NASMI and Advances in Clinical Education

From Sports Medicine Research: In the Lab and In the Field

Blog Written by: Jane McDevitt MS, ATC, CSCS

Reviewed by: Stephen Thomas

Assessment and Management of Sport-Related Concussions in United States High Schools

Meehan WP, d’Hemecourt P, Collins CL, Comstock RD. Am J Sports Med. 2011 Oct; ahead of print

http://www.ncbi.nlm.nih.gov/pubmed/21969181 (link to abstract)

There are several different concussion assessment tools (e.g., SCAT2, BESS, Headminder) to evaluate an athlete, however, little research is done on what medical professionals use to assess concussions. The purpose of this study was to describe the medical providers and medical studies used when assessing sport-related concussions, as well as, to determine the effects of medical provider type on timing of return to play, frequency of imaging, and frequency of neuropsychological testing. This study followed 192 U.S. high schools with at least one full time athletic trainer during the 2009 to 2010 academic year. The results showed that nearly 15% (1,056) of the athletic injuries were concussions. Boys’ contact sports had the highest number of concussions per 100,000 athletic exposures (i.e., football, ice hockey, and lacrosse). Most of the concussion (53%) took place during a varsity contest, and grade level was about the same (freshman 25.8%, sophomore 25.1%, juniors 22.7%, seniors 23%). The most commonly reported sign and symptoms were headache (94%), dizziness (76%), difficulty concentrating (54%), and confusion (44%). Most athletes had resolution of symptoms within 7 days (78%), but 2.8% had symptoms lasting within a month. Nearly, 93% of the time there was a medical professional on the scene at the time of the concussion, where athletic trainers were there 70% of the time. However, there was no significant difference found between having a medical professional at the scene of the injury and duration of symptoms or return to play time. Out of all the recorded concussions an athletic trainer assessed 94%, 59% were evaluated by a physician, and 5% were evaluated by an orthopedic physician. Most were assessed by more than one medical professional (87% assessed by athletic trainer and physician). Computed tomography (CT) was used in 21% of the concussed athletes, where only 3% received magnetic resonance imaging (MRI). Return to play decisions were commonly made by an athletic trainer (46%) or a physician (50%), but there was still almost 3% getting cleared by nonmedical professionals like coaches. Athletes whose symptoms took longer to resolve (over 7 days) were seen more often by a physician.

It is imperative the medical professionals know how to handle and manage sports-related concussions. Though, few studies have been done to evaluate who and what tests are evaluating concussive injuries. This epidemiologic report did find that most of the concussions were first evaluated by an athletic trainer; however, this study only included schools that had at least one full time athletic trainer on staff. Many schools in the U.S. still do not have a full time athletic trainer, and it would be advantageous to investigate these schools. Also, 60% of the athletes were evaluated by a physician that does not specialize in treating athletic injuries. Although, return to play time was not significantly different between athletic trainers or physicians, this suggests that both use similar evaluation tools. However, the actual tools that the medical professionals used were not reported. Finally, this study revealed that 1 and 5 concussed athletes receive a CT as part of the evaluation process, but these concussions do not usually involve structural damage that can be seen in a CT. MRIs are radiation free and are more sensitive in detecting concussions. This study demonstrates the need for general physicians to continue their education in concussion injuries due to the common occurrence of these injuries. Also, future research should consider specifying what type of concussion tests are being used for diagnosis and treatment. Specifically, what tests are being used at the site of the injury; what tests are being used in the athletic trainer room, and what tests are general physicians using? Current concussion literature states that a battery of tests [i.e., concussion sign and symptom survey, SCAT2, BESS, and a computerized exam (e.g., ImPACT, Headminer)] are sensitive enough to evaluate a concussion, however there have been no studies done on what is actually being practiced especially within a general physician’s office.

A great discussion was carried out in our recent running injury con ed course in Denver, CO. regarding an interesting article that was published in JOSPT in September 2011 on The Effect of a Hip-Strengthening Program on Mechanics During Running and During a Single-Leg Squat (Willy R. & Davis I.).In this study, the exercise group performed a 6 week hip abductor and external rotator strengthening program, the control group did not perform exercises. The first 2 weeks of strengthening were performed in a non-weightbearing position, and the next 4 weeks were weightbearing including one of the two exercises involving a squatting technique. “The conclusions of this study suggest that strengthening alone may be insufficient to alter abnormal movement patterns of the lower extremities during running. Despite large and significant gains in the strength of the hip abductors and hip external rotators, nochanges were seen in abnormal hip mechanics druing running.” However, favorable results were found in change of mechanics during a single limb squat. What can we take from this? That it doesn’t matter how much we strengthen the hip it’s not going to change faulty movement patterns in runners? NO! The importance of looking at this closely is that it proves a point that therapists who are ONLY performing standard hip strengthening and not taking the runners the next step into RUNNING SPECIFIC exercises that you are not helping a faulty movement pattern. It is important to start with some pure strengthening but it is imperative to move into retraining these muscles in the functional movement pattern of the running motion. These participants performed squatting exercises that facillitated and strengthend the hip abductors and external rotators at the same time and yes, it did carry over to improving that squatting movment pattern. What it failed to do was incorporate running specific exercises. A key point is found at the end of the article…”Hip strengthening alone may not be sufficient to change abnormal hip mechanics during running. Activity-specific neuromuscular training may be necessary to alter these aberrant motions.”

