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Athletic Trainers Key to Diagnosing Concussions in Colorado High Schools

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Secondary School

Athletic Trainers Key to Diagnosing Concussions in Colorado High Schools

Article reposted from The Daily Sentinel
Author: Matt Meyer

Two high school football players collide along the sideline at Stocker Stadium. One wobbles as he pulls himself up, then complains of blurred vision.

Decades ago, this was known as getting your bell rung. Now, armed with an increased awareness and plenty of research on the long-term effects of concussions, District 51 has a clear plan in place to address potential head injuries.

Area football coaches said they’re more aware of head injuries than they were in the past, but at the high school level, there are few changes in on-field technique. For some teams, there is a continued focus on a proper form when tackling. For others, there is a renewed emphasis on the age-old football adage “only hit what you can see.”

For the past several years, coaches have been armed with training, clear guidelines and a state law to limit the damage of potential head injuries.

The process often starts with either coaches or an athletic trainer recognizing that a player might be concussed, District 51 Athletic Director Paul Cain said. Football games, especially those at Stocker Stadium, often have an athletic trainer and sideline doctor present. Other sports, especially on busy days, sometimes might not have an athletic trainer or doctor attending the game.

All coaches, as part of their yearly Colorado High School Activities Association certification, must complete a concussion education course through the National Federation of State High School Associations. This year, more than two million high school coaches nationwide completed the test, which covers concussion protocol and a section for each state’s individual laws regarding concussions.

For Colorado, the law is the Jake Snakenberg Youth Concussion Act. Snakenberg was a freshman at Grandview High School in Aurora who died from Second Impact Syndrome, the result of head injuries sustained in back-to-back weeks. He collapsed during a freshman football game in the fall of 2004 and died one day later. The bill was signed into law in the spring of 2011 and went into effect at the start of 2012. At the time, it was one of only a dozen or so laws addressing concussions in youth sports. Now, all 50 states have variations of return-to-play laws.

Colorado’s law spells out a clear process for coaches, trainers and doctors to follow when a player might have sustained a head injury or is exhibiting concussion-like symptoms.

Dr. Justin McCoy, a primary care sports medicine physician at Rocky Mountain Orthopedic Associates, has worked as a sideline doctor during District 51 sporting events. During his education and residency, McCoy spent time at the University of Arizona, Boise State, BYU and Wake Forest working with Division I athletes. McCoy said he specializes in athletic injuries and, particularly, concussions.

The first line of defense against concussions is recognizing the symptoms, something athletic trainers and coaches are in a better position to accomplish.

“A coach or an athletic trainer spends more time with the athlete and is going to recognize much easier than I would whether an athlete is exhibiting the symptoms of a concussion or is just a goofy kid,” McCoy said. “I rely heavily on (coaches or trainers) to recognize an athlete might be concussed.

“It’s important that coaches and trainers, who are much more familiar with the athletes, recognize the concussion symptoms so we can get them in the locker room and perform more formal concussion testing.”

St. Mary’s Hospital athletic trainer Noah Larsen, who works primarily with Central and Palisade, said athletic trainers play a vital role in recognizing concussion symptoms. Trainers also play a large role in getting athletes ready to return to play, but not before the athlete goes through the medical process.

After an athlete is determined to possibly have sustained a concussion, only a medical doctor, a doctor of osteopathic medicine, a physician’s assistant or a nurse practitioner may clear the athlete to return to competition. Athletic trainers are often responsible for communication with coaches, parents and teachers when an athlete sustains a concussion.

The trainers also lead the athlete through the six stages of concussion recovery, a widely used practice for concussed youth athletes that gained traction during the Third International Conference on Concussion in Sport in 2008. Each stage must be completed without symptoms returning and Larsen said the increase in activity at each level allows trainers to test for lasting symptoms.

The first stage involves recognition and recuperation. If a concussion is suspected and then formally diagnosed, an athlete will likely miss school in the days after a head injury and a medical professional must clear the athlete to proceed to the second stage, which Larsen said consists of light aerobic exercise.

“Maybe 10 minutes walking, jogging or riding a bike,” Larsen said.

If all goes well, the next day an athlete will perform more intense, sport-specific exercises for 20-30 minutes. The fourth stage involves returning to practice in a non-contact capacity and the fifth stage involves full contact in practice. Once the player completes the return-to-play process, trainers notify the medical professional, who clears the athlete to return.

There used to be district-wide imPACT baseline concussion testing, but that was ended after 2013 and a pilot program at Grand Junction was shuttered after 2014. Cain, Larsen and McCoy argued against the large-scale feasibility of testing each athlete. In a perfect world, athletes would receive baseline testing individually, or in small groups, but time, money and personnel don’t allow for that.

Larsen added there were several instances of athletes scoring higher than their baseline after suspected concussion.

McCoy said the most important aspect of a concussion is quick recognition and careful treatment.

“Every concussion is unique, so it’s important to see a doctor,” McCoy said. “It’s important to follow up with the doctor after the initial diagnosis and it’s important to follow the advice and treatment.”