To Play or Not to Play (Football)? It’s the Parents’ Decision

by Daniel Pokrifka, ATC/L
HeadFirst Concussion Care Program Administrator

In my years as an Athletic Trainer, I’ve had the opportunity to interact with many parents, helping them to foster a safe sports environment for their children and to guide a few of them through the road to recover after an injury. During these exchanges I always felt competent in my guidance, and leaning on my research-based medical practices, I provided sound advice. But this past summer I ‘ve added a new perspective to my consultation résumé… I became a Dad.

As I hold my new baby boy, my thoughts go back to these families as I can now empathize with their fears of letting their children leave the safety of mom’s and dad’s arms and expand their world. Watching Alex grow from this tiny baby who I could hold in the palms of my hands into the beginnings of a sturdy little boy, I find myself thinking about one of the most common questions asked of me by parents while sitting in a clinic with their injured son or daughter: “With all the injuries in sports, should I continue to encourage my child to participate in athletics?”

The answer was always an emphatic ‘YES!’ I explained how, in my opinion, the benefits of athletics clearly outweigh the risks of injury and the lessons learned can last long into their future. Inevitably, the follow-up question was always “What about going back to football”? Ah, always a little more challenging of a question… or should it not have been?

Years ago, as an athlete, I would have expressed my opinions emphatically about how football teaches the principles of teamwork, commitment and self-confidence while placing demands on the athlete that are not only physical but require a level of grit determination found only on the gridiron under the Friday night lights. But as a sports medical professional, and now as a parent, would I still provide this same advice to myself if my son decides to play?

I have heard from many new parents who say they would never allow their child to play football because they don’t want them to get a concussion, which is usually followed by “my son or daughter will play soccer because it’s ‘much safer.’” At this point, parents are usually looking for a nod of confirmation.

It seems popular nowadays to listen to all the ‘soft’ studies reported by the media that directly relate concussions and other catastrophic injuries to playing football. In my experience, the hard numbers show that concussions are not solely a football problem. My professional responsibilities inherently place me directly around young injured athletes in many different sports and activities and I have seen concussions in all of them.

Heads Up: Concussion in Football

This is also a good time to mention that most of the concussions I have seen over the past few years did not occur during a sport at all…
…kid got hit in the head with a drum mallet during marching band
…whole family suffered concussions from a motor vehicle accident
…kid said he got hit by a shelf
…sledding accidents, trampoline mishaps… and on the list goes.

We’ll never be able to fully protect our kids from the world, but we CAN demand a higher level of safety from those responsible for our children. We CAN and SHOULD educate ourselves — and our children — about the injuries that can occur during sports and prepare ourselves for if and when they occur. We CAN be truthful on our kid’s sports physicals and go further than the minimum requirements. We CAN inquire about baselines for concussions and pre-participation strength and agility training to prepare our kids for the physical demands of the sport. Injuries cannot be prevented, but the risk can be minimized with preparation.

My profession allows me to be at the forefront of this preparation, to be an advocate for safety, and to educate anyone willing to listen. And I can say that many athletic associations are taking notice of the rise in injury awareness and utilizing their authority to help protect our kids.

My message here in this post is convey to parents that even a dad in the “business”— one that has access to all the data and research — still struggles with the decision on whether I will allow my son to play football.

Now for the toughest part: my answer.

Let’s just say I’m lucky that I have another seven to ten years of research until I have to make this decision, but I will say something inside me is excited to start finding those permission slips in the bottom of his backpack.

Athletic Trainers Treat and Manage Concussions

by Eric Hansen, ATC/L
HeadFirst Concussion Care Director of Sports Medicine

Last month was Brain Injury Awareness Month, but did you know it was also Athletic Training Month? However, it’s important to be educated throughout the year about the roles that both play in sports. As a Certified Athletic Trainer (ATC), I’ve taken the past few weeks to reflect on the progress of care for mild traumatic brain injury (MTBI) and how it fits into the development of the athletic training profession.

