Sports Medicine Broadcas‪t‬ Jeremy Jackson

Jovan Means is an Athletic Trainer and a professional cutman. It would seem that these jobs conflict each other but Jovan shares how these professions work together for him.















Where does your Cutman story start?







16 years as an AT







DC native







Currently working in the same school system, he graduated from (not at the same school though)







Jovan has always been a fan of boxing and MMA and thinking “I always wanted to expand my skill set.”







One day he was watching a fight with his son and he said “Dad, that is similar to what you do.” 







Light bulb moment.







Started reaching out to cutmen in the area and Mike Rodriguez reached out to him and serves as his mentor.







Being a cutman is an inside job. You have to know someone to get your foot in the door.







Mike Rodriguez invited him to a cutman workshop and they sparked a friendship.







What about taping?







It takes Jovan takes 12 minutes to wrap one hand







Different classes and commisions have requirements for the amount of tape per hand.







Make gauze pads for knuckles.







Tape must be 1 inch from the knuckles.







Monitored by an official and the opponent’s team.







There are a lot of rules to follow.







Back to cutman business







You got 60 seconds to get in the ring, handle swelling, overheating, and out of the ring.







He has learned how to anticipate what injuries will be coming and how he will handle it.







2019 Jovan was in Las Vegas for NATA and there were a few fights in Las Vegas that he was able to shadow him.







Mike is really big in boxing; it was really a blessing for him to be connected with such a big name.







Chris Colbert allowed Jovan to walk out with him







Mike reminded him you gotta start in the trenches.  The Las Vegas week was pretty "big-time" but definitely solidified Jovan’s desire to grow in this field.







Jovan does a lot of volunteer work at a local boxing club.







Some cutmen do not tape hands...so for Jovan's fighters it is a bonus.







Ringside you get a 10-second heads up to jump into action.







Keep the “Enswell” tool on ice.







Jovan also uses an ice cream scooper to help with swelling.







Wound care is something we obviously know how to do as ATs.







What is your priority as a cutman?







Over the eye first - blood







Swelling before under the eye-bleeding







Nose plug







How do you stop the bleeding?







Dog ear cleaner q-tips







You are allowed some medicines, but you gotta know the rules.







Adrenaline chloride 1:1000 and other coagulants

The wife is the greatest source of growth. I trust my wife and if she tells me I need to be kinder, slower, more active with my kids then I usually listen.







Ryan Stevens asked a few of his colleagues and their wives to join us and see what makes a good AT Dad...and what does not.















How did you meet? 







Dave and Annie McCune - Annie was a PA and took a sports medicine course at Rutgers where she met Dave.  They waited until she finished her rotation to start dating of course







Kevin & Kim Briles - Kim was coaching at the same school and came in to ask why her kids did not have water setup. 







Kevin Blew up on her, set her straight about the role of the Athletic Trainer, and then the rest was history.







Sarah and Jeremy - We were at a college dance with other people and kept checking each other out. We started hanging out after that and now almost 16 years and 3+ kids later we are here.







Ryan and Jamie met in an AOL chat room, stayed in touch and 15 years and 4 kids later 







What does your life look like now? 







Annie -







Craziness - 







We just moved back for Dave’s job at Rutgers.







I was doing door dash







Staying home with their son







Dave has to be at school early for testing







One 6 year old together







Dave was living in a dorm for a little while when he was transitioning jobs.







Was able to come back to Virginia during COVID







* Kim







Ships passing in the night







We kind of have opposite schedules







15/17/20-year-old kids







We have a son that hasn’t left his pajamas in 10 months







It is a good crazy, we are used to it.







* Jeremy, what about your wife Sarah?







Sarah is a stay at home mom and works part-time at the church.  She is the primary caregiver to our kids both biological and foster.







3 boys under the age of 10 and a foster daughter under 1







* Ryan and Jaime







Wife stays home with the 4 young kids







Ryan says “I could not make it without her.”







Paint a picture of the relationship you have with your children now. 







Briles: the wife gets up at 4:30 to get the kids to daycare on time.







Kids ride the bus home







We had to orchestrate the entire fall season of who was picking the kids up from school.  We had grandparents and family that we trusted.







We use to take them to school and the teams would automatically babysit for us







There was a  time I needed a break. It was Christmas time, we were supposed to go to this event - I told Kevin “Get everyone out of this house and do not come back until I tell you”







Kevin called the wife a few times to see if he had permission to come home.







McCune: I used to take them to school with me all the time pre-COVID







Annie says she needs that time alone. As the mom and the wife everyone needs something and she just needs some time alone.







