Athletes Saving Athletes Relay the Message walk/jogathon a HUGE success

Thank you to all volunteers, sponsors , athletic trainers and participants who came out to support our event on March 2 ! It was a blast!
We will be updating you soon on all the details , click on the link below to view event day photos!
Thank you to photographer Amy Connor!

http://aconn.smugmug.com/Other/AIA-RELAY/37429959_fxWdWc#!i=3104032023&k=htLhn6J

Overuse Injuries and Burnout in Youth Sports: A Position Statement

Overuse injuries and burnout in sports is not catastrophic in the same way as SCA, neck injuries and EHS have the potential to be, but these are two “hot topic” concepts are making their way through the news these days.  These concepts have become a popular topic of conversation as youth sports continues to be a major focus here in the US.  Overuse injuries may be the physical consequence of the changing youth sports participation (or should I say competition) environment, while burnout is the mental consequence.  The AMSSM position statement does a great job of introducing you to the concepts of overuse injuries and burnout and can provide you key information in a variety of areas, including risk factors, sport specialization and prevention.

OVERUSE INJURIES

According to the position statement from the American Medical Society for Sports Medicine (AMSSM) an estimated 27 million children between ages 6 – 18 participate in team sports, while 60 million children participate in some form of organized athletics (44 million in more than one sport).  Overuse injuries are estimated at approximately 46% across all sports, with lower incidence in sports such as skiing (37%) and higher incidence in sports such as running (68%).  These numbers are attention getters, but even more important to note is that many experts believe these injuries are underestimated in the literature based on how “injury” is defined.

When focusing on overuse injuries, prevention is the best medicine, but also understanding which athletes may be at risk (so you can modify their activity as needed) may be helpful.  The position statement clearly delineates several key factors to help you identify whether your athlete(s) may be at risk.  Parents should be familiar with these factors in an effort to safely navigate the youth sport experience.  Sometimes, more isn’t always better.  Especially in the case of injuries described as “high-risk”.  These are the injuries that can result in a lot of time loss from sport and may even endanger future sports participation.  Do you know what these “high-risk” injuries are?  If not, refer to the position statement.

BURNOUT

“Burnout”, as a psychological term was coined in the 1970s by Herbert Freudenberger as a way to describe the consequences of severe stress and high ideals.  He originally coined this term when looking those in the helping professions who because exhausted and listless, often quitting their jobs because they struggled to balance caring for their patients and themselves, often putting their patients first.

Today burnout is used frequently to describe anyone who is experience emotional exhaustion, alienation and reduced performance (most often relative to a job or work), but a clear definition still alludes the experts.  This idea of emotional exhaustion, alienation from activities and reduced performance has made it into the sports landscape and is a common area of investigation.  Burnout in sports is similar to burnout at work and at its worst often leads to young athletes dropping out of their (once favorite) sport.  As with overuse injuries understanding important risk factors and key signals can help any parent decrease the likelihood of burnout in their young athlete(s).  The position statement lists some key facts to understand about burnout,

In the end overuse injuries and burnout in youth athletes seem to be connected in some ways,  similar risk factors ranging from possible early sports specialization, over training and high performance expectations.  It is important to recognize these potential risk factors and make decisions on behalf of your young athletes to help preserve their health, both physically and mentally.

 

Heather L. Clemons, MS, MBA, ATC

 

 

 

YOUTH SPORTS SAFETY: LOOKING BEYOND OUR BORDERS

It seems each week as I discuss different youth sport topics I am constantly directing you to information made available by a wide range of professional organizations, institutes and associations that most often originate here in the United States.  As I continue to push what I can learn and convey I’ve started to find useful information made available by other countries and international organizations.  The concussion statement out of the 4^th International Congress on Concussion in Sport (Zurich, 2012) is probably the most familiar example of the growing international effort and cooperation on improving youth sport safety.  Keeping this in mind I wanted to introduce you to a few organizations that you may not be familiar with since they are not US-based.  Many of these organizations provide statements that support much of what we know here in the US, but other statements may actually provide new information on a familiar topic or address and sport or activity that isn’t addressed directly in the US.

