Year Long Sport and Early Specialization

Early sport specialization and year long sport has become a major problem for our young athletes.  There are many reasons and justifications for this by parents, coaches and administrators as there is a perceived success for those who do specialize early.  Some are unaware of the detriment to their athletes bodies and some just choose to ignore what they see and hear.  Athletes can achieve success in their careers even when starting to specialize as late as age of fifteen.  

There are both physical and psychological negatives to the early specialization of young athletes. Overuse injuries and burnout are the most common, which lead to early retirement.  By the age of thirteen 70% of adolescent and child athletes will have dropped out of their given sport or activity.  By encouraging and registering them in a cross spectrum of sports benefits include an increase of joy, talent and the use of the full body.  

By involving your child in sports that involve the full body, you decrease the likely hood of overuse injuries.  Repetitive strain injuries such as Osgood-Schlatter, Sever's disease, Little League Elbow, tendinosis, and stress fractures are all linked to excessive repetitive motions and repetitive training cycles.  Gymnastics, diving and figure skating are the only sports to show some benefit with early specialization due to their use of periodization.  Graded increases in activity, are the most beneficial for the physical and skill development of athletes.  Rest both during the season and off season, is imperative to keeping young athletes engaged and injury free.  

The long term effects of overuse injuries can be seen in the number of baseball players especially pitchers in both the college and professional levels who are suffering ulnar collateral ligament sprains.  The philosophy of no pain, no gain has long been shown detrimental in both coaching and conditioning realms.  By engaging in multiple sports different parts of the body and brain are engaged, making turning the child into a better overall athlete.  People marvel at college athletes who compete and excel in more than one sport.  What we should be doing is using them as an example of how non-specialization actually leads to success.

By allowing our young athletes to engage in more than one sport and delaying specialization we will create not only better athletes but better adults as well.  By reducing overuse injuries and burnout at the younger ages, athletes will continue on being active throughout their adult lives.  That is true success over medals and accolades.

Follow us on Twitter @EliteInjuryMgmt and check out our website at www.eliteinjury.com

Resources used for this post

 Overuse injuries and burnout in youth sports: a position statement from the American Medical Society for Sports Medicine, DiFiori et al; Br J Sports Med 2014;48:287-288

Any Given Monday: Sports Injuries and How to Prevent Them for Athletes, Parents, and Coaches - Based on My Life in Sports Medicine, Dr. James Andrews 

http://researchrepository.murdoch.edu.au/4422/1/sport_specialization_in_youth.pdf

Anaphylactic Reaction

Anaphylaxis is a serious allergic reaction to a food or environmental stimulant.  The most common stimulants in Canada are peanut, tree nuts, milk, eggs, fish, shellfish, sesame seeds, soy and wheat.  Insect stings such as yellow jackets, hornets, wasps and honey bees are can also trigger an anaphylactic reaction.  Medications as well as rubber latex can also trigger a reaction. 

Signs and symptoms of a anaphylactic reaction can be categorized into five categories:

• Skin system: hives, swelling, itching, warmth, redness, rash
• Respiratory system (breathing): coughing, wheezing, shortness of breath, chest pain/tightness, throat tightness, hoarse voice, nasal congestion or hay fever-like symptoms (runny itchy nose and watery eyes, sneezing), trouble swallowing
• Gastrointestinal system (stomach): nausea, pain/cramps, vomiting, diarrhea
• Cardiovascular system (heart): pale/blue colour, weak pulse, passing out, dizzy/lightheaded, shock
• Other: anxiety, feeling of “impending doom”, headache, uterine cramps, metallic taste

Any sign or symptom should be dealt with immediately as the severity can change rapidly.  Every athlete with severe allergies should have an emergency plan.  Included in this plan should be knowledge of past reactions, location of epinephrine auto injector.  Anaphylaxis policy changes depends on your province and school board, it is important to check what is allowed or not allowed in your jurisdiction.  

In North America there available auto-injectors include Twin Jet, Epipen and Allerject.  The amount of epinephrine comes in two dosage strengths and is based upon weight.  Consultation with your physician and pharmacist as to the appropriate dosage.  

The management plan for an anaphylactic reaction:

1) Give epinephrine auto-injector at first sign of reaction

2) Call 9-1-1

3) Administer second dose of epinephrine if available

Having a well planned out plan for any emergency is important, knowing what to do when that emergency is an anaphylactic reaction is the difference between life and death. 

