Friday, January 9, 2015

Over the last couple of years, I have resumed an outdoor running program.  This has been one the best things I have ever done for myself and I certainly don't want to give it up for the winter. However, with temperatures consistently falling into the single digits (Fahrenheit) and even below zero, there are precautions that I need to take to continue to run outdoors. These are some of the things that I need to be aware of when I continue to run through the cold months. I think it is important to share with anyone else who may be considering running outdoors.

Most importantly, anybody with asthma, heart problems or Raynaud's disease, needs to check with a doctor before running in the snow. These conditions can be exacerbated with the cold temperatures.  

Winter runners also need to keep an eye on the forecasts and be ready to modify their activities when the temperature drops to extremes of the wind chill makes it feel excessively cold. Frostbite can develop quickly in extreme cold to exposed skin. Covering hands, feet, and faces are especially important since these areas tend to be most prone to frostbite.

Wearing multiple layers is also recommended. Over dressing can be just as dangerous as under dressing. Over dressing can cause a person to sweat heavily. When combined with cold winds, this sweating can quickly lead to hypothermia or frostbite too.

Hydration is still very important to maintain. Winter running does not mean that a runner will not perspire under all the layers of clothing that they will wear. Maintaining your hydration through drinking enough water remains important throughout the winter season.

Winter also means shorter daylight hours which means more people will be forced run after dark. Make sure you wear reflectiveothing that they will wear. Maintaining your hydration through drinking enough water remains important throughout the winter season.

I have also seen several videos that describe how to alter your running shoes so as to decrease the chances of slipping on snow pack and ice. While I have not tried these techniques myself, I will add one of the most promising videos, in my opinion, to link to and check out for yourself. Gear Tip: Convert Your Sneakers for Winter Running - YouTube. There is one point that the video doesn't make. When modifying a pair of running shoes, be aware of the model of shoe. Many shoes like Nike and Asics have air bladders or gel packs in the middle of the heel to help disperse the forces of impact when the foot strikes the ground. Obviously, it would be counterproductive to puncture these features of the shoe. It is a safe bet to keep the screws closer to the edges of the shoe in the heel and forefoot to avoid rupturing the bladders.

Wednesday, July 23, 2014

Ohio Department of Education Website for PASP

The 2014-15 Lake Health PASP provider number that you will need is: 2015-008463.  Please remember that this will not work for you unless you were in attendance at our program since we are required to report directly to the ODE who was in attendance at this course.

For reference:
The 2013-14 Lake Health PASP provider number is: 2014-008463
The 2012-13 Lake Health PASP provider number is: 2013-008463
The 2011-12 Lake Health PASP provider number is: 2012-008463

The link to the resources page is:

The link to the bibliography page that was handed out at this course is:

The new concussions in youth sports law requires all coaches to attend an online course that converse the issues related to this injury. The Ohio Department of Health has all of this information linked on their website. The two courses are found at: and at

Resources for High School Coaches

Below is a list of resources that high school coaches may find useful in planning their practices and other activities.  It is my hope that this page will be updated often and have new content added regularly.

I) Heat Illness
   A) This is a urine color chart excerpted from the NATA position statement on hydration in athletes.  This allows athletes to have a quick reference to know how hydrated they are. Here is a link to a PDF format of the urine chart.

   B) This is the temperature and humidity chart for determining the risk of heat illness in a given practice. Pictured is a temperature and humidity chart, a link to a colorized version of the temperature and humidity chart, and a third, colorized chart that has some additional information on it.  I leave all three up here since some people will want to print these graphics while others will keep them on their mobile devices, each with different screen resolutions.