CANADIAN ACADEMY OF SPORT AND EXERCISE MEDICINE (CASEM)

This group is akin to the American Academy of Sports Medicine (ACSM) and provides direction in a variety of sports and topics.  I bring this group to your attention for two reasons:  1) It provides information on topics (ex. snowboarding) that is harder to come by here in the US and 2) Athletic Trainer is a profession in Canada (it’s referred to as Athletic Therapist) and it is possible to practice as an AT in Canada and vice versa assuming you meet certain guidelines.

Here are some statements published by CASEM that I thought you might find interesting:

Bicycle Helmets (2013)

Abuse, Harassment and Bullying in Sport

In-line Skating (2012)

Head Injuries and Concussions in Soccer (2010)

Snowboarding Injuries (2006)

Violence in Hockey (2007)

Physical Activity Recommendations for Children with Specific Chronic Health Conditions (2010)

The site also provides additional links where you can find more information about other sports medicine organizations around the globe.  One particular link I found interesting was the Sport Concussion Library.

SPORTS MEDICINE AUSTRALIA (SMA)

A comprehensive sports medicine website providing information for providers, parents and athletes alike.  While it appears that there are not direct links to position statements as we understand them here there is a resources and advice section that includes tons of useful information.  This information is divided into fact sheets (injury and sport) and policies and guidelines.  The fact sheets cover common injuries and sport-specific information.  The policies and guidelines are divided to special populations including active children, weather conditions, and health conditions and screening among others.

INTERNATIONAL FEDERATION OF SPORTS MEDICINE (FIMS)

This group is an overarching organization that could encompass all national sports medicine organizations worldwide.  This is a member-based group that functions in a similar capacity as national organization providing educational opportunities for sports medicine providers around the world.  Similar to the ACSM and CASEM, FIMS has provide a series of position statements on a wide range of sports medicine topics.  Some of the statements I thought you might be interested in include:

 

Fluids in Sports (2012)

Female Athlete Triad (2011)

Exercise Induced Asthma (2011)

Vegetarian Diet and Athletes (2009)

Scoliosis and Sports Participation (2008)

Diabetes Mellitus and Exercise

Excessive Physical Training in Children and Adolescents

Eye Injuries and Eye Protection in Sports

Athletes with a Family History of Sudden Cardiac Death

BRITISH ASSOCIATION OF SPORT AND EXERCISE MEDICINE (BASEM)

I put this link in here so that you’re aware of this organization.  The educational tab on the association website focuses primarily on continuing education for its members and doesn’t appear to have on outward, public focus, but the British Journal of Sports Medicine (BJSM) is published by BASEM.  BJSM is a commonly cited journal when addressing current topics in sports medicine.

 

Submitted by Heather L. Clemons, MS, MBA, ATC

Concussion Recognition and Management: Where Are We Now?

Concussions are such a prevalent sport safety topic in the news that I must admit I have days where I don't want to read another article or news story on the topic.  I'm just hoping the day you decide to click on this blog entry you're in the mood to read one more commentary on the topic.  While concussions are not the only injury that can potentially be suffered by our child-athletes, it's the one that has the most legs in the media these days.  This means there is lots of information to sift through when educating yourself. 

I was recently teaching concussion evaluation to a group of students and was looking through the current position statements to see what I wanted to convey to them.  I realized that I had a longer view on the topic given my years in the profession of athletic training and I wondered how I could demonstrate how far we've come in the recognition and management of these injuries despite continued challenges.  The result was an assignment that asked students to compare four different concussion statements by various organizations.  The four statements were:

• National Athletic Trainers' Position Statement:  Management of Sports Related Concussion (2004)
• Consensus Statement on Concussion in Sport (Zurich, 2012)
• American Medical Society for Sports Medicine Position Statement:  Concussion in Sport (2013)
• American Academy of Neurology:  Position Statement:  Sports Concussions (2013)

If completed as directed the assignment would be a table that allowed comparison between statements on a variety of topics ranging from concussion definition, evaluation guidelines, assessment tools discussed, management recommendations, and recommendations specific to youth and adolescent athletes among others.  After completing my answer key for the assignment I began to notice how much we've pushed ahead in just the last 10 years.

