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
‘Tis (out of) the Season
April 2, 2015
By Rob Kaminski
MHSAA benchmarks editor
Those who live in close proximity to high schools throughout Michigan don’t even need a calendar to know what time of year it is when a new sports season begins.
Whistles piercing through the hum of their air conditioners on the first Monday morning in August mark the start of fall from nearby football facilities. The ping of aluminum as sidewalks and grass re-appear from winter’s grip signifies the start of spring.
Office supply stores could see calendar sales soar in those households – or occupants might at least do a double-take when checking smartphone calendars – in the near future if MHSAA out-of-season coaching regulations are modified. The familiar sounds of the seasons could resonate in non-traditional months as well.
A major topic of the recent MHSAA Update Meetings and AD In-Services in the fall was the possibility of revamping the regulations regarding out-of-season contact for school coaches with school teams during the school year. The Summer Dead Period would remain in place and has been largely supported by membership since it was implemented for the 2007-08 school year.
It should be noted that out-of-season revision is not a certainty, but simply in the exploratory stage at this point.
Yet, the time was ripe to initiate discussion on this topic in the fall. The growth of non-school athletic programs and demands placed upon students by such entities in recent years was one factor. The difficulty the MHSAA has enforcing – and schools have interpreting – current out-of-season coaching regulations is another factor.
“The fundamental question is how to allow more contact between coaches and students out of season without encouraging single-sport participation,” MHSAA Executive Director Jack Roberts said.
Can this be done? Can trends toward specialization and away from multi-sport participation be reversed through greater contact periods for each sport within the school year?
Proponents of this school of thought believe that time otherwise spent with non-school coaches would be best served with education-based coaches who, in theory, would be on the same page with peers at their school, all encouraging multi-sport participation.
“Part of the explosion of AAU and club involvement has been the perpetuation of the notion that without additional training and competition, students will not reach their potential nor maximize their chances of being recruited by colleges,” said Scott Robertson, athletic director at Grand Haven. “When our high school coaches have the ability to provide a similar experience, but with an education-first mindset regulated by athletic directors, the expectations of student-athletes by coaches can be tempered.”
It is a lively debate that will be picking up momentum for the remainder of this school year and into the next.
Following are some of the concepts and comments from the fall, with key points from a statewide survey to be published later this week. The MHSAA's Representative Council discussed these results at its March meeting, and action is possible during its final meeting of the school year in May.
Let's begin
Perhaps the most criticized, misinterpreted, ignored, and/or difficult to enforce rule in the MHSAA Handbook resides in Regulation II, Section 11 (H): the three- and four-player rule for coaches out of season during the school year. (See bottom of this page.)
Debate has long spiraled in dizzying circles around definitions such as “open gyms,” “under one roof,” “conditioning,” “drills,” and other components.
“One of the problems is the MHSAA finds this specific rule difficult to enforce and interpret,” MHSAA Associate Director Tom Rashid said. “Another perceived problem is that there might be a disconnect between school coaches and students out of season, which might be driving students toward non-school programs.”
It’s simple to recognize lightning rods, but quite another to construct a device for harvesting the sparks in a productive manner. To that end, Rashid prepared an outline for discussion on the topic as he hit the trails around Michigan this fall for Update Meetings and AD In-Services.
“We felt we needed to see if we could do better,” Rashid said. “Rather than say to 600 ADs, ‘What do you think about out-of-season coaching rules?’ we asked about a new concept. We created a starting point for discussion.”
The basic premise brought forward to the masses was this: a voluntary contact period of one month to six weeks with a limit of 10 or 15 days of contact in that period – and perhaps three in any one week – between a coach and his/her athletes out of season with any number of students, grade 7-12. Due to large participation numbers in football, some consideration was given to limiting the number of players in any one out-of-season session to 11, thus not creating “spring football.”
A straw poll from the gatherings in the fall indicated nearly 70 percent of attendees in favor of “contact periods” versus the current rule, prompting a detailed survey to all member schools sent in October to further measure the climate and hone in on specifics for desired changes.
“It was a very open process with great discussion,” Rashid said. “All size schools, all demographics, and all corners of the state weighed in.”
As always, the devil is in the detail, and the October survey yielded plenty of detail.
Numbers favor no numbers
As mentioned earlier, nearly 70 percent of attendees at MHSAA fall gatherings indicated that they might prefer a rule that specified coaching contact periods outside their sport during the school year, as opposed to limiting the number of student-athletes per session.
