Preparing for the Upcoming Season as a Parent

Well the September long weekend is over, kids are back at school and the fall/winter activities are starting up.  As a parent you are getting the year schedule and are soon finding your calendar is full.  Before you reach for the bottle of wine, take a deep breath, you will get through this.  The following will help you get through this season hopefully injury free, but if an injury does occur with your young athlete, you will be prepared for it. 

Write down the schedule, not just this months, but the whole year.  Put it in a master calendar with everything on it.  Important school dates, holidays, practices, games, tournaments and competitions.  Again before you scream there is a reason for this.  Do you notice any trends?  Are there days off?  If you your child is in multiple activities are there any conflicts?  Is there conflicts between each child's schedule?  By noticing any conflicts now, you have the time to manage them now, instead of last minute.  The stress that you express when something happens is felt by your children and can distract them their task at hand.  Back to days off.  Rest is important, very important.  Both physical and mental fatigue lead to injuries or burnout.  For more on fatigue in athletes go here.  

Proper meal planning is also very important.  Being prepared with lots of meals in the freezer that can be easily thrown into the oven or slow cooker will save you time and the dread of heading through the drive thru.  A supply of healthy snacks in the car can get you through those school to sport moments.  

Being prepared for injuries is like having insurance, you hope you don't need to use it but are glad you have it if something does happen.  Knowing basic injury management principles will help you not only with your child's injuries but are also a good life skill to have.  It is also important to have a health care professional that you trust in case your child does suffer an injury, that way your not searching after the fact.  If the sport your child is involved in is prone to concussions, have baseline evaluations done by a qualified health care professional.  

Asking your child's coach, teacher or instructor as to their qualifications and preparedness for injury situations.  Do they have first aid and CPR?  Have taken an injury management seminar or course?  Do they have an EAP and a risk management plan?  What is their policy on return to activity after injury?  These are all questions you need to ask them.  Most of the time they will be the one responding to your child's injury, not you.  You want to make sure they are prepared for the situation and that there will be no confusion after the fact as to return to activity. 

The final thing that you must remember to do for the season is to have fun. 

For more information on our injury management seminars and other services offered check out our website at www.eliteinjury.com.  Please follow us on Twitter @EliteInjuryMgmt

Intro to the Female Athlete

The female is a complex being turn that female into an athlete and you have made her even more complex. The female athlete provides many challenges to the coach, parent and athletic therapist.  To fully understand the female athlete will take more than this one post.  Today will be an overview of future topics and if you feel I am missing one or want me to talk about something specifically let me know as not all athletes are the same.

Female Athlete Triad, simply it is the combination of disordered eating, amenorrhea, and osteoporosis.  It is a vicious cycle that starts with disordered eating and progresses.  No sport is exempt from this as it is typically seen as an aesthetic or performance sport issue.

Anterior Cruciate Ligament Sprains, this ligament helps prevent anterior translation of the tibia relative to the femur.  In more simplified terms it stops the lower leg from moving forward compared to the upper leg.

Disordered Eating,  detrimental effects on energy levels do not require an athlete to have a diagnosed eating disorder such as Anorexia Nervosa or Bulimia Nervosa, the slightest change in energy intake for the athletes energy output will place unnecessary strain on their body.

Physical characteristics, the differences between males and females can predispose females to injuries that their male counterparts may not experience.  These characteristics may also predispose the athlete as to what sport or position they may participate in.

Why the participate?  The reason for female participate in sport varies depending on the individual however there are some constants.  Friend participation both effects the reason to start sport participation as well as when females decide to no longer be involved.

One of the new areas of study on the female athlete is in the area of concussions.  Still in its infancy we are learning a great deal about how females react to a concussive injury and if there is differences from their male counterparts.

As a parent or coach it is important to understand how to deal with the female athlete.  Learning how to deal with them will give both you and them an advantage on their path to success.

Proper Concussion Management

Gone are the days of returning to the game the same day you suffered a concussion.  Well it is supposed to be.  Even with all the media attention and front line education on concussions; coaches, parents, officials, athletes and trainers are still missing the message.  After a concussion has been diagnosed it is extremely important to have the athlete rest.  Not only physical rest but cognitive as well.  No matter the age of the athlete it is important to offer them this rest.

