Athletic Parents Meeting

1. Athletic Parents Meeting May 21, 2008 7:00pm-9:00pm Sarah E. Sander, MS, ATC, PES Debra Keppler, RN, BSN

2. PIAA Comprehensive Initial Pre-Participation Physical Evaluation • Member schools may rely upon a comprehensive initial pre-participation physical evaluation preformed by a licensed physician of medicine or osteopathic medicine and certified to on the PIAA Board of Directors recently adopted PIAA Comprehensive Initial Pre-Participation Physical Evaluation form. May 25, 2006; PIAA Board of Directors approval on amendment to ARTICLE V, HEALTH, Section 1, Pre-Participation Physical Evaluation Necessary Before Student Begins Practice, of the PIAA By-Laws

3. PIAA Comprehensive Initial Pre-Participation Physical Evaluation • A re-certification is required, for each subsequent sports season, if the student (a) suffers an illness or injury which renders the student unable to participate in 25% or more of the Regular Season Contests in the immediately preceding sports season; and/or (b) suffers an illness or injury which resulted in absence from school for ten (10) or more days and/or which requires surgery. May 25, 2006; PIAA Board of Directors approval on amendment to ARTICLE V, HEALTH, Section 1, Pre-Participation Physical Evaluation Necessary Before Student Begins Practice, of the PIAA By-Laws

4. CIPPE • Prior to any student participating in Practices, Inter-School Practices, Scrimmages, and/or Contests, at any PIAA member school, the student is required to complete a physical evaluation. • A student completing a CIPPE need not have a re-certification for a period of twelve (12) months, unless the student suffers a serious illness or injury within those twelve (12) months.

5. Old (PPE) 1 full physical by MD or DO per athletic year Re-certification by physician required for ALL subsequent sports participated in during same athletic year, regardless of illness or injury New (CIPPE) 1 comprehensive physical by MD or DO per athletic year Only need a re-certification by physician IF illness or injury occurs that results in 25% of contests missed or 10 days of school missed and/or which requires surgery Pre-Participation Physical Exam

6. CIPPE • Sections 1 and 2 must be completed by parent/guardian • Section 4 must be completed by a licensed MD or DO • Sections 1, 2, and 4 must be turned into the school for retention of the school • Upon completion, Section 3 may be retained by the student and/or the student’s physician

7. Review CIPPE forms • Schedule for 2008-2009 physicals (Thursday, July 24, 2008): • 8am-10am: Fall boys sports • 10am-12pm: Winter and Spring boys sports • 1:30pm-3:30pm: Cheerleading and Fall girls sports • 3:30pm-5:30pm: Winter and Spring girls sports

8. Concussions • What is a concussion? • A concussion is a disturbance in brain function that occurs following either a blow to the head or as a result of the violent shaking of the head that may or may not result in a loss of consciousness • Approximately 300,000 sport-related concussions are REPORTED in the US each year • An estimated 1.6 to 3.8 million sports-related concussions occur each year. Many concussions go unreported or unrecognized by certified athletic trainers and physicians CDC Physicians TookKit, 2007 (In Press); Langlois, Collins, Gioia, Mitchko

9. Concussions • Athletes who suffer 1 concussion are 3-6 times more likely to suffer a 2nd • Lingering or lasting effects from concussions have been found in the high school population • Younger athletes may be more vulnerable to long-term effects than older athletes

10. Concussions • What happens as the result of a concussion? • The brain is injured as the result of impact with the skull • Causes bruising, stretching/tearing of blood vessels (hematoma), and/or stretching/tearing of nerve axons/neurons • Natural development of brain (growth and learning) can become disrupted

11. Signs Appears dazed Confused about play Moves clumsily Answers questions slowly Personality/behavior changes Forgets things prior to hit (retrograde amnesia) Forgets things after hit (anterograde amnesia) Loses consciousness Symptoms Headache Nausea Balance problems Double vision Sensitivity to light Feeling sluggish Feeling foggy Change in sleep pattern Cognitive changes Concussions

12. Second Impact Syndrome • Occurs after an athlete suffers a concussion and returns to play too early • Shown to occur up to 14 days post-injury • Catastrophic increase in intracranial pressure • Occurs in athletes <21 years old (only occurs in kids!) • Mostly occurs in adolescents because the brain is not fully developed yet, leaving it vulnerable • Almost always fatal! If not fatal, causes permanent dysfunction

14. Post-Concussion Syndrome • Lingering symptoms that continue to affect day-to-day life • May continue for months or years after initial injury • Signs: decreased processing speed, short-term memory impairment, concentration deficit, irritability/depression, fatigue/sleep disturbances, general feeling of “fogginess”, academic difficulties

