Varsity Season Over, Lesson Learned

Last night was our last varsity game, though we have one more JV game in about 30 minutes (thanks to my student for getting it all set up).  From a concussion standpoint, we ended the varsity season with a total of 4 concussions.  Over a nine-game schedule that is less than .5 per game.  The rate would be 45 players divided by concussions for a rate of 11.45 on the season, slightly higher than current rates.

That is what leads me to this post.  In our last game, we faced a team that has athletic trainers by the name of John Storsved and Steven Broglio, PhD.  Both are active in the athletic training community, working at nearby state universities.  Dr. Broglio is working with the HITS program (helmet sensors) at the University of Illinois.  John is the Clinical Instructor for athletic training at Eastern Illinois.  Prior to the game, the three of us were engaged in “nerd” talk about the increase in concussion rates.

We have all observed more concussions this season and were discussing possible causes of this alarming trend.  Although didn’t reach a consensus on a singular cause, we did all agree that awareness has increased across the board.  Parents, coaches, and student-athletes are allowing more access to the “unseen/unreported” concussions of the past.  But one topic we did spend some time on was the violence and velocity of the hits kids are taking and delivering these days.  This too could be a reason for an increase in concussions.  This leads me to my editorial for the day.

NFL players are getting paid millions to, in effect, destroy their bodies, brains included.  However, I feel that kids are emulating what they see on Sundays by taking to the field on Fridays.  The lowering of the head is something that coaches DO NOT teach, yet we see the best football players in the world continually do it, without penalty.  Last night I saw and heard a perfect example from one of our players.

He was blocking late on a play where there was a scrum and launched himself into the pile head first to make a block/hit.  It WAS NOT flagged (should have been), and he came off to the sidelines.  I asked this player what he was thinking and why he did that. His response…”They do it in the NFL.”

Enough said.

NFL Concussion Report Week 7

These players are listed to have concussion, head, or migraines and will be probable for week 7 games;

  • Josh Cribbs, WR, CLE
  • Riley Cooper, WR, PHI

 

These players are listed to have concussion, head, or migraines and will be questionable, doubtful or out for week 7 games;

  • Dunta Robinson, CB, ATL
  • David Garrard, QB, JAX
  • Mohamed Massaquoi, WR, CLE
  • Rocky McIntosh, LB, WAS
  • Chris Cooley, TE, WAS
  • Clifton Ryan, DT, STL
  • DeSean Jackson, WR, PHI
  • Julian Edelman, WR, NE
  • Brandon Myers, TE, OAK
  • Husain Abdullah, S, MIN

These are taken directly from NFL.com/injuries.

Enormous Problem for Military

Concussions can hit anyone at any time.  Sure, those that play high-impact sports, like football and hockey, are more susceptible.  But this problem is one that will effect all of us.  This cannot be more true than on the battlefield (see The Concussion Blog Archives on this).

“It’s an enormous issue,” she said. “Concussion and TBI have been called the signature medical issues of the wars in the Middle East because of IEDs (improvised explosive devices), the weapon of choice for the insurgents, and rocket-propelled grenades, which can cause blast injuries that we’re just learning about.

“An explosion can cause different kinds of injuries because of the heat and noise, the shock waves and electromagnetic pulse,” she said. “And troops can be exposed to several blasts even in the same day. We take athletes out of a game after one concussion, but troops often go right back into action.”

That is a quote from Dr. Susan Thompson, a clinical neuropsychologist in Grand Forks, North Dakota.

You can read the entire story written by Chuck Haga HERE.

Nightmare on a Football Field

The most recent concussion I handled was my worst nightmare right before my eyes.  Some of the scariest moments in athletic training are those when kids are returning from an injury.  On the inside, you are scared that they will re-injure, that what you have provided was not enough, that you could have done something more to protect them.  All of that is amplified by about ten-fold with a player returning from a concussion.

This player was one of our first concussions of the season.  He sustained it September 13th and was not allowed to return with MD clearance until September 27th.  He went through the graded return to play.  He passed that, and then passed his ImPACT test with flying colors.  He participated in lower level games and one varsity game prior to last week.  Each game he was debriefed by one of us in the athletic training room.

However, this past Friday he sustained another hard shot to the head.  I saw it, and cringed a bit as he was on the ground, but he popped right back up.  As he began his way to the bench from across the field, he grabbed his head and I knew something was wrong.

