Tracking concussions could lead to safer sports for athletes

Gerber, Tim. “Tracking Concussions Could Lead to Safer Sports for Texas Student Athletes.” KSAT. KSAT, 08 Oct. 2016. Web. 11 Oct. 2016.



Big hits are a big part of the action under the Friday night lights, but just how many of those violent collisions result in traumatic brain injuries?

The answer may be surprising: No one knows.

But the KSAT-12 Defenders have learned that the state of Texas could be the first in the nation to establish its own concussion research database to find out. In 2011, Texas legislators passed House Bill 2038, known as Natasha’s Law, which established a statewide concussion protocol to be followed by all schools.

“What that specific law did was require every school district to adopt a concussion oversight team. The concussion oversight team has one charge — to develop the return-to-play protocol for any student suspected of having a concussion.” said Jamey Harrison, deputy director of the University Interscholastic League, which oversees most high school sports in Texas. “If they suspect a student has suffered a concussion, the student must be removed from play and go through the return-to-play protocol before they can re-enter play.”

Clark High School football player Michael Oliver went through the protocol when he suffered a concussion during practice last year.

“I knew as soon as it happened, because I felt it,” Oliver said, recalling about the hit.

Oliver said he knew instantly something was wrong, so he went to the sideline and told a coach, who then sent him to see a team trainer. The trainer pulled Oliver from practice and told him he needed to see his personal physician to be evaluated for a concussion.

Oliver’s doctor, Evan Ratner, diagnosed him with a concussion and ordered him to rest his brain, removing him from school for a few days and ending his football season.

“I wasn’t allowed to use electronics or drive,” Oliver said. “It was constant pain. My head hurt all the time.”

According to numbers provided to the Defenders by several local districts, Oliver was just one of several hundred student athletes to suffer a concussion last year.

Northside ISD provided the most detailed numbers, offering up to two years worth of concussion injury data kept by district trainers.

The numbers revealed 527 concussions were logged by the district’s high school and middle school student athletes, 230 were suffered by football players, while girls soccer had the second most concussion injuries with 85.

The numbers may seem high but not when you consider how many student athletes participate in NISD’s sports programs.

“We’re around 1.6 percent to 2 percent out of 14,000 athletes, and that’s middle school and high school,” said Paul Rost, coordinator of NISD’s Athletic Trainers. “They (numbers) pretty well stay the same. We’ll have years just like any other injury or sport where you’ll see years that you have a lot of knee injuries or ankle injuries the next year, it goes up and down.”

Rost said any student suspected of having a concussion is immediately pulled from the game or practice and placed into the state mandated five-day concussion protocol established by Natasha’s Law.

“Once we are told that they have a concussion, we have to get the doctors note. We hand them the form and they have to go through our protocol before they can go back on the field,” Rost said.

Even if a doctor finds the student didn’t have a concussion, they must still wait five days to return to play.

NISD takes it a step further when it comes to middle school athletes, requiring those students to sit out at least eight days.

“Mainly because if you get a concussion and the symptoms reoccur during your evaluation period, you have to go back to the doctor. So we just wanted to give those middle school athletes a little more time. Younger brain, a little bit more time to heal up,” Rost said.

In addition to establishing the concussion protocols, the UIL was the first organization of its kind to also set limits on full contact practices to reduce concussions. Texas schools are limited to 90 minutes of full contact practice per player per week. Even with those measures in place, some feel the UIL could do more to reduce the impact of concussion injuries in the state.

Since 2011, the UIL has been collecting information on concussion injuries as part of its injury reporting system, but it only included a handful of schools and only for concussions that occurred on the football field.

“Right now, our injury reporting is only a sample of schools. It is not a scientific study. It was never intended to be a scientific study. It merely provides a snapshot of data,” Harrison said. “It sounds very easy in the general public to say you should collect concussion data, but just knowing that someone was concussed or suspected of having a concussion doesn’t do us much good. It has to be a scientifically based study and we’re not a medical research institution.”

That’s why the UIL is now partnering with the University of Texas Southwestern Medical Center and the Texas Institute for Brain Injury and Repair to launch the first comprehensive study of sports-related concussions called ConTex. For now, the study is a voluntary pilot program, but Harrison expects that to change.

