Physicals...The Inevitable - 217

Whether it’s seeing 217 athletes in 4 hours or having a history of “spleen tore in half,” physicals have a way of being memorable. ATs share their stories from the chaos that are pre-participation screenings.

Featuring stories from Robert M, Hayley S, Mason B, Chris H, Kjersten M, David H, Kristen L, Justin N, & many more!

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-Sandy & Randy

Episode Transcript

(00:01):
Hey, this is Sandy. And Randy?
And we're here on AT Corner. Being an Athi trainer comes with
ups and downs, and we're here toshowcase it all.
Join us as we share our world insports medicine.
Welcome back to another season of AT Corner.
You know in TV shows when they like, leave you off on a
cliffhanger. Yes.

(00:23):
For like season ending and you know, it's like a season ending
episode. Yes, I feel like, I mean, we
don't do that. I feel like it'd be really mean.
That would be mean. I don't even know how we would
necessarily do that. I don't know, I feel like our
summer has been like a re energizing, like it's full, like

(00:48):
we have so many ideas for this new season and ATA was really
amazing and heartwarming. Met a lot of people.
Yeah, honestly, it was. It was so much fun, so much
networking, so much connecting. Yeah, absolutely.
And now here we are. Here we're we're back.
And yeah, we're back for anotherseason and for this episode,

(01:10):
'cause I know some people were probably waiting for the episode
part, we have an awesome story episode that I think really
kicks off the year for everybody.
Physicals. See it works physicals.
So one of the very first questions I asked on our
Instagram story and and I will talk about some changes that

(01:31):
we're making this season about these questions is do you host
on campus physicals for your athletes?
Yes, but I've also been at multiple institutions where we
did not. I we do, I actually can't think

(01:51):
of a single place that doesn't host.
Oh that's funny, I feel like I'mthe opposite.
I feel like more and more placesI see don't do it anymore.
Yeah, I have been a part of so many different physicals.
Yeah, so many different ones. And actually, I tell my students
this when they're having troublewith their Lochman.
I say what you have to do is youhave to go sign up to do

(02:14):
physicals and do the ortho screen because that's how I got
my my Lochman down after doing like 200 Lochman's in a row.
Like boom, solid. Boom.
I mean, I can only practice on Randy's knees so many times.
And it does get sore. After a while, so we did get on

(02:37):
our pole which was a couple 100 responses, yes was about 51%, no
was 49%. I feel like that's a number that
I would probably expect I would.Be interested Almost half and
half. Yeah, I would almost be
interested to see what what would it be like over time like
has, has, has, have the Nos increased or have the yeses

(02:59):
increased because I feel like more and more I feel like more
people are just going to be like.
I feel like we've asked this before, but I mean, it hasn't.
I mean, our, our listeners have also like shifted and changed.
So, so like I can't, it's not a not submissible for a peer
reviewed study, unfortunately, yeah.

(03:21):
Publish the results. Not these ones the best I could
do is podcast for you that works.
So anyway, we are making some changes to our story prompts.
We are still asking our story questions on Instagram and
getting that's how we're fielding all of our stories.

(03:41):
However, we now have the option for you to sign up for this
thing called the Broadcast channel, which is somewhat new
to me. I'm still trying to figure it
out. Definitely new to me.
It's basically a like a group message that I, I think you can
reply to, but I think you have to like reply in the thread.
Like I don't think it's like a big like group message like you

(04:06):
would just texting your friends.But basically, if you subscribe
to that, every single time we post story questions, I will
message out like story prompts are up so you don't miss them.
And this will help too, because I would really like to post more
on our Instagram story. And I know, I know some people
had the post notifications on for the story, but I don't want

(04:27):
you guys to get over like bombarded with some of our other
stuff that we're posting. And then you miss the story
prompt. So the broadcast channel like
yes, there will be like polls and different things like as I
figure more of it out, but I would really like it to be more
of like an alerting system for the story prompts.
Hopefully it keeps them all in kind of one spot.

(04:49):
Yeah, I mean, and also like, I know sometimes like especially
since we're starting a new season and we haven't we haven't
put the story prompts out in a couple months.
Like our story might be like behind for a while, you know,
like it won't like pop up first.So I would really like for
people to still be able to like find them or if they like listen

(05:12):
this episode, they're like, Dangit, I didn't get to submit my
story, but we still got a a goodplethora of different stories
this run and a lot of them that we didn't have like a lot of
like repeats, which was like really nice to sort through.
And I thought I think we have some really good like different

(05:32):
perspectives on. Yeah, I'm really excited because
I do want to know what other people do for their physicals
because we all know physicals. It could be a cluster.
We know that day is you leave shell shocked.
Yes, yes. So actually the first time I put
in is a voice note which I was so excited to get and I'm going

(05:54):
to play it for you right now. It is from Robert M He is
talking about how the physicals that he does go.
I work for a local hospital chain but at the largest
hospital in this small rural area we employ 9 athletic

(06:16):
trainers between the local college and two high schools.
We work with our local family medicine facility so we get a
couple providers from there and so we have the standard stuff,
height, weight, blood pressure, vision.
We do a functional ortho screen.We will review any injuries and

(06:38):
such and then a physician or APAwill go over the state required
PPE form with them and then we will.
We have also partnered with a nonprofit organization called
who We Play for that does EKG screenings to look for heart
defects in kids that are otherwise asymptomatic at just

(07:00):
$25.00. So we offer that completely free
for all of our student athletes in the community.
And then since we all use healthy rosters I system, what
we do is at the end is we uploadthose PPE forms into everyone's
healthy roster, make sure all the contact information is up to
date. That really saves a lot of time
in getting all of our valid or important medical records at 1

(07:25):
go. Nice.
He also said the event lasts 5 days.
They the past year they saw 217 athletes and they're there for
about four hours a day, with thekids being scheduled within in
15 minute slots. Like individual kids or I'd be,

(07:47):
that's what I'd be. Interested.
Like I I'm the way that I took it is like someone scheduled for
three, someone scheduled for 3/15, someone scheduled for
3:30. Not that it only takes 15
minutes. Yeah, of course.
But like, but like those are when.
They're going through it. Yeah, Yeah.
That's interesting. That's cool.
That's very organized and I think I think that's a good way
of just like we know, like, you know, it's going to be a lot,

(08:12):
but like, you know, it's coming and you have it.
It's like it's just boom, just here.
Just RIP the Band-Aid. We're going to focus on this,
get it done. I was super excited to hear that
like a local hospital did it. Like I've I've seen, I mean, I,
I guess there are high schools that with athletic trainers like
contracted out through, but I'm trying to like picture.

