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Dear @DangeRussWilson… From a High School Athletic Trainer

28 Aug

Dear Russell Wilson;

Mid-morning yesterday I get a text from a former coach that simply states “Water that helps concussions…thanks Russell Wilson”.

That led me immediately to the interwebs to find out what he was talking about and it took me about 3.576 seconds to get results. You were touting a product that supposedly helped with your concussion, I mean head injury, I mean injury that occurred last year in the playoffs. When I saw this I LOL’ed, seriously I laughed out loud. I thought this was a joke. Alas, it was not.

Then I get to school and another coach asked me about it as well, not so much would it work rather how big of an “idiot” you were (not my words). It was reassuring to know that this coach as well as the other two that stopped me before practice completely understood that this was not possible with what we know. But the fact that they were a little confused, even for the slightest moment, give me pause about what you and others can do with your platform.

I was glad all of this was taking place during school hours and practice so the kids wouldn’t have questions – actually statements about how you know more than me and where to get this. What I didn’t realize was that the parents of the kids had seen this; and wouldn’t you know I had my first email about it at 5pm.

I started to hope this would get out of the news cycle but late last night it picked up steam and this morning, more emails and Continue reading

Ready For Primetime

27 Aug

This post is a continuation of the ongoing in the wild review of the Vector Mouthguard System. You can see the previous posts about what I have experienced to this point by clicking on the hot links. As always if you have questions please comment, email or tweet I will do my best to answer.

The system has been on site and in the hands of the kids and I for the past nine days; the good is far outweighing the bad at this point. However, there is plenty of things that I have yet to figure out or apply, rather figured out how to apply. Tomorrow is the first game action, a point in this trial that I am both scared and excited about for the Vector Mouthguards. Time for the bright lights.

I am not scared or apprehensive about the overall performance of the data that I have been seeing thus far. One thing that I can firmly state at this point is that the perceived accuracy and consistency of impacts below 50g is all that I hoped and more. As the practices have progressed and I have reviewed the hitting drills by film, the hits of the interior lineman and linebackers seem to show on almost every play where there is full effort. This would match up with my line of thinking about football (as a reminder I have my system set up to report impacts of 10g or greater), this is a collision sport. I guess at this point I wonder if I am collecting a lot of “noise” in the system because the amount of hits it is recording. I do want to see the overall number of hits collected by the kids but if the 10-20g range of linear impacts are doing nothing other than that, it makes me think. On the other side I do want to have that data in case a kid were to be injured and it was a very low threshold.

The not so awesome thing at this time is the frequency of the anomalies I have seen. The last number I remember seeing for total hits that the system had captured was nearly 2,000 (4o players for 8 days of practice, about 6/player/day) and that number seems about right to me. But, the real issue is of that nearly 2,000 data set there are 12 hits that have exceeded 80g on the monitor and none of them “looked” like an 80g hit on film, in fact some there was no contact. Granted this can happen with technology, some part of an algorithm that didn’t weed out this report. Upon review I was able to identify four of these instances: one was previously mentioned with a player yelling (I have since reboiled the mouthguard and have not seen from that sensor), one was a player whipping out his mouthguard and kicking it while it still had some spit on it, and the other two were the cause of a coach tapping – rather slapping – the mouthguard on the helmet after taking it out of a players mouth to mess with me. In regards to the last two instances the good thing is that this only happens one time because the mouthgurad deactivates when the slobber is off.

Continue reading

Practical Application of Data: VMG

21 Aug

Before practice the coach, I should say coaches, wanted a report from me about what I had seen and how the system was going. I showed them the video from the previous day and where on the head the hits were registering for our worst offenders of dropping their heads at contact (verified). I also noted that some of our starters were getting more hits collected than the average teammate.

The head coach made it a point to tell the assistants to address the players that were leading with their head to correct that during our form tackling and to reinforce during live action to get the eyes up. Then after that was all done he came to my training room and asked me about how many hits and how big some of the players were getting.

I had noticed the previous two days what these 30 and 40g hits looked like and they were above “normal” collisions but not “make the crowd go oooh” type hits. He inquired about the big hit that the LB/RB took in that drill mentioned in the earlier post. I told him it was below 50. He wanted a number of hits that the kids had taken, for what other than his information I had no idea, and boy was I wrong and in a good way.

