"THE TRAINERS CORNER"

by Sean Hurney (St. Andrew’s Certified Athletic Trainer)

Welcome back to the Trainer's Corner. Every month's tips are also included as I feel this information is important to review on a regular basis. All tips, links, and information are important.

Important Information:

St. Andrew’s has extra custom made mouthguard kits, O-Pro, that can be purchased for $45.
Energy drinks and supplements are widely available to athletes and sold over the counter (like GNC). Most are not regulated by the FDA so there is no guarantee that what is on the label is actually in the product. Harmful substances may also be present in these supplements and we would not even know. Just because they say natural does not mean that they are safe.
All athletes at St. Andrew's will have the opportunity to take a computerized cognitive test before their sports season. The purpose of the software is to establish a baseline reading for each athlete. If a concussion is sustained during a season, this baseline will help your medical team in their evaluation process. Using the software will help take the guesswork out of concussion management and “return to play” decisions. This innovative program is called ImPACT ( Immediate Post Concussion Assessment and Cognitive Testing) It is used by many high school, college and professional teams.

The program uses multiple tests including memory, reaction time and processing speed. If an injury is sustained, the tests will be repeated to help document an athlete’s post-concussion symptoms. The results will then be compared and return to activity will be determined. The goal is to test all athletes prior to the start of the season so that we can establish a baseline for each individual athlete since all athletes have different cognitive levels, attentions spans, reaction times and processing speeds.

If for some reason an athlete sustains a concussion during the season they will need a post-concussion test. The test will either be done at school before the athlete goes to the doctor or it can be done @ certain doctor’s offices. It is important to know that this program does not diagnose a concussion. Only a doctor can diagnose. Only neuropsychologists or physicians can interpret the results of the concussion management programs. In the event an injury is sustained, the athlete will need a see a physician and or a neuropsychologist. Athletes can see their own doctors or they can go the Sports Concussion Clinic run by Children’s hospital that has several locations in the area. (They have been featured on CBS Channel 9 News and NBC Channel 4 News.)

The athletic trainer will administer the 20 minute test to all athletes each school year prior to the beginning of the season. It is in a “video-game” type format. This is not an IQ test.

Interesting Facts

According to the American College of Sports Medicine more than 775,000 children under 14 are treated in emergency room for sports injuries each year. Almost half the injuries were reported as preventable. Around 300,000 athletes experience heat related illnesses each year and almost of them should have been prevented!!
According to recent estimates, over 82,000 people will seek medical treatment this coming year for injuries suffered while skiing, 62,000 will be injured playing hockey, 37,000 snowboarding, and 25,000 while sledding. Over 270,000 Americans are expected to visit hospital emergency rooms after suffering winter sports-related injuries this year.
This is from Dr. Demorest’s presentation. Of Olympic hopefuls 98% reported that they would use a banned substance if it were undetectable and allowed them enhanced performance. >50% would use a substance if it allowed them winning for 5 years followed by death

Sports Health (It’s all about prevention!)

Muscle cramps and dehydration are two very common but easily prevented problems for all athletes. The recommendation for the general population is to drink at least 64ounces (2 quarts) of fluids a day; depending on the sport and the weather, athletes should drink considerably more than that. This is best accomplished by drinking smaller amounts all day long, all year long. Adding salt to food can replace lost sodium and help prevent muscle cramps and dehydration. Also, eating at least one banana a day for potassium and drinking milk for calcium can help prevent heat related injuries. Not consuming enough electrolytes or water during the day can lead to lead to serious or fatal injuries.
Proper stretching is equally as important after a game or practice as it is before. Stretching should be done from head to toe with all stretches being held for 30 seconds.
Warmer weather brings the chance of thunderstorms and lightning. Lightning is responsible for hundreds of deaths and injuries each year. Once there is lightning please seek shelter immediately. Where there is thunder there is lightning. Do not stand in open doorways watching the storm or stand under a tent. They are not safe. Also avoid being on the highest point of an open field, under trees, flagpoles, light poles, on open water etc. League rules state that no one can return to the playing field until 30 minutes after the last sound of thunder or sight of lightning. Lightning can strike from up to 10 miles away! It does not have to be cloudy overhead for lightning to strike. When inside avoid indoor swimming pools, telephones, household appliances, taking a shower etc. Lightning can enter electrical or telephone wiring and plumbing through ground current although this is rare. If you are caught off guard, and feel your hair stand on end, skin tingle, or hear “crackling noises” assume the lightning safe position. The lightning safe position is crouched on the ground, weight on the balls of your feet, feet together, head lowered and ears covered
Now that we are all outside again don’t forget to wear sunscreen! Athletes spend more time outside than an average person therefore they are exposed to the sun more. UV waves do pass through clouds so you can get sunburn even when its cloudy outside.
Reminder- The first day of preseason or practice should not be the first day that you wear your shoes. You need to break them in first. Don’t buy them the night before. You should wear them around before you practice. This helps prevent blisters and injuries. Please do the same thing with your game shoes

