May 17, 2015Heads Together
In the heightened battle against concussions, it’s critical to get everyone on the same page. At Colgate University, a collaborative approach has resulted in a comprehensive prevention and management program.
The following article appears in the May/June 2015 issue of Training & Conditioning.
Over the past five years, head trauma is the athlete welfare issue that most concerns athletic trainers, physicians, university athletic administrators, coaches, and athletes and their families. Despite the recent attention to brain injuries in sports, what we know for certain is that there is much we don’t know. However, that is no excuse to be passive.
Two aspects of head trauma are of particular concern: concussions and the corresponding possibility of early-onset mental deficiencies later in life. Here at Colgate University, we felt compelled to take action. We wanted to do everything we could to understand the nature of concussions and do whatever was in our power for the safety and well-being of our athletes.
Beginning in June of 2014, our president, a group of trustees, sports medicine personnel, athletic administrators, and coaches collaborated to address the issue and determine how Colgate could take the lead on the prevention, recognition, and care of head injuries affecting our athletes. We utilized resources both within and beyond our campus, reaching out to a myriad of experts. What we came up with was a comprehensive plan that includes several phases of dealing with head trauma.
In the summer of 2014, we put the plan into action, which includes four areas. One is a concussion management protocol. The second is a strategy to educate all concerned parties. Third are policies for limiting contact during practices in several sports. Fourth is a commitment to remain up to date on research and technology.
As most all institutions have done, we set up our concussion management protocol according to guidelines issued by the NCAA and NATA. These cover injury recognition, concussion recovery, return-to-play progression, and documentation.
Injury recognition starts with baseline testing and the presence of a certified athletic trainer at all contact sport competitions. For away games, teams are either accompanied by a Colgate athletic trainer or a student athletic trainer, who is then overseen by the home school’s athletic trainer. Our team physician is involved in all diagnoses, and we use the SCAT 3 (Standardized Concussion Assessment Tool) and the ImPACT system.
After a concussion diagnosis, it is well-known that rest from both physical exertion and cognitive work is crucial. When needed, our team physician contacts university academic personnel to discuss the need for adjustments to schoolwork. Every effort is made to minimize academic load and pressures during concussion recovery. Since no two concussions are identical, each case is evaluated individually by the team physician, and thorough communication with academic personnel ensures adjustments are formulated.
We have been fortunate that our coaches, deans, academic faculty, and athletic academic services all recognize the importance of cognitive rest after a head injury. Having a process in writing ensures everyone truly understands their role and the exact steps to follow.
Our return-to-play protocol is fairly standard, allowing for the recommended step-by-step progression with gradually intensifying activities over the course of several days. If an athlete does not recover in two weeks, the team physician may set up a neurology or psychological consultation for them.
Documentation is also critical in concussion management to help determine return to academics and sport and for sharing information. Everyone involved needs to be on the same page to prevent confusion as the recovery proceeds. Accurate documentation also remains the university’s most important defense against legal action in any medical situation.
Amongst the research on sport concussions, one of the most alarming findings is that athletes still hesitate to report a head injury. They don’t want to be pulled from a game and give little thought to long-term consequences. It can be tough to identify a concussion if we don’t have the athletes’ cooperation.
Therefore, a big part of our program is player education. For many years, our athletic trainers would discuss head injuries and the need to report them at initial team meetings. But we realized we needed to do more, as well as adapt to more modern learning techniques.
Now, at the start of the year, we require each athlete to watch an informational video produced by the NCAA about concussions. We make it part of athletes’ compliance information submission, meaning they must attest to watching the video before they can play.
From there, we developed educational ideas that reach today’s athlete. Because this generation obtains their information quickly and in small bursts (e.g., Twitter), we offer information that can be captured in not much more than a glance. For example, we display posters around our athletic facilities and play short infomercials on TV screens that describe concussion symptoms and encourage self-reporting.
Many of the posters are in our athletic training facility, where we have a captive audience while ankles are being taped and athletes are warming up or foam rolling. Additionally, our athletic trainers continue to speak to athletes in initial team meetings and in casual conversation.
We are also focusing on education for our coaches. We believe that concussion education should not be the same for both athletes and coaches, as their roles and responsibilities are different. Therefore, we mandate that our coaches annually take an online course (created by Sport Safety International), which is geared specifically toward coaches and their role in the prevention, recognition, and care of head injuries.
It’s not possible to prevent all concussions, but there are ways to minimize risk by reducing the amount of contact players experience. While this cannot realistically be done during competition, it can be accomplished during practices.
It’s a fact that there are more practices than games in a season. And it’s a fact that during practice, players contact each other, thus increasing the possibility of head trauma to one of our athletes. That convinced us to convene a committee of the director of sports medicine, administrators, and coaches to create policies that limit contact during practices.
These restrictions have taken hold at the high school level, where about half of state athletic associations have implemented rules that limit contact during football practices. At the college level, the Ivy League and Pac-12 have taken the lead, and we looked to them to put our own limits in place.
