Feel free to send in a note, picture, video about your favorite Athletic Trainer or the profession itself. I don’t know where the credit goes but DANG ITS AWESOME!!! (click to enlarge)
From my home state of Illinois, I give you Oswego High School… Make sure you see the interviews at the end of the video!!!!!!!!!!!
This post is from March 22, 2011 and is great to bring back for all to read. I am unaware of any changes in Paul’s professional life, but this remains relevant!
During the month of March we will continually highlight the work of an athletic trainer. This series will incorporate open letters about the men and women of the profession from other professionals, the aim is to have at least one a week. If there are others out there; parents, coaches, teachers, doctors, lawyers, athletes or anyone that would like to form a letter please do so and send it to firstname.lastname@example.org.
I have saved this letter for publishing toward the end of the month, because we should be thinking about what an athletic trainer does every month, and every day if you are lucky enough to have one around. Paul LaDuke Jr. is a full-time athletic trainer for a public high school in Pennsylvania and has “uber” years devoted to athletic training. Not only does he provide daily coverage, he has recently created a blog entitled “Promote The Profession” devoted to Athletic Training. Paul has been a wonderful resource and “reality check” for me during my process. It is an honor that he took time to write this letter;
What is it like to be an Athletic Trainer? Continue reading
It is that time of the year again to point the spotlight on the countless, often faceless, professionals that do much more that many know in protecting your physically active peers. This year the message is “We Prepare You Perform” and has many different meanings to many different people. I want to take this time and space today to tell you what this means to me.
It still happens, I get the occasional “what do you exactly do” comment/question from people. Certainly most of that comes from those that are not in a sporting type setting, be it at the HS level or connected to professional sports in an interest type of way. However, it is a great question that I love to answer even though it can get tiresome realizing that our profession is not universally understood.
What “I” do is not that different from what other athletic trainer does. Bringing it to a more practical analogy, it is not much different that what one does a parent; as I have learned being a father of three. What we do is make the lives of those in an active lifestyle or profession safer and when warranted BETTER. The core foundation of this comes from preparation, period.
WE PREPARE. You imagine it, there is a good chance we have prepared for it in the active arena. This goes for sports, where the vast majority of athletic trainers are employed, to the industrial setting where the hard-working, blue-collar workers need to be at their best as well.
The easy cop-out would be to say this comes from our education, at least four but increasingly more like six years of study. Sure that is some of it, but the reality is that no matter what you learn in a classroom setting has little to do with what we do on the “ground” in our profession. The more complex and reality of the preparation we do comes from experience and adapting. Constantly thinking of what could happen — and we don’t want to happen — and how to react in those situations. The first time Continue reading
I have been asked by many people what my thoughts are on the first law suit filed against a state high school association in regards to concussion. With this coming in my “home” state of Illinois, people figured I would have a strong statement or unique perspective. I have struggled with coming up with exactly what I wanted to say and could not figure out why. This is in my wheelhouse, commentary on recent and public events; one would think it would have been natural.
Then, I figured out why I couldn’t come up with something… BECAUSE I ALREADY DID, 29 MONTHS AGO!!!
Almost like I could see into the future. Below is what I wrote here and sent off to the Illinois High School Association in May of 2012. Looking back on it I still feel strongly in the proposals and the rationale. Take a quick look for yourself:
I have been working on this letter for a little while but was really spurred to action by the parent in Maryland, Tom Hearn who discussed his concerns with the local school board. I have tried and tried to use the “chain-of-command” with these thoughts and ideas, however at every step I got the feeling I would have to go alone on this, so I have. This letter may or may not reflect the opinions of my employer, high school, athletic training sanctioning bodies, or others I am involved with. This letter is from a concerned individual who feels I can spread the message effectively by these means. I have emailed the letter, proposals and the Sports Legacy Institute Hit Count White Paper to all Executive Directors and Board of Directors of the Illinois High School Association.
May 15, 2012Illinois High School Association c/o: Marty Hickman, Executive Director 2175 McGraw Drive Bloomington, IL 61704-6011 (309) 663-7479 – fax
Dear IHSA – Executive Directors, Board of Directors and Sports Med Advisory Board:
I am writing this letter to address the growing concern of concussions in sports, mainly in football. It should be noted that football is not the only sport with a concussion issue; however this sport combines the highest participation, highest risk, and highest visibility. This letter should not be construed as an attack on the sport of football, but rather a way to keep the sport continuing to grow.
As a licensed and practicing Athletic Trainer, researcher, commenter, father, and survivor of too many concussions, I feel that in order to keep the sports we love, proactive steps must be taken. Often being proactive is a painful process and easily dismissed because of the trouble it will cause. I urge all involved to think about what the future of all sports will be if nothing is done.
The Illinois State Legislature with the IHSA took the initiative by creating a mechanism of concussion education and awareness in response to the mounting scientific evidence of potential long-term impairments resulting from mishandling of this injury. However, this only represents a first step in the process; passing out a flyer or having parents and athletes initial that they have read the information is one small element of the issue. Another crucial element of the issue is coaching. We must ensure that those we entrust with the care and leadership of our children understand Continue reading
In what has been a long time coming the National Federation of State High School Associations (NFHS) has released the long-awaited guidelines from their concussion summit in July. The NFHS is basically the governing body that most, if not all, states look to when implementing rule changes in sports, policies for participation and for sports medicine advice/guidelines. Many states do not act, even with good information, with out the NFHS “seal of approval”.
