Archive for August, 2016

NSCA position on Long Term Athletic Development

Thursday, August 25th, 2016

Tim Koba, MS, ATC
Twitter: @timkoba
Blog: www.timkoba.blogspot.com

Posted August 25, 2016

By Tim Koba, MS, ATC

The National Strength and Conditioning Association (NSCA) has released a position statement on long term athletic development. With the rise in youth sport participation, injury trends, sport specialization and long term inactivity of today’s adults, it is important to encourage youth to participate in physical activity. This tenet forms the cornerstone of the position statement.

While long term athletic development is generally taken to mean the development of athletes, the NSCA broadened the term to include all youth and to consider all youth athletic. In this manner, they address the concern and health implications of physical inactivity and they believe that all youth should be encouraged to be active.

There are 10 pillars for successful long term athletic development (LTAD):

1. LTAD pathways should accommodate for the highly individualized and non-linear nature of the growth and development of youth.

2. Youth of all ages, abilities and aspirations should engage in LTAD programs that promote both physical fitness and psychosocial wellbeing.

3. All youth should be encouraged to enhance physical fitness from early childhood, with a primary focus on motor skill and muscular strength development.

4. LTAD pathways should encourage an early sampling approach for youth that promotes and enhances a broad range of motor skills.

5. Health and wellbeing of the child should always be the central tenet of LTAD programs.

6. Youth should participate in physical conditioning that helps reduce the risk of injury to ensure their on-going participation in LTAD programs.

7. LTAD programs should provide all youth with a range of training modes to enhance both health and skill related components of fitness.

8. Practitioners should use relevant monitoring and assessment tools as part of a LTAD strategy.

9. Practitioners working with youth should systematically progress and individualize training programs for successful LTAD.

10. Qualified professionals and sound pedagogical approaches are fundamental to the success of LTAD programs.

When working with youth, it is important to remember they grow and mature at different rates. Customizing a program specific to each individual is preferable to implementing a general one size fits all approach. Programs also need to take into consideration each individual’s specific movement patterns and volume of activity. Many individuals are not engaging in free play prior to organized activity and, as such, are not prepared for the volume of training that occurs. Coaches, Athletic Trainers, personal trainers and strength coaches need to understand that fatigue and recovery are important aspects of a successful long term plan. By engaging in a well-rounded movement based training plan, youth can become acclimated to the rigors of sport and physical activity.

It is also of vital importance to maintain physical and mental health of young individuals. Programs should incorporate neuromuscular control, movement training and injury prevention exercises to reduce the risk of injury. Programs should also strive to be inclusive and foster a community of acceptance for all the participants, regardless of age or physical ability.

Due to the long term health consequences of physical inactivity, we need to encourage all youth to participate in some form of physical activity. Programs that encourage movement, play, control and strength can be an enjoyable experience for all those who participate.

Reference

Lloyd, R.S, et. al. (2016). National strength and conditioning association position statement on long-term athletic development. Journal of Strength and Conditioning Research, 30 (6). https://www.nsca.com/long-term_athletic_development_position_statement/

 About the Author

Tim Koba is an Athletic Trainer, strength coach and sport business professional based in Ithaca, New York. He is passionate about helping others reach their personal and professional potential by researching topics of interest and sharing it with others. He contributes articles on injury prevention, management, rehabilitation, athletic development and leadership.

 

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Limiting Pitch Counts to Reduce Injury: Is the Formula that Simple?

Wednesday, August 24th, 2016

Posted August 24, 2016

By: Claudia Curtis, MS, LAT, ATC

As a heavily media influenced society, we’ve become hyper aware of some of the major injuries of sports. For example, we frequently note concussions in contact sports such as football and ulnar collateral ligament (UCL) tears leading to Tommy John surgery in baseball.