It was pretty simple the RB/LB combo players had taken the most with an average 22 in two days (day one shortened due to lightning), next were the RB only with an average of 15, then the DL with 14 and the OL with 11. Not as many as I expected, but then again our coach is very limited in hitting drills. In a five-minute segment they maybe get off 12 plays at the most and there are no more than six of those a day.

This is a good point to also tell you that these are “thud” drills, we have had one five-minute of live all season so far to go along with our 1’s vs. 1’s for four plays at the end of the day.

At most you could see 72 impacts a day, if you were in on every single rep of thud action in a practice. The starters probably see about 70% of the reps so we could expect to see at most 51 impacts in a practice. And in day two most any starter registered was Continue reading

Seeing Is… Starting… To Believe (Video Link)

21 Aug

Inside DrillWith one day of the Vector Mouthguards in the book – a lightning shortened one – and a warp speed implementation it was time to get this puppy up and running.

The players had not lost a mouthguard overnight, which is quite amazing because they always seem to lose their other ones, and all were on the chargers overnight. The clock struck 5:30 and it was go-time. The antenna receiver on the sidelines and players not wondering what it was going to feel like, just getting to practice.

As the system fired up the tiny computers in their helmets were reporting to my laptop, one green light after the other, it was working as promised. A few of the mouthguards took a minute to “warm up” with spit, I guess, but when it was time to hit I had nearly all on-line. Of the 40 issued, 32 were communicating with 2 of them on injured personnel (not concussion), we will get more in-depth about that later.

As practice started I did not want to be tethered to the computer so I could do my job as an athletic trainer so I left the base station and went about my business. The way our coach practices is in five-minute segments, flying around. It is high intensity and constant moving on my part to keep a keen eye on where it is needed and on who it is needed. I basically forgot it was over there other than the occasional parent or media asking what that “radar” looking thing was.

At the first water break I stepped over to see the computer and the hits it had captured. I was able to scroll through all the registered hits in about two seconds and only stopped on any that were above 40g. The graph like output of the system makes this a breeze. I also had noted that every hit is time stamped so when there was a hit that I thought should be captured I made note of the time and cross referenced that in the system, and yes they were there.

As the team went to a segment with inside run drill work it happened to be next to my base station for filming purposes. I yelled up to the camera operator and asked if the film time stamps and he said no. Because I had two students with me I was able to hold the tablet and look at that between reps. After every play the screen changed with more impacts; the DL, LB and RB getting the lions share of the notices. I was impressed at the speed and accuracy of the information given to me in real-time. But, one of the LB’s who was delivering the hits on D was also rotating on O as a RB and his mouth guard was not communicating, I was a bit concerned. Was this really going to keep the data in the mouthguard until it was able to communicate, like they promised? Was I going to miss out on some of his hits. And just then…  He was smashed by the defense right to the left earhole. He was none worse for wear but it was a noteworthy hit as the team yelled out due to the collision like all other teams do when that happens. He was just fine and I didn’t even take a step towards him.

As practice progressed all was going well, I was taking notes on times of hits and they all looked good and none that I found concerning in viewing them live or on the data. That’s when I scrolled across a player that had taken the largest hit seen, a Continue reading

Vector Mouthguards – Day 1

18 Aug

Don’t get to excited, I don’t think I will give you daily updates about the Vector Mouthguards but I do feel that the first day is important on many fronts, including: customer service, supplies, and ease of use out of “box”.

I had previously met with the kids individually and emailed the parents to open a line of communication about what was coming and what we could expect. I also told everyone about my expectations for this system. I received many questions from the kids that I could easily answer (looks, weight, how it works, “will my braces mess it up?”). The parents really only cared about performance and many were excited about it, even the parents of the kids that were not selected to wear them.

We ended up getting enough money to outfit 40 players so I had so select a group of kids that I thought would be a good cross section for what I wanted to know from this. I chose the following people: all varsity starters on both sides of ball except for QB, the 2’s that would be getting the most work on the scout team, players that would play both JV and Varsity, and the remaining were players that are probably not going to see much action – mainly on their own volition in practice or games (if you know what I mean). Within that group I have 4 players that have previous history of concussion, including two that have multiple concussions in their past. This I feel represents the kids that will see the most possible impact throughout the season.

I received the shipment yesterday and included were the mouthguards (lanyards number stickers), the chargers, a computer, the antenna for the system with a tripod and a carrying case for it. All was set up and ready to rock after getting the players and mouthguards into the system.

