Staying Ahead on Head Safety
July 6, 2015
By Rob Kaminski
MHSAA benchmarks editor
Three stacks of concussion-related material offered precious little space on MHSAA Executive Director Jack Roberts’ desk, and perhaps consumed even more room in his head as he tried to wrap his mind around the seemingly daily “latest and greatest” documents outlining signs, detection and return-to-play elements involving head trauma.
Without a doubt, the scene is quite similar on any given day in the offices of his cohorts across the country as school sports leaders are faced with the daunting, dizzying task of devising plans to address concerns aimed at the health of their games.
Lawmakers, rules makers, medical experts and the court of public opinion all want the same thing for student-athletes: a reduction in the chances of head-related injuries. And they all are perfectly willing to offer instant fixes to those in charge.
They often expect those in Roberts’ position to analyze, digest and create action plans as soon as possible without considering the research and resources it will take to get there.
“All parties involved want the same thing. We all want to provide the safest environment for educational athletics through protocols and practices that will offer the most minimal risk of injury,” Roberts said. “But, this can’t be accomplished through unfunded mandates which would stifle the already struggling athletic budgets in many schools.
“Changes have to occur through training and education, orchestrated through state offices and executed locally. And, it takes time to research the best and most effective means. There is so much information, and so many devices in the field today that those in athletic leadership roles almost have to have a medical background as well.”
For instance, there are documents which list as few as five symptoms for concussions, and those listing as many as 15. There are sideline detection methods which purport to take 20 minutes and those which claim to determine concussions in 20 seconds. There are as many return-to-play protocols as there are state associations.
Increasingly, state high school associations are seeking opinions and expertise from local medical personnel. In March, in one of many such meetings, Roberts and other MHSAA staff welcomed several from the Michigan Department of Health and Human Services to their office to discuss sideline detection methods and return-to-play issues.
“There are two areas that concerned us most,” Roberts said. “One, sideline detection of head injuries is inconsistent across the state in terms of both results and resources. Two, we need methods which generate immediate reports and permanent records.”
As the group which convened in March discussed the topic, potential hurdles and new perspectives on sideline management came to the forefront.
On the money and manpower front, who would be responsible for administering sideline tools? Most ideally they would need to be overseen by medical personnel rather than coaches or team managers.
From a perspective standpoint, an interesting view was volleyed out to the group: could sideline detection actually speed up a student’s return to play rather than slow it down? Current protocol prescribes that if competition continues while an athlete is withheld for an apparent concussion, that athlete may not be returned to competition that day but is subject to the return-to-play protocol. And, clearance may not be on the same date on which the athlete was removed from play. Only an M.D., D.O., Physician’s Assistant or Nurse Practitioner may clear the individual to return to activity. With immediate sideline detection, are parties more vulnerable should a student pass immediate tests, only to have undetected effects of the incident increase over time?
“The group shed a different light on the various scenarios, which was a primary purpose for the meeting,” Roberts said. “As one can see, there are so many variables to consider when attempting to determine the next plausible and practical steps toward minimizing and detecting head injuries.
“Further, we have to take into consideration practice sessions as well as competitions, and all sports, not just select sports.”
Adding to the challenge is simply the nature of athletics. Competitors at any level are just that: competitive. Often, students – or their parents – will attempt to hide symptoms or be reluctant to come forward with injuries, particularly head injuries which can’t be seen.
In more cases, perhaps the symptoms simply are not recognized, which is why education is paramount.
First, association leaders have to tackle the due diligence of researching issues and potential solutions to situations currently threatening the well-being of scholastic sports. Considering that some 1,620,000 results are offered when “sideline concussion detection tools” is typed into a search engine, this is a laborious and continual chore.
Such information then needs to be packaged and presented to leaders at the local levels – athletic directors – to pass on to coaches, the individuals who have as much or more influence on students that perhaps any other adults, including parents in some cases.