Football’s answer to reducing the concussion risk in young athletes has been to limit contact practice time on a weekly basis.1 Baseball has been following suit as of late, as many high school associations have adopted stricter rules on pitch and inning counts.2,3 These counts allow associations to place quantitative restrictions on a problem that is far from black and white. The intent is honorable, knowing that most elbow and shoulder injuries in baseball are chronic and related to overuse. However, if we set forth guidelines to reduce the risk of overuse, do we reduce the risk of injury?

According to Dr. James Andrews, a name synonymous with youth sports injuries and UCL reconstruction, he’s seen a five to sevenfold increase in UCL injuries requiring surgical reconstruction in high school athletes since 2000. He cites the top reasons for UCL injury as poor mechanics and overuse, noting the combination of the two is lethal to the UCL.4 Instituting the previously mentioned pitch count restrictions addresses the second risk factor of overuse, but not the first.

Imposing these limits on contact time, instituting pitch counts and limiting the age soccer players are allowed to head the ball are all designed with the noblest of intentions. The goal is to find ways to control injury risk and impose less harm on young bodies and brains. All of the aforementioned actions are technique based. My question for injury prevention personnel is, are we doing enough to address technique issues at a young age? Would we see a larger drop in injury if technique was a larger focus? With the current coaching structure in the United States, is this a reasonable approach to consider?

Resources

1. Jones, Brandon. “States Adopt Plans to Limit Contact in Football.” https://www.nfhs.org/articles/states-adopt-plans-to-limit-contact-in-football/

2. Unruh, Jacob. “NFHS Mandates Member States to Adopt Pitch-Count Rule.” http://newsok.com/article/5509251

3. Mercogliano, Vincent Z. “Why Haven’t More States Implemented High School Pitch Count Rules.” http://usatodayhss.com/2016/why-havent-more-states-implemented-high-school-pitch-count-rules

4. Berra, Lindsay. “Force of Habit.” http://espn.go.com/mlb/story/_/id/7712916/tommy-john-surgery-keeps-pitchers-game-address-underlying-biomechanical-flaw-espn-magazine

Injuries in Gymnastics

Monday, August 22nd, 2016

Tim Koba, MS, ATC
Twitter: @timkoba
Blog; www.timkoba.blogspot.com

Posted August 22, 2016

By Tim Koba, MS, ATC

If you’ve been watching the Olympics, you may have been mesmerized by the physical abilities of the gymnasts competing. Their ability to run, jump, leap, twist, twirl and flip is awe-inspiring. It may also leave you wondering how prone to injury they are given the skills they need to perform and the training required to reach this elite level.

Different studies cite different overall injury rates, but gymnastics generally has a greater risk of injury than many other sports.  Injury rates differ between male and female gymnasts, the events and the various apparatus.

Female gymnasts are more likely to suffer lower extremity injuries while their male counterparts have higher levels of upper extremity injury. Due to the upper body dominant skills of the male events, they are much more likely to suffer wrist and hand injuries. Women are more likely to have ankle and foot injuries. For female gymnasts, the most commonly suffered injury is an ankle sprain on 3 out of 4 apparatus, except for uneven bars which is upper body injury of the shoulder or wrist.

As young gymnasts progress in skill and hours training, their risk of injury goes up since they spend more time under load practicing higher level skills. As they produce more force with their maneuvers, the risk of having an injury increases. Younger athletes are also prone to wrist injuries at the growth plate. As their wrists extend under a load, the forces are transmitted to the growth plate and can result in pain and injury. This is most pronounced in athletes aged 10 to 14. Care should be taken to assess total volume and pain at this level to avoid wrist injury or manage it early.

Injuries in competition are more common as a result of performing the high level skills at higher speeds and greater heights without the benefit of crash pads and landing pits utilized in practice. Unfortunately, traumatic knee injuries, including ACL tears, are the most common cause of long term time away from the sport, surgery and medical disqualification from participation. Injuries as a result of floor routines are the most common mechanism for ACL injury in gymnastics.

