Posted on

Ole Miss Athletic Trainers Talk Concussions

After suffering a concussion Oct. 17, Ole Miss defensive tackle Robert Nkemdiche needed six days to complete the team’s protocol for returning from the injury.

However, the junior still missed the Rebels’ game last Saturday against Texas A&M, one day after being cleared, because he experienced symptoms that morning. Nkemdiche is expected to return for Saturday’s 11 a.m. road game against Auburn.

While incidents such as Nkemdiche’s aren’t out of the ordinary, Shannon Singletary, Ole Miss senior associate athletic director of sports medicine/strength and conditioning, said while speaking in general, they do illustrate the difficulty of treating an athlete who has received a concussion.

“It can be very similar to delayed onset muscle soreness,” Singletary said. “You lift weights really hard on Tuesday, you don’t get really sore until Thursday or Friday. Sometimes they go through that contact practice, no symptoms all along, they’ve done great all week.

“It may take 24 hours (for a reoccurrence of symptoms). ‘You know, I’m not recovering as quick as I would have normally.’ You’ve got to listen to that.”

All NCAA teams follow the same protocol, which is comprised of objective and subjective tests over multiple days, to treat athletes returning from a concussion.

A football player who suffers one in a game Saturday must wait until he is symptom-free, usually about one or two days, to begin the concussion treatment.

The first step is the ImPACT exam, which has around 30 questions and takes about 30 minutes to complete. The computer-based test measures memory and reaction time, and players can pass only if their results are comparable to the baseline score they received when they took the test following their arrival on campus as a freshman or a transfer student.

Once cleared, they complete an exercise such as riding a stationary bicycle or using a step machine in an effort to raise their heart rate to see if symptoms return. If none do, athletic trainers raise the intensity by making the athlete sprint or lift weights.

Athletic trainers rely upon athletes being honest about a reoccurrence of symptoms that can’t be diagnosed, such as blurred vision. Others, such as sensitivity to light, can be spotted.

To help combat what Singletary calls the “tough guy” or “tough coach” aspect of athletes trying to rush back, they undergo an objective test for balance, which includes three 20-second parts: standing with feet together; standing on one leg with the other lifted and bent; and standing with one foot in front of the other, all with the athlete’s eyes closed and hands on his or her hips.

Points are deducted each time the athlete sways out of the starting position. His or her score is compared to the baseline test the person takes every year.

If there are no setbacks, players return completely to practice usually by Thursday, five days after their concussion. If they experience symptoms again, they repeat the step one day later.

Athletic trainers don’t stop working with players until determining they’re fine following their first competition after being cleared, usually a week following the concussion.

An important part of the process, Singletary said, is following up each day with athletes with questions such as what was it like when stepping outside that day or how did reading go in class. These test the patient’s sensitivity to light and ability to concentrate.

Head football athletic trainer Pat Jernigan stressed the importance of athletes being knowledgeable about concussions. Ole Miss athletes sign a form stating they will take responsibility for reporting injuries or illnesses and are given information about concussions.

“Back in the ’70s, ’80s and probably early ’90s, it was, ‘You’re fine to go back,’” Jernigan said. “It seems like it always take a generation for all that to catch up. Kids are more apt to say, ‘Hey, something happened, I’m not feeling right’ than to not say anything.

“It’s not your ankle. This is your brain. You have one of them, so you got to take care of it.”

Contact Daniel Paulling at dpaulling@jackson.gannett.com. Follow @DanielPaulling on Twitter.

ORIGINAL ARTICLE:
http://www.clarionledger.com/story/sports/college/ole-miss/2015/10/29/nkemdiches-concussion-shows-difficulty-treatment/74824400/

Posted on

Concussions in women’s soccer closing the gap on football

Olivia Homer always knew whom she’d defend whenever her Monmouth Academy soccer team stepped on the field.

“The biggest and the fastest,” said Homer, 16, a junior.

Fearless yet standing just 5-foot-2, Homer embraced that challenge.

But after suffering two concussions in a little less than two years, she had to give up the sport she’d loved since kindergarten out of fear for what a third would do to her quality of life.

“Right now, I guess I’m a little worried,” said Homer, who still experiences migraine headaches she attributes to the concussions. “But I’m not as scared as I would be. I think that I’d be more scared if I was playing.”

