Sports Medicine & Athletic Training

TVS ATHLETIC TRAINING

An athletic trainer (AT) is an allied health care professional who collaborates with physicians and other healthcare professionals to optimize activity and participation for active individuals. After completing a four-year, accredited education program in Athletic Training, a candidate sits for an exam to obtain the national credential of Certified Athletic Trainer (ATC). Over 70% of athletic trainers complete an advanced degree. ATs are required to comply by National Athletic Trainers’ Association (NATA) ethical standards and practice acts while remaining current with their continuing education hours.

The athletic trainers at Trinity Valley School provide immediate care for athletic injuries and illnesses, ranging from a scraped knee to a catastrophic head or neck injury. Whether a student suffers a sprained ankle or a concussion, the TVS team has the tools to manage the situation. Frequently, an injury can be handled and resolved “in-house.” However, when more serious issues arise, the ATs evaluate and manage an injury while concurrently referring to a physician for further care. Because TVS has close working relationships with many medical professionals, the ATs serve as the link from school injury to timely medical care. Oftentimes, the ATs make a phone call to expedite an ER trip or to arrange an immediate visit to a physician’s office.

Rehabilitation of athletic injuries and return-to-play progressions are other services the TVS athletic trainers provide for returning athletes to their sport. After any major injury, rehabilitation is necessary to restore range of motion, strength, and full function. The TVS team focuses on creating a program beginning with basics and leading up to sport-specific functional exercises. Depending on the injury specifics, the rehabilitation process may be as brief as one week, or as long as several months. Athletes often do rehab with the athletic trainers two to three times per week and supplement with either a home program or physical therapy.

Starting in 2019 all students will need a current physical exam on file with the TVS Nurses prior to participation in athletic, dance, PE or TOE Trips.

Injury Evaluation, Treatment and Rehabilitation Hours

Evaluation of New Injuries, Treatment or Scheduled Rehabilitation
- Morning Flex Period, Student Free Period (BY APPOINTMENT), or Lunch Period

Preventative Treatment, Taping or Stretching
- After Final Class Period of Day

Required Athletics Medical Forms

All students participating in TVS Athletics (including cheer, dance and PE) in grades 7-12 are required to have a Pre-Participation Physical Exam performed by a physician to determine if they are physically capable of participating. To better align with preventative healthcare and best practices a new physical exam is required every year.

In addition to the pre-participation physical exam, each parent and student should complete the TVS Student Medical Information form which can be accessed through the TVS Parent Portal. This form is located through the TVS Parent Portal via the RenWeb Button > Web Forms > Demographic Medical Forms > Student Medical > Student Medical. This form will give the TVS Medical Staff a more detailed and complete picture of your child’s health history. The Student Medical Information form includes; a Permission to Treat Acknowledgement, a HIPPA Statement, and Concussion Acknowledgement Statement. The Student Medical Form along with a Pre-Participation Physical should be complete annually and on file with the TVS Nurses prior to participation in any extracurricular activities.

Please submit the completed pre-participation physical exam to the Nurses prior to the start of your child’s sport season or activity begins. You can submit the forms via email medforms@trinityvalleyschool.org via Fax #817-321-0161 or deliver to the Central Administration Office to ATTN: Nurse Coats.

Head Injuries

Trinity Valley School Concussion Policy

Based on current standards of care and in compliance with Texas state law, Trinity Valley School has established this concussion policy. All athletic trainers, coaches, student-athletes, and parents shall follow these procedures and policies stated from here forth concerning the care and diagnosis of concussions. On a yearly basis, each student-athlete, his/her parent/guardian, and all coaches must read and sign the Concussion Acknowledgement on RenWeb prior to athletic participation.

Definition – a concussion is a complex pathophysiological process affecting the brain caused by a traumatic physical force or impact to the head or body, which may: include temporary or prolonged altered brain function resulting in physical, cognitive, or emotional symptoms or altered sleep patterns; and or involve loss of consciousness. The “TVS Medical Team” consists of the TVS Athletic Trainers, TVS Nurses, Concussion Specific Referral Physicians and TVS Medical Coordinator.

