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The First Aider

Athletic Trainer Profile NANCY BURKE, ATC: ‘I’ve had an amazing career!’

August 25, 2017

Congratulations to Nancy Burke, MS, LAT, ATC, on her retirement! Her last day of work as athletic trainer with the Fairfax County Police Department in Fairfax, Virginia, was Aug. 11. Nancy blazed several trails during her athletic training career, including the one that brought athletic training to local law enforcement. And by the way, this wasn’t Nancy’s first retirement…and it looks like it won't be her last.

Nancy got her first exposure to athletic training while attending James Madison University in Harrisonburg, Virginia. She explains, “I was playing field hockey and there was an injury. Many in my family have medical careers, and I thought someone should be able to fix these things. The university was growing at the time, and in 1969 – 1970 they offered a class in athletic injuries. It was only open to men getting certified to coach. Women couldn’t take the classes. Then a wonderful man, Ramey Martin, started teaching at the college. He had been a student athletic trainer and was teaching a graduate level course for coaches in the area to get information on treating injuries. I couldn’t get credit for it, but he let me audit it.”

Nancy was immediately intrigued by athletic training, and soon discovered Cramer’s The First Aider newsletter. “In the newsletter, Cramer advertised their $5 home study kit that included something like a couple rolls of tape, a bottle of Iso-Quin salt tablets, and a book of instructions. There are a bunch of us ‘experienced’ athletic trainers who got started in the profession with this $5 box from Cramer. I ordered it and over the summer I practiced taping on all of my family members. It had me hooked. I went back to school and some of the ladies’ coaches let me be the student athletic trainer for their teams, which mostly consisted of wrapping, bandaging, and taping.”

At the same time, a male student interested in athletic training had similar responsibilities for the men’s soccer and basketball (no football then) teams. “The college built an athlete training facility, and we each had a key,” Nancy recalls. “Things were certainly different back then! There was no head athletic trainer-- just Mike and myself, the physicians, and a few students we mentored. I learned everything I could from the team physician while helping him take care of athletes. I also spent hours in the stacks at the libraries and talking to other doctors and university health professionals, soaking up all the knowledge I could. I joined the NATA and was the first female member of District 3.”

Nancy received her undergraduate degree in 1973 and took a high school teaching position. “I missed athletic training, though,” she says, “and decided to take the certification exam. I passed--though I’m not sure how! I was among the first 20 women to become certified. For me, it wasn’t a passion to be certified as a woman—I just really wanted to learn everything I could. The path was there, and there were no limits that I could see.”

She continues, “Since I had the certification first, I realized I didn’t know anything about managing a program and should get a master’s degree somewhere that did!” Nancy was accepted at Eastern Kentucky University, and after graduating in 1976 she accepted a position as a teacher and athletic trainer at South Lakes High School in Reston, Virginia.

Nancy was heavily involved in the early growth of the Fairfax County athletic training program along with Larry Nottingham, ATC. “We spoke to parent groups, introduced coaches and athletic directors to athletic training coverage for playoff events, and established early protocols for safety.” Over time, the county added more athletic trainers and now there are two at each high school. During those same years she became the chair of the U.S. Women’s Lacrosse Association’s Safety Committee, and was integral in the design and instrumentation of eyewear for women’s Lacrosse. “I was sitting with a manufacturer and explained what could be done to make the eyewear better,” she says. “I drew it on a napkin, he built it, and I supervised testing with varying ball speeds, impact, etc., with five Division I NCAA women’s teams.” As chair of the U.S. Lacrosse Association Safety Committee, Nancy encouraged efforts to mandate protective eyewear and to increase helmet safety standards.

Nancy had been with South Lakes for 29 years when she decided to retire in 2005. “The time was right in many ways to say, ‘Okay, it’s time to move on,’” she reminisces. The school’s sports medicine facility is named in her honor.

The next chapter of Nancy’s career developed from connections made while working at the high school. “There were always police officers present during high school games, and they saw what I did for the student athletes,” Nancy explains. “They would approach me with a hurt ankle or knee, and ask for my treatment recommendations, though I explained that I couldn’t treat them. Then one day I received a call from the station. Someone had an injury and couldn’t get in to see a physician for two weeks, and they wondered if I could help. I looked at their physician list, called one of the docs, and got the officer an appointment for the next day. His ankle was severely injured and the doctor wanted him to start rehab the next day—but the lieutenant called and said they couldn’t get him into rehab for a few weeks! I was able to get him started right away…and to think that otherwise, he might have gone four weeks without appropriate care.”

Nancy did some research and couldn’t find anything about athletic training in a local police department setting—but that didn’t stop her from writing a letter to the commander of the police department. “I gave a background of the athletic training skill set, and said I thought that an athletic trainer could save the department a minimum of 10 percent in medical costs annually. He called me about three days later and wanted to meet for lunch. By then I had more information and statistics, and he had done some research on me as well. We talked for over two hours. It was spring of 2005, and I had already announced that I’d be retiring in October. He called me back around the first of August and asked if I’d be willing to try a small three-month pilot program at the Criminal Justice Academy once I retired from the school district. I liked the idea of starting small to iron out the bugs, and I planned to work 10 hours a week for those three months. But after about a month, a recruit had a major injury. I saved the county $25,000.00 by handling the rehab, the recruit successfully completed the Academy.”

