COVID-19
IMPORTANT RESOURCES: COVID-19 Requirements & Mandates

For all other resources & information related to COVID-19, please visit the COVID-19 section of the CHSAA Sports Medicine page on CHSAANow.com.

Head, Heart and Heat
Click Below:

Head
Heart
Heat

Sports Medicine Advisory Handbook
Click Below:

HANDBOOK

PURPOSE
The CHSAA Sports Medicine Advisory Committee is a collective group of medical and educational professionals whose expertise provides current information to the association membership. It is designed to reflect and evaluate information provided throughout several resources.

MISSION
The mission of the Sports Medicine Advisory Committee (SMAC) is to provide information, vision, and guidance to the Colorado High School Activities Association (CHSAA), while emphasizing the health and safety of students participating in interscholastic sports and activities.

Athlete Hygiene/Skin Infections

The transmission of infections such as Methicillin-Resistant Staphylococcus aureus (MRSA) and Herpes Gladiatorum, blood-borne pathogens such as HIV and Hepatitis B, and other infectious diseases can often be greatly reduced through proper hygiene.

UNIVERSAL HYGIENE PROTOCOL FOR ALL SPORTS

• Shower immediately after every competition and practice, using liquid soap and not a shared bar of soap
• Wash all workout clothing after each practice, washing in hot water and drying on a high heat setting
• Clean and/or wash all personal gear (knee pads, head gear, braces, etc.) and gym bags at least weekly
• Do not share towels or personal hygiene products (razors) with others
• Refrain from full body and/or cosmetic shaving of head, chest, arms, legs, abdomen and groin

SKIN INFECTIONS

Viral Skin Infections – Herpes gladiatorum and herpes labialis (cold sores)
Fungal Skin Infections – Tinea corporis (ringworm), tinea capitis, tinea pedis, tinea cruris
Bacterial Skin Infections – Impetigo, Folliculitis, Carbuncle

CHSAA recommends the following actions:

• Prevention – Remind athletes to shower immediately after practice/meets, change workout clothes/socks daily and do not share equipment or towels.
• Be Vigilant – Look at athletes’ skin daily for wounds or lesions, clean and cover open wounds or scrapes so they don’t get infected and let athletes know they should report skin lesions to the coaches or athletic trainer immediately.
• Seek Treatment – Get athletes to a health care provider immediately for diagnosis and treatment of skin lesions. Many of these skin infections require minimum treatment times in order for the athletes to be eligible.

For complete CHSAA Athlete Hygiene and Skin Infection information, please click HERE.  

Spine Injury

MANAGEMENT

• Immediately stabilize the Cervical spine.
• If a helmet is present it should not be removed unless proper personnel are onsite (3 or more with proper training in equipment removal).
• If helmet remains in place, ATC or EMS should remove facemask using appropriate tools while maintaining the head and neck in a neutral position.
• Stabilization of the neck in a neutral position is performed by grasping behind the ears and cupping the back of the head and simply supporting the head, preventing side to side, forward or backward motion or rotation of the neck.
• Under no circumstances should traction be applied to the athlete’s head or neck.
• If the athlete is in a sport without protective gear or protective gear has been removed, a cervical collar should be placed by ATC. Cervical collar alone is not enough to protect the neck, continue to hold stabilization.
• The athlete’s head should be moved into the neutral position unless moving the athlete’s head/neck causes increased pain, muscle spasm, loss of neurological function or restriction in range of motion.
  • A player found in the prone position (on stomach/facedown) must be returned to the supine position (on back/faceup) for evaluation.
  • The proper technique for transitioning the prone patient to supine is the “prone log roll technique”
    • This means that the body, arms, legs and head, with 4-6 people helping, are all rolled together as a unit at the same speed.
  • Emergency cards should be easily accessible, and parents of the athlete should be contacted ASAP.
  • It is the responsibility of the school to contact their local EMS services and to have a protocol in place for management of suspected spine injuries. This is a vital part of EAP and training.
  • Once EMS arrives, they will assume responsibility of the situation and may add or remove equipment as they see necessary. There should continue to be teamwork between ATC, on-field staff and EMS.

For complete CHSAA Spine Injury information, please click HERE. 

Head Trauma & Concussions

A concussion is a type of traumatic brain injury, or TBI, caused by a bump, blow, or jolt to the head or neck that can change the way your brain normally works.

