Tales From the Coaching Front Lines

I know I promised an article on ankle sprains and it is on the way, but I wanted to share some first-hand experiences relating to sports medicine that I have encountered in the last month or so while coaching my U18G team in Midwest Regional League (MRL). One experience is especially interesting after writing about concussions early this year that you can read here.  Please note the information provided in this piece is NOT meant to diagnose or treat specific individuals. If you have a sports medicine injury or illness you need to consult with an appropriate medical professional.

KNOW YOU MEDICATIONS:
A player of mine came back from Spring Break in Mexico with stomach issues (aka Montezuma’s revenge) just before we were set to leave for a weekend of games for MRL in Ohio. She had gone in to see a doctor (wasn’t her primary because he was booked on short notice) and he prescribed Ciproflaxin (Cipro) which is a very powerful antibiotic – so powerful it is used in the treatment of anthrax. It is also a medication that has a black box warning on it for tendon ruptures, especially Achilles tendon ruptures. Thankfully her dad does his homework on the medications prescribed for his kids and voiced concern. I don’t know if the doctor didn’t understand she was a highly competitive athlete or wasn’t concerned with the tendon issues. The medication was changed and the player was good to go for the weekend. Good call, dad.

KNOW YOUR HEAD INJURIES:
On the following MRL weekend in Indianapolis I ran into another situation with a head injury. If a player gets struck squarely in the head by a swinging elbow and has vision issues, headaches, and dizziness – it is probably a concussion; even if the ER doctor says you don’t have a concussion because you never “blacked out” (Why this is prehistoric thinking). It is estimated that 75% of concussions involve no loss of consciousness.

In my opinion, it is always a good idea to err on the side of caution the first 24 hours and not give pain meds to a probable-concussed player so you can accurately monitor symptoms and act quickly if they are getting worse; even if the ER doctor prescribes Vicodin. (Really?) Masking head symptoms by a drug is not a good idea and masking it by a narcotic which has side effects that mimic concussion symptoms is probably a worse idea. I recommend Tylenol after 24 hours, not ibuprofen or other NSAIDs. I had her roommates monitor her the night of the injury and I allowed her Tylenol the next day after I felt confident symptoms were not getting worse.

Despite how much a player with a probable concussion and lingering symptoms pleads for you to play, don’t let them play until they are cleared by a sports medicine professional trained to manage concussions. Yep, even if it is a day later in a match against the team you are battling for 1st place and a wildcard spot to USYS Regionals is on the line…and the game is tied…and you are short on players due to other injuries…and she is begging you to play.  When in doubt, sit them out.

Side Note:  The opponent’s GK in this particular game got crushed in the head by the ball and two of her defenders in a 6yd box scramble. From the sideline she appeared clearly in a fog, had problems standing straight, but got subbed right back in after her bloody nose was cleared up. In my opinion, it isn’t worth the risk of Second Impact Syndrome (estimated 30% incidence rate but 50% mortality rate, Sanford Sports Medicine Conference 2011) to let a kid “tough it out” in a close game.  They didn’t have another GK either which I assume played into the decision to go back in goal.

If your players take baseline ImPACT tests with their high school teams (or any team) but are not really paying attention while they are taking it (whole team in one room, distractions, not taking it seriously, etc) the score is meaningless, often gets thrown out, and now you have no standard to compare their cognitive functioning pre- and post-concussion. This is only one tool for assessment and shouldn’t be used as a stand-alone measure for return to play, but it is routinely used from youth sport to professional sport as a valuable assessment tool in the concussion assessment toolbox. Make sure you provide the right environment to take the ImPACT test so it is meaningful or you are wasting everyone’s time.

For the sake of privacy, details of the medical handing of this case will be left absent. However, I highly recommend Dr. Daniel Peterson at Edina Family Health (and team physician for the NHL’s MN Wild) for those in the Twin Cities area looking for a sports medicine physician who is excellent at managing concussion cases with athletes. I have no professional ties to Dr. Peterson but he has been sharp as a tack in handling a couple of my players for non-orthopedic sports medicine concerns. The player in question is now on a graded return to play protocol and should be back to the field safely in the near future. She has been out for 16 days as of today and we are in the middle of State Cup. She will play when her brain shows it is ready and not before.

POSITIVE THOUGHTS GO TO LINDSAY TARPLEY:
USWNT midfielder Lindsay Tarpley tore her ACL in her right leg on Saturday with 15 minutes left in the game vs Japan. This is just days after being named to the 2011 US Women’s World Cup Squad. She had torn that same ACL in 2009 while playing for the Chicago Red Stars (WPS) and worked feverishly to get back into form to make the 2011 World Cup squad. Best wishes to Lindsay on a successful recovery from a heart-breaking injury that happens far too often.

ACL PREVENTION PROGRAM IN THE TWIN CITIES:
For those in the Twin Cities area, I will be teaming up with Velocity Sports in Champlin again for the 2nd ACL Program of 2011 geared towards the highly competitive athlete looking to be assessed for ACL risk, and 7 weeks of training to address high risk movement patterns, muscle imbalances, inefficiencies and overall lower extremity injury prevention (and performance enhancement as a result.) For more information please go here. The program starts on July 5 and I will be personally leading this program. Space is limited. I like to think of it as a 7-week education-by-doing for high aspiring athletes.

About the Author: Julie Eibensteiner PT, DPT, CSCS is a physical therapist and owner of Laurus Athletic Rehab and Performance LLC, an independently owned practice specializing in ACL rehab and prevention in competitive athletes. In addition to being a regular contributor to IMS on topics of sport injury and prevention, Eibensteiner holds a USSF A License, coaches a U18G MRL team for Eden Prairie Soccer Club, and assists with the Men’s and Women’s soccer programs at Macalester College.

To view other sports injury and rehab articles by Julie Eibensteiner click here.