Injury Recognition Matters. US Club Soccer Partners With Sideline Sports Doc To Bring Injury Recognition Training To Coaches.

By Dev Mishra, M.D.

President, Sideline Sports Doc

Clinical Assistant Professor of Orthopedic Surgery, Stanford University


Brian Cole, M.D.

Professor of Orthopedic Surgery, Midwest Orthopaedics at Rush

Head Team Physician, Chicago Bulls (NBA)


Tal David, M.D.

Synergy Specialists Medical Group, San Diego, CA

Head Team Physician, San Diego Chargers (NFL)


Bert Mandelbaum, M.D.

Kerlan Jobe Institute, Santa Monica, CA

Head Team Physician, Los Angeles Galaxy (MLS), FIFA F-MARC


Key Points:

  • US Club Soccer becomes the first major US youth soccer organization to require comprehensive injury recognition for all coaches
  • The training will provide a sideline evaluation process for injury recognition, as well as specific guidelines for some injuries such as concussion, knee, and ankle
  • We believe the training will make the game safer for all kids and promote growth in youth soccer

Injuries are an unfortunate reality in youth sports, but that doesn???t mean gloom and doom. In fact, from the injury standpoint we???d say there has been no better time to be a young athlete in America than now. What? Does that sound controversial? Let???s explain.??logo

Thanks to scientific study over the last couple of decades we???ve made huge strides in proper recognition and treatment of injuries in young athletes. As recently as 20 years ago we paid far less attention to issues about overuse and burnout, medical conditions such as heat illness did not have the types of preventive strategies we have in place now, and our knowledge of the seriousness of concussion was not really on the radar. We???ve made great progress in the care and treatment of injuries to the knee and ankle. And there is a training program for soccer players that is proven to reduce lower extremity injury rates and at the same time improve performance.

One area that hasn???t received as much attention as we???d like is on-field injury recognition for youth coaches. But that is changing now too. We???d like to announce an unprecedented partnership between US Club Soccer and Sideline Sports Doc. Unprecedented because US Club Soccer is the first major U.S. youth soccer organization to require completion of comprehensive injury recognition training for their coaches in order for the coach to obtain a passcard.

The training covers serious injuries such as concussion or spine injuries, but perhaps more importantly it provides a method that the non-medically trained coach can use to evaluate just about any injury on the field. Clear, concise, reliable. The training is focused on providing practical information for the coach that results in confident injury recognition for the range of injuries commonly encountered by the youth soccer coach. We fill the gap between prevention and treatment.

We believe that proper training in injury recognition for the non-medically trained youth coach is an important piece of the overall health and wellness for the player. With US Club Soccer???s initiative we???ve taken another step forward and say again: there???s never been a better time to be a young athlete in America.





Posted in Coaches, In the News, Parents, Soccer | Leave a comment

The Multi-Sport Prescription

By Dev Mishra, M.D.

President, Sideline Sports Doc

Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • We have a strong cultural bias towards early sport specialization, with the belief that specialization from the youngest ages is the best way to achieve elite status as teenagers or young adults
  • However, early sport specialization is correlated to increased risk of sport-ending overuse injury and burnout
  • The vast majority of NCAA athletes report that they participated in multiple sports as kids and didn???t specialize until around age 15
  • A recently published scientific review article provides valuable summary recommendations as I note below, including benefits of early multi-sport participation and limitation of hours in sport per week (max hours per week= child???s age in years)

Close to 30 million adolescent and teenage kids in the United States play club or 6-17-09-7 XATHLETEScompetitive sports, and yet somehow that doesn???t translate to a lifetime of fitness. Furthermore, early sport specialization doesn???t ensure a better chance at securing elite status as young adults. I???d love to see more kids playing sports because they really want to, and then have that lead to a lifetime of strong fitness habits. I???d also like to see those kids who truly have the desire and potential to be elite athletes get the chance to develop. So how do we create a structure that encourages broad participation for most kids and elite development opportunities for those who want it? Many experts in childhood sports medicine are drawing upon their experience and published scientific literature to recommend multi-sport participation for the young athlete, and later sport specialization for the highly motivated athlete.