15. Concussion Management • Remove athlete from competition/participation • Monitor symptoms overnight. If symptoms become more severe or new symptoms develop, take to ER immediately! • Overnight, wake every few hours to monitor symptoms • Do not give pain medication within first 48 hours of injury! • Masks symptoms, making it impossible to monitor symptom severity

16. Concussion Management • Take ImPACT test (compare to baseline test) • See physician • CT scan/MRI will often come back negative. Does not mean that no injury occurred! • All concussions should be evaluated by a physician… • Only 10% of concussions result in a loss of consciousness (LOC)—many athletes who don’t experience LOC have long-term problems • Concussions usually have a waterfall effect • Symptoms last longer with each concussion suffered

17. Concussion – Return to Play • ImPACT results return to normal (as compared to baseline) • Symptom-free, and symptoms do not return with exertion • Headache usually most lingering symptom • Clearance from physician • Process usually takes a minimum of 7-10 days

18. Concussions • How can athletes avoid concussions? • Proper technique • Full attention during practice • Unable to fully prevent this injury from happening

19. Concussions - Research • One study showed that 19% of athletes who did not report concussion symptoms still demonstrated impairments • May be motivated to minimize or under-report symptoms to be able to participate in practice or competition

20. Skin Diseases and MRSA • Any skin disease can occur in almost any sport • The best prevention is proper hygiene (particularly frequent hand washing), cleaning and covering all cuts/scrapes, and frequent and proper cleaning of all equipment

21. Skin Diseases - Impetigo • Bacterial infection • Easily spread by contact with the infected area, contact with items that contacted the infected area (towels, clothing, etc.) • Signs/symptoms: blisters or sores on the face/hands, blisters may become yellowish-brown and crusty • Treatment: antibiotics (complete entire prescription!); non-contact participation for 48-72 hours (as directed by physician), cover all areas when return to participation • Prevention: good hygiene, don’t share personal items, keep cuts, rashes, etc. clean and covered during practice/competition

22. Skin Diseases - Impetigo

23. Skin Diseases - Ringworm • Fungal infection; AKA athletes foot, jock itch, etc. • Easily spread—can get from animals (cows), contact with infected area, contact with infected person before symptoms appear, contact with surface or object that the infected person touched • Signs/symptoms: red and round with a distinct border (usually white); yellow crusty areas sometimes develop. Symptoms don’t usually occur until 10-14 days after exposure—contagious before outbreak! • Treatment: anti-fungal medicine (Lamisil, Tinactin), topical or oral • Prevention: get appropriate treatment immediately, do not share personal items, good hygiene

24. Skin Diseases - Ringworm

25. Viral infection Fever, sun exposure, stress can cause recurrent outbreaks Easily spread by direct contact with affected area Signs/symptoms: cluster of honey-colored bumps with red base, may feel tingling or irritation prior to outbreak. Symptoms appear 2-7 days after exposure Treatment: culture lesions to determine of area is contagious, Valtrex lessens severity of outbreak Must be cleared by physician to return to participation Prevention: no participation with active sites, clean all mats and common areas, proper hygiene, Valtrex *May take Valtrex prior to large tournament or camp to prevent contamination/outbreak Skin Diseases - Herpes

26. Skin Diseases - Herpes Herpes gladiatorum (mat herpes) Herpes Zoster  (shingles) Herpes Simplex I  (cold sores)

27. Community-Acquired Methicillin Resistant Staphylococcus Aureus (CA-MRSA) • Bacterial infection that is resistant to penicillin, amoxicillin, methicillin, etc. • Rapidly progressing bacteria that attacks the soft tissue areas of the skin and can become systemic by entering the blood stream (endangers joints and vital organs) • Many people are carriers, but it can only enter the body if there is a disruption on the skin (cut, scrape, rash, etc.)—important to keep all these covered during participation!

28. CA-MRSA

29. CA-MRSA • Signs/symptoms: looks like a spider bite, area becomes red and hot, pustules, red streaking around area, longer than normal healing time, unusual or unexplained pain or sensitivity, hardness around area • Will appear in an area that has/had a skin disruption—mat burn, ingrown hair, cut, scrape, rash, etc.