• • •

Homer says her decision to not play soccer this season was difficult. She and teammate Haley Fletcher dreamed of being team captains for their senior years.

Yet doctors and athletic trainers say athletes who decide not to play a sport after suffering a concussion are making the correct decision if they can’t overcome fears of another one.

But are these fears founded?

A recent High School Sports-Related Injury Surveillance Study shows that concussions are more common in soccer, particularly in the girls game. Furthermore, the data also shows the gap between girls soccer and football is not as wide as commonly perceived.

The survey collected information on 20 sports from 100 American high schools between 2005 and 2014 and found that for every 10,000 “athlete exposures” (times a student-athlete played soccer in a game or in practice), 4.5 girls and 2.8 boys suffered a concussion.

Only football (6.4), boys hockey (5.4) and boys lacrosse (4.0) had higher rates.

In all gender-comparable sports, such as soccer and lacrosse, girls had a higher rate (1.7) than boys (1.0).

Another study from the National Athletic Trainers Association also showed concussions in girls soccer are more prevalent. The national study, which was based on information from the 2005-06 high school sports seasons, showed girls soccer had a concussion rate of 51 (out of 1,000 exposures). Boys soccer, meanwhile, had just 33 while football came in at 201.

Experts say a number of factors could account for the high rate in girls soccer, from physiological and playing style differences to girls possibly being more likely to report a head injury.

Furthermore, athletes who’ve suffered a concussion at any time in their lives have an increased risk of suffering another, according to the Centers for Disease Control.

In soccer, the greatest risk comes from collisions resulting from trying to head the ball and not — as commonly believed — from head-to-ball contact.

“The real problem we’re seeing is athlete-to-athlete contact and, particularly in women’s sports, head-to-head contact, head-to-shoulder, head-to-body contact,” said Tim Weston, head athletic trainer at Colby College and District One director for the National Athletic Trainers Association.

According to a 2007 report by some of the same Sports-Related Injury Survey authors, only motor vehicle accidents trump athletics as the leading cause of concussions among individuals 15 to 24 years old.

Homer suffered her first concussion in a July 2013 car accident, just days before she was to start soccer practice as a freshman. She missed a couple of games due to headaches but she was mostly symptom-free once school started. She wore headgear through the season with the hopes of preventing another concussion.

She made it through that season and last fall without incident and earned the trust of coach Gary Trafton, who assigned her to mark St. Dominic’s Faith Grady, Madison’s Kayla Bess and other top players in the Mountain Valley Conference.

While playing indoor soccer last March, Homer got knocked down. She got back up and started playing again, only to be knocked down a second time. This time, she fell on her shoulder and her head snapped toward the ground. She remained conscious, but immediately felt dizzy and confused when she got back on her feet.

A doctor in attendance examined Homer. He told her and Susan Norton, Homer’s mother, that he didn’t think she needed to go to the hospital immediately, but recommended they see their primary care physician the next day. He also reminded them to keep a close eye on any symptoms.

Homer’s symptoms worsened overnight and she was diagnosed with a mild concussion the next day.

The symptoms continued to get worse and left Homer confined to her bedroom.

“I had to be in a dark room,” she said. “The lights were so sensitive. It was hard to see. It was hard to think. I just had to lay and do nothing.”

It took her two weeks to get back to school. Even then she could only do half-days at first, and she would spend most of that time alone in a dimly-lit conference room because she was still sensitive to light and noise.

“That’s when I started to realize that sports would be different, school would be different,” Homer said. “The second one hit me so hard. It was diagnosed as moderate, but it felt severe. It took me a while to fully feel better. And I still get headaches. I think from the concussion I got migraines.”

“I just never really came back the same,” Homer added.

Homer’s story mirrors some of the ones told by pro and amateur football players. Athletic trainers and doctors credit the publicity surrounding brain injuries in American football with raising the public’s consciousnesses of concussions in general. But they believe public perceptions of other sports can end up skewed by football’s high-profile battle with concussions and possible long-term consequences, such as chronic traumatic encephalopathy (CTE).

“The focus on football, I think, has done wonders in terms of saying concussions are important and it’s provided media coverage and resources to the science. But what it really has done is skewed to say football is bad and everything else is good,” said Dr. Paul Berkner, director of the Maine Concussion Management Initiative (MCMI) at Colby College. “We have parents making decisions about concussion risks that are not informed.”

