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coach1As I was doing some rummaging through the intranet, I stumbled upon an interesting blog site. The blog site is entitled High School Cover 2 and is written by Jim Olsen and Dick Kalla. These two gentlemen have played, coached, scouted, and talked football for much of their lives – nearly a century worth of experience between them.  The purpose of the blog is to address issues and topics related to High School football, particularly in the Pacific Northwest.

I enjoy football as much as anyone but a recent blog post entitled Head Injuries – Ring my bell by Jim really caught my interest. I’ve written about concussions before but the thoughts expressed in this post were extremely noteworthy and worth sharing.

Let me quote the last two paragraphs from the post for you:

“The key to curbing the incidence of SIS (Second Impact Syndrome) is vigilance and firmness. If a kid comes out of a game with a “ding” or having his “bell rung”, he does not go back in the game! Not until a doctor clears him to play. He´s going to tell you that he can play; he´s okay. He´s ready. Okay, Coach? Okay? No! Of course he is going to tell you he´s okay. He´s a football player. But, he´s not playing. Not without a doctor´s release.

So, how do we handle these violations? If a kid launches himself using his head as a weapon into another player, he´s out the rest of the game and the following game as well. For a second violation, he´s out for a season. At all levels, a third violation should result in a player being banished from the game for good. Is this too strict? Ask the kids who have suffered brain damage due to SIS and who function at an extremely reduced level. I believe they would like to have had these warnings and consequences in place before they played their last game.”

I don’t think I could say it any better. That level of wisdom, support, and discipline from a coach regarding this touchy subject is rarely seen from someone not in the medical profession. Jim makes things very clear for all coaches to understand and describes a tremendous blueprint for all football coaches across the country to follow.

Athletic trainers are only part of the solution. Coaches taking responsibility for preventing dangerous behaviour and enforcing strict Return to Play guidelines really gives substance to a football program that is committed to player safety.

Refreshing to say the least.

Jim also notes that these guidelines don’t simply pertain to football but other sports as well, such as baseball and soccer, that will begin soon here in the Midwest.

So I just wanted to share some outstanding insights from others that are fighting along with us as we try to ensure the health and safety of those under our care.

Outstanding job gentleman – keep up the great work!

Photo Credit by taylorpad212

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When is the last time you evaluated your approach to concussion management?

football-picWith the high school and college football season in the books, hockey season going full tilt, and outdoor soccer a few months away (in the midwest at least), this may be a great time to reassess how you manage concussions.

Well here is some food for thought to get the evaluation process rolling.

Nancy Shute, in her Blog Post for US World News Report writes about concussions in her post entitled Concussions Pose a Long-Term Health Threat to Young Athletes. She sites some startling statistics that are presented in the new January Issue of Pediatrics.

The numbers are eye-opening; 69 percent of high school football players in Minnesota who were hit so hard they lost consciousness kept playing that day, as did 81 percent of players who had a concussion without passing out. Someone who has just had a concussion is far more likely to have another within 10 days, the researchers say, and repeated concussions greatly increase the risk of permanent brain damage.

About 5 percent of high school football players have reported having concussions, but the number is probably much higher. A survey of coaches found that 42 percent think concussions happen only when someone loses consciousness, even though that’s not true; 25 percent would let an athlete return to play with concussion symptoms. Add to that the fact that fewer than half of athletes understand the long-term deficits in thinking and memory that can come as a result of concussion, and you’ve got a big problem.”

Two North Carolina athletes tragically died this past fall due to complications following a head trauma. As a result, a panel of sports medicine experts tightened the return to play guidelines for high school athletes in North Carolina.

Before I go any further, there is nothing suggesting that Athletic Trainers were present in any of these cases so this is not an implication on our profession. However, these cases really should cause us to pause and reassess how we manage concussions. 

I have included the Summary and Agreement Statement of the 2nd International Conference on Concussion in Sport, Prague 2004. This article is complete with the Sport Concussion Assement Tool (SCAT) included at the end. Here is what was concluded regarding an acute concussion: 

  1. The player should not be allowed to return to play in the current game or practice. 
  2. The player should not be left alone; and regular monitoring for deterioration is essential over the initial few hours following injury.
  3. The player should be medically evaluated following the injury.
  4. Return to play must follow a medically supervised stepwise process. 

I have also included the National Athletic Trainers’ Assoication Position Statement: Management of Sport-Related Concussion which was published in 2004.

Here is an excerpt from that statement.

“The decision to disqualify an individual from further participation on the day of the concussive episode is based on the sideline evaluation, the symptoms the athlete is experiencing, the severity of the apparent symptoms, and the patient’s past history. The literature is clear: any episode involving LOC or persistent symptoms related to concussion (headache, dizziness, amnesia, and so on), regardless of how mild and transient, warrants disqualification for the remainder of that day’s activities. More recent studies of high school and collegiate athletes underscore the importance of ensuring that the athlete is symptom free before returning to participation on the same day; even when the player is symptom free within 15 to 20 minutes after the concussive episode, he or she may still demonstrate delayed symptoms or depressed neurocognitive levels. Lovell et al found significant memory deficits 36 hours postinjury in athletes who were symptom free within 15 minutes of a mild concussion. Guskiewicz et al found that 33% (10/30) of the players with concussion who returned on the same day of injury experienced delayed onset of symptoms at 3 hours postinjury, as compared with only 12.6% (20/158 ) of those who did not return to play on the same day of injury. Although more prospective work is needed in this area, these studies raise questions as to whether the RTP criteria for grade 1 (mild) concussions are conservative enough.”

In an NATA News Release entitled 10 Tips to Reduce the Severity of Sport-Related Concussion in High School and College Athletics released April 5, 2007 offers this:

“Because damage to the maturing brain of a young athlete can be catastrophic, younger athletes (under age 18 )should be managed more conservatively, using stricter RTP guidelines than those used to manage concussion in the more mature athlete.  Therefore, youth athletes are strongly encouraged to never return to play on the same day that a concussion is sustained.”

Finally, in response to the recent athlete deaths in North Carolina (as referenced in an article cited above):

“A panel of sports medicine experts said… that any high school athlete suspected of suffering a concussion must be cleared by a physician before he or she can play or practice.”

There sure is a wealth of support that indicates that any athlete, particularly youth and high school aged,  that sustains a concussion should not return to play again that day.

What do you think? What is your current concussion management approach? As someone who still provides occasional event coverage, this definitely has me rethinking my concussion management approach.

Some of the decisions made by coaches, parents, and athletes in our absence are frightful. The decisions that coaches, parents, and athletes are willing to make in spite of our professional expertise is downright terrifying. The impetus for proper education on concussion management is paramount. Having a definitive plan of action for concussion management that is shared prior to a decision having to be made is imperative.

Is your concussion management plan in place? Is everyone on the same page? What are your thoughts? Please share your thoughts and experiences.

Photo Credit, by Monica’s Dad

 

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