ATC vs Coaches: How Did We Get Here?

Written by admin on March 31, 2014 – 10:26 am -

Preview the original article here

The author addresses a recent, growing and troubling trend in modern medicine. Medical decisions are increasingly influenced, if not driven, by the profit center concept rather than the best interest or the medical well-being of the patient. This represents further erosion in the doctor-patient relationship and an involuntary separation between the doctor and his Hippocratic Oath. This wedge of separation assumes a variety of names: hospital CEO, Board of Directors, Insurance Company, (Insert Name of Government Agency/Politician here), or as highlighted in the referenced article, collegiate athletic directors and head coaches. Many are unaware that Licensure of athletic trainers is dependent upon and subordinate to the medical oversight of their supervising medical doctor. Sports medicine professionals have allowed the athletic directors and universities to suborn this relationship. This has not been a conscious decision or a voluntary submission, rather a gradual erosion by the weight of financial expectations borne of the pressure to “win” above all else. The importune actions of others, including decisions by Universities to place athletic training providers under the purview of head coaches, does not abrogate medical-legal responsibility and does not supersede the doctor-patient relationship. Unfortunately, the team doctor and the athletic trainer can be replaced by the athletic director or head coach at whim, so as a result, the Athletic Director or Head Coach becomes the de facto supervising medical provider. The ATC and Team Physician are thus pressured to make decisions that put athletes on the field when they otherwise should not be allowed to play. How is this done? Providers that make decisions that anger the head coach/AD are not renewed for the next season or are dismissed, and the message is sent. Conversely, those providers that are malleable become the “coach’s guy.” When the coach gets a new job, he brings with him his own hand-picked personnel replacing the previous staff. Last season, during the NFL playoffs, we were all afforded a rare glimpse into these operations when the Redskins’ team physician publicly disagreed with team officials regarding the availability of an injured RGIII. We all know how that story ended. This is the exception—a team MD with the stature to defend the rights of his athlete, but highlights the inner-workings of the industry. Co-opt the MD and the ATC into making decisions in the best interest of the Club rather than in the best interests of the patient (the athlete).
The team physician must be afforded the autonomy for adjudicating the medical care of a patient, and the Athletic Trainer, as an extension of the Team Physician, must be accorded the same freedom. Athletic trainers and medical doctors cede this right only at their great and grave peril and at the expense of the athletes entrusted to their care. It is incumbent upon all health care providers, athletic trainers, and team physicians alike, to protect the health, well being, and rights of their patients whether or not they are athletes or weekend warriors. The excuse “I was just following orders (of the athletic director, the head coach, etc.)” is and ever has been unacceptable. It will stand neither the test of time in the court of law nor the court of public opinion. It not only fails the ethical responsibilities and obligations of the health care provider to the patient, but also shouldn’t we expect more from ourselves and other health care providers? It is ridiculous to suggest or operate under a different set of rules simply because the patient is a scholarship athlete and or under contract. Indeed, it can be argued that these patients, as they are subjected to higher levels of stress and danger of injury, should be even more closely protected than the average patient – not less so. Given the recent legal decisions regarding players’ safety in the NFL, the ever-increasing awareness of athletic-related injuries, and diminished longevity of playing careers at all levels, we should remain steadfast to our Hippocratic Oath and to our desire to always protect our patients above all else. Unfortunately, if we relinquish these rights, there are many who will be only too happy and quick to assume our responsibilities, as currently evident at the highest levels of athletics and sports medicine. If we are truly serious about protecting the rights and health of our athletes – our sons and daughters – then we must reclaim our position and our responsibilities as the preeminent decision makers in healthcare matters at all levels of athletics and sports medicine.