Both have come a very long way in the time I’ve been involved with them. More importantly, though, is where each is headed in the future. Certainly, the two fields will remain integral to each other. When I was taking undergraduate courses, the instruction given regarding concussion care amounted to little more than a few PowerPoint slides in a single lecture in one class of my sophomore year.

At the time, the guidelines for returning an athlete to play were to wait just 10-15 minutes of being free of symptoms! I remember realizing the signs and symptoms of concussions and counting on both hands the number of concussions I must have sustained during my high school days that were never diagnosed or treated. For most of those injuries, the only thought going through my head was ‘get up before the other guy’ and ‘make sure you go back to the correct sideline!’

While an athlete’s mentality may not have changed much, thankfully medical understanding of MTBI and the care standards have increased dramatically. While we still have a long way to go, I am confident we have at least reached a precautionary stage that will turn the tide, and begin to pay dividends in the long term health quality of today’s athletes and athletes yet to come.

The other major change I have seen is in the field of athletic training. ATCs are recognized and valued in the medical community and general public at a much higher level than in previous years. Often in my career I’ve had to answer questions about what an athletic trainer is and does. Many times, I’ve explained that I’m not a strengthening and conditioning coach, nor a personal trainer, nor a fitness instructor. I’ve also had to explain to medical providers and staff my reasons for, and legality in, obtaining medical information for the continuing care of our patients.

These days, we see physicians volunteering the information to ATCs, and often seeking their opinion and input in the care of an athlete. Many providers, parents, and school administrators rely on Certified Athletic Trainers for creating, instituting, advising and enforcing care plans, policies and procedures, liability issues, and more. The benefits gained for the athlete with this partnership are huge.

ATC Word Cloud

I believe concussion care is headed the same way, and soon, we’ll see tremendous scientific breakthroughs in medical technology which will translate to safer healthy sports. As we gain a better understanding of MTBI and learn the most effective courses in preventing, diagnosing and treating these injuries, the role of an ATC will become more defined. Our role in concussion care will be as important as our role in treating, for example, sprained ankles and dehydration.

As a result, we’ll need to become keener in our decisions about when to treat a concussion and when to manage it. To parallel two common injuries to understanding the difference between treating and managing concussions, a sprained ankle requires an ATC to provide first aid, treatment, and rehabilitation to get the athlete back on the field. They understand the healing process and the necessary intervention.

A sprained anterior cruciate ligament (ACL), however, is a different matter. Although ATC understand all of the necessary interventions, they can’t provide all the treatment an athlete will need. The athletic trainer will refer the athlete to an orthopedic surgeon to order an MRI, conduct surgical intervention, and prescribe any necessary medications. In certain settings, the post-surgical rehabilitation may be better handled by a physical therapist.

While the ATC relies on these providers for the care of their athletes, it is still the ATC that manages the injury by directing the referrals, following up on the athlete’s compliance and resolving any issues that arise in the care plan.

As the seriousness of MTBI has been realized, so has the availability of well-trained medical personal with unique specialties to assist ATCs in the care of concussions. We now have a variety of referral sources to care for athletes including neurologists, neuropsychologists, vestibular therapists and ocular-motor therapists.   With these valuable referral sources, ATCs will always be the direct link and closest manager of the best care available for athletes.

Brain Injury Awareness Month is Winding Down

by Tony Doran, Psy.D.
HeadFirst Concussion Care Program Director

Brain Injury Awareness Month is drawing to a close. I hope that you have taken the time to look at a few websites, read a journal article or attend a talk or two to learn more about concussions and mild traumatic brain injuries. The Brain Injury Association of Maryland’s conference last week was a tremendous success. Attendees told me about some exceptional presentations: Brianna Scurry’s personal story of recovery, Dr. Jeff Barth’s research data on concussion as people age, HeadFirst’s own Dr. Robert Graw’s presentation on a community-based concussion clinic and Dr. Kevin Crutchfield’s talk on cervical injuries.

