SPORTS MEDICINE

HANDBOOK

© 2013 Kentucky Orthopedic Rehab Team. All rights reserved.

Introduction 1Calling 911 2Myth Buster 3-4Cold vs. Heat 5-6Lightning Safety 7Proper Hydration 8-9Heat-Related Illness & Dehydration 10Heat Safety 11-12Prevention Of Heat Illness 13Dental Injuries 14Eye Injuries 15Nasal Injuries 16Sprains vs Strains 17Dislocations and Fractures 18 Common Arm Injuries 19Common Leg Injuries 20Functional Movement Screen (FMS) 21Concussions 22-24Return to Play 25-26 ImPACT Testing 27Comprehensive Concussion Program 28Concussion Flowchart 29Concussion Infographic 30Locations 31Notes 32

KORT has always been involved with local communities by providing educational information on a wide range of topics. We continue this tradition by providing you with this Sports Medicine Handbook. The handbook is designed to provide you with information on variety of injuries that can occur while participating in a physical activity. While this handbook will provide you with some important information it is not to be used as a medical guide or to stop someone from seeing a physician.

WehopeyouwillfindthisSportsMedicineHandbookuseful.

TABLE OF CONTENTS

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CALLING 911The most important thing you can do whenever someone goes unconscious or has a life-threatening emergency is to call 9-1-1. When you call 9-1-1 you are bringing trained medical professionals to help the individual. Some communities may not have a 9-1-1 system, so it is important to know what number to call in an emergency situation in your community.

By calling your local emergency number you are putting the victimin touch with medical professionals who can provide care.

WHEN SHOULD YOU CALL 911?

• When victim is unconscious• When victim is having trouble breathing or is not breathing• When victim is having a seizure• When victim has suffered a serious back or neck injury• When victim has suffered a serious fracture• When the situation is unsafe and you cannot approach the victim• When the victim is suffering from serious heat illness• Anytime you feel you are not equipped to handle the situation

**THIS IS NOT A COMPREHENSIVE LIST AND 911 SHOULD BE CONTACTED FOR MANY REASONS NOT ON THIS LIST**

WHEN CALLING 911 WHAT SHOULD YOU SAY AND DO?• Stay Calm• Make sure you give the operator the most accurate information you can.

Including but not limited to:

• DO NOT HANG UP• Stay with the victim until help arrives

• Your name• Your location with as much detail as possible including cross

streets, landmarks, room numbers, etc. This will help the emergency team reach you as quickly as possible

• The victim(s): name, age, ailments and current condition • Be as detailed as possible

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MYTH: If your child didn’t lose consciousness, he/she doesn’t have a concussion. FACT: Most concussions occur without a person losing consciousness. In fact, fewer than 10 percent of children and adolescents lose consciousness or are “knocked out” from a concussion.

MYTH: A ding or “getting your bell rung” or a “mild” bump or blow to the head can’t cause serious injury. FACT: Even a “ding,” “getting your bell rung,” or what seems to be a “mild” bump or blow to the head can be serious and should be checked out. Concussion symptoms generally show up right after the injury, but thefulleffectoftheinjurymaynotbenoticeableatfirst.Somesymptomsmay not show up or be noticed until hours or days after the injury. If you notice symptoms of concussion, seek medical attention right away.

MYTH: Youth that play sports are more susceptible to risky behaviors such as smoking and illicit drug use. FACT: Physical activity and sports participation offer more than just healthbenefitsforkids.Somestudiessuggestthatparticipationinsportsmay help prevent or control some risky behaviors such as smoking and illicit drug use. In addition, some studies have concluded that being physically active is also associated with better academic performance and fewer disciplinary problems.

MYTH: Helmets prevent concussions. FACT: While there is no concussion-proof helmet, a helmet can protect your child or teen from certain serious brain or head injuries, such as a skull fracture. Even with a helmet, it is important for your child or teen to avoid hits to the head.

MYTH: Heat-related illnesses like heat cramps, heat exhaustion or exertional heatstroke are not preventable.FACT: Heat-related illnesses are preventable. Youth should be properly acclimatizedtotheheat,maintainaminimumlevelofphysicalfitness,have regular breaks and be properly hydrated. Coaches should adjust the length and/or intensity of practice according to weather conditions and ensure athletes are dressed appropriately for the heat.

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SPORTS SAFETY MYTHS

MYTH: Sugar-sweetened beverages such as sports drinks are appropriate for children who participate in moderate activity in dry mild temperature environments for less than 60 minutes. FACT: Sport drinks are sometimes used to replace electrolytes and provide energy for people who sweat a lot, are doing intense activities that last 60 minutes or more, or for those who practice more than once a day, particularly in hot, humid conditions. For short practices, sports drinks are likely not necessary and no better than plain water because many contain ingredients that aren’t needed in these conditions, such as calories, sugar and electrolytes. Water is the least expensive, most readily available drink. Athletes need to drink water before, during and after workouts. Athletes should develop a personalized hydration strategy that takes into account the amount of exercise, environmental conditions and their individual needs. For kids, thirst and urine color aregreatwaystoassessfluidneeds.Urinecolor:lightlikelemonade=hydrated,darklikeapplejuice=dehydrated.

