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.

Frontline Report "High School High"



Last night's report by Frontline on PBS was a sobering view of the commercialization of high school football. The show featured a small, private school in Arkansas who decided in the 1990s that they wanted to be able to compete at an elite level. It took several years, but their very significant investments recently started to pay off with very big dividends. They were repeatedly competing for state titles and attracting high quality athletes to move into the area to enroll. However, the report also showed that the increases in the program have not been without some serious drawbacks.

The report discussed what the excesses in one program creates via competition in neighboring and rival programs and, eventually, how they impact the game itself. The size, strength, and speed of high school teams today are growing at a very rapid pace. Because of these increases, the force of the collisions are increasing as well. This has led to some staggering statistics in the amount of TBIs that have occurred across the country. 60,000 TBIs are reported in the US due to high school football per year according to this report. When you combine that with the statistic that only about one third of high schools have a full time AT on staff to manage the injuries, this number gets even more intimidating.

Also included in this report were several quotable lines that I found appalling. "We don't cancel practice because of the heat" was one of the quotes that I really had a hard time comprehending. Granted, northeast Ohio is not the same climate as Arkansas and Texas and the heat is a concern for them all season log. (Up here, issues with heat are rare after week 3 of the season in early September.) I am sure that the heat index also climbs higher with greater frquency than it does here, so I understand that practice has to happen at some point. However, I wish the report would have stated that these practices are altered to accommodate the climate when it does get excessively hot. I am fairly sure that happens regularly.

The other quotable line in the documentary was regarding the return to play status of an athlete with a TBI being based, in part, on the game situation. There is not a single coach or AT at this point that should be unaware of the current standards of practice that would preclude returning an athlete with a TBI to play in the same game. I found this to be exceptionally disturbing and the coach to almost be bragging about his bravado in the situation.

With all that was presented in this documentary, I do have one big critique on it. This project paints coaches in a VERY negative manner. The film claims that the external pressures to have and maintain a winning program are so great that it often corrupts the coach into making poor choices. While I am not naive enough to believe that this doesn't occur, I have maintain that, at least for everyone that I have worked with, that this is just simply untrue. The overwhelming majority of coaches take their commitment to the kids they work with very seriously and would never knowingly put a youngster in an unacceptable situation. The coaches and school administrators that I currently work with daily are a testament to this assertion. They do understand that, in the end, it is their responsibility to educate the kids and guide them to being responsible adults, not to win at all costs. I do wish that the report would have indicated somehow that this is not, by any means, the majority of coaches that would risk a kid's future to win a game.

If anything, I usually get greater resistance to holding a kid out of game from parents and the athletes themselves, not from the coaches. I think that this is where more education is required and that films like this will at least spawn healthy discussions about these topics.

Addendum: After an online discussion with the film maker in an online chat, she reassured me that the coaches that she interviewed were more caring for the kids than I thought they appeared to be in the video.  This was very reassuring.

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.