I has amazed me over the years that parents, athletes and coaches have tried to circumvent the return to play protocols because the concussion occurred in another sport. It is the parents role to inform teachers and other coaches of their child's concussion.  Concussed athletes may need to take time off work or school, to give the brain the rest it needs.  Student athletes need to be given the chance to fully recover before returning to full mental and physical activities.  Having athletes refrain from attending school while still suffering symptoms will aid in their recovery.  It may be required for the student athlete to remain home from school until symptom free as the level of concentration at school is too much.  Gradually introduce them back into school and homework.  Consultation with their teachers is important, ask for extra time to complete assignments and tests.  The other major part of cognitive rest is to take away screen time.  Put down the phones, turn off the computer, TV and video games.  That scream you just heard was every young athlete having a minor heart attack due to this.  The bright lights, sound and concentration needed for these activities do not help the brain heal.

Right after injury it is imperative that you do not give the athlete any pain medication.  Advil, Tylenol, Aspirin and Ibuprofen will only mask the signs and symptoms of the concussion.

Your qualified health care provider will complete a concussion test and compare it to the athletes baseline evaluation.  Only when an athlete is sign and symptom free do they progress onto step two of the return to play process.  A minimum of 24 hours is required between each step where the athlete must remain symptom free.
Step 1 - Rest until 24 hour symptom free.
Step 2 - Light aerobic exercise such as biking or jogging for 20-30 minutes.
Step 3 - Sport specific exercises such as skating in hockey, running drills in soccer or football.
Step 4 - Non-contact training drills such as passing drills.
Step 5 - Full contact training drills upon medical clearance 
Step 6 - Return to normal game play.

An athlete should remain at step 5 until both the athlete, parent and coach feels that the athlete is able to keep up with the play both physically and mentally.

Key points to remember are:

• Return to learn before return to sport
• No difference in management between elite and non-elite athletes.
• Younger athletes may require longer to recover.  

Rushing any athlete back to sport to quickly can cause serious damage both to the brain and other areas of the body. Following proper concussion management may help to decrease the long term effects of concussions. 

Concussion - Recognizing the Symptoms

"Coach, I have a headache", those five words make every coach grimace, dreading the worse, hoping the athlete does not have a concussion.  A headache is the most common symptom of concussed athletes, but by no means the only one.  No one concussion sign or symptom is more important than the others and all must be taken seriously. To start we will define the difference between signs and symptoms.  A sign is something that you as the coach, parent, trainer or fellow athlete will notice.  They include poor balance, slow or slurred speech, poor concentration, vacant stare, delayed response to questions and a change in the level of performance.  Symptoms, how the athlete tells you they feel, fall under four categories.  Somatic (physical), emotional, sleep disturbances and cognitive.  Somatic symptoms include headaches, nausea, vomiting, balance problems, visual disturbances, dizzy spells, sensitivity to light and sensitivity to noise.  Emotionally an athlete may be sad, depressed, nervous and more irritable.  They may sleep more or less and may have trouble falling asleep.  Cognitively, they may have difficulties concentrating, trouble with remembering, feel mentally slowed down or that they are in a fog.

If an athlete presents with any of these signs or symptoms they need to be removed from activity immediately and evaluated further.  As a coach, parent or trainer, use the Sport Concussion Recognition Tool to determine what further care is needed and refer them to a trained health professional in the area of concussions.  It is very important to rule out a cervical spine injury as well with any athlete that is displaying concussion symptoms.  Typically concussion symptoms are quick in there onset and involve short lived impairment for the athlete.  It should be noted though that in some cases signs and symptoms are delayed in their onset.

Next to knowing what signs and symptoms to look for the greatest tool you need comes from knowing your athletes.  Being able to recognize the difference in your athletes is key.  An athlete may tell you that they do not feel right and if you ask many parents and coaches who have dealt with concussions will say the athlete was not themselves.  Even though they are symptoms take notice of them.  Coaches one of your biggest indicators to watch will be how well the athlete is performing.  If a skill typically always done well can is being done poorly, something is causing it.  Remove the athlete and evaluate, it may not be a concussion but no matter what it is always better to error on the side of caution.  Parents, pay attention to how your child is acting.  They may not tell you they are suffering but you will notice changes in their behavior.  Everything from how they are sleeping, eating and interacting with the family and friends will be an indicator of how they are feeling.

Many of the former athletes when asked about concussions will say they never knew that they had one and definitely did not know what to do when did occur.  Recognize that a concussion has occurred and remove the athlete from activity, do not let them return until evaluated by a trained health care professional. Next is proper management, following the proper return to play can be the difference from a quick return to activity or the unnecessary lengthening of symptoms.

