Hydration while Hiking

When I first moved to Seattle, I learned that this is a place for "outdoor people."  You know the type... people who like to do activities outside for fun.  Hiking, fishing, skiing, snow shoeing, biking, boating, camping, backpacking, rock climbing... basically a lot of things I wasn't really into.  Prior to moving here, I ran outside or went for walks and I have always loved to kayak, but mostly my outdoor activities were barbecueing and sitting by a pool.  Eager to fit in and make friends in the PNW, I accepted an invitation from a coworker to hike at Mount Rainier.  We had probably walked about two miles when I said... "Ummm.... I don't think I've ever actually hiked before."

"What do ya mean?" she asked. "Well," I replied, "Connecticut doesn't really have high mountains.  I can see we are still headed away from the car and have probably already walked two miles, but my previous hikes would never have surpassed maybe 3 miles and were a lot flatter.  I'm not sure if I'm well enough prepared for what we're going to do today." She did the smartest thing you could possibly do in that moment.  She asked what was in my backpack.  What was my water situation? I had two 20-oz plastic bottles in my backpack, both mostly frozen still.  Did I mention it was August and at least 70 degrees in direct sunlight?  What else was I carrying?  I had a peanut butter and jelly sandwich and an apple, an extra pair of socks, and a long sleeve shirt.  That was it. 

Mt. Rainier August 2016

I ran out of water.  I ran out of food.  And my phone said we walked about 12 miles that day. By the time we got to the car, my legs felt like brick walls and you can imagine how my feet did walking that much in an old pair of NIKE Shox tennis shoes.  But the view!

Since that first hike in August 2016, I have regularly fallen into the trap of agreeing to hike with this same friend.  If it sounds like I'm blaming her, I'm not. I really love going.  I've seen some really incredible places and made a great friend along the way... I just tend to hit a wall of physical misery somewhere around 10 miles of walking and she does an awesome job of finding us 12 mile hikes.  We recently went to the Olympic Peninsula and did the Dungeness Spit hike... my phone says we walked 14 miles that day. I feel like I keep falling for the same trick... or I keep asking for it!

Every time we go for a hike, I think I get better with my preparation.  I no longer wear all cotton.  I now have a Camelbak Backpack that can carry multiple liters of water.  (This same hiking friend got it for me, isn't she the best?!)  I carry sunscreen so I can re-apply.  I carry nail clippers and band aids and a small amount of medical stuff in case there is a need for it.  There is a lot more food on every outing, also.  As a physical therapist, I really should have known the importance of hydration and nutrition on this amount of physical exertion as well as for recovery, but I really didn't know how under prepared I had been.

Recently I was chatting with some of my current coworkers discussing the basic things you should have when you hike.  I don't really feel the need to carry fire starting materials or shelter when I go for a day hike, because I don't plan to spend the night in the wilderness, but some websites recommend you prepare to be stuck out there and carry these types of things. Also, I have an irrational fear of getting lost and a terrible sense of direction, so I should probably prepare better for this type of situation. If you're curious to know more about the basic essentials you should bring hiking or camping, REI has a post about it, here, and I'm sure they'll sell you all the equipment listed so that you can have the safest hiking or camping experience ever!

But today the focus is hydration.  Water is essential for our survival.  This scientific paper was really interesting and explains a lot about the importance of hydration.  Water makes up our blood, helps regulate our body temperature, serves to transport nutrients and wastes, and is an essential component of cellular processes.  The paper states "during challenging athletic events, it is not uncommon for an athlete to lose 6-10% of their body weight... decrements in performance can occur with as little as 2% loss of body weight" Running out of water while hiking or exercising can be scary because drinking water found in nature can make you really sick.  I don't know all the rules, I just know that when I ran out, my friend wouldn't let me drink from the lake because of the risk of bacterial infections which lead to serious tummy aches... and other gastrointestinal issues that I'll spare you the details of.  Just know that if you drink water in the wild, you could end up feeling really miserable.  Fortunately she had enough water to share to finish our hike.  But how much should you bring when you have to carry it and it can be super heavy? 

I read several websites and articles looking for the recommendations.  Most of what I found says a half liter for every hour you plan to be out walking.  More water if it's hot, if you're going on a steep incline/heavy exertion hike, you're not a regularly trained hiker, you sweat a lot, or you tend to drink a lot of water in general. 

