Please… Let This Be an Anomaly UPDATED

Updated (19:43 CST with a new email, see below…

There are tons of you that write in, and I do my best to respond.  Then there are some of you that I get an email and I immediately investigate, this email received from a fellow athletic trainer has me scratching my head and hoping this is not the norm (emphasis mine);

Good Morning Dustin:

I was at a wrestling meet to watch my son on Saturday and one of the wrestlers girlfriend was there.  She is in college and her major is biology and exercise science and I am not sure where she goes to school. I see her book is Athletic Injury Management and then I see her study guide.  I see on the study guide a section on concussion and grading of concussions.  I told her that she should inform her instructor that the information is wrong as there is no grading system for concussions anymore.  She said that is what her instructor had said however they still teach the grading because coaches understand the grading and it is to appease the coaches so they know how severe the concussion is.  I just shook my head.

So in some colleges it sounds like grading of concussions is still being taught and if I had to hazard a guess, it is by instructors that do not teach athletic training students.

I just wonder how many other colleges are still teaching the grading systems because that is what coaches understand.

This is an outrage to me.  Why are we convalescing to the coaches “feelings and education”.  Why are we not, as the allied healthcare professional, educating the coaches on what is happening around them.

Sure, the conversations are uncomfortable at first, but it is our JOB to make them understand what they and we will be dealing with.  It really is not hard to explain to coaches that concussions are a unique injury to each athlete.  Once one is sustained and the recovery has begun then we will get a better picture of return.  Until we get a clearer picture, I feel coaches at the levels below the professional ranks should assume the player is going to be out for a minimum of 8 days (that is the ABSOLUTE MINIMUM, IMHO).  Yes, I would like to see it be longer, but as soon as we – as athletic trainers (need your help docs) – start to lay down an accepted and minimum time frame that eliminates a rush back for a game one week later we will begin to see some progress.

Doing it the way above does nothing to advance the information out there, advance your standing within the community, and if anything makes the athletic trainer look unprepared or behind in area of concussion.  Perhaps you could use the “grading system” as context of what we DON’T do any more.  But disseminating that information only creates even more minutia and problems.

If you know of any college/university teaching it this way, tell me, I would love to have a conversation and try to understand why.  Even better I would love to Skype to the class and present some reasons as to why this is a bad idea.

Thanks for the emails everyone!



Avid reader of the blog and I work in Concussion Clinic in __________ , _________ is my boss.

In regards to the latest blog, heck yes on the grades… I really don’t want to mention a name but at our __ state meeting I was sitting in on the “student” program and the topic was concussion sideline eval and tools. Using iPads etc…

Anyway, this AT is a Head AT of a DIII school in Western __, talking about concussions and talked about grade 2 & grade 1.  I about fell off the chair… and then he said it AGAIN!!  I wanted to raise my hand and say what the heck are you talking about get in 2013 my friend – to think he teaches future ATs.

Granted I don’t know all, but I try.

Had a kid come into Concussion Clinic and his mom said that the AT at his school said he had a grade 2 concussion, I went a little bonkers, tried not to throw a colleague under the bus but man come on!

Anyway its out there still

It would be tough to question a colleague in the front of others, but perhaps questioning them will spark debate and eventual corrections.  It is very frustrating to all of us that are trying our hardest to make sure the proper information is out there.  That is probably the #1 reason for starting the blog.

Keep the emails rolling in…

4 thoughts on “Please… Let This Be an Anomaly UPDATED

  1. Michael Hopper December 11, 2013 / 11:43

    Wow. Back in 2009 I was taught all of the grading scales too. And let it go in one ear and out the other. That was shortly after Cantu had come out and basically said his grading scale was worthless.

  2. Kids SRC Doc December 11, 2013 / 23:50

    I kindly do throw health care professionals that use grading scales under the bus. I will tell families that the person they are working with is using information that is a decade old….on a subject matter that where our understanding changes (often significantly) on a 1-3 year basis.

  3. Brooke de Lench December 12, 2013 / 11:20

    Easy answer to this situation of why so many people still use this antiquated system? A leading neurosurgeon still publishes his “grading guidelines” and the media follows.

    Defending the no more grading guidelines (!!) has been a major problem of ours at MomsTEAM and the reason why I decided to put my tough journalists hat on when I took Dr Robert (Bob) Cantu, MD to task for including his “Cantu Grading Guidelines” in his new book; “Concussions and Our Kids: America’s Leading Expert on How To Protect Young Athletes and Keep Sports Safe.”

    From my review:

    ” But most inexplicable, and, frankly, astounding is the discussion in the book about the “grading” of concussions and Dr. Cantu’s continued advocacy for the use of a return to play matrix he developed in the late 1980’s, revised in 2001, and again in 2011, which determines how long an athlete is sidelined by a concussion depending on the “grade” and the number of concussion suffered that sports season, return-to-play guidelines that he includes as the last appendix in the book.

    The problem I – and many others- are likely to have with suggesting that concussions be given a “grade” and that using a cookie-cutter approach to return to play is acceptable is that they completely fail to account for a number of critical changes in concussion management over the last decade, as well as some of Dr. Cantu’s own advice: ,,”

    (full review here: )

    I have great respect for Dr Cantu but I knew that his book would lead to major issues for all of us who are working so hard to make sure that no one uses this system.

    A sad update to my hard hitting review — the new updated paperback (fall 2013) just came out and he and Mark Hyman- co writer left the grading grid in. Darn, I was so wanting to write a positive update.

    Brooke de Lench

    Producer/Director: THE SMARTEST TEAM: Making High School Football Safer (PBS Fall 2013/Winter 2014)
    Author: HOME TEAM ADVANTAGE: The Critical Role of Mothers in Youth Sports (Harper Collins)
    Exec Direcor:

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