The SSE Airtricty Dublin City Marathon 2018 was a great success!

This was an important year for ARTI as it was the first year Certified Athletic and Rehabilitation Therapists (ARTC) were involved in supporting the health and safety of the athletes taking part in the Dublin City Marathon. Both qualified and student ARTI members were invited to assist at the event. ARTCs were responsible for the provision of emergency care and management of acute injuries and illnesses. In a great example of the importance and benefits of multi-disciplinary care, each ARTC was allocated a Medical Tent, where they treated casualties along with  a nurse and a medical doctor. During the event, they dealt with patients with issues such as hypothermia, cramps, psychogenic shock, exhaustion and many musculoskeletal injuries.

ARTCs proved to be a very successful addition to the Dublin City Marathon Medical Team. Owen Feeney ARTC who worked at the event thoroughly enjoyed the expierence and the coollaboartion with a multi-disciplinary medical team.

“Getting to interact with the other therapists and medical staff was a unique experience. It was very well organized and I hope to be a part of the event again next year”.

The student ARTI members involved in the event also gained great expierence. Kirsty Mc Ilwaine, a third year student of Dublin City University’s BSc in Athletic Therapy and Training remarked:

“I enjoyed the event. The exposure I got far outweighed the demanding nature of the work. It was a great environment to put our Emergency First Responder skills into practice which was very rewarding. It gave us a good insight into my future  role as a Certified Athletic and Rehabilitation Therapist.”

We look forward to this being an annual event for ARTCs moving forward. Thank you to Dr. May Tan, the Medical Director of the Dublin Marathon and the Race Series, and thanks to all ARTI representatives who attended.

This week ARTI is chatting to Owen Feeney ARTC, a recent graduate of the BSc in Athletic Therapy and Training programme in DCU. Owen set up his own clinic in January 2018, just a few months after graduating.

Owen is based in UrbanHealth, Ranelagh for the last 5 months. “The space is open plan and shared between various therapists and instructors, including myself. Equipment and gear is brought in prior to each session and is often shared which is helpful, especially when starting off. It helps to keep initial costs to a minimum.”

Owen treats a mixture of patients, many of them coming from teams he works with. “The majority of my clients are athletes from the teams I work with.  Time constraints mean I don’t get to treat everyone on match days. I also see individuals from gyms who often have issues from overuse, impeding their return to full activity. I treat office workers whose issues arise from a lack of activity or repetitive daily actions that cause them issues. The treatments are often quite different which makes it interesting and challenging.”

Owen shared some advice with us on important things to consider when setting up on your own. Owen believes the location of your clinic is key when considering setting up on your own. “Take your time making this decision as it will influence business. Thankfully for ARTCs, we don’t need a huge workspace and we can do a lot with a little when it comes to equipment.”

“One of the things I would never have considered before finishing college would be how to sell yourself and advertise as well. Be it social media, business cards or flyers you should consider how to advertise optimally”.

Planning is important but don’t give up at the first hurdle. “You will do things right and wrong and it will take time before you understand the business side of it.  I haven’t completed a business degree, so it will take time and research. Seeking advice from someone with a business or marketing background may really help. I was lucky enough to have such a person and honestly, I wouldn’t have thought about half of the things I needed without their help. It is ok to ask for help and ask for advice, you’re only fresh out of college, no one expects us to be the Bill Gates of the ARTC world so don’t put too much pressure on yourself.

Owen highlighted the importance of maintaining involvement in pitch side work.  “Getting involved with a sports team will help with spreading your name and building a client base.

Pitch side and clinic-based rely on the same body of knowledge yet are so vastly different.  Working in both environments, you learn that one compliments the other.  I think it would be best to think of one as an extension of the other.

Thanks to Owen for his time and advice. You can contact Owen directly on

0857315944 or owenfeeneyat@gmail.com, or on his website

www.owenfeenetat.com.

This week ARTI is chatting to Hannah Tallon ARTC, a recent graduate of the BSc in Athletic Therapy and Training programme in DCU. Hannah began working in her own clinic very soon after graduation.