(08:36):
You know, what's funny is you with you saying that like I feel
like that's not a, that's not big in Socal.
It's it's not as big. You're right.
That's. What I'm trying to think like I
don't, I can't think of a lot ofhospital systems down here that
do like do this, like where theyemploy a TS and then send them
out to like the local schools. I feel like that's more like I

(08:58):
know some in Northern Californiado it and obviously I've
definitely heard it various states in the US, but I feel
like in Soca that's not really athing yet.
Yeah. Yeah.
Not as much, but I mean, so likemaybe this is I'm I'm just

(09:19):
trying to picture the only otherphysical that I know of that
wasn't through a like specific like school.
I feel like some of the high schools do like joint physicals
around here, but but I don't think it's necessarily like
through the hospital like. Maybe within the district?

(09:39):
But I did volunteer when I was in grad school.
I volunteered and I barely remember this.
I remember going. I have no idea who told me about
it, but it was for a performing arts like PPE basically.
And it was for anyone in the community, a performing artist

(10:03):
who just wanted to come through like do a health screening.
And it wasn't just like like we had, we had PTS and we had a
bunch of different specialties, but like we did movement
screens, but that was just like a piece of it.
There was like you met with a nutritionist, you met with
different mental health people you met with like like there

(10:25):
were so many different stations and I can't remember if I can
find it. I'm going to try try to find the
name. Like it wasn't like dance Usai
don't remember who it was through, but it was it's
basically put on for any professional dancer.
That's dope. It was it was really cool and I
haven't ever gone back because Inever heard anything about it

(10:49):
again. And again, I don't remember who
like connected me to it, but that was that was like a
community physical. Yeah, that's pretty cool.
That's pretty dope Do. You want to read this next one
from Haley? Yes, Haley, yes, says.
I work for a Division 2 high school in Ohio.
We had four doctors, 7 ATS and achiropractor.

(11:11):
The AT did the ortho portion which was just basic range of
motion of all joints and a duck walk.
There are two ATS at each station or one AT and the
chiropractor. So one AT took height, weight
and vitals and then the other did the muscoskeletal.
Then the athletes would go to the doctor for full clearance
with heart and lung check. We had about 120 athletes come

(11:33):
through over a 2 day period. Each day we offered physicals 3
to 5. That's kind of interesting.
That's kind of cool. I feel like that's a pretty good
time frame too. Like ours, we do.
We have about 400 or less than 400 athletes probably who come
through our physicals and we do them on four different days.

(11:54):
So we do the first day is football, the second day is most
of the other fall sports, the third day is some fall sports
and winter sports, and then the 4th day is all the spring
sports. And that's a general, that's a

(12:14):
generalization. But then we we have different
stations as well. So we have usually 21 to two of
our fellows come through, our ortho fellows and they do an
orthopedic exam. We have our nurses from the
Health Center come by and they do heart and lung, which is

(12:37):
really nice. And then the orthos don't have
to do it and they also do a Med history check for the nurses do.
So basically when they come through, they start with their
sportswear and they do all theirsportswear stuff and then they
go do their blood pressure first, also with people from the
Health Center. And then they fill out their Med

(12:59):
history portion of the physical going to the next room, do
height, weight. And then one of our athletic
trainers comes by and does a Medhistory review and highlights
anything that needs to be reviewed by the nurse, by the
nurse practitioners. And then they, and then there's
basically like 2 lines and it's like you can go in either line

(13:21):
and we, we stacked their papers.And then it's like, OK, so
you're Next up. And then we call you for either
line and we just make sure they go to the nurse or the ortho.
And then we make sure that whichever one they went to, they
do the opposite. Yeah, you have to go through
both. And then you check out with me
and then I check your sportswear, I check your
physical, I write down any follow-ups, and then you pay,

(13:46):
which is a fundraiser for us. So how do you do the how do you
guys do the Med history review? Like, I don't know.
What do you mean? Like how do you guys go through
the Med history with them? Any yes.
Because do they do it? Because I'm assuming, do they do
it ahead of time and then they give it to you and then you're

(14:08):
looking at it? Or do you literally go through
it with them? No, no, no.
They already fill it out OK. Got you.
And you just any yeses? Any yeses and then our nurses do
a good job of if they have no yeses, they kind of dig a little
bit deeper. They don't just take it for face
value. Yeah, yeah.

(14:32):
So I guess it kind of depends onwho you get.
Yeah, but like we try to dig a little bit.
Oh, yeah. My favorite is when I'll have,
like, a football guy come in and, like, all their
muscoskeletals know, and I'll look at them like, so you've
never been injured And like, no,I'm like, so you've never had
pain before? Never.
Like. Oh, well, you know, I thought it
was like, major stuff. I mean, I had surgery.

(14:52):
Yeah. We're like, oh, like I've
sprained my ankle. I'm like, that would be one
thing to list. Yes.
Thank you. One time I did ask a kid.
I think I said this in the last physicals episode we did one
time I had a kid that I said I was about to do an ortho screen.
I'm starting. I, I must have started his
ankles because it's the first thing I asked him.

(15:13):
And I said, have you ever sprained your ankle before?
And he said no. And then I did a tailor tilt
inversion and he like almost jumped off the table And I was
like, are you OK? And he was like, yeah, I just
hurt my ankle last week. And I was like, Oh well.

(15:35):
See, that's why I've started asking.
So you've never had pain before?You got to make it their
language, you know, Maybe you didn't know that was what a.
Sprain. Exactly.
Yeah, because that's my thing. It's like no sprain, nothing.
And they're like, oh, I've rolled them like, well, OK,
technically it's probably a sprain, but my guy.
So this next one is anonymous. They said I, I'm starting my

(15:57):
second year at a private K through 12 and it's definitely
interesting how they've been running it.
Before I got here, students havehad to get a physical every two
years. It's uploaded to their online
portal and it's supposed to be verified by our school nurse.
Key phrases supposed to be Therewe go because I found out in the
spring that they fell off with doing so a few years back.

