how coaches can work with medical providers to get athletes back in the game
WIAA RULES 17.11.1 D. A written statement by the examiner as to the fitness of the student to undertake the proposed athletic participation, together with suggestion for activity modification if necessary. 17.11.4 To resume participation following an illness and/or injury serious enough to require medical care, a participating student must present to the school officials a written release from a physician licensed to perform physical examinations as listed in 17.11.2 and/or a dentist t as applicable.
Communicating i with ih medical providers
The usual note from the medical provider: To Whom It May Concern: The above named patient may return to: Limited work activity on: Full work activity on: Limited athletic activity on: Full athletic activity on: School on: Other:
FERPA and HIPAA
FERPA DEFINITION OF AN EDUCATION RECORD
HIPAA: Communication with family: Health professionals, using their best judgment, may disclose to a family member, other relative, close personal friend or any other person you identify, health information relevant to that person's involvement in your care or payment related to your care
Communicating i with ih athletes and parents
Release forms are the backbone of both HIPAA and FERPA, and can legally be required by schools as a precondition for participation. Without release forms, there's very little information a HIPAA institution can legally disclose beyond the immediate healthcare community. But with properly written, attorney approved forms, there's virtually it no limit it to the authority an athlete t can give a school to release information.
STUDENT ATHLETE AUTHORIZATION/CONSENT FOR DISCLOSURE OF PROTECTED HEALTH INFORMATION I, (PRINT STUDENT ATHLETE NAME) hereby authorize the University of Utah Health Sciences Center and its hospitals, clinics, physicians, and other health care providers to disclose my protected health information and any related information regarding any injury or illness that may affect my participation in high school athletics ( Health Information ) to the University of Utah Orthopaedic Center Outreach Program and it s administrators, athletic trainers and/or staff, as well as on a need to know basis to high school coaches and administrators. I understand that the Health Information disclosed pursuant to this authorization will be used by these individuals and entities to make decisions regarding my athletic ability and suitability to compete while I am a student athlete I understand that my Health Information is protected by federal regulations under the Health Insurance Portability and Accountability Act (HIPAA) and may not be disclosed without my authorization under HIPAA. I also understand that once my Health Information is disclosed to a person or entity who is not governed by federal privacy regulations (for example, a high school coach) that my Health Information will no longer be protected by federal privacy regulations. The University of Utah Sports Medicine Outreach program understands that your medical and health information is personal. Protecting your health information is important. We follow strict federal and state laws that require us to maintain the confidentiality of your health information. This authorization/consent expires upon graduation and/or when I am no longer involved in high school athletics. However, I have the right to revoke it in writing at any time by sending written notification to Director of Sports Medicine Outreach, 590 Wakara Way, SLC UT 84108. I understand that a revocation takes effect on its request date and does not affect any action taken prior to that date. Student Athlete Signature DATE Parent/Guardian Name Parent/Guardian Signature DATE
Return to Play Progression (concussion) Baseline (Step 0): Rest As the baseline step of the Return to Play Progression, the athlete needs to have completed physical and cognitive rest and not be experiencing concussion symptoms for a minimum of 24 hours. Keep in mind, the younger the athlete, the more conservative the treatment. Step 1: Light Aerobic Exercise The Goal: only to increase an athlete s heart rate. The Time: 5 to 10 minutes. The Activities: exercise bike, walking, or light jogging. (Absolutely no weight lifting, jumping or hard running.) Step 2: Moderate Exercise The Goal: limited body and head movement. The Time: Reduced from typical routine The Activities: moderate jogging, brief running, moderate intensity stationary biking, and moderate intensity weightlifting Step 3: Non contact Exercise The Goal: more intense but non contact The Time: Close to Typical Routine The Activities: running, high intensity stationary biking, the player s regular weightlifting routine, and non contact sport specific drills. This stage may add some cognitive component to practice in addition to the aerobic and movement components introduced in Steps 1 and 2. Step 4: Practice The Goal: Reintegrate in full contact practice. l Step 5: Play The Goal: Return to competition
Return to Play Progression (Injury) Pain free, full range of motion: The injured body part should have a full range of movement and flexibility with little or no discomfort. Return of strength: The strength of the injured body part should be approximately equal (90 to 95 percent) to its counterpart before returning to full activity. Minimal pain or swelling: Some mild discomfort, stiffness and/or swelling during or after exercise are to be expected during the initial return to activity. It should respond well to ice therapy. Retaining functionality:you should be able to effectively perform the specific motions and actions required for your sport before returning to activity. For example, retraining a lower extremity injury in basketball should involve the ability to run, stop, change directions and jump. Progressive return to activity: Consider starting at 50 percent of your normal activity and progress up as tolerated. An informal guideline you can use is to increase activity by 10 to 15 percent per week if the previous level of activity does not result in increased symptoms during exercise or the day after exercise. Continue general conditioning with cross training: Using an alternative exercise allows maintenance of general cardiovascular fitness while not interfering with the healing of an injury. For example, ankle or knee injuries may do well with bicycling or swimming. M t l fid i bilit t d i Y f l h d i j Mental confidence in your ability to do exercise:you must feel that you and your injury are ready to perform at the level required for your particular activity.