MYTH: Youth athletes are likely to tell an adult (parent and/or coach) about pain or possible injury. FACT: Forty-two percent of youth athletes said they have hidden or downplayed an injury during a game so they could keep playing. Fifty-four percent of athletes said they have played injured. Top reasons included: injury was not that bad, they were needed and couldn’t let the team down, they did not want to be benched, and it was an important game.

MYTH: You have to be a healthcare provider to give CPR or use an AED. FACT: One of the most important ways to improve survival from cardiac arrest is to provide CPR as quickly as possible. This means that CPR given by friends, family members or other bystanders is critically important. You do not need to be a healthcare provider to give CPR, and the AHA offers many options for non-healthcare providers (www.heart.org/cpr). AEDs are safe and easy to use by anyone. They can be found in many public places like airports, shopping malls and schools.If someone has a cardiac arrest, it is very important that the AED is used as soon as possible. The combination of CPR and AED will give a person in cardiac arrest the best chance of survival.

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SPORTS SAFETY MYTHS

COLD VS. HEAT

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When should you use ice?• Immediately after the injury

and up to 72 hours afterwards• When swelling is present• After activity to relieve soreness

Why use ice?• Ice decreases swelling by

constricting local blood vessels.• Ice will decrease pain by

numbing the area.

How should you apply ice?• Apply ice for 20 minutes once an hour.• Do not apply ice over night.• A barrier should be used between chemical ice packs and the skin to prevent a

burn.

During the first 48-72 hours it is important to use the RICE principle:• R=REST:Stayoffoftheinjuryasmuchaspossibleandespeciallylimit

activities that cause pain.• I=ICE:UseiceandNOTheat.• C=COMPRESSION:IfthereisswellingkeeptheinjurywrappedwithanACE

bandage. Watch for constriction so you don’t cut off blood supply and don’t sleep with the wrap on.

• E=ELEVATION:Keeptheareaelevatedif/whenpossibleandifcomfortable.This will help to decrease swelling.

Ice can always be used post-activity to relieve any soreness

Directions:1. Add water and alcohol

in a ratio of 2(water): 1(alcohol) or 3(water): 11/2(alcohol)

2. Add more alcohol for a slushier cold pack. Can leave cold packs in freezer for up to one month.

Home Remedy Cold Pack Recipe

Materials Needed:1. Ziplock baggies

(1/2 to 1 gallon size)

2. Water3. Rubbing Alcohol

Hint:1. Use double baggies for

leakage control!!!2. Cold packs will conform

to any body area because of the alcohol that is in the cold pack.

3. Place towel/cloth between cold pack and skin.

When should you use heat?• 72 hours after the injury• Before activity

Why use heat?• Heatpromotesbloodflowtotheinjured

area, helping to remove damaged tissue.

• Theincreaseinbloodflowcanalsohelpto loosen up stiff muscles and decrease the chance of injury or re-injury

How should you apply heat?• Heat should be applied for 15-20

minutes prior to activity.• There should be a barrier placed

between the skin and heating element to prevent burns.

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COLD VS. HEAT

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LIGHTNING SAFETYIn the United States, lightning results in an average of 42 deaths and over 400 injuries per year. For this reason, it is important to have a plan in place in case there is a threat of lightning during your outdoor activity.

The National Federation of State High School Associations and The National Athletic Training Association recommend the following guidelines to prepare for lightning:

1. Assign a staff member to monitor weather before and during the event.• Know the difference between a thunderstorm watch and warning

• Watch=Whenthereisariskofhazardousweather• Warning=Whentherearealreadyhazardousconditionsintheareaor

are imminent• Have a lighting detector on hand.• Use the flash-to-bang count:After lightning strikes, count thenumber of

seconds until you hear the bang of thunder. Divide this number by 5 (sounds travels 1 mile in 5 seconds). This gives you the approximate distance (in miles) between where you are and where the lightning is.

• Example• secondsbetweenflashandbang:30seconds• 30/5=approximately6milesbetweenyouandthestorm

2. Develop an evacuation plan. This included identifying the closest enclosed shelters and the quickest way to get there.• Avoid water, high ground and open spaces.• Canopies, trees, picnic shelters or anything with metal objects are not safe

shelters.• Vehicles that are completely enclosed are safe places to be.

3. Develop criteria as to when to resume play. The KHSAA has the following guidelines: • Theheadrefereeorumpirewillstopplayat thefirstsoundof thunderor

sight of lightning. • The playing site shall be evacuated to the closest shelter.• Play will resume 30 minutes after the last lightning strike is seen or thunder

heard.

If someone is struck by lightning, you must call 911 immediately. Approach the person only if the conditions are safe to do so. It is safe to touch and treat the individual following a lightning strike. Immediately assess the individual and render care as needed.

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What is dehydration? Dehydrationoccurswhenathletesdonotreplacebodyfluidslostbysweating.Being even slightly dehydrated can make an athlete feel bad and play less effectively. Dehydration can cause a person to become hotter and have a higher heart rate while also putting them at greater risk for heat illness.

