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II
75-14,813
REDFEARN, Richard Wayne, 1936THE STATUS OF THE HEALTH CARE CAPABILITY OF
ATHLETIC PROGRAMS IN MICHIGAN SENIOR HIGH
SCHOOLS.
Michigan State University, Ph.D., 1974
Education, health

Xerox University Microfilms r

©

C o p y r i g h t by
RICHARD WAYNE REDFEARN
1974

Ann Arbor, Michigan 48105

THE STATUS OF THE HEALTH CARE C APA BIL ITY
OF AT HLETIC PROGRAMS IN MIC HIGAN
SENIOR HIGH SCHOOLS
By
Richard Wayne Redfearn

A DI SSE RTA TIO N
Su bmitted to
M i c h i g a n State U n i v e r s i t y
in partial fulfill men t of the requirements
for the d egree of
D OCTOR OF P HIL OSO PHY
D e p a rt men t of A d m i n i s t r a t i o n and Higher Education

1974

ABSTRACT
THE STATUS OF THE HEALTH CARE C APA BIL ITY
OF ATHLETIC PROGRAMS IN MICHIGAN
SE NIOR HIGH SCHOOLS
By
Richard Wayne Redfearn

The survey of the health care capabilities of the
athletic programs in Mi chig an senior high schools was
intended to identify the practices of athletic medicine
pr esently found in interscholastic athletic programs.
survey was

The

the initial vehicle of discovery, w h i c h provided

a comprehensive view of six basic areas of good safety and
administration of the high school a thlete and the general
p rogram that supported or ganized sports.
The need for the survey was re adily evident.

There

is no single do cument available that relates the medical
aspect of interscholastic sports in the state of Michigan.
There are several empirical studies of individual high
schools or c omm unity institutional plans,

but no publication

that provides a c o m p re hen siv e view of the statewide program.
The survey was accomplished w i t h the assistance of
the M i c h i g a n High School A thletic A s s o ci ati on and the
Michigan High School Coaches Association.

The schools

selected for the survey were ra ndomly selected from the

Richard Wayne Redfearn
709 high schools that form the high school athletic a s s o c i a ­
tion.

Seventy schools were selected from each of four

classes,

and the principals of these schools wer e the

respondents.
1973,

Of the 28 0 questionnaires ma i l e d in September,

216 were returned,

percent.

for a statewide percentage of 77.15

The distrib uti on of return,

by class, was nearly

even.
Respondents were asked fifty questions.
were open ended, and solicited the respondents'

Two of these
opinions

about rules changes for the safety of high school sports,
I

football in particular.
The six categories that received attention were:
(1) physical me dic ine
letic training,

{and the practice of s a m e ) , (2) a t h ­

(3) athletic equipment and surfaces,

(4) athletic m edical education,
trauma and rehabilitation,

and

(5) records of athletic
(6) athletic me dic al- leg al

aspects.
The survey attempted to identify practices that can
be evaluated by both medical educati on and physical e d u c a ­
tion.

Once areas of need can be determined,

then the e d u ­

cational components of the state universities can act
appropriately to alleviate the situation.

In this regard

the results of the study provide a basis for advocating
service and education for the high school c omm unity as wel l
as additional research.

To my wife Deborah, who maintai ned love and
warmth in the home and faith in our future.

ACKNOWLEDGMENTS

To Dr. Louis C. Stamatakos, m y gra titude for his
trust and confidence in m y competen ce to successfully n e g o ­
tiate graduate study in higher education.

His respected

role of teacher and trusted advisor has always b e e n a source
of strength during m y quest for the d oct orate in education.
To Philip E. Greenman,

D.O. , m y a p p r e cia tio n for

his continuing support of my re se a r c h in athletic medicine.
Wi thout the u nfa iling mo ral and professional assist anc e of
Dr. Greenman,

this re search may never have re ached the

pioneer stage of med i c a l educat ion it pr esently possesses.

TABLE OF CONTENTS
Page
LIST OF T A B L E S .............................................
LIST OF F I G U R E S ..........................................

vi
X

Chapter
I.

INTRODUCTION

......................................

Backgro und ......................................
Purpose of Ath l e t i c Me dicine ................
Need for the S t u d y ............................
Statement of the P r o b l e m .....................
Setting of the S t u d y ..........................
Plans for the S t u d y ..........................
Ov erview of the S t u d y .......................
II.

R EVIEW OF SIGNI FIC ANT LITERATURE

..............

Literat ure Re lated to the Physical
E x a m i n a t i o n of At hletes
...................
L i te ra t u r e Re lated to the Psychology
of A t h l e t i c s .................................
Literatu re Re lated to the Medical
As p e c t of Wo men's Athletics
Literatu re Rel ated to Athletic
Eq uip men t Safety ............................
Su mmary of the L i t e r a t u r e ...................
III.

DESIGN OF THE S T U D Y ............................
D e fin i t i o n of Po pul a t i o n and Sample
. . . .
D e sig n of the S t u d y ..........................
Statement of Res earch Categories ............
Analysis of the D a t a ..........................
S u m m a r y ........................................

IV.

PRE SENTATION OF D A T A ............................

iv

1
2
5
17
21
23
23
27
29
29
37
40
44
51
54
54
61
63
65
67
68

Chapter
V.

Page
SUMMARY,

CONCLUSIONS, A N D REC OMM END ATI ONS

. .

S u m m a r y ........................................
Purpose of the S t u d y ........................
Limitations and Scope of the Study . . . .
M e t h o d o l o g y .................................
F i n d i n g s ......................................
Conclusions and R e c o m m end ati ons
............
State Associations' R e s p o n sib ili ty
and I n v o l v e m e n t ..........................
Local Communi ty R e s p ons ibi lit y ............
Administ rat ors ...............................
State L e g i s l a t u r e ..........................
Implications for Fu ture Res earch ............
Recommendations Regar din g Survey
P r o c e d u r e s ...................................
A P P E N D I C E S ...................................................

133
133
133
134
13 4
135
141
142
143
145
145
14 6
148
151

A.

Q U E S T I O N N A I R E ....................................

152

B.

LETTER OF I N T R O D U C T I O N ........................

166

C.

FOLLOW-UP LETTER

169

D.

OPEN-ENDED RESPONSES TO QUE STION FORTY-NI NE

E.

OPEN-ENDED RESPONSES TO QUESTIO N FIFTY

BIBLIOGR AP HY

...............................
.

. . .

.................................................

V

171
176
180

LIST OF TABLES
Table
1.1

3.1
4.1
4.2

4.3
4.4
4.5
4.6
4.7

4.8

4.9
4.10

Page
D i s t r i but ion of High Schools by Class, as
As sig ned by the Mic h i g a n High School
Athletic A s s o c i a t i o n ............................

24

The Rate of Return of Hi gh School Identifier
Postal Cards .....................................

59

D is t r i b u t i o n of C ont rac t Te am Physicians in
Mi ch i g a n Senior High Schools ...................

69

Rel ati ons hip of Contracte d T e a m Physic ian
to Physical Examinations for All I n t e r ­
...................
scholastic S tudent-Athletes

70

Med i c a l Specialties for Respond ent Schools'
Team P h y s i c i a n s .................................

71

A tte nd a n c e of T e a m Physician at Home
Football Games ...................................

72

A tte nd a n c e of T e a m Physician at Awa y
Football Games ...................................

73

A d h e re nce to a Standard Physi cal E x a m i n a t i o n
for Hig h School A t h l e t e s .......................

74

P r e s e nta tio n of Nine Subjects of Me dicine
C o n s t itu tin g a C o m p r ehe nsi ve Physical
E x a m i nat ion and the Percentages of Usage
of Each by M ich i g a n High S c h o o l s ..............

75

C o m p a ris on of Medical Cov e r a g e in Mi chi gan
High Schools by All opa t h i c and Osteopathic
P h y s i c i a n s ........................................

82

Di str ibu tio n of At hletic T rai ner s in
Mi chi gan High S c h o o l s ..........................

83

Qualify ing Tra ining for High School
A t hl e t i c Tra iners
...............................

84

vi

Table
4.11

4.12
4.13
4.14
4.15
4.16
4.17
4.18
4.19
4.20

4.21
4.22
4.23
4.24
4.25
4.26

Page
Distances F r o m At hle t i c Co ntest A r e a s to
Nearest Hospital With Em erg e n c y T r e a t m e n t
C a p a b i l i t y ........................................

86

Ac ces sib ili ty to Physical Th era p i s t by
Mi ch i g a n High S c h o o l s ..........................

87

Preseason Physical C o n d i tio nin g Programs
in Mi chigan High S c h o o l s .......................

88

Possession and U tilization of Th era py
Eq uip men t
.........
. . . . . . . . . . . . .

90

Nursing Positions and Their Involvement
With Ath letic I n j u r y ............................

91

Care of Injured At hlete by E ither Family
or School Ph ysician
............................

92

A v a i l abi lit y of Eme rg e n c y Equ ipm ent at
Athletic Contests and Practices
..............

93

Docume nta tio n of A thl e t i c Injury Thr oug h
Existing Records in M i c h i g a n High Schools

94

. .

Percentages of High Schools Using Game
Fields for Daily Football Pract ice ............

95

Percentages of High Schools That Evaluate
Their Game Field to Be in the Same
Condition as the Practice Fields ..............

96

Percentages of Football Games Pl a y e d at
Night and in the D a y t i m e .......................

96

Percentages of High Schools That Practice
Football U nder Artific ial Lighting ............

99

Percentages of Football Games Played on
Friday, S a t u r d a y , and Sunday ...................

100

Organic or C hemical C o m p o s i t i o n of High
School Track ......................................

101

C omposition of Basketball Courts in
Michigan High S c h o o l s ..........................

102

Concept of Legal Li ability by High School
Ad ministrators ...................................

103

vii

Table
4.27
4.28
4.29
4.30

4.31

4.32
4.33

4.34

4.35

4.36

4.37

4.38

4.39

Page
Utiliza tio n of Informed Co n s e n t F o r m in
Mi ch i g a n High S c h o o l s ..........................

105

Percentages of High Schools Ut ili z i n g OffSeason Weight T r a i n i n g Pro grams
..............

106

Opinions on Co r r e l a t i o n of At hle tic
Ac h i e v eme nt and Social and Ac ad e m i c Success

107

.

Ratings of M an n i n g Levels in Physical
Ed ucation De par tmen ts and Coa c h i n g Staffs
in Mic higan High S c h o o l s .......................

108

Opinions on A thl e t i c M e d i c i n e Pr o g r a m of
Education, Research, and S ervice Ori gin ati ng
at M ichigan State U niv er s i t y or Other StateSupported I n s t i t u t i o n ..........................

110

Opinion of Respon den t to Ph ysi c i a n At ten dan ce
at All High School Ath let ic E v e n t s ............

Ill

Opinion of Res pon d e n t to A thl e t i c Trainer
At ten d a n c e at All H i g h School A t h l e t i c
E v e n t s .............................................

112

Opinion of R esp on d e n t to the Sugges tio n That
Physician A t t e n d a n c e Become a M a n d a t e of
the M ichigan High School At hle t i c
A s s o c i a t i o n ......................................

113

Percentages of R e s p o n dent s W h o S upport More
Stringent Rules Reg arding the W e i g h t Loss
and Gain in High School W r e s t l e r s .............

114

Percentages of High Schools M a i n t a i n i n g
Me dical Records on Inter sch ola sti c
At hletic Partici pan ts
..........................

115

Percentages of Hig h Schools Keeping Medical
History, Annual Ph ys i c a l Evaluation, Injury
Record, T r e a t m e n t and R e h a bi lit ati on
R e c o r d s ..........................................

116

Percentages of High Schools That U t i l i z e a
Form of P s y c hol ogi cal M e a s u r e m e n t Wi th
Their A t h l e t e s ...................................

117

Percentages of H i g h Schools T h a t Have C l a s s ­
room Instruction Prior to S eason to Discuss
Rules, Discipline, and Phy sical Fitness
. . .

119

viii

Table
4.40

Page
Educational and Personality Preferences by
Administrators in Hiring N e w F aculty .........

120

Av ail abi lit y of M edi cally Trained Person to
Contend With Medical E mer gency ................

121

Identification of Med ically Trained
People to Attend Medical E mer gency

............

122

T he Fitting of Athletic E qui pme nt to High
School Ath letes
.................................

123

4.44

Ou tdoor Practice Times for Football

...........

124

4.45

Football Eq uipment Utiliz ati on

..................

125

4.4

6 Percentages of High Schools That Possess
the Airways Passage Device .....................

126

Percentages of High Schools Tha t T r e a t the
Ankles of High School Athletes With Tape
or W r a p ..........................................

127

4.48

Types of Helmets Utilized in Football

128

4.49

Percentages of High Schools That use Foam
Rubber Goal Line Markers in F o o t b a l l .........

129

Methods of Updating Athletic Training or
..............
Physical Conditioning Practices

130

Opinions of the Respondents to Proposed
Rules Changes in Football for the Intended
Purpose of A thletic Safety .....................

131

4.41
4.42
4.43

4.47

4.50
4.51

ix

.........

LIST OF FIGURES

Figure
1.

Page
Hypothesized Medical Care for V arious L eve ls
of Athlet ic Competiti on .......................

x

14

CHAPTER I
IN TRODUCTION

The present i n v e s t i g a t i o n was de signed to focus upon
the health care d e l i v e r y systems pre se n t l y em ployed b y the
senior high schools in the state of Michigan.
cifically,

More spe ­

the h e a l t h c a r e c o n t i n u u m was isolated as it

pe rt a i n s to the m a l e and female athletes who compete on an
i n t e r sch ola sti c level.
The n e c e s s i t y for the study arose from the r e c o g ­
nized in ability of those in me d i c a l e duc a t i o n to identify
accurately,

from any p u b l i c a t i o n or study,

the present

pr act i c e s e mpl o y e d b y high schools in the m edical care
categories of p hysical evaluation,
tion,

p hysical training,

psychol ogi cal e v a l u a ­

e mer gen cy m ed i c a l techniques,

me d i c a l care e d u c a t i o n of faculty teaching or coaching a
sport,

p r o x i m i t y of v a l i d m e d i c a l assistance,

rehabilitation,

physical

and r e e v a l u a t i o n of the injured athlete.

Until these p r a c t i c e s c a n be d ete rmi ned by people
who in tend to d e d i c a t e their re se a r c h ca pab ili ty to the
b e t t e r m e n t of a t h l e t i c s a f e t y and physical competition,
the f o u n da tio n for such an u n d e r t a k i n g is nonexistent.

1

2
Background
The initial d isc us s i o n of the subject of athletic
me dicine between the investigator and Philip E. Greenman,
Doctor of Osteopa thi c M e d i c i n e and C h a i r m a n of the D e p a r t ­
m e n t of Biomechanics at Mich i g a n State University,
place in the fall of 197 2.

took

The investi gat or had developed

an interest in the m edical edu cation and re search i n t e n ­
tions of the M S U C oll e g e of O s t e o pa thi c Medicine,

particu­

larly how the Co llege would r egard the topic of athletic
medicine.

The resources of a college of medicine,

the

ability to m ars h a l l e d u c a tio nal programs in the physical
sciences,

and the g ene rally rec ogn i z e d need of better health

care for athletes b ecame the foundation of thought that led
to the pe rc ep t i o n that rese a r c h o n the subject of athletic
m e di c i n e is merited.
The
the Col lege

De par t m e n t of B i o m e ch ani cs had been charged

by

of Osteopat hic M e d i c i n e to re search the a p p l i c a ­

tion of o s t e o pa thi c princip les
of the human body.

in the m u s c u l o s k e l e t a l system

Gr ee n m a n stated he had a definite

interest in

the field of a thletic medicine,

the newness

of the Co llege

but because of

(founded in 1971}

he had not yet

found the ex per t i s e in faculty or the finances to research
any p hase of m ed i c a l care and the applicat ion of o s t e o p a t h y
as it relates to the athlete.^"
"^Philip E. Greenman,

1972.

However,

he did state that

in conversation,

September,

3
any empirical res earch that identified areas in which an
athletic m edi cin e effort would be of signific ant b ene fit
would become a focal point for future discussions.
It seemed appropriate that the two disciplines,
me dicine and education,

should merge into a positive effort

to produce the necessary support required to pr omote the
furtherance of athletic medicine.

The initial step was to

poll the potentially interested academic commun ity at the
university regarding their possible contribu tio ns to a p r o ­
g r a m of athletic medicine.
A unique situation exists on the campus at Mic hig an
State University.

There are two colleges of medicine,

and

a large intramural and intercollegiate athletic pr o g r a m is
supported by the university.

Since both m ed i c a l colleges

have only recently been established,

neither has become

involved in providing partic ula riz ed m edical assistance to
the athletic program.
A general survey of the interest in athletic m e d i ­
cine was solicited from individual faculty members of the
various areas germane to athletic medicine.

Ideas and

observations were gleaned from faculty me mb e r s in physical
education

(Gale E. M i k l e s ) , human med i c i n e

osteopathic me di c i n e

(Larry L. B u n n e l l ) , n utr ition

M i c k e l s e n ) , exercise physiolo gy
mechani cal engineering
(David G. M c C o n n e l l ) .

(James S. F e u r i g ) ,
(Olaf

(Wayne D. V a n H u s s ) , b i o ­

(Robert W. L i t t l e ) , and bi o c h e m i s t r y
The result of the a ppr aisal was

4
encouraging.

It seemed that the willin gne ss to embark on

a scientific undertaking,
was re ad i l y available.

ultima tel y ben efi t i n g the athlete,

Individually,

each person was

inclined to e nvision hi mself in a p ositive contributory
role.
In further discu ssi ons with Dr. G ree n m a n of the
Co lle ge of Ost eop ath ic Medicine,

the prospects of college

co mmunity involvement w i t h the amateur and interscholastic
athlete were considered.

The c oncept of family practice

usually encompasses the r e s p o n s i b i l i t y of being the team
ph ysi c i a n for the local high school athletes and those who
compete on the amateur level.
nesses

The family pr act iti one r w i t ­

trauma g ene r a t e d by physical insult during athletic

competition.

Thus

it was decided an evalua tio n of the health

care capabili tie s of at hletic programs in the senior high
schools in Mi ch i g a n would

identify the need for athletic

me dicine educational pro grams to be pla c e d in future m edi cal
and educat ion al curriculums.

Should the res earch present

evidence of a need and a vi able educational mod el be des igned
to contend w i t h the e xpected situation,

then an academic and

re search function in the D e p a r t m e n t of Biomec han ics would
address itself to athletic medicine.

However,

the primary

concern of this study was to gain rese a r c h ev idence about
and identify me d i c a l needs of the high school athletic p r o ­
grams .

5
Purpose of Athletic Medicine
Athletic m edi c i n e is the application of science to
the understanding of the influence of athletic p articipation upon the human organism.

2

The effects of cybernation

and leisure have necessitated self-regulated ac tivity to
occupy

time not involved m

effects of sedentary life.
people,

work or to avoid

the undesirable

In a nation of 220 mi lli on

there is no accurate estimation of what percentage

of the population engaged in physical activity.
A l though the professional athlete receives expert
medical advice and care related to his particular sport,
the average part-time or amateur athlete receives little
guidance from the me dical profession that informs him about
the potential benefits or hazards of his engaging in athletic
participation.

It is estimated

that seventeen m ill ion

Americans are injured in recreational sports each year.

3

Thus is seems appropriate to attempt to identify the p r o ­
cedures,

habitual settings,

or beliefs that contribute to

the injury of the athlete.
The commonly accepted image of "the athlete"
individual who,

is that

while in his youth or early adult years,

participates in o rga nized athletic competition in secondary
2

The A m e r i c a n College of Sports Medicine, The
Encyclopedia of Sports Science and Me di c i n e (New York:
Mc Millan & Company, 1971), preface.
3
James A. Nicholas, "Spreading Sports Medicine
Around," Me dical World News 14 (April 1973): 7.

6
school,

college, professional,

or selective amateur ranks.

All these participants are r eadily identifiable,

but the

total census of athletes is swelled by the extrinsic
accountability of the people who qualify for athletic
status by performing in solo or group sports in sporting
clubs,

Young M e n 's/Women'g Chr istian Associat ion s

W H A ) , or independently participate in swimming,
wrestling,

self-defense,

jogging,

bowling, walking societies,

(or YM/

boxing,

track and field events,

or exercise by some form of

physical endeavor.
I

In the current study the question then became:
"How do we relate the practice of med ici ne to the human
form that is in athletic participation?"

The gen era lly

accepted philosophy was, whatev er trauma pr esented itself
to the physician could in turn be acted upon w i t h a p p r o x i ­
mately the same procedure for both the athlete and the
4

nonathlete.

This m anner of practice was acceptable until

the tally of injuries from athletic co mpetition and the
ledger of n o n a thl eti c-o rie nte d injury began to take on
differing aspects of treatment to accomm oda te variances in
the same traumatized anatomical member.
In the three decades since World W a r II, me dical
education has seen the practice of g eneral me dic i n e evolve
into the practice of specialty medicine.
4

The e duc ati on of

L. L. Bunnell, Director, Ingham County Hospital
Family Care Clinic, Lansing, Michigan, in confere nce on
Family H ealth Care Delivery, February, 1974.

7
physicians today is progra mme d with the t hought in mi nd
that the student will be p r e d i spo sed to a c onc ent rat ed area
of m edical study.

With the expansion of med i c a l knowledge

it has b e e n difficult to e nvision any phy si c i a n w i t h the
intellectual capabilities sufficient to re t a i n the various
functions and practices of physical m e d i c i n e currently
available in the higher levels of m ed i c a l education.
sequently,

Con­

expertise is d e m o n s tra ted in every imaginable

specialty of physical medicine.
The orthopaedics specialty t r a d i tio nal ly has been
clinica lly involved w i t h the trauma a s s o c iat ed with the
skeletal system of the human body.
ciation,

Be cause of this a s s o ­

the orthop aed ic phys ici an has h i s t o r i c a l l y been the

first source of reference for the athlete.

The p r e p o n d e r ­

ance of data on athletic injury has ha b i t u a l l y d e a l t with
the skeletal structure of the human body.
The evolution of the m a n y sports e mbraced by A m e r i c a n
society has led to e xce lle nce of p e r f o r man ce tha t w as thought
to be nearly impossible a number of years ago.

The p rod uct

of this achieve men t is the athlete who has turned his every
effort into a quest for a c h a m p io nsh ip p e r f o rma nce in a
singular sport.

The profess ion al and collegia te ranks are

illustrations of this effort.

The a thlete has ev olved in

much the same ma n n e r as the physician;
ists in their own field.

bo th could be s p e c i a l ­

The subject m a t t e r for physicians

has grown at such a rapid rate that a dequate c omp r e h e n s i o n

8
of the total medical
any individual.

s pectrum is impossible to expect of

The same is true for the athlete.

Time

and effort have been a llotted to a specific program that
has so occupied the athlete that little time remains to
engage in other ath letic programs.
skills, motivations,

Consequently,

and energies exhibited by the athlete

have been channeled into a specialty.
ollary,

the

To add to this c o r ­

one may compare the selective study neces sar y for

the physici an to b ecome a specialist in orthopae dic s to
the selective effort of the ath lete to become a h igh-calibre
performer.

Both have narrowed their field of achievement.

The dimensi on of the study and effort no longer e ncompasses
the broad latitudes of subject or sport,
embarked on a third d i m e n s i o n — depth.

5

but rather has
T h e y both choose to

excel in one segment of the total spectru m of either m e d i ­
cine or the sport.
time,

energy,

In both cases,

knowledge,

the ability to devote

and skill to their respective

endeavors will increase their achiev eme nt in their selected
specialties.
T h e intent of this dis cus sio n has been to i l l u s ­
trate the present
education.

Each u n d e r t a k i n g has called for emphasis in a

selected subject,
5

iirections of a thletic training and m edi cal

regiment ed by r i g i d limitations

in the

H. Royer Collins, paper p r e s e n t e d at the Ten th
Annual Post- Gra dua te C o n f ere nce o n the Medical A s p e c t of
Sports, Uni ver s i t y of Rhode Island, Kingston, July 27, 1973.

9
applica tio n of educational mat erials to that subject.
retrospect,

In

it seems there has been a narrowing of the

educational pr ocess to achieve an accurate focus on some
knowledge that represents the u l t i m a t e specialization.
At hle t i c medicine,
specialty,

represe nte d in the or thopaedics

has w i t n e s s e d the necessi ty for spe cialization

of study on a subject.

However,

there is a he sitancy to

state that the o r t h o pae dic spec ialty applies,
to the care of the injured athlete.

Moreover,

universally,
in these

days of care a p r i o r i , the o r t h o p a e d i s t is ruled out of

the

primary care of ath letes because he lacks complete medical
knowledge of the athlete.

This represents an a c k n o w l e d g ­

m e n t by the medical p r o f es sio n that the athlete presents a
problematic case that m u s t be satisfied by m a n y areas of
medicine.

The ne ces s i t y of additional data conce rni ng

athlete m u s t be recognized.
nutrition,

Biomechanics,

r eha bil ita tio n physiology,

the

hematology,

and r a d i o log y have
C

all gained importance in the care of the athlete.
represented by specialties

All are

in the medical profession.

Each

occupies a po sit i o n equal to that of orthopae dic s when it
was acknow led ged as being the specialty associ ate d with
athletic medicine.
Likewise,

the athlete w h o is p ort rayed in a single

event needs to include other sciences and techniques in his
g
James S. Feurig, in conversation, Ath l e t i c M e d i ­
cine Clinic, M i c h i g a n State University, September, 1973.

10
pr ogram to complement more fully his des i r e to become a
superlative athletic performer.

Tra ining techniques have

gone beyond the parameters of how the refinem ent s of the
event should be negotiated.
sport,

The practical aspects of a

such as wha t kind of competi tio n an at hlete should

be placed against and the type of surface the event should
be played on,
of the coach.

are satisfied by the k now ledge and experience
The sciences offer their exp ertise to the

athlete also.

The cardiology limitations of training
0
become a consideration.
Proper diet informa tio n is avail□

able through the food scientist.

W e i g h t limitations are

recommended by the exercise p h y s i o l o g i s t . 1 ^

The mo nit ori ng

of vital organ function under b oth physical stress and
basal states is accomplished by the b ioc he m i s t and the
p h a r m a c o l o g i s t . 11

These are m a j o r consid era tio ns for the

athlete and are important to acknowledge,

as they all have

a significant function in his performance.
7

Robert Castleman, Var s i t y T rac k Letterman, Michigan
State U n i v ers ity Big T e n and N C A A C ham pio n in intermediate
distances, 1973 and 1974, in discussion, April, 1974.
n
Richard Lampman, Director, Car dia c E val ua t i o n Clinic,
University Hospital, A n n Arbor, in clinic, May, 1974.
Q

Olaf Micklesen, Professor, Food Sciences, Mic hig an
State University, in discussion, December, 1972.
10Wayne V a n H u s s , Professor,
Physical Ed ucation and Recreation,
in discussion, January, 1974.
LI

De p a r t m e n t of Health,
M i c h i g a n State University,

James G. Garrick, Director, D ivi s i o n of Sports
Medicine, Univers ity of Washington, in di s c u s s i o n of sports
medicine at Mi ch i g a n State University, March, 1974.

11
Both the athlete and the physician have followed
similar pathways to achieve excellence in their respective
specialties.

In so doing,

they cannot adequately function

outside their immediate fields of end eavor without i n v o l v e ­
me nt with other specialties.

The physician who is inclined

to direct his me dical aspirations

to the field of medical

care for athletes is faced w i t h the fact that a single
medical specialty,

u sually orthopaedics,

will not suffice

if the intention is to render comprehensive care.
It would appear that the m edical practitioner has
been confronted with an evolut ion of med i c a l desirability
that has come full circle.

Me dical practice for athletes

has witnessed first the general practitioner,
specialist,

then the

and recently the concept that a br oad - s p e c t r u m

medical practice is necessary for the care of athletes.
However,

12

the fact that b r o a d- spe ctr um m e d i c i n e is now in

vogue does not indicate that the general practitioner of
several decades ago will be returned to his p osition of
importance.
will,

On the contrary,

of necessity,

the new gen eral practitioner

have to di splay a firm g rasp on the m e d i ­

cal knowledge that is represented in the aforementioned
medical specialties.

The d e p t h of knowledge will not be as

demanding as any one of the specialties,

but a fundamental

expertise will be par amount for proper care of the athletic
community.

12
A major concern of the p resent study was that once
the area of health care for athletes reached a plateau of
organized athletics b e l o w the collegiate or professional
level,

the ability to accommodate specialization would be

missing.

A small number of athletes have access to good

me dical care, while the gre atest number,
the youth of the nation,

represented by

have access to little or no medi-

.
13
cal c a r e .
The situations regard ing

the specialized physician

and the specialized athlete should serve to illuminate the
philosophical position each endeavor now holds.

The guidance

of both pursuits has been o m n i d ire cti ona l as a result of a
certain unident ifi abl e lack of educational surveillance.
For three decades

the e xpl osive nature of me d i c a l education,

resulting from a vast r esearch capability,
gentially from the core of medicine,
as general medicine.

w h i c h was once known

Instead of monito rin g

medicine in a pro portional sphere,

has grown tan-

the growth of

the me dic al profession

has allowed me dicine to assume a d esign in which the s p e c i a l ­
ties are appendages of the shrinking core, which represents
the aforementioned general medicine.
The same analogy applies to the athlete.

Time and

specialization have transformed the athlete into a specific
sports representative.

The word athlete histor ica lly has

indicated competition in sports, games,

13

Nicholas,

or exercises.

"Spreading Sports Medicine,"

p. 8.

The

13

p r e s e nt- day athlete seldom participates in more than one
sport,

game, or exercise.