Concussion - Where to Start

Concussions, after staring at my computer screen for about an hour trying to come up with a new and inventive way to talk about concussions and why everyone in sport needs to be educated about them, I realized that their is nothing new to say.  The message is still the same, hopefully you will gain some new knowledge or understanding after spending some time reading this.  That is my hope, that by a coach, parent or athlete reading this, they will learn something about concussions.  We can't necessarily prevent concussions unfortunately it is one of the risks of sport, but we do need to increase the awareness of signs and symptoms and proper management when they do occur.

This may seem like a redundant thing to say but a concussion is a brain injury.  I state this because I have had a coach in the past say a kid could play because the emergency physician said he had a mild brain injury.  He must have been listening to me, he knew that he could not play a kid with a concussion, and obviously I had not educated him enough. As defined from the 4th Concussion Consensus Statement from Zurich November 2012, concussion is a brain injury caused by a direct blow to the head, face, neck or an impulsive force being transmitted to the head from a direct blow to somewhere else in the body that causes a set of physical, cognitive or somatic symptoms.  It is important to say that everyone person will respond differently to a concussion both in the symptoms they show and how they recover.

Every day it seems there is something new coming out about concussions.  For a coach or parent trying to keep up at times seems impossible.  I have found Twitter to be an excellent resource.  Follow health professionals who are known for concussion research to stay up to date and informed.   It is unfortunate that most general practitioners are not up able to stay up to date on the latest concussion research and proper return to play.  When dealing with any health professional ask them questions, if they have never heard of the consensus statements or are still following the earlier versions find someone new.  A great resource is a certified Athletic Therapist in Canada or Athletic Trainer in the States.  Proper concussion management is in their scope of practice and they deal with sport concussions on a regular if not daily basis.

So as a parent or coach what do you need to know.  We are going to break it down into three posts.  First we will focus on the importance of baseline testing, secondly recognizing a concussion, thirdly proper management.

Baseline concussion testing can involve a couple of different aspects.  Depending on your health practitioner they may choose to do a different test.  The most popular and common are the Sport Concussion Assessment Tool 3 (SCAT3), ImPACT and King-Devick.  The SCAT3 has a version designed specifically for athletes aged 5-13 as well as the standard for those 13 and over.  ImPACT should be used along with the SCAT3 or King-Devick.

The importance of having baseline testing done is not to compare to other athletes but to understand the athletes normal state as well as to determine their past concussion history.  Finding out if an athlete has suffered a concussion before and if they have any medical conditions that may effect their recovery from a concussion if one should occur.  Athletes, coaches and parents always ask if the baseline test was passed.  This is where the naming can be deceiving, baseline testing is not a pass or fail, it is to determine how the athlete normally feels to a set of symptoms and to evaluate their memory recall, balance and thinking skills.  It is an evaluation.  How many of us have a headache on a regular basis?  Since headache is the number one symptom of concussion, it is good to know if the athlete regularly has a headache when trying to determine if a concussion has occurred.  When doing baseline evaluations athletes typically tell me they have a hard time with numbers or remembering months.  If we had not done the baseline evaluation I would not have known that and it could effect my evaluation of them post injury.

Education about concussions is always important but that includes the health practitioners education about each individual athlete.  Doing baseline evaluations allows us to get to know the athletes better, which in turn gives us an advantage when an injury does occur.  Have your athletes do baseline evaluations prior to each season as their physical and mental growth and development will change their outcome.  Think of a baseline concussion evaluation as an insurance policy.  We never want to have to use our insurance but are sure glad we have it when it is needed.

Balancing the Scales: Sport, School and Life

Being a student athlete is hard work.  The amount of time and dedication it takes to compete at any level can at times leave little room for anything else.  Finding time to schedule in school work, friends and family soon leaves many athletes overwhelmed and unsure of how to deal with all that is on their plate.  The majority of young athletes that excel in their sporting venue also excel in school because of their internal drive to succeed.  It is also what makes them say yes to student council, yearbook and many other school activities.   Creating an environment for the athletes to succeed is job held by many and each of them have specific roles.

As the parent you are the master conductor and scheduler.  You shuttle the kids from school to practices and games and back home again, watching them do homework in the back seat or in the stands while waiting for their siblings to be done.  You see them texting their friends or talking to them after school.  Part of your job as master scheduler is to put time in each day for your children to complete their school work.  Try to give them uninterrupted time and space to complete their homework for the day.  When planning for weekends away, have the children speak to their teachers in advance to get their assignments and reading for that period.  Schedule time each week for them to have friend time, family time and down time. It is very easy for everyone to get caught up in the rat race of classes and sport, even young athletes need time to spend with their friends.  It may be they end up playing street hockey, a pick up game of basketball or doing cartwheels in the basement but it needs to unstructured socialization time with their friends.  Family is important, as you will be who they fall back on when things get tough in life.  Spend at least one night a week together as a family to reconnect, turn off the phones and find out how everyone's week has been.  Each person needs some me time, so let them have it.  This time will be useful as your athletes will discover how they are feeling both physically and mentally when the world slows down around them.