SIGNS AND SYMPTOMS OF CONCUSSION

Physical

• Headache
• Blurred vision
• Dizziness
• Poor balance
• Seeing “stars”
• Neck pain
• Nausea/Vomiting
• Numbness/Tingling
• Sensitivity to light
• Sensitivity to noise
• Ringing in ears
• Vacant stare/Glassy eyed

Emotional

• Irritability
• Personality change
• Feeling more emotional
• Feeling anxious/nervous
• Sadness
• Inappropriate emotions

Cognitive

• Disorientation and/or confusion
• Feeling mentally “foggy” or “slowed down”
• Memory loss or difficulty remembering
• Difficulty concentrating, feeling easily distracted
• Slowed and/or slurred speech

Sleep/Energy

• Drowsiness
• Fatigue
• Increased sleep
• Trouble falling asleep or staying asleep

For complete CHSAA Head Trauma & Concussions information, please click HERE. 

Hydration/Dehydration

AVERAGE FLUID VOLUMES FOR ADOLESCENTS

• 4 hours before → 16 fluid ounces of water (about 1 water bottle)
• 10-15 minutes before → 8 fluid ounces of water
• Every 15 minutes when exercising for < 1 hour → 4 fluid ounces of water (2-3 large gulps)
• Every 15 minutes when exercising vigorously for > 1 hour → 4 fluid ounces of sports drink (2-3 large gulps)
• Do not drink > 1 quart per hour during exercise
• Young athletes should continue to hydrate 2-3 hours after event
• Consume 20-24 fluid ounces (1 to 1 ½ water bottles) of water or sports drink for every pound lost during exercise

For complete CHSAA Hydration/Dehydration information, please click HERE.

For all CHSAA Sports Medicine Advisory Committee Information, please click HERE.

Call the toll-free National Suicide Prevention Lifeline (NSPL) at 1-800-273-TALK (8255), 24 hours a day, 7 days a week. The service is available to everyone. The deaf and hard of hearing can contact the Lifeline via TTY by dialing 711 then 1-800-273-8255. All calls are confidential. Dial 911 in an emergency.

Learn more on the NSPL’s website.

SYMPTOMS
All individuals may not exhibit every symptom
These symptoms may indicate depression, particularly when lasting for more than two weeks:

• Poor performance in school
• Withdrawal from friends and activities
• Sadness and hopelessness
• Lack of enthusiasm, energy or motivation
• Loss of interest in activities they used to enjoy
• Anger and rage
• Overreaction to criticism
• Feelings of being unable to satisfy ideals
• Poor self-esteem or guilt
• Indecision, lack of concentration or forgetfulness
• Restlessness or agitation
• Changes in eating or sleeping patterns
• Substance abuse
• Sexual promiscuity
• Risk-taking behaviors
• Problems with authority
• Suicidal thoughts or actions

TEEN SUICIDE WARNING SIGNS
• Suicide threats (direct and indirect)
• Obsession with death
• Poems, essays or drawings that refer to death
• Giving away belongings
• A sense of “hopelessness” and/or no
future vision
• Dramatic change in personality or appearance
• Irrational, bizarre behavior
• Overwhelming sense of guilt, shame or rejection
• Significantly changed eating patterns (including drastic weight gains or losses)
• Significantly changed sleeping patterns (especially contributing to school truancy)
• Severe drop in school performance or social interest

GOAL SETTING:
As our student athletes’ transition to a new year, this can be a natural time to think about setting goals, perhaps for their specific sport, academics or areas of interest.  This may be especially true after a very challenging year like we’ve had.  When psychologists work with athletes, they often use a variety of different methods to help athletes achieve their goals.  One of the most commonly used strategies is setting SMART goals.  SMART stands for:

Specific:  Write out clear, concise goals
Measurable:  Make sure to track you progress…write it out!
Achievable:  Set challenging yet achievable goals.
Relevant:  Set goals that are relevant to your plan, be it sports, academics, etc.
Timely:  Make sure your goal has a target finish time.

Some common pitfalls that can happen in goal setting:

1. Focusing only on the outcome of winning or losing. It is really important for individuals to set goals based on their own levels of performance.  When you focus on the performance goal, you’re chances of winning increase.
2. Don’t set too many goals at once. The more you set, the more difficult it can be to evaluate your goals or change them if an injury or other life situation happens.
3. Setting unspecific or unmeasurable goals: the less specific, the harder it will be to measure.  For example, “Improving my passing in soccer” is a difficult goal to measure.  A baseball catcher wanting to improve his throws to 2^nd base when a runner is stealing is much more specific and measurable.

As a reminder, if your child, teen or athlete appear to be struggling with symptoms of anger, stress, depression or anxiety, let them you know you are there to support them.  Scheduling an appointment with their pediatrician or family doctor can be an important step to getting them the help they need.   Students can also reach out to the Colorado Crisis Line and text or talk with a professional. Text “Talk” to 38255 or call 1-844-493-8255.

