Skip Navigation
request an appointment my chart notification lp musc-logo-white-01 facebook twitter youtube blog find a provider circle arrow
MUSC mobile menu

MUSC Health Blog

Keyword: football

Guest Post by:
Brittany Darling, MS, ATC
Athletic Trainer
MUSC Health Sports Medicine

This past week, high schools across the state stepped onto the football field looking to begin their season strong. Jumping into a new season can be a difficult transition for many high school aged athletes, especially at this time of the year. With the summer season come longer, hotter days of staying up late and eating unhealthy foods. This pre-season time period can make or break an athlete fighting for a starting position, and there are some simple tips to help you feel better prepared for the rough days ahead.


One of the biggest issues I see with the high school athletes is that all summer they have been staying up unreasonably late, and once football practice begins they fail to change and adjust their sleeping patterns. It is ideal to get eight to nine hours of sleep every night, and in order to accomplish this social outings may need to be put on hold for the time being. Both the body and brain require this rest to function properly, and if it is receiving significantly less then it can result in difficulty concentrating, poor decision-making, and even injury. A coach will know the difference between a well-rested and focused player versus a tired and inattentive one. Additionally, when given that rare day off- make sure you take it. A light stretch and relaxation is better to utilize than a heavy lift or hard run on your only off day of the week.


Hydration does not just take place during practice, but before and after it as well. Drinking water to hydrate all day long is more beneficial than chugging an entire water bottle in the middle of practice. It is actually dangerous to consume an excess of water at one time, and can lead to a condition called hyponatremia, which is a medical emergency. It is best to carry a water bottle around with you throughout the day because it will remind you to drink it. When having a meal, chose water over sweet tea or sodas, which can actually dehydrate you further. Try and limit Gatorade intake to one to two a day during activity because it also contains excess sugar, which is not needed all day long. For coaches, I like to recommend built-in water breaks at practice every 10 to15 minutes, but a player should always have water available to them if it is needed sooner. As the heat index climbs during these late August weeks, water breaks should be even more frequent and excess equipment removed when necessary per NATA standards.


Food is the fuel for your body, and what you provide your body with for fuel will have a direct effect on how your body feels. Greasy, heavy food will make your body feel just that- heavy and difficult to move. Try to avoid fast food during pre-season, and make a strong attempt to get in a solid 3 meals per day with snacks in-between. Some good snack options before or during practice include pretzels, fruits and vegetables, or simple sandwiches without condiments on it. A post-practice meal should contain proteins and replenish you after a hard practice. Skipping meals or not eating enough can result in low energy at practice, and in the heat of summer possibly even lead to syncope or fainting.

Equipment Check

It is extremely important to make sure all of your equipment fits the way it is supposed to. Helmets should not be too big or too small or they can cause serious injury. Although many like smaller shoulder pads for better mobility, these must come down to cover the entire shoulder and kneepads also must be worn. Additional equipment such as a back plate or a horse collar is personal preference, but can be very useful in preventing injury. Mouth guards are another must have that at least one player always seems to be missing. If you are unsure about whether your equipment is fitting correctly, your coach and athletic trainer should be able to help you.

Guest Post by:
Brittany Darling, MS, ATC
Athletic Trainer
MUSC Sports Medicine

The first week of September - high school football is in full swing, college football has just begun, and the NFL is taking off this weekend. Over the past few years the sport of football has become practically synonymous with the dreaded word “concussion.” The media is in a frenzy about whether it is even safe to play this classic, beloved sport. As an athletic trainer, I hear the term “he just got his bell rung” from coaches, parents, and other players more often than I would like. I hear the arguments exclaiming that, back in the day, all you had to do was be able to declare that you see the two fingers being held up in front of your face, and you’re good to go! With advances in medicine and technology, the medical field is bringing light to the nature and side effects of concussions, and it is not a pretty story. The good news is, there are many steps that can be taken to prevent the occurrence of a concussion.

