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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.
 

Dr. Candi Jump and family
Dr. Candi Jump and family 
Photo provided by Emily McGinnis Photography

“I grew up on the Jersey Shore, but probably not the Jersey Shore you are thinking of,” laughs Candi Jump, pediatric gastroenterologist at MUSC Children’s Health. While slightly joking about her New Jersey connections with her persona of calm and casual, anyone who has a child with GI issues knows that she is a very serious and accomplished physician when caring for these children.

Having been at MUSC and in Charleston now for three years, Dr. Jump could not imagine a more perfect setting for her and her family. She always knew she wanted to teach on some level and proudly states, “I come from a family of teachers – my mom, sister, and aunt are all in education, and I knew that my career choice would involve teaching. My role at MUSC Children’s Health has allowed me to do just that.”

“Working at MUSC in pediatric healthcare has given me the opportunity to give back to the next generation of physicians. I can be a mentor, as well as closely involved in academic medicine at the same time. I also love caring for kids and always knew pediatrics would be my path in medical school. Now, as the program director of Pediatric Gastroenterology, Hepatology, and Nutrition Fellowship Program, I have the opportunity ability to fulfill all of my passions.”

When she is not running around after her kids on the beach or treating patients at MUSC, Candi is not afraid to explore all of the adventures Charleston has to offer. One week, it may be Charleston Power Yoga, the next it’s surfing, or maybe checking out the newest “place to be” on James Island with friends. One thing is certain — Candi Jump knows how to soak up the sun and enjoy an active lifestyle in the Lowcountry. When asked how she envisions a perfect Saturday in Charleston she smiles and says, “That’s easy; morning yoga, brunch with the family, and a day on the beach – it doesn’t get much better than that.”

While fun in the sun is important, Candi is very serious about her role as a physician. She completed her residency and chief residency at the University of Connecticut in Hartford. She then went on to complete her training as a fellow in pediatric GI at the world famous, Children’s Hospital of Philadelphia. After training, she opted for a closer-knit academic center in a desirable location. MUSC Children’s Health in Charleston fit the bill, and the rest is history.

Candi and her husband, an avid surfer and surf artist on James Island, love the coastal life of the Lowcountry. The family can often be found hanging beach side at Folly with their two kids, Cooper and Ruby, and their rescue lab, Moose. With two toddlers and a dog in tow, Candi is never sitting still for too long. Her office is filled with images of small kids and the beach, illustrating her life as a mother and wife. As a physician, her life is equally fulfilling as evidenced when she speaks of the children she treats and the other physicians with whom she is privileged to work. 

“What I value most about what I do at MUSC Children’s Health is the impact that our pediatric GI group has in this community. There is such a large need for pediatric GI providers in the state, and I enjoy working with such an accomplished group of physicians who are passionate about what they do.”

Candi Jump is among that group of passionate doctors and we are very glad the beaches of Charleston charmed this incredible physician away from the Jersey Shore.  

by guest blogger Carolina Kosh, PharmD

Caroline Kosh, PharmD

Caroline Kosh, PharmD

Did you know tobacco is the number one preventable cause of death in the United States? Cigarette smoking substantially increases risk of heart attack, stroke, COPD, other respiratory illnesses (asthma, emphysema, chronic bronchitis), and lung cancer. 

Quitting smoking is one of the best things you can do for your health and will help almost every part of your body, including lowering blood pressure, improving cholesterol, improving circulation, and improving your immune system, just to name a few. Many of my patients also loathe the stigma attached to smokers and wish their teeth and breath looked and smelled better.

The good news is that it’s never too late to quit and make a difference for your health. In just 24 hours after your last cigarette, your blood pressure returns to normal. In just two weeks to three months your heart attack risk has started to drop and your lung function begins to improve (goodbye smoker’s cough!). One year after quitting your risk of coronary heart disease is half that of a smoker’s. And the list goes on!

That is why we highly encourage our patients to quit smoking. MUSC Health offers a pharmacist-led smoking cessation program which includes counseling, medications, and support through constant follow-up. Studies have shown that patients are TWICE as likely to quit by having a combination of medications and counseling. We like those odds. That’s why our program includes one-on-one sessions with our pharmacists who will talk with you about your smoking and medical history, discuss past quit attempts, help select the right therapy for you, plan for and set a quit date, and offer support and follow-up during your transition to becoming smokefree. 

We have the capability to measure carbon monoxide levels here in the office, which for many people, is eye-opening and provides motivation to make a permanent change. Many people have been successful through this program. We have a pharmacist available in several different locations who would love to talk with you. If you are ready to change your life for the better, please talk with your MUSC Health primary care provider to be enrolled in our program today. 

With the start of October comes the start of wrestling conditioning before the official season starts. The conditioning helps to get the wrestler ready for the season as well and is a time for an athlete to start cutting weight safely, if needed, to determine a healthy weight class for competition. High school wrestling programs should have a weight management program that includes urine testing with a specific gravity test that does not exceed 1.025, a body fat assessment no lower than 7 percent for males or 12 percent for females, and a monitored weekly weight loss program that does not allow for more than 1.5 percent per week of the alpha weight. Before competing, all wrestlers must go through a weight assessment to determine an alpha weight to include hydration and skin fold testing. The alpha weight will be used to help determine possible weight class as well as used for any weight loss during the season.

The alpha weight, hydration assessment, and skin fold testing are to be tested all at the same time and required to be completed no later than two weeks prior to the district certification deadline, this includes any appeals. This is all prior to the start of any competition with another school for any of the athletes.

A trained assessor will perform the testing protocols on each wrestler and will record results on the proper weight certification forms. There are three parts that are tested:

  1. Hydration Assessment: This is a pass/fail urine test based on the specific gravity levels of less than or equal to 1.025. If greater than 1.025, the test is a failure and can be re-assessed after a 24-hour wait period. Specific gravity determines how hydrated the athlete is at the time of test. This urine test can be judged using a color chart, but to get a better or more accurate reading, the use of a dipstick or specific gravity refractometer or other hydration testing methods is acceptable. If the hydration assessment is passed, the athlete will then weigh in to determine the alpha weight right then with no exercise or delays between the tests. 
  2. Alpha Weight Determination: The wrestler weighs in on a certified scale and that weight is the athlete’s alpha weight for the year. The alpha weight is the weight used to calculate a descent calendar using the 1.5 percent loss per week rule. After the weigh in is performed the athlete will move on to the skin fold testing.
  3. Skin Fold Measurements: Using the proper testing calipers, the skin fold measurements are performed on the bare skin. Each site is tested three times and each measurement recorded accurately. This is to allow an average overall percentage to be determined. Skin fold sites that are tested are the abdominal, tricep, and subscapular areas for males and tricep and subscapular areas for females. All testing is performed on the right side of the body.

Once all testing has finished and all the data collected, it’s then recorded properly in a computer system that will determine a minimum weight class at which the athlete can compete. The weight class is determined by a predicted body weight at 7 percent for males and 12 percent for females including a 2 percent variance made by the system. If the predicted weight including variance is a specific weight class, then that is the athlete’s minimum weight class. But if the athlete's weight is in between weight classes, the higher weight class is determined as the minimum weight class. If the athlete already has a body fat percentage below the allowed 7 percent or 12 percent, then their alpha weight including 2 percent variance is used to determine minimum weight class.

Although there is not much to be done for the testing and protocols, these are very important steps that must be done for the safety of the athlete. Making sure all testing protocols are done properly and accurately is key and can play a big part in the athlete’s season.

 

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