Today, Tanner Nussbaum from the Green Bay area drove down to help with the fitting and getting system up and running, and hew as on time and ready with all answers to any questions I had conjured up over night. We had the 40 players meet at 1:30 for fitting and computer inputting with final instructions, the last players were done after an hour and 20 minutes. It all went rather smoothly, minus some Continue reading

It Is Actually Happening, Impact Sensors At My School.

6 Aug

Over the years I have researched many, tried a few and heard all about impact sensors, and for the time the blog has been going you have all known I have had a “standoffish” approach to them. That is not because I don’t think they may have a place but it is because of what they can actually do and how reliable they actually are.

I have made it well-known that the “most applicable” system I have seen is the HITs system that is exclusive to Riddell helmets. It is not the best because of factors that include: cost, helmet exclusivity, and it – like all other sensor systems – is not without scientific flaws.  However, what makes HITs near the top is the information that can be gained as well as the feedback/real-time information. There are other types of impact sensors you will see “certified this, certified that” but many of them attach to the helmet making the NOCSAE warranty invalid as well as some helmet manufacturer warranties. Most, if not all do not take center of mass into effect either, making some of the objective numbers askew. As you can see I have had issue trying to adapt to one or the other, enough so that I would be willing to try it out on our teams.

I and our school cannot afford the HITs system and we promote the use of any helmet that fits properly on each kid, because of that I have been looking for other sensors and complete systems that may actually be of help to me as an athletic trainer. I did remember that I have always been intrigued by a mouthguard sensor and when the Vector Mouthguard started making its debut in colleges I started doing more and more research about it. That led me to a conversation – a very honest and blunt one – with CEO Jesse Harper.

After that conversation I did even more dirt digging on what I could and asked many people about the system and what it purportedly could do and all the scientific and mechanical engineering stuff I could comprehend. I came away satisfied, satisfied enough to invest some time and resources to try to procure this system for use in the Fall. Basically, I am ready to dive into this sensor phenomena head-on (pun not intended), finally.

Key Support

Before getting this event set in motion, school administration needed to be apprised of the plan and they would ultimately have to say yes. That conversation occurred in May when I approached the Principal and Athletic Director about this.

It did not take long to explain the benefits of this, not only from a player safety issue but from a coaching aspect as well. They both liked the idea of us looking out for player safety and showing it by being innovative, if nothing else than in perception.

They only had one statement/question for me, “there are not any drawbacks to this, unless we are missing something?”

Hurdle cleared.

Fund Raising

With most any product, good ones, the biggest barrier for most is going to be cost; that was no different here. Starting in early May I started to ask around for donations and support for this system. Although I really only had to get enough for the Continue reading

Illinois Governor Signs Concussion Bill Into Law – UPDATE

4 Aug

UPDATED: 15:20, see below…

Yesterday Illinois Gov. Rauner signed  SB0007 into law making it Public Act 099-0245 effectively titled Youth Sports Concussion Safety Act bringing a much more robust set of standards when dealing with concussions in Illinois.

The bill/law is basically an extension of the IHSA Policies regarding concussions plus some strengthening for player/participant safety.

Most notably this law now pertains to all sports, not just limited to the high school sports.

There will be more to follow on this as I get more time to delve into the entire bill.

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I have read the bill a few times and here are the other important takeaways from this bill:

  • Any Park District and Youth Sports program must make available concussion information
  • Returning from a concussion in youth sports programs or other organized sports (see club sports) must go through same steps as the IHSA/IESA standards
  • All schools under the State Board of Education must have the following:
    • A concussion oversight team that includes the following:
      • at least one physician
      • if school employs athletic trainer they must be included
      • if school employs nurse they must be included
      • administrator of protocol (essentially someone in charge of paperwork and policies)
      • if wanted any other healthcare provider as outlined in bill (MD/DO, PT, OT, ATC, RN, PsyD)
    • A concussion return-to-play protocol
    • A concussion return-to-learn protocol
    • All members of the concussion oversight team, coaches and officials must have no less than two hours of continuing education, from respective and approved providers, on concussion every two years.
  • If suspected of a concussion and pulled from game or practice the injured must meet minimum requirements to return to play and can only be signed off by a physician or athletic trainer working under a physicians license/direction.
    • If concussed the injured MUST go through the RTP protocol as set forth by each school and the RTP must be approved by the IHSA

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Minutes From First Illinois Advisory Council on Player Safety

16 Jun

PSPHlogo“Welcome to a historic event.” Is how Associate Executive Director, Kurt Gibson opened the first meeting of its kind in Illinois and for the Illinois High School Association (IHSA). With the vast majority of the Council present it did not take long for all of us to get to “work”.