A recently published review article by lead author Gregory Myer in the journal Sports Health offers a number of valuable insights. There???s a very common belief that single sport specialization from a very early age (just past diapers in the case of one Tiger Woods??) is the best way to gain elite status as a teenager, or a college scholarship, or professional greatness. This may in fact be true for sports such as figure skating or gymnastics but it doesn???t appear to be true for almost all other sports, especially team sports. Retrospective reviews of NCAA athletes in several sports have shown that close to 90% of the athletes played multiple sports as a youngster and didn???t specialize in a single sport until around age 15. Clearly, it???s common for high-level collegiate athletes to come from a multi sport background.

And furthermore, there is a strong and growing body of evidence that points to single sport specialization in the young athlete as a key factor in developing overuse injuries (potentially sport ending injuries), burnout, and decreased interest in lifetime fitness.

The summary recommendations from the review article make sense, although I would point out that it would be helpful if future studies could prove a cause and effect relationship (for example, following the hours based recommendations leads to fewer overuse injuries, etc.). Here are the key points in my opinion:

  1. The youngest athletes should avoid single sport specialization and should be given opportunities for sampling several sports through free unstructured play
  2. Participants in gymnastics, diving, and figure skating should wait until early adolescence to specialize
  3. Participants in tennis, golf, and most team sports should wait until middle adolescence to specialize
  4. Participants in endurance sports, track, and distance events should wait until late adolescence to specialize
  5. Children who do participate in more hours of sport per week than their age in years and who are specialized in sport activities should be closely monitored for indicators of burnout and overuse injury

These recommendations won???t be easy to implement across the board as there is a strong cultural bias towards early specialization. But I do hope that increased awareness of the possible problems with specialization will start the conversation towards a better environment for young athletes to succeed for life.



Posted in Coaches, Parents, Prevention, Sports Science | Leave a comment

Data Can Reduce The Emotion Surrounding Concussion Policy

By Dev Mishra, M.D.

President, Sideline Sports Doc

Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • Good objective data can help guide decisions regarding concussion policy and can also help reduce the emotional intensity surrounding some of the decisions
  • Objective data specific to young athletes is hard to come by but more research is being conducted
  • We can use data on collegiate athletes to at least start our decision process and extend some of the thinking to young athletes. One good study was recently published and provides detail on concussion mechanism.

I think it will be quite a while before we are able to analyze the impact of concussions on concussion_girlsyouth sports in a less emotional and more objective fashion. In the last year or so I???ve had coaches in a number of sports who I know well and respect make exasperated comments to me. For example, a football coach stating that if we continue to take a very broad approach to concussion recognition that it will ??mean every kid who takes a hit might have a concussion and it could end the game as we know it.?? Girls??? lacrosse coaches telling me that requiring headgear on all girls would change the nature of the game and embolden more aggressive stick play, potentially increasing the number of concussions. And soccer coaches swearing to me that they???ve ??never seen a concussion caused by heading the ball.?? Each of these comments represents an interesting point with some merit. But there???s also a lot of emotion involved, these coaches generally love the game as it???s currently played and they are having a tough time adapting.

I get that. And certainly we can find comments at the other end of the emotional spectrum too but in the world of sports medicine it???s generally unwise to make ??always?? and ??never?? type statements. One way to help make measured and objective decisions is to use data to help guide us.

The data pertaining to young athletes can be very hard to come by. We are gathering a decent amount of data for professional athletes and high level collegiate athletes but that data likely will not be applicable to young athletes, adolescents, or teenagers. But we can at least start using the data available to make reasonable extensions to the youth game and help guide research specific to young athletes.

One recently published study in the American Journal of Sports Medicine sheds some light on the exact sport actions that lead to concussion in NCAA athletes.

What they studied:

The study by Zuckerman et al used the NCAA Injury Surveillance Program starting with the 2009 fall season through the 2014 spring season. 25 sports were included, for men and women. The data relies on the athletic trainers from each of the schools to accurately report injuries to the database. The study analyzed the data by sport, over time, and also examined the type of impact in the sport that caused the injury. For example, was the concussion caused by player to player contact, player to equipment contact, or player to ground contact. One aspect of this study I like is that it does get down to a granular level.