Information provided by:
Alex J. Reed, PsyD, MPH
Assistant Professor, University of Colorado School of Medicine

RESOURCES
Suicide and Mental Health Resources in your area of the state
Principles of Effective Goal Setting
Strides (App)

For more Mental Health Information, please click HERE.

Call the toll-free National Suicide Prevention Lifeline (NSPL) at 1-800-273-TALK (8255), 24 hours a day, 7 days a week. The service is available to everyone. The deaf and hard of hearing can contact the Lifeline via TTY by dialing 711 then 1-800-273-8255. All calls are confidential. Dial 911 in an emergency.

Learn more on the NSPL’s website.

SYMPTOMS

All individuals may not exhibit every symptom
These symptoms may indicate depression, particularly when lasting for more than two weeks:

• Poor performance in school
• Withdrawal from friends and activities
• Sadness and hopelessness
• Lack of enthusiasm, energy or motivation
• Loss of interest in activities they used to enjoy
• Anger and rage
• Overreaction to criticism
• Feelings of being unable to satisfy ideals
• Poor self-esteem or guilt
• Indecision, lack of concentration or forgetfulness
• Restlessness or agitation
• Changes in eating or sleeping patterns
• Substance abuse
• Sexual promiscuity
• Risk-taking behaviors
• Problems with authority
• Suicidal thoughts or actions

TEEN SUICIDE WARNING SIGNS

• Suicide threats (direct and indirect)
• Obsession with death
• Poems, essays or drawings that refer to death
• Giving away belongings
• A sense of “hopelessness” and/or no
future vision
• Dramatic change in personality or appearance
• Irrational, bizarre behavior
• Overwhelming sense of guilt, shame or rejection
• Significantly changed eating patterns (including drastic weight gains or losses)
• Significantly changed sleeping patterns (especially contributing to school truancy)
• Severe drop in school performance or social interest

ANGER MANAGEMENT

This year has been like no other for students, athletes, coaches and parents. The many changes to school and athletics can understandably set off different emotions, including anger. Anger is a normal emotion which can range from mild irritability to rage. It can be caused by both external and internal events. You could be angry at a person (parent, coach, sibling), a situation (not getting to play in a game) or it could be caused by worry about personal problems. Anger can be a helpful emotion; it can give you a way to express negative feelings or motivate you to find solutions to problems. But excessive anger can cause problems, including difficulties with thinking, worsening performance and physical/mental health consequences. Here are a few tips to help with anger:

1. Be assertive: Learn how to make clear what your needs are, and how to get them met, without hurting others.  Being assertive doesn’t mean being pushy or demanding; it means being respectful of yourself and others.
2. Be calm: Try a relaxation breath. STOP, breathe and then decide on your next step.
3. Use the AIMS app to learn tools such as deep breathing, muscle relaxation, thought stopping and time out.

If your child, teen or athlete appear to be struggling with symptoms of anger, stress, depression or anxiety, let them you know you are there to support them. Scheduling an appointment with their pediatrician or family doctor can be an important step to getting them the help they need. Students can also reach out to the Colorado Crisis Line and text or talk with a professional. Text “Talk” to 38255 or call 1-844-493-8255.

Information provided by:
Alex J. Reed, PsyD, MPH
Assistant Professor, University of Colorado School of Medicine

RESOURCES

Suicide and Mental Health Resources in your area of the state

APA – Anger

AIMS for Anger Management (App)

For more Mental Health Information, please click HERE.

HYDRATION/DEHYDRATION

Definition of Dehydration

• A mismatch between water intake and body water loss
• Loss of greater than 2% of body weight
• Most athletes do not voluntarily drink adequate volumes to maintain hydration in practices/games
• Dehydration is impacted by the intensity of exercise, environment and availability of fluids
• Predisposes to heat illness
• Significantly impairs performance
• Knowledge does not always translate into behavior

Symptoms of Dehydration

• Thirst
• Irritability
• Cramps
• Headache
• Nausea/Vomiting
• Fatigue/Weakness/Dizziness
• Decreased Performance

Management of Dehydration

• Assess level of distress/symptoms, consider removing from activity depending on the level of symptoms
• Rest the athlete and establish a rehydration plan to replenish lost fluids
• Water or sports drink may both be utilized to rehydrate the athlete

Prevention of Dehydration

• Water is something all young athletes need prior to exercise
• Develop a hydration strategy: drink before, during and after exercise. Hydration plans need to be individualized.
• Daily hydration habits are important for overall hydration status
• Monitor hydration by evaluating urine color
o A light color like lemonade indicates adequate hydration
o A darker color like apple juice indicates dehydration
• Fluid volumes needed to maintain hydration vary by size of the athlete, the athlete’s sweat rate, and the intensity of exercise

Coach Responsibility

• Educate athlete’s regarding the importance of hydration for safety and performance
• Allow easy access to fluids and schedule water breaks especially in the heat
• Monitor hydration status and player status when exercising in the heat

For complete CHSAA Hydration/Dehydration Protocols information, please click HERE.