• Thirst• Dry mouth• Being irritable or cranky• Headache• Dizziness• Nausea and vomiting

• Heart palpitations• Lightheadedness• Decrease urine output• Dark urine color• Exercise session weight loss >2%

Signs and symptoms of dehydration

PROPER HYDRATION

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PROPER HYDRATIONWhat to do to hydrate properly:

• Establishaproperhydrationschedulespecifictoyoursport• Consumefluidsbefore,duringandafterexercise.• Current recommendations for pre-practice hydration:

• 20oz 2-3 hours prior to event.• 7-10oz 15 minutes prior to event.

• Fluid replacement during exercise helps to keep weight loss to less than 2% of your body weight. Pre-practice and post-practice weigh-ins are the best indication of proper hydration.

• Itisrecommendedthatanyweightlossbereplenishedwithfluidswithin2hoursof activity.

• Itisrecommendedthat7-10ozoffluidbeconsumedevery10-20minduringexercise.If water breaks are limited to every 30 minutes, athletes should consume 10-15oz.

• Monitor body weight changes and check urine color. • Most weight lost during activity is because of water loss. For every pound of bodyweightlost,anathleteshoulddrink16ouncesoffluid.

• Urine that is light or like lemonade indicates proper hydration. Urine color that is dark like apple juice would indicate dehydration. (Note: Supplements or medications can alter urine color.)

What not to do:• Consume caffeine or alcohol during athletic activity. Both of these lead to dehydration.• Consume sugary drinks with carbohydrate concentrations higher than 8%.• Eat poorly; this includes cutting out carbohydrates.• Eat salt tablets; sports drinks are more appropriate for sodium intake.

Preventing Heat-Related Illness and DehydrationTake the proper steps before and during exercise to stay cool:

• Check the heat index (or preferably the wet bulb globe temperature) for your area before practice. Avoid practicing during the hottest part of the day.

• Take time to adapt to the hot environment over the course of 10-14 days (acclimatization).

• Take water breaks every 15-20 minutes. Athletes should be able to drink as much as they wish. As the temperature increases, rest/water breaks should be takenmore frequently.Water and fluids should be readilyaccessible throughout practice.

• Neverdenyordiscourageanathletefromdrinkingwaterorfluids.• DoNOTpunishathletesbywithholdingwaterorfluids.

Tips to help keep athletes cool:

• Practice where there is a shaded or cool area nearby.• Water and rest breaks should be in shaded/cooler areas, if possible.• Have ice towels to use during rest breaks.• If an athlete begins to show signs of heat-illness remove them from

play, move to shaded/cooler area, have them sit or lie down, elevate legs, and if needed rotate cold, wet ice towels of the body to help the body cool.

• In competition scenario, minimize warm-up or warm up in an air-conditioned environment.

• Stay hydrated before, during and after practice.• Maintainaminimumlevelofphysicalfitnessevenwhennotpracticing.

HEAT-RELATED ILLNESSES AND DEHYDRATION

Remember, hydration needs are individualistic, so athletes should be aware of their own hydration needs to maximize performance and safety.

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HEAT SAFETYRisk factors for heat-related illnessesBody temperature can increase for many reasons besides exercise alone. The best way to protect athletes is to modify the risk factors that are responsible for causing heat illness. These factors can be categorized into two groups, intrinsic (factors unique to that individual) and extrinsic (factors outside the athlete’s control). Heat illnesses are almost always preventable by reducing risk factors that are responsible for causing heat-related illnesses.

Intrinsic Risk Factors Extrinsic Risk Factors

• Lowerfitnesslevel• Lack of sleep• Illness• Taking certain meds

(antihistamines, diuretics, antihypertensives), supplements and/or stimulants

• Overweight or obese• Not used to the heat

• High temperature or high humidity• Equipment and/or heavy clothing• Direct sun exposure• Intense or prolonged exercise without

enough breaks• Notenoughfluidsorbreaks

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What are some types of heat-related illnesses?Staying cool in the heat when exercising is important. Increased body temperature and high blood requirements by working muscles when exercising can lead to heat illnesses such as heat syncope, heat cramps, heat exhaustion and exertional heat stroke.

HEAT SAFETY

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Heat Syncope Fainting or lightheadedness.Heat Cramps Painful, visible muscle cramps that

feel hard.Heat Exhaustion Weakness or exhaustion from heat

that stops a person from continuing exercise. The person may feel hot, tired, weak, dizzy and collapse.

Exertional Heat Stroke Bodytemperatureover105˚Fwith central nervous system dysfunction. Obvious central nervous system problems can include dizziness, collapse, confusion, irrational behaviors, seizures and coma. Rapid pulse; rapid, shallow breathing; nausea; vomiting; muscle cramps; and weakness may also occur. Heat stroke is a medical emergency. Immediately cool the athlete with copious amounts of water and call 911.

Signs and symptoms of heat-related illnesses

PREVENTION OF HEAT ILLNESS1. Ensure that appropriate medical care is available. It is important that

these medical professionals have the ability to evaluate, examine and remove any individual from participation that displays signs and symptoms of heat illness.