This has been evidenced in the past when it comes to concussion “mitigation”, in terms of undue risk – contact limitations. There have been many states that have not waited for the NFHS (California, Arizona, Wisconsin come to mind) while there are others that sat on their hands regarding this topic. Regardless of where your state is/was it now has some guidelines to follow when it comes to the controversial topic of impact exposure.
Before I post the full press release from the NFHS, I would like to highlight the recommendations from the 2014 NFHS Recommendations and Guidelines for Minimizing Head Impact;
- “Live” and “Thud” are considered full-contact
- I really like that there is a clear definition
- Full-contact should be allowed in no more than 2-3 practices a week; 30 min a day and between 60-90 minutes a week. Only glossed over was the fact that theNFHS strongly suggests that there should not be consecutive days of full-contact.
- A great place to start, although there are a vast majority of programs, around here, that do not do more than 2-3 times a week.
- The time limits are great.
- Unaddressed is the specific back-to-back days of games to practice. For example a Monday game and Tuesday full-contact practice. Sure common sense should prevail, but there will be plenty of loophole finding on this issue.
- Recognition of preseason practices needing more contact time to develop skills.
- Obviously a sign that these guidelines are taking everything into consideration.
- During 2-a-days only one session should be contact.
- THANK YOU!
- Review of total quarters played for each player
- This has been one of my biggest points of contention with any concussion policy. The risk for injury during a game is much higher and kids that play multiple levels have an exponentially higher risk.
- Although nothing more was stated than above, this should get people talking and moving. The issue, of course, will be monitoring this. Regardless, the fact that this important point is included is a massive thumbs up!
- Considerations for contact limits outside of traditional fall football season
- Acknowledging the ever-growing practice of off-season practices.
- Implementing a coach education program
- Ideal for understanding all of this and the issues we face.
- Education of current state laws and school policies (if schools don’t have one they should)
- Putting pressure on the institutions to take some onus.
- Emergency Action Plans (EAP) and Athletic Trainers should be utilized
- AT’s should be at both games and practices.
- EAP’s should be in place and the best person for taking care of an EAP is an AT.
- The first “governing” body that has firmly suggested the use of athletic trainers for football at all levels in practice and games. This is truly noteworthy, and appreciated.
Auspiciously omitted from this document was USA Football’s “Heads Up” tackling program. They referenced the USA Football definitions of level of contact and coaching courses; but never mention the embattled “Heads Up” program. I must say, my confidence in the NFHS has skyrocketed after reading this, and a lot has to do with the people on the task force. I am looking squarely at: Mark Lahr, Tory Lindley, Steve McInerney and John Parsons. Those gentleman are of the highest quality and character when it comes to athlete safety.
Here is the full press release… Continue reading
Yesterday I wrote about concussions and the difference between professionals and adolescents using Jamaal Charles as an example. What happened last night on the professional field with millions watching was completely unacceptable, professional athlete not withstanding.
Late in the third quarter of the game, last night, San Diego’s defensive back Jahleel Addae (#37) ran into a pile to finish the tackle on the Denver running back. He was running at full speed and led with his left shoulder, but as he made contact with the RB his head dropped and he also made (incidental) helmet to helmet contact with the runner. This type of collision is very frequent and looked innocuous… Until you saw the after math…
Addae was bounced back, still on his feet, and began “short circuiting” for the national audience to see. He begins to look around, kind of, and stumble, kind of, and lose full control of his extremities, all of them. As a medical professional and athletic trainer I would have documented this OBJECTIVE finding as “unsteadiness and disorientation”. It looked like a boxer/MMA fighter catching a fist/kick in the face late in a boxing match; the type of reaction that any referee in those sports would stop a match for and award a TKO to the other guy.
It happens from time to time in this and other sports, that is not the issue here. The issue is that Addae returned to the game (oh, it gets worse). Here is the tweet from last night (h/t to Brady Phelps’ Vine);
From what I can piece together this play was the last of the 3rd quarter and reports had him taking the field on the first play of the 4th quarter. HE DIDN’T MISS A SINGLE SNAP! Even with the long commercial break between quarters there is a maximum of 4 minutes, but if my DVR time was correct it was between 2 and 3 minutes. This is not nearly enough time for a full concussion evaluation, by anyone.
“Maybe he was screened, like you said yesterday, Fink.”
There was absolutely no reason for a cursory “screen” in this situation, Addae showed a clear and overt sign of neurological impairment, in concussion recognition jargon: a sign. When any player shows a sign there is no screen it means Continue reading
It has been a truly busy season – in regards to injuries – where I perform my “day job”. I was going over some records that I keep and this season has been the busiest in my 15 years. In fact, when discussing with peers they too have had a high volume of injuries in the training room. I would say it is karma; last season we were as slow as I could remember.