Because of the nature of the sport, and the extreme flexibility needed to perform, gymnasts also sustain other injuries. Rates of back pain differ, but low back pain is one of the top 5 most common injuries. The main concern with gymnastics is developing a stress related fracture from constant extension. With the extreme range of motion in the hip, there have been case reports of hip instability and impingement syndromes of that joint. The hours required to learn and master a maneuver can lead to gradual overload and overuse injuries.

Conclusion

• Rates of injury in gymnastics differ, but the most commonly injured areas are the ankle and foot for females; wrist and hand for males

• Knee sprains are the most common cause of time lost from sport and injuries requiring surgery

• Injuries are more likely to occur in competition than in practice and when progressing from one level to another

• There are some unique injuries as a result of participation including wrist growth plates, low backs and hips

Understanding common injuries associated with participation and specific apparatus can help to develop prevention and rehab programs geared toward helping gymnasts successfully participate at their desired level.

References

Kerr, Z. et. al. (2015). Epidemiology of National Collegiate Athletic Association women’s gymnastics injuries, 2009-2010 through 2013-2014. Journal of Athletic Training: 50(8).

Kox, L. et. al. (2015). Prevalence, incidence and risk factors for overuse injuries of the wrist in young athletes; a systematic review. British Journal of Sports Medicine: 49.

Saluan, P. et. al. (2015). Injury types and incidence rates in precollegiate female gymnasts. Orthopaedic Journal of Sports Medicine: 3(4).

Tirabassi, J. et. al. (2016). Epidemiology of high school sports related injuries resulting in medical disqualifaction: 2005-2006 through 2013-2014 academic years. American Journal of Sports Medicine: 20(10).

Weber, A. et. al. (2014). The hyperflexible hip: managing hip pain in the dancer and gymnast. SportsHealth: 7(4).

Westermann, R. et. al. (2014). Evaluation of men’s and women’s gymnastics injuries: a 10 year observational study. SportsHealth: 7 (2).

About the Author

Tim Koba is an Athletic Trainer, strength coach and sport business professional based in Ithaca, New York. He is passionate about helping others reach their personal and professional potential by researching topics of interest and sharing it with others. He contributes articles on injury prevention, management, rehabilitation, athletic development and leadership.

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Consensus Statement on Injury Prevention

Thursday, August 11th, 2016

Posted August 11, 2016

Tim Koba, MS, ATC
Twitter: @timkoba
Blog: www.timkoba.blogspot.com.

By Tim Koba, MS, ATC

The American College of Sports Medicine (ACSM) recently released a consensus statement on injury prevention geared to the team physician. Their conclusions, however, are beneficial for coaches, athletes, parents, Athletic Trainers (ATs) and other healthcare professionals.

In the statement, the authors focus on ankle, patella femoral syndrome, ACL, shoulder, elbow, head and neck injuries in high school and college athletes. They also touch upon sudden cardiac death, heat illness and skin infections. The article systematically addresses the mechanisms of injury and injury reduction strategies of each injury. I will include a brief summary with action items of the statement and refer those interested to the complete article.

Ankle: Ankle sprains have a high risk of repeat injury and are the most commonly suffered injury in athletics. Key prevention strategies include balance training; neuromuscular training to include jumping, landing and cutting exercises; and technical training. Once an ankle is injured, bracing is an effective way to provide support while the athlete is performing rehabilitation.

ACL: Although not a very common injury, it does account for significant time lost from activity and long term joint health. In high school, the sport with greatest risk of injury is football. In college, it is women’s soccer, with female athletes being at increased risk of injury in general over their male counterparts. Adopting an injury prevention program that addresses strength, core strength, neuromuscular control, cutting, jumping and landing can effectively reduce the risk of injury. Bracing is not an effective means of reducing injury risk.

Patellofemoral pain: Patellofemoral pain is characterized as pain around the front of the knee. Contributing factors include muscle weakness, previous injury, training error and improper movement patterns. Injury prevention techniques include assessing and training for proper jumping and landing form and implementing a structured training program to minimize muscle imbalances with an emphasis on quadriceps, hamstring and hip abductor strengthening.