“Our hope is that for as early as next school year, it would become mandatory for all schools to report suspected concussions to that registry through their module for every sport,” Harrison said. “That would include all sports, boys and girls, sub-varsity and varsity. So it would be a very comprehensive data collection and simply the most comprehensive model in the country. Concussions are a problem in every single sport, even swimming and diving,” he said. “Every sport we have, there is a concern about concussions. And how to go about addressing those concerns may differ from sport to sport, but we have to get that information so we know how to move forward.”

Harrison said the UIL hope the study will help them identify best practices that can be applied to reduce concussions. It could potentially identify what some Texas schools are already doing well that could be shared with other with schools in the state, such as teaching different techniques and identifying which schools are doing a better job of returning students to play after a concussion with less instances of reoccurrence.

“Ultimately, what we hope to do in getting the information back from those medical researchers is to make the games we provide as safe as they possibly can be,” Harrison said.

Ratner said one thing schools could start doing in the meantime is requiring student athletes to undergo baseline concussion testing prior to starting their sport each season.

The computer program Ratner uses puts the athletes through a series of tests and creates a score that can then be used to evaluate a student after suffering a concussion.

“Everybody’s baseline concussion testing is unique. It’s not an IQ test. It doesn’t tell me how smart the person is. It doesn’t tell me how good of a student they are. But different people think differently and their brains react differently and their reaction time is different,” Ratner said. “So what may be a normal baseline for someone, might represent an injured brain for someone else. I can compare someone not just to age and gender controls, but I can compare them to themselves.”

Ratner said having the baseline test can help determine when an athlete has recovered from a concussion, allowing a physician to clear them for return to play when their bodies are actually ready. He said the danger of returning a student to play too soon could have long term effects.

“Until a concussion is healed, the threshold for re-injury is much lower. So if they’re back to their routine activity and they’re taking big hits, every single one of them exceeds the threshold. Every single one of them is going to make things worse,” Ratner explained. “And by worse I mean more severe symptoms, symptoms that last longer even potentially permanently and in pretty rare conditions you can get something called second impact syndrome which is unfortunately even fatal.”

When it comes to creating a statewide concussion database and clinical study, Ratner believes the UIL is taking a big step in the right direction.

“We still don’t know exactly who’s going to have long-term effects and who’s not going to have long-term effects. So, by gathering the data and gathering this information it will really help us determine over the long-term who’s at higher risk for chronic injuries over many, many years,” Ratner said. “If we can keep track of concussions well it gives us an idea of really the scope of the problem and what we’ll come to realize is we’re not doing enough for them in San Antonio and we need to increase what we’re doing, including adding the baseline concussion studies.”


Interactive Map-

Natasha’s Law-



Dr. Evan Ratner-

KSAT Digital Team Story on Concussion Helmets-






New tool helps screen young athletes for concussions


10-year old Blaine Dyer is getting a checkup of his brain.

Gwinnett Medical Center pediatric neuropsychologist Dr. Adam Shunk wants to know how the Dacula fourth-grader is doing after Dyer took a hard hit during a youth football scrimmage game a couple of months ago.

“When I play football, I don’t cry unless I’m really hurt,” says the Gwinnett fourth-grader.

But, this time, Dyer did cry, for good reason.

“This kid grabbed my legs and then another kid came beside me and hit me right on my head,” he says. “It was hurting my head, because my helmet was squishing my head a little.”

Dyer was taken out of the game, suspected of having a concussion.

That hit may have jarred or shaken his brain inside his skull.

Sometimes there are symptoms, but sometimes not.

And while it’s dangerous to return to play too soon, before the brain has had time to heal,  Dr. Shunk says many young athletes may be reluctant to admit they’re hurting.

“I mean every kid wants to get back on the field as quick as possible,” says Shunk.  “So they’re not always going to tell you when they’re having symptoms.”

Dyer says he wanted back on the field.

“And I was kind of mad, because I really wanted to play my game, because I’d been waiting for it,” he says.

But a new screening tool could take the guesswork out of screening children as young as 5 for concussion.

It’s called ImPACT Pediatric.

“It evaluates areas that are sensitive to a concussion: such as speed of processing, their learning and memory abilities and general attention, that can be disrupted when you’re recovering from a concussion,” says Dr. Shunk.

Many high school and college athletes already get baseline ImPACT screenings before their season begins.
Then, they retake the test to look for changes in their performance after a suspected concussion.

Now, Dr Shunk says, they can do the same before and after screening for athletes between the ages of 5 and 11.

Blaine Dyer, who is now happily back in the game, recently scored his first touchdown of the season.

