It's that time of year, again! Time to stair train for the annual Climb to the Top for Multiple Sclerosis. I've previously written about this fundraiser here where I describe climbing New York's Rockefeller Center's 66 flights of stairs. This will be my fifth year participating with Team Kapniss - the Top Fundraising Team - in honor of my friend Leigh, who has MS. Interested in donating? CLICK HERE.
Last year I completed the Climb in 23 minutes and 45 seconds and it is always my hope to do it faster than the previous year. Over the past four years, I've cut seven minutes off my time, improving annually, so now I've had four previous rounds of trying different training methods to see what has worked and what hasn't. While everything has helped me improve - I think the biggest benefit has come from strength training - ie lifting weights - along with stair intervals and what helped the least was working on running endurance. I had listed out in this blog post my 2018 training program - which was going really well until summer came and I just wanted to enjoy the sunshine and my kayak. So now I'm back to developing my training program for this upcoming climb, mostly starting in a de-conditioned state, I'm definitely up in weight which will also be something that can slow me down. I decided I'd use this opportunity to share more about the health benefits of stair training and discuss the ways I use stairs in patient care.
Livestrong.com has a nice article here that describes many of the health benefits of stair training. It's cardiovascular exercise, so it helps build up your endurance and burns calories, but it also requires strength to propel yourself upwards against gravity! Stair training is a difficult activity that can burn a lot of calories in a short time. Depending on how you're using the steps - you can target your aerobic or your anaerobic training systems using stairs. If that's unfamiliar to you - a brief explanation is that your muscles make energy in different ways. With long distance activities over a longer period of time, you will use oxygen to make the energy for your body to function - an aerobic activity. For shorter bursts of energy, your body will make energy without using oxygen - an anaerobic training system. (There are actually three systems the body uses for this, but for now - that's probably all we need to discuss). Depending on your daily activity or the demands of a sport or activity you participate in, you may benefit from training aerobically or anaerobically or focusing on both of these systems.
In the clinic, I use step up and step down variations for numerous reasons. We have steps of varying heights ranging from about 4 inches to metal boxes that are 18 inches high as well as a small stair case. We use them to help with strengthening one leg at a time with optimal form. For example, someone who has knee pain or recently had surgery on their knee might not yet be strong enough to climb the stairs "normally." But they may be able to go up and down a smaller height, so by practicing, they can improve their strength and form with the activity to progress up to higher steps until they are back to their usual level of function.
Stepping up onto one foot also challenges balance. To stand on one foot on the ground requires control at the joints in your foot, ankle, knee, hip, pelvis, and core. That's a lot of things to control! Sometimes I work on balance from the ground-up... standing either on the floor on one foot or on various objects like a wobble board or bosu ball or airex pad. This makes you control all of those things at the same time, unless you're working on one of those activities sitting down and taking out the joints above the knee. A step up exercise also works on balance from the ground up. Sometimes I also train balance from the core/pelvis downwards - working in kneeling or quadruped (on hands and knees) positions so that you're taking the knee and foot out of the activity. Either way, every time you go up a set of stairs, you're standing on one foot at a time and need to be able to balance and control all those joints - or you need to hold on to prevent yourself from falling over.
Recently I was working with someone who is recovering from an ACL reconstruction who is getting close to returning to soccer. When thinking about soccer, it's easy to picture a lot of running and kicking, but people often forget about the amount of jumping that is involved. You jump to head the ball or to kick the ball higher in the air or to change directions or to avoid an opponent. So we were working on some box jumps in the clinic. With two feet, he could easily jump up onto the 12 inch box. Piece of cake. With his non-surgical leg, he could jump 12 inches on one foot. But he couldn't get himself to jump up 12 inches on his surgical leg alone. I've written about my own experience being unable to jump onto a 12 inch box before in that same post linked above - but watching a patient experience that block and then overcoming it was different than dealing with it myself. We worked our way up to it two inches at a time, both jumping up and down, until he was able to jump that high. Part of this is a confidence issue - where your brain doesn't think it can be successful, so it inhibits you from trying. How cool is it that if your brain doesn't think you can land - it (usually) won't let you jump? By learning that he could land from a jump that high and from progressive heights below it, he was ultimately successful. It was a big win for him and fun to see such a change in ten minutes in the clinic. Even better was that he was still able to do it at his follow up visit - and right away!
When training on stairs, you have to consider going both up and down. So basically you're going to be using all the muscles in your legs and core - and if you use a hand rail or swing your arms - you're going to get the upper body and chest and back involved too! All those joints I mentioned before that are involved in balancing - the muscles around those joints are needed to stabilize you and propel you up or control your descent. The other thing to consider is that one leg is moving while the other is holding you up. So it's a complicated activity that also requires coordination.
So, if you're looking for a new training activity to try out - stair climbing is an option you can consider. Today I did a short training session of 450 stairs in 10 minutes on a stair climber machine and I'm convinced that the machine is considerably more difficult than being outside on the stairwell, but I didn't have to go back down when I ran out of stairs because on the machine, they just keep coming!
Again - please consider a donation to the National MS Society in support of my Climb to the Top. Link above. And if you want to go climb some stairs around Seattle together, just let me know!
Welcome back to the recurring segment on the blog: "What do Physical Therapists Do?" I've previously written four other posts on this topic, all tagged with #WhatDoPTsDo so you can search the blog for those previous posts if you're interested. I spent the last two days getting my certificate in Wilderness Emergency Response and First Aid hosted by the REI flagship store in Seattle. (Beautiful fall weather and somehow managed to get out of there without buying anything!)
Before you get too far into this, you should know that in general, many physical therapists are not trained for emergency response care. As trained healthcare providers who usually have training in CPR and First Aid, I would think that a physical therapist would be better in an emergency than someone without any training - but in general we're not trained for emergency response. But we can be! This is a key difference between physical therapists and athletic trainers where, generally, physical therapists are not present when an injury occurs and help rehabilitate the injury days or weeks (or sometimes much more time) later. Athletic trainers are specifically trained to respond at the time of an injury or to an onset of illness to the athletes they work with. There are many ways in which PTs and Athletic Trainers With regard to urgent response, athletic trainers and educated physical therapists also differ from EMTs in many ways. In the case of an emergency, 911 is still your best bet, but since I just attended the course, I thought I'd share why I would learn about emergency response and some of the tips and tricks I learned.
The class was structured with didactic learning intertwined with case scenarios. We'd learn how to assess a patient and then practice in groups. Then we'd learn about various signs and symptoms of different conditions and then assess patients again. There were numerous repetitions and they even used makeup to make bleeding/bruising so that you were looking for injuries to treat. Conditions we discussed included musculoskeletal injuries - like I'm used to treating - and special focus on injuries to the spine, plus wounds, burns, weather-related conditions, abdominal pain, chest pain, allergic reactions. We learned basic treatment techniques to help determine needs for evacuation/emergency care as well as splinting and wound care.
