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MUSC Health Blog

Date: Dec 2017

Athletic trainers are essential in triaging various types of athletic injuries on and off the field prior to allowing an athlete to return to play. It may be necessary to refer to a physician for clearance, particularly in head injuries in order to safely return the athlete to physical activities. Concussions are constantly in the media these days, with a great deal of discussion regarding health risks, both short and long term, in various sports; so it is very important to make the correct call when allowing an athlete to return to play. As a certified athletic trainer, I would like to share an interesting case about an athlete’s experience with a concussion. Hopefully, by sharing these types of experiences, it will help health care providers determine when it is appropriate for an athlete to return to play after a head injury.

In this case, a high school football player was hitting a pad in practice then fell down, hitting his head face first on the ground. He somehow bounced off the pad and then hit the back of his head on the ground. The player immediately experienced dizziness and headaches. However, he had no loss of consciousness, so I directed him sit out of practice and then evaluated him. I used the SCAT5 concussion assessment exam, which is tool that is used at all levels in order to evaluate a concussion. The score on test was slightly elevated due to his symptoms, which helped me promptly diagnose a concussion, so I instructed him to see his doctor for a formal evaluation. His mother took him to his primary care pediatrician and the doctor performed a basic exam where he only checked his eyes and asked about his current symptoms. The doctor subsequently wrote a note to clear him return to play. When I received the note, I was concerned because his symptoms had not completely resolved. I put him through intense running exercises and his symptoms immediately returned. Because I was concerned about the athlete’s persistent symptoms, I sent him to one of our sports medicine physicians, Dr. DeCastro, who commonly treats many of our concussions with MUSC Health Sports Medicine.

It is essential that physicians and athletic trainers to work to together when dealing with head injuries, so an athlete does not fall through the cracks. This head injury could have been more serious or even fatal if it had not been caught and the athlete held out of sporting activities. Currently this athlete continues to recover, but it has been nearly three months since the injury and this athlete continues to experience post-concussion symptoms. I would like Dr. DeCastro to share his experience from a physician’s point of view.   

Dr. Alec DeCastro, Chief of Primary Care Sports Medicine, MUSC Health:

Concussions have garnered a lot of media attention over the past few years, and are prevalent in football but even in non-collision sports. The Center for Disease Control (CDC) recently estimated that 1.7 million people in the U.S. suffer some form of traumatic brain injury every year, which is twice the number of heart attacks that strike Americans each year. About 75 percent of those brain injuries are considered concussions or other forms of mild injury. And 80 to 90 percent of people will recover from a concussion within a seven to 10-day period, according to the National Institutes of Health (NIH).

The hype regarding concussions has caused a lot of trepidation in sports, particularly after the recent movie starring Will Smith. Actually, the condition discovered in the movie by Dr. Bennett Omalu is called chronic traumatic encephalopathy (CTE). Education regarding concussions is the key, and recognizing early signs and symptoms may make all the difference for athletes, parents, and coaches. The CDC has created an initiative called Heads-up Concussion, which has resources and tools to help recognize, respond to, and minimize the risks of concussion.  

It is important that the physician and athletic trainer to work together and apply an individualized approach to the diagnosis and care management of athletes with these types of head injuries. One of the most valuable factors in managing concussions is the athletic trainer’s comprehensive knowledge of the individual athlete. It may be imperative that whoever works most regularly with the athlete reviews his or her treatment. The athlete’s history, behavior, and risk factors need to be included as well in order to figure out the best patient-centered care plan for speediest recovery of the athlete’s concussion.

Treat the Athlete, Not the Body Part

I recently attended a medical conference in New York, focusing on current sports medicine concepts in baseball.  The presenters were sports medicine providers including members of the sports medicine teams from both the New York Yankees and Chicago White Sox. The conference was outstanding, discussing some of the most current research and treatment techniques for injuries afflicting baseball players from the Major Leagues to collegiate and youth athletes.  There were over 20 different presenters from orthopaedic surgeons, physical therapists and athletic trainers; one of the biggest take home messages I learned was that there is little absolute consensus on treatments for different injuries.  There are a variety of different diagnostic and surgical approaches to a variety of shoulder and elbow injuries.  However, there was one consensus that ran through each section; the importance of core strengthening and stability as part of the athlete’s daily work-outs and rehabilitation process.

The idea of treating the entire athlete is not new; it is something that is discussed at almost every sport medicine conference and a topic that I have presented on a number of times in the past.  Unfortunately, players, coaches, and parents do not always have access to this information.  So there can be a lot of misconceptions out there amongst the non-medical population with regards to baseball players:

  • My shoulder hurts so I need to just rehab my rotator cuff
  • I want to throw harder so I need to hit the gym and get stronger
  • I lose my control the deeper into the game I throw, so I need to throw more in practice

For ideal results in performance, injury prevention and rehabilitation, the athlete’s entire body has to work in symmetry.  It is not about just one body part or one muscle group; it is about the entire body working in harmony to achieve a common goal.  So for the athletes that I work with, their programs focus on a variety of body parts from the rotator cuff to the peri-scapular musculature (latissimus dorsi, trapezius muscles, rhomboids, serratus anterior) to core and pelvic musculature, to the lower body.  The goal is to build strength, stability, and muscular endurance throughout the entire body to support the demands of their sport. 

You may now be thinking, how am I going to do this, my workout will take hours?  There is definitely a time and place for isolation, but the majority of the time, you can combine exercises to achieve the desired results.  There are still thousands of different exercises that you can do, but here are my top 6 exercises that I give to the majority of my throwing athletes to incorporate into their workouts:

  1. “Y’s” –  bilateral shoulder scaption prone on a stability ball
  2. “T’s” – bilateral shoulder horizontal abduction prone on a stability ball
  3. Bilateral scapular retraction to external rotation prone on a stability ball
  4. “I’s” – bilateral shoulder extension prone on stability ball
  5. Push-ups on stability ball or BOSU ball with holds
  6. Shoulder external rotation while in a side plank position

* Exercises should include high repetitions with little to no weight (zero to two pounds at most) focusing on slow controlled movements, body mechanics, and alignment. 

One of the athletic trainers at the conference said that “throwing programs should always be written in pencil, since they are constantly changing to meet the needs of the individual athlete.” I could not agree more, but I also take this philosophy to include all strengthening, rehabilitation, and maintenance programs. Every athlete is different and their program should be tailored to meet their specific needs, focusing on the entire athlete.


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