Comments on a Webinar Today

First, for those of you who don't know what it is, think of a seminar performed over the web.  That is how it gets its name.  The topic of a webinar can be anything you can think of.  The nice part is that you can attend a webinar in your pajamas from home.  You are not expected to arrive at some venue and sit in a lecture hall for a seminar.  It is an outstanding way to bring content over long distances too, since you don't have to travel.

This webinar was presented my Dr. Mickey Collins, a leader in the United States on sports related TBIs.  He is one of the founders of ImPACT software that many schools, colleges, and professional teams use to baseline and test their athletes to judge the severity of a TBI and when it is safe to RTP.  It was very encouraging to hear Dr. Collins assert that often times, EDs will give advice as to when it is safe to RTP when they really should not be doing it.  There are far too many variables that go into treating a TBI that can create a large difference in the rate of recovery between athletes.  He states that there is no way any ED physician could know when it is truly safe to RTP unless they are able to follow up with the athlete consistently.  This, of course, is not within the scope of ED physicians.  Dr. Collins even went so far as to say ATCs should disregard those recommendations completely.  Since I recently had an ED physician try and offer RTP guidelines recently that I ignored, I was very pleased to hear this.  However, I foresee a parent who will not be as agreeable when I hold a child out longer than the ED physician stated was necessary in the future and it can create a serious amount of tension.  I would hope that some education to the ED physicians about referring mild TBI cases to those trained in follow up care would be shortly forthcoming.

The other fascinating part of the webinar was the description of what is going on physiologically in the brain to create the energy deficit that the brain experiences after sustaining a TBI.  Now I admit, I was never one to find the physiology of anything else all that exciting and trying to explain the Kreb's cycle now would be fruitless without some serious review.  The concept of how long the brain remains in an energy deficit state is the part that is really scary.  With athletes that report lingering symptoms, the deficit can last up to a week in 90% of cases and even longer in the other 10%.  A few cases never really recover and need to be removed from participation in contact sports.  Certainly after watching the number of videos that can be found on secondary impact syndrome, it is enough to scare anyone into doing the right thing.

Finally,  the last point that I found interesting was that the research stated that children who sustain TBIs heal much slower than adults do.  Children, whose brains are still developing up until the age of 22, simply take longer to heal from TBIs.  That is not the point that was new to me, as I have heard that many times before.  However, Dr. Collins points out that just because an NFL player (who are all adults and most are older than 22) can return from a TBI in a week, doesn't mean that a high school player or their parents should think that it is safe for the high school athlete to do the same.  Again, this point can become a strong point of contention with a parent who thinks that their son or daughter really needs to be out on the field playing in order to earn the scholarship.

One thing is for sure, I will be sharing this webinar with colleagues so that they can all benefit from the same information.

Another helpful video on TBIs released by the NATA

The National Athletic Trainers' Association has released another video online regard TBIs in football.  This one is hosted by Steve Young and is another superb resource for coaches and parents.  This video helps to explain the risks of injury and why there has been such a large spotlight turned on this subject for the past year.

Drug Prevention and Testing

Our school district is re-examining our policies on drugs and alcohol use and looking into the community's reactions to the possibility if testing for drug use.  Needless to say, this is a hot topic in our district just as it has been in many others.  Ohio law states that we can test any kid that participates in any extra-curricular event they don't receive a grade for.  This includes athletics, drama club, chess club, and even parking sticker privileges.  I don't know how this final revision of our policy will take shape, but if the following meetings are to be anywhere near as entertaining as the open forum last week, the notion of testing will be hotly contested.  Tonight's second public forum meeting will be, I'm sure more of the same issues being raised.  There are a great number of people who, despite its legality, think that the schools are overstepping their charge and becoming more of a parent if they do test.  I have to admit, I find it very hard to argue with this assertion.

Another resource I just located

USA Football has four videos on their website about safety precautions including:

1. Concussion (TBI) awareness
2. Heat Illness Prevention
3. Helmet Fitting
4. Shoulder Pad Fitting

These are a must see for any first time youth football coaches to obtain a better understanding of the risks associated with playing football.

This is VERY scary for many reasons.

In an article by Richard C. Senelick, M.D., on his blog in the Huffington Post, he tackles the issue of inappropriate comments made by parents, spectators, and coaches of youth sports during games.  He even points to a very disturbing video on Youtube that shows a couple of kids colliding during a practice with very poor tackling technique that results in the one kid crying after the play.  Quite frankly, he was lucky to be moving after the hit.  The most disturbing part of the video is not in the short 8 seconds that is played, but rather the number of comments from viewers who think the video is some how funny or encouraging.  Some parents even go so far as to say that they hope that their kid hits in the same way.  This is vile, disgusting, and reprehensible.  Quite frankly, I feel that this kind of behavior needs to be treated with zero tolerance and have those parents banned from participation.

Facemask Removal Cheat Sheet

Published by the College of Health and Rehabilitation Sciences at Sargent College, this is a cheat sheet for proper facemask removal to access a victim's airway.

TBI cheat sheet for coaches

The National Athletic Trainers' Association just published this article in their NATA News for September 2010.  It is a cheat sheet for your coaches to help identify TBIs when they occur.