Hannah is based in KLeisure Gym, Naas, Co.Kildare where she treats a variety of demographics, both athletic and general. “I’m really enjoying the challenge that is working on my own. It’s great to put the knowledge and practical skills to use as soon as you can after college. Certainly, it’s a learning curve for me. I love meeting new people and new problems daily. It keeps me interested and constantly learning”

Following her degree, Hannah completed a course in dry needling which she says is very effective and popular with clients. “Dry needling is a very effective drug free pain relief to offer clients. In my experience it can offer immediate and long-lasting relief. It’s definitely a good idea to build on the skills you learn in college.  It’s important to keep investing in your education.”

Hannah chose to work in a clinical setting because she enjoys the one-on-one encounter. “I enjoy the client-clinician dynamic and the work itself can be very rewarding.” Hannah agrees setting up on your own can be a daunting prospect but assures that it is worth it in so many ways. “Only a few months along in my career, I would advise anyone considering taking a similar route, to jump in with two feet and go for it. Nothing ventured, nothing gained. I’m grateful that I got the opportunity to give it a go at least.”

Hannah gave some advice on setting up your own clinic as a new graduate. Setting up in a gym is a good starting point for new graduates as it requires very little alteration before you get going. It will already have parking, toilets, changing rooms etc, not to mention footfall! Many of Hannah’s clients are gym members. “Not having to find clients allows me to focus on my work more.”

“At the start, you can be very excited about it all and take on a bit too much. Be aware that there is an adjustment period so allow yourself to get used to it before you give up on it.” It takes time to get into a routine. Rest becomes as important as work, otherwise the standard of work will inevitably fall.

Hannah highlighted the importance of confidence early in your career. “It’s important to realize the skills you have when leaving college and take confidence in the practitioner you already are. You will always have a lot to learn and working on your own makes you learn that bit quicker – why not start now?”

Thanks to Hannah for giving her time to discuss her new clinic. You can contact Hannah on Facebook at https://www.facebook.com/HTmusculoskeletaltherapy/ or book an appointment with her on 0894072263.

ARTI Student Information Evening in DCU

Dublin City University hosted our inaugural ARTI Student Information Evening recently. The evening, organised by our Education Committee was a great success in helping students gain an insight into what to expect following graduation. Hazel Cooney, ARTI Education Committee member and DCU graduate organised the evening.

“ARTCs experience a huge learning curve following graduation. ARTCs have to quickly learn to promote ARTI in order to promote themselves. Very often to work as an ARTC you need to pursue self-employment and I think that this is an option that students may find daunting.”

The evening was designed to educate students about ARTI, employment opportunities and further education options open for to our ARTCs. Five ARTCs who were all past graduates of the DCU ATT programme spoke to the students. Four video presentations from ARTCs that couldn’t make it on the night also featured.

From the evenings presentations, it is apparent that ARTCs are working as an inherent part of multi- disciplinary teams in professional and high level amateur sports throughout Ireland and abroad. A number of graduates have pursued self-employment, and it was clear that they had become quite successful running their own businesses. ARTCs are becoming more widely recognised in the community by the general public and other health professionals. This seems to have been mainly achieved through networking and involvement in community events. Many students have also decided to pursue further education including medicine, physiotherapy, and research degrees and highlighted the value of maintaining their affiliation with ARTI as they consider it an asset to their future career prospects.

“The speakers discussed practical real-world perspectives into the workings of ARTI and daily life as an ARTC and really highlighted the importance of networking, professionalism, and having a strong work ethic”

The DCU students found the event inspiring and the ARTI Education Committee plan to host similar evenings in Athlone IT and IT Carlow in the comings months.

Thanks to Hazel Cooney ARTC for organising the night and our speakers, Ciara Mulrooney ARTC, Sam Rice ARTC, Aoife Burke ARTC, James Storm ARTC, Karen McCann ARTC
for their helpful practical tips and insights to our student members. Thanks to Emma Doherty ARTC, Ciaran Nannery ARTC, Eadaoin Holland ARTC and Laura Langton ARTC for sharing their video presentations in their absence.

