NFL Report

February 20, 2018

Just before the season ended, the NFL offered a behind-the-scenes glimpse into the medical setup for games. With athletic trainers, neurotrauma physicians, and data technicians, there are a range of professionals included for the procedures with about 30 medical staffers on the sidelines.

As outlined in an article from The Virginian-Pilot, part of the process is a pre-game meeting. During that hour-long meeting, everyone involved with the medical procedures is in attendance. This is partly so everyone can work together without any glitches during the game.

“The collaborative effort between teams is where it should be… seamless and flawless,” Eric Sugarman, MS, ATC, Head Athletic Trainer for the Minnesota Vikings.

Part of the meeting is dedicated to the Emergency Action Plan. Along with descriptions of what to do in almost any emergency situation, hand or arm signals are included for smooth communication when action is needed.

Each stadium has a “quiet room” that is designated for concussion-related examinations. The unaffiliated neurotrauma consultants and a member of the team’s medical staff are in that room for the exams that typically take 10 to 12 minutes. Otherwise, no one is allowed into the exam areas.

Although the NFL has been criticized about its concussion protocol, Allen Sills, M.D., Chief Medical Officer for the NFL, disagrees. “I like to say it wasn’t written on the back of an envelope on an elevator ride one day,” he said. “There is a tremendous amount of planning, of study, of preparation, of gathering expert opinion. And frankly, I find it very offensive when people say, ‘Gosh, the concussion protocol is a joke.’ Because it is a very rare scientific document. No protocol is perfect. No protocol accounts for every single medical scenario, and that’s why we have to continue to make it better. But we are incredibly dedicated to the task of making it as good as it can be.”

Local athletic trainers are hired as concussion spotters, working with video technicians who tag plays that end up with injuries. The athletic trainers’ are stationed in a booth, with the task of keeping an eye out for head injuries. If one occurs, they can call for a medical timeout and a sideline monitor can play the video for the medical staff to see what happened.

“People like me might have looked at it with a crooked eye,” Sugarman said. “Big Brother looking over your shoulder. But it’s been invaluable. You can’t see everything. It’s very protective to know they’re looking out for you.”

Along with the game-day spotters, the NFL has worked to train the medical staff on concussion and head trauma. The league hosted a training session last summer that was dedicated to that topic.

Image by Pats1
February 16, 2018
By David Hoch
David Hoch retired in 2010 after a 41-year career as a high school athletic director and coach. In 2009, Dr. Hoch was honored as the Eastern District Athletic Director of the Year by the National Association for Sport and Physical Education. He was also presented with the National Interscholastic Athletic Administrators Association Distinguished Service Award, and in 2000 he was named the Maryland State Athletic Director Association’s Athletic Director of the Year. Dr. Hoch has authored over 460 professional articles and made more than 70 presentations around the country.

As a coach, having your job run smoothly depends on creating a good working relationship with a number of people at your school—your athletic director, custodial and secretarial staffs, other coaches. If your school is lucky enough to have an athletic trainer, this is another key person you need to collaborate with.

For a successful collaboration, however, it is important to understand the roles you and your athletic trainer each play. While you are the head coach, in charge of your team and sport, the athletic trainer does not report to you. The key word is that you work with this individual. You are equal professionals with separate responsibilities. What exactly does this mean?

As the head coach, you are in charge of squad selection, skill instruction, scouting, game planning, decision making during games, supervising your assistants, and all other sport-specific items. On the other hand, an athletic trainer is the expert on everything related to injuries, rehabilitation, return-to-play decisions, and injury prevention, and he or she has the final say in these areas. Each of you have equally important, but separate, responsibilities. You both care about the athletes, but you deal with different aspects of their participation. And that is the way it has to be.

With that understanding in place, what is the best way to work with your athletic trainer? The following are some considerations for developing and maintaining a good working relationship:    

Respect their role. The athletic trainer’s main objective is to treat injuries and maintain the health and safety of the athlete. Unless you are teaching an unsafe skill technique, your athletic trainer should never interfere with your instruction, coaching philosophy, or approach. By the same token, it is vital that you respect his or her education and training and don’t interfere with his or her methods of treating and rehabbing injuries.

Accept their decisions. Never downplay an injury or pressure your athletic trainer to put a player back in a game after being examined or treated. This decision belongs solely with the athletic trainer, who is only looking out for the welfare of the player. He or she is not concerned with winning a game, and shouldn’t be. While it is okay to ask questions about the status of an injured player, you should never create even the perception that you are displeased with a medical decision.

Support them publicly. Explain to the team that the athletic trainer is the expert and in total charge of anything having to do with injuries. This stance should also extend to parents, who need to understand the parameters when their son or daughter is injured.

Educate athletes. Be sure your athletes understand that they must report every injury to the athletic trainer, even if they don’t think it is serious. Any athlete who has sustained an injury must be checked out by the athletic trainer. Some injuries, like concussions, are far more serious than they might first appear.

Show appreciation. Publicly thank your athletic trainer for the extensive time and effort he or she puts in to take care of your players. When you see an athletic trainer tending to an athlete on the field or sideline during a game, realize that much more is involved behind the scenes. Your athletic trainer confers with physicians, spends hours helping athletes rehab, and calls home to check on their progress. Athletic trainers put in long hours, just like coaches, and it is important that you show gratitude for all they do.

As with most working relationships, it takes a little understanding and energy to create and maintain a good rapport with your athletic trainer. And because the health and welfare of your student-athletes depend on this individual, that effort is well worth your time.


February 16, 2018
By Ron McKeefery
Ron McKeefery, MA, CSCS*D, MSCC, is Vice President of Performance and Education for PLAE. Previously, he served as a strength and conditioning coach at the professional and collegiate levels, most recently as the Director of Strength and Conditioning at Eastern Michigan University. Named the 2008 Under Armour Collegiate Strength and Conditioning Coach of the Year and 2016 NSCA Collegiate Strength and Conditioning Coach of the Year, he is the founder of the popular Iron Game Chalk Talk podcast and the author of CEO Strength Coach.

Part 1 of this article can be found here.

Before you can engage athletes, you have to determine what drives them. To do this, find their “why,” as Simon Sinek wrote in his book Start With Why. Problem is, no one really explains how to do this.

I begin by modeling vulnerability. In a highly competitive, ego-driven business like athletics, being vulnerable is often viewed as a weakness. In truth, it’s a strength. I try to model this behavior by meeting with players at the start of each training period. We call the first 15 minutes their “why meeting.” During this time, I open up by telling players my why, and then I ask for theirs. By showing vulnerability first, I set the tone for the discussion and allow players to get to know me. When they start to see me as more than just their coach, I can begin the process of obtaining their permission to lead them.

Even if you’re open and honest with athletes, you still might have to dig to get at their why. It is difficult to get athletes to truly define why they play the game, and, often, it has nothing to do with the sport itself. To discover their deeper motivation, I usually ask three questions:

• If you could no longer play your sport, what would you do? You would be amazed how many players have never thought about their mortality as athletes. It can be hard to get an answer, as most athletes will simply shrug their shoulders, say they don’t know, and expect you to move on. Don’t. Ask about their hobbies or past jobs and if they enjoyed any of them. And when all else fails, use silence. Sit there and stare at them until they give you an answer.

Once they do, you’ll probably be surprised at what they say. I had one player tell me he would sail around the world. Another said he wanted to be an ESPN broadcaster, and I’ve heard many other ideas. Knowing what athletes want to do after their playing days are over connects you to them on a deeper level and forms a basis on which you can motivate them.

• What is the most difficult thing you have been through in your life? It is very easy to rush to judgment about an athlete’s attitude or character based on a single interaction. Asking this question keeps that reflex in check and provides some background on your players.

That being said, if you ask this question, be prepared for some potentially shocking answers. I had one player tell me that he watched his father shoot his mother and then commit suicide right in front of him. Before knowing this, my younger coaching self might have called him “soft” or tried to intimidate him with fear if he was dogging on a sprint. But after learning about his past and what he had to overcome just to stand in front of me, I knew he wouldn’t respond to fear-based tactics. It provided me the appropriate empathy I needed to develop and motivate him.

• Who is the most influential person in your life? I want to know who has the athlete’s ear, who they respect the most, and why. I then get the athlete’s permission to contact their “influencer,” and I reach out to them. In this initial communication, I also ask the influencer if I can continue to contact them throughout the athlete’s career. My ultimate goal is to get them to sign off on me. Not only is this extremely powerful in the athlete’s eyes, but it gives me someone to rely on if I ever need to refocus the athlete.

Of course, calling everyone’s influential person takes time. But that’s okay, because you spell love t-i-m-e. To make it fit into my schedule, I call one or two influencers every night on my way home from work. You might think this would be a drain, but it actually reenergizes me.

Once I determine each athlete’s why, I enlist motivational tools to make necessary changes to their behavior. There are two methods for doing this: Analyze-Think-Change and See-Feel-Change.

When presented with a request to alter a habit, athletes rarely analyze it, think about it, and change their behavior accordingly. One of the reasons for this is positive illusion bias—meaning, athletes always view themselves more favorably than their peers.

For example, say an athlete who is usually on time shows up late for a workout, and you come down hard on him. In his head, he will try to justify why you gave him the same reprimand that you delivered to another player who has a serial tardiness issue. He will think, “I have only been late twice, but Johnny has been late five times, and he has the same accountability.” It won’t add up, and the player won’t change his behavior.

On the other hand, See-Feel-Change plays on our emotions, both negative and positive. This is especially powerful when trying to motivate athletes.

Emotions like fear and anger tend to elicit faster responses but aren’t great for long-term solutions. I only use fear and anger to change behavior when I need to drive home a point. Additionally, when dishing out this type of reinforcement, I keep it unemotional. When both the coach and the athletes have negatively charged emotions, it can often lead to very bad outcomes.

One example of when I use fear- and anger-based tactics is at the beginning of each training period. I remind players of the consequences they will face for common indiscretions, and I get their pledge that they understand the expectations and are committed to the program. If they fail to meet those standards, I simply remind them of their pledge and what the accountability measures are. The fear should be of the consequences, not of you.

More often than not, however, I use positive emotions, such as curiosity and joy, to change athletes’ mindsets and actions. I would much rather have players come to the weightroom engaged and excited than fearful and angry.

February 16, 2018

A gesture commemorating a high school wrestler’s last home match ended up being called unsportsmanlike and was the difference in his team’s one-point loss.

According to an article in the Warren Times Observer, it took Warren (Pa.) High School senior Liam Stevenson just 34 seconds to pin his opponent in the 170-pound bout during Warren’s Senior Night Match on Feb. 12. Then, after shaking hands with his opponent and having his hand raised by the referee, Stevenson knelt to the floor and missed the mat. The referee deemed the gesture unsportsmanlike and deducted a team point from Warren.

Although the 170-pound match was contested early in the dual meet, that point proved to be the difference as visiting St. Mary’s High School walked away with a 33-32 victory. Had the teams finished tied, Warren would have been credited with the win since it held the tie-breaker.

“I knew it would be a close match either way,” Warren Coach Dean Johnson told the paper. “If we had tied, we would have won on criteria. This was a little hard to take.”

Doctor on Board

February 16, 2018
By Larry Cooper

Larry Cooper, MS, LAT, ATC, is Head Athletic Trainer at Penn-Trafford High School in Harrison City, Pa., where he also teaches health, physical education, and sports medicine classes. Since 2012, he has served as Chair of the NATA Secondary School Athletic Trainers’ Committee. Winner of a 2016 NATA Most Distinguished Athletic Trainer Award, 2015 T&C Most Valuable Athletic Trainer Award, and 2014 NATA Athletic Training Service Award, he was inducted into the Pennsylvania Athletic Trainers’ Society Hall of Fame in 2014. Cooper can be reached at:


Team physicians and athletic trainers need to go together like peanut butter and jelly. Both entities have a mutual desire to help our student-athletes do something they love to do.

Athletic trainers rarely have input over the team physician’s employment and vice versa, so we often need to work in order to make the best of a given situation. Understandably, this does not occur overnight. Both of us play an integral part in developing this relationship. Just like the connections with your significant other, your parents, your coaches, and your athletes, it takes time to nurture and build this relationship. So, how can you make the most of the athletic trainer and team physician dynamic?

In order for the physician to sign off on your emergency action plans, standard operating procedures, weight certification forms, and protocols, they need to work with you every step of the way.
First and foremost, you need to open the lines of communication. That can be a challenge for some in today’s society due to our use of devices and the proliferation of social media. It seems that actual face-to-face interaction and communication is getting to be a lost commodity. This however, is the ONLY way to develop a relationship with your team physician. Some are extremely organized and have post-surgical protocols for each surgery they perform. Others may rely on your experience or expertise for suggestions about a post-surgical patient.
You will not know what type of physician you are dealing with until the questions have been asked, and that can only come from spending time together. This can be on the sidelines, during school physical exams, while shadowing in the doctor’s office, or time spent together away from school, athletics, or the office.

Going off of that, make sure you’re on the same page with your physician about different treatment approaches. We all have differing philosophies on injuries, rehabilitation, return-to-play criteria, taping, and the like, so it is extremely critical to spend time with your physician and discus different scenarios and each other’s approach. This can help both of you understand what parameters you should work within.

Make no mistake, following these pieces of advice will take some effort. But if handled properly, it will make everyone’s job much easier. In order for the physician to sign off on your emergency action plans, standard operating procedures, weight certification forms, and protocols, they need to work with you every step of the way. More importantly, it will improve the level of athletic health care that is available to your school community.

There is no way that I can impress upon you the magnitude of the bond between physician and athletic trainer. I would go as far to say that it is the single most important investment you can make for your professional development in the secondary school setting. So take the time to develop and cultivate a meaningful, long-lasting association.

February 15, 2018

Have you noticed that your athletes aren’t as explosive as they need to be? Maybe you’ve found that they struggle when it comes to leg exercises. Coaches can remedy this situation by using the box squat in their training programs. And while it is a relatively simple exercise to teach, this exercise offers many benefits to ready your athletes for game day.

In a blog for elitefts, Nate Harvey, MS, CSCS, explains that the box squat not only builds strength and explosiveness, but also helps decrease stress on other body parts. During this exercise, athletes load the glutes and hamstrings, which means less pressure is placed on the knees. The box squat also helps prepare athletes’ bodies for positions that they might not consider during sport.

“It’s very common for an athlete’s feet to go wider than shoulder width on the field, so we need to have strength out there too,” writes Harvey. “The wide stance and hitting proper depth also helps build mobility in the hips. How many times have you heard a coach describe and athlete as too stiff and say he can’t open up at the hips? Box squatting builds mobility through strength.”

Another benefit of box squatting is helping athletes move quicker out of a fixed position. Harvey calls this first step ability, and explains that most athletes will need to be able to change from a semi-static position to a dynamic contraction in a miniscule amount of time. During the box squat, athletes must pause at the bottom, and then explode with fierce energy. And this movement also improves athletes’ ability to move laterally.

“When performed correctly the athlete drives out (laterally) on their feet,” writes Harvey. “This has great transfer to change of direction. We hardly ever did ‘agility work’ and our athletes agility scores consistently improved. How’s that for sport specific?”

In order to gain these benefits, and lessen the chance of injury, athletes must do the movement correctly. Before beginning the exercise, coaches should make sure that their athletes’ boxes are set up at the right height. To do this, Harvey recommends having the athlete stand in front of the box as if they are about to squat then have them sit on the box while maintaining a perpendicular shin angle to the floor. The next step is to adjust the box height until the top of the kneecap is parallel with the crease of the hip.

Here are the steps to the box squat laid out by Harvey:

  1. Make sure the bar is even with the collarbone while in the rack.
  2. Place hands even on the bar with your feet wide enough to feel lateral pressure on the sides of your shoes.
  3. Stand up and take two steps back until you are in front of your box.
  4. Push your hips back first, and descend pushing out your knees on the way down.
  5. Pause on the box, but keep the pressure out on the stomach and feet. Don’t allow the toes to come up.
  6. Drive the shoulders into the bar and explode off of the box back into starting position.

Harvey recommends starting every squat day with 15 to 20 reps of using just the bar. Then add weight slowly. Harvey has athletes do sets of two reps until 80 percent of the group is squatting correctly. He also offers some coaching cues to help you assess and adjust your athletes while they are squatting.

One tip is to keep their chin slightly up before unracking to help them keep good positioning. Athletes should then make sure their feet and the weight are settled before moving into the squat. Another coaching cue from Harvey is to make sure the athlete is leaning into the squat a little.

“Very often [the athlete will] try to keep their torso completely vertical,” writes Harvey. “If they continue to struggle with this or rock backward on the box when they sit, take the bar off their back, have them sit on the box as if they’re squatting and hold a proper position (pressure out on feet, learning forward, knees forced out, chin up). Many times they just don’t understand the proper position, so sitting there and holding it for a few seconds really helps with the above problem.”

To see a tutorial of the box squat, watch this video from Paradiso CrossFit.

February 15, 2018

Circuit training offers a challenging and efficient way for athletes to develop endurance, strength, flexibility, and coordination. It is also an extremely versatile training method that can be adapted to the needs of every sport. In order to get the most out of using circuits, here are some tips to keep in mind.

According to Sports Fitness Advisor, designing the right circuit course can help athletes in a variety of ways. Whatever the area you are hoping to improve (strength, endurance, etc.) there is likely a course that can help make that happen. These exercises are also a great way to supplement weightroom workouts with something fun and refreshing.

The typical circuit structure consists of 10 exercise/stations completed for 60 seconds in sequence with 30-60 seconds of rest in between. This is one model to go off of, but there are many other options to choose from that might be better for your athletes’ specific needs. When designing a course, be sure to consider what exactly you’re hoping to train and how this relates to your sport.

If you are hoping to develop all around fitness, Sports Fitness Advisor recommends completing a variety of resistance exercises and high intensity cardiovascular exercises. Resistance bands, medicine balls, and bodyweight exercises are all great for this type of circuit. With around two to four brief session per week, your athletes will be able to improve their overall physical fitness. Similar to resistance training, athletes should be given 48 hours of rest before training the same muscle group. These circuits are also best for off-season training because you don’t want to overload athletes during the season.

For sport specific strength development, it’s important that athletes first go through a phase of basic strength training where they build a base of muscle. This will help prepare their bodies for the strenuous work of the circuit. For these types of circuits, allow for longer rest intervals and don’t make it so intense that form starts to slacken. That means there will be fewer exercises than most circuits. Also, be sure to alternate muscle groups and incorporate exercises that will help athletes correct muscle imbalances that develop from playing their sport.

Muscular endurance is essential in many sports, and circuit training is a great way to develop this trait. To do this, Sports Fitness Advisor suggests keeping rest intervals short, loads light, and quickly alternate between exercises and muscle groups. This allows for more work to be completed for a longer period of time and creates a cardiovascular element. Be sure to consider the demands of the sport and whether athletes are making short, quick sprints, such as a soccer player, or running straight for longs period of time, such as a track or cross-country runner.

Each of these different types of circuits offer a great way to supplement your other training. They are not meant to be the primary way to build strength or endurance, but they can certainly help athletes improve in a number of areas. When designed properly, circuits can also help address muscle imbalances that form when performing the same movements over and over again. Try to find a way to incorporate this training into your strength and conditioning program in order to help your athletes be their best. 

February 15, 2018

From a rocky career beginning — having his athletic dreams dashed and working in a steel mill — Todd Toriscelli has become an accomplished athletic trainer, a distinguished alumnus, the director of sports medicine for the Tennessee Titans and an NFL Super Bowl champion. And he said it all started at Ohio University.

After graduating high school, Toriscelli attended the University of Akron in an attempt to play football but was told by coaches it would be some time before he saw the field and he was perhaps more suited for another level of play. Devastated, he went home to Steubenville and gained employment in a steel mill. One day, a friend enrolled at Ohio University in the College of Health Sciences and Professions’ athletic training program, convinced Toriscelli to look over some of the material he was studying to see if it would grab his attention. It did.

“It was really interesting to me and I decided I wanted to enroll at OHIO,” Toriscelli said.

But, it wasn’t that easy. Toriscelli’s grades, quite frankly, didn’t make the grade but Charles “Skip” Vosler, an Ohio University hall of famer who served at the time as OHIO’s director of the athletic training education program, conditionally granted Toriscelli’s request.

“(Vosler) told me he had never let anyone into the program with my grades and said that if I got one C, I was gone,” said Toriscelli. “That was exactly what I needed to hear at that point.”

Toriscelli never earned a C. In fact, he fell in love with the program and the school. He admits the curriculum was “extremely hard” but said the bonds he formed with classmates were unique and special and said his time at Ohio “was the best four years of my life because of the people.”

Toriscelli said what he learned most at Ohio, outside of even the academics, was the importance of building relationships.

“You have to know your stuff, of course, but there’s nothing more important than relationships. As an athletic trainer, you have to have good relationships with your athletes, your coaches and fellow ATs. If there’s no trust, you can’t do your job,” said Toriscelli. “I was taught at OHIO very early that everything you do — all the knowledge and skills — are all brought together by the relationships you have with people.”

Toriscelli has served as the National Athletic Trainers Association’s liaison to the NCAA Football Rules Committee and been a member of the NFL Health and Safety Panel. He worked for seven years at the collegiate level as a head athletic trainer and for 17 seasons with the Tampa Bay Buccaneers, first as the head athletic trainer and then for four years as the director of sports medicine and performance. He was hired in 2014 as the director of sports medicine for the Tennessee Titans and is looking forward to a new season under new head coach Mike Vrabel.

When he’s not at the Titans’ facility, Toriscelli spends time with his wife Chris as they visit New York to watch their daughter, Jenna, perform as a dancer in shows, or to follow their son, Shane, as he performs as a musician.

If you would have told a discouraged young man working in a steel mill after having his football dreams dashed that this would be his life all these years later, Toriscelli never would have believed you.

“I would’ve been in complete disbelief to know I’d have the opportunity to do the things I’ve done and meet the people I’ve met. I’ve been very, very blessed.” Toriscelli said. “Sometimes in the NFL, you develop a sense of entitlement but I refuse to allow myself to do that. If you keep gratitude in your heart, you’ll be successful in everything you do.”

February 15, 2018

According to Stanford Children’s Health, there are over 3.5 million children who sustain sports-related injuries every year. Add to that the notion that around 70% of kids who play organized youth sports quit by the time they turn 13, and it’s clear to see the red flags. Those who have a school-aged athlete can help them to avoid being injured and becoming burned out, leading to a longer love of and participation in sports.

“Many parents start out seeing how their child loves a particular sport, only to be surprised when they either walk away from it altogether or they end up with injuries,” explains Coach Sarah Walls, personal trainer and owner of SAPT Strength & Performance Training, Inc., who is also the strength and conditioning coach for the WNBA’s Washington Mystics. “The good news is that by taking a proactive approach, this can largely be avoided. I’ve worked with many young athletes and have helped them to avoid injuries and hold onto that passion for the game.”

Research published in the journal Orthopedic Clinics of North America, estimates that 30 to 45 million children participate in organized sports each year. Along with the increase in the number of children participating in sports, there is an increase in the number of injuries that take place. They estimate that over half of all youth sports-related injuries each year are due to overuse, which is an injury that results from constant stress without enough recovery time.

According to the American Academy of Pediatrics, overuse injury is damage that happens to the bone, muscle, ligament, or tendon from repetitive stress without giving the body time to heal. They report that overuse injuries have four stages, which include pain after the activity, pain during the activity that does not restrict performance, pain during that activity that does restrict performance, and chronic, persistent pain even when at rest.

The other issue plaguing many young athletes is burnout, which is the mental changes that can affect performance. Signs of an athlete being burned out include having performance changes, lacking motivation to play the sport, no longer getting enjoyment out of playing it, and having emotional changes. Burnout can happen when an athlete is focusing too much one particular sport and not taking adequate breaks from it, as well as from the pressure to be too competitive.

Coach Walls has worked with countless young athletes, helping them to reduce their risks for injury, as well as to avoid burnout. Here are her tips that parents and coaches can use to help the young athletes in their lives avoid injury and burnout:

  • Avoid playing only one sport. Being a multi-sport athlete will create a change in season, allow them to stay engaged without being bored, and help the body recover to avoid repetitive injuries.  
  • Listen to their feedback. If the child is under the age of 14-15, they could express consistent complaints of fatigue or disinterest, which means that they would need a break. For athletes over 15, it may be more an issue of adjusting to using recovery methods.  But in either case, these are initial signs of an athlete who is becoming burnt out. This needs to be addressed so they can come back to the sport in a more refreshed way mentally and physically.  
  • Stress a healthy lifestyle. Encourage young athletes to get plenty of sleep; follow age-recommended guidelines for a pediatrician. Also, encourage healthy eating habits to help them feel better, recover faster, keep their mind fresh, etc.  
  • Keep it fun and enjoyable. Trying to deemphasize competitiveness if they are feeling burnt out. Look at overall communication over the sport; shift the focus on being fun not as much competition. 
  • Focus more on strength. Engage in strength training to reduce risk of injury, increase recovery time, and come back to the sport stronger so they can be better and have more fun. A research study published in 2017 in the journal Sports Health reported that overuse injuries are preventable, and that muscular imbalances after accelerated growth periods predispose young athletes to overuse injuries. They recommend modifiable risk factors such as flexibility, strength, and training volume should be regularly monitored to help prevent the injuries.
  • Pull back on pressure. External pressures the high school athletes can feel from parents, coaches, etc. about to go to college and play could decrease interest, which would lead to a burnout.

“Over the last generation or two there has been a big emphasis on raising star athletes,” added Coach Walls. “There’s nothing wrong with that, but there are some precautions and steps people should take so that it doesn’t lead to problems. You want your athlete to be happy with playing sports, reduce injury risks, and to play for years to come.”


Sarah Walls has over 15 years experience in coaching and personal training. Owner of SAPT Strength & Performance Training, Inc., founded in 2007, she offers coaching to develop athletes, adult programs, team training, and has an online coaching program. She is also the strength and conditioning coach for the WNBA’s Washington Mystics, and has over eight years of experience working as an NCAA D1 strength and conditioning coach and personal trainer. To learn more, visit the site:

Located in Fairfax, Va., SAPT Strength & Performance Training, Inc. is a high-performance training club that specializes in helping to develop athletes of all ages. They offer athletic training programs for youth, college students, and amateurs. The company was founded in 2007 by Sarah Walls, a professional strength and conditioning coach and personal trainer with NCAA D1 experience, who is the strength and conditioning coach for the WNBA Washington Mystics team. To learn more, visit the site:




# # #


American Academy of Pediatrics. Preventing overuse injuries in young athletes.

Orthopedic Clinics of North America. Prevention of Overuse Sports Injuries in the Young Athlete.

Sports Health. Overuse Physeal Injuries in Youth Athletes.

Stanford Children’s Health. Sports injuries statistics.



February 14, 2018
By Keith Doolan & Frederick Purnell

Keith Doolan, MSEd, ATC, is the Senior Director of Sports Medicine for Virginia Tech athletics. Frederick Purnell, MSEd, ATC, is a Director of Sports Medicine for Virginia Tech athletics. 

At Virginia Tech, the sports medicine staff works hard to maximize athlete performance and minimize injury. One of the ways they do this is through a detailed preseason medical screening program.

These assessments have allowed the sports medicine staff to identify at-risk athletes and initiate treatment before they begin training. In addition, the screens engage student-athletes in their personal health by integrating them into our system early on and introducing them to team physicians, sports nutrition, strength and conditioning, and athletic training staffs. Here’s a look at how we test for sickle cell trait (SCT), iron deficiencies, and cardiac issues:

Sickle cell trait: We test for SCT in a lab screening. All athletes who test positive are required to meet with our team physicians to discuss the results and become educated on the potential risks of playing sports with SCT. Further, we require these athletes to complete online training on SCT through the NCAA’s Sport Science Institute. They are then closely monitored and acclimatized during their training, both in and out of season.

Iron screening: The purpose of screening for iron deficiency is to identify clinically relevant, preexisting hematological abnormalities. Our goal as a medical staff is to ensure adequate hematologic testing for all “high risk sport” student-athletes. These individuals are identified by their team’s athletic trainer or a physician during a physical.

Between 2010 and 2012, we screened 149 student-athletes for iron deficiency, and 88 (59 percent) of them met the criteria with a ferritin level of less than 40. Any student-athlete who is found to have low ferritin levels receives dietary recommendations from one of our sports nutritionists, along with counseling from a team physician. They are also instructed to begin taking ferrous sulfate 325 milligrams (mg) (65 mg of elemental iron) two to three times daily on an empty stomach, with 500 mg of vitamin C to increase absorption.

Cardiovascular screening: Our cardiovascular screen provides student-athletes with a determination of medical eligibility for competitive sports by identifying (or raising suspicion of) clinically relevant, preexisting abnormalities. Any athlete identified as “high risk” based on their medical history and physician’s exam is given an electrocardiogram (ECG). Once the physician has reviewed the ECG, it is sent to the team cardiologist for analysis.

From 2008 to 2013, we studied cardiac screenings for athletes from 14 different sports. A total of 388 student-athletes (11 percent) tested positive for potential cardiac issues and received a subsequent ECG. There were 13 different categories of findings from these ECGs, and the most common (28 percent) was that of “normal” or no pathological finding or abnormality.



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