C) Weight loss calculation charts and instructions
D) Coach Smart App by Vanderbilt Sports Medicine--Free (iOS, Android)
   E) OHSAA heat index guidelines for practices

II) Lightning Safety
   B) Coach Smart App by Vanderbilt Sports Medicine--Free (iOS, Android)
   C) Boltmeter by Allisonhouse LLC-- $1.99 (iOS)

D) Mobile Storm by Skywatcher-- (Android)

E) Weatherbug - (Spark) (iOS, Android)

III) Traumatic Brain Injury (TBI)
   D) Concussion Recognition and Response App: Coach and Parent Version by PAR-- $3.99 (iOS, Android)

   E) Proper Football Helmet Fitting Guidelines:
      1) Riddell Football Helmets (PDF files are on the right and videos are lower on the page)
      2) Schutt Helmet Videos
         a) AIR-XP
         b) DNA Recruit
         c) Youth Ion 4D
      3) Generic Video
      4) USA Football Video (partnered with Riddell)
   F) ImPACT (Neurocognitive testing software purchased by Lake Health for its contract schools)
   H) TBI information
   I)  Nowinski, C. (2006). Head Games: Football'sConcussion Crisis from the NFL to Youth Leagues. Plymouth: Drummond Publishing Group.
   J) Carroll, L., & Rosner, D. (2011). The Concussion Crisis: Anatomy of a Silent Epidemic. Philadelphia: Simon & Schuster.

IV) Nutrition
   C) (Federal Drug Administration)     
   D) (Federal Trade Commission)
   E) (Blue Cross/Blue Shield)
   F) / (United States Dept. of Agriculture)

V) Injury Treatment
   B) American Red Cross First Aid App--Free (iOS, Android)

VI) Record Keeping
   B) First aid kit supply list (Football)- This list is broken down into "essential, recommended, and luxury" supplies that are commonly found in first aid kits.
   C) A sample lightning emergency action plan

VII) Infection Control

VIII) Drug and Supplement Assistance
   A) World Anti-Doping Agency App by WADA--Free (iOS, Android)
   B) (World Anti-Doping Agency)

IX) Injury Prevention - Equipment Fitting
   B) Proper helmet fitting videos---See above in TBI resources (Section III)
   D) Hockey Helmet

X) Lake Health PASP Information
   C)  (Lake Health website)

XI) Miscellaneous Online Classes, Links, and Videos
     1) The National Federation of High Schools has a host of free classes that cover topics like concussions, heat acclimatization, and sportsmanship.
     2) The NFHS also has several courses for learning the techniques of coaching most common high school sports for a fee. $50-$75
   B) -- A host of videos sponsored by the National Athletic Trainers' Association on a wide range of topics.
   C) NATA recorded webinars -- Webinars designed for athletic trainers on a wide variety of sports medicine topics.
   D) My social bookmarking site -- My social bookmarking site where there are thousands of articles and videos tagged.
   E) (The Great Lakes Athletic Trainers’ Association)
   F) (The National Athletic Trainers’ Association)
   I) (The National Collegiate Athletic Association)
   J) (The National Federation of High Schools
   K) (The Ohio Athletic Trainers’ Association)
   L) (The Ohio High School Athletic Association)
   M)  (The International Olympic Committee)

Please note: If you have any other resources that you feel should be added to this list, think something is missing from it, or you find a dead/broken link, please leave a comment below so that I may address the issue.  This is not an exhaustive list and you may know of a resource that is even better than what is listed here. This also means that this is a dynamic blog post that is intended to change often and updated regularly.  I highly recommend that you check back often.

Wednesday, July 9, 2014

Final Forms

The new system for Perry's athletic department forms can be found at Perry Final Forms. All of the forms that your son or daughter will need for the upcoming school year, whether they are middle school or high school, can be found on this website. The only form that will require you to print it out is the physical form. The physical cannot be be done completely online since our families will be going to many different physicians to get this part completed. To attempt to do the physical online is impractical since every physicians office would also need their own identifying code to be able to sign the form. This would incur a great cost with programming and maintenance that neither the school district nor the company behind the online forms are willing to incur or pass on to parents.

We hope that you find the new forms easier to use and keep in mind that the athletics department is looking to be the test market for possibly doing this with all of our school forms for next year. This would cut down on the redundancy of forms and make your lives as parents, easier. If you have any comments on this system, please direct them to me or to the athletic department.