CONGRATULATIONS to Dr. Siobhan O’Connor  M.Sc., Ph.D., ARTC who has been newly ratified as the Vice President of the World Federation of Athletic Therapy. This is a fantastic achievement and we are so lucky to have an ARTI member holding such a prestigious position. We wish Siobhan the very best of luck! Onwards and upwards! Follow this link for more info http://www.wfatt.org/ 

 Conor McIllwaine ARTC working alongside the Cycling Ulster Senior Men’s team at “L’estivale Bretonne 2017′ in Brittany, France.

ARTI Member Conor Mc Ilwaine has been working with Cycling Ulster teams for the last two years and has traveled around Ireland and across the water to Wales and France.

Tell us about your recent work as an ARTC

I have been lucky enough to work alongside some of Ireland’s most talented athletes with Cycling Ulster. Many of the races were internationally renowned, such as ‘Ras na mBan’, a 5-day International Women’s Stage Race held in Kilkenny, and the ‘Junior Tour of Wales.’ ‘Travelling with the teams is definitely a perk of the job. It has allowed me to see some beautiful parts of the world’

What are your responsibilities when working with a cycling team?

In the cycling world the role is called ‘Soigneur’, which is French for helper/trainer. My responsibilities included: looking after the riders’ nutrition on and off the bike. This involved a feeding during the stage and examining and treating any injuries. In this role, you see a range of injuries from chronic injuries like lower back pain or overuse knee issues to injuries to acute injuries such as wrist sprains/breaks occurring during crashes. We also see more race day issues like bad road rash etc.

Did you manage any road crashes?

I have managed plenty of road crashes. In the cycling world, these are just so common particularly in stage races. Some can be difficult to manage in that they cover such a large area, and they can be nasty. The main thing is just to avoid infection at all costs. Making sure dressings are changed frequently and wounds kept clean is essential. Simple tips like vaseline and cling film at night to stop from sticking to the bedsheets is a simple trick of the trade.

Do you have any advice for ARTCs looking to get involved in the cycling community?

Well first things first I wouldn’t get involved at all if you don’t want to work hard. Working with cycling teams is quite taxing! You cover all the needs of the cyclists and not just massage and recovery. It is an exciting environment to be part of, from navigating your way to feed zones in the French countryside, dressing wounds and treating chronic injuries to buttering bread rolls in the back of the team van. As you can imagine, it can get quite busy. All in, a fantastic experience for anyone keen on traveling.

You’ve just returned from Rotterdam. How was that experience? How did working with Triathletes compare to working with just cyclists?

Rotterdam was a magnificent experience. The trip was just so relaxing. The high-octane paceh!! With regard to racing, the level was just so high, even though the weather was awful. I have a new-found respect for triathletes and there exceptional bike handling skills in the greasy, wet cobbles of Rotterdam. All in it was one of the best experiences I have had working with a team so far. The professionalism of Triathlon Ireland, meant that everything ran so smoothly. It was a fantastic opportunity for me to be involved in such a professional set-up. of cycling races couldn’t have differed more from the relaxed and focused triathlon approach. I even managed to get to see some of Rotterdam, provided I woke early enough!! Regarding racing, the level was just so high, even though the weather was awful. I have a new-found respect for triathletes and their exceptional bike handling skills in the greasy, wet cobbles of Rotterdam. All in it was one of the best experiences I have had working with a team so far. The professionalism of Triathlon Ireland, meant that everything ran so smoothly. It was a fantastic opportunity for me to be involved in such a professional set-up.

ARTI members can avail of an insurance facility with Glennon Insurance which offers indemnity for Combined Medical Malpractice, Public and Products Liability Insurance.

The current annual premium payable is €203.75 for a €1,000,000 aggregate Limit of Indemnity

Members can avail of this facility by contacting Glennons at 01-7075800 or by email arti@glennons.ie

The crew at Glennons are most helpful and quick in processing requests.

In order to secure your insurance, you will need to:

1. Ensure you are an ARTI member by paying your ARTI membership fee on https://arti.info/

(If you sat and passed the ARTI exam in 2017, the fee paid included ARTI membership for this coming year)

2. If you are a new ARTI member that passed your ARTI certification exam, make sure you scan or post a copy of your up-to-date EFR cert, CFR cert and your transcripts from an ARTI accredited program to artisecretary@gmail.com
3. Don’t forget to take note of your ARTI membership number (this is the same number as your ARTI certification exam number).Make contact with Glennons
4. They will send you a contract that you must fill in and return
5. Pay the premium

Remember without professional indemnity insurance your ARTI membership is invalid!