The ensuing survey sent to member schools in late October reflects that sentiment in schools of all sizes, and in all zones of the state. On the topic of counting contact days out of season with no limit on the number of students involved, more than 72 percent of 514 responding schools favored the plan. Class A schools led the way with nearly 76 percent in support. Class D schools chimed in at 69 percent in favor. Support was strong across the zones of the state as well, led by the Detroit metro area (Zone 3) at 76.5. The middle of the state (Zone 5) was the low, but still found close to 60 percent in favor of such a revision.
The survey revealed consistencies across the board relative to the amount of three- and four-player sessions currently utilized by schools of different sizes, and the support and opposition to questions regarding revised regulations on the topic. For instance, nearly 50 percent of Class A schools indicate that their coaches work with students under the current rule most every week during the offseason, while 40 percent of Class D schools report that most of their coaches never utilize the three- or four-player rule at all out of season. Not surprisingly then, in questions posed where three-and four-player stipulations might still exist, the larger schools favored such changes at a higher rate than the smaller schools.
Survey data also reveals a reason for such opposition at lower-enrollment schools: a simple numbers game. In Class C and D, the majority of schools report that 60-80 percent of their student-athletes participate in more than one sport. So, with more students busier year-round than at their larger school counterparts, there are fewer people to attend out-of-season sessions.
Similarly, the concept of extending the current preseason down time for all sports was supported more in Class C and D schools than Class A and B.
“It is always a challenge for individual schools to see things from the other schools’ perspectives,” Rashid said. “It’s hard for people to say, ‘It might be different for us, but for the greater good, we might have to change our culture here.’”
But, that line of thinking is certainly understood at Chelsea High School, a Class B school of more than 800 students. Athletic director and football coach Brad Bush is an advocate of multi-sport participation, regardless of school size.
“The current three- or four-player rule benefits kids by developing skills, but does not force kids to feel pressure to be at a full practice,” Bush said. “Changing this rule could reduce the number of multiple-sport athletes. Our staff and league is united in believing that changing this rule could be a big mistake.”
Outside influence
Part of the balancing act in attempting to revise out-of-season rules is to encourage greater participation on school teams, while not promoting specialization.
Interestingly, a number of schools in the survey reported that they have policies in place limiting in-season athletes from attending sports-specific training from out-of-season coaches. The percentages ranged from 27.6 percent in Class D to 41 percent in Class B.
Most schools allow weightlifting during the season, followed in decreasing order by three- or four- player workouts, conditioning and open gyms. However, more than 40 percent of responding schools have in place a policy prohibiting non-school competition for in-season athletes. The message seems to be that if activity is taking place, the preference is for it to be under supervision, and for that supervision to come from school coaches.
“If a coach is going to hold three workouts per week out of season, a student may leave another sport to play in the offseason of their preferred sport,” Rashid said. “As such, many ADs identified that it would be the role of each school to regulate out-of-season coaching. Right now, the ADs have to keep a handle on out-of-season activities and if the rules change, depending on their demographic, they might need to be involved even more.”
With advance planning, an environment can be created in which all of a school’s sports can exist in harmony and encourage multi-sport membership.
“Athletic directors can guide all coaches on their staffs to work together to create 12-month calendars that focus on the needs of kids and respect the desire of many to participate in multiple sports,” Robertson said. “In doing so, coaches can work to avoid overlaps in important opportunities where kids may be put in win-lose situations. With careful planning student-athletes will be afforded more opportunities to train and develop with their classmate peers and within their own communities.”
Chris Ervin, athletic director at St. Johns High School, is one of many in the camp that believes the current system accomplishes a school’s missions when properly supervised.
“Our coaches have ample opportunities to coach in the three- or four-player setting, and our athletes have plenty of opportunities to improve their skill sets through open gyms which are not coach-directed,” Ervin said.
Others agree that any change might introduce unwanted consequences. One source, an administrator in a strong football community, speculates in that town and others like it, football programs could smother other sport programs by scheduling full workouts on top of other in-season sports. Voluntary or not, it is opined that kids would gravitate toward the out-of-season football workouts if that’s the signature sport in town.
Ervin can see the same point. “I don't see this affecting my role too much, but I do believe this could lead to even more specialization. For example, if football coaches are able to work with their players 11 at a time in the offseason, I believe athletes will feel more pressure to be part of that football workout while they are in-season with another sport.”
Under another scenario, school coaches might someday be allowed to coach non-school teams during the school year. The rationale is that if students are participating outside the school campus anyway, wouldn’t it be better that they are coached by school personnel so that the educational message is delivered appropriately?