In fact m a n y sports are divided

into several contribu tor y events that c o l l e cti vel y are
called a sp ort — i.e.,

track and field, wh ere the running

events alone entail distances of 220 yards,
880 yards,

the mile,

m a ra t h o n distance.

two miles,

440 yards,

and so forth on up to the

An athlete seldom can participate in

all or even the ma jo r i t y of these events.

The athlete who

is subclassified as a track m a n

is not expected

(or woman)

to have the requisite skills and stamina to accurately be
I

called a track man.
specifically,

The term then becomes a generality;

a person is a miler,

a d a s h man,

and so on.

Thus specialization has called for exactness w h e n speaking
of an "athlete."
The specialized athlete can call upon the talents
of other specialists in the physical education fields.
Likewise,

the me dical specialist can re quest a ssistance

from other specialists to supplement his needs as the cases
arise.

All of this m a k e s one wo n d e r how athletic safety

will survive and how med i c a l protect ion can be given to the
vast m a j o r i t y of our athletic p o p u l a t i o n by the specialty
or general medical profession.
Figure 1 depicts a c oncept of the a v a i l ab ili ty of
m e dical care for several levels of at hletic competi tio n and
how they relate to the envisio ned ad equacy of m ed i c a l hea lth
care.

In this p res ent ati on the medical capability represents

14

Level of
Medical Coverage

Level of
Competition

100%

approx.

/
.
/

20 to 3 5 % ............ yfunior high'^school.

\
approx. 5 to 8%. . .

little league l^seball
. . ./.. . .Pop Warner footbfcU.1
\ /
pee wee ice hockey
/

L ________________V

----------------^

V

Medical Care C a bability..

.

.

Level of Competition...... /

ji

A1

/

i

Figure 1.--Hypo the siz ed m ed i c a l care for various
levels of athletic competition.

15
the m e d i c a l p r o f ess ion in general.

The inverse p r o p o r ­

tions are illustrative of the c on c e r n of he a l t h care
d elivery systems as they p res e n t l y exist in the state of
Michigan.
In summary,

several salient thoughts m a n i f e s t

themselves through out this introduction to athletic m e d i ­
cine and the pro b l e m areas of the topic.

The first n e g a ­

tive aspect is that the trend of m e d i c a l edu cat ion m a y si g­
n i fic an tly ref r a i n from teaching the collec tiv e skills
necessary for treating athletes.
The f ina ncial structure
t
in w h i c h s p e c i a liz ati on has placed itself is a s ingularly
r e s t ri cti ng c on c e r n for the consumer.
treated by one specialist,
reasonab ly be satisfied.

If athletes could be

then the m o n e y problems m i g h t
However,

w h e n several specialists

are involved in a case the costs b ecome astronom ica l and
totally unrealistic.

Second,

there is an evi denced lack of

appropriate edu cat ion for physicians.

14

T h e annual a t t e n ­

dance at seminars and symposiums on sports m e d i c i n e w i t ­
nesses a gr o w i n g n u m b e r of physicians w h o re g a r d the athlete
in a d i f f e r e n t cat ego ry of pa t i e n t than the usual traumatized patient.

15

Third,

there w i l l be a continuing

James A. Nicholas, "The Ho u s e That N i c h o l a s
Built," The P h y s i c i a n and S p o r t s med ici ne 1 (November 1973):
73.
15

A. A. Savastano, Opening remarks at the T e n t h
Annual P o s t - G rad uat e C o n f e r e n c e on the Me dical A s p e c t of
Sports, The Un ive r s i t y of Rhode Island, Kingston, J u l y 26,
1973.

16
di sproportionate distrib uti on of physicians if the medical
student is schooled in the m erits of specialty medicin e
vice general medici ne. ^®

Specialists inhere ntl y are found

in great numbers around p opu la t i o n centers and universi ty
structures.

This is not at all encouraging to the p o p u l a ­

tion in need of medical services who live in other areas
of the state.

Such ma l d i s t r i b u t i o n will create additional

anxiety in the rural and sparsely p opu lat ed areas of the
state, w h e r e people have been treated by ge neral p r a c t i ­
tioners throughout their lives,

but now see them either m o v ­

ing away or dying and not being replaced.

Finally,

the

ignorance of physicians about athletic med i c i n e will n e c e s ­
sitate additional education for the profes sio n on a p o s t ­
graduate level.

The problem also calls for emphasis on the

expansion of the physical education curric ulu m to embrace
the professions of athletic trainer,
clinical nurse,

p hysical therapist,

scientifically o riented physical educators,

and others of the associate profes sio nal me di c a l fields.
This expansion,

in some ways, wi ll lighten the demand upon

the physician.

Several organizations are pressing the

M i chigan legislature for licensure rights
certified athletic trainers.

17

to pr actice as

The most potent of these

"^John A. Doherty, E xec utive Director, M i c h i g a n
Health Council, East Lansing, Michigan, in discussion,
September, 197 2.
17

George Andrews, Cer ti f i e d A thl eti c Trainer and
Member, Great Lakes A thletic Trainers Association, in
discussion, March, 1974.

17
factions is the National Athletic Trainers Association,
represented by the Great Lakes Athletic Trainers A s s o c i a ­
tion.

This group is a professional athletic trainers o r g a n ­

ization,

dedicated to the advancement of physical safety in

athletics.
The practice of med ici ne has gravit ate d away from
the general p ractice field that at one time carried the
major por tio n of the responsibility for care of high school
athletes.

The o ver v i e w of the medical situation, while

growing more sophisticated in a me dic al- t e c h n i c a l sense,
has illustrated a fear that the m edical care for high school
athletes has d ete r i o r a t e d significantly.

Within the last

several decades there has been a polari zat ion in medicine.
Medical education research does not have any reliable e s t i ­
mates of how this evolution in medicine has affected the
athletic po pul ati on of the high schools in Michigan.

Such

base data have to be realized before any firm commitm ent to
athletic med i c i n e can be made in the C ollege of Osteopathic
Medicine at M i c h i g a n State University.
Need for the Study
It was envision ed that the logical popula tio n from
which to d r a w dat a wo uld be the one wit h the largest numbers
of people

in at hletic participation.

Referring to Figure 1,

the ob server would possi bly start at the little league level.
However,

little league and the junior high school level of

athletic particip ati on would require contacting teams

18
throughout the state.

Little league does not have a s t a t e ­

w i de o rg a n i z a t i o n that exhibits administrative continuity
in all the areas of the state that wo uld be needed for
proper representation.

The junior h igh school programs

are very well or ganized in h igh-density population areas,
but are virtual ly nonexistent in the lesser populated
areas of Michigan.
The next alternative,

then, was the high school

level and it is quite possibly the segment of organized
athletics that needs to be studied because of the lack of
medical data on the high school athlete.

The high schools

in Mi ch i g a n also pr esent an o rga nized format from which
data can be drawn.

A realistic co ncept for a research

effort would be a survey of the actual health care c a p a ­
bility sequences

that follow the interscholastic athlete.

A study that w oul d solicit factual information from -a
reliable source w as suggested by Dr. P. E. Greenman,

C hairman

of the Department of Biomechanics at M ich iga n State U n i v e r ­
sity.

It was felt by the investigator and Dr. Greenman

that the main thrust of any athletic medici ne research
emanating from a state-s upp ort ed institution would be the
collection of data intended for the design of educational
models that,

in turn, m i g h t signific ant ly alter the health

care policies as they presently exist in Mic h i g a n high schools.
This collection of base line data and general evaluation of
athletic med ical provisions and services in Mi chigan high

19

schools was intended to provide basic information for the
d esign di sc ussed above.
propriate,

Because it was felt to be inap­

no compari son would be made between one school

and another or one class of schools and others.
Concern ed physicians,

physical educators,

and hi gh

school administrators have voiced a growing suspicion that
ex isting health care practices in the high schools are fall—
ing far short of their intended goals.

18

P roper health

care is not structured on a statewide basis.

Rather, health

care de li v e r y is recommen ded by the Michigan High School
«

Athleti c Association,

b u t is subject to interpretation and

compliance at the local level.

There is no state dictate

pertaining to the m edi cal care of an individual interscholastic athlete.

19

In 1927,

the state of M ich i g a n e s t a b ­

lished the requirem ent for a preseason physical examination
for i nterscholastic athletes.
tion in its day.

20

This was landmark legisla­

The Na tio nal Collegia te At hl e t i c A s s o c i a ­

tion did not require p rese aso n physicals for football p l a y ­
ers until 193 3 . ^
18

Gale Mikles, Chairman, Department of Health,
Physical Ed ucation and Recreation, Mic higan State University,
in conversation, September, 1973.
19

Al l e n W. Bush, Director of Athletics, Mic higan High
School A thl e t i c Association, Lansing, in conversation,
September, 197 3.
20

Me dicine 1

Wesley W. Hall, Editorial, The Journal of Sports
(September 1972): 19.

20
The lack of health care in the high school athletic
setting is us ually self-evident.

For example,

it can be

witnessed in abnormal gr o w t h and physical de velopment
retardation.

22

Adams stated that in physical examinations

of eighty high school w res tle rs

in Philadelphia,

he found

seventy-six of them to have an irregular gro wth pattern.

23

Lack of health care could also be w i t n e s s e d by the announced
re jection of the values of sportsmanship that w e r e taught
m

youth.

24

The youth in the high school setting place their
trust in the admini str ati on for their well-being.
medical care, althoug h ill de fined at present,
expect to receive.

However,

Proper

is what they

few st udent athletes in s e c o n ­

dary schools have the e duc ati on or ma turity to qu est ion the
medical practices they observe annual ly in their own schools.
Ideally,

athletic me dical care embraces a broad

spectrum of involvement with physiology,
physical medicine.
becomes

psychology,

and

A d m i n ist eri ng these categor ica l sciences

the keynote to the establishment and m a n a g e m e n t of a
22

T. K. Tcheng and C. M. Tipton, "Iowa Wrestling
Study: A n t h r opo met ric Measur eme nts and Predic tio n of a M i n i ­
mal Body W eight for High School Wrestlers," M edical Science
in Sports 5 (1973): 1-10.
23

Joseph S. Torg, in seminar discussion at the Tenth
Annual P o s t - G rad uat e Conferenc e on the Medical A s p e c t of
Sports, The Univer sit y of Rhode Island, Kingston, July 27,
1973 .
24

Zdenek Hornof and C estmir Napravnik, "Analysis of
Various A cci den t Rate Factors in Ice Hockey," Me dical Science
in Sports 5 (1973): 283-286.

21
conscious e ffort to insure that the youth of our high
schools receive the med i c a l conside rat ion s their trust
demands.
The philos op hy of athletic m e d i c i n e is e xpr essed in
the fundamental b elief that athletes should have the best
m e dic al care that is appropr iat e for the sport in which
they participate.

To take this logic and apply it to the

Mi chigan high school athlete was the initial step of the
analysis.

To ev aluate M i c h i g a n high schools,

do cum ent s and

related pub lis hed m ate ria l wer e so ugh t w h i c h w o u l d indicate
the current po sition of me d i c a l care in s eco ndary school
athletic programs.
No identi fia ble d o c u m e n t or co lle c t i o n of d ocu men ts
revealed and cr iti q u e d the he a l t h care c a p a b i lit ies that
exist for the intersc hol ast ic athlete
schools.

In this context,

in M i c h i g a n high

the M i c h i g a n High School A t h l e t i c

A s s o ci ati on gave this study its support and cooperation.
It was of par am o u n t importan ce that a resear ch instrument
be constructed that would pro v i d e an ad equate o v e r v i e w of
the health care d eli ver y systems for h igh school athletes.
It was envisio ned that the ov er v i e w wou ld include r e c o m m e n ­
dations regarding inadequacies

in the health care d e l i v e r y

systems and p lanning for their improvement.
St atement of the Pr obl em
The primary p r o b l e m examined in this study w as the
amount and kind of medical care M ich i g a n high schools

22
provide d while attending to the preca uti ons necessary for
safe physical partici pat ion in the interscholastic athletic
programs.

This care has histor ica lly been satisfied by an

evaluation of the degree of m edical and first-aid e x p e r ­
tise engendered in the faculty and physical education staff.
Profici enc y has tra ditionally included knowledge of p h y s i ­
cal training techniques;

level of education,

specifically

in the physical sciences of exercise physio log y and k i n e s i ­
ology;

and athletic psycholo gy

(athletic ps ych olo gy being

the latest to be applied to the athletic communi ty by the
behavioral scientist

25

),

The ability of a physical educator

or coach to recognize injury and adequa tel y tend to that
injury has been a questio nab le area of he alth care.

26

Con­

cern for the athlete encompasses the rules of the contest,
the eq uipment to be worn,
surface,
play,

the conditions of the playing

the adequ acy of the officials to gu arantee fair

and

injury or

the sequences of m edical pro cedure

in the case

of

incapacitation while engaged in an athletic c o n ­

test .
The high school has an
effort to

insure safety of the

o b l i g a t i o n to make every
athlete.

The problem is

that there is no known m e a s ure men t in use that could
25

B. C. O gi l v i e and T. A. Tutko, Problem Athlet es and
How to Handle T h e m (London:
Pelham Books, Ltd., 1965).
Thomas D. Meek, "Football Injuries: Acute Subdural
Hematoma W ithout Loss of Consciousness," Texas M edi c i n e 66
(July 1970): 58-59.

23
accurately ascertain and evaluate the m edical care co n s i d ­
erations and the ph ysi cal safety of the athlete in Mi chi gan
high schools.
Setting of the Study
The setting of the study was
in Michigan.
years

the senior high schools

This included high schools

(grades nine,

ten, eleven,

that counted four

and twelve)

as senior high

school and those that de clared the grades of ten,
and twelve to be senior high school.

eleven,

The three-year senior

high schools were c u s t o ma ril y found in the class A and
class B hig h schools.

The four-year senior high schools were

those of lower total enrollment,

p red omi nan tly

identified

with the class C and class D high s c h o o l s .
Total,

f ull -time student e nro ll m e n t is used to

assign high schools to one of the four classes.
sake of fair play,

For the

schools are r equired to pa rticipate in

interscholastic athletics w i t h teams that repr e s e n t other
high schools of similar size.

T a b l e 1.1 reveals the class

di stribution for the state of Mi ch i g a n in the fall of 1973,
as prescribed by the Mic hi g a n High School At hl e t i c A s s o c i a ­
tion .
Plans for the Study
Upon receipt of the information from the high
schools,

a g rouping of the

high school.

The elicited

data was to be m a d e by class of
information was not to be

24
utilized in a c omp ar i s o n fashion.
that the goal of the res ea r c h was

It m u s t be remembered
to ascertain the c a p a b i l i ­

ties of the high schools to del iver compre hen siv e me dic al
care to the resident student- ath let e population,

not to

grade one high school a gainst another.

Table 1.1 .- - D i s tri but ion of high schools by class, as
assigned by the M ich i g a n H igh School Ath l e t i c Association.
Class

Total High Schools
in Class

E n r o l l m e n t Numbers

A

1361 or more students

181

B

651 to 1360 students

183

C

339 to 650 students

177

D

Fewer than 339 students

168

State total

709

The ad equacy re v i e w was to be c ond ucted by using a
cross-reference comprised of the sports m e d i c i n e research,
the opinions of the m e d i c a l professi ona ls vi s-a - v i s s t a n ­
dards of health care in Mic h i g a n hig h schools,

and the

expertise of physical edu cation faculty at b oth Mic hig an
State University and The Univ er s i t y of Michigan.
The inform ati on elicited would have a practical
aspect as well.

It was planned that a p p r o pri ate data would

be transmitted to several state agencies

seeking re f e r e n d u m

in the state legisla tur e for rule changes.

L e g i s l ati ve

25
leadership could then inaugurate m a n d a t o r y compliance to
acceptable m edical and health care d eli v e r y systems for
high school a t h l e t e s .
The Mic hig an High School A thl e t i c As s o c i a t i o n
wanted the data for a critical analysis of the practices
they administer in the state.

The A s s o c i a t i o n was aware

that the health care for athletes in Mi ch i g a n high schools,
in some instances, was ope rating in a ma rg i n a l to u n s a t i s ­
factory fashion.

However,

the A s s o c i a t i o n felt rather

restricted because they kn ew of the severe financial con*
27
straints the high schools were experiencing.

It was

presumed that the m o n i e s allocated for each athletic p r o ­
gram have been employe d to the maximum.

Should an A s s o c i a ­

tion m a n d a t e regarding medical availabi lit y be thrust upon
Michigan high schools,

the ensuing financial b urden may

cause some interscholastic activities to be cancelled,
because of insurmountable financial difficulties.
The in formation was also to be sent to the Mi chi gan
High School Coaches A s s o c i a t i o n for review.

A p ortion of

the findings from the survey w oul d be e xam ine d by that
Association to est imate the po tential for rule changes.
The Coaches A s s o ci ati on also d esired information and o p i n ­
ions on injured player eligi bil ity and a standardized
27

A l l e n W. Bush, D ire c t o r of Athletics, Mi chi gan
High School Ath letic Association, Lansing, in i n t e rvi ew and
discussion, September, 1973.

26

physical examination for the physically rehabilitated
athlete.

The fact that an athlete is consider ed physica lly

fit for the day-to-day social and academic events of the
school should not be m isc ons tru ed as medical clearance to
return to the sport in wh ich he was or igi n a l l y injured.
Time spent in the healing process usually causes a degree
of atrophy in the injured musculation.

The return of a

previously injured athlete to normal p a r t i c ipa tio n fr e­
quently presents several psychogenic components.
athlete may d isplay the traits of emotion,
fatigue,

or apathy,

The

discouragement,

all of wh ich make him m ore susceptible

to reinjury than the uninjured athlete is to initial injury.

28

The Mic h i g a n Health Council desired demographic
data, which they could use to evaluate the availability of
various medical professions in several areas of the state.
Such data supplied to the Council were the numbers of p h y s i ­
cal therapists,

nurses, me dical facilities

(and the r e l a ­

tive distance from school to h o s p i t a l ) , licensure of physician
(allopathic or o s t e o p a t h i c ) , and the availabi lit y of e m e r ­
gency aid that was to be found in the community or the county
that sponsored the high school.
The study,

in toto, was also to be placed at the

disposal of the National At hle tic Trainers A s s o c ia tio n for
use in a legislative effort to seek a standard licensure
28

D. Ryde, "The Role of the P hys ician in Sports
injury Prevention," The Journal of Sports Med icine 5
(1965): 152.

27
for certified

(NATA)

at hletic trainers.

29

A c t i o n by the

state legislature in L ansing on this licensure was pending
at the time of this w r i t i n g . ^
It was expected that this survey would yield i n f o r ­
m ation that would become foundational re se a r c h m a t e r i a l
for the design of a functional d ivi s i o n of at hletic m e d i ­
cine and r esearch in the D e p a r tme nt of Biome cha nic s at
Michigan State University.

A por t i o n of the re search in

this di vision was to be c ond ucted on the campus at M ich iga n
State University,

but the m a i n thrust of the res ea r c h was

to be directed toward the senior hig h school a thlete p o p u ­
lation in the state of Michigan.
O v e r v i e w of the Study
In Cha pter II the literature re levant to the topic
of athletic me di c i n e is reviewed.

There is a pa ucity of

research on the athletic med ical programs and the a p p l i c a ­
tion of those medical programs to the high school setting.
The focal point for much of the subject is e xpr essed in
specific publications that address specialty fields of
medicine.

29

Bobby Gunn, President, N ational Ath l e t i c Trainers
Association, Indianapolis, Indiana, and Head Tr a i n e r for
the Houston Oiler Football Team of the Na tio n a l Football
League, personal correspondence, May, 197 3.
^°Donald Graham, President, Don Gr aham Associates,
Licensed Physical Therapists, in discussion, April, 1974.

28
In Chapter III,

the d e s i g n of the study is explained.

The d emo gr a p h y of the study is a c c o unt ed for, as is the
method of selection of respondents.

The operational p r o ­

cedures are explained,

as well as the procedu res used in

identifying the data.

Additionally,

c ertain questions that

need further investigation are discussed.
Ch apter IV contains the re se a r c h findings and the
results of the analysis of the data.
Chapter V is a s ummary of the results and co nclusions
of the study,

with d i s c u s s i o n and the r e c o m men dat ion s g e n ­

erated by the research.

C H A P T E R II
RE VIEW OF S I G N IFI CAN T LI TER A T U R E

The nature of the study n e c e s s i t a t e d a g eneral review
of research p ert i n e n t to the pr actice of me di c i n e

in the

r e a l m of the secondary school at hletic programs.

The first

section of this chapter is de v o t e d to a p res ent ati on of
represe nta tiv e w rit i n g s on the subject of ph ysi cal m e d i c i n e
and the examination of the po tential high school athlete.
The second section is intended to r eport the literature
re lated to the field of at hletic psychology.

Wri tin gs on

the growing segment of a thletic m e d i c i n e that concerns the
w o m a n athlete are pre se n t e d in the
ter.

third

part of the c h a p ­

Reviewed in the fourth section is the literature c o n ­

cerned with the safety of at hletic equipment.
Li ter atu re Related to the Physical
E x a m i n a t i o n of A thl ete s
You w on't be surpri sed to know that an accurate
h i story is by far the m o s t important thing in d i s c o v e r ­
ing and evalu ati ng disabilities; but getting a good
history from an athlete is not easy.
He m a y not
unload symptoms like m o s t patients in your practice.
Chances are he is not sick or in pain, and you pose
more of a threat than an asset to his career.
Keep
this in mind, b ecause athletes have been k nown to d i s ­
tort, conceal or deny important items in their past
history.
More distressing, parents sometimes en courage
or aid the evasions, and you m a y find a p hys i c i a n goes

29

30
along with it by om itting specific points in a c a r e ­
fully w orded letter that evades r e s p o n s i b i l i t y if the
boy does play.l
The pr ece d i n g statement by H irata draws a tte nti on
to the fact that proper care of the high school athlete
the r e s p o n s i b i l i t y of the physician,
athlete,

is

the family of the

and the school system that supports the a thl eti c

pr ogram in which the athlete participates.

The statement

also accur ate ly portrays the basic reason for the pau cit y
of personal me d i c a l histories,
survey.

as r epo r t e d in the current

The lack of kn owledge of the personal health h i s ­

tory has plagued the me di c a l p rof ess ion since health records
became mandatory.

It m atters not w h a t the findings have

been on any g i v e n individual,

if the re cording of those find

ings has not been accurate and intelligible.
Weed recommended that each he a l t h history be a pro2
cess of edu cation to both the p atient and the physician.
The patient's

fear of exposure,

to w h i c h Hi rata alluded,

could be allevia ted by the m e t h o d o l o g y champion ed by Weed.
Ignorance could be adequately contended w i t h by teaching
the pa ti e n t that the me dical record is b o t h a di a g n o s t i c
tool and a teaching instrument.

The fundamental fear of

most athletes is that they have some dis abi l i t y of whi ch
they are unaware,

and that the p hys ici an will u nc o v e r some

^Isao Ilirata, Jr., "When to Ex clude At hl e t i c C o m ­
petition," The C o n s u l t a n t , January, 1974, p. 79.
2
La wrence L. Weed, The Pr o b l e m Ori en t e d System
(New York:
Medcom, Inc., 1972), p. 23.

31
ph ysical weakness or malformity.

M u c h inform ati on about

the ath let e-p ati ent can be ascert ain ed b y the family h i s ­
tory.

The rec ording of a family m ed i c a l history is a basic

fu nction of v irt ually every me dical practice.

The inf or­

m a t i o n gl eaned from knowledge of the family traits and
habits contributes to an over all u n d e r st and ing of any i ndi ­
vi d u a l in that family.
preferences,

The ethnic origin,

religious beliefs,

n utritional

and a host of other c har ­

acterist ics become inferences and identities to certain
types of pathology.
Add to this the social and dem ogr aph ic
*
considerations, and a competent ph ysi c i a n has an excellent
start on a data base.

3

The findings of a physical e x a m i nat ion of an a t h ­
lete are the b ackbone of a medical record.
the question:
examination?

What

constitu tes an ade quate physical

Vandeweg he stated that there is no m i n i m u m

ph ysical examination.^

The ne cessary ingredi ent of a s a t i s ­

factory physical examination,
cal history,

This raises

he said, are a complete m e d i ­

including a list of past injuries and the

sports in w h i c h the athlete competes,

and an undressed

e x a m i nat ion to search for anomalies of the re s p i r a t o r y
tract,

the heart,

blood pressure and b lood count,

ge n i t o -ur ina ry tract,
3I b i d ., p.

skin,

skeletal system,

the

and a

23.

^Darrel Maddox, " S p o r t s p a g e s ," Th e Fhy sic an and
Sp ortsmedicine 2 (April 1974): 20.

32
neurological workup.
urinalysis,

A d d to that an electrocardiogram,

and X-rays.

Vandeweg he added that he did not

believe in a min imum physical because it lulls one into a
sense of false security.

As w i t h n u t r i tio n standards,

if

m in i m u m is the norm, h o w can one expect m a x i m u m p e r f o r ­
mance?

"A doctor taking only blood pressure and not li s t e n ­

ing to the heart is like a football player we a r i n g only
half a helmet."^
Rachun
by Vandeweghe.
lete,

6

and Rose
Rachun,

7

reiterated the concerns stated

in dealing w i t h the juvenile ath ­

urged the ph ysician to go beyond the search for an

acute infection or a history of renal,
impairment,

cardiac,

or sensory

and take partic ula r care to look for a history

of athletic or other injury or chronic m u s c u l o s k e l e t a l c o m ­
plaints.

For example,

youngsters w i t h serious head injuries,

wo bbly knees, memen tos of severe ligamentous damage,

and

re current shoulder sprains or d i s l o cat ion s should not be
allowed to play football or basketball.

Indeed,

if a

youngster who had a subluxating shoulder p roblem is premitted to play basketball or football,

he stands a very good

chance of completely d i s l o cat ing that shoulder.

The

5I bid.
c

Alexius Rachun, "The Most Dangerous Game," Emergency
Medicine 5 (August 1973): 102.
7
Kenneth D. Rose, Editorial, The Journal of the
American Me dical A sso cia tio n 219 (February 1972): 900-901.

33
p hys ician should take the time to investigate existing or
potential problems if he finds them,

and should keep the

youngster away from sports that m i g h t aggravate his c o n ­
dition .
Rachun further cautioned the p hys i c i a n to be r e a l ­
istic w h e n counseling potential athletes
setting.
hefty,
ease,

in the high school

The would-be athlete may see himself blocking a

hard-charging linebacker or moving w i t h N ama th- lik e
but the skinny lad with nary a mu s c l e to show for his

fifteen or sixteen years of existence or the obv iou sly
clumsy,

poorly coordinated boy who has never played foo t­

ball before simply is not ready for such a strenuous sport,
no matter how strong his d ete rmi nat ion m i g h t be.
The point with all these youngsters
ever their disqualifications,
the door,

is that w h a t ­

the phy sician should not close

but should open one for them.

The physical e x a m ­

ination is an opportunity for him to evaluate a youngster's
physical

standing and head him toward a sport that meets

his particul ar n e e d s — one that does not carry a risk for an
existing disabi lit y or one that p ermits mea s u r e d physical
develop men t of an underdeve lop ed boy.
range of activity from w h i c h to choose,
fications are absolute.

There is a wide
and few d i s q u a l i ­

Assista nce and gui dance at this

point can be of invaluable consequence to the developing
youth in the high school athletic program.

34
Rose,

in speaking of treating a d u l t athletes,

ca uti o n e d aga inst the u n d e te cte d defect in the heart,
kidneys,

or c i r c u l ato ry system.

also
liver,

Blood p ressure and age of

the ath lete constitute hazards from which the phy sic ian
should take a warning w h e n evalua tin g the po ten t i a l athlete.
The subject of physical examination of the athlete
does not always confine itself to the p r e p a r t i c i p a t i o n stage
of the med i c a l e v a l uat ion sequence.

The me di c a l ex ami nat ion

is e qu a l l y important in the evalua tio n of injury,
nosis,

and in rehabilitation.

in d i a g ­

R e h a b ili tat ion is d efi ned in

We bst e r ' s N e w C oll eg i a t e Dictio nar y as "to restore to a
g
former capacity: reinstate."
Marshall stated that the
first ten mi nutes of an injury are the mo st important ten
minutes of the total sequence of rehabilitation.

A proper

m edical e x a m i n ati on m u s t pr oduce the d iag nosis of injury
and the initial step in rehabili tat ing the injured player.'1'0
The d i a g n osi s of what the trauma appears

to be and the m e d ­

ical techniques app lied to aid the p atient and a ssist the
healing process are p ara m o u n t consid era tio ns in r e h a b i l i t a ­
tion.

The pitfalls of mi s s e d diagnosis,

inept care,

8Ibid.
g
Webster 's Se venth N e w C o l l e g i a t e D i c t i o n a r y , 1970,
p.

722.

^■^John L. Marshall, "When Does the Par t i c i p a n t
Return" (presentation to the T w e n t y- Fir st Annual Me e t i n g of
the A m e r i c a n Co l l e g e of Sports Medicine, Knoxville, T e n ­
nessee, M a y 9, 1974).

O

35
superfluous prognostication/

and lack of proper treatment

may cause undue incapacitation or even cripple the athlete.
Pisani outlined a definite time schedule for the
treatment of injured knees.

11

He stated that the first

twenty-four hours are the most crucial.

The diagnosis and

testing mus t be completed in that time because of the
pathology the injured knee presents.

The ligamentation

of the knee, once subjected to injury, becomes gelatinous
and quite unmanageable in surgery.