Equipment

All St. Andrew’s athletes (except Cross Country, Tennis, Golf, and Track) are strongly encouraged to wear mouth guards. Mouth guards not only prevent dental injuries but can also possibly reduce the chance of concussion. In regards to a frequently asked question custom made mouth guards can be used on athletes with braces . Mouth guards act as shock absorbers. A blow to the face or head sending shock waves through the jaw or skull into the brain causes most concussions. While boil and bite mouth guards are adequate, custom-made mouth guards are significantly better. Certain brands can have the athlete’s name and phone number engraved on them to prevent loss.
Athletes with a history of multiple ankle injuries and following an ankle injury should wear ankle braces.
Athletes with ankle injuries should not wear high heels, flip-flops, and sandals.
Athletes should wear shoes designed for the sport they are playing and those shoes should be broken in prior to the start of practice or play. It is a good idea to wear new shoes around at home before using them for sports.
Lacrosse players are encouraged to attach a throat guard to their helmets. This inexpensive piece of equipment can prevent serious and even fatal injuries from trauma to the throat and neck. The guard should continue past the Adam’s apple to cover the entire throat area.
Baseball and softball players are encouraged to wear a cage or shield on their helmets along with a mouth guard. A cage or shield can prevent facial, dental and eye injuries that can be serious and can have lifelong effects.
Baseball and Softball players are encouraged to wear shin/leg guards when batting.
All protective pads and helmets must fit properly. Poorly fitting equipment can lead to a false sense of protection resulting in injury. For example, chest protectors must cover the entire chest area even when the arms are raised.
Protective eyewear is available for all sports. Baseball and softball players can even use different eyewear when at bat or in the field. Basketball, baseball and softball players sustain the greatest number of facial and eye injuries; some of which can be serious with lifelong effects.
The Certified Athletic Trainer can be contacted for questions and information about equipment and what brands are better than others. The trainer can also be used as a resource for the names of Doctors who have specialties with different injuries. Shurney@saes.org or by phone at ext. 269

Injuries

Most concussions Do Not involve loss of consciousness.
Following an injury, often the first and best treatment is Ice applied to the injury in cycles of 20 minutes on and 20 minutes off for 4 to 6 cycles or more. Heat should not be applied to an injury for at least 3 days.
When injuries occur a compression sleeve or an Ace wrap should also be worn to provide compression to the area.
Also during the first 72 hours of an injury it is best to Elevate the injury site above the heart as much as possible to reduce swelling.
Bruises should be taken care of the same as you would take care of a sprain or strain. Ice for the first 72 hours and then heat followed by a cross friction massage.
When an injury occurs on the field, please remain on the sideline until the Athletic Trainer; coach; athletic director or school nurse has assessed the injury. If your child is injured, he/she will be brought to you on the sideline. If the injured student is not your child, because of confidentiality guidelines, we must ask you to remain with other spectators and not go onto the field or approach the bench. If you are a medical professional, your assistance will be requested if necessary.
The Certified Athletic trainer does have an AED (automatic external defibrillator) at all games that he attends.
So what is a Concussion? A concussion is an injury to the brain. They are usually caused by blows to the head or face. Most of the time there is No loss of consciousness. Symptoms of a concussion include headache, dizziness, loss of balance, trouble sleeping (change in sleep pattern), confusion, ringing of the ears, nausea, difficulty concentrating, feeling “in the fog” or sluggish, vision problems, trouble concentrating, or memory problems. An athlete may experience any of these and it may only be one or two symptoms. It is important for an athlete to report these symptoms to coaches, parents, and athletic trainers immediately so that further action can be taken. When would you go to the hospital? Loss of consciousness, confusion that gets worse, stiff neck, difficulty walking, speaking or using your arms, severe headache, repeated vomiting, convulsions, unusual sleepiness. However, if there is any doubt weather to go or not do not hesitate. Head injuries can be very serious. After an athlete has been evaluated thoroughly, return to play decisions can then be made. An athlete must Never return to play while experiencing symptoms even if it is just a headache or dizziness. Returning to play to soon could result in “ Second impact syndrome” which is when a second blow to the head (no matter how minor it is) occurs to an athlete before they have fully recovered and the result is usually death. Please take a look at these links.

http://www.momsteam.com/alpha/features/health_safety/second_impact_syndrome.shtml

Here is an Article from the Denver Post about 2 athletes that kept quiet about their symptoms. This article was sent to me by a Neuropsychologist. PLEASE READ! Click on the link in the upper right corner.