Dr. Mark Galland is a Board Certified Orthopaedic Surgeon and adjunct Clinical Professor, specializing in sports medicine, and is the Supervising Physician for over 20 ATCs in NC

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Athletic Training: Expanding Horizons in Modern Healthcare

Written by admin on March 3, 2014 – 11:48 am -

Where does an athletic trainer work? You think you know the answer? Easy, right? In a college, high school, or with a professional sports team. As true now as it has ever been, but times are changing, and the reach of Athletic Training is at the forefront of that change. Although the origins of the profession are deeply rooted in athletics and in sporting events, their work environments now stretch far beyond those typical settings.
Though athletic trainers are now indispensable components in a variety of different organizations, it has only been in the past 10 years that they first began to appear in non-traditional settings: the military, motorsports, fire and police departments, and the performing arts. Perhaps most surprisingly, the U. S. military has fully embraced the athletic trainer as an integral member of their medical teams. Navy and marine bases now have Sports Medicine and Rehabilitation Therapy (SMART) clinics and the Army has the Musculoskeletal Action Team (MAT) to serve their soldiers. These clinics/teams, staffed by athletic trainers and physical therapists, are being implemented at military bases around the world. Their presence has proven to decrease the number of emergency room and orthopaedic physician visits (which are often costly, unnecessary and delayed from time of injury) and provide their personnel the immediate, specialty musculoskeletal care that they need. Initiating care earlier (often immediately after injury) and lowering the cost of the care provided. The Army and Marine Corps also utilize athletic trainers during basic training to keep their trainees “in the game.” The addition of athletic trainers to basic training camps has resulted in a noticeable increase in the number of trainees graduating. Not traditionally considered the seat of innovative thought, the U. S. military has proven agile in this instance and our soldiers, sailors and marines are the beneficiaries. Athletic trainers have been the very soul of that innovation.
From humble origins but always true to their core mission: health and welfare of athletes, athletic training has become an indispensable partner for various and disparate organizations. An athletic trainer is an invaluable healthcare asset to any organization. Athletic Training—thinking outside the box: it’s not just for sports teams any longer!

Alyssa Rabert is a nationally Certified, state Licensed Athletic Trainer and post-graduate Resident in training at The Galland Orthopaedics and Sports Medicine Athletic Training Residency– a 12 month immersional program allowing ATCs to maintain and hone clinical skills while developing those talents necessary to be effective in the clinical setting as an ATC/physician extender. Find out more at

Posted in Injury Prevention, Sports Medicine | No Comments »

Running: Does it Really Matter What’s Under Your Feet?

Written by admin on November 3, 2013 – 2:33 pm -

Where’s your favorite place to run? Ask ten people and their results probably vary as much as the different types of shoes they sport while doing so. As a recreational runner myself, I stick to my trail running like I stick to my Asics—invariably. Being an athletic trainer, though, has made me concerned about my joints and longevity of this activity. And so I began wondering, what surface is best? I searched high and low, looking through published research articles and running magazines alike, and here are the most well-founded and useful tidbits I came across:

• Overall, grass is king. It is soft, has a good amount of give, and thus provides the lowest impact forces of all the typical running surfaces. Unfortunately by its nature, grass has a tendency to hide obstacles like rocks or holes and is slippery when wet so consider the quality of the ground before lacing up.

• Next best are trails that are made of ground/natural materials (woodchips, dirt, or that stuff that looks like kitty-litter [think American Tobacco Trail]). Trails can be a great way to mix it up and get closer to nature. In the summer months, they are an especially valuable option because trails that run through wooded areas are often much cooler. However, variables such as roots and snakes are cause to be on the lookout. Also, I would be careful of running on trails the day or two after significant rainfall because it loosens the running surface and can often leave channels in the trails that are dangerous to unprepared runners.

• If you have to, pavement will do but try not to run on banked surfaces and make sure you have a supportive shoe that is in good condition.

• Sand is a unique option that has its benefits if you are fortunate enough to find yourself at the beach. Loose sand easily dissipates the energy of your foot strike and challenges your leg musculature in ways harder surfaces cannot. If you choose to run closer to the water where the sand is more compact, pay attention because that is often where the steepest banking is, which can put uneven pressure on your joints.

• Variety is also beneficial, but ease into new training mediums. The different surfaces stress various muscle groups which can help with overall performance. If afforded different options such as track, trail, and treadmill; take advantage of them.

• If you’re more competitive and/or aiming for a race, it would benefit you to have your training mimic the race. This includes the running surface. If you know ahead of time that you’re going to running on pavement, increase the proportion of your running on similar surfaces as you get closer to race day.