(16:18):
So now that AD thinks it's his job and my anxiety has me
running through all of them myself anyway so I'm not
blindsided during an eval. Also, we have a lot of
international boarding students for 9th through 12th grade, so
many of them get school standardized and very minimal
form signed off by physicians intheir home country.
I follow up with my asthma, type1 diabetes, and concussion
patients or anything else that stands out.

(16:39):
Private schools are wild let. Me tell you about the
international medical system, especially when you're working
at like a four year that is following like the NCAA's like
sickle cell trying to get European doctors on board with
why does this person need to be sickle cell tested?
I'm just like I understand, but we just need them to and my

(17:01):
favorite was when I actually hada doctor ask me what test is it?
I'm like, Oh no, my God, I need you to know that.
So then I had to look it up, tell this doctor it's this test
that I need them to run. That's pretty funny.
Yeah, it was pretty wild. Well, that was nice that they
kind of trusted you. Yeah, they're like, I'll run it
and just tell me what I need. To do I mean, I get it from

(17:22):
their standpoint, they're like this population they definitely
like there's probably less than a 1% chance that they have it,
but it's just dude, it's just it's the rules.
What do you? Want me to do Yeah by the way,
anonymous you it is not your anxiety that you are running
through all of them. You should probably, Yeah.
I've think everyone should be going through their physicals.

(17:47):
So this next one is from Mason B, and it's really interesting.
I've never actually heard this before.
Super excited to share this. The American Academy of
Pediatrics came out against massphysicals in 2019 and 2020 or 29
to 2020 ish and the American Academy of Family Physicians in
2021. So our hospital system stopped

(18:10):
providing them. That's interesting.
I would be interested to see like the publication on that
'cause he. Did he did send the family
physicians one the the AAP one is behind a paywall so he didn't
send that one. We might be able to find that.
We'll look. We'll.
Oh yeah, so so, Mason says. But it makes sense.

(18:32):
I've seen one physician go through the entire list with a
room of 10 high schoolers at thesame time, $20 a head.
I think this is the type of practice they were hoping to
discourage someone just checkingoff boxes as a cash grab.
Another point I think about withthe AAP and AAFP, physicians
were doing mass physicals for two to three hours after a full

(18:52):
clinic slash surgical day. Not only are they exhausted, but
their brains get into a rhythm of just going through the
motions of one physical after the next.
Very easy for things to be missed in a scenario like that.
At least when we did at the university, every station was
pretty much so low except blood pressure, vision and height
weight. So on Ortho 111 on one primary
care one-on-one, they were flagged with AT reviewing

(19:14):
histories or by either physician, they'd see
cardiology, mental health and ornutrition one-on-one.
Yeah, I agree. I think I I mean I get why like
that was like frowned upon, right?
Because I've never heard that's crazy like I would be.
I feel like more people would. Talk about that, how do you get
any? I can't imagine doing a group

(19:35):
physical like HIPAA. Oh yeah, yeah, that one, That
one's wild. But I think just from the just
in general, just like, like, like Mason was saying, like a
lot of times, yeah, the surgeon or the doctors coming in, Oh
yes. Or even in the middle of like
our physician is our team physicians in ortho.

(19:55):
So middle of his middle of his days, like he comes after a
surgery sometimes, right? And then he probably has a
surgery later. Like he's cutting out time to do
this. Like that's really hard to lock
in. And then yeah, it does kind of
turn into like, hey, we're just trying to get these kids, like
let's get them in and out. So I could see why.

(20:17):
Like organizations are saying like, hey, this probably isn't
good. It's probably not the best way
to handle these things. Whereas if the kids are kind of
like, hey, they, they're kind ofresponsible for getting it, at
least they're going to a provider where it's in their
work day, they are theoreticallygetting that one-on-one.
So I could see why that was. Hey, they're we probably

(20:41):
shouldn't be doing mass physicals.
See, I I see what you're saying.Yeah, I feel like the the
students who the student athletes who go to our physicals
are getting a much better healthscreening than they are if they
go to some random urgent care that has no idea how to do an
ortho. Screen for sure.
And I think that's that's like akey component of it is like if

(21:06):
it could be organized in a certain way, kind of like like
you're saying like how they wereat the university, like
something like that where it's very organized like that.
I think you can probably get away with it where there's more
help, like if you have multiple stations, stuff like that.
I think that can that can help probably alleviate some of the
concern. I mean, even I volunteered for

(21:29):
the Anaheim Ducks physicals and they did.
I mean, it's not that many of them, but like they did a mass
physical event where they had multiple stations and everyone
was going through and everyone was and it was the same.
They're also doing media day at the same time and like.
Well, again, that makes sense too for them because I'm sure
they had a lot of help. They did smaller.

(21:51):
Group exactly and they're getting more with it like right.
So it could definitely be done. I think it's probably the manner
that it's done is what exactly is what makes it good and what
makes it doesn't. Yeah, if you're doing like you
have kids in a room, yeah, you're just checking boxes at
that point. So I did also ask what does an
athlete need to do to be medically cleared in your

(22:13):
setting? The top answer was a physical
within physical. There was a little bit debate on
whether people said within a year or within the last two
years, which would have been a good follow up question.
I don't know that we would have had like, I don't know where our
samples were coming from necessarily.

(22:35):
So I'm sure like some people like Haley S, she has the in,
she's in Ohio and their physicalexpire every 13 months.
So I mean it, it does kind of depend on like where you're at.
I think even I have to look again to see, I don't think we

(22:56):
need to require a physical everyyear, but I think what we we do,
but I don't think that by our bylaws, I don't think we have
to. Our level says they need one
physical and then everything after is up to the institution
what they want. So that's where we are.
We get we require physical when they're incoming and then the

(23:18):
next year it's just an update. But you do have discretion.
Like if this kid like disappearslike halfway through the year
and I like I don't ever see thiskid again, I'm going to make
them get a physical because like, I don't know what happened
to you. But if you're in like if you're
with us the entire time, then like I pretty much know.
See, I feel like it's, it's a lot easier to be like, OK, this

(23:40):
is what you need to do for medical eligibility.
Like I do everyone, everyone, I'd go to the meeting at the
beginning of the of the season and I say, OK, you need a
physical, you need a concussion test and you need sportswear
with all your forms done and everything filled up.
Now the concussion test we keep on file, unless you have a

(24:05):
concussion and then you redo it.Oh, OK, interesting.
Nice. But like we just everything
else, I mean updated because I mean the updated physical also
they're going to get an updated blood pressure updated
everything. It was really nice at the
university we didn't because again, like NCAA NAI, you have

(24:25):
the potential to have athletes four or five years.
Again, it was the same thing when they're incoming just a
physical and after that each year was just an update.
Every year so you can have like a four year old physical.
Yeah, because they're with us the entire time and we know
everything that's pretty much going on with.
Them I've never worked professionally at that level.