Sadly, we are reminded all too often that brain injuries can affect anyone, at any time, even those close to home. Close to us here in Maryland are two midshipman from the U.S. Naval Academy who have been affected. Please keep in your thoughts and prayers MIDN William McKamey, a Naval Academy football player suffered a neurological event while at practice three days ago and succumbed to his injuries at University of Maryland R. Adams Cowley Shock Trauma Center in Baltimore on Tuesday, March 25th. Also please keep in your thoughts MIDN Hans Loewen, who sustained a severe brain injury while skateboarding and is being treated at the same medical center. We pray for the McKamey and Loewen families, the Naval Academy football coaches and team, and their Naval Academy Family.

Brain_Injury_Awareness_Month

Don’t Give Up! You Will Recover After a Concussion

by Sherray Holland, PA-C
HeadFirst Concussion Care Provider

Editor’s Note: Following is a first-hand account from HeadFirst Concussion Care Provider Sherray Holland, PA-C (pictured below), about her own experience with brain trauma while engaged in the most routine of activities — grocery shopping.

Sherray_HollandI want to start off and say that this is a subject near and dear to my heart. I have worked with concussion patients since 2008. According to the Centers for Disease Control and Prevention (CDC), at least 1.7 million people in the United States sustain a concussion each year and seek help, but we believe this number is actually doubled because so many people still do not get checked out.

When I was younger (I am in my mid 30s now!), I was told to “shake it off” and keep playing or not go to sleep after hitting my head. Sound familiar?! So much has changed since those days as more education and research has been done about concussion. However, I think we still have that mentality when it comes to ourselves and we end up trying to push hard through the pain.

Now, I would like to share my story. A few years ago, I was texting and walking into a store in a shopping center. As I stepped onto the curb, my shoe got stuck and I tripped!  I could not gain control (picture my arms flailing and trying to stand). Then I suddenly realize I was going to fall…and hard. I kept thinking, “This is going to hurt.”  My next memory was lying face up with a few people looking down at me in panic. I remember being upset because an older man said “Boy that was a bad fall, are you okay?” Embarrassed, I thanked everyone, dusted myself off, grabbed my boot (which came off) and took my purse. My head hurt but I went in anyway to get a few items. I figured “Hey, I work with brain injuries so I will check myself out later.”

You can imagine my annoyance when I was stopped by a security officer. He said, “Ma’am, are you ok?” Frustrated, I said, “Why is everyone so concerned, I just fell!” The next few words have always stuck in my head. He replied, “You may want to get checked out, I can call for help. You have been wandering the store for two hours.” I rolled my eyes but I caught a glimpse of myself in a mirror. I was in shock! I was bleeding down my head, onto my face. I saw cuts and bruising to my forehead and left cheek. My knee was bleeding through my jeans. I was a mess! I ran out of the store, leaving my empty cart.

I went home and cleaned myself up. I figured since I was a medical professional, I could treat myself. I knew I needed to rest. I took medication for my headache. I took the next couple days off and slept. I returned to work full-time and cared for my infant son as usual.

Easy peasy, right? Wrong! I struggled tremendously, especially with my memory. I could not remember anything:  What a patient asked me two minutes ago; what my supervisor just told me to do; what I read in a chart or typed on the computer, not to mention at home with my son and family. I had headaches from trying to think too hard. I was so tired all the time. I was emotional and frustrated because I could not do it all anymore!

Finally, I gave in. I confided to my supervisor and doctor because I wasn’t getting better. They echoed what I already knew:  RELAX. REST. WRITE THINGS DOWN, etc. Once I cut back my hours, gradually went back to work and did not stress about things at work or my life I immediately saw improvements. It took me longer because I did not want to slow down but I am fully recovered.

Here is the bottom line: If you have been seen and told you have a concussion, please do the brain rest and gradually go back to the activities, whether it is work, school or sports or all of the above. Trust me, I’ve been there.  I wanted to go back to my regular activities immediately but it simply is not the way to go. You will NOT be giving yourself a fair shot if your brain does not have the time to heal completely.

