Mar 9, 2016From The Field
This article first appeared in the March 2016 issue of Training and Conditioning.
Pop Up Privacy
For years, Jeff Allen, MS, ATC, Assistant Athletic Director for Sports Medicine and Head Football Athletic Trainer at the University of Alabama, had searched for a way to provide more privacy during sideline injury evaluations. Failing to find an effective method, he came up with his own solution-a portable, collapsible tent that provides shelter from peering fans and cameras.
“The first 10 minutes after an injury are critical in terms of getting an accurate evaluation and diagnosis,” Allen says. “That can be very difficult to accomplish in a game environment, especially here at Alabama, where we have 105,000 people in the stadium and millions more watching on television. The crowd and noise create a lot of distractions for the player, as well as privacy issues. In the past, we’d have people hold up towels to shield the athlete, but that never really worked.”
Last May, Allen got the idea for the tent and discussed it with the dean of Alabama’s College of Engineering, who put together a team of four students to develop it for their senior project. Leaving the design of the tent in their hands, Allen didn’t expect it to be completed before the end of the fall semester. So he was shocked to see a prototype prior to the 2015 season opener. “They showed me their work, and I knew we had a winner,” he says.
When in use, the tent is seven feet tall, 12 feet long, and six feet wide, allowing room for a standard treatment table and four or five people. During all other times, it lies flat on the ground around the table. The tent’s sides can easily be put up or down with a handle in less than 10 seconds. It weighs about 60 pounds and folds up, making it easy to transport for road contests.
The tent was used at all but one of Alabama’s games in 2015, and it has far exceeded Allen’s expectations. “I knew it would help with privacy, but I never thought it would help players’ emotional state,” he says. “I’ve seen a big change in their demeanor during evaluations. There’s nobody watching them or yelling their name, so they calm down quicker, and they’re more relaxed, which allows us to get a better idea of what their injury is.
“We’ve also found it to be very beneficial when testing for concussions,” Allen adds. “They are incredibly difficult to assess on the sidelines because of all the distractions. You still have the noise factor in the tent, but everything else is blocked out, so you can get a better evaluation.”
Many athletic trainers nationwide have expressed interest in getting a tent for their own programs, and Alabama’s engineers are currently figuring out how to manufacture and distribute it on a larger scale. Allen expects the tent will be affordable for schools of all sizes, especially since the cost can be mitigated by selling advertising on its side panels, as the Crimson Tide athletic department has done.
“We’re in a landscape now where we’re trying to do everything we can to provide our athletes with quality medical care,” he says. “You might not think a small tent can do that, but in my experience, it really can.”
Before They Play
The only way for some high school athletes to easily get a pre-participation physical exam (PPE) is by lining up in their school gym or cafeteria to take part in a mass screening. In some communities, however, doctors are refusing to work these events, putting athletic trainers who organize them in a bind.
The problem stems from new guidelines suggested by medical groups, including the American Academy of Pediatrics and American College of Sports Medicine, which have expressed concern over the quick and impersonal nature of most school-sponsored mass PPEs. “In the last couple of years, it has become apparent to our physicians involved in these mass exams that we can’t meet the recommendations set out by these medical bodies by seeing kids in a public environment, especially when they are examined by a physician they have never seen before,” Sean Convery, MD, a Physician at Premier Sports Medicine in Centerville, Ohio, and Team Physician for University of Dayton athletics, told the Springfield News-Sun.
Medical professionals also worry that the group screenings are not conducive to spotting health problems. “These mass physicals are often held in the gym or locker room, and it is almost impossible to listen to someone’s heart and lungs in those environments,” says William Heinz, MD, Sports Medicine Doctor at the OA Sports Medicine Center in Portland, Maine, and Chair of the NFHS Sports Medicine Advisory Committee. “Plus, half the time, the kids have been playing basketball while they wait to be examined, so their heart rates are already elevated. And one of the main things we’re trying to identify is who may be at risk for sudden cardiac death.”
Beyond making it difficult to identify physical issues, mass PPEs don’t typically allow time to delve into personal matters that could have an impact on player wellness. “They don’t provide the opportunity to address concerns related to physical growth or interpersonal problems at school,” says Dale Block, MD, Team Physician for Mason (Ohio) High School. “When athletes reach 12 years of age, they are no longer children-they are adolescents. We begin screening for depression and other mood disorders, and we start talking about illicit drugs, alcohol, and sexual activity. The visit is not only about physical health but encompasses an adolescent’s entire well-being.”
Moses Lake (Wash.) High School had to cancel its mass PPE event this past summer after the local health care council stated it would no longer participate. “They said that as a medical society, they cannot continue to support [our] Sports Physical Night and that pre-participation physicals should be performed in the physician’s office rather than a mass setting in order to provide the best medical care possible for patients,” Sarah Aiken, ATC, Moses Lake’s Athletic Trainer and Sports Medicine Teacher, told iFIBER One News. “It will be heartbreaking to see it go for many reasons, but it is not possible without the support of our medical community.”
Heinz says that regardless of the challenges presented, it’s best for athletic trainers to follow the guidelines that were issued by the American Academy of Pediatrics in 2010. “They spell out all the questions the athletes should be asked and the areas that need to be checked. They also recommend that the exams be performed by athletes’ primary care physicians,” he says. “However, if you are going to have a group event, it’s important to at least have it in an office setting with qualified personnel on hand so the athletes have some one-on-one time with a physician.”