(24:45):
I've never worked at more than atwo year, Yeah, so.
Interesting. Now again, same thing like if
the kid like leaves, like like quit the team and then all of a
sudden decided, no, I'm back, then yeah, I'm going to be like,
you need to get another physical, my guy.
Right, right. But yeah, there were some people
after their freshman year, they never got another physical with

(25:08):
us because again, we just, they're around us.
We know what's going on. So in order from most common to
least common in the responses medical history check a
concussion test and ortho screensome sort of forms like waivers

(25:28):
sent to treat in their EMR, an EKG and or echo.
I was surprised to see that thatwas so common, actually.
That's interesting. That's cool.
A mental health screen? Oh yeah.
Such as like an adapted PHQ 9 orsome other questions that people
use. Actually, 74% of people, this is
a separate question. 74% of people said they do include
mental health questions on theirphysical, which is so much more

(25:51):
than I think when we asked last time.
That's good. And yeah, I'm seeing that this
is like transitioning a lot more.
I would be interested to see what people do with them.
For us, we, we do have mental health questions and we and I
kind of make a generic statementfor everyone.

(26:11):
And I started off with, OK, anyone who puts even one yes
answer on your list. So basically like I'm not
freaking them out by, by, you know, anyone who has at least
one yes in this section. I just give mental health
resources no matter what, like how big, how little.

(26:34):
And then there's also a questionon there that says, do you want
to follow up with a, a mental health professional or do you
want to make an appointment witha mental health professional?
And I do, even if they write no,I ask it anyway.
And then I tell them, you don't have to decide today.
You don't have to decide tomorrow.
You can decide in two months. You can decide whenever.

(26:56):
Just come in, talk to one of thethree of us and you don't have
to say anything. You just say, hey, can you help
me make that appointment? And then I'll take care of the
rest. Yeah.
We really proud of our screen because I, I basically took this
one from one of my previous institutions at the like the D1
level and brought it to the Community College and we screen

(27:20):
for like anxiety, depression, disordered eating.
Then there's like some other questions in there.
So same thing, like if I'd noticed like what I want to do
is just give everyone the resource.
Well, a lot going on here. Perfect Dream would be mental
health professionals a part of the physicals so they can
actually screen them, which I'm working on it.

(27:42):
One day it's going to happen because that's what we did at at
the D1 level. We actually had a day where
mental health professionals would because we didn't do our
own physicals. So basically our physicals were
mental health physicals, I guess, where they'd actually
meet with the CAP staff and theywould basically do the triage
part, right. They'd screen them.
So people who had like nothing like basically all knows and

(28:05):
didn't have anything to report. Basically it was just AI work at
CAPS. This is CAPS.
Here's how you kind of like so they could put me.
In case you need. It yeah, they could put a face
to the name and stuff like that but yeah so that would be
perfect world but what I want todo is like kind of like you said
like just so it's not like, oh the person who got the

(28:25):
information like, oh, something's wrong with them.
Just get the mental health information to all these student
athletes and then they have it and then now the screen's not
like yeah but I do have to say the mental health screening has
been huge because I feel like itmakes student athletes
comfortable talking about it with you because they know you
do this. Like I feel like I've had more

(28:47):
student athletes reach out aboutlike hey I am interested in an
appointment because of this thenbefore it was introduced.
That's a really good point, a really, really good point.
So I feel like it it opens the door.
Yeah, at the end, I at least what I think, I don't know if
student athletes think this way,but I feel like it shows that

(29:07):
like, hey, like we want to talk about it.
Like we're OK with you not beingOK.
You know, actually Speaking of this year in physicals, I
actually don't think I had a normally I have maybe 10% of the
people who I need to follow up with for mental health and I'm

(29:30):
making several appointments. I don't think I needed to follow
up with a single person for mental.
I gave resources I didn't need to make up any follow up
appointments, which I thought was really interesting.
Now, several of them who were flagged were already working
with a mental health professional.
So I don't know like specifically, but I, I think

(29:52):
that it's really interesting actually, because I feel like
the stigma has been changing. Yeah.
Slowly but I but I feel like, soI feel like a lot, we were
seeing a lot of being open to mental health, but I feel like
this was the first year that I kind of noticed people are

(30:15):
actually doing OK. Yeah, You know what, one of some
some of the stuff that's in the literature that I've noticed is
a lot of student athletes are want to seek help.
Like it's not necessarily it's getting better to where that's
not the problem anymore, that they're just not wanting to seek
help. They want it, they just don't

(30:37):
know how to access it or it doesn't it?
It's hard for them to access it because of schedule and like
stuff like that. So, and I've actually had in our
mental health screen, one of thequestions are, have you worked
with someone in the past? And I've actually gotten a lot
of yeses. So I think that kind of relates
to what you're saying. Like I think a lot of people
have seeked help right and feel pretty good.

(30:59):
Yeah. I mean, it also could we, I
mean, I don't know, like return or new people wise, but I mean,
if a lot of these were also addressed last year, like you
were saying, and maybe just the new incoming, they've also had
it something addressed, you know, previously, but I don't
know, it was a good year for us for mental health so far.