If you're thirsty, you're already probably a bit dehydrated and need to drink.  In fact, the paper  listed above describes the need to drink before you reach this point, even when not thirsty, while being active.  There are recommendations of consuming water every 20 minutes, but again, this really varies based on exertion level, fitness level, temperature, and sweating.  Still, dehydration and heat stresses can become medical emergencies if they're not properly handled.  Conversely, you can drink too much water without sufficient salt which is also a medical problem.

You can actually find out a more specific amount of water you should consume by weighing yourself, exercising while measuring your water intake, and then re-weighing yourself.  The Seattle Storm go through this every season in order to try to determine how much fluid replacement players might need for optimal recovery after practice and games.  Fluid replacement is important with exercise of all types, but for today, I'll just try to be safer while hiking and be prepared as much as I can be for the conditions I'm expecting.  There are so many other important reasons to consider hydration.  In the clinic, we discuss drinking more water with patients experiencing post concussion syndrome and chronic pain a lot, also headaches, and anyone experiencing dizziness.  In general, we probably all need to drink more water, particularly when we're active.  Let's hope the summer sunshine is here to stay in Seattle, and here's to a summer filled with gorgeous hikes!

Physical Therapists in the WNBA

The 2019 WNBA Season is finally here!  Earlier this week, the WNBA announced their new Commissioner, Cathy Engelbert, CEO of Deloitte, after a search that began in October.  You can read about that here. She's coming into the WNBA at a time when the league and players' union are negotiating the collective bargaining agreement as well as a time when women's sports are on the rise.  Since the WNBA is the longest running women's professional sports league, they have a sizeable platform which comes with responsibility and opportunity.  The choice to use the title of "Commissioner" rather than President, which has been the historical title of the WNBA's highest leader, is, I'm sure, purposeful. Thanks to Wikipedia: "A commissioner is a person who has been given an official charge to do something."  Most men's professional sports leagues in the USA are directed by commissioners - Adam Silver in the NBA, Roger Goodell in the NFL, Rob Manfred in MLB... there are more.  Cathy Engelbert will be the first WNBA Commissioner, and while I can't really find a source that defines the difference between a Commissioner and a President, this choice makes her appear to be at the same level of Adam Silver rather than the previous title that made all WNBA Presidents look like they were a step below the NBA Commissioner.  Whether or not she reports to Adam Silver, I like the way this looks. 

Photo: Steven Yee

Also this week, the Seattle Storm played their two 2019 pre-season with games against the Phoenix Mercury and Los Angeles Sparks.  I love pre-season games because it gives all the recent college graduates who are trying out for teams the opportunity to play WNBA basketball.  The college game may look the same as the WNBA to some people when you're watching on TV, but truly, they differ.  The size, strength, and speed of these athletes - who are truly the elitest of the elite - just can't be matched by the college teams.  Both are excellent to watch, in my opinion, but they're different. Also, sometimes I forget in the off-season how big Brittney Griner really is... but then you see her on the court and remember.  SO BIG. Wikipedia says 6' 9" and 205 pounds... but basically she's a brick wall on the basketball court.

I also look forward to pre-season games to see how the staff gets into their game day routines.  Just like the players on the roster change and each person has to find their role among that list, the staff evolves and each person's roles may change from season to season.  With new medical staff on board this year, this was the first opportunity for us to all work a game together and see how everyone fits and what roles we will all play.  And every year since I started with the Seattle Storm, I've wondered how many physical therapists are on WNBA staffs this season, and what role do they play?  But this was the first year that I wondered how this compares to the NBA?  So... I did a search, and this is what I found:

In the WNBA - there are only two teams out of the twelve in the league that list physical therapists among their staff.  The Atlanta Dream have a Head Athletic Trainer who is also a physical therapist and the Seattle Storm have me on their list.  In addition, the Seattle Storm Head Athletic Trainer is also a physical therapist.  So 16% of WNBA teams list a physical therapist on their staff list and my google searching suggests that Minnesota may also has a dedicated team physical therapist, though she's not listed on their staff directory, but if we count her in the mix, it makes 25% of teams.  This number seems insanely low - but even more concerning to me was that there were three teams who don't even have a Head Athletic Trainer listed on their website!  We're in-season and it is required that all teams must have one. This concerns me because it gives the impression that the sports medicine personnel are not an essential part of the organization. While teams obviously do not have to announce who they are using, every NBA team has their athletic trainer listed. I realize the season is just starting and getting websites updated is time consuming so maybe the sites haven't been updated for this season. 

