High School Coaches Know Concussion Signs but Don’t Act

High school coaches have a good understanding of the signs and symptoms of concussion, but they often don’t make the right management decisions, a new survey shows. That’s where athletic trainers come in, said Meredith Madden, athletic trainer at Boston College who did the survey and reported the results June 26 at the National Athletic Trainers’ Association (NATA) annual convention.

“Most of our coaches are there for a very specific job description — to coach. Athletic trainers are important members of the team and at the end of the day it’s our job to keep the kids safe. Not every hit to the head will result in a concussion, but that is up to a qualified athletic trainer to determine, not a coach,” Madden noted in an interview with Reuters Health. Madden and colleagues got 104 Massachusetts’ public high school coaches to complete an online survey to test their knowledge of concussion signs and symptoms and management. They also interviewed 12 coaches by phone or in person.

Most of the coaches correctly identified symptoms of confusion (94%), headache(94%), dizziness (91%) and blurred vision (90%) as indicators of a concussion. Most also identified loss of consciousness (87%), nausea (82%) and amnesia (75%) as indicators of concussion, but fewer than half (42%) recognized sleep problems as a sign of concussion. About one in 10 associated non-concussion symptoms as primary indicators of concussion, which suggests that they are unable to distinguish concussion symptoms from other injuries and lack in-depth knowledge or understanding about concussion, the researchers say. Over 90% of coaches knew appropriate management strategies in typical concussion scenarios, but when faced with atypical scenarios, only 57% would appropriately remove an athlete from play.

“The coaches had really good knowledge about signs and symptoms of concussion,” Madden told Reuters Health. “But when we looked at their overall management, they often weren’t making the right decisions. This suggests that they know what to look for, but they don’t necessarily know what to do, or they are uncertain, or there is some other conflict that is coming into play.”

Larry Cooper, head athletic trainer, Penn Trafford High School in Harrison City, Pennsylvania, and Chair of the National Athletic Trainers’ Association Secondary School Committee, told Reuters Health, “We have come a long way in educating coaches and they certainly have increased their knowledge of concussions and certain things to look for but we still have a ways to go.” This survey “underlies what we have been trying to push all along and that is to have an athletic trainer in every secondary school,” said Cooper, who wasn’t involved in the survey.

“With concussion evaluation and management, or any other type of injury, the athletic trainers are the health care professional that can do it, regardless of the sport, the event, the score, and provide even-keel medical evaluation,” he said. He added that coaches’ ability to evaluate an athlete “with a neutral mind is sometimes lacking.”

“Athletic trainers are the ones who should decide whether an athlete stays in the game or doesn’t. Any coach in their right mind would not want to take that on, just because that is not what they are trained to do. We’re the ones providing the health care, the coaches are the ones doing the coaching,” Cooper said.

Madden added, “We all want to make athletics safe, because they are a good vehicle for our students for character development and for scholarships. We have qualified athletic trainers to assess and provide care for our student athletes.”

by Megan Brooks, Reuters Health

Overuse Injuries More Common in High School Females

HealthDay news imageYoung female athletes appear to face a far greater risk for repetitive motion injuries than young males do, new research suggests. The finding stems from an analysis that looked at overuse injuries among 3,000 male and female high school athletes participating in 20 different sports. Researchers from Ohio State University Wexner Medical Center in Columbus report that the highest overuse injury rate was observed among girls who ran track. This was followed by girls who played field hockey and girls who played lacrosse.

By contrast, among boys the most overuse injuries occurred among swimmers and divers. Their rate of repetitive motion injuries was pegged at only about a third of what investigators saw among female runners. The study was published recently in the Journal of Pediatrics.

“During this point of their lives, this is when girls are developing bones at the greatest rate,” study author Dr. Thomas Best said in a center news release. He is a professor and chair at OSU’s department of sports medicine. So “it’s incredibly important that they’re getting the proper amounts of calcium and vitamin D,” he said.

Best and his colleagues pointed out that overuse injuries make up about half of all athletic injuries. They are particularly common among children between the ages of 13 and 17. Overuse injuries also account for about twice as many visits to sports medicine doctors than incidents of acute trauma, the authors noted. Overall, most overuse injuries involved the lower leg, the study team noted. This was followed by knee and shoulder injuries.