(31:23):
Nice. Some other top answers actually,
actually less common blood pressure check and emergency
medication care plans. Smart.
So Chris H says for emergency medical care plans, they have to
be filled out by the physician they're seeing for the
conditions. South Texas has an asthma action
form that we use. It's honestly the most user

(31:44):
friendly one that I've ever used.
It uses a stoplight system for albuterol use and at what point
when it becomes a medical emergency, which is super nice,
especially with the middle school coaches.
They also have a Spanish one as well.
Diabetes plans can be on a template, but if complex, it can
be pages long. Seizures are the only ones that

(32:06):
require meeting with our team physician.
And then he sent in the form, it's actually also from the AAP
for the South Texas Asthma Action Plan.
I'm pretty sure that's the one that he sent over and it looks
pretty cool. And that's another thing from
that I was going to say about our mass physicals too, is like

(32:30):
our like how I was saying before, how our like nurses go
into depth about something. It's really nice because like,
like, so I'm in this in the samearea as like the nurses and the
ortho, so I can be accessible for both of them.
So if we have someone who needs to follow up with something and
we do spread them out enough that like even the chairs, we

(32:52):
don't have a lot of people waiting by the nurses or the
orthos and the people who are waiting are far enough away out
of earshot. So it should be pretty private,
but if there is someone who like, for example, we had a lot
of people this year who need to follow up for their asthma, like

(33:13):
their asthma is not as controlled as it used to be.
So their prescription needs to be like tweaked a little bit.
So like our they might not have written that right on their
their plan, but that's somethingor not on their plan on their
medical history, but that's something that our nurses
following up with. And that's something that like
maybe some random provider at urgent care might do, but some

(33:37):
someone might not do, especiallysomeone who's not as familiar
with sport specifically, you know, if they're seeing a
different population all day long.
So that is something that I feellike is a benefit of our
physicals as they actually go into depth about certain things

(33:58):
that I feel like I haven't gotten from if someone says all
Nos on something like how many follow up questions are you
getting from whatever provider you went?
To and I would the form saying that's really cool.
I really want to do one for the diabetes just to be consistent
with the position statement, which we did do an episode on
where they talked about having anice care plan.

(34:19):
I I want to make a form for that.
I think that's a great idea. Which should be ACU.
It is. Shout out shout out to athletic
training chat and clinically pressed for providing our C us.
Thank you so much. So if you're interested in
those, Scroll down to the show notes below.
We have several free and severalpurchasable.
Very affordable for your reporting year.

(34:43):
That's right. So Kirsten M says only
returners, our returners only have their blood pressure
pressures checked. We recheck all of the high ones
a day or so later and lots are fine, like white coat syndrome,
which we get a lot of that too. Usually those that stay high

(35:05):
have high blood pressure and might be on medication.
So we keep those numbers as a baseline for our records.
Yeah, we do that for a returnerslike that's their like returner
physical is we basically update BP, pulse and weight.
What do you so you do physicals not on one single day.
Can you explain like a little bit of?

(35:26):
We do it like you guys. So we have 4 physical dates, 1
is exclusively for football right?
So we just bang out football andthen one's for all the rest of
the fall sports. And then the third one we do
before the non traditional season for spring sports.

(35:46):
So like they're like fall ball. So we do a physical for them to
get cleared for that and then we'll do a spring physical in
January for spring sports. So for anyone that came in late,
anyone who's just like, cause a lot of times like swim and
track, like they don't really dothat much in the fall.
So they'll be bringing people infor the spring.

(36:06):
So that's kind of how we do ours.
But you do it on two different parts.
You don't do it all in one day. Oh, yeah, no.
So that's it. Yeah, that's another difference.
We do what's called like pre screens, where we do everything
that you would normally see in aphysical, like the vitals, the
ortho screen, and like the Med history review their forms, all

(36:28):
that. And then our actual like
physical day, literally the kidsjust seeing the doctor and then
leaving and that's it theoretically now.
Do you do you have a problem with people not being able to
make it to two days? Because we were going to do that
with ours, but then we were worried about like, well, what
if someone only does half of their physical?

(36:49):
Or like what if someone just shows up to the physical
thinking like without doing anything beforehand or like.
Not really that does there are. That's what makes our physical
day like not necessarily like just see the doctor because
there's always a kid that's likewasn't there for the pre screen
and then think wants to try and get their physical done, which
is fine. But then you look at their
sportswear and stuff and they did nothing and you're like,

(37:11):
dog, you've had weeks to do this.
So I don't think that's necessarily a concern because
the pre screen we kind of work it out with the coach.
Hey, what day's going to be goodfor you guys and their coach
gets them here. So we do get a majority of our
student athletes that way. I think the limitation of it or

(37:32):
what I'm more concerned about isjust when we're doing them, like
a lot of times it's after the kids practice.
So you try and do their vitals and they're through the roof and
you're like, bro, now I got to wait and you got to do it again,
right? So are you getting a true
resting? And then also to like making

(37:53):
sure the kids get their sportswear done before we do the
pre screen? Because the whole point is so I
can look at your history, do your ortho, but if you haven't
touched your sportswear, you nowhave to go do that, right?
So I think it's that like makingsure they're all done with that
stuff ahead of time before I even see them is a huge help.
So like for my my teams, I bugged the hell out of them like

(38:19):
weeks before they're like quote UN quote pre screen, like get
this done, get this done. You still need to get this done
and it does work. I'm I'm lucky that I only have
to really yell at football in the fall.
And most people wouldn't say that.
It's, it's herding cats sometimes, but it's, but it's

(38:42):
only one team. I mean, they are, they're like a
bunch of mini teams together. But at least there's one kind of
collective. But we put them in a computer
lab beforehand, and I do that and I do it all together, yeah.
Most years I do that 'cause thenlike, 'cause like, again, like

(39:03):
completely understandable. Like some of these kids are 1718
years old. You're asking them to fill out
forms that mom, dad, guardian, like anyone else used to do
besides them, and you're asking them about insurance, like they
don't know. So there's a lot of questions
and that's OK, right, Right. So that's why I liked doing it
that way. But this year I didn't really do
that. And it actually worked out fine.
I was actually pretty surprised that there weren't as many.