Fake Makeup Hand Injury
Why would a physical therapist get trained in emergency response? Many physical therapists are also athletic trainers and, as such, need to keep their education current to best treat urgent cases. There are, however, PTs who are not athletic trainers who also provide sideline coverage for sporting events (like myself with the Seattle Storm) and who can take these advanced courses in order to work towards board certification as a Sports Certified Specialist Physical Therapist. For me, personally, I was also an EMT in my previous life and have always loved learning about urgent response. I like knowing that I can be a helpful resource in an emergency situation. The courses are also great reviews of basic anatomy and common illness or injury situations.
Key tips and tricks I learned in this course:
1) If you ever come across a person or group of people who are in need of emergency response, you must first make sure that the area is safe. Otherwise you risk becoming an additional victim! A person who fell off their bike in the middle of the street or someone who experienced a snake bite are both scenarios in which you could be putting yourself in danger and need to consider the surroundings before you can really provide adequate care.
2) Once the surroundings are determined to be safe, start with the key life threatening findings which are remembered by ABC. Airway. Breathing. Circulation. If a person is sitting up and talking to you after an injury - their airway is open and they are breathing and have a pulse - but you should still look for major bleeding that can impact circulation. Nothing else matters if the person does not have an adequate airway, respiration, or circulatory system because those are life threatening situations.
3) Medicine happens at the skin level. This is something that was discussed a lot in PT school and I appreciated this reminder. If someone says their shoulder hurts - LOOK AT THEIR SHOULDER! I remember a case we discussed in school where a patient came to PT complaining of back pain. He went to the doctor first, was given pain medications (that weren't helping) and was sent to PT. The physical therapist started their examination by lifting up the shirt to look at the back and see if there was any bruising - only to find a large rash. PT wasn't going to help that condition. Once life threatening conditions are ruled out, an injured person should be assessed from head to toe and any pain region should be exposed.
4) Failing to prepare is preparing to fail. Take a first aid kit with you when you go hiking or backpacking in the woods. At the very least, have the ability to splint an injury, protect injured skin, and stay hydrated and energized with enough water and food. And always tell someone where you're going and when you should be back. If you don't return by a certain time, they should send for help because if you're stuck in the wilderness with a major injury, you're going to need help.
5) Injuries may be easy to see, but illness may not be. Things like heat exhaustion, altitude sickness, hypothermia, allergic reaction, diabetic emergency, or a heart attack are hard to identify if you don't know what to look for. If you're concerned about someone feeling poorly but you can't see anything - you're better off calling for help!
I hope this is helpful if you ever find yourself in a situation where someone needs emergency care - but know that this was a 5 minute overview of a 2 day course, and that my EMT training was weeks long with ambulance calls and real life response training. Again, you should always call 911 in an emergency situation, and only help a person in ways that you have been trained to do so. If you're an adventurer, you should probably take a course in emergency response and/or first aid, whether or not it's specific to the wilderness, because many of the principles are similar. I hope you go learn all this information and never need to use it!
This morning I visited the pain clinic to observe patient examinations at the Seattle Children's Hospital- Bellevue location. If you've read my blog in the past, you've probably noticed that I've taken a particular interest in chronic pain over the past two years having seen more and more children experiencing pain for an extended period of time. I've written about chronic pain on several occasions - particularly referencing the books I've read - to better understand the science behind pain. Some of those posts can be found here, here, and here.
Today's post isn't about the science of pain... I've done a fair amount of that in the posts linked above. Instead, this looks at how a patient experiencing chronic pain can be evaluated from a multidisciplinary perspective. Each patient was started off with a whole group of healthcare providers interviewing the patient (and their accompanying parent). The providers included a physician, a pain psychologist, and a physical therapist. This was done so that the patient's story didn't have to be repeated numerous times when each provider evaluated them individually. Since all of these patients had already seen a handful of healthcare providers to examine their symptoms, their stories have been told countless times.
When evaluating a patient experiencing chronic pain, it's important to discuss their medical history fairly extensively. They started with the symptoms being experienced currently, and then worked backwards through pain experiences and previous conditions. Things like how did your pain start? When did it start? What has been done to try to make it feel better? What makes it worse? Describe your pain in words. Describe your pain in numbers on the pain scale. What do you think is the reason for your pain? It was very thorough - and sometimes the pain has been going on for so long that details have been lost along the way. If I had stubbed my toe three years ago and ultimately developed chronic pain from that experience, I'm not sure I would be able to remember the details of my toe injury. So the recall of the history is challenging enough - and then you go into so many other areas of life.
The group did a really great job at explaining to each family that pain can be really complex and that sometimes it takes a team working together to help guide patients through it. While the conversation began with pain, it certainly didn't end there. Further questioning regarding previous treatments trialed up to this point were recorded. All of today's patients had seen multiple doctors of different specialties - cardiologists, rheumatologists, surgeons, orthopedic physicians, and physical therapists - and they had also received multiple potential diagnoses for what may have been causing their pain. This has to be super confusing for children and frustrating for parents. It's also difficult to recall all the treatments that have been attempted over extended periods of time. Painting a complete picture of the past is challenging.
And then the discussion transitioned into activities that pain impacts in their lives. Are they going to school? Are they regularly bathing? Do they exercise despite the pain or can they not tolerate that? What activities do they like to do? Does it impact their time with their family and friends? Is it at the same time of the day or does it come and go? How is sleep? It was a lengthy discussion, for all the right reasons. It was interesting to see what came up from asking some questions that seem rather simple - but then exposed patterns in these kids lives.
After completing the medical history, the providers individually worked with each patient to further examine their areas of specialty. The physician discussed past medical history of more extended family members, medications, hospitalizations, surgeries, things documented in the medical record, bowel and bladder function. He did many components of a typical physical exam looking in the mouth, palpating areas of the body that are known "pain points," assessing flexibility, mobility, and strength and checking reflexes as well as using tools to assess response to temperature, sharp pressure, and light touch.
The psychologist also had an opportunity to have a one on one conversation with the child and parent as well as with the child alone to try to rule out any concerns with abuse or neglect and to further examine mental health. These conversations further explored relationships with family members and friends, participation in school and recreational activities, any interactions with a therapist or counselor in the past, self assessment of mood, emotions, sadness, anxiety, depression, and suicidal ideation. She asked questions about dating and relationships and about friendships. It was interesting to see moments when the patient would feel as though their pain is worst when stressors int heir personal life were also increased - which doesn't always occur but did in one case today.
