CCHS Athletic trainer helps keep athletes safe, healthy and in the classroom

Diagnosis and treatment of concussions has changed dramatically in the last 10 years.The recent series that we have been running in the Central Oregonian regarding concussions presents a sometimes bleak and dangerous picture of the world of high school athletics.

Although concussions are a real part of athletics, as are other injuries, the reality is that at least in the Crook County School District athletes are safer than they have ever been.

"I think it's priceless," Crook County High School athletic director Rob Bonner said of the school having an athletic trainer on staff. "When I first got this job at Crook County High School, we had a year or so without a trainer, and that really showed me how valuable a trainer is."

Bonner noted that without an athletic trainer, he found himself making decisions about whether or not an athlete could play that he wasn't really trained to make.

"We were put in situations with kids wanting to play and parents wanting kids to play, and that's a rough place for an athletic director and coaches to be that aren't highly trained in that area," he said. "My coaches did a great job with making those calls and sitting them out and that kind of thing, but it just carries a different weight when it's coming from an athletic trainer. So after bringing Michael Estes on, I guess you could say there was this collective sigh of relief that came over the sports program."

Estes became the school's athletic trainer in 2015, following two years without an athletic trainer.

Bonner said that although coaches are all trained in recognizing and diagnosing concussions as well as a number of other safety issues, the school is better served with an athletic trainer on staff.

He added that the primary focus is on injury prevention, followed by rehabilitation.

"First, we want to focus on prevention," he said. "So he is working with kids to strengthen the body so there isn't an issue. There are a lot of times when it is a nagging little pain, and they see Michael, and he can work with them before there is an injury, so it's preventative in that regard. Then, when there is an injury, it's getting kids back to action quicker and giving the parents faith that their child is being well taken care of at school. That's a big part."

Bonner added that it isn't just local athletes who are treated by Estes, visiting athletes are treated as well.

"When we didn't have a trainer, we felt bad that we couldn't give our visitors the same type of care that they were used to experiencing at home, and now we can," he said. "So I'm very proud of that. Visiting parents can rest assured that when they are in Crook County, they are getting quality care, and Michael follows up with the injured athletes after they get back home. It's just classy, and it's the way a program should be run."

That care includes the full gamut of athletic injuries, including concussions.

With recent research about concussions indicating that they have much more lasting impact than previously thought, diagnosing and treating concussions has become an important part of athletic safety.

With that in mind, the Crook County School District has taken several steps to ensure that athletes get the best outcome possible in the unlikely event of a concussion.

When it comes to concussions, the school district starts with baseline testing of all athletes who participate in contact sports.

"It's wonderful to have a baseline test to see where they are before anything happens," Bonner said.

"All of our athletes who are in any kind of contact sport get baseline impact tested," added Estes. "In a perfect system, it's their freshman and junior years, but if someone transfers in, we get them when they transfer."

Estes added that the baseline impact test is done on a computer and is a neurocognitive test that measures short term memory using recognition of shapes, words, symbols, numbers and reaction time.

The test compares athletes to a series of norms for athletes of similar ages in similar sports.

"So they get scored. For example a freshman football player gets compared to thousands and thousands of freshman football players nationwide who take the test," Estes said. "It takes into account their grade level, what kind of student they are, how much sleep they got last night. Someone who got three hours of sleep last night according to the norms is generally not going to score as well as someone who got nine hours of sleep, so it factors all of that in and compares it to other people who fall into all of those parameters. When you look at all that data, you get a bell shaped curve, and we can generate norms based on what every other freshman football player looks like."

Athletes given the baseline impact test include football players, boys and girls soccer, boys and girls basketball, volleyball and wrestling.

Starting in the 2017-2018 school year, the school district also began testing middle school athletes.

Then, if an athlete suffers a blow to the head or there is any suspicion that there might be a concussion, the athlete goes through a series of tests before being allowed to play again.

Oregon state law requires athletes be removed from competition and be evaluated by a medical professional before they can return to participation.

If there is any doubt as to whether or not there is an injury, the athlete is automatically held out of competition.

Those tests include the SCAT5 test, or sport's concussion assessment tool fifth edition.

That test does a symptom inventory.

The next test that athletes can expect to go through is a balance test, called the Balance Error Scoring System.

