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The following information is intended to be a resource for students, coaches, student-athletes and parents. In the event of injury, medical professionals should ALWAYS be consulted.
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Getting Hurt in AthleticsIf an athlete is injured during athletic participation, no matter what type, he/she should never be moved. If the injured athlete has a head or spinal injury and is moved, the vertebrae can shift and severe the spinal cord. A severed spinal cord can mean permanent paralysis for that athlete. Thus, you should never move an injured athlete! In the absence of a medical professional, a parent or coach should always call an ambulance for any athlete who has sustained a head or neck injury or who complains of any numbness or tingling in the arms or legs. If a child is crying, always assume he/she is truly hurt. When in doubt, dial 9-1-1.
In athletics, there are bound to be minor injuries that occur to athletes. In minor cases, a physician referral will not be necessary. To help keep athletes “in the game”, here are some helpful tips when dealing with these minor injuries. The information on this website is intended to serve as a general guide. Parents, coaches, athletes and others are strongly advised:
Always consult an ATC and/or a physician if injury occurs.
A concussion is “Any transient neurological dysfunction resulting from a biomechanical force that may or may not result in a loss of consciousness” (Giza & Hovda, 2001, p. 228)
Concussions do not always involve a loss of consciousness. ANY traumatic blow to the head or to another part of the body (which causes a whiplash effect to the head) should be considered as a mechanism of concussion injury. While headache is the most common symptom of concussion, all people will experience concussion differently. Therefore, all of the potential signs and symptoms of concussion should be considered. A symptom checklist can assist the evaluator in making a more objective return to play decision.
If a player sustains any signs or symptoms of concussion, he/she must be pulled from play. Only an athletic trainer or a physician may clear the athlete to return to play.
Most Common Signs and Symptoms of Concussion
ALL ATHLETES WHO EXHIBIT ANY OF THESE SIGNS OR SYMPTOMS AS A RESULT OF PARTICIPATION IN SPORT SHOULD BE REFERRED IMMEDIATELY TO THE ATHLETIC TRAINER AND/OR A PHYSICIAN!!!
Pre-Participation Physical Examination Acquiring the following information is recommended for all contact/collision sport athletes prior to athletic participation. • Concussion History • Should include specific questions about previous concussion symptomology • Other head, face and neck injuries • Equipment • Baseline Cognitive Assessment • ImPACT, CogSport, HeadMinder,… • Baseline Sign and Symptom Score • Balance Error Scoring System
Concussion Assessment When a concussion is suspected, evaluation should include not only on subjective questioning ("Do you have a headache?") but also on objective assessment. • Standard orientation questions are unreliable • Memory assessment questions are preferred • Neither should be used as the sole assessment and neither should be used to determine Return to Play
On-Field Assessment of Concussion When a concussion is suspected, this guide can help you ask the athlete the "right" questions. Any discrepancies or failure to answer questions correctly should be considered reason-enough NOT to return the athlete to play and to refer that athlete to a physician for further evaluation. • Orientation • What stadium is this? • What city? • Who are you playing? • What is the day/month? • Anterograde Amnesia • Repeat the following words, “girl, dog, green • Retrograde Amnesia • What happened last quarter? Before the hit? • What was the score before the last play? • Concentration • Recite the days of the week backwards/months backwards • Repeat numbers backwards (36, 647, 7149…) • Word List Memory • Ask the athlete to repeat the three words from earlier (girl, dog, green)
Managing Sports-Related Concussion When a player displays ANY signs or symptoms of a concussion • The player should not be allowed to return to play in the same game or practice • The player should monitored • The player should be medically evaluated • Return to play must follow a medically supervised stepwise process “When in Doubt, Sit Them Out!”
Stepwise Return to Play Once an athlete is cleared to return to play after concussion, it is very important NOT to allow that athlete to return to full activity right away. Instead, experts recommend those athletes follow a stepwise return to play protocol. The athlete can return to the next step AFTER successfully completing one full practice and remaining asymptomatic.