And the physical therapist also did an examination. This is what I was most interested in observing, because I'm hoping to have the chance to use this knowledge more in my evaluation and treatment of this patient population. The number of tests available to a physical therapist is extensive - so I kept wondering if we would have the patient do certain movement patterns or choose other components instead to prioritize the use of time. The patients were observed walking and running, balancing, a cardiovascular test was done, squat pattern and plank form were screened, strength and mobility were assessed. It was a more global assessment than is frequently used in the clinic for a more localized patient in an acute or shorter term pain pattern.
Then the providers sat down and compared notes on each patient and discussed what should be included in the patient care plan. Were medications indicated? Should they participate in PT and are there any particular recommendations for the patient to follow as a component of that treatment? Should acupuncture be trialed? Follow up with the pain psychologist for some counseling? It was very interesting hearing the different providers discuss each patient with their pertinent findings and then each patient was provided with a plan and appropriate referrals for follow up.
My key takeaways of the morning were:
1) Pain presents very differently from person to person and oftentimes requires a collaborative effort to help move patients forward.
2) A child's perspective of their pain or what's going on in a child's mind is generally not the same experience their parent is having. Even when kids discuss their pain or their mood or troubles at school with their parents - it may not be the complete picture. Sometimes opening up to a complete stranger is more comfortable than potential embarrassment in front of a parent.
3) As a healthcare provider, the language we use with patients is a BIG DEAL. To treat this patient population means working to change their beliefs about pain, how their bodies work, what they're able to do, and their perspective of themselves relative to the world. I wrote down quotations from each patient session that were negative images that had to come from somewhere. We have to do better with the words we use with our patients so they don't think their backs are "out." They're not so fragile!
4) Learning about how long it took for these patients to be seen demonstrates a likely high demand for this type of patient care. Physical therapists are a vital contributor to this team as we're likely to be the ones seeing the patients for follow up visits most frequently to get them moving in new ways and to regularly reinforce pain science education. This is optimized by a collaborative effort - but also - physical therapists with interest in working with this patient population need to have a better understanding of how pain works than we get in PT School.
5) Don't give up hope. If you've experienced pain for a long time - or your child has experienced pain for a long time - it may be frustrating that you haven't found the answers to improve your quality of life yet. But the key is - YET.
October is National Physical Therapy Month! Wahoo!!! A whole month to celebrate physical therapists - which means celebrating so many of my friends, my coworkers, the providers who keep me moving when I need some physical help, and my old pals from UConn Physical Therapy! If you're currently seeing a physical therapist for care, wish them a Happy PT Month!
I frequently get asked about what PTs do. The cool thing is that we can do so many things! PT school is a little bit like medical school in that when you finish, you're a generalist and basically know enough to not hurt people (hopefully)... while you then continue your education to specialize. The big difference is that PTs don't (yet) have to complete residencies and fellowships for our specialties - we learn them in our choices of clinical affiliations towards the end of school and then we further learn our practice on the job. Physicians go into many years of residency to specifically learn the specialty they will practice.
The current specialties for physical therapists - in which you can become board certified - are: cardiovascular/pulmonary, clinical electrophysiology, oncology, women's health, geriatrics, neurology, orthopedics, pediatrics, and sports. But this is just areas we can choose to further our knowledge in, take a test, and then get some fancy letters after our names. (Don't get me wrong, I'm working towards this and think this is great - I'm just pointing out that this is only the start of things PTs can do).
Physical therapists are considered to be the musculoskeletal experts. We help people optimize their functional mobility - whether that be rehabilitative (trying to gain a function they used to have but somehow lost) or habilitative (acquiring a new function they haven't previously had). This could include treatment for patients with burns and wounds, care for children born with developmental or congenital conditions, adults who have had a heart attack and are regaining their endurance, children who need help at school... so many things! We can work in clinics, hospitals, sports venues, athletic training rooms, large corporations, nursing homes, schools, in people's homes, at a horse barn!, in a gym or fitness center, in a doctor's office, in the emergency department. We can work with old or young people, males and females and those who do not identify with either of those, people who just had surgery or who are trying to prevent it, people with all different sorts of pain, and more!
The best part is - we don't really have to choose just one patient population or one location to work, either! Personally, I only work as a Sports/Orthopedic Physical Therapist. My full time job is at Seattle Children's Hospital's North Outpatient Clinic and I treat children between ages 5-21 with sports or musculoskeletal injuries. The most common conditions I treat there are people with knee pain or who had a knee surgery, ankle sprains, broken arms, and back pain - though I also work with children who have been experiencing chronic pain, concussion symptoms, neck pain, and many other conditions. The ways these kids get hurt varies considerably, too! On the side of treating patients, I also participate in research projects around the conditions I'm working with, which helps me learn. When I'm not at Children's, I also treat athletes in the athletic training room or at the basketball arena as well as at a dance studio. I get to work in three different settings and find that to be cool In the past I have treated people in nursing homes - and that setting wasn't for me, but some physical therapists love doing that! And, if I woke up tomorrow and decided I wanted to start working in a different setting, I could change my continuing education and learn more so that I could transition to a different area of work.
Why am I discussing this? Well... first of all, because so many people just don't know what we do... and that's partially because we do so many different things based on the environment we're working in. But also because I've previously written about "What Physical Therapists Do" and those were more from my perspective as a Sports Physical Therapist. This is one of the recurring themes on my blog - and you can check out "What Do Physical Therapists Do? Installment #1: We Look at Mechanics, here. Or #2: We Listen. here. And the third installment: "We Strength Train" here. But truthfully - we do so much more!
One of the big initiatives the American Physical Therapy Association has been working on is fighting the opioid epidemic in the United States. This is a target because physical therapists help patients who are experiencing pain to get back to a more functional life. Often times, people experiencing pain use medication to try to get rid of the pain... but pain is a symptom! Medication can sometimes attack the cause of the underlying problem, but oftentimes - it will only mask the symptom, perpetuating the problem. I've previously written about chronic pain several times: here, here, here, and here. PTs are learning more and more about the science of how pain works and can help patients better understand pain so that they can move forward and back to their optimal level of function.
It should be said that not all physical therapists practice the same way. This has made the general perception of what we do cloudy for many people. At the end of the day, what should matter most is that you're feeling better and doing more of your favorite activities. Here are a few things you should consider if you are currently going to physical therapy:
1) Your physical therapist should not be hurting you! Now - if you just had surgery last week, and we're guiding you with some gentle movement, you may feel some discomfort... but you should only be working within your tolerance and if it's really painful, the PT should stop. If you don't exercise often and you're starting PT and moving in new ways - your muscles may feel some soreness. But again, this should remain within your comfort level. Think about the last time you were having pain. You tighten up and definitely can't relax. What good is it doing to fight through that? I can't say this enough... treatment should not be painful. Nobody should feel like they're receiving torture when they come to PT. Physical therapy is not the place for cliches like "No pain, No gain." Period.
