Appeared in the Banner Journal, August 31, 2011 By JoDee Brooke

With the beginning of a new school year comes the start of a year’s worth of high school sports. Student athletes incur injuries in every sport. Often enough, those injuries are evident. However, some of the injuries go undetected until later and by then, additional injury may have progressed.  

Local medical providers from Black River Memorial Hospital (BRMH) and Krohn Clinic have specific programming for management of concussions. The sports medicine programming began in 2001 when medical providers started working with athletes and coaches on injury screening and management and return to play.

BRMH sports physical therapy providers are present at all Black River Falls varsity football, home junior varsity football, wrestling and hockey events. Krohn Clinic medical doctors are present at all varsity football games.

Acute injuries are assessed and treated on the sideline by the doctors and/or therapists to determine whether an athlete may return to play.

In addition to providing care at sporting events, physical therapists offer injury evaluation and recommendations as part of the Lump Bump Clinic. The evaluation may result in immediate referral to the athlete’s physician or periodic monitoring by a therapist. Recommendations for the coach related to return to play are also provided. This service is by appointment only and at no cost to the athlete. For the majority of these athletes, musculoskeletal injuries are the predominant reason that medical care is provided.

Recent attention has been shed on athletes who may or may not have suffered a concussion. While concussions occur in every sport, 85 percent of the reported 3.8 million sports- and recreation-related injures occurring last year went undiagnosed at the time of the incident.

Black River Falls High School junior Mara Ranson knows first-hand what it’s like to suffer a concussion. It was just a couple of years ago, as a member of the Black River Falls hockey team, when she found herself “checked into the boards,” she recalled, causing her to come back and fall on the ice and hit her head.

“Dr. Mahan was there,” recalled Ransom. “He took me and asked me questions about where I was, what day it was, things I should know. I couldn’t see clearly, and I just didn’t feel good. I couldn’t finish the game.”

Ransom had additional testing done at the hospital, where it was confirmed she’d suffered a concussion. She began physical therapy to gradually bring her back to the level of physical activity she experienced in a game.

“I failed the rehabilitation test a couple weeks after I got hurt,” Ransom explained. “I was running and just got sick.” Ransom said since her concussion, she also suffers from migraine headaches.

She won’t be skating the ice this year as a hockey player, not because she can’t. “I’m going to work at the hospital, instead,” she shared.

To address growing concerns, local medical teams at the beginning of the sport season prior to athlete participation will have student athletes complete balance and ImPact (Immediate Post Concussion Assessment and Cognitive Testing) testing. ImPact is a computerized concussions evaluation system, which is the most widely used testing program in the world. It is used with high school, collegiate and professional levels of participation. This neurocognitive testing has recently been called the cornerstone of proper concussion management by an international panel of sports medicine experts.

“We’ve been doing the ImPact testing for probably six years,” explained Black River Falls High School football coach Jim Bible. “We’ve been very proactive in keeping our kids safe.”

 “The baseline testing is conducted onsite at area schools by BRMH Rehabilitation Department,” explained Nicole Schweitzer, BRMH Rehabilitation Services manager. “Post injury testing is done at the doctor’s office at the time of the office visit. We all log onto a website to access the database.”

“We have a doctor at every game,” explained Dr. Rory Johnson. “If a player gets hit, they are examined to see what their symptoms are. Are they dizzy or confused? We check their eyes, their strength and ask them basic questions they should know the answers to. If they can’t, they are taken to the sidelines. If they experience a headache, neck pain or nausea, they are sent to the emergency room for a Cat Scan. That doesn’t happen too often.”

Bible said the number of concussions players have experienced varies from year to year. “We’ve had some kids that when they get hit will lay on the ground with their eyes rolling back. Other kids might have a headache.”

When an athlete suffers a concussion, their physician completes a comprehensive evaluation, which includes repeating the ImPact test to see if the athlete’s performance changes. The physician determines how he or she can be progressed, allowing them to be able to return to play.

The student athlete will follow through treatment with his or her physician and physical therapists where they will begin with simple exercises, gradually working their way back to regular exercises as they pertain to the sport.

Johnson said those who suffer a concussion are at risk of suffering a second concussion, referred to as second impact syndrome, if they aren’t careful and allow themselves time to heal. “They really need to allow adequate time for the injury to heal,” Johnson said, “and everyone is different. Some kids will heal faster than others. Most do recover completely.”

With physician’s direction, physical therapists introduce certain activities such as exercise and sport-specific drills to see if symptoms return.

Communication between the physicians and therapists with the athlete, parents and coaches provides guidance regarding how the athlete’s activities can be advanced to eventually return them to sport participation.

“All of our kids are in a better style of helmet,” Bible explained. “They don’t prevent injuries but they do reduce the severity. We encourage the kids to get a good mouth guard. We push the kids in the weight room to really work on strengthening their neck muscles. We teach them to tackle properly and we practice that every day. We will never put a kid into a situation we think they can’t handle. I feel very confident we’re keeping the kids safe, and we really appreciate what the medical team is doing for the players.”

Funding for the program is provided through community service efforts of BRMH and Krohn Clinic. License fees for the ImPact concussion management software is sponsored for the 2011-2012 and 2012-2013 school years by the Partners of BRMH.