Part of what I do in my job is to evaluate the injuries and determine if there are any that could have been prevented. Certainly preseason preparation – weights and conditioning – is a huge factor and we did that here, but there is always a place to learn and watch to make adjustments. In reviewing the injuries (over 50 – not all concussions) I’ve encountered that required medical care beyond the athletic training room the results were “good”. Only three were incidents that I considered “preventable”, one of which I posted about weeks ago. That is less than 10% of injuries that could have been prevented, which is good, not great, but good. In years past I have seen numbers as high as 25-30% of injuries that I deemed “preventable”. I take pride in doing my job and if I can prevent every single incident and only have injuries that occur on a “random” basis I will take it (has yet to happen in my 15 years).
Before we go further, I would like to give a glimpse into how I review injuries. We will use a tib/fib fracture we had this year; this player was injured in a game and to me that is “un-preventable”. However, a few years back we had a tib/fib fracture that occurred in practice – a practice with only “uppers” on and players were not supposed to take anyone to the ground – that incident was considered “preventable” to me. If players and coaches were vigilant to the rules of practice that player would never have been rolled up on during a tackle. Concussions are similar…
I feel that concussions can be “prevented” in practice with contact limits and proper technique during drills. The other two incidents, thus far, I deemed preventable occurred in practices and were concussions. One player was hit by a teammate during a non-contact soccer drill as a “joke” and the other did not use good judgement and ran into a pile and was rocked.
The take home here is that most injuries are part of sports and we must accept this. Also, athletic trainers have much more to worry about and analyze than most think.
All of the observation and learning also pertains to return to play; whether that be orthopedic rehabilitation or concussion return to play protocol. We, as athletic trainers, must express our voices when there is something going on that is a player safety issue. This can be as simple as modifying team warm-ups all the way to the case I had yesterday.
One of the concussed kids was on his final step for RTP (full contact practice), he is Continue reading
If you follow college football or listen to sports radio there is a good chance that you have been exposed to the story of Michigan quarterback, Shane Morris, and the apparent failure to keep him from the field after sustaining a head injury. The official story from the University is that it was a communication error.
Believe it or not, that could be exactly correct. Now, were there some possible missteps along the way by ALL involved, yes. Is there one single person or policy in place that is to blame, no. I offer some perspective before everyone eviscerates their choice of target in this case, lets take a look at how this could have went sideways.
Morris was roughed up a bit as the game progressed; he is a sophomore QB that was just elevated to the starting position on a premiere football program. Certainly he displayed some orthopedic distress as he was limping heavily after a play – how many times have we seen players play through ankle/knee/leg/foot injuries and some times even celebrated for doing so. Morris was playing through pain trying to help his team, but what happened next need not happen; however the player himself has a lot to do with how it will and did go down.
After Morris was hit in the head he attempted to get up and was obviously unsteady on his feet, he even waved off the medical team. I have been told by a good source that he even told the sidelines it was his ankle that was the issue, not his head. Which is entirely plausible, but due to the mechanism of the previous play would be unlikely the main reason for his wobbliness.
Athletic trainers as medical professionals are not omnipotent but we sure are close (ha) when it comes to injuries on the field/court of play. We do rely upon input from other human beings to make quick and decisive decisions. Doing so, in some instances, can end up creating a delay in proper treatment as it did in this case. Morris’ insistence that he was ‘OK’ immediately after the hit was taken for face value in that very short period of time. Considering the confluence of all the other factors for player safety – his ankle, his immediate response to the sideline, his demeanor – he was not ripped from the field. To be honest here, I have never seen a coach, teammate, athletic trainer or other – in the college or professional ranks – step on a field to remove a player that got up and “shook it off”; usually it takes the player going down and staying down for that to happen, if he/she does not leave the field under their own volition. Because of this, it is on the player to make sure they are seeking the proper care for their own well-being.
After the next play, Morris was removed for evaluation of his injuries. Part of that evaluation included his head and the team Continue reading
The fine people over at InjureFree have a wonderful blog post about the cost for care as it relates to athletic trainers. This is an ABSOLUTE MUST READ for those interested in athletic training at the high school level. Rather than re-post the entire article I will present you with their infographic and give some quick thoughts.
This is for a high school with an athletic trainer, who as the blog post notes, can identify and asses acute injuries as part of their health care provider education. Not only can the ID the injuries but also place the injured athlete in the proper place within the continuum of care depending on the injury itself. Meaning, if the AT feels the injury will warrant possible surgery or is in need of immediate care they will be directed by the AT to “skip” the primary care physician and go directly to a specialist. This not only saves some money for a doctor visit, but it also will save time, which can be of the essence in some cases.
Secondly, if you did not have an AT on staff, and an injury that would have warranted further investigation by a doctor and it went “unchecked” the injury could have morphed into greater damage and further costs.
The athletic trainer is not limited to the above examples, not shown in this infographic is rehabilitation costs. Many times – depending on state regulations – the AT can perform rehabilitation services right at school at no or little cost. Moreover, the very minor injuries that require taping or simple stretching/monitored practice are at no cost to the injured player and their insurance. Again saving money.
Yes, this is a commercial for athletic trainers. We really need people to understand that our profession will not only save time and money when someone is injured, but we also save lives and stress of those dealing with the injuries.