If corrective surgery

cannot be performed within twenty-four hours of the injury,
the next recourse is to attempt a major reconstruction of
the knee using adjacent muscle and cartilage.
The orthopaedic examination considerations are the
most important to a high school athlete.

Hirata stated

that the physician should decide who is to compete.

The

responsibility of decision making should not be delegated
to the coach or the trainer.

12

The orthopaedic examination

is important because of the fluctuating process of m a t u r a ­
tion in the high school athlete.

The hum an body experiences

an ossification process that begins in the sixth fetal month
and concludes w ith the fusion process in the twenty-fifth
year.

13

The fibrous,

cartilaginous,

and synovial joints are

^ A n t h o n y J. Pisani, "Pro Football's Injury S c o r e ­
card," Medical World N e w s , November 16, 1973, p. 43.
12Hirata,
13
(New York:

"When to Exclude," p. 79.

Roger C. Crafts, A Textbook of Human An ato my
The Ronald Press Company, 1966), p. 11.

36
pa r t i c ula rly v u l n e r a b l e to injury

du r i n g the years

epiphys eal o s s i f i c a t i o n is taking

place.

in

which

A diagnosed

we akness in any skeletal m e m b e r should d r a w immediate a t t e n ­
tion to the pos sible c o n s e q uen ces of da m a g e that wo uld
compound the d e v e l o p m e n t process.

The human body has

twenty-three points of ossification,
shoulder,

clavicle,

elbow, wrist,

Regarding proper movement,

14

located in the

hip,

knee, and ankle.

c irc u m d i c t i o n and rot ation

depend

upon normal g ro w t h and s t r e ng the nin g of the skeletal system.
The young ath l e t e m a y p r e s e n t m a n y m o r e chances
for physical injury
vidual.

than an older,

phy sic all y m a t u r e in di­

Klafs and A r n h e i m warned ag a i n s t the da ngers of

not recognizing the d i f f e ren ces b et w e e n skeletal age and
chronol ogi cal age.

15

The d i f f e r e n c e between the calendar

age and the skeletal age m a y best be de m o n s t r a t e d in this
discussion.

The boy who p resents hi mself for the e x a m i n a ­

tion with the e xpr e s s e d in tent of com peting in a sport
that has calendar age as a p r e r e q u i s i t e should be clo sel y
examined to obs erv e if he has the same skeletal strengths
and po tential for c o o r d i n a t i o n as the age group w i t h w hom
he is to participate.
is advanced skeletally,

This also applies

to the athlete who

but not by cal e n d a r age.

He may

p r esent a problem of n o t i c e a b l e p hysical superiority,

15

to'

Carl E. Klafs and Daniel D. Arnheim, Mo d e r n P r i n ­
ciples of Ath l e t i c T r a i n i n g (3rd e d .; St. Louis:
C. V.
Mo s b y Co., 1973), p. 23.

37
the point of u n c o n tes tab le dominance,

in his peer group.

This si tuation should come under the pur v i e w of the p h y s i ­
cian.
Li ter a t u r e R elated to the
Ps ych olo gy of Athletics
The subject of athletic psycho log y is relativ ely
new to the field of athletic medicine.

It represe nts the

effort to und ers tan d the m e n t a l app roach to athletics.
Vi r t u a l l y every segment of society has bee n res ear che d
r e g a rd ing the science of the mind.
The at hletic realm had
I
been ignored until two clinical psychologists, Ogi l v i e and
Tutko of Californ ia State Uni ver s i t y at San Jose,
the research.

C oaching

staffs

had rarely been exposed to

athletic psy cho l o g y and those who had been,
uates,

pioneered

as u n d e r g r a d ­

tended to ignore the potential of m e a s u r i n g the

m o t i v a t i o n s of the v arious levels of athletes they gui ded
in sports.

This scene is changing rapidly.

Og i l v i e and

Tutko b e g a n their e v a l u a t i o n of the problem at hlete in 19 64
w i t h a p u b l i ca tio n of m u c h the same n a m e . 16

A n out c o m e of

the r ese a r c h was an acknowl edg ment that the athlete did
have troubles and that the d i s c i p l i n e of psy cho l o g y could
be of some use in finding a solutio n for the v arious areas
of difficulty.
16

Bruce C. Og i l v i e and Thomas A. Tutko, Pro ble m
At hle t e s and H o w to Handle T h e m (London:
P e l h a m Books,
L t d . , 1965).

38
Athletic ps ycho l o g y began at the apex of the a t h ­
letic la dd er— the professional.

Professionals used the

results from tests conducted by Og ilvie and Tutko.

Lyon

gave a very fine o v e r v i e w and assessment of the Ogilvie and
Tutko psycho log ica l scalpel.

17

The test is officially

named the At hl e t i c M otivational Inventory,

but was referred

to by Ogilvie and T utko as "the instrument."

It contains

190 m u l t i p l e - c h o i c e questions designed to measure the s u b ­
ject in eleven p e r s o nal ity traits:
aggressiveness,

drive,

self-confidence,

c o a c h a b i l i t y , determination,

e motionality

(handling f e e l i n g s ) , conscience development,

trust,

sibility,

Jares related

leadership,

and m ental toughness.

respon­

these traits to a pragmatic situation in a professional
football camp.

18

The situation dem onstrates the po sit i o n of

the coach in regard to his need to understand the thoughts
and m ot i v a t i o n s of his athletes.
The ab ility of a coach to underst and the mental
attitudes of his players should be of inestimable value.
Psychiatrists have been nurturing the concept that many of
the patients they c ounsel have had their athletic paranoia
m a n i f e s t e d either by re jec t i o n by coaches or by abject
17

L eland P. Lyon, "A M ethod for A s s e s s i n g P e r s o n ­
ality Cha rac ter ist ics in Athletics: The At hletic M oti va t i o n
Inventory" (Master's thesis, Califor nia State University,
1972).
18
Doctor,"

Jo s e p h Jares, "We Have a Neuro tic in the Backfield,
Sports Illustrated, January 18, 1971, p. 32.

39
failure in sports and subjection to ridic ule by peer group
or from others w i t h i n the structure of the sport.

19

The ab ility to communi cat e w i t h a young person and
respect his individual desires wou ld go a long w a y toward
solving the apathy,

disillusionment,

emotion,

and possible

m a l i ng eri ng that subacceptable perfor man ce or und er- par
coaching m a y generate.
necessary for success

The a bi l i t y to evaluate the skills
in athletics need not be obtained

solely by physical means.

Brown stated,

We test them [potential football players] on the four
things you can determ ine absolute ly by testing, . . .
intelligence, pure speed, a gility and a bility to learn
football.
Th ose things, plus size, you can de ter min e
wi thout scrimmage.
We put all the players through our
tests.
The ones who were lacking were sent home.
There is no point in scrimmaging a boy you know is
not going to m a k e your team.
T her e is no need to
bruise him and no need to spend extra time on him. I
would rather concen trat e m y time on the players who
will be with me during the s e a s o n . 20
Clarke stated that it has been hypoth esi zed and
fairly well p roven that the athletic stature of the i n d i ­
vidual is d ire c t l y related to his p e r s o n al- soc ial status
and academic achievement.

21

Ad dit i o n a l studies on the

phenome non of sophomore and junior year drop-outs from
19

Thomas Tenbrunsel, C linical Psychologist, C oll ege
of Urban Development, Mi ch i g a n State University, in d i s ­
cussion, December, 1973.
20

Paul Brown, Head Coach, Cincinna ti Bengals F o o t ­
ball Club, quoted in Tex Maule, "Rude Wel c o m e Back for Paul,"
Sports I l l u s t r a t e d , September, 1968, p. 28.
21

H. Harriso n Clarke, "Characteristics of Athletes:
The Medford, Oregon, Study," Ph ysical Fitness Research
Digest 3 (April 1973): 14-18.

40
athletics are needed before any correlation among athletic
achievement,

academic success,

and social status is m a d e

by educators involved in a thletic psychology.
Getze reported his viewp oin ts of juvenile athletics,
which m a y be the seeding g round for teenage weariness of
sports, when he stated the predicament:
the conclus ion is that the

[little]

".

leagues'

. . In general
o r g a n i zat ion

and games are really for the pleasure and b en e f i t of the
adults.

The boys
Obviously,

. . . are like pawns in a chess game."

22

a coach who is aware of and interested

in the mental attitude of an athlete can alleviate a good
part of the "ho-hum"

attitude toward athletics.

The athlete

usually responds favorably to the face-to-face ap proach of
the coach in regard to any concerns
A cordial relationship,

the athlete m i g h t have.

without prostituting authority,

can

be inaugurated by a coach.
Li ter a t u r e Related to the Medical
As p e c t of Wom en' s Athletics
"With few exceptions wom en athletes
injuries as m e n in the same sports.
as well cared for as the men,"

suffer the same

But they have not been

said Sherry Kosek,

the first

woman to be certified as a trainer by the National At hle tic

22

George Getze,
Th e (Lansing, Michigan)
p. C— 1.

"Adults Hi nder Child's Play,"
State J o u r n a l , October 31, 1973,

41
Tr ai n e r s Association.

23

The sudden turn of events in b oth

at hletics and athletic m e d i c i n e has n e c e s s i t a t e d a new
look at the female athlete and a r e e v a l u a t i o n of the p h y s i ­
cal and m ental problems that n o r m a l l y b e s e t them.
Wi l m o r e stated that some sports m e d i c i n e experts
are ha iling the surge of w o m e n into sports as a longov erdue r e j e c t i o n of old wives'
of

the d a i n t y female.

24

tales and the s ter eot ype

W o m e n have r ece i v e d national

ac claim for feats of at hl e t i c e x c e l l e n c e in track,
running,

swimming,
Today,

Los Alamos,

25

fencing,

holds the record

L y n n Cox,

of

for the E n g l i s h

twenty-six m i n u t e s be t t e r than the men's

And Nat a l i e Cullimore,

Francisco,

and basketball.

a s e v e n t e e n - y e a r - o l d woman,

California,

Ch annel swim,
record.

tennis,

di st a n c e

was

thirty-three,

of San

the w inner of last year's o n e - h u n d r e d - m i l e

Am a t e u r A t h l e t i c Union

(AAU)

o p e n s u p e r m a r a t h o n run.

26

E v e n young girls are d o i n g w h a t was once c o n s i d e r e d
impossible.

M a r y Etta Boitano,

ten, of San Francisco,

has been run n i n g the m a r a t h o n di sta n c e of

twenty-six miles,

38 5 yards since she was seven years old.

This spring,

placed f ourth in the first w ome n ' s A A U marathon,

she

doing the

23

Sherry Kosek, " S p o r t s p a g e s ," The P h y s i c i a n and
Sports Me di c i n e 1 (June, 1973): 15.
24Jack H. Wilmore, "The C o m p l e a t Athlete?" M e d i c a l
World N e w s , M a y 24, 1974, p. 35.
25

Ibid.

42
distance m

three hours and one minute.

27

A fourteen-year-

old, June Chun, was an unofficial fifth among the women,
finishing in a fraction over three hours at the recent
Boston Marathon, which bars runners under eighteen as
official entrants.

28

Women are not without their physical limitations
when they participate in sports.

Kirk, Ansell and Bywaters

called for proper regard for the female anatomy by athletes
and physicians.

29

They stated that, anatomically,

the

knees of the m ale and female athletes are identical, but
that clinical studies show the following differences:
(1) Women do not appear to tolerate pain in the knee as
well as men,

(2) patellar

quent in women,

(knee cap)

injuries are more fre­

and women's knee joints generally are looser

and more hyperextensible than men's.

Hughston further

advised that patellar instability in most cases is a result
of congenital laxity of the quadriceps m e c h a n i c s m . ^
Lichtor advised that the loose-jointed woman athlete can
avoid trauma if a proper medical evaluation is given and

29

J. A. Kirk, B. M. Ansell, and E. G. Bywaters,
"The Hypermobility Syndrome," Annual of Rheumatic Diseases 26
(1967): 419,
tn

J. C. Hughston, "Sublaxation of the Patella,"
Journal of Bone and Joint Surgery (Am.) 50 (1968): 1003.

43
po ssible r emedial exercises are p e r f o r m e d to strengthen
the k n e e .^
The subject of little league bas eball and its effect
on y o u t h has b e e n dis cussed in increasi ng volumes in the past
32
33
few y e a r s . Torg
and Pat r u s k y
stated the case for
re lax a t i o n of pressures upon the childr en to be instant
winners.

The loosers in m a n y instances become the p o s ­

sessors of d e f e a t e s t attitudes that continue on into adult
years.
To com pou nd the p r o b l e m of y o u t h and little league,
t
w e have w i t n e s s e d the ab ility of the y o u n g female baseball
p layer and her desire to compete on an equal basis with the
boys.

Torg and Torg w r o t e on the m e d i c a l - l e g a l aspects

pertain ing to p r e a d o l e s c e n t girls and their proposed place
xn the ranks of lxttle league ba seb all players.

34

Hale

35

31

Jo s e p h Lichtor, "The L o o s e - J o i n t e d Young Athlete:
R e c o g nit ion and Treatment," The Jo urnal of Sports Med i c i n e 1
(September/October 1972): 22.
32

Jo s e p h Torg, "Little League: T h e T h e f t of Carefree
Youth," The P h y s i c i a n and S p o r tsm edi cin e 1 {June 1973):
72-78.
33

Be nja m i n Patrusky, "The Secret Psyche of the Peewee
Sportsman," The Phy si c i a n and S p o r t s med ici ne 1 {June 1973):
82-86.
34

B a rbara G. Torg and Joseph S. Torg, "Sex and the *
Little League," The Ph ysi c i a n and S p o r t sme dic ine 2 (May 1974):
45-50.
35

C r e i g h t o n J. Hale,
World N e w s , M a y 24, 1974, p.

"The C o m p l e a t Athlete," Medical
37.

44
and Sheehan et al.

36

expressed two d i f f e r i n g viewpoints,

both fortified w i t h med i c a l logic, o n w h y pr eadolescent
girls should be allowed to p a r t ic ipa te in little league
baseball.

Hale would bar any c o m p e tit ion whatever,

the ma jo r i t y of the prota gon ist s see no danger,
or psychologically,

whi le

med ica lly

in the involvement of girls in little

league.
L i ter a t u r e Related to Athletic
Equipment Safety
The safety of athletic equ ipment has received little
at tention as a cause for concern.
their inherent hazards:

V ari o u s sports have

Track has the three-quart er- inc h

spike on the shoe, and coaches have always stressed the
danger of ru nning up the back of a competitor's leg.
javelin has injured a number of field contestants,
has usually been an area problem.
thousands of players,
ball,

swimming,

of bodily insult.

but this

Baseballs an nually injure

in various degrees of trauma.

wrestling,

The

Basket­

and tennis all have their moments

Nevertheless,

the maj o r i t y of athletic

injury stems from an improper ph ysical approach to the game.
A lack of physical conditioning,
i.e.,

disregard for the rules,

allowing a noncontact sport to become a con tact sport,

or a flagrant display of bravado with an overt dis regard for
personal safety are some examples.
36

The result of such

George Sheehan et a l ., "The Compleat Athlete,"
Medical World N e w s , May 24, 1974, pp. 36-68.

45
actions can cause a c c i d e n t s , and these accidents take only
a minute to occur.

The medical profession accepts these

occurrences as unavoidable;

however,

little attention is

given to the safety factors of sports in w h i c h pr edesigned
collision is not part of the game.

As a result of this

seemingly arbitrary neglect of noncont act sports,

little

has been w ritten about the equipm ent used in those sports.
The emphasis in the literature pertai nin g to e q u i p ­
m e n t is di rected pri marily to football.

Garrick a rt i c u ­

lated the usage of the football helmet in both the preinjury
stage and the post-in jur y setting.

37

The ability to remove

the helmet from a player who has sustained a cranial injury
or a cervical spine injury necessitates g r e a t skill and
planning,

and involves a life-and-death situation.

More­

house researched the safety design features of both the
football helmet and the face mask.

He found that the face

guard has reduced the number of fractured noses and c h e e k ­
bones

in football, but b ecause the face guard inadvertently

acts as a "handle,"

it may trade face injuries for neck

38
inj u r i e s .

37

James G. Garrick, "Sideline Decisions: A Practical
A p proach to Clinical Recognition and Immediate Ma nag eme nt
of Injuries in Athletes" (paper pre sented to the TwentyFirst Annual Mee t i n g of the A merican College of Sports
Medicine, Knoxville, Tennessee, May 9, 1974).
38

Ch auncey A. Morehouse, "Helmets, Faceguards and
Be tter F o o t b a l l , " The Physician and Sportsmedicine 1
(November 1973): 32.

46
Hall stated that di r e c t injuries to the head,

neck,

and spinal cord cause the highest percentage of deaths in
football.

39

To illus tra te the point,

the v arsity fullback

for the Mic higan State Univ er s i t y football team during the
fall of 1973 cracked five football helmets in the course
of the season.

In addition,

it was ob served that the

team's football helmets were not constructed to keep the
metal frames that cover the face from bending in toward
the nose and m o u t h area;

such was the force of impact

be t w e e n one player and another, or between player and playmg

£
40
surface.
A d k i s o n et al.

that,

stated there can be little doubt

aside from questions raised relating to safety,

synthetic turfs offer advantages over natural turf.
However,

the results of the high school football injuries

study in Seattle,
major

41

Washington,

field types studied,

revealed that of the three

the Astro Turf

fields had sig­

ni fic a n t l y higher injury rates than did grass or Tartan
Turf.

Grass had an intermediate number of injuries per

39W esley H. Hall, "Sports Medicin e Editorial," The
Jo urnal of Sports Me di c i n e 1 (September/October 1972}:
19 .
40

Martin Daly, At hle t i c E qui p m e n t Manager, M ich iga n
State University, in d i s c u s s i o n on athletic headgear,
N o v e m b e r , 197 3.
4^John W. Ad k i s o n et al., "Injury Rates in High
School Football: A Com par i s o n of Synthetic Surfaces and
Grass Fields," accepted for publ ica tio n in Clinical
Orthopae di cs and R elated Research, 1973.

47
game,

and Tartan Turf had the lowest injury rate.

the alterat ion of a single environmental variable
this case the playing surface)

Thus
(in

had a significant impact

on the frequency w i t h which injuries were sustained.
Torg conducted a study that pr obably has been as
significant a de ter ren t to injury in football as anything
that has been published in the past several years.
the Torg study,
was issued.

42

Within

the r e c o m men dat ion for soccer-type cleats

The soccer-type cleat has a shorter length,

but there are more of them on the sole of each shoe.

Some

soccer shoes have as few as fourteen cleats and some as
many as twenty-two nipple-type cleats.

The new cleat is

part of a molded sole, which is a poly-p las tic compound
and can break a vertical grip with the playing surface
with less horizontal or diagonal
cleat was a threaded,
either steel,
sheath.

torque force.

The old

screw-on type of device that was

aluminum, or plastic with a metal threaded

W ithin the medical p r o f ess ion the domina nt thought

is that the Torg report has c o n c l usi vel y p res ented a p o s i ­
tive argument that knee and ankle safety is better assured
with the soccer-type cleat.

It m i g h t be assumed that high

schools that adopt this style of footwear should have better
safety records with regard to knee and ankle injuries.
42

Jo seph S. Torg, "Effect of Shoe Type and Cl e a t Length
on Incidence and Severity of Knee Injuries Among High School
Football Players," Research Qu arterly 42 (May 1971): 203211.

48
O ' Don o g h u e stated that all players

should have

therr ankles wr a p p e d prior to practices and games.

43

The

subject of ankle support is appropriate in this d i s c u s ­
sion because it has generated more comment and deb ate than
any other a rticle of safety equipment.

Ryan s t a t e d ,

Increased professi ona l recognition must be justified
by prompt elimi nat ion of "folklore" treatment. . . .
In short, we m u s t be able to provide sound reasons
for wh at we do or we should stop.
It is a we lldocumen ted fact that good intentions do not guarantee
good results nor do they guarantee any results at
a l l .44
This statement applies to the beliefs that surround the
commonly accepted practice of taping ankles.
joint,

unlike the knee joint,

muscles.

The ankle

is not supported by strong

The only powerful m us c l e group that crosses the

ankle joint with its tendon is the gastrocnemius s o l e u s ,
and it lies too far pos terior to serve as a stabilizer.
Thus,

there is no p o s s i bil ity of strengthening the ankle

by exercising the muscles whose tendons cross the joint.
Additionally,

Ryan stated that no one has yet demonstrated

in the adult human that ligaments can be strengt hen ed with
45

exercise,

a lthough this a ppa re n t l y is po ssible in animals.

O ' Don o g h u e sup ported Ryan's statement,

but b elieved

that use

43
A t hletes
p. 26 .

.
Don H. O'Donoghue, T r e a t m e n t of Injuries to
(Philadelphia:
W. B. Saunders Company, 1962),

44

Al l a n J. Ryan, "Taping Prevents A c u t e and
Repeated A n k l e Sprains," The P hys ician and S p o r t s m e d i c i n e 1
(November 1973): 40.
45

Ibid.,

p.

41.

49
of tapes is a mea s u r e that should be re se r v e d for rehabilltating an ankle injury.

46

Ferguson's vi ewp o i n t aptly pr ese n t e d the o p p o s i ­
tion to Ryan.

Fergus on stated there is evide nce to i n d i ­

cate that taping m a y have a d e l e t er iou s effect,

and instead

of preventi ng injuries taping m a y ag gra v a t e t h e m . 4^

A

major factor w or k i n g against the pr es u m e d be nefit of
t api ng— the rigid support of the at hle t e ' s a n k l e — is the
mobile nature of the skin itself as it m o v e s over the s u b ­
cutaneous tissue that in turn m o v e s over the bones and
t

ligaments taping is intended to reinforce.
is inefficient at the start, and,
be neath the tape,
ther.

Thus,

taping

as m o i s t u r e accumulates

skin ad herence is le ssened still fur­

As an injury preventative,

to have little actual effect.

then,

taping can be seen

Calf m u s c l e b uildup is one

of the m o s t important m easures to pr eve nt ankle sprains.
The rolling m o t i o n of the subtular joint,

just ben eat h the

ankle,

inverts and everts the foot and acts as a "safety

valve"

for the ankle joint and knee,

mu scle of the calf.

stabilized by the

The false securit y of taping not

only tends to d imi n i s h tone in these muscles,

but also

acts to inhibit the natural injury p r e v e n t a t i v e m o t i o n of

46
O'Donoghue,

op. cit.,

p. 27.

47

Al b e r t B. Ferguson, "The Case A g a i n s t Ankle
Taping," The Journal of Sports M e d i c i n e 1 (JanuaryF e bruary 1973): 46.

. .
48
the subtular joint.
lar to Ferguson's.

49

Rarick pr esented an a rgument simiRarick contend ed that the stress of

activity quite rapidly loosens the tape and leaves the
ankle with little actual protection.

This is further

evidenced when the locker room procedures in most high
schools include the taping of the "star" athlete first as
a matter of protocol,

but the action ac tually leaves that

athlete with the poorest support by game time merely
because he has had it on for the longest p e r i o d of time.
Kozar took a neutral pos ition on the topic of
taping.

He con tended that ankle taping does not signifi-

cantly improve the dy namic balance of athletes.

50

Kozar

reported that the two m o s t common responses by athletes,
regarding the effects of taping on their production,

were:

(1) They felt that having their ankles taped restricted
their flexibility at the ankle joint,
performance;

and

w hic h hin dered their

(2) They felt that fatigue set in sooner

as a result of the taped ankles.

51

4 8 T, . .
Ibid.
49

G. L awr e n c e Rarick et al., "The Mea sur a b l e S upp ort
of the A n k l e Joint by Convent ion al Me thods of Taping,"
Journal of Bone and Joint Surgery 44 (1962): 1183-90.
50

Bill Kozar, "Effects of A n k l e Taping Upon Dynamic
Balance," The J ournal of the Nationa l Ath l e t i c Trainers
As soc iat ion 9 (June 1974): 96.
51,..
Ibid.

51
Summary of the Li ter atu re
The literature related to the physical examination
of the athlete stressed the need for a thorough scrutinization of the p ote ntial athlete,
tally.

M a n y physicians,

as a result of their degree of

involvement w i t h athletes,

be lieve there is no fin ali za­

tion to the physical examination.
the physician,

both physica lly and m e n ­

The limits imposed upon

in his conduct of the examination,

di ct a t e d by time,

pa tient cooperation,

are

and m onetary c o n ­

straints .
The literature related to ath letic psychology is
di rected to two fertile research f i e l d s — the motivational
traits d isp l a y e d by athletes in their individual sports and
the area of youth athletic competition.

The a bility to

understand w h y a p erson wishes to participate in a sport
has never been ad vanced concerning high school athletics.
The growing hypot hes is that youth sports may be d e t r i m e n ­
tal to p roper mental and physical develop men t has become a
cause for co ncern in the education field.

The literature

is qu i c k to quest ion the necessity for intense co mpetition
before the high school age group in the fourtee nth year of
life.

The pr in cipal authors on the subject have their

reservations on the merits of highly o rga niz ed sports p r o ­
grams for youth in pre-h igh school years.
The literature p ert ain ing to the med ical aspect of
women in athlet ics calls for a ree val uat ion of the physical

52
capabilities of w o m e n athletes.

The revelation that is

predominant in the literature is that w o m e n "can do,"
"desire to do," and "will do" in the field of competitive
sports.

The concern is that the female musculoskeletal

system, although very similar in structure to the male
counterpart,

does not have the strength in musculation,

nor does the female physique readily adapt itself to
becoming musculated.

Additionally,

the medical

"knowns"

that pertain to the medical aspect of females in sports
are far behind the "unknowns."

Much research must be

undertaken if the proper niche is to be assumed by the
female athlete.
"Pop Warner"

The female rple in little league baseball,

football,

and peewee hockey will have to be

resolved before contact and collision sports have tragic
effects upon the developing anatomy of the young female
athlete.
The literature that discusses safety in athletic
equipment has be en wr i t t e n by a small segment of the m e d i ­
cal researchers who have an interest in athletics.

There

seems to be a hesitancy to publish information that runs
contrary to traditional beliefs.

Pure medical research on

football equipment has been late on the publishing scene.
There are only a few good reports on playing surfaces,
footwear,

supportive ortho pae dic equipment,

changes for athletic safety,

proposed rule

and protective head gear.

53
Only incidentally has med ical research directed
any of its well-en dow ed investigation to the realm of the
high school athlete.

For whatev er reason,

there is a

conspicuous absence of research literature that addresses
the maturing young adult high school student as an athlete
and supports hirti in that environment.

CHAPTER III
DESIGN OF THE STUDY

This chapter consists of a d e s c r ipt ion of the p o p u ­
lation, m e t h o d of selection,
of the respondents.
methodology,

and reason for the selection

It includes a d e s c r i p t i o n of the

a statement of the r esearch categories,

and

an explanat ion of the reaso nin g and data treatment employed
in the a n a l y s i s .
D e fi ni t i o n of Po pul a t i o n and Samples
The popula tio n selected for this study consisted
of both three- and four-year senior high schools

in Michigan.

The q u a l i f i c a t i o n for selection was that each high school
be a m ember of the M ich i g a n High School A thl eti c A s s o c i a ­
tion.

Th e m e m b e r s h i p of the M i c h i g a n High School Athleti c

Association,

in September,

and parochial high schools.

1973, was 709 private,

public,

The schools were di vided into

four classes for purposes of e qui table athleti c c o m p e t i ­
tion.
Seventy high schools w e r e selected from each class,
using the technique

of

sampling explain ed by Raj.^

^Des Raj, The D esign of Sample Surveys
McGraw- Hil l Book Company, 1972), p. 32.

54

The

{New York:

55
high schools were selected from the roster of members
listed in the M i c h i g a n High School Ath let ic A s s o c i a t i o n
2
Bulletin.
The number of high schools selec ted was 280,
which repres ent ed 39.52 p ercent of the total n umber of
high schools in the state.
The survey incorporated sixty-two cou nties in both
the Upper and Lower Peninsulas of the state.
ties were not included in the survey.
Keewenaw,

Luce, Ontonagon,

Peninsula and Alpena,
Roscommon counties
overt attempt

El e v e n c o u n ­

They were Delta,

and School cra ft in the Upper

Crawford,

Lake,

Mason,

in the Lower Peninsula.

to exclude these counties

Mecosta,

and

The re was no

from the survey.

Their omi ssion was m erely a by-product of

the selection

process.
The size of

the sample,

seventy high schools from

each of four classes, was decided upon after discussi ng
3
the survey with M cSw een ey and Schmidt.
They r eferred to
the potential return percentages as being most crucial to
the success of the survey.

It was

their stated opi nio n

that seventy high schools from each class was more than
adequate if a return of 75 to 80 percent was

finalized for

evaluation.
2

49

Mi chi g a n High School At hle t i c Association,
(November 1972).
3

Bu lletin

Mary Ellen Mc Swe e n e y and W i l l i a m H. Schmidt, faculty
members, De par t m e n t of Counseling, P ers onnel Ser vices and
Educatio nal Psychology, M i c h i g a n State University, in d i s ­
cussion, April, 1973.

56

B a c k s t r o m and H u r s h stated that there is no set
percent age of a n y gi v e n p opu lat ion that is co nsi der ed
standard.

4

The size of the sample in r ela t i o n to the pop5
ulation is g e n e r a l l y irrele van t in field surveys.
Raj
stated that "representative"
defined.

g

samples act ually ca nnot be

A p p a r e n t l y no set per cen t a g e of any pop ula tio n

is c ons ide red helpful.

Raj

fu rther stated that if we

a t tempted to select a m i n i a t u r e p o p u l a t i o n from the larger
7
population, we w o u l d not k n o w how.
T h e r e f o r e the advice
of M c S w e e n e y and S c h m i d t b ecame the r eas on for the selection
of seventy high schools

in each class for the survey.

The pri nc i p a l o f f i c e r for each school was the
d e sig n a t e d r e s p o n d e n t of the su rvey questionnaire.
p r o c ed ure was r e c o m m e n d e d by Robert James,

This

Secretary-

Tr eas u r e r of the M i c h i g a n High School Co aches Association.
In his o p i n i o n a h i g h school pri nci pal was mor e likely to
give an ac curate a s s e s s m e n t of his high school's c a p a b i l ­
ity reg ar d i n g m e d i c a l care for athlet es than was any other
po tential respondent.

Second,

the pr inc i p a l wo u l d pro bab ly

insure a r e a s o n a b l y e x p e d iti ous re t u r n of the q u e s t i onn air e
to the researcher.

Third,

the q u e s t i o n n a i r e sent to the

4

C h arles H. B a c k s t r o m and Gerald D. Hursh, Survey
R e search {Evanston, Illinois:
N o r t h w e s t e r n U niv er s i t y Press,
1962), p. 28.
SI b i d .
6R a j , op.

c i t . , p.

^ I b i d ., p . 6.

5.

57
principal would identify the fact that there is an interest
in the wel fare of the high school athlete in a co llege of
m edi cin e in the state of Michigan.

Furthermore,

the u l t i ­

mate goal of the res earch ema nating from the De par t m e n t of
Biomechanics

(through this researcher)

wo u l d be to attempt

to des ign m od e l s of ed uca t i o n and veh icles of service to
improve the health care capabili tie s of each high school.
A n y viable changes in the existing health care that are
advocated by m ed i c a l a uth ority will need support from the
secondary school administrators.

W i t h the principal being

the res pon den t to this questionnaire,

a significant part

of the political apparatus will have been involved on a
p r e l im ina ry basis.
It may well be that the actual supplier of i n f o r m a ­
tion was the athletic dir e c t o r or the coach of a particular
sport.

T h e fact remains that the principal was the

acknowl edg ed r e s p on den t and thus knew of the intent of
the survey.
The survey was m a i l e d to the intended respondent,
by name,

the last w e e k of September,

1973.

The name of

each pri ncipal was taken from the M i c h i g a n High School
At hl e t i c As s o c i a t i o n B u l l e t i n , Di rectory Issue,

of 1972.

The m a i n office of the Mic h i g a n High School At hle tic
A s s o c i a t i o n revised the list of names they knew had changed
during

the time lapse following di rec t o r y publication.

Se ptember ma il i n g time was

selected because it seemed

The

58
appropriate to correspond w i t h princip als after their
schools had been open for three weeks to a month.
Several school dis tricts in the Detroit,

Saginaw,

and Flint areas were delayed in op ening for the fall classes
because of disputes over contractual clauses between t eac h­
ers and the represen tat ive school boards.

As a consequence,

several qu estionnaires were returne d to the researcher in
late Nov ember from schools in those areas,

with letters

attached explaining the predicam ent and the reason for a
tardy reply.
Each q ues tio nna ire was accomp ani ed by two enclosures.
The first was a letter of introduction from the researcher
relating the intent of the survey,
vey,

the sponsor of the sur ­

and that the goals of the survey were endorsed by the

Mi chigan High School At hletic A s s o c i ati on and the Michigan
High School

Coaches Association.

As me nti o n e d in Ch apter I,

both of the

endorsers were consulted at the outset of the

survey proposal for input of ideas for the questionnaire.
In the op inion of the researcher,

the high survey return

was di rectly attributable to the effort and cooperation of
both Associations.
The second enclosure was a self-addressed post card
to be completed by the respondent,
its address,

soliciting only the

name of the

school,

and zip code.

be returned

under separate post, to the researcher.

shows the rate of post card return.

It was to
Table

3.1

59
Table 3.1.— The rate o f return of high school identifier
postal cards.
Number Ma ile d

Class

N u m b e r Returned

Percent age

A

70

48

69%

B

70

51

73%

C

70

48

69%

D

70

41

59%

280

188

67%

Total

In addition to the 188 total post card r e t u r n s , two
cards were received w i t h illegible addresses.

The postal

card returns provided a general awareness of w h a t areas
of the state were complying w i t h the request to assist in
the study.
Before any further d e s c r ip tio n of

the study,

it

should be noted that the respo nde nt was g u a r a n t e e d anonymity
of response.

The success of the findings was predicated

upon honest and realistic answers.
not given this guarantee,

Had the que sti onn air e

the respondent quite possibly

might have portrayed a m u c h m o r e positive p icture of the
situation in the high school.

In light of the fact that

the questionnaire asked some rather specific questions that
could cause embarrassment,

for a number of reasons,

it was

decided that there should be no way to single out a school
that was not complying with Michigan High School Ath le t i c

60
A s s o c iat ion directives or one that had a poorly organized
me dical care structure for the interscholastic athlete.
The o n l y way a school could be identified was by class.
This was accomplished by printing the questi onn air e on four
colors of paper.
questionnaires,

Class A high schools receiv ed ye llo w
Class B green,

white questionnaires.

Class C blue,

and Class D

The last request was that the r e s p o n ­

dent circle the class of school to which his institution
belonged.

A row of letters— A, B, C, and D — was placed at

the end of the questionnaire and was indicated to be the
*
only class identifier in the survey.
Of all the q u e s t i o n ­
naires received, only two had a certain color code and an
inappropriate letter circled, w h i c h indicated that the
ma jor i t y of the respondents attempted to be honest and
accurate in their replies.
The final edition of the questionnaire was a
result of three prior questionnaires that had been c i r c u ­
lated among physicians,

athletic trainers,

and educators on

the campus at M ichigan State Universi ty for comments,
tions,

or additions.

ques­

Sample questions were also given to

high school basketball,

football,

the Ingham C ounty area.

In all,

naires were disseminated.

and swimming coaches

in

fourteen sample q u e s t i o n ­

The final q u e s t i onn air e was a

compila tio n of the suggestions offered by the fourteen
initial respondents.
found in Ap pe n d i x A.

A copy of the question nai re may be

61
Design of the Study
The design of the study was calculated to elicit
a comprehensive ove r v i e w of the facilities,
medical supportive methods,

staffing,

and planning that the high

schools promote w i t h regard to the interscholastic athletic
program.

The question nair e was d esigned to identify the

health care delivery system by asking questions that were
easily identifiable and wit h i n the scope of the athletic
pr ogram supported by the high school.
not in effect in the high school,

If a pro g r a m was

the responde nt could

easily indicate this void in the structure of the athletic
department.
be:

An example of this type of question ing would

"Do you have a ph ysician at all home games?"

answer was yes,

If the

there apparen tly was no medical assistance

pr oblem at home games.

If the answer was no,

was a me dical assista nce pr oblem area.

then there

Regardless,

answer sought was either a ’’yes" or a "no."

the

This me tho d

of questioning attempted to bring to the r e s p o n d e n t ’s a t t e n ­
tion an area that needed consideration:

The high school

should procure the services of a p hys ician for all home
games.

The questions were intended to be a reminder that

athletic me dicine is a significant co ncern in an i nte r­
scholastic athletic program.
tive answer,

If the respon den t gave a p o s i ­

there was a correla tio n bet w e e n what was c o n ­

sidered necessary and what was actual practice wit h i n the
high school athletic program.

If the answer was negative.

62
it was hoped the qu estion w o u l d raise issue with the a d m i n ­
istrator and initiate action to a lle v i a t e the condition.
The questions asked w e r e c o n s id ere d important for a
total underst and ing of the proper a d m i n ist rat ion of a h eal th
care capability in high school interscholastic athletics.
A hypothetical athlete was con sid e r e d from the first day of
any athletic competition.

E v e r y med i c a l sequence that

should be available to the individual athlete was included
in the questionnaire.
examination,
tial athlete,

Included were the phy sical fitness

the psycho log ica l a d a p t a b i l i t y of the p o t e n ­
the training reg imen for pr e p a r a t i o n in a

particu lar sport,

the available med ica l care and type,

em ergency m edical facilities and equipment,

m edical t r a i n ­

ing of all personnel involved w i t h the athlete,

and r e h a b i l i ­

tation of the injured athlete.
In addition to the pe rti n e n t me d i c a l situation
questions,

inquiries were made about the types and c o n d i ­

tions of various
ball,

track,

surfaces upon which teams played.

Basket­

and football contests are con ducted upon d i f ­

ferent types of surfaces.

Furthermore,

information on the

c ond ition of the playing surfaces was desired.
day allocated for practice was requested.

The time of

The types of

sports sponsored by the hig h school and what levels of p a r ­
ticipation were called for by sport,
tion

(varisty or junior v a r s i t y ) .

sex,

degree of c o m p e t i ­

63

Finally,

the respondents'

o pinions w e r e invited

w i t h regard to the areas of educational change needed in
the u n i v e r s i t y setting.
for any school system,
athletes,

The m o s t expeditious assistance
regard ing their medical care for

was envisioned to begin in the university.

It

may well be that the extension course of ferings by several
s tat e-s upp ort ed institutions could p rov ide the educati on in
athletic training to existing high school faculty.

This

w o u l d u pgrade considerably the present potential for a d e ­
quate me di cal coverage.

The second option is to change the

undergr adu ate cu rri c u l u m so that it better prepares physical
ed uca tio n majors and m ino rs to contend wit h the medical
needs of an a thlete that do not necess ari ly demand a
p h y s i cia n's attention.

Impressions and ideas on potential

future courses in colleges and universi tie s

that would

be nefit the high school athletic pro grams were also solicited.
Statement of Research Categories
The following que stions were intended to represent
six catego rie s of inquiry that would best elicit the i nfo r­
m a t i o n nec es s a r y for proper eva lua t i o n of the m edical care
capabil iti es of the i nterscholastic a thletic programs in
Mi c h i g a n high schools.
this study.

The categories were not original to

They have been topics of d i s c u s s i o n for m any

individuals and groups for a number of years.

Two physicians

64
who articulated the questions best were Ni cholas
g
O 'D o n o g h u e .

8

and

The six categories under consideration were:
(1) physical medicine,
equipment,

(2) athletic training,

(4) athletic med ical education,

athletic trauma and rehabilitation,

and

(3) athletic

<5> records of

(6) athletic m edi cal -

legal aspects.
Category 1
1.

How many teams do not have a regular physician?

2.

A r e pr e p a r t i c i p a t i o n physical examinations c o m p r e ­
hensive; is there an existing standardized physical
examina tio n form?

3.

Is the med ica l coverage for an athletic contest
adequate?

4.

Is the eme rgency care constant and satisfactory in
the case of injury to athletes?

Category 2
1.

Do coaches possess the nec essary fundamental k n o w l ­
edge of athletic injury frequencies and proper
treatment of injuries oc curring in their sports?

2.

Do Michi gan high schools have adequate supportive
medical assistan ce for team athletics or solo a t h ­
letes in the person of a certified athletic trainer?

3.

Do Mi ch i g a n high schools possess the appropriate
em ergency equipment that could avoid ca tastrophic
asphyxi ati on resulting from athleti c trauma?

4.

Do M ich i g a n high schools support athletic training
and physical d e v e l o p m e n t of individual athletes both
in season and out of season?
^Nicholas,

"The House that Ni cho las Built,"

9
O'Donoghue,

T r e a t men t of I n j u r i e s .

pp.

72-79.

65
Category 3
1.

Do M ichigan high schools have the proper equipment
for each sport?
Do they have the proper facilities?

Ca te g o r y 4
1.

Is there an adequate flow of up-to-date, essential
knowledge on athletic m edical technique and research
to the team physician and the athletic staff?

Category 5
1.
2.
3.

Is a standard nomenclature of athletic injuries and
diagnosis being u sed among the high schools?
✓
Is an audit system being used in the recording of
athletic injuries?
Is there historical data pertaining to the categories
of physical examination through the rehabilitation
progress and final clearance for full p articipation
in a sport?

C ategory 6
1.

What is the procedure for the assumption of medical
liability; by the physician? by the high school?
or by the third party insurance?
Analysis of the Data
Responses in the six categories were summarized by

comparing

the responses among classes A,

B, C, and D and

also by comparing each class to the state percentage
each question.
were used.

for

Simple rather than statistical comparisons

Percentages were employed because of the ease

of comparison w ithin the columnar display of mul t i p l i c a t e
numbers.

The objective of the survey was to identify areas

of medical care and general athletic safety that exist in

66
the high school populati on of the state of Michigan.

The

investigation did not attempt to assess or ide ntify any
significant gradient of excellence among classes.
It was bel ieved that perce nti le data w o u l d net,
best,

at

topics for di scu s s i o n among v ari o u s groups that either

govern the high school athletic pro grams or seek a vehicle
for change in the existing policies c o n c ern ing the student
athlete and the m edical profession.

The percent ile data

will be evaluated by the Mi ch i g a n High School A t h l e t i c
Association;

the M i c h i g a n High School Coa ches Association;

the Great Lakes Chapter of the Na tional A t h l e t i c Trainers
Association;

the Departme nt of Health,

Physi cal E d u c a t i o n

and Recreation, Mic hi g a n State University;
Athletic Medicine and Research,
M i chigan State University;
Physiology,

the D ivi s i o n of

D e p a r t m e n t of Biomechanics,

and the D e p a r t m e n t of E xercise

University of Michigan.

The m eth od of ev alu ati on was to identify the "have"
and "have not" areas in the medical care sequence in the
high school athletic programs.

The o pin ion s g a t h e r e d were

expected to provide insight to the p roblems in the health
care of the high school athlete.

The d i r e c t i o n and m a g n i ­

tude of an educational model designed to assist the high
schools in educating faculty to care for v arious facets of
health care a d m i n i str ati on depends on the r e s p o n d e n t s '
replies concerning health care delivery.
identification of paucity areas

In addition,

the

in any o f the a for em e n t i o n e d

67
six categories of question ing m a y pro vide m oti vat ion to
additional, more selective research in those areas of c o n ­
cern.
Summary
The total sample of the study consisted of seventy
randomly selected high schools from each of the four classes
of athletic competition prescr ibe d by the Mi ch i g a n High
School Athletic Association.

A total popula tio n of 216

high schools participated in the survey,

wh ich represented

31 percent of the total popula tio n of 709 m e m b e r high schools
of the Michigan High School Athletic Association.
from the original mailing,

Sixty days

follow-up letters were sent to

all high school principals from w hich a postal card reply
had not been received.
The study population was requested to answer the
questions on a survey form covering the topics:

physical

medicine,

athletic

athletic training,

medical education,
tation,

athletic equipment,

records of athletic trauma and r e h a b i l i ­

and athletic medical-legal considerations.
The analysis was accomplished by an evaluation of

the responses, with a correlated d isc us s i o n of the topics
by members of the me dical and ed ucation professioris who have
addressed the field of ath letic med ic i n e through articulated
research projects or in professi ona l publications.

CHAPTER IV
P R E S E NTA TIO N OF DATA

This c hapter c ontains the results of the i n v e s t i ­
gation.

Each que sti on is restated,

data and discussion.

accompa nie d by the

The qu estions are presen ted in the

order in which they were p r e s e n t e d on the questionnaire.
Each of the six ca te gori es men ti o n e d in Ch apter III is d i s ­
cussed as a unit in C h a p t e r V.
tion,

the "no answer"

To simplify the p r e s e n t a ­

cat e g o r y has been omitted.

centages are based on the 100 p ercent maximum.

Th e p e r ­
Consequently,

any columns that total less than one hundred had the remaint

der represented

in the "no a n s w e r ” category.

It is a p p r o p ria te

to es tablish one basic u n d e r s t a n d ­

ing at this p oint in the discussion.
cussion,

In the following d i s ­

the athlete or groups of athletes referred to are

high school athletes.
pubescent,

The specific age group is post-

including ma l e s and females from thirteen to

eighteen years of age.

This di s t i n c t i o n should be noted

b e cause the me d i c a l concern s

for the high school athlete

many times deal w i t h both m e n t a l and physical maturation.
Because of the pe riod of g r o w t h that this age group r e p r e ­
sents, m edical care for the h igh school athlete is s i g n i f i ­
cantly d iff ere nt than it is for the mature individual.

68

69
Question 1
Does your high school have a regular team phy sic ian
(under co ntract for services)?

Table 4 . 1 . — D i s t r i b u t i o n of contract team physicians
Mi ch i g a n senior high schools.

in

Class A

Class B

Class C

Yes

52%

31%

18%

8%

No

48%

69%

82%

92%

Class D

The respon den ts v o l u n t eer ed several e xplanations
that serve to a lle viate some of the que stions a bout why so
few high schools have regular physicians.

The res pon den t

po pul a t i o n did not univer sal ly understa nd the me a n i n g of
re gular physician,
naire.

and that was the fault of the q u e s t i o n ­

The ph ysician scarcity in some areas of the state

has neces sit ate d the r equest for services,
and n onpay basis,

on both a pay

of interns from local hospitals.

In m a n y

instances the intern has either had an interest in the team
or the sport,

or he has looked upon the ex per i e n c e as a

learning practicum.

All interns are licensed physicia ns

the state of Michigan.
in attendance,
was satisfied.

in

Thus in cases where an intern was

the neces sit y for the pr esence of a p hys ici an

70
Question 2
Is the same physici an engaged for all sports
physical examinations?

Table 4.2.— Relatio nsh ip of contracted team p hys ician to
physical examinations for all interscholastic s t u d e n t - a t h l e t e s .
Class A

Class B

Class C

Class D

Yes

37%

39%

40%

40%

No

61%

51%

50%

41%

This set of figures was the first indicator that the
physical examin ati on standards are d iverse because of the
acknowledged change in physicians.

The Mic higan High School

At hl e t i c A sso cia tio n has a recommended physical examina tio n
listing,

but it is not mandatory.

This raises an additional

qu es t i o n on the s u b j e c t — having an annual standard physical
examinat ion that m u s t be satisfied in every category for
each high school athlete in the state of Michigan.

The lack

of 100 percent response to this question m a y be an indica­
tion that the n onr esp ond ent schools did not know the answer
(which is indicative of poor m a n a g e m e n t ) , did not have p h y s i ­
cal examinations for all sports,
physician.

In the future,

or did not have a team

a questi on that m a y need to be

an swered is why the schools seemed to experie nce such an
ap pa r e n t turnover of physicians,
to the initial question.

as indicated by the replies

71
Question 3
Is the specialty of the team physician:
a.
b.
c.
d.
e.

Family p ractice (general practice)
Or thopaedics
Internal me di c i n e
Physical med ici ne
Other (please state)

Table 4 . 3 . — M edical specialties for respond ent schools'
team physicians.
Class A

Class B

Class C

Class D

Family practice

48 %a

55%

48%

46%

Or thopaedics

11%

13%

4%

2%

Internal m edicine

2%

2%

Physical me dicine

4%

1%

Other

5%

—

2%

—

2%
—

—
—

All percentages repres ent affirmat ive answers.
The 5 percent in Class A represents the w r i t e - i n
of another sp eci a l t y — p h y s i a t r y — the specialty of physical
me dicine w i t h an emphasis on phy sical rehabilitation.

In this que stion the totals of all specialties in
class C and D barely ex ceeded 50 percent.

Either the q u e s ­

tionnaire ne glected to include a specialty or specialties
that could account for the remaining percentages#

or the

respondents did not know w h a t facet of m e d i c i n e their team
physician represented.

72
Question 4
Is the team ph ysi cia n in atten dan ce at all home
football games?

Table 4.4 .--Attendance of team physician at home football
games.
Class A

Class B

Class C

Class D

Yes

82%

63%

44%

27%

No

13%

27%

42%

46%

The obvious lack of physi cia n attendance,

especially

in the descend ing order by class, m i g h t be satisfactorily
e x plained if the variables could be identified.

The e x a m ­

ining ph ysician may have estimated that the most important
aspect of his athletic medicin e role was satisfied with the
physical examination.

Second,

the a v a i l a b i l i t y of the

ph ysician may have been nil, and p ara -pr ofe s s i o n a l l y trained
people substituted."^
Tr ain ed par a-p rofessionals are usually acceptable
me dic al deputies

if they have board ce rti fic ati on in any of

The subject of substitutes for physicians in a t t e n ­
dance at athletic events has been brought up for discussion
in Pennsylvania.
A growing lobby in Harrisb urg is s u g ­
gesting to legislators that the chirop rac tic profession
is capable of being given state credential to perform
at hle tic physical examinations and to be in attendance at
high school athletic contests.
The impact of any fa vor ­
able legisla tio n regarding the c h i r o pr act ic profession could
be felt in Michigan.

73
the emergency medical fields or fi rst-aid-oriented fields of
employment.

If a physician is on call, most athletic events

can proceed safely w i t h a para-professional in attendance.
The idea that a specialist or a general practitioner needs
to be in attendance at all athletic events is not universally
2
accepted in the me dical profession.
Question

5
Is the team physician in attendance at all or some
of the away games?

Table 4 . 5 . — Att end a n c e of team physician at away football
games.
Class A

Class B

Class C

Class D

All

3 2%

11%

12%

6%

Some

32%

44%

42%

19%

None

29%

32%

30%

48%

This question was included

in the survey simply to

attain a better understanding of the completeness of me dic al
coverage

the high school athlete was receiving.

Many teams

compete ag ainst o t h e r high schools that do not have a
physician in attendance.
2

This question points out the need

James G. Garrick, "Type and Frequ enc y of Injuries
in Sports and the Decision-Making Process" (paper presented
at the Twe nty -Fi rst Annual Me eting of the A m e r i c a n College
of Sports Medicine, Knoxville, Tennessee, May 9, 1974).

74
for a coach or a dmi nis trat or to ob tain ad vance knowledge of
the lack of a ph ysi cia n at the away playing site.
tionally,

Addi­

they should d ete rmine the avail abi lit y and q u a l i ­

fication of any possible emergen cy service in the vi sited
community.
Q u estion 6
Do you have a standard physical that st ude nt-athletes
m u s t successfully complete to qu alify p hys ic a l l y for
interscholastic competition?

Table 4 .6. — Adh erence to a standard physical e xa m i n a t i o n for
high school a t h l e t e s .

Yes
No

The word

Class A

Class B

Class C

Class D

93%

92%

92%

90%

5%

8%

6%

10%

"standard" was ambiguous in this question.

A standard physical is recomme nde d by the M i c h i g a n High
School At hletic Association;

it suggests eva lua tio n of the

examinee in nine categories that can be surveyed by the
medical examiner.

In contrast,

if several ph ysi cia ns were

to set their own standards for a physical examination,
examinee being the high school athlete,
formats would govern the examination.

the

several differing

75
Question 7
Of the fol lowing categories, how m a n y are used by
your school in ph ysi c i a n evaluation of the potential
student-athlete?

Table 4. 7.— Pre sen tat ion of nine subjects of m e d i c i n e
constitu tin g a co mpr ehe nsi ve physi cal e x a m i na tio n and the
p e r c en tag es of usage of each by M i c h i g a n high s c h o o l s .
Class A

Class B

Class C

Class D

77%

58%

64%

71%

Blood pre ssure
Fa mily me d i c a l
history
t
General physical
condition

38%

37%

24%

35%

71%

73%

66%

81%

Personal medical
history

50%

47%

34%

33%

Em otional stability

14%

10%

10%

6%

Ca rdi o l o g y
evaluation

66%

39%

52%

46%

Or tho pae dic
ex ami nat ion

39%

24%

36%

29%

Eye e xamination

25%

42%

30%

29%

Ne uro l o g i c
evaluation

14%

19%

12%

13%

Note:

Pos itive ide nti fic ati on answers are given.

Al t h o u g h the nine subjects stated in the qu es t i o n
are r e p r e sen tat ive of what should be done on a phy sical e x a m ­
ination,

they do not,

physical examination.

collectively,

rep re s e n t a "standard"

There is no standard or u n i v e r s a l l y

76
ac cepted e x a m i nat ion on record.

However,

several noted

physici ans have approved of all nine subjects in their
3
4
respecti ve writings.
O'Donoghue,
Klafs and Arnheim,
and
5
Rachun
all stated these subjects should be covered in a
c o m p r ehe nsi ve ph ysical examination.
Blood p r e s s u r e .

Perhaps the m o s t basic indicator.

of p a t h o l o g i c a l d y s f u n ctio n is blood pressure.

Blood pressure

indicates the body hydrauli cs and pr essures e xerted upon the
heart.

Should the pre ss u r e bec ome higher than the limits

expected by me d i c a l calculation, for any given age and
1
we i g h t group, the po tential for m o r b i d i t y or m o r t a l i t y
increases proportionately.

A blo od p res sur e check takes a

m a x i m u m of three to four minutes.
Family medical history.

Recording a family m e d i c a l

history is a basic p a r t of vi rtu a l l y every m edi cal practice.
The informa tio n gl eaned from kn owl e d g e of the family's traits
and habits c o n t r i but es to an o verall u nde r s t a n d i n g of any
given individual in that family.
tional preferences,

The ethnic origin,

relig iou s beliefs,

nutri­

and a host of ot her

c h a r a cte ris tic s become inferences to ce rtain types of p a t h ­
ology.

A d d to this the social and d e m o g rap hic considerations,

3

O'Donoghue,

T r e a t m e n t of I n j u r i e s , p. 36.

^Klafs and Arnheim, M o d e r n P r i n c i p l e s , p. 20.
5
Rachun, "The M o s t Da nge r o u s Game," p. 100.

77
and a com pe t e n t physician has an e xce l l e n t start on a data
,
6
base.
General p hysical c o n d i t i o n .
co ndition is self-explanatory.

The general physical

The word

"general"

indicates

a great deal of flexibility in w h a t the e x a m i n a t i o n entails.
In m a n y instances the e x a m i nat ion is so general

that the

p h ysi c i a n performs only a cur s o r y visual examination,

cul­

minating with the visual check for hem orr hoi dal tissue at
the anal sphincter.

Alternatively,

the general ph ys i c a l c o n ­

dition m a y involve pal pa t i o n of va rious soft tissue regions
to a sce rta in the general w e l l - b e i n g of the examinee.
Pe rsonal medical h i s t o r y .

Hir ata's sta tem ent

regarding the d iff ic u l t y of o b t a i n i n g an acc urate m e d i c a l
history underlines the basic reason w h y there is a pa uci ty
of personal medical histories,
survey.^

as rep o r t e d by the p res ent

A more intense effort at health education of the

student and accessibility to the a thletes by the p h y s i c i a n
may all eviate the obvious pr o b l e m of no b a c k gro und kno wle dge
on each po tential athlete.
E m otional s t a b i l i t y .

This

subject has been ignored

because it has been an u nknown area of involvement.

Few

coaches have v/ished to become implica ted w i t h an ath let e who
has a mental problem,
Weed,

and will shy away from any po si t i v e

The P rob lem - O r i e n t e d S y s t e m , p.

^Ilirata,

"When to Exclude,"

p.

79.

23.

78
identification met hod that will aid in isolating the causes
of any men tal hiatus in athletes.

There is no general area

of u n d e r sta ndi ng on this subject.

The athlete w h o craves

physical contact is l ooked upon by m a n y o ther athletes,
noncontact sports,

as b eing different.

in

Whe t h e r or not the

various differ enc es in athletics c ons ti t u t e a need for a
mo tiv ati ona l testing schematic has yet to be determined.
The coach and physic al edu cat or of the future will need a
great deal m o r e u n d e rst and ing of the mental process of their
athletes.
Cardiology evaluation.
be m eas u r e d in several ways.

The ca rdi o l o g y eva lua t i o n can

First,

if the examin ati on c o n ­

sists of p alp a t i o n and stethoscopic exploration,
tations of potential findings are preordained.

the l i m i ­
The heart

sounds can give the p h y s i cia n indicators of strength,
and r hythm of blood flow,

but not m u c h else.

volume,

Some physicians

have indicated this e x a m i nat ion represents an adequate c a r ­
di ology evaluati on of the young athlete.
high school phy si c i a n who conducts

V i r t u a l l y every

this form of evaluation

endorses it pro f o r m a .
The m a i n reason for a physical e x a m i nat ion is to
identify ir reg ularities in gr o w t h or p a t h o l o g y of importance
in human development.

The major finding of a perfunct ory

examination m a y be an e n l a r g eme nt of the heart,

or "athlete's

heart" as it is com mon ly refe rre d to by physicians.

In the

past two de cades there has been a break in the belief that

79
an enlarged heart indicates po tential danger.

In fact,

the

belief that competi tio n in the sports arena b ro u g h t an early
death was en dorsed by Hippo cra tes and Galen,

and the vie w

Q

pr evailed into the twentieth century.

Ryan stated that

cardiac enlarge men t unquesti ona bly o ccurs in the young
athlete,

both because the heart m uscle fibers become thicker

and stronger with heavy exercise and because the chambers
dilate.

Both these responses are adaptive and advantageous,

since they enable the heart to pump more efficie ntl y and at
a slower rate.

If a p erson later stops vigorous activity,

the chamber dil at i o n disappears,
remains.

b u t the muscle hypertr oph y

It should not be consid ere d pathologic.

Q

The enlarged heart syndrome can best be illustrated
by a comparis on of somatotypes.

The 1972 w ome n ' s world

record holder for the mile happened

to be a w i s p of a wom an

w eighing only n i n e t y-s even pounds.

Proportionately, her heart

was twice the size of those of the two biggest discus throwers
engaged

in O lympic competition.

Each m a n we ighed just under

300 pounds and was actively engaged in trace and field
e v e n t s .10

O

Henry J. Montoye, "Today's Rigorous Training of
Young Athletes," Medical World N e w s , April 13, 1973, p. 53.

q

Allan J. Ryan, "Today's Rigorous Train ing of Young
Athletes," Medical World N e w s , April 13, 1973, p. 54.
July,

^ E r n s t Jokl,
1972, p. 46.

"Exercise and the Heart," The C o n s u l t a n t ,

80
U n e x pe cte d fatal col lapses during exercise do happen,
but rarely.

In people with normal hearts,

cise does not cause d e a t h . ^
exercise

strenuous e x e r ­

Since fatal collapse during

is caused by p reexisting heart disease,

the q u e s ­

tion arises w hether these diseases can be detected in time.
The answer

is "yes."

A co mpetently c ond ucted examination

can detect m o s t people w h o s e lives are endangered because
12
of heart d i s e a s e .
O r t h op aed ic e x a m i n a t i o n .

The orthop aed ic ex amination

occupies a p rom inent posit ion in the series of examinations.
It is critical

to the assurance that an athlete is struc­

turally sound.

The stresses exerted upon the human body in

the course of athletic competi tio n demand excellence in a n a ­
tomical function and maneuverability.

Much of the o r t h o ­

paedic examin ati on can be accomp lis hed by having the examinee
display himself,

unclothed,

to the physician.

O bse rva tio n

of symmetry of appendages and mec ha n i c s of gait can indicate
structural pathology.
Eye e x a m i n a t i o n .
sophisticated equipment.

The eye examin ati on employs little
The a thlete should be checked for

depth percepti on and the need for correct ive lenses.
eye examination should take a m i n i m u m of ten minutes.
thermore,

A good
Fur­

the p ath o l o g y prese nte d by the s t u d e n t - a t h l e t e ,

11I b i d . , p. 48.

81
once dia gnosed pr op e r l y through the r outine physical, may
serve to save him a lifelong fight w i t h improper vision or
no vision.
Neurological evaluation.

The n e u r o log ica l e x a m i n a ­

tion is g e n e ra lly co nf i n e d to testing r eflex action.

The

testing is initiated using a small triangular rubber hammer.
The examiner gently strikes the ha mmer o n the v arious reflex
points in the appendages.
nerve fibers are intact;

A pos itive m o v e m e n t indicates

the

p roper sen sory reactions can be

expected from a thl e t e s w h o di s p l a y the rea c t i o n capability.
A more involved series of tests can be given,

but they r e p ­

resent additional and unusual so phi sti cat ion not often a s s o ­
ciated w i t h annual p hysical e valu a t i o n procedures.
The data i ndi cated that a portion of the aboveme nti o n e d nine subjects are be i n g observ ed by the high
school physician.

However,

there seems to be a lack of

appreciation for the me dical con cerns of the athlete.
were only three subjects
total population re ceived

in w h i c h 50 p er c e n t or more of the
that m ed i c a l consideration:

(1) blood pressure,

67 per c e n t of population;

physical condition,

73 percent;

uation,

51 percent.

T her e

and

(2) general

(3) c ard iol ogi cal e v a l ­

The r ema i n d e r of the subjects

fell into

de sce n d i n g pop ula tio n averages of:

pe rsonal m edi cal history,

42 percent;

34 percent;

tion,

family me d i c a l history,

32 percent;

o r t h o p a e d i c examination,

neurological evaluation,

15 percent;

eye e x a m i n a ­

31 percent;

and e mot ional stability

82
(psychological)

evaluation,

10 percent.

The data repre­

sented a reasonably low s tandard of p h y s i c a l e x a m i n a t i o n for
the cro s s - s e c t i o n of the high school ath l e t i c programs.
Qu es t i o n 8
Is the team phys ician a s t a t e - l i c e n s e d al lop ath ic
or osteop ath ic physician?

Table 4 . 8 . — C omp ari son of m e d i c a l co ve r a g e in M i c h i g a n high
schools by allopa thi c and o s t e o p a t h i c p h y s i c i a n s .
Class A
Al l o p a t h

(M.D.)

Osteopath

(D.O.)

Class B

Cl a s s C

Class D

43%

48%

36%

35%

32%

34%

28%

17%

The o s t e op ath ic p r o f e s s i o n has m a d e signific ant
inroads in the care of the p o p u l a t i o n in rural and sparsely
settled areas of Michigan.

At

the b e g i n n i n g of 1974,

there were ove r 2,200 li censed o s t e o p a t h i c ph ysi c i a n s in
Michigan.

13

However,

no substan tia l d o c u m e n t s

the ratio b et w e e n allopath and osteopath,
care of high school athletes.

illustrate

regarding the

The s urvey included this

qu estion to o b t a i n a r e p r e s e n t a t i o n of the care for athletes
by profession.

13

Medicine,
1074 .

Robert C. Ward, Chairman, D e p a r t m e n t of Family
M i c h i g a n State Universitv, in discussion, January,

83
Question 9
Does you r h i g h school have a c e r t i f i e d trainer?

Table 4.9 .— D i s t r i b u t i o n of at hle tic trainers in M i c h i g a n
high schools.
Class A

Class B

Class C

Class D

Yes

18%

6%

8%

6%

No

80%

92%

88%

86%

. The q u e s t i o n n a i r e did not e x p l a i n what the term
"certified" m e a n t in this case

In m o s t at hl e t i c circles,

the ce rtified ath letic trainer is a m e m b e r of the Nat ion al
At hle t i c T rainers Association.
is long and thorough,

The c e r t i f i c a t i o n process

and c e r t i f i c a t i o n by the N ati ona l

A t hl e t i c T rainers A s s o c i a t i o n is gra n t e d by that o r g a n i z a ­
tion o nly after proper ed uca t i o n and testing r eq u i r e m e n t s
and internships have s a t i s f a c t o r i l y be en completed.
respondent,

however,

the term c e r t ifi ed

number of credenti ali ng processes.
credential for training skills
from an accredited institution,

could

To the

have m e a n t a

O n e c o m m o n l y a cce pte d

is the b a c h e l o r ' s degree
w i t h an em phasis on e duc ati on

in physical education.

Question 10
W h a t is the aca de m i c or as s o c i a t i o n c r e d ent ial of
the tr ainer of the v a r s i t y sports?

84
Table 4 . 1 0 . — Qua lif y i n g training for high school athletic
trainers.
Class A
Student, trained
by a phy sic ian

2%

Student, trained
by coach

25%

Student, trained
by outside trainer

Class B

Class C

Class D

2%

2%

18%

26%

23%

9%

2%

10%

2%

Faculty, trained
by physician

5%

3%

—

Faculty, trained
by coach

4%

5%

Faculty, trained
by o utside trainer

7%

2%

23%

19%

16%

17%

3%

4%

83

Faculty, physical
ed ucation major
Faculty, physical
educati on minor
Licensed physical
therapist

—

—

—
4%

Chiropra cto r

5%

—
8%

4%

6%
—

2%

—

—

—

N.A.T.A. certified
trainer

—

4%

—

2%

—

The eleven categories of athletic trainers cover
ma jority of possible sources for a high school trainer.

the
The

student trained by the coach relies upon the skills learned
by the coach and his ability to teach these skills to the
student.
coaches,

Clearly,

there is a m an d a t e among the high school

stating that each team should have the services of

85
an individual w h o s e m a i n c o n s i d e r a t i o n is the care of the
athlete.

14

This is m e a n t to be a ca tegory of care that is

n o nphysician in nature.
The categor ies of student and faculty m e m b e r who
are trained by either a p hys ician or another trainer from
ou tside the school m a y reflect their potential for i n v o l v e ­
ment.

The physici an and the trainer,

physical therapist,

who may be a clinical

ev idently are either in short supply or

do not have the interest or the time to be involved w i t h the
high school ath letic program.
The data also indicated that the four classes did
not have suffic ien t trainers to con tend with the day-to-day
necessities of as sociate medical support for the athletic
program.

The tally in Class A revealed that 83 percent of

the schools had trainers of all descriptions.
60 percent,

class C 70 percent,

Class B had

and class D 58 percent.

This would initially indicate that those schools wit hou t
athletic trainers are taking the coach from his m a i n r e s p o n ­
sibility of co aching and, by default,

requiri ng him to p e r ­

form the functions of the athletic trainer.

Either case

would d eprive the student- ath let e of the benefit s to whi ch
he is en t i t l e d - - p r o p e r care and proper coaching.

One ind i­

vidual cannot a deq ua t e l y pe r f o r m both functions.

14

Al l e n W. Bush, Director, M i c h i g a n High School
At hletic Association, in discussion, September, 1973.

86
Question 11.a
Does your community have access to a hospital for
all me dical contingencies?

Table 4 .11 .— Distances from athletic c ontest areas to nearest
hospital wi th eme rgency treatment capability.
Class A

Class B

Class C

Class D

One to three miles
from school

64%

48%

30%

13%

Four to six miles
from school

29%

16%

20%

6%

Seven to ten miles
from school

5%

11%

18%

31%

Eleven to twenty
miles from school

2%

21%

26%

29%

4%

6%

19%

Twenty-o ne or more
miles from school
Note:

—

A ffi rma tiv e answers are i n d i c a t e d .

The distances indicated in the responses to this
qu estion bring to focus the pro ble m of treatment of the
injured athlete.

The necessity for trained personnel

to be

in attendance at an athletic co ntest is m a g n i f i e d by the
acknowl edg ed lack of available secondary me dic al assistance
in many areas of the state.

It is a stagqering thought to

place the immediate emergency care of an injured athlete
solely upon the team coach w h e n the nearest eme rgency tre at­
ment for that injured athlete is more than twenty-one miles

87
away.

Yet 19 pe rcent of the class D schools are faced wit h

that o minous proposition.
Q u est ion 11.b
Does your c omm unity have access to a phy sical the ra­
pist for at hletic r e h a b il ita tio n wi t h i n the c o m m u ­
nity or the county?

Table 4.12. — A c c e s s i b i l i t y to physical therapist by Michigan
high s c h o o l s .
Class A

Class B

Class C

Class D

Y^s

77%

66%

44%

40%

No

20%

31%

50%

52%

This part of q ues t i o n eleven was intended to show
some correlat ion b et w e e n the a vailability of physical t h e r a ­
pists and the part of qu estion ten that asked if the high
school trainers w e r e physical therapists or if physical
therapists were training students or faculty in the skills
and re spo nsibilities of that position.
A future study of the d i s t r ib uti on of physical
therapists in M i c h i g a n may gain some insight from these data.
There have been some strenuous object ion s to the programs of
training in physical therapy,
physical therapy,

the levels of e duc ation in

and the evidenced inability to keep

88
gr aduates of the physical

therapy curriculums in Mic hig an

after graduation-"*"5
Qu estion 12
Do st udent-athletes have a p r e s e a s o n physical c o n ­
di tio nin g p ro g r a m adminis ter ed by a trainer or
me m b e r of the p hysical ed uca t i o n staff, in the fol­
lowing sports?

Table 4.13.— Pr ese a s o n phy sic al c o n d i tio nin g programs in
M i c h i g a n high s c h o o l s . 3

Football
Soccer
Baseball
Basketball
Hockey
Track
Wr est lin g
Swimming
Cr os s - c o u n t r y
Gymnastics

yes
no
yes
no
yes
no
yes
no
yes
no
yes
no
yes
no
yes
no
yes
no
yes
no

Class A

Class B

Class C

Class D

96%
2%
11%
4%
73%
5%
89%
2%
30%
6%
84%
4%
73%
4%
68%
3%
80%
2%
16%
5%

89%
6%
3%
10%
43%
13%
76%
9%
3%
10%
68%
5%
55%
11%
13%
11%
58%
11%
8%
4%

90%
6%
2%
10%
38%
18%
66%
14%
2%
14%
62%
10%
30%
10%
2%
14%
42%
10%
4%
2%

88%
12%
2%
21%
44%
29%
75%
17%
2%
19%
65%
18%
6%
22%
23%
2%
15%
20%
2%
8%

aLacrossei was de leted bec a u s e of a lack of r e s p o n s e .
The survey included the sport of lacrosse bec ause it was
thought lacrosse had greater p o p u la rit y than was the case.
La crosse w i l l not be repor ted on in the following questions.

15

John A. Doherty, E x e c u tiv e Director, Mi chi g a n
Health Council, East Lansing, Michigan, in discussion,
October, 1973.

89
The various sports listed in this que s t i o n are played
throughout the state of Michigan.

The sm aller high schools

inherently display fewer sports and the larger high schools,
wi th the gr eater numbers of participants,

support a d d i ­

tional sports.
P r es e a s o n physical conditio nin g pr ograms have met
w i t h mi x e d reactions in the high s c h o o l s . 1 ®

Pr opo n e n t s of

the programs claim the regimen of p hysical a ctivity keeps
the athlete in good physica l c o n d i tio n in the off season.
Additionally,

the exercises aid in proper ph ysi cal d e v e l o p ­

m e n t in the growing years.
of the coaching staff,

The interest shown by a m e m b e r

faculty,

or a trainer sometimes

gives incentive to the athlete to adhere to a training s c h e d ­
ule that ultima tel y will help in his chosen sport.
Op ponents of the pr ese a s o n training pr og r a m say it
is too m u c h like sem i-p r o f e s s i o n a l i s m and that it inhibits
d e v e l o p m e n t in other areas of athletics,
civic,

and family interests.

scholarship,

social,

The time spent in the t r a i n ­

ing pro g r a m could be spent more p r o f i tab ly elsewhere.
O p ponents of the p res e a s o n ph ysical training progra ms feel
the p rogram is illustrative of over emphasis on high school
athletics.
The popular sports of football,

basketball,

and track

had the highest repor ted p a r t i c i p a t i o n in pre sea son al
1 6 Robert James, S e c r e t a r y - T r e a s u r e r , M i c h i g a n Hi gh
School C oaches A s s o c i a t i o n — 1973, in discussion, September,
1973 .

90
training.

A future question m a y well be d esi g n e d to o bta in

a r eason for the lack of pr ese a s o n p hysical con dit ion ing
in the class D high schools.
(73 percent)

and class D

The d iff er e n c e b etw e e n class A

(6 percent)

in wre st l i n g would dra w

an inquiry about the p h i l o s oph ica l differe nce be tween the
two classes regar din g p res eason conditioning.
an inexpensive

sport to support.

W res tling is

It also demands sup e r l a ­

tive physical conditioning.
Q u e s t i o n 13
Does your high school p ossess and utilize either
or both of the following:

Table 4 . 1 4 . — P oss es s i o n and u t i l i z a t i o n of therapy equipment.
Class A

Class B

Class C

Class D

64%

6 8%

58%

50%

9%

15%

2%

4%

Hy dro the rap y
equipment
El ect rot her apy
eq uip men t
Note:

Af f i r m a t i v e answers are i n d i c a t e d .

This q ues t i o n was asked to gain an indication of how
m u c h therapy e qui pment was in use in the high schools.
Hy d r o t her apy has been in use for m a n y years and requires a
mi ni m a l amount of m e c h a n i c a l skill to op e r a t e the various
hy d r o t her apy modalities.
however,

The el ect r o t h e r a p y modalities,

can be d ang erous if not operated properly.

They

91
utilize electric current,
waves or dry heat.

usually converted to either sound

Improper execu tio n of the therapeutic

treatment can r esult in serious, or sometimes fatal,

con­

sequences .
Questio n 14
Is there a nurse pos ition in your high school?
If yes, is the nurse available for treating athletic
injuries?

Table 4 .15 .— Nursing positions and their involvement w i t h
athletic i n j u r y .

i

Class A

Class B

Class C

Class D

Yes

55%

48%

40%

13%

No

45%

50%

58%

85%

20%

21%

12%

4%

7%

6%

2%

6%

34%

20%

28%

5%

Does p osition exist?

Is nurse available
for treating
athletic injuries?
Intramurals, during
the school d a y only
All sports up to
5 p.m.
No contact w ith
athletic injury

The availab ili ty of nursing care for the high schools
in M i c h i g a n is nonstandardized.

Some communities have a

school nurse w h o sees to the ge neral health care of the

92
total school system

(K-12).

Other communities have a "com­

munity nurse" to make general calls o n the high school#
junior high school,

and grade schools.

In addition,

the

community nurse acts in a public health nurse role.

The

general health concerns of the co mmunity are her primary
responsibility.
elderly,

She m ay make house calls on the sick,

and the infirm.

same role,

the

The county nurse is del egated the

only o n a much larger scale.

Some communities

and counties have no nursing capabil iti es at all.

The data

showed that 2 percent of all athletic injuries m a y be seen
by a publicly supported nurse,

and to receive at tention the

injury has to happen before five p.m.
Qu estion 15
Is an injured student cared for by the family
physician, the school physician, or both?

Table 4 .16 .— Care of injured athlete by either family or
school physician.
Class A

Class B

Class C

Class D

Family physician

70%

77%

8 8%

90%

School physician

4%

8%

2%

2%

21%

12%

8%

8%

Both

These data serve to illustrate further the r e l a t i o n ­
ship b etween the athlete,
physician.

the school,

and the attending

It m a y well be that the school p hys ician and

93
the family physician are the same person.

This variable

may be found all across the state, but it does show that
the association w i t h the school by any ph ysician is minimal.
The q uestion could have better stated the time in the
sequence of treatment of the athlete that involved either
the school ph ysician or the family physician.
Question 16
Does your high school have any of the following
emergency equipment available for athletic injuries
(within a three- to five-minute time frame)?

Table 4 .17 .— Availabi lit y of emergency equipment at athletic
contests and practices.
Class

Class A

Class B

Class C

yes
no

98%
2%

94%
2%

92%
4%

94%
6%

Stretcher and bindings

yes
no

98%
2%

94%
3%

90%
6%

92%
8%

Blankets

yes
no

981
2%

89%
8%

76%
18%

90%
10%

Bandages

yes
no

90%
4%

98%
2%

Quick access to telephone
and physician/hospital
telephone numbers

89%

98%

—

—

Pharmaceuticals (for cuts
and abrasions, etc.)

yes
no

89%
11%

97%
—

88%
2%

95%
5%

Motor vehicle for
transportation

yes
no

82%
13%

91%
15%

80%
14%

81%
13%

First-aid-trained indi­
vidual to handle emergency

yes
no

91%
4%

77%
16%

82%
14%

'

85%
15%

94
These seven categories were considered to be m a n d a ­
tory items and capabilities that should be p resent at every
interscholastic athletic contest.
should also be present.

17

Additio nal equipment

A cardiovascular con sideration

should be given not only to the players#
tators.

but to the s pec ­

An ambulance with resuscitation equipment should be

in the area near the contest,
spectators and the players.

but not in plain v i e w of the
The ambulance wo u l d contain

all of the equipment available.

Othet transportation could

be used to transfer cases of non-1if e-t hre ate nin g injury.
Question 17
Can you doc ument athletic injuries through your
exis ting system?

Table 4 .18 .--Documentation of athletic injury through existing
records in Mi chigan high schools.
Class A

Class B

Class C

Class D

Yes

71%

66%

66%

63%

No

25%

26%

32%

31%

One concern w i t h this question has been brought to
light by medical research.
me dical problem,
17

When confronting any demog rap hic

there has to be a common denomi nat or .plateau

James G. Garrick, "Sideline Decisions: A Practical
Approac h to Clinical Recognition and Immediate M ana gem ent of
Injuries in Athletes" (paper delivered to the A m e r i c a n Co llege of
Sports Medicine, Knoxville, Tennessee, May 9, 1974).

95
of reference.

If a resear che r attempted to study the f o o t ­

ball injury rate for fifteen- yea r-o ld males du r i n g November,
he would have g rea t d i f f i c u l t y collecting the data.

The

lack of standardization gives license to each high school
to record and transmit the event in its own way.

This leads

to difficulty and the m e c h a n i c s of survey organi zat ion suffer
accordingly.
The qu estion was asked primarily

to identify how

many high schools kept any records of injury.
thirty-four restates the question,
approach.

Q ues tio n

but from a different

The composite answers to the two q ues tions give

some insight to the a mount of record keeping of athletic
injury that is pre sently practiced by the high schools.
Question 18
Does your football team practice on game fields?
Table 4 . 1 9 . --Percentages of high schools using game fields
for daily football practice.
Class A

Class B

Class C

Class D

Yes

71%

18%

30%

42%

No

29%

76%

66%

43%

Question 19
Is your practice field in the same condition as
your game field?

Table 4 . 2 0 . — Percent ages of high schools that evalua te their
game field to be in the same cond ition as the practice fields.
Class A

Class B

Class C

Class D

Yes

21%

18%

32%

33%

No

75%

74%

66%

42%

Qu estions 18 and 19 have no pract ica lit y because
there is no basis for comparison.
the condition of the game field.

The survey did not ask
The initial co ns i d e r a t i o n

was to gain some insight about where the coach held p r a c ­
tices.

Research has shown that ankle injuries h appen on

pr actice fields m o r e than they do on game fields.

X8

Question 20.a
Do you play football games at night
or in the daytime?

(under lights)

Table 4 . 2 1 . — P ercentages of football games played at night
and in the d a y t i m e .
Class A

Class B

Class C

Class D

Night

64%

77%

86%

58%

Day

23%

6%

2%

13%

Both

11%

9%

10%

14%

1 8Jt ohn
k
W. A d k i s o n et al . , "Injury R a t e s ."

97
Ni g h t t i m e football

in Mi ch i g a n is a tradition da tin g

back to post-Wo rld War II days.
of the state,

In the agricult ura l areas

football was played at night so the w e e k e n d

would be free for the high school boys to tend to their
chores w i t h i n the com munity and at home.
p o pulated areas,

In m o r e d e n s e l y

the games were played at night for the

b e nefit of the spectators.

To play a game on S atu r d a y wo uld

c o nflict w i t h the local college team,

w h i c h had the better

calibre of football for the spectator.
Today,

not too many college teams play the q ual ity

4

of football that wo u l d take spectators away from high school
games.

In the Det r o i t area no major co lleges p l a y football,

yet all of the city and suburban l eagues play on Friday
nights.

The ex ception to this is the Cat h o l i c league, w h i c h

plays some games on S unday afternoons.
The pre val e n c e of nighttime football led the inv es­
tigator to q u e s t i o n the safety aspects of playing football
on F r i d a y nights.

M i c h i g a n has an ave rage te mperature of

forty de g r e e s in the evening in the mo n t h s of O c t o b e r and
November, m u c h of it in concert with i ncl ement weather.
Snow,

rain,

and sleet are not u nco m m o n during the latter

part of football season.

The turf u p o n w h i c h the game is

played suffers accordingly.
and then another freeze,
results

A freeze,

followed by a thaw

compoun ded by precipitation,

in a treacherous p laying surface.

98
Artifici al lighting, m u c h of it borde rli ne candlepower,

creates visual problems for the participants.

The

artificial atmosphere contributes to hes itancy and confusion
in the actions of some football players.

Their inability to

adjust v ision to accommo dat e the swift mo vem e n t s of the game
is tested many times during the course of a game.
times during the game,

At various

the v isual acuity of a player becomes

impaired because of an inability to adapt to the inconsis­
tent illumination of the field.

Gr ound-level action can be

tolerated by most players quite easily.

The m o s t obvious

d i f f ic ult y is when a player is the receiver of a thrown or
kicked football.

19

The various light spectrums that c o n ­

front the player attempting to catch a football are greatly
di ffe r e n t than natural light.
The final concern with night football is the player's
ability

to display mental and physical reactions that can

accommodate the fast pace and contact of football.

A game

played on a Friday night begins after the student-athlete
has been awake for a period ave raging be tween thirteen and
fifteen hours.
resting.

V e r y little of that time has been spent

The pace of a school day and the inherent a n x i e ­

ties of the event do little to prepare an a thlete for a
football contest.
19

He must adapt to fatigue,

climate,

Charles McCallum, Football Referee, M i d - A m eri can
Football Confe ren ce and National Colleg iat e Ath l e t i c A s s o ­
ciation tournament football official, in discussion,
September, 1973.

99
atmosphere,

topography,

lighting,

and the pressures of the

game.
The survey showed that only 11 percent of the re s p o n ­
dents played their games in daylight.

The m a j o r i t y of this

percentage were from the Upper Peninsula,
the cold weather,

where,

because of

the high school football season ends two

weeks before it does in the Lower Peninsula.

20

Qu estion 20.b
Do you practice under the lights?

Table 4.22.— Percentages of high schools that practice foot­
ball under artificial lighting.
Class A

Class B

Class C

Class D

Yes

16%

29%

28%

27%

No

80%

63%

66%

60%

The question was asked to identify what percentages
of the high schools allowed their players

the advantage of

acclimatization to the artificial lighting.
to the player,

In fairness

the coaching staff m u s t provide him the o p p o r ­

tunity to adjust to the lighting,

the field surface,

and the

temperature difference.

20

Mi chigan High School Ath l e t i c Association,
Directory Issue, p. 304.

Bulletin,

100
Question 21
Do you play football games on ei ther Friday or
Saturday?

Table 4. 23. — Percentages of football games played on Friday,
Saturday, and Sunday.
Class A

Class B

Class C

Class D

61%

71%

72%

48%

Saturday

5%

3%

6%

15%

Sunday

4%

5%

2%

2%

27%

13%

18%

22%

Friday

Friday or Saturday

The Sunday and Friday or Saturday responses were
w r itt en on the response sheet by the respondents.

The

Sunday percentages probably represen ted the Cat holic high
schools, which do play aft ernoon Sunday games.

The replies

that fell in the Friday or Saturday cat egory diluted any
assumption that the percentages in the F riday category w ere
representative of the high school population.

Any a s s u m p ­

tions would need further clarification of how many games
were actually played on Fridays and Saturdays.

Question 22
Is your track composition sand and clay,
or artificial surface?

cinder,

101
Table 4.2 4.— O rganic or chemical c o m p o sit ion of high school
track.
Class B

Class C

Class D

5%

10%

12%

15%

Cinder

41%

55%

34%

23%

Artificial surface

48%

27%

28%

4%

Class A
Sand and clay

The introduction of artificial surfaces to the sp ort ­
ing event of track was beneficial
respects.

to the athlete in several

The artificial surface is resilient,

cushioning effect on the runner's

feet,

ankles,

and has a
and legs.

With the cushion effect also have come better running
in each event.
thrust,

The artificial

times

track gives a superlative

in addition to the improved physical c apa bil ity

of the athlete.

The artificial surface is easy to maintain.

Varying temperatures have little effect upon the co mpo sit ion
of the track.

Foul weather may make the track a bit slick,

but it remains man age abl e for the runner.
incurred,

Fewer falls are

and when the athlete does fall to the surface

there is less opportunity for abrasion to the intergumentary
structure.

21

Consequently,

there is a better potential for

keeping the athlete in compet iti on w h e n the general abs enc e
of injury and infection is noted.
21

Team,
1973.

Of the populat ion r epl yin g

Jerry Kimbrough, A thletic Trainer, Var s i t y T rac k
Michiga n State University, in discussion, December,

102
to the questionnaire,

only 77 p er c e n t a c k n owl edg e that their

high schools had a track;

of those schools,

28 percent had

artificial surfaces on their tracks.
Qu es t i o n 23
Do you play basketball on artificial surface or
wood?

Table 4.2 5.— Composi tio n of basketball courts in M i c h i g a n
high s c h o o l s .
Class A
Ar tif i c i a l surface
Wood

Class B

Class C

Class D

9%

2%

8%

13%

89%

95%

90%

83%

This que stion was asked to establish some u n d e r ­
standing of w h a t percentages of high schools had the a r t i ­
ficial surface on their basketball courts.

The artificial

surface basketb all court has the same benefits for the
basketball player as does the artificial track for the
track athlete.

The artifici al basketball court has a smoother

finished surface and the same cushioning effect.
the basketball is somewhat livelier,

but players acc ust om

themselves to the di ffe r e n c e quite.easily.

22

As a result

22

Gus Ganakas, Head Basketb all Coach,
University, in discussion, October, 1972.

Mi ch i g a n State

103
Question 24
In the case of legal process for al leged medical
malpractice, who becomes the def en d a n t in a suit by
a player or a family of a player that seeks damages?

Table 4.2 6. — C onc e p t of legal liability by high school
administrators.
Class A

Class B

Class C

Class D

The school ph ysi cia n

21

%

13%

20

The school

39%

35%

32%

48%

Legal process waived
by parental p erm iss ion

14%

10

%

4%

%

6

%

8

%

The res ponses to this que s t i o n indicated that a p p a r ­
ently there is no c lea r-cut proce dur e to satisfy claims of
alleged me dical m a l p r a c t i c e in the case of the high school
athlete.

Bush stated that in cases where medical m a l p r a c ­

tice is an issue,

the claim ant has h ist o r i c a l l y filed suit

with all parties concerned,
physician,
rence.

23

the school,

i.e.,

the coach,

the attending

and any other party to the occur-

The lack of clearly defined lines of r e s p o n s i ­

bility necessitates

this

"shotgun" appr o a c h to satisfaction

upon the part of the claimant.

It would be a valid project

for the future to r es o l v e the apparent hiatus in the legal
procedure for m e d i c a l - l e g a l claims.
23
Allen W. Bush, Director, Mi ch i g a n High School
At hle t i c Association, in discussion, July, 1974.

104
The third category,

parental permission by waiver,

was not initially part of the question.
tion asked,

The original q u e s ­

"Is the legal process w aived by any means?

yes, by what legal vehicle?"

If

The wr ite -in replies were all

addressed to the w aiver response.

The waiver form of r e l e a s ­

ing respo nsi bil ity for an act or acts of medical practice
has not been accorded a valid rec eption by the courts in
Michigan.

24

The courts have ruled an individual may sign a

w r i t of release that would seemingly d isc harge a physician
from respons ibi lit y for acts of medical practice upon that
person or a minor dependent,

but the M ich i g a n courts have

ruled this is a br each of licensure and that the obligation
for competent medical practice is incumbent upon the practicing physician.

25

Qu estion 25
Does your high school have a valid informed consent
ac knowledgment agr eement between the school and the
student-athlete (parents or gua r d i a n if in mi nor i t y
status) that explains the schedule of treatment in
athletically incurred injuries?

24

Richard Larapman, Director, Ca rdiac E val ua t i o n Unit,
University of Mic hig an School of Medicine, A n n Arbor,
Michigan, in discussion, June, 1974.
25 t.
-j
Ibid.

105
Table 4.27. — Utilization of informed co nsent form in Michigan
high schools.
Class A

Class B

Class C

Class D

Yes

59%

44%

46%

40%

No

38%

51%

50%

52%

The informed consent form is not a waiver in the
sense of the one referred to in question twenty-four.
informed consent form is permission,
guardian,
age,

The

given by a parent or

allowing that son or daughter, who is of m ino r i t y

to compete in i nterscholastic athletic competition.

Once a student athlete reaches

the m a j o r i t y age of eighteen,

he may sign the consent form.

The schedule of treatment is

in reality the acknowledgment of the high school to the
parent that a physician will be in attendance at inter­
scholastic events.

These events are specifically the sports

in w h i c h the son or daughter is participating.

There is no

mandate to include a schedule of medical procedures,

but the

procedure could have a reassu rin g effect upon the parents of
participants.
Qu estion 26
Do your interscholastic athletic partici pan ts have
a school-sponsored, off-season, we i g h t training
program?
(By sponsored, it is m e a n t the pro gra m
is planned and monitored by a m ember of the physical
education staff or faculty.
If yes, circle the
party responsible for mo nit o r i n g of the program.)

106
Table 4 . 2 8 . — Percentages of high schools utilizing off-season
we ight training programs.
Class A

Class B

Class C

Class D

Yes

89%

74%

62%

42%

No

11

%

23%

36%

58%

This qu estion was a v a r i a t i o n of the theme in q u e s ­
tion twelve.

In that question the emphasis was on the p r e ­

season training a ctivity of the athlete.

In this question

the c o n s i de rat ion was for the off-se aso n training program.
Off season may be interpreted to include the complete a ca­
demic calendar year,

less the time spent partici pat ing in a

va rsity seasonal sport.
istered,

We ight training,

properly a d m i n ­

helps to pr event injuries by hardening the body and

increasing resistance to fatigue.

26

Sixty-eight percent of

the respond ent popula tio n replied that they were sponsoring
an off -se a s o n weight training program.

This is an excellent

indicator of intensive effort to ma in t a i n the physical w e l l ­
being of the s t u d e n t - a t h l e t e .
Questio n 27
Th e P r e s i d e n t ’s Council on Phy sical Fitness, in a
high school study of student-athletes by H. Harrison
Clarke in the Physical Fitness Research D i g e s t ,
2 fi

Safeguar din g the Health of the A t h l e t e , A joint
statement of Th e Com mittee on the Medical As pects of Sports
of the Ame r i c a n Med i c a l A s s o c i a t i o n and The Nat ional F e d e r ­
ation of State High School At hletic Associations, 1965.

107
stated that there is a c o r r ela tio n between athletic
excellence and academic and social success in the
high school years.
Do you believe that this st ate ­
m e n t could be valid in your high school?
Answer by one of the following measures.

Table 4 .29.— Opinions on correlation of athletic a chievement
and social and academic success.
Class A
The statement applies to
the greater majority of
athletes in this high
school— over 80%.
The statanent applies to
the majority of athletes
in this high school—
51 to 80%.
The statorient applies to
many of the athletes in
this high school—
40 to 50%.
The statement applies to
some of the athletes in
this high school—
20 to 39%.
The statement applies to
a few of the athletes in
this high school—
1 to 19%.

Class B

Class C

Class D

%

18%

22

%

33%

52%

58%

54%

4 2%

16%

13%

10

%

15%

7%

5%

12

%

8

%

2

%

21

2

%

1

%

—

The object of this series of questions was to obtain
a perspective of how the high school athlete was observed
by the high school principal.

The refere nce to the research

by Clarke may have served to elevate the positions of a t h ­
letic,

academic,

and social successes of each principal's

108
student-athlete population.

The answers w o u l d give hope to

the advocates of interscholastic sports.
responsibility,
assume,

teamwork,

personally,

The discipline,

and trust that each athlete m ust

to achieve goals in athletics seem to

be of great benefit in the m a t u r i n g process.
Qu estion 28
How would you rate your athletic d e p a rt men t p e r s o n ­
nel and coaching staffs w i t h regard to the number
of physical educators and coaches per sport?

Table 4. 30. — Ratings of ma n n i n g levels in physical education
departments and coaching staffs in M ich i g a n high schools.
Class A

Class B

Class C

Class D

Optimum levels of man­
ning have been achieved

23%

21

%

16%

17%

Adequate studentinstruetor, coaching
ratios have been
achieved

48%

45%

54%

48%

Instruction & coaching
of sports are being cov­
ered by some faculty,
employed outside their
specialty. Adoubling-up
by faculty has guaranteed
coverage of our athletic
program.

20

33%

%

21

%

26%

Be low-par manning levels
have necessitated the
curtailing of some athletic
events and programs.

5%

10

%

2%

Lack of sufficient person­
nel has led to cancella­
tion of athletics.

4%

—

—

—

—

109
These answers

indicated that a ppr o x i m a t e l y 4 pe rce nt

of the respon den t high schools were in jeopardy of c u r t a i l ­
ing athletic programs b ec a u s e of insuffic ien t fac u l t y or
staff to adequately adminis ter the program.

The 4 per cen t

in class A that indicated at hletic programs had been c a n ­
celled because of lack of perso nne l should be investigated.
in this regard,

Bush stated he was not aware of any class A

high school withdrawing from interscholastic competition.

27

Question 29
Would you be in favor of a m o r e c e n t r ali zed ath let ic
me di c i n e pr ogram of education, research, and service
being inaugurated in this unive rsi ty or any other
state university?
This would n e c e s s i t a t e s t a n d a r d ­
ized physical examinations, possible i n v o l vem ent of
medical students in the medical a d m i n i s t r a t i o n of
your program, possible retrain ing for the a thletic
staff in physical training and rehabilitation, and
implementation of an athletic injury audit system.
The rec eption to this q uestion was positive,
varying degrees,
(see Table 4.31).
progress

in

from 9 2 p erc e n t of the survey p o p u l a t i o n
This rec ept ion was m o s t favorable

for

in resear ch and ed uca tio n in the field of at hle tic

medicine.

The response can be interpreted as a m a n d a t e

from the high school princi pal s to initiate a p r o g r a m of
education,

research,

and support that will u l t i m a t e l y b e n e ­

fit their respective hig h schools.
27

Allen W. Bush, Director, M ich i g a n High School
At hletic Association, in discussion, July, 1974 (after the
data for this quest ion had been compiled and p r e s e n t e d to
the A s s o c i a t i o n ) .

110

Table 4. 31. — Op inions on athletic me dic ine pr o g r a m of e d u c a ­
tion, research, and service o r i g i nat ing at M ich i g a n State
U n i v er sit y or o ther state-s upp ort ed institution.
Class A
%

Class B

Class C

S trongly oppose

2

Oppose

2%

1

Oppose, w i t h some
reserva tio n

4%

3%

4%

Favor, with some
r eservation

34%

35%

32%

33%

Favor

34%

21

%

40%

31%

S trongly favor

25%

35%

%

24%

Qu estions

30,

2%

Class D

%

2%

—

22

2

%

2

%

6

%

31, and 32

Preface:
A p p r o p r i a t e m ed i c a l c overage of i n t e r ­
scholastic athletic con tests has long been a su b­
ject of d i s c u s s i o n among high school administrators.
In the spaces be l o w you are asked to reply with
your preference, pro or con, to the three areas of
m e dical coverage.
The p erc ent age s will be pr esented as composites of the four
classes.

Sep arate class data will be provided by the

r e sea r c h e r upon request.

Question 30
The f oll owing list of sports should r eceive medical
c o verage by a qualified, p hys i c i a n in every instance
of i n t e r s cho las tic athleti c competition.

1X1
Table 4,3 2.— Opinion of respo nde nt to phy sician a tte nda nce
at all h i g h school at hletic events.
Strongly
Ag ree

Agr ee

Disagree

Strongly
Disagree

Football

81%

16%

1

%

—

Soccer

33%

25%

8

%

—

Baseball

20

%

35%

35%

Hockey

50%

19%

2%

Swimming

17%

21

%

31%

2%

Track

22

%

30%

36%

3%

W res tli ng

39%

30%

15%

2

%

Cr oss - c o u n t r y

16%

29%

34%

6

%

Gymnastics

27%

22

%

18%

2

%

1

%

—

The m a j o r i t y of the respond ent s agreed that a
ph ysician should be in attendance at every interscholastic
event involving contact sports.
baseball,

swimming,

track,

The noncon tac t sports of

cross-country,

did not gain this type of support,

and gymnastics

but e n c o u r agi ngl y there

was no strong d i s a g r e e m e n t to a p hys i c i a n being

in attendance

at these events.
Q uestion 31
The sports listed bel ow should have in att end anc e
at interscholastic sports events a m e d i c a l l y q u a l i ­
fied athletic trainer.
(By q ual ified it is m e a n t
that the individual should be either Red Cross c e r ­
tified, or u niv er s i t y or co llege c r e d e n tia led as a

112

trainer, be a physical therapist, or be ce rti fie d
by the National Ath l e t i c Tr ainers Association.

Table 4 .33 .— Opi n i o n of respon den t to athletic trainer
attendance at all high school a thletic events.
Strongly
Agree

Agree

Disagree

St ron gly
Di sag ree

Football

67%

27%

2

%

—

Soccer

38%

29%

2

%

—

Baseball

32%

36%

22

%

—

Hockey

45%

24%

2

%

—

Track

30%

40%

19%

Swimming

24%

30%

17%

Wr est lin g

43%

37%

5%

C r oss -co unt ry

25%

33%

25%

Gymnastics

31%

29%

11

—

1

%

1

%

—

%

—

This questio n removed the potential for having a
student trainer endorsed by the p r i n c i p a l .

Each category

of training was adaptable to the faculty member.

It wo uld

take an exceptional student to m ast er the Red Cross course
the exception to the rule m u s t be

in first aid.

However,

acknowledged.

Some teenagers have e nrolled in Red Cross

life-saving courses and passed them to gain m e m b e r s h i p in the
National Ski Patrol.

28

A m b i g u i t y is also illustrated

in the

^ D o n a l d Lawson, C ert ify ing Examiner, M i d - M i c h i g a n
C h apter of the N ational Ski Patrol, in discussion, July, 1973.

113
op t i o n for a uni ver sit y- or c o l l e g e-t rai ned ath letic trainer.
Such an op t i o n is ex tremely flexible,

as there are no cur-

riculums design ed for a de g r e e in at hletic training.
ever,

How­

there are courses of instruction w i t h i n the various

p h ysical educat ion c urriculums that teach the skills n e c e s ­
sary to become certi fie d as an athleti c trainer by the
Na tional A th letic Trainers Association.

29

Qu estion 32
Please state your opinion, pro or con, on the sub ­
ject of new l egislation in the M i c h i g a n High School
At hl e t i c A s s o c i a t i o n reg arding m a n d a t o r y attendance
(contracted) by a phy sic ian at an interscholastic
athletic event. Which sports should have, without
fail, p roper med i c a l (physician) coverage?

Table 4 . 3 4 . — O p i n i o n of r esp ond ent to the suggestion that
ph ysician attend anc e become a m and ate of the M i c h i g a n High
School Athlet ic Association.
Strongly
Agree
Football
Soccer
Baseball
Hockey
Track
Swimming
W r est lin g
C r oss - c o u n t r y
Gymnastics

75%
26%
9%
42%
10%
8%
28%
7%
19%

Agree
14%
20%
20%
16%
17%
16%
23%
17%
17%

Disagree
4%
15%
40%
8%
43%
32%
23%
41%
24%

Strongly
Disagree
2%
2%

9%
2%
8%
8%
3%
10%
5%

29
C l i n t o n B. Thompson, Ce rti fie d At hl e t i c T r a i n e r and
Head At hl e t i c Trainer, D e p a r t m e n t of I n t e r col leg iat e A t h l e t ­
ics, M i c h i g a n State University, in discussion, September,
1973.

114
This q uestion had the same intent as q uestion thirty,
but it was w orded as if it had a chance to be come a dictate
by the Michi gan High School At hle t i c Association.

Responses

for every sport showed additional ne gative response to the
proposition of m a n d a t o r y attendance by a physician.

The

wording of the que stion m a y have errone ous ly indicated that
the possibility of
Association.

such a ma ndate was forthcoming from the

Such is not the case.

There is no talk of

instituting a rule on m a n d a t o r y attenda nce by a physician.

29

Question 33
Do you b elieve in more stringent rules regarding
the we igh t limitations of high school wrestlers?
(This q ues t i o n is asked be cause of the inherent
dangers of rapid we igh t loss to the growth and
d e v e l opm ent of the young adult and the lingering
cardiol ogi cal implications of high percentages of
weight loss and gain in wrestlers.)

Table 4 . 3 5 . — Percentages of respondents who support more
stringent rules regarding the we i g h t loss and gain in high
school wrestlers.
Class B

Yes

80%

81%

66

%

58%

Ho

14%

13%

26%

9%

29 Bush, op. cit.

Class C

Class D

Class A

115
Seventy-two percent of the survey p opu la t i o n would
support a rules change designe d to help the h i g h school
wrestler avoid losing and gaining significant amounts of
body weight.

This pr oblem has been with high school w r e s t l i n g

for many years and no satisfac tor y solution has yet been
achieved.

The support that the data indicated may serve

to give impetus to a change in the existing rules on we igh t
control in high school wrestling.
Question 34.a
Are m edical records mai nta i n e d by either the high
school athletic phy si c i a n or your of f i c e regarding
athletic trauma?
This pertains to the injured
athlete by type of injury, treatment, m edi cal p a y ­
ments, rehabilitation, and r e i n s tat eme nt of the
athlete to active c o m p e ti tio n in athletics.

Table 4. 36. — Percentage of high schools m a i n t a i n i n g me dic al
records on interscholastic athletic participants.
Class A

Class B

Class C

Class D

Yes

45%

40%

36%

29%

No

52%

58%

58%

54%

Question 34.b
If yes,

please check the appropriate record:

116
Table 4 . 3 7 . — Percent ages of high schools keeping medical
history, annual physical evaluation, injury record, treatment
and r e h a b i l i t a t i o n records.
Class A

Class B

Class C

Class D

Me dical history

2 0%

8%

10%

13%

Physical e valuation
record (annual)

21

%

18%

18%

19%

Injury d i a g nos is and
treatment record

23%

13%

20%

8%

4%

3%

4%

2%

45%

40%

28%

19%

Re hab ili tat ion
record
Permissi on to
particip ate clearance (by physician)

An a ttempt was made through this q u e s t i o n to i llu s­
trate the involv eme nt of the high school a d m i n i s t r a t i o n with
the va rious stages of r ecord keeping n e c e s s i t a t e d by injury
to a high school athlete.

The underl yin g que s t i o n remains

to offer some con fu s i o n to the issue:

Does the high school

have an o b l i g a t i o n to m a i n t a i n these records?

Or is it an

o b l i g a t i o n of the high school to m a i n t a i n the records as
part of a commitm ent to their role in the a d m i n i s t r a t i o n of
health care d eli v e r y to the s t u d e nt -at hle te?
have valid arguments.

Both questions

It m i g h t be n e c e ss ary to establish

positions of r e s p o n s i b i l i t y b e t w e e n the p h y s i c i a n and the
high school re garding the m o n i t o r i n g of the health care
de li v e r y to the injured athlete.

117
Question 35
Do you have any m e t h o d of
that a student- ath let e is
to the sport w i t h i n w h i c h
ticipate?
If yes, select
methods.

establi shi ng the fact
p s y c h o l o g i c a l l y ada pta ble
he is attempt ing to p a r ­
one of the following

Table 4 .38 .— P e r c e n tag es of high schools that uti l i z e a form
of psycho log ica l m e a s u r e m e n t w i t h their athletes.
Class A

Class B

Yes •

14%

8

No

86

%

Class C
%

17%

90%

83%

%

8

89%

Class D

1

All Classes
In terview w i t h c oac h

7.0%

In terview w i t h p hys ici an

3.0%
.5%

Known m edical history
Parental c on s u l t a t i o n

2

Ps ychological testing
service

.0 %
.5%

In terview and
c o n s u l t a t i o n w i t h school

1

.0 %

Each high school at hlete has m a n y re asons for being
an athlete.

There have b e e n g e n e r a l i z e d a c k n o w led gme nts

that at hletics are a challenge.

It m a y be that a ce rta in

sport me r i t s p a r t i c i p a t i o n bec ause it is p opular among the
student body and one's p a r t i c ipa tio n will in crease his p o p ­
ul arity accordingly.

The st udent m a y v i e w at hle tic s as a

118
means to gain upward mobility.

A good high school record

may lead to a co llege scholarship and o p p o r t u n i t y for the
future.

All of these assumpt ion s are valid.

In addition,

in many cases the student is influenced by peer group or
parental pressure,

or an inflated ego.

The g rowing concern

for placing athletes in the sports in w h i c h they rightfully
belong,

based upon somatotype and motivation,

too-distant future.

is in the not-

Mikles stated that student-athletes

need to be r egarded seriously for their physica l and mental
potential for a sport,

and also the age at w h i c h they choose

to enter c o m p e t i t i o n .^
Qu es t i o n 3 6
Please identify the int erscholastic sports your high
school supports.
The answers to question th irt y-s ix have been de let ed
from the data analysis.

The variati ons of answers received

from the respondents were e x t r em ely d i f f i c u l t to comprehend.
Some respondents gave an ac curate summa tio n of their school
sports by m a l e / f e m a l e and v a r s i t y and junior varsity.

Others

placed one w i t h the other and c reated a m i x t u r e of levels of
competition.

The resulting ma t r i x of sports and categories

gave no indication of being an e ffe c t i v e presentation.

^ G a l e E. Mikles, T h e (Lansing,
J o u r n a l , August 1, 1974, p. C-l.

Michigan)

State

119
Question 37
Is there a formal classro om session scheduled for
the prospect ive athletic p articipants that is .
expressly d esi g n e d for teaching the rules of the
game and the nec essity for mental awareness and
physical conditio ning in any of the following
sports?

Table 4 . 3 9 . — Percent age s of high schools that have cl ass roo m
instruction prior to season to discuss rules, discipline,
and physical fitness.
1
li

Ij

‘j

ii

h

1
ll
i!

i!

Class A

Class B

Class C

Class D

Football

50%

52%

44%

4 4%

Swimming

27%

15%

2%

4%

7%

8%

6%

4%

Basketball

45%

48%

36%

48%

Hockey

14%

3%

6%

6%

Track

29%

39%

24%

31%

Cross-c oun try

23%

21

%

14%

13%

Gymnastics

16%

6

%

2

%

4%

Wrestling

30%

34%

24%

8%

Soccer

Note:

Affirma tiv e answers are indicated.

The initial i ntroduction of a sport or a new season
to interscholastic athletes should be a primary consideration of the coaching staff.

The necessity for a compreh en-

sive underst and ing of the rules and the physical rigors of
the game

and

the individual r e s p o n sib ili tie s for the c o n ­

duct of the game should be firmly pr esented to the athletes.

120

As a result,

the game will be played and administered

better.
Qu estion 38
W h e n considering the application for employment
of a prospe cti ve physical educa tio n faculty member,
do you select him for:
(Please rank order 1, 2, 3,
etc. the following categories from m o s t important
to least important in your estimation.)
Each category will be reported by the percentages of those
chosen as number one consideration when hiring new faculty.
The other nine categorical ratings will be supplied by the
researcher upon request.

Table 4. 40. — Educational and personal ity preferences by
administrators in hiring new faculty.
Class A

Class B

Class C

Class D

%

10%

13%

14%

6%

8%

11%

5%

3%

10%

13%

%

32%

32%

19%

Experien ce

9%

8%

4%

6

Expertise in sport

4%

3%

6%

4%

Institution attended
(undergraduate)

2%

Years of coaching
experience

5%

Co aching capability
Personality
Ac ademic background;
scientific minor
Physical education
major

5%

34

8

%

8%

Ad a p t a bil ity to
pr ogram

3 9%

27%

30%

33%

Academi c background

13%

3%

6%

17%

121

These data gave an insight into the qualifications
that high school administrators look for in p rospective c a n ­
didates for a physical education position.

The remaining

categories of qualifyi ng potential had m u c h the same d i s ­
tribution of respondents'

expressed likes and dislikes.

There was no one solid choice in any level of ranking p r e f ­
erences .
Question 39.a
If you have a football player ingest his tongue
in a practice scrimmage session, do you have a
person present who can act appropriately in the
situation?

Table 4 . 4 1 . --Availability of m edi c a l l y trained person to
contend with med ical emergency.
Class A
Yes
No

Question 39.b
If yes, who?

Class B

Class C

Class D

93%

84%

98%

77%

4%

8%

2%

15%

122

Table 4. 42. — Identifi cat ion of m e d i c a l l y trained people to
attend m ed i c a l emergency.
Class A
Physician

—

Coach

Class B

Class C

Class D

2

%

2

57%

68

%

84%

70%

Trainer

27%

8

%

6%

4%

Fi rst -ai d-t rai ned
individual

11

%

11

%

6%

6%

%

—

The threat of a player being rendere d u nconscious
and consequ ent ly losing the control of his tongue is e v e r ­
present in athletics.

The tongue can obs tr u c t the airways

passage and become a threat to life w i t h i n seconds,
athlete becomes unconscious.

once an

The nec es s i t y for h aving an

individual present w h o can restore the airways passage to a
functional status is self-evident.

The lack of p hys ician

at tention strongly points o u t the need of proper emergency
training for all faculty and students involved in the a t h ­
letic program.
Question 4 0
Are your student- ath let es fitted, w i t h o u t exception,
to the e qui pme nt they wil l wear in practice and the
actual games?

123
Table 4.43.— The fitting of athletic equipment to high school
athletes.
Class A

Class B

95%

87%

88

%

83%

%

10

%

13%

Yes
No

5%

10

Class C

Class D

The necessity for proper fit of equipment is quite
evident in the collision sports.
affords the wearer no protection.

A loosely fitting helmet
Conversely,

the helmet

that fits too tightly affects the wearer from the moment
he puts it on his head.

Improperly fitting shoulder and

thigh pads might slip and cause injury to the wearer.

The

edge of the shoulder pad can act as a cutting instrument.
Facial damage is not uncommon w hen a player is struck by an
exposed shoulder pad.

The same considerations apply to

ill-fitting shoes or sneakers, oversized or cumbersome
clothing,

and tight-fitting or motion-restricting clothing.

Neck collars prevent spinal injuries only if they are fitted
properly.

The neck flexion potential is appreciably d i m i n ­

ished if the collar is worn snugly between the helmet and
the shoulder pads.
Question 41
Beyond the preseason conditioning days of practice,
what are the time durations of a daily practice for
football (outside)?

124
T a b l e 4 . 4 4 . — Outdoor pra ctice times for football.
Class A
One hour

—

O n e and a half hours

13%

One hour and fortyfive m inu tes

20

Class B

Class C

Class D
—

2

%

—

21

%

26%

2

%

%

26%

36%

21

%

Tw o hours

46%

35%

34%

25%

Two hours and
fifteen m inu tes

11

%

5%

—

35%

Tw o hours and
thirty minutes

9%

Two hours and fortyfive min ute s

—

2

%

1

%

2

%

5%
2

—

%

There is a d irect r e l a ti ons hip among the length of
practice,

the ensuing fatigue factor,

injury in athletics.
practice,
actions,

31

and the incidence of

The longer an athlete stays out to

the more susceptible to injury he becomes.
respiration,

to a certain extent.

Reflex

and visual acuity all become impaired
The q ues t i o n was placed in the q u e s ­

tionnaire to o b t a i n some information o n the du rat ion of the
av erage high school pra ctice session.
Q u e s t i o n 42
Does your football e qui pment list include:

31

Ryde,

"The Role of the Physician," p.

152.

125
Table 4 . 4 5 . --Football equipment utilization.
Class A

Class B

Class C

Class D

Soccer-type cleats

77%

69%

76%

67%

Neck collars

86

%

79%

78%

65%

Face guards

93%

92%

96%

85%

—

92%

98%

85%

93%

89%

96%

75%

Dental p r o t e c t i o n —
m o u t h pieces
Elbow and knee
protection
Note:

A f f i r mat ive answers are indicated.

The five items listed in Table 4. 45 are becoming
recognized as valuable football equipment

Face guards

are compuls ory e qui pment for players on both the high
school and collegiate levels of competition.

Dental p r o ­

tection was legislated into the rule books last year when
the National Co lle g i a t e A thletic A s s o c i a t i o n m a d e their
inclusion on the equ ipment list for football mandatory.
El bow and knee pads have been a part of the football u nif orm
since before the days of the helmet being used as a p r o t e c ­
tive device.

Question 43
Does your emerge ncy trainer's bag have an airways
pa ssage device?

126
Table 4 .46 .— Percentages of high schools that possess the
airways passage device.
Class A

Class B

Class C

Class D

Yes

61%

37%

50%

31%

No

34%

56%

42%

48%

The airways passage d e v i c e is a polyeth yle ne tube
that is constructed like the adult human throat.
approxi mat ely six inches long and costs,
supplies wholesaler,

through a medical

about three dollars.

uable piece of equipment to the trainer,
had occ a s i o n to use it will testify.

It measures

It is an inval­
as those who have

The device helps keep

the tongue in its proper position in the mouth.

The device

serves to keep the throat open and unobstructed,

and also to

provide a clear passage for breathing.
in emergencies,

The device is used

and only until proper m edical authority

assumes treatment of the incapacitated individual.
Qu estion 44
Wh i c h of the following are used on the ankles of
your athletes?
(See Table 4.47.)
The practice of taping ankles has question abl e protective value.

O'Donoghue,

Ryan,

and Fer guson

32

all q u e s ­

tioned the use of tape as a pr imary protecti on of the ankle.

32

Supra,

pp.

48-50.

127
Tape has become an expensive item for such questionable
protection.

Forty percent of the respondents indicated

their athletic departments taped ankles for both practices
and games.

Only 4 percent indicated no support.

A future

research project may prove justified if the injury rates to
ankles and knees in those respect ive high schools were known
to a me dical researcher.

Table 4. 47. — Percentages of high schools that treat the
ankles of high school athletes with tape or wrap.
Class A

Class B

Class C

Class D

Tape, only for
a game

7%

Tape, practice
and game

25%

45%

42%

48%

Tape or wrap
for a game

14%

6%

6%

4%

4%

3%

6%

4%

39%

19%

26%

28%

_ _

10

%

4%

4%

—

—

No support
Tape or wrap
when needed
Wrap, practice
and game
Wrap,

game only

6

%

10

%

—

Question 4 5
What kinds of helmets are used for football?

10

—

%

128
Table 4 . 4 8 . — Types of helmets utilized in football.
Class A

Class B

Class C

Class D

Full padded lining,
plastic shell

50%

52%

52%

44%

Suspension lining,
plastic shell

54%

50%

50%

48%

7%

3%

Padded lining,
padded shell
Suspension lining,
padded shell

18%

Water cell lining,
plastic shell

2%

6

%

2

%

18%

8

%

10

%

4%

—

—

Football helmets are a concern for more than the
a pparent impact considerations.

The helmet's ability to

expand and contract in extremes of heat and cold is n e c e s ­
sary for player safety and comfort.

Two considerations are:

(1 ) that the plastic shell not become brittle in cold w eat her
(as may be the case in the Mic hig an f a l l ) , and

(2) that the

suspension lining is in original condition either through
upkeep and maintenance or through replacement.

The ability

to have a padded exterior to act as an insulation device and
also have the padding inside the helmet for comfort and p r o ­
tection is a factor that makes

the plastic shell,

suspension-

lined helmet a poorer risk than the other alternatives.
helmet with a padded shell
in w armer climates.
one

The

and padded lining has a dr awb ack

The a mbient air temperatures are usually

to o ne-and-one-half degrees F

higher

than the outside

129
air t e m p e r a t u r e . ^

This p h e n om eno n could c ause great d i s ­

comfort and di sor ien tat ion to the w e a r e r after a period of
time.

It could also contri but e to dehydration,

w h i c h wou ld

further compound the potenti al harm to the athlete.
Question 46
Are your football goal line ma rkers
fill, v inyl covered, spring type?

the foam rubber

Table 4.4 9.— Percentages of high schools that use foam rubber
goal line ma r k e r s in football.
*

Class A

Class B

Class C

Class D

Yes

79%

66%

64%

56%

No

14%

21%

30%

29%

This q uestion was asked to identify w h a t p e r c e n ­
tage of the survey pop ula t i o n was using the safety goal line
markers.

Players will,

line markers.

upon occasion,

Flags, m e t a l markers,

fall across the goal

and poles have all

been used in high school football to m a r k boundaries,
including the goal line.

If another survey w e r e taken in

the future and this q u e s t i o n asked again,

it would be

encouraging to see the 23 p e r c e n t w h o did not have the
safety m arkers b ecome a zero.
33

A. Eu gene C ol e m a n and Amr K. Mortagy, "Ambient Head
Temperature and Footb all H e l m e t Design," M e d i c i n e and
Science in Sports 5 (Fall 1973): 204-208.

130
Question 47
W h a t source do you u ti l i z e in up da t i n g athletic
training or physical condit ion ing practices?

Table 4. 5 0 . — Me t h o d s of upd ati ng athletic training or
p h ysical c o n d i t i o n i n g practices.
Class A

Class B

Class C

Class D

43%

29%

28%

15%

2%

3%

4%

4%

Coach's decisions
(empirical)

64%

58%

64%

63%

Me dic al journals

27%

11 %

14%

21%

Athletic periodicals

63%

48%

68 %

54%

Other

11%

11 %

4%

4%

The team physician
A physical therapist

(clinics)

Once again the data illustrated

the d epe nd e n c y upon

the coach to supply the ne ces s a r y knowledge to keep the
physical

training abreast of c urrent changes

education.
tion.

in physical

The p hys ici an is also a factor in this e v o l u ­

If the p h y s i c i a n does not m a k e a p oint of keeping in

touch with the pr actice of at hletic medicine,
bution will be somewhat less than desired.
cals are an ambiguous option.

his co n t r i ­

Ath l e t i c p e r i o d i ­

The overriding concern with

this q uestion is that the data m a y have indicated the coaches'
support of
cation.

"folklore" m e d i c i n e and practices

in physical e d u ­

131
Question 48
W h i c h of the following changes in football rules
would you endorse for the purpose of reducing
injury?

Table 4. 51. — Opinions of the respondents to proposed rules
changes in football for the intended purpose of athletic
safety.
Class A

Class B

Class C

Kick-off only after touchdown
(field goal would give oppo­
nent the ball on their own
twenty yard line).

18%

11%

16%

8%

More leeway for officials
to call unnecessary rough­
ness on tackling plays.

52%

42%

36%

31%

Ejection frcm a game for a
second face mask violation
by a defender.

25%

26%

30%

17%

A five yard "free zone" for
the player fielding a punt,
nullified after contact
with the ball.

27%

16%

26%

17%

Neck collar become mandatory
equipment (except for the
quarterback).

18%

16%

22%

25%

Any player taken out of a
game a second time for the
same injury cannot return
to the contest.

63%

58%

46%

48%

Class D

These que stions were submitted to the respondents in
the fall of 1973.

Variat ion s of the first and fourth changes

have now been adopted by the new World Football League.
respond ent s did not think too highly of the suggestions

The
in

132
options one and four.
ambiguous.

The leeway issue for officials is

Good officials will o ffi ciate well;

includes roughness calls on tackling plays.
will hesitate to call a close play.

that

Poor officials

The face m a s k v i o l a ­

tion has been a subject of discus sio n at all levels of
football officiating.

34

In question forty-two,

77 percent

of the respondents stated they supplied neck collars to
their football players,
wanted

yet in this q uestion only

20

percent

to see man da t o r y use of the neck collar introduced

into the equipment rules.

The injury q uestion has always

been at the discretion of the attending physician,

but it

is evident that a sizable number of high schools do not have
physicians in attendance.

This may be just cause to open

the subject of m and a t o r y removal of an athlete from a c o n ­
test for repetitious injury,

especially head and neck

injuries.
Questions 49 and 50
These questions solicited open-ended answers from
the respondents.

The respondents usually gave short replies

on various subjects.

All of the replies to questions forty-

nine and fifty are included in A ppe n d i x D.

34 McCallum,

in discussion.

CHAPTER V
SUMMARY,

CONCLUSIONS,

A N D RECOMMENDATIONS

Chapter V is de voted to a summary of the study,
followed by a discussion of the findings g ene rated from
the data,

and concluded with recomm end ati ons and i mpl ica ­

tions and implications for further research.
Summary
Purpose of the Study
The basic purpose of the study was to assess the
health care capabilities for interscholastic athletes in
Mi chigan senior high schools.

Health care capabilities

were identified through the use of a question nai re that
solicited responses regarding health care practices.

The

questionnaire c ont ained six categories of concern having a
direct bearing on the medical w elfare of the high school
athlete:

(1 ) the physical examination,

cal training,
education,
and

(3) athletic equipment,

(2 ) athletic p h y s i ­

(4) athletic medical

(5) records of athletic trauma and rehabilitation,

(6 ) athletic medical-legal aspects.

133

134
Limitations and Scope
of the Study
The limitations of the study were as follows:
1.

The study dealt only with senior high schools
in Michigan.

2.

The study was co ncerned only w i t h the m edi cal ly
related practices that are programmed for and
executed by the interscholastic athlete in all
interscholastic s p o r t s .

3.

The design

of the study did not p rovide for c o m ­

paring the findings of one school and another or
of one class of school w i t h other classes.
Methodology
A survey was conducted by means of a ma i l e d q u e s t i o n ­
naire containing fifty questions, of w h i c h forty-eight w ere
of the closed -re spo nse variety.

The two remaining questions

solicited opinions on possible rule changes in high-schoollevel football.

The respond ent was the principal officer

of the high school.

Two hundred and eighty high schools

were randomly selected from the m e m b e r s h i p of the Mic hig an
High School
of

the

Ath letic Association.

four classes--A,

Seventy schools from each

B, C, and D — comprised the r and om

sample from the total m e m b e r s h i p of 709 schools.

Seventy-

seven p ercent of the 280 high schools solicited r esp onded to
the survey.

This number r e p r e se nte d 31 percent of the total

As s o c i ati on m emb er s h i p of 709 high schools.

135
Findings
Ca tegory O n e :

Physical E x a m i n a t i o n .— The findings

in this category indicated that:
1.

The majority of the high schools

(72 percent)

in the survey indicated they did not have a regular physician.
2.

The m ajority of the high schools did not have a

continuing relation shi p w i t h the same physician.

This is an

indicator of the varying consistency of health care delivery
to the athlete.

Only 39 percent indicated they did have s us­

tained care by the same physician.
4

3.

The physical examina tio n of the student,

repre­

sented by the nine medical subjects included in the question,
was generally not of the standard thought to exist prior to
the survey.

The subjects and their percentage of inclusion

in the physical examination were

(represented as a composite

of all c l a s s e s ) :
Blood p r e s s u r e ......................67%
Family me d i c a l h i s t o r y ............ 34%
General physical condition
.. . .73%
Personal medical h i s t o r y .......... 42%
Emotional s t a b i l i t y ................. 10%
Cardiol ogy e v a l u a t i o n ...............51%
Orthopaedic e v a l u a t i o n ............ 31%
Eye e x a m i n a t i o n ......................32%
Neurolo gic e v a l u a t i o n ...............15%
4.

There was considerable evidence to indicate a

basic misunder sta ndi ng exists pertaining to adequacy of
health care for athletes.

A dequacy indicates that there is

sufficiency for a specified requirement.
diction in the respondents'

The prime c o n t r a ­

answers was illustrated by the

136
fact that the m a j o r i t y indicated they bel i e v e d the physical
ex amination given their studen t-a thl ete s was "adequate,"
and yet the responses to the nine a f o r e m e n t i o n e d medical
categories contra dic ted that belief.
5.

Ph ysician atten dan ce at intersch ola sti c athletic

contests is not required by the M i c h i g a n High School A t h ­
letic Association.

The varying p e r c e n tag es of physician

attendance for each of the four classes

indicate the n e c e s ­

sity for concern regarding the tr eatment of injured athletes
during an i nterscholastic athletic event.
6

.

The e mer gency care is p r e d i c a t e d on the presence

of either a physician or ap pr o p r i a t e l y trained personnel.
The lack of physician attenda nce at games indicates a heavy
reliance upon the local hospitals.

The di stances from field

to hospital and eme rgency care capabilities are depicted
in the following figures:
Hospital
Hospital
Hospital
Hospital
Hospital

wi t h i n
wi t h i n
wi t h i n
wi t h i n
farther

Ca tegory Two:

1-3 m i l e s .......... 4 0%
4-6 m i l e s .......... 18%
7-10 miles . . . .16%
11-20 miles. . . .14%
than 20 miles . . 7%

of
of
of
of
of

survey
survey
survey
survey
survey

A thl e t i c P hysical T r a i n i n g .— The

findings in this ca tegory indicated that:
1.

The survey did not d e t e r min e the level of m

cal knowledge or awa reness of certain types of athletic
injury possessed by the high school coaches.
was included

No question

that wou ld have y ie l d e d that information.

137
2.

The responde nts indicated only 2 pe rce nt of

the trainers attending high school athletes were certified
by the Nat ional A t h l e t i c Tra iners Association.
3.

The ability to treat an a thlete who has had his

tongue block the airways pa ssage de pended on the skills and
ability of the coach in 61 p ercent of the respond ent high
schools.

E leven p ercent dep ended upon a trainer and 9 p e r ­

cent relied upon a f irst-aid-trained individual.
1

Less than

p ercent had quick access to a ph ysician and 18 p ercent of

the respondents acknow led ged they had no trained individual
to take appropr iat e life-saving measur es with a potential
asphyxi ati on case.
The nursing position in the high school setting was
identified as b e i n g av ailable to treat athletic injuries in
2 p ercent of the sample population.

Few injuries incurred

after 5 p.m. re ceived care from the nurse;

only 2 percent

of the nurses were available after 5 p.m.
4.

The airways passage device

(a d evice that aids in

clearing the oral c avity of obstruc tio ns and also contains
an airways corridor)

was pos sess ed by 45 percent of the

respond ent high schools.
5.

Percentages of respon den t high schools supporting

preseason physical condit ion ing programs w e r e as follows;

138
Football . . .
Soccer . . . .
Baseball . . .
Basketball . .
Hockey . . . .
T r a c k .........
Wrestling. . .
Swimming . . .
Cross-country.
Gymnastics . .
6

.

.88%
. 5%
.50%
.77%
.1 0 %
.70%
.43%
.22%
.51%
. 8%

Sixty-eight percent of the high schools in

survey practiced off-se aso n we i g h t training programs.
Category Three;

Athl e t i c E q u i p m e n t .--The findings

in this category indicated that:
1.

Eighty-eight p ercent of the respondents stated

they issued properly fitting equipment to their athletes.
2.

Twenty-eight percent of the respondents had

artificial surfaces on their track areas.
3.

Ninety percent of the respondents conducted

their basketball games and practices on w o o d floors,
7 percent used an artificial surface.

while

The remaining 3 p e r ­

cent had no basketball c ourt or did not support a basketball
team.
Ca teg ory Four:

A t h l e t i c M edical E d u c a t i o n .— The

findings in this category indicated that:
1.

High school athletic teams ob tained new mat eri als

and information pertaining to me d i c a l and physical education
from several sources.

Such sources were:

139
The p h y s i c i a n
29%
The c o a c h
62%
A physical therapist . . 3%
Me dical journals . . . .
18%
At hl e t i c periodicals . .
58%
At hletic clinics . . . .
8%

of
of
of
of
of
of

the
the
the
the
the
the

time
time
time
time
time
time

There was evidence that some respondents used more
than one method to keep abreast of changes in med i c i n e and
physical education.

Again,

the high school adm inistration

respondents exhibited great discrepancy about the real or
imagined skills and edu cation of the team coach.

This is

another illustration of the mis c o n c e p t i o n that the coach has
ma st e r y of several physical edu cation skills,

including a

substantial number of the physical sciences.
Ca tegory Five:

Records of Athle tic Trauma and

R e h a b i l i t a t i o n .— The findings in this category indicated
that:
1.

The survey instrument did not provide adequa

informa tio n and direction to the respondent that would allow
for response to what kind of nomencla tur e was being used to
keep records on athletic trauma.

Standa rdi zat ion of r e p o r t ­

ing injuries was virtually nonexistent.

T hir ty- eig ht percent

of the reporting high schools indicated they kept medical
records on injured athletes.
high schools)

These 38 percent

ma int a i n e d five separate records.

(by percentage of each c a t e g o r y ) :

(eighty-two
They were

140
M e dical h i s t o r y ................... 12%
Annual physical evaluati on . . .19%
Injury diagnosis ................. 16%
Rehabil ita tio n r e c o r d ............. 3%
Permiss ion (from physician)
to p a r t i c i p a t e ................. 34%
The "permission to participate" d ocu m e n t is usually
retained by the high school as a m a t t e r of me dical-legal
importance.

Any athlete who later reinjures the same a n a ­

tomical me m b e r may seek redress in the form of a liability
suit.

In the case where the school has the "permission to

participate"

form in their possession,

the d efe ndant in any

legal arbitration is usually the signing physician.
2.

No audit system of athletic injuries was use

by the high schools that responded to the survey.
C a tegory Six;

A thletic Medical -Le gal A s p e c t s .--The

findings in this category indicated that:
1.

Where there is clearly cause for legal redress

in the case of a liability suit,

the naming of a def end ant

of defendants becomes a subject of some con fus ion regarding
who will be accused in the complaint.

The apparent lack of

clearly defined lines of responsibility for the safety of
the athlete leads to m ultiple allegations against several
parties.

In the case of a liability suit regarding n e g l i ­

gence resulting in physical injury to an athlete,

16 percent

of the respondents stated the ph ysician would become the
defendant;

39 percent indicated the high school would be

the responsible party;

and 15 percent had the impression

141
that the legal process can be waived by a parental consent
form.

Bush stated that in m a n y cases the claimant often

named the coach,

physician,

and the school in the suit,

with the intent that the court signify the liable party.

1

Conclus ion s and Recommendations
The he a l t h care of the M ich i g a n high school in ter ­
scholastic athlete is sporadic.
ment,

A l t h o u g h changes in e q u i p ­

rules, or techniques of a sport man ife s t e d progress

in the concern for the welfare of the s t u d e n t - a t h l e t e ,
direct changes in the delegati on of proper health care to
the athlete have been few.

The paucity of health care for

the high school athlete is evident in the data revealed by
this study.

The omissi ons and shortcomings in health care

delivery to the high school at hlete can be ov ercome by a
concerted effort toward alleviating the conditions of health
care de livery systems reported in this study.
The health of the individual student-athlete is,
initially,

the charge of those people who are close to him

on a daily basis.

Good or bad practices in the care of

athletes could be recogniz ed by the high school a d m i n i s t r a ­
tive officers,

the community, or the pa rents of the athlete.

Good health care is not always unders too d or appreci ate d by
various segments of our society, and the status q u o appears
to be acceptable to m a n y me mb e r s of the community.
^Allen W. Bush,

in discussion, April,

1974.

142
State Associations*
Responsibility and Involvement
Should the community have the awareness to identify
poor health care practices,

they can e ither attempt to r e c ­

tify them on a local basis or seek a statewide referendum.
The latter course of action would involve several a s s o c i a ­
tions and possibly the state legislature.

It m a y well be

that local efforts to improve conditions of health care for
high school athletes have fallen short of their goal.
Finances,

availability of health care professionals,

lack

of education and information, or public apathy are several
reasons why there has been little improvement in health
care delivery s y s t e m s .
Serious thought should be given to rule changes

in

sports where contact or w eight limitations are considered
paramount for success.

However,

pol icy-making bodies cannot

make accurate judgments on rule changes because they have
no real,

factual evidence to support an all ega t i o n that a

certain practice is injuring a significant number of high
2
school athletes.
Four state-supported o ffices could effectively
assist in the improvement of health care for the
2

At this time there is no w a y to asc er t a i n the n u m ­
bers of knee, spine, neck, or head injuries that occur each
year in Mic higan high schools, nor are there ade quate h i s t o r ­
ical records available w h i c h could show trends in or tho pae dic
trauma.
However, the capabil ity for collection and p r e s e n ­
tation of such data is readily available through several
computer systems in the state, w h i c h can accommodate all
needed information fairly inexpensively.

143
interscholastic athlete.

T h e y are:

(1)

the Mic h i g a n Health

Council, w hich has an active role in the p lac ement of health
care professionals in var ious fields of employm ent in
Michigan;

(2) the M i c h i g a n High School Ath l e t i c Association,

w h i c h is responsible for rules e n f o r ce men t and or gan iza tio n
of league and tournament play for all sports;

(3)

igan A s s o c i ati on of Sec ondary School Principals,
ma k i n g body of high school officers;

and

(4)

the M i c h ­
a po l i c y ­

the Mic hig an

State Department of Lic en s i n g and Regulation,

which controls

the certifying of health care professionals.

C omm uni cat ion

w i t h these groups,

e ither singularly or collectively,

would

be the first step in attempt ing to enlist their aid in rec ­
tifying the conditions and problems affect ing adequate health
care,

as revealed in this study.

Significant

improvement

can be attained if the a f o r e m ent ion ed statewide interest
groups and formal or ganizations lend their support to the
cause of improved health care d eli v e r y systems for high
school athletes.
Local C omm unity Responsi bil ity
A review of the various categor ies m e a s u r e d in the
survey gives w ei g h t to the inference

that the state of

M i c h i g a n lacks sufficient health care capab ili ty for the
high school athlete.

The p hysical examination,

attendan ce at athletic events,
sored by the local community,

physician

u t i l i zat ion of nurses spo n­
presen ce of athletic trainers,

di stance to emergency med i c a l care, emergency equipment,

and

144
the m e d i c a l - l e g a l area of athletic admini str ati on all need
closer scrutiny and act ion by public and private groups.
The community and its school off icials have a s i g ­
ni fi c a n t r esp onsibility and role in finding a satisfactory
solution to the problem of inadequate medical coverage of
the high school athletic contests.

The q uickest respo nse to

the ath letic m edicine problem could come from affected
local communities.

Each high school should have an active

p a r e n t - t e a c h e r group that can advise the local school board
of the needs of the high school athletic p rogram and its
me dical care capabilities.
p a r e n t - t e a c h e r group

A political force,

such as the

(especially if it has been a deq uat ely

informed through a statewide continuing education p r o g r a m ) ,
can bring strenuous pre ssure on school boards and a d m i n i s ­
trators to provide qu ality medical care for those students
who partic ipa te in interscholastic activities.
Ad equ a t e health care need not always involve the
presence of a physician.

In many instances a faculty member

can accrue sufficient associate medical training to qualify
as an at hletic trainer or p h y s i c i a n ’s assistant.

An a l t e r ­

native to the at hletic trainer from the faculty could be
the nurse or physical therapist w h o can be identified in the
local co mmu nit y and solicited to serve in the athletic m e d i ­
cine program.

145
Ad ministrators
High school administrators could become a driving
force for referendum and change in the pr esent athletic
medical policies of the Michigan high schools.

Many of the

responding principals stated that the bi ggest impasses in
obtaining adequate m edical coverage have been:
of funds to pay physicians,

(1 ) lack

(2 ) lack of physicians who can

be hired to attend athletic events,

(3) lack of associate

medical personnel in the high school area,

and

(4) either

lack of me mbers on the faculty w h o will assist the coach or
lack of qu alified

(training and experience)

faculty members

to attend adequately to the health care problem.
In this regard the researcher recommends

that a

panel of principals recommend to the state Board of E d u c a ­
tion and the High School At hl e t i c A s s o c iat ion specific
pr oblem areas and courses of action to be taken toward the
solution of inadequate athletic he alth care in the state's
714 high schools.

It is believed the solutions m u s t be

generated through this "in house" method to gain support
and favor of the individual high school administrators
affected by such action.
State Le gislature
The legislative authori ty and power of the state of
Mi ch i g a n could be brought to bear on the subject.

The cre-

dentiali ng of associate me dical professionals could become
a reality if

(1 ) the state would authorize such cer tif ica tio n

146

or licensure/

and

(2 ) if the positi on of state-certified

athletic trainer were man dated for each high school in the
state.

These positions could be classified and financed in

the same way as coaching positions.

Extra monies are a l l o ­

cated for the faculty member who teaches during the day and
coaches after school hours.

The same remune rat ion could

exist for the faculty member who is credentialed as an
associate medical professional or athletic trainer and who
would stay after regular school hours to tend to the athletic
m e dical needs of the student interscholastic athlete.
Implications for Future Research
The combination of the mat ura t i o n process and the
juvenile's involvement in physical exercise and organized
athletics represents a varying period in the growth and
development of the human body.
of the literature,

As m ent i o n e d in the review

virtually no me dical research has been

directe d to junior and senior high school athletes,

except

for that begun in the past few years.

recent

In addition,

research has raised more questions than it has answered.
Medical practice involving the high school athlete has endured
on w h a t Ryan labeled "folklore" medicine.

3

What was done

before is good enough and, w it h o u t c ontrary scientific
argument,

3

it shall prevail.

Ryan,

"Taping Prevents,"

p. 40.

147
N e w studies are needed to examine the practice of
depriving the growing high school wr es t l e r of fluids and
nutrients so that he can attain a predet erm ine d we i g h t that
will qualify him for a contest.
ignorance and expediency,
ethics of the practice,

It is firmly believ ed that

with only a cursory thought to

prevail in the state of Michigan.

Discussions on the subject with various wre stling coaches
have led the researcher to believe that these practices are
not to be tolerated any longer than necessary.

There is a

break in the belief that weight loss is proper,

and this

a

break is coming from the younger wrestling coaches.

Genuine

concern for more than winning is appar ent ly altering, wit h
some merit,

the "folklore"

training habit of semi-starvation

prior to a wrestli ng contest.
Women's athletics should undergo extensive research.
Medical and physical educators lack knowledge and u n d e r ­
standing of the pathology of the female body w h e n under a
stress and exercise condition.

Given the increased p o p u ­

larity of women in athletic competition in educational
institutions,

researchers have an opport uni ty to study,

under clinical conditions,

this ne glected area.

Findings

of such research can be readily applied to the development
and promulgation of policies,

rules and regulations,

and

health provisions pertinent to w omen before undesirable
practices and attitudes become firmly established in the
adminis tra tio n of women's athletic programs.

148
To reiterate,

little researc h has been directed to

the realm of the thirteen to eightee n-y ear -ol d male and
female athlete.

The subject has not been considered cr u­

cial or profitable enough for co ncentrated m edical research.
In the estimation of this researcher,

this value judgment

has been erroneous to the point of negligence on the part
of m edicine and education.

Both owe a di fferent attitude

and effort to the youth of this state.
Recommendations Regarding Survey Procedures
The survey questionnaire contained fifty questions,
of which forty-eight were closed- res pon se questions.

The

reason for including such a large number of questions was
the notion of a thorough inquiry into "every facet" of the
medical program pertinent to the interscholastic athlete.
Questions we re designed and tested,

and then m ail ed to the

respondents before the full scope of the resea rch effort
was realized by the researcher.

As a consequence,

the task

was too complex to be accommodated by the survey instrument,
as well as the available d a t a - pr oce ssi ng system.
In this regard,

it is recomm ende d that in future

research in the athletic m e d i c i n e field,
followed:

two procedures be

(1 ) that each que sti on contain no m o r e than nine

"yes" or "no" answers or m a n d a t o r y single responses,

since

the presently available Control Data 6500 com puter will not
record any number past nine,
answer per question

and it will indicate only one

(multiple answers are not tolerated by

149
the c o m p u t e r ) ; and

(2 ) that the survey or re search ins tru ­

ment state que stions p ertaining to a single category of
research or those areas that are closely related to the mai n
topic of the survey.

The m u l t i p l e - c a t e g o r y questionnaire

may appear to be an all-inc lus ive v ehicle that initially
should yield many answers#

but it can become a co ncern of

major proportions when the time for interpretation of the
data is at hand.
The questio nna ire replies for 216 respondents
required 64 8 key-punched compu ter cards.

The task could

have been considerably lighter had a different question nai re
format been utilized.

One viable o ption would have been to

group questions concerning the six major categories reported
in the survey into unified presentations,

i.e., all the

physical examination questions in section one of the survey,
all of the questions
in section two, etc.

involving athletic physical training
Wi t h i n each section,

the questions

should be designed to offer one response to five a l t e r n a ­
tives

(or more,

not e x c e e d e d ) .

providing that the nine alternatives are
The q u e s t ion nai re can quite easily be adapted

to keypunch cards and in turn the cards can be accommodated
by the Control Data 6500 computer.
As noted earlier,

om issions of the survey instrument

have been men tio ned when appropriate.
as follows:
advance,

Other concerns are

(1) The researcher should have known more,

about the ph ysi c i a n and his role in the actual

in

150
sequence of h ealth care del ivery to the athlete.

This

would have included the physician's check of the athlete
prior to the game,

an audit of the e mer gency equipment that

the ph ysician considers necessary,
the coach and the physician.

and the rapport be twe en

This knowledge would have

allowed the resear che r to design more specific questions
that w o u l d have yielded answers about types of equipment
de sired for the players,

and would have established a line

of demarca tio n that w o u l d relieve the coach of player p a r ­
ticipation responsi bil iti es in the d e t e r m ina tio n of player
injury and p a r t i c ipa tio n and place them in the charge of
the physician.

Additionally,

it would have allowed the

researcher to follow the p attern of the p hys i c i a n regarding
the actual provisions of a pregame check of the athlete.
It would have been helpful to know to what extent the p h y ­
sician evaluated the athlete prior to a contest.

APPENDICES

151

AP PEN D I X A
QU EST ION NAI RE

152

APPENDIX A
Q U E S T IO N N A IR E

1. Does your high school have a regular team physician (under contract
fo r services)?
Yes

ho

2. Is the same physician engaged fo r a l l sports physical examinations?
Yes

_______ No_____

3. Is the specialty o f the team physician:
(

4.

a)
b)
c)
d)
e)

fam ily practice (general practice)
orthopedics
Internal medicine
physical medicine
other (please state)

Is the team physlcan in attendance a t a ll home fo o tb all games?
Yes

_______ No____

5. Is the team physician in attendance a t a ll or some of the away games?
a) a ll
b) some
c) none

check one.

6. Do you have a standard physical that student-athletes must successfully
pass in order to physically q u a lify fo r In tersch o lastic competition?
Yes

No

7. Of the q u alifyin g categories, how many are used by your school 1n physical
evaluation o f the potential student-athlete? (Please check.)
a )_____ blood pressure
b )_____ fam ily medical history
c )_____ general physical condition (obese or meager b u ild , proportionate
to frame)
d )_____ previous personal medical history
e )_____ emotional s t a b ilit y
f )_____ cardiology evaluation
g) *____ orthopedic evaluation
hi_____ eye examination (depth perception, a c u ity , peripheral)
i ) _____neurologic evaluation

153

154

0. Is the team physician a state-licensed a llo p a th ic or osteopathic
physician?
M.D,
9.

0 .0 .

Odes your high school have a c e r tifie d tra in e r?
Yes

No

10. What is the academic or association credential o f the tra in e r o f the
v a rs ity sports?

*

11.

a)
b)
c)
d)
e)
f)
g )_____

student, lo c a lly trained by physician
student, lo c a lly trained by coach
student, lo c a lly trained by tra in e r (outside school)
fa c u lty member, lo c a lly trained by physician
fa c u lty member, lo c a lly trained by coach
fa c u lty member, lo c a lly trained by tra in e r (outside school)
fa c u lty member, u n iversity or college trained byphysical
education department. I f yes, what u n iversity or college?

h)

fa c u lty member, u n iv ersity or college tra in e d , but as a
physical education minor; i f yes, what college or university?

1)_____
j)
k)
1)

a licensed physical th erap ist
a member of the National A th le tic Trainers Association ( c e r tif ie d )
a chiropractor
other

Does your community have access to:
a) a hospital fo r a ll medical contingencies:
1 to 3 miles from school
4 to 6 miles from school
7 to 10 miles from school
11 to 20 miles from school
21 or more miles from school
b) a physical th erap ist fo r a th le tic re h a b ilita tio n w ith in the coomunlty
or county?
Yes

___________No___

12. Do studsnt-athletes have a preseason physical conditioning program admini­
stered by a tra in e r or member of the physical education s t a f f , 1n the follow ing
sports?
a)
b)
■=>
d)
o)
f)

fo o tb all
lacrosse
soccer
baseball
basketball
hockey

Yes
Yes
Yes
Yes
Yes
Yes

No
No
No
No
No
No

g) track
h) wrestling
1 swimming
J cross country
k) gymnastics

Yes___
Yes
"
Yes
Yes
~
Yes

No
No
No'
No"
No

155

13. Does your high school possess and u t i l i z e e ith e r or both o f the follow ­
ing?
Hydrotherapy Equipment
Electrotherapy Equipment Yes
14.

Yes
No____
______________ No_____

ts there a nurse position 1n your high school?
Yes

No_____

I f yes, 1s the nurse av a ila b le fo r tre atin g a th le tic Injuries?
_ _ _ _ Intram ural, during school day only
a l l sports up to 5:00 p.m.
r.o contact with a th le tic In ju ry
15.

Is an injured student cared fo r by:
fam ily physician
school physician

16. Does your high school have any of the following emergency equipment
a v a ila b le fo r a th le tic In ju rie s {w ithin a 3 to 5 minute time frame)?
a) quick access to telephone and physician/hospital telephone members
Yes
No_____
b) stretchers and bindings
Yos
No_____
c) blanfcets
Yes
No_____
d) bandages
Yes
No_____
e) pharmaceuticals (fo r cuts, abrasions, lacerations)
Yes
No
f ) motor vehicle fo r transportation
Yes
No
g ) f i r s t aid trained Individual to handle emergency
Yos
No_____
17.

Can you document a th le tic in ju rie s through your existin g system?
Yes

18.

No_____

Does your fo otball team practice on game fie ld s ?
Yes

No

156

19.

Is your practice f ie ld In the sane condition as your game fie ld ?
Yes

20.

__________ No_____

Do you play fo o tb all games a t night (under lig h ts ) or daytime?
Night

(C irc le one)

Day

21. Do you play fo o tb all games on e ith e r Friday or Saturday (C irc le one),
or other__________ ,
Do you practice under the lig h ts a t night?
Yes
22.

'
23.

__________ No_____

Is your track composition:
sand and clay
cinder
_____ a r t i f i c i a l surface.

I f so, what type?

Do you play basketball on:
a r t i f i c i a l surface
wood.

Hd. In the case of legal process fo r alleged medical m alpractice, who becomes
the defendant in a s u it by a player or fam ily o f a player th at seeks damages?

a)
the school physician
b)
the school
c )_____ Is the legal process waived by any means?
vehicle? _______________________________

I f yes, by what legal

25. Does your high school have a v a lid informed consent acknowledgement agree­
ment between the school and the stu d en t-ath le te, (parents or guardian I f 1n
m inority s ta tu s ), that explains the schedule of treatment 1n a t h le tic a lly
Incurred injuries?
Yos

No

157

26. Oo your Interscholastic a th le tic p articip an ts have a school sponsored,
offseason, weight tra in in g program? (By sponsored 1t 1s meant to be planned
and monitored by a member o f the physical education s t a f f or fa c u lty . I f
yes, c ir c le the party responsible fo r monitoring o f the program.
Ves
m

- -■ - ■

No

■

27. The President's Council on Physical Fitness, In a high school study o f
stodent-athletes by H. Harrison Clarke In the Physical Fitness Research Digest.
stated that there Is a c o rre la tio n between a th le tic excellence and aceifenrlc
and social success In the high school years. Do you believe th a t th is s ta te ­
ment could be v a lid In your high school? Answer by one o f the follow ing
measures.
The statement applies to the greater m ajo rity o f a th lete s 1n th is
high school; over 80%.
The statement applies to the m ajority of athletes 1n th is high
school; 51-80%.
The statement applies to many o f the a th lete s in th is high school;
AO-50%.
*

The statement applies
20-39%.

to some o f the athletes 1n th is high school;

The statement applies
one-19%.

to a few o f the athletes In th is high school;

None o f the above.
20. How would you ra te your a th le tic department personnel and coaching s ta ffs
in regard to the number o f physical educators and coaches per sport?
Optimum levels of manning have been achieved.
Adequate s tu d en t-in stru c to r, coaching ra tio s have been achieved.
The In stru ctio n and coaching o f sports are being covered by some
fa c u lty , employed outside th e ir s p e cia lty. A doubllng-up by
fa c u lty has guaranteed coverage of our a th le tic program.
Eelow par manning le vels have necessitated the c u rta ilin g o f some
a th le tic events and programs.
Lack of s u ffic ie n t personnel has led to can cellation o f a th le tic s .

158

29. Mould you be 1n favor o f a more ce n tra lize d a th le tic medicine program o f
education, research, and service being Inaugurated In th is u n iv e rs ity or any
other s ta te university? This would necessitate standardized ptyslcal examina­
tio n s , possible Involvement o f medical students in the medical a<bn1n1strat1on
o f your program, possible re tra in in g fo r the a th le tic s t a f f In physical t r a in ­
in g , and re h a b ilita tio n and Implementation o f an a th le tic In ju ry aud it system.
m

Strongly oppose
Opposed
Oppose, w ith some reservation
Favor, with some reservation
Favor
Strongly favor
Appropriate medical coverage of 1nterscholast1c a th le tic contests has long
boon a subject o f discussion 1n the ranks of high school adm inistrators.
In the spaces below you are asked to reply with your preference, pro or con,
to tha' three areas o f medical coverage.
30. The follow ing l i s t o f sports should receive medical coverage by a q u a li­
fie d physician 1n every instance o f In te rs c h o la s tic , a th le tic competition.
«

Strongly Agree
Football
Soccer
Gaseball
Hockey
Sw1nm1ng
Track
k'rostl ing
Cross-country
Gymnastics
Lacrosse

Agree

Disagree

Strongly Disagree

159

31. The sports lis te d below should have 1n attendance a t Interscholastic
sports events a medically q u a lifie d a th le tic tra in e r (By q u a lifie d I t 1s
meant that the Individual should be e ith e r Red Cross c e r t if ie d , or univer­
s ity o r college credentlaled as a tra in e r , be a physical th e ra p is t, or be
c e r tifie d by The National A th le tic Trainers Association).

Strongly Agree
Football
Soccer
Basebal1
Hockey
Track
Swimmi nq
Wrestling
i
Cross Country
Gymnastics
Lacrosse

Agree

Disagree

Strongly Disagree

160

32. Please s ta te your opinion, pro or con. on the subject o f new le g is la tio n
in The Michigan High School A th le tic Association regarding mandatory attend­
ance (contracted) by a physician a t an In terscholastic a th le tic event. Which
sports should have, without f a l l , proper medical (physician) coverage.

Stronqlv Agree

Agree

Disagree

Stronqlv Disagree

Footbal1
Soccer
Baseball
Hockey
Track
Swi^nl nq
H restlin q
Cnoss-country
Gymnastics
Lacrosse

33. Do you believe In more string ent rules regarding the weight lim ita tio n s
o f high school wrestlers? (This question is asked because of the Inherent
dangers o f rapid weight loss In growth development o f the young ad u lt ond
the lingering cardiological Im plications of high percentages of weight loss
end gain 1n w re s tle rs .)
Yes

No_____

34. Are there medical records maintained by e ith e r the high school a th le tic
physician or your o ffic e regarding a th le tic trauma? This pertains to the
injured a th le te by type of in ju ry , treatm ent, medical payments, r e h a b ilita tio n ,
and reinstatement of the a th le te to active competition 1n a th le tic s .
Yes

No

_

I f yes, please check appropriate record:
medical history
physical evaluation record (annual, freshman, or sophomore thru senior
year
in ju ry diagnosis and treatment record
re h a b ilita tio n record
permission to p a rtic ip a te clearance (by physician)
other

161

35. Oo you have any method o f establishing the fa c t th a t a studen t-athlete
Is psychologically adaptable to the sport w ith in which he/she Is attempting
to participate?
Ves

No_____

I f yes, select one o f the follow ing:
' a ),____
bj.
c)
d)
el
fj
g)

Interview with coach o f sport
interview w ith physician
known medical history
parental consultation
psychological testin g services
interview and consultation with school
none o f the above (Conment I f d esired .)

36. Please id e n tify the interscholastic sports your high school supports.
Each sport 1s categorized In three columns; B fo r boys; G fo r g ir ls .
1
Footbal1
Lacrosse
Swlmminq
Soccer
Basebal1
Basketball
Hockey
Track
Cross-country
Gymnastics
Wrestling

Varsity

J r . Varsity

Intramural

162

37. Is there a formal classroom session scheduled fo r the prospective a th le tic
participants th a t Is expressly designed fo r teaching the rules o f the game
and the necessity fo r mental awareness and physical conditioning In any o f
the following sports?
Football
lacrosse
Swimming
Soccer
Basketball
Hockey
Track
Cross-country
Gymnastics
UrestUng

Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes

No
No"
No
No"
No"
No
No"
No"
No"
No"

38. When considering the application fo r employment o f a prospective physical
education fa c u lty member, do you select them fo r: (Please rank order 1, 2 , 3,
etc. the following categories from most Important to least Important 1n your
e s tim a tio n .)
coaching c a p a b ility
personality
academic background; s c ie n tific minor
physical education background, physiology, anatomy, e tc.
experience
expertise In a singular sport
in s titu tio n attended
years of coaching experience
evident a d a p ta b ility to your school and programs
academic background (open)
39. I f you had a fo otball player Ingest his tongue in a practice scrimmage
session, do you have a person present who can act appropriately In the s itu ­
ation?
Yes

No_

I f yes, whom?
physician
Coach
tra in e r
f i r s t aid trained individual
40. Are your student-athletes f i t t e d , without exception, to the equipment
they w ill wear In practice and the actual games?
Yes________________ No_____

163

41. Beyond the preseason conditioning days o f p ra c tic e , what are the tin e
durations o f a d a lly p ractice fo r fo o tb a ll outside?
a)
b)
c)
d) ' *
e)
f)
g)
42.

hour
and a h a lf hour
hour and f o r ty - f iv e minutes
hours
hours plus 15 minutes
two hours plus 30 minutes
longer (to ta l time ■ _____________________ )

Does your fo o tb a ll equipment 11st include:
a)
bj
c)
d)
e)

43.

one
one
one
two
two

soccer type cleats
Ves_____
neck c o lla rs
Yes_____
face guard protection (b ird cages)
Yes_____
dontal protection mouth
pieces
Yes_____
elbow and knee abrasion
protection devicesYes

Does your emergency tra in e r's bag have an airways passage device?
Yes

44.

No.
No.
No.
No]
No.

No_____

Which o f the following are practiced on the ankles o f your athletes?
Answer below.
a)
bj
c)
dj
oj
f)
g)

tape - only fo r game
tape - practice and game
wrap only fo r practice
wrap p ractice and game
no external support 1n practice
wrap only fo r game
no external support practice or game

The above question and answer apply to:
a) fo o tb all
b) hockey
c) lacrosse
d} cross-country
o) w restling
f ) baseball
n) basketball
h) nymnastlcs
i ) crack
.i) soccer

164

45.

What kind o f helmets are used fo r fo o tb all?
a)
b )_____
c )_____
d j
o) "
f ) _____

f y l l padded lin in g - p la s tic shell
suspension lin in g - p la s tic shell
padded lin in g - padded shell
suspension lin in g - padded shell
not applicable
other type _____________________ ( f i l l

in )

45. Are your fo o tb all goal lin e markers the foam rubber f i l l ,
spring typa?
Ves

No_____

vinyl covered

Not applicable_____

47. Mhat source do you u t i l i z e in updating a th le tic tra in in g or physical
conditioning practices?

,

a)
the team physician
b )_____ physical th erap ist
c )_____ coach decisions (em p irical)
d )_____ medical journals
e )_____ a th le tic periodicals
f ) _____ other _____________________

43. Which of the following changes 1n fo o tb all rules would you endorse fo r
the purpose of reducing Injury?
a )_____ kick o ffs only a f te r touchdowns (F ie ld goal would give opponent
the b all on th e ir 20 yard lin e .)
b )_____ more leeway fo r o f f ic ia ls to c a ll unnecessary roughness on
tackling plays (In many Instances, i t is the th ird or fourth
defender which causes the In ju ry to a b all c a r r ie r .)
c )_____ e jectio n from a game fo r a second face mask v io la tio n by a
defender
d )_____ a fiv e yard "fre e zone" fo r the player fie ld in g a punt return;
n u llif ie d a f te r contact w ith the b all
e )_____ neck c o lla r become mandltory equipment Issue (except fo r quarter­
back)
f )_____ Any player who 1s taken out of a game a second time fo r the seme
in ju ry should be barred from fu rth e r competition 1n th a t contest.
(This applies mostly to head In ju rie s where visual acu ity and
alertness are measurably im paired.)

c- CJ

49. Assuming th at good ru le s , properly enforced, aid in the prevention o f
a th le tic in ju ry , then what are your thoughts about existing ru le s . What ru le
by sport, would you lik e to see more strongly enforced. I f so desired, pleas
comment on the enclosed blank sheet o f paper.

165

SO. Irlhat new rules would you lik e to see put Into the rules book. Please
s ta te by sport. Your conment Is appreciated on th is question a ls o , keeping
in mind th at player safety and sportsmanship are paramount In rules consid­
eratio n s.

I

This high school Is a class

A

B

C

D

school.

Due to the anonymity o f the questionnaire, th is Id e n tific a tio n 1s the only
ivay we have an In d ic ato r o f the response success of the survey.
Thank you fo r your assistance and consideration.

APPENDIX B
LETTER OF INTRODUCTION

166

APPENDIX B
LETTER OF INTRODUCTION

MICHIGAN STATE UNIVERSITY
( i ;i i i i .k m
IH -PA II1M IM

i n m w a t 1 1 it h h h i i m

• taj i h h

h a u

!)► B H l M K T I A N l t S

Scptenior 26, 1973

'

The Department of Biomechanics, Michigan State University, in cooperation
with the Michigan High School Athletic Association and the Michigan High
School Coaches Association, is conducting a survey of the Michigan high
schools regarding the health care delivery systems employed by the high
schools in the care of athletes. The athlete we are attempting to focus
upon is the male or female student-athleto that is participating in an
interscholastic sports event.
The survey is being conducted to identify the health core capabilities of
the high schools in general. The questionnaire that is appended to this
letter contains questions that address the various facets of athletic
medicine that are paramount to the athlete. We recognize the fact that high
schools are working with varying economic and conceptual programs. There
will be widely diversified ideas and opinions on many of the questions asked.
To gain an accurate self-evaluation, we are soliciting your assistance with
the assurance that anonymity of all returned responses will be honored.
Only the collective information will be subject to editing and evaluation.
We do not desire to have a high school identify themselves.
The objective of the survey is to establish the conditions and practices in
the Michigan high schools as they exist today. Should the collective responses
indicate the necessity for undergraduate educational change at the university
level, then we will have a guideline for reevaluation. Additionally, the
curriculum of medical education may be positively affected by an acknowledged need within the state school systems. The structure of high school athletics
presents the most advantageous organization to work with. There ere two
reasons for this observation. First, the information will become a valid base
frcm which to construct educational programs in athletic medicine for the
physician and the allied health professional. Secondly, the high school, which
is envisioned as the potential employer, will benefit from better credentialed
associates or faculty members. If a health care need can he recognized and
articulated, then an attempt will be made to alleviate that circumstance
through an educational mechanism at the university level.
Our request for your assistance reflects the vitality to the survey that your
comments contribute. Without perfect candor, the validity of the information
becomes an e::cTcise in futility; an expensive one at that.

167

168
September 2b, 1B73
Page two
A sizable space in the questionnaire has been included for your ideas and
desires on athletic medicine. Please make comments that are pertinent to
your high school. Be specific when describing the existing conditions and
as precise as possible when accounting for the medical care capabilities,
by skill, of the school system, cosranunity, and county or region.
We do wish to make the most of the survey. Ultimately the high schools of
the state should be the primarybeneficiary of the educational programs
initiated in the University and the State.
Thank you for your cooperation and assistance.

They are greatly appreciated.

illchard W. iledfeam
Department of Biomechanics
Michigan State University
Tel:

(517) 353-4730 or 4731

Alien W. Bush
Director of Athletics
Michigan High School Athletic
Association

Robert W. Ji
Secretary/Treasurer
Michigan High School Coaches
Association

APPENDIX C
FOLLOW-UP LETTER

169

APPENDIX C
FOLLOW-UP LETTER
M I C H I G A N STATE UNIVERSITY

e a s t l a n s i n g . M ic h ig a n

4Bhd

COLLEGE OF OSTEO PA THIC M EDICINE • EAST FEE HALL
DEP A R TM E N T OF DIOMECHANICS

On September 28, 1973, this department, in concert with the Michigan High
School Athletic Association and the Michigan High School Coaches Associa­
tion, mailed to you a 50 question survey form. Enclosed with that survey
item was a postcard that was to be utilized as the receipt acknowledgment
of the requesting letter and questionnaire.
To this date we have not received any postcard from your high school. This
represents an intermission in our efforts to compile accurate data from
a maximum number of respondent high schools. We realize that there are
a number of reasons why the card and the questionnaire have not yet been
received by this office.
This letter is intended to be a reminder that we are depending upon your
cooperation to insure completion and accuracy in the survey. Please
return the card and the questionnaire form separately at your earliest con­
venience. The lack of a card from your school has precipitated this
letter. The questionnaire remains anonymous.
Thank you for your cooperation.

Richard W. Redfearn
Office of Athletic Medicine Research
Department of Biomechanics

170

APP E N D I X D

OPEN-ENDED RESPONSES TO QUESTION FORTY-NINE

171

APPENDIX D
OPEN-ENDED RESPONSES TO QUESTION FORTY-NINE

Question:
Ass umi ng that good rules, p rop erl y enforced, aid
in the p r e v ent ion of athletic injury, then w h a t are your
thoughts a bout existing rules?
Wh at rules, by sport, w oul d
you like to see more strongly enforced?
If so desired,
please comment on the enclosed paper.
A n s w e r s : The following answers w e r e taken from the q u e s ­
tionnaires.
They are presented by class.
There is r e p e t i ­
tion, and not all statements are c omp l e t e sentences.
Class A
1.
2.
3.
4.

No face tackling or blocking, spearing etc. in football.
Wa t c h for excess use of elbows in basketball.
Spear blocking or tackling should be made illegal.
L eave rules as they are, but get referees that know how
to enforce them.
5. If pr esent rules can be enforced, they seem okay.
6 . F o o t b a l l — not enough calls for penalty in piling on,
line play, tempers; throw flag on coaches who commit
offenses.
7. B a s k e t b a l l — too m u c h contact permitted on rebounding.
8 . G e n e r a l — All sports should emphasize sportsmanship.
9. Knock off spearing in football.
10. Stop roughing after whistle.
11. Call face m a s k violati ons in football.
12. Rules seem good- -in our league the o ffi cials do a good
job.
13. The spear block; blocking, tackling w i t h head or face
d r i v e n into the opponent, eliminate this from football.
14. Wedges should not be allowed on kickoff returns.
15. Diving over piles by ball carriers should be outlawed.
16. Rules for contact sports should be ev alu a t e d on a year
to year basis.
17. The rules need to be enforced by the officials.
18. Enforce the p i l i n g-o n penalty in football.
19. Enf orce the clipping rule in football.
20. La nding pits in track should come under more careful
inspection,
21. Wre st l i n g mats should be standardized.
22. Stop hitting w i t h m a s k and h elmet in football.
23. Stop cra ckback block on linebackers and ends in football.
24. Stop clipping and crackback blocks.

172

173
25.
26.
27.
28.

No crack back blocking allowed.
M a i n c oncentration upon good o f f i c i a l s — rules we have
are good if officials are trained; state v e r y poor in
control of officials in all sports.
Crack back block and clipping need greater enforcement.
Use of forearm by defense should b e watched m u c h closer.

Class B
1.

Get officials to call unnecess ary r o u g h n e s s — too m u c h
leeway now.
2.
M o r e p enalty for spearing.
3.
E jec t i o n from game for deliberate face mask holding.
4.
En force crack back block rule.
5.
Crack back block; rule needs m u c h better enforcement.
B a s k e t b a l l — eje ction for d efe nsive player who "cuts
down" off ensive player on way to bas k e t for a lay-up.
6 .
Get officials who can enforce the rules and control
the g a m e .
7.
Better referees who can enforce the rules will mean
fewer injuries.
8 .
Pre-sea son conditioning, better (more thorough) physical
exams and rigid enforc eme nt of the rules will d ecr eas e
injuries.
9.
Illegal use of forearm, "clubbing" should be stopped.
10.
W a t c h closer for head slapping techniques that amount
to unneces sar y roughness.
11. Face m a s k vio lat i o n s aren't called enough.
12. Off icials should call m o r e un nec ess ary roughness.
Too
m a n y players are hurt on late hits.
13. Officials try hard, but m a n y have d isp l a y e d poor j u d g ­
ment; r e p e a t e d l y .
14. Intentional fouls, in all sports, should be re -ev alu ate d
annually.
15. Eli minate spearing from football.
16. No football e qui pment until after one w e e k of physical
conditioning.
17. Do away with spearing.
18. Better enforcem ent of "piling on" and "late hitting"
in f o o t b a l l .
19. M H S A A is doing a good job of rules enforcement.
20. Open football season earlier for be tte r weather.
Enf orc e
all rules as currently wri t t e n and avoid adding others.
Too m a n y rules are worse than none.
21. O n l y shoulder blocks, downfield, should be al lowed in
football.
No cross body blocks at l e g s — too m u c h injury.
22. F o o t b a l l — I believe [respondent replying] the rule wh ich
allows contact by def ensive m a n after offensive line
motion, allows def en s i v e man a "cheap" shot to u n s u s p e c t ­
ing opponent.
This rule should be changed to a d e f e n ­
sive foul.

174
Class C
1.
2.

Limit the length of athletic c o m p e tit ion season.
The personal conduct of a p a r t i ci pan t should be
m o n i to red c l o s e r — sportsmanship should be paramount.
Es p e c i a l l y noticeable in basketball.
3.
Stop defense from hitting intended pass r ece i v e r after
an incomplete pass.
4.
En force roughing the passer rule better.
5.
El iminate the tie-breaking rule.
6 .
More stringent enforcement of proper bench conduct by
coaches.
7.
Of ficials are getting better.
A n off icial who has
control of a game can help eliminate a lot of injuries.
8 . A n injured pl ayer should be
taken out of a game, by
mandate, if a d octor cannot give an accurate sideline
diagnosis of injury.
9. Pass interference should be at the point of infraction.
Kids del ibe rat ely interfere on passes g re a t e r than
fifteen yards from scrimmage.
10.
No crack back b lock at all above or b e l o w w a i s t from
person outside clip zone at point of snap.
11.
Send rules enfor cem ent down to school sponsored seventh
and eighth grade p r o g r a m s .
12.
Elimina te linoleum basketball courts.
13.
Elimina te u n d e r cut tin g an airborne player (layups or
jump for r e b o u n d ) .
14. En force clipping rules better.
15. H a n d - to- han d combat in line play is o v e r lo oke d by
officials.
16. More emphasis on enfor cem ent of spearing in football.
17. Better training for coaches and individuals involved
in sports.
18.
Tie br eaker in high school football should not be used.
19. E lim inate crack back blocks.
20. En force clipping violations.
21.
O u t l a w the crackback block by split end or flanker;
and enforce it.
22. Get rid of crack back block.
Class D
1.
2.
3.
4.

Pre s e n t rules are adequate.
F o o t b a l l — enforce rules on crackba ck blocks and u n n e c e s ­
sary roughness.
Better enforce me nt of non-c ont act rules in basketball
is needed.
A delibe rat e foul in basketball should have a m ore
severe penalty.

175
5.

W h e n a runner is sliding into a base, make sure the
umpire enforces the rule pertaini ng to the runner sli d­
ing into a base and not going after the defensive
player.
6 .
S o c c e r — watch for u nnec ess ary ro ughness and foul langauge.
7.
Better and m o r e consiste nt o ffi cia tin g in ice hockey.
8 .
All football shoes should be soccer style.
9. More e n f o r c eme nt on clipping.
10. It is hard for some officials to enforce the existing
rules.
11.
El iminate cross body block on an interior li neman by
a split end or flanker.
12.
Poor judgment and m i s h a n d l i n g of game conditions are
the major cause of athletic i n j u r i e s — Get better
officials.
The rules are good if you can get an official
w i t h a knowledge of the game and the discipline to use
the rules properly.

APPENDIX E
OPEN-ENDED RESPONSES TO QUESTIO N FIFTY

176

APPENDIX E
OPEN-ENDED RESPONSES TO QUESTION FIFTY

Q u e s t i o n : W h a t new rules wo u l d you like to see put into the
rules book?
Please state by sport.
A n s w e r s : The statements listed b elow were taken from the
q u e s t ion nai re form.
There m a y be a bit of r e d u n d a n c y and
carry-ov er from the previous q u e s t i o n in A p p e n d i x D.
Answers
will be categorized by class of respondent.
Class A
1.

All sports— d isr e g a r d cu rrent e l i g i b ili ty standards;
use only semester records.
2.
Initiate better rules for wei g h t loss for wrestlers.
3.
Le gi s l a t e rules that will eliminate knee and ankle
injuries on punts and kickoffs.
4. M a k e spearing illegal.
5.
Man da t o r y suspen sio n for fights in h o c k e y — pos sib le
psychol ogi cal e x a m i n a t i o n for repeat offenders.
6 . Eli minate cross body block in football.
7.
Rules are okay; but off icials and coaches either do
not know them or will not e nforce them to keep c omm and
of athletic events.
8 .
Main c o n s i d e r a t i o n — referees do not en force rules and
coaches do not teach rules to players.
9. The wedge on kickoffs should be eliminated.
10. No leaping over players for additio nal yardage.
11. Remove the trampoli ne from high school gymnastics.
12.
Better enforce men t of p laying surface acceptability.
Football fields and basketball floors c o n t r i b u t e to
athletic injury a great deal of the time.
13.
Remove fighters from game (rest of game) in hockey.
14. M a k e slipping illegal an ywhere on the field.
15. F o o t b a l l — put in o ver t i m e rule and start f r o m the
twenty yard line.
16. N o n e in p a r t i c u l a r — they have screwed the rules up
enough already.
17.
F o o t b a l l — all crackb ack or do wnf iel d b locks above the
wais t .

177

178
Class B
1.
2.
3.
4.
5.
6 .
7.

.

8

9.
10.
11.
12.
13.
14.
15.

B a s k e t b a l l — limit schedule to fourteen games and
tournament.
B a s k e t b a l l — give the fouled team the o ption of taking
the ball out of bounds in the last three m in u t e s of
play.
This m a y eliminate
intentional fouling.
F o o t b a l l — m a k e spear bl ocking and tackling (using
head as a butt) illegal.
M e w rules for w e i g h t controls in wrestling.
Five yard pe n a l t y for face mask u nless it is a flagrant
violation.
Move goal posts to goal line.
Mor e stringent r e q u i re men ts for c e r t i fi cat ion of
officials.
Pass int e r f e r e n c e — should be first down at point of
infraction.
M a k e of ficials en force rule that says teams m u s t be on
the field of play three min u t e s prior to second half
of (play.
T unn e l i n g in bas ket bal l should be disallowed.
A m o u n t of w e i g h t r edu ction in w r e s t l e r s should be
mo n i t o r e d closer.
Some boys lose too much.
Make ph ysical e x a m i nat ions fall 30 days, or less, prior
to sport competition.
As it stands now a boy could get
a physical in S e p t em ber and play a spring sport.
F o o t b a l l — pass i n t e r f e r e n c e — first d o w n at p o i n t of foul.
Make spearing in football illegal.
Intentional fouls, w h i c h injure a player, should al low
the team that the injured player is on, to k i c k a field
g o a l — or at least a tt e m p t one.

Class C
1.
2.
3.
4.
5.

6

.

7.

No indian b l o c k i n g — leaving feet c o m p let ely to knock
op po n e n t down.
E l i m i n a t e d o w n f i e l d blo ck i n g after ten yards from line
of scrimmage.
P hysical e xam ina tio ns m u s t be given prior to each c o m ­
pe tit i v e sports s e a s o n — not once a year.
W h e n game co n c l u s i o n is imminent, i.e., ten seconds
to go and first and ten situation, eli minate needless
sneak to cause a p i l e - u p — de cl a r e the game over.
A n y school g u i l t y of riotous b ehavior after school game
or contest on school p r o p e r t y — should have host p r i v i ­
lege suspended, pe nding league or confere nce r e v i e w and
recommendation.
F o o t b a l l — fair catch should be caught or else it is a
free ball.
Place ball at point of infract ion on pass interference.

179
8

.

9.
10.
11.

Kick after touchdown should be one p o i n t and run or pass
play, done successfully, a fter touchdown should be two
points.
Pass i n t e r f e r e n c e — ball placed at point of interference
and aut omatic first down.
Spearing in football should m e a n expulsion from the
game.
Have a standard rule for w e i g h t loss in wrestling.

Class D
1.
2.

E n f o r c e the existing rules better.
A rule that demands better crowd c o n t r o l — for the
protect ion of the players and the fans.
Too many
of ficials are influenced by the conditions under whi ch
they work.
3. I think the state has done an e xce l l e n t job in the
p r eve n t i o n of injuries by the rules in each sport.
4.
M i c h i g a n should require all offic ial s of all sports
to receive training in officiating.
This is the
gr ea t e s t single d raw b a c k of sports in our state.
5.
I w o u l d like to see seminars for school people c o n ­
ducted in the upper penin sul a for the expre sse d purpose
of teaching how to e l i m ina te or treat at hletic injuries.
6 .
Eli mi n a t e the potential h azard of u n d e r c u t t i n g a b a s k e t ­
ball player w hil e he is off the floor.
7. Referees do not call p ili n g - o n in football the way
they s h o u l d .
8 . Eli mi n a t e spearing in football.
9.
A d o p t a standard football shoe that will cut d o w n knee
injuries.
10.
Bring ba ck finesse to basketball; re strict b ody contact.
11.
Dis a l l o w intentional spiking w h e n sliding into a base.

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180

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Medical World N e w s , Aug ust 18, 1972, pp. 20-36.

Tcheng,

T. K . , and Tipton, C. M.
"Iowa Wr est l i n g Study:
A n t h r opo met ric M e a s u rem ent s and P r e d ic tio n of a
Mi nimal Body Weight for High School Wrestlers."
Medical Science in Sports 5 (Spring 1973): 1-10.

Thompson, Richard A . , D.O.
"Principles and M ethods of
Tr eating Some of the Co m m o n Injuries in Contact
Sports."
Unpublished paper wr itt en while Dr. Thompson
was the team phys i c i a n for the De tr o i t Lions P r o ­
fessional Football Club, 1962.
"Today's Rigorous T raining of Young Athletes."
W o r l d N e w s , April 13, 1973, pp. 51-57.
Torg,

Medical

Barbara G . , and Torg, Jo s e p h S.
"Sex and the Little
L e a g u e ." The Phy sician and Sports Medicine 2
(May 1974): 45-50.

Torg, Joseph S., M.D.
"Little League: The Theft of C a r e ­
free Youth."
The Phy sician and Sports Medicine 1
(June 1973): 72-78.
_________ , and Quedenfeld, Theodore.
"Effect of Shoe Type
and Cleat L ength on Incidence and Sev erity of Knee
Injuries Among High School Football Players."
Re search Quarterly 42 (May 1971): 203-10.
Westerman, Richard L . , M . D . , and Martin, Charles.
"Fluid
Loss of Football Players in Dry Climate and
Humid Climate."
Kalamazoo, Michigan:
Upjohn
International, 1973.
(Mimeographed.)
Wilmore,

Jack H.
"The Com p l e a t Athlete?"
N e w s , May 24, 1974, p. 135.

Medical World

_________ , and McNamara, John J . , M.D.
"Prevalence of
C o ronary Heart Disease Risk Factors in Boys, Eight
to Twelve Years of Age."
The Journal of Pediatrics
84 (April 1974): 527-33.