Using the NATA (2004) position statement as a starting point and a basis for comparison when reviewing the more recent statements the evidence of changes in practice becomes easier to see.  Many of the things on this list are now more standardized or the supported standard of practice as compared to the guidelines presented in 2004.  Here are some of the highlights I noticed:

• The definition of concussion has been expanded to include descriptions of various injury mechanisms and the pathophysiological response of the brain
• Treating concussions has become an ever expanding team effort
• Grading scales are no longer used to classify concussions in the acute stage
• Same day return to play is not recommended, especially with adolescents and youth
• Various concussion assessments are consistently recommended as a key component of every sideline evaluation and follow up as appropriate, assessments have been clarified and developed to focus on those areas research shows are most impacted by concussion injuries
• Neuropsychological testing continues to be one tool used in the assessment of concussions; but broad stroke baseline testing is not always recommended; it's effectiveness may be better served when using it with specific groups of athletes/patients
• Legislation has been passed in all 50 states that requires concussion education and evaluation guidelines 
• Clear graded return to play protocols are the standard as part of an athlete's return to sports
• Following a concussion athletes must be cleared by a trained medical professional (physician) before returning to play
• Cognitive rest and gradual return to academics has become just as important as physical rest and gradual return to play (although clear guidelines for academic return have yet to be developed, basic recommendations have been provided by the American Academy of Pediatrics)
• We have confirmed via research that teens typically take longer to recover from concussions and it a symptom free return to sport is critical in preventing the possibility of second impact syndrome
• Prevention has focused on education efforts along with legislating key safety steps; despite continued advancement in protective equipment effective prevention starts with limiting the number of head contacts through practice guidelines, game rules and proper techniques

Sometimes it can be hard to sift through all the information out there. but as you see here if we can organize it in a way that allows for easy comparison we can learn a lot about the standard of care and the progress we've made.

Heather L. Clemons, MS, MBA, ATC

Current Popular Topics in Youth Sport Safety

Taking inspiration of the recent State of Union Address I thought I would take some time to scour the Internet to see what types of things are brewing in the area of youth sport safety.  As always, concussions at all levels are a hot topic, but what else has happened in recent weeks that you might have missed?

 
Padded Caps Approved for MLB Pitchers
This has been a widely reported story in recent days.  I applaud MLBs efforts to address a growing problem in professional baseball.  If pitchers make the decision to wear the caps (it’s currently optional) it may protect them from hits directly to the front and side of the head.  I do have concerns that it may provide a false sense of security given the fact that it does not protect the face, jaw or ear region of the head and face.  Some of the most severe injuries of late resulted in hits to the head in the ear area; a region not currently protected by the new cap.  Perhaps this is the first step to face shields at all levels of baseball.

New York City Councilman Proposes Youth Football Safety Act

Councilman Levin has proposed legislation that will require a physician and/or athletic trainer be available at all youth football games and full contact practices for teams that use Department of Education or Parks and Recreation fields in New York City.  The leagues impacted by the legislation would be PSAL, Catholic High School League and Pop Warner.  The proposal has been supported by the New York State Athletic Trainers’ Association (NYSATA).  I hope this move is the beginning of mandating necessary coverage with all youth sport leagues around the country.

Girl Soccer Players Play With Concussions

Recent research from the University of Washington shows that young girls often continue to player soccer through concussion symptoms.  Additionally, many of them did not seek evaluation, even after the match concluded.  It’s not just young football players who want to continue to play after suffering a concussion, you must be diligent with all youth sports.

Friday Night Tykes Continues to be a Hot Topic

Sports at a young age are supposed to be about fun and learning sport and life skills, but Friday Night Tykes is quite the opposite.  The growing concerns regarding the culture and behaviors chronicled in the show continues.  The concern has grown to such a level that the National Athletic Trainers’ Association has issued an official statement regarding the show and its disregard for player safety.