Shoulder pain: The disabled throwing shoulder is a term to describe pain and dysfunction with overhead sports. Risk factors are muscle imbalances, previous injury and training error. Prevention is focused on following recommended pitch counts, optimizing form for throwing and serving, balancing activity with rest and strengthening the upper body to correct any imbalances in the shoulder, arm and scapula.

Elbow injury: There are no injury prevention programs developed for reducing elbow injury in throwing athletes. The main focus currently is on monitoring fatigue, incorporating adequate rest periods, monitoring total throwing volume to reduce overload, not throwing too many months out of the year and undertaking a general strength program to improve strength and reduce any imbalances.

Sudden cardiac death: Luckily, sudden cardiac death is a rare phenomenon and occurs for several reasons, including genetics. From a prevention standpoint it is important that all athletes have a physical to determine their risk factors and follow-up testing as indicated by their doctors. All athletic sites and sports should have a written and communicated emergency action plan in the event of a catastrophic injury. Access to an AED is essential, and one should be close by to provide care to a fallen individual within 3 minutes of collapse. Chest protectors do not prevent death from sudden impact, also known as commotio cordis, but using a softer ball in youth sports might. It is also not recommended that athletes step in front of a shot due to risk of having a commotio cordis event.

Exertional heat illness: The main risk factors for exertional heat illness are environment, previous injury and some heritable traits such as sickle cell. The main prevention strategy is acclimatization. Ideally, athletes prepare for the environmental conditions that they will be playing in. Coaches can monitor and modify practice and equipment needs depending on the weather. In preparation for weather, athletes can pre-hydrate, stay hydrated during activity and monitor weight loss between practice sessions. Having an emergency action plan in place in case of emergency is essential to management of heat illness.

Skin infections: College wrestling has the greatest incidence of skin infections. Other risk factors include previous skin infection, reduced immune function, body shaving, facility cleanliness and sharing personal care items. Some general rules are important for reducing risk of skin infections and include good hygiene, immediately laundering of uniforms and practice garments, facility cleaning, not sharing equipment or care items and promptly reporting any wounds or lesion to the team AT or your physician.

Conclusion:

While this statement is geared for the team physician, the information is very valuable for those working in athletics to understand and implement.

- Pre-participation physical exams to identify risk factors and assess health history prior to participation.

- Instituting a school wide or at least team wide training program to improve strength, neuromuscular control, balance and technique is an effective means to reduce risk of injury.

- Monitoring athletes to provide adequate recovery and early intervention can delay time lost from competition for musculoskeletal injuries and heat illness.

- Crafting an emergency action plan that is easy to understand and implement, in conjunction with quick access to an AED, can provide the best chances for survival in the event of a catastrophic injury.

Resources

Special Communications. (2016). Selected issues in injury and illness prevention and the team physician: a consensus statement. Medicine and Science in Sports and Exercise, 48 (1). http://journals.lww.com/acsm-msse/Fulltext/2016/01000/Selected_Issues_in_Injury_and_Illness_Prevention.21.aspx

About the Author

Tim Koba is an Athletic Trainer, strength coach and sport business professional based in Ithaca, New York. He is passionate about helping others reach their personal and professional potential by researching topics of interest and sharing it with others. He contributes articles on injury prevention, management, rehabilitation, athletic development and leadership.

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Olympic Athletic Trainers Prepare for the Zika Virus with Complex Prevention and Early Detection

Monday, August 8th, 2016

Posted August 8, 2016

Erin Chapman
MS, LAT, ATC

By Erin Chapman, MS, LAT, ATC

The summer months for Athletic Trainers (ATs) are often a time to re-energize, visit with friends and family or work summer camps. However, since it is an Olympic year, some of our fellow ATs have traveled to Rio de Janeiro, Brazil to assist the United States elite athletes.