The Council (which we shortened to PSAC – Player Safety Advisory Council) dove right into the meat of the issues surrounding sports and player safety. Rather than giving a play-by-play I will let you read the minutes from the meeting (LINK HERE);

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MINUTES OF THE PLAY SMART. PLAY HARD PLAYER SAFETY ADVISORY COUNCIL MEETING June 9, 2015

The Play Smart. Play Hard Player Safety Advisory Council met at the IHSA office in Bloomington, Illinois on Tuesday, June 9, 2015, beginning at 10:00 a.m. Committee members present were Dustin Fink, Sara Flanigan, Tory Lindley, Dennis Piron, and Cole Steward. Also in attendance were Associate Executive Director Kurt Gibson; Assistant Executive Director Matt Troha; and guest, Sports Medicine Advisory Committee member Greg Gaa. Not present were members Tregg Duerson, Senator Napoleon Harris, and Allison Hieb.

ITEMS OF GENERAL DISCUSSION:

1. IHSA administrators Kurt Gibson and Matt Troha welcomed the council to the first meeting of the Play Smart. Play Hard Player Safety Advisory Council.

2. The council reviewed its purpose of monitoring current IHSA programs and initiatives, identifying new areas to advance player safety, and helping communicate the Play Smart. Play Hard vision.

3. The council reviewed the following materials from the IHSA’s Sports Medicine Advisory Committee (SMAC): ● minutes of the committee’s April 2015 meeting ● recommendations made by IHSA’s Football and SMAC regarding football contact ● Managing Heat/Humidity Policy recommendation The council’s feedback on the football contact and Heat Policy recommendations are listed below under items.

4. The council discussed Senate Bill 07, which is currently awaiting signature from Governor Rauner. Among other things, SB 07 creates a Concussion Oversight Team in schools to monitor Return to Play and Return to Learn for student-athletes who have sustained a concussion, requires education on concussions and symptoms for coaches and athletic officials, and requires schools to develop school-specific Emergency Action Plans (EAP’s) to address serious injuries that may occur on campus.

5. The council heard reports from Allison Hieb and Cole Steward, the two student members of the council, on concussion from the perspective of student-athletes. Both students shared the perspective of how their schools have addressed concussion with their student-athletes on both the individual and team level. As a part of that discussion, the council suggested that the IHSA consider developing some kind of post-video assessment be created for students to complete. Additionally, the council thought it may be worthwhile for the IHSA to register and track student-athletes from a sports medicine perspective. IHSA staff indicated they would begin the process by working on some kind of checklist that all member schools can utilize.

6. In reviewing the football recommendations made by the IHSA Football and Sports Medicine Advisory Committees, the council expressed their desire to see the IHSA be bolder with its recommendations concerning the amounts of full contact Continue reading

May Mailbag

4 Jun

As the sports season winds down at the high school I am finally getting to the various emails I have received. I do truly enjoy the many stories and questions I get here, often times they are very learned for me; which translates to more information for you the reader.

I picked out one such email and gained permission to reprint it here. The sole purpose of this email is to get feedback about the return to learn aspect of concussions. Tom would like you to give it a read and make comments below.

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Return To Learn in the High School

I am an athletic trainer in a high school in the north suburbs of Chicago. We have a concussion program in place and see about 80 concussion a year in our athletics. I am fortunate to have some control over the return to learn side of concussions in my school. I have found that this is essential in order to properly manage a concussion. I find when physicians only see an athlete once and set accommodations for a determined amount of time, it does a disservice. The same is true if the time between physician evaluations is too long, especially when kids are kept out of school for long periods of time. I find many concussion students don’t need to be out of school, and those that do usually have their symptoms decrease significantly within 1-3 days.  Many times concussions progress rapidly and Continue reading

When and How ‘Not a Concussion’ Becomes a Concussion: Klay Thompson Injury

28 May

The Western Conference Finals not only provided an opportunity for the Golden State Warriors a chance at winning an NBA title it has provided a wonderful opportunity for people to learn more about concussions. The knee-jerk reaction to incidents like we have seen in Games 4 and 5 are often a mix of truth, hyperbole and eye-rolling; however what is clear they are cases that we can use to forge further understanding and education.