2) Your physical therapy treatments should be specifically made to address your issues and goals. If your goal is to walk without pain - and you're not doing any exercises that look like they're going to get you to your goal, you have the right to ask why you're doing the things you're doing. Sometimes it's hard to tell how the path you're on may get you to the target destination. But - in order to run, you must first be able to walk, and to walk, you must first be able to stand up. When I'm working with patients, I'm breaking down the goal activities into components, and I can explain why I have chosen every single activity. Healthcare providers should be encouraging their patients to ask questions and understand their own care. They should also be educating patients/
3) Physical therapy only works if a) the patient buys into the things the physical therapist is saying and b) the patient commits to doing the program. You may only spend 1 hour per week with your PT. That leaves you with a whole lot of time where you're not working with them - but should be working on things to improve yourself. Take charge of your recovery. Take charge of your own body! As a patient, it can be hard to understand medical conditions - and that's scary! Your back hurts and someone you don't know is touching you and then telling you to move in weird ways... you have to feel comfortable and there needs to be a little bit of trust to be successful. This is really difficult when patients have previously seen a different physical therapist and didn't get better. Maybe it wasn't the right fit for you... give another PT a try and make sure they treat you differently than the last one.
4) You have the right to "fire" your physical therapist. At Seattle Children's, I often share the patients I'm treating with one other physical therapist. There are pros and cons to sharing a patient - but my favorite pro is this: if you don't like me - see the other therapist! My feelings won't be hurt... I just want you to get better! I can promise you we won't do things exactly the same way. The best way is the one you like most as the patient. Sometimes I even recommend patients see one of my coworkers because I think they'll be a better fit. I'm a female... sometimes young male patients just do better with a male physical therapist. I'm very direct and tend to be pretty loud... sometimes the more shy kids need one of my more gentle or softer spoken coworkers. Any PT who gets upset that you would prefer to see someone else isn't looking out for your best interests.
5) If you feel like you've been going to PT for months and not making gains - you should see if you have a better outcome with another PT. Don't give up hope! I think - because health insurance often pays the bulk of the costs - and because people are having pain - they forget that their healthcare providers are PROVIDING SERVICES. We only have jobs because patients find us to be helpful. You wouldn't use a carpenter to fix your toilet instead of a plumber just because they both know how to use a wrench... don't settle for a physical therapist who isn't fitting your needs.
Now that you know more about Physical Therapists, make sure you reach out to your favorite PT and let them know that you're celebrating them this October. If you're experiencing pain or having trouble with one of your favorite activities - sports or otherwise - find a PT near you to get treatment. Having trouble finding the right fit? I'm happy to help you find someone near you. Reach out with questions. And know that the biggest compliment you can ever give to a physical therapist is to send your friends or family members to see them.
Happy October 1st! Fall is upon us and schools here in the Pacific Northwest has been up and running for about a month. With the return of school comes the start of the local fall sports teams. This year I've noticed several patients in the clinic coming in with a recent concussion. For my caseload, they've all been girls and most of these have occurred with playing soccer. This is of course not a rule - in the past I have worked with males who have experienced concussions and they've come from all sorts of mechanisms of injuries. What comes to mind are falling off a bike, getting hit in the head playing softball, inner tubing, and trampoline parks. Though football players statistically tend to have more concussions, I don't think I've treated any of those.
I personally have experienced two concussions myself! My first one was in high school when a friend of mine and I were walking away from each other and she threw a basketball and it bounced off the back of my head. I initially thought I was fine and later woke up on the bathroom floor. I had a headache for a few days and saw a doctor for it but was ultimately fine. My second concussion was getting hit in the face with a softball that broke my nose and I had a loss of consciousness for about 3 seconds. Apparently that's what the glove is for... catching the ball. I didn't see a doctor that time, which was not the smartest on my part. With that one I also had headaches for a few days, dizziness, some nausea, and a lot of sensitivity to light. My sleep was disrupted and I had trouble looking at my computer screen at work. My glasses broke during the injury so I was wearing my prescription sunglasses at work which helped some. I'm so fortunate that both of mine were years apart and that I recovered so quickly, and it helps me to relate to these patients since I've gone through it a little bit. Plus this gives me a great opportunity to share the photos of my black eyes from when I had my last one! Notice the softball stitches visibly imprinted into my face.
Concussions are a really interesting diagnosis because each person presents very differently. I've previously written about the WNBA Concussion Protocol here following one of the Seattle Storm players experiencing a concussion this past season, but since I've been treating more of these patients in the clinic, I've been reviewing my previous Medbridge courses on concussion and refreshing my knowledge to better treat this patient population. Here are some interesting things about concussions you should know.
1) Concussions are brain injuries. Concussions get a reputation for being less significant than they are because people have used terms like "getting their bell rung" to describe what happened on the playing field when the injury occurred. This is a problem because concussions are brain injuries. Many of the kids who come in for concussion treatment have a variety of symptoms - headaches, dizziness, trouble with school from a variety of causes, difficulty sleeping... and they almost brush these off as normal because of a concussion. But these are all symptoms of the brain going through a healing process! You wouldn't act the same way if you had a fractured skull or a stroke - both also serious head injuries. Let's start acknowledging how serious a concussion is so that kids who experience them take their recovery a little more seriously!
2) Concussions are not anatomical problems- they are physiological. I'll simplify that. Anatomy defined: the structure of something. So with a concussion - we're not looking at the structure of the brain. With an anatomical (structural) problem, when a doctor is trying to diagnose what is wrong, imaging is generally done. Typically, a person who has experienced a concussion will not have anything wrong on XRAYS, CT Scan, or MRI. These imaging studies are used to look at anatomy - again - like the skull fracture - to see if any structures have been damaged. Imaging is helpful to rule out these other anatomical problems, but they don't tell us much about the concussion or the person experiencing it. So - if the structure of the body isn't the problem - what is? The function of these structures are what is affected in a concussion. Physiology is how things work... so how the anatomical structure operates. Example - your lungs are a structure which can be injured. They also function to breathe. Anatomy: lungs. Physiology: breathing. Concussion structure involved is the brain - but there is no anatomical problem. The physiology of the brain is what has been injured.
This concept is important because it can impact expectations of recovery. It's pretty easy for people to understand the idea of an anatomical injury and how that recovers. A broken bone takes approximately 8 weeks to heal and can be seen on an XRAY broken and then healed later on. Concussion recovery is much more complicated and you can't see a starting point or a finish line. So what's actually happening? Well.. that's what I'm working hard on learning to better understand.
