According to Jim Withrow, Little Rock Hall High School’s head football coach, student-athlete safety has come a long way since he started coaching nearly 30 years ago. Today, he can easily rattle off the symptoms of concussion, dehydration and heat fatigue. Thanks to required continuing education, Withrow says coaches “know exactly what to look for and how to help someone showing signs of distress.”
Chad Burke, a sports medicine teacher and athletic trainer for the Cabot School District, agrees that safety awareness has improved over time. “We have better information in making decisions about our athletes,” Burke, who chairs the Arkansas Athletic Trainers’ Association’s Secondary School Athletic Trainers’ Committee, said.
“This time of the year, heat-related illnesses are at the forefront,” Burke said. To keep players safe from the heat, he uses a WetBulb Globe Temperature measurement, which is a measure of heat stress in direct sunlight. Armed with that information, Burke can make better decisions about the amount of strenuous outdoor activity athletes can safely perform — and when it’s appropriate to alter or postpone a practice.
Over at Hall High’s locker room, wall posters detail common signs of dehydration and heat illness, and during the hot summer months the players’ weights are charted before and after practice so the athletes and coaching staff know just how much fluid they’ve lost.
In case of a heat emergency, Hall’s locker room is equipped with a cold tub. Cold water immersion is an effective way to rapidly reduce body temperature and is considered the primary treatment for heatstroke.
Combining sports medicine knowledge with an ability to provide immediate care, Burke says athletic trainers play a critical role when it comes to preventing and managing head injuries. Athletic trainers are often the first responders when a head injury occurs. They assess the severity of the injury and have the authority to remove a player from play.
Now that more is known about the severity of concussions and their potentially long-lasting effects, athletic trainers are serious about educating athletes, coaches and parents, and trainers work with players to teach them proper techniques and strategies to mitigate risks.
This might include teaching athletes to avoid dangerous collisions, encouraging proper tackling and heading techniques, and promoting safe play.
If a concussion is diagnosed, Burke says they use “neurocognitive testing to assess and track the recovery process of our student-athletes” and work collaboratively with other medical professionals.
Following the state’s “return to learn” and “return to play” concussion protocols, accommodations are made for student-athletes both on the field and in the classroom.
The protocols call for a gradual and monitored recovery before a player is allowed to resume full participation in their sport. It may also call for special allowances to be made in the classroom.
Student-athletes must meet very specific physical and cognitive benchmarks and show symptom improvement before graduating through the steps. The Arkansas Activities Association, which governs interscholastic sports in the state, provides schools with the guidance and resources needed to implement the protocols, and coaches and sports medicine staff are engaged at every turn.
“We help the student-athlete maneuver through the process of recovery in both the classroom and athletics,” Burke said.
Cody Walker, athletic trainer and supervisor of sports medicine at Arkansas Children’s Hospital, says the role of athletic trainers is as much about risk reduction as it is about injury evaluation and treatment.
“We work with coaches and other staff to provide athletes with safe progression in strength and conditioning programs,” Walker said. “Performance-wise, athletic trainers may help coaches determine if athletes have weaknesses in certain movements and add in corrective exercises to address those weaknesses.”
Anterior cruciate ligament (ACL) injuries are common, costly and time-consuming. With the knee injury widespread among athletes, athletic trainers may tailor their approach to prevention depending on the sport. Exercises that strengthen the quadriceps and hamstrings are nearly universally prescribed, but volleyball players might also be instructed in proper landing technique while soccer players are told to incorporate hip mobility exercises.
“We are trained to provide athletes with strategies to help prevent injuries before they happen,” Walker said.
Building relationships with student-athletes, especially players just entering the program, is another big part of keeping them safe. “We watch the new players for two or three weeks so we know what their baseline is,” Hall’s Withrow said. “Who are these kids? What can they do? What is their pushing point?”
But before Arkansas student-athletes even begin playing, they are required to have a pre-participation physical exam (PPE) and schools are mandated to host informational parent meetings. During these meetings, parents are educated about concussions, sudden cardiac arrest, heat illness and more. The exams include a medical history questionnaire, orthopedic screening, vital signs measurement and physician evaluation.
One way athletes can prepare for the PPE and be game-ready, Withrow said, is to stay active year-round. “Offseason and summer work is crucial to maintaining health and safety.”
Walker concurred. “We like to view offseason training as the base of a pyramid and in-season training as the peak of the pyramid. In order to build a tall pyramid, you need a wide and strong base,” he said.
Walker says the offseason is also a good time for athletes to explore other sports and activities to build new skills and reduce burnout.
And whether it’s burnout or another mental health issue, both Walker and Burke acknowledged that working with players day in and day out puts them in a position to be able to recognize problems early.
“We are around our athletes on a regular basis so we get to develop working relationships in a way other health care providers may not,” Walker said.
“The number of mental health issues that we are dealing with is on the rise and it is incumbent on anyone working with children to be trained in recognizing and supporting those who may be in a crisis,” Burke said.
Ensuring student-athlete safety is a collective responsibility — one that has evolved over time. Growing awareness about the severity and lasting impact of some sports injuries has, in many cases, literally changed the game.