Sunday, May 18, 2014

Physicals 2014-15

The OHSAA dropped another surprise on us for next year and we are scrambling to make sure it works well. This time, the OHSAA decided to move all the documentation of the pre participation physical evaluations (PPEs) online and to ditch the old paper form. What is different this time, is that they made these changes with the caveat that they are available this year, but not required until the 2015-16 school year. Right now, our athletic department is looking at the OHSAA system and their partnership with PrivIT ( and a few other competing options.  More information will be coming shortly, so stay tuned Perry and we will move on this as quickly as possible.

Tuesday, January 21, 2014

Simple Illness Prevention

As we come closer to the postseason tournaments, I would like to remind all of our athletes that we are also hitting the peak of cold and flu season. If you are around somebody who is dealing with these bugs, please make sure that you are using proper hand washing techniques frequently and practicing good hygiene. Also, please do not feel embarrassed to decline shaking hands or hugging others, especially if they are sick. Simply explaining that you are trying to be careful and remain healthy for the postseason will often alleviate any hard feeling that others will have. Finally, I recommend that each of you stops at Marc's or Walmart and invest in a small bottle of hand wash that you can attach to your bag and keep with you. USE the hand wash regularly when running to the bathroom to wash your hands is not feasible.

Tuesday, January 7, 2014

Finally getting back to more posting

This year, I will bring a different perspective to this blog in some of my posts. This past year, I returned to an activity that I enjoyed in high school, but got away from in the years since I graduated. I rediscovered how much I enjoyed running and how much of a release it is to be able to run each day.

The reason I will include this is because there is now a sports medicine angle to be examined. A week and a half ago, while in recovery from a hernia repair surgery, I coded. After a couple more incidents under surveillance, it was determined that I needed to have a pacemaker implanted because of a vasovagal response that caused a bradycardic episode and led to a transient AV node block. This caused me to lose consciousness. At forty years of age, this was a huge shock to me. And no, there is no prior history of cardiac issues in my family. (At least not until after the age of 60.)

So now I will have to rebuild my distance of running (once my cardiologist lets me start) back to my pre-surgical status of about a 10k/day. Since I will have been out for at least two weeks after the surgeries, it will be interesting to see where I am starting from again. I am hoping to make it at least two miles before I feel like dropping.

I plan on periodically posting some information on things go and I hope that this will lead to some learning experiences for us all. Who knows, we may have to deal with an athlete at some point in our lives with this same issue.

Sunday, October 27, 2013

A renewed, valuable perspective

There has been a lot of attention paid to professional athletes who sacrifice so much of themselcpves for our entertainment recently. This includes a major lawsuit brought by former NFL players that suggests that these players were doing so blindly because the NFL "told them it was safe to play." They claim the NFL minimized the risk of concussion injuries while making a lot money. However, the validity of this argue net is not the point of this post. Whether the players are right or if it is the NFL owners that have the high ground inps a debate for another time.

This brings me to my point. These athletes are crying foul while most of the youngest retirees (and some of which were a part of the lawsuit) made a lot of money playing a game. Let me say that again. They made a lot of money playing a game. And yes, I understand that the medical costs and the squandered fortunes that are often associated with these ex-players is also devastating. However, I met somebody this weekend that gave me a whole new perspective on this discussion.

This weekend, the high school that I work with hosted an alumni football game as a fundraiser that helped the athletic departments of the my school and that of our next door neighbor. During the pre-game, I met a father who is an alum of the high school where I am employed. (He also has at least two sons that we talked about that evening who are students in the same district.) This gentleman came in to get his ankles taped before the game.

I asked for a brief history of his injuries so I could give him the best treatment I could. After a remarkably long list of injuries, I had to ask how a person who appeared to be in his mid 30s ended up with such a dubious collection. He explained that he has been a military man for his entire career of 16 years if my memory is correct. He then offered that he is soon expecting to reenlist for another 6 years and hoped that it would be his last enlistment.

What struck me the most is that he was not looking for anything except the taping for his ankles. I regret that I did not have the time to talk to him more about his experiences and his injuries. I look forward to talking to him again and I hope he will be willing to share more about his experiences.

Here is thing that has really bugged me; prompting me to write this post. Here is a hero, a real hero, that is sacrificing as much and risking so much more than the professional athletes that we give so much attention to. He isn't asking for fame, isn't expecting a fortune for doing what he does, and yet, is doing much more. Most people will agree that it is always appropriate to always thank our members of armed services, but the irony of this conversation just heavily reinforced for me the need to follow though on it.