• At the end of the day, as long as it’s even, debris-free, and dry, you’re probably good to go. Your body adjusts to the surface automatically after the first few steps by changing how much you flex your knees while running to absorb the shock. If you are truly a distance runner and really rack up the miles, it’s better to be kind to your joints and go for a softer surface if you have the option to do so.

When it comes down to it, there is considerable research on the forces experienced by the joints when running on various surfaces, which can have an impact (pun kind-of intended) in the long run (nailed it). However, you’d be hard pressed to find a study that directly relates any one kind consistently to injury, and so there is still room for question and a lot we don’t know. Take the above tips with a grain of salt and ultimately rely on your body’s feedback to guide your running choices. If you find yourself in a performance rut or with constant aches in the confines of your running routine, maybe it’s time to branch out and blaze a new trail (sorry, I couldn’t help myself). Happy running!

Alex Vitek is a nationally Certified, state Licensed Athletic Trainer and post-graduate Resident in training at The Galland Orthopaedics and Sports Medicine Athletic Training Residency– a 12 month immersional program allowing ATCs to maintain and hone clinical skills while developing those talents necessary to be effective in the clinical setting as an ATC/physician extender. Find out more at

Posted in Foot & Ankle, Health and Fitness, Sports Medicine | No Comments »

Orthopaedic Specialists Of North Carolina Partners With St. Mary’s School Athletic Program

Written by admin on October 27, 2013 – 12:27 pm -

“Dr. Mark Galland, lead physician at Orthopaedic Specialists of North Carolina (OSNC), has announced that the practice has partnered with St. Mary’s School in Raleigh to provide on-site care and treatment to student-athletes at school sporting events. OSNC personnel will be present for the school’s sporting events and will be responsible for treatment to athletic injuries.”

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Dr. Mark Galland Speaks To News 14 About Injury Prevention For Student-Athletes

Written by admin on August 14, 2013 – 8:43 am -

Dr. Galland spoke with Marti Skold from News 14 on Friday to discuss how student athletes can prevent injury as they return to their fall sports. As athletes begin training in the hot summer sun, it is very important for athletes to understand safety precautions that will help ensure a safe practice. To view the segment, visit–orthopedic-surgeon-dr–mark-galland .

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Posted in Around the office, Health and Fitness, Injury Prevention, News Releases, Sports Medicine | No Comments »

