PRE-PARTICIPATION SPORTS EXAMINATION

The upsides of Child Athlete participations in Sport, Recreation and Exercise far outweigh the negatives. There remain negatives that should be addressed. The benefits and downsides from SRE participations are included in the following discussion.

However, without the participations of Doctors and Healthcare Personnel in SRE severe legal liability risks would eventually terminate Child Athlete SRE participations.

Doctors and Health Care Personnel are in the center of the Comprehensive Model for Child Athlete Sports, Recreation and Exercise (SRE) participation and supervision and Accidental Child Athlete Injuries and Not-Accidental Child Athlete Abuse Injuries.

Doctors, Trainers and Health Care Personnel are engaged in SRE for start to finish for each and every Athlete. The following is the Comprehensive Model:

→ SIGNED PERMISSION BY PARENT OR GUARDIAN, who sign permession to participate in SRE, supervised by a Coach with the standard of care toward Athletes.
a. An awareness of this standard, which the law imposes on coaches, is a powerful tool in minimizing legal risks.
b. When coaches fail to meet this standard, they may be negligent,
c. and when coaches are negligent, they may also be liable.
d. Negligence and liability are legal terms with precise meanings in law. Negligence refers to conduct, while liability refers to responsibility for negligent conduct. Legally, a coach’s behaviour is negligent only when all four of the following elements are present:
i. There exists a duty of care towards the athlete.
ii. This duty imposes a standard of care, and, this standard is breached.
iii. Harm or loss is suffered by the athlete.
iv. The breach of the duty of care causes, or substantially contributes to, the athlete’s harm or loss.
v. The concept of negligence is founded on the notion of “reasonableness.” As adults, we are all credited with the same general intelligence and sensibility, and thus the law expects each of us to behave in a reasonable fashion when confronted with similar circumstances. [Coaches Report (1995) Vol. 2(1)]

→ Following Permeission, DOCTOR PRE-PARTICIPATION PHYSICAL – EXAM 1.
→ CLEARED ATHLETE TO PARTICIPATE IN SRE → ATHLETE READINESS

→ IF CHILD ATHLETE INJURY → DOCTOR INJURY – EXAM 2.

→ CHILD CLEARED TO RESUME SRE PARTICIPATION– EXAM 3.

→ FOLLOW-UP INJURY EVALUATIONS – EXAM 4+.

→ GAME EXAMS BY TEAM DOCTOR, attending games, on call for injuries, cell phone access

→ EMERGENCY DOCTOR EXAMS, 911 Emergcncy Action Plan, ‘Be Prepared’, Boy Scout Motto.

Athletic trainers, team physicians, physical therapists, coaches, administrators and schools all face potential liability during SRE activities.

“Common principles can be found among the laws of each state, but material differences exist in the decisions of the higher courts of each state and from state statutes.

“Everyone owes a duty of reasonable care to others in the course of their daily lives. A tort (wrongdoing) is committed when failure to act as an ordinary and reasonably prudent person under similar circumstances and cause injury to another person.

“For example, licensed Physicians, like Coaches and others, are held to the standard of care of possessing and applying the knowledge ordinarily used by reasonably well-qualified physicians in providing professional services under same or similar circumstances i.e SRE participations.

In a court decision, the court held that “colleges, private schools, and public schools have a legal duty to exercise reasonable care toward their students.

Additionally, an athletic trainer “has the duty to conform to the standard of care required of an ordinary careful trainer.”

“Courts have recognized a number of areas of potential liability in the context of organized athletic events at the high school level:
•Preparticipation physicals and screening examinations
•Providing or refusing initial medical clearance to play in any particular athletic activity
•Emergency Action Plan in case of injury
•Diagnosis and treatment of injuries occurring during the athletic activity
•Return-to-play medical decisions following assessment and treatment of injuries
•Informed consent in the context of clearance to play
•The relationship between a team physician and athletic trainer (whether certified or not) and appropriate supervision
•Recommendations for and follow-up medical care and assessments
•Inappropriate disclosure of confidential medical information, including violation of federal statutes such as Health Insurance Portability and Accountability Act of 1996 (HIPAA) and Family Educational Rights and Privacy Act (FERPA)
•Inadequate certification/training/supervision of coaches, physicians, athletic trainers, and others
[Legal Liability in Covering Athletic Events by Eric F. Quandt, JD,†* Matthew J. Mitten, JD,‡ and John S. Black, JD§ Sports Health. 2009 Jan; 1(1): 84–90]

“Most parents encourage children to play sports to help children’s self-esteem and enhance mental and physical growth and development. Parents, guardians and Athletes should be patient selecting the sports that will pay off in the long run.