As wildfires across Colorado continue to burn, the air quality across the state is a concern. Please see the following information from the Sports Medicine Advisory Committee.

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ATTENTION ATHLETIC TRAINERS

As you may be aware, our state is currently experiencing wildfires in various locations throughout the state.  As a result, air quality throughout our state, and in the affected areas specifically, has been impacted.  We urge you to visit the SMAC Handbook and Air Quality section of the Sports Medicine page on CHSAANow for helpful information.

As referenced from the CHSAA Sports Medicine Handbook:

AIR QUALITY INDEX (AQI)

The AQI is an index for reporting daily air quality. It tells you how clean or polluted your air is, and what associated health effects might be a concern for you.

MANAGEMENT

• Distance runners should avoid running next to busy roadways.
• Ozone exposure can be lessened by early morning work outs.
• Athletes with asthma must be carefully monitored when AQI is above 100.
• Athletes with asthma should always have a rescue inhaler readily available.
• Practices, contests, and outdoor activities should be modified or moved indoors when AQI is above 100 and consideration given to rescheduling or moving them when AQI is greater than 200.

In order to quickly assess the daily AQI in your area, please refer to this website:

Detailed Air Quality Summary

Other resources for information on air quality:

• Colorado Wildfire Information
• Colorado Smoke Outlook
• Colorado Air Quality Summary/Air Quality Advisories
• Front Range Action Day for Multiple Pollutants
• CDPHE Air Pollution Control Division – Facebook
• CDPHE Air Pollution – Twitter

(Steve Oathout)

With temperatures beginning to drop late into this fall season, the decision on whether or not to postpone games is a local-level decision.

To assist with that decision, the CHSAA staff, in conjunction with the Sports Medicine Committee, is sending out the following reminder to schools about their cold weather recommendations.

Again, any decision on whether or not to play a game is a local-level decision, and both schools should work in tandem to come to an agreement. 

Football has a rule limiting players to seven quarters in a week, and six quarters in three days. A week is defined as Thursday to Wednesday for the purposes of that rule.

Please see the SMAC Handbook’s Cold Weather Protocols for more information. More information about Cold Weather Safety is available from the National Weather Service.

The Sports Medicine Advisory Committee sends out updates on pertinent information periodically. Today’s topic is heat illness.

Heat Illness

• Definition: Heat illness is a spectrum of disorders occurring in athletes exposed to excessive environmental heat.

Heat Related Disorders

• Heat Cramps: Heat cramps present a mild form of heat-illness that can be easily treated. These intense muscle spasms usually develop after prolonged, intense exercises in the heat. The cramps are thought to result from fluid and electrolyte loss from sweating.
• Heat Exhaustion: Heat exhaustion is a moderate heat illness that occurs along a spectrum of severity and is associated with symptoms that may require medical attention.
• Exertional Heat Stroke: Heat Stroke is severe heat illness and represents a medical emergency that requires immediate action. Heat stroke can lead to permanent disability or even death if left untreated.

Prevention is key

1. Monitor environment
2. Adjust workload/equipment in dangerous conditions
3. Acclimatization of athletes
4. Mandate scheduled rest/breaks/hydration during practices for participants
5. Proper diet and hydration methods

For complete CHSAA Heat Illness information, please visit the Sports Medicine homepage.

The following newsletter was sent to schools on Aug. 9, 2018.

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Head, Heart & Heat videos

• Head
• Heart
• Heat

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• Sports Medicine Advisory Handbook

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Purpose

The CHSAA Sports Medicine Advisory Committee is a collective group of medical and educational professionals whose expertise provides current information to the association membership. It is designed to reflect and evaluate information provided throughout several resources.

Mission

The mission of the Sports Medicine Advisory Committee (SMAC) is to provide information, vision, and guidance to the Colorado High School Activities Association (CHSAA), while emphasizing the health and safety of students participating in interscholastic sports and activities.