Please follow us on Twitter @EliteInjuryMgmt and check out our website at www.eliteinjury.com 

The Art of Taping

As an Athletic Therapist one of the things that we do on a regular basis and by regular I mean multiple times daily is taping.  Be it an ankle, thumb, knee or wrist we have to know that exact place to put the tape and what way the that piece of tape needs to go to prevent and stabilize the joint.  

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Recently I was instructing a class of high school students on various tape jobs.  There were varying degrees of experience with taping as well as degrees of interest in doing them properly.  One of the first steps we went over was reviewing the motions of the joints we were going to tape.  Before you even can touch a roll of tape you have to know what way the joint your going to tape moves.  It would be very detrimental to tape an ankle inversion sprain and pull the ankle into inversion instead of eversion.

Learning to tear tape is another skill that needs to be mastered prior to applying tape to the body.  Poor tears cause wrinkles and tight spots which are both huge no-no's with any tape job.  The use of scissors or tape sharks to cut regular white taping tape is not efficient nor practical.  

You may be asking by now why is this post called the Art of Taping.  It may seem more technical than artistic.  As much as you need the technical knowledge as to the body and its motions, taping is truly an art.  No body part is the same.  For example no arch in the foot is the same.  Being able to recognize this and know the difference, while taping essentially on the fly is part of the artistic aspect. 

 Many of you may not think so but tape jobs are pretty.  They should be viewed like a sculpture.  The absence of wrinkles and windows (where skin shows through between two pieces of tape) makes for a smooth, flawless tape job.  This combined with the ability of the strength of the tape to prevent injury is beautiful.  

If you still doubt how taping can be art.  Watch an Athletic Therapist at work.  The fluidity of their motions as they move the roll of tape around the body of their athlete or patient is at times as graceful as a ballerina or pianist.  

I hope that after reading this you have gained a little more appreciation for those of us who tape.  It is not as simple as throwing on a piece of tape as though it is a bandage.  Each piece is in its place for a reason and put there purposefully, as a painter puts each brush stroke on their masterpiece.  

Please follow us on Twitter @EliteInjuryMgmt and check out our website www.eliteinjury.com for more tips and services that we offer in keeping everyone in the sport of life.  

Fatigue in Athletes

Many athletes become fatigued during the season.  With the prevalence of year round sport, young athletes are becoming fatigued more often that before.  As a coach and parent there are two main ways you can help deal with athlete fatigue.  Firstly you must plan a schedule that will help prevent athlete fatigue, secondly you must be able to recognize the signs and symptoms of athlete fatigue.  

Signs to look for when seeing if your athlete is becoming fatigued come as both physical, mental and emotional.  Physically athletes may become more prone to sickness.  Missing practices, games and competitions due to illness more often than normal is an easy sign for parents and coaches to see.  An increase in pain as well as slower recovery from work outs or injuries occur as athletes become more fatigued during the season.  As the body uses its energy to try to keep up with normal daily activities, It finds it harder to find the energy to heal, compete and learn new skills.  Skills that were once automatic become harder to complete.  

Mental and emotional fatigue can end up leading to depression, so it is imperative that early recognition occurs.  Athletes may appear moodier or more emotional.  The happy go lucky athlete who cheers everyone on, soon becomes withdrawn and irritable.  You may notice an increase in irritability.  Snapping at parents, siblings or teachers without cause or over reacting to situations can be early indicator of fatigue.  

Altered sleep patterns, both a increase or decrease in the amount of sleep is a sign of both mental and physical fatigue.  When or wear an athlete chooses to sleep as well.  You may find that an athlete is falling asleep during dinner or needing naps after school.  If this is typically abnormal and becomes more than an occasional occurrence, further investigations as to the cause need to occur.  

One of the major clues or signs to look for is a decreased enthusiasm for their sport.  Not wanting to attend practices or competitions, coming up with excuses as to why they don't want to go or wanting to leave early are all signs of this loss of enthusiasm.  This type of fatigue is associated with burnout and is typical with athletes involved in sports with early specialization and year round sport.  

Prevention of fatigue as with all types of injuries is simpler than dealing with it after it occurs.  When organizing an athletic year follow the principles of periodization.  Both physically and mentally the athlete can not be at peak performance all the time.  There must be highs and lows of training and competition. 

As parents, coaches and teacher-coaches; a balance between school, sport and social life must be achieved.  When scheduling practices and games allow time for both the body to recover as well as time for your athletes to complete homework and spend time with friends and family.  