Diagnosis – A concussion is diagnosed clinically on the basis of history, physical exam findings, and certain screening and diagnostics tests. Any student-athlete suspected of a concussion shall be removed from practice or competition for further evaluation by an athletic trainer or physician. Concussion evaluations may be performed on the sideline, practice field, court or in a controlled environment. The athletic training staff will use peer-reviewed research based methods to evaluate and diagnose the injury. Evaluation will consist of verbal communication, functional testing and symptom scoring. The SWAY Medical platform will be used to give quantitative data on balance and reaction time at time of evaluation and throughout follow up care. If a concussion is still suspected and/or diagnosed, the student shall not return to activity that day, will be referred to the appropriate physician, and the procedures below must be followed. Due to the fact that some symptoms may not present immediately, a student-athlete may be monitored and evaluated for a concussion by the TVS Medical Staff for upto 48 hours, following a suspected incident.

Exclusion from Concussion Evaluation - If there is a presentation of any “red flags” (post-impact seizure, delayed seizure, loss of consciousness, recurrent vomiting, severe uncontrolled headache, altered mental status, con-commitment major distracting injury, or hard neurologic findings), a higher level of care will be sought out immediately. This may include, but is not limited to calling the parents for immediate referral to the student’s primary medical provider, immediate referral to an emergency room (ie Harris Southwest, Harris Fort Worth, Cook Children’s) via parent/ guardian transportation, and/or activate the appropriate Emergency Action Plan (calling 911). The mode of transportation to higher level of care may be based on the discretion of the athletic trainers, sideline coaches (when AT is not available), school nursing staff (non-sports related head injury), or other responsible party at the time.

Cognitive Rest – A student diagnosed with a concussion will need cognitive as well as physical rest to allow the brain to heal. According to the CDC cognitive activity includes heavy concentration or focus, visual stress, memory activities, reasoning, reading or writing. No two concussions are the same and do not present with the same symptoms or timeline for recovery. Each patient’s case will be handled individually based upon their initial symptoms. The athletic trainers will communicate with the appropriate division heads, academic advisors, counselors and school nurses to make academic accommodations as needed based on their symptoms. Accommodations can be as simple as limited use of electronic devices and extended time for assignments, to no tests or quizzes while symptomatic, or the student may need to stay at home while symptoms are present. Patients will be granted academic accommodations for the first 48 hours, but will need documentation from a physician for further accommodations. Once the student reports to be symptom free for two full days of school, the athletic trainer will inform their division head that the student is back to normal cognitive function and no longer needs academic accommodations as a result of their recent brain injury.

Recovery Process - Each patient will be treated on an individual basis, as it relates to their individual symptoms, recovery process and physician directions. While a student is symptomatic, s/he will be monitored by the TVS Medical Staff. Patients will need to track their symptom scores using a paper and pencil or electronic version, at a minimum every third day for the extent of their injury. The patient's balance and reaction time will be tracked using the SWAY Medical platform throughout the recovery process. Students will progress through from cognitive rest to a gradual return-to-learn progression, based on their individual recovery process. Once, symptoms have normalized, a patient may begin light submaximal (Heart Rate Less than 50%) stationary bike riding or walking for no more than 10 minutes per day. If parents allow the student to take supplements, they may take up to the following amounts of Omega 3: 9000mg for 1 week, 6000mg for 2nd week and 3000mg for the 3rd week. Studies support that cognitive rest, light physical activity and Omega 3 supplements help in the recovery process.

Treatment and Return to Play – Every student-athlete diagnosed with a concussion must be evaluated and cleared by a physician and must complete the TVS concussion return-to-play protocol (“RTP”). Once the student-athlete is asymptomatic for one full day of school s/he may begin the RTP process.

