By Morgan Devane, MS, LAT, ATC

My name is Morgan Devane, and I have been working with the Carolina Hurricanes this season as their athletic training student. I have been pursuing a career in athletic training since high school, obtaining my Bachelor of Science in Kinesiology from Oregon State University and a Master of Science in Athletic Training from the University of Connecticut (UConn). It is typical for graduate programs to require clinical preceptorship as a means of getting hands-on, real-world practice prior to entering the field; with this, UConn’s athletic training program and clinical coordinators put me in a position to work with the Hurricanes as my clinical rotation, since I expressed a passion for ice hockey and goals of working in the professional league one day.

I am very fortunate to have had my time spent with the team. Because of the unique range of knowledge within the medical staff and the wide range of personalities and backgrounds of the players, this environment allowed me to grow not only as an athletic trainer but as an individual.

As an athletic training student, I worked directly with the medical staff, which consisted of Doug Bennett (Head AT), Matt Aiello (Asst. AT), Nick Mahaffey (Team PT), Mike Maresca (Massage Therapist), and Bill Burniston (Head S&C Coach). Every morning, the medical team gathered before players arrived to discuss a basic plan for our most pertinently injured players. We focused on what needed to be modified in the gym for workouts, what needed to be limited on the ice, and what treatment, rehabilitation, or protocols needed to be followed—all dependent on different injuries and timelines.

My initial daily clinical tasks consisted of observing and helping where help was needed. Every morning, I would be attentive during meetings to see where I could potentially help out or learn from throughout the day. As time progressed and trust from my preceptors and players increased throughout the season, I was able to take on a few more athletic training-specific roles, including developing and assisting with rehab plans and performing treatments. A large part of the increase in responsibility led to an increase in handling therapeutic modalities and gaining comfort in using new tools I had not been exposed to in prior clinical rotations. These modalities included shockwave therapy, laser therapy (LLLT), dry needling, blood flow restriction (BFR), etc. Similarly, I had the opportunity to use many tools pertinent to timely rehabilitation and data tracking for performance, such as velocity-tracking devices in the gym, bilateral differences in strength evaluators on ice, Biodex machines for objective power and endurance measurements, force plates, eye-tracking and reaction-timing tools, and more. Observing all the different tools and their applications has been incredibly educational in allowing me to be creative and apply the same concepts with what is readily available to me at lower levels of competition.

One opportunity that gave me a lot of comparison and insight into professional organizations was the ability to liaison the medical arrangements for a PWHL game hosted by Carolina; being able to observe the differences in communication styles and how medical staff worked together to achieve success was something that benefited me in many ways. Navigating a predominantly male field as a woman has at times been uncomfortable, yet these experiences, while challenging, have offered critical insight into the kind of clinician and leader I want to become.

This experience taught me a lot about reshaping expectations, learning to adapt, thinking on my feet, and rolling with the punches. I’ve come to believe that the most chaotic and unpredictable environments—though often uncomfortable—are where you learn how to think quickly and advantageously. Each day presented an opportunity to observe my preceptors closely, learning not only from their strengths and innovations but also from their missteps and challenges they faced. From navigating communication to managing a range of personalities and strategies, I absorbed a wide spectrum of clinical approaches. These moments helped me begin to shape my own evolving identity as a new clinician.

By Karen Rich Little, DPT

My name is Karen Rich Little, and I am a Doctor of Physical Therapy, certified in vestibular rehabilitation with a focus in sport related concussion.  I have been treating concussions since 2010 and I am entering my 7th season working with the Carolina Hurricanes Sports Medicine Staff, Dr. Josh Bloom, Dr. Jim Blount, Doug Bennett (ATC), Matt Aiello (ATC) and Nick Mahaffey (PT). 

A typical assessment of a concussed athlete within our team will consist of the initial time of injury SCAT assessment and a follow-up assessment the next morning. This inherently includes a brief assessment of coordination with gross observation of oculomotor tracking and observation for extraocular movements and completion of the mBESS.  However, this is just scraping the surface of vestibular function. 

As a vestibular concussion PT, I will see athletes within 48 hours after injury for a more in-depth assessment. This will consist of a visio-vestibular exam, with symptom tracking, using a visual ocular motor screen (VOMS). Every test will start and end with a subjective rating of headache, dizziness, nausea, fogginess, and eye fatigue/pain/pressure. Testing consists of: Smooth pursuit, horizontal and vertical saccades, horizontal and vertical VOR gaze stability, near point convergence, visual motion sensitivity, and monocular accommodation.