Communication is pivotal for both recognition and prevention of fatigue.  Talking and listening to your athletes to both verbal and non-verbal actions will allow you to take any steps needed before it is too late.  

Athlete fatigue is more than just being tired and can lead to long term health problems.  Preventing and recognizing this before it becomes severe is important in truly making the athletes health a priority. 

Follow us on Twitter @EliteInjuryMgmt and check out our website at www.eliteinjury.com 

Becoming an Athletic Therapist

So you want to become an Athletic Therapist.  Congratulations and welcome to one of the most rewarding careers you can find. If you want more information than provided here please go to www.athletictherapy.org

The first step towards becoming a Certified Athletic Therapist is to attend an accredited institution. We have seven institutions in Canada.  University of Manitoba, University of Winnipeg, Camosun College, Sheridan College and Concordia University all have degree programs in Athletic Therapy.  Mount Royal University offers a post degree certificate as well as a collaborative program with University of Regina, University of Calgary, University of Lethbridge and Trinity Western University.  York University currently has probationary status. 

Upon completion of your education you will continue on the path of certification.  Before attempting the national certification exam you will need to have met the following requirements.  A valid CPR-HCP certification, completed a First Responder course, have your Supervisory Athletic Therapist (SAT) to approve your application and have completed 600 hours of both field and clinical work.  

The national exam consists of two parts.  The written exam consists of 200 multiple choice questions.  The oral-practical portion consists of both field and clinical components.  During the field exam you will face an urgent or non-urgent on field scenario, a sideline return to play scenario and a taping/support scenario.  The clinical component has to scenarios, injury assessment and rehabilitation.  The oral-practical exam is marked live by Certified Athletic Therapists.  

There are 6 domains of competencies that you will gain during your education and will need to demonstrate during your national exam.  

1. Prevention
2. Recognition and Evaluation 
3. Managing, Treatment and Disposition
4. Rehabilitation
5. Organization and Administration
6. Education and Counselling

Once you have completed all these steps you will receive one of the greatest pieces of mail stating you our now a Certified Athletic Therapist and get to use the professional designation of CAT(C).

Please follow us on Twitter @EliteInjuryMgmt and check out our website at www.eliteinjury.com

First Aid supplies

Every team needs to have a fully stocked first aid kit on site during all team, club or sport activities.  Having these supplies at hand, knowing what is available and knowing how to use them are all part of a well organized risk management plan and emergency action plan for your group. 

Not all first aid kits are created equal.  A kit used at home, work or in the car will not meet the needs of an athletic event.  Depending on your expertise you may expand the supplies you keep on hand, but it is very important to only have supplies you are trained to use.  When being given a first aid kit by your organization or club it is very important to go through it.  Knowing what supplies you have on hand or not can mean change how prepared you are for the injury situation. 

Basic supplies that everyone should carry are:

• Barrier protective gloves - non latex is best, but if you have not latex allergies in your athletes latex is fine.
• CPR mask or shield 
• Bandaids - I always recommend butterfly or knuckle as they have more coverage and stay on better.  You may need to pay attention to adhesive allergies. 
• Triangle Bandages - They aren't just for slinging shoulders, in my world the more the better.
• Tensor Bandages - 3" and 4" are best, depending on your knowledge adding a double 6" is beneficial.
• Saline Solution - Used to clean wounds.
• Antibiotic Cream - Keep wounds clean 
• Gauze - Sterile and non-sterile to dress wounds, 3" is sufficient
• Alcohol Sanitizer - You can not always make it to a sink to wash.
• Hypafix or similar product - Keeps gauze on great
• Prowrap - Even if you don't know how to tape this comes in handy for many things
• White Athletic Tape - Zinc Oxide tape is the basic tape used in athletics.  If you have a taping and strapping course carry enough to tape.  If you do not know how to tape still carry some as you can use it to hold on bandaids or gauze. 
• Scissors - Rescue Shears or Utility Scissors can cut through shoulder pads, great to have on hand for emergency or everyday issues.
• Helmet Removal Tool - Depending on your sport having something to properly remove the face mask can be life saving.  An pair of angled pruners or the Trainer Angel work well, a Utility Knife is not safe for either the athlete or person using it. 
• I do not recommend chemical ice packs as they can break and tear.  Leaving the athlete prone to chemical burns or the ice pack has already been activated prior to needing to be used.

