VU athletic trainers: ER docs on the field

Feb. 11, 2014

By Jerome Boettcher | Subscribe to Commodore Nation

Jackson Five blasts through the iPod speakers at 8:18 a.m. on a recent Wednesday — Motown Wednesday to be exact —reverberating through the ground floor of Vanderbilt’s McGugin Center.

For more than an hour now, student-athletes have trickled in for morning rehabilitation at the A. Brant “Pinky” Lipscomb Athletic Training Room.

The 4,300 square foot facility, which is due for an upgrade, serves as the crowded recovery hub for Commodore student-athletes. Head athletic trainer Tom Bossung is in charge.

Fans get only glimpses of athletic trainers on TV, when they rush onto the field or onto the court to assist injured players.

But long before, and long after, that moment, Vanderbilt’s athletic trainers are on the scene — assessing injuries, taping ankles and wrists, molding braces, stretching out sore hamstrings, supporting an athlete through exhausting rehab sessions.

“The trainers run the show,” says Warne Fitch, an assistant professor of emergency medicine who is one of three team physicians for the football team. “They are ER docs on the field. They have a broad understanding of a lot of injuries. First ones the athletes go to. The first ones the coaches go to. They are involved with every aspect of this team and have a very broad knowledge base. They are constantly asking questions, trying to do more training. They are outstanding here.”

Thirteen Certified Athletic Trainers (ATC)— 11 full-timers and two yearly term professionals — tend to Vanderbilt’s 350 student-athletes. Each of the 15 varsity programs has an athletic trainer assigned to it, though some trainers double up.

Unlike most collegiate settings throughout the country, the athletic trainers at Vanderbilt are employed through the Vanderbilt University Medical Center. The department falls under the division of Sports Medicine in Vanderbilt Orthopedics.

This minimizes many of the conflicts of interests other athletic departments face.

“It is not really an issue,” said Bossung, who came to Vanderbilt as a graduate assistant in 1990. “That’s because of the support (athletic director) David Williams has given us. He emphasizes to the coaches, this is our setup, this is the way we like it, and this is the way it is going to be. Medical staff, which includes us and the doctors, will make all the final medical decisions.”

When hearing TV announcers were quick to diagnose wide receiver Jordan Matthews with a concussion on the opening night of college football, Bossung cringes.

As a kid, he dreamed about becoming a sports broadcaster. But when realizing former professional players or coaches had inroads to spots in the booth, he started looking at a different career path.

The Indiana native passed on Division II scholarship offers for baseball and football to get a head start as an athletic training student. When he was promoted to his current position in 1999, at the time he was the youngest head athletic trainer in the SEC at 32. He relishes the weekly challenge of working with an injured player and getting him back to the field healthy.

So when his work is questioned, he, understandably, is irritated.

“If I’m not in full support of this team, why would I do what I do and spend as much time away from my family?” Bossung asks.

Against Ole Miss that night, Matthews had experienced cramps throughout his body and was taken to the locker room earlier in the game to receive an IV and rehydrate.

Matthews suffered a blow to the abdomen when he was tackled late in the fourth quarter. His helmet scraped the turf and, as he was getting back to his feet, he began to vomit. The announcers saw this as a symptom of a concussion when, in actuality, the senior was regurgitating fluids which had helped him stay hydrated on a steamy August night.

Matthews was taken to the sidelines, cleared by Bossung and team physicians and went back on the field a play later.

Bossung knows the concussion issue is a hot button topic right now. In 2011, Vanderbilt took a ginormous step in address this potential life-altering injury by opening the Vanderbilt Sports Concussion Center.

In fact, for two years, athletic trainers Justin Wenzel, Tracy Campbell and Shannon Gordon compiled a 31-page concussion evaluation guideline manual—an example of the athletic training staff’s Continuing Quality Improvement projects. The TSSAA and Belmont have modeled their “Return to Play” procedures after Vanderbilt’s extensive approach.

“I feel like the way we manage concussions, to begin with, is ahead of the curve,” said Campbell, who hopes to publish the manual. “I feel like this is really ahead of the curve compared to most institutions.”

They pieced together the manual with the guidance of neurosurgeon Allen Sills and neuropsychologist Gary Solomon. Sills, an associate professor of neurological surgery, is not only a tremendous asset for Vanderbilt sports but is an international expert. He was one of 12 doctors on panel at the International Conference on Concussion in Sport held in Zurich, Switzerland last year.

“Whatever comes out of that meeting is how everyone manages concussions,” Campbell said. “He is part of the exclusive group of people — and we have him as a resource. Just having those type of people support us is awesome.”

With one foot in the air, the tight end focuses on keeping his balance.