Return to Play (“RTP”) Protocol

  • Step 1- Follow Recovery Process Recommendations patient will monitor symptoms and SWAY Balance progression.
  • Step 2- Once asymptomatic for a full day of school and back to with in 2% of their Avg Combined SWAY Score
  • Step 3- Begin the RTP protocol.
    • RTP occurs over a minimum of five steps. Must wait 24 hours between each step.
      • RTP 1- Light Aerobic Activity - 15 minutes. Stationary Bike - HR Below 70%
      • RTP 2- Weight Lifting & Aerobic Activity - 45 minutes. Re-Test SWAY and Symptoms prior to activity. Balance, Light Resistive Training & Bike or Jogging
      • RTP 3- Sport Specific Functional Drills. Non-Contact Practice or 2nd Wt Lifting Day up to 1 hour
      • RTP 4- Full Contact Activity
    • Must be in a full day of practice with contact prior to participating in contact game.
    • Non-contact sports may participate in a game
    • If symptoms return during any step, the student-athlete must go back to the previous step and start over after 24 hours.
    • Total days missed will vary and are determined by how long it takes for symptoms to resolve, and /or if any steps have to be repeated.
  • Step 4 – The student-athlete will be cleared to return to full participation after completing the RTP protocol (Steps 1-4) while remaining symptom free, written consent is received from the treating physician and the parent/guardian, and all documents are submitted to a TVS Athletic Trainer.

All other students will be treated and monitored while symptomatic and through the recovery process. Once asymptomatic for a full day in school, recommendations will be made for a gradual return to a normal activity workload or participation in off campus activities. AT will monitor in a return to play progression if recommended by physician.

Parent Concussion Guide

TVS Return to Play Form

Physician Visits

Any student-athlete who sees a physician, physician assistant, nurse, or physical therapist for any injury or illness must present a written note to a TVS AT documenting that he/she is cleared for further participation in athletics. Without proper documentation, the student-athlete will not be allowed to participate in any athletic practice or event until proper documentation is submitted.

Treatment and Injury Reporting Policy

The athletic trainers’ primary responsibilities are prevention, recognition and rehabilitation of musculoskeletal injuries. Any injury that is a result of activities associated with TVS Athletics or Dance need to be reported as soon as possible to an athletic trainer, coach or instructor. If you suspect that you have sustained an injury that may require additional treatment or result in lost playing time; make arrangements to meet the with the athletic trainers during your free period or the morning flex period for further evaluation and to develop of a proper treatment plan. The small window of time before athletics begins is usually not sufficient enough time to evaluate, treat and communicate your injury status to your coach prior to the beginning of practice. Failure to appear at designated treatment times is not an acceptable excuse to miss a practice, as all athletes will be expected to be present for team practices.

The TVS Athletic Trainers, offer a wide variety of therapeutic modalities, to provide the best and latest treatment options for your child. Each year we attend continuing education courses and review the latest articles to provide an evidence based treatment approach. Both TVS ATs hold additional certifications in Instrument Assisted Soft Tissue Mobilization and Myofascial Decompression. All student athletes are informed of the treatment plan and anticipated results prior to application of any modality. Here is a link for a list of modalities that are provided here on campus.

Hot Weather Policy

Prevention of Heat-Related Illness is a major goal at TVS. However, the majority of fall sports in North Texas are played during the hottest time of the year, it would not be prudent for us to cancel practices frequently and still expect our athletes to perform at a high level of competition. As a result, Trinity Valley School has reviewed the latest research and leading position statements to establish a “Hot Weather Policy” with the goal of keeping our student-athletes safe while also preparing them for competition.

Student-athletes who participate in an outdoor sport during the fall season are recommended to participate in a summer conditioning program. Students who continue to work and train in a hot environment are better prepared to participate in sports under similar conditions. All student-athletes will go through an acclimation period during the fall sports season which is appropriate to their specific sport season. TVS will continue to follow the Southwest Preparatory Conference heat acclimation policy in regards to pre-season practices. Football players need to participate in four days of helmets only practice before they are allowed to participate in any padded practice.

Student-athletes are encouraged to consume proper amounts of water or electrolyte based drinks throughout the day prior to participating in outdoor activities. In general 17-20 fl oz two hours before athletic participation and at least 7-10 fl oz 10-20 minutes before practice or games.