If it was written on the wall, what would be your mission statement for your fami...

John Ciecko is a goal setter, so in AT Dads 2 we discuss the end goals and how we can work backward from that to make all 940 weekends count.















Ryan, give us an intro to your family.







3 boys and a girl







10 and under







What does the end of your career look like as related to your family?







John - For a goal setter the end of my career has always been saved for… the end of my career. Now I’m focusing on financials more, planning and goal setting for 4 rather than just 1. Is there a career change, job change. I’m now more aggressive in my job responsibilities and worth at my current job. 







Ryan - I am not a goal setter, I set priorities and work towards making those good.I want them to be functioning and contributing members of society.All my kids will be adults by thenWe want them to always feel welcome to come back and spend time in our house







Let’s work backward from there to make a plan.







20 years







Jeremy - approaching retirementAll Bio kids out of college; Possibly grandkids.I want to know my grandkids the way my mom and Sarah’s parents do.  I want to be an actively involved part of their life.  This doesn’t happen if I am absent from my kid’s life now.







John: As Jenny says, in 20 years, I’ll be close to 100! - I’ll be approaching retirement or onto my “second” career in retirement. I will be focusing on Davids’s post-college and Cece's college years. These are very important years for them, where advice and communication are important to their adulthood. I’m building capital and “collecting coins” now so that my words then will have more of an impact on them when they need it. 







10 years







Jeremy - I will have 2 out of high school and at least one to go.







Dating my Wife







Intentional conversations and interactions with my kids.







Ryan: I’ll have 4 teenagers…







I want them to be safe







Foster a relationship that allows them to tell you the bad stuff too.







John: in 10 years David will be getting ready to try out for the basketball team at my high school...if that is what he chooses.I look forward to dealing with “father/son/patient/medical provider scenarios”I want them to fail so they can learn, but not fall.







Next year







Jeremy - adopting MJ, attending school events, taking them to school and events with me.







It is not about the big events, but the daily interaction.







“Dating my kids” - giving them individual time to invest in our relationship







DATING MY WIFE 







John: Focusing on my relationship with Jenny so that our relationship with our children is meaningful. We are intentional with our words and actions throughout our relationship. 







How are we as AT Dads going to get there?







John - Pulling on inspiration and examples from my ATDads/Men mentors like Jeremy, Tom Ford, Larry Cooper etc. 







Call to action:







“Dad can you look at this or are you too busy (with your phone)”...if you are hearing this look at why and respond appropriately.







Make a plan for how you will hit your target.







Watch AT Dads 2 ...

AT Dads are similar to dads in every other profession: great, average, or awful. Dads are one of the biggest influences in the life of a child for both good and bad.















Meet our AT Dads







Ed, what is the one question you want answered by the end of the episode?







What were some of the biggest challenges you faced balancing being a father and an athletic trainer? 







* Prioritize and set non-negotiables 







Were you able to increase the amount of quality time throughout their childhood and adolescence? And if yes, how?







* Friday Pizza Nights







* Driving to school with altered schedules







Joel?







How understanding does your significant other need to be in order to find the balance?







Larry’s wife was non-athletic so she does not fully understand the lifestyle.







Larry used to hold a team meeting to discuss the week and expectations and schedule.







Has the balance ever brought you to consider changing settings/roles in the profession?







Jeremy:







As an AT Dad, How do I foster a lifetime relationship with my children?







Larry, let’s start back in the beginning.







When did you meet your wife and marry?







Wrestled in high school and in community college







Left and went to Pitt







Wanted to be an architect, then an accountant.  Realized he could not stay inside all day every day







Larry’s uncle introduced him to athletic training







Was a student teaching and doing field experience at Baldwin high school.







One of the team members introduced him to his wife.







Went to Sugarbowl with Pittsburgh and spent a lot of money on alcohol and she possibly saved his liver and his life.







First Job in Arlington VA as a certified AT







Got married over Thanksgiving in his first year as a teacher.







His wife attended a lot of the games and they became friends with one of the coaches and his spouse.







Moving 6 hours away from his parents brought him closer to his wife.







Waited 5 years to have kids and spent a lot of time investing in each other.







Larry’s wife got a job at Larry’s school so they got to work together.







The first kid







Sarah born in April 1990







The most rewarding job I have ever had was being a dad.







They moved back to Pennsylvania and worked at a clinic.  He used this time to spend with family.







Larry would take his daughter to pre-school daily and work on the counting skills while in the car.







The Second Kid







Molly was born in 1993







Another AT joined Larry on staff that allowed him some more time off







Third time is the charm...