I let my student perform the evaluation on him.  He wanted back in the game, saying he was fine.  Although, you could tell that the weeks of drilling him about the symptoms and dangers of concussions were beginning to seep through.  He was more truthful and compliant with us, so I focused my attention to the game on the field, while my student watched over him.  As I was trying to find a ride for him (other than the bus) to get home, I was beckoned by my student.  She reported to me that his condition was deteriorating, as she was telling me this he started to close his eyes and sway badly.

Without thought I bolted across the field, while teams were in the huddle, Continue reading

Friday Night Lights Week 9

After a one week hiatus, it’s back – my personal experience and feelings on concussions.

It’s the last week for football at the high school I cover, as our team will not have enough wins to qualify for the playoffs here in Illinois.  Two games remain (varsity tonight, JV Monday) and I am not ready for it to end.  I have had one of the most fun and fulfilling years on the gridiron both personally and from an athletic trainer’s stand point.

Recapping the past few weeks, we have had four concussions since I last wrote, two in football and two volleyball players.  All of them were different presentations and circumstances, one of which had me scared out of my wits.

The first of the four was last Thursday as a player was tackled late in the second and came off the field complaining of wrist and hand pain.  The significance of this player is that he was the best on the field and the best player the coaches had at that game.  He came off and we took a look at his wrist/hand, slapped on some tape and had him return, which he did.  But after halftime, the coaches reported to us that this player was “not like himself” during the break, and seemed like he was not paying attention.  They thought he may have a head injury, which was news to us, as we only knew of his hand/wrist injury.  As we walked over to the player he has the “gaze,” as though he is looking straight through you, and grabbing his head.  My student performed the standard tests, Rhomberg, Neurocognitive challenges, and he is obviously struggling.  After we determine that he does in fact reek of concussion, we quizzed him on how he got hurt, and he has no clue.  We talked about the hit that caused his wrist/hand to hurt, and he said he did not remember his head getting hit.  All of his memory was there, but we could not for the life of anyone on the sideline, including his father, figure out where his head was impacted.  The conclusion we finally decided on was that he did not sustain a “monumental” blow, Continue reading

Rodeo Concussions

Living in a semi-rural area and growing up in a western state, rodeo has been a part of my life. From watching the rodeo club in college, to taking dares growing up, to the television, I have enjoyed the sport and even wanted to be on the Justin Sports Medicine team.

Something crossed my mind for the first time last night as I was watching the second round of the PBR national finals. “How many and how often do these cowboys participate with concussions?” I thought this because I noticed, also for the first time, that the riders without a cage/helmet stuck out more than the ones with protective head-gear. In fact there may have been more helmets than cowboy hats.

The ultimate “macho” man sport likely wears head injuries like a badge of honor, but these could be leading to horrific ends, and we don’t even know about it. When you search “rodeo concussions” on Google (News) you get returned with 11 results with in the past 3 months. For comparison “soccer concussions” gets 370 results in October alone and “football concussions”, 472 in a week.

With the NFR coming up in Las Vegas I suppose we may see more articles on this injury in rodeo, but awareness needs to trickle down to all sports at all levels. For us as medical professionals to say “football only” would be hypocritical, it may be the most popular but concussions in sport can happen at anytime to anyone.

Pro Rodeo Cowboys Association

MLB Considering Shorter DL for Concussion

Major League Baseball has a unique problem when dealing with concussions… the disabled list. The DL can be so complex it warrants its own Wikipedia entry (http://en.wikipedia.org/wiki/Disabled_list). The MLB season is a long grind – days and days of back-to-back games for months on end…yet the shortest stay clubs can place an athlete on the DL is 15 days, which can create roster management problems. For this reason, many clubs are forced to do what they can to avoid sending someone to the DL who really doesn’t need to be there for a full 15 days. Making a DL decision with a concussion can be more complicated than with a “run-of-the-mill” orthopedic injury.  Clubs have been hesitant to diagnose a concussion when one occurs due to the unpredictable recovery rate. But according to reports surfacing today, it appears MLB is preparing to create a shorter DL stay for players with head injuries. Initial reactions appear to be positive, and from what I can tell, seems to be a step in the right direction. This fundamental change would allow clubs the flexibility to wait out every symptom and not rush an athlete back before they should because of  roster management reasons.