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Venue Specific Emergency Action Plan (VEAP)

* New Bylaw *

• Every member school is required to create a Venue Specific Emergency Action Plan (VEAP) for each site that the member school practices and hosts athletic contests. The VEAP must include location, emergency access, emergency contact information and a listing of each member in the protocol’s duties.
• An annual VEAP training must take place no less than one time per year.
• To access the VEAP template and checklist, visit Arbiter Athlete.
• Small schools: The template provided can be modified to the unique needs and characteristics of your school, area, and community. Although it is not expected to look the same as some of our larger, more urban schools, it is expected that your VEAP is detailed and carefully constructed.

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Weather: Lightning

The purpose of the CHSAA lightning and tornado policy is to minimize the risk that lightning and other severe weather poses to players, staff, officials and spectators by implementing a lightning safety guideline. This policy shall be followed for all outdoor practices and contests. Prior to your events please gather weather information and have a plan.

• “No place outside is safe when thunderstorms are in the area.”
• “When lightning roars, go indoors!”
• Develop a lightning specific EAP for each venue or event
• When a thunderstorm seems eminent, lightning is seen or heard, or the weather app indicates that lightning is within 6 miles (8 miles for larger venues), the outdoor venue needs to be evacuated.
• The use of weather apps such as WeatherBug® Spark™ App, Storm by Weather Underground or the National Weather Service app are recommended (when not available, NFHS policy shall be followed).
• Activities shall remain suspended until there has been no lightning or thunder activity within a 6-mile radius for at least 30 minutes or 30 minutes has passed since the last flash of lightning was seen or clap of thunder was heard
• For the complete CHSAA lightning and tornado policy, as well as all other information regarding weather and lightning, please click here.

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Hydration

Dehydration

Signs and symptoms:

• Dry mouth
• Thirst
• Being irritable or cranky
• Headache
• Dizziness
• Cramps
• Excessive fatigue
• Individual not able to run as fast or play as well as usual

Treatment

• Move individual to a shaded or air-conditioned area
• Provide cold fluids/sports drink

For the complete CHSAA hydration protocols, as well as all other information regarding hydration, please click here.

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Concussion management

A concussion is a type of traumatic brain injury, or TBI, caused by a bump, blow, or jolt to the head that can change the way your brain normally works.

Important points of emphasis

• Signs and symptoms can be evident in four areas: Physical, Cognitive/Thinking, Emotions/Mood and Energy/Sleep
• Know your athletes at “baseline.” Know their pre-concussion level of symptoms, know their learning and attentional style, know their balance pre-concussion, know their headache and medical history, know their past concussion history and know their personality
• Research suggest that most students with a concussion may need a few days (usually 1 to 3 days), to be home resting with a gradual return to activity such as school and family activities.
• An athlete should be symptom-free (or back to pre-concussion functioning) in all four domains before being allowed to start the graduated return to play
• Complete CHSAA concussion management information and protocols

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Mental health

• See pages 27 & 28

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For all CHSAA Sports Medicine Advisory Committee Information, visit the Sports Medicine homepage.

The Colorado High School Activities Association’s Sports Medicine Advisory Committee met Wednesday in its continuing efforts to provide a safer participation environment and lessen risks to student participants in the state.

The committee, which meets several times throughout the year, continues to examine best practices and make recommendations to the CHSAA membership on risk minimization and safety.

“The CHSAA Sports Medicine Advisory Committee in comprised of the experts in pediatrics and children’s safety. Their voices have to be respected as we move forward to strengthen our risk minimization and safety platform,” said CHSAA Commissioner Rhonda Blanford-Green.

Among the outcomes from Wednesday’s agenda were:

1. The launch of Head, Heart and Heat Program which focuses on three major areas of concern for student safety.
2. Mandate Venue Emergency Action Plan (VEAP) – The committee will forward a recommendation to the CHSAA Board of Directors for the creation if a bylaw that mandates VEAPS. This will be voted on by the membership at the January Legislative Council.
3. A restructuring of the CHSAA Sports Medicine Handbook to better facilitate information
4. The development of CHSAA-sponsored educational videos on numerous topics for sharing with the membership and their collective constituencies.

“Colorado is fortunate to have a diverse SMAC committee. The committee consists of leading doctors, school personnel and athletic trainers. The members volunteer their time for the betterment of students when it comes to safety and risk minimization,” said SMAC liaison Assistant Commissioner Jenn Roberts-Uhlig. “As we continue to grow and evolve the expertise around the table help us keep recommendations and policies at the forefront of what we do.”

The CHSAA SMAC has been a part of the Association’s advisory committees for nearly 25 years.