The location of the Summer Olympics has brought unique challenges to ATs. Many ATs have spent a lot of time learning and preparing to keep the athletes safe. One of these challenges is the current Zika virus outbreak in parts of South, Central and North America. The best defense ATs have against Zika or any contagious disease is to know more about it. Here is some important information medical professionals should know about Zika.

The Zika virus is a flavivirus (Petersen et al., 2016) and is transmitted from mosquito to human, human-mosquito-human, mother to fetus during pregnancy and sexual transmission (male to partner). Patients testing positive for Zika virus have reported the following symptoms: conjunctivitis, rash, arthralgia, fever, myalgia, headache, retro-orbital pain, edema, vomiting or a combination of symptoms. The adverse fetal outcomes from mother to fetus transmission are not completely known; however, Zika virus RNA has been found in the amniotic fluid of fetuses and newborns with microcephaly.  An unknown incubation period makes the diagnosis and prevention of Zika virus challenging.

Zika virus is diagnosed using the RT-PCR and IgM-capture enzyme-linked immunosorbent assay. Currently, the treatment of Zika virus is focused on symptoms since there is no Zika virus vaccine. Thus, prevention and control measures center on avoiding mosquito bites, reducing sexual transmission and controlling the mosquito vector.

Ultimately, it is a complex prevention and early detection approach that will help protect the Olympic elite athlete community. Such steps will most likely be taken to reduce the chances of being infected with Zika virus; however, more research still needs to be done in this area to understand this virus better.

As healthcare professionals, we should have a good foundational knowledge regarding different illnesses especially while traveling to other countries. Zika may not affect us; however, the unknowns of this virus and its effect on us here in the United States should influence professional learning behavior. The athletic training profession emphasizes prevention and the steps to prevent, diagnose and treat; thus Zika virus prevention and treatment ought to be our approach to new challenges in our clinical settings.

The Centers for Disease Control and Prevention provides up-to-date recommendations for those traveling to Brazil. These recommendations are constantly updated as more information is gathered and should be checked frequently for any changes.

What can travelers do to prevent Zika?

As mentioned previously, there is no vaccine or medicine that can prevent Zika virus. Travelers can protect themselves by preventing mosquito bites http://wwwnc.cdc.gov/travel/page/avoid-bug-bites):

- Cover exposed skin by wearing long-sleeved shirts and long pants.

- Use EPA-registered insect repellents containing DEET, picaridin, oil of lemon eucalyptus (also known as OLE, para-menthane-diol or PMD) or IR3535. Always use as directed.

- Pregnant and breastfeeding women can use all EPA-registered insect repellents, including DEET, according to the product label.

- Most repellents, including DEET, can be used on children older than 2 months.

- OLE should not be used on children younger than 3 years.

- Use permethrin-treated clothing and gear such as boots, pants, socks and tents. You can buy pre-treated clothing and gear or treat them yourself.

- Stay in places with air conditioning and window and door screens to keep mosquitoes outside.

- Sleep under a mosquito bed net if air conditioned or screened rooms are not available or if sleeping outdoors.

- Mosquito netting can be used to cover babies younger than 2 months old in carriers, strollers or cribs.

- Sexual transmission of Zika virus from a man is possible. If you have sex (vaginal, anal or oral) with a man while traveling, you should use condoms.

Petersen, L. R., Jamieson, D. J., Powers, A. M., & Honein, M. A. (2016). Zika virus. New England Journal of Medicine, 374(16), 1552-1563

About the Author

Erin Chapman started working for The College at Brockport as an Athletic Trainer (AT) in March of 2010.  She completed her bachelor’s degree in Athletic Training/Exercise Science at Ithaca College in 2007, and her master’s degree in Human Movement at A.T. Still University in 2009.  She is working toward a doctorate in Athletic Training at the University of Idaho.  Chapman's research interests are in breathing pattern disorders in the physically active population and concussion education in intercollegiate athletics.