Chronic Exertional Compartment Syndrome: A Review

Written by admin on July 15, 2013 – 10:00 pm -

Active individuals, including athletes or people with highly active jobs, have a risk of sustaining an orthopedic condition. While a lot of the focus remains on the traumatic, or acute, injuries, a vast majority of conditions may result from overuse. The body can only take so much before these overuse injuries begin to create dysfunctions and inflammation in the body, thus causing chronic pain syndromes. One syndrome that results due to overuse is a condition to the lower legs called chronic exertional compartment syndrome.
Chronic exertional compartment syndrome (CECS) is the direct result of increased pressure within one or more of the four compartments of the lower leg. These compartments include the anterior, lateral, superficial posterior, and deep posterior. This increase in pressure causes compression of the muscular and neurovascular structures located in each compartment. The anterior compartment is the most common compartment for this syndrome to occur in, however, any or all compartments may be involved (Blackman, 2000). The condition is activity related as symptoms are generally felt only during activity. These symptoms may include a deep aching pain, tightness, and swelling of the involved compartments. These same symptoms will resolve fairly quickly with rest.
One such case involving CECS involved a 22 year old male soccer athlete who reported to clinic with insidious, yet sudden, onset of bilateral lower leg tightness. This pain was felt consistently about 50 minutes into soccer activities and would resolve within 15 minutes of rest. Examination of lower legs revealed firmness to the bilateral anterior and lateral compartments which is a common finding in this condition. To confirm that CECS is present, the best method is by measuring the compartment pressure. Compartment pressure measurements were taken in this patient. These measurements revealed resting compartment pressures well above average in bilateral anterior and lateral compartments. It was determined that this patient was suffering from CECS.
Once CECS is identified, treatment and management of the condition is the next barrier that needs to be addressed. This patient was given options for both non-operative and operative interventions. Upon consideration, the patient elected to receive bilateral anterior and lateral compartment release by fasciotomy.
Surgical intervention involving fasciotomy compartmental release remains the main form of management for this condition, particularly in younger, athletic individuals such as the soccer player described above. The American Journal of Sports Medicine recently published an article that investigated functional outcomes and patient satisfaction after fasciotomy for CECS. In this investigation, the authors identified patients between 1998 and 2008 that presented with CECS that had failed non-operative management and presented them with the option of either continuing to receive non-operative treatment or to receive referral to orthopedic surgeon for fasciotomy release. Patients with a minimum 2-year follow-up were provided a questionnaire describing their pre-treatment and post-treatment conditions. This questionnaire included quality and duration of symptoms, analog pain scale, symptomatic and functional responses to treatment, and satisfaction with treatment. All medical records and patient outcomes were then reviewed. After interventions were implemented, the operative group had a much higher rate of success and patient satisfaction rate at 81% in both categories compared to the non-operative group with success and satisfaction rates of 41% and 56%, respectively. Patients that received combined anterior and lateral compartment release had a much higher failure rate (31%) than those receiving an isolated anterior compartment release (0%). Also, the data analyzed revealed that those patients who were college-aged or younger had a higher satisfaction rating when compared to patients post-college. The authors concluded that patients 23 years old or younger with isolated anterior compartment syndrome are excellent candidates for fasciotomy release. Furthermore, they conclude that lateral compartment release should be avoided unless clearly indicated by symptoms and compartment pressure measurements (Packer, Day, Nguyen, Hobart, Hannafin & Metzl, 2013).
In the case of this 22 year old soccer player, he elected to receive bilateral anterior and lateral compartment fasciotomy for CECS. Despite the conclusions of Packer et. al., this particular patient responded favorably to both anterior and lateral compartment releases. Factors that likely attributed to the success of this individuals surgery were the fact that he was younger and fell into the group of people that respond more favorably. The athlete was able to return to soccer activities and has not had any recurrence of symptoms.
Additional studies supporting the use of compartment fasciotomy include one study published in 2010 that concluded compartment release is a cosmetic, safe, and effective means of treating CECS (Wittstein, Moorman & Levin 2010). Another study later concluded that, for athletes, a meticulous surgical intervention for CECS will yield good outcomes and return to play can be expected in as quickly as 8-12 weeks (Murray & Heckman, 2012).
Despite the overall support for the implementation of surgical intervention for patients suffering from CECS, many patients wish to avoid surgical interventions by means of more conservative management. For athletes, particularly those involved in intense aerobic activities such as soccer or track athletes, conservative management is a realistic option to pursue.
One key component that must be addressed is analyzing the athletes running mechanics to identify a possible cause for why the condition became a problem. In 2012, the American Journal of Sports Medicine published an article investigating the effects of forefoot running on pain and disability associated with CECS. The investigators identified 10 individuals that were clinically indicated for surgical compartment release. Once these individuals were identified, surgical intervention was postponed and conservative management was implemented in the form of a six week forefoot strike running intervention. Multiple variable were measured before and after the six week intervention including compartment pressures at rest and post-running, running distance, and reported pain. The results showed that after the six-week intervention, mean post-run anterior compartment pressures significantly decreased from 78.0 ± 32.0 mm Hg to 38.4 ± 11.5 mm Hg. Additionally, running distance significantly increased and reported pain while running decreased. No subject involved in the study needed surgical intervention (Diebal , Gregory, Alitz & Gerber, 2012).
Based on the results of this study, any high caliber athlete wishing to avoid surgical intervention should strongly consider a running gait analysis from a qualified professional to determine if forefoot running is a viable option to remain off the operating table.
While the surgical intervention of the 22-year old soccer athlete was a success, the question must be raised: would the athlete have been able to avoid a surgery by altering his running gait? Future research and clinical trials must be implemented in order to draw more support towards successful non-operative interventions for CECS. For some patients, this may be viable substitute to surgical intervention.