It’s really exciting,” he says.  “When you first go out there, and you have a concussion.  And then you  go back on the field and score a touchdown, it’s really cool.”


Galvin, Beth. “New Tool Helps Screen Young Athletes for Concussion.” WAGA. FoxATL, 28 Sept. 2016. Web. 29 Sept. 2016.


Concussion diagnoses in children up 500 percent

At a time when athletes are bigger, stronger and faster than decades ago, precautions are being implemented to reduce the risks of concussions.

Concussion diagnoses in children and young adults under age 22 rose 500 percent from 2010 to 2014, according to a new study published by FAIR Health, a national, independent, nonprofit organization who says its “mission is to bring transparency to healthcare costs and health insurance information.”

This study, the organization said in a release, was conducted based on healthcare insurance claims filed from 2007 to 2015 for people ages 0-22 years old.

An initiative by the National Football League intended to increase the safety of the game, specifically by preventing, diagnosing and treating head injuries, is being felt all the way down to youth football, local coaches said.

“We’re all accountable,” said Lance Engleka, Middletown High School football coach.

The Ohio High School Athletic Association has joined dozens of states in adopting recommendations from the National Federation of State High School Associations’ Concussion Summit Task Force to address the diagnosis and management of concussions.

Since last year, the OHSAA has banned student-athletes from returning to play after a suspected concussion without a release from a doctor or athletic trainer. That permission must be written and submitted to the official before a player can return to a game after leaving with a potential concussion, said Dan Ross, OHSAA commissioner.

The state also instructed schools to limit full contact on consecutive days; a student-athlete is limited to 30 minutes of full contact in practice per day; a student-athlete is limited to 60 minutes of full contact in practice per week; and a student-athlete can be involved in full contact in a maximum of two practices in a seven-day span.

All coaches must review and know the signs and symptoms of concussion and to prohibit any athlete who displays these signs or symptoms from participating in a practice or a contest, the OHSAA said. Officials also are required to know the signs and symptoms of concussion and to direct immediate removal of any athlete who displays these signs or symptoms.

The state rule regarding return-to-play after concussions applies to about 350,000 high school athletes, Ross said.

A different perspective

Engleka has experienced concussions on two levels: as a parent and a coach.

His son, Cam, a junior football player at Springboro High School, was brought up to the varsity team toward the end of the season his freshman year, to run the scout team as the Panthers prepared to face Lakota East in the state playoffs. It was cold and rainy that day, so Engleka watched practice from his car.

He remembers his son getting sandwiched between two defenders.

“That’s a pretty good hit right there,” Engleka remembers thinking.

When his son got in the car after practice, he fell asleep, and his father had to wake him up when they got home. He took a shower, then fell asleep again, his father said. Then he was diagnosed with a concussion. The football coach faced what parents fear.

“As a coach you’re always concerned for your kids and their well being,” said Engleka, in his 23rd year of coaching. “But you’re looking at it from a football perspective. This was a different perspective for me. It was pretty unique. It made me more cognitive when players are complaining of head injuries.”

A standout athlete at Miamisburg High School, Engleka, 46, said when he played football, there weren’t the precautions like today.

“I don’t think the word concussion was ever uttered in a football setting,” said Engleka, a 1988 Miamisburg graduate who played baseball at Miami University. “They always used the words, ‘Did you get dinged?’ or ‘Do you see stars?’ There was a mindset that you didn’t want to show weakness, you didn’t want to come out, you wanted to keep playing.”

Then he added: “That has changed a great deal. The safety of the players is always first and foremost.”

Paul Young, a 1985 Badin High School graduate who played football at the University of Indianapolis, agreed.

“We were told to ‘suck it up and get back in there,’” Young said. “Going out of a game was considered a sissy thing.”

Young, now a coach and director of the Junior Rams football program, said his organization participates in Heads Up Football, a safety program that teaches football players the proper, and safer way, to tackle. The players are taught to lead with their shoulders, not their helmets.

Engleka said parents who have children interested in playing sports should educate themselves on the dangers associated with concussions, ask if medical professionals are available and what is the concussion protocol.

“Be as informed as possible,” he said.

Also, he said, players need to understand that if they suffer a concussion, there’s a possibility they may miss at least one game until they’re cleared to return. It’s a hard lesson for some players to understand, he said. They want to play. They aren’t thinking about the possible longtime effects of brain damage.