Added Dr. Chris Lutrzykowski, who specializes in non-operative medicine, including concussion management, for Maine General Health in Augusta: “The pendulum has swung from blowing off a possible concussion, and I think it has swung a little too far with parents making choices for kids (out of fear of injuries).”

Nevertheless, coaches, parents and the athletes who’ve suffered concussions are asking questions.

“I see a lot of coaches who are much more educated with regard to concussion management, and parents are as well,” Weston said. “I certainly get more questions from parents like ‘What are the long-term effects for my son or daughter. What is going to happen down the road?’”

Medicine has made great strides in concussion management in just the last decade, and Maine high schools — spurred by a 2012 state law that required them to have a concussion management program — are now more equipped than ever to determine if and when an athlete can return to action.

Many Maine high schools use the program ImPACT, a computerized neurocognitive test that establishes a baseline score for athletes who have been diagnosed with a concussion to match before they can play again. MCMI partners with schools to collect the data, and, with the help of a federal grant, hopes to work with more schools in launching the Head Injury Trauma program, which it says will make it easier for athletic trainers and school officials to record and track concussions.

Baseline testing has its flaws, chief among them being that there is no way of knowing whether test-takers tried their best or simply slacked off to establish a lower baseline score and improve their chances of returning if they do suffer a concussion.

“Pre-concussion testing can be a useful tool, but it’s nowhere near a panacea,” said Chris Sementelli, an athletic trainer for 29 years and program director for Maine General Sports Medicine.

Athletic trainers work closely with schools and sports medicine physicians to help manage concussions, a relationship that has become more common in the state since the 2012 legislation. Public education and media coverage of concussions has athletes, coaches and parents more aware of concussion signs and symptoms, which in turn gives the medical professionals critical information to help the athlete.

“The difference in concussion management has been the improvement in recognizing the signs and symptoms,” Lutrzykowski said. “One of the key pieces of managing concussions is now we’re better able to recognize them.”

Even with access to more information, there is still much medicine does not know about the repercussions of and recovery from concussions. There are many questions a doctor or athletic trainer can’t answer, such as what will happen if an athlete suffers another concussion.

That can cause a lot of uncertainty in a young athlete, and uncertainty doesn’t translate well to the field.

“A key to getting an athlete back to playing after a concussion is working through that piece of fear,” Sementelli said. “I will not let an athlete back on the field unless they have full confidence in themselves.”

Homer didn’t step near Monmouth’s soccer field when the preseason started and might have avoided it altogether if her coach, Gary Trafton, and her teammates didn’t encourage her to come back as the team’s scorekeeper. She was worried about the temptation to play again.

“I was really close, I think (to trying to play again). At the first game, I started to think, ‘Well, I can be out there. I can play,’” Homer said.

Homer hasn’t missed any school time this year due to her concussion. Without any noticeable symptoms, other students sometimes have a hard time accepting that she has given up her favorite sport.

“She’s had to develop a thick skin,” said Norton, her mother. “She feels like she’s constantly had to defend herself.”

“They think that they would play, but they don’t know exactly what goes on in my head. The headaches I still get sometimes will still feel like I have a concussion,” Homer said.

Norton and Homer said they understand too well how much perceptions about concussions still need to be changed.

“They haven’t had to face their future. You don’t think about it until you’ve had a concussion so bad that it took you out of school,” Homer said. “I’ve had a lot to learn.”

ORIGINAL ARTICLE:

Heads up: Concussions in soccer, particularly in girls game, a concern

Posted on

David Hamen and Aaron Sage implement New Ohio guidelines

When high school football practice begins for the 2015 season in Ohio on Saturday, coaches and players will be functioning under a new set of national guidelines addressing concussions, which was adopted and introduced by the Ohio High School Athletic Association on July 13.

In a memo to the OHSAA membership of more than 700 high schools, commissioner Dan Ross said the association “has joined dozens of states in adopting recommendations from the National Federation of State High School Associations’ Concussion Summit Task Force, which will reduce the risk in football for concussions and head impact exposure.

Ross has long stated that the top priority of the OHSAA is the safety of its athletes, and the new guidelines are designed to give football coaches some direction in the intended reduction, recognition, and treatment of head injuries in practices and games.

“With the support and leadership from the football coaches association, we have been out in front of concussion awareness and education, and these changes will now bring Ohio up to a place as a national leader in this area,” Ross stated in the memo. “Like many of our regulations, these guidelines are to be followed and monitored by member schools and coaches, but we are fortunate in Ohio that many coaches have already been following these safety measures.