Blackman, P. (2000). A review of chronic exertional compartment syndrome in the lower leg. Medicine and Science in Sports and Exercise, 32(3 Suppl), S4-10. Retrieved from
Diebal , A., Gregory, R., Alitz, C., & Gerber, J. (2012). Forefoot running improves pain and disability associated with chronic exertional compartment syndrome. The American Journal of Sports Medicine, 40(5), 1060-1067. Retrieved from
Murray, M., & Heckman , M. (2012). Chronic exertional compartment syndrome: Diagnostic techniques and management. Techniques in Orthopaedics, 27(1), 75-78. Retrieved from
Packer, J., Day, M., Nguyen, J., Hobart, S., Hannafin, J., & Metzl, J. (2013). Functional outcomes and patient satisfaction after fasciotomy for chronic exertional compartment syndrome. The American Journal of Sports Medicine, 41(2), 430-436. Retrieved from
Wittstein, J., Moorman, C., & Levin, L. (2010). Endoscopic compartment release for chronic exertional compartment syndrome: surgical technique and results. The American Journal of Sports Medicine, 38(8), 1661-1666. Retrieved from

Matt Rongstad is a nationally Certified, state Licensed Athletic Trainer and post-graduate Resident in training at The Galland Orthopaedics and Sports Medicine Athletic Training Residency– a 12 month immersional program allowing ATCs to maintain and hone clinical skills while developing those talents necessary to be effective in the clinical setting as an ATC/physician extender. Find out more at

Posted in Foot & Ankle, Sports Medicine | No Comments »

Dr. Galland Featured in American Council on Exercise Article

Written by admin on July 8, 2013 – 4:10 pm -

Dr. Mark Galland was recently featured in an article published by the American Council on Exercise, titled “Muscular Imbalances Increase Your Client’s Risk for Injury.” In the article, Galland provides insight on muscular imbalances, their causes and how exercise helps prevent them.

To read the full article, visit:

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Dr. Mark Galland Named Team Physician And Medical Director Of Rolesville High School Athletics

Written by admin on July 3, 2013 – 9:31 am -

RALEIGH, N.C. – Dr. Mark Galland, orthopaedic surgeon and sports medicine specialist at Orthopaedic Specialists of North Carolina (OSNC) (, has been named team physician and medical director of Rolesville High School’s athletic teams. In this position, Galland will be responsible for leading and coordinating the medical staff and medical services for all of the school’s sports teams and student-athletes.

Rolesville High School will open in August 2013 with an anticipated enrollment of 600 to 700 students, with a maximum capacity of approximately 2,300 students. The school will offer football, volleyball, soccer, basketball, softball, baseball, track, tennis, golf, swimming, wrestling, cheerleading and lacrosse programs.

Since joining Orthopaedic Specialists of North Carolina, Galland has continued his commitment and dedication to the treatment of injured athletes. He currently serves as team physician and Orthopaedic consultant to the Carolina Mudcats, the Advanced A affiliate of the Cleveland Indians Major League Baseball team; medical director and orthopaedic consultant to the Louisburg College Athletic Program, medical director of the Barton College athletic program, adjunct clinical professor at Marietta College and team physician and Orthopaedic consultant to several area high schools.

“I am honored to be named team physician and medical director of Rolesville High School,” said Galland. “I look forward to providing orthopaedic care to the school’s student athletes to ensure they are able to compete to the best of their ability and enjoy a safe and healthy sports season.”

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Dr. Mark Galland is an orthopaedic surgeon, sports medicine specialist and physician at Orthopaedic Specialists of North Carolina. Galland received his medical degree from Tulane University’s School of Medicine and completed his residency in the university’s Department of Orthopaedic Surgery. He began his career in orthopaedic surgery and sports medicine while serving in the United States Navy at a naval hospital at Camp Lejeune, N.C. There, he served as chief of orthopaedic surgery and was the recipient of numerous awards for both leadership and excellence in treating injuries common to sailors and marines. Since beginning with Orthopaedic Specialists of North Carolina, Galland has continued to treat injured athletes. He currently serves as a team physician and orthopaedic consultant to the Carolina Mudcats, the High-A affiliate of the Cleveland Indians Major League Baseball team, and as medical director and orthopaedic consultant to the Louisburg College athletic program. He also serves as the team physician and orthopaedic consultant to several local high schools, as well as on the board of directors for the Trentini Foundation, a nonprofit scholarship organization. For more information, visit or

Jordan Smith
MMI Public Relations
(919) 233-6600


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Prevention of Anterior Cruciate Ligament Injury in Athletes

Written by admin on June 9, 2013 – 7:16 pm -

A Review
Thomas Trojian, MD, Lindsay DiStefano, PhD, ATCDisclosures

Clin J Sport Med. 2013;23(2):120-121.

