Oct 04 Journal

Volume 2, Issue 1 October 15, 2004 IHS Sports Medicine Journal A publication of Irving High Sportsmedicine www.irvingisd.net/tigersportsmed Special Focus for this Issue— Concussions – Pages 3-5 The online release of this issue of the IHS Sportsmedicine Journal has been delayed. A special issue of the Journal will be e-mailed in November. This issue has a special focus on concussions in sports. The National Athletic Trainers Association and the University Interscholastic League have both made prevention and standardized care of concussions a primary focus this fall. As a service to you and the Irving High School athletic community the NATA position statement on concussions and information from the UIL is contained in this issue. This information as any information regarding athletic injuries in the Journal is not intended to replace consultation with your physician or health care provider. Remember– concussions can happen in all sports October/November Events • Oct 21-23 Region 10 Sports Extravaganza • Oct 28 Football Senior Night • Oct 30 District Cross Country Chamionships • Nov 20-28 Fall Break Inside this issue: Student Trainer News Sports Medicine Web Links Ice and Exercise/Sports Medicine Term NATA Position Statement on Concussions 2 2 New Assistant Athletic Trainer at Irving High Irving High welcomes Tana Pyle as Assistant Athletic Trainer. Ms. Pyle has a Bachelor's Degree in Health and Human Performance from Northeastern State University in Oklahoma (2001). She earned her Master's of Education in Health and Kinesiology from the University of Texas at Tyler in 2004. Previously Ms. Pyle served as the Head Athletic Trainer for Tyler T. K. Gorman High School and Assistant Trainer at Chapel Hill HS. She has also been an athletic trainer for the East Texas Twisters Semi Pro Football Team Ms. Pyle is both a state Licensed and NATABOC Certified Athletic Trainer. She is currently pursuing her state certification as a math teacher. 3 4-5 UIL Information on Con- 6-7 cussions Use of Ice ans Heat for Injuries 8 Page 2 IHS Sports Medicine Journal Student Trainer News Nick Rash at SMU Nick Rash, former Irving High Student Athletic Trainer, is currently a Freshman Student Athletic Trainer at Southern Methodist University. As all incoming student trainers, Nick is working with the SMU football team at the daily practices, home games, and some road games. He traveled to Boise State with the team earlier this month. After football Nick will work with the various intercollegiate sports to gain experience in all aspects of sports medicine. IHS Student Athletic Trainers Visit SMU Four student Athletic Trainers visited the SMU Athletic Training Program on October 16, 2004. Tiffany Walker, Jacob Garrett, Heather Young, and Heather Halford toured the athletic facilities, watched pre-game treatments and taping, and shared sports medicine information with SMU athletic trainers. They also met with Cash Birdwell, athletic trainer at SMU for over 30 years. SPORTS MEDICINE WEB LINKS: National Athletic Trainer’s Association– www.nata.org American College of Sports Medicine http://www.acsm.org/index.asp Texas Department of Health– http://www.tdh.state.tx.us/default.htm Volume 2, Issue 1 Page 3 Study Shows Cold Therapy Does Not Affect Agility Athletic trainers and other sports medicine professionals often use cryotherapy or cold therapy in treating both acute and chronic injuries, as well as in rehabilitation. The therapy relieves pain while reducing muscle spasms and inflammation. However, there has been concern that cryotherapy may hamper agility, potentially making it unsafe for athletes to exercise following cold treatment. Studies conducted by athletic training researchers at the Indiana State University Sports Injury Research Laboratory in November 27, 1995 showed that cryotherapy on joints before vigorous exercise is both effective and safe. "Our study of 24 male intercollegiate athletes indicated that a 20-minute cold treatment applied to the foot and ankle does not adversely affect functional agility -- or an athlete's ability to exercise safely -- just 30 seconds after removing the joint from ice," explained certified athletic trainer Christopher Ingersoll, PhD, one of four co-authors of the study and associate professor, Athletic Training Department, Indiana State University. The study's authors suggested the slower times might have resulted from apprehension among subjects after placing their feet and ankles in ice for 20 minutes. The athletic trainers who authored the study pointed out that -- in practice -- cold application is usually followed by other forms of treatment such as range of motion, strengthening and functional exercises, as well as taping and thorough warm-up. The authors explained cryotherapy on musculoskeletal injuries can encourage exercise sooner after an injury because it reduces pain. Sports Medicine Term What is meant by the term R. I. C. E? Following Injury remember- R I C E Rest Ice (20 min per hour) Compression with elastic bandage Elevation above the heart Page 4 IHS Sports Medicine Journal NATIONAL ATHLETIC TRAINER’S ASSOCIATION ISSUES 2004 POSITION STATEMENT ON CONCUSSION HOW TO REDUCE SEVERITY OF SPORT-RELATED CONCUSSION AND IMPROVE RETURN-TO-PLAY DECISIONS In recent years, new scientific research and clinical-based