The pilot program was soon expanded to include three work sites. Nancy was more than willing but told them she needed more equipment. “I basically was working with ice and bandages!” she says. As a short-term solution, Nancy called pal Bubba Tyer, head of sports medicine for the Washington Redskins (who has since retired). “Bubba loaned me some equipment for a few months, and that’s when the program really took off,” she says.

At the end of the three-month pilot period, Nancy was offered a 20-hour-a-week part-time job. By the following August, they offered her a full-time position, providing care to the entire police force of about 1800 which included officers and civilian employees. “I went into this thinking it would be a part-time job that could save the department at least 10 percent,” Nancy says. “Ultimately I saved them more than 20 percent, and if you include the savings in overtime, it was 40 percent. In the Criminal Justice Academy, the savings actually reached 90 percent because the recruits were no longer going to the ER for everything, and there was on-site rehab. I provided intervention and preventive care that kept people from collapsing from heat, for example, by reminding them to wear a hat and stay hydrated. Other interventions included blood pressure awareness and concussion management. The money saved meant they could hire more people and buy more equipment the force needed. And most importantly, care from an athletic trainer keeps our officers on the streets. When they come in for care in uniform, there’s often something I can do right on the spot and send them back out—just as we send players back onto the field or court.”

In 2009, Nancy formed the Public Safety Athletic Trainers’ Society, and she is nationally known as the definitive expert in this area. After 12 years with the Fairfax County Police Department, though, Nancy felt the time was right to retire—for the second time. “I’ve had an amazing career, and have been so blessed. A great number of athletic trainers have contributed to my career in so many ways they may not realize. I mirror their work and passion.”

When entering a new environment, Nancy says, it’s not always understood what athletic trainers can do. “But once we show them, the support is there,” she says. “Since launching the program in Fairfax County, other municipalities have hired athletic trainers including Denver, Seattle, and San Antonio. The time is right because it’s proven that we can significantly cut costs. I’m getting requests to help other cities set up programs…so now I’m starting another career as a consultant!"

All of us at Cramer Products thank you for your vast contributions to the athletic training profession, Nancy! We wish you the very best as you begin an exciting new chapter of your life.

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FROM THE ARCHIVES From the September 1, 1955 issue of The First Aider

August 25, 2017

You Need Help, Coach

Part of your job, as a high school coach, is the proper care and treatment of the athletic injuries incurred by your athletes. In accepting the job of coaching sports you automatically accept the responsibility of prompt injury care for your boys.

Oftentimes during practice, a perplexing problem arises. “Should I continue to coach the squad or personally administer to an injured player?” A player injured on the field requires your immediate attention. Your first act is to check the seriousness of the injury. In most cases, injury care is routine. With a sprained ankle, for example, the standard procedure is to wrap the ankle with an elastic bandage, apply cold packs, and X-ray. If you have properly instructed a student trainer, he can carry out this procedure and get the boy safely to the doctor for an X-ray.

The student trainer can be vital to your success. You can concentrate on coaching, knowing that your instructions on injury care are being carried out.

A Keystone To A Successful Season

Your training room can become the basic foundation of your athletic program. It can be a keystone above which you build a successful athletic season because it is headquarters for prevention and injury care.

This training room must be equipped with those products necessary to treat or prevent injury. It would be suicidal to plan otherwise. Read More

Your training room should be the cleanest, neatest place in town. Your athletes should be educated to help keep it that way. Make cleanliness a part of your program.

Pro-Lastic Tear Stretch Tape: The tape you’ll tear, stretch, and love!

August 25, 2017

Have you given Pro-Lastic Tear Stretch Tape a try? Pro-Lastic is Cramer’s heavyweight, non-adhesive cotton stretch tape that tears easily by hand. The consistent stretch of this tape ensures easy application and outstanding conformability to any joint or muscle.

Pro-Lastic’s durable backcloth makes it ideal for a variety of uses, including:

  • Strains, sprains and muscle support
  • As a wound dressing
  • Covering gauze
  • Over top of traditional ankle tape (Pro-Lastic’s stretch offers additional support!)
  • To help secure knee braces of any type

The tape is available in 7-½ yard rolls of either 2” or 3” widths, black or white.

Patrick Spieldenner, ATC, head athletic trainer at San Diego State University, says he and his staff use both the 2” and 3” Pro-Lastic tape. “We like it for ankle tape jobs,” he says. “The elastic component gives the tape some rigidity. It stretches and then comes back to its original form. Pro-Lastic with white tape over it is a great combination.”

Patrick says they use Pro-Lastic in various ways with athletes in volleyball, basketball, football, and soccer, and sometimes with track and women’s lacrosse as well. With volleyball, for example, Pro-Lastic is used over white stirrups because it offers support and keeps everything nice and snug. For basketball, Patrick says it’s a Pro-Lastic base with white tape over it.