It’s the beginning of high school football season across this glorious land. I honestly love nothing more than getting back on the gridiron with the high school kids. There are so many intangibles that the beginning of any sport brings; and in our massive consumption of football world this sport seems to bring a lot of people together, quickly. You will see a lot of this “love for the sport” breeding through my posts and rants – the same love I have for all sports. Seeing kids overcome hurdles and demons and using sport/activity to express their selves is awesome. Seeing boys and girls using sports as a conduit to become better men and women by learning virtues such as: integrity, commitment, discipline and expecting to succeed.
Over the years I have obviously developed a keen eye for concussion as it relates to sport. There is no greater sport for this injury to occur at my high school than football. I have been blessed with coaches and administrators that listen to my input regarding overall safety, particularly when it comes to concussion. But this past week I noticed something that perhaps I had seen plenty of times before, but it just finally hit me.
It has to do with the practice collisions and how things that start innocently enough can change and create issues. I must give my head coach massive credit for being on the same wave length and even finishing my sentences when we were discussing my observations. It shows, to me, that he has the best interest of the players in mind – and he wants a fully healthy team. Secondly I happened to read a recent research paper about data collection on forces in football (while writing up my Sensor Overload post).
In a simple “technique” tackling drill two players were approximately five yards apart. To either side of the players were agility bags spaced at about 4 yards. The purpose of the drill was for the ball carrier to angle run to either bag, while the defensive player was to use proper technique and wrap up the ball carrier – not taking him to the ground. The players were outfitted in helmets and shoulder pads only. The players were directed to begin at “3/4″ speed and the ball carrier was to be willing to let the defender use current “proper technique” to achieve the form and fit for a tackle (face mask up, wrap-lift-drive through the man). It started all well and good, and the players naturally began to increase their speed/effort as they became comfortable with the drill. The drill lasted five minutes from setup to finish.
Upon completion of the drill – rather near Continue reading
With all that is new to the concussion realm, nothing is really new. This includes: how the injury occurs (traumatic variable force vectors – often unanticipated – jarring the brain case), its recovery (unique and undefinable), its identification (mainly subjective but overtly obvious when objective), overall education and general understanding from day-zero to day-undetermined.
The current “hot topic” for concussions is sensors. These sensors are nothing new, they have been around for years. As with most technology the devices are getting smaller and more accurate; natural evolution, if you will, for sensors. I have had the fortune of testing some products, getting deep information on others, and curiously viewing some brought to my attention. The constant thought I have is: no product has provided a clear-cut reason for inclusion – at this moment in time.
Are sensors a good idea?
Sure, if and when they become accurate enough for trained individuals to use them without impeding current standards of care. Further, I also believe that down the road we will be looking for a product that can accurately and systematically determine the gross effects of every blow the brain case takes. The key being EVERY BLOW. Not just hits to the head, or at full speed, or only in practice, or in helmeted sports.
The overwhelming information we have on concussions and their occurrence is that we just don’t know a threshold; for mine, yours, your son’s, your daughter’s or anyone. We have a general Continue reading
Sure the lede looks backwards, but the overwhelming point, in my opinion, of the NCAA recent settlement on concussions has to deal with my profession of athletic training. The issue is athletic trainers; the need for more of them and what happens if you cannot find them or afford them?
Don’t get me wrong, the fact that attention is being paid to the need for athletic trainers — although the wording does not explicitly name our profession, rather “medical professional” — is tremendous and often overlooked. Sure, you can have a doctor on the sidelines, but what is their cost? Perhaps there are some semantics that would allow other medical professionals to be in attendance, but what would be their experience, education and knowledge about concussions? And how cost/time effective would it be to have another “medical professional” that didn’t have the ability to assess, treat, manage, and rehab other injuries that occur on a sporting field?
In other words, this is an awesome advertisement and endorsement for athletic training.
But there is an issue, as stated in the Chronicle of Higher Education;
Colleges have their own concerns about the settlement, including a requirement that they have a medical professional on the sidelines for every practice and game in the highest-contact sports: basketball, field hockey, football, ice hockey, lacrosse, soccer, and wrestling.
While many big athletics programs already provide such coverage, lower-level NCAA institutions will be hard-pressed to afford it, several athletics officials said.
The requirement could lead colleges to use graduate assistants or others with little medical training, or to cut sports altogether over fears of liability.
“I’m worried about the financial fallout from this, and how it will impact Division II and Division III, and how it’s enforced,” said Tim Kelly, head athletic trainer at the U.S. Military Academy and a former member of the NCAA’s Football Rules Committee. “I’ve always wondered, Do too many schools provide too many sports at a level that’s not effective?”
If you have spent time in the “lower levels” of NCAA sports or even the NAIA you would note the very understaffed sports medicine team compared to the “big boys”. This is no fault of the fine institutions, rather an economic issue. From personal experience I can tell you that Continue reading
I received this email late last night:
Assemblyman Cooley’s office just phoned to say that Gov. Brown has signed Ca. AB 2127, making California the first state to legislate reduced contact on high school practice fields. As you know, other states have taken similar action via their governing bodies of high school athletics but, after failed attempts in Texas, Illinois and Connecticut, Ca. is the first state to pass legislation and have it signed into law. Public announcement will be made shortly. Thanks to Warren Moon, Oliver Luck, Patrick Larimore, Leigh Steinberg, Dr. Chris Giza and others who made it happen.