In short, I am thankful (and regretful) that God introduced me to this person and I look forward to our next conversation so that I can correct my oversight. God bless the men and women who do such tremendous service to our country and keep them safe.

Tuesday, October 8, 2013

The Sound of Ideas

Dear Diary,

Today I appeared as a guest panelist on our local PBS radio station, 90.3 WCPN in Cleveland, Ohio. I  participated in a call in show titled "The Sound of Ideas." Our topic was concussions in youth football. I was able to offer some ideas on the problem and have some fun in the process. The show also featured Dr. Joseph Congeni of Akron Children's Hospital, the president of a local youth football league (John Prochaska, his son Sam, and one other player on his son's team, Dylan Himmal.  Many issues were discussed and I thoroughly enjoyed my time. Below is the embedded link to the episode that I appeared on from their podcast feed.

(Click on the logo to go to website and download the episode or subscribe to their RSS/podcast feed)

Many thanks to Ida Lieszkovszky (producer) and to Mike McIntyre (host) for their generous invitation and hospitality today.

Friday, September 20, 2013

Lightning strike at high school football halftime show

This video is offered here without comment. If this was as random a lightning strike as is being reported, that is scary. If, however, the strike could have been foreseen coming with a smartphone app, then there is no excuse for it.
Video as reported by WTAM in Cleveland, Ohio

Tuesday, September 3, 2013

Another big hit in HS ball.

I struggle with this many times and continue to try to preach the dangers of hits like this one.
This occurred in a recent game that I was working and you can see the defensive end get ear holed by the pulling guard. I am not sure if the officials saw this hit, but if they had (they did not penalize it,) then I need to seriously step up my educational efforts. These kinds of hits need to end.

Tuesday, August 6, 2013

Falling behind again

We are now back into fall season with everybody underway in their preseason practices as of yesterday. This year, we had a different wrinkle since the football team didn't start until four days after everybody else did. It is unusual because in most years past, the other teams either started after football or on the same day.

The worst of these arrangements is having everybody starting the same day, bar none. It makes it very difficult to spend time with each team when they all start at the same time and I find myself being pulled to football more often than not for many minor details. (Usually a helmet needs some air added or removed.  Ironically that just happened as I was typing this too.) If I had one wish for the OHSAA during this time of the year, it would be to make sure that we keep some sort of staggered start to the fall seasons.  It doesn't matter to me who goes first, (although I like the later start to football) since it is a lot easier for many of us who deal with every sport.

Beyond that, we seem to be having a very cool and dry summer in northeast Ohio this year. Despite the lower risk of heat illness, it is still vitally important to maintain hydration levels since the temperatures are expected to climb somewhat over the next couple of weeks. It is my hope that the temperatures do not spike on one day (like opening night) and have all the kids wilting on the field since they were unprepared for the heat.

Finally, I am also heading back to school for a second Masters degree in applied exercise science so that I can sit for the corrective exercise specialist exam and add that those credentials after my name as well. At the pace that I am going on that, I may have multiple alphabets after my name by the time I am done.

Hopefully, in all of this and my family life, I will still find the time to be more active on this blog.  It may even become more important for me to do so just to maintain my sanity at times. Here is to hoping that everything goes well!

Monday, July 1, 2013

Seminar Season

It has been too long again since my last post. I am finding myself busy doing many other projects and this blog has suffered as a result.

Anyway, welcome to summer! 

As we get ready for the heat and begin preparations for the return of fall seasons, this is my chance as a high school athletic trainer to go out and continue to learn. I had the opportunity a couple of weeks ago to attend a conference in PIttsburgh, Pa. that was presented my the UPMC staff on concussions. 

The course was an update as to what has changed in the last few years and a glimpse of some of the more promising research for the future. I was particularly excited to see a demonstration of a new MRI technique that showed an extremely high definition picture of the the brain being scanned. The potential for this technology os extremely promising and it would be a welcome addition to the arsenal of diagnostic tools.