Engleka’s message: “You have the rest of your life to think about.”

Research still in its infancy

Engleka is not surprised by the increased number of concussions, especially considering the size and speed of today’s athletes.

“Bigger bodies in motion at a higher rate of speed, colliding, there is going to be some kind of residual affect to that,” he said. “It looks like the brain is taking the majority of those impacts.”

Dr. Scott Albright, of Orthopedic & Sports Medicine Consultants and Associates in Middletown, called concussion studies “the new frontier” because research is in its infancy. He said it may take years to better understand the potential damage done by brain injuries.

“Every kid is different,” he said. “Their brains are still developing. We don’t know the ramifications.”

He said baseline tests are used to assess an athlete’s balance and brain function as well as the presence of any concussion symptoms, he said. Results from baseline tests can be used and compared to a similar exam conducted by a health care professional during the season if an athlete has a suspected concussion, Albright said.

The NFL and its 32 club owners will provide $100 million in support of engineering advancements and medical research in addition to the $100 million previously pledged by the league to medical and neuroscience research, Commissioner Roger Goodell has announced.

Since 2002, the NFL has made 42 rule changes to protect players, in addition to staffing each game with 29 medical professionals, he said.

Player safety made national headlines since forensic pathologist Dr. Bennet Omalu’s 2002 identification of chronic traumatic encephalopathy, or CTE, in the brain of former Pittsburgh Steelers center Mike Webster, 50, who committed suicide. CTE is a progressive, degenerative disease set off by repeated head trauma, Omalu said.

Nearly a decade later, former Chicago Bears defensive back Dave Duerson, 50, committed suicide, aiming a gun at his chest rather than his head so his brain could be preserved and studied. Boston University researchers made a postmortem diagnosis of CTE.

In 2012, 80 concussion-related lawsuits on behalf of more than 2,000 NFL players were combined and filed as a single class-action lawsuit in federal court. The players accused the NFL of negligence and failing to notify them of the link between concussions and brain injuries.

Three years later, a federal judge gave final approval to a settlement in the lawsuit. This agreement provided up to $5 million per retired player for serious medical conditions associated with repeated head trauma and reportedly could cost the league $1 billion over 65 years. The deal also called for baseline medical exams for retired NFL players and monetary awards for those who are diagnosed with Alzheimer’s, Parkinson’s disease, dementia, amyotrophic lateral sclerosis and certain cases of CTE.

An estimated 3.8 million sports concussions occur in the U.S. each year, said Dr. Stanley Herring, of the University of Washington, a concussion expert and the team doctor for the NFL’s Seattle Seahawks and Major League Baseball’s Seattle Mariners.


McCrabb, Rick. “Concussion Diagnoses in Children up 500 Percent.” News & Information for Hamilton, Middletown and Butler &… Journal News, 21 Sept. 2016. Web. 22 Sept. 2016


FDA Clears First Device Specifically Designed to Assess Function After Concussion

The US Food and Drug Administration (FDA) has given its first-ever clearance for marketing of devices designed to help clinicians assess cognitive function immediately after a suspected brain injury or concussion.

Called Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and ImPACT Pediatric, the tool was approved under a new FDA category titled “Computerized Cognitive Assessment Aid for Concussion.” The test battery is already used by more than 7,400 high schools, 1,000 colleges and universities, and 900 clinical centers as a way to test cognitive skills such as word memory, reaction time, and word recognition. ImPACT is designed for use on individuals aged 12 to 59, and operates on a desktop or laptop computer; ImPACT Pediatric is intended for children aged 5 to 11, and is run on an iPad.

While not intended as the sole tool for making a diagnosis or return-to-play decision, the ImPACT device can provide additional evaluative information though comparisons with age-matched databases or patient baseline scores, according to an FDA news release. Pittsburgh, Pennsylvania-based ImPACT Applications submitted more than 250 peer-reviewed articles—half of which were independent clinical research studies—supporting the safety and reliability of the devices.

Prior to the ImPACT approval, the FDA had cleared only devices that help determine the need for imaging after a head injury.



“FDA Clears First Device Specifically Designed to Assess Function After Concussion.” APTA. News Now Staff, 12 Sept. 2016. Web. 15 Sept. 2016.

Concussion safety: A parent’s guide to the fall sports season

Football season has kicked off, and Friday night lights are shining for parents around the nation. Unfortunately, with football comes injuries, and the most common injuries discussed today are concussions. Even if your child doesn’t play football but is involved in another sport, you should know the definition of a concussion and what this means for your child.

