Many of Your Misconceptions About Concussions Answered: An Interview with Poudre High School’s Head Athletic Trainer
By: Carson Cooper
I recently had the opportunity to correspond with Victoria Sechser, the head athletic trainer at Poudre High School, via email. I asked her questions about concussions that many wonder about. She was certified as an athletic trainer in 2017. I asked her about her experiences with athletes who suffer from concussions and how she goes about the whole process. Her answers were very honest, and allow one who may have misconceptions to hear how it really is straight from a person who regularly deals with this injury.
Due to the subjective nature of concussions, meaning you never truly can recognize if someone is concussed or not, can you talk about how concussions go under-reported often? You can definitely truly recognize when someone is concussed. In fact, sometimes the signs and symptoms are glaringly obvious. I think what you mean is that you cannot test for it objectively. There are some recently developed objective tests such as testing for certain blood-based biomarkers. Although these objective tests are interesting, concussions are still primarily diagnosed clinically.
Why else do you think that concussions are underreported? I believe that if a player does not report their concussive symptoms, often their reasoning involves the pressure and the desire to continue playing. No one wants to sit on the sideline. What most athletes do not understand is that for every day you continue playing with a concussion, 2–3 days are added to the average recovery time. Most concussions will be resolved in 1–2 weeks. By removing yourself from play as soon as possible, you are actually doing yourself and your team a huge favor. Additionally, the recovery time of 1–2 weeks is fairly quick if you think about how long it takes to return from other common sports injuries like a strained hamstring, a broken bone, etc.
What is your role in trying to prevent the underreporting? My role in prevention of under-reported concussions is to educate as many athletes as possible about the symptoms, diagnosis, and treatment of concussions. Second Impact Syndrome occurs when a person receives a second head injury before they have recovered from the first. Second Impact Syndrome results in either death or permanent mental and/or physical handicap. Because of this risk, head injuries need to be taken very seriously.
What is the concussion protocol and how does the whole return to play/work/school system work? This protocol is individualized for each sport. The process can begin after the athlete has received a physician’s note of clearance. Basically, it is a graded return to play that takes about 5 days. The first day starts with a 50% heart rate max and very simple exercises like walking indoors and neck stretching. By the fifth day, they can join their team in a full practice as usual. On the sixth day, they could play in a game. This may take longer than the fivedays for patients who have more severe symptoms or symptoms that last longer.
With all the new research about concussions and rules being implemented into the game of football to make it safer, do you think that has worked and that the game has gotten safer? I think that a head injury is an accepted risk with an impact sport just the same as you might expect any other impact injuries in football. I think that the recent technological advancements in helmets, mouth guards, etc. are all fantastic. However, the risk of head injury in football will never be eliminated.
At Poudre HS, what are the three sports where you see concussions occur the most in student-athletes? American football, baseball/softball, and basketball.
What are your checks and balances for concussion evaluation? Is there any pressure on you getting the judgment call right on whether or not a kid should go back into play? Evaluating someone for a concussion is not “difficult.” The signs and symptoms are often quite apparent. There are simple tests to evaluate the function of each of the 12 cranial nerves. Most athletic trainers will use tests called Balance Error Scoring System and Vestibular/Occulomotor Screening. These two tests can be very useful in the diagnosis because through them you will see whether the patient has decreased balance, double vision, changes in the movement of the eyeball during vision, and they may cause or increase dizziness. Fortunately, Poudre High School is a very positive and supportive environment. I do not feel pressure from the coaches or parents. My decisions are based on science and the currently accepted practices.
How much harder does it make your job when you’re the one that has to assess a kid on the spot and deem whether or not it’s safe for them to go back into the game/practice? Concussions are diagnosed clinically. That means that the decision is not made based on any 1 test. Rather, concussions are diagnosed based on all of the signs and symptoms presented. What can make the diagnosis more difficult is that the symptoms can develop over the 24–48 hours following a hit to the head. Sometimes, the patient may seem symptom free at the time even though they have an underlying injury.
Are you seeing a trend in lower participation rates for contact sports like football? I have not read any research on the change in participation rates in football. I believe that people are now more aware of the risks of head injury than ever before. I also believe that American Football contributes majorly to our culture and heritage in this country. I personally do not see any risk to the future of football in this country. Concussions are a manageable injury just as any other sports related injury. With the proper education of coaches, athletes, and parents, athletic participation should be considered as a safe and healthy opportunity.
Is there any advice you can offer to parents and athletes? Get to know your athletic trainer. Feel comfortable texting, calling, or visiting their office. We can save you money! We are here at the high school every single day and are more than happy to evaluate an injury no matter how big or small. Sometimes, we will refer you to see a physician. Often, we can evaluate and treat the injury right here at the high school. As an athletic trainer, I am always here to help.
Lastly, is there anything else you wish to would like people to know about? (Victoria referred me to a PDF document that details the risk factors for sports-related concussion). “A history of concussion is associated with a higher risk of sustaining another concussion. A greater number, severity, and duration of symptoms after concussion are predictors of a prolonged recovery. In sports with similar playing rules, the reported incidence of concussion is higher in females than males. Certain sports, positions, and individual playing styles have a greater risk of concussion. Youth athletes may have a more prolonged recovery and are more susceptible to a concussion accompanied by a catastrophic injury. Preinjury mood disorders, learning disorders, attention deficit disorders (ADD/ADHD), and migraine headaches complicate diagnosis and management of concussion.”
-American Medical Society for Sports Medicine Position Statement: Concussion in Sport
file:///C:/Users/phsguest/Downloads/American_Medical_Society_for_Sports_Medicine.1.pdf