What they found:

The majority of concussions occur during competition, even though athletes spend far more time in training than competition. Some sports such as football, women???s ice hockey, and men???s lacrosse appear to be increasing concussion rates over time but for other sports the data was not clear. As far as the mechanism of concussion, that was also interesting. In women???s soccer the data showed that 11% of concussions occurred from ball contact while heading a ball. And in women???s lacrosse about 11% of concussion occurred from stick contact while defending.

This is one study, in an older group of players, with different rules and often different equipment than is used in the youth game. So there are some limitations but studies like this can help take some of the ??always?? and ??never?? out of the concussion discussion for young athletes and help guide us towards more objective decisions.






Posted in Concussions, Football, Lacrosse, Soccer, Sports Science | Leave a comment

Seven Cool New Concussion Technologies That Could Be Game Changers

By Dev Mishra, M.D.

President, Sideline Sports Doc

Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • The GE/NFL/Under Armour Head Health Challenge is an extraordinary competition designed to produce radical improvements in concussion diagnosis, safety equipment design, and materials. I believe some of the technologies could find their way to the youth sports landscape fairly soon, and I highlight some of the projects below.

Our focus at Sideline Sports Doc is on youth sports, and specifically to focus on topics of Head-Health-Challenge-II-Infographic-12.3.15interest to parents and coaches of young athletes. To start off 2016 I???d like to highlight seven very cool new technologies that have the potential to improve sideline concussion recognition for athletes in all sports, and to reduce concussion risk in football.

Collaboration between GE, the NFL, and Under Armour has been under way for several years, called the Head Health Challenge. The Head Health Challenge is a three-part competition amongst researchers and developers from universities, private industry, and the government. Part 1 of the challenge hopes to lead to methods of improved concussion diagnosis; the technologies are impressive but geared towards clinicians and are unlikely to make it to the sidelines of a youth club sport. Parts 2 and 3 however, have applications that in my opinion could positively affect every level of sport from professionals down to youth leagues.

The Part 2 winners were announced in December 2015; Part 3 winners are expected to be announced in the fall 2016. Here???s my take on the seven finalists for the Part 2 challenge, which focused on sideline concussion diagnosis and improved materials for impact absorption:

  1. Rate-dependent tethers developed by the Army Research Laboratory, Aberdeen, MD

What It Is: smart materials in flexible tethers connect the helmet to the torso. The materials are fully flexible at low speeds allowing for head movement during sport movements but they become rigid at high impact, reducing whiplash or rotational movement of the head.

Why It???s Important: there is increasing evidence that whiplash or rapid back-and-forth movement of the head is one of the main contributors to concussion. Techniques such as neck strengthening can reduce concussion risk, and an external tether would be somewhat like your airbag in your car inflating during a crash- the tethers would reduce the rapid movement of the head. Very early testing is now underway, and I see great potential for this technology even in the youngest age groups.

  1. Revolutionary football helmet design from the University of Washington.

What It Is: new testing underway to design a football helmet that can better absorb impacts.

Why It???s Important: Designs like this could be incorporated into conceivably any type of sport helmet at any age group.

  1. Viconic/General Electric shock-absorbing synthetic turf underlayer.

What It Is: a novel underlayer for synthetic turf fields can reduce impact when the head or body hits the turf.

Why It???s Important: One way to get a concussion is with an impact of the head hitting the ground. With more and more fields now made from synthetic turf, a field with better shock absorbing ability has the potential to reduce concussion risk. This technology also has great potential but I believe it will require very careful study as it may change risk of lower extremity injuries too (higher risk, lower risk, neutral risk- all will need long term study)

  1. UCLA and Architected Materials, Inc. are developing a new energy-absorbing microlattice material for improved helmet performance.

What It Is: a truly unique lattice structure material allows for shock absorption, improved airflow, and ability to modulate specific areas to reinforce.

Why It???s Important: This material has the potential to dramatically reduce impacts to the skull and brain and could be used in any application with a helmet. This could improve safety in the military, football, hockey, lacrosse, cycling, etc.

  1. Helmetless tackle training, University of New Hampshire.

What It Is: a back to the basics approach with a remarkably radical concept: if you teach proper tackling technique without a helmet and shoulder pads in practice, will it improve tackling technique during games?

Why It???s Important: this clinical study aims to get at the heart of basic concepts of muscle memory, technique, and psychology. If the researchers are able to prove their premise then I see every reason to believe their concepts could be used to teach proper tackling at every level of the game.