(39:25):
Like what? What'd you do here, dude?
Yeah, So I was pretty proud of them.
Nice. So David H says we have mass
physicals where we bring in our RN program, MA program and local
ROPCTE students to help with vitals.
Our MSAT students help fill in the cracks.
We got through 132 weeks ago andhave another 140 this Monday,

(39:47):
each time with six providers from our team physician's
office. 6 That's nice. I know that is nice.
We used to have around then around that at a different place
I used to work, but we only did one physical day.
So I think having like it would be nice if we could have two
every time, but we really only have one sometimes same, which

(40:09):
is which is a bummer. I mean mostly for them, like
they have to do like 60 in a day.
And again, like we talked about,it's like in the middle of their
day or after their day. Right, right.
They complete their medical history for doc to review prior
to their physical and they upload a picture of the front
and back onto our EMR. Sportswear, once they complete

(40:32):
their basic info, medical insurance card, upload medical
forms we require and then uploadtheir physical and medical
history, they do their concussion test and they're
cleared. Sportswear has actually that
sounds very similar to mine. Sportswear has a function that
we can print reports showing whohas what missing and we color
code it and send it to coaches so they can send them in.
If doc makes a mark on their physical for for follow up, we

(40:54):
act accordingly. Usually it's like a monitor this
or tape this or rarely I want animage for this first.
If it's something more in depth then we talk to doc with the
student athlete present. Nice.
So we kind of already talked about this, but I also did ask
if you require a new physical every year of participation and

(41:16):
76% of people said yes, I'm. Surprised. 24% of people said no
I. Feel like I'm surprised by that
number. I mean, I don't know how many of
it. Like again, I'm biased because
just being at non high school level, like college, university,
like I feel like I remember highschools, they had to do it every
year. So I figured like a lot of those

(41:37):
come from high school, but I don't know, I'm fine.
I'm surprised by that. Yeah, I I'm not because we
always did so. Yeah, no, yeah.
See based on your experience. Kirsten, or actually Kristen L
says. I work in collegiate NAIA.
We have sport physicals mandatory every two years and

(41:58):
they have to be completed on ourphysical form.
That was a big thing. What?
Yeah, that we were like that. Like it has to be on our form.
That's for us too. We like it has to be on our form
because you can get so many different things everywhere.
Like we wanted to like, 'cause if they get a physical somewhere
else, like we're not screening the, they're not screening them
for mental health or like if they get somewhere, whatever,

(42:20):
they're not screening them for the same questions we asked.
So one thing that I've noticed I've gotten a couple times that
I feel really bad about, but like I can't do anything with it
is like when a kid gets a physical, like your normal
health physical and they bring all the forms and like it's so
detailed, like all this stuff ofwhat was checked, but it's not

(42:40):
like a sports physical. So there's nothing that says you
were cleared for participation? Oh, I don't really get that.
I've never. I've gone a couple times and I
look at them like, unfortunatelyI can't take this.
Like it doesn't say you're cleared for sport.
I usually if I get anything likethat, that's like because
usually it's just not on our forms.
So I usually just say, hey, callthe office and see what when you

(43:02):
can come back to just get it signed.
Yeah, because usually they don'thave to make another.
Appointment, yeah, and that's. If they already have a physical.
In those cases, that's what I'lltell them like hey, like take
this form, see if they're OK at least just filling this out
since you already did this. Right, right, Kristen continues.
All physicals, risk consent forms, drug consent forms,

(43:24):
insurance info, etcetera, gets uploaded under each athlete in
our EMR system. Then we have a spreadsheet that
we track everything on and checkoff as they complete things.
So that's like very similar to yeah, Justin N says.
I think it really depends on your resources you have.
I really like this, this, this take.
I don't think you want to overwhelm your dogs by making
every single kid get a physical every year unless something

(43:46):
drastic happened the prior year.I think new kids and anybody who
had something happened within the past year, such as anybody
who received a concussion or hadsurgery the year prior.
Seems like a bit of a burden on your team physician to have a
bunch of healthy athletes that nothing happened to to have them
go through the entire physical process again.
Yeah, I get that. I mean, that's why I like, I
like, again, like we would do one and then for the rest of the

(44:08):
four years like or for the rest of the three.
Wait, do you require your returners to get a new physical?
No. Now it's a medical history
update and then our returner physical, which is just updating
vitals, which even then I'm kindof like, do we really need?
Do we need? To cause like again, every other

(44:29):
institution I've been to, we never did that and like we did.
When do you ever use that? Like I use the blood pressure in
like when I'm checking vitals like I'll check to see what
their normal blood pressure is. I do it like after like I'll
look to see are we seeing any differences?
But again, like I said, like sometimes our pre screens,
that's after their practice. And so it's like, oh, that's

(44:50):
hard. I know that's one limitation of
it, but that's why a part of me is like, I mean, they don't
really change that much. So unless I had someone that
like all of a sudden started having cardiac symptoms like
within the year, I think that would be a better way to do it.
Yeah, I don't know. I kind of want to get rid of
that. Yeah, I feel like it's, it's

(45:11):
hard because I, I, I can see howboth sides I, I, I areas also
depends on institution. Yeah.
And what your team doc wants, right?
Like team doc technically is overseeing this.
So if they want that, they want that.
I mean like we had, this is the first time for me.

(45:31):
We had a kid who like we don't normally check, I don't really
pay attention to their weights like at all.
But our nurses caught 2 that their weights have changed
drastically. One of them had been because of
a surgery and one of them I'm suspecting some GI issues and

(45:56):
they're one of them was new and one of them was a returner.
So it's really interesting that that weight was caught on the
physical that it probably wouldn't have been.
And that's The thing is like howdo I know who to like RE?
I wouldn't have known about thisreturner.

(46:18):
So I don't know. I think it's helpful going back
to Haley's, we're talking about the 13 month thing, she said.
Since I am in Ohio, physicals expire every 13 months.
All fall athletes need to have aphysical on file by August 1st
to be eligible in any forms through the athletic department.
Filled out concussion, understanding, Lindsay's law,
emergency contact forms, etcetera.

(46:41):
In Ohio, the 13th month is like a leeway month to get in.
To get it in on time, students need to have a physical on file
with office before they can participate.
My coach only sees the time frame left for the physical,
like a countdown until it expired, and then the secretary
only uploads the physical that has been checked off the exam
date and that they're medically eligible.

(47:05):
So I also asked what are some reasons your athletes are not
cleared on their physical most common answers?
Actually we had two most common answers, cardiac clearance and
post surgical. Nice.
And they need some sort of clearance for that.
Yeah, I would say the cardiac. I mean, yeah, definitely.
We get a ton of cardiac. Definitely the post surgical but
surprisingly we've had neuro. Really.

(47:26):
We've had the past couple years,we've had some kids with neuro.
Like. I actually had a kid with drop
foot. Oh, and like I I told the doc
and he looked at drop foot. I was like, yeah, that's the
only way I could describe this. And we were looking.
I was like, holy smokes. He does kind of have droplets.
Yeah. And then?