The law limits full-contact practices to two 90-minute sessions per week during the season and preseason, and prohibits full-contact practices during the offseason. Currently, coaches can hold full-contact practices daily. The law also forces schools to bench players for at least a week if they suffer a concussion. Current rules allow players to return within a day.
The last part of the above paragraph has me very excited about this legislation – AT LEAST one week down time!
Good on CA for taking this to the next step, honestly I don’t think we need more legislation, however if you don’t want to listen this may be the route it has to go…
NOW CALIFORNIA GET YOUR BUTT IN GEAR AND LICENSE THE ATHLETIC TRAINERS IN YOUR STATE! THEY MUST BE RECOGNIZED FOR WHAT THEY ARE: ALLIED HEALTH CARE PROFESSIONALS.
Over two years ago I sent an open letter and proposals to the Illinois High School Association (IHSA) regarding hit limits in football. Some took this as a “candy ass” approach and one that was not needed. I disagreed with that assessment, in fact, I felt that what I wrote at the time was proactive and could be a way for this state to be a leader in the area of protection in concussions;
I am writing this letter to address the growing concern of concussions in sports, mainly in football. It should be noted that football is not the only sport with a concussion issue; however this sport combines the highest participation, highest risk, and highest visibility. This letter should not be construed as an attack on the sport of football, but rather a way to keep the sport continuing to grow.[…]
Recent evidence suggests that even the subconcussive hits – those that effectively “rattle” the brain but do not produce signs or symptoms – become problematic as the season wears on, let alone a career. As the researchers in this field gain focus and more specific diagnostic tools, I feel we will see damning evidence that will put collision sports in jeopardy as they are currently constructed – the key being “as they are currently”. There can be a change, both positive and proactive, that will signal to everyone that the IHSA is taking this matter seriously and can set a nationwide standard.
Needless to say it was brushed aside and was ignored, except for a kind email saying things were happening behind the scenes. Now, two years and one month later there could be a 12th – TWELVE – states that have contact limits in place for high school football; as Arkansas looks into the matter;
According to reports, the Arkansas Activities Association has passed a recommendation to ask school superintendents to cut full contact practice time to just three times during game weeks. With one of those being the game itself, it leaves just two days of tackling if the proposal passes.
Jason Cates is the lead trainer for Cabot High School, and the former President of the Arkansas Athletic Trainers’ Association, he says, “Something has to be done.”
“The more studies that are showing that hit counts do count and add up.”
The Arkansas proposal limits the full contact days to three, opposed to the two I proposed, but it seems to me that others have seen the light. That light is both the end of the tunnel and the oncoming freight train. Kids need Continue reading
If you have a son or daughter in Little League Baseball you probably have heard of a pitch count. Basically it is a set number of pitches a pitcher can throw in a certain time period. The reasoning seems simple and sound, in my opinion; to protect the overuse of the arm/elbow. Sure, there are many coaches out there in the baseball world that know what they are doing and will only throw players when they are fully rested. On the other hand there a plenty of coaches out there that either don’t know or knowingly put players at risk when it comes to overuse of the pitching arm.
This has a relation to the concussion world; well, Sports Legacy Institute hopes so. In an effort to be PROACTIVE about issues surrounding concussions and especially the youth players of collision sports SLI has created an initiative to limit, log and research “hits” absorbed. I have blogged about it here when the initiative began.
Like many things that are new and different, people often dismiss or fail to grasp what is being attempted or cannot see what may be accomplished by doing them. In regards to the Hit Count, it to is simple; limit the number of hits one sustains while playing sports – collision sports to begin with.
I may not be the worlds biggest advocate for sensor technology as we currently know it, however this approach is different and unique. It is something that should be paid attention to, if not for the currently proposed reasons, at the very least the research capability. How can we know if we don’t know. In other words; how can we measure if we are making a difference with any of our so-called “advances in concussion issues” if there is not something to measure it against. For a small niche in the medical community that is all about “baselines” and return to “normal” our peers seem to get all squirmy when people want to find this baseline.
The Hit Count most likely will not be the panacea which our culture so desperately wants but this is at least a step in the right direction. Below you can see the full press release on the Symposium. I cannot attend on July 15th, but I have been afforded two (2) transferable registrations. Please contact me if you will be in the area and are looking to attend. Without further ado:
For Immediate Release —Thursday, June 12, 2014
Media Contact: Chelsea McLeod (781) 262-3324 or email@example.com
Sports Legacy Institute Announces 2014 Hit Count® Symposium to be Held on Tuesday, July 15, at the Boston University School of Medicine to Advance Discussion on Use of Head Impact Sensors in Sports to Prevent Concussions
Co-Chaired by Dr. Robert Cantu and Dr. Gerry Gioia, event will gather researchers, athletic trainers, coaches, parents, athletes, medical professionals, and administrators to explore how Hit Count® Certified sensors can be used to improve brain safety Continue reading
You can follow the link below for the rebroadcast of the “summit” on concussions in sport held at the White House yesterday.