6 and 7. Two new methods for sideline concussion diagnosis: Emory University and Georgia Tech iDETECT system; University of Miami, University of Pittsburgh, and Neuro Kinetics Inc. I-Portal PAS System.

What It Is: each of these systems aims to utilize very subtle changes in neurologic function (such as eye movement tracking) to provide immediate diagnosis at the point of injury.

Why It???s Important: an objective, portable, and fast method of diagnosing a concussion would be an enormous benefit to trainers and physicians on the sidelines. This technology would take much of the guesswork out of concussion assessment.








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Perspectives on US Soccer???s required changes for youth heading

By Dev Mishra, M.D.

President, Sideline Sports Doc

Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

This week???s post is a little bit ??holiday light?? as I???d like to point you to an excellent video segment from San Francisco???s station KTVU.??Screen Shot 2015-12-15 at 11.51.44 AM

As expected, there has been considerable debate surrounding the US Soccer Federation???s recently recommended changes to rules about heading in practices and games for younger age groups. From my standpoint as a sports medicine doctor the changes make a lot of sense and I fully support them, while I also recognize that changes to the policy are likely to occur over the next several years as additional scientific research becomes available. It is a first step in the right direction.

I like this brief television segment as it highlights some perspectives from a youth coach, and also from Mike Woitalla, the highly respected Executive Editor of Soccer America magazine. It???s true that coaches will need to change the way they coach younger players, but it???s possible this will improve skill level in other areas of the game.

Have a look and decide for yourself. Lots of questions remain about sport concussion in young athletes, but the steps taken to make youth sports safer by US Soccer Federation, USA Football, and USA Hockey are providing a direction that is likely to stay.






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Snowboarding Injuries to the Foot and Ankle

By Adam Bitterman, DO

Fellow, Foot and Ankle Surgery

Rush University Medical Center


and Johnny Lin, MD

Assistant Professor, Midwest Orthopaedics at Rush

Rush University Medical Center

Key Points:

  • Snowboarding is growing in popularity, especially amongst young people
  • Lightweight boards with less rigid boots lead to faster speeds, with an increase in injury risk
  • Injuries to the foot and ankle with snowboarding may include fractures, sprains, and tendon injuries.
  • Most injuries can be successfully treated but will require accurate diagnosis and treatment from your doctor

As snowboarding continues to grow in popularity, so too does the number of injuries snowboardingsustained. According to a 2010 report, there were nearly 8.2 million people who snowboard versus 11.5 million who participated in skiing. Currently, there are younger and younger participants snowboarding and therefore more accidents and injuries each year. The surge in injuries from snowboarding may be due to it being a relatively new sport and the inexperienced beginners are more prone to hurting themselves. Yet, some believe that it may be the experienced snowboarder who is more at risk since they are likely to take risks and attempt to navigate more challenging slopes1.

As the sport has evolved so too has the equipment. Lightweight boards and boots have resulted in faster speeds traveling down the more challenging slopes ??? another reason for the surge in these injuries2. Less rigid boots lead to less support around ankle and foot, thus resulting in ankle and foot sprains, strains and fractures.

Landing from a jump may lead to the foot being rotated inward or outward as it sustains an upward force from the ground. These rotational forces combined with the upward force from the ground impact may result in a break. Ankle fractures may involve the tibia (shin bone) or the talus. The tibia bone may have a single break or breaks at multiple sites. The inside of the ankle, also known as the medial malleolus could be fractured or the outside may have sustained the force, which would lead to a lateral malleolus fracture. In regards to the talus bone, snowboarders are at increased risk of breaking their lateral process, commonly referred to as the ??snowboarders fracture??.

Treatment of these ankle injuries depends on the type of break and the amount of displacement of the bone pieces. Fractures with significant distance between the bone fragments are usually best treated with surgery. By doing this, the broken segments are realigned in their normal anatomic position and fixated with appropriate implants. In cases where there are small fragments or too many to address individually, the decision may be made to leave them alone and allow them to heal and incorporate in their current position. Nonoperative management may also be chosen for ankle fractures that have little to no displacement. This decision will be made in close consultation with your doctor.

Generally these injuries are rehabilitated with nonweightbearing using crutches with the length of time being dependent on the specific treatment. Functional physical therapy may be needed to help return the individual to their baseline activity level. Once again, each individual situation is different and you???ll discuss specifics with your doctor.