AP Report via ABCNews

Helmets Protect for Concussion, WRONG.

Once again Alan Schwarz has published a VERY, VERY good article pertaining to concussions.  In this article in the New York Times he has looked at the outdated helmet standards by NOCSAE.

That assumption, made by countless parents, coaches, administrators and even doctors involved with the 4.4 million children who play tackle football, is just one of many false beliefs in the largely unmonitored world of football helmets.

Helmets both new and used are not — and have never been — formally tested against the forces believed to cause concussions. The industry, which receives no governmental or other independent oversight, requires helmets for players of all ages to withstand only the extremely high-level force that would otherwise fracture skulls.

CLICK HERE for entire article.

Need to Keep the Positive Momentum

Yup Crowder... Go ahead and play without your helmet... (Photo courtesy of Boston Globe)

Since the  multitude of concussion episodes in the NFL last  weekend, the media coverage has been relatively positive. A quick google news search returns 2,680 results for the search term “NFL Concussion”  dated between Sunday and Wednesday.  (http://bit.ly/9ExWRx)  But something happened yesterday afternoon.  NFL players (specifically defensive players), bloggers, radio hosts and guests began making considerably more negative comments about the NFL decision to impose suspensions as opposed to fines.

Across the web you will find various references to how football is a “warrior’s” sport and how it has and always will be dangerous. Many news outlets reported on James Harrison’s comments about having to sit out NFL games until he can learn to tackle or possibly just retire from the NFL because he doesn’t think he can play the game under the NFL’s rules (maybe in some strange way he is correct… maybe he should step away from the sport if he only knows how to play is to injure others).  Other players felt that the NFL response is a material rules change that should be addressed in the offseason and subject to the collective bargaining agreement. But one comment by Miami Dolphins linebacker Channing Crowder really stands out…..

“If I get a chance to knock somebody out, I’m going to knock them out and take what they give me.  They give me a helmet, I’m going to use it.”

While I could spend an entire post about how a helmet was never intended to be used as a weapon (as he is implying) or if this is the only way you can play defense, maybe you don’t have enough talent or speed to play that position…but the real problem with the quote is the amount of “air time” Continue reading

Hunter Hillenmeyer Thoughts

The Chicago Bear linebacker that was put on the injured reserve after one game this season due to a concussion and its lingering symptoms, has some interesting thoughts about the changes the NFL has made the past few days.

Judging intent is a very tricky thing to do. Punishing players for anything but the most egregious, deliberate headhunting would not make the game safer. Reaching that goal requires a comprehensive overhaul, including improvements in health care, equipment and research, not just a reaction to the gasp-inducing hits on Sunday.

The above quote is his last and should be the most poignant.  But one thing no one can take away from the NFL is the fact that they address the issues, as quickly as possible.

Article from USAToday.

Hunter Hillenmeyer is on many committees for the NFL, one of which is the Traumatic Brain Injury Committee of the NFLPA.

Sleeping is Good

It used to be that doctors would tell you to keep people awake with head injuries.  That has changed, quite a bit.  Keeping someone awake might be indicated for a possible brain bleed, but concussions need the sleep and recovery time.

Sleeping is first. If you’re not sleeping, forget it,” said Cara Camiolo Reddy, the co-director of the UPMC Rehabilitation Institute brain program and the medical adviser to the Sports Medicine concussion program. Sleep is vital in the recovery process because the injured brain needs rest to begin to heal itself. The concussion program and Camiolo prescribe medications, however, only to post-concussion syndrome sufferers who are three weeks or longer into their injury.

This quote was from and article by Chuck Finder of Scrips Howard News Services and appeared on NewsChief.com today.

In the article you will find that this prescription is not widely accepted by the community that deals with concussion management.  However in my experience it is vital to let the brain rest.  When I am debriefing with the athlete and their parents, the most often question I get is “can you sleep too much?”.  My answer is no.  To make the parents feel better I have them arouse the concussed individual at infrequent rates to observe their arousal response.  I also have the parents ask the three words that we asked the person to remember right after the concussion episode.

With our experience at our school, the kids and parents that abided by the recommendations of sleep and complete brain rest have recovered at a much quicker rate.  The kids and parents that did not listen are still dealing with symptoms and have yet to be cleared.

