We have had a lot of rainouts!

Just for kicks, I decided to look at the schedule in full to see what it looked like after all of the rain we have had over the last month. I was even surprised to see how many games have been rescheduled and I only looked at our varsity softball schedule.  Knowing we have 1 more softball team, three baseball teams, track, and tennis as well, that is a lot of games.  Look for yourself at the varsity softball schedule:

Monday 3/28	**POSTPONEDto 4/8 4:30PM	vs.	Cuyahoga Hts. H.S.
Tuesday 3/29	4:30PM	@	Kirtland High School
Saturday 4/2	TBA	@	Marion Harding (double header)
Monday 4/4	**POSTPONEDto 4/13 4:30PM	@	Kenston High School
Tuesday 4/5	4:30PM	vs.	Kenston High School
Wednesday 4/6	**POSTPONEDto TBA 4:30PM	@	Kenston High School
Friday 4/8	**POSTPONEDto 5/5 4:30PM	vs.	Cuyahoga Hts. H.S.
Saturday 4/9	11:00AM	vs.	Mentor High School (Double Header)
Monday 4/11	**POSTPONEDto 4/14 4:30PM	vs.	Orange High School
Tuesday 4/12	**POSTPONEDto 4/15 4:30PM	@	Orange High School
Wednesday 4/13	4:30PM	@	Kenston High School
Wednesday 4/13	**POSTPONEDto 5/13 5:00PM	vs.	GILMOUR ACADEMY
Thursday 4/14	**POSTPONEDto 5/9 4:30PM	vs.	Newbury High School
Thursday 4/14	4:30PM	vs.	Orange High School
Friday 4/15	4:30PM	@	Orange High School
Monday 4/18	**POSTPONEDto 4/21 4:30PM	vs.	West Geauga H.S.
Tuesday 4/19	**POSTPONEDto 4/28 4:30PM	@	West Geauga H.S.
Thursday 4/21	**POSTPONEDto 5/11 4:30PM	@	Edgewood High School
Thursday 4/21	4:30PM	vs.	West Geauga H.S.
Saturday 4/23	11:00AM	vs.	Conneaut High School (Double Header)
Monday 4/25	**POSTPONEDto 4/29 4:30PM	@	Aurora High School
Tuesday 4/26	**POSTPONEDto 4/27 4:30PM	vs.	Aurora High School
Wednesday 4/27	**POSTPONEDto 5/10 4:30PM	vs.	Riverside High School
Wednesday 4/27	4:30PM	vs.	Aurora High School
Thursday 4/28	**POSTPONEDto TBA 4:30PM	@	Beachwood High School
Thursday 4/28	4:30PM	@	West Geauga H.S.
Friday 4/29	**POSTPONEDto TBA 4:00PM	vs.	Madison High School (Double Header)
Friday 4/29	**POSTPONEDto 5/4 4:30PM	@	Aurora High School
Monday 5/2	**POSTPONEDto 5/5 4:30PM	vs.	Chagrin Falls H.S.
Tuesday 5/3	**POSTPONEDto 5/6 4:30PM	@	Chagrin Falls H.S.
Wednesday 5/4	4:30PM	@	Aurora High School
Thursday 5/5	**POSTPONEDto TBA 4:30PM	vs.	Cuyahoga Hts. H.S.
Thursday 5/5	4:30PM	vs.	Chagrin Falls H.S.
	4:30PM	@	Chagrin Falls H.S.
Monday 5/9	4:30PM	vs.	Newbury High School
Tuesday 5/10	**POSTPONEDto TBA 4:30PM	vs.	Riverside High School
Wednesday 5/11	4:30PM	@	Edgewood High School
Friday 5/13	5:00PM	vs.	GILMOUR ACADEMY

I am really getting tired of all the rain!!!


5/17/2011 Addendum -- I guess I spoke too soon.  The rain is still severely hampering our schedule and our district semifinal game is continuing to be postponed as well.  It looks as if there is no end in sight to this rain. It is getting really depressing.

Peyton Manning Makes a Joke?