“No other thing in life affords children such opportunity to develop positive character traits and to soak up many quality values as Sports does.

Here are some benefits that may come from playing Sports:
•“Kids’ character and moral principles are formed through fair play, children engaged in sports can be good role models for their peers
•Sports enables creation of friendships they otherwise might not have formed.
•Everyone understands the language of Sports [United Nations]. Sports brings Athletes together regardless of their nationality, religion, culture, or skin color.
•Teamwork and benefits of social interaction among children are best seen in sports, how to win with class, and lose with dignity.
•Competitions are opportunities to learn from their success and failure.
•Learn to respect authority, rules, team colleagues and opponents.
•Numerous studies have shown children who play sports perform better at school.
•It is also within sport that peer status and peer acceptance is established and developed.
•Sports experiences help building positive self- esteem in children.
•Helpful reducing stress and increasing feelings of physical and mental well-being, as well as fighting against juvenile delinquency, conflict and aggressive outbursts.
When children learn positive life lessons through Sports, will become honest, reliable adults who will try to help others in need at any moment.
[The Importance of Sports for ChildrenIn 2016, by administration, Novak Djokovic Foundation Apr 2015 and Apr 2015 the Novak Djokovic Foundation launched the Djokovic Scienceand Innovation Fellowship at the Center on the Developing Child at Harvard University]

As stated above there remain negatives that should be addressed. SRE adverse childhood experiences (ACEs) persist too high.

“Approximately 30 million athletes younger than 18 years and another 3 million athletes with special needs receive medical clearance to participate in sports every year.1

“The purpose of the pre-participation physical evaluation (PPE) is to maximize the health of athletes and their safe participation in sports. The most comprehensive guideline on the PPE is the 4th edition of the American Academy of Pediatrics’ PPE recommendations, which contains consensus recommendations and has been endorsed by multiple stakeholder medical societies.2

“Although studies have not found that the PPE prevents morbidity and mortality associated with sports participation,2 it may detect conditions that predispose the athlete to injury or illness and can provide strategies to prevent injuries.3
“The pre-participation physical evaluation is a commonly requested medical visit for amateur and professional athletes of all ages.

“The overarching goal is to maximize the health of athletes and their safe participation in sports. Although studies have not found that the pre-participation physical evaluation prevents morbidity and mortality associated with sports, it may detect conditions that predispose the athlete to injury or illness and can provide strategies to prevent injuries.

Doctor’s Clearance of Athletes is key. “Clearance depends on the outcome of the evaluation and the type of sport (and sometimes position or event) in which the athlete participates. All persons undergoing a pre-participation physical evaluation should be questioned about exertional symptoms, presence of a heart murmur, symptoms of Marfan syndrome, and family history of premature serious cardiac conditions or sudden death.

“The physical examination should focus on the cardiovascular and musculoskeletal systems. U.S. medical and athletic organizations discourage screening electrocardiography and blood and urine testing in asymptomatic patients. Further evaluation should be considered for persons with heart or lung disease, bleeding disorders, musculoskeletal problems, history of concussion, or other neurologic disorders. [The Preparticipation Sports Evaluation Mirabelli MH1, Devine MJ1, Singh J2, Mendoza M1.Am Fam Physician. 2015 Sep 1;92(5):371-6]

“Playing on a community or school sports team is a great way for teens to stay in shape and learn teamwork. That’s probably why more than 38 million American children and teenagers play at least one sport.

“No matter which sport your teen plays — whether it’s soccer, football, baseball, track, or martial arts — there’s always a risk of getting hurt (Accidental, Non-Preventable SRE Injuries).