While in a practice or game environment it is recommended that athletes drink 3-5 ounces of water for every 15-20 minutes of activities. The best piece of advice is to drink to thirst. Once one is thirsty they are already dehydrated setting them up for performance deficits and can be prone to heat illness. There will be ample amounts of hydration stations and a cooling location available for all student-athletes at TVS, during all practices and games. All students are encouraged to drink water throughout the course of practice outside of the scheduled water breaks. For more information specific to your child’s hydration needs, you can read more information on the Korey Stringer Institute website https://ksi.uconn.edu/prevention/hydration/. A well-balanced diet filled with a variety of fruits, vegetables, carbohydrates, fats and proteins throughout the day is also an essential part of preventing heat-related illnesses. Meals prior to and between workouts help the body maintain a steady level of energy and can better adapt to exercising in a hot environment.

TVS has a weather station on campus that monitors ambient temperature, relative humidity, wind speed, and direct solar radiation from the sun, giving us a WBGT reading. The WBGT reading is a well-accepted measure of monitoring environmental conditions during exercise. Established WBGT guidelines dictate modification of outdoor activity (work: rest ratio, hydration breaks, level of equipment worn and length of exposure) which play a huge role in helping prevent heat-related illness. All official readings will come from the Perry Weather Station located on the practice fields west of the stadium press box. The following weather zones will be used as guidelines for the modification of all TVS Athletics and PE Classes.

This policy was created from the Korey Stringer Institute for Heat-Illness and position statements from the National Athletic Trainers Association.

WBGT Zone

US - Practice Conditions

MS - Practice Conditions

Game Conditions

Clear Zone

Normal Activities - Make water available to all participants.

Provide 3 breaks per hour of activity

Normal Activities - Make water available to all participants. Provide 3 breaks per hour of activity

No Modifications Recommended

Green Zone

Be advised of conditions:

Provide water to all participants, at least 3 breaks per hour at least 4 min long

Be advised of conditions:

Use discretion for intense or prolonged exercise

Provide water to all participants, at least 3 breaks per hour at least 4 min long

No Modifications Recommended

Yellow Zone

Maximum practice time is 2 hours; minimum 4 breaks per hour, 5 min long

Football - Shells only, if WBGT rises to this level during a practice may keep full pads on

Maximum practice time is 1.5 hours; minimum 4 breaks per hour, 5 min long

1 break per hour in the shade

Football - Shells only, if WBGT rises to this level may keep full pads on, every other break must be in the shade helmets off.

Advise water breaks during the game as the sport allows.

Red Zone

2:1 work/rest ratio;

i.e. 10 min work 5min break; two breaks per hour need to be in shade

Football - Helmets only

Maximum practice time 1h;

2:1 work/rest ratio;

i.e. 10min work 5min break;

two breaks per hour need to be in shade

Football - Helmets only

MS-Additional water breaks or shorten halves as sport allows

US - Advise water breaks during the game as the sport allows.

Black Zone

Walkthrough activities only allowed; minimal running.

May move practice indoors or shaded area as available.

Walkthrough activities only allowed; minimal running.

May move practice indoors or shaded area as available.

MS - Play at AD discretion

US - Require water breaks or shorten halves

*Modifications can be made to practice plans at AT & AD Discretion

Lightning Policy

Trinity Valley School will be using Perry Weather Services for detection of lightning and other life threatening weather. TVS has an outdoor warning system which will alert the school of impending danger of lightning strikes by an audible horn and flashing light. It is recommended for all individuals who plan to be outside during the school day track and watch the weather for potential dangerous storms.

Common sense should prevail, don’t wait to be notified, these catch phrases should be used to improve safety.
“When Thunder Roars, Head Indoors” Or “If You See It, Flee It”

Lightning Information – Lightning can strike and kill a victim up to six miles away. To decrease the chance of a lightning injury here on campus we have set up a 10-mile radius to notify and advice all individuals to seek shelter. Due to the risk that lightning can strike in any direction, a 30 minute all clear countdown clock will start when there are no detectable strikes within the 10-mile radius of TVS. All of this information will be tracked and notified to you through the Perry Weather Services. Ultimately, if you see it, flee it, don’t wait to be notified.

Appropriate Shelter – In the event that lightning strikes within the 10-mile radius of campus all individuals should seek out a safe shelter location. Safe shelters areas have four walls, a roof and are plumbed and wired for electricity. A school bus or car is also an appropriate safe shelter as long as the occupant stays away from the windows. Un-safe shelters include the TVS Athletics Pavilion, TVS Dugouts or under free standing objects.