This is why MHSAA rules meetings, Coaches Advancement Program sessions and other statewide forums continue to bang the drum on health and safety issues; to make sure the messages and procedures reach the student-athletes.
And, it’s why the MHSAA is asking coaches and ADs to be accountable in verifying that the plans in place are being carried out.
Less Could Mean Less
There are times when it’s good to say, “less means more,” but in the case of contact sports, practices and competitions, the idea is for less to mean less. As in less time for collisions to occur yielding fewer injures.
It’s early yet, and one year does not constitute a large sample size, but the MHSAA Football Practice Policy instituted last August could be one step toward reducing head injuries.
Beginning this past football season, the number of practices with helmets, shoulder pads and full pads were limited to start the season, and preseason “collision” sessions were limited to one per day. During the season, such practices were limited to two per week, while the length of practices was also regulated.
Dr. Steven Broglio of the University of Michigan Neurosport department is conducting a three-year study of the Ann Arbor Gabriel Richard football program with the assistance of Richelle Williams to determine the “Effects of Concussion and Sub-Concussion.” The study began in 2013, one year prior to the new MHSAA guidelines.
Research in 2013 showed approximately 650 “impacts” per player. In 2014, the number dropped to approximately 500 impacts per player. Impacts are defined as greater than 10 gs of acceleration. Williams stated that a slap on the back is 4 g, coughing is 3.5 g. On average, a helmet hit is 25-45 g. Concussions usually happen (roughly) between 80-150g.
An encoder is embedded into each football athlete’s helmet which monitors head impacts and exactly where the impact is located. Williams sits at each practice and game and through a pager identifies the player’s number and impact from a hit of 90g or more.
They are also looking at those who do not sustain an impact concussion, but rather sustain multiple head impacts and whether those multiple head impacts lead up to brain changes (measured through EEG).
The initial findings, as submitted by the study team, indicated two reasons why there were fewer overall impacts from 2013 to 2014:
Primary reason: The MHSAA adoption that became effective in August 2014 with new limitations that were placed on “collision practices” and conditions that full pads could not be worn until the fifth day of team practice.
Secondary reason: Fewer players evaluated in 2014 than 2013.
Fit for a King?
Editor’s Note: There are many sideline detection tools on the market, as a quick Google on the topic will reveal. The following, the King-Devick test, is among the highly recommended tests, summarized here simply to provide an idea of the types of systems available and how they operate. The following is from King-Devick’s website.
The King-Devick Test is an objective remove-from-play sideline concussion screening test that can be administered by parents and coaches in minutes. The King-Devick Test is an accurate and reliable method for identifying athletes with head trauma and has particular relevance to: Football, Hockey, Soccer, Basketball, Lacrosse, Rugby, Baseball, Softball and Other Collision Activities.
King-Devick Test is an easy-to-administer test which is given on the sidelines of sporting events to aid in the detection of concussions in athletes. King-Devick Test (K-D Test) can help to objectively determine whether players should be removed from games. As a result, King-Devick Test can help prevent the serious consequences of repetitive concussions resulting from an athlete returning to play after a head injury.
How King-Devick Test Works
Concussions are a complex type of brain injury that is not visible on routine scans of the brain, yet are detectable when important aspects of brain function are measured. King-Devick Test (K-D Test) is a two-minute test that requires an athlete to read single digit numbers displayed on cards or on an iPad. After suspected head trauma, the athlete is given the test and if the time needed to complete the test is any longer than the athlete’s baseline test time, the athlete should be removed from play and should be evaluated by a licensed professional.
Remove-From-Play vs. Return-To-Play
Both remove-from-play and return-to-play decisions are crucial in concussion recovery. It is critical to remove a concussed athlete from play in order to prevent further damage. It is also extremely important to keep the athlete from returning to play until they have made a full recovery. There are tools to assist in making both remove-from-play and return-to-play decisions.
