The weekly blog of an athletic trainer covering high school sports, including injury recaps. This is an insight into the daily life/profession of an athletic trainer. All incidents are meant for educational purposes and names/teams may be changed in order to protect identification. That’s A Wrap will post on Tuesday mornings as a recap of the previous week and any upcoming highlights.
Week one of fall high school sports is always greeted with high anticipation. A majority of time has been spent on preparation for football but there are other sports going on as well: Cross Country, Golf, Girls Tennis and Volleyball. In the future there will be injuries in those sports but this week was all about football.
Preparation
The season technically began on August 10th with the opening of camps for all sports, with the weather possibly being a concern with the heat indices near 110 the previous weeks some extra preparation was needed. I was able to communicate with all the coaches and administrators regarding proper hydration and signs of heat illness on the Tuesday prior. Although I feel that our school is very well versed in all sorts of injury prevention it never hurts to remind them of perils. Tuesday was also reserved for our school districts coaching concussion seminar, a step beyond the current state law. If any school in the nation would be “tired” of hearing about concussions it would be this one, however they greeted the information (constantly changing) with tons of wonderful questions and insight. I feel as though our staff may be the most prepared for concussions, whether I am there or not, in any sport and any instance. Last year I had a college student athletic trainer getting her intern time, this fall I have two high school boys looking to get experience, to determine if this is what they want to do in the future, a junior and senior.
Practices
Throughout the first three days of sports there were the usual “non-conditioned” type injuries: exhausted, tendonitis, muscle strains and blisters, A LOT of blisters. Even though we filled up the kiddie pool each morning with ice water it was never used, in fact it has not been used and no athlete has even had a cramp in any sport up to this point (knock on wood). Then comes the first Saturday, first day of hitting on the football field, traditionally a big day for injuries. After two hours of intense practice and heavy conditioning there was only one incident that needed attention, a hamstring strain – whew.
Over the next nine days the injuries started to mount in all the sports, mainly they were back spasms and lower leg pain. A few ankle sprains were documented in volleyball, and one in football but the majority of the injuries seen in the training room were non-contact type issues. Believe it or not there was a simple reason for all the issues, dry field conditions. We don’t have an irrigation system for the football practice field and we (especially the farmers) have not seen rain (significant) for nearly 40 days, making our practice field like a dust bowl with the firmness of a parking lot. This constant pounding on that type of surface in cleats translates into anterior lower leg pain, something people call “shin splints” (however you will not see me use that term). Since practice has only been going on for about 11 days the likelihood of stress fractures is low, what is way more likely is that the arches of the kids are not supported properly in the “flat soled” cleats, combined with not enough time spent on stretching the lower leg muscles, especially the soleus. In my estimation as the compartments of the lower leg get compacted due to nominal swelling it presents in the anterior portion of the lower leg. We have been able to manage most of the issues with simple stretching and icing, the tougher ones were managed with arch supports – tape or over the counter type, all have resolved. The only other anterior leg pain seen outside of football was a cross-country kid who was wearing year old shoes putting in heavy mileage, once the footwear was addressed, no more problem. Heading into the first Friday of games the lingering issues were a groin strain, quad issue, and the above mentioned hamstring strain (out for game).
Game Time
Friday the 26th arrived and we were on our way to the game, a quick one hour bus ride north, all geared up with two “green students” in tow. As I have explained to them multiple times the job of an athletic trainer is to prevent injuries, so if the job is done properly we can just watch the game uninterrupted (rarely happens). Pregame tape in a sweat-box of a locker room entailed: a wrist, two ankles, two spats, hip spica for groin and quad wrap. After that was finished it was time for a field inspection, granted the home teams usually do a great job of preparing fields I have found holes and exposed sprinkler heads many times in a pregame check. It is also a good time to see what the sideline area presents: low fence, close fence, opening in fence, benches, sprinkler boxes, track, etc.
After warm-ups all tape jobs and wraps were rechecked and things are good, making sure players are taking water, getting everything tight on the equipment and final stretching, it is time to line up and play. The team is performing well throughout the first half, some mistakes but needless to say a lead, and one issue; the quad has tightened up, had to determine at half what his status was going to be, one-way, both ways or out (he was changed to a one-way player). Kickoff of second half the quad gets run over and stepped on, his hamstring this time, now he has gone from a two-way player to out with a locked up leg, even with a wrap under the pants and a wrap on the outside of pants he is unable to go. This started my second half, needless to say I did not see much of the next 24 minutes of action.