The most important form of prevention is education. Without knowing how a concussion can occur or what a concussion feels like, it is difficult to know if you, indeed, have a concussion or not. The difficult part is that a concussion is not like a broken bone; you cannot get an x-ray and say definitively yes or no, you have a concussion, like you can with a fracture. Concussion diagnosis is primarily subjective, based upon reports from the patient about how they are feeling or what might have happened. Symptoms include a headache, nausea, dizziness, double vision, sensitivity to light or noise, and feeling off balance. More severe symptoms may include vomiting, memory loss, or loss of consciousness (blacking out). Sometimes this can be difficult for a younger individual to differentiate, but I have found that to err on the side of caution will always produce the best possible outcome. As a coach, parent, or player, if a significant hit to the head is witnessed, either from head to head, head to ground, or even whiplash, then that athlete should be removed from play and evaluated by the athletic trainer or team physician.Football block

Teaching the correct tackling techniques can be extremely helpful in preventing concussions. Many football players, especially those more inexperienced, will put their head down and lead into a tackle with just their head. Some will even purposefully do this, known as a “helmet to helmet” hit. This is incorrect and very dangerous! The head should be up, and the tackle should be made by wrapping arms around the other player. Referees have recently become more aware and have been helping to eradicate this type of tackling. Learning to land when being tackled is also a useful technique to practice, and can prevent many other injuries as well. Always be sure that all equipment, especially the helmet, is fitting appropriately and doing its job to protect you.

Many institutions are now utilizing baseline testing, which performs a cognitive evaluation of the athlete and can be used post-concussion to compare results and ensure that the individual is ready to return to play. This is not used on its own, but in combination with a variety of other diagnostic tools such as the SCAT3, symptom check, and balance error scoring system (BESS). If diagnosed with a concussion, it is important to seek appropriate medical help from a physician, specifically a concussion specialist who has experiencing managing these types of injuries. It is absolutely possible to return to playing football after suffering a concussion, however it is important to follow the return to play protocol provided by your school’s athletic trainer and to be certain of full recovery. With efforts to educate parents, players, and coaches, simple modifications can be applied to make the sport of football safer while still enjoyable.

Guest Post by:

Michael J. Barr, PT, DPT, MSR
Sports Medicine Program Manager
MUSC Health Sports Medicine

As the NFL regular season is coming to an end, some teams are now preparing for the “what-if” scenarios to making the playoffs, while others have clinched and are waiting to see who their first or second round opponents are going to be.  No matter their standings or “power-rankings” all teams are examining their positional depth charts to try and figure out how to adapt for current injuries and players lost, due to injury, throughout the season.

As an avid NFL fan, this year seems like there were significantly more season ending injuries compared to previous seasons; or it may just feel like that this year as my beloved Baltimore Ravens have been decimated by season ending injuries to both their offensive and defensive teams.  Concussion are always in the news and can potentially have significant short and long term medical issues related to them, but do they account for the greatest number of missed weeks?  So as I looked more into injuries in the NFL, I found some very interesting statistics; according the majority of weeks missed due to injury are for injuries to the knee, both ACL and non-ACL related.  During the previous 15 seasons (2000-2014), knee injuries accounted for over 20,000 regular-seasons missed weeks.

Season ending ACL injuries are one of the leading causes of these missed weeks of some of our favorite stars and of players the majority of us have never heard of.  In 2014 there were 34 reported ACL injuries in the NFL.  The 2013 season set the record for the greats number of ACL injuries in NFL history with 61, however 2015 is not too far behind.  Through week 15 of the 2015 season there were a total for 45 reported ACL tears, interestingly enough 27 of those injuries occurred during pre-season.

New rules, and accompanying fines, focusing on reducing the potential risk for head injuries and head to head contact are causing players to tackle lower on their opponent’s body, however according to Dr. Timothy Hewett, director of biomechanics and sports medicine research at the Mayo Clinic, approximately 70% of all ACL injuries in the NFL are non-contact injuries.

