Anyone who is a fan of college football held his or her collective breath the Saturday night when the University of Florida’s quarterback Tim Tebow was sacked by an unblocked University of Kentucky defensive end. It was a clean hit. His head had been jarred forward on the knee of one of his teammates. He lay motionless for several minutes. He was knocked unconscious and athletic trainers rushed to him on the field to assess his injury.
It was that moment in time, when the Heisman trophy winning quarterback had suffered a severe concussion and it caught the attention of every high school and college coach in America. According to media reports, Florida’s Head Coach Urban Meyer said several days after Tebow suffered the concussion, he still suffered from a headache. Although he was able to attend team meetings, he hasn’t been allowed to watch television or read, and didn’t attend practice.
Dr. Aaron Karlin, Director of Ochsner’s Pediatric and Adolescent Concussion Management Program, said that this program is the only one of its kind in Louisiana. He spends his Friday nights on the sidelines of the Covington High School football games assisting their team doctor.
Developed out of Pittsburgh, Karlin uses a program called “IMPACT”. It is a computerized neuro-cognitive test utilized by the NFL, NHL, MLB, NBA and many colleges and universities. It is one of the tools in their toolbox to diagnose concussions and other sports related injuries. “According to studies, about 10-20% of the student athletes on each football team will have a concussion during the season this year that go unreported. One of the big goals of our concussion program is education. Most concussions go undiagnosed because the coaches, trainers or kids don’t know what a concussion is. Most think that you must have loss of consciousness or loss of memory. Most concussions occur without loss of consciousness or post-traumatic amnesia,” Karlin said.
The “Impact” Program at Ochsner, although it is not an I.Q. test, looks at an athlete’s reaction time, processing speed of the brain, memory and things that are affected from a cognitive standpoint from a concussion and then track the physical and cognitive symptoms. Karlin says, “We can then get baselines on these athletes to see how things are and then if the athlete gets a concussion during the season, we can compare after they have been concussed and then make determinations on when they can get back in the game.”
The therapy for this type of injury is physical and cognitive rest. Karlin says, it’s very difficult to shut kids down completely, however, you need to limit their driving, television, movies, homework and computer use to 30 to 45 minutes at a time. Any kind of stimulation of the brain can cause headaches and sometime nausea.
With concussion injuries, there is a progressive return to play. Although an athlete may look symptom free doesn’t mean they are ready to get back in the game. Karlin says you can look great sitting around doing nothing. But he conducts a simple physical test such as 60 seconds of an aerobic challenge like jumping jacks in his office. If all their symptoms (21 different symptoms) are a zero on a scale of zero to six, we can then start talk about returning to play. We look at their reaction time and use a six-step process being recommended and used all over the world since 2008. The first step is physical and cognitive rest until they are asymptomatic. The next step is some light aerobic conditioning on a stationary bike and then limited sports specific drills and conditioning with the team. They continue with full conditioning and full drills with the team. Then they do weightlifting, which is held later in the process, and the last step is a non-contact practice with the red jersey. Then the athlete goes through a full contact practice and if there are no further symptoms, they are usually cleared to play in the next game. There must be 24 hours between each step.
If an athlete gets a concussion on a Friday night, he is definitely out the next game, says Karlin. “That’s only because of the timing of the game. If you played a game every 10 days, you would likely be back for the next game. Eighty-five percent of athletes with concussions are back full-time on the field by three weeks and eighty to ninety percent have resolution of their symptoms by 10 days. However, ninety percent of recurrent concussion injuries occur within 10 days of their first or initial injury.”
David Giardina, Athletic Trainer at the North Institute in Lacombe and past president of the Louisiana Athletic Trainer Association says it’s very important to work with student athletes in a positive manner. “At the North Institute, we treat student athletes in a very personal way to have them understand, pending the severity of their injury, that they may be off the field for a while. It’s a delicate time for them, but hard work will get them back. “The athletes want some type of structure and a timeline to getting back on the field. We definitely give them structure, but cannot guarantee their return on a specific date. If the student athlete is not being treated by one of our physicians, therapists or trainers, we want them to be involved with the team as much as possible. It’s definitely a positive for the student athlete. However, most, but not the entire medical field, doesn’t understand that concept,” said Giardina.
Southeastern Louisiana University’s Assistant Athletic Director of Sports Medicine, Tony Trombetta says, Southeastern is one of only five schools in the State of Louisiana with an accredited Athletic Training education program. It is the oldest program in the State with the highest number of students. The hottest topic amongst the athletic trainer community is the Tim Tebow concussion. ESPN sports network has a physical therapist as their medical expert talking about this concussion. ESPN has been very rough with athletic trainers as a profession and I want folks to know that we are not trainers, we are certified athletic trainers, which are considered allied health professionals recognized by the American Medical Association. As a group, athletic trainers take being called a trainer as a derogatory term. We are much more capable of talking as an expert, especially on concussions. Physical therapists see patients after the physician has diagnosed a problem or an injury. “The athletic trainer is out on the field, sees the injury occur, manages it from an emergent situation and then follows that athlete from an acute situation through an injury evaluation and diagnosis and then refers them to a physician and then gets the athlete back for rehabilitation,” said Trombetta.
The Athletic Training Education program at Southeastern is very comprehensive. Not very long ago, athletic trainers were considered just workers. Now, it is tied into their education very much like a clinical nursing program. What makes Trombetta proud since he has been at Southeastern is that they have bridged the gap on what students are learning in the classroom and what they experience in practice. “We have a clinical coordinator that makes sure students are exposed to high schools and area clinics through North Oaks Hospital’s sports medicine. They also participate in medical rotations at orthopedic surgeon’s offices and the health care clinic on campus – we are pulling everything together. Our students come out of this program with a B.S. in Kinesiology with an emphasis in athletic training. Once they graduate, they are eligible to take their national exams. Last year we had 10 students graduate and pass their national exams. The national average is 40%. We have a really good program of which I am very proud, said Trombetta.
The North Oaks Sports Medicine Program Head Athletic Trainer Jeffrey Schmitt, ATC, LAT, STS, Daryl Ricard, DPT, and Scott Higgs, PT, recently presented research on a Performance Enhancement Program (PEP) for prevention of Anterior Cruciate Ligament (ACL) injuries to 16 Tangipahoa and Livingston Parish school coaches before the football season started back in August. ACL injuries are common in sports that involve sudden changes of direction. According to the National Center for Injury Prevention and Control, there are an estimated 80,000 annual ACL tears in the U.S.; 56,000 occur during sports. Recovery can take from 3 months to 1 year and usually requires intensive rehab.
The purpose of this presentation was to heighten awareness among coaches about resources which may help decrease the incidence of ACL injuries to their athletes, Schmitt comments.
The presentation included demonstrations of PEP exercises like stretching, strengthening, plyometrics and agilities that should be performed before athletic activity for approximately 15 minutes at least 3 times per week.