Notification of Campus – There are three ways in which the campus will be notified of a potentially dangerous storms.

1)An Outdoor Warning Siren with Flashing Light – An audible horn will blow one 3-second burst to announce that a lightning strike has occurred within 10 miles of campus.
2)Text Notification – Texts will be sent to Athletic Trainers, Athletic Director, Outdoor Coaches and Security, when strikes are detected within 20, 15 and 10 miles.
3)Email – All Division Directors, Administrative Assistants, Athletics Staff Security and Explorer Director will receive an email when strikes are detected within 10 miles of campus.

These notifications will alert appropriate TVS personal that lightning has struck within the 10-mile radius of campus and it is no longer safe to be outside.

Alerting Faculty, Staff & Students During Regular School Hours – Once the campus is alerted that there has been a strike with in the 10-mile radius the following actions should be taken.

LS/MS/US

Security

Athletics/P.E.

Listen for the horn and look for the flashing light.

Administrative Assistants or Divisional Heads will announce over the intercom system.

Lightning has been detected close to campus, stay inside in a safe location.”

All outside activities (recess, class projects, brain breaks, etc.) should be suspended until further notice.

A member of the security team will drive through campus. Advise individuals that there is dangerous lightning in the area and they should seek appropriate shelter immediately.

Listen for the horn and look for the flashing light.

Listen for the horn and look for the flashing light.

Administrative Assistant or an Athletic Trainer (AT) will notify any PE classes during that time. Any teams outside will be advised of the danger by an AT, AD or Coach.

Lightning has been detected close to campus, stay inside in a safe location.”















Alerting Spectators of Sporting or Other Outdoor Events – When outdoor events are scheduled and there is a possibility of storms, event organizers should be cognizant of the weather and monitor it closely. In the event a lighting strike is detected within the 10-mileradius of campus when an outside event is taking place the following actions should occur.

Athletic Event

School Fair, Concert etc.

TOE Activity

Once the audible horn is detected the TVS Athletic Trainer or Athletic Director will notify the appropriate coaches and officials of the impending danger and suspend play until the all clear is given. They will advise all players and spectators to seek appropriate shelter in one of the gyms or their school bus.

TVS Security will help clear the stands and parking lots of spectators.

Once the audible horn is detected TVS Security will alert the event organizer of the impending danger as well as making announcements to the participants of the outdoor event. They will advise all participants to seek appropriate shelter until the all clear is given.

Once the audible horn is detected TOE Leaders will notify their group of the impeding danger and seek appropriate shelter. TOE will monitor weather appropriate to their location.

All Clear – Perry Weather Service will monitor the storm and lightning strikes. Once there are no strikes detected with in the 10-mile radius for 30 minutes, a second “All Clear” email or text will be sent to the appropriate individuals. At this time is safe for students to participate in outside activities.

- An announcement should be made over the intercom system, event organizers or athletic participants; “It is now safe to resume outside activities.”

Common sense should prevail to improve safety.
“When Thunder Roars, Head Indoors”

Cold Weather Policy

Cold exposure can be uncomfortable, impair performance, and even become life threatening. Conditions created by cold exposure include frostbite, chilblains, and hypothermia. Wind chill can make activity uncomfortable and can impair performance when muscle temperature declines. Frostbite is the freezing of superficial tissues, usually of the face, ears, fingers, and toes. Chilblains are painful inflammation of skin blood vessels as a response to repeated exposure to wet environments. Hypothermia, a significant drop in body temperature, occurs with rapid cooling, exhaustion, and energy depletion. The resulting failure to the temperature‐regulating mechanisms constitutes a medical emergency. Exposure to cold air can also exacerbate conditions for those persons with asthma.

Clothing is one of the most important parts of keeping the athlete’s body warm. Athletes should dress in layers and try to stay dry. Layers can be added or removed depending on temperature, activity, and wind chill. Athletes should layer themselves with wicking fabric next to the body, followed by lightweight pile or wool layers for warmth. Athletes should use a wind-block garment to avoid wind chill during workouts. Heat loss from the head and hands are a major concern in cold conditions; therefore the head and hands should be covered while outside in this environment.