The ARTI AGM was held last week and marks the beginning of another ARTI membership year. The AGM proved very successful, one of great innovation and positivity and thanks to all members that attended.  Following the AGM, there have been some changes made to the executive committee effective as and from Tuesday 15^th August 2017. For this ARTI membership year 2017/18, the executive is as follows:

• President – Mr Andrew Watson
• Vice President – Mr Paul Berry
• Secretary – Mr Richie Walsh
• Assistant Secretary – Ms Hazel Cooney
• PRO – Dr Siobhán O’Connor
• Vice PRO – Ms Hannah Tallon
• Treasurer – Mr Michael Donohoe
• Vice Treasurer – Mr Tom Quinn
• Executive Member – Mr Enda Whyte

Find our contact info at https://arti.info/contact-us/

We’d like to thank the outgoing officers for their commitment, hard work and huge achievements during their term. We wish the newly elected committee good luck in this coming year.

(Please use links provided to access the material via BJSM)

TQ: “What are the most significant changes or updates to the consensus statement on concussion in sport that would be of interest to ARTC’s working in sport at all levels?”

DG: “Several papers have emerged from the 5th Consensus. The overall summary would be that the SCAT5 provides “the most well established and rigorously developed instrument for sideline testing”. This is true.

One of the most important outcomes of the Berlin Conference is the publication of not only their findings but thorough descriptions of how such vital guidelines were built. The highest scientific standard was adhered too for the purpose of transparency and quality.  Clinicians should now be appropriately comfortable and confident with the SCAT based on several versions now being common practice. All previous versions should be removed from circulation and best practice should be parallel to the SCAT5, Child SCAT5 and CRT5.

Some of the most significant changes include changes to the……

Consensus statement

• There are 11 ‘R’s’ to the management of sports related concussion. The statement is laid out by each ‘R’ (recognise, remove, re-evaluate, rest, rehabilitation, refer, recovery, return to sport, reconsider, residual effects and sequelae, risk reduction). (They have laid the document in a very concise manner all italic writing demonstrating new or changed opinion).

Further changes to the definition

• The best approach to the recognition of SRC is a multidimensional test guided by the exert consensus.
• The SCAT is best utilised immediately after injury with its utility decreasing significantly from 3-5 days post injury.
• The symptom checklist is beneficial in tracking recovery.
• Baseline testing may be useful but not necessary for interpreting post injury data.
• Additional testing that can be helpful includes timed reaction testing, gait/balance assessment, video observable signs and oculomotor screening.
• When concussion is suspected the athlete should be removed and tested with a multidimensional assessment.
• Sporting bodies should allow adequate time for this assessment  (10 min) and provide and adequate environment both on and off-field.
• Rule changes may need to occur in some sports to allow for this without unduly penalising the injured players team or the flow of the game.
• The final determination regarding a sports related concussion diagnosis and/or fitness to play is a medical decision based on clinical judgement.
• A return to school strategy table has been provided.
• Advanced neuroimaging, biomarkers and genetic testing are valuable research tools but still require further validation in SRC evaluation.
• There is currently insufficient evidence that complete rest is required. After a brief acute period of rest (24-48hrs) patients can be encouraged to become gradually more active while staying below their cognitive and physical symptom threshold. The exact amounts are not yet well defined and further research is required.
• Literature has not yet evaluated early interventions for rehabilitation as most recover in 10-14 days. Data supports interventions that include psychological cervical and vestibular rehabilitation. Closely monitored active rehabilitation that includes controlled submaximal exercise at sub-symptom-threshold level has shown to be safe and beneficial. The evidence around this and several other areas of rehabilitation requires further work.
• A whole section has been added in as persistent symptoms under “refer”. It is suggested that a definition should be determined for post-concussive symptoms which occurs (10-14 days adults, >4 weeks children) beyond typical recovery.
• The best predictor for slower recovery is the severity of symptoms initially. A new paragraph has been added which makes specific reference to those with a history of migranes, mental health or ADHA.
• Establishing time to recovery has also been a significant addition but remains a grey area.
• A specific call has been made that the next consensus should have adequate evidence for children. It has suggested that schools should have a concussion policy that includes education on SRC prevention and management for teachers, staff, students, parents and should offer appropriate academic accommodation and support during a students recovery. Children should not return to sport until they have returned to school.
• The literature on neurobehavioral sequelae and long-term consequences of repeated head trauma is inconsistent. The potential to develop Chronic Traumatic Encephalopathy must be considered…….a cause-and-effect relationship has not yet been demonstrated between CTE and SRC or exposure to contact sports.
• A significant addition has been made in the area of prevention detailing emerging research.
• The conclusion states “while agreement exists on the principal messages conveyed by this document the authors acknowledge that the science of concussion is incomplete and therefore management and return to play decisions lie largely in the realm of clinical judgement on an individualised basis.”