Baseline Neurocognitive Assessment Baseline neurological tests help to evaluate and document multiple aspects of neurological and neurocognitive functioning. These tests may include batteries on memory, brain processing speed, and reaction time. With concussion, baseline tests are compared to post-concussion tests. There are several tests out on the market and available to athletic trainers, athletic administrators, coaches and medical professionals. They include ImPACT, Headminder CRI, and CogSport. • ImPACT; Headminder CRI; CogSport • Functional Assessment of the Brain • Concussion Symptom Scale • 21 Item Likert scale (e.g. headache, dizziness, nausea, etc) • Eight Neurocognitive Measures • Measures domains of Memory, Working Memory, Attention, Reaction Time, Mental Speed, Verbal Memory, Visual Memory, Reaction Time, Processing Speed • Detailed Clinical Report • Automatically computer scored • Outlines demographic, symptom, neurocognitive data
Balance Error Scoring System • The athlete stands with the feet narrowly together, the hands on the hips, and the eyes closed with a double leg stance. The athlete holds this stance for 20 seconds while the number of balance errors (opening the eyes, hands coming off hips, a step, stumble or fall, moving the hips more than 30 degrees, lifting the forefoot or heel, or remaining out of testing position for more than 5 seconds) are recorded. • The test is repeated with a single-leg stance using the non-dominant foot; • A third time using a heel-toe stance with the non-dominant foot in the rear (tandem stance). • All three tests are performed on a firm surface and again on a piece of medium-density foam.
Other Methods of Concussion Prevention · Revolution helmet · Soccer headgear · Head Impact Telemetry System
Cranial Nerves
Dermatome Chart Click on image to enlarge
Recognizing Fractures: An open fracture will typically be self evident due to the exposed bone. The following clues suggest you are dealing with a probable closed fracture: • The athlete felt a bone break or heard a "snap"; • The athlete feels a grating sensation when he/she moves a limb; • One limb appears to be a different length, shape or size than the other, or is improperly angulated; • Reddening of the skin around a fracture may appear shortly after the injury is sustained; • The athlete may not be able to move a limb or part of a limb (e.g., the arm, but not the fingers), or to do so produces intense pain; • Loss of a pulse at the end of the extremity; • Loss of sensation at the end of the extremity; • Numbness or tingling sensations; • Involuntary muscle spasms; • Other unusual pain, such as intense pain in the rib cage when a patient takes a deep breath or coughs.
Ice On A Fracture Can Make the Injured Area Throb Worse…
Splinting Any suspected fracture should always be splinted before the athlete is allowed to move. Splint the joint above and below the affected area.
How to Splint: 1. Check pulse. Then remove clothing from the injured part. Don't force a limb out of the clothing, though. You may need to cut clothing off with scissors to prevent causing the athlete any additional pain. 2. Apply a cold compress or an ice pack wrapped in cloth. 3. Place a splint (or boards) on the injured part by keeping the injured limb in the position you find it. Add soft padding around the injured part placing something firm (like a board or rolled-up newspapers) next to the injured part, making sure it's long enough to go past the joints above and below the injury keeping the splint in place with first-aid tape. Re-check pulse. 4. Seek medical care, and don't allow the athlete to eat or drink anything, in case medication or surgery is needed.
Lightning
IF YOU SEE LIGHTNING ANYWHERE IN THE SKY, EVERYONE NEEDS TO MOVE INSIDE.
Idaho's athletic trainers recommend that all coaches carry portable lightning detectors. The general rule is if you can see it, it's too close. You need to move inside.
Avoiding Heat Related Illnesses People suffer heat-related illness when the body's temperature control system is overloaded. The body normally cools itself by sweating. But under some conditions, sweating just isn't enough. In such cases, a person's body temperature rises rapidly. Very high body temperatures may damage the brain or other vital organs. Factors that contribute to heat-related illness include high humidity, obesity, fever, dehydration, poor circulation, sunburn, and drug and alcohol use. To try to prevent heat related illnesses • Drink plenty of fluids before, during and after exertion; • Include electrolytes in the fluids (salt, sodium, potassium); • Wear light clothing on hot days; • Wear sunscreen; • Schedule practices during cool periods (avoid 10am to 2pm) and acclimate athletes to heat gradually.
Heat Related Injuries cramping, exhaustion, rapid and shallow breathing, weak pulse, moist pale skin, sweating · Remove athlete from the hot environment. Place in a cool environment (air conditioned); · Loosen athlete’s clothing and fan. Watch for shivering; · Have athlete lay down with legs elevated; · Give athlete water (if not nauseated); · If athlete is having muscle cramps, apply moist towels over cramping areas.
Cold Related Injuries • Get the athlete out of the cold environment; • Warm the affected area (gradually); • If the injury is to an extremity, check pulses, splint, and recheck pulses; • Do not rub or massage the area, and do not re-expose it to cold. If the area is white and waxy, grayish colored, or blotched, suspect frostbite and send to hospital.
