Another Video Explaining the Dangers of TBIs

What is a Concussion? by the NATA, and the NHL.

Youth football leagues and concussions

With the new rule that is going into effect at the high school level, I now question what many youth football leagues will do to try to comply with the rule. It will be a significant liability to simply volunteer as an Athletic Trainer to clear a kid to return to play. I imagine that if any ATC does volunteer to do it, they would certainly maintain a very conservative stance on allowing a kid to return, even more so than for the high school student athlete. (If being more conservative is even possible.) Our local youth league is already looking into various options and I plan on consulting to offer them insights as this develops.

Another article to underscore the current attention given to concussions

Concussions policy fuzzy for student athletes

Timing is everything

It seemed unusual that no sooner had I read an article about the young pitcher in California who was hit in the head with a baseball, that I had a near miss at one of our first games of the year. The pitcher in our game was hit in the left shin with a line drive and, despite being able to remain standing, was in obvious pain. He tried to minimize the injury and continue to play, but his coach (they were the visiting team) decided he didn't want him to continue. (Fortunately, I would have recommended the same.) The young man spent the rest of the game on the bench with ice on his leg.

What I found most interesting was the conversation that ensued. An older gentleman who was watching the was horrified "to see this happen again" and wondered why the metal bats were still permitted in the game. To say that this person was a traditionalist would be an understatement. He continued to complain until a couple of younger fans accused him of being "outdated, out of touch and being an alarmist." I found it disconcerting to see the younger fans with such a lack of concern for the potential severity an injury. I assume that it was primarily because I have been around the game long enough to see some terrible injuries from line drives. It also demonstrated for me the "invincible attitude" that adolescents possess and use in their decision making process.

While I am not convinced that the metal bats have increased the number of injuries that have occurred from the line drives, I do feel that the severity of the injuries are certainly greater. I also understand that the home run makes the game much more exciting, but I question if it is worth the risk of injury.

Concussion Management in High School

With all of the attention that the NFL has finally given to the issue of concussions, it is not a suprise that the NFHS has begun to reexamine their rules as they relate to concussions as well. The first place to start is obvious, in football. The reasons to start here is first, the timing of the season, since rules changes for football for the succeeding season are usually approved in February. It is also one of the sports with the highest risk. However, I have not heard if the same rule was instituted in soccer. I would hope so, since now is the time to make changes there as well.

I also understand that since the official is the one person that is closest to the athletes that are at risk of injury during the course of the game, that they are given more authority to remove a student athlete from the game than they previously had. (Previously, they could only send an athlete out of the game if they suspected that the athlete was rendered unconcious.) The new rule allows the official to send an athlete out of the game for any suspected concussion symptom.

Now this is where it gets complicated. The previous rule allowed for an athlete to return to the game only with a written clearance from a physician. This was not a bad way to do it. However, now the official, who more than likely has no medical background whatsoever, can send an athlete out for any symptom including a headache. The problem here is that an athlete may complain to a teammate of a headache caused by skipping lunch or having a small, relatively benign, muscle pull in their neck during the game. If an official overhears this, he should send the athlete out of the game to be looked at. The problem is that there is not always a physician on the sidelines of a game. This is especially true at the sub-varsity levels. Under the old rule, there was no way to return an athlete if this was the scenario.

Fortunately, the rules comittee was willing to expand their interpretation of who could allow the athlete to return. However, this still poses yet another problem. The NFHS is a national boady and cannot make the rules too specific to govern who is qualified for all 50 states. Therefore, they chose to use vague language in the rule and settled for "appropriate medical personnel." I believe that it was understood to be left to each state athletic governing body to define this rule more specifically for each state. This is necessary because of differing state practice laws for many the diverse medical professionals that may be present at games. I can assume that the rules committee wanted to include Certified Athletic Trainers (that can also be licensed or registered depending upon the state.) I am also fairly certain that the intent was not to expand the list too greatly so as to prevent any individual from simply walking out of the stands and saying "I can do this." This can place far too many people and organizations at risk of litigations.

I am also aware of that the Ohio High School Athletic Association (OHSAA) is looking into defining this terminology as we speak. They have contacted other professional organizations in the state of Ohio asking for their input into this matter. This includes the Ohio Athletic Trainer's Association (OATA.) It is my hope that every ATC that received the invitation to the survey participates. The OATA has brought up some interesting arguements about whom to exclude from the list for various reasons.

The survey also asks about the possible use of neurological baseline testing requirements for all athletes at a local hospital or clinic. While I think this would be ideal, I question some of the logistics of getting this done. The locally popular software program has been advertised widely as a premier program for this assessment. I have had some experience using it in the past, and I agree that it is a high quality product. However, when it became cost prohibitive to the high school I work for, we had to discontinue the annual subscription. The hospital system that I am employed by has looked into becoming a provider of this program as well. However, this has run into a serious roadblock since larger, globally recognized hospital system that is in our market area already has a contract with the software program. The software company will not even return our phone calls due to their contractual commitments to this other system.

Video Links:
ESPN commentary on YouTube
Time Magazine article on long term effects of concussions

If anyone else has thoughts on this topic, please feel free to comment.