Injuries to the foot or ankle that do not lead to a break may be the result of overuse and repetitive stress on a particular area. These injuries can be contusions, sprains or stretching of ligaments, or strains due to tendon inflammation. Appropriate treatment will likely include a period of rest and immobilization of the painful ankle while the painful process resolves on its own.


  1. Ishimaru D, Ogawa H, Sumi H, Sumi Y, Shimizu K. Lower extremity injuries in snowboarding. J Trauma. 2011;70(3):E48-E52.
  1. Mahmood B, Duggal N. Lower extremity injuries in snowboarders. Am J Orthop (Belle Mead NJ). 2014.43(11):502-5.
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Hockey Training Tips: Off-Ice Balance Training

By Steve Chmielewski, DPT

Physical Therapist at Athletico, Westchester, IL

Key Points:

  • This blog post first appeared in Sports Medicine Weekly, founded by our partner Dr. Brian Cole
  • The author points out the need for proper balance training as part of off-ice preseason hockey preparation, to improve power and reduce injury risk especially to the knees
  • A simple single leg balance progression is outlined

Lower extremity strength training is a priority when considering a comprehensive training iStock_000014161453XSmallprogram for youth hockey players. Most coaches consider dynamic stretching, functional strengthening and plyometric training to be enough. However in a sport where agility and balance are essential it is important to consider how players can improve these components off the ice.

In the hockey community the term ??bender?? is often used to describe a player that has ankles falling inward which is known as rearfoot or hindfoot valgus. ??From a coaching and overall performance perspective, it is obvious that this is not an ideal foot position when performing a hockey stride. Power from each stride will be reduced as the player transfers his/her kinetic energy through the trunk, hips and knees into the ice effecting both the player???s speed and agility. This may have a significant impact on the player???s overall skill development when practicing edge work and stopping drills. With a lack in development, the athlete may ultimately have limited confidence pursing pucks along the boards or in congested areas of the ice. This can foster the development of a timid player who may be less likely to compete in these areas, thus further stunting his/her development and ultimately his/her long-term participation in the sport.

From a biomechanical and injury prevention perspective, a chronic weakness and malposition of the ankle may also place added stressors on the knee and lead to an increase risk for knee pain limiting his/her participation throughout the season. One can argue that the support from the boot of the skate should counter the athlete???s lack of strength, but it must be understood that the stiffness of the boot will break down over time and potentially expose the athlete???s strength deficits over time.

With 25 different muscles in the lower leg and foot one may wonder, ??How can I strengthen my ankles to better myself on the ice????? Simple single leg balance activities on the ground are a great place to start. When standing on one leg it is important to focus on keep 3 points of contact with the foot: (1) the big toe, (2) the little toe and (3) the heel. The athlete is expected to be able to hold this position for 30 seconds, 4 times, prior to adding tasks or changing the surface (couch cushion, pillow). Common tasks such as turning one???s head, closing one???s eyes, stickhandling, juggling balls, and squatting can be incorporated into the individual???s single leg stance training to improve his/her coordination.

If a specific individual is unable to maintain a neutral foot position while balancing barefoot on a flat surface, a towel can be placed under the middle half of the foot to improve the overall ankle control. It is important to note that pain during any type of balance training activity is not acceptable and should be assessed by a physician or licensed physical therapist. These conditions may require formal therapy to address specific deficits within the hips, knees and ankles to restore good balance and control.

Simple Progressions

1) Stand on one leg, eyes open on a firm surface ???> progress to a couch cushion or other unstable surface

2) Stand on one leg, eyes closed on a firm surface ???> progress to a couch cushion or other unstable surface.

3) Other activities you can attempt to master

  • Single leg stance while passing around a ball around in the locker room
  • Single leg jumps forward and backward/side to side over a line (3 sets of 10 jumps in each direction)

By Steve Chmielewski for Athletico




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Safety Rules Changes Needed To Grow Youth Sports

By Dev Mishra, M.D.