I know that is not a research study in its most proper form, but the observational evidence tells us, and those in the above article that sleep is indeed needed.

57

The week 7 injury reports have been released (except for NYG and DAL, MNF).  And the total number of injuries listed as concussion, head, or migraines is 57 (with pre-season news reports).

Last

First Position Team Week
1 Curry Aaron LB SEA -1
2 Murphy Louis WR OAK -1
3 Sicko Scott TE DAL -1
4 Grant Ryan RB GB 0
5 Addai Joseph RB IND 0
6 Clayton Mark WR BAL 0
7 Ware DJ RB NYG 0
8 Bing Darnell LB HOU 0
9 Thomas Jay CB OAK 1
10 Ghee Brandon CB CIN 1
11 Lacey Jacob CB IND 1
12 Keiaho Freddy LB JAX 1
13 Sorensen Nick S CLE 1
14 Furrey Mike WR WAS 1
15 Ware DeMarcus DE DAL 2
16 Ryan Clifton DT STL 2
17 Bradley Stewart LB PHI 2
18 Hillenmyer Hunter LB CHI 2
19 Moore Matt QB CAR 2
20 Kolb Kevin QB PHI 2
21 Boss Kevin TE NYG 2
22 Martin Charly WR CAR 2
23 Gay Randall CB NO 3
24 Bryant Anthony DT WAS 3
25 Follett Zack LB DET 3
26 Davis Will LB ARI 3
27 Dahl Craig S STL 3
28 Moore Evan TE NYG 3
29 Witten Jason TE DAL 3
30 Mitchel Carlton WR CLE 3
31 Redding Corey DE BAL 4
32 Ryan Clifton DT STL 4
33 Trusnik Jason LB CLE 4
34 Manningham Mario WR NYG 4
35 Cooper Riley CB PHI 5
36 Samuel Asante CB PHI 5
37 Cutler Jay QB CHI 5
38 Martin Sherrod S CAR 5
39 Scheffler Tony TE DET 5
40 Shipley Jordan WR CIN 5
41 Gay Randall CB NO 6
42 Johnson Landon LB DET 6
43 Macintosh Rocky LB WAS 6
44 Bell Jacob OL STL 6
45 Rodgers Aaron QB GB 6
46 Thomas Demaryius WR DEN 6
47 Robinson Dunta CB ATL 7
48 Garrard David QB JAX 7
49 Cribbs Josh WR CLE 7
50 Massaquoi Mohamed WR CLE 7
51 Cooley Chris

TE

WAS 7
52 Ryan Clifton DT STL 7
53 Jackson DeSean WR PHI 7
54 Cooper Riley WR PHI 7
55 Edelman Julian WR NE 7
56 Brandon Myers TE OAK 7
57 Abdullah Husain S MIN 7

-1 = Training Camp, 0 = Preseason

Some notes; 90 regular season games and 49 listed head injuries…  .5444 concussions/game, or just over 1 concussion every 2 games…  8.167 concussions per week…  At current concussion/week rate there would be 139 concussions in the year…   The concussion rate for NFL players would be 8.2%…  That concussion rate is lower than all other levels of football…  Players listed multiple times were removed from the injury list for at least one week then reappeared (Clifton Ryan)…  Teams on byes do not have to list concussions (Detroit & Indy amongst others this week)…  Concussions by position; WR-13, DB-12, LB-10, TE-7, QB-5, RB-3, OL-1…  Top 3 teams with listed head injuries PHI-6, CLE-5, NYG-4…  Teams without concussions; BUF, KC, MIA, NYJ, PIT, SD, SF, TEN, TB…

All regular season injuries were posted at NFL.com on their Injury LINK

FEEL FREE TO COMMENT…

Coming Soon!!!

*An up-to-date concussion list from the NFL with new numbers.  Thanks to Deadspin.com and their friends at AutoAdmit Discussion board I was able to compile a comprehensive list of concussions from training camp through week 6.  The Week 7 official injury list has not been made available as of yet, but when it does I will have the fresh list for you.^

*Note: During training camp and pre-season teams did not have to officially list concussions, those players are listed because of wire stories.

^Skepticism: Possibly teams will not list players with a concussion, even though they sustained one or more symptoms of a disruptive head trauma (i.e., in Week 6, and this weeks injury report, we may not see; Addai (shoulder), Heap (stinger), or Follett (neck)) as “official concussions” and wont be counted on this list.