Let's assume that the WNBA team websites would be at least as frequently updated as the NBA lists.  Where I had to search extensively in the WNBA to see if teams even have sports medicine personnel at all, the NBA makes it pretty easy to search because they have professional organizations for their athletic trainers and strength and conditioning coaches.  The NBA Athletic Trainers Association (NBATA) and NBA Strength Coaches Association (NBSCA) list members from each team. I first went through all the NBATA members which showed that fourteen NBA teams (46%) have physical therapists on staff, most of whom are dual-licensed athletic trainers and physical therapists, and that about half of the teams had a head athletic trainer along with two more assistant athletic trainers.  Then I went through the strength and conditioning coaches association and found a few more teams, but some of these were duplicates with the NBATA because it looks like physical therapists are allowed to be in both. 

And then I did a google search and found that every single team in the NBA has an affiliated physical therapist.  100%.  Many of the teams that did not list them in their staff directories are clinic owners that consult for the team and likely aren't listed in their staff directory for this reason.  This might be happening a little in the WNBA, but more likely, injured WNBA players are not seeing someone designated to their team and with training specifically corresponding to training high level athletes.  I strongly believe that every team should have a physical therapist, but also realize that this would be a financially complicated situation.  Athletes of this caliber don't just show up in every neighborhood PT clinic every day, and most clinics aren't equipped with heavy enough equipment to adequatlely rehab people this strong!  Overwhelmingly, the medical staff lists in the NBA are much longer than those in the WNBA despite having rosters that are only 3 players larger than in the WNBA.  I suspect that there will be more and more physical therapists moving into professional sports in the upcoming few years as more athletic trainers pursue the dual degree designation.

Some interesting findings during my google searching: at least two NBA strength and conditioning coaches were previously strength coaches for the Seattle Storm.  There were at least six women listed among the NBA's High Performance positions.  For example, the San Antonio Spurs Director of Rehabilitation is a female physical therapist.  And finally, there were at least two graduates from the University of Connecticut working in the NBA, which is just another testament to the level of education the kinesiology department there offers.

I am hopeful that the new appointment of Commissioner Cathy Engelbert will also improve the medical staff opportunities around the WNBA.  The NBATA and NBSCA regulations do not allow WNBA medical providers to join them, but they offer really awesome continuing education opportunities, improved ability to collect data and publish research related to injuries and training, more opportunities for league-wide sponsorships, and shared resources that ultimately improve the safety and health of the league as a whole.  The NHL, NFL, and MLB also have similar groups, but the WNBA does not. Yet.  It's not because the providers in the WNBA have not tried to start their own organization.  They have.  And continue to do so.  As the WNBA moves forward with their negotiations looking towards better pay, better travel arrangements, better living accommodations, and a more realistic livelihood - I hope that their healthcare options might also be considered and that this component is taken seriously.   My best day working for the Storm is when no players are injured and nobody needs any care - but regardless of injury status, there's always room for players to gain strength and improve their performance.  Here's to a healthy 2019 WNBA season!

Show Me the Money!

I really love being a physical therapist.  It's funny to say that now, because I didn't know this was the right career path for me.  I never said I wanted to be a PT when I was growing up.  I applied to the PT program at UConn as an undergraduate - but was also considering several other options.  When I was accepted, I set up a meeting with the program director and the dean and was told that I could not continue my role as a manager for the UConn Women's Basketball Team if I wanted to be in the PT program - the two were just not compatible.  I withdrew from the PT program.  #BasketballIsLife

Anyways, a few years later, I was again at a cross roads.  My basketball life was going in a direction that didn't really fit me and I felt like I was meant to do more for the athletes than travel arrangements and video taping practices.  There's nothing wrong with those jobs - some people love doing that - it just wasn't what I was meant to do.  So I applied to PT School again.  Got accepted again.  And back to UConn I went.  I didn't know it was the best career decision for me until I started my job at Seattle Children's Hospital.  Now I'm certain it was the right path.  Despite the cost. 