“The casualties of teen sports can range from minor sprained ankles and repetitive strains, to more serious conditions like heat stroke or exercise-induced asthma.

To avoid getting hurt or sick on the field, court, and track, teens need to be prepared.

“That preparation starts with seeing a health care provider for a sports physical to make sure their bodies are ready for the season ahead and that there isn’t a family history or past medical history that requires further attention.

“Sports physical should start with a thorough medical history. The health care provider will ask about any history of illness, hospitalizations, or injuries that might prevent Athlete from playing, or that might limit the amount of activity. The Athlete should be asked to fill out a health history form as well as a questionnaire that investigates daily habits and lifestyle choices ( it asks about drug and alcohol use, among other topics). [Physical Exams and Teen Sports 2005 – 2017 WebMD]

The Pre-Participation Medical History Should Include questions and answers about:
Asthma
Shortness of breath or chest pain during exercise
Dizziness or fainting spells
High blood pressure
Excess fatigue
Diabetes
Frequent headaches
Eating disorders
Vision problems (wearing glasses or contact lenses)
Epilepsy
Past surgeries or injuries (broken bones, fractures, dislocations, or concussions)
Heart problems such as a murmur or abnormal heart rhythm
Bone, joint, or spine injuries
Skin problems
Severe allergies such as to food, pollen, or stinging insects
Liver or kidney problems
Use of certain medications including prescription, over-the-counter, illicit, and herbal medicines
A family history of heart problems or sudden death before age 50
The medical history will be followed by a physical exam, in which the health care provider will:
Measure height and weight
Take pulse rate and blood pressure
Check the heart and lungs
Check neurological function such as reflexes, coordination, and strength
Test vision and hearing
Check the ears, nose, and throat
Look at joint flexibility, mobility, spinal alignment, and posture
Screen cholesterol, obtain a hemoglobin count, and perform a urinalysis
Genital exam (to screen for hernias in males)
Immunizations if needed

“Girls may also be asked about their period, and whether it’s regular. Additional testing such as blood tests, X-rays, or electrocardiogram may be ordered during the sports physical.

“If everything checks out during the sports physical, the health care provider will give the OK to play without any restrictions. Or the health care provider might recommend certain modifications, like using special protective equipment, carrying epinephrine auto injectors for severe insect allergies, or using an inhaler if your teen has asthma.

“It’s rare for teens to be barred from playing entirely. Most health conditions won’t prevent kids from participating in sports, but sometimes they’ll need treatment and a follow-up exam in order to play. [Physical Exams and Teen Sports 2005 – 2017 WebMD]

Some believe that all SRE Pre-Participation Examinations should be completed in a Doctor’s office.

“While there are no national regulations, the American Academy of Family Physicians along with the American College of Sports Medicine, American Academy of Pediatrics and the American Medical Society for Sports Medicine recommend a complete Pre-Participation Physical Exam (better known as a PPE or sports physical) be performed at each new level of participation.

“When warranted during interim years, a review of the medical history and subsequent evaluation should be conducted as well.

“The main objective of sports physicals is to screen for conditions that may be life threatening (certain heart conditions for example) or that predispose athletes to injury or illness.

Secondary objectives are to: Determine general health and Serve as an entry point to the health care system for adolescents and Provide an opportunity to initiate discussion on health-related topics.

“The sports physical starts with completion of a history form consisting of questions about the athlete’s medical and family history. This form is reviewed by the medical provider and then a physical exam is performed.

Based on the findings from the history and exam, the athlete may be:
•Cleared for participation without restriction (most likely)
•Cleared for participation with recommendation for further evaluation or treatment
•Not cleared for participation in some or all sports, possibly pending further evaluation (rare)

“Sports physicals should ideally be performed at least 6 weeks prior to the start of practice to allow adequate time for further evaluation, treatment and rehabilitation of any identified conditions and should be performed by the athlete’s primary care physician in the medical home.

“This allows for evaluation by a provider who knows the athlete personally and who has access to the athlete’s complete medical record, making unnecessary restriction from sport less likely.