Delaney was born in 1997 and they had 3 full-time ATs on staff at that time







Larry was involved in the state association and coaching soccer..life was busy, but life was good.







All 3 played Volleyball, cross country, soccer.







The administration was supportive and family-oriented when his daughter was born.

An emerging setting is the non traditional roles, athletics, an Athletic Trainer is employed in.







The Physician Practice Setting only makes up around 2% of Athletic Trainers currently.















About Max:







* He played football and graduated from Louisiana College* Worked in Alexandria, Louisianna for 2 years with an independent minor league team and as a physician extender* Went back to Lousianna college to work as an AT







* Went back to school and got his masters at the University of Houston* Worked as the Baseball AT after graduating* Got hired by Memorial Hermann to work with the Sugarland Skeeters







What do you need to work in the PPS? 







DME - Durable Medical Equipment - need to be able to communicate how and why to use these devices







Casting and splinting - both removal and application.







Communicating the goals and expected outcomes.







Physician Practice Value Model







* Manual for what ATs do in this role







What does max do in this emerging practice setting?







* HPI* Exam* Initial assessment / DDx* Answer questions* Confer with Doctor* Plan* Imaging* HEP vs PT* RTP protocol* Orthos referrals* In-office procedures







Pros and Cons of Physicians Practice Setting







Pros







* Work closely with doctors* Set schedule vs athletics* Had freedom to pick “regular AT” per diem* Wide variety of patients* Pediatric* Youth* Geriatric* A lot of concussions 







Cons







* Public’s lack of knowledge of an AT* Difficult/ rude patients* They are not there to see Max* A lot of concussions* A lot of the same stuff* neck/back







CPT Codes







* ICD vs CPT* 97110 Therapeutic Exercise for 15 minutes* Codes are not profession-specific







Financial Impact







* Worth and Value* Worth - the monetary cost of the service* Value - is the perceived worth* ATs can increase efficiency by performing the non-billable tasks and freeing up the Doc for the billable tasks.* Pecha et al study* Increase of $200-$1200 per day increase* In Max’s clinic study over 6 months, this value would have been about $16,000* Patient satisfaction survey







Sugarland Skeeters experience:







* He has been there since the inaugural season* Mostly veteran players trying to get back to affiliated ball







Facebook video















Contact Us







Max







Jeremy







Financial Supporters

It is the ultimate biohack, but is BFR in adolescents a good idea?







Devin Kielur DAT, LAT, ATC joins Kyle Kimbrell PT, MPT to discuss procedures, protocols, outcome measures...not just hey this is cool...















Blood Flow Restriction: What contraindications are there?







It is like a hybrid car - there are two ways two produce energy for movement







With BFR you are limiting the ability to produce aerobic energy.







Too much load can be problematic post-surgery







Open wounds - no BFR







* With any clotting issues, there should be a doctors clearance* Post-op is the target time* The first teaching was: wait until the wound was closed* With use, there has been less concern with waiting until the wound was closed.







Hypertension







Who is administering it?







What methodology? - you need to have the means to measure the pressure







Do you need it at all?







* Encourage the behavior of “Is this going to outweigh the risk?”







Athletes that do not like having their BP taken.







Sickle cell and diabetes could cause problems.







Clotting disorders







ORS has trained over 8,000 people in the US alone.







What is the main goal or purpose in using it?







Devin likes to focus on good sleep, nutrition, hydration, and body awareness.







How do you decide what load is used?







We use an RPE scale







Then use our rep scheme and by the end of the exercise, we need you to be exhausted.







We found the analgesic side very beneficial - the cuffs seem to settle the pain down







* Tissue flossing produces a similar effect on the ischemic area and reduces pain...but it should not be counted as occlusion training







Do these goals change in adolescents?







Reduce pain







Limit muscle atrophy







Repeated inflation and deflations of the cuffs change the hydration of the cell and trick the body into “feeling normal”







* This would need to occur frequently







Cuffs allow for movement and walking.







This allows PTs to space out the sessions







RPE - 







Omnires scale







“I do not want to make your pain worse, but do not tell me your pain.”







I do not tell them what number I am looking for.







They give me the number they feel fits







30/15/15/15 rep scheme with 30-second intervals







***use the patient as the guide***







Initial BFR goal: I want them to be mesmerized by it.







This means I have set the load up and it seems really low at first.







We need a continual push for growth to occur







What procedures or policies would you recommend before beginning to use it.







* Measure LOC* Prescribe pressure based on that number* Some companies have not* Document the number for full occlusion * Document the pressure for each session* Document the length of time the cuff was on* Document the load used* ...