There were some interesting thoughts passed along and it was great to hear the POTUS discuss athletic trainers and the need for them. The next step in that “finger” of concussion care is to find funding and placement of athletic trainers.
I did enjoy Taylor Twellman’s honesty and direct nature during his time.
The blog began simply enough, making notice of information about concussion in a time when there was so much misunderstanding. It turned into a cathartic exercise on how I have dealt with concussions as an athletic trainer – the good and the bad. It has slowly morphed into a platform for change; not only concussions but the healthcare profession of athletic training, in particular at the secondary school level (high school).
Adolescent concussion is not only staggering in terms of exposure but in terms of mismanagement, the true problem in this concussion crisis, in my humble opinion. I feel – biased – that athletic trainers not only can help with the management but with the overall “acceptance” of this brain injury as it relates to sports. Because of those thoughts I have been openly and behind the scenes, clamoring for a way to get more AT’s in the high school. Not just game-day ATC’s either, full-time and daily coverage for our most vulnerable. The analogy still remains: would you send you kid to a public swimming pool without a life guard on duty? Why would you send your kid to collision sports without an athletic trainer on duty?
Yes, this is being spurred on by the concussion issue at hand, but in reality an athletic trainer is SO MUCH MORE! We deal with the mundane (common cold) to the emergent (cardiac arrest) when it comes to athletic or high school (dealing with situations during a school day) injuries.
I came across a tweet today from Rick Burkholder (@proatc), Head Athletic Trainer of the Kansas City Chiefs that is putting this into action.
The NFL is starting a grant process to place certified athletic trainers (ATC’s) into more high schools. The monies are limited from what I can tell, but this is the start that I have been dreaming of for the past few years.
The education of concussions is great, the legislation is in the right place but there is absolutely no accountability for instances where athletes are “failed”. Before I go on, I am not perfect, I have and will continue to miss some things here and there (I missed an ACL in football which bothers me). In fact, looking at the pressure I put on myself and hoping the world puts on my chosen profession of athletic training it may be a bumpy road. However, missing obvious problems of health and welfare of athletes when one is an athletic trainer is inexcusable. I implore anyone out there that feels I have missed something to call my ass to the carpet as well.
This brings me to something that I found in my inbox recently and it made me sick and should be handled. This particular incident occurred in a state that has similar mechanisms for concussions as here in Illinois. To create the back story on the “mechanisms” in play you should understand the state legislation and high school association concussion education;
- Players, parents and coaches all have been given information regarding concussions
- Officials have been given authority to remove player for concussion signs or suspicion including mechanism of injury (MOI)
- Once removed they cannot return unless cleared by approved medical professional (IL is ATC, MD, or DO only)
With that information here is the email from a fellow athletic trainer – emphasis added is mine – (obviously stripped of identifying information);
Still have a long road ahead of education.
I was at a basketball game Friday night as a spectator and watched a player bounce [their] head off the floor. Opponent had set a screen and athlete ran right into [defender], bounced off and landed on floor bouncing head off the floor. The player then rolled around on the floor grabbing head and could tell [athlete] was in pain. Time was called by the officials to attend to the player. MOI would strongly Continue reading
It’s not actually snowing, but no school today because of -20’s windchill. With my kids out and some time to relax, I have found myself looking back and getting a bit nervous for the upcoming week.
It was a heckuva weekend as an athletic trainer and this week is shaping up to be a big week in terms of concussion education for me. As you may have already noticed I am heading to New York tomorrow to be part of the #C4CT Concussion Summit, both as a live blog feed and a panelist. I hope many can make the event, and many more learn from what I can get down on the interwebs.
Let us first reexamine the life of an athletic trainer this past weekend…
It started Friday night as the boy’s team was on the road and I caught wind (we seem to have a ton of sources as AT’s) of a collision between two players in the game. One of them had to go to the ER for some sewing work the other was ruled out by the AT with a concussion. So began my communication and information gathering well into the late night – and I wasn’t even there.
Saturday came with anticipation of seeing the injured players, fully assessing and beginning a recovery plan – while attending to a high school wrestling dual tournament. I don’t think many non-AT’s appreciate the juggling act necessary to even take a leak during these type of events let alone get some food, but now throw in two separate concussion evaluations and meetings with parents it becomes a minor miracle. However, I would be remiss if I didn’t have an outstanding volunteer first responder and student AT.
After testing and making the decision to let one player travel but not play and the other to not travel at all, it was time to focus on the wrestling. It was a very good set of matches with an unlikely victor as a team. However, in the aftermath there was a bit of false bravado by an athlete as a fist and arm went through a double-paned glass window – the ones with wires in them – and then extracted said arm.
Having an athlete present with possibly the “ugliest” injury you have ever seen can be a bit discomforting, which it was as blood was not only leaking out it was pulsing out of the large gash. Some how, some way when controlling the bleeding there was not one drop on my clothes, an absolute miracle. The stories being related after the fact have been from preposterous to accurate, the net-net was that we had a life-threatening injury and it was taken care of quickly and professionally. On top of that the athlete was all taken care of and went home that night, a very lucky kid in the face of doing something very dumb.