literature have given the athletic training and medical professions a wealth of updated information on the treatment of sport-related concussion. To provide certified athletic trainers (ATCs), physicians, other medical professionals, parents and coaches, with recommendations based on these latest studies, the National Athletic Trainers’ Association (NATA) issued a new position statement – “Management of Sport-Related Concussion” – in the Fall 2004 issue of The Journal of Athletic Training. The statement will be available online, as of Tuesday, September 28, at http://www.nata.org/publicinformation/files/concussion.pdf. Below are some of the highlights: Defining & Recognizing the Concussion • The term “ding” should not be used to describe a sport-related concussion as it generally diminishes the seriousness of the injury. If an athlete shows concussion-like signs and reports symptoms after a contact to the head, the athlete has, at the very least, sustained a mild concussion. Signs of concussion include: fluctuating levels of consciousness, balance problems, memory and concentration difficulties and self-reported symptoms, such as headache, ringing in the ears and nausea. Evaluating and Making the Return-to-Play Decision • For athletes playing sports with a high risk of concussion, baseline cognitive and postural-stability testing should be considered. If an athlete is injured, the time of the initial injury should be recorded. Serial assessments of the athlete should be documented, noting the presence or absence of signs and symptoms of injury. The ATC should monitor vital signs and level of consciousness every 5 minutes after a concussion until the athlete’s condition improves. The athlete should also be monitored over the next few days after the injury for the presence of delayed signs and symptoms and to assess recovery. Concussion Assessment Tools • Formal cognitive and postural-stability testing is recommended to assist in determining injury severity and readiness to return to play (RTP). Once symptom-free, the athlete should be reassessed to establish that cognition and postural stability have returned to normal for that player. When to Refer to a Physician • An athlete with a concussion should be referred to a physician on the day of injury if he or she lost consciousness or experienced amnesia lasting longer than 15 minutes. A team approach should be used in making RTP decisions after concussion. This approach should involve input from the ATC, physician, athlete, and any referral sources. When to Disqualify • Athletes who are symptomatic at rest and after exertion for at least 20 minutes should be disqualified from returning to participation in a sport on the day of the injury. • • Athletes who experience loss of consciousness or amnesia should be disqualified from participating on the day of the injury. Athletic trainers should be more conservative with athletes who have a history of concussion. Page 5 IHS Sports Medicine Journal Special Considerations for Young Athletes Because damage to the maturing brain of a young athlete can be catastrophic, athletes under age 18 years should be managed more conservatively. Home Care • An athlete with a concussion should be instructed to avoid taking medications, unless acetaminophen or other medications are prescribed by a physician. Any athlete with a concussion should be instructed to rest, but complete bed rest is not recommended. The athlete should resume normal activities of daily living as tolerated, while avoiding activities that potentially increase symptoms. Equipment Issues • The ATC should enforce the standard use of helmets for protecting against catastrophic head injuries and reducing the severity of cerebral concussions. The ATC should enforce the standard use of mouthguards for protection against dental injuries, even though there is no scientific evidence supporting their use for reducing concussive injury. The following individuals contributed to conception and design; acquisition and analysis and interpretation of the data; and drafting, critical revision, and final approval of the article: Kevin M. Guskiewicz, PhD, ATC – Professor and Director of the Sports Medicine Research Laboratory, Department of Exercise and Sport Science,Inside Story Headlineof North Carolina at Chapel Hill; Scott L. Bruce, MS, ATC – Certified AthUniversity letic Trainer, California State University of PA, California, PA; Robert C. Cantu, MD – Chief of Neurosurgery Service, Emerson Hospital, Concord, MA; Michael S. Ferrara, PhD, ATC – Professor, Exercise and Sport Science, University of Georgia, Athens, GA; James P. Kelly, MD – Associate Professor, Department of Neurology, Northwestern University, Feinberg School of Medicine; Michael McCrea, PhD – Head of Neuropsychology Service/ Neuroscience Program Director, Waukesha Memorial Hospital, Waukesha, WI ; Margot Putukian, MD – Director, Athletic Medicine, Princeton University, Princeton, NJ; Tamara C. Valovich McLeod, PhD, ATC – Assistant Professor, Department of Sport Health Care, Arizona School of Health Sciences, Mesa, AZ. National Athletic Trainers' Association position statement: sport-related concussion. J Athl Train. 