Abstract and Introduction

Sadoghi P, von Keudell A, Vavken P. Effectiveness of anterior cruciate ligament injury prevention training programs. J Bone Joint Surg Am. 2012;94:769–776.

Objective: To investigate whether anterior cruciate ligament (ACL) prevention programs reduce risk of injury in athletes, and which prevention program is most effective, by means of a review of the literature and meta-analysis of the results.

Data Sources: PubMed, MEDLINE, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials databases were searched online using the terms anterior cruciate ligament, knee, injury, prevention, and control. The reference lists of relevant studies were searched for further trials.

Study Selection: Prospective controlled studies of humans, in any language, that reported on proprioceptive neuromuscular training techniques for ACL injury prevention compared with usual training programs were selected if they reported clinical outcomes and had an attrition rate of <20%. Three independent reviewers selected the studies and resolved differences by consensus. After duplicates were eliminated, the search identified 723 reports. Eight studies met the selection criteria.

Data Extraction: Details of the study design, participant characteristics, the intervention, the number of ACL injuries at follow-up, the duration of follow-up, and the sport played were extracted. Study quality was scored 0 to 3, according to use of randomization and blinding and adequacy of follow-up of participants. Pooled risk ratios (RRs) were calculated in random-effects models.

Main Results: Participants in the studies were predominantly women or girls who played soccer, basketball, or volleyball. The interventions included proprioceptive neuromuscular training and agility skills as well as strength, flexibility, and cardiovascular training, done either preseason or for 30 days to 12 weeks during the season. With 1 exception, the results of the interventions were positive, with the number needed to treat to prevent 1 ACL injury varying from 5 to 187 in those 7 studies. The pooled RR favoring the interventions was 0.38 (95% confidence interval [CI], 0.20–0.72). This included 34 ACL injuries among the 3905 intervention participants and 181 ACL injuries among the 6703 control participants. The pooled RR among female athletes was 0.48 (95% CI, 0.26–0.89) and among male athletes was 0.15 (95% CI, 0.08–0.28). The mean quality score for the studies was poor (mean, 1 point; 95% CI, 0.43–1.57 points). No variable such as type of intervention, timing of the program, or length of the program was clearly related to effectiveness.

Conclusions: Neuromuscular-focused exercise training programs to prevent ACL injuries were effective among both female and male athletes. Despite the poor methodological quality of the studies, the results were consistent.

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Posted in Knee, Sports Medicine | No Comments »

As SCD awareness on the rise, changes likely in pre-participation screen

Written by admin on April 21, 2013 – 9:49 am -

“Preparticipation screening of endurance athletes has gained interest during the past decade. Its main focus is to prevent sudden cardiac death (SCD) from unrecognised cardiac pathology, including hypertrophic cardiomyopathy (HCM) and arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) in individuals <40 years, and predominantly coronary artery disease in ≥40 years of age.[1–3]

If the results of clinical evaluation or preparticipation screening (including medical history, assessment of symptoms and signs and ECG) of athletes warrant further investigation, non-invasive imaging is typically used to identify the presence of structural heart disease.[4,5] The most frequently used imaging modality is echocardiography, which can accurately assess cardiac function and morphology, while being inexpensive, rapid and widely available."

For more info please see the complete article (from BJSM) posted below:

Head-to-head Comparison Between Echocardiography and Cardiac MRI in the Evaluation of the Athlete’s Heart

Niek H J Prakken, Arco J Teske, Maarten J Cramer, Arend Mosterd, Annieke C Bosker, Willem P Mali, Pieter A Doevendans, Birgitta K Velthuis

Posted in Cardiac, Sports Medicine | No Comments »