Sunday was not a rest day as 11 hours in the gym was on the docket again, for the little kids wrestling individual tournament. I actually learned a ton from being there (only had 5 bloody noses and one “injury). I learned that if kids/parents want kids to be in a “collision-type” sport that demands physical and mental discipline that wrestling may be the answer, over football for as young as 5.
Although school is out today my job is still in full swing. Beyond the paperwork from the weekend I had to figure out a way to meet with the injuries at school and talk with parents. Set up doctors appointments. Track an injured athlete trough surgery. Call coaches and admin to remind them of my absence. And get the training room cleaned, set-up and directions for the sub AT coming in for me.
Oh, there is this blog too, which will have breaking news today.
As I am writing this I only wanted to share what an athletic trainer does. Sure, because I post here makes me not the “normal” AT but there are many athletic trainers out there that do this and much more than me on a daily basis. It is very important to me to share my experiences so you can see how valuable AT’s are.
Parting, I would like to now extend an invitation to Commissioner Rodger Goodell to meet with me while I’m in New York. I am actually staying a block or so away from NFL HQ. So, Mr. Goodell (or representatives) just give me a shout in my in box! hahahaha. Can’t say I didn’t try!
In the NFL we have publicly disclosed injuries, including concussions, so we can (and have) track the numbers that are reported to see if there is a change in outcomes. Certainly there are flaws with the reporting system as we have discussed many times but at least we can get a set of consistent numbers (we hope) from year to year.
But what about the NCAA, where there are many more players: 126 FBS teams at about 80 players per team means 10,080 players in FBS alone. Or, about 8,387 more football players than the NFL – this number does not include FCS, DII, DIII or even the NAIA or Juco football schools.
Timothy Bella of Al Jazeera America (I guess the NSA has my IP address now and yours too if you go to links, ha) has produced a great article on this problem of tracking concussions at the NCAA level;
For this college football season, America Tonight has been tracking all the publicly reported concussions in the 10 FBS conferences and the independent teams. Auburn was one of 42 FBS programs to not publicly report a single concussion this season, accounting for exactly one-third of the 126 FBS programs. The group includes Rose Bowl and Big Ten champion Michigan State and Big 12 champion Baylor.
In fact, in the 10 conferences and the independents, coaching staffs and media outlets only reported 192 concussions at all among more than 10,000 players, according to data compiled from early August 2013 to Dec. 27, 2013, in the America Tonight Concussion Map. That’s an average of fewer than two reported concussions per team.
That number is STRIKINGLY low – due to reasons outlined in article – but 192 concussions is less than the 217 concussions we found in the NFL from preseason through the end of the regular season.
I provided many thoughts to Bella about why this may be occurring, including the teams with higher press presence Continue reading
In a little over three weeks, Brewer Sports International (BSI) along with #C4CT (Coalition for Concussion Treatment) founding partner Amarantus BioScience will be hosting their 2nd Concussion Summit in New York, at the United Nations. There have been many press releases on this event, and I have mentioned it a time or two on Twitter (and will continue).
Sure, there are many “summits” around concussions and head trauma – which is great as it keeps the dialog going – but few are populated by people with ideas on going forward. Often, we find ourselves sitting, listening to bright people talk about what was done and can’t be done; rarely do we find the same bright people addressing the issues going forward. Whether that be with tactical changes or with management or even the possibility of intervention with traumatic brain injury.
This edition of the #C4CT Summit on January 29, 2014 will hear from some people in many fields – you can see the current line-up HERE – focusing on the burgeoning topics of chronic traumatic encephalopathy (CTE), general neuroscience, pharmacology among other topics.
Interestingly enough, yours truly, was invited to sit on a panel and discuss how all of this information has been translated to the high school level – as an athletic trainer. I was not only surprised by the invitation but feel it is VERY OPPORTUNISTIC for a “boot on the ground” athletic trainer to provide input. I feel that not only have athletic trainers seemed to be seen and not heard, the vast majority of us practice in the high school setting, where the adolescents are playing sports. I can assure you I will do my very best to be a quality representative of not only athletic training (it appears I am on the only AT in a speaking role) but those of us working with the most kids/athletes.
Anyhow the cast of speakers/presenters is indeed “star-studded” and even has some opposing view points on where we should be headed; which should make for some quality discussion. If I can get my technology working and to NYC I will attempt to live blog/tweet the event for those that cannot make it.
Speaking of that, I know that time is short but I encourage anyone who is going to be in NYC during Super Bowl Week try to attend this event. If there are scribes out there I am sure the wonderful support staff at BSI can arrange for you to cover and meet the star of the show – me, of course – hahahahaha, I kid. Seriously, you can register HERE and if you have questions feel free to contact them.
I hope to see you all there!
I trust everyone has had a wonderful Christmas experience (or Hanukkah or Kwanzaa or going to have a good Boxing Day), with that I would like to wish everyone continued successes in whatever endeavor they choose. Over the Holiday I have received many an email regarding concussions; apparently the down time has given people opportunity to share frustrations or good news.
Today I am bringing you a specific case in which we all can learn from. At the least we can read this and prepare for similar situations that may arise – whether as a parent, doctor, coach or athletic trainer.