On clinical examination, I am looking for variations from the evidence based normative values, as well as for any of the most common following findings:

• Smooth pursuit: losing track of the moving object and use of a saccadic correction to recover the target.
• Saccades: hypo/hypermetric (undershoot/overshoot the target) movements, slower velocities, and smaller peak accelerations
• VOR gaze stability and Visual motion sensitivity: delay in movement or slower velocities in one eye as compared to the other
• Near point convergence: >6cm to the point of double vision and/or a lateral shift of one eye
• Monocular accommodation: >12cm to the point of blurry vision

Interventions are based on exam findings.  Specifically, I note which directions the corrective saccades and delays occur and at what part of the visual field.  For example, an athlete with right to left, and superior to inferior corrective saccade will likely be given inferior left quadrant exercises.

Interventions are also based on the athlete’s position, as the reactions to the visual/vestibular stimulus, including speed and directions of head/eye movements, and use of peripheral vision, will be different for a goalie versus a center.  

For hockey players specifically, consider your speed and conditions of testing.  A normal tracking speed may be symptom free, but when the speed increases to that of a slapshot symptoms may be elicited.  Cardiovascular and vestibular fatigue can affect this population where their resting state may show no signs of compensations, but once fatigued, deficits are elicited. Before making return to play decisions, I suggest testing athletes at “normal testing speeds” and faster rates, as well as at a rested and fatigued state. It is important to note with speed of testing, that the guidelines are set based on anatomical capabilities, so we are looking at this from a purely symptom standpoint versus an observable deficit.

For treatment, I am utilizing the principles of adaptation, habituation and substitution and will begin with straight plane motions and very quickly progress into functional movement.  I will incorporate direction changes and multiplane movement, to replicate the players position movement demands, with single point and then multi point gaze stabilization. For example, a version of the ProAgility Drill with the typical pattern, and then progressed by adding circling a cone at one end or with the addition of a ball(s) tossed during both straight areas of the pattern and during direction transitions.  Intentional ball tossing into different zones of the visual field based on symptoms during the exercise or during testing will provide additional challenges.  With all exercises during recovery, we are trying to elicit symptoms, but at a level of 1 on our 6 point scale.

Other considerations with testing and recovery include: testing environment, life beyond the rink, and medical history.

Environment: Includes lighting and the stimulation level of the room.  Initial assessment and treatments will be performed in a natural light and low stimulation environment, then progressed to more stimulation and return to practice/play on the competition surface.  Use of the competition surface before complete return to play is an important step as the lights, screens and ad banners in the game arenas are often not replicated otherwise.

Life beyond the rink: Daily self and family care including children, and driving/travel.

Medical History:

• Previous history of concussions including the subtype(s) of concussion,
• History of headache/migraine,
• History of motion sensitivity (car sickness),
• Pre-existing and new anxieties,
• ADD/ADHD (formally diagnosed or not).

We do have research to support that recovery trajectories and timeline can be protracted with any of these history components and all of them can impact vestibular function.

For example, when performing a VOR exercise, the athlete has trouble maintaining focus on an object. We must ask ourselves the cause. Is it a vestibular deficit in tracking or gaze stabilization, a visual deficit in accommodation potentially from an unresolved previous visual subtype concussion, or an attention deficit from an underlying ADD.

Lastly, but perhaps most importantly, is to utilize a multi-disciplinary team approach to care.  It is common to see multiple subtypes of concussions within one athlete including: ocular, post traumatic migraine, cognitive fatigue, anxiety/mood and cervical. Subtypes often overlap, so although they may have vestibular deficits on testing, we should take note if deficits are with specific movements of the neck, or with complaints of blurry/double vision which may indicate a need for other specialties. Working with a team and knowing when to reach out for more specific care is key to recovery.

Concussions in professional athletes is a challenging and multi-factorial diagnosis, but given the right targeted interventions, we can improve the recovery and return to play timeline.

All photos courtesy of Doug Bennett

Doug Bennett, Head Athletic Trainer, Carolina Hurricanes

PHATS: What made you want a career in the athletic training profession and how did you get your start?

DB: I went to college as an undecided major and part of my requirements were to take surveys and questionnaires about things such as, what I liked, what I was good at, what I wanted in a profession, etc., and the advisor would send me to seminars or club meetings of different majors.  Basically, I learned that I wanted to care for people, specifically healthcare, and I loved sports.  So, I ended up in Athletic Training.  As for hockey, I was working at a PT Clinic that had a contract with the Johnstown Chiefs of the ECHL and Chris Stewart was the AT.  Chris got an opportunity to move up to the AHL (and subsequently NHL) and there was an opening, so I jumped at the chance to get into hockey. 

PHATS:  Early in your career you worked in the NFL with the Seattle Seahawks.  How did that experience help you before joining a professional hockey team?

