The football season is in its waning phases, however that does not mean the concussion risk is gone. Yes, it will be reduced slightly, but awareness is continued and the importance of an athletic trainer is underscored more. During the winter months we will spend time blogging about the life of an athletic trainer, what I do, and what we can do for schools.
Recently I sent out a tweet about wrestling and that I have “issues” with injury time. I love wrestling, no it’s not the WWE version, it is Folk Style, and the pure athleticism that is needed for this is amazing. Not only must you defeat your opponent but you must defeat yourself doubts, a great sport. The issue I have is the limited time you have to assess an injury. If you think something like football is demanding to make a judgement, try this on for size… You get a minute and a half, 90 seconds, to determine what is wrong and if they can continue. Not only that you must apply any bracing/taping in that 90 seconds. For most injuries like a knee, ankle, or elbow that can be done, but with a concussion NOT A CHANCE. In this sport you get 5 minutes of “blood time”, to stop and bandage any blood, but for injuries you get 90 seconds. Oh, I failed to mention, that time is not for each incidence, but rather cumulative for the entire match, and with injuries you can only stop twice the third constitutes a DQ.
I completely understand the nature and spirit of the rule, they do not want wrestlers taking advantage of stoppages in the match as conditioning is a HUGE part of the sport. And as I mentioned with most injuries it’s not an issue, but the concussion is troublesome. The easy answer is to just remove the wrestler if he hits his head hard enough to produce symptoms, dully noted and done on my part. However, what do you do with the individual that has a headache or is squinting his eyes with no known mechanism of injury? A proper evaluation could determine if he/she has a head injury or is just dehydrated or hypoglycemic, and 90 seconds is not enough for that.
I will continue to work within the frame of the rules, cause we have to, but that will not stop me from mentioning to officials and coaches the need to look at the rule again and make sure it has the best interest in mind of the competitor.
As I have highlighted, as an athletic trainer we are completely accustomed to the unpredictable and working within the confines of a rigid system called sports. There is protocol after protocols with regards to injuries; who to contact, where to send them, knowing about diagnosis’, rehabilitation, and return to play just to name a few. Each and every case presents a different path down the road to recovery and it even could be different from injury to injury on the same individual. As G.I. Joe once said “Knowing is half the battle,” and as a childhood hero of mine he was and is still right. But what do you do if you don’t know? The answer is simple, find out.
As a person or professional you are as only good as what you know and can pass along to those that thirst for you knowledge, this goes for doctors, lawyers, and athletic trainers. Part of the problem with every single one of us (meaning everyone) is that we don’t have the ability to say “I don’t know,” believing that this will shatter the trust of whomever we are currently working with. Specifically as an athletic trainer there are times and injuries that baffle me, or I forget a bones name, or tendon/ligament attachment, or what nerve innervates what area of the body, it happens. Instead of deflecting and avoiding those situations I relish in them, because it gives me an opportunity to not only teach myself, again, but the injured person I am working with about the issue at hand. It also creates a situation where more people can become involved in the process, i.e. a specialist.
The above paragraph is not directed at anyone person or professional, however the continuity and competency of care should always be questioned when dealing with health issues. I once heard someone say about my knowledge of injuries; “Get back to me when he (me) gets an MD behind his name.” Why? Why do initials behind your name make your message any better than someone else that does not have them? I am certainly not saying I am an expert, or trying to say that athletic trainers are experts in general, but we may be an “expert” in a specific area. People, especially athletic trainers spend a lot of time, money and effort to better themselves in their profession, and to immediately be dismissed because there is not an MD behind the name is a shame. Heck some of the greatest coaches I have ever known did not flourish as athletes in that particular sport, but what they had, was a drive to better their knowledge and the ability to pass that information along. If the information being passed along is both accurate and verifiable then why do people take umbrage with their knowledge. More so, if their care is exactly the same or better, as documented, then why do some people and/or entities discredit or ignore what they have to offer? I have seen plenty of doctors manhandle and poorly treat various injuries, usually providing care that is outdated and no longer suggested. And as documented here, some MD’s feel that a person with a concussion will be able to return to full activity and previous levels of function within 24 hours. All research and current treatment of that particular injury would lead one to question that MD. Then why shouldn’t they be questioned, just because of their stature or initials?
All of this is leading me to a frustration of mine as an athletic trainer; information must flow up the chain (AT to MD) and direction must come down the chain (MD to AT). Why? Why can it not go both directions? Don’t get me wrong there are some OUTSTANDING MD’s that practice in such a manner, and the continuity and competence of care is second-to-none. Not only is it relevant in the sports setting but the clinic setting as well, many physical therapists deal with this great frustration. Doctors have earned the right to “trump” others as it relates to medical issues, but I believe that does not give them the right to dismiss out of hand any suggestions from a medical team. Perhaps the knowledge of those treating the patient may be more up to date and provide better results. Instead, as clinicians and initial evaluators of injuries we are saddled with covering for the doctor, in fear of retribution. I am not suggesting a ‘coup de tas’ against those that are clearly providing poor care, rather I am proposing that instead of settling with what has been done, try to rectify the issue as professionally as possible. This goes for all areas that relate to athletic training; coaches, players, parents, insurances, fellow athletic trainers, chiropractor, etc. Part of this job is having a spine and sticking up for what you know and believe is right.
It also means that if you don’t know, have the intestinal fortitude to step back and get the answers.