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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
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MHSA(Q&)A: Stevensville-Lakeshore wrestling coach Bruce Bittenbender
February 9, 2012
Bruce Bittenbender grew up in Bethlehem, Pa., in the heart of steel country, and worked part-time in a mill as a young adult. That helped land him in Michigan City, Ind., not long after graduating from Milligan College in Tennessee in 1969.
But Bittenbender wanted to teach and coach.
Bittenbender took a teaching job at South Haven that fall, and as an assistant coach helped that school's wrestling team to the MHSAA Class B championship. A year later the wrestling coaching job opened at Stevensville Lakeshore. He says now that he was too young for the job, but Bittenbender applied and was hired. The program was struggling at that point -- but not for much longer.
According to the National Federation of State High School Associations' record book, Bittenbender trailed only Rex Peckinpaugh of New Castle, Ind., in career dual coaching wins heading into this season (796-780). Bittenbender won his 800th match on Jan. 14 -- and has his team just two more victories from MHSAA Finals weekend Feb. 24-25 in Battle Creek.
Bittenbender retired from teaching two years ago after 35 teaching biology and seven more physical education. At 64, he still gets on the mat with his wrestlers from time to time, although perhaps not as much as he once did. But countless wrestlers -- including those who won a combined 20 individual championships -- have benefited from his instruction.
His coaching tree includes current Rockford coach Brian Richardson and former Lowell coach Dave Strejc, who led teams to MHSAA Division 2 championships in 2002 and 2004. Bittenbender was named National Coach of the Year by the National Federation of State High School Associations in 2002 and again by the National High School Athletic Coaches Association in 2010. He is a member of the Michigan Wrestling Association Hall of Fame, and he will be inducted into the Pennsylvania Wrestling Coaches Association Hall of Fame this spring.
Stevensville Lakeshore is ranked No. 7 in Division 2. His team won its District on Tuesday, downing St. Joseph 35-34 with a decision win in the final match.
What keeps you coming back for another season?
Every year, when you think you've seen it all, something else comes up. When I was in middle school, it was junior high school back then, I was on the edge. The coach (Jim McIntyre, who went on to coach at Kutztown University) grabbed me on the back of the neck and said, "What are you doing?" I was hanging out with kids of questionable character, and he said, "You need to come out for wrestling." I still go back and play golf with that guy once in a while. ... I came from a big family. We didn't have much. I have empathy for the kids that were kicked around, misdirected. Somebody took time out for me. I felt maybe I could kick some of that back.
After so many wins, do you still enjoy all of them the same?
I tell ya, last night I certainly enjoyed the win. It was just like I was 23 again. Yeah, I enjoy it. It's addictive. That's what you're out there for.
The NFHS changed its wrestling weight classes this season, but Michigan chose to stay with its current lineup. What is your thought on that switch?
I think it's going to switch back. It makes no sense to me. The average kid graduating from high school is 5-(foot-)9, 155 pounds. Why add a weight class at the top where you have to compete for kids with football and basketball. … Our sport has prided itself on giving the little guy a chance. ... He can be a state champ in wrestling.
Your teams have finished MHSAA Finals runner-up twice. How much would you like to win that first championship?
I would love to. That's the ultimate goal. We've been so close. We were up three points in '94, and got pinned at heavyweight (to lose 28-25 to Fowlerville). In '86 we broke the record for individual number of points scored, but Eaton Rapids broke it too. We were that close.
I'm assuming you're not going to stop coaching any time soon.
Being around people and the community, and working with kids, it keeps you young. Keeps you in shape, keeps you motivated. I think that's one of the reasons. Now that I'm not teaching, my wife and I are able to travel quite a bit in the fall and summer. I think that's basically a motivator, just being around people.
What do you tell, or would you tell, young coaches who are just getting started in high school wrestling?
I tell them to be careful the first few years. It's different today. … I tell coaches you need to set up standards, discipline, goals and objectives, and go by those. You try to accommodate some of these kids, and this and that, but you can go only so far. You’ve gotta stick to the rules and let the cards fall where they are. If you don't, you'll have problems down the line.
And I think communicating with people, making friends, getting out there and strumming up support for the program is important too. I've had the opportunity to speak to the Lions Club, various civic organizations, at hospitals. You have to try to make yourself available. People have to learn to put their trust in you."