After getting him taken care of, talking to his mother and my students placing ice on his leg it was time to turn my attention to the game, when I could. Players all of sudden were having issues with their gloves being wet so getting towels and securing them to the pants consumed a lot of time and attention. At a small school, not only am I the athletic trainer but the equipment manager, hydration manager (see water boy) and occasional “coach” so depending on the situation the game could be the furthest from my mind (ALL INJURIES COME BEFORE ALL OTHER DUTIES). The next time I feel I am watching the game I see a player down, a tough player who I know is now hurt, but the stripes would not beckon me on the field. Nothing is more frustrating than having to wait for the referees to allow you on the field, if you don’t a yellow hankie will go flying – I know stupid. As I get to the player he is holding his left leg up and says he felt it pop. He was tackled in a huge pile up so I did not even see the mechanism of injury (MOI), the athletic trainer from the other team did not see it either, we had to go on what he said; an eversion MOI of the left ankle. A quick palpation of the tibia then the fibula with a “step off” noticed on the distal fibula. No pain at either malleolus, a squeeze test was negative and a bump test positive over the distal fibula. After standing him up he tried to put weight through the leg with no avail, he was hurt and bad. Over the next few minutes further tests were done and it was determined that he needed to go for an x-ray, but he wanted to stay. That lasted for about 10 minutes when the pain became unbearable for him and off he went.
The rest of the game was uneventful, except for the other team as they went on to score twice to which we were unable to answer and as the clock read 0:00 it was 0-1 in the record book. After packing up the sideline and getting to the locker room for a check of any injuries (clear) it was time to go to the hospital to sit with the family and leg injury. A few hours later it was confirmed what I had initially thought when placing my hand on him on the field, a fracture. A bad way to start the season for him, but he will be ready in 4-6 weeks with some luck.
The Next Day
Our league only has Saturday games in the opening week when the freshman play (they usually play the Thursday before the varsity game). In our area the athletic trainers cover all home and away varsity contests, but the lower level games are taken care of by the host school, it is a good working relationship amongst all of us. This also presented a good chance to evaluate the quad/ham kid from the previous night and at half I did just that and again it signified the last time I “saw” the game. The visiting team had an injury, ankle to attend to at half, some tape and he was rearing to go. Back to our sideline when I was beckoned over to the visiting sideline again, this time for a head injury. The report from the coach and other players was that he hit his head on the ground after a tackle and wanted me to check him out (the officials actually requested it). In Illinois if an official suspects a head injury they cannot come back until cleared by an athletic trainer or physician. Upon arriving to the athlete he was squinting with a chief complaint of dull headache. After getting him some water and a breath it was time for the sideline evaluation: cranial nerves, three words, number sequence backwards, orientation, balance assessment and delayed memory. He passed them all, BUT! This was not a kid I knew that well, the MOI was disturbing to me and he was slow in his responses so it was time to talk to parents. After some discussion and talking about remaining games/practices we came to a mutual discussion that we would not return him. Was it a concussion? I am not in the business of diagnosing rather evaluating, and upon evaluation I did not feel it was a concussion. But the low, and dissipating headache combined with the MOI gave me pause it is not worth extending someone with a possible head injury in game one, so he was not allowed to return and the coach was agreeable. As I departed for my sideline once again the officials asked if he was allowed to return and I told them he was not.
Not more than two plays later I was back across the field for a leg injury; after evaluation talking to parents (that I don’t know) and ice application he too was out. Time to run back to our sideline, EXCEPT that play another player came off with a wrist issue. Quick evaluation of that showed just some edema with no strength or range of motion issues sans pain, so he returned, talked to the parents (who are now knowing my name) and trotted to the other side of the field. Half way across I look back at the previous play and another visitor was down – it is getting comical at this point – except he was hurting bad. He was holding his arm and when I got to him there was massive ecchymosis and a mark consistent with a face mask. Unable to straighten the arm or squeeze my hand he was ushered off the field and time to talk to the parents again. This time I hear a comment from the stands “maybe we should just pay you?” which made me chuckle a bit. He too was out and parents were going to take him for an x-ray after the game. The whole time I am texting their athletic trainer with names and evaluation of injuries, after the last one I got a response from him: “is there ne1 not hurt?”, to which I responded “idk, hahaha”.
The game ends in another loss for our team, but we remained healthy, a win in my book. There were no cramps Friday or Saturday and we had not sustained a head injury. Two players most likely will be lost for a few weeks which can be decimating for a program with 50 total players, but it was good that there was an athletic trainer there to attend and take care of all problems.
That’s A Wrap
According to one of my student athletic trainers we did not do our job very well, because there were injuries. I laughed at him and told him in a perfect world all of our work is done during the week, before and after every game, he better get used to not seeing a lot of the action.
I would like to thank all for the suggestions for the name of this weekly blog post, but the winner was my mom!
The Concussion Blog 