What are the effects of dehydration? An athlete will go through decreased performance. This could start in less than an hour of practice or even immediately if the athlete began practice dehydrated. Signs of dehydration are thirst, irritability, headaches, weakness, dizziness, cramps, nausea, and decreased performance. Drink a minimum of 64 ounces of water a day. It is important to salt your food as well. Avoid sodas, coffee, etc.

LINKS- Here are some interesting links

Commotio Cordis is caused by a blow to the chest (directly over the heart) that occurs between heart contractions. The blunt force causes a lethal abnormal heart rhythm. It is not determined by the speed of the impact. According to the U.S. Commotio Cordis Registry, since 1998, 130 athletes have died from blunt force injury to the heart (Commotio Cordis). Of those, 70 were children ages 4-18, according to the Heart Center at TUFTS New England Medical Center. In an effort to educate the public about the potential risks physically active youth can face, the National Athletic Trainers’ Association (NATA) Age-Specific Task Force recommends that parents and coaches take proactive steps to protect their athletes against Commotio Cordis. Ways to help are: The NATA recommends continued research on Commotio Cordis because current information is limited. However, use of properly fitted, quality chest protectors are recommended to reduce the risk of injury to the athlete. Ensure all protective equipment fits properly and is used as intended by the manufacturer. Use all-purpose sports chest protectors during practices and games. Teach athletes how to protect themselves against chest injuries. Maintain an even and clean playing surface. . Here is some information on how it happens and why it happens.: http://www.momsteam.com/alpha/features/cardiac_awareness_center/commotio_cordis.shtml
Here is a link for parents with tons of useful information regarding sports specifically for parents. Their goal is to create a safer, saner, less stressful, and a more inclusive youth sports experience for all. They have an article on hazing and how is it best to talk with a coach or official, etc. Also included on the site is a page devoted to cardiac awareness which is a must view.: http://www.momsteam.com/index.shtml
They also put together a page that has all the athletes that tragically lost their life during sports during the fall of 2003 ( including second impact syndrome, commotio cordis, and heat stroke). Hopefully we can learn from some of these unfortunate incidents to help prevent future loses.: http://www.momsteam.com/alpha/features/editorial/seventeen_athletes.shtml
This is a site for promoting an overall safer sporting environment for youths. Their mission: Creating a Safer youth experience. Their Philosophy: The number of children who suffer catastrophic death or injury while playing sports is on the rise. Tragically, many of the lives lost could have bee saved had proper precautions and safety equipment had been available Goals: To reduce the number of catastrophic injuries and deaths in youth sports simply and cost-effectively by providing critical and reliable information.: http://www.teamsofangels.org/index.htm
Here is a guide for eye protection in sports and statistics on eye injuries. Can you guess which sport is #1 in eye injuries?: http://www.physsportsmed.com/issues/2000/06_00/vinger.htm
Why is it important to wear mouth guards in all sports? Take a look at these athletes who didn’t: http://www.dentagard.com/mouth-protector-statistics.html
Here is another link supporting mouthguards.: http://www.momsteam.com/alpha/features/health_safety/mouth_guards.shtml
For those parents, coaches, or athletes that are interested in preventing facial/dental injuries, Game Face has a good product on the market. They can be used in almost all sports especially the spring sports! For more information here is the link.: http://www.gameface.com/
Living to 100 Life expectancy calculator.: http://www.agingresearch.org/calculator/
WebMD is a great site for medical information and answers.: http://www.webmd.com/
All Athletes who have asthma should take this test.: http://www.asthmacontrol.com/
NBC channel 4 recently did a story on concussions in athletes. Dr. Gioia was interviewed about ImPACT You can view the video report or read the article. Here is the link. If you remember, channel 9 did a similar story a few months before this one.: http://www.nbc4.com/healtharchives/4441156/detail.html

Local Doctors

Dr. Gioia is the Director of the Pediatric Neuropsychology programs and the mild TBI/ Sports Concussion programs @ Children’s Hospital.

Dr. Polun is a Podiatrist certified in foot and ankle surgery. He has had a private practice for 19 years with offices in DC and Potomac. For more information on him or information about foot and ankle problems check out his website. http://www.doctorpolun.com/ I would like to thank Dr. Polun for coming in and doing free foot screenings for several of our teams over the last few years.