The NCAA salutes the more than 380,000 student-athletes participating in 23 sports at more than 1,000 member institutions SPORTS MEDICINE 2008-09 NCAA® Sports Medicine NCAA 65859-7/08 MD 09 Handbook THE NATIONAL COLLEGIATE ATHLETIC ASSOCIATION P.O. Box 6222 Indianapolis, Indiana 46206-6222 317/917-6222 NCAA.org Nineteenth Edition July 2008 Compiled By: David Klossner, Director of Education Services. Distributed to directors of athletics, senior woman administrators, faculty athletics representatives, head athletic trainers, team physicians, CHAMPS/Life Skills coordina- tors, individual student-athlete advisory committees and conference commissioners. Note: Revisions to the guidelines contained in the NCAA Sports Medicine Handbook may be made on a yearly basis. Between printings of the handbook, revisions will be published on NCAA.org. It is important that persons using this handbook be aware of any such revisions. The NCAA Committee on Competitive Safeguards and Medical Aspects of Sports suggests that such revisions be recorded in the hand- book, thereby keeping this publication current. New guidelines and major revisions have been highlighted with orange shading. NCAA, NCAA logo and NATIONAL COLLEGIATE ATHLETIC ASSOCIATION are regis- tered marks of the Association and use in any manner is prohibited unless prior approval is obtained from the Association. Member institutions and conferences may reproduce information in this publication for their own use, provided the NCAA copyright is included on the material. Also found on the NCAA Web site at the following address: NCAA.org/health-safety. Copyright, 2008, by the National Collegiate Athletic Association. Printed in the United States of America. 1 PREFACE The health and safety principle of required to follow to avoid legal the fall. Please view the NCAA the National Collegiate Athletic liability or disciplinary sanctions by Sports Medicine Handbook as a Association’s constitution provides the NCAA. However, an institution tool to help your institution develop that it is the responsibility of each has a legal duty to use reasonable its sports medicine administrative member institution to protect the care in conducting its intercolle- policies. Such policies should health of, and provide a safe envi- giate athletics program, and guide- reflect a commitment to protecting ronment for, each of its partici- lines may constitute some your student-athletes’ health and pating student-athletes. To provide evidence of the legal standard of well-being as well as an awareness guidance in accomplishing this care. of the guidelines set forth in this objective and to assist member handbook. schools in developing a safe inter- These general guidelines are not collegiate athletics program, the intended to supersede the exercise NCAA Committee on Competitive of medical judgment in specific Safeguards and Medical Aspects of situations by a member institu- Sports creates a Sports Medicine tion’s sports medicine staff. In all Handbook. The committee has instances, determination of the agreed to formulate guidelines for appropriate care and treatment of sports medicine care and protec- student-athletes must be based on tion of student-athletes’ health and the clinical judgment of the institu- safety for topics relevant to inter- tion’s team physician or athletic collegiate athletics, applicable to health care team that is consistent a large population of student- with sound principles of sports athletes, and not accessible in medicine care. These recommen- another easily obtainable source. dations provide guidance for an institution’s athletics administra- This handbook consists of tors and sports medicine staff in guidelines for each institution to protecting student-athletes’ health consider in developing sports med- and safety, but do not establish any icine policies appropriate for its rigid requirements that must be fol- intercollegiate athletics program. lowed in all cases. In some instances, accompanying references to sports medicine or This handbook is produced annual- legal resource materials are provid- ly and sent to directors of athletics, ed for further guidance. These senior woman administrators, recommendations are not intended faculty athletics representatives, to establish a legal standard of care athletic trainers, team physicians, that must be strictly adhered to by CHAMPS/Life Skills coordinators, member institutions. In other student-athlete advisory commit- words, these guidelines are not tees and conference commission- 2 mandates that an institution is ers at each member institution in 2008-09 Sports Medicine Guidelines Foreword ......................................................................................................................................................... 4 1. Administrative Issues a. Sports Medicine Administration .......................................................................................................... 6 b. Medical Evaluations, Immunizations and Records ............................................................................. 8 c. Emergency Care and Coverage............................................................................................................ 11 d. Lightning Safety................................................................................................................................... 13 e. Catastrophic Incident in Athletics........................................................................................................ 16 f. Dispensing Prescription Medication.................................................................................................... 18 g. Nontherapeutic Drugs.......................................................................................................................... 21 h. Institutional Alcohol, Tobacco and Other Drug Education Programs ................................................. 22 2. Medical Issues a. Medical Disqualification of the Student-Athlete .................................................................................. 26 b. Cold Stress........................................................................................................................................... 27 c. Prevention of Heat Illness.................................................................................................................... 30 d. Weight Loss—Dehydration ................................................................................................................. 33 e. Assessment of Body Composition ...................................................................................................... 34 f. Nutrition and Athletic Performance ..................................................................................................... 39 g. Dietary Supplements and Banned Substances ................................................................................... 42 h. “Burners” (Brachial Plexus Injuries).................................................................................................... 45 i. Concussion or Mild Traumatic Brain Injury......................................................................................... 48 j. Skin Infections in Athletics .................................................................................................................. 52 k. Menstrual-Cycle Dysfunction............................................................................................................... 60 l. Blood-Borne Pathogens and Intercollegiate Athletics ......................................................................... 62 m. The Use of Local Anesthetics in College Athletics .............................................................................. 69 n. The Use of Injectable Corticosteroids in Sports Injuries..................................................................... 70 o. Depression: Interventions for Intercollegiate Athletics .......................................................................72 3. Special Populations a. Participation by the Student-Athlete with Impairment ........................................................................ 78 b. Participation by the Pregnant Student-Athlete .................................................................................... 80 c. The Student-Athlete with Sickle Cell Trait............................................................................................ 82 4. Equipment a. Protective Equipment........................................................................................................................... 86 b. Eye Safety in Sports............................................................................................................................. 92 c. Mouth Guards...................................................................................................................................... 94 d. Use of the Head as a Weapon in Football and Other Contact Sports ................................................. 96 e. Guidelines for Helmet Fitting and Removal in Athletics...................................................................... 97 f. Use of Trampoline and Minitramp....................................................................................................... 100 Appendixes a. NCAA Legislation Involving Health and Safety.................................................................................... 104 b. NCAA Injury Surveillance System Summary .....................................................................................