Contact injuries are going to occur in all dynamic contact sports; however it is the non-contact injuries that we need to focus on.  According to Hewett, non-contact ACL injuries in the NFL can be reduced between 50 and 70% through biomechanical analysis, specific training methods, and an open mind to new ideas based off of proven medical research.  In article by Mike Tamier, NFL national lead writer, Hewett describes his “Milk Carton Test” to analyze knee mechanics and identify those players at higher risk for potential knee injuries, but once these potential risks are identified, what is done about it?

In 2006 the International Federation of Football Associations (FIFA), implemented the FIFA 11+ injury prevention program, suggesting that all amateur and professional soccer players around the world participate in this specific warm-up program focusing on neuromuscular control, strengthening and stability exercises at least 2-3 days per week.  Since publication in 2006, there is an estimated 35% reduction in all lower extremity injuries for players consistently participating in the FIFA 11+ program at least 1.5 times/week.

I have said it thousands of times, professional athletes, especially NFL players, are physically freaks of nature; they can run faster, jump higher and are stronger than the general population.  NFL athletes in particular, have such variable demands on their bodies by position that a “one-size-fits-all” program like the FIFA 11+ may not be as beneficial; however a base program tailored to the individual needs of each position and each player could show a significant reduction in these non-contact injuries.

As a local sports medicine provider, over 50% over my patients are either pre-op or post-op ACL reconstruction patients.  As these athletes are finishing their rehab and have met their specific return to sport goals, I educate them on an individualized maintenance program to help prevent recurrent and new injuries.   However, athletes come to me after they have already sustained an injury, if the NFL would develop a base program that could be tailored to specific athletes and specific positions by athletic trainers and coaching staffs; ACL injury prevention could be funneled down throughout all amateur football players similar to what FIFA did for professional and amateur soccer players.

As I previously stated, contact injuries are going to happen, but we need to focus on the prevention of those non-contact injuries that are occurring at all levels of play.


1.      Binney, Zachary: “NFL Injuries Part 1: Overall View.” Published 9/25/2015 on

2.      Tamier, Mike: “Preseason ACL Injuries Can be Drastically Reduced.  Here’s How.”  Published on 8/27/2015 on

3.      Olson D, Siukka R, Labountry A, Christensen T.  Injuries in Professional Football: Current Concepts. Current Sports Medicine Reports by the American College of Sports Medicine.  2013; 12: 381-390.

4.      Barengo N, Meneses-Schavez J, et al. The Impact of the FIFA 11+ Training Program on Injury Prevention in Football Players: A Systematic Review.  Int. J. Environ. Res. Public Health.  2014; 11: 11986-12000.

Guest Post by:
Lindsey Clarke, MS, ATC, CMT
Athletic Trainer;  Massage Therapist Charleston Battery
MUSC Sports Medicine


You’ve been to camp. Family vacation was great.  The summer has flown by, and the beginning of the school year is looming.  While it’s the time to relax and have fun, summer is also the perfect time for athletes to start getting their bodies ready for their upcoming fall sports. By maintaining and following good nutrition and hydration practices in the off-season, leading up to and throughout pre-season, you’ll be able to work out, train and compete at your best.

While off-season is the time to address any changes you’d like to make as far as body weight or composition, your main focus during pre-season should include making sure you are consuming adequate calories, staying properly hydrated to match sweat loss, as well as recovery nutrition.  While it may seem at times all you’re doing is going to practice, eating constantly, and running to the bathroom, adolescents/younger athletes need to account for the fact they are not only playing a sport, but growing and developing as well…both of which require a large amount of energy. According to the National Academy of Sciences’ Food and Nutrition Board of the Institute of Medicine, Estimated Energy Requirements (EER) for very active 14-18 year old athletes range between 3283 calories to 3804 calories per day.  Leaner athletes, or those who tend to burn more calories or those who need to gain weight, may require an additional 500-1000 calories.  Consuming that many calories can be a challenge for athletes, but being mindful of your hydration practice, as well as consumption of healthy foods and adequate calories will ensure your success in meeting these demands.