2. Conduct thorough, physician-supervised, pre-participation physicals to identify athletes that are pre-disposed to heat illness.

3. Adapt athletes to exercise in the heat over a 10-14 day period. For tips on how to do this visit www.nata.org

4. Educate athletes, coaches and parents regarding the prevention, recognition and treatment of heat related illnesses.

5. Encourage athletes to sleep 6-8 hours a night in a cool environment and eat well-balanced meals.

6. Develop practice guidelines based on the heat index. The following are the guidelines that KHSAA follows (if you are not in Kentucky please research your state’s guidelines) remember these are based on heat index not temperature:

• Under 95 degrees: practice normally • 95 degrees – 99 degrees: Water breaks every 30 minutes that

last 10 minutes; helmets and other equipment should be removed when athlete is not directly involved in a drill

• 100 degrees – 104 degrees: Water breaks every 30 minutes that last 10 minutes; helmets and other equipment may not be worn and therefore suspend play that requires those articles

• Above 104 degrees: Suspend all outdoor activity7. Check the heat index before and frequently during activity. Make any

appropriate changes to activity based on your guidelines and the change in weather.

8. Planadequaterestbreaksandhaveaccesstoplentyoffluidsduringthese rest breaks and have long rest breaks during the day during mealtime.

9. Weigh athletes before and after activity to estimate the amount of fluidlostandensureaproperamountofre-hydrationbeforethenextactivity.

10. Practice in the shade, wear as little gear as needed and shorten practice when possible.

11. Make sure to supply cold water, ice and a tub for immersion during outdoor activities in the heat.

12. Never limit water or tell someone they can’t get a drink

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DENTAL INJURIESDental injuries can occur in any sport at any time. It is important to know what to do in the event of a tooth or jaw injury to prevent further or long-term damage.

Do not overlook the obvious: many dental injuries occur as part of a blow to the head. Make sure to check for signs and symptoms of a concussion.

Wearing a mouth guard can help to prevent dental injuries. Athletes that participate in contact sports should wear a mouth guard, even if the league does not require it. It is recommended for any athlete participating in sport.

Dislocation of the Tooth: If the tooth becomes completely dislodged from its socket the individual needs to be referred to a dentist immediately and the following guidelines should be followed:

• Rinse the tooth but do NOT scrub or scrap the tooth. • If it cannot be EASILY placed back in the socket then the tooth should

be placed in a “Save a Tooth” kit, milk or saline soaked gauze. • If you do not have any of the above items then place the tooth under

the individual’s tongue. Do this only if the individual is conscious. • Do NOT handle the tooth by its roots. • The sooner the individual gets to a dentist the better chance there is

to save the tooth.

Fracture of the Tooth: If a tooth breaks the individual should be referred to a dentist within 24-48 hours if they are not in pain due to the injury. If the fractured off part can be recovered then simply place it in a plastic bag.

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EYE INJURIESWhile eye injuries are very rare, they do occur in sport and proper management is essential in preventing long-term damage to vision.

It is important to determine:

• How did the injury happen?• If there is loss of vision and if so how much?• If there is loss of vision, was it gradual or immediate?• Was there loss of consciousness?• Is there still an object in the eye?• Is the individual wearing contacts?

Common Eye Injuries:

• Black Eye: This is when there is bruising around the eye socket. This can range from mild to severe depending on how the injury occurred. Individuals should seek medical treatment when there is altered vision.

• Orbital Fractures: This occurs when a blow to the face breaks the bony framework of the eye socket. This is a medical emergency and the individual should be immediately transported to the closest emergency room. Cover the eyes to restrict movement but do not place pressure on the area.

• Foreign Object in the Eye: When something is in the eye that shouldn’t be this causes extreme discomfort and disability. Try to keep the individual from rubbing the eye this will prevent the object fromscratchingthecornea.Trytoflushtheobjectoutwithsaline.If the object cannot be easily removed or becomes embedded, the individual should contact a medical professional.

• Retinal Detachment: This is a disorder of the eye in which the retina separates from the layer underneath. This can occur when an individual is hit in the eye with an object like a ball. The individual will complainofspecksfloatinginthefieldofvision,flashesorblurredvision. Eventually they will describe a curtain falling over their fieldofvision.Anyonedisplayingsignsandsymptomsofaretinaldetachment should be immediately referred to an ophthalmologist.

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NASAL INJURIESNasal injuries occur when there is a direct blow to the face. Ranging from mild to severe, it is important to correctly manage the injury to prevent long-term damage to the airways.

Nasal Fractures: these are the most common fractures to the face. Although obvious deformity may not be present, it is important to get an x-ray. This will help to rule out any internal damage and prevent long-term damage. Neglecting to treat a nasal fracture may require surgery down the road.