King-Devick Test for Remove-From-Play Decisions
- Quick, objective sideline testing
- Measures impairments of speech, language and other correlates of suboptimal brain function
- Instant screening feedback in minutes
- Administered by parents, coaches, athletic trainers and medical professionals in remove-from-play decisions
- Neurocognitive Testing for Return-To-Play Decisions
- Computerized concussion evaluation system (in the computer lab)
- Measures verbal and visual memory, processing speed and reaction
- Tracks recovery of cognitive processes following concussion
- Assists clinicians in making return-to-play decisions
Task Force Building Multi-Sport Message
November 11, 2016
By Geoff Kimmerly
Second Half editor
Walled Lake Western’s Cody White draws his perspective on high school sports from a background that, while perhaps not unique, has to be close.
The Warriors senior is one of the top college football prospects in Michigan, a Big Ten-caliber player who has committed to continue his career at Michigan State University after he graduates in the spring.
Our state has a handful of athletes like that every year, of course. But White also is the son of former NFL player and Detroit Lions executive Sheldon White – and has followed his father’s Dayton, Ohio, footsteps in playing three sports during his high school career.
White plays football, basketball during the winter and baseball in the spring, in addition to travel basketball and baseball during the summer. He has played these same sports throughout high school. His freshman year he also competed in track & field, along with baseball. As of May – when White and his multi-sport experience were featured on Second Half – he hadn’t ruled out returning to track & field, in addition to baseball, as a senior.
“I couldn’t see myself not competing in those sports,” White said at the time. “I love them so much. I want to finish my senior year playing all three.”
It’s White’s experience, and the benefits enjoyed by so many who have shunned the recent trend toward specialization, that is driving the MHSAA’s Multi-Sport Task Force as it aims to promote the value of a varied sports experience through high school, even for athletes considered “elite” in a sport they’ll go on to play at higher levels.
The Multi-Sport Task Force met for the third time Oct. 27 and includes coaches, administrators and teachers with diverse experiences in athletics at schools large and small; urban, suburban and rural and in both the interscholastic and club settings.
The idea of moving away from specialization and back toward playing multiple sports has gained steam in recent years with pronouncements of how doing so paid off for nationally-recognized stars like professional golfer Jordan Spieth, baseball Hall of Famer John Smoltz and a number of members of the U.S. women’s soccer national team who played multiple sports through high school.
The MHSAA’s task force is working to develop that message, package it in the most digestible formats, and deliver it to the key decision-makers to benefit athletes at the age where the message can have the heaviest impact on their sports careers and growth into physically fit adults.
“This is a fundamental topic in school sports,” MHSAA Executive Director Jack Roberts told the task force during its most recent meeting. “This is something we’ll be talking about five and 10 years from now.”
The task force is charged with a series of goals that will be discussed below and are still in development. But there’s no doubt coaches will play a significant part in promoting and carrying out this important mission.
“Growing up was a little different (for me) than the usual kid. Going to Lions games and just being around football all the time. I think I love the game more because I was around it so much. But I think playing three sports helped me, too. The twisting of your hips in baseball, when you swing the bat, you’re using different muscles. And all the jumping you do in basketball. You have to move in tight spaces. With football, you’re with the football guys. By doing all three you meet different people.” – Cody White, “Western’s White Enjoys ‘Special’ Career” – May 4, 2016
What we’ve learned
The task force’s first meeting in April included discussions with Dr. Tony Moreno of Eastern Michigan University, a frequent Coaches Advancement Program instructor, and Dr. Brooke Lemmon of the MSU Sports Medicine Clinic. Among points from their focus on medical issues that result from specialization:
• Specialization has chronic, long-term affects; young people who do not learn physical literacy – how to solve movement problems – are less likely to be physically active and, hence, less likely to be physically fit. This is becoming an expensive health issue for society.
• The loss of physical education from schools is the root of these problems and has led to the creation of “privatized PE” for those who can afford a club sports experience. Physical education in schools, done correctly, can create a relatively noncompetitive environment that increases student interest in becoming physically active.