Cold Exposure:

• Breathing of cold air can trigger asthma attack (bronchospasm)

• Coughing, chest tightness, burning sensation in throat and nasal passage

• Reduction of strength, power, endurance, and aerobic activity

• Core body temperature reduction, causing reduction of motor output

Cold Recognition:

• Shivering, a means for the body to generate heat

• Excessive shivering contributes to fatigue, loss of motor skills

• Numbness and pain in fingers, toes, ears, and exposed facial tissue

• Drop in core temperature; athlete exhibits sluggishness, slowed speech, disoriented

The TVS Athletic Trainers have set up a cold-weather policy to determine when we should and should not allow our students and staff to be exposed to the cold weather. When considering whether it is reasonable and prudent to have our community out in the cold for practices and games, we will consider the following four factors:

1) Ambient temperature (Temp)

2) Wind chill (W.C.)

3) Precipitation and/or wet conditions (Wet)

4) Age and/or level of competition (Var, JV, MS)

TVS will use the Perry Weather Station located on campus to determine the current weather conditions.

For the safety of our community, the following modifications will be made under these conditions:

Weather Conditions

US Practice

MS Practice

> 33 Temp or W.C. & Dry

Advised of conditions, layered clothing recommended; jackets, hats & gloves as needed

Advised of conditions, layered clothing recommended; jackets, hats & gloves as needed

32-26 Temp or W.C. & Dry

Limited Practice Times 1 hour

layers of clothing needed; jackets, hats & gloves strongly advised

Limited Practice Times 45 min; layers of clothing needed; jackets, hats & gloves strongly advised

<25 Temp or W.C. & Dry

No Outside Exposure

No Outside Exposure

31-35 Temp or W.C. & Precipitation

Practice limited to 45 min, layered clothing required, rain jacket or coat preferred

No Outside Exposure

< 30 Temp or W.C. & Precipitation

No Outside Exposure

No Outside Exposure

Weather Conditions

Varsity Games

Sub-Varsity Games

>30 Temp or W.C & Dry

No Changes

Advised of conditions, layered clothing, jackets, hats & gloves as needed

No Changes

Advised of conditions, layered clothing, jackets hats & gloves as needed

30-25 Temp or W.C. & Dry

Games played at Athletic Director’s discretion

Clothing layered, jackets, hats & gloves recommended

Shorten halves (5 min less), decrease overall exposure rate

Advised of conditions, jackets hats & gloves strongly advised

<25 Temp or W.C. & Dry

Games played at Athletic Director’s discretion

No Outside Exposure

>30 Temp or W.C. & Precipitation

No Changes

Advised of conditions, layered clothing, rain jackets, hats & gloves recommended when appropriate **

Shorten halves(5 min less), decrease overall exposure rate

Advised of conditions, layered clothing, jackets, hats & gloves strongly advised**

<30 Temp or W.C. & Precipitation or <15 Temp or W.C. & Dry

Only Conference games played at Athletic Director’s discretion - Additional layered clothing strongly advised

No Outside Exposure

**Supplemental Heat provided on benches under advised temperature.**

Over the Counter Medicine

Over-the-counter medication will only be distributed to student athletes at the time of an injury or when the athletic trainer deems appropriate. Students seeking daily dosage of any over-the-counter medications should consult their physician.

Taping and Bracing

Taping and bracing can be used for preventative measures, for acute injury, and during post-injury rehabilitation. Taping is usually done at the discretion of the TVS athletic trainers, or by written request from a physician treating the injury. Injuries should not be expected to be alleviated by taping alone. Appropriate treatment and rehabilitation should be done under the direction of the athletic trainers.

Ankle braces are required during participation in upper school football and girls’ volleyball. Bracing is also recommended by the TVS athletic trainers for upper school boys’ and girls’ basketball, and boys’ volleyball. There are many options for supportive ankle braces on the market. Each athlete may choose to buy their own, or ankle braces are available from the TVS athletic training department for $30 per pair.

Mouth Guards

For sports in which mouth guards are required (football, field hockey, lacrosse), the TVS athletic trainers will provide each athlete one at the beginning of the season. Replacement mouth guards will be provided thereafter for $1.00 each.