As an AT, Chapman assists Golden Eagles athletes by working with field hockey; men’s and women’s basketball; men’s and women’s indoor and outdoor track and field; and men’s lacrosse. Prior to working for The College at Brockport, Erin spent two-and-a-half years as the Head AT and biology teacher at the Winchendon School in Winchendon, Massachusetts.  Chapman is a BOC Certified AT and licensed in New York state.

 

In-Depth Look: Athletic Trainer for the USA Women’s National Volleyball Team

Friday, August 5th, 2016

Posted August 5, 2016

Jill Wosmek, ATC

Jill Wosmek, ATC is Head Athletic Trainer for the USA Women’s National Volleyball Team. She has been working in this setting for over 7 years.

Describe your setting:

I work with the Women’s National Volleyball Team and Olympic level athletes.

How long have you worked in this setting?

I started working in this setting in May of 2009.

Describe your typical day:

My day starts early. I like to get in a morning workout prior to the day starting so am up at 4:30am. I’ll then start admin and prep work for the morning session with the team. The athletes start to arrive around 7:00am for pre-practice treatment and therapy. The team trains from 8:30am to 11:30am. I will do a variety of things during that time including admin tasks, rehab with post-op athletes or watch practice. We’ll then preform post-practice treatments, and afterwards, go to lunch.

In the afternoon, we prepare for a second session. This may be more court work, yoga or weightlifting depending on the day and the athlete’s needs. We end the day with lots of recovery and individualized treatment plans. At some point, we normally have a staff meeting, so there is always time to strategize with our team.

USA win first Women's World Championship title.

What do you like about your position?

I like working with elite level athletes and having the responsibility of being an influencer to this unique group. I also like having a leadership role that goes beyond a typical Athletic Trainer position.  I’m lucky to feel fulfilled and challenged in my role and have the ability to provide selfless service that goes beyond just a sport.

What do you dislike about your position?

Like any athletic training position, time management can be challenging. It can be hard to find time for yourself outside of work.

What advice do you have about your practice setting for a young AT looking at this setting?

My advice would be to gain as much experience as you can! We all have so much to learn, and I still feel overwhelmed at times when I come across things I’d like to know more about. It can be tough to fit it all in.

I would also say to appreciate other disciplines and rely on their insight as well. The best service you can provide to your athletes and staff is a comprehensive approach to sports medicine and performance along with humility.

 

 

Concussion Baseline Assessments: What Should Clinicians Capture?

Monday, August 1st, 2016

Posted August 1, 2016

Nicole T. Wasylyk,
MSEd, LAT, ATC

By Nicole T. Wasylyk, MSEd, LAT, ATC

Traumatic brain injuries (TBIs) are an ever-prevalent topic in our society today, in part due to their high incidence rate. It’s estimated that 1.7 million Americans sustain a TBI each year.1 Diagnosing and managing TBIs can be a complex pathway. Clinical assessment of patients is key to diagnosis since there is currently no objective diagnostic tool to identify whether a patient has sustained a TBI.  Assessing a patient’s baseline is also key in the post-injury assessment and management process.

In order to craft the best clinical assessment to identify TBIs, we need to understand the key components that make up the assessment toolkit. A baseline assessment should consist of the following key components.2

Clinical History and Self-Reported Symptom Assessment

There are many useful tools clinicians can use to assess symptom number and severity. The most frequently used and researched tools include the Standardized Assessment of Concussion (SAC), Head Injury Scale, Graded Symptom Checklist, Brief Symptom Inventory 18 (BSI-18), Sport Concussion Assessment Tool Version 3 (SCAT3)3 and the Concussion Symptom Inventory. The SCAT, now in its 3rd version, is a useful tool that incorporates more than just a self-reported symptom scale. In 2012, a consensus statement was released by the International Conference on Concussion in Sport4 supporting the use of the SCAT3 and the Child SCAT3 (ages 5-12). 5