President, Sideline Sports Doc

Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • US Soccer recently recommended several changes to rules about heading the ball for younger age groups, designed to decrease the risk of concussion
  • US Soccer???s moves follow the changes implemented by other organizations such as USA Hockey and USA Football to minimize injury risk amongst the younger players
  • The theory overall is that minimizing injury risk in the youngest age groups through rules changes will keep kids playing the sport longer
  • USA Hockey is one of the few US youth sports seeing substantial enrollment increases between 2009 and 2015, with the changes in safety rules for the youngest players often cited by parents as a factor in promoting the sport for their kids
  • My opinion is that rules changes like these are necessary to grow each sport, or at the least to stem the tide of declining participation

Today???s post contains a lot of personal opinion, backed by science, data, and what I think Screen Shot 2015-11-24 at 9.03.52 AMis common sense. My guess is that my opinions will be totally dismissed by some or found to be controversial by many.

My fundamental beliefs are that lifelong exercise is critically important to the health of increasingly obese adults, and that proper sport participation as kids can lead to great habits as adults. I also believe that team and individual sports can be great for many, many kids, and that those kids who are especially gifted or motivated should be given opportunities to advance to the elite or professional levels.

The facts, however, reveal declining sport participation in almost all US team sports, as shown in the graphic. Several excellent studies have been conducted by independent organizations as well as internal data collected by sports governing groups. Parents across many sports typically cite the same negative influences in deciding which activities to cut back on:

  • Time commitments
  • Cost, especially travel teams
  • ??Professionalization?? of youth sports
  • Injury risk, especially in collision or contact sports

Rules changes designed to reduce injury risk are amongst the most effective ways to decrease traumatic injuries (such as concussion) and overuse injuries. When combined with changes addressing some of the other common concerns the result can be dramatic growth of participation. This has been proven by one of the organizations to first implement broad changes in the youngest age groups, USA Hockey.

Some of the changes included in USA Hockey???s American Development Model (ADM) include elimination of its 12 and under national championship (reducing interstate travel), ban body checking in the under 14 age groups (reducing traumatic injury risk), and even encouraging players to play multiple sports.

Five years in to the ADM we see that youth hockey participation in the US is up by 44%.

Changes such as rules on heading the ball for young soccer players are sure to create an emotionally negative response from game traditionalists- at least initially. But over time my prediction is that sports such as football and soccer will be able to use these changes to effectively stem the tide of declining participation in the same way hockey has done.

So you get to choose. Do you want to take steps to grow your sport and ensure its survival or do you want to ignore the trends and see it slowly disappear?






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After Concussion: Don???t Just See A Doctor, Be Sure To See The Right Doctor

By Dev Mishra, M.D.

President, Sideline Sports Doc

Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • It???s important to see a doctor trained in sport concussion management after a concussion. Not all doctors know about return to play protocols.
  • Appropriate doctors are typically trained in sports medicine or neurology, and web searches will usually indicate whether they have training in sport concussion. See also the link I provide in the text below for the American Medical Society for Sports Medicine.
  • You (or your child) have only one brain: treat it well and don???t take chances with returning to play before properly going through a return to play protocol

Much has been written about concussion in young athletes but today I want to devote a few words to an area not often discussed: who should the young athlete see after a suspected concussion???concussionbasketball

Most of you are likely familiar with leagues such as the NFL and NBA where athletes with a suspected concussion are required to go through a ??concussion protocol??. The protocol typically involves a clinical evaluation by a physician skilled in sport concussion management. This would include the physician evaluation, possible sophisticated diagnostics such as neuropsychiatric testing, and a gradual return to play protocol. The gradual return to play protocol exists because sometimes concussion symptoms might not be present at rest but might return with physical exertion. The protocols are designed to give the athlete the best possible chance of safe return to play.

Many of you might not be aware that most state interscholastic (meaning: high school) federations, and several national governing bodies for youth club and recreational sports also have gradual return to play protocols after a concussion. The protocols call for an initial evaluation by a physician knowledgeable in sport concussion, and then a return to play protocol that takes 5 to 7 days for an uncomplicated concussion. This is pretty much the same type of protocol followed by professional sports leagues.

