Advocates For Injured Athletes
Thursday, March 13, 2014
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
Monday, February 24, 2014
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
Monday, February 17, 2014
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 4th
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.
Submitted by Heather L.
Clemons, MS, MBA, ATC
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.
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.
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
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.
Labels:
Australia,
BASEM,
Canada,
CASEM,
FIMS,
position statement. British,
SMA,
sports medicine association
Saturday, February 8, 2014
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:
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:
Heather L. Clemons, MS, MBA, ATC
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)
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
Heather L. Clemons, MS, MBA, ATC
Thursday, January 30, 2014
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.
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.
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.
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.
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?
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.
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
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.
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.
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.
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.
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?
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.
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
Wednesday, January 22, 2014
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:
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 1st
team or 2nd 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
Sunday, January 19, 2014
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
Subscribe to:
Posts (Atom)