AthleticTrainers: Tasked With Identifying Head & Neck Injuries

By: Dan Crowley
Published: 10/21/11

 Part 2 in a three-part series on the importance of athletic trainers

One of the most deceptive injuries in athletics is the concussion. A concussion is a brain injury and all concussions are serious. There is no such thing as a minor concussion. They can occur without loss of consciousness or other obvious signs.

According to the Centers for Disease Control, “Young people participating in sports or recreational activities sustain between 1.6 million and 3.8 million concussions each year, most of which are not diagnosed.”

The long-term effects of concussions and how they differ from individual to individual are not completely understood, and the issue is one that affects every level of athletics, from the professional levels down to youth sports.

On July 19, 2010, Massachusetts enacted a new “concussion law.” The main provisions that apply to all public schools and any school subject to Massachusetts Interscholastic Athletic Association rules require athletic trainers, coaches, parents, parent volunteers, physicians/nurses involved with school activities and athletic directors to participate in annual concussion training. The law requires the removal of any athlete suspected of having a concussion from a practice or game. It mandates that athletes not be allowed to return to practice or a game until evaluated by a licensed physician, neuropsychologist or athletic trainer and have written medical authorization to do so and that schools maintain compliance records.

“We are the only allied health care field specifically trained to identify, evaluate, manage, refer appropriately, and help make return-to-play decisions for concussion patients, as well as all other athletic-related injuries,” Northeastern University athletic trainer Steve Clark said. “Many physicians, those who aren’t specifically sports medicine-trained, don’t have that wide a skill set.”

“You need to have someone (on the field) to recognize concussions for immediate care and care after the injury,” Worcester State University athletic trainer Kevin MacLennan said. “There should be someone to reassess the situation every day. We don’t know a lot about the human brain yet. Concussions are long-range.”

“With concussions, the signs aren’t always easy to detect,” Keith Chagaris, the athletic trainer at Barnstable High School, said. “If there wasn’t a trainer there to make the determination and the player were to go back into the game, there is the possibility of second impact syndrome and even the possibility of a fatality.”

Ralph Evans, the head athletic trainer at Wentworth Institute of Technology, has been in the profession for more than 22 years. He has worked as a trainer at Boston University, Bentley College and with the United States Air Force. Over the course of his professional career he has experienced a lot; however, one of the worst injuries he dealt with involved concussion.

“One of our soccer players sustained a contrecoup mechanism, a concussion in which the brain is jostled. He was in an altered state. We got him into an ambulance and to [an area hospital]. Expecting that they would hold him overnight, we notified his family.

“Based on the wrong information being given to the hospital by the EMTs he was released. We took him to a different hospital and there they did a battery of tests, determining that he had a severe concussion.

“Had we not followed up the situation, it could have become much more serious. He might have returned to play and that would have set him up for second impact syndrome. Fifty percent of all athletes injured in a second impact have died.”

Mr. Evans continued, “What we understand about the brain is extremely minimal. Schools that have no athletic trainer are setting themselves up for a serious lawsuit. Coaches don’t understand how serious head injuries can be. Many times they will make decisions that they are totally unprepared to make. A lot of damage is being done at the lower levels [high school] that can be prevented.”

Concussions, even minor in nature, can have long-lasting effects. Coaches who are not trained to recognize the subtle indications of injury could unknowingly send an athlete back onto the field, where the damage could be magnified.

“In a high school football game two years ago we had a player receive a concussion,” Curry College athletic trainer Isaac Weaver said. “The player said he was feeling okay, but maybe not 100 percent. He wasn’t relaying all the information. Sometimes they just want to play, or there is pressure to get back onto the field. It is important to tell the trainer what is going on. One of the most important things we can do as athletic trainers is educate coaches, players and parents on the need to be upfront. We can help coaches recognize what is happening.”

“I’ve seen concussions where the kid concussed did not know it happened,” said Brian FitzGerald, an athletic trainer and nurse in the department of sports medicine at Children’s Hospital in Boston, said. “Untreated, it could have long-lasting effects. When something like that happens, you do not want that kid going back onto the field. If they suffer a second concussion, and not necessarily a second impact syndrome concussion, it could still be devastating.

“Prevention is the key, and that’s something an athletic trainer can help with.... We can work to condition the athlete to help prevent an injury. We don’t want to put coaches into the position of diagnosing and treating injuries, but the schools don’t have the budgets [to hire a full-time athletic trainer].”

Two years ago at the Cape Cod Classic at Falmouth Ice Arena, Falmouth High School athletic trainer Tim Wakefield faced an extremely difficult situation.

“One of our players hit a player on another team with a clean body check, and the kid hit the boards awkwardly, resulting in a concussion. Since the kid was unconscious, we had to spine-board him and suspected a cervical injury. What made it scary was as the minutes were going by, the young man started to convulse and have seizures. His father came down to check on him and he [the father] passed out, and that made it doubly hard. Thankfully, I was there and we had two EMTs on-site, and a doctor was in the stands, and they all came out to help. All precautions were followed, and he was sent to Falmouth Hospital.”

Kathleen Burke, the athletic director at Falmouth High School, added, “Tim is able to cover all of our training needs and we’re lucky to have him, because other schools have trouble filling that spot. It’s even more important than it used to be with all of the concussion regulations; MRSA (methicillin-resistant Staphylococcus aureus) when that comes up; and our other needs, and Tim is able to tend to all of it. He fills a vital role. I don’t know how a lot of other schools deal without someone like that; he fills a void. We’d have a lot more gaffes without him. He was indispensable before the new concussion regulations, and I don’t think that we could manage them without him.”

Head and neck injuries should never be taken lightly. A headache or sore neck may be signs of something serious. Athletic trainers have the education and training to recognize even minor symptoms as possibly something more. From a cut or bruise to more severe injuries, their training can save lives.

“At a football game one of our cheerleaders was performing during halftime,” Dennis-Yarmouth High School athletic trainer Colleen Norton said. “She was doing a tumbling pass, lost her footing and was airborne and upside down when she lost her momentum. She landed on her head, essentially pile-driving herself into the ground. I was at a disadvantage because I didn’t actually see the injury happen, as I was in the locker room with the football team. When I arrived, the cheerleader was conscious and breathing but was complaining of severe pain in her neck and back. She also complained of some tingling in her left hand. A police officer called the fire department to start rescue. At that time it was a matter of keeping her calm, not moving her, keeping her head still and performing continuous assessments until we could put her in a cervical collar and get her spine-boarded. When the fire department arrived, I was able to give them the rundown of what happened, who the patient was, identify her parents in the crowd and give them her emergency medical information that I always carry with me. In the end, she was diagnosed with a fracture of the C2 (second cervical) vertebrae and also compression fractures of T4 (fourth thoracic) and T5 (fifth thoracic).

“If there hadn’t been a certified athletic trainer present, the possibility of this young lady being permanently paralyzed was extremely high. The fractures at T4-T5 could have affected her spinal cord, causing permanent damage.

“The fracture of C2, had it moved,” she said, “could have potentially ended her life as it would have affected her brain stem, which controls all the involuntary motor controls: mainly heart rate and respiration. Sometimes as an athletic trainer we need to take absolute control of a situation to make sure that the athlete/patient gets the best possible care. This is what we are trained to do from the first day of entering an athletic training program in college.”

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