Congressional Hearings on TBIs

In this article, Lindy Washburn describes the testimony of a seventeen year old basketball player who appeared before a congressional committee to talk about her long term symptoms related to her repetitive TBIs.  She stated she had as many as seven TBIs from playing basketball over her short career and has since had five more due to other incidents after she quit basketball.  While I realize the severity and the consequences of second impact syndrome and the effect that multiple TBIs can have on a young brain, I have a big problem with congressional hearings on the subject and the potential for federal guidelines as a result.  At one point in the article, the writer makes a very dubious remark about the reliance on athletic trainers and physicians for determining the RTP standards for each athlete.  While the TBI testing software is a very useful tool for helping doctors and ATs to determine how much progress an athlete has made, it is still not the final answer.  There is much to be said about the clinical experience and expertise of physicians and ATs using the tools.  Even the developers of the software suites are quick to point this out.  This article makes it sound as if the software is the only determining factor in the RTP decision.  This seems to be a little irresponsible to overstate the value of the software.

Wow, this could be really big.

Last week, the Columbus Dispatch published a week-long series of articles that looked at the culture of youth sports in America, and specifically, in Ohio.  This series was referenced in by previous post dated August 29th, 2010.  It now appears that in response to this series of articles, that the OHSAA is willing to reach out and provide leadership and oversight to the many recreational programs in Ohio that offer youth sports.  This would be a large undertaking that would require a vast expansion of staff and finances for the OHSAA.  I find this to be very interesting since the article indicates that Governor Strickland would be in favor of looking at this and possibly pushing the state legislature to provide funding for it.  This could be a huge market increase for athletic trainers as well since it only makes sense that we will be called on to assist in the development of programs.  This would not only create a much larger market of jobs for LATs in Ohio, but would also create a big shortage of LATs.  Things could get interesting VERY quickly if this goes well.

Affects of youth sports on children and parents

This should be an interesting series of articles by the Columbus Dispatch this upcoming week. I do plan to follow this report and see what they found in their research. I anticipate that this report will try and gain a perspective on the drive to have kids participate on travel teams that cross the country to play in the most competitive tournaments at great financial costs and, occasionally, with significant injury.

Why ATCs are an important part of any school's athletic program

Over the last few months, there have been a staggering amount of publications that argue very strongly for the need to place Certified Athletic Trainers at every high school. The argument has even been made that if you can't afford an athletic trainer, then you can't afford sports like football, wrestling, hockey, and lacrosse. I have never thought about this problem too much since the majority of the schools that I have consistent contact with have an athletic trainer on site. However, after having started out as a part time ATC for a local school, I do appreciate how difficult that can be. I have only recently begun to think more about why it is so important for the schools to have full time athletic trainers as most of the current articles call for. I have to admit, they are right. With the attention being focused so heavily on TBIs and heat illnesses today, there is no good excuse for a school system to not have a full time ATC for their program. It is simply a demonstration of fiscal responsibility to make sure that your school has a full time athletic trainer. The athletic trainer does so much in prevention and treatment that they usually end up paying for themselves.

Addendum 8/28/10: Scripps News has a series of articles that discusses this problem in depth.

The correct kind of sports bra?

OK, so aside from all the jokes that can be made (and probably already have,) this is an aspect to sports medicine that has often been swept under the rug and ignored. The people who are conducting the research are often laughed at and given over to ridicule for looking at this subject. However, as this article points out, this is a much more serious subject than previously thought. Having the right kind of sports bra can make a big difference in the rate of injury in other areas of the body if the findings from this research turn out to be reliable and valid.

The obvious question is does size matter in this case? The research and article suggest that it does matter, a lot. Individuals with larger cup sizes tend to distribute weight differently during exercise than those with smaller cup sizes. Because of the increased stress on the inside of the legs during running, this can possibly lead to a greater incidence of shin splints and stress fractures. This then discourages women from exercising regularly and creates a whole litany of issues. Yes, this topic does matter and needs to be treated seriously and researched more. I, however, will gladly let others do the research so that I can't be accused of having other motives for wanting to conduct the research.

Repeated TBI and Lou Gehrig's Disease?

Researchers will publish an article tomorrow in the Journal of Neuropathology and Experimental Neurology that links repeated head injuries to Lou Gehrig's disease, according to Alan Schwarz of the New York Times. In Mr. Schwarz's article he describes that Lou Gehrig's disease may not be the same as A.L.S. as it has been thought for the last 70 years. In fact, the researchers hypothesize that it is an entirely new condition that presents like A.L.S. The researchers site different protein strains are at work in the brain for Lou Gehrig's disease that aren't found with A.L.S.

Mr. Schwarz also does an exceptional job recounting the number of reported injuries that Lou Gehrig suffered during his career in his article. With the details that he gives, it makes me shudder to think that he was allowed to RTP. Of course, that was a different era of sports medicine that didn't recognize the risks involved with letting him RTP. I will look forward to reading the research tomorrow and see what their findings are.

A look at gender and rate of injuries in high school

At Ohio State, there has been an injury tracking system in place for a few years now that assembles information about the rates of high school injury in various contexts. In this article, it compares the rate of injury between genders. Of no surprise is that more boys are injured, but that is greatly influenced by football and wrestling. (Two sports with minimal participation by girls.) However, girls are getting injured at higher rates in basketball, soccer, and softball when compared to the boys' comparable sports. As of yet, there is minimal explanation as to why, only hypotheses.

Looks like metal bats will stay, for now.

It looks like a deal has been struck in California to avoid a state legislature writing a new law banning metal bats from youth baseball. The agreement looks like the fielders will be required to wear a piece of protective headgear. I am unsure from this article as to which fielders will be required to wear the headgear, or even if this will affect any athletes outside of California. It is natural to assume that the pitcher would be required to wear them. The debate would rage over the infielders, particularly the shortstop and the second baseman. I don't see the need for any of the outfielders to wear the head gear.