The impact of Athletic Trainers in Industrial Medicine

Heidi demonstrates a simulated pull during a post-offer test to assess the employees ability to perform their job duties.

Advanced PT’s Heidi Bohl had the opportunity recently to share her experiences as an industrial athletic trainer to college students on the AT track in South Carolina. The college seniors who comprised her audience have been the beneficiaries of a number of presenters who highlighted a variety of topics related to pursuing a career in athletic training, but this was their first exposure to industrial athletic training.

While there are many paths open to those earning an athletic training degree, the majority make their debut in organized athletics (secondary schools, colleges, etc.). Already employed at the YMCA when she joined Advanced Physical Therapy & Sports Medicine, Bohl was initially hired for on-call work, covering for full-time athletic trainers to provide care to high school and middle school athletes as well as to club team participants.

Bohl enjoyed the work but made clear to her audience the importance of considering options and thinking about what is most important to each individual as they continue their education and pursue their career goals

“The schedule of a high school athletic trainer isn’t necessarily conducive to raising a family,” Bohl said. “My husband and I knew we wanted kids, and I wanted to be home for them.”

Bohl continued with part-time efforts at both jobs until her position at the YMCA was eliminated due to COVID; to replace those missing hours, she looked to the bourgeoning field of industrial rehabilitation, where companies hire providers to deliver healthcare services onsite to their employees.

It just so happened her current employer was a leader in the delivery of industrial onsite services. And because of the growth in that area, Advanced was looking for additional providers.

“Rob Worth (President of Advanced PT) knew me through the PRN work I had done, and we discussed the kinds of services Advanced was performing at companies,” Bohl said. “We both thought it would be a great fit for me.”

Advanced PT works with over 60 industrial companies, who employ physical therapists, physical therapy assistants, occupational therapists, occupational therapy assistants, and, of course, athletic trainers from Advanced to deliver the services necessary to keep employees at their best. The idea driving the model is simple yet profound: reduce the time and money lost to a company by reducing employee injury.

“We look at the employees at our companies as industrial athletes,” said Bohl. “Our presence onsite allows them to work safely at their job and enjoy life outside of work.”

Bohl’s skill set is vast, and good thing, as there are a multitude of areas on which to focus, including early intervention services, job testing, injury prevention, ergonomics, and wellness initiatives, to name a few. Programs are customized by the employer; they choose what best fits their needs and objectives.

After three years in industry, Bohl now dedicates all her hours to a single employer. She’s available onsite, naturally, but she’s also available by phone, text and email when not onsite to discuss injuries and determine plans of care.

“We promise opportunities for access to care within 24 hours if we aren’t onsite, which includes access to orthopedic providers we partner with,” said Bohl. “That kind of rapid response is a win-win scenario for employees and the employer.” Typically, companies utilizing the onsite model will see a reduction in OSHA recordable injuries by at least 50%, along with significant reductions in healthcare costs from both work-related and non-work related injuries. Bohl covered a lot of information in her thirty-minute presentation, but she saved a few minutes at the end for questions.

“Can you discuss the importance of developing rapport with the employees and understanding the company culture?”

“It’s vital,” said Bohl. “You have to know your employees and know how to interact with them. I provide services at a concrete and construction company. My dad was a general contractor. My uncle does concrete for a living. This is just a natural fit for me.”

If students didn’t understand the concept of variety in the world of industrial athletic training at the beginning, they sure were on board at the end.

“You’ll be on the floor, moving from area to area, employee to employee, encouraging people to come talk to you if they have questions, then you’ll head back to meet with the employees who made appointments to see you. Afterwards, you’ll be at a safety meeting sharing data and ROI; following that, it’s time to perform a jobsite analysis and then an ergonomic evaluation,” said Bohl.

After a busy day that included many of the aforementioned tasks plus the Zoom presentation to prospective industrial athletic trainers located a thousand miles away, Bohl was back at her full-time job, the primary focus of which revolves around getting her children to and from a plethora of practices, games and competitions.

She has a vast mom skill set too.

Trail Blazer to Trailblazer

Ray Mack is inducted into the St. Francis High School Hall of Fame by Dr. Deborah Kerr, Superintendent of Schools, on December 9, 2022

Many physical therapists have an injury story that contributes to a career path.

But most don’t include a connection to a legendary Wisconsin team whose mad dash to a national championship helped make March Madness what it is today.

Ray Mack of Advanced Physical Therapy & Sports Medicine vividly recalled a high school football injury from six decades ago that led him from athlete to athletic trainer.

“As defensive end, it was my job to get crushed first on a student body left,” Mack said. “Hurt my back and that was it. To continue participating in sports, I decided to become a student athletic trainer.”

And the rest, they say, is history. A history that includes the improbable journey with the Marquette Warriors basketball team from 1973 through 1977.

Understand that at the time of Mack’s injury, circa 1970, athletic training was in its infancy: it was the coaches who primarily handled injuries to their athletes. Outside of football hotbeds like Texas, the presence of athletic trainers was few and far between.

The year after Mack’s injury, he became the student trainer at St. Francis High School and would continue for the remainder of his high school career.

“I wanted to continue participating in sports and I had the aptitude for the health and medical stuff,” said Mack.

As a result of his performance, the St. Francis football coach obtained a scholarship for Mack to Marquette University as a student athletic trainer, which also allowed him to attend physical therapy school there. He covered multiple sports at the university including soccer, wrestling and cross country/track. Ray was also one of the first student athletic trainers for the new Marquette University's Title IX women’s sports program.

It was Division 1 college basketball, however, that powered the engine that was Marquette sports.

“I was blessed to be part of the national championship at Marquette in 1977 under legends Al McGuire, Hank Raymonds, Rick Majerus, and Bob Weingart,” said Mack. “All Hall of Fame members.”

While many know the names of the coaching legends, Mack highlighted Weingart’s impressive resume, which included 38 years as Marquette’s head athletic trainer as well as trainer for the USA track team in the 1972 Olympics.

“He was the man at Marquette,” said Mack. “Working with Bob was both an honor and an opportunity.”

It was during Mack’s senior year stint as the Warriors student athletic trainer when he was told he couldn’t continue with the basketball program during his second semester, as he was being sent to New York for his physical therapy residence—exactly when Marquette would make their run to college basketball’s ultimate prize.

Though Mack didn’t exactly appreciate the timing of the move, he later came to appreciate the wisdom of the choice his advisors made, sending him to areas that took him well beyond his identified niche in sports medicine.

“As a function of that experience, I became through my VA tenure an amputee specialist and a medical surgical clinic specialist,” said Mack. “It broadened my horizons dramatically.”

After 45+ years as a physical therapist, Mack continues to treat patients, specializing in the non-operative treatment of orthopedic-related injuries of the spine/pelvis and extremities. His personal interests are as vast as his medical pursuits and include photography, website development, history, learning theory and aquatics.

Oh, throw in mustaches and Hawaiian shirts too.

Mack described his work as an athletic trainer and physical therapist not as an occupation but a vocation, something he was meant to do in life. And while there is plenty to look back upon, there’s much more ahead.

“I'll do this for as long as I feel like I can contribute and make a difference.”

Advanced PT Presents at the 4th International Physical Employment Standards Conference

Traci Tauferner, Director of Industrial & Tactical Medicine at Advanced Physical Therapy & Sports Medicine, presented “Developing a Return to Work Assessment for an Injured Police Officer: A Case Report” at the 4th International Physical Employment Standards Conference in Gold Coast, Australia on February 26, 2023.

 The prestigious conference, hosted by the Bond University, will address the three T's essential to supporting physical performance in physically demanding occupations: Theory, Testing and Training. Specific topics will include physical employment standards, identifying and mitigating injury risk factors, physical conditioning and assessing occupational readiness.

 The conference content will be a blend of research and applied practice in a range of physically demanding occupations including military, law enforcement, fire and rescue and first responders.

 Modeled on some of the world’s best educational institutions, the vision for Bond University, Australia’s first private, not-for-profit university, is to provide an educational experience of the highest international standards under the tutelage of the country’s leading academics.

 During the past 30 years, Bond University has become one of Australia's leading institutions of higher education, renowned for its expertise in study areas ranging from business, law, medicine, architecture, and data analytics, to film and television, communication, sports management, and occupational therapy.

 Home to the Tactical Research Unit, Bond University research facilities attract world-renowned academics, working with state-of-the-art technologies and resources to develop cutting-edge innovations.

 Previous conferences were held in Australia (2012), Canada (2015) and the United Kingdom (2018).

Contact us to learn more about the details of the case report and how it helped the officer and agency.

“Police Support Staff Person of the Year.”

Traci Tauferner supplying rehab services at Wausau PD.

On January 7, 2023, the Wausau Police Department recognized Traci Tauferner as “Police Support Staff Person of the Year.” Tauferner, the Director of Industrial & Tactical Medicine at Advanced Physical Therapy & Sports Medicine, provides onsite preventative and reactive care for members of the Department and has been doing so since 2020.

Those who know Traci understand how squirmy this blog will make her, as she is the consummate team player who shuns any form of self-aggrandizement; however, the award is in her name, so we’re going to roll the dice and hope she’s too busy to notice we posted this.

And to put us in an even more precarious situation—because Traci flips really big tractor tires just for the fun of it—we’re going to use her own words to explain what she does and why:

“My passion to do my job to serve and protect others can be directly linked to the events of 9/11. The moment I saw TV news footage of departing soldiers leaving their families at airports across the country, I knew I was also going to help. I joined the Army soon after, and my 17 year old self went from "What have I gotten myself into?" to "I am capable of so much more than I have ever thought.

“I spent nine years in the National Guard, including a six-month deployment in Iraq providing security and surveillance support for tactical units. This training led me to where I am today. Helping others do what their job requires is what fuels and excites me, and a good deal of my energy now goes into developing programs and strategies that ensure essential job requirements can be performed safely.

“The day-to-day work with my tactical teams puts me in the unique position of understanding the physical and mental stressors they face; more importantly, it affords me the opportunity to do something about these circumstances. By providing the most advanced conditioning and rehabilitation resources available to the professionals tasked with keeping their communities safe, we can keep them performing at the highest levels while dramatically reducing the financial burdens placed on their departments.”

Congratulations, Traci!

Advanced Physical Therapy & Sports Medicine provides onsite therapy for Wisconsin companies, organizations and municipalities ranging from 50 to over 5,000 employees. To learn more about how we can customize an injury prevention and management program for your workforce, contact Traci Tauferner at 920-979-5597.

Make a Resolution to Not Make a Resolution

It’s the time of year when many people (well, perhaps not George Costanza) ponder making some improvements in their lives.

But let’s not consider this blog a catalyst for creating a list of New Year’s resolutions, as 25% of us quit those in the first week and nearly half of us are done by February 1.

So, how about trying to be a little more mindful in 2023?

Studies suggest practicing mindfulness leads to a plethora of benefits that include the reduction of anxiety and depression, greater enthusiasm for life, and improved self-esteem.

Best of all, mindfulness is accessible to all!

So this year, instead of joining the Seinfeld 4 (show creator Larry David insisted Jerry, George, Elaine and Kramer were to show absolutely no growth, ever) let’s try a little mindfulness, often described as the ancient art of being present in the moment.

First, Mindfulness Meditation:

Find a place where you can sit quietly and not be disturbed. For a few moments, anyway. Let’s start with 8-10 minutes, but don’t get overly concerned with timing.

Focus attention on your breathing, as it enters and exits the body. Won’t be long before your mind wanders, which means you’re being pulled out of the present. That’s all right. Try to notice your thoughts and feelings as if you’re an outside observer. Return focus to your breathing. Notice where your thoughts are going, accept what’s happening, but always try to return your concentration to your breathing.

Try to do the 8-10 minutes once a day. Before long you will be able to put more focus on your breathing and less on any upcoming plans you may have.

Next, Mindful Eating:

A practice food often used is the raisin. Yes, a single raisin. Move slowly through the following steps.

· Pick up the food. Notice it’s texture, color, size.

· Hold the raisin to your nose and notice the smell.

· Place raisin on your tongue but don’t eat it. Notice texture again. Roll it around your mouth and notice taste as well as paying attention to the feeling.

· Finally, begin to chew the raisin. Pay close attention to the flavor, the texture inside, how it reacts with your body—saliva, temperature of your tongue, any other sensations.

This process just slows everything down and helps you become more aware. Once you do this with a raisin (should take a minute or two), imagine how much more enjoyable your favorite foods become? And you don’t have to wolf things down. Practice often.

We’ll revisit mindfulness throughout 2023. There’s so much to learn, but it’s best to start small and doable. Declaring that the new year will be a veritable “Summer of George” is a bit vague, much too broad, and entirely unrealistic.

Remember, mindfulness is all about paying attention to your thoughts, your actions, and your body. Taking these little steps on a regular basis—grounding yourself in the present—can lead to big benefits and a healthier life.

Near-Site Care for School Districts

Advanced Physical Therapy & Sports Medicine's location at 402 Eureka Street is part of a multi-specialty clinic delivering high quality, low cost services to Ripon Area School District employees in 2023.

Only a generation ago, you’d be hard-pressed to find a school district in Wisconsin self-funding their health insurance.

Oh, how times have changed.

About 40% of school districts statewide are now self-funded, and that number continues to trend upwards. With self-funding, employers pay for claims out-of-pocket as they are presented instead of paying a pre-determined premium to an insurance carrier for a fully funded plan.

In essence, the employer becomes the insurance company.

One of the most recent to join the ranks is the Ripon Area School District (RASD), which will go self-funded in 2023. They will add a near-site medical clinic as well, with multiple care providers including a primary care physician, cardiologists, an orthopedic surgeon, and physical therapists available free to RASD staff.

Advanced Physical Therapy & Sports Medicine, a leader in direct contracting and onsite/near-site physical and occupational therapy care, will supply the physical therapy at the near-site clinic.

School districts must be laser-focused on the cost of health care, generally the second biggest budget outlay after salaries. With rising health care costs, districts know that money has to come from somewhere, and the simple truth is this: when revenue doesn’t increase and the cost of health care and operations does, those dollars will come from just about every student-centered program in the district.

Becoming wise consumers of health care is on every district’s and employer’s agenda—looking at data, doing their homework, finding the best care at the best cost—so money that is saved can go to the education of students, facility needs, or employee cost of living increases.

To learn more about the money-saving steps being taken in Ripon and other districts across the state, read Bethany Gengler’s article from the Ripon Commonwealth Press here:

https://www.riponpress.com/news/ripon-area-school-district-will-make-switch-to-self-funded-insurance/article_873ec986-605e-11ed-a2af-17529821152a.html

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Dry Needling

Autumn Paul, PT, DPT

You may have heard about dry needling from one of your friends or family members and now you are thinking, “What is dry needling? Could I benefit from it?”

Dry needling involves the practitioner using a solid filiform needle or hollow-core hypodermic needle (similar to an acupuncture needle) to place it through the skin and enter the muscle. The goal is to place the needle specifically into a myofascial trigger point (hyperactive muscle fibers).

These trigger points can be located in a tense band of muscle. For example, many people have tightness or soreness in their shoulders or necks from the tension they carry throughout the day.

These hyperactive muscle fibers (tense bands of muscle) can send signals to other parts of your body which are considered “referred pain”.

The goal of dry needling is to pierce these trigger points in order to allow these muscle fibers to relax, which can help reduce your pain levels.

“So what conditions may dry needling help with?”

● Headaches

● Shoulder/neck pain/tightness

● Lower back pain/ tightness

● Tennis and golfer’s elbow

● Knee pain

● Shin splints

● TMJ/jaw pain

● Plantar fasciitis

● Hip Pain/ tightness

“Can any physical therapist perform dry needling?”

In order to be able to perform dry needling, the physical therapist is required to go through extensive training. This training includes studying human anatomy and hands-on practice. These training sessions are often a weekend course or even several weekend courses.

“Awesome, I want to see a physical therapist who can assess and see if I could potentially benefit from dry needling. How do I make an appointment?”

First, look online to see what location is closest to you. Then, you can request to schedule an appointment with a physical therapist who is certified to perform dry needling.

—-

References:

Firth C, Meon J, Price M, Taylor J, Grace S. Dry Needling: A literature Review. Journal of the Australian Traditional-Medicine Society . 2020;26(1):22-28. Accessed January 14, 2021.

http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=143040461&site=eds-live

http://www.kinfolkwellness.com.au/dry-needling-adelaide

Benefits of Diaphragmatic Breathing

Kelsey Hinkley, DPT

We tend to underestimate the power of breathing! Breathing is an automatic response we typically do without thinking about it. However, breathing and how we breathe has shown to be extremely important.

There are many benefits specifically to diaphragmatic breathing. Some include but are not limited to:

·        Lowering cortisone (the body’s stress hormone) to help your body relax (6)

·        Lowering the body’s heart rate

·        Lowering blood pressure

·        Reducing gastric reflux by applying pressure to the esophagus (4)

·        Increasing sustained attention (6)

·        Reducing swelling and improving efficiency of the lymphatic system (1)

The diaphragm is an upside down U-shaped, skeletal muscle that separates our chest from the abdominal cavity. When we inhale, the diaphragm contracts pulling down and flattening. This helps create a vacuum effect to pull air into our lungs. When we exhale, the diaphragm relaxes back into that U shape, helping to push air out of the lungs. (4,5)  The more air we bring into our body, the better we can oxygenate our blood.

Here is a link to a video tutorial that provides a 3-D view of the diaphragm during diaphragmatic breathing: https://www.youtube.com/watch?v=hp-gCvW8PRY

If we are stressed or have cardiopulmonary issues, we tend to be shallow breathers and use accessory muscles in our necks rather than our diaphragm.  This could lead to muscle imbalance, tension, headaches, decreased oxygen levels, and pain. The more we perform diaphragmatic breathing, the more optimally we function. If we do not breathe like this naturally, it is important to practice this type of breathing. The more we practice, the more efficient and more automatic this type of breathing becomes.

How to Perform Diaphragmatic Breathing (3):

1.      Lie on your back with your knees bent and your back flat

2.      Place your hands on your stomach (A.) or place one hand on your stomach and one on your chest (B.) and concentrate on your breathing

3.      Inhale while expanding your stomach with minimal to no trunk or chest movement

4.      Then exhale without forcing.

5.      There should be a short pause after each exhale before the next inhale.

According to the Cleveland Clinic website, it is recommended to initially practice diaphragmatic breathing exercises 5-10 minutes about 3-4 times per day. (2) If no dizziness or discomfort is noted, gradually increase the length of time as desired.

I hope that after reading the benefits of diaphragmatic breathing, you will take the last 5-10 minutes of your busy day to perform this type of deep, relaxed breathing. You may be amazed how it may benefit your daily life.  Remember, we all get stressed and overwhelmed in life, however, it is how we overcome and deal with these emotions that matter.

Citation:

1.      Abu-Hijleh MF, Habbal OA, Moqattash ST. The role of the diaphragm in lymphatic absorption from the peritoneal cavity. J Anat. 1995;186 (Pt 3):453-467.

2.      Diaphragmatic Breathing. Cleveland Clinic website. Updated September 14, 2018. Accessed December 27, 2020. https://my.clevelandclinic.org/health/articles/9445-diaphragmatic-breathing

3.      Diaphragmatic Breathing. Physiotec Website. Copyright 1996 to 2020. Accessed December 27, 2020. https://hep.physiotec.ca/

4.      Drake R, Vogel A, Mitchell A. Gray’s Anatomy for Students. 2nd ed. Churchill Livingstone, an imprint of Elsevier Inc.; 2010.

5.      Hadjiliadis D, Harron P, Zieve D.  Diaphragm and lungs. National Library of Medicine: Medline Plus. Updated May 16, 2019. Accessed December 5, 2020. https://medlineplus.gov/ency/imagepages/19380.htm

6.      Ma X, Yue ZQ, Gong ZQ, et al. The Effect of Diaphragmatic Breathing on Attention, Negative Affect and Stress in Healthy Adults. Front Psychol. 2017;8:874. Published 2017 Jun 6.doi:10.3389/fpsyg.2017.00874

Winter Fall Safety (For Your Hands!)

Peg Hau, OT, MHS, CHT

Winter is a wonderful time for outdoor fun; but it can also be a time for falls and wrist injuries.  A fall on an outstretched hand can occur while walking on ice and snow to even the most cautious person.  There are a variety of wrist injuries that can occur from a spontaneous fall on an outstretched hand.  These injuries are sometimes termed FOOSH (fall on an outstretched hand) injuries.