“The office setting provides a quiet environment which makes it easier to perform an accurate physical exam and provides more privacy for the athlete. Sports physicals provided by the athlete’s own physician allows for more time to discuss confidential health issues and makes it easier to coordinate care with consultants as needed for any follow-up evaluation.

“For the reasons listed above, the PPE 4th Edition (an advisory document published by the American Academy of Pediatrics with input from various medical organizations to advise providers on the best practices regarding pre-participation evaluations) recommends sports physicals be performed in the office setting. [Why Your Child’s Sports Physical Should Be Done in a Doctor’s Office
Author: Steven Cuff PUBLISHED AUGUST 9, 2016 IN: KIDS & TEENS, PARENTING, SPORTS MEDICINE 700 Children’s ‘ 700childrens.nationwidechildrens.org/sports-physical-should-be-done-doctors-office]

Doctors issue a few words of caution.

“In the world of sport and fitness, the expression or motto “no pain, no gain” is frequently used to encourage athletes to push harder, even if it means enduring pain, in order to achieve quality in their sport or profession. Without a doubt, the culture of physical fitness is built on sacrifice and self-discipline, but we must also be cautious, especially with young athletes, to use common sense when pain or injury occurs.

Playing through ‘pain’ can be extremely dangerous.

“Many young athletes are reluctant to discuss pain issues for fear of losing their chance to play, disappointing parents or coaches or even peer-pressure. In spite of pain, determination and toughness can persuade young athletes to persevere and avoid addressing an injury. It is important as adults to know what type of pain is beneficial and what type can be detrimental. Playing through pain can lead to other complications in a child or young adult’s athletic career if not properly diagnosed and treated.

“Sports and exercise are undoubtedly beneficial to a healthy lifestyle and it is common at times for pain to be associated with these activities. Beneficial pain is normally caused by overused muscles and ligaments which result in the tearing of microscopic muscle fibers. However, these tears will repair themselves, the muscle will rebuild more densely with appropriate training and the pain and soreness will disappear. Athletes are taught that in order to improve their performance, some discomfort is necessary for muscle strength to increase, but the pain involved should be short-lived.

“In some cases, over-exercising or pushing through pain can be detrimental. For this reason, coaches, trainers and parents need to recognize risk factors when young athletes complain of ongoing pain. A pain that lingers for a few days with no relief or becomes worse should be checked out by a physician. Constant pain is the body’s signal that a significant injury may have occurred. Some examples of detrimental pain include joint or ligament pain, muscle tears and micro fractures.

In the past 10 years, sports-related injuries in young athletes have been on the rise; approximately 10-15% of acute injuries treated in the emergency room involve sports. These injuries need to be addressed promptly before they become serious or chronic and ultimately sideline an athlete’s playing career.

“Untreated injuries can increase the chance that surgery will be needed to make a repair, as well as the possibility of a long-term impact on health and mobility into adulthood.

“Complete history and physical examination are of paramount importance and in most circumstances will identify the problem. However, often times the diagnosis can be elusive and the condition considered to be idiopathic in nature; pain of unknown cause.

“In the majority of cases, sports injuries are the result of excessive stress on immature muscle-bone units; the most common are sprains, fractures, dislocations and knee injuries. A sprain is most likely to occur in the wrist, ankle or knee as a result of fibers within a muscle or tendon being overstretched; it could be moderate or severe. Knee injuries may be more complicated and involve tendonitis, bursitis, synovial impingement, meniscal injury, patellar instability, contusions and even fractures. Shoulders and fingers are the most common joints to be dislocated. All of these types of injuries, however, cannot be shielded by the umbrella of “no pain, no gain.” They are serious and require proper diagnosis and treatment.

The solution is not to push through pain, but prevent pain and injury through knowledge and education. Parents and coaches need to put more emphasis on training for sports rather than using the sport to build muscle tone.

“Most important, if pain or injury does occur and it is persistent, seek medical advice immediately. Living with chronic pain certainly has no gain! [“No Pain, No Gain” Beneficial or Detrimental? Stamford HealthP.O. Box 9317
Stamford, CT 06904 February 04, 2015]

The Doctors’ Decision To Clear Athletes To Return To Play After Injury Is mandatory

Research found that “doctors give greater weight to medical and sport risk modifiers, not external factors important to teams, coaches, parents.