Video gait analysis is found to be very beneficial to runners and sports medicine professionals as it can slow down the running motion over 1000 frames per minute. The human eye is able to capture and process 30 frames per second often missing important dysfunctions in the gait cycle of runners. A common dysfunction seen in runners is contralateral hip drop causing excessive hip adduction and internal rotation at the femur. When this occurs there is a significant risk of overuse injuries. Several research articles have been published demonstrating runners with these characteristics are more likely to suffer Iliotibial band injuries, stress fractures, and patelofemoral pain. (Milner et al. 2005; Milner et al. 2010; Ferber et al. 2003; Ferber et al. 2010) Learn what to look for during a complete biomechanical assessment and video running gait analysis from head to toe in multiple views to identify potential injury risk or determine why your patient is injured in our upcoming  PT Con Ed seminar titled Lower Quarter Management of Overuse and Traumatic Injuries in the Running Athlete.

So far the Fall schedule is off to a great start with all of the NASMI PT Con Ed courses! This weekend we had two great groups in Atlanta, GA and Charlotte, NC.

Paul and Scott kicked off the weekend on Friday with newest addition to the PT seminar schedule with  “Lower Quarter Management of Overuse and Traumatic Injuries Related to the Running Athlete” in Atlanta. Although Scott had a run in with food poisoning it sounds like the guys did a great job and had an excellent group of participants with a genuine interest in the management of their injured running athletes. One course participant has already been in contact with Scott following up on course material and it’s always nice to hear feedback like this…

“I also wanted to thank you for the upbeat and outgoing personality that you and Paul portrayed.  I had a great time at the course and was interested to see what others are doing in different regions of the country.  It is nice to see that there are others out there doing the same things and use the same philosophies that we currently use at our clinic.  It is refreshing to hear and see this as sometimes you lose perspective and it is good to know that you are teaching and performing the right treatments.” -Running Course Participant

Good work guys! Rumor has it a guest appearance was made by NASMI’s Tab Blackburn and that there were some good photo ops!

We are looking forward to the next 2 PT con ed running courses this Fall in Denver (October 8-9) as well as San Diego (November 19-20). Keep up the great work.

Also on tap Saturday and Sunday was the PT con ed course  Selective Functional Movement Assessment in Charlotte with Mike and Robyn. As always, there was a great turn out of clinicians eager to learn the SFMA. From the sounds of it people really grasped the concepts and easily saw the clinical importance and application. Below are just a few comments from the course evals…

“This was a very interesting course. The presentations were very logical and made sense! I know I can use it tomorrow in the clinic.”

“This is such an amazing course!! The instructors were VERY helpful and as a bonus had a great sense of humor.”

“This was an excellent course! I really appreciated the exercise suggestions given for each discovered impairment. The instructors did a great job of making this a fun practical course.”

“This was a lot of information in 2 days-But very applicable, efficient approach to the diagnosis of movement dysfunction. I will apply these concepts immediately.”

Great job to Mike and Robyn! Next up for SFMA, Brandon and Mike in Dallas (October 7-8).

This weekend Tab Blackburn will be taking his talents to Fayetteville, AK for the always wonderful PT con ed course Upper and Lower Quarter Course. Be sure to check out all of our fall PT con ed courses available HERE.

It is with great pleasure and excitement to honor three NASMI faculty members who have received extremely high honors during the first half of 2011.

During CSM 2011 in New Orleans Barb Hoogenboom, PT, EdD, SCS, ATC received the Ron Peyton Award and Danny Smith, PT, DHSc, OCS, SCS was awarded the Turner A. Blackburn Hall of Fame/Lifetime Achievement Award.

This June during the APTA’s Annual Conference & Exposition, at National Harbor, Maryland, Michael L. Voight, PT, DHSc, SCS, OCS, ATC achievements were recognized with the Catherine Worthingham Fellow Award.

We are so proud of Barb, Danny, and Mike’s commitment to excellence and can’t wait to see what else this amazing group can accomplish!

This blog has been a long time coming and we are so excited to finally be up and running! There have been a lot of wonderful things happening in our world so far in 2011 and so much to look forward to for the fall.

From the addition of a new course (Lower Quarter Management of Overuse & Traumatic Injuries Related to the Running Athlete), and starting our own online store, to members of our faculty being awarded VERY prestigious awards, we have so much to be excited about.

In a world of tweets, trending, posts, and check-ins, the NASMI gang has decided to join the “in” crowd with our Facebook and Twitter accounts. Be sure to “Like” us and “Follow” us to keep up with the latest updates in regards to courses, news in the rehab world, and our antics on the road of course!

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Our goal with this blog is to keep everyone up to date on the latest and greatest in the world of physical therapy. Not only will we keep you posted on all of the great things happening within our company, but we will be providing our friends and colleagues with a journal club for article reviews, exercise videos, and links to some other great PT blogs we have found along the way.

Whether you have been to one of our course before or you have just happened to stumble upon this site, you will not be disappointed with what we have to offer.

Check out our great FALL SCHEDULE here, and sign up now!! Hope to see you all soon!