“There will always be a risk for concussion, but football is safer now than it has ever been, and these guidelines will make it even safer.”

According to the OHSAA memo, the three principles that the guidelines reflect include exposure of an individual athlete to full contact in terms of frequency and duration, the cumulative effect of the exposure on an individual athlete, and recovery time for each athlete after contact.

The recommendations adopted include spring, summer and all off-season contact. Already the rule in Ohio, there is no contact permitted except during the season, and pads may not be worn at any time except during the season.

The new guidelines are aimed at preseason practice and practice during the season.

New to preseason practice, full contact will be limited during two-a-day practices.

When more than one practice takes place in a day, full contact is permitted only during one of the practices. Further, if full contact occurs during the second session of two-a-days, full contact will not be permitted during the first session the following day.

Once the season has begun, individual athletes are limited in full contact on consecutive days to 30 minutes in practice per day and to 60 minutes per practice week. An athlete can only be involved in full contact in a maximum of two practices in a seven-day span.

Contact with soft equipment such as bags, shields, sleds, etc., does not count toward full contact limitations.

“These regulations are being put into place for the safety of our student-athletes, and it is incumbent on coaches to monitor the contact in their practices,” Ross said. “Our coaches are educators and leaders. They want what’s best for kids, and these regulations are in line with these safety recommendations.

“These regulations will evolve and may become more restrictive as additional concussion research emerges.”

Adapting to the changes

The changes adopted by the OHSAA will not be viewed as drastic to most Ohio high school football programs, as many coaches had already become more vigilant to the potential for head injuries.

Head coaches at three of the Toledo area’s top football programs from recent seasons each said they have long been aware of the danger of concussions, and that the safety of their players is paramount.

Last season, coach Matt Kregel’s Perrysburg team finished 11-1 and was the top-ranked Division II team in Ohio. Greg Dempsey has coached Central Catholic to three state playoff championships in the past 10 years (2005, 2012, 2014). Whitmer’s Jerry Bell guided his 14-1 Panthers to a Division I state runner-up finish in 2012.

“I think we’ve always done a good job of controlling the hitting,” Kregel said. “We don’t have enough kids to two-platoon, so we have to monitor the hitting ourselves. I don’t think [the new OHSAA rules] will have a huge effect on us and how we coach things.

“We monitor ourselves. It’s a common-sense approach. We’ve always done it this way, and the good coaches in the area that I’ve talked to have said they’ve always done it this way.

“I don’t think this is going to have a huge effect on how guys coach high school football. At least for the guys who do the right thing and are concerned about the kids.”

Safety is first and foremost.

“I definitely think things have to be done to protect the kids that participate in football,” Dempsey said. “And, by doing so, you’re protecting the future of the sport.

“You definitely need to be better educated, and there needs to be some parameters set.

“I’d say 99 percent of the coaches are doing it right. But there’s some people who, for whatever reason, usually cause rules like this to be put into effect.”

Even though they already have the athletes’ safety in mind, there will be extra incentive for coaches to adhere tightly to the full-contact limitations.

“All it takes is one parent who’s unhappy with playing time to say ‘You’re hitting too much throughout the week,’ ” Bell said. “We’re going to monitor that throughout our practice plans and make sure we have it right.

“It’s for the safety of our kids. When you look at the way people are practicing nowadays, I think that we already err on the side of caution with concussions to begin with in making sure that the drills we’re doing are putting safety first, and teaching kids the fundamentals of the game.

“Over the years, we’ve learned how to do that without full contact. We want our kids healthy throughout the season, especially with the schedule we play. When I look at the new rules, it really doesn’t change much in how we practice. We’ve been doing this for years.”

Out with the old

Kregel, Dempsey, and Bell have each been around the game long enough to see the evolution of high school football practice from a more physically demanding and dangerous past to today’s more sensible training methods.

That includes greater awareness of head injuries.

“You can’t beat your kids up,” Kregel said. “There were years in the past when everybody was two tight ends and I-formations when that’s all you did was line up and bang. That’s not the case anymore. The guys who have sense will do it the right way.