A well packed and organized first aid kit can make a huge difference when managing injuries.  By knowing what supplies you have on hand and how to use them will save you time when an injury does occur. Nothing is worse than trying to find gloves and gauze when dealing with a wound.  Always keep your first aid kit stocked and check for expiration dates on any supplies.   Check with your sport governing body or organization as to if there are any restrictions as to what you can carry in your kit. Some sport governing bodies do not allow you to carry anything that has a drug identification number (DIN).  The final step to having an effective first aid kit is making sure you take it to all sport events. Practices, games, training and competitions all require having your first aid kit on site. 

Please follow us on Twitter @EliteInjuryMgmt and check out our website for more information at www.eliteinjury.com.

Emergency Action Plan Part 2

As a continuation from last week we will continue with Emergency Action Plans to continue showing the importance of why all teams, clubs and organizations need to have an effective EAP.  I would like to thank Dr. David Geier, Mike Hopper, ATC and Stop Sports Injuries blog for their posts on EAPs as well in the last couple of weeks as some of the basis for this post will come from them.

Last week we discussed the three major roles that are needed to have an effective EAP, these make up the personnel portion based on Dr. Geier's components.  The second component is communication, both with each member of the EAP, parents, other teams and administrators.  We covered communication within the EAP last week so we will discuss communicating with parents and administrators.

Parent communication is so critical prior to competition, once an injury occurs and after an injury occurs.
Prior to the season starting or competitions inform your parents that you have an EAP, they do not need to know the details, just make them aware that if an injury does occur you have a detailed plan.  It is very important to let them know that the plan includes injury care and contacting EMS as it will help avoid multiple calls to dispatch.  During injury care, it becomes the job of the control person or additional members of the team staff to help calm the parents of the athlete.  Inform them of the degree of the injury, that they are being cared for and that EMS is on route.  This would be the same if you are travelling and the parents are not there, you need to contact them as soon as possible to advise them of the situation.  Post injury stay in contact with the parents to ensure that everyone is on the same page as to severity and rehabilitation of the injury.

When acting as the host for events, you should let the other team know of your EAP as there may be differences as to activating EMS and access to the facility compared to their home venue. When visiting ask the other team or facility these questions, you can not always be reliant on them having an EAP and there maybe the same differences as if they were the visiting team.

Whenever a major injury occurs especially in a school based setting, letting the administrators know can be vital.  In school settings the athletic director, principal and at times the school board must be made aware of the situation.  For minor sports, the club or organizing body will need to know the details of the incident.  In both cases it primarily will be about liability and insurance.  Depending on the insurance plan, there can be time frames for starting a claim and retrieving the information needed.  Usually it will involve paper work from the hospital which can take time to receive and insurance companies usually don't budge on their deadlines.

The third component is ensuring you have proper equipment to deal with emergency situations.  That equipment will vary depending on whether you are a coach, parent, or Athletic Therapist.  The most basic things that everyone in sport should have on the sidelines are:

• Up to date medical information on all participants in your care including coaches
• Face mask removal tool - football 
• Rescue shears for removal of equipment
• CPR mask & other Personal Protective Equipment such as gloves
• Wound supplies - gauze and towels to stop flow of blood
• ICE 
• Triangle bandages
• Splints 
• AED - you may not have a portable one but knowing where it is located at the venue is extremely important

An AED can mean the difference between life and death in emergent situations involving the heart.  The rate of survival increases by 75% when and AED is used.  For every minute that an AED is not used the rate of survival drops by 7-10% and by 12 minutes without defibrillation the rate of survival is only 5%.  Having one on site during any sporting event is a major step towards proper injury management.

You never know what each day at the rink, field or gym will bring.  Hopefully everything goes off fine and no injuries occur, but at some point an injury will happen.  Emergent situations can range from a spinal injury, head injury or an open fracture.  You may have a medical situations such as heat stroke, allergic reactions or an athlete with diabetes who is either hypo or hypoglycemic.  Be it in a school setting, a club or team sport having a detailed documented EAP that fully defines the roles and actions of everyone involved is the critical step in ensuring athlete safety.  Having someone on hand as a first responder, be it a coach with first aid and CPR, an Athletic Therapist or an EMT, without the prior planning of what to do in that emergent situation, no matter what their skills are, the athlete's well being and safety has been put in jeopardy.

For more information on EAP's please contact us at info@eliteinjury.com or visit our website at www.eliteinjury.com.

Resources used

Dr. David Geier - Why are Emergency Action Plans Critical for sports teams?
Mike Hopper, ATC - Sports Emergencies
Heart and Stroke Foundation - Public access to AEDs
Stop Sports Injuries - Why all sports teams should have an Emergency Action Plan