19.08 November 2009

Q&A with John Geist

Knoch High School, Saxonburg, Pa.


John Geist is a hometown kind of guy. Now in his 20th year as Head Athletic Trainer at his alma mater Knoch High School in Saxonburg, Pa., he graduated from nearby Slippery Rock University, and his wife is an art teacher and volleyball coach at Knoch.

But that doesn't mean Geist has spent his entire life in one place. Through networking and building athletic training connections, he has traveled to Wales and Australia, learned rehab techniques from the Welsh National Rugby Team's physiotherapist, and worked the sidelines at the Pittsburgh Steelers training camp.

Geist also serves on the Western Pennsylvania Interscholastic Athletic League's Sports Medicine Steering Committee, where he helps shape rules for equipment and safety. And at the 2005 NATA Convention, he spoke about preventing injuries in the javelin throw. In this interview, he discusses the different challenges of working with high school athletes and NFL players, what he learned from the Welsh rugby team, and the experience of rehabbing himself.

T&C: What do you enjoy most about your job?
Geist: Being with the kids and making a difference. When you get teenage athletes back on track, they respond so quickly, and you can see daily progress. We've had kids with injured ankles as big as grapefruits back at practice in a week because they heal up so fast. I enjoy working with that age group and seeing how well they respond to everything.

What's the hardest part of your job?
I usually work from 1 p.m. until 9 p.m., which is limiting. My son is 14 and he doesn't attend the school I work at, so it's tough to not have a lot of time with him. I also miss out on certain evening activities, like playing in a softball league and things like that. But I absolutely love the job and couldn't imagine doing anything else.

How did you become involved with the Pittsburgh Steelers?
My school signed a contract with the University of Pittsburgh Medical Center [UPMC] in my 12th year here, which gave me the opportunity to meet a lot more doctors and make some connections. Each year, the Steelers invite two athletic trainers who work with UPMC schools to training camp, and I was first invited in 2001. I hit it off really well with [Steelers Head Athletic Trainer] John Norwig and have been back every summer since.

What is it like to work with an NFL team?
Most people don't realize it's still a blue collar job. You might think working in the NFL is a 16-week position, but the athletic trainers work long hours all year round like others in the profession. The best part is being on the forefront of sports medicine. You get to test new treatments and products--opportunities I probably wouldn't get anywhere else.

Another interesting thing is seeing the pro athletes with their families and realizing they are real people and not just figures on television. It's eye opening to see them off the field with their wives and kids.

What's the biggest difference between the high school setting and the Steelers?
Individual treatment time. At my school, we don't have a lot of time to do stimulation modalities, massages, and things like that. We are more focused on getting the kids out to practice as soon as we can and covering games and practices. With the Steelers, we have two hours to get the players ready for practice and an hour and a half afterward to take care of them. We can practically give them around-the-clock attention.

But one thing I still like about high school is that teenagers often heal up in a matter of days. The professional athletes don't respond as quickly to treatment as our kids do.

What is your favorite memory from working with the Steelers?
I got to travel with them two years ago to the Hall of Fame Game and took a private Hall of Fame tour with the players. Seeing guys who are probably future Hall of Famers walking through the museum was pretty special.

What other opportunities have opened up for you through the Steelers?
In 2005, a group of Welsh Rugby Union athletes visited us at camp. I got to know their physiotherapist and developed a relationship with him, which allowed me to travel to Wales to watch the team win the Six Nations Championship. Being on that field was one of the most amazing experiences I've ever had. In Wales, rugby is the national sport, and they have a gorgeous 80,000-seat stadium. The country was in a frenzy when they won--it was like the Steelers winning the Super Bowl.

What did you find to be the biggest difference between their medical approach and yours?
Their physiotherapists receive a much wider range of education than we do as athletic trainers. But they don't really focus specifically on sports medicine--they receive more general medical training.

It's also interesting that some of the techniques they use are older, and some are newer than what we practice. For example, they still do electrical stimulation with the old sponge pads rather than the new gel pads we use. They also still tape MCL injuries, and I don't know anybody who has taped MCLs in America in the past 20 years.

But some of their rehab ideas were new to me. We usually set up one Bosu or do workouts using one apparatus, while they use obstacle courses with five Bosus and five core boards. The athletes hop on one leg from one surface to another without hitting the ground. It challenges the athlete more, and I now use this idea in my program.

They also focus on proprioception during strength training. They emphasize lifting on tilt boards and stuff like that. The proprioception rehab programs they use really seem to reduce ankle problems. In fact, when taping ankles, they apply stretch tape very lightly with one heel lock on the outside and no figure eight. I thought, "How does this provide any support?" Then I showed the physiotherapist how we tape ankles and he wondered, "How does a guy move in that?"

What are the current issues in injury prevention for rugby?
There is discussion on how as players wear more protective equipment, they tend to make more reckless tackles. The big debate now is whether to get rid of the small foam shoulder pads because they may make players more aggressive. They are seeing more shoulder and acromioclavicular joint injuries, and people worry that the athletes believe their padding overrides the need to make safe tackles with correct form.

What are some advantages of working with UPMC?
We were one of the first high schools to get the ImPACT test, and it's made a big difference for me in assessing concussions. Back when I started in the early 1990s, we just had to go by what kids told us. Now you can compare what the kids tell you with what the computer reports, and see if they match up. It's not the only source of information we use to decide whether to keep an athlete in or out, but it's a very effective management tool.

Also, I am now able to get our high school kids in to see the orthopedic surgeons who work with the Steelers. The best surgeons in the country are right here in Pittsburgh, and our relationship with UPMC allows our athletes to see these doctors within one or two days, as opposed to the general public, which typically has to wait three weeks.

What's the toughest rehab you have conducted?
Two years ago I tore my ACL playing volleyball, and I looked at it as an educational experience because I'd never had a major injury. I decided to try some things my own way to see how they work. As an athletic trainer, you want to come up with new, creative ideas without hurting people, but sometimes you're afraid to try. You can experiment on yourself with techniques you might not prescribe for other people. So I used some of the proprioception techniques I learned from the Welsh Rugby Team using Bosus and core boards.

When the ACL tore I actually didn't have any pain, so during the rehab I wasn't thinking about how horrific the injury was and fearing it would happen again. That's a big difference from someone who is screaming on the field--they have it in their mind from the outset that it's going to be tough to get over because the injury is so painful. That fear can stay with an athlete during rehab and when they return to play.

What have you learned through experience that you wish you knew when you started your career?
Everything. I try to learn something from everyone I meet. When I work with the college interns at Steelers camp, I ask them about what they're learning and the theses they're writing. If there is a better way of doing something, I want to know about it.

One specific thing I've learned is to treat the problem, not just the pain. We can all hook up stimulation units to take away the pain, but we also need to fix the underlying cause.

That was my message when I spoke at the NATA annual meeting about preventing javelin injuries. Athletes get these elbow syndromes and athletic trainers tend to treat the pain to make it feel better. But if you don't change the mechanics of the throw, you're going to end up with the same problem again and again.



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