“The guys who want to stretch the rules and do it the wrong way, I think that’s who this rule is for — to protect those kids. At the beginning of two-a-days, you’ll still have some kind of one-on-one, man-up kind of drills. You’ll do that for 10 minutes. Everybody bangs, and then you go to the next drill.

“But you do something where you’re not hitting full speed. We never just line up and knock the living crap out of each other for an hour and a half.

“I think that’s the direction football is going in. It’s not blood and guts and knocking the crap out of each other. You have to be smart about how you conduct business.”

Dempsey believes today’s high school football is a much safer version of the game.

“I feel better about kids playing football now than ever because of the awareness and the education and the protocol,” Dempsey said. “We’re much more aware and, when an event happens, the protocol for a kid’s return is much safer.

“If a concussion happens, it’s something we’ve got to watch. If two of them happen, it’s something we’ve really got to watch. Right now, I believe it’s as safe as it can be to play football.

“I think we know more about [recognizing concussions] now. It used to be macho to hide stuff as a player, and coaches used to make remarks about a kid having ‘his eggs scrambled’ and stuff like that. It’s much different now. You might even have some things now that are labeled as a concussion that really aren’t. But it’s better to err on the side of caution than it is to ignore it, which is what used to happen.”

Bell sees current high school coaches as much more enlightened regarding the dangers of the game.

“Overall, our coaching profession is very good at understanding the game and understanding the fundamentals, and how to teach the kids the fundamentals without putting them at risk,” Bell said. “The days of you running drills like ‘bull in the ring’ are long gone at the high school level. “With the research that they have done on concussions, and looking at long-term factors for kids with how it can impact them as adults, us being proactive on this is a step in the right direction.

“We can teach and do our jobs without having to put our kids at risk during the training sessions, and still have them function at a high level and be able to make a sound tackle and a good block with these new procedures in place.”

A watchful eye

According to information provided by the Mayo Clinic, signs and symptoms of a concussion might include headache or a feeling of pressure in the head, temporary loss of consciousness, confusion or feeling as if in a fog, amnesia surrounding the traumatic event, dizziness or ‘seeing stars,’ ringing in the ears, nausea, vomiting, slurred speech, delayed response to questions, appearing dazed, and fatigue.

Coaches might not have the ability to diagnose such symptoms, but they have athletic trainers on hand at nearly all practices and every game, and many high school games are staffed by a team physician.

Perrysburg, Central, and Whitmer have a team doctor on hand at every game.

The coaches rely heavily on their athletic trainers to recognize potential concussions. Whitmer, like many area schools, utilizes athletic trainers provided through Mercy Sports Medicine, a division of Mercy Health.

Athletic trainers David Hamen and Aaron Sage work full-time with Panther athletics.

Hamen has been an athletic trainer since 2003 after earning his bachelor of science degree from Bowling Green State University. He has worked with Whitmer athletes since 2008.

As the 2015 football season approaches, Hamen has been busy utilizing one of the most important tools available to medical personnel in recognizing concussions.

He has been conducting what is called baseline testing for all of Whitmer’s fall season athletes who will be competing in contact sports. Nearly the entire football team has already been tested and placed in the accompanying computer system.

The trainers utilize Mercy Health’s ImPACT evaluation procedure to help diagnose concussions in athletes.

ImPACT, which stands for Immediate Post-concussion Assessment and Cognitive Testing, utilizes neurocognitive baseline and post-injury testing to evaluate the athlete’s normal cognitive ability (baseline) versus his or her cognitive ability after a head trauma.

Mercy Health touts that this procedure — comparing baseline to post-injury function — as “the most scientifically validated computerized concussion evaluation system.”

In a nutshell, each individual athlete takes an online test to establish his or her normal “baseline” cognitive ability. When a possible head injury has occurred, athletes are retested to see if there has been a measurable dropoff in their cognitive performance.

“It’s a series of different tests,” Hamen said of ImPACT. “Some of it is a memorization of words, some of it is memorization of shapes or patterns. It gives us a baseline for where the kids are [in normal cognitive state].

“If we ever suspect there is a concussion, we’ll have the kid sit down and take the test again. It will give us a readout of where they were initially and where they are now. Depending on the score, it will give us a better idea if there’s a potential concussion there, and to seek further help. It’s a tool for us to help identify concussions, and to protect our kids.”

The high school football season, for most Ohio teams, begins Aug. 28.

ORIGINAL ARTICLE:

http://www.bcsn.tv/news_article/show/537483