The brain is composed of about 100 billion neurons. Neurons are the types of cells that make up nerves. Neurons look a bit like this:
These nerves interact with each other to send electrical signals throughout the brain and the body so you can do whatever task you want to do in life - and even the tasks you don't choose to do but that the body does for your survival, like breathe. When a concussion occurs, these nerve structures can be stretched or twisted just enough that the way that the electrical signals are passed along is impacted and all different types of messages can be influenced.
If you fall on the ground and scrape your knee on the ground, your skin may experience an abrasion and bleed a little bit. The skin cells near the surface will, over the next several days, heal. Fortunately, with the type of injury that occurs to neurons (nerve cells) during a concussion, they can also generally heal. Most concussions will heal spontaneously very quickly, but some take much longer to recover. These patients with slower recovery concussions are the ones I generally work with in the clinic. People whose neurons may have recovered from the initial concussion processes, but who are still experiencing symptoms.
3. Treatment varies for each person with a concussion. This is because every person who experiences a concussion will present differently. Even better... a single person experiencing concussion symptoms can vary hour by hour or day by day with their own symptoms, particularly in the first few days after a concussion. So I track symptoms (using a graded symptom checklist like this one) over time with these patients to see if they're trending towards improvement and I can't compare one person's recovery to any other. Every time I have taken a course learning about symptoms with concussion, it has been important to recognize that the goal is not to be a 0 on all of these items. Teenagers get headaches occasionally. They also get emotional sometimes. But the goal is to reduce the overall symptom total and get them to stay at a relatively consistent level that does not fluctuate in response to physical or mental stressors.
I will say that there are some common themes with treating these patients. Just like I don't treat every patient who experiences an ankle sprain the same way - the components of treatment for those patients is usually similar. With a person who has experienced a concussion, there is often a headache and neck pain which tends to come from the upper cervical spine more than the lower cervical spine. Some have vision and vestibular symptoms that require completely different treatments. Symptoms for concussion have been grouped together into four categories of concussions: 1) vestibular symptoms, 2) visual symptoms, 3) cognitive symptoms, and 4) migrainous/headache symptoms. These can overlap, but the treatments tend to fall into the categories that match the symptoms. If the person is experiencing headache symptoms alone, the treatment likely shouldn't target vestibular or vision problems. This is important because a person experiencing vestibular symptoms likely won't recover from those without specific vestibular treatments and those should be addressed prior to the other considerations.
4. It is the law that you must be cleared by a medical provider to return to sport activities following a concussion. Laws vary by state and Washington State was the first one to pass such a law in 2009. However, if you are a coach, and you have an athlete who experiences a concussion, there are many states which require 1) That the athlete stop playing immediately and cannot return for a minimum of 24 hours and 2) that the athlete must be cleared by a healthcare provider to play. Some states allow physical therapists to be the person who clears these athletes for return to activities - but at Seattle Children's Hospital, we leave that decision up to the diagnosing physician. So any of these kids who I'm working with to get back to sports - they're not playing in a sport competition until the doctor says so. And it's not just word of mouth. Schools are supposed to require that the clearance comes in writing! Here's why these rules are important.
First - let's say you hit your head in a game and show some mild signs of a concussion but then a few minutes later you think you're feeling ok and try to play again. Concussion symptoms are not immediate to show up, but reaction time and coordination can be impacted by a concussion. So now, you've just experienced a concussion and are re-entering your game at considerably higher risk for another injury. This is dangerous. No sporting event - championship or scrimmage - is ever important enough to risk a brain injury. Second - there is actually a name for someone who experiences a concussion, and then experiences a second one before the first one has resolved. It is called Second Impact Syndrome. It has a name because it increases the risk of mortality by 50% and it increases morbidity by 100%. That means that if you experience two concussions in close succession, you increase your risk of death by 50% and 100% of these people have significant delay in recovery. Doesn't it just make more sense to recover fully from the first one to reduce the risk of these much more severe outcomes?
I'm really enjoying learning about this patient population because it is fairly complicated in comparison to some of the other things you treat, and once these patients start to feel better, their quality of life is significantly impacted for the better. Concussions can affect tolerance to sitting through classes in school with reading or looking at the whiteboard, they can influence tolerance to lights and noises and participation in sports - which is huge for some of these kids. They can make you dizzy which makes all activity terrible. These are serious and I hope that writing this helps people better appreciate the need for them to be treated appropriately.
Happy Fall Sports Season, everyone! Let's try to play smart and safe!
I’m so honored by the number of people who read my last post and who reached out to comment on it. (First post to pass 500 hits!) I can’t imagine any of my currently planned posts will have as much interest- so today we’ll go a completely different direction and I’ll tell you all about the book I just finished reading: Charles Darwin’s “On the Origin of Species” originally published in 1859.
Overwhelmingly, whenever someone saw me reading it (since it took so long), they'd ask "Why would you do that?" This book is not for the faint of heart and, sorry to whoever gets the royalties for purchases of it, I would not recommend you go out and pick up a copy. I was out with two friends at a used book store in Edmonds, WA when I came across a reprint of the first edition which, for some reason, had to come home with me. When you work in medicine, you study A LOT of science and Darwin's theories are at the core of so much of that learning, it seemed like fate. I had to check it out, and while I'm glad I did, I think I could have better used my time reading an article or two on Wikipedia and then moving on.
I started reading it in January 2018 and was fascinated by many of the ideas and with the scientific approaches Darwin considered while writing it. In my opinion, there were far too many pages on the structure of bee hives or on the hybrid forms of dogs or on the reproduction mechanisms of plants, but Darwin was trying to show numerous examples of the same concepts to prove his points and I came to respect his methods. Other readers might be fascinated by these parts and less amused by the similarities between the animal and plant kingdoms that I was so enthralled by. I stopped reading for a few months mid-way through to do some continuing education courses, picking it up again recently to finish it. I'll spare you the time of reading it by providing you with this summary! If you’re a true fan of science- feel free to check it out, but you've been warned. It wasn't as bad as Moby Dick - which I tried to read for six months before finally giving up and watching the movie. At least I learned things from this book... I found some of it to be fascinating between segments of repetitive boredom.