Add to this the fact that 100 percent of surveyed schools reported conducting open gyms in basketball and 66 percent in volleyball – the two most high-profile AAU sports – would it benefit schools to have trained personnel in those non-school leadership roles?
“This would connect our coaches to school kids but also could have the unintended consequence of specialization,” Rashid said. “However, the coaches in place would be our coaches, whereas currently we don’t have a say in the AAU coaches of our students.”
Not yet. This topic on the survey was favored by roughly 60 percent overall, but an equal 20.4 percent were at opposite ends of the spectrum strongly in favor and strongly against, with the highest percentage falling just above lukewarm.
By Class, the C and D schools were slightly more opposed to this idea than Class A and B. Why? Very often, in the smaller communities, there are no non-school opportunities; school sports are the only option.
Robertson believes that incorporating a revised out-of-season coaching plan could assist families financially in the long run.
“By having the ability to include larger numbers of kids in development activities and allowing for a limited number of competitions, there is a strong likelihood that students and their families will choose the out-of-season activities offered by their schools over the AAU/club activities that exist,” Robertson said. “In doing so, there will be no rental of outside gyms, no mandatory club fees, and reduced costs to families.”
Not all ideas have elicited opposing views. One item on the docket that schools uniformly opposed was the possibility of scrimmages within the out-of-season contact period. Most schools indicate a preference for these periods to be instructional only.
Just a tweak
Perhaps the current rule just needs a splint and not a full cast. Maybe it’s not broken after all.
The most popular proposal to emerge from the survey was simply the removal of three little words in the current regulation: “under one roof.”
More than 80 percent of schools favored removing the phrase “under one roof” from Regulation II, Section 11(H) 2. a., which means as long as only three or four students are receiving coaching, then others may be in the facility working on conditioning, or in groups on their own.
Receiving close to 70 percent support from schools is the prospect of removing the portion of Handbook Interpretation 237 which currently prohibits schools from setting up rotations. This would allow a coach to work with dozens of players, three and four at a time.
And, Robertson says, in less time than coaches are currently expending.
“Most high school coaches already commit an enormous amount of time to the offseason development of student-athletes,” he said. “By removing the limit on number of athletes they can have contact with at one time and by placing a limit on the number of dates they can actually have this direct instructional contact, the net gain will be fewer dates, but with a greater impact.”
Rashid forecasts slight modifications of current rules rather than wholesale changes, at least in the near future.
“It wouldn’t surprise me if a few changes come sooner than later,” Rashid said. “One, allow rotations in the three- or four-player rule. Two, allow more than three kids under one roof as long as only three kids are receiving coaching. These two are a broader interpretations of our current rules.”
Simpler could be the answer. Perhaps over the course of time, in trying to be everything to all schools, the rule became more difficult for schools to follow, and for the MHSAA to oversee. Outside influences that could not have been predicted a generation ago have crept into the picture as well.
“These rules are very old, and that doesn’t mean not good,” Rashid said. “They were written at a time when the majority of students played multiple sports; before students began playing in 3rd and 4th grades, and before the non-school sports explosion.”
Even with the current trends and abundance of choices for some athletes, there are strong feelings from various leaders to leave things status quo.
“Our staff and league believes there needs to be a greater emphasis on the current rules with stronger punishments,” Bush said. “The answer is to enforce to current rules that we have, and not change the rules.”
There is a certain irony to this topic in front of athletic administrators and coaches, who spend so many hours in the here and now; in-season, in practices, in games.
“Who would think that what you do out of season could be the most critical piece of school sports discussion that we’ve had?” Rashid ponders. “It’s not what happens during the season, but in the offseason, that might be at the core of encouraging and maintaining school sports participation.”
Current Out-of-Season Rule (Three- or Four-Player Rule)
From MHSAA Handbook, Regulation II, Section 11(H):
2. These limitations out of season apply to coaches:
a. Outside the school season during the school year (from Monday the week of Aug. 15 through the Sunday after Memorial Day observed), school coaches are prohibited from providing coaching at any one time under one roof, facility or campus to more than three (or four) students in grades 7-12 of the district or cooperative program for which they coach (four students if the coaching does not involve practice or competition with students or others not enrolled in that school district). This applies only to the specific sport(s) coached by the coach, but it applies to all levels, junior high/middle school and high school, and both genders, whether the coach is paid or volunteer (e.g., a volunteer JV boys soccer coach may not work with more than three girls in grades 7-12 outside the girls soccer season during the school year).