Are Hit Counts Going to Become the Reality in Youth Sports

Supported by the Sports Legacy Institute, Hit Count® is a program that utilizes impact sensors to track the number of hits a player receives in any given game or practice.  If a player receives a certain number of hits (20G force or greater of linear acceleration) they would be removed from play.  There are some concerns whether the program is realistic given the cost to implement the program.  Also, can it be implemented in non-helmet sports such as soccer?

Researchers Test a Protocol to Diagnose Heart Conditions That Could Lead to SCA

Efforts continue to find an appropriate and fiscally reasonable test that could be included as part of a typical sports pre-participation physical to detect potentially fatal heart conditions.  The intention would be to reduce the incidence of SCA in young athletes.

Surveyed NFL Players More Concerned About Knee Injuries

A recent anonymous survey of over 200 players shows that players are more concerned with sustaining a knee or leg injury since it is seen as potentially more immediately career end than suffering a concussion.  This is despite the available information that continues to demonstrate the long-term effects of suffering repeated concussions.

Submitted by Heather L. Clemons, MS, MBA, ATC

How Does your School Stack Up on Sport Safety?

The intention of this week’s post is to help parents understand how to assess their child’s school sports safety program.  The focus will be on high schools, since most legislation and policy standards focus on school sponsored activities.  This doesn’t mean that you should not hold your youth league organizations to the same standard, but it just means they may not be held to the same legal standards depending on the legislation on record in your state.  There are a variety of resources and programs that can give you a glimpse into various programs that can help parents.  I will highlight the NATA’s Safe School’s Program and policy resources available via the Korey Stringer Institute.  I selected these organizations because I believe they provide the most useful information in one place, making it easier for parents to access as much information as possible with as little searching as possible.

KOREY STRINGER INSTITUTE RESOURCES:

 

KSI, led by Executive Director Doug Casa, PhD, ATC, FACSM, FNATA (check out his previous blog feature), is focused on policy-making, education, research and advocacy in the area of preventing sudden death in athletics.  A particular area of expertise for KSI is exertional heat illness (EHI), but time is spent addressing other conditions that could lead to sudden death (Just check out their education and research tabs).  As part of the policy-making arm KSI has developed a series of policy recommendations for states when trying to make youth (especially HS) sports safer.  KSI has taken the time to create graphics that can help you understand whether or not your state meets any or all of the recommended guidelines in a specific area.

Guidelines for High Schools are available in these areas:

 

Heat Acclimatization

Concussion

Emergency Action Plan

Automated External Defibrillator

Coaching Education

Wet Bulb Globe Temperature

These graphics are relatively easy to understand and allow you the option to click on your specific state and “drill down” to the specific policies that may or not be in place.  For example, if you’re interested in understanding more about heat acclimatization guidelines be sure not to scroll past the summary information to get to the interactive map.  This summary information clearly delineates the research supported KSI recommendations (which you’ll need to know to understand the map).  Once you know the recommendations go ahead and see how you’re state stacks up to others based on the overall graphic.  If you want to know the specific recommendations your state meets, click on your state to learn more.

 If you want to be an advocate for your state and get all KSI recommendations supported, KSI is willing to work with individual states to get guidelines in place, if it’s not already happening.  There are many states that do not have all the recommendations in place at the high school, so there is work to be done.  Ultimately, I would love to see these guidelines be required with youth sport organizations as well.

NATA SAFE SPORTS SCHOOL:

The Safe Sports School Award is a recognition program initiated by the NATA in March 2013.  A review of the application packet delineates all the guidelines for being designated as a 1^st team or 2^nd team school.  First team schools meet all recommendations, while second team schools only meet required recommendations.  The list of requirements include:

 

 

 

• Create a comprehensive athletic health care administrative system
• Provide or coordinate pre-participation physical examinations
• Promote safe and appropriate practice and competition facilities
• Plan for selection, fit, function and proper maintenance of athletic equipment
• Provide a permanent, appropriately equipped area to evaluate and treat injured athletes
• Develop injury and illness prevention strategies, including protocols for environmental conditions
• Provide or facilitate injury intervention
• Create and rehearse venue-specific Emergency Action Plans
• Provide or facilitate psychosocial consultation and nutritional counseling/education
• Educate athletes and parents about the potential benefits and risks in sports as well as their
• responsibilities