The most exciting thing that I heard that weekend is that there will be an iOS and android version of the new SCAT3 test available this fall.  I am hoping that the test will be released in the iTunes Store before August 1st, which is our start date.  However, there was no definite date given and it could be released much later in the season.  I guess I'll have to stick to the paper and pencil version for now.

The conference also pointed out that the SCAT3 does not include any testing for the vestibular system and it was the strong opinion of the UPMC crowd that this oversight needs to be corrected. Visual tracking and looking for nystagmus is one thing, but testing the cicadic movements of the eyes and other forms of visual tracking are also important. These additional tests don't require much more time or training to perform and should be included in an evaluation.

There was also some discussion about the upcoming and long promised pediatric version of ImPACT. A preview of the format was given and, as expected, it is more game like than the original adult version. There was a focus given to avoid reading as much as possible especially since this is designed to be taken by 5 year old children.

The thing that surprised more than anything with ImPACT is that they talked about being able to take the adult version of the test as early as age 10. Previously, I had heard that the minimum age was 13. However, the UMPC group did recognize that the normative data for this 10-12 year olds needs to be separated out from the adult scores since there is a large difference in the scores.  Needless to say, I am happy that I will be able to offer the test to my middle school children now, but that does involve a lot more work too.

Now I did say in my opening paragraph that this was about summer seminars. The other big seminar I am attending this year is in Las Vegas for the National Athletic Trainers Association convention. In fact, I am writing this blog post while en route. I hope to have more to share after what should be a fun week in sin city.

Thursday, April 18, 2013

Unsung Heroes at the Boston Marathon

On Monday, April 15th, 2013, we were given another reminder about how the dangerous the world in which live is. The bombing of innocent victims at a marathon of all places is disgusting and inexcusable. While authorities struggle to find who was responsible for the horrific attacks, the media has been busy bringing attention to the heroic acts of the doctors, nurses, EMTs, police, military, and firefighters. These people demonstrated extreme heroism since it is fairly well known that these kinds of attacks often involve multiple explosions designed to injure the first responders. These people scoffed at that danger and rushed in to help. Congratulations and thank you to each and every one of you.

Secondly, and no less important than my first point, my prayers go out to the victims and their families. I hope that they are all able to move past this horrible event and find peace.

Now for my small rant against the media. It has been very disappointing to me to see how these well known and celebrated professionals are the only ones who get the recognition that they deserve. This may come as a surprise to many in the public, but these people were not the only ones responding. Within that group of "other healthcare providers" were athletic trainers, physical therapists, and likely a few others. It sickens me that these these other professionals get less recognition for their efforts in this tragedy. I wish I had the resources available that the media does to be able to get a list from race organizers of all of those who were there that day and responded. I don't think that it would be any great effort on the media's part to publish a full list of the professionals that responded. I guess the recognition will only come after many more long and arduous years of public education.

Monday, April 1, 2013

A Prime Example of Why We Need More ATs

Yesterday, in the first half of the Duke vs. Louisville elite eight men's basketball game, Kevin Ware of Louisville attempted to block a long shot in front of his bench and landed awkwardly.  The landing resulted in an open compound fracture of the tibia and fibula (both lower leg bones) and you can see in the video where the tibia was protruding from the leg at the point of the break.  (As coach Pitino said after the game, "It was protruding by about six inches from his leg.") The injury was horrifying and my prayers will meet with yours that this young man will make a full and speedy recovery and I hope that this will not affect his future to too great of a degree.

Warning: This video is considered by some to be graphic.
The highlight of this terrible situation has to be the quick and appropriate response of the Certified Athletic Trainers, physicians and EMTs that were present.  Their quick and practiced response helped to make this young man as comfortable as possible in a quick fashion.  The rapid response played a large part in getting this young to the hospital quickly where he underwent successful surgery that evening and has a bright outlook.  I commend the medical staff for their efforts and we should all be thankful that this high quality service was available yesterday.

The centerpiece of this response team was surprisingly not the physician.  The people that were doing the splinting and such were the teams' Certified Athletic Trainers.  These were the people that were making the decisions on the best splint to use and how best to transfer the patient to the gurney.  These were the people who were practiced in the emergency responses that they designed and executed flawlessly yesterday when is was needed.  These are the people who are at their best when you are at your worst.