The American Academy of Pediatrics’ monograph on pre-participation physical exams is available on its website at: www.aap.org.
At Saginaw Valley State University, the most popular addition to the school’s athletic training room is not a fancy new whirlpool or high-tech wearable-it’s chiropractor Dan Kehres, DC. By including Kehres on its sports medicine team in the fall of 2015, SVSU is likely the first school in NCAA Division II to offer on-campus chiropractic care.
For Jeremy Glaser, MS, ATC, Head Athletic Trainer at SVSU, the hire has paid off already. “The kids all really like Dr. Kehres, and we’ve seen great outcomes,” says Glaser. “He has helped us with some of our chronic injuries, especially low-back pain. We’ve seen much quicker results getting kids pain-free and back on the field following those types of injuries.”
Glaser first got to know Kehres through his work with SVSU athletes at his private practice, including a former football player who’s now in the NFL. “Dr. Kehres has two offices in the Saginaw Valley region, and we’d been sending athletes to him who were looking for local chiropractic care,” says Glaser. “One of those athletes was Jeff Janis, who now plays for the Green Bay Packers. Jeff regularly saw Dr. Kehres during the season and while preparing for the NFL Scouting Combine and spoke very highly of those experiences.”
After receiving similar feedback from other SVSU athletes, Glaser wanted to make chiropractic services more accessible. He approached Kehres this past summer about the possibility of holding office hours in the athletic training room. “I liked what I heard, and he liked what I had to say,” says Glaser. “We both knew immediately that the relationship would work-and it has.”
Once a week, Kehres sets up two adjustment tables in the SVSU athletic training room for two hours, treating around 10 athletes per session. When signing up for his services, athletes first meet with Glaser, who writes up injury evaluations for them and shares them with Kehres. “He uses the evaluations to guide his pre-treatment questioning for each athlete,” says Glaser. “Having that information ahead of time keeps him from doing a full evaluation on every kid, which can take a lot of time.”
Payment for the chiropractic services is facilitated by SVSU’s insurance provider. Kehres bills the athletic department for each athlete, and the claims are submitted accordingly. So far, Glaser says the process has been affordable and issue-free.
Along with Kehres’ passion for treating athletes, Glaser says he is impressed by how chiropractic care complements athletic training. “He’s not just doing spinal adjustments,” says Glaser. “He’s also big into foam rolling, core strengthening work, and manual therapy-all things athletic trainers are very familiar with. What he does meshes nicely with the modalities we’re using in the athletic training room.”
Kehres has also become an asset to the SVSU athletic training education program. “The athletic training students can observe him when he’s treating our student-athletes to satisfy their physician hours,” says Glaser. “He’s great at explaining what he’s doing and why, and our students get a great deal out of those interactions.”
Calling the relationship win-win, Glaser believes chiropractic care can help round out a comprehensive sports medicine approach. “The best part about adding Dr. Kehres is that he has become another resource in our quest to provide holistic health care,” Glaser says. “Having another expert here to help us take care of our athletes has made our lives easier and given them a better experience.”
Narcan Training for ATs
With the problem of young people overdosing from opioids reaching crisis levels, schools across the country are training nurses to administer the overdose-reversing drug naloxone, also known as Narcan. One district in Massachusetts is also bringing athletic trainers into the fold.
On Dec. 16, Norfolk (Mass.) District Attorney Michael Morrissey hosted more than 80 athletic trainers and nurses from 30 schools in the county for a workshop. The goal was to educate them about the risks of opioid abuse and teach them how to administer Narcan in an emergency.
The half-day event began with Screening, Brief Intervention, and Referral to Treatment (SBIRT) training. Participants learned how to recognize substance use and potential risk factors for abuse-such as a family history of addiction. They also received guidance on how to raise awareness about the risks of opioid abuse among athletes.
Next, the athletic trainers and nurses practiced administering Narcan on mannequins. The drug is given via a nasal spray, a method approved by the Food and Drug Administration last November. Previously, it was delivered by injection.
According to Morrissey, athletic trainers can play a key role in overdose prevention because of the close connection they have with injured athletes. In reviewing the circumstances behind fatal opioid overdoses, his office uncovered some surprising trends.
“Many overdose decedents were introduced to opioids during their high school years following surgery for a sports injury,” he told The Patriot-Ledger. “Everyone with a medical role in our schools needs to know that. It may save lives.”
“That was something I had never considered because we don’t tend to have those problems here,” says Maria Hutsick, MS, ATC, LAT, CSCS, Athletic Trainer at Medfield High School, who attended the workshop. “But listening to the event’s organizers speak about how athletes can be at risk for an opioid overdose really opened my eyes to the dangers they can face. I now know that I need to mention it to my players and their parents.”
Although worried at first that learning to administer Narcan would be challenging, Hutsick says it was simple and non-invasive. She also enjoyed the chance to work side by side with school nurses at the workshop to address this important issue. “We’re the medical professionals in a high school, so we’re the ones who are going to be called in an emergency,” she says. “It is critical that we be on the same page.”