KISS K.I.S.S.
Stay fit maintain balanced physical conditioning Participate i in a full functional rehabilitation i program Keep a positive, upbeat mental attitude
1) What is the diagnosis? An accurate diagnosis is crucial in addressing the cause of the symptoms, the best treatment options, time frame for recovery, and expected level of recovery. General labels such as knee sprain or back spasm do not provide enough information to make a treatment plan or determine how long recovery will take. 2) How does the condition affect performance? Will the condition get in the way of the athlete s ability to practice and play the sport? For example, does the condition adversely affect endurance, flexibility, strength, or coordination? 3) What is the risk of the condition getting worse from playing? Injuries occur to vulnerable structures. As a result of injury, the injured structure may become even more vulnerable. If an athlete returns to play before a full recovery, the injury will predictably get worse. Mild sprains can become severe sprains. A stress fracture can become a complete fracture. A mild concussion can increase the risk of a second brain injury or even death.
4) What is the risk of secondary injury? When athletes favor or try to protect an injured area, they may expose other body parts to injury and become secondarily injured. If an injured football player can t execute a block properly, p his teammates may become secondarily injured. Secondary injuries can also occur if there is a communicable disease that can spread through contact with other teammates or competitors. 5) What has been the effect of treatment? Is there treatment available for the condition? Has treatment been carried out? How effective is the treatment? Are there any negative effects of treatment? Has the treatment been completed? Have the deficits from injury/illness been restored?
6) Can the sport or level of participation be modified to be safer? Can the athlete temporarily play another position or cut back on specific activities without jeopardizing recovery? Can the hours of practice or number of teams be reduced during recovery? Can the technique or equipment used for the sport be modified to allow the athlete to continue to play? 7) Are there published guidelines that address the return to play decision? The AAP publishes guidelines that address many playability issues. Because the guidelines may be incomplete, controversial, or unclear as they pertain to your specific return to play question, talking with your doctor is an important element of fully understanding the implications of published guidelines on your return to play decision. 8) Is there a disproportionately high risk for further injury? All sports have some risk of injury. The risk is higher for contact and collision sports. Serious and long term injury can also occur from noncontact and endurance sports. These risks should be understood and accepted by the athlete and family before playing any sport. However, if injury or illness increases the risk even more, it may be ill advised to play. When the risk for further injury is disproportionately high, doctors have a responsibility to identify these situations and recommend changes or restrictions of participation.
9) Is there informed consent? Playing sports may seem to have nothing in common with scheduling a surgical procedure, but both activities require informed consent. The previous questions help define the risk of further injury or other complications associated with return to play. In some cases, the true risk is not known. In other cases, the risk is elevated or unacceptable. Whatever the case, return to play should not take place until all risks are understood and considered to be acceptable by the athlete, family, and doctor. 10) Does the athlete want to play? Most young athletes who enjoy sports want to return after an injury or illness. If athletes do not want to return, they should not be cleared to participate. There are a variety of reasons why an athlete may not want to return to play. It may be fear of further injury; concern that their injury does not allow them to play as well; loss of interest; burnout; or pressure by coaches, parents, or others. Whatever the reason, athletes who do not want to play should not be pressured to return even if the injury has resolved. Last Updated 5/11/2013 Source: Care of the Young Athlete Patient Education Handouts (Copyright 2011 American Academy of Pediatrics)
Request a Recovery Plan including phases of recovery what are the guidelines for progression to the next phase? Recovery from an injury involves a series of logical steps from the time of the injury until you are able to be back on the field or court. Each step should be outlined and monitored by your physician and physical therapist.
Recovery from an injury involves a series of logical steps from the time of the injury until you are able to be back on the field or court. Each step should be outlined and monitored by your physician and physical therapist or athletic trainer.
Sample Recovery Plan: date: (athlete name) may during practice: Participate in team dynamic warm up activities Full Or with the following limitations: Perform Home Exercise Program (HEP see attached exercises and guidelines) Complete minutes of aerobic conditioning using (circle one) stationary bike elliptical jump rope step ups/stair climbing core exercises (see attached) other: Participate in sports specific drills Type Duration Participate in scrimmage activities with the following limitations: Duration Contact Non contact The athlete MAY NOT perform the following:
THANK YOU Heidi Peterson ATC AT/L NASM PES hjpatc@aol.com