The key part of the equation is seeing the right doctor after a sport concussion. Let???s start off with examples of who not to see. First off, I???m an orthopedic surgeon and team physician, and most of my orthopedic colleagues would not be the right person to see after a concussion because we will usually not be skilled in doing the neurologic testing. We are very knowledgeable in remove from play on the field, and can monitor the return to play protocol, but not good for the detailed evaluation. Next, seeing doctors who have zero knowledge of sports medicine is just a bad idea. We have seen parents who get a clearance note from their next-door neighbor who happens to be a dermatologist. Really? You???d mess with your child???s brain that way? Shame on you parents, and shame on you Dr. Dermatologist. And finally, this may come as a surprise to you but your local pediatrician or family doctor might not be the best choice either, as many of them have no idea of the gradual return to play protocols.

The types of doctors that would be good choices are usually non-surgeons who are specifically trained in sports medicine. These doctors with special qualifications in sports medicine come from a variety of medical specialties such as family practice, internal medicine, emergency medicine, or physical medicine + rehabilitation. An excellent resource to find these sports medicine trained physicians is the American Medical Society for Sports Medicine. On the lower right corner of their home page is a ??Find A Sports Doc?? search tool. Put in your zip code and a wide enough search radius and you???ll likely find an excellent choice.

In some cases such as multiple concussions, post-concussion syndromes, or other serious conditions it would be best to see neurologists or other concussion specialists at a concussion center. You???ll find these at most major universities that have medical schools.

If you???ve had a concussion I urge you not to cut corners in the return to play process. The cost of a bad decision is simply too high. See the right doctor, make sure to follow his/her instructions closely and give yourself the best chance of a successful recovery from concussion. You only get one brain. Use it wisely.











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Yes, Sometimes You Really Should See A Doctor

By Dev Mishra, M.D.

President, Sideline Sports Doc

Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • Very broadly speaking, see a physician if you have a nagging physical ailment that you???re just not sure about
  • For acute injuries on the field of play there are some ??red flag?? situations that I outline below that often need immediate evaluation
  • And finally, for ongoing problems you???ll need to be on the lookout for decreases in sport performance or chronic painful movements. These may indicate an underlying physical problem. Proper evaluation and treatment can often shorten the recovery time and improve performance while still allowing modified play during healing.

One of the most common questions I???m asked by friends or by parents of players at events girlsbasketballconcussionis ??do we need to go see a doctor??? This isn???t always easy to answer, as some simple injuries don???t need to be seen by a professional, and in other instances waiting too long to see a doctor can result in making a simple injury a potentially permanent problem. So let???s look at a few scenarios.

First: See A Physician If You Have Something You???re Just Not Sure About

I???ll start off with a very broad statement: go see a physician if you???re just not sure about something. This could literally be anything from a headache that doesn???t go away, a lingering cough, or even vague nagging joint pain. Many things are treatable, and it all starts with a diagnosis from a skilled clinician.

Second: Some On-Field Injuries Will Need Immediate Evaluation

Sideline Sports Doc is in the business of teaching coaches how to perform basic on-field evaluation of injuries. We teach about what we call The SAFE Method, which involves an assessment of the Story, Appearance, Feel, and Effort. In each of these categories are some red flags that would signal the need for immediate attention. For example, in Story, if there are complaints of significant pain, you???d be wise to see a physician immediately. Under the Appearance category you???d look for things such as immediate bruising or swelling. If either of those happens in the first minute or two, you???ll likely need to go to the local emergency room. With Feel we are asking you to press lightly on the injured area, and if this produces considerable pain with light touch that warrants immediate evaluation. And finally with Effort you???ll check for the ability of the injured athlete to move the injured area on their own. If this effort is painful or if they are unable to move the area at all then get to a physician urgently.

Third: Ongoing Pain, Discomfort, or Poor Sport Performance Could Benefit From Proper Evaluation And Treatment

This is sometimes a tricky decision. The young athlete often hides ongoing or nagging injuries from their parents or coaches out of fear that something will be discovered that keeps them out of play for an extended time. And they might be right. But more often than not, proper diagnosis will allow some treatment that can actually shorten the recovery time and at the same time allow for continued modified activity. After physician evaluation there might be treatments such as short term medication, bracing, physical therapy, or working with an athletic trainer that can really help. My advice is that if you have discomfort or pain that causes you to come out of a practice or game then you should see a sports physician. And similarly if you are noticing decreases in performance that???s not corrected by proper form or training, it could mean there???s an underlying physical problem. Good evaluation, proper treatment, and perhaps a short time off can make a huge difference in the long run.

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