 

The application clearly delineates what each of these concepts include and of those which are required and which are recommended.  The NATA does not dictate how the school and/or district works to meet these requirements outside of utilizing current position statements to develop relevant policies and procedures.  A few other things that you need to about this award program are 1) there is a non-refundable application fee and 2) the application packet clearly states that award designations are made by the NATA, based solely on the information reported by the school.  There is no submission of supplemental documentation or on-site verification required.  As an individual professional I would like an additional verification process, but that does not mean the award is not a useful designation when it comes to understanding the level of commitment to athlete safety at your child’s high school.

Once you understand where you’re state, league and high school stands on these safety recommendations you become better prepared to protect your children during sports participation.  It is always important to follow up with your school and understand how specific policies are executed beyond the general recommendations delineated here.  The ability to execute these policies and procedures in an emergency is what truly protects athletes.  Proper execution requires regular review and hands-on practice of policies and procedures. 

So, does your school meet the recommended guidelines?  Are the relevant emergency procedures practiced regularly?  If you can answer “yes” then your child is participating at a safe school.  If the answer is “no”, it doesn't mean your child's school is completely unsafe, it may means there is still some work to do.  What are you doing to make things better?

Heather L. Clemons, MS, MBA, ATC

Condition Highlight: Commotio Cordis

The calendar has turned to January bringing a new year and the beginning of spring sport seasons for many (especially at the college level).  As colleges ramp up for the start of softball, baseball and lacrosse seasons high school and youth seasons are not far behind.  These sports along with field hockey, ice hockey and other sports that use high-velocity, low mass balls (as compared to football, basketball and soccer balls) can put youth athletes at risk for certain injuries.  Eye injuries can be more common in this sports where protection is not required (think some racquet sports too), but there is also concern for commotio cordis.  Commotio cordis is a rare and potentially fatal cardiac condition that is the result of a blow to the chest by a blunt object.  Today’s post is going to highlight some of the basics of this condition.

UNDERSTANDING COMMOTIO CORDIS

Commotio cordis (CC) is a condition that can lead to sudden cardiac arrest (SCA) as the result of a blunt trauma (blow) to the anterior chest.  This blow results in a ventricular arrhythmia and ultimately death.  It is different than other cardiac conditions that can lead to SCA because it is not the result of an undetected electrical anomaly in the heart.  CC is an extremely rare condition because the precise nature of events that must occur to lead to an arrhythmia.

 

For CC to result a potential victim must be struck directly over the left ventricle of the heart during the upstroke of the T-wave of the heart rhythm.  In other words, there is an extremely small window in which the ventricular arrhythmia will occur.  You must be struck in the chest over the heart during a specific point in the heart rhythm.

Heart rhythm graphic:  Understanding wave parts

 

Current statistics show about 20 events annually on the national registry, but there is some belief that there is some underreporting due to poor recognition and underreporting.  Other statistics include:

• 80% are white
• 95% are male
• 10-18 year olds are most susceptible with 75% under 18 and 26% younger than 10
• Survival rates have increased from 10 to 58% thanks to increased availability of AEDs in recent years

If you’re reading this wondering what prevention steps you can take, check out the Korey Stringer Institute (KSI) link.  The following resources are some of the most useful in understanding the condition and recognizing it. 

ADDITIONAL RESOURCES

KSI:  Commotio Cordis

Louis J. Acompora Memorial Foundation

Commotio Cordis (Review published by Sports Health)

National Athletic Trainers’ Association:  Official Statement on Commotio Cordis

KSI:  Publications Database (Cardiac Conditions)

 