You’ll love the strength, stretch, versatility and tearability of Pro-Lastic. Now’s the time to give it a try! Read More

Vitamin D deficiency linked to muscle injuries

August 25, 2017

More than half of college football athletes participating in the 2015 NFL Combine had inadequate levels of vitamin D, and this left them more susceptible to muscle injuries, according to a study at New York City’s Hospital for Special Surgery (HSS).

"Vitamin D has been shown to play a role in muscle function and strength," said Scott Rodeo, MD, senior investigator and co-chief emeritus of the Sports Medicine and Shoulder Service at HSS. "While most prior studies have focused on the aging population as the group most likely to experience the harmful effects of inadequate vitamin D, few reports have looked at the impact on muscle injury and function in the high performance athlete."

Dr. Rodeo and colleagues set out to determine if there was a relationship between serum vitamin D levels and lower extremity muscle strains and core muscle injuries, or "sports hernia," in college football players. The study included 214 athletes participating in the 2015 NFL Combine. Baseline data was collected, including age, body mass index (BMI), injury history, and whether they had missed any games due to a lower extremity muscle strain or core muscle injury.

The average age of the athletes was 22. Their vitamin D levels were determined with a blood test. A total of 126 players (59%) were found to have an abnormal serum vitamin D level, including 22 athletes (10%) with a severe deficiency. Researchers found a significantly higher prevalence of lower extremity muscle strain and core muscle injury in those who had low vitamin D levels. Fourteen study participants reported missing at least one game due to a strain injury, and 86% of those players were found to have inadequate vitamin D levels.

"Our primary finding is that the athletes in the study at greatest risk for lower extremity muscle strain or core muscle injury had lower levels of vitamin D. This could be related to physiologic changes that occur to muscle composition in deficient states," Dr. Rodeo explained. "Awareness of the potential for vitamin D inadequacy could lead to early recognition of the problem in certain athletes. This could allow for supplementation to bring levels up to normal and potentially prevent future injury.”

Though our skin produces vitamin D when it is exposed to sunlight, there are estimates that more than 40 percent of the U.S. population is deficient in the vitamin. Sun avoidance and the use of sunscreen may in part account for deficiencies. Milk and vitamin D-fortified foods, including orange juice and some cereals, can also provide vitamin D, but one would need to consume a large amount of these foods. When individuals are found to have a deficiency, vitamin D supplements are usually prescribed.

"Although our study looked at high performance athletes, it's probably a good idea for anyone engaging in athletic activities to give some thought to vitamin D," Dr. Rodeo says. "Indeed, adequate levels of vitamin D are important to maintain good muscle and bone health in people of all ages."

The study was presented at the American Academy of Orthopaedic Surgeons Annual Meeting this past March. Read More

New Deep Learning Techniques Analyze Athletes' Decision-making

August 25, 2017

A new automated method of sports analytics, based on deep learning techniques, has been developed by researchers at Disney Research, California Institute of Technology, and STATS, a supplier of sports data. With the new method, detailed game data on player and ball positions is analyzed to create “ghost” models of how a typical player in a league or on another team would behave when an opponent is on the attack. It is then possible to visually compare what a team's players actually did during a defensive play versus what the ghost players would have done.

"With the innovation of data-driven ghosting, we can now, for the first time, quantify, analyze and compare detailed defensive behavior," said Peter Carr, research scientist at Disney Research. "Despite what skeptics might say, you can indeed measure defense."

The researchers presented their method at the MIT Sloan Sports Analytics Conference in Boston in March. Though they demonstrated the method using data from 100 games of a professional soccer league, they emphasize it also is applicable to other sports, such as football and basketball.

"Precise, second-by-second game data is now widely available, and as technology improves, is becoming even more thorough," said Markus Gross, vice president at Disney Research. "As valuable as they are, metrics such as 'Wins-Above-Replacement' and 'Expected Point Value' are not the be-all and end-all of sports analytics. As this new research shows, we're just beginning to realize the full potential of what the data can tell us."

Carr noted that ghosting has been used by several teams including the NBA's Toronto Raptors. However until now, available software required extensive manual annotation of game data. The Disney-led team, by contrast, developed a fully automated approach using advanced machine learning techniques.

"Our approach avoids the need for manual input," Carr said. "Our ghosting model can be trained in several hours, after which it can ghost every play in real-time. Because it is fully automated, we can easily learn models for different subsets of data, such as all the games of a particular team."

Deep learning uses brain-inspired programs called neural networks. To learn the fine-grained behavior model for each player role in a formation, they used recurrent neural networks, a popular deep learning tool that examines the recent history of player actions to make predictions of subsequent actions. Similar tools were famously used to create artificial intelligence programs that mastered video games and beat top human players of the board game Go. Read More

For games such as soccer, where the game state is continuous in both space and time, standard deep learning techniques were not sufficiently robust. As time progressed, the predictions tended to veer from ground truth. To address this issue, the researchers leveraged techniques from imitation learning, a tool that learns from demonstrations and has proven useful in robotic applications.