To limit risk, the researchers advised that all high school athletes play more than just a single sport and make a conscious effort to change up their movements. Parents, they added, should encourage their children to get the rest and foods they need to stay healthy.

SOURCE: Ohio State University Wexner Medical Center, news release, June 24, 2015


Key Points:

  • Participation in yoga is increasing amongst all age groups in the United States
  • When done correctly, yoga has many benefits for young athletes in improving core strength, flexibility, and psychological benefits
  • Some poses may need to be avoided or modified if the athlete has some pre-existing medical conditions, such as avoiding lunges if you have Osgood-Schlatter syndrome

kids yogaVarious estimates of yoga participation in the United States appear to show increases in all age groups. It’s generally believed that the percentage of U.S. adults who said they practice yoga increased from 5.1 percent in 2002 to 9.5 percent in 2012, according to one survey conducted by the National Institutes of Health and the Centers for Disease Control and Prevention. Yoga participation amongst kids is also on the rise: the percentage of children ages 4 to 17 who do yoga increased from 2.3 percent in 2007 to 3.1 percent in 2012.

I’m generally a yoga fan, although there’s quite a bit of commercialism surrounding mainstream yoga. Yoga encourages balance, strength, proper posture, improved breathing, control, and awareness of one’s body, and has potential mental benefits as well. We are seeing some more injuries than we did several years ago, but with a few simple guidelines, many of these injuries can be prevented or limited. Additionally, when working with an experienced instructor, yoga may be helpful for injury recovery from numerous orthopaedic conditions such as common strains and sprains.

There are several types or disciplines of yoga. Not every form is friendly for beginners and some can be quite strenuous. Depending on your athleticism, fitness, flexibility, and conditioning as well as pre-existing medical conditions, you should choose a style that fits you well. You should also communicate your goals and needs with the instructor before embarking on a new program.

Injuries can be avoided by knowing your limitations. If you have pre-existing medical problems or extremity injuries, consult your physician or orthopaedic surgeon prior to starting or renewing a yoga program. Discuss any pre-existing conditions with the yoga instructor before starting a class. They may want you to avoid certain poses or positions.

Typically, injuries occur when participants attempt a challenging pose or posture without having the initial capability, flexibility, or strength to perform that maneuver or when the pose is performed improperly. In yoga, it is better to do a portion of the maneuver perfectly than to push from poor alignment into a full pose.

Two common areas for potential problems are with pre-existing conditions such as Osgood-Schlatter syndrome in the knee or Sever’s syndrome in the heel. If a young athlete has these conditions you’ll likely need to modify or avoid some poses, such as avoiding lunges.

With proper techniques and guidance yoga can be extremely rewarding both physically and mentally. Following this straightforward advice, injuries are unusual and the disciplines can be quite beneficial for core and postural strength, balance, and flexibility.

By Dev Mishra, M.D., President, Sideline Sports Doc, Clinical Assistant Professor of Orthopedic Surgery, Stanford University



While baseball is commonly known as a non-contact sport, the risk of collision is certainly not minimal. Some are due to contact with the ball, bat, or another player, but it is easy to forget that a base can cause injuries. Help young baseball players avoid sliding injuries with these tips from Dr. Daryl Osbahr.

As the Assistant Team Physician for the Washington Nationals, a member of the USA baseballtournamentBaseball Medical & Safety Committee, and a member of the STOP Sports Injuries Outreach & Education Committee, I work with players, parents, coaches and athletic trainers to reinforce the importance of proper baseball sliding technique. Here are some helpful tips that you can apply in your own life or teach to your children to help avoid a serious injury:

  • Always take time to stretch and warm up properly. This will help you avoid lower body ligament injuries while maintaining flexibility and strength.
  • It is important that proper sliding technique is taught and practiced before using an actual base.
  • Always practice with a sliding bag first. Once the player has learned the correct technique, gradually move to a breakaway base and then, if your league requires it, to a standard, anchored base.
  • Players under the age of 10 should not be taught to slide.
  • When coming into home plate, the baserunner should attempt to slide safely in order to avoid a collision with the catcher.
  • The obstruction rule should always be taught and observed. It is dangerous to get in the way of the runner or block the base without possession of the ball because it could cause serious injury to both the baserunner and the fielder.
  • If league rules allow it, use separate bases for the runner and the fielder to help prevent foot and ankle injuries.
  • Always wear the appropriate footwear. Your cleats should have enough traction to help avoid slippage, but not so much that they can get caught in the turf or injure another player.
  • Know what equipment your league (or your child’s league) is using, and be sure to have a thorough understanding of league rules.