Free photo 3643050 © Melissa Evanko - Dreamstime.com

I work in an office with a lot of younger clinicians balanced by a few more experienced ones who share their experiences and wisdom generously.  Those more experienced clinicians, however, do not typically share the same burden of student loan debt that many of the rest of us face.  I've briefly discussed my student loan payment approach here where I celebrated my achievement of getting my student loan balance under $100,000 from my starting balance around $124,000.  In that November 2018 post, I talked about some of Dave Ramsey's principles that I had applied to my payment plan to try to move the balance down.  That post was six months ago.  I'm currently sitting at a balance of $86,500, and, thanks to Facebook, I recently learned about Fitbux.  

If you're a new graduate physical therapist - I'm going to 100% recommend you reach out to them as soon as you know how much your total debt looks like from school.  You may have accumulated your loans at a much higher rate than you can get by making a change.  I waited almost five years to do this - who knows how much more money I could have saved if I did it sooner.  If  you're not yet done with school or you've been out for a bit longer, I'll also recommend you connect with them, just to see if they have any recommendations.  It only takes 30 minutes.  Here's how it works:

Fitbux is a company run by Joseph Reinke, a CPA (certified public accountant)- who actually was the one that posted a comment on Facebook in response to questions about mountains of student loan debt- and whose wife is a physical therapist.  They've combined their finance knowledge with their knowledge of physical therapy income and high student loan debt and created this company.  Fitbux offers FREE CONSULTATIONS to anyone (physical therapist or other careers) to assess their student loans to make recommendations on payment plans, approach for payment, consolidation, refinancing, and - I'm sure - many other things, though I don't know finance so I probably don't understand those.  

Until now, I had been doing a pretty good job of paying off my student loans and making a dent in them, but I still felt like it was a huge burden and had hoped something could make this a little better.  I had asked my own accountant about recommendations regarding consolidation and refinancing in the past and was advised not to do either.  Perhaps those were the best choices at the time, but my consultation with FitBux showed me that I could lower my average interest rate from 6.73% to a fixed loan at 3.75%.  My FitBux consultant calculated that I could now be done in five years and pay at least $8,000 less than the plan I was previously on.   They even found me a loan company that offers a bigger discount in interest rate to APTA Members! Yes, I'm paying a little bit more money per month than I was previously committed to in order to get that low interest rate, but we're talking a 3% decrease!  If I keep making extra payments like I had been - I could be done even sooner!

I'll repeat here that I'm not advising anyone to refinance or make financial changes without some professional advice.  They explained a lot of things to me that I thought I understood - but now understand much better.  I will advise everyone to take these free consultations.  FitBux explained to me that they get paid if you choose to refinance through one of the companies they point you to - and there are many options.  So, since they advised me to check what rates I would be eligible for through one of the companies they work with, and I then had this new company buy my loans for a new rate - FitBux will get a kick back from this arrangement.  The loan companies pay them so we can have this free service and I didn't have to commit to anything - but FitBux supported me through the entire transition of my loans.  FitBux also offers a tracker that you can purchase which will track your student loan payments to make sure they're being applied to your loans in the way in which you intend them to be paid.  So that's how they can offer this service for free.  

And who doesn't like free stuff?  Check it out.  Worst case scenario - you're already in the best student loan debt situation you can find yourself in and nothing changes.  Best case scenario - you save a boat load of money!

2019 WNBA Season Training Camp Begins Sunday, May 5th!

The 2019 WNBA Season is almost here!!! This week, the Seattle Storm Sports Medicine Staff gathered at Storm Headquarters to prepare for our upcoming team physicals and training camp!  Players will be starting to arrive in Seattle and get settled in their apartments with camp starting on Sunday, May 5th!  It was nice to see the Championship Trophies, including the most recent 2018 WNBA Championship Trophy, proudly on display along with catching up with all my sideline pals.  This will be my fifth season with the Storm and many of the medical providers have been there for at least three of those other seasons - so it's always a bit of a reunion getting back together after the off-season.