A common mistake made by athletes is over-consuming protein. Protein is most definitely important for building muscle and repair, but excess intake can be detrimental to your diet. Hyper-focusing on protein consumption can negatively affect the balance of carbohydrates, protein, and dietary fat. Athletes’ energy (glucose) stores can be greatly affected when protein displaces needed carbohydrates.  Excessive protein can also lead you to consume fewer fruits, vegetables, and whole grains that have necessary nutrients for performance.  These nutrients aid in processing the energy needed for physical activity.  Gaining your energy and nutrient requirements from whole foods is best, as it is more bio-available.  Unless you are dealing with an allergy, intolerance or deficiency, more often than not you should be able to gain all your nutrition through a well balanced diet including lean/vegetable protein, carbohydrates, and healthy fats with limited, if any, supplements.

Hydration plays a very large role in your performance.  Pre-season typically demands multiple practices a day, often outside in the elements(heat, humidity, etc.).  Even the smallest amount of dehydration can negatively affect performance.  Athletes should consume at least 64-80 ounces of fluid a day-more so if you sweat heavily, wear padding (as in football), or it is hot/humid. Maintaining a balanced state of hydration throughout the day is important, as it prevents entering a practice or training session in a dehydrated state.  It is near impossible to properly rehydrate during activity.  About two hours before exercise, start consuming about 20 ounces of fluid. About 30 minutes before, drink another 8 ounces and then drink 4-8 ounces every 15-20 minutes during activity. Any water weight lost during exercise should be recovered by 20-24 ounces of fluid for each pound of water weight lost. The goal with proper hydration, however, is to lose minimal water weight during exercise.  This helps ensure an adequate level of hydration for future practices or training sessions.

Adequate fuel before, during, and after training during pre-season, is paramount in maintaining the weight and muscle gains achieved in the off-season.  Without proper hydration and nutrition, recovery from hard pre-season training will be insufficient causing the body to be weak heading into the regular season.  This can then lead to decreased performance and injury. Preparation starts before you even step foot on the court or field.  Commit to become more involved in your dietary practices.  Getting enough calories with the right balance of nutrients is key for the maintenance of a healthy, and well-primed body during your season.

Guest Post by:

Stephanie Davey, ATC
Certified Athletic Trainer
MUSC Sports Medicine

It’s that time of year again……High School Football season!  July 31st marks the first day of high school football pre season training in South Carolina.  Hopefully, our student athletes have had a fun and safe summer, but now that the summer is over we find out how prepared they are for the upcoming season.Football players on field

All high school football programs have a different policy for summer training.  Some make it mandatory to participate in a strength and conditioning program run by the coaches.  Some trust their student athletes to train on their own.  When the football players report to the first day of practice, some will be in the best shape of their lives, some will not.  It’s likely to be very hot and very humid.  In order to protect the athletes, coaching and sports medicine staffs have to account for the varying levels of fitness and prepare for the worst.  One way to do that is by setting a practice schedule that allows all players to acclimatize to the heat.

Allowing athletes to acclimatize to the heat, prepares their bodies to physical exertion in high heat and humidity.  This helps protect them from the varying stages of  heat illness.  Acclimatizing is a gradual increase of time and exertion in the heat.  Practices start with the football players wearing helmets, shirts, and shorts only.  Gradually, they add equipment until they are in full pads.  They also increase the time spent in the heat gradually.

Currently, there are only a handful of states that have mandates requiring heat acclimatization.    Some states do have guidelines and some states high school governing bodies have rules.  In South Carolina, teams follow a 14 practice schedule.  On practice day 1, they are limited to 3 hours in helmets, shirts, and shorts.  They gradually increase to full gear on day 14.

While we all want our student athletes to be able to relax and have fun over the summer, reporting to fall practice out of shape can be dangerous.  Not only does proper fitness increase their performance, but it also decreases an athlete’s chances of suffering a heat illness episode.  So encourage all your student athletes to have fun and stay in shape over the summer!


Share Your Story

Subscribe to the Blog