“The vast majority (95%) of team doctors said they would “clear” an athlete for RTP if they had no symptoms and no elevated risk of re-injury and no risk of long-term problems, and more than half (53%) would clear the athlete for play with continued symptoms or signs as long as they felt they were not of sufficient concern to place the athlete at undue risk for either re-injury or adverse long-term health problems as a result of returning.

One in four (23%), however, would still clear an athlete for RTP despite an increased risk of re-injury if there was no increased risk that RTP would have an adverse effect on the athlete’s long-term health, and a slightly higher pecentage (29%) would clear the athlete where there was no increased risk of re-injury but there was an increased risk of long-term problems.

“Within each step of the decision-based RTP model, the factors potential seriousness of injury (step 1, 36%), type of sport (step 2, 57%) and timing and season (step 3, 48%) received the highest ranking, while some factors in step 3 were selected as “not applicable” (ranging from 10% for timing and season and pressure from athlete to 45% for fear of litigation).

“At the heart of the RTP decision is the ability to assess the risk of injury to the athlete and the factors in steps 1 and 2 of the RTP decision-making model affecting this risk were generally considered important.”

That factors that reflect other athletes’ needs/desires (Step 3) were more often considered non-important to the RTP decision process, she said, “suggests that sports medicine clinicians may have a more restricted view of the ‘athlete’s best interest’ compared to the athlete him/herself.”

“If so, either the generally recommended shared decision-making process may not be applicable in some or all sport medicine contexts or would require a change in culture/legal liability framework before it could be effectively implemented,” Shultz writes.

The study demonstrated, said its authors, that “return-to-play decision making remains a complicated issue in sports medicine, as it is multifactorial in nature and affects many players, from the athlete, team, coaches, and parents,” and “most sports medicine clinicians currently believe that factors affecting risk of injury are important, but some believe that other factors of potential importance to athletes should not be considered in RTP decision making.”

“Although further data is needed to understand RTP clinical decision making,” says Shultz, “it is likely, at this point, that a more granular definition of ‘clearance’ would be helpful for quantitative analysis. [1. Shultz R, Bido J, Shrier I, Meeuwisse WH, Garza D, Matheson GO. Team Clinician Variability in Return-to-Play Decisions. Clin J Sport Med. 2. Creighton DW, Shrier I, Shultz R, et al. Return-to-play in sport: a decision-based model. Clin J Sport Med] [Doctors’ Decision To Clear Athletes To Return To Play After Injury: Wide Variability In Factors Considered By LINDSEY BARTON STRAUS, JD, Read more: http://www.momsteam.com/health-safety/wide-variability-seen-in-return-to-play-decisionmaking-by-doctors#ixzz4roB7Dt4Q

