The BFS perspective on how to deal with injuries to young athletes
Sports Medicine The BFS perspective on how to deal with injuries to young athletes In January physical therapist Nick Liatsos gave a seminar at the Poliquin Strength Institute called “Accelerated Healing from Sports Injuries: The Lower Back.” At this seminar trainers and coaches were exposed to many advanced forms of sports medicine techniques, including microcurrent therapy (MCT). A remarkably versatile treatment that involves applying precise frequencies of electrical current matched to the specific tissue and injury, MCT was examined in the January/February 2005 issue of BFS magazine.
ith budget cuts and decreasing numbers of parents who have time to volunteer to help, the responsibilities of coaches in middle schools and high schools have increased enormously. A coach will wear many hats, from sports coach to strength coach to equipment manager to sports administrator. But one hat the coach should not try to wear is that of doctor. With higher levels of sports competition come greater risks. Case in point: cheerleading. Acrobatic gymnastic lifts, along with tumbling and throwing fliers, have increased the physical demands on competitive cheerleaders.
A study published in 2008 that looked Wat sport injuries in 2007 concluded that although only three percent of the girls in high school were cheerleaders, they suffered 65 percent of all catastrophic sport injuries among young women in high school. Sports liability expert Dr. Marc Rabinoff, professor of human performance and sport at Metropolitan State College of Denver, has served as an expert witness in several cases in which cheerleaders suffered permanent injuries; in two of these cases the girls became paralyzed. Says Dr.
Rabinoff, “Cheerleading has become the numberone cause of injuries in young women, and the severity of their injuries can be as bad as anything you would ever see on a football field. The problem is that cheerleaders are performing increasingly difficult gymnastic stunts and movements, and many cheerleading coaches are not adequately trained to teach these skills.” This is the dilemma: There is a high level of competition resulting in a greater risk of injury, but there is also a lack of funding to provide optimal sports medicine care. What can coaches do in preventing or responding to accidents, and what can they not do?
Let’s examine this problem in three parts: standard of care, privacy issues and injury rehabilitation. SEPTEMBER/OCTOBER 2010 Emergency Care Coaches should have forms on hand to document the details immediately after an accident occurs. Further, all coaching staff and assistants need to know the school’s emergency plan to deal with serious injuries, including the location of local hospitals and emergency rooms. Knowing that the details of an accident were carefully documented and that a school had an effective plan for dealing with an injury is a significant deterrent to a plaintiff pursuing a lawsuit.
One of the most common reasons coaches get sued is related to duty, which in the context of this discussion is the concept that one person has a special responsibility for the safety of an individual. Says Rabinoff, “In a lawsuit, the plaintiff first needs to establish that the defendant had a duty to him or her at the time of an injury. No duty, no lawsuit. If a duty is established, the next step is for the plaintiff to show that the duty was breached and that the injury was a result of the actions of the defendant. Then the plaintiff must show that the breach actually happened at that facility, a legal concept known as proximate cause.
Finally, the plaintiff must prove that there were damages.” It is reasonable to expect coaches to have a duty to provide emergency care for athletes in the areas of CPR and first aid. It is also expected that coaches will be certified in these skills and keep their certifications current. Regarding waivers, Rabinoff says a US citizen cannot waive their right to sue, but most likely it’s not going to provide a coach with any legal protection – in fact, Rabinoff says that waivers had been signed in a majority of the 400 lawsuits in which he has testified.
Sports liability expert Dr. Marc Rabinoff is a professor of human performance and sport at Metropolitan State College of Denver. He has testified in over 400 lawsuits in the areas of athletic and physical fitness training.
Injury Rehabilitation If a student is enrolled in a physical education class or a school sports program, what should a coach or physical education instructor do when they are told that the student had a previous injury? According to Rabinoff, the first step is to acquire documentation from the school’s athletic trainer, if one is available, or the student’s doctor that explains the exact injury, the mechanism that caused it, the prognosis and what the healthcare providers recommend for dealing with it. One conclusion might be, unfortunately, that this student may not be allowed to participate in a sport or certain forms of strength and conditioning due to this pre-existing condition.
Ideally, you want to have some form of documentation from a medical expert that the injury in question has been sufficiently rehabbed. Otherwise, if you start training this student, then your actions fall into the category of performing rehab. There is a difference between preparing a student for a sport and rehabilitating a bodypart that has been damaged. They are two different training regimens, and each requires different approaches and qualifications for those prescribing and supervising these workouts. But unless a coach is certified or licensed to do rehab, then he or she should not be prescribing such exercises for a student.
“I have seen coaches and PE teachers on trial for similar actions, and even though they may keep their positions or be reassigned in the system, their names have been forever tainted with a negligence conviction from a jury verdict,” says Rabinoff. “The last thing a coach or PE teacher wants is to have a jury find from the evidence that their negligence caused injury to a student.”
Privacy Issues A coach may have an interest in an athlete’s medical history to guide their training, especially in the areas of strength and conditioning, but he or she is not entitled to their medical Coaches and physical education instructors must know how to adjust their programs as athletes mature. Team BFS member David Kandel recently turned 13 years old – these two photos were taken seven weeks apart. records. There are federal laws that protect an individual’s right to keep their medical records private (from HIPAA, the Health Insurance Portability and Accountability Act).
Says Rabinoff, “If the parents of this athlete agree to show you their child’s medical records, that may be one exception (unless the athlete is older than 18, in which case the athlete would have to give his or her consent), but you cannot coerce your athlete to bring you their medical records. Just this one mistake alone could be grounds for a lawsuit against you and your school, and administrators could risk losing their jobs from violating the law in such a manner.” Even if you did have access to medical records, you’d still have to answer the question of how you are qualified to interpret them. Do you have a medical degree?
Says Rabinoff, “I have testified in many cases in which coaches and personal trainers were extremely embarrassed when opposing counsel confronted them with this very question. For example, if you read a notation in some medical records that an athlete had spondylolisthesis, would you be able to understand the different ratings and types of this condition: grade 1 vs. grade 2, anterior vs. posterior? Or if you read where the athlete had scoliosis, would you be able to explain to a jury the difference between thoracic curve scoliosis and lumbar curve scoliosis?”
Although a coach’s intentions may be good, he or she cannot afford to be ignorant of the proper way to deal with an athlete with a pre-existing injury. More importantly, knowing how to properly handle such a situation is in the best interests of the athlete’s safety. And although you may not be able to avoid a lawsuit, you can win if you show you performed your job according to the current standards of care of your profession. Regardless of how well an athlete is trained or the level of their sport skills, athletes will get injured. Such is the nature of sport.
But professional coaches and physical educators need to understand their responsibilities in dealing with these injuries so that athletes can recover and then continue to progress to higher levels of athletic achievement.
Coaches have their athletes stretch to improve performance and prevent injuries. Fascial Stretch Therapy™ is an advanced stretching method that involves placing an individual on a treatment table and moving their limbs though various ranges of motion. The advanced program was developed by Ann Frederick, shown here at the Poliquin Strength Institute, and her husband, Chris.
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From BFS Magazine — September/October 2010. Part of the BFS Magazine Archive (1980–2014).
