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Minimizing the Risks

Introduction

Athletics are an important part of the high school experience for many students. Sports can provide a positive learning environment that will help student-athletes in many aspects of their lives. And like pep rallies, Friday night football and cross-town rivalries -- injuries are an inevitable part of high school athletics regardless of the preventive measures taken. Students can, however, reduce their risk of injury by following several basic steps. One of the most important is proper overall conditioning, which can also enhance rehabilitation and shorten the "down time" of athletes.

The following guidelines have been developed based on interviews with a number of certified athletic trainers around the country. This listing is not all-inclusive, but is designed to provide guidance.

In addition to these general guidelines, the National Athletic Trainers' Association encourages all athletes to develop the specific skills involved in their sport and to be aware of the rules governing their athletic endeavors.

It is essential to remember that medical, legal, financial and professional standards, limitations and requirements change continually and vary from place to place, person to person and setting to setting. These guidelines must not, therefore, be taken to represent uniformly applicable national standards.

General Guidelines

Every student-athlete should receive a pre-participation physical exam, including a general exam and an orthopedic exam. The general exam should include checks on height, weight, blood pressure, pulse, respiration, eye, ear, nose, chest and abdomen. The orthopedic exam should focus on joint flexibility, joint range of motion and a re-examination of past bone and joint injuries.
Athletes should work with athletic trainers and coaches year-round to ensure they maintain their condition with appropriate exercises and nutrition. In addition, athletes should engage in appropriate conditioning programs for a minimum of six weeks before the start of daily practice.
Athletes should focus on developing muscular strength and endurance, cardiovascular fitness and flexibility.
Good nutritional practices incorporate the basic food groups: grains, fruits and vegetables, dairy, and meat/poultry/fish. Athletes' diets should be high in complex carbohydrates while also including essential proteins and fats.
Athletes practicing or playing in warmer climates should become acclimatized to high levels of activity in hot weather. Practice should be held early in the morning or late in the afternoon.
Limit workouts and practices to no more than two hours.
The night before an event, athletes should hydrate with electrolyte fluids to reduce the risk of dehydration.
Fluid breaks should be offered at least every 45 minutes, and athletes should be entitled to unrestricted amounts of fluids to help prevent dehydration and other forms of heat-related illness.
All athletes should use appropriate equipment that fits properly. This equipment should be checked before and after each use to ensure that it is in proper working condition, and replaced or repaired immediately if any problems are noted.
Appropriate protective equipment should be worn in all practices as well as during competitions.
Shoes should fit appropriately and provide the necessary support for each individual sport.
Foot diseases, such as athlete's foot, should be treated immediately and fully to avoid more extensive problems.
Mouth guards should be used in all collision sports, including ice hockey, football and rugby; and recommended for all sports where contact could occur, including basketball, baseball, lacrosse, soccer, etc. Not only do they help to prevent dental injuries, but they can also absorb shocks from blows to the jaw or head and reduce the severity of these blows.
Players should stretch properly before and after workouts of any kind.
A minimum 15-minute warm-up period before any game or practice, and an appropriate cool-down period afterward, is recommended. Athletes should also warm up for five minutes during any prolonged breaks in activity (including half time, between periods, etc.).
Ice should be available on the sidelines of every game and practice to apply to appropriate injuries.
Injuries involving bones or joints should be examined by a licensed physician.
All injuries should be evaluated immediately.
Parents should be aware of who is responsible for injury care at their child's school. Parents should ask if this person is qualified to handle all injuries and provide proper instruction and rehabilitation, as well as whether he or she is available for both practice and games.
Every school with an athletic program should have a written emergency plan which is reviewed regularly and addresses every level of medical care for injured athletes.
Every school should be encouraged to develop an Injury Protection Manual, which answers any questions a parent may have about the way an injury is to be handled and who will be primarily responsible. The school should distribute this manual to all athletes' parents.
The athletic department should be encouraged to have an Emergency Medical Authorization Card on file for every athlete. This card gives parental permission for emergency medical care if it is required. The card should include name, address, parents' home and work phone numbers, etc.
The athletic department should be encouraged to have parents sign a waiver that indicates they are aware of the inherent risk of injury to their children.
Coaches should be certified in first aid and CPR and, where possible, earn a state- or nationally-approved certificate to coach specific sports.
All individuals involved in the athletes' health and safety -- including athletic trainers, coaches, physicians, emergency medical personnel (paramedics and EMTs), school administrators and parents -- should be encouraged to maintain cooperative liaisons.

Football-Specific Guidelines

Intentional spearing of opponents should be discouraged.
Blocking below the waist should be minimized during practice.
Block and tackle with the head up to reduce the risk of neck injuries.
In addition to total strengthening and conditioning, football-specific conditioning exercises should strengthen the neck to allow players to keep their heads firmly erect while making contact during blocks or tackles.
Make sure the practice and playing areas are safe. Look for holes, broken glass and other hazards on and around the practice field, game field and blocking sleds.
Ample fluid replacement should be available at all times.

Basketball-Specific Guidelines

Players should focus on conditioning exercises for the total body, including upper and lower extremities.
Players should focus on good warm-up and stretching prior to any ballistic movements.
Footwear should fit properly to minimize the risk of ankle- and foot-related injuries.
Replace footwear when the shock absorption is no longer adequate.