I have to say that I have had nothing but respect for Peyton Manning and the way he has conducted himself.  He has appeared, to date, to take his position as a role model seriously and has stayed out of trouble.  Therefore, is was disappointing to see the article written recently in which he admitted to dogging the neurocognitive baseline tests in order to allow himself an easier return to play after a TBI.  In a time where kids in middle school and high school work very hard to emulate those that they look up to, I found this comment disturbing.  The fact that Mr. Manning more recently called it all a joke doesn't help matters.  He has basically encouraged kids to try to subvert the system in any manner that they can to be able to return to play as quickly as possible.  I  hope that over the next few weeks, he will continue to try to retract his statement in full and promote taking the exams much more seriously.

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.

New Legislation in Ohio on TBIs

The Ohio legislature introduced on March 7, 2011, a new bill that will change the way TBIs are handled in all youth athletic programs, not just the scholastic programs.  The TBI bill (HB143), as it is currently written, will mandate several steps when dealing with head injuries in youth.  In a letter from the Ohio Athletic Trainers Association President, Hollie Kozak delineates what these changes will be.  She summarizes the mandates this way:

"As currently drafted, the legislation requires both school sponsored sports and “youth sports organizations” to adhere to the following requirements:

1.)     Requires students to submit a form signed by their parent stating that the parent and the student have received concussion and head injury information sheet

2.)     All coaches must hold a pupil activity permit (PAP) for coaching interscholastic athletics, and requires the (PAP) to develop additional training program specifically focused on brain trauma and brain injury management

3.)     A coach shall remove from practice or competition a student suspected of having sustained concussion or head injury during a practice or game

4.)     A student shall not be returned to practice or competition on the same day they were removed

5.)     In order to return the student to play: the student must be assessed by a physician, or athletic trainer and must have written clearance to return to play or practice.

The Ohio Department of Health would be the regulatory body to oversee the program."


The legislation was cosponsored by several interested parties including the Ohio American Academy of Pediatrics (OAAP), the Ohio Brain Injury Association (OBIA), Nationwide Children’s Hospital, and the Ohio Children’s Hospitals Association.  The bill was introduced by Representatives Michael Stinziano and Sean O’Brien and has many legislative cosponsors.  This is the same legislation that the National Football League has also endorsed in many other states, and I assume will do the same here.  


With all of the support, I  suspect that this will be run through fairly quickly and will be in place before the fall season of 2011.  Assuming it will be passed, this will make for a mad scramble for youth leagues to get all the necessary paperwork in order and be ready for the start of their seasons.  In our community, I have already reached out to all three organizations that run the local athletic programs and will be offering educational programming for all the youth coaches.  The best place to access a lot of this information at this time is through the CDC website where they offer a great deal of educational materials at no cost.


The hospital system that I am employed by is also looking to do a few other things for the various leagues and we should be hearing about them shortly.  Hopefully, this will allow us much greater access to all the youth living in the school districts in which we are currently employed.

An Encouraging Sign

Very often, athletic trainers find themselves at the front of the educational push to increase the awareness of a health related issue amongst the athletes they serve.  This has certainly remained true with the latest issue, TBI. Usually, we find ourselves frustrated to no end trying to educate our clientele as to the intricacies of an injury, only to have somebody suffer the injury we were warning them about.  The infuriating phrase "I never heard you say that" or the same old, outdated argument(s) are often the excuse given by the athlete.  We then wonder how much of our effort was actually worth it and should we really keep plugging away at trying to educate people.



I can finally say yes, it is absolutely worth it.  Earlier this week, I was discussing an unrelated injury with an athlete when he mentioned to me "I hit my head playing a soccer game this weekend and I think I might have a [TBI].  At this point, I pulled out my testing materials and began to examine him.  Sure enough, through the interview process and discussing his symptoms, he scored high enough that I believed that he had a TBI.  When I asked him what made him think that he had a problem, he cited the large amount of press coverage that the topic was receiving and that he thought he better get it looked at.  I commend the young man for being so proactive and taking the necessary steps to take care of himself appropriately.  Maybe, just maybe I will be able to see a little more of this responsibility and less of the macho "leave me alone, I can handle this" attitude that is usually associated with this injury.