A concussion is caused by a bump, blow or jolt to the body, with a force transmitted to the head, causing an injury to the brain. Because kids are not fully physically developed, having thinner skulls and weaker neck muscles, they are more susceptible to concussions.

Concussions have been estimated to account for 9 percent of all high school athletic injuries. However, it is estimated that 50 percent to 75 percent of concussions among high school athletes go unreported. What is most alarming in youth sports is that those 13 and younger are more likely to receive a concussion, and most of those are not reported.

Before your children get involved in sports, it’s important that you and your kids are properly educated and know what to do if a concussion is suspected. This should start with a checklist of the basics:

▪ Does your child know how to recognize and report a suspected head injury?

▪ Does your child know how to express a head injury to a coach, parent or teammate?

▪ Does your child’s team or league have a concussion protocol?

▪ What type of physician (neurologist, family medicine or pediatrician) would you take your child to for the evaluation and treatment of a concussion?

Once your child has started playing, become vigilant about head injuries. If you suspect your child has suffered a hit to the head, watch for these common symptoms of a concussion:

▪ Headaches.

▪ Confusion or the feeling of being “in a fog.”

▪ Dizziness or balance problems.

▪ Fatigue or drowsiness.

▪ Nausea and/or vomiting.

▪ Sensitivity to light and noise.

▪ Irritability or nervousness.

▪ Trouble concentrating.

If you think your child or adolescent has a concussion, there are a number of dos and don’ts to follow:

▪ Do stop playing – immediately!

▪ Do tell a coach, trainer, teammate, friend or parent.

▪ Do consult a physician.

▪ Do keep hydrated.

▪ Do get some rest.

▪ Don’t continue playing.

▪ Don’t return to sports activities without medical clearance.

▪ Don’t consume alcohol.

▪ Don’t drive.

The nation’s growing awareness of concussions in the last decade has helped pass legislation to improve the treatment and management of concussions, especially in young athletes. State law requires parents, coaches, athletic trainers and, in some states, athletes to provide education about the symptoms and risks of a concussion. During athletic events, an athlete exhibiting concussive symptoms must be immediately taken out of play and is not allowed to return until they have received clearance from a medical professional.

As a result of legislation and research findings, the “6 Steps to Safe Play” were developed. Of particular significance are the tests now available to test your child’s brain function before and after injury. If your teen participates in a school sport, the following “6 Steps to Safe Play” are recommended:

1. Your child should have a preseason baseline, which is completed with ImPACT, a neurocognitive computerized test for kids 13 and older.

2. Sideline testing with SCAT 3, King Devick or BESS should be available.

3. If your child is injured while playing, he or she should be re-tested with ImPACT.

4. If concussion symptoms and ImPACT indicate a possible concussion, immediately seek medical treatment at a concussion clinic.

5. Once cleared by the doctor, your child can return to play and return to learn.

6. The team’s athletic trainers should have access to the Concussion Injury Surveillance System, a tool used to track concussions.

If a concussion is left untreated or an athlete sustains multiple concussions, your child could suffer permanent brain injury. The inherent competitive nature of sports and culture to win at all costs may sometimes overshadow the need to call attention to reporting injuries. As a coach, parent, athlete and even a fan, we must encourage the reporting of head injuries within the sports culture. An athlete’s awareness of the signs, symptoms, and effects of a concussion can only improve the safety of our athletes. Educating all parties, particularly our youth athletes, has shown to increase concussion awareness and reporting, making it a vital component of sports safety this school year.

For more information, visit

Gillian Hotz, Ph.D., is the director of the Kidz Neuroscience Center at UHealth – the University of Miami Health System. For more information, visit

Read more here:
 Hotz Ph.D, Gillian. “Concussion Safety: A Parent’s Guide to the Fall Sports Season.” Miamiherald. Miami Herald, 12 Sept. 2016. Web. 13 September 2016

Doctors offer tips to avoid overheating at football games as summer wanes

With fans packing stadiums for Saturday’s Auburn and Alabama football games, one thing’s for sure: it’s going to be hot.

With thousands of people in close quarters and many of them drinking, medical professionals want you to make good choices when it comes to your health.

“Any big event, whether it’s a concert, whether it’s a football game, whether it’s a race at Talladega, you put a lot of people trying to have fun in the heat and you have multiple people getting sick each time,” said Dr. Matthew Delaney with UAB’s emergency services.