2004;39(3). For more detailed information visit http://www.nata.org/publicinformation/files/concussion.pdf Volume 2, Issue 1 Page 6 University Interscholastic League on Concussions The UIL Legislative Council in concert with the Medical Advisory Committee has mandated the implementation of a Concussion Management Protocol for all UIL activities beginning with the 2004-2005 School. While all interested understand that concussion and brain injury are not the only risk associated with participation in extracurricular activities, a comprehensive and standardized plan to deal with occurrences of such injuries is a step in a positive direction for the health and safety of our participants. In order to provide a consistent and safe process for dealing with possible traumatic brain injuries, the UIL has contracted with the Brain Injury Association of America to provide 25,000 Management of Concussion in Sports Palm Cards to the schools and coaches of Texas. These cards were included with the Football Coaches Manual that was mailed to the school. These cards will be the protocol that must be followed by every school when dealing with possible head injuries that occur in any practice or game situation for all UIL activities. These pocket-size concussion cards are designed for sideline evaluation by coaches and/or athletic trainers. Information contained on the card includes a brief explanation on the grades of concussion, management recommendations for the coach and/or trainer, guidelines on when the athlete can return to play and sideline evaluation tests. Changes to The Tigersportsmedicine Web Page When you visit the Tigersportsmedicine Webpage you will notice some changes. • • • • Useful links have been revised. IISD policies on heat, Athlete Safety, and Lightning have been added. Weekly athletic schedules will be found one “click” from the entry page. New photos An injury rehabilitation page is now under construction. Standard rehabilitation protocols, photos, and videos will be added. The most exciting addition will be a secure area of the page where athletes can access their individualized rehabilitation programs. Look for the changes and additions in the near future! Volume 2, Issue 1 Page 7 ~ CONCUSSIONS - “EVEN MILD CONCUSSIONS CAN BE DEADLY” ~ SOME SIGNS OF CONFUSION/CONCUSSION: Confusion can be defined in many defferent ways and listed below are some of the signs and symptoms frequently associated with minor head trauma (a.k.a. “ding,” “Bell Rung,” Dazed). Most categories of impairment appear to be deficits of attention, concentration, information processing speed and memory. We also have suggested some of the means of assessing these signs and symptoms to decide whether the athlete is “clear” to return to action. 1. Thinking deficits: Tests such as the Paced Auditory Serial Addition Task (PASAT), and Trails Making A & B Test have proven to be helpful in identying post-head-trauma residual problems brain function. 2. Lack of sustained attention: Difficulty sustaining adequate focus to complete a task or persevere with a coherent stream of thought can be a sign of poor attention. Repearing digits forward and backward, stating the months of the year in reverse order or counting backwards by a certain interval are ways of identifying this lack of concentration ability. 3. Confused mental status: Disorientation to time, date, place, address and phone number may be helpful; however, recent studies suggest that information relating to the game such as opponent, score, quarter, play was injured on and individual assignment on the play are more relevant to identifying deficits after minor head trauma. 4. Amnesia: Retrograde anmesia usually represents a more serious deficit than post-traumatic amnesia. 5. Dazed look or vacant stare. 6. Slurred or incoherent speech. 7. Vomiting and/or nausea. 8. Slow motor and verbal responses. 9. Emotional liability: Reactions that seem out of proportion and inappropriate, as well as combative and/or aggressive behavior can be seen for a period of time after a concussion. 10. Memory deficits (short-term and delayed memory): A common manifestation is the repeated asking of the same qustions over and over again. Asking for details of the contest, names of teams in prior contests, remembering three words or objects at 0 and 5 minutes and asking about significant recent news events are ways of evaluating memory status. 11. Poor coordination: A recent study indicated an individual’s balance was abnormal for three to five days after a concussion even without other residual signs and symptoms. Tests of strength, coordination and agility, such as finger-to-nose testing and tandem gait observations, can be helpful in analyzing the athlete’s state of coordination. 12. Dizziness.13. Headaches: This is a very important symptom and has been one of the gold standards of clinical symptoms to help determine return to play. 14. Restlessness: Changing position frequently and having trouble resting or “finding a comfortable position” can be manifestations of post-head-trauma difficulties. 