Opening Day is here again!

A year ago, I posted the picture of our very wet, unplayable softball diamond on opening day.  This year, our fields aren't just wet, they are frozen!!!  I really have a hard believing that it is opening day when I see this on the weather report.  I am especially excited by the "feels like 23°" right now.  That definitely reminds me of baseball.  Thankfully, all our home events are postponed, but beat of luck to our varsity baseball team in their season opener on the road.

New TBI app for iPhone/iPod Touch

Last week, in a tweet from SportsConcussions.org, they advertised their new TBI assessment tool that is designed to work with the iPhone and iPod touch.  The Blackberry and Android versions are expected to be released in the near future, according to the website.  To begin with, the application shows great promise since "The diagnostic tests are a combination of the medically accepted SAC, SCAT2, BESS, and the CDC's On-Field Mental Status Evaluation."  

The funny part of it is that, at the moment, I could not purchase the application on my 2nd generation iPod, since it "hang in a loop" after tapping the buy button.  (I contacted the programmer, and they are working to correct this issue.  We have shared several emails and they said it seems to limited to certain models only.  I fully expect to hear from them soon letting me know that the problem has been corrected.  I also plan to update this post once I get the response.)  


The funny part is, it does work on my iPad 2.  The working screen is small since it is written for the smaller devices, but it is usable.    I suggested to the programmer that they optimize the program for the iPads.  They agreed that it was a good idea and I assume will tackle that soon. 


The frustrating part is that the tweet came 2 days after my athlete's last TBI.  (I just missed being able to try it out.)  Therefore, I was relegated to making up a fictitious athlete to see how well it worked.  I was pleased to see that it is an easy program to use and does have the potential to be used by coaches and parents as well.  Obviously, I'd prefer to see more input from other ATs and potentially from some physicians before it makes its way to the lay public.


The important part to remember with this testing is that many of the studies that examine the tests upon which this software is based indicate that they should only be used acutely (on the sidelines.)  These tests are not supposed to be used for follow-up care and and are not sensitive to the chronic issues associated with post-TBI syndrome.


I am hoping that this works as well as I expect it to and will make carrying paper and pen around to perform a SCAT2 test obsolete.  So the only question I have now is...Who wants the first big smack in the head to give me the opportunity to try this?  No volunteers?  I guess I will just have to wait it out then.

"Legal hits to the head"

The NHL, during its recent GM meetings in Florida made a whopper of a statement referring to how they intend to try to prevent TBIs.  Gary Bettman, the league commissioner said "a full 14 percent of N.H.L. concussions are caused by what Bettman called “legal head shots”; i.e., north-south hits to the head that did not specifically target the head."  The time has come to make sure that these hits are illegal as well.  Hits that target other areas of the body and end up hitting the head should be illegal regardless of their ordinal direction.  As stated in the previous post, this is highly subjective and leaves far too much room for interpretations.  I will be very disappointed if the NHL continues to maintain the hard line stance of "it's just a part of the game."  If hockey wants to survive, it had better modernize along with science and medicine.  

I also have to disagree that the team athletic trainer should have no input as to whether an athlete can return to the ice or not.  I understand that the NHL has the resources to have a "neutral physician" examine any athlete that takes a hit, however, it is the AT that spends the most time with the athlete.  The AT can give valuable information to the physician as to the athletes baseline personality and intelligence to aid in the RTP decision.  Taking the athlete away from this resource, into a quiet room away from everybody is a mistake.

There is Absolutely No Excuse for This!

There is no reason for this hit.  The NHL needs to come down extremely hard on Chara for this hit.  These guys are professionals who spend hours on the ice and know exactly where they are and how risky a hit like this is.  It sets an extremely poor example for young athletes to follow.  I would hate to see this go punished lightly and for kids to think this is acceptable in any way.  There are already several other like minded athletic trainers saying the same thing that I am here.  Dustin Fink ATC, of the concussion blog, has already posted similar sentiments. 