He says that if you get too hot, you should pay attention to your body’s symptoms. Signs of heat stroke and heat exhaustion include nausea, confusion, a change in sweat, and chest pains. If you experience those symptoms, try to cool off immediately. You may even want to take a break indoors.

However, Dr. Delaney says it’s better to avoid overheating before it happens. To do that, drink plenty of liquids, but cap your alcohol intake.

“The effects of alcohol are greater when it’s hot, so maybe drink a little less than you normally would,” he said.

You should also try to stay in the shade as much as possible, and avoid the direct sunshine.

“It’s great to be excited and it’s great to have fun, but we just want people to use common sense,” Dr. Delaney said.

Bivins, Britany. “Doctors Offer Tips to Avoid Overheating at Football Games as Summer Wanes.” Alabama News Weather Sports Traffic. WIAT, 09 Sept. 2016. Web. 12 Sept. 2016.

Concussions: Don’t let children return to sports too soon

School is back in session and along with it the fall sports season. Youth sports promote physical activity and camaraderie, and the lessons of team sports can last a lifetime.

But injuries are a reality with youth sports, and kids are especially vulnerable to head injuries and concussions. There has been a lot written about sports-related head injuries in the last few years, yet kids and parents alike often downplay symptoms of concussions and rush too quickly to get back to the field or court.

There has been a lot written about sports-related head injuries in the last few years, yet kids and parents alike often downplay symptoms of concussions and rush too quickly to get back to the field or court.

A new study points out the risk involved with returning to sports too soon after a head injury. Researchers from Arkansas followed 70 young athletes who came to a medical facility for treatment of a sports related concussion. The average age was 15½. Half of the young men and women were removed immediately from play, while the other half were allowed to continue playing. Neurocognitive testing as well as assessment of symptoms such as headache were done a week later then again a few weeks after the first assesment.

The group that was allowed to continuing playing despite concussion symptoms took twice as long to recover compared to the group that was removed from play immediately (44 days versus 22 days). Kids who were allowed to continue playing were also more likely to have a long recovery from concussion symptoms (more than three weeks) including headache, dizziness, impaired cognition, academic, and psychosocial problems. The authors concluded that kids recover from concussions significantly faster if they are removed from participation immediately after their injury compared to those who were allowed to continue playing.

The findings from this study are not surprising. More than 3 million sports or recreation-related concussions occur in the U.S. annually. Adolescents are at the greatest risk for sports-related concussions and recover much more slowly than adults for unknown reasons, but possibly because their brains are still growing and developing.

Research has shown that the injured brain loses its ability to protect itself from a second injury, making the risk of a short-term second impact potentially catastrophic, and the risk is amplified is children and adolescents.

The danger period after a first concussion is unknown but it is likely at least 10 days. But even weeks later, kids can have subtle effects of a concussion, including emotional and mental symptoms including irritability and frustration. The psychological effects of a concussion may even start weeks after the physical effects have resolved.

In 2013, The American Academy of Neurology released guidelines on the evaluation and management of sports concussions. The first recommendation of the guideline is that an athlete suspected of having a concussion should immediately be removed from play and should not be allowed to return to play until evaluated by a trained health-care professional with training in both the diagnosis and management of concussions.

The guideline further recommends that high-school age or younger athletes should be treated much more “conservatively” than college or adult athletes, acknowledging that growing children and adolescents are at much higher risk of serious brain injury.

There is no evidence that any medications or other treatments hasten recovery over simple rest.

For boys, the risk of sports concussion is greatest with football and rugby, followed by hockey and soccer, while for girls the risk is highest with soccer and basketball.

Most sports injuries, such as a sprained ankle or broken wrist, are easily diagnosed and treated. But concussions may represent a far greater and longer-term risk. As a parent or coach, always put the player’s well being first and treat any head injury as a potentially serious injury.


Correspondent, Bill Elliott IJ. “Concussions: Don’t Let Children Return to Sports Too Soon.” Concussions: Don’t Let Children Return to Sports Too Soon. Mariniji, 04 Sept. 2016. Web. 06 Sept. 2016.

Stay hydrated during preseason practice

The athletes playing football in this extreme heat, especially two-a-day practice sessions must think seriously about dehydration.

Coaches, captains and parents must encourage the player to increase fluids and be well hydrated by drinking before, during and again after practices.