• More time spent in one activity will lead to more injuries, especially of the chronic nature. The number of hours per week a child spends on one sport activity shouldn’t exceed that child’s age (8 hours per week for an 8-year-old, for example).
Dr. Dan Gould, the director of the MSU Institute for the Study of Youth Sports, talked to the task force during its second meeting about how children perceive sports – and the need to adjust parents’ expectations for their kids’ success. He explained how kids can lose their identity focusing on just one sport, and also the importance of free play – the games kids make up themselves while playing in a structure-free environment.
Bob Mancini of USA Hockey visited with the task force most recently, explaining how his was the first governing body to tell athletes it wanted them to play their sport – but in order to do so well, play other sports also. USA Hockey’s American Development Model was launched in 2009 to in part promote multi-sport participation – and is growing hockey in the process, with increased participation seen at youth levels over the last three years.
“It’s just really fun to do different things. We don’t have a lot of the numbers, but we have the people who are willing to put in the hard work, even if it’s not their best sport. Each season is only three to four months at the most. So it keeps things exciting.”— 2016 Bronson graduate Kelsey Robinson, a defensive specialist in volleyball, former cross country runner, guard in basketball and a third baseman and centerfielder in softball, “Multi-Sport Experience ‘Special’ for Bronson” – February 2, 2016
Questions & Answers
The task force will meet again Feb. 8, and in the meantime there are a number of questions – and answers – to be considered.
The group has pinpointed a series of goals:
1. Partner with groups promoting diverse physical activity.
2. Encourage those promoting more and better physical education.
3. Prepare tools for administrators for use in interviewing prospective coaches, conducting meetings with their coaching staffs and encouraging them to “walk the talk” of balanced participation.
4. Assist in the explanation of the multi-sport experience to parents through a variety of media, including a guidebook and video explaining its benefits.
Carrying out these aspirations comes with plenty to discuss.
Who most needs to hear the message of multi-sport participation? It’s most likely junior high and middle school parents, or even those of elementary students just starting to experience organized athletics.
What do these parents and children most need to know? Parents are stakeholders in their children’s athletic ventures. The challenge is convincing them our way is best for their kids’ futures, from a health and development standpoint.
Who should deliver this message? Celebrities obviously carry clout when they talk about how their multi-sport experiences led them to become successful adults. But there also could be a strong emotional tug from current student-athletes who tell their stories.
How can coaches and athletic directors help spread the word? The MHSAA, with input from the task force, will develop tools to help. But the options are many: could it come in video form, eye-catching graphics for use at coaches meetings, or live interaction at regional summits?
We are looking for ideas, both for getting out the message and incentivizing taking part in the multi-sport experience. Schools already are doing great things to promote multi-sport participation, and we’d love to hear about what's working.
To that vein, we’ll close with a final success story from this fall about a team that benefited from a lineup of multi-sport athletes:
Grosse Pointe Woods University Liggett on Oct. 15 ended an eight-year championship run by Ann Arbor Greenhills at Lower Peninsula Division 4 Boys Tennis Finals. Knights coach Matt Sobieralski relied on a roster filled with multi-sport athletes, including No. 1 singles player T.J. Dulac, who also ran cross country this fall.
Only one player on the Liggett roster plays only tennis, and Sobieralski says his players’ multi-sport participation served them well.
“It makes you tough, mentally tough and strong. And they’re competitive. That’s important. I think tennis, a lot of times, is 80 percent mental and 20 percent ability. You win a lot of matches with guts and just hanging in there. I always say a good player can win even when they’re not playing their best, because they’ll try something different and they keep fighting. That’s the team I’ve got. I’m really proud of their fight.” – Matt Sobieralski, “Liggett Ends Greenhills’ 8-Year Reign” – October 16, 2016
PHOTOS: (Top) Walled Lake Western's Cody White runs ahead of a group of Lowell defenders during last season's Division 2 Semifinals. (Middle) Bronson (right) goes for a kill during last season's Class C Semifinal against Traverse City St. Francis. (Top photo courtesy of Walled Lake Western athletic department.)