Soccer-Specific Guidelines

Players should be encouraged to wear appropriate shin guards during practice and play.
Provide fluids on the sidelines throughout practice and games. Although soccer requires non-stop play with no time outs, athletes should be encouraged to come to the sidelines or touch line where they can replenish fluids without penalty.
Warm up for approximately 15 minutes, beginning for half that time without a ball. Warm-up exercises should include light jogging and stretching. Without these warm-ups, the explosive action of shooting can result in strained muscles.
Adhere to the rules of the game when tackling.
Although soccer does not provide time outs, injuries should be evaluated immediately to ensure the athlete is not worsening the injury.

Baseball/Softball-Specific Guidelines

Most injuries in baseball and softball involve the throwing arm and shoulder, but these injuries usually result through a gradual process. Athletes should not abuse the throwing arm by overusing it.
Players should incorporate conditioning and stretching exercises for the shoulder into their overall program.
It is to the player's advantage to warm up and cool down the throwing arm properly to minimize the risk of injuries.
Condition all shoulder muscles, emphasizing muscles in the back of the shoulder that are required to stop the pitching motion. Muscles in the front of the arm are naturally stronger -- shoulder injuries can result from weaker muscles in the back.

Track and Field-Specific Guidelines

Stretching is key to minimizing the risk of injury in every event.
Conditioning programs should concentrate on muscular strength, muscular endurance and flexibility. Individual event training should be emphasized.
All athletes involved in running events should work to maintain year-round cardiovascular endurance.
Before and after each event, athletes should warm up and cool down, stretch and hydrate with fluids.
Special attention should be paid to the nutritional needs of the endurance athlete.

Wrestling-Specific Guidelines

Depleting food and fluid to make a particular weight class may be detrimental to the health and safety of the athlete. Body composition and weight loss should be closely monitored.
Wrestlers should be encouraged to wear protective headgear that provides ear protection.
Wrestlers should be encouraged to wear protective knee pads.
To reduce the risk of skin diseases, wrestlers should shower before and after workouts; wash their workout clothes daily; dry their skin adequately; clean mats daily; avoid wearing street shoes on wrestling mats or wrestling shoes off the mats; wipe headgear down with alcohol pads after each use; and conduct daily total body skin inspections.
Wrestlers with open wounds, broken skin or diseases of the skin should be discouraged from participating until the skin is healed or the wrestler has been cleared to participate by a licensed physician. If allowed to wrestle, the athlete should have the affected skin covered to prevent cross-contamination.
Proper strength and conditioning regimes should be encouraged.

Volleyball-Specific Guidelines

An overall strength base with emphasis on leg, back and posterior shoulder (rotator cuff) strengthening during pre-season is vital.
Proper equipment should include volleyball-specific shoes and knee pads for shock absorption.
A proper warm-up and stretching program should emphasize the shoulder, low back and legs. Do not start spiking before warm-up stretching for the shoulder. After stretching, start throwing a volleyball easily, gradually increasing intensity until the muscles are warm.
Advanced drills and conditioning, such as plyometrics or jump training, should not be conducted unless the athlete has been tested and can demonstrate balance, flexibility and strength.
Ample fluid replacement should be available at all times.

Heat Related

HEAT CRAMPS

Heat cramps are due to excessive loss of sodium chloride (salt) by profuse sweating during activity at high temperatures. Onset is often abrupt, with muscles or arms and legs affected first. The cramping will make the muscles feel like hard knots. Vital signs will usually be normal. Skin may be either hot and dry or clammy and cool depending on the humidity. In most instances, heat cramps are prevented and relieved by drinking fluids or eating foods containing sodium chloride.

HEAT EXHAUSTION

Heat exhaustion is due to excessive fluid loss. Adequate warning is usually given by increased fatigue, weakness, anxiety and drenching sweats. Vital signs will be slow thready pulse and low blood pressure. Skin will be cool pale and clammy. Body temperature will be below normal. The person may be confused and disoriented. Heat exhaustion requires restoration of normal body fluid level. Get the person to a cool area and give small amounts of cool slightly salty fluids every few minutes.

HEAT STROKE

Heat stroke is due to failure of the body's ability to cool itself and dangerously high fever. An abrupt onset is sometimes preceded by a headache, dizziness and fatigue. Absence or cessation of sweating is a key sign, as is a hot, flushed, dry skin. The pulse will be rapid usually greater than 150 bpm, respirations will increase but blood pressure is seldom affected. The person will be disorientated and confused. The body temperature will climb rapidly to 105 or greater. The person will feel like they are burning up. Heat stroke is a serious emergency and unless promptly treated can result in death. A person should be wrapped in a iced wet blanket and transported to the emergency room.

**When talking about salty fluids we are talking about either Gatorade or PowerAde. This products will give the person the balance that they need. Never give salt tablets. The can cause an overload of the body's system to the point of possible stroke, heartache, or possible kidney damage. If you not sure always go back to just plan water, since that is what your body is made with. Also they talked about the use of pickle juice. Never give this to an athlete, child, or even an adult. When this was done it was done under a controlled amount. This can through a body into a shock that again it could lead to a stroke or even death.

Note- the above are Guidelines from the National Athletic Trainers' Association, and are reprinted with the their permission.

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