He’s standing on a Bosu stabilizing ball—a blue, rubber dome—as he tries to catch a football tossed by Campbell.

This wouldn’t be easy for someone with two legs, but after suffering a medial collateral ligament (MCL) sprain, this is part of his rehab. Campbell is trying to strengthen his leg while also bridging a connection between his brain and muscles.

The tight end isn’t alone for morning rehabilitation. More than a dozen student-athletes spread throughout the training room, which includes eight taping stations, 10 tables for therapeutic methods such as ice compression, ultrasound and electrical stimulation and proprioception mats. Nestled in the back are an eight foot-deep rehabilitation pool and two therapeutic whirlpools. (The baseball, basketball and track teams also have small athletic training rooms on location at Hawkins Field, Memorial Gymnasium and the multipurpose indoor facility.)

Hopefully soon, the athletic training home will receive needed renovations.

Athletic director David Williams recently announced plans to more than triple the current training room to more than 14,000 square feet. The state-of-the-art facility will include three hydrotherapy pools, modernized equipment, more treatment tables, taping stations and cardio equipment. It will serve all student-athletes and teams.

The project will cost $6.5 million and funding for the project depends solely on philanthropic contributions. So, construction will begin once fundraising is complete and the project has received formal approval by Chancellor Nicholas Zeppos and Vanderbilt Board of Trust.

But right now, no inch of space goes unused. The storage room near the street entrance of the training room is a prime example. On most days, crutches and coolers line the walls and football pads hang off pipes. Several giant storage cabinets with answers inside to scratches and headaches (among other potential problems) and other medical supplies are also tucked against a wall along with 100 cases of Gatorade and a utility vehicle used to haul medical equipment to games and practices.

And, twice a week, this same space is transformed into a massage therapy room.

Amid all the clutter, four licensed soft tissue specialists—massage, active release technique, muscle energy technique and sports chiropractic — come in to loosen up the knots and ease the pain.

“We use them to help us out,” athletic trainer and clinical coordinator Justin Wenzel says. “These guys go out on Saturdays and beat their bodies up. This is kind of an augmentation to rehab for some of them.”

Across the room, Kerry Wilbar (ATC) monitors a player going through exercises necessary to return from an acromioclavicular (AC) joint separation in his shoulder.

Adam Clemens (ATC) assists a graduate assistant coach whose foot was stepped on by a lineman at practice the night before and has blood under his toenail. Coaches frequent the training room, too, often receiving treatment for ailments ranging from old playing day injuries to minor bumps and bruises.

John Marshall, a student intern from Western Carolina University, channels his inner mechanic to repair a bulky knee brace. Each lineman is required to wear the braces, which cost more than $500 each, as a precautionary measure.

“Who knows how many ACLs these have saved?” Marshall says.

Campbell demonstrates a tape job to protect an injured thumb. Tape is everywhere. A few hours later, football players will line up at the taping stations for wrapping up their wrists and ankles before practice.

Before one practice, senior cornerback Steven Clarke jests Bossung:

“You don’t have that womanly touch!”

“I would hope not,” Bossung replies.

“You’re so gruff,” Clarke answers with a laugh.

Bossung smirks and gently applies the final tape. Clarke smiles and gives his approval as he jumps off and the next player hops up.

The day starts at 7 a.m. for the five football athletic trainers, a yearly term professional and Marshall. It includes rehabilitation, pre-practice, post-practice and triage sessions, and it won’t end until 9 p.m.

Game days are also long, beginning four hours before kickoff with setup of the field and ending at least two hours after the final whistle with injuries to tend to. Then they’re back on Sunday, assessing new injuries and starting the week all over again with practice.

“They are in the training room before we’re awake and they leave when we’re in our dorms,” kicker Carey Spear said. “Something that shouldn’t go unnoticed—that’s for sure.”

Two days before the Commodores walk into Neyland Stadium and upset their archrival, Bossung focuses on a player who won’t be on the field.

Wearing a red non-contact injury jersey, a freshman wide receiver works with Bossung off to the side while the rest of the team practices. He tore his anterior cruciate ligament (ACL) back in the summer and had surgery on Aug. 30. Eleven weeks later, he is making a breakthrough.

Activity has been limited to this point, but Bossung wants to see him walk, heel to toe, across the practice field.

“You looked somewhat robotic,” Bossung says. “Loosen up.”

He decides to show the hesitant freshman his surgically repaired left knee is healing better than he thinks. Raising his hand chest high, Bossung urges his patient to kick up his knee.

The leg begins pumping as Bossung shouts out words of encouragement. The wide receiver is pleasantly surprised when he is jogging by the end of practice.

