Concussions are receiving more attention than ever. Athletic trainers have evolving resources and new information to combat concussions. With Bill Nervig, assistant athletic trainer for the Arizona Coyotes, athletes’ health are in experienced hands, as he has seen the evolution of athletic training and the evolution in diagnosis and treatment of concussions.
The University of Pittsburgh Medical Center did a nationwide study and found that between 1.7 and three million sports related concussions happen each year. Having someone who can spot an athlete who may be showing signs of a concussion and knowing what to do next are keys in preventing further damage. That is where an athletic trainer comes in.
Being an athletic trainer was what Nervig said he always wanted to do ever since he was in junior high. He has been a trainer for more than 20 years, and worked for teams such as the Omaha Beef indoor football team, the Omaha Lancers hockey team and was even recently brought up to be the assistant athletic trainer for the NHL’s Arizona Coyotes.
Nervig said that he had an athletic trainer in high school sports who he respected a great deal. That athletic trainer inspired him and led him to recognize that he wanted to be somebody in that field that would help athletes in the same way that trainer helped him.
Nervig said he was also still a competitor at heart though, and wanted to stay in that competitive mindset. He said he wanted to be on the field and in the trenches. Becoming an athletic trainer gave him that opportunity. Nervig is still able to live the highs and lows as if he was playing but gets that experience from a sideline perspective. Nervig said it was the perfect combination of what he was passionate about and he has now spent 23 years on the bench with hockey teams.
With 23 years of athletic training experience, the bulk of Nervig’s experience came from his time with the United States Hockey League’s (USHL) Omaha Lancers from 1999 to 2019. The Lancers won three Anderson Cups, given to the regular season champions, in 2001, 2005 and 2008. They also won two Clark Cups, the league championship trophy, in 2001 and 2008.
Nervig spent his time with the Lancers working as the head athletic trainer and equipment manager. His responsibilities for these roles varied from treating major injuries to sharpening skates.
Nervig said he did the things to get players in the best situation to play well. He coordinated physicals for when they arrived in town, stretched them out, massaged them, and took care of their bumps and bruises.
On the equipment management side, he did lots of laundry, sharpened skates, repaired equipment and made sure that everybody had the right sticks and helmets.
“Really anything that the players touched physically came across my desk,” Nervig said. “I was responsible for making sure we procured it, it fit within our budget, and everything was functioning properly.”
Nervig also said the injury treatment for athletes was very comprehensive and covered all the areas of player healthcare.
Nervig also evaluated major injuries and referred them to the appropriate physicians on their sports medicine team. He worked with the player through rehab and get them back out on the ice.
One of those major injuries Nervig dealt with were concussions. This is an injury that is extremely common in contact sports and also gets the most media attention. Concussions are unique, though, because how they are viewed and treated has drastically changed over the course of the last 20 years and drastic changes over even the last five years.
“When I first started, concussions were something that we were aware of and were trained to evaluate but the tools that we had available to us were very, very limited,” Nervig said. “A lot of it with concussion diagnosis, when I first started out, was just knowing the guy and being able to tell there was something off with them.”
Nervig said he believes the biggest change he has seen in his time as an athletic trainer is from coaches and management. He said that, an athletic trainer said a player had a concussion, but coaches or management would roll their eyes and would reinforce the old cliches or stigmas that went with concussions for a long time.
“They used to say that a player ‘just got his bell rung’ or ‘he can just walk it off, he’s still fine to play,’” Nervig said. “If you tell management that a guy has a concussion, they don’t question you for a second. It’s remarkably inconvenient to have a guy out of the lineup. But it’s much more remarkably inconvenient to have a guy permanently injured.”
Nervig said he also has recognized a change in the way players handle concussions. He has seen a shift into players taking much more seriously the long-term health of their bodies and the bodies of their teammates.
“The players recognize it, and they don’t scoff at it, they take it seriously,” Nervig said. “They want to help each other out as well. They’ll come to me and tell me they aren’t feeling themself or one of the other guys isn’t acting himself. And the athletes, when I first started, would hide their symptoms from you because they didn’t want to come out of play. I’m not going to say that doesn’t happen at all anymore. But it’s far less frequent.”
Nervig said he has seen noticeable changes in the way concussions are handled in the last few years, too.
Nick Hart, Bill Nervig’s successor as the Omaha Lancers’ head athletic trainer, has been in athletic training for nearly nine years and even he has seen concussions begin to take a front seat in the media’s, coaches’ and players’ minds.
A change hart said he’s noticed is a more uniform and consistent set of policies teams follow.
“We’ve come an awful long way even in the past, you know, five years compared to the way we used to handle concussions,” Hart said. “The USHL has a concussion policy that all teams are supposed to follow. And that policy ranges from everything from baseline testing to how you return athletes to play.”
The way players act is also something Hart has noticed a change in.
“I’m finding every year, and this goes back to concussions just being talked about more and more in the media, and the NFL doing a great job on how they handle it, it gets easier and easier to take athletes out,” Hart said. “Players know how serious this is and can have potential life changing effects that come from having too many or returning to play too soon.”
Another key part that has evolved along with people’s view of concussions and different leagues’ policies for concussions has been the treatment of concussions. ‘Concussion protocol’ is the term thrown around most often, and there is a bit of mystique behind it as it is used to describe a process that is somewhat fluid. It is a very broad term. It refers to anywhere in the phase from making an initial diagnosis to the rehab and recovery phase and the return to minor practice.
The first step is spotting the concussion, and doing so can be tricky because there are many different symptoms and not all will always show up.
“The symptoms vary person to person and concussion symptoms can also be other normal things,” Nervig said. “If you have a sinus infection, you might have a headache before a game. But then if you take a big hit, is your headache a concussion or is your headache just from that sinus infection? Not every headache is a head injury. But also not every head injury comes with a headache.”
Luckily for players and trainers, no concussion diagnosis is made by one specific individual. Other players, coaches and