Nosebleeds: nosebleeds can occur from a direct blow to the face, allergies, high-humidity or other more serious facial injuries. The most important thing in dealing with a nosebleed is to control the bleeding. To do so, follow these simple guidelines:

• Have the person sit upright. Do not lean them forward or backwards. When you tilt the head back, the nose continues to bleed but it runs down into the throat. Sitting forward can cause pain and pressure in the area

• Apply a cold compress to the nose• Applyfirmpressuretotheaffectednostrilfor5minutes• A rolled up piece of gauze or a nasal plug inserted into the nostril

will facilitate clotting and contain any continued bleeding• The individual needs to seek medical attention if the nosebleed

cannot be stopped

Again, it needs to be kept in mind that any direct blow to the face or head that causes a nasal injury can also cause a concussion. Any individual with a nasal or facial injury needs to be checked for concussion by a sports medicine professional.

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SPRAINS VS STRAINSThese are two of the most misused and misunderstood terms in sports medicine. Although most people use these terms interchangeably, they are very different things.

SPRAIN: This is an injury to a ligament. Ligaments are sheets or bundles ofcollagenfibersthatconnectbonestootherbones.

STRAIN: This is an injury to a muscle or tendon. Tendons are what connect muscles to tendons.

Both sprains and strains are evaluated in terms of grades:• GRADE 1: Least serious. Tendon or ligament is stretched or only

slightly torn.• GRADE 2: Moderate tearing of tendon or ligament. All signs and

symptoms are moderate in nature. • GRADE 3: Most serious. Complete tear of ligament or tendon. Results

in swelling, bruising, loss of function, pain and deformity

• Strains and sprains should be treated with the RICE principle for the first48-72hours.

• Whenever there is a loss of function or severe pain, you should been seen by a sports medicine professional.

• Properly warming up and stretching before any exercise can prevent strains.

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DISLOCATIONS AND FRACTURESWhen someone fractures a bone or dislocates a joint it can be a very scary situation for all involved. Here’s what you need to know so you can appropriately handle the situation.

Fracture: A broken bone; there are many different types of fractures and some are more serious than others.

Open Fracture: Also known as compound fracture, this is when the bone penetrates the skin when it breaks.

Dislocation: When a bone comes out of its socket or out of alignment. Dislocations can lead to damage to the surrounding area including nerves, ligaments, cartilage, etc.

Subluxation: When a bone comes partially out of socket or alignment but immediately returns to the proper place. This can also cause damage to the surrounding areas.

All of the above are injuries that require immediate medical attention. When determining the severity of the injury, consider the following:

• Do NOT move an individual that has an injury to the hip or legs• Do NOT move an individual that has a gross deformity of an area• Do NOT move an individual that has an open fracture. • Do NOT try to put the dislocated joint back into place• Call 911 when any of the above situations are present or you are not

comfortable handling the situation. • Keep the individual calm• Keep the crowds away. Often when there are gross deformities due to

fracture or dislocation people gather trying to take a look. Their reactions to the injury can affect the injured person in a negative way and should be limited as much as possible.

• Immobilize the area when possible and do not transport the individual until the area has been immobilized.

• If there is an open fracture, place a sterile dressing over the open wound to decrease the chance of infection.

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COMMON ARM INJURIESThese are some of the most often seen arm injuries among everyday athletes and individuals. These descriptions are no substitute for visiting your doctor or another sports medicine professional. Speak with your doctor before starting a new workout regimen or medication.

Rotator Cuff Tendonitis: One of the most common shoulder injuries, this can lead to more serious issues if not treated correctly. Rotator cuff tendonitis is characterized by pain in the shoulder that increases with overhead activities, tenderness over the front of the shoulder, weakness with overhead activities, and general tightness over the entire shoulder.

AC Sprain: Also known as a separated shoulder, this most often occurs when an individual falls directly on their shoulder. Individual will have pain on the top of their shoulder at the end of their collarbone, this is known as the AC joint. Depending on the seriousness of the injury the collarbone may appear to be sticking up. It is recommended to get an x-ray to determine the seriousness of the separation.

Tennis Elbow: Also known as lateral epicondylitis, this is the most common elbow injury in sports. It is caused by repetitive hyperextension of the elbow. Signs and symptoms include a pain on the outside of the elbow, weakness in the hand and wrist, the inability to fully extend the elbow and increased pain with activity.

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COMMON LEG INJURIESThese are some of the most often seen leg injuries among everyday athletes and individuals. These descriptions are no substitute for visiting your doctor or another sports medicine professional. Speak with your doctor before starting a new workout regimen or medication.

Meniscal Tear: the meniscus is the cartilage that sits between the femur and the tibia. It can be injured over time from the wear and tear of sports, or acutely when the individual plants and twists the knee. Signs and symptoms include pain with squatting, pain going up and down stairs, clicking/popping/catching in the joint, feeling like the knee is going to “give out”, locking of the knee, aching and swelling.

Medial Collateral Ligament Sprain: the MCL is the ligament on the inside of the knee. It is most often injured with a direct blow to the outside of the knee. Signs and symptoms include pain and point tenderness over the inside of the knee, mild swelling, loss of range of motion in the knee, stiffness and sometimes, bruising. The individual should seek medical attention to determine the severity of the sprain and to ensure no other structures were compromised.

Ankle Sprain: the most common lower leg injury in sport, an ankle sprain happens when the ankle either turns in or out and the ligaments of the ankle are stretched or torn. Signs and symptoms include pain, swelling, bruising, and loss of motion and function. If the individual cannot walk without a limp, crutches should be used. If the individual cannot bear any weight on the foot, an x-ray should be obtained to rule out fracture.