Rubber Crumb Safety: EPA "Steps Back" From Previous Statements

As I do on an almost daily basis I scan the news for interesting stories that relate in some way to sport safety.  A story that caught my attention as we were all preparing for the holidays was research published by the Environmental Protection Agency (EPA) discussing the safety of the recycled rubber used as part of the infill on  many athletic fields, putting greens, parks and other outdoor spaces.  These artificial fields are often referred to as “Field Turf”.  Field Turf ® is actually the name of a leading company that designs and constructs many of the artificial fields that use plastic grass (fiber), sand and recycled rubber tires to construct many of the natural grass-like fields utilized on a daily basis.  According to information on its website it has installed over 7,000 fields (15,000 total projects) and considers itself, “the safest, longest lasting, and highest performing artificial turf system available.”   These artificial turf systems came to be after the concerns that initial attempts at artificial surfaces (think 1966 Astrodome) were actually increasing the number of injuries (especially knee) to the athletes that played on them.  While it appears that these new systems have decreased orthopedic injuries to some degree there are still questions regarding the safety of the small rubber pellets (aka crumb rubber) used in the system generated from recycled tires.  The EPA addresses previous study results these rubber pellets.

UNDERSTANDING FIELD TURF CONSTRUCTION:

According to FieldTurf® a solid system includes fiber, infill and backing.  A video on their website can help you understand how these components work together to create a more realistic artificial surface.  The fiber is the component of the field that looks like grass, but is intended to be more durable and reduce skin friction common with artificial surfaces.  The backing is what allows the fibers to be connected in rows and helps the surface maintain its integrity.  The infill, the area of focus of the EPA study, is most often a combination of sand and rubber pellets that is worked into the spaces between the fibers.  The ratio of sand to rubber is adjusted depending on the desired field performance characteristics.

FieldTurf® states that their patented infill system is what makes the difference in safety (injury reduction), durability, drainage and performance as compared to other artificial field systems.  It is not the within the scope of this post to discuss the drainage, durability and orthopedic safety of these systems.  According to FieldTurf® there are two parts to the infill:  silica sand and cryogenic rubber.  These two components are layered in specific way (see website) to create appropriate performance characteristics.  The top most layer of field turf is large cryogenic rubber pellets.  These rubber pellets are created from recycled tires that are cryogenically frozen and turned into granules.  They account for 30% of the total weight of the infill, approximately 216,000 pounds of rubber for a typical field.  

CURRENT HAPPENINGS:

The EPA was recently in the news around the topic of crumb rubber (the rubber used as part of infill on most synthetic fields) because it was asked to retract comments it made regarding the safety of crumb rubber based on 2009 research study.  Citing results from the 2009 study, the EPA assured consumers that crumb rubber was safe despite finding trace levels of lead and other chemical compounds in the crumb rubber.  As of December 2013 the EPA has now updated its website and crumb rubber fact sheet to more accurately reflect that it is unsure of the effects of the chemicals in crumb rubber on children.  The EPA has also made clear that more research is needed.  Review of the updated information includes an extensive list of compounds in crumb rubber that includes acetone, arsenic, benzene, nickel, latex, and lead among others.  I encourage you all to read these updated statements to better understand what crumb rubber is.  As a precaution the EPA states, “Both the Consumer Product Safety Commission and the Centers for Disease Control and Prevention recommend that young children wash their hands frequently playing outside and before they eat.  The EPA also recommends these practices.”

There are many other resources out there that come down on both sides of the debate regarding crumb rubber.  FieldTurf® has compiled this report that says it includes independent research to support the safety of crumb rubber.  The New York State Department of Health has a fact sheet (as do many other states).  Other sources for you to review in order to get a fuller picture of the debate include:

Protecting Employees Who Protect Our Environment (PEER):  Correspondence with EPA

Safety Concerns When Re-Using Infill on Artificial Athletic Field (Turf) Installations (2012)

Safety of Artificial Turf Containing Crumb Rubber Infill… (2010)

Review of Impacts of Crumb Rubber in Artificial Turf Applications (2010)

In the end, as with any safety issue that affects our children each parent must make a choice they are comfortable with.  Field installation companies continue to tout the safety of these fields and the studies on crumb rubber continue in efforts to have more conclusive results in one direction or another.  Finally, there are towns that have taken matters into their own hands and fought to have fields and playground components that include crumb rubber removed.  It’s not my place to tell you where to come down on this issue, but as always to help you educate yourself on the issue and let you decide.