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