“Ahh,” he yells with a smile. “I can run!”

The player still has a ways to go before he’ll be cleared for contact drills. But Bossung pulls out a piece of paper and sketches a chart showing the wide receiver how the graft, which replaced the torn ligament, in his leg has strengthened in the last 10 weeks.

Assuring student-athletes make a full and safe recovery after surgery has been commonplace for Bossung and his staff.

Just on the football team, of the 11 starters on offense and the top four reserves, 13 players have undergone 19 surgeries throughout their careers. On defense, nine players have had 13 surgeries.

Thirty-two surgeries. Eight have been under the knife multiple times, including six operations on one veteran player. The procedures on the team vary from wrist, knee, shoulder, ankle, appendicitis, sports hernia and hand.

“There is a specialist in every field at Vanderbilt—and we’ve needed it to have good success with a lot of our athletes,” Fitch said. “I think that is unique to Vanderbilt, actually, having a great medical center right here that is willing to help out and get these athletes (seen) very quickly.”

Athletic trainers have a hand in the process. They have specialists on speed dial. They set up the surgeries. They’re in the waiting rooms during the procedure. And when the rehabilitation process begins, the athletic trainers will be on hand for every step.

“I wouldn’t be playing if it wasn’t for them,” defensive end Kyle Woestmann said.

“What drew me into athletic training versus physical therapy is the population that I could work with,” assistant manager and athletic trainer Mollie Malone says.

Malone, like Wenzel, initially wanted to pursue physical therapy. But she gravitated toward addressing sports related injuries after observing an athletic trainer at a military base in her native Alabama.

Only Bossung has been at Vanderbilt longer than Malone, who stepped on campus in 1992 as a graduate assistant. For 21 years, she’s bounced around inside the department as an athletic trainer for football, cross country, track, women’s soccer and men’s and women’s tennis teams. Currently, administrative duties account for 90 percent of her job. She handles the budget, ordering medical supplies and insurance, among the other business related tasks of her job.

She stays involved with the student-athletes, too, as the athletic trainer for the men’s and women’s golf teams.

“I know they’re passionate about what they do, especially at the collegiate level,” she said. “They’re very motivated. They have a goal in the end and I’m here to help facilitate that, process that, and get them back to their goal.”

The hours are daunting.

Campbell, who just finished her sixth football season at Vanderbilt, recently logged 93 hours during one week. During the season, 14-hour days are the norm, and days off are essentially nonexistent. The closest such thing usually comes on Mondays, when the team doesn’t practice, and offers a slight reprieve—an eight-hour workday.

Overtime? Not for athletic trainers, who are salaried employees.

“We have to love what we do, or else we won’t last,” Campbell said. “People weed themselves out of the profession pretty quickly if they’re not up for it.”

But the reward is indescribable.

When quarterback Austyn Carta-Samuels injured his knee in the first half against Georgia, he soon learned he had torn his ACL. But it didn’t end his season. That’s because Carta-Samuels and Campbell weren’t ready for his college football career to be over.

“I really wanted to do his rehab,” Campbell said. “I knew it was going to be a challenge and I was up for it. Not everyone can return to play. I don’t know if it is genetics, physiology. A lot of it is mentality. A lot of people, that factor really holds them back. But Austyn attacked the rehab, had great confidence in me, himself and his knee and his physicians.”

From the start of his rehab on Oct. 24 to Dec. 4, the date of Carta-Samuels’ surgery, he worked five hours a day with Campbell to bolster his quad, hamstring and hip muscles. In addition, Campbell said, dynamic stabilization exercises helped bridge the gap between his brain and muscles to compensate for the lack of an ACL.

In fact, a week after diving into intense rehab Campbell put him through a functional hop test to measure the strength and balance of his left knee. The results were outstanding as his injured knee actually outperformed his unscathed right knee.

From there, she took him outside and ran him through a five-step or seven-step drop back. Then he progressed to rolling out and running and throwing.

“When you work with the trainers really well and you believe in the trainers, they believe in you and take care of you,” Carta-Samuels said.

Campbell never felt resistance from Carta- Samuels. She relished the time working from the self-motivated fifth-year senior, who, prior to the injury, had a “pristine knee” and little experience in the athletic training room.

When Carta-Samuels stepped back onto the field against Kentucky, for the first of his final three games (all wins), Campbell began to tear up.

“But I didn’t let anyone see,” she said, smiling. “I was so proud of him because he had worked so hard. He was able to get back on the field after thinking his college career was going to be over. It was a lot of fun to see that and I enjoyed helping him through the process.

“It was really, really rewarding. That is why we do what we do."



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