Doug Collins Concussion

The head coach of the NBA Philadelphia 76ers missed last nights preseason game, and is going to miss at least one more due to Post Concussion Syndrome.  Coach Collins is reported to have sustained the concussion over the Memorial Day weekend.  His headaches and dizziness has persisted and intensified leading him to sit out games and seek further medical attention.

ESPN.com LINK

NY Times Blog at Mayo

Jeff Z. Klein of the NY Times has been in Rochester, Minnesota at The Ice Hockey Summit, blogging during the event (this is for the Slap Shot Blog, dedicated to hockey, of the New York Times).

In one of his later posts he reported that Jason Mihalik of the University of North Carolina, presented on the most dangerous sport in terms of concussions in the NCAA, woman’s ice hockey.

The concussion rate in N.C.A.A. women’s ice hockey is 2.72 per 1,000 player hours. For men’s ice hockey it’s 1.47 per 1,000. Even for N.C.A.A. football, the rate is 2.34 per 1,000 — lower than it is for the women on the ice.

Concussions comprised about 25 percent of the injuries in women’s ice hockey, the highest cause of injury in the sport. In men’s ice hockey concussions account for 9 percent of the injuries (No. 2 in the sport), and in football they account for 7 percent (No. 3 in the sport).

And a little note about woman’s ice hockey, CHECKING IS NOT ALLOWED!!!  Go Figure.

If you have a minute check out his other blog posts from the day at the Slap Shot Blog.

Penalizing The Hits

The TMQ (Tuesday Morning Quarterback) is a blog/Op-Ed piece written by Gregg Easterbrook of ESPN.com Page 2.  In today’s edition he spoke on why the NFL continues to have the problem with helmet-to-helmet hits.

For too long, NFL headquarters and sports commentators both have acted as though there is some gigantic mystery regarding why NFL players make so many dangerous helmet hits. Here’s why in three words: because they can. The play is almost never penalized.

As many people know the youth of America, especially sporting America, look at/to the professionals as examples, right or wrong.  And setting a good example in the NFL may help save some unneeded head/neck injuries at the lower levels.

QC Times Concussion Series 3 of 3

Today in the final installment of the Quad City Times Head Games Series Andrew Peterson looks at new helmet designs and how they can help with reducing concussions.

One of the most widespread evolutions has come in the protective qualities of football helmets. In the 1960s, the plastic helmet first gained popularity, but in the past decade much more attention has been given to the quality of interior padding.

In 2002, Riddell released its Revolution helmet, featuring redesigned padding and an inflatable liner. Four years ago, the University of Pittsburgh Medical Center published three years worth of research indicating that Revolution wearers are 31 percent less likely to suffer a concussion.

Also in the article Andrew wrote about mouthguards, rule adaptations, and what is next in the area of concussions.  I must say the Quad City Times picked a perfect weekend to run these stories, and good for them!  Andrew Peterson and Doug Green did a marvelous job looking into this hot topic.

Read the entire story HERE.

First Article.

Second Article.

Ice Hockey Summit: Action on Concussions

The Mayo Clinic is hosting this conference today and tomorrow in hopes of examining, educating and making changes in the sport of hockey to reduce the concussions.  As you have seen here on this blog NHL concussion are numerous, already.

The conference is being led and put together by Dr. Michael Stuart.

Stuart, the vice chair of orthopedic surgery and the co-director of sports medicine center departments at the Mayo Clinic, is spearheading a two-day summit on concussions beginning Tuesday.

Scientists, trainers, coaches, officials, and equipment manufacturers from the United States, Canada and Europe will gather at the clinic’s sports medicine center for the “Ice Hockey Summit: Action on Concussion” conference.

What is groundbreaking about this summit is that there will be an action plan voted on by the attendees and put into place after the summit is over.

“When this is done, we’re not only going to have the most up-to-date information about concussions, but we’re also going to have an action plan which has been prioritized by leaders in the medical community as well as the sport of hockey,” Stuart said.

Read the story at the WashingtonExaminer.com.

Why Provoke That Guy?

A paparazzi photographer is suing Mike Tyson for allegedly punching him in the face with a closed fist, according to TMZ.com.  The photog said the results were a concussion and “strained” spinal cord, and wants 25 million in damages.