Last night in the would be close-out game of the WCF, Klay Thompson shot faked and the defender rose as he [Thompson] ducked and the defender’s knee blasted the side of Thompson’s head right in his right ear.

Unlike his teammate from the game before, Steph Curry, Thompson did not show overt signs, to my trained eyes, of a concussion. His face was “scruntched” in pain and he immediately grabbed for his ear, plus after the incident he immediately rose to his feet and walked straight to the locker room without assistance. As noted in Tuesday’s post signs are paramount when making critical in-game decisions about return to play; if they are there, there should be no doubt about removal.

The next report we received on TV or Twitter was about Thompson having an ear laceration and that they didn’t need to do a concussion evaluation. Which is entirely possible but unlikely, because I do believe they did a concussion “screen” at the time. The Warriors med staff probably didn’t do the full-blown evaluation because five minutes would not have been sufficient for that, but that was enough time to go over any symptoms and quick balance assessment (think roadside sobriety test). It is also important to know that because concussion are mainly subjective that a massive portion of any concussion evaluation is the interview: talking, questions and mental challenges about venue/score/date/etc.  Continue reading

“Contussiongate”*: The Steph Curry Incident

26 May

*I will admit that I could not come up with a catchy title for this post so I ripped this from Mike Freeman’s twitter feed (@mikefreemanNFL) last night:

But not only is this funny but it is about as accurate as it could have been when summing up the Steph Curry incident last night in Game 4 of the Western Conference series. So, thank you Mr. Freeman for your insightfulness and wonderful wordplay.

Those that were watching the game last night and happened to be on Twitter should know the entire process this sequelae; because of that I will be as brief as possible while injecting the overriding issues and thoughts on this.

It all began in about halfway thought the second quarter as the Warriors were getting throttled by the Rockets;

There is not speculation when looking at that vine, Curry hit his head on the court after taking an uncontrolled fall. What is not seen in the vine is Curry laying prone on the floor for a few minutes as the medical staff took a look at him (even noted checking his c-spine). When the world was brought back to the game from commercial we saw Steph getting assistance off the floor to the locker room, where further evaluation was to be done, obviously.

The first point to note in this event is that Curry not only immediately grabbed his head where it contacted the floor but he also was “down” for some time, that is obviously not normal. He hit his head and very hard so of course he would be slow to get up, but it was the amount of time that would and did have me concerned.

Before we go further we should define concussion for all of you out there, if you want the drawn out and dictionary definitions you can find it HERE, but for the simplest and most poignant way: a concussion is a disruption of normal brain function after a traumatic event. Notice there is nothing about getting hit Continue reading

Play Smart. Play Hard.

12 May

PSPHlogo

Today the Illinois High School Association (IHSA) launched a national initiative for overall student-athlete safety and participation in sport. It is called Play Smart. Play Hard. 

The campaign will focus on education and equipping athletes, parents, coaches and schools on ways to better safeguard the heath and welfare of student-athletes, including minimizing the risk of head injuries.

The main function of this campaign is to have readily available information and tools for player safety; taking on the current issues/risks as well as being forward-thinking and discussing and formulating plans for other issues that are of concern in sports. At the center of Play Smart. Play Hard. are the resources including a Player Safety Toolkit which is directed at concussions at this time. When going to the Play Smart. Play Hard. page (www.playsmartplayhard.org) in the resource tab you can find all the current Illinois and IHSA concussion information as well as the National Federation of State High School Association (NFHS) and Centers for Disease Control (CDC) concussion info.

Play Smart. Play Hard. may have been trumpeted by the IHSA and Illinois but there are many other state high school association supporters of this innovative approach, 27 to be exact, check the site to see if your state is part of it.

As mentioned on the blog yesterday Continue reading

Illinois Advisory Council on Player Safety

11 May

It was last month and I was routinely checking the inbox when I noticed a correspondence from the Illinois High School Association (IHSA) with the subject line “IHSA Request”. Of course this piqued my interest because it is not often I get information from the state high school organization and the ‘request’ portion may have been dealing with athletic training. As I opened the message I simply thought this was a blasted email with necessary information from the IHSA…  I was wrong, on so many levels.

This is how the email opened;

Good morning, Dustin.  I hope things are going well.