Think of your brain like a sprained ankle for a second. You would not want to hurry and start walking on it right away. I think we forget how important it is because we cannot see the brain injury. Recovery time can vary and depends on other things such as your past medical history, symptoms, etc. But the sooner you seek help and follow the guidance of your provider, the sooner you will improve!

Know the signs and symptoms of concussion. If you or someone you know has had a head injury and is not getting better, please contact HeadFirst Concussion Care at 855-SIT IT OUT (748-4868) to speak with someone and/or set up an appointment for an evaluation. Visit myHeadFirst.com for more information on concussion.

Thank you for allowing me to share my story, and I would love to hear yours.

The AB and ZZZZZs of Sleep for Athletes: Get Your Rest Before Taking Your Baseline Test!

by Sherray Holland, PA-C
HeadFirst Concussion Care Provider

It is recommended to get a good night’s sleep on a regular basis, but how much is considered a “good” amount? How long do you sleep?  I am mainly asking high school and college athletes here. And I know sometimes it is easier said than done when you factor in homework, sports, other extracurricular activities….maybe even a job!

Picture this: You are eager to start your season.  Then your coach or athletic trainer tells you to take a baseline test. You may have heard about it from other students or not at all. Most schools and many organizations, including HeadFirst Concussion Care, are using the ImPACT® baseline test to measure the way an athlete’s brain functions, including cognitive thinking, memory and reaction time. The computerized test takes about 25 minutes to complete (as cited in Lovell, 2010) and is intended to give your coach, trainer, and provider a baseline measure of your normal brain function. In the unfortunate event of a concussion, you will take the ImPACT test over time (usually every office visit) to help your healthcare provider, coach, athletic trainer, and teachers make proper decisions for school and returning to play as you recover.

Getty Images

Getty Images

Okay, back to the subject at hand. Now it is the night before the baseline test. How long should you sleep? A recent study published in the American Journal of Sports Medicine reported that athletes who slept fewer than seven hours before the baseline performed worse on three of four ImPACT scores and reported more symptoms related to their brain injury (as cited in McClure, et al., 2014).

Here’s the bottom line: it is important to get enough sleep on a regular basis, aiming for more than seven hours. If you do not get enough sleep before your ImPACT test, it may not represent your academic ability at its best, especially if you have to go through the entire day and take it after school. Many times in the HeadFirst clinic, I have seen the results of a patient’s test after a suspected concussion better than his or her baseline!  Remember, this is a serious matter so make sure to put your best effort forward. I hope you found this helpful and would like to hear your thoughts.

Tips for Getting a Good Night’s Sleep

Having trouble falling or staying asleep? Here are some helpful advice for healthy sleep habits:

  • Keep a regular bedtime routine every night
  • Do not exercise or eat a heavy meal three hours prior to going to bed
  • Do not drink or eat foods with caffeine three hours prior to going to bed
  • Avoid naps. If you are tired and must take a nap, make sure it is a short nap and not close to your bedtime.
  • Rest and unwind before heading to bed. Avoid stimulating television shows or video games.
  • Make sure your room is quiet, comfortable, and without bright lights.
  • If you do not go to sleep after 30 minutes,  try reading , listening to music, or other quiet activities to encourage relaxation.

Ms. Holland typically works at HeadFirst Waugh Chapel clinic. She received her Bachelor of Science in Physician Assistant Studies/Certificate in Primary Care at Howard University. Ms. Holland is a Board-certified Physician Assistant and is a member of the American Academy of Physician Assistants and an American Academy of Physician Assistants Veteran’s Caucus Member.

March is Brain Injury Awareness Month

by Tony Doran, Psy.D.
HeadFirst Concussion Care Program Director

In the past several years, few medical problems have generated as much public interest as sports-related concussions. Coaches, parents, and players are increasingly aware that a concussion involves an injury to the brain and that an athlete suspected of having a concussion should be removed from play and evaluated by a licensed health care professional. I’d like to share a little bit about myself and how I became interested in the area of mild traumatic brain injury (mTBI).