Coaches need to remember that sport is not their athletes full time occupation, school is.  Schedule enough time for your athletes to rest, do school work and have fun.  Athletes who are both mentally and physically fatigued will not be able to focus on the skills expected of them.  You should encourage your athletes to excel at school, as the problem solving and critical thinking skills they gain there will help improve their on field performance.

As an athlete you may feel the pressure to say yes to every request you get.  Learn to say NO and to find a way to schedule time for yourself.  Using a day timer or calendar to organize and write down when assignments, tests and games are will allow you to manage your time wisely.  You don't want to have to worry about doing the ten page essay after family supper on Sunday night.  Talk to your friends, find time to hang out with them away from school or gym.  Your friends and family will help you out when you start feeling like everything is too much, keep them close so they are their for you when it happens.

Usually as a teacher you are probably doubling as teacher during the day and coach at night.  Be understanding of your student athletes when they let you know they will be away, let them know what work they will miss so they don't fall behind. Students who exercise typically do better in class, help them excel at both school and sport.

Everyone involved in student athletes lives needs to pay attention to how much pressure they are putting them under to complete everything asked up them.  We all need to be realistic in our expectations of them and to pay attention to the signs of burn out.  If they are getting burnt out, be there for them and help them adjust as need to so they can live that balanced lifestyle where they gain the full benefits of school, sport, family and friends.

Symptoms of Burn Out
low motivation, decreased energy, concentration problems, loss of desire to play, lack of caring, sleep disturbances, physical and mental exhaustion, lowered self-esteem, negative affect, mood changes, substance abuse, change in values and beliefs, increased anxiety, highs and lows.

Teach an Athlete to Drink

It amazes me that no matter the experience or level of competition that an athlete competes at you still must remind them to hydrate.  Proper hydration is one of the key components in athletic performance.  Dehydration not only effects the body physically but those physical side effects will effect you mentally as well.  Hydration does not start when you step into the dressing room or at the first water break, it is a continual ongoing process.  Think of your body as dam.  You need a water source coming in, a place for it to rest and somewhere for it to go.  The water you consume is like the river flowing into the dam, your body is the the reservoir, and the river flowing out is the water you lose through sweat and urination.  How well do the muscles work if they are not lubricated?  How will they receive the nutrients they need to perform?  Water is used throughout our bodies, we need make sure it has an ample supply.

If you are able carry a water bottle with you so that you can hydrate throughout the day. A 120 pound person should consume 8 - 8oz glasses of water each day if they have not exercised.  For every hour of exercise you should consume 16 oz or 2 cups of water.  It is important to hydrate before, during and after activity.  A good rule of thumb for during activity is to drink 1 to 1.5 tablespoons every 15-20 minutes. Continue to replenish after activity, for athletes who are losing excessive amounts of water replenish with the amount of weight lost during activity.  Yes, chocolate milk is a great post activity drink to help replenish liquid, protein and carbohydrates, I still recommend drinking water on top of that.

For coaches, parents, and trainers be on the lookout for the following as they are signs and symptoms of mild dehydration:

• Dry, sticky mouth

• Sleepiness or tiredness — children are likely to be less active than usual

• Thirst - dulled with activity

• Urine that is yellow or gold in colour

• Decreased urine output — eight hours or more without urination for older children and teens

• Few or no tears when crying

• Dry skin

• Headache

• Constipation

• Dizziness or lightheadedness

• Decreased mental awareness

Learning how to hydrate is an something that all coaches, parents, trainers and athletes must do to keep the body performing at its peak.  Your body is 60% water and requires it for many body processes.  Replenish your stores with glorious water.  Sport drinks should not be used by children and only in certain circumstances by adult athletes.  No one should be consuming energy drinks at all and definitely not as a means to hydrate.  As a coach schedule water breaks no more than 20 minutes apart and encourage your athletes to drink.  Parents should check with your children's schools to see if they can carry a water bottle with them, it is amazing how often they will take sips if it is sitting right there.  Athletes, it comes down to you, if you want to succeed you need to provide your body with its major nutrient, so grab a bottle of water and good luck in achieving your goals.