One of the most common and well known FOOSH injuries is the distal radius fracture.  A fractured distal radius may cause pain, swelling, bruising and tenderness, and, in some cases, the wrist may look abnormal or even out of place.   Other symptoms can include numbness and tingling in the fingers, or the inability to bend or straighten the fingers.  As a Certified Hand Therapist at Advanced Physical Therapy & Sports Medicine, I probably see one distal radius fracture per week during the winter months, and sometimes more than that.

If a FOOSH injury occurs, a doctor may need to evaluate the wrist, and if they suspect that the radius is fractured, an X-ray of the forearm, wrist, and hand will be taken. If the doctor determines there is a fracture of the distal radius, a decision will be made regarding how to treat the break. Some fractures will require simple immobilization in a cast; others may require surgery to realign the bone.

The hand therapists at Advanced Physical Therapy & Sports Medicine work closely with the doctor to discuss when a patient is ready to begin moving the wrist after immobilization or surgery, and progressing functional use at home, work or school.   We also educate and instruct the patient on how to reduce swelling and pain while the fracture heals. For protection, we might also make an orthosis or protective splint to help support the wrist while it continues to heal. When it is safe, exercises that will help move and strengthen the fingers, wrist and forearm will be started.

A single blind randomized clinical trial completed in 2016 found that a supervised PT program is effective in the short and medium term, showing a clinically and statistically significant increase in function. This treatment also reduces pain and improves wrist ROM compared with a HEP in patients older than 60 years with distal radius fracture. For the patient, this would mean a faster return to every-day activities including work, home activities, and life!  Sounds like a win to me!

The hand therapists at Advanced Physical Therapy are located at the Appleton, Green Bay and Marinette clinics.  Please contact them with any questions or to schedule an appointment.

H. Gutiérrez-Espinoza et al. Supervised physical therapy vs home exercise program for patients with distal radius fracture: A single-blind randomized clinical study. Journal of Hand Therapy 30 (2017) 242e252.

Baseline Concussion Testing

Ben Benesh, PT, SCS

What is a concussion?  The Center for Disease Control and Prevention (CDC) definition:

“A concussion is a type of traumatic brain injury—or TBI—caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells.”

According to a Pediatrics study from 2016, it was estimated that between 1.6 and 3.8 million sports concussions occur annually in the United States. Concussions can happen in sport during a violent head to head collision in football or taking a charge and hitting the back of your head in basketball. They can be sustained during a whiplash-type injury in a flyer during a competitive cheer stunt or when a young athlete takes a volleyball spike to the head or face. Besides the obvious appropriate post-concussion management for these athletes, a proper baseline concussion test is key in the successful return to school and sport.

High school-age athletes are baseline concussion tested as a Freshman and again as a Junior. They are usually tested in school by their athletic training team. The group that needs the most attention are the elementary and middle school-aged children, that do not have access to athletic training staff, and do not have school-based concussion baseline testing. These kids are still playing sports, including collision type sports that put them at risk for a concussion. Over the last 7 years of treating patients following a concussion, I have seen plenty of soccer and football athletes, but have also treated basketball players, volleyball players, wrestlers, competitive cheer athletes, and even swimmers! In order to treat these patients as effectively as possible following a concussion, baseline testing is crucial.

In healthy athletes, baseline concussion testing includes concussion education, past head injury medical history, baseline ImPACT neurocognitive computer testing, baseline vestibular/oculomotor screening and assessment, and baseline balance assessment. These objective measurements will be saved and used following a concussion to determine if your athlete is back to “normal” following injury and can safely return to their sport they love to do.

In this crazy time dealing with the COVID-19 pandemic, sporting events are delayed or canceled and then rescheduled without notice. The training schedule may not be as consistent or as intense as previous years as kids are quarantined or had exposure to COVID-19 or coaches are unable to secure facilities to practice. Parents are often not even able to watch their children play sports because of spectator restrictions in gyms. All of these reasons make this year unique. But the truth is, concussions still happen during a pandemic and we need to be best prepared to give our young athletes the best care possible if they sustain a concussion.

Please contact us for more information or to schedule your Baseline Concussion Test at our Appleton North or Community First Champion Center or online (ages 12+) clinics!

References

https://www.cdc.gov/headsup/basics/return_to_sports.html

McCrory et al. Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. BJSM April, 2017

Elbin et al. Removal From Play After Concussion and Recovery Time. Pediatrics August, 2016