Unfortunately, this is not always the case.  According to statistics from the National Athletic Trainers Association, only 42% of high schools in the United States have access to an athletic trainer.  This is an appalling statistic in and of itself.  When you examine it even further, you will find that this means that only 42% of high schools have ANY access to an athletic trainer.  This does not mean that there is a full time athletic trainer available for all events that a high school and covering both games and practices.  No, this statistic includes all the part time athletic trainers at schools that might "drop by" once a week for an hour to examine injuries that have occurred in the last week. This is obviously far from ideal, but is still included in this statistic. 

It has been estimated that only a third of these 42% of schools have a full time athletic trainer. (I am looking for the article to cite it.) If you work that out, only 14% of schools in the United States have full time access to an athletic trainer. That is embarrassing! The other point that isn't covered in these stats is that of those 14%, many of those ATs are working 60-70 hour weeks.  They often report that they are not able to keep up with the demand at the schools they work for because of the numbers of athletes and contests that are scheduled concurrently. They are not able to fully implement rehabilitation protocols, preventative measures, or spend the appropriate amount of time that is needed for each athlete because of time constraints.

I can sympathize with this since that is my current situation.  Often, I have to make decisions on which sport to sit and watch depending on the likelihood of an injury occurring.  One prime example that happens a lot is deciding between a varsity soccer game and a freshman football game.  It is tough to have to decide between them since both have a similar high risk.  Often, when the injury occurs where I am not, this causes tension amongst the parents and school.

Finally, this statistic talks to high school athletics only.  It does not discuss the need for athletic trainers to be available for middle school and youth and even recreational adult events where injuries also occur.  In these instances, when there is no athletic trainer who has the training to respond appropriately, you are often left the best of what's available. Sometimes, that option is far less than what is needed and emergencies become tragedies. This is why athletic trainers are so badly needed.  And don't fool yourself, injuries like this happen across the country at every level of play.

It has been an amazing experience for me to see first hand the number of unqualified people who are always too willing to jump in and try to help in an emergency situation.  In conversations last night on Twitter with fellow athletic trainers, we discussed some of our nightmares where well-intentioned, but unqualified people were way too quick to insert themselves into an emergency situation.  I have been verbally accosted by many people in the past because they didn't appreciate my qualifications.  Having a nurse standing over me as I am trying to work and shouting instructions to the group or the EMT handing me his cellphone that he used to call a local physician for a kid that needed EMS transport were the worst examples parents that didn't understand their limits.  I understand that this is a burden that reinforces my drive to educate the public about what it is that I am qualified to do.  However, some of my colleagues have had instances of lab techs, and other lay persons who had NO business on the field, yet felt the need to do something to help.

The ironic part of Kevin Ware's injury is that it occurred on the last day of March, which is National Athletic Trainers Month.  The injury helped to underscore the need for athletic trainers at every level of play.  The number one excuse for not hiring athletic trainers is, and likely always will be, cost.  The Mom's team article that is link here even reflects that 9% of people think a volunteer health care professional is appropriate for this job.  If you plan on hiring the lab tech or the medical secretary to cover the next football game, I will probably hold my child out.  That is unacceptable.

There is a growing mantra from athletic trainers that helps to underscore this idea that is captured in this article.  It states that "If you cannot afford an athletic trainer, then you can't afford football."  I have agreed with others that this should be taken this one step further to include hockey, lacrosse, and other collision sports into this mantra.  Yesterday's injury only underscored this belief and it should probably include contact sports like baseball, softball, basketball, soccer, and other sports like it.

However you approach it, there is an obvious need to change things in our athletic society today. We need to increase the number of athletic trainers in the United States that can be these first responders to injuries like this. I would implore anyone reading this that agrees and would like to see changes made in their local community to perform their own research and discover for themselves what an athletic trainer can provide for their athletic program(s). Listed below are a few more articles that I found very quickly that help to support this argument and can offer direction to anyone doing their own research.

Also, over the last couple of years, I have been saving links to various articles on my social bookmarking (Delicious) account.  There are hundreds of articles linked here: