisting activity associated with repetitive traction on an apophysis.Not an acute traumatic event such as kicking which may result in an avulsion.

Symptoms:
The most common sites include the Anterior Superior Iliac Spine (I) and the Ishial Tuberosity (V).These can occur as a result of kicking, rapid acceleration and deceleration, or jumping.

Treatment:

  1. Ice the apophysis for 20 minutes pre and post activity.
  2. Add heel cushioning to shoes or change to shoes with more heel padding for the majority of the practices.Save cleated shoes for games.
  3. Limit running during practice regardless of shoes worn.
  4. Give periodic rest during activity to allow hips to rest.
  5. Pain will not go away until the athlete can rest the knee for several weeks.
  6. Modify cardiovascular activity – bike or swim when possible to reduce repetitive trauma to the knees.

For additional information about Hip Apophysitis injuries, please look at the following video:

Heat-realated Illness

Playing in high temperatures can be dangerous. Sweating is the process our body uses to cool itself, but with high humidity and hot temperatures, athletes' bodies can have trouble maintaining a safe body temperature.This may lead to heat-related illnesses. Athletes who are unconditioned or getting over illnesses are more likely to experience heat-related illnesses. Athletes and coaches should learn the warning signs and symptoms of heat illnesses in order to act quickly and give the appropriate care.

The following are heat-related illnesses and websites to help distinguish the warning signs and aid in the proper course of treatment:

The Hawaii High School Athletic Association recommends athletes take the following precautions to lower the incidence of heat-related illnesses:

  • Monitor their body weigh before and after activity to ensure they are replacing fluids, especially during hot and humid events.
  • Monitor their urine color to ensure proper hydration levels.Replace fluids with water and/or sports drinks to replace fluids and electrolytes.
  • Sleep 6-8 hours a night and eat a well balanced diet.

For further information on how to prevent dehydration, please refer to theKorey Stringer Institute's website.

Injury Terminology

Acute Injury

An acute injury is an injury with a sudden, recent onset.

Chronic Injury

A chronic injury is a reoccurring complaint by the patient/athlete that has become persistent to the extent that it impacts individual health. This complaint may involve all body systems, however in athletics this is generally a skeletal or muscular problem.

Traumatic Contact (TR C)

A traumatic contact injury involves contact or collision for the individual athlete. This contact may be the result of a collision with another athlete, the ground or a stationary object. These injuries are generally the most severe reported by athletes with potential injuries to all body systems. Muscular and skeletal injuries are the most frequently reported injuries in athletics, however, internal injuries are also noted.

Traumatic – Non Contact (TR NC)

A traumatic non-contact injury is generally a self-inflicted, sudden onset injury involving the muscular and skeletal system. These injuries include, but are not limited to, sprains and strains to muscle, tendons and ligaments.

Overuse

Overuse may define an injury, but also may be the mechanism of injury. The etiology of overuse injuries is a gradual onset of discomfort due to the repetitive motion causing micro trauma to the body part. These are non-contact injuries, but due to the etiology they are not classified as
TR-NC injuries. Injuries within this category include inflammation to soft tissue and may include skeletal injuries.

Other

This is a broad catch-all term to cover non-skeletal or non-muscular problems which may occur with athletes. This includes illness, skin infections, lacerations and similar medical problems that are not easily classified in the preceding injury types.

Injury

An injury is defined as any athlete complaint that required the attention of the athletic trainer, regardless of the time lost from activity

Time-Loss Injury

Time-Loss injuries include any injury resulting in at least 1 day lost from activity. Five injury severity classifications are used: 1) minor, no time lost from activity; 2) mild, 1-7 days lost; 3) moderate, 8-21 days lost; 4) severe, 22 or more days lost; and 5) catastrophic, permanent disability, dismemberment, or death.

No-Time-Loss Injury

No-Time-Loss injuries include any athlete complaint that does not result in lost time from activity, practice or game. The athlete may be evaluated, treated and returned to activity.

Athlete Exposure (AE)

An Athlete Exposure is defined as one athlete participating in one practice or match. Participation was not recorded daily. Exposures were estimated using team rosters and number of practice and match dates.

Injury Risk

Injury Risk determines the likelihood of injury for any athlete within a specific sport. This is represented as a percentage with a score of 1.0 indicating that every athlete is at risk of at least one injury.

Injury Rate

Injury Rate determines the number of injuries per athlete based on injury data collected. This number can exceed 1.0.

Exposure Rate (ER)

The Exposure Rate determines the number of injuries sustained divided by the Athlete Exposures for a sport. This is represented as Injuries/1000 Athlete Exposures (AE). The ER allows for comparisons between sports, levels and genders.

Overhead Athlete Injuries

Shoulder Impingement/Rotator Cuff Tendonitis

One of the most common physical complaints for overhead athletes is shoulder pain. The shoulder is made up of several joints combined with tendons and muscles that allow a great range of motion in your arm.However, high range of motion makes the shoulder vulnerable to many different problems. One of the most common is shoulder impingement/rotator cuff tendonitis.

For more information:
healthline.com
orthoinfo.aaos.org

Overuse Injuries

There are basically two types of injuries: acute injuries and overuse injuries. Acute injuries are usually the result of a single, traumatic event. Overuse injuries generally occur over time and are the result of repetitive micro-trauma to the tendons, bones, and joints.Common examples include tendinitis "tennis elbow", "swimmer's shoulder", "runner's knee", "jumper's knee", Achilles tendinitis, and shin splints.

Physical stress, consisting of exercise and activity, is beneficial for our bones, muscles, tendons, and ligaments, making them stronger and more functional. This happens because of an internal process called remodeling that involves both the breakdown and buildup of tissue. There is a fine balance between the two, and if breakdown occurs more rapidly than buildup, an overuse injury occurs.

A majority of overuse injuries can be prevented with proper training and common sense. In general, you should not increase your training program or activity more than 10 percent per week. This allows your body adequate time for recovery, rebuilding tissue and response to the muscular stress. This 10 percent rule also applies to increasing pace or mileage for walkers and runners, as well as to the amount of weight added in strength training programs.

A warm up activity as well as a cool down period should be completed before and after activity to allow the body to prepare and recover around a workout.Workouts should incorporate strength training, flexibility training, and core stability to minimize the risk of overuse injuries.

Some tips for treating an overuse injury include:

  • Cutting back the intensity, duration, and frequency of an activity
  • Adopting a hard/easy workout schedule and cross-training with other activities to maintain fitness levels
  • Learning about proper training and technique from a coach or athletic trainer
  • Performing proper warm-up activities before and after
  • Using ice after an activity for minor aches and pain
  • Using anti-inflammatory medications as necessary

If symptoms persist, a sports medicine specialist will be able to create a more detailed treatment plan for your specific condition. This may include a thorough review of your training program and an evaluation for any predisposing factors. See your athletic trainer for evaluation if you think you have an overuse injury.

  • Rapid acceleration of the intensity, duration, or frequency of activity
  • Returning to a sport or activity after injury and trying to make up for lost time by pushing to achieve the level of participation present before injury.
  • Improper technique

Other contributing factors that may increase the likelihood of overuse injuries

  • Imbalances between strength and flexibility
  • Body malalignment (ie. knock-knees, bowlegs, unequal leg lengths, and flat or high arched feet) Weak links due to old injuries, incompletely rehabilitated injuries, or other anatomic factors
  • External factors include improper equipment (ie. inappropriate running shoes) or terrain (hard vs. soft)

Reference:

American Orthopaedic Society for Sports Medicine

Additional Links

physioworks.com.au
natajournals.org

Patellofemoral Pain Syndrome

What is it?

Patellofemoral pain syndrome (PFPS) is a broad term describing general pain at the front of the knee and around the patella or kneecap. PFPS is the most common injury in athletes whose sport requires a high frequency of running and jumping.Pain is typically at worst with actions such as climbing or descending stairs, running, jumping, and squatting.

The most common cause for patellofemoral pain is a malalignment of the patellofemoral joint as a result of a sudden increase in training level or overuse during intense athletic activity.

Symptoms

The most common complaint for PFPS is a dull ache in the front of the knee.Oftentimes crepitus may be present, a popping or cracking sound or sensation in the knee, especially while climbing stairs or standing after sitting for a long time.

The level of pain will be directly related to activity – type of activity as well as intensity and duration.

  • Pain increases with:
    • Exercise, particularly activities with repeated knee bends such as using stairs, running, jumping or squatting
    • Sitting for long periods of time with knees bent (ie. in a classroom, theater or airplane)
    • Increase of activity level

View more information

Shin Splints

Shin Splints – Medial Tibial Stress Syndrome (MTSS)

Commonly known as shin splints, Medial Tibial Stress Syndrome (MTSS) is an exercise-induced overuse injury and the most frequent lower leg injury in sports. It is defined as pain along the inner border of the shinbone (tibia) that is associated with exertion such as running and jumping.

Although MTSS is often not a serious injury, it can be disabling acutely and has the potential to progress into a more serious condition if not treated properly.

Cause
The most common cause for MTSS is a sudden change in physical activity, where one tries to do too much too soon.Runners are at the highest risk of developing MTSS. Pain is caused by inflammation of the muscles, tendons and bone tissue around the tibia.

Risk Factors
The following are risk factors that may increase an athlete's likelihood of developing MTSS:

  • Pronation – Navicular Drop
  • Orthotic use
  • Body Mass Index
  • Running experience
  • Weakness of the lower leg muscles

For more information on what causes shin splints, how to treat it and how to prevent it go to the following links:

orthoinfo.aaos.org
drjordanmetzl.com

Tendonitis Data

Overuse injuries may be defined as a mechanism of injury as well as a specific injury. For the purpose of this discussion overuse injuries will be defined as a category of injury with specific injury etiology due to repetitive microtrauma with a gradual onset of pain. Overuse injuries are generally chronic in nature without a single onset episode.

