The Concussion Blog

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 an offensive and defensive lineman, and as part of my protocol I watch them in the drills where there is heavy contact and constantly ask them how things are going.  Yesterday I noticed something disturbing and made my voice be heard, to him.

As he was blocking and taking on blocks I noticed that he was not using his hands, as taught, rather he was leading with his shoulder and head.  Basically predisposing himself to unnecessary contact to that region.  I wasn’t the only one, the OL coach also noticed and verbally corrected him before the next snap.  He did not adjust, so he showed the player how he was to do it – using me as the dummy (fit me well).  Next snap a little better.  Finally after no correction the fourth snap he reverted back.

I asked the coach to take him off and discuss why this was a bad technique for him, in terms of player safety, and the coach said “also tell him why he won’t play [improper technique] if he doesn’t get it right.”

If you have ever dealt with high school athletes – especially ones that are starters – they think they never do wrong and do everything perfect.  This was the case of the FIRST conversation;

Me: “You must use your hands to block and not your shoulder and head or you will get another concussion, quickly”

Athlete: “I was”

Me: “N0, you were not, you were using your head on snap one against ‘X’ player, in snap two you pulled and used your shoulder.”

Athlete: “After coach said something I did it right! ”

Me: “Kind of, for one snap and you led with your head again.”

Athlete: “No I didn’t!  And that kid is bigger than me I have to use my shoulder and head.”

Me: “That is exactly why you use your hands!  Why are you standing over here then?”

Athlete: “Because you are checking on my head…”

Me: “Yes, but also to tell you that if you don’t fix it Coach won’t get a chance to pull you or drop you on the depth chart, I will not allow you to play, for player safety reasons.”

Athlete: “OK, I will do it right”

The wonderful thing, as I have mentioned many times, is that all of our coaching staff’s allow me to do this sort of thing.  I can be a concussion or a sprained ankle, I have the authority to pull someone – at any time – for player safety.  Rarely do I get grief from coaches, mainly from players and their parents.

Back to my athlete…

Drills change and now on defense; as he attempts to make a tackle he drops his head – he whiffs – and the DL coach just jumps him.  Not that he missed the tackle that if he leads with his head he will get hurt, the coach never once jumped him because of missed tackle!  He was pulled from drill to think about it, and I let him be – although he found me watching from about 25 yards away and made eye-contact with me and was not happy (I know he was blaming me for getting in the coaches ear, but I didn’t).

Later in practice we get back to offensive drills, this time at full speed and full contact.  Prior to that the OL coach and I both told him to use his hands or he was coming out.  First play he pulls and drops his head and makes zero attempt to use his hands and protect himself and be technically sound.  Not only did he miss the block, both the coach and I simultaneously yelled for his backup to get in there.  This time the conversation was a bit more one-sided;

Athlete: “I know I dropped…”

Me: “That is exactly why you will continue to be at risk for concussion!”  “If you think you are going to finish this season you are mistaken, you won’t play if you cannot fix this.”

Athlete: “I understand” as tears start to well up

Me: “You’re only a sophomore, at this pace you won’t even get to play football again, this is your second concussion in as many years.  Do you want to play football?”

Athlete: “Yes.”

Me: “I am only doing this to protect you, that is my job.”

Athlete: now crying “I know, Fink, thank you.”

Me: “Fix it, please.  Now go talk to coach.”

After being corrected and again demonstrating what he was doing wrong by the coach he was sent back in with the caveat “one more mistake and you will not dress on Friday.”

The rest of practice the kid didn’t lead with his head or shoulders, it was with his hands.  And when he missed a block the coach didn’t jump on him, rather told him good job with the technique the rest will come.

I imagine today there will be a film session with the unlikeliest of people, the athletic trainer, to visually show him what he was doing wrong in practice.  There will also be discussion about how he will be on a very short leash during the game with three sets of eyes watching him.

The moral of this post is simple; as athletic trainers we must voice our concerns and even “coach” up the kids when player safety is an issue.  I fully understand that some AT’s don’t have the liberty that I enjoy, but that does not mean conversations cannot be had with the coaches of any sport to work your way to that place.  In this example, had I said nothing (not usually my M.O.) or not paid attention this kid was on a track to be back on the sidelines with injury very quickly.  Had nothing been done that helps no one, including the team.  It is our place to: watch, learn and speak up when necessary.