30. CA-MRSA • Treatment: • Must see physician!! Will usually culture the site and prescribe a very strong antibiotic • Keep all suspected areas covered with a dry, clean bandage • Use an antimicrobial proven to kill MRSA to disinfect common areas of house, locker room, common room, etc. • Evaluate vitals and observe infected area daily

31. The most effective and inexpensive treatment PROPER HYGIENE is KEY!!! Wash hands frequently or use an alcohol-based hand sanitizer Cover all skin disruptions Shower after every practice/competition BEFORE leaving the facility DO NOT share personal items (razors, towels, bars of soap, etc.) Wipe down ALL equipment after each use (especially head gear and shoulder pads) Wash practice clothes after each practice in HOT water and detergent, dry on HOT Let equipment fully dry before next use (DON’T LET IT SIT IN A GYM BAG—dark, moist area perfect environment for bacteria to grow and multiply!) CA-MRSA—Prevention

32. Nutrition • Athletes require more energy and water than non-athletic teens • On average, an athlete needs up to an extra 2,000 calories each day compared to non-athletic teenagers • The extra calories should come from eating extra servings from the vegetable group and the bread, cereal, rice, and pasta group • Contain a lot of starch, an excellent source of food energy

33. Nutrition • A well-balanced diet, consisting of foods from all the different food groups, should provide all of the nutrients your child needs to stay healthy and maintain the high energy level required for athletics • Should not need to take vitamin or mineral supplements (unless prescribed by a physician) or protein supplements

34. Nutrition • What to eat before a game: • Eat meals high in starch (pasta, baked or sweet potatoes, rice, etc.) 24-48 hours before competition • Eat breakfast the morning of competition • Should eat an easily-digested meal (higher in starch) no later than 3 hours before competition—avoid foods that contain lots of fats and oils (harder to digest) • Avoid candy or honey—cause rapid swings in blood sugar, resulting in lower energy levels

35. Nutrition • At all day events (tournaments/track meets) • Consume several high-starch mini-meals or snacks, along with lots of fluids • Other tips: • Eat snacks high in carbohydrates, and don’t forget to snack before bedtime (keep energy levels up) • Select meals containing all 5 food groups—our bodies use the nutrients better when consumed together

36. Hydration • Misconception: Athletes need less water • Truth: Conditioned athletes need MORE water • Able to store and burn more energy in shorter time • The body releases more heat, requires more cooling, loses more water, and needs more water to replenish its stores • May have an increased sweating response

37. Hydration • If the body is low on water: • The body can overheat • Losing 1-2% can hurt performance • Losing 5% can cause heat exhaustion • Losing 7-10% can result in heat stroke and death • By the time you feel thirsty, you may have already lost 1-2% of your water

38. Hydration • Dehydration causes both short- and long-term threats to your health: • Short-term: body’s cooling system can’t work properly, leading to heat exhaustion or heat stroke • Long-term: repeated episodes of dehydration can be damaging to the kidneys

39. Hydration • Dehydration primarily causes poor endurance and poor performance • You cannot rapidly drink and immediately regain optimal performance • It may take up to 24 hours before your body completely rehydrates, and optimal performance is reached • Caffeine acts as a diuretic and can increase the time to dehydration. Do not use caffeine before, during, or after practice/competition to rehydrate!!

40. Hydration • Guidelines/Tips for staying hydrated: • Don’t wait until you are thirsty to drink water • Drink more than enough to satisfy your thirst • Drink more than you think you need before an event or practice to make sure you are fully hydrated or rehydrated • Drink moderate amounts of fluid frequently during activity • Drink plenty of fluids after activity to rehydrate

41. Hydration • More specific drinking guidelines: • Drink at least 2 cups (16 oz) 3 hours or more prior to competition • About 15-30 min prior to the start of competition or practice, drink a cup (8 oz) or more of fluids • During activity, drink 6-8 oz of fluid every 15-20 min • After activity, drink back your body weight lost during activity to ensure complete rehydration • Cool water is the best—helps absorb body heat and empties out of the stomach at a faster rate, allowing it to be absorbed into the body more quickly

42. Hydration—Sports Drinks • When activity lasts 1 hour or more, sports drinks may be advantageous for both carbohydrate and electrolyte replacement • Should have less than 80% total solids (sugars and electrolytes)—more concentrated solutions can delay fluid absorption • Avoid drinks that contain fructose as the only source of carbohydrate  may lead to an upset stomach, must first be converted to glucose before it can be used as energy, delaying its use as an energy source

43. Hydration—Energy drinks • Red Bull, Monster, Amp, Jolt, etc. • Contain high concentrations of sugar and caffeine—slows the body’s ability to absorb water • Energy drinks have been associated with death in athletics • An 18-year old died after playing a basketball game after consuming 4 cans of Red Bull • Causes increased heart rate, increase in blood pressure  add in adrenaline and the effects of exercise (increased heart rate and blood pressure), there is a very high risk of heart attack, even in youth and teens

44. The End Questions?

45. References • PIAA: www.piaa.org • ImPACT: www.impacttest.com • NWCA Optimal Performance Calculator: www.nwcaonline.com • University of Illinois Extension: Sports and Nutrition: The Winning Connection: www.urbanext.uiuc/hsnut/ • Gatorade Sports Science Institute: www.gssiweb.com