Bee Stings (noticeable bite/sting, blotchy skin, pain or itching, burning, weakness, chills, fever, nausea, etc) The two greatest risks from most insect stings are allergic reaction (which occasionally, in some individuals could be fatal) and infection (more common and less serious). If an athlete is stung by a bee, wasp, hornet, or yellow jacket, follow these instructions closely: • Check to see if the stinger is injected. Do not try to pull it out as this may release more venom; instead gently scrape it out with a blunt-edged object, such as a credit card or a dull blade; • Wash the area carefully with soap and water. This should be continued several times a day until the skin is healed; • Apply a cold or ice pack, wrapped in cloth for a few minutes; • Apply a paste of baking soda and water and leave it on for 15 to 20 minutes; • Instruct athlete to take acetaminophen (Tylenol) for pain. If the athlete acknowledges an allergy to stings or has trouble breathing, call 9-1-1
Recommended Procedure for Football Helmet Fitting Session Coaches have a responsibility to do everything they can to ensure the safety of their players. That begins with making sure their equipment fits properly before they even set foot on the field. Every player is someone’s child. Follow these suggestions and you are on your way to a safer season. • Determine the normal hair length of the athlete. His hair length when he is fit may not be the same length as it will be during the season, especially if the fitting is done in the off-season, e.g., in spring before the players leave for the summer. • Try to wet the athlete’s hair prior to fitting the helmet. A damp cloth or some water applied to the hair makes the initial fitting easier and will also approximate game and practice conditions when the players perspire. • Check to see if player’s ear openings are in center of helmet ear openings or below center. If the helmet’s ear openings are too high, the helmet is too small or possibly the inner liner may be over inflated. If the helmet ear openings are too low, the helmet is too big or the inner liner is under inflated. • Check to see that the eyebrows are approximately 1–1-l/2” below the helmet’s front rim. A general rule of thumb is to use 1–1-l/2 finger widths. If there is a gap of more than 1 inch, generally the helmet is too small and if there is less, it is too large. • Try to rotate the helmet side-to-side. There are various ways to do this. One is to ask the player to “bull” his neck. Grab the faceguard in the middle and attempt to move the helmet from side to side. There should be some movement of the forehead skin and hair with the helmet, but it should not slip. Using the center loops on the faceguard as a guide, the nose should stay within a line directly down the center of the helmet and the center of the loop. If the nose moves to the right and left beyond these loops, generally the fit needs to be adjusted or the helmet is still too big. • Check the crown adjustment of the helmet. Again, there are various ways to do this. One method is to request the player to clasp his hands over the crown of the helmet and push straight down. The pressure should be felt on the crown. This test also cross-checks the eyebrow test. • Check the forehead pressure and back-to-front fit. One method to do this is to have the player rotate his hands down to the rear of the helmet from the crown test. Keep the hands clasped together and attempt to push the helmet forward. Usually a gap of a finger width or less between the forehead and front sizer is acceptable. • Check the jaw pads to see that they fit correctly. They should be neither undersized nor oversized. They should follow the contours of the cheeks. • Check the chin strap fit. The function of the chin strap is to hold the helmet in place. Make sure the cup is centered on the point of the chin and all four straps have the slack taken out. Begin fitting with the back or lower chin strap first. It is important that the high hook-up chin straps go underneath the facemask. • Check the faceguard. There should be adequate spacing between the faceguard and the tip of the nose. • Check the fit in the rear of the helmet. The occipital lobe should be covered by the shell. The rear of the helmet should cradle the neck. It should not chafe from a tight fit, nor leave a large gap from a loose fit. • Check the player’s vision, both peripherally, as well as up and down. Peripherally, the player should be able to track a finger about 180 degrees, up and down to about 75 degrees.
· CHECK ALL HELMETS REGULARLY (every other day) TO BE SURE THEY HAVE AIR · NEVER CUT MOUTHGUARDS · REPLACE WORN DOWN MOUTHGUARDS
Athletes should be especially cautious to stay well-hydrated. While water is essential, it is also imperative to replace lost electrolytes. Consuming sports drinks such as Powerade and Gatorade is one way of doing this. High energy drinks such as Red Bull and Rockstar, however, are not recommended as a safe way to replenish electrolytes and hydrate the body.
Generally speaking, the most important thing is that the athlete stays well-hydrated while not getting too much sugar intake. Here are some general guidelines to follow:
Encourage athletes to drink 16-32 ounces of fluid for every pound lost during activity.
Impetigo & Staff Infection If undetected, the MRSA virus can be fatal. It is absolutely imperative that all rashes and red areas be reported to an athletic trainer and evaluated by a physician. To prevent MRSA, athletes should practice good hygiene. Practice and game clothes should be washed daily. Lockers should be cleaned and aired out nightly. Athletes should shower with soap after engaging in any physical activity. Towels and water bottles should never be shared.