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FMSFunctional Movement Screen

What is FMS?The Functional Movement Screen is an innovative system used to evaluate movement pattern quality for clients and athletes.

The screen is comprised of seven fundamental movement patterns that require a balance of mobility and stability and place the individual in extreme positions where weakness and imbalances become noticeable.

Benefits• A consistent and reliable testing method• Easilyidentifiesmovementlimitationsanddysfunction• Improvesefficiency,durability,andperformance• Provides an enhanced foundation for exercise and performance

programing

The 7 Tests of the FMS:1. Deep Squat2. Hurdle Step3. In-Line Lunge4. Shoulder Mobility5. Active Straight Leg Raise6. Trunk Stability Push-Up7. Rotary Stability

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CONCUSSIONSConcussions are often thought to occur only in contact sports such as ice hockey, football and lacrosse, but in reality they can occur in any sport and at any time. It is essential to diagnosis and treat concussions quickly and correctly. While concussions themselves are very serious, it is the mismanagement of concussions that result in serious long-term brain injuries.

Concussions are a type of traumatic brain injury or TBI. TBIs occur as the result of a direct blow to the head, a fall that jolts the head, severe shaking, or anything that makes the brain hit the skull.

How can I help keep my young children or teens safe?Sports are a great way for young children and teens to stay healthy and can help them do well in school. To help lower your young children’s or teens’ chances of getting a concussion or other serious brain injury, you should:

• Work with their coach to teach techniques to lower the chances of getting a concussion.

• Talk with your children or teens about concussion and ask if they have concerns about reporting a concussion. Emphasize the importance of reporting concussions and taking time to recover from one.

• When appropriate for the sport or activity, athletes should wear a helmet to lower the chances of serious brain or head injuries. However, there is no “concussion-proof” helmet.

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What to do if you think your child has a concussion:

1. Schedule an appointment with a neurologist or sports medicine professional. These are the people most equipped to correctly handle and treat a concussion. If there is an athletic trainer on site at the time of injury they can assess the individual at the time of injury and accurately document signs and symptoms. It is now a State law in Kentucky that when a concussions occurs or is suspected the athlete must be evaluated and cleared by a doctor to return to participation of any kind. Remove individual from participation and seek medical attention. It is important to remove the injured individual from play at any level, including practice, until a medical professional sees them. When in doubt, sit them out!

2. Report the concussion. It is important to tell all involved members about the concussion. This includes the individual’s coaches, teachers and athletic trainers. This way the proper plan can be developed to safely return the individual to play. Constant communication between the concussed individual, coaches, teachers and the sports medicine staff is the only way the individual will heal correctly and safely.

Symptoms reported by athlete Signs observed by parents or coaches

• Headache or “pressure” in head• Nausea or vomiting• Balance problems or dizziness• Double or blurry vision• Sensitivity to light• Sensitivity to noise• Feeling sluggish, hazy, foggy or

groggy• Concentration or memory

problems• Confusion• Just not “feeling right” or is

“feeling down”

• Appears dazed or stunned• Is confused about assignment or

position• Forgets an instruction• Is unsure of game, score or opponent• Moves clumsily• Answers questions slowly• Losesconsciousness(evenbriefly)• Shows mood, behavior or personality

changes

CONCUSSIONS

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• It is not necessary to wake up the individual every 15 minutes or every hour or every two hours. The individual needs to rest. If a more serious brain injury is suspected the sports medicine professional will have recommended transport to an emergency room.

• Do NOT give the athlete ibuprofen. The ONLY medication that should be given is Tylenol (acetaminophen.) Refrain from giving medication unless absolutely needed.

• Do NOT let the individual engage in extreme visual stimulation until cleared to do so by your doctor. This includes texting, watching TV, being on the computer, playing video games or being in areas of bright light and sound.

It is important to follow all of these guidelines to help the individual heal as quickly as possible and avoid sustaining a second impact syndrome.

A second impact syndrome (SIS) occurs when an individual returns to play with a concussion that is not fully healed and they suffer a second concussion. This can lead to severe, long-term brain damage or even death. It is important to remember that neither hit needs to be severe for SIS to occur and in true SIS most cases progress very quickly and result in death within minutes.

Referral to a sports medical professional is very important in treating a concussion. There is a lot of misinformation about concussions in the medical community and therefore it is best to seek treatment from a medical professional that has experience treating concussions. This allows for the safest return to play for the individual.Forhelpfindingoneoftheseprofessionals,contactyournearestKORTclinic or your school’s athletic trainer. For more information on concussions visit www.cdc.gov/.

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CARING FOR A CONCUSSION

RETURN TO PLAY FOLLOWING A CONCUSSION

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Always refer to your State law about concussions as to who can assess an athlete who may have sustained a concussion and if there is a particular protocol needed for their return to sport. To check your particular state law, follow the link below.http://www.ncsl.org/research/health/traumatic-brain-injury-legislation.aspx

Following a brief period of initial rest (24–48 hours), symptom-limited activity can begin. The following Stages were established based upon the 5th international Conference on Concussion in Sport held in Berlin, October 2016.