Physical Motor Control Testing

Assessing motor control can include any number of functional tests to assess gait, postural control, fine motor control or hand control and proprioception. Most commonly utilized tests include simple heel-toe gait observation and the Balance Error Scoring System (BESS). The BESS is a quick, portable and cost effective way to evaluate motor control. Although there is variability, the BESS has been found to be both a valid and reliable tool to assess motor control.6

Neurologic Exam

A neurologic exam should certainly be completed post injury. Baseline assessments most often do not demonstrate deficits but are helpful to perform for completion and practice’s sake.

Neurocognitive Testing

Computerized testing is the most frequently utilized form of neurocognitive testing. This type of testing is a comprehensive evaluation of specific domains such as memory, attention, problem solving, language, visuospatial and motor processing speed. Commonly used tests include the ImPACT test, Wisconsin Card Sort and King-Devick. There are numerous computerized tests to assess patients; it’s important to review and understand each of the domains the test seeks to evaluate and ensure it meets your patient population needs.

This leads us to the following question: What makes up the best baseline concussion assessment?

We do not yet have strong evidence to suggest the gold standard for clinical assessments. However, we do know that a combination of assessment tools, such as the SCAT3, which incorporates both a clinical history and self-reported symptom assessment and physical motor control testing, along with ImPACT testing is a robust way to evaluate patients. Almost all of the tests, aside from the computerized ones, are low cost, reliable, valid and easily implemented. They also carry little burden on both the clinician and the patient.

Recently the National Collegiate Athletic Association (NCAA) and the Department of Defensehave partnered together on a comprehensive study of concussions. This multi-center center study titled Concussion Research Initiative of the Grand Alliance7 will seek to answer questions on the etiology, evaluation, diagnosis and prevention of concussions. The study has 3 aims: to create a sustainable framework to achieve clinical and scientific research, to investigate the natural history of concussions, and to conduct advanced research that will integrate biomechanical, clinical, neuroimaging and genetic markers of injury to advance our understanding of TBIs.8

Hopefully there will be more information in the coming years regarding evidence based management of concussions. Currently, best practice is to utilize a multimodal approach to assess and manage concussions. This includes symptom assessment, physical motor control testing, neurologic exam and neurocognitive testing if available.

Resources

1. Daneshvar DH, Nowinski CJ, McKee AC, Cantu RC. The epidemiology of sport-related concussion. Clin Sports Med. 2011 Jan;30(1):1-17, vii.

2 .https://www.nata.org/sites/default/files/Concussion_Management_Position_Statement.pdf

3. 4. SCAT3: http://bjsm.bmj.com/content/47/5/259.full.pdf

5. McCrory P, Meeuwisse WH, Aubry M, et al. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. Br J Sports Med. 2013 Apr;47(5):250-8.

6. Child SCAT3: http://bjsm.bmj.com/content/47/5/263.full.pdf

7. Bell DR, Guskiewicz KM, Clark MA, Padua DA. Systematic review of the balance error scoring system. Sports Health. 2011 May;3(3):287-95. PubMed PMID: 23016020;

8. http://www.careconsortium.net/research/

9. http://www.cdc.gov/traumaticbraininjury/basics.html

About the Author

Nicole Wasylyk works as an Athletic Trainer in a physician practice at Dartmouth-Hitchcock Medical Center (DHMC) in Lebanon, New Hampshire. Prior to DHMC she resided in Madison, Wisconsin and was an Athletic Trainer in a physician practice at Meriter-Unity Point Health. Wasylyk obtained her Bachelor of Science in Athletic Training from Boston University and Masters of Science in Education from Old Dominion University. She has completed a residency program for healthcare providers who extend the services of a physician at UW Health. Wasylyk also obtained her orthopedic technician certification. Her professional interests include injury surveillance and prevention, standardization of best practices and patient reported outcomes collection.