15. Neurasthenia and hyperesthesias: Neurathenia, which is nervous weakness, exhaustion and irritability, and hyperesthesias, excessive sensitivity to various ensory stimuli such as touch, pain, light, sound, etc. It is very important that these assessments be done both in the resting state, and if the individual appears “clear,” to ask the athlete to perform many of them after sufficient exercise such as short sprints, push-ups, sit-ups and knee bends to raise the heart rate. If any abnormal signs return, the athlete should be withheld from participation. Prepared by Vito Perriello, M.D., a member of the NFHS sports Medicine Advisory CommitteeNational Federation of State High School Associatioins Volume 2, Issue 1 Page 8 Cold vs Heat Which One When? Most athletes know that you should apply ice to an acute injury, like a sprained ankle, but you might also have heard that heat can be used on injuries as well. How do you know when to use heat and when to use cold, here are a few tips to help you understand. Acute and Chronic Injuries There are two basic types of athletic injuries: acute and chronic. Acute injuries are “new” injuries. They are sudden, sharp, traumatic injuries with a rapid onset (within 48 hours) and possibly severe pain. Typically, acute injuries result from some sort of trauma such as a fall, sprain, or other impact. They are often associated with pain, swelling, inflammation, redness and warm to the touch. These injuries are most common in “contact” sports; such as football, basketball, volleyball, soccer and wrestling. Just remember ‘if you have swelling it is considered an acute injury.’ Chronic injuries are slow to develop, can come and go, and may cause dull pain or soreness. They are often the result of overuse but sometimes develop when an acute injury is left untreated. Chronic injuries are most commonly seen in cross country and track runners, baseball and softball pitchers. They can also be seen in golfers and swimmers, as well as any other sport. Cold Therapy Cold therapy with ice is the best immediate treatment for acute injuries because it can reduce swelling and pain. Ice is a vasoconstrictor (causes the blood vessels to constrict and narrow). This limits bleeding at the injury site. Ice also reduces the pain of an injury and promotes healing. Cold therapy is also helpful in treating some overuse injuries or chronic pain in athletes. An athlete who has chronic knee pain that increases after running may want to ice the injured area after each run to reduce or prevent inflammation. Never ice a chronic injury before exercise. Learn how to properly ice your injury. Time Required: 15-20 minutes 1. Icing is most effective in the immediate period following an injury. The effect of icing diminishes significantly after about 48 hours. 2. Apply ice directly to the injury. 3. Keep the injured body part elevated above the heart while icing--this will further help reduce swelling. 4. Ice for 15-20 minutes, NEVER LONGER. You can do more damage, including frostbite, by icing for too long. 5. Allow area to warm for at lease 45 minutes before beginning the icing routine again. You can and should ice several times a day as long as the injured area has returned to normal temperature. Volume 2, Issue 1 Page 9 Tips for Icing at Home: 1. 2. 3. 4. Ice Option 1 -- Traditional: Use a Ziploc bag with ice cubes or crushed ice. Add a little water to the ice bag so it will conform to your body. Ice Option 2 -- Best: Keep paper cups filled with water in your freezer. Peel the top of the cup away and massage the ice-cup over the injury in a circular pattern allowing the ice to melt away. Ice Option 3 -- Creative: Use a bag of frozen peas or corn from the frozen goods section. This option provides a reusable treatment method that is also edible Ice Option 4 – Alternative: To make your own form of a reusable gel ice bag; add equal parts of rubbing alcohol and water to a Ziploc bag. Remove excess air in bag and freeze overnight. The bag will not freeze completely but instead will make a very cold gel. WARNING: when using these or any over the counter gel pack, be sure to put a barrier between the skin and the bag to prevent frost bite. Heat Therapy Heat is generally used for chronic injuries or injuries that have no inflammation. Sore, stiff, nagging muscle or joint pain is ideal for the use of heat therapy. Athletes with chronic pain or injuries may use heat therapy before exercise to increase the elasticity of joint connective tissues and to stimulate blood flow. Use heat before activities that irritate chronic injuries such as muscle strains. Heat can help loosen tissues and relax injured areas. Heat can also help relax tight or spasmed muscles prior to exercise or competition; you should never apply heat immediately following exercise. Because heat increases circulation and raises skin temperature you should not apply heat to acute injuries or injuries that show signs of inflammation, swelling. Safely apply heat to an injury 15 to 20 minutes at a time and use enough layers between your skin and the heating source to prevent burns. Moist heat is best so you could try using a hot wet towel. Specialty hot packs can be purchased or you may use a heating pad. One should never leave heating pads on for more than 20 minutes at a time or while sleeping. Never use a heating pad on a location where one is laying on the pad– burns can result. Check the skin frequently for redness and undue heating. Be especially careful if you have light colored skin or over bony protuberances such as the tip of the shoulder. Remember– Always consult a physician or health care professional if you have any questions about an injury which does not respond to simple care.