As always you can write in and with your permission I will re-post anything you would like (and it may suit the audience). It can be attributed to you or anonymously. Keep it between 500-2000 words and omit any personal identifying factors if it involves patient care or sensitive information.
Here is our post today – by Anonymous:
Obviously today is Christmas Eve and in most regions of the country kids are not in school for at least the next two weeks. Maybe less, maybe more. All in all it is a great time to rest up that brain and recharge your body. As athletic trainers we also know that sports do not stop for the holidays. For the most part at least. If you remember last year I read an op-ed article that you put on your blog titled “Parental Decisions Can Undercut Good Concussion Laws” or something of that nature. Well, it’s happened again (as it has many times between that time and now but this one is a little more ridiculous than the last) and I’m nauseous!
To be as brief as I can on this without boring you this is the case of a female soccer player who sustained a nasal fracture as well as a concussion when fighting for a header in the air with an opposing player almost a month ago. To be clear, she actually suffered a deviated septum. Anyway, after our AT did a beautiful job of getting this athlete “entered” into our concussion protocol (which Mom still couldn’t get over the fact that she indeed had a concussion; whoda’ thunk it, right?) we all sat in our physician’s office (Mom, AT, myself, physician, athlete) and witnessed the concussion as well as the nasal issue being addressed. The athlete was clearly concussed (clinical exam, balance assessment, and symptom reporting were all abnormal but ImPACT scores remained at baseline) and the athlete was sent for an MRI and referred to an ENT for further evaluation of the nasal issue. Pretty simple. These folks were given the “red carpet” treatment as all of our athletes/parents are and everyone left happy. The consensus was to see the ENT and address that issue then to follow back up with our physician for the resumption of the concussion issue. The athlete ended up having surgery about a week later. She was out for about a week after that. The ENT cleared her to resume play and actually said that there was no concussion. Wow! OK!
Fast forward to last week during exams and the athlete did not follow-up with the AT during exams like she was instructed to do. She THEN shows up to a game on Saturday with a face shield and tries to plead her case to enter the game. The AT did her job and did not allow the athlete to play. Mom was irate. Athlete conceded. Coach was with the AT. So athlete did not go through the GRTP process and as of today the mother refuses to follow-up with our physician for final clearance after all of the objective information is noted. She is choosing to Continue reading
This “throwback Thursday” thing is kinda cool for a guy that has a ton of stuff on this site that new people may have missed. With that I will attempt to drudge up some “oldies-but-goodies” for you the audience. I am certain I will re-read some of this and laugh at myself or have changed in the way of thinking but I will leave it as it was originally printed.
This weeks post comes from the very first month of this blog, September, 2010. Back then, when the concussion information on the world-wide web was hard to find I was blogging my experiences on the field as an athletic trainer. It is funny reading back on these as you can see my knowledge grow as well as how policies were set. Enjoy, including the REALLY horrible writing style (wow, it was bad).
Lets just begin by saying we did not have to travel to an emergency department last friday. That being said there were some lost opportunities for the team to get an underdog victory. The kids played hard, in a hard-hitting game, so the Continue reading
I am a bit on edge this fine, foggy-impending-wintery-weather, day. No, it’s not the great coffee I am drinking now and the nice jog I had clearly didn’t ease my current frustration. This forthcoming “strongtake” may get my ass in hot water with some readers, but so be it.
People need to calm down, slow down, take a step back, reflect and realize some important things. Before I go further understand that I have tried to be as “neutral” as possible – a simple athletic trainer that sees concussions on an intimate level from occurrence to recovery. I have had 13 myself. This post is something that apparently has boiled up from all the press clippings I have read and feedback I am getting. Not one person, entity, sport, or profession is my target here; these are observations and opinions (in my most succinct way possible).
First of all, concussions are not a football problem, they are not a soccer problem, they are not a doctors problem, they are a societal problem. Rightly so, football in America gets the mass attention, because it happens there more than any other sport out there (don’t waste my time with the skewed numbers of other sports and genders). With that being said because of the higher incidence in football that does not mean the sport as a whole needs to be banished. You know very well where I stand on this but I will spell it out for those new here.
Professional football is a different animal from the other forms of the sport, mainly because they are grown adults making informed decisions about their health. And they get paid to do it, other than providing immediate safety for the concussed players and proper information about the injury, short and long-term, they can and should be able to make their own decisions. However, this does not indemnify those players or the sanctioning bodies from having some casual responsibility for the emulation of the game at the lower levels. A clear line must be drawn between amateur and professional medical care; for concussions and all other injuries. Remember that the professionals have much greater medical care available to them, and if you think that is unfair well too bad, that’s life and where the money is. Professional football holds a certain responsibility to inform its fans and future players of the risks and rewards of the sport.
As for the lower levels, with proper coaching and medical care/coverage I feel there is a place for this sport as we know it. Unfortunately as we trickle down in age the participation numbers go way up and at the bottom, youth, is where we have the greatest disconnect from coaching and medical coverage/care. Because of this and other factors I am of the ilk that kids should wait until the arbitrary age of 14 or freshman in high school to begin full collision football. Believe it or not this has to do with more than just concussions, in my opinion. And here is where my first beef is coming from. Continue reading