I wanted to write you today to invite you to be a member of the Illinois High School Association’s (IHSA) newly established Illinois Advisory Council on Player Safety, which aims to influence, shape and strengthen the IHSA’s commitment to protecting the welfare of all those involved in interscholastic competition in Illinois.

Needless to say I was kind of taken aback, but after that fleeting moment I was honored and excited and quickly read the entire correspondence and even more quickly responded to the IHSA with a definite yes (I didn’t want them to second guess my invitation, hahaha).

The Illinois Advisory Council on Player Safety aims to be a well-rounded plenary body – with much and varying expertise – that can guide discussion on ways the Illinois high school athletic community can improve, advance, set initiatives and create higher standards for player safety. This body cannot create policy but it can influence decisions and create internal debate. Initially the main focus will be on head injuries, however, it is thought that the Council will eventually take time to look at all player safety issues going forward (heat illness, sudden cardiac death, and many more). The Illinois Advisory Council on Player Safety is a part of a greater campaign that the IHSA is unveiling tomorrow (more on that then).

The Council is going to be made up of eight members from across the state; student-athletes, coach, official, athletic trainers, alumni and state legislators.  Below are the quick bios of the Council at this time: Continue reading

It. Has. To. Stop. (revisited)

10 May

This is one of my more outspoken and shared opinion pieces about concussions, it originally was penned in August of 2013.

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There is a lot of belief and trust each and every one of us has in those that are medical professionals.  The further you go up the chain in those professionals our trust is greater and our belief is stronger that they know more.  The sad fact that in some instances those near or at the top of the chain don’t know enough and are putting people, in this case a kid, in danger; not only in the near future but the long-term.

Compared to a physician (MD/DO) I would say my medical skills are pale in comparison, and rightfully so; their schooling and experience far outpace what I have learned in the medical field.  Because of this the athletic trainer (I) am not held as in high regard when it comes to decisions about the care of an athlete; which I am fine with… 97.43% of the time (I just made up that number, ha).  However there are times when a MD/DO – those making the final and binding (in parents and patients minds) decisions – make a mistake.  This is not just some Monday morning quarterbacking either, its FACT.

Just recently I had an athlete take a blow to the body and head in a practice, and they immediately came to me distressed.  How distressed?  Well that is one advantage I have over a MD/DO, especially the ER doc, I know the kids and have the resources of his/her peers as well as coaches who have known the kid for many years.  In this case the Continue reading

Athletic Training: Why I Love My Job

27 Mar

Dustin Fink:

A great read! And excellent write up!

Originally posted on I Train Therefore I Eat.:

I’m an Athletic Trainer.

Oh, so you’re a gym teacher? NO. 

Oh, so you’re a personal trainer? NO

Oh, so you’re a strength coach? NO

Wait, so what do you do?

Believe it or not, this type of exchange actually happens a lot.  It’s funny, because athletic trainers (ATs) are everywhere. Most high schools, colleges, semi-pro teams, Olympic teams, professional teams, and basically any organized athletic association has them. Athletic Trainers work for corporations, for the military, as physician extenders, and in the performing arts (Yes, Cirque du Soleil employs athletic trainers for the performers).

Athletic Trainers are on TV all the time. Although they’re usually being called “trainers” by the talent at ESPN or your local news organization, so I don’t blame you if you don’t know who we are.

athletictrainer

I work at a small Division III college in Boston, and along with my colleagues, am responsible for the…

View original 1,301 more words

Photo Essay #NATM2015

24 Mar

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)

AT make

#NATM2015 YouTube Video – OATS

11 Mar

From my home state of Illinois, I give you Oswego High School…  Make sure you see the interviews at the end of the video!!!!!!!!!!!

Well Done!

NATM 2011 Letter (3/22/11)

6 Mar

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!

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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 theconcussionblog@comcast.net.

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

We Prepare – You Perform

2 Mar

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

Being From IL, People Want To Know What I Think of Law Suit Against IHSA

8 Dec

Sq 300 JI 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:

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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.

OPEN LETTER

May 15, 2012

Illinois 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

NFHS Develops Concussion Guidelines for Football

13 Nov

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

This Is Unacceptable, In My Humble Opinion

24 Oct

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);

https://twitter.com/concussionblog/status/525487638481235968

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

Constantly Learning and Watching: There is a Time to Act

16 Oct

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

Weighing in on Michigan Situation

1 Oct

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.

The Player

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

What Is The Cost For Care?

8 Sep

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.

#AT4ALL

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