DB: Working with elite, high level athletes was something that I immediately loved about my internship with the Seahawks.   Their dedication to their craft and desire to get healthy was something I found to be motivating to me

PHATS: In 2017 you took over as Head Athletic Trainer in Carolina.  Can you speak to that transition from Assistant to Head?  What did you find most surprising about the new role?

DB: It was a good transition because of my familiarity with the organization and the people in it.  Our group of Team Doctors were so supportive of me both as an Assistant and currently as a Head AT that it made it a lot simpler.  There wasn’t all of the extra stuff of getting situated in a new city or learning new names and faces.  The biggest change was now all of a sudden, the buck stopped at my desk and there’s an added or heightened stress that comes with that. 

PHATS: There have been so many advances in the field of Athletic Training.  What advancement has helped you the most?  

DB: The amount of research that gets pumped out yearly is amazing.  We are really lucky here in Raleigh that we are surrounded by strong academic Universities that produce a lot of research on everything from concussions to knee injuries.  The advancements we’ve made in caring for our players is jumping by leaps and bounds.  Personally, I took the Owens Recovery Science, Blood Flow Restriction course a few years back and have found that to be a huge asset in treating a variety of injuries.

PHATS:  In an effort to keep the season going amongst a pandemic, training staffs have had to adjust their rolls and take on additional responsibilities.  Can you speak to how your role as a Head AT has changed?   

DB: I don’t think there is enough space in the newsletter to address all the things Athletic Training staffs have taken on to keep hockey going safely.  We’re COVID administrators in addition to our normal duties.  We organize, schedule and review testing.  We apply and enforce NHL policies of social-distancing, mask wearing and make sure every department from Food and Beverage to Security is adhering to these policies because the success of the team depends on keeping COVID-19 out of our locker room.

PHATS: With the added responsibilities of Covid-19 safety protocols and the stress that brings to everyday work and home life, what are ways in which you are looking after your own wellness? 

DB: Honestly, this has been the toughest part.  We are quarantined at home and our outlets to relieve stress have been limited.  Personally, I use an app called Headspace to relax and calm myself daily.  My wife and kids are the best, so any free time I get, I’m spending with them and all is well again.  Also, we’ve got a few text threads with other AT groups (Head AT’s, Central Division COVID Administrators, etc..) that we bounce ideas and issues off each other and that helps to keep the sanity. 

PHATS: Sadly, we won’t be meeting in person once again this year but are looking forward to connecting virtually this July.  Tell us about a favorite Conference memory you have.   

DB: I think the first time I was in a Hot Stove session and Rammer (Jim Ramsay) started to ‘loosen up’ the conversation and we all had a good laugh was a fond memory.  I, also, just love our little or big, however you look at it, hockey family.  Its so nice to see other ATs, equipment guys and vendors in a more relaxed environment.  It feels like a family.  We’re not rushing around to get something for a player or coach and we’re able to appreciate our time together.

PHATS:  Do you have a professional mentor or Athletic Trainer you admire?

DB: I was an intern for Rick Burkholder when he was with the Philadelphia Eagles (before he moved to the KC Chiefs) and he has always been a champion of mine and of Athletic Trainers in general.  He showed me the value of building relationships with our athletes.

PHATS:  What has been your most memorable moment working in Professional Hockey?

DB: My first NHL game.  Growing up loving the sport, driving with my dad all over the place to watch hockey games, spending some time in the ECHL, working hard to get better, and then there I was working in the NHL, something I’ll never take for granted.  It felt surreal.

PHATS:  After what will arguably go down as a very trying season, what are you most looking forward to this summer and the upcoming 2021-2022 season?

DB: My Stanley Cup Party, haha.  Every AT should be dreaming of one of those, especially after this season.  And to be honest we all deserve one. 

Tell us about yourself, your family and your hobbies.

I’m originally from Johnstown Pennsylvania.  My family includes my wife Shelley and our 2 kids Sunny (4) and Carter (2).  We love the weather here in Raleigh and the ease of access to the beautiful beaches of the Carolinas.  We are members of Good Shepherd Lutheran Church and enjoy volunteering for the non-profit Family Promise, which helps support Families experiencing homelessness.  Personally, I like to golf, listen to music (everything from Country to 80s to Rock’n’roll) and travel the world. 

All photos courtesy of Doug Bennett

He’s been with the Carolina Hurricanes’ franchise since 1972. Now he plans to retire.

By Chip Alexander. The Carolina Hurricanes could soon be losing their longest tenured employee.

Equipment manager Skip Cunningham, who has been with the hockey franchise since 1972, plans to retire, Canes president and general manager Don Waddell said in an interview with The News & Observer Monday. Click here to read more…

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