The athlete who begins exercise with less than normal amount of body fluid runs the risk of adverse reactions to the cardiovascular system, body temperature regulation, and performance during the practice or game.

Athletes playing football can lose as much as 10 quarts of fluid during the sweat rate each day. Large losses of sodium and chloride occur when one sweats. These must be replaced during the practice sessions from day to day. The athletes should begin their strength training exercise conditioning before going out for preseason practices. This helps them to become acclimated to warm weather.

If one begins to exercise dehydrated, this will create the risk of heat illness and poor performance. The athlete should get into a habit of drinking at least 16 ounces of fluid in the evening, before retiring and another 16 ounces upon awaking to maintain fluid balance.

It is important to drink 16-32 ounces one hour before and another 16 ounces about 20 minutes before the training sessions start. One may get into a method of weighing oneself before and after exercise to make sure one has taken enough fluid to prevent dehydration.

At times, with heavy sweating, fluids that contain carbohydrate and small amounts of sodium chloride will be helpful in fluid and mineral replacement during the practices or competition.

If the athlete has the slightest sign of thirst, this is a warning sign of dehydration and possible heat illness. Drink at least 8 ounces every 15 minutes to replace fluid loss and 24- ounces for every l pound of body weight loss after exercise.


Weiss, Dr. Robert F. “The Running Doctor: Stay Hydrated during Preseason Practice.” Westport News. Westport News, 23 Aug. 2016. Web. 24 Aug. 2016.

Playing it safe in the heat!

In case you haven’t noticed — it is hot! With participation in outdoor fall sports beginning, schools and coaching staffs are taking extra precautions to keep their athletes safe from heat-related issues. In recent visits to both area high schools, coaches and staff members were following strict guidelines to help ensure the safety of their players.
According to the National Weather Service, heat is a leading weather-related issue in the United States that results in fatalities or illnesses. With heat advisories popping up throughout the state, it is important to monitor the heat index, a measure of how hot it really feels when relative humidity is factored together with the actual air temperature. During extremely hot and humid weather, the body’s ability to cool itself is challenged, which can result in heat cramps, heat exhaustion or even a heat stroke.

Cortney Bowers, certified athletic trainer for Colleton County High School, is cranked up for football season – meaning she’s on-duty during practice to help ensure the players’ safety. According to Bowers, South Carolina does not have actual heat regulations, but most athletic trainers within the state use a work/rest/water and continuous work/water consumption guideline made available by Fort Jackson.

“The guidelines are a way for us to categorize the temperature-vs.-work ratio to gauge when we should stop practice due to temperatures,” explained Bowers. “Athletes often don’t realize the toll heat takes on their bodies until they are suffering from a heat-related condition. As temps hit the high notes, I hit the water bottles and get out the Kestrel,” said Bowers. “The Kestrel is a dry-bulb/wet-bulb globe thermometer which measures temperature, humidity and heat index. It will work standing in the middle of a football field.”

Bowers is also charged with helping keep the players hydrated during practice. “I try to keep every player as hydrated as possible throughout practice, with plenty of water on the practice field,” said Bowers. “I have 18-20 sets of water bottles, so each coach has two sets of their own in groups. I have two 20-gallon water boys that I use on opposite sides of the practice field. The linemen, who tend to be bigger, have 4-to-5 sets of bottles and a 20-gallon water boy to help keep them hydrated. Last year, we had a continuous feed water boy purchased for us, which enables me to put ice in the chest and plug it up to a water hose for a continuous flow. On standby, I have 7-8 ten-gallon coolers filled with just ice to replenish the smaller water boys as needed and keep a seven-gallon cooler with towels, ice, water and ice bags in it for emergency.”

The Cougars will go full gear on Wednesday, which means Bowers will be going a step further in her preparation. “Once we put pads on, I will have a tent on the sidelines,” said Bowers. “I’ll keep the water under the tent and have tubs set up for emergency cold soaks or just for the guys to take a nice dip after practice. I also have the whirlpool inside that is ready to go if needed.”

According to Bowers, part of staying safe in the dangerous heat begins before athletes step on the field. “I preach to these kids to drink lots and lots and lots of water,” she said. “Although some Gatorade is acceptable, nothing beats water. Gatorade, which is heavy in sugar, can actually cause cramping. So, I always tell players if they drink Gatorade, fill the empty bottle back up with water. It is also very important to eat in the mornings before practice — whether it’s eggs and bacon or a peanut butter sandwich, it gives them the necessary energy for practice and helps reduce overheating. Dressing in loose fitting, comfortable clothing or heat gear, is another component to staying cool.”