Stage 1 - RestAn athlete must be going through classes in school throughout the day and symptom free for 24 hours of doing so in order to begin the RTP protocol. If symptoms are experienced, the athlete must wait before beginning stage 2.

Stage 2 - Light Aerobic ExerciseAthlete performs light aerobic training sessions with no head impact activities for 20-30 minutes without return of symptoms. Light aerobic training sessions could include: a. Exercise bike b.Walkingonthetrackorfield c. Pool workouts if monitored by a coach or communicated with lifeguard*** DOES NOT Include strength training exercises

Stage 3 – Interval Training ExercisesThese sessions include body weight exercises (no weight training), intermixed with light sprints.Some exercises that could be included in this stage: a. Sit-ups b. Jogging / Sprinting intervals c. Pushups d. Mountain climbers e. Fast feet drills f.Anylightsportspecificexercise*** NO HEAD IMPACT DRILLS

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Stage 4 – Sport Specific Training (Non-contact)Athlete may start to practice without risk of contact. • Football: non-defended pass routes, pass defense without a receiver, position

specificdrills• Soccer: ball drills, passing drills, shooting drills

*** NO HEADING • Field Hockey: passing drills/lines, shooting drills• Basketball: dribbling and defensive drills without partner, shooting drills • Lacrosse: passing and shooting drills • AnysportspecificexercisewherethereisNO POSSIBILITY of CONTACT

Stage 5 - Full Contact PracticeAthlete may return to full participation in practice

Stage 6 - Return to Sport Athlete may resume normal activities

There should be at least 24 hours for each step of the progression. If any concussion-related symptoms occur during the stepwise approach, the athlete should drop back to the previous asymptomatic level and attempt to progress again after being free of concussion-related symptoms for a further 24-hour period at the lower level.

Generally, each step should take 24 hours, so that athletes would take a minimum of 1 week to proceed through the full rehabilitation protocol once they are asymptomatic at rest. However, the time frame for RTP may vary with player age, history, level of sport, etc., and management must be individualized.

RETURN TO PLAY FOLLOWING A CONCUSSION

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ImPACT TESTING

TIME?

WHAT?

HOW?There are 2 ways one can receive ImPACT Baseline Testing. Simply call any KORT clinic to set up a convenient time for you, or contact your school’s athletic trainer. For a complete list visit our website www.kort.com/services/sport-medicine/default.aspx.

ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) isthefirst,mostwidelyused,andmostscientificallyvalidatedcomputerizedconcussion evaluation system. ImPACT was developed to provide useful informationtoassistqualifiedpractitionersinmakingsoundreturntoplaydecisions following concussions.

Developed in the early 1990s by Drs. Mark Lovell and Joseph Maroon, ImPACT is a test that has become a standard tool used in comprehensive clinical management of concussions for athletes from age 10 through adulthood.

ImPACT takes approximately 45 minutes to complete. The program measures multiple aspects of cognitive functioning in athletes, including:

• Attention span• Working memory• Sustained and selec-

tive attention time

• Response variability• Non-verbal problem

solving• Reaction time

$5SPECIAL OFFERBring this coupon and receive the Impact Testing for only $5!

COMPREHENSIVE CONCUSSION PROGRAMAFFORDABLE CONCUSSION BASELINE TESTING

EDUCATION

ON-FIELD MANAGEMENT

SPECIALIST REFERRAL

REHABILITATION/POST CONCUSSION TESTING

KORT offers ImPACT Baseline Testing for each athlete. ImPACT is web based testing and HIPAA compliant. It’s another tool your physician may use to help determine an athlete’s return to play.

KORT provides educational information to parents, coaches, and athletes about the signs and symptoms of a concussion, what to look for and how to respond.

All KORT Certified Athletic Trainers work with Team Physicians on thesidelines to properly assess and effectively manage concussion injuries.

The Athletic Trainers will assist parents in referring players with a suspected concussion to a Neurological Specialist.

KORT offers vestibular rehabilitation and post concussion testing while communicating with the athlete’s physician to help aid him/her in determining an athlete’s safe return to play. KORT follows a strict return to play protocol addressing dizziness, balance, and headaches.

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SuspectedConcussion

ATC Assessment on site Physician Assessment

KORT Clinic AssessmentSCAT5

Balance AssessmentImpact (Baseline or Retest)

Audiologist

Neuro-opthomologist

Neuropsychologist

Neurologist

CONCUSSION FLOWCHART

KORT

VestibularRehab

BalanceRetraining

Cervical Spine Evaluation &

Treatment

Initial Return to Play

Progression

ImPact Testing

*

KORT

50%

FACT:Boys have a 50%

greater risk ofconcussion than girls.

WHAT SHOULD THE PLAN INCLUDE?