(47:47):
What? What happened?
Did they? It wasn't really my athlete, so
like, I don't know what. Ended up happening.
To them like the doc wanted themto check in with the neuro.
You know what, last year I had acouple of neuros too and and
last year I had a couple of incoming football players who
had previously fractured vertebrae.

(48:10):
I love that. I had, I can't remember if I had
two or three and I was like, it is two or three too many.
Yeah, that's crazy. Yes.
Oh, you know, I think it was 2. But then one of them had history
of being spine boarded but didn't have any fractures.
So I think that's what it was. Crazy though, yeah, we get a lot

(48:33):
of oh, and then I also had a a weird neuro that they're pinky
wouldn't stop moving. That's wild.
Yeah, cardiac clearance, we get a lot.
High blood pressure, we get a lot.
I've had high blood pressure that still with rechecks

(48:54):
wouldn't come down. So we just send and they get on
meds and then they're fine. Nice Oh blood pressure was
another high reason why people are not cleared, but not as high
as vision. That's interesting.
We had a lot of people say that vision wasn't clearing athletes,
which we at my current school, we don't check vision.

(49:15):
We don't check vision, but we'vechecked.
I've checked. It's been part of our check
before. Not at this current school but
like other other places like I've I've been at places that
they check vision. Oh yeah, I remember those days.
Mm hmm. This one from Anonymous says
heart murmurs and hernias are the top 2 I see.

(49:36):
Hernia's crazy. I know right?
I thought that was crazy too. Most of them after doc hears A
murmur they will send them to get a cardiac clearance.
Hernias. I've had one or two every year.
It's usually boys with inguinal hernias.
They get sent for surgery and then they're good.
The recovery is not long at all.They can start working out after
a couple weeks and they're fullycleared for sports around 6 to 8

(49:56):
weeks. So if they were good and planned
ahead, they really don't miss much of their season.
Nice. Yeah, I only have two more
things left, so we're kind of wrapping up here, but the
weirdest answer that you've seenon a physical, I had to include
this one, of course. What is the weirdest thing that

(50:16):
you've seen on? That see now I don't remember.
I'm trying to think because I feel like it's never really the
answers like on the form, it's their explanation of things and
I'm trying to think. I can't think of most of the
time. It's like sometimes I could just
a condition I've like never heard of or like just some kids
like what they're dealing with. Like, Oh my gosh.

(50:37):
Right, right. That's crazy.
We've changed ours. I think I saw this somewhere and
I was like, I need to change ours immediately because you
know how usually it's like you have the question and the little
yes, no. And then at the end it's like,
explain all your answers here. And they're all jumbled in this
paragraph. Like no, I wasn't.
No, we're not doing that. So what we've, what we've

(51:00):
changed it to do instead is eachquestion has a little, it's
there's a yes, no, but the yes is way bigger than the no.
And so they have a little spot to write something and then if
it's not big enough, they can write at the end.
So nice, so we. So they can't just like check
mark the yes, they actually haveto write a little explanation.

(51:21):
So, so we do our medical historylike on sportswear.
So we use the history function and there's the you can tab yes
or no. And then there's a comment
section where they are supposed to explain it.
Yes, right, right next to the question, right next to it,
right. I'm going to emphasize right
next to it. And no matter how many times I

(51:41):
tell them, like if they're in person, if you check yes,
explain it here. If you check yes, explain it
here. They don't have like a required.
No. I should look to see if that's
possible, but I don't. Think so.
See we don't do the sportswear Med history anymore because we
do all the physical and no one checks the sportswear Med
history. So I feel like it's redundant.
But you use it for your returners, right?

(52:02):
Yeah, but no, actually the returners, their Med history
update is one of the forms in sportswear.
Oh, interesting. Yeah, it's wild stuff, but now
that's actually a good point. We.
Should switch it. Yeah, you should, but.
We did do like where I was at before their medical history was
a form on sportswear, like the actual form and same thing.

(52:23):
You have all the questions and they yes, and then at the end
they would explain it right, Same problem.
No one explains it. So even after I tell them, Hey,
explain it here, I'll go throughtheir history and there's like,
yeses, I'm like you're. Supposed to explain this.
Yeah. Don't you think I want to know
more, Right. Like don't you think I want I I

(52:43):
need to know what your. Yes, I've had knee pain.
Can we explain this a little bit?
So the weirdest answer that I'vegotten.
Was something I think it was last year someone wrote the
under their allergies section. They wrote they were allergic to
seafood, but only after they only if they eat seafood and

(53:05):
then work out. So like they can eat seafood.
Just fine. They can eat seafood every day
of the week, but if they eat seafood and then they work out,
they will go into anaphylactic shock like well hold on babe,
they can't eat. Seafood every day of the week.
You can't eat it on the leg day.Correct.
Because like they had an EpiPen for it.

(53:27):
That's and I was like, how did you figure this out?
Yeah, I was going to say for thephysicians.
And the athlete to figure that out.
So it was something about. They well, they were from the
South and so seafood is something they eat a lot.
And so they were like, I'm like would never have a problem with
it, but it but every single timeit happened like I'd be working

(53:49):
out and I'd figure out that likeI had seafood beforehand.
And I think they related it to some how like the inflammation
of like working out like that created like, I don't know, they
explained it to me, but it was their best, their doctor's best

(54:11):
guess of what was happening. All right, makes sense.
OK, some other ones we've gotten.
Someone said they were allergic to pre wrap that one's.
Wild. I wonder if it was more like a.
Like a heat rash or like a folliculitis?
Spleen tore in half. That's wild.

(54:32):
I would. Want to know the story so much?
More to that, you know what this?
Is going to drive me crazy. But I was sitting, I'm checking
out and I was within because I'msitting pretty close to the
nurses. I was within earshot of the
nurses and the nurse said to someone that she was asking
questions and I wasn't really paying attention.

(54:52):
And she said, well, she she was saying so.
And then she was like, well, I mean that makes for a really
crazy story. And I was like, Dang, I like I
missed it. I don't know what they're
talking about, but I like the person came through and I
totally did not ask what the crazy story was.
And I didn't see anything crazy on the physical.