The State of South Carolina has mandated that all coaches take an annual test through the National Federation of State High Schools on heat illness prevention, concussions and sudden cardiac arrest. This precaution allows coaches to know the signs and symptoms and to both stay educated and help educate.
“With coaches and athletic trainers understanding what to watch for, it means more eyes to watch for signs and symptoms, which is better for our athletes,” said Bowers.


Crosby, Cindy. “Playing It Safe in the Heat!” Walterboro Live. Walterboro Live, 12 Aug. 2016. Web. 23 Aug. 2016.



High schools must adopt guidelines to prevent sudden deaths of athletes

The death of 14-year-old Lewis Simpkins has once again raised questions about whether we are doing enough to prevent sudden deaths in sports.

The sophomore defensive tackle at River Bluff High School stumbled through the end of a 2-hour, 15-minute football practice before collapsing in the locker room on Aug. 10. Coaches gave him CPR and used a defibrillator. Paramedics took him to Lexington Medical Center, where he was pronounced dead.

Over a recent 20-year period, 243 deaths occurred during high school and college football practices and games. That’s about 12 per season. The most common causes were heart failure, brain injury and heat illness. The cause of Simpkins’ death has not yet been determined.

A recent article in The State newspaper pointed out that South Carolina high schools show poor compliance with guidelines to prevent sudden death. These guidelines come from the Korey Stringer Institute, a leader in research and education to improve safety and prevent sudden deaths for athletes and the military.

In the article, South Carolina High School League commissioner Jerome Singleton noted that he wasn’t familiar with the Institute or its guidelines. He did point out that coaches in this state must complete online courses regarding heat acclimatization and concussions. He also emphasized that the SCHSL reviews its medical policies annually.

Korey Stringer was an NFL offensive lineman for the Minnesota Vikings. He died from exertional heat stroke after an August practice in 2001. His wife Kelci partnered with heat stroke expert Dr. Douglas Casa at the University of Connecticut to create the Korey Stringer Institute. The NFL, Gatorade and other companies and organizations contribute to the Institute’s efforts.

One area of concern for football teams in the South is the heat, with 63 percent of deaths from heat stroke in football occurring in the South. Fortunately, these deaths are largely preventable. Unfortunately, South Carolina does a poor job complying with guidelines that can prevent these deaths.

While North Carolina and Georgia, as well as Alabama, Mississippi, Arkansas and Texas, meet the minimum best practice guidelines for heat acclimatization, South Carolina only meets one of the seven KSI guidelines. These guidelines include limits to the number and length of practices in the first weeks of summer football and recommendations for gradually adding protective equipment.

South Carolina schools also meet none of the guidelines regarding the use of Wet Bulb Globe Temperature (WBGT). The WBGT requires a special device to measure the outside environment for heat stress. It’s likely that the cost of the device plays a factor in our poor compliance, but Georgia meets all nine of the best practice guidelines for WBGT.

South Carolina does somewhat better with access to automated external defibrillators (AEDs) and training in CPR and AED use — meeting five to six of the Korey Stringer Institute’s eight best practice guidelines.

In terms of plans for emergencies like the tragedy at River Bluff, South Carolina again needs work. Of the 11 guidelines issued by KSI regarding emergency action plans — schools coordinating with local EMS, athletic trainers and physicians on-site to develop plans should a medical emergency occur — South Carolina meets none of them.

The South Carolina High School League needs to adopt these heat acclimatization and emergency action plan guidelines. It should work with its high schools and the state legislature to arrange funding for WBGT and certified athletic trainers for each school.

Schools, though, don’t have to wait for a statewide mandate to take action. Concerned parents of high school athletes can talk to the athletic directors and coaches to discuss plans to treat and prevent deaths from cardiac arrest, heat stroke and brain injury.

This isn’t about pointing blame at the SCHSL or the high school athletic directors and coaches around the state. My goal is to raise awareness and encourage change.

As tragic as the sudden death of a high school athlete is, it creates a perfect time to take steps to prevent another one.

Geier, Dr. “High Schools Must Adopt Guidelines to Prevent Sudden Deaths of Athletes.” Post and Courier. Post and Courier, 19 Aug. 2016. Web. 22 Aug. 2016.