Didn’t our parents say something about feeding the animals, or provoking wildlife while we were growing up?  Perhaps the photog did not recognize one of the most scary men on the planet (although the tattoo on his face should have given him away).

Listen,  I am not for violence, but if someone asks you to please get out of their face, multiple times, maybe you should watch out!

Quick Response Expected

According to Chris Mortensen of ESPN, the NFL is going to announce the “cracking” down of excessive hits.  The primary concern in the helmet-to-helmet hits, and instead of just fines, there will be suspensions.  The suspensions will also be handed out for first time offenders, getting rid of the “free pass” that has been around for some time.

Other News: Chris Cooley played with his concussion but took himself out after he realized things were not getting better…  David Garrard became the 11th (by my count) concussion of week 6 last night on MNF…  Dunta Robinson also diagnosed with a concussion…  Awaiting the injury list on Wednesday

NHL Concussion Report 10/18

These players are listed as having a concussion or head injury.

  • Ondrej Pavelec, ATL
  • Marc Savard, BOS
  • Jason Pominville, BUF
  • Raitis Ivanas, CAL
  • Rene Bourque, CAL
  • Peter Mueller, COL
  • Jamie Benn, DAL
  • Johan Franzen, DET
  • Pierre-Marc Bouchard, MIN
  • Marcel Goc, NAS (upper body)
  • Matthew Lombardi, NAS (upper body)
  • Bryce Salvador, NJ
  • Ian Laperriere, PHI
  • Cam Janssen, STL
  • Keith Ballard, VAN

11 concussions last week, 9 still remain from last week, 6 new ones.  TOTAL = 17

Again the NHL has a problem with fully disclosing head injuries (well any injury), the Goc and Lombardi concussions are found via web search about the injuries.  C’mon NHL.

Xenith’s Building the Enlightened Warrior

Vin Ferrara is the CEO of Xenith and believes that he has found a way to make a football helmet that could revolutionize the game in terms of concussive episodes.  The X1 helmet is used by a very small number of professional players, because they are not provided by the NFL/team due to contracts with Riddell and other makers.

Mr. Ferrara is working hard on getting his product out, including great programs with lower level football, extending down to the high school level and earlier.  There is a purchasing program they have developed to get these helmets on heads as fast as possible.

I have yet to work with these helmets at my school, however I have convinced the administration and coaches to purchase some for our use.  It’s a tough task to eliminate the concussions, and we probably will not, but prevention is the best medicine, as well as being prepared.

Please click on the link to the left (Enlightened Warrior) to see what Mr. Ferrara has in mind and has put on paper.  Here is a quote:

BELIEVE IN PREVENTION
First and foremost, anyone involved in athletics should believe that prevention of neurological injury is of paramount importance. An undercurrent of “concussions are inevitable, we just have to manage them” permeates the sports world. Just because some concussions may still occur, this does not warrant an attitude of complete resignation towards preventing the injury. Prevention is possible. Prevention is critical.

I would also like to thank Mr. Ferrara for recognizing the importance of certified athletic trainers as well.

Quad City Times Concussion Series

 

Rock Island trainer Tim Mangold, left, and Dr. Thomas Von Gillern tend to the Rocks’ Chris Glover on Oct 8. Glover was shaken up on the play but did not sustain a concussion. (Louis Brems/Quad-City Times)

This is the second part to the concussion series being run by The Quad City Times and the prep section, written by Doug Green.  The first one was yesterday and focused on the injury itself.  Today’s story is about the athletic trainer and how they are at the front line of this issue.

 

As an athletic trainer I feel that our profession is not only capable but NEEDED at all levels of sports.  Either on-site for the games/practices or a phone call away.  A lot of educational time is devoted to head injuries for athletic trainers, and our continuing education requirements offer us the ability to continually learn in this area.  Sure, we are not MD’s/DO’s but our experience and rate of seeing these injuries make the athletic trainer somewhat of an “expert”.

As one doctor in the article states, deferring to the athletic trainer to know if the athlete is “right” is, in fact, a prudent and important step in returning athletes.

“I rely on the trainer to know what an athlete is normally like,” said Jessica Ellis, who is the team doctor for the Davenport school district and St. Ambrose University. “I have standardized tests with memory, cognition, balance checks.”

Read the rest of the story HERE.

Know what an athletic trainer is, HERE.