“The popularity of SRE is growing by leaps and bounds. The number of Children (age <18) and Youth (15-24 U.N. definition) participating in SRE increases dramatically each year, which increases the potential for Child Athlete Abuse Syndrome, “a new disease”. “It is estimated that 41 million+ American Children are involved in children’s SRE, a number rising significantly, according to the National Alliance for Youth Sport, (NAYS). “69% of girls and 75 % of boys in the United States participate in organized and team sports, (2008). From 2006 to 2007, approximately 7,342,910 boys and girls participated in high school sports, alone. That is not counting all other school and non-school ages participating in SRE. “In an ideal, non-corrupt sports world the practice of a regular physical activity induces benefits for both physical and psychological health. But currently, the sports world for Child and Youth Athletes is crammed-full of corruption often hidden from view. “Win-At-All-Costs” is the culprit and remains too extensive. The duty for Child and Youth Protection is paramount in all venues on every inch of earth during every second of time. [ACES To High, Esta Soler Elevates Child Trauma to National Policy Stage, by The Chronicle of Social Change, Dec 8, 2015] [SPORTS’ ADVERSE CHILDHOOD EXPERIENCES ARE TOO HIGH December 12, 2015 by admin. http://www.cappaa.com/sports-adverse-childhood-experiences-are-too-high] Coaches, the administration and the fans need the chutzpah to lose, for the sake of integrity, with dedicated, self-disciplined, well-conditioned student athletes, who have the stamina and can finish in the 2nd half of the game, rather than recruit and support other reputation kinds, for the sake of their abilities, who, instead, wilt in the 2nd half. Many factors punctuate college football today. Excessive alcohol use during season accompanied by “partying” and misbehavior has become a severe problem among SEC athletes. According to an unofficial athlete arrest count, tallied from 2010-2012, Missouri had 18 arrests, not counting two coaches’ arrest for DWI. Vanderbilt had the fewest with only 1 in that span: Florida (17), Georgia (15), Arkansas (12), Ole Miss (11), Auburn and, Kentucky (9 each), Alabama (7), LSU (6) and Mississippi State, South Carolina, Texas A&M, Tennessee (5). [By Hank Rippetoe, The Times-Picayune, on Jul 1, 2013, NOLA.com] “Football coaches say they are struggling with the Marijuana epidemic among football recruits. [College football coaches grapple with marijuana ‘epidemic’, by Edgar Thompson, Brendan Sonnone, Shannon Green, Orlando Sentinel, Nov 24, 2015] The D-1 college football culture has changed from years past. The problems are multifactorial. The athletes now demand freedoms, possibly imagined in the past, but not acted-out by athletes in those days. It appears that the football culture needs to return to an Athlete Centered Sport with predominately respectable Athlete, Coach and Athletic Community integrity. “Many coaches say athletes enter college addicted to the drug that they’ve seen widely used in many of their communities or, in some cases, even in their homes. Florida State Coach Fisher said “he hopes he can make it clear to his athletes that they simply have to stop smoking marijuana in college.” “You’ve got to prevent it,” Fisher said. “You’ve got to help the ones you do (see test positive). … Where they come from, a lot of times it’s accepted. You’re trying to help someone, not throw someone out. You can catch anyone doing anything anytime you want to, but it’s about helping educate those kids and getting a better life for themselves.” So, some coaches are not fully disciplining their athletes who break the rules. Has the D-1 football culture become a culture of marijuana addicts and have coaches become quasi rehabilitation officers and drug court judges, who risk losing with athletes, who violate rules, in hopes of winning addicted recruits, who might possibly make a big play? Credible research should be initiated. Coaches, the administration and the fans need courage and boldness and risk losing games with self-disciplined, student athletes for the sake of athletes “going long” setting moral, self-disciplined conduct, leadership standards. [College football coaches grapple with marijuana ‘epidemic’, by Edgar Thompson, Brendan Sonnone, Shannon Green, Orlando Sentinel, Nov 24, 2015] Great mentally tough athletes with proper attitude for sports • are able to play hard, smart and tough the entire game • are able to lead their teams to victory in the 4th quarter and championships • honorably finish every game and every season, giving their all for the team and coach • exemplary human beings • dedicated, committed, self-sacrificing athletes • dedicated and committed to the Sport • persevere when times are difficult • devoted to their Mentor Coach, the team and themselves • willpower is insurmountable • overwhelming real, true grit and leadership • self-discipline and self-control • self-sacrificing • are able to play aggressively • don’t smoke, drink alcohol, break rules, keep late housr and thus don’t waste their performance physicality and fritter away their opportunity in sports • always in Great Physical Condition • maintains strict physical shape, stays in excellent shape year round • doesn’t smoke tobacco and marijuana • doesn’t drink alcohol • gets plenty of Rest and eat Nutritious Foods and Drinks • seize every moment to stay in top condition • keep their mouth shut, don’ trash talk and “let their balling do the talking” • When the Going Gets Tough the Mentally Tough get going • and the million dollar athletes and other athletes with 10¢ attitudinal brains stops going. Its on the athlete. “Great Athletes desire to be a player in something bigger than self, part of a successful team. The athlete places team victory first before personal achievement, while aware of the team’s success with the help of his/her personal accomplishments. They are exceptionally diligent. They are very persistent about their Sport and thoroughly and meticulously work-out and practice and perfect their skills and assignments. Great Athletes come with self-Motivation, Drive, Inspiration, Purpose, and Goals. Athletes know that they “can’t soar with the Eagles if they hoot with the Owls all night.” Athletes’ main competition comes from within. Each Athlete’s body is unique. No other individual has the same body, same skills or the same DNA and Genome. The inner challenge is to maximize one’s ability with the body equipment for which they have been blessed. Mastering the inner challenge of how the Athlete does it better in Sports than others and defeats opponents during competition is extremely rewarding and intensifies the love-of and passion-for the game. Inner drive is monumental compared to the Coach driving the Athlete. Defining and delivering the Athlete-self is further strengthening and rewarding. Coach Pat Summit, former UT women basketball head Coach said you can’t beat trust into an Athlete; you have to Earn their Trust. “Trust is the Core of Coaching. The mentor does not have to be an employed athletic coach but a parent, friend, minister or another confidant. Naturally it is better if the mentor is the designated athletic coach of the sport in which to participate. “The nucleus of Mental Toughness is the Athlete’s Mentor Coach and his or her Coaching Philosophy. The Coach must cultivate respect in themselves and then EARN respect from the athletes and others around them. Thus the formulae for “Going Long”: SPORT BUILDS GOOD CHARACTER WHEN GOOD CHARACTERS COACH, PARTICIPATE-IN AND SURROUND THE SPORT. [SPORT BUILDS GOOD CHARACTER WHEN GOOD CHARACTERS COACH, PARTICIPATE-IN AND SURROUND THE SPORT. COACHING ATHLETE SAFETY 1ST, PUBLIC DISPLAY OF GOOD BEHAVIOR BY ATHLETES on November 30, 2015 by admin] [Coaching carousel tracker: Every head coach hiring, firing by SI Wire] Going into Athlete participations in Sports, Recreation and Exercise (SRE) Activities, a few motivational dogmas and beliefs are due consideration. Early sport specialization is one dogma. Abstract: “Early sport specialization is not a requirement for success at the highest levels of competition and is believed to be unhealthy physically and mentally for young athletes. It also discourages unstructured free play, which has many benefits. “The primary outcome of this think tank was that there is no evidence that young children will benefit from early sport specialization in the majority of sports. They are subject to overuse injury and burnout from concentrated activity. Early multisport participation will not deter young athletes from long-term competitive athletic success. “Conclusion: Youth advocates, parents, clinicians, and coaches need to work together with the sport governing bodies to ensure healthy environments for play and competition that do not create long-term health issues yet support athletic competition at the highest level desired. [AOSSM Early Sport Specialization Consensus Statement Robert F. LaPrade, MD, PhD, Julie Agel, MA, ATC‡, Joseph Baker, PhD, April 28, 2016] PTSD is another consequence. “The part of the brain that helps control emotion may be larger in people who develop post-traumatic stress disorder (PTSD) after brain injury compared to those with a brain injury without PTSD, according to a study released today that will be presented at the American Academy of Neurology’s Sports Concussion Conference in Jacksonville, Fla., July 14 to 16, 2017. “Many consider PTSD to be a psychological disorder, but our study found a key physical difference in the brains of military-trained individuals with brain injury and PTSD, specifically the size of the right amygdala,” said Joel Pieper, MD, MS, of University of California, San Diego. “These findings have the potential to change the way we approach PTSD diagnosis and treatment.” “In the brain there is a right and left amygdala. Together, they help control emotion, memories, and behavior. Research suggests the right amygdala controls fear and aversion to unpleasant stimuli. For this study, researchers studied 89 current or former members of the military with mild traumatic brain injury. “People who suffered a concussion and had PTSD demonstrated a larger amygdala size, so we wonder if amygdala size could be used to screen who is most at risk to develop PTSD symptoms after a mild traumatic brain injury,” said Pieper. “On the other hand, if there are environmental or psychological cues that lead to brain changes and enlargement of the amygdala, then maybe such influences can be monitored and treated.” To learn more about the AAN’s Sports Concussion Guideline and access resources, visit https://www.aan.com/concussion. [PTSD May Be Physical and Not Only Psychological Press Realease, July 11, 2017 American Academy of Neurology, visit AAN.com ] The Pre-participation Sports Evaluation is key before Athletes participate in SRE>

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