"The BEST is really useful if we are a little on the fence," Estes said. "Because balance plays a pretty big role in that."

Athletes are then retested on the baseline impact test to see if there is any difference in performance on the test, as someone who has suffered a head injury would be expected to score lower on the test than they had prior to the injury.

"If we aren't sure, maybe they are acting a little funny, but they aren't complaining of any symptoms, I can send them inside, put them on the computer, retest them and compare it to their baseline," Estes said. "It spits out the norms and gives me an error value compared to their own baseline test."

If the athlete shows any symptoms at all, they are held out of both practice and games until they are cleared by a medical professional.

Individuals who can clear an athlete to resume participation include doctors, nurse practitioners, physician's assistants and psychologists.

"Our protocol is to error on the side of caution," Estes said. "The minimum is a 24-hour wait, and that's an absolute minimum, and that's if I'm not convinced that anything was weird that day, and I talked to their mom that night and talked to their mom the next day, and they attended school normally. Even then, I might make them do a sprint test. I will physically exert them, and I will try to get symptoms out of them."

He added that if there is any doubt, he will refer them to a doctor.

"The Oregon School Activities Association has a form that they require when someone does have a concussion, so I can make sure that all of our bases are covered by referring it up the chain of command to a physician."

Although there are many more individuals diagnosed with concussions today then there were just 10 years ago, Estes doesn't believe that there are actually any more injuries occurring.

Rather, he believes that recognition and diagnosis of concussions has improved.

"Ten years ago, we were still grading concussions on a level of severity based on if the athlete went unconscious on the field or how quickly their symptoms resolved," Estes said. "When I started my training eight years ago, we were still saying if their symptoms resolve within five minutes they can go back in and play right away. There has been a significant shift, and now it's 'I don't care when your symptoms resolve. If you have symptoms, you are done.'"

Estes added that the difference is because research has brought about a greater awareness of what a concussion is and what the possible long-term impacts of a blow to the head can have on the body.

"With every other injury, the younger you are, the better you heal, but that is not the case with a brain injury, and that's what a concussion is," Estes said. "A concussion is a traumatic brain injury. A young brain does not recover well from a brain injury, so we are trying to mitigate the damage, basically."

Both Estes and Bonner believe that the increased awareness and the more vigilant diagnosis and reporting of concussions make athletes safer than in the past.

"Not only does Michael work with the coaches, he works with the athlete academically as well," Bonner said. "There is a progression when a concussion happens. This isn't just athletic in nature. It's academic, so having an athletic trainer gets them back in the classroom sooner."

"There are people who will say you never had all these concussions before," Estes added. "I think we had them. We just didn't know what we were looking for. I don't think the incidents of concussions has gone up. I think the incidents of reporting it and treating it and safely removing a kid from play so they don't further injure themselves has gone up. We have just reduced the risk of further damage."

It's difficult to get an accurate picture of exactly how many athletes have suffered concussions at CCHS since Estes took over as athletic director.

What is known is that in those three years, athletes have been put into the concussion protocol 45 times. That doesn't mean that there have been 45 different students suffer concussions during athletic practices or competition.

Since the number of athletes identified by the school as being put into the concussion protocol does not include names, or sports, the 45 incidents could include the same athlete suffering more than one concussion. It could also include things that happened outside of the athletic program.

For example, an athlete who was in an automobile accident would still be diagnosed and put into the concussion protocol.

As a result, there is no way to identify exactly how many CCHS athletes have actually sustained concussions either on the athletic field or court in the last three years.

What we know for sure, is that there is an average of 15 individuals a year who have gone through the protocol. Athletes placed into the concussion protocol include both boys and girls soccer players as well as football, volleyball, wrestling and basketball. There may have been athletes from other sports as well, although more precise records are kept due to student confidentiality rules, those records are at present unavailable.

What both Bonner and Estes want people to know is that despite the best safety training and injury prevention efforts, injuries still happen, whether concussions or other injuries. Regardless of the type of injury, both say that the priority is the athlete's wellbeing.

"I just think it's important to make sure that everyone knows that we have the best interest of the kid in mind," Estes said. "We are not here to win a game. I love watching our kids win, but my number one priority is keeping the athletes safe."

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