EDUCATION

SIGNS & SYMPTOMS FOR REMOVAL

FROM PLAY

RETURN TO SCHOOL & RETURN TO PLAY

WHO NEEDS EDUCATION?PARENTSATHLETES

COACHES10 SIGNS OF CONCUSSION AS OBSERVED BY OTHERS

APPEARS DAZED OR STUNNED

CONFUSED ABOUT ASSIGNMENT OR POSITION

FORGETS AN INSTRUCTION

UNSURE OF GAME, SCORE OR OPPONENT

MOVES CLUMSILY

ANSWERS QUESTIONS SLOWLY

LOSES CONSCIOUSNESS (EVEN BRIEFLY)

SHOWS MOOD, BEHAVIOR OR PERSONALITY

CHANGES

CAN’T RECALL EVENTS PRIOR TO HIT OR FALL

CAN’T RECALL EVENTS AFTER HIT OR FALL

RETURN TO SCHOOL & RETURN TO PLAYA GRADUATED RETURN TO ACTIVITY SHOULD BE USED AFTER GETTING CLEARANCE FROM

A QUALIFIED HEALTHCARE PROFESSIONAL. SUPPORT FROM SCHOOL FOR CLASSES, EXAMS AND SCHOOLWORK IS IMPORTANT. THE RETURNTOPLAY AND RETURNTOSCHOOL

PROGRESSION HAS SEVEN STEPS

12

3 45

6 7

RESTRETURN TO

SCHOOL AND/OR DAILY

NON-ATHLETICACTIVITIES

BEGINAEROBICEXERCISE

SPORT SPECIFICTRAINING/

CATCHING AND THROWING

NON-CONTACTDRILLS/LINE

DRILLS

CONTROLLED FULLCONTACT ACTIVITY/

SCRIMMAGE

FULL RETURN TO PLAYAND GAME COMPETITION

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CENTRAL KENTUCKY

LOCATIONS

Bardstown875 Pennsylvania AveBardstown, KY 40004502-349-6961

Brandenburg815 Hillcrest Dr, Suite CBrandenburg, KY 40108270-422-3366

Campbellsville315 E. Broadway, Suite ACampbellsville, KY 42718270-469-1076

Elizabethtown708 Westport Rd, Suite 200Elizabethtown, KY 42701270-766-1213

Lebanon703 E. Main St, Suite 1Lebanon, KY 40033270-699-9503

Mt. Washington300 High Point Ct.Mt. Washington, KY 40047502-538-2332

Owensboro3515 Frederica St.Owensboro, KY 42301270-684-7856

Sheperdsville115 Huston Dr, Suite 3Sheperdsville, KY 40165502-921-0272

Springfield49 Bonnie Blvd, Suite 1Springfield,KY40069859-336-9901

LEXINGTON AREABeaumont3070 Lakecrest Cir, Suite 700Lexington, KY 40513859-296-4080

Brannon Crossing169 E. Brannon RdNicholasville, KY 40356859-245-4000

Bryan Station1650 Bryan Station Rd, Suite 122Lexington, KY 40505859-293-6133

Chevy Chase836 Euclid Ave, Suite 104Lexington, KY 40505859-268-0510

Falmouth1308 W. Shelby St, Suite 4Falmouth, KY 41040

Frankfort111 Westridge DrFrankfort, KY 40601502-227-3186

Georgetown101 Eastside Dr, Suite DGeorgetown, KY 40324502-867-0111

Hamburg1792 Alysheba Way, Suite 140Lexington, KY 40509

Nicholasville102 Williams RdNicholasville, KY 40356859-881-0333

LOUISVILLE AREACrestwood6003 Pleasant Colony CtCrestwood, KY 40014502-241-5597

Downtown210 E. Gray St, Suite 807Louisville, KY 40202502-587-9350

Downtown Hand315 E. Broadway, SUite 195Louisville, KY 40202502-589-5961

English Station12935 Shelbyville RdLouisville, KY 40243502-489-5002

Fern Creek9368 Cedar Center WayLouisville, KY 40291502-231-3979

Goss Ave1227 Goss AveLouisville, KY 40217502-636-1200

J-Town2152 S. Hurstbourne PkwyLouisville, KY 40220502-499-0107

Jeffersonville1725 E. 10th St., Suite FJeffersonville, IN 47130812-218-8039

New Albany3602 Northgate Ct, suite 15New Albany, IN 47150812-944-1377

Old Brownsboro Crossing4950 Norton Healthcare BlvdLouisville, KY 40241502-339-6490

St. Matthews616 Executive ParkLouisville, KY 40207502-896-9355

Preston7926 S Preston Hwy, Suite 101Louisville, KY 40219502-964-5404

Shively Center4420 Dixie Hwy, Suite 122Louisville, KY 40165502-447-2750

Springhurst3584 Springhurst BlvdLouisville, KY 40241502-339-4700

Summit9424 Brownsboro RdLouisville, KY 40241502-339-4678

Tyler Center12613 Taylorsville Rd, Suite 118Louisville, KY 40299502-267-1480

Valley Station10631 Dixie HwyLouisville, KY 40272502-933-1777

Richmond5006 Atwood Dr, Suite 2Richmond, KY 40475859-623-2057

Tates Creek4101 Tates Creek Centre DrLexington, KY 40517859-271-2887

Winchester1547 Bypass RdWinchester, KY 40391859-744-4411

NOTES

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