Signs of MRSA • skin boils • redness (first appears like a spider bite in most cases) • sometimes accompanied by fever and chills
Preventing MRSA • Avoid contact with infected individuals • Cover all wounds • Practice good hygiene: SHOWER with SOAP immediately after EVERY practice/game and do not re-wear sweaty clothing • Wash practice clothing DAILY • Do not share clothing • Clean all equipment - helmets, shoulder pads, wrestling mats, weight equipment, etc. • Report all skin blemishes/changes to athletic trainer for evaluation • Prevent getting turf burns • Wash hands REGULARLY
Treating MRSA • Requires Physician evaluation and prescription for specific type of oral antibiotics and topical cleanser
Allergic Reactions · If an athlete has an allergic reaction, it is important that he/she gets medical treatment immediately. · If the athlete experiences breathing difficulty and and/or if he/she has an Epi-Pen, get it for them and have him/her give themselves an injection. Do not do it for them. If they cannot do it themselves, call 9-1-1. · If the athlete’s reaction is minor (hives, itching, irritation, etc.), contact parent. In most cases, a Benadryl will fix the problem but as a coach, you cannot give that medicine to the athlete.
Asthma • Only athletes who have been diagnosed with asthma should use inhalers; • Athletes with asthma should only be allowed to use their own inhaler; • If trouble persists, call 9-1-1.
Dental - Broken Tooth If an athlete gets a tooth knocked out (or broken off) · Keep the tooth; · Put the tooth in a cup of milk (only enough to cover tooth). If milk is unavailable, use water; · Have athlete chew gum and put over the exposed tooth in mouth (to prevent nerve irritation); · Send to dentist – don’t forget to send the tooth.
Diabetics Symptoms: rapid onset of altered mental status, intoxicated appearance, elevated heart rate, cold and clammy skin, hunger, seizures, anxiousness
What to Do: Ask the athlete. The athlete will direct you (is he/she hypoglycemic or hyperglycemic?). Does he/she want juice? Sugar? Get him/her what they need.
Muscle Cramping • Poor hydration and low electrolyte count is the cause; • Administer Gatorade or other sports drink; • Have the athlete chug some mustard (seriously!) and chase it with lots of water.
Seizures • Have athlete lie down. Remove any objects in hand or nearby; • Loosen restrictive clothing; • Allow the seizure to finish; • After the convulsions have ended, protect the airway.If athlete is blue, lift chin and tilt head back. Always Call 9-1-1
• Apply ice and compression wrap immediately after injury is sustained. Include a felt or foam horseshoe over the malleolus (ankle bone) on an ankle sprain to help squeeze out severe swelling. • Ice 3 to 4 times daily for 20 minutes. • Anti-Inflammatory medication may help (Ibuprofen, Advil, etc.) • Never apply heat to a sprain or strain within the first 48-72 hours after the injury is sustained.
REMEMBER R.I.C.E.: REST – ICE – COMPRESSION - ELEVATION
Shin Splints: Shin splints are caused by overuse of the lower legs. The pain associated with shin splints is a result of fatigue and trauma to the muscle's tendons where they attach themselves to the tibia. In an effort to keep the foot, ankle and lower leg stable, the muscles exert a great force on the tibia. This excessive force can result in the tendons being partially torn away from the bone.
Causes: · Exercising on hard surfaces, like concrete; · Exercising on uneven ground; · Beginning an exercise program after a long lay-off period; · Increasing exercise intensity or duration too quickly; · Exercising in worn out or ill fitting shoes; and · Excessive uphill or downhill running.
“Cures”: The best way to treat shin splints is to take appropriate measures to avoid getting them. This includes proper, thorough stretching before and after activity. Wrapping/Taping has not been proven to help shin splints at all (in fact, it can make the condition worse) so the athletic trainers will not tape shin splints. Once an athlete gets shin splints, the best hope is to manage them so they don’t turn in to stress fractures. Here’s a few tips: · Cold whirlpool treatments each morning with the athletic trainers · Heat immediately before activity followed by extensive stretching & massage · Thorough warm up · Ice after activity · Ice massage in the evenings · Ibuprofen to manage swelling and pain (follow bottle’s directions) · Arch supports inside shoes · Alter training regiment with closed chain activities (bike instead of run) | |||||||||||||||||||||||||||||||||||
Recognizing
Concussion
