Sports Medicine and the Concussion Challenge

L Howard Quackenbush II D.P.T., ATC, CSCS

I have been working in the Sports Medicine world since 1992 and have seen a tremendous evolution for the better regarding athletes and head injuries.  We have seen equipment improve, better technique and better coaching but concussions remain a problem in all sports.

There has been a renewed interest in not only preventing injuries but finding ways to assess the athlete and ensure that they have fully recovered and are safe to return to play. The problem is that our testing has often been performed after the injury has occurred.  We have been trying to apply tests to an individual and using generalized benchmarks to grade them without a healthy benchmark to compare the results.

Concussion management has been an ongoing study and evolution of best practices.   For example, in 1994, our standard was that an athlete should feel well and be able to run a mile without a headache and then was cleared to again play contact sports.  As we learned, head injuries are not just a headache but have cognitive and balance implications as well as life altering effects. For this reason, more tests were designed.  The Sport Concussion Assessment Tool (SCAT) was introduced in 2004 trying to better assess the various factors. This test then was modified to the SCAT2, later the SCAT3 and now the SCAT5.  These tests have been very useful in evaluating athletes for concussion and head injuries. They are now frequently used to assess symptoms, memory and balance in hopes of returning the athlete back to competition when the symptoms have resolved.

The problem with the SCAT assessments is that the athlete learns how to cheat very quickly. They under report their subjective symptoms and often score poorly on their pre-season assessments to make it easier to pass if they have an injury.

Also, the SCAT assessments are very time consuming.  They can take 20 minutes or more to perform and there is no understandable scoring system or benchmarks.  Most concerning is they should be done as a baseline and very few amateur athletes, youth or even high school/college athletes undergo the testing as suggested.  I recently surveyed several high schools that had mandated that all athletes have a SCAT assessment prior to competition. My unscientific survey estimated that only 5-8% of the athletes had this done. Those that did, often did not know who had their pre-season data. The physicians that were Centers for Disease Control trained with the Heads Up training did not know how to interpret the SCAT 3 results. Those that did not have a pre-competition assessment did not have “normal data’ to compare making the return to play decision more challenging.

Admittedly, the assessment and management of these injuries continues to improve and will continue to evolve but it only makes sense to utilize the most current and effective tools to assess what is the athlete’s baseline status and then be able to reproduce the assessment easily after an injury. The testing needs to be quick, reproducible and useful.

To accomplish this goal in our Sports Medicine facility, we have begun using the TRAZER concussion management system in addition to the traditional BESS tests, SCAT-5 Assessment and Biodex Balance Assessments.

The TRAZER system allows us to quickly perform a movement, speed, agility and balance assessment as a baseline test.  The computer scans the athlete as he/she performs the drills and then documents any deficits, limitations and performance. This data is then stored in a HIPPA compliant cloud for future reference.

When the athlete suffers an injury they then are assessed again and if there is a significant difference, then additional assessments, studies and tests may be performed to more fully understand the severity and course of care.

Here is the beauty of the TRAZER…. Once an athlete has completed their rehabilitation, they are again tested and compared to their PRE-INJURY testing for movement, balance, agility etc.  If they are then able to pass at this level, it gives greater confidence that they are ready to return to play. If not, they now know the standard they need to meet to get back to competition.

We are excited about this addition to our Sports Medicine regimen because it is easily accessible, reliable, inexpensive and most importantly quick.

At Delta Physical Therapy and Sports Medicine PC, the health and well-being of our clients is what drives us to be the best. We will not cut corners or clear athletes until they are safe to return to play. Using the best known and current tools helps to keep us on the cutting edge of rehabilitation and Sports Physical Therapy.

I invite you to do one of the following:

  • Have your preferred healthcare provider do a standardized baseline assessment on your athlete prior to the sports season and have the data available for comparison if an injury occurs.
  • Take advantage of the TRAZER offer through our clinic to do a baseline assessment
  • Or just hope you athlete doesn’t get hurt and guess when they are better.

The evolution of injury prevention and management will continue. Let’s all work together to utilize the best tools and knowledge base we have available to make athletics and sports safer and more rewarding for those that participate at any level.

My expert team and I look forward to serving you and your athlete for any Physical Therapy or Sports Medicine need.

L. Howard Quackenbush II P.T., D.P.T., ATC, CSCS

Director of Delta Physical Therapy and Sports Medicine, PC
Dr. Quackenbush has 28 years of experience working with all levels of amateur and professional athletes and general population Physical Therapy care. He can be reached at:
Delta Physical Therapy and Sports Medicine PC
95 White Sage Ave. Suite C
Delta, UT 84624