(55:14):
So I will never know. Although one of my guys
previously, I think I've shared this before, it wasn't on his
physical because he was scared that it was going to make him
disqualified somehow. I don't know, but I was treating
him. I don't remember what I was
treating him for, but he said that he had previously fractured
his pelvis. And I said how how did you do

(55:36):
that? And he said when he was a kid,
he, his parent, his dad worked for, like, a logging company.
And he and his brother were, like, playing in the logs.
And the logs started rolling. Yeah.
And so. Somehow.

(55:57):
He fell and the log like rolled all the way up to his pelvis and
so crushed everything from hips down but didn't.
I don't know if someone stopped it or if it just like momentum

(56:17):
like stopped and then rolled back down.
That's wild, right? And he and I was like.
Dude, I don't remember seeing this on your physical, like I
would have remembered seeing like you broke every bone from
the hips down and you were hospitalized.
But no, he was like, no, I didn't write anything.
Wow. I was scared it was going to

(56:39):
make me disqualified. It's like, no, you're fine.
I just, that's. I would like to know that
though. Yes, David H said this.
Oh, hold on, we got a little more.
That I've been waiting for. Oh, you want to read this mental
health one? Yes to a mental health question.
Someone had. I'm an anxious girly, but I'm

(57:00):
OK. That's funny.
That's what I was waiting for. I think that's hilarious because
I'm for sure one of my athletes would put that down.
Oh yeah, I thought that was hilarious.
All right, you may. Continue.
David H said this. One is new for me.
We have my first student athletewith a confirmed heart
condition. He's cleared to play but we
monitor him closely. He has tetrology of fellow.

(57:25):
Is that how he said sure. It is surgically repaired when
he was an infant and he has monthly checkups with his
cardiologist. Doc brought me over and
clarified it for the student athlete and has a card that they
have everywhere, so if they go to the ER or something, they can
show that dope. Yeah, I feel like I've heard of
that before. I could not tell you a single

(57:46):
thing about it, but I think I'veheard of it.
I don't think I have. I'm going to look it up
afterwards. Usually this is where.
I learn about conditions. Is through physicals, yeah.
G6 PDI had no idea what. That was right.
You get stuff like that and you're like, you have to look it
up and like, oh. See, look, I learned something
new. We have a section that asks
about their. Medications and like what

(58:06):
they're taking, if they're taking any supplements or
medications, and it actually used to be at the top near the
instructions and everyone would skip it because I think they
thought it was part of the instructions.
So I moved it down to the bottomthis year and everyone's folded
up. It's just people with the eye
doesn't skip it anymore. Good.
Because it's not part of the instructions.
Yeah, that's right. So.

(58:31):
I usually get some random. Medication knowledge there where
I'm like, I have no idea what this is for.
Can you tell me? And then that's how I learn new
medications. Yeah.
Or it's interesting to see how many people take like
Ashwagandha or like, yeah, creatine.
Everyone takes creatine. Everyone takes.
Creatine. Good job everybody.

(58:54):
David H also said four things tofollow up with on the physical.
I live in the Central Valley, soif you don't have some sort of
asthma, you're really lucky. For us, it's the difference
between vocal cord dysfunction and asthma, which I didn't.
I had never heard of vocal cord dysfunction before grad school
and I've never had an athlete actually with it.

(59:18):
But I think that's, it's really fascinating.
Like I feel like it's actually pretty calm even though like I
haven't seen any. But, like, I feel like I hear
about it more often than I wouldthink.
We heard it in our doctorate. We did.
We did. Yeah.
We read. We.
Read We read a. We did a little journal thing

(59:38):
about it right? That was my section.
That I had to do, that I had to do.
I mentally blocked out though. But yes, yeah, I feel like yeah.
I feel like it was kind of like a really buzzword condition like
a couple years ago, like everyone was talking about,
yeah, like, like five years ago,right?
But then like now, like no one talks about.
Vocal cord? No, I have not seen it come.

(59:59):
Through but it was big like fiveyears ago I.
Remember there was a lot of NATAtopics on it and a lot of
presentations on it. So maybe it's more out there now
people are a little more familiar.
Yeah, I feel like the big buzzword right now is.
Like cartilage Macy procedure Amicelle.

(01:00:20):
OK, OK. I haven't heard the.
I only heard it from you. I actually haven't heard the
Macy. I've had two people who have
been. Recommended.
And then more like 4 or five people with cartilage chairs.
And then recently and then I sawat CATA that someone did a case
study. Nice presentation.

(01:00:41):
I was like, man, this is a hot topic right now.
I feel like we're getting the tail end.
Of like Vertigo. Oh yeah, that was that was a
really big one, but. Now I I I'm starting to.
Slowly see, like you don't see as many sessions on it and
you're starting to phase out. Now I am trying to think, OK,
what is the new, like really bigone?
I don't know. I mean, maybe it is Macy.

(01:01:02):
Procedure. I'm just.
I'm just, you're behind the times.
Yeah, apparently I'm. I need to catch up.
So Speaking of catching up, I hope you guys had enough time to
catch up over the summer. With the rest of our episodes.
Actually, it's pretty interesting.
I don't know about you guys, butI sometimes if I ever go back,

(01:01:25):
like I can barely remember some of the episodes that we have
done in the past, like even though we're sitting here living
it. So it's sometimes fun to go back
and see like what we've done. And I'm sure if you're looking
for a topic, I'm still trying toput together that podcast
directory so you guys can betterfind some of our old episodes.

(01:01:46):
So I mean, they do live on, but they only live on if if you
access them. So there are some some cool
topics that we've had in the past.
And if there's something you want to hear in the future,
please reach out as we are stillpiercing together and trying to
figure out what exactly we're putting together this season.

(01:02:07):
We do have our CU still available on our website.
We have some AT discounts and some other things.
We're going to try to put that directory up pretty soon and
maybe some patches and some other podcast merch on the way
were. You going to say something?
Yeah, I was. I was just going.

(01:02:28):
To say speaking. Of like older like episodes and
stuff. What's crazy to think is being
Season 6, like some of our Education episodes from our
first season, can be updated this year with new literature.
Yeah, we're, we're going to be getting a lot of updates.
Yeah. So that's how long it's kind of
been. Since those episodes, so we can

(01:02:48):
actually provide some. Here's what the literature says
now. I think that's all I have.
Thank you for helping us showcase athletic training.
Behind the tape. Bye.