The NHL may consider a small redesign of that portion of the rink. Instead of a 90 degree angle of glass, they may consider a pair of 45 degree angles to help decrease the risk in this part of the rink.  However, even this small change would not excuse this kind of hit.

Finally, and most importantly, our prayers need to go out to Max Paciorietty and his family.  I hope that he recovers fully with no ill effects despite the violence of this incident.

3/15/11 ADDENDUM:

I find it very disturbing that despite the fractured vertebrae and the TBI suffered by Paciorietty that the NHL figured the hit was not intended to inflict harm and let Chara go with the penalty he served in the game.  The NHL needs to avoid interpreting intent.  This is far too subjective and leaves way to much room for interpretation.  This hit was unnecessary and ugly.  It required far more attention from the league's management.

Once again, our prayers need to continue for Paciorietty's speedy recovery and for his family.

National Athletic Training Month

March is National Athletic Training Month. Why is this significant? It means that athletic trainers across the country are going to spend the month of March trying to increase awareness and educate the public about what an athletic trainer is. This will happen in many creative ways limited only by the imagination of ATs. Twitter, Facebook, and many PSAs at local games are the primary ways of getting the word out because they are so inexpensive.

So now you will probably ask "What are the athletic trainers saying?" Most ATs will spend their time linking to the NATA website and quoting their definitions about what an AT is. Others will spend time trying to differentiate athletic trainers from personal or fitness trainers and will insist upon being called by their full title. Finally a few will also try to differentiate us from physical therapists (with whom we have a lot in common,) or other allied health professionals. Personally, I'd prefer that the differentiation be made between athletic trainers and physical therapists for the simple fact that both require college degrees for entry level. Granted, PTs require a DPT now, but it wasn't that long ago that they required a bachelor's degree like ATs. I often hesitate to contrast us with personal trainers simply because there are a great many programs with varying standards for certifying personal trainers in the country. This, as ATs discovered and corrected, is not an efficient way to develop a profession. (Albiet, athletic trainers only had two paths to certification and not many.)

In light of some recent poor reporting in a small newspaper where the qualifications of athletic trainers were questioned, the importance of getting the word out about who we are was severely underscored.  Athletic trainers need to get into their communities and spread the word through education at various youth league events and through parent education pieces.  The recent explosion of coverage in the media that TBIs have received gives all ATs an incredible opportunity to increase their exposure.  Because of our unique intimacy with this issue, we should be on the forefront doing this education.  Far too many physicians and neuropsychologists have been singing our praises about our abilities and need us to continue the work we do.  This is a more meaningful kind of exposure in my mind because it demonstrates our abilities rather than simply discussing or bragging about them.  The power of demonstration, as many of our teachers in the past have pointed out, is much more significant than simply reading about a topic.  These demonstrations of our knowledge and experience are a much more powerful example of what we can do than retweeting the last promotional message from @NATA1950 and thinking that you have fully contributed to NATM.

There are many excuses why we can't be out talking to our volunteer parents at the elementary school leagues to explain what is going on with current research and giving them the latest guidelines for safe return to play after TBIs.  However, this is the best place where we to be recognized since this becomes an investment into the future of each community.  The elementary kids are, for the most part, the future of the high schools where most of us are employed.  Getting in front of the parents at that age will only help them to trust in your decisions once their kids are under your direct care in a few years.  You may not have to do it alone either.  Local collegiate ATs and those working in other, nontraditional settings may be willing to help with the outreach education and decrease the burden for any one person.

The final point to make is that whatever you do, make sure you represent your profession properly and always do it to the best of your abilities.  Make sure people know who athletic trainers are and what it is that we do.  Too often, we are in the background doing the work that only the athletes, coaches and administrators see.  We need more than that if we are to grow as a profession.