All of this is occurring in the same week as the Women's National Soccer League announcing their official roster for the 2019 World Cup and a group of over 200 professional women's hockey players announcing they'll be sitting out this upcoming season.  So much going on in women's sports!  We're facing a time of change.  You can see it in politics.  You can see it in education. You can see it on the news.  You can see it at work.  And, without question, you can see it in sports. It has been inspiring to see the platform athletes have through sports, and I do not take it for granted that I have the opportunity to stand on the sidelines and watch with a front row seat.  But, in the wake of all this change, we have the chance to embrace opportunities and seize every chance that presents itself.

So today, I'll highlight a little about what the beginning of the WNBA Season looks like for the medical team working behind the athletes. In truth - all sports teams require multiple teams to operate at their best.  You have the athletes on the court, the sports medicine providers - like the team doctor, athletic trainer, strength and conditioning coach, and other specialists - you have the business staff that makes sure the front office operates - and this can include your ticket sales team, marketing team... so many teams!

Our meeting was to get everyone organized. New members of the crew were introduced.  We reviewed the medical status of all of the incoming players.  This is helpful to prepare for our physical exams that will occur in the upcoming few days to know who is coming in injured and may need some rehab programming right from the start versus getting a strength and conditioning program ready.  We get details on who will still be playing overseas in the European Leagues - because some of the Storm players are going to be playing for championships in other countries and will join us later than other players.  We won't get into the discussion on why this occurs - it's financially based and it certainly increases the risk of injury on these athletes by not allowing them rest breaks or an off-season - which makes our physical exams even more important.

Truly, doing physicals for incoming WNBA players and attending training camp practices has been one of my favorite times to work with the team.  Here's why:

1) The WNBA has 12 teams with 12 players on each team - so there are 144 professional female basketball players in our league.  This compares to the 30 teams in the NBA which have 15 player spots available for a total of 450 possible jobs to play professional basketball.  That means, whoever gets invited to training camp is the cream of the crop, ultimate best at what they do.  Who doesn't want to meet, and work with, the greatest athletes in the sport they love?  Of the group that comes in, a handful won't make the team, but they will get exposure from their invitation to training camp which will help their future in basketball anyways.

2) The rookies are usually coming in from college, their first job away from home, and it's an awesome opportunity to help them in whatever way possible.  They all have different needs.  For example, one year, the Storm Strength Coach and I were doing our physical exams on a player who had come from college... she hadn't even graduated yet.  We asked her how she was settling into Seattle and she expressed some concerns about grocery shopping and cooking.  Her college team and college dining halls had fed them most of their meals - so she had never had to do those things before.  We could provide her with resources from day one of where to shop, what things to look for, and which players on the team were excellent cooks that they should ask for advise on techniques.  The team also has a nutritionist that they can meet with to help design meals, but for starters, we needed to make sure they stopped eating out every meal, because it is far too expensive and time consuming.

3) Some of the best basketball practices are during training camp.  Because there are only 12 spots on the team, these athletes are fighting hard for their spots.  At this level, they work hard almost all the time, but for sure this is some of their best basketball.  Training camp or the playoffs.  When it really matters the most.  And the coaching staff sets the tone for the whole season right from the start.  So you're just in for a good time if you're on the sidelines.

What will we do at team physicals?  Well - the team physician will go through the usual things that any other person would have done at a physical exam.  Height, weight.  Any pain?  How is the body moving?  How is strength?  Any recent illnesses?  Listen to heart and lungs, look in eyes, ears, and mouth. Any reason to get any blood tests?  Nothing out of the ordinary.  Hopefully you've had your own physical recently... and if it has been more than a year - schedule one!

The team Strength Coach and I will do movement screens that we have developed over the past few years.  When I was with the Connecticut Sun, our team physical therapist and strength coach did movement screens too, so I would imagine all the teams in the league are doing some sort of assessment to determine where they should start their strength and conditioning programs for each athlete and see how everyone looks.  As a physical therapist, I’m looking at their squats, jumping and landing, overhead motion, and some core strength tests.  If you're not assessing your athletes before a season, you're guessing with their training for the whole time.  Baseline measures are essential.  And that's about it.  Then we can prepare for the season!

I'm ready... who's coming to a game!?!  Go Storm!