See complete details about Tendonitis Data

Nutrition for Athletes

Hydration

  • Before, during and after training and games, drink water or sports drinks to prevent mental and physical fatigue.

  • Use a personal water bottle to hydrate throughout the day.

  • Drink 16-24 oz. of fluid one to two hours before practice/game.

  • Drink 5-10 oz. every 15 to 20 minutes during practice/game.

  • Consume a sports drink such as Gatorade when your activity goes longer than one hour.

  • Drink at least 24 oz. for every pound lost through sweat after practice/game.

No Energy Drinks

  • Beverages such as Red Bull, Monster, Rockstar, etc. contain B vitamins, herbs, sugar and caffeine. Energy drinks are not tested or regulated by the FDA.

  • The differences between sports and energy drinks are:  Sports drinks replenish electrolytes, sugar, water, and other nutrients; whereas, a large portion of energy drinks contain mostly sugar and high doses of caffeine.

  • Drinking an energy drink before activity may dehydrate the athlete since it contains caffeine, which is a diuretic.

  • Children and young adults under the age of 18 should not consume these drinks due to possible adverse reactions such as stroke, seizures, and sudden death.

Pre-Event Meals

  • A pre-event meal is important to prevent hunger and to supply energy to muscles.

  • Three to four hours before the game, focus on carbohydrates, moderate protein, low-fat foods and fluids (pasta with a light marinara, a chicken or turkey wrap, vegetables, peanut butter sandwiches, a baked potato, cereal with low fat or fat free milk, crackers, rice, fruit, water, milk, juice, sports drink).

Muscle Recovery Post Exercise

  • Help muscles recover faster by consuming 1-2 cups of low-fat chocolate milk within 30 minutes after intense exercise.

  • Eat a high carbohydrate, moderate protein meal one to two hours later to continue with muscle recovery.

  • Rehydrate immediately following

Tournament Play

  • Get into a routine of using water and sports drinks for hydration and energy.

  • Drink water or sports drink in the dugout between breaks.

  • If your event is lasting longer than 1 hour, eat small amount of carbohydrates such as non-caffeinated exercise energy bar or granola bars, exercise energy gels, exercise energy chews, exercise energy shot, a small banana, slices of an apple, pretzels or a whole grain fig bar.

  • Have snacks available throughout the day:  energy bars, bananas, oranges, fluids.

  • Replenish fluids and carbohydrates with nutritious meals within a half hour of post exercise.

Balanced Diet

  • Focus on refueling with fluids, carbohydrates and protein.

  • Meet energy needs by getting the right fuel on board from foods and fluids.  The best balance:  55-60% of calories from carbohydrates, 10-15% from protein and 20-30% from fat.

  • Watch fat intake and a high-fat diet is not healthy- but neither is a zero-fat diet.  Go for low-fat foods.

Carbohydrate (CHO) Recommendations

  • Carbohydrates are the main energy source for exercise and major fuel for the brain.

  • Carbohydrate stores in the body are limited.  Athletes must replenish muscle glycogen every day.

  • Carbohydrates should consist of about half of your total daily intake of calories. i.e. 2000 total calories /2= 1000 cal of CHO/4 grams in each CHO= 250 grams of  CHO

  • Top food sources:  fruits, vegetables, whole wheat pasta, brown rice, breads, skim or low-fat milk, low-fat yogurt, whole wheat or grain cereals such as Cheerios, pretzels, whole wheat or grain bagels, honey, sweet potatoes, vanilla wafers or granola bars

Protein Recommendations

  • Protein is important for building muscle, fighting infection and making enzymes and hormones.

  • Recommended intake: 1.4-1.7 grams protein per kg body weight.

  • Protein sources:  poultry, meat, cheese, fish, yogurt, milk, nuts i.e. almonds and peanuts, seeds i.e. sunflower or pumkin, peanut butter, almond butter, eggs, tofu, and edamame.

  • Leaner protein:  chicken and turkey breast meat, egg whites, fish, and cuts of beef.

For further information regarding specific diets and diets for the injured athlete, refer to teamusa.org

Contact

2014_AC_30_Beachy_Glenn.jpg

Glenn Beachy, MS, ATC
Head Athletic Trainer
808.944.5769 Tel

FACSTAFF_Funai_Darryl.jpg

Darryl Funai, MEd., ATC
Assistant Athletic Trainer

FACSTAFF_Harrington_Michelle.jpg

Michelle Harrington, ATC
Assistant Athletic Trainer

2014_AC_20_Young_Beth.jpg

Beth Ann Young, ATC
Assistant Athletic Trainer