The toughest decisions

A recent article by  a staff writer at MDNews.com (and was also commented on by D. Fink at The Concussion Blog) does a great job of expressing the difficulty that both physicians and athletic trainers often face when deciding whether or not to return a kid to play safely or not.  The article points out that while a clinician's exam should lead the AT or physician to a reasonable idea of what is going on, it isn't always the only factor influencing the decision.  Often, there are great pressures brought by parents, coaches, and the players themselves to try to get the athlete back into play.  It is often very easy to sit from the sideline and assess whether or not the right thing was done, especially several hours after the incident has occurred.  (A familiar idiom often used in athletics comes to mind about hindsight being 20/20.) The other issue that everyone need to keep in mind is that not all TBI symptoms appear immediately at the time of injury.  Occasionally, it takes a few minutes to half an hour for the symptoms to become detectable.  While there are always those hits that everyone cringes about and it is obvious something is wrong, that isn't always the case.  To further complicate things, sports like wrestling give the AT or physician only a minute and a half to perform their evaluation and come to a conclusion.  This is where the rules need to change BADLY.  This is a near impossibility in most cases to be able to determine if the athlete has suffered a TBI or not in such a short amount of time.  Hopefully, this will be addressed in this upcoming off season.

Custom shoes may be not all they are supposed to be.

In an article that is surely going to have many cross country and track coaches scratching their heads (and probably a few shoe manufacturers and salespeople screaming its illegitimacy,) the author shows some recent research that demonstrates custom shoes may have no real benefit.  It may be a little counter-intuitive, and certainly requires a few more trials of the study to be certain, but it looks like the very expensive running shoes may not actually help reduce injury.  For about 20 years now, there have been three kinds of shoes on the market for every kind of runner and their foot type.  Even more recently, there are now over the counter orthodics with a computerized foot measuring device that determines what kind of orthodic you should buy.  The shoes go by different names based on the manufacturer, but the premise is the same.  They are either extra soft, or cushioned, for people with very high arches, extra rigid (supportive) for those who have flat feet and pronate excessively, and a mid-range shoe for those with relatively normal feet.  The interesting part of this study is that there was no significant change in the injury rate for from those people who ran with a shoe that was custom versus those that ran with another shoe.  The study was performed about 1400 Marines during 12 weeks of their training.  It certainly flies in the face of what runners have been taught to look for in a shoe for quite some time.  In the end, it should probably just come down to what feels comfortable and "run with it."



Another insult

So the columnist decided to not follow through and perform any research since he had his mind made up already about how effective ATC's can be. Instead, he holds to his insults and defended his comments from his initial post. I will admit that I found this extremely irritating and responded with a scathing email in which I pointed out that all professions have those in their ranks that are barely minimally competent. This should not reflect the majority. Finally, I flatly refuse to give this marginally competent columnist any more press. This discussion is over since it is now obvious all this columnist wants is the press.

At least the NATA had a reasonable response to this garbage. I include the link, but it is password protected for NATA members only.
http://bit.ly/dE1mpA

Response to the previous post.

It seems it didn't take long for the newspaper to respond to the outrage generated by Mr. Carpenter's comments late last week. Below is a link to what the paper had to say. http://bit.ly/i50sLk Needless to say, I look forward to the promised response from Mr. Carpenter in tomorrow's publications.

Another author needs an update

I was looking through my series of news alert when I saw headline that grabbed my attention.  "Bill to ease concussions is bogus" was how the headline read and it immediately got me to wondering what the author was getting at.  Paul Carpenter, a writer for the "The Morning Call," was trying to relate his experiences while participating in athletics 30 years ago and somehow call it relevant today.  He makes a serious charge when he states "trainers are nothing but flunkies for coaches, some of whom are willing to do anything to win."  The problem here is that we are not "trainers."  We are athletic trainers.  This subtle, but important distinction allows us to distinguish ourselves from personal trainers and fitness trainers who do not have the background in studying mild traumatic brain injuries (mTBIs) and should not be able to make a return to play decision.  By demeaning athletic trainers in the way you have, you only made yourself look foolish.  I was hoping that when I read your story, that you would have been more focused on the rules changes that are trying to decrease the number of risky hits, the style of helmet, or some other aspect to the TBI controversy a the moment.  In closing, I would like to invite Mr. Carpenter to visit the National Athletic Trainers' Association website through the link provided below.  I would hope that in the future, he would take the time to ask a few more questions before jumping into the fray with terribly outdated statements.