In every situation, prevention is always the best treatment. Together, we can make sliding safer—but it takes an athlete’s entire influence circle to make a difference. The athlete, parents, coach, team personnel and doctors all need to be dedicated to preventing injuries together.

By Daryl Osbahr, M.D.

Improve your Understanding with 3D Animation on Articular Cartilage Problems

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5 “Harmless” Sleep Problems You Shouldn’t Ignore

It’s easier than you think to tame your tossing and turning: You can cure some minor sleep disorders after just one therapy session, suggests new British research. Study participants had acute insomnia, or trouble sleeping for a period of 2 weeks to 3 months because of a life event like stress or illness. But 3 months after the subjects sat down for a 1-hour therapy session, nearly 75 percent reported being completely cured of sleep struggles.

It’s much easier to nip insomnia in the bud through therapy before it becomes chronic, says study author Jason Ellis, Ph.D. The problem: Most people don’t identify with the term “acute insomnia” even if they have it, he says. And soon enough, frequent sleep issues become harder to fix. Even if these five common sleep problems only strike occasionally, you should still bring them up with your doctor.

These occasional snoozing struggles could signal a bigger issue

1. You Don’t Sleep through the Night

Waking up frequently could be a sign that you have sleep apnea, says Men’s Health sleep advisor W. Christopher Winter, M.D. When you snooze, your airway closes and forces your brain to choose breathing properly over staying asleep. You wake with a jolt, the muscles in your airway readjust, and then you’re knocked out again before you realize what happened, Dr. Winter says. It doesn’t matter if you’re rousing every 5 minutes or every hour. If sleeping in chunks makes you feel worn-out the next morning, then it’s a problem—and you need to see your doc, says Dr. Winter.

2. You Wake Up from Nightmares

You’re lying on the beach with a Corona in hand when a tidal wave hits you. Suddenly, you’re back in your bedroom gasping for air. If you’re constantly waking up from dreams like this one, it could be another indicator of sleep apnea, says Dr. Winter. Throughout the night, you dream in cycles known as REM sleep, or rapid eye movement. During your REM cycle, the muscles that keep your airway open become paralyzed and can cause it to collapse, says Dr. Winter. Then, your brain takes that feeling of suffocation and incorporates it into the fabric of your dreams. It might seem like you’re waking up from fear, but apnea is likely the culprit, he says.

3. You Get Morning Headaches

A migraine in the morning could also mean you have a more mild form of apnea known as upper airway resistance syndrome, says Dr. Winter. If you don’t inhale and exhale properly, you don’t get rid of enough carbon dioxide. And when you keep in all this excess gas, it leads to a pounding head—which serves as a cruel alarm clock in the A.M. Before you see a doc about this sleep problem, see if it’s an easy fix. Avoid pulling the covers over your head prior to dozing off. Trapping yourself in a blanket dome with all the carbon dioxide you’re breathing out can give you what’s called a “turtle headache,” says Dr. Winter. If you can’t resist yourself, at least leave an air hole, he says.

4. You Grind Your Teeth

If you sand down your chompers, it could mean stress is keeping you from getting a good night’s sleep. Although you’re probably not aware of it, you’re actually conscious when you grind your teeth, says Dr. Winter. The action happens during short awakenings in the night. If something’s bothering you, you wake up and subconsciously clamp down as a release. In the morning, you’re left with a sore jaw—and later, a lecture from your dentist.

5. You Do Things You Don’t Remember

Does your girl wake you with tales of weird things you did last night that you can’t recall? Don’t laugh them off, says Dr. Winter. If there’s no booze in the equation, this kind of behavior falls under the umbrella of parasomnia disorders, which involve doing abnormal things while you sleep that could hurt yourself or others. Eventually, you could escalate to sleep walking, sleep driving, or even “sleep sexing,” says Dr. Winter. Bring up your strange nighttime adventures with your doctor.

By Jada Green for Men’s Health