http://bjsm.bmj.com/content/early/2017/04/26/bjsports-2017-097699

TQ: “What are the main differences or practical implications between the Scat 5 (new edition) and previous edition (Scat 4)?”

DB: “The SCAT5 is very similar to the previous. This was a decision based on its world-wide use, common understanding and familiarity. The changes are outlined in box 1 SCAT 5 modifications. Changes include but are not limited to; a declaration that it cannot be completed in less than 10 min. Indications for emergency management, clarified symptom checklist instructions, additional post injury questions, SAC 10 word option. A notation of the last word recall time. A rapid neurological screen has been included, return to sport  states rest should last no longer than 24-48hr. A school progression has been added and specific indication that return to sport should occur only by written approval by a healthcare professional.”

“THE MOST SIGNIFICANT ADDITION IS THE NEUROLOGICAL SCREEN WHICH INCLUDES READING AND EYE MOVEMENTS AMONGST OTHERS.”

http://bjsm.bmj.com/content/51/11/851

TQ: “Can you tell us briefly about the CRT5 and its relevance for non-medical practitioners involved in sport?”

DB: “The CRT5 is again a follow up document. It is for the lay-person and should not be used for a diagnosis. It is to recognise possible SRC and to lead to appropriate steps and action taken if one is suspected. Little research has been conducted on its utility of efficacy. Again this presents another call for research by the CISG.

Key modifications include that it is not a diagnosis, greater emphasis for recognise and remove, expansion of red flags, immediate referral points, list of signs and symptoms, awareness questions and cautions regarding acute management and restrictions on behaviours.

It of course is a helpful tool as long as it is utilised. It should be widely disseminated. It provides instructions with clear language for the lay person thus assisting in the identification and care of concussion in many populations.”

http://bjsm.bmj.com/content/51/11/872

TQ: “Are there any new emerging trends in concussion research that may have future potential to help with our diagnosis of concussion?” 

DB: “Several references were made to video analysis and other diagnostic tests (that don’t yet have sufficient power to support their use). Although force sensor analysis was discussed again there is a lack of consistent evidence to support its use. Further mention was given to sophisticated areas of research such as neuroimaging, genetic testing, pharmacology and fluid biomarkers to assist in diagnosis but again insufficient evidence is currently available.” 

TQ: “Return to learning/work and return to play is an extremely important aspect for practitioners using the SCAT 5. Can ARTC’s working in sport be confident that the SCAT 5 is sufficient in this regard?  or would you recommend using the SCAT 5 in conjunction with other concussion assessment tools such as the VOMS (vestibular/ocular motor screening assessment)?”

DB: “The consensus outlines that medical practitioners must use experience and judgement. This adds to their suggestion that the SCAT5 is the most robustly testing assessment strategy available but others may be used in addition to the SCAT5 to further inform the clinician. I think the additional of reading and eye-movement to the SCAT5 is a significant development which can be viewed at a nod towards further assessment in these areas for example VOMS. With any additional testing it is important to consider the population and the practitioners understanding and training to utilise a test correctly and effectively. Though they may not have appropriate power and be lacking in quality in areas, there is certainly research to support other methods of testing. I think the area of vestibular and oculomotor examination will continue to have positive findings in support of their use”.

TQ:  “Dearbhla, on behalf of the ARTI board I would like to thank you very much for your time and for this invaluable information that is of such great importance to our members.”