We also extended the modifications to other contact sports beyond football. And we offered very specific ideas on how to lessen head injury risk in particular sports. (See “Sport-Specific Limits” below for a rundown of the guidelines we’ve put in place.)
KEEPING UP TO DATE
While we’ve carefully researched and developed our concussion program, by no means is it set in stone. We will, at a minimum, review these concepts and procedures annually and adjust them in correspondence to the latest research. We recognize that there are always new strategies and solutions to consider, and we’re committed to implementing them when they can make a positive impact.
Our athletic trainers stay abreast of the very latest information through reading materials from the NATA, regional and national meetings, and continuing education. The NCAA also serves as an important resource for recommended procedures, and our conference, the Patriot League, has been excellent at dispersing pertinent head injury information to its membership.
Recently, we started utilizing an app (C3 Logix) that not only allows us to streamline head injury care, but also uses iPad technology to assess balance deficiencies in athletes. We plan to use this app for all 25 varsity programs.
In addition, we make neck and upper-back strength a priority in strength and conditioning programs. Although there is minimal scientific evidence correlating increased neck strength to a decreased chance of a head injury, anecdotal reports are abundant. It also makes sense that a strong neck musculature may minimize the detrimental effect of a blow to the head and absorb whiplash effect. And there are no negatives to strengthening the neck and upper back.
Prior to making our new protocol public, we had it reviewed by our team physician, our university’s legal counsel, and an outside specialist who is considered an expert in the field. The university made it available to the public by posting it on our website under the “Inside Athletics” tab.
Some of our constituents have wondered if our teams might be at a competitive disadvantage due to limits on contact during practice. We feel we have done nothing that compromises our competitive edge. Our primary concern was, and will always be, athlete health and wellness. The two are not mutually exclusive.
How will we know if our strategy works? Frankly, only time will tell. But so far, our athletic trainers, coaches, staff, and athletes are embracing the changes. Coaches continue to develop ways to limit contact in practice. Athletes are heeding the messages about the importance of reporting concussion symptoms. And when an athlete is down on the field after suffering a head injury, our athletic training staff is doing all they can to manage it.
SIDEBAR: SPORT-SPECIFIC LIMITS
Below are the guidelines we have put together at Colgate University for the lacrosse, basketball, football, ice hockey, and soccer teams to limit contact during practices. “Championship segment” refers to the traditional season.
• When practical, coaches use tennis balls rather than lacrosse balls during goalie sessions and practices to minimize body and head trauma while still practicing technique.
• During shooting drills at goalies with no defense involved, coaches limit the proximity of shooters to goalies to minimize the potential for injury.
• Coaches do not employ dedicated “hitting drills.”
• Men’s lacrosse full-contact ground ball drills occur in practice one time per week at most.
Preseason and non-championship segments
• No more than half of practice time is dedicated to full-contact scrimmage.
• No more than half of practice time is dedicated to full-contact scrimmage.
• Practice duration decreases as games approach.
• Coaches place special and detailed emphasis on teaching proper techniques for taking charges and blocking out, two areas in the game where head injuries are most prevalent.
• Coaches use soft blocking pads, as opposed to actual players, to give players a safe sense of contact in practice.
• Collision-based loose ball drills are not employed in practices at any time.
Preseason and non-championship segments
• No more than one-third of total practice time is dedicated to five-on-five, full-court play.
• Coaches emphasize technique, teaching, and developing fundamentals.
• No more than one-fourth of total practice time is dedicated to five-on-five, full-court play.
• As games draw closer, practice contact decreases and strategy discussion increases.
• Throughout the season, coaches teach proper blocking and tackling techniques so players can avoid head contact.
• Coaches adjust practice plans if positional depth deficiency leads to potential overuse and/or extra contact between players.
• During two-a-day practice days, full contact is only allowed at one of the two practices.
• Full contact occurs at no more than two practices per week. (This is 60 percent below the number of NCAA-allowable, full-contact practices.)
• Of the permissible eight full-contact practices, full contact occurs at no more than two practices per week.
• In practice, coaches instruct players to shoot low at goalies.
• Recognizing that the purpose of body checking in hockey is to separate the opponent from the puck, coaches teach players to control the puck by “angling off” an opponent and to safely use their bodies to protect the puck from another player.
• No dedicated “hitting drills” are conducted at any time.
Championship and non-championship segments
• Only two practices per week involve full-contact drills.
• Coaches emphasize technique in heading and defending.
• Coaches recognize that an injury from collision often occurs to the player who is unprepared for the contact. Colgate coaches emphasize contact preparation in practice and games.
• Coaches limit repetitions when teaching proper heading techniques.
• During heading drills, coaches use “shadow defenders” to minimize the incidence of head collisions between athletes competing for a ball.
• For goalkeeper training, where practical, cones are used to mark goalpost locations in order to minimize the incidence of collisions with posts.
Preseason, championship, and non-championship segments
• On days prior to games, there is minimal contact between players and no heading allowed.
• Mats are often used during “diving” practice for goalkeepers.