First, a bit about the author. The introduction of the book notes that Darwin was destined to be a physician, but that he couldn't stomach observing surgery, so he changed career paths and studied botany and geology. Plants and rocks are definitely less nauseating than incisions and innards. He spent five years (1831-1836) on The Beagle, a ship that traveled around the world with inland expeditions to collect his data. He wrote a different book about his observations on the ship, called "The Voyage of the Beagle," after which he wrote many other publications on his research. "On the Origin of Species." was published in 1859, 23 years after his voyage. At that time, religion overwhelmingly superseded science, so a book about evolution went against many societal beliefs and accepted thoughts. This book was groundbreaking and Darwin is considered to be the Father of Evolution because of this work. Fun fact: Charles Darwin shares the same birth date as Abraham Lincoln: February 12, 1809.
There are two overarching themes throughout "The Origin of Species" that are founding theories of evolution. These main themes are supported by additional observations that Darwin described in detail. The first theme is natural selection - the concept that creatures evolve into more and more advantageous versions of themselves and will reproduce to pass on these more ideal traits. This aligns with "survival of the fittest" in which the strongest beings survive and multiply while the weakest will not procreate and will ultimately become extinct. The second concept is “common descent with branching evolution.” This is the idea that all living creatures on Earth come from the same origin, and are genetically related. It is the basis of the belief that humans are closely related to apes. Darwin never mentions the relationship between humans and primates, but it was nonetheless extrapolated from scientists who reviewed the book, and that is how it has remained understood to this day.
Darwin comes across as both humble- referring often to those whose work came before his- as well as open-minded. He recognized that though he had scientific evidence supporting his theories, he could suggest ways that they could be disputed - and he sought evidence to disprove his own ideas. He ultimately did not find contrary evidence to his proposed theories of evolution. In fact- most of his ideas have remained undisputed. He even recognized that his suggestions were controversial and did not align with the beliefs of the church, but that they were backed by scientific data. While I’m sure this isn’t the oldest piece of evidence-based literature, by any means, it’s certainly the oldest research I think I’ve ever read.
Some of the concepts he described that support his overarching themes include variation between creatures, adaptations to stresses, instincts, heredity, extinction, geological time, and environmental influences on development. He presents numerous ideas with all sorts of animal and plant examples to demonstrate his principles. Here are some of the examples he presented that I found most interesting.
On adaptations to stresses:
A duck in the wild was compared to a duck in captivity. The bone density of the wings and legs to compared to the bone density of the rest of the body differed. The wild duck had larger wing bones whereas a captive duck had larger leg bones. This makes sense because the duck in the wild will fly to escape from predators more often than a duck in captivity which would have a greater tendency to walk, as it is protected.
But what would happen if you took one and put it into the other’s circumstances- would it ultimately adapt to the opposite presentation? Over time, would it evolve back into the adaptations that were previously present? The duck adapted in response to the stresses of its environment. I liked this because it corresponds well to principles in physical therapy and body healing - such as adaptation to stresses in bone after a fracture or the response of muscle tissue to progressive loading.
On interacting with the environment:
Similar to the above example, wild dogs generally have their ears erect more than captive dogs, who would adapt more floppy ears - because they are not in danger and use those ear muscles less.
On variation:
Darwin spends more than 80 pages in this edition discussing variation and how this contributes to natural selection and heredity. At length he compared pigeons of all different types ultimately concluding they must have come from a common ancestor. He describes differences in their characteristics with regard to color, size, and bone structure and discusses how different types of pigeons may not resemble one another very much, but through long periods of time with small changes, tracing steps backwards, they would likely have a common ancestor.
In consideration of my work as a physical therapist, I can appreciate that all my patients are human but that they don't have exactly the same anatomical features, and that they certainly look different from person to person. This is not a good example of variance, however. More of a variance would be a child born with Down Syndrome, who has a genetic difference - Trisomy 21. The likelihood of a person with Down Syndrome reproducing is decreased compared to the typical population. Darwin also goes into detail about ways that variation can influence fertility and how it fits into the "survival of the fittest" mentality with varieties that are most efficient becoming more and more prevalent.
On extinction:
The negative response to variation is when changes occur which do not optimize function for the species. When a creature no longer exists on earth, it is extinct. Based on Darwin's theories, people with Down Syndrome will not reproduce sufficiently to continue passing on the Trisomy 21 trait and ultimately (over a very, very long time) the whole group would be extinct. But the mutation doesn't come entirely from heredity... the cause is unknown. I wonder how Darwin would have dealt with some of the unique circumstances of 2018 if he was here to see the world today, and had access to the equipment now available.
I had previously never considered that this is the ultimate effect of natural selection, but it becomes apparent that if a species is repeatedly at a disadvantage, it should ultimately cease to exist. These changes take extremely long periods of time to occur, and as such, the descendants of an original species may have created other variations that persist- the long lost cousins may not even resemble one another and their ancestors being extinct are not likely to be identifiable.
There are many other ideas to consider throughout the Origin of Species, but overwhelmingly, a more thorough understanding of "The Survival of the Fittest" was what appealed to me most. With an appreciation for the slight variations that occur within a species, it is easy to understand that any variation that occurs which is profitable will be passed through generations. Darwin chose the name Natural Selection because the way nature selects differs from how humans select the characteristics of their animals when they breed them - but the purpose for doing so is ultimately the same: to make the best version of an animal or plant possible.
Ultimately, Darwin should get the credit for the science behind “is it true that if you don’t use it, you lose it?” Because yes! According to Darwin it is!!! His presence on my bookshelf makes me seem a lot smarter... but now I'm ready to go do some light reading, like a Harry Potter book.
(This is my longest blog post yet. You've probably heard the saying "When you make it big, make sure you remember the little people." The Seattle Storm winning the WNBA Championship this past week was a big moment for me... so I'm taking the time to remember some of the people who were there along the way.)
On Wednesday, September 12, the Seattle Storm won the 2018 WNBA Championship. They battled the Washington Mystics in the Finals to conclude, in my opinion, the best year of WNBA basketball yet... and I've been watching for at least fifteen of their 21 seasons. I've previously written about how I feel at the end of a basketball season here... but as a recap, for me, the end of a season is always sad... a period of mourning... even with a championship! Standing on the court after the win as WNBA President Lisa Borders presented the Storm with their trophy, there were tears in my eyes. Tears of pride and joy and relief and sadness... so many emotions!
The 2019 season can of course be amazing, too, but it will never be the same. This year, the Storm led the WNBA standings pretty much all season, league-wide there was incredible basketball, more media promotion, increased awareness and fan support, and continued exposure for players to promote their causes to make the world a better place. My role as the team physical therapist was similar to past years, though I was able to attend more practices and also spend more time in the front office than in previous years working on some different projects. The WNBA is so important... at the end of the day, the league is about much more than just basketball. Changes from previous years were palpable. Beyond great competition, the league also had new partnerships with their “Take a Seat. Take a Stand" initiative - I just love this video:
Everyone in my circle knows how much I love basketball and how grateful I am for the opportunities I've had from working in sports. I was excited the Storm ended up playing against the Washington Mystics because it gave me a chance to visit my brother who recently moved to D.C., but also because Coach Thibault was my first WNBA Head Coach from 2007 until 2010 with the Connecticut Sun, and I have immense respect for him and his family - so it's always great to see them having success, even though it ended in our favor. After Game One of the WNBA Finals, I saw the whole Thibault clan leaving the arena, had the chance to catch up, congratulate them on their recent successes, give hugs... and reflection mode started to kick in.
It's a little weird, right? I work in the athletic training room and the weight room and I stand on the sidelines watching, rarely touching a basketball, but I'm still reflecting. What went well this year? Did I make an impact? Does the time I spend with the Storm have any value for them? What should I change next season? How can I do more? Is the balance of my job at Seattle Children's and my time volunteering with the Seattle Storm working out for everyone? Will the team keep me on their medical staff next season? How mad will my family be when they hear me tell them (again) that I'm not moving back home to Connecticut because this is where I want to be? But mostly, I think, how did I get here and is this the path I’m meant to go down?
Each year I've been with the Storm, (this was my fourth) I've had a few people reach out - usually high school or college students - asking me if I would share my story because they aspire to have a role like mine. They're seeking career advice. Young women want to know that they can work in professional sports, even if doesn't mean they're going to be a professional athlete. I'm always happy to share how I got here, and I like to give people hope. I wanted to play in the WNBA as a little girl, long before I realized I was never going to be a basketball player... but look how close I came to my childhood dream?! I'm in a rare position... more than half of the WNBA teams don't even have a physical therapist listed on their staff - and most of the teams that do have a PT, the same person is their athletic trainer. There just aren't that many opportunities to work in professional women's sports. So, knowing I'm in a unique role as a female physical therapist working for a professional women's sports team, I'm going to share my journey and tell you all that I'm working hard to create more opportunities for women in sports medicine... so keep working, and keep hoping.
My Life On The Sidelines:
(This spans 19 years... so maybe grab yourself a cold drink and get cozy before you start reading?)
I grew up in Connecticut. In 1995, I was nine years old when the University of Connecticut Women's Basketball Team won their first NCAA Championship. People's Bank gave away free posters that had Gampel Pavilion in the background with Rebecca Lobo, Jennifer Rizzotti, and Coach Auriemma and it hung on the wall of my bedroom. I played rec basketball and watched UConn on TV, because that was starting to be possible.
Four years later, in 1999, I was a freshman at Cheshire High School, still in Connecticut. I went to the girls basketball team tryouts which started with a meeting where the head coach outlined his expectations for the season. Following the meeting, instead of getting changed to try out, I asked him if he could use a team manager. I don't think I’ve ever said this to anyone before, but the truth is I really wanted to play basketball. I had zero self confidence, I weighed almost 250 pounds at age 14, I didn't exercise, I didn't eat well, I had only played a little rec basketball before then, and I didn’t think I could make the freshmen team... so I took myself out of consideration without ever trying. It was cowardly. I’m still ashamed. But I loved the game, and this was how I was going to be part of it.
On my first days at practice as a high school team manager, I yelled at some of the varsity girls to run faster during practice. The senior captain at that time, Michelle (Libby) Vieira, now the current Head Coach of Cheshire Girls’ Basketball and also a great friend told me that she immediately thought “Who does this kid think she is?” I just wanted to win... while sitting on the sidelines.
When basketball ended, I met with the softball coach. Again I wanted to play... but I was committed to Hebrew High School on Wednesday evenings that conflicted with many of their games (and with Dawson's Creek - which aired on Wednesday nights and starred Cheshire native James Van Der Beek. Hebrew High School really got in the way of my life!). So I planned to be the softball team manager. A few days later, I was sitting in Rich Pulisciano’s (2018 Nominee for National Boys’ Lacrosse Coach of the Year and all around awesome guy) freshmen health class when he said I was his new team manager. He was pals with Girls' Basketball Coach Sarah Mik and somehow had decided to steal me from the softball team. I didn’t actually know what lacrosse was, but I never made it to a day of softball.
Fast forward a little bit. I sat on the sidelines (or scorer's table) for every Cheshire Girls’ Basketball freshmen, junior varsity, and varsity game for four years. In 2001 and 2002, my sophomore and junior years, we lost in the Connecticut State Tournament Quarterfinals. I don’t really remember games, though. Or practices. I remember the people. I remember bus trips, pizza parties, playing Cranium, crazy hat days, hanging out in Coach Mik's office, and decorating lockers. I remember gel pen notes and movie nights... doesn't every teenager hang out at the movie theater? I remember having friends because I was part of a team, which is why I encourage so many patient families to get their kids involved in ANY sport. And I remember my pal Brittney Arisco tearing her ACL, not knowing until many years later that it had impacted me so much. (Wrote about that a little bit in the past, too, here). That was the first time I saw someone tear their ACL in front of me... unfortunately it wasn't the last.
I only worked with the varsity lacrosse team. I'm not sure why I loved it so much... but those guys were the best. They always gave me the front seat on the bus as the only girl surrounded by a group of guys with the worst smelling equipment ever. It's the gloves. Gross. They taught me to never drink the yellow Gatorade. They drove me home in their beat up cars, proud that they had just gotten their driver's licenses. They were polite and respectful to me, they made their moms proud. And talk about talent! In June 2002, the Cheshire Boys Lacrosse team won the Connecticut State LL Lacrosse Championship. I still have the coin from the toss for that game. That was the first championship team I ever worked with. #RamPride
2002 Connecticut State Champions - Cheshire High School Boys Lacrosse
And then senior year came around. One of the basketball coaches asked me if I wanted to dress and play in the game on senior night, but we had five seniors, and... ARE YOU KIDDING ME? Of course I did not do that. I sat in a special beach chair at the end of the bench with a non-alcoholic frozen beverage with an umbrella in it, under a beach umbrella with a blow up palm tree, holding my stat clipboard, wearing a pleather skirt, and, you guessed it, held back the tears in my eyes. Or not... they flowed freely. I wear my heart on my sleeve. Emotion can also be redefined as passion. I'm full of that.
After high school was UConn. I was one of the team managers for the greatest women's basketball team and the best college coach and associate head coach of all time, Geno Auriemma and Chris Dailey. #GOAT Four amazing years of sitting on the sidelines. My freshman year was Diana Taurasi’s senior year- the team was coming off back-to-back national championships and would go on to win a third consecutive trophy that year. (Ironically, the Seattle Storm have three UConn players on their roster, but none of them were in college with me... though I did meet all of them in Storrs long before ever working with them in Seattle.. and all three participated in my graduate school thesis.) Again, I mostly don't remember the games... I remember the friends I made, the other managers being some of my closest friends, still, hotel nights, team meals, chartered airplanes, selection show parties, and falling down the stairs at Coach Auriemma's house on New Year's Eve. One game, the managers And I were trying to get into the locker room, and a security officer said we couldn’t go there because it was only for the team. I yelled “We are the team” because we had work to do... the sideline crews always become a team in their own way, a part of it but also quite separate. I remember them winning the National Championship freshman year... I was sitting in a packed Gampel Pavilion watching it on a huge TV screen. That week, the UConn Women and UConn Men's basketball teams both won their Final Four and National Championship Games so basically we spent a whole week watching amazing basketball in Storrs, CT. When the team won, I again cried... and I wasn't even with the team. And there were three graduating seniors who I had grown to love. #BleedBlue So now I had gotten to work for a team that won the High School State Championship and another who won the NCAA title. Unbelievable.
2004 NCAA Women's Basketball Champions - University of Connecticut
Fast forward to senior year- April 7, 2007- I was in my hotel room in Fresno, California getting ready to go to the Elite Eight game where Sylvia Fowles and her LSU team ultimately whooped UConn to go to the Final Four when my cell phone rang... it was the Head Athletic Trainer for the Connecticut Sun, Jeremy Norman, offering me a job as their Equipment Manager and Travel Coordinator. I was already discussing a similar opportunity with the Seattle Storm when he called, but moving to Seattle before graduation seemed impossible and the Sun just made so much more sense! I took the job. When UConn lost that night, my college basketball chapter ending, me - again - in tears, a fellow team manager gave me a hug and said “Cheer up, Abby, you’re going pro tomorrow.” Ha! We took a red eye charter flight home from Fresno and I was at my first team staff meeting at Mohegan Sun the next night, sitting a few seats away from Coach Mike Thibault.
I LOVED working for the Connecticut Sun. It was my first real job out of college. They were pretty good, but not great. I remember we lost a few games in a row and had a record of 5-10 and Coach Thibault called me into his office and asked me what was wrong. The four previous years, the team I worked for had never lost back-to-back games. In fact, UConn Women's Basketball only lost nine games total while I was in college! We had just lost 10 games in 2 months. I was struggling. Did I mention that I was the Equipment Manager... and I was getting depressed over the team losing? The Sun ultimately made the playoffs, losing in Indiana in the first round including a first game triple OT win, the only triple overtime game in WNBA playoff history. It was the beginning of another four seasons on the sideline. I spent my first off-season in Spain with one of their players, who was traded when we came back to the USA. That was the when I learned about basketball as a business. #GetSun
I left the Sun when I realized that I would be doing laundry for basketball players forever if I didn't figure out what to do with my future. Ultimately I landed back at UConn for graduate school to study Physical Therapy. Fortunately, they had an incredible faculty member, Dr. Lindsay DiStefano, who was working on ACL Injury Prevention research and was willing to advise me on writing my own thesis project studying leg injuries in Women's Basketball Players at the college and WNBA level. This project really interested me - as I was sure that basketball players were tearing their ACLs because they weren't stretching. I was wrong. But the project kept me in contact with all my colleagues in the WNBA over the years I was in grad school, which was vital for my future.
I had been fearful upon leaving the Connecticut Sun that I wouldn't be able to get back into the WNBA because many of the teams didn't have a PT. As graduation approached, I reached out to everyone I knew in the league. Seattle Storm Head Athletic Trainer, Tom Spencer, who also owns a PT Clinic, had an opening in his office, but the Storm had never had a PT before. I arrived at his clinic wearing a boot on my left leg from having had an ankle reconstruction surgery eight weeks earlier. Tom treated my ankle - which got super swollen from the cross-country flight - while he interviewed me. Talk about an interesting interview! I had not yet taken the PT Licensing exam. I had not yet treated a patient independently. All I wanted was basketball, and I was willing to move 3,000 miles to get that.
After the interview, Tom took me to Key Arena for the Seattle Storm versus Chicago Sky game which he needed to work that night. I'm good friends with the Sky Strength and Conditioning Coach, who hugged me as we bumped into each other walking into the arena. The timing of that was helpful. Tom didn't say anything about what I was supposed to do while he worked. I quietly sat in the corner (no really, I was quiet!) watching how things operated in his training room. The chiropractor introduced himself - Dana McCracken - best chiropractor name and all around nice guy. And then Sue Bird walked in. I don't think Tom realized I had met her ten years earlier and that our paths had crossed countless times. We're not friends, but she knew me well enough to give me a hug and ask me what I was doing there. I told her I was interviewing with Tom for a job in his clinic. She looked at him and said - to be with the team, too, right? He told me after the game that her reaction was enough for him to hire me on the spot. Four seasons later, I watched her win her third championship. #WeRepSeattle
2018 WNBA Champions - Seattle Storm
So that's the journey. I hope you'll notice that it's really all about the people. Career advancement occurs because of the people you surround yourself with. I have awesome supervisors at Seattle Children's who support me working towards my dreams on the basketball court. I give my time away in an effort to elevate women's sports and, hopefully in the future, to provide more opportunities for women who want to work in sports medicine. I've worked with some of the greatest athletes in the world. I've posted three championship photos above, and I worked on the sidelines for all three of those groups... but you may notice I'm not in a single one of those photos. I know my role and I cherish that. The advice I give to young people aspiring to work in professional sports is to meet new people and keep on working hard. Give of your time doing things you love and the rewards will come.
Coach Auriemma used to send me to get him a hot tea almost every day for practice. Soon after the team won the National Championship and the season was over, I picked up a tea and went into his office. I asked him how he measures success. He told me it wasn't about the Championships, trophies, rings, awards. It was about the fact that his players come back to visit. I've heard him say this since then, too. His former players choose to look back and cheer for the young teams still playing in the same jersey they once wore. Players who don't want to look back and connect with the places they came from or the coaches they played for - that says something about their past. I still swing by the Cheshire High School Gym and Gampel Pavilion and Mohegan Sun Arena when I get a chance to, because there are connections there that will forever be part of my heart. The first text message I received sitting in the stands on Wednesday night, just after tip off, was Sarah Mik. My High School Coach sent me a text saying "Where are you sitting?" I didn't tell her I was going to be there. I hadn't talked to her in about two weeks. She just somehow knew it. And my heart skipped a beat knowing it started with her almost 20 years prior. I turned to my brother and told him it was about to be the biggest night of my basketball career. And it was. The basketball world is a family, and though my role in it is small, it has been an awesome ride. I've received far more than I can ever give... and I couldn't be more grateful.