My name is Dr. Tony Doran. I was a clinical psychologist for the Navy for the past 20 years. The Navy sent me to Harvard Medical School and I specialized in pediatric neuropsychology. Over the course of my career, I have worked in a variety of diverse positions at Portsmouth Naval Hospital, Iwakuni Medical Clinic Japan, and the United States Naval Academy. I have treated kids and adults with everything from adjustment reactions and craniosynostosis to mTBI and PTSD (post-traumatic stress disorder).

As my time in the military was winding down, I began to explore where my next adventure would take me and I naturally gravitated to conducting evaluations for Special Forces Units throughout the United States. After more than 10 years of war, I have treated and evaluated hundreds of service men and women who were dealing with the wounds of war coping with PTSD and mTBI. As the war was coming to a close, I began to look at what other avenues I could explore. My contracting position of evaluating Special Forces Units involved a lot of travel away from my family, which initially was exciting and interesting, but after 3 years was beginning to wear on myself and my family. So I began to look for a permanent position.

Having been a consultant, I had performed some services for a new company in the area of concussion care called HeadFirst. HeadFirst was evaluating and treating hundreds of kids with mTBI and a substantial percentage of these kids had some special needs – autism, learning disabilities, attention problems or other psychological problem. My experience and training in mTBI and childhood disorders would help me treat and evaluate these children. HeadFirst was looking for someone to evaluate the enormous amount of data they were beginning to collect and also help them branch off and start new research projects. My years of data analysis and research in the Navy would assist me in this area. Several weeks later, I was hired as the Program Director of HeadFirst. I look forward to educating parents, children and coaches in the area about mTBI, treating children and teens with mTBI, and conducting research in the area of mTBI.

Dr Doran-Bug-Sm

I was at a meeting the other night with several health care providers and asked them to please share a story about what a concussed child or family member had asked them about after brain rest had been explained to them. As we went around the room, kids and family members asked about playing the drums, going snowboarding, playing football with dad in the yard, sleigh riding, mountain climbing, just shooting baskets or just swinging in a batting cage. Answers like theirs beg the question: Are our kids, families, and coaches getting the message about the seriousness of mTBI?

Pardon the Navy analogy, but sometimes big ships take a while to turn. I am encouraged when I hear teens make comments like “Hey, that kid has to stay out of competition for at least 7 to 10 days” after witnessing a concussion and a parent discussing with a child that she might need to permanently switch to a different sport – like track or swimming – after her fourth concussion in soccer. However, when I still get questions like “Can I go ride my go cart?” after explaining brain rest, I am reminded that we, as providers, educators and researchers, have more work to do.

If you are interested in joining the concussion discussion, please visit this blog as we will be having different providers, coaches, parents and recovering patients contribute. Also please see our website for community events.

The Brain Injury Association of Maryland is having their annual conference March 20th-21st – please see their website to find out more and I hope to see you there.

Run, Sam. Run!

This week over 2 million viewers watched Sam’s impressive speed and versatility on YouTube. Sam Gordon is a girl playing in an all-boys tackle football league in Utah.  Sam finished the 2012 season with a stat line that would make any parent and coach proud. According to the video, she scored 35 touchdowns on 232 carries, totaling 1,911 yards and averaging 8.2 yards per carry. And just for the fun of it, she also had 65 tackles.

It is hard not to watch this video and be wowed, but in this era of concerns about concussions, on all levels of football, this video raises some concerns.  The last minute of the video shows clips highlighting the 9 year old girl “taking a hit”.  Some of them are quite jarring. Gordon is not even 60 pounds, and there’s a kid on her team who weighs more than 150 – his nickname is Tank.

In his new book, Concussions and Our Kids: America’s Leading Expert On How To Keep Sports Safe And Protect Young Athletes, Dr. Robert Cantu – a clinical professor of neurosurgery at the Boston University School of Medicine — proposes that children should not play tackle football until they are 14 years old. The better game for children under 14 is flag football — in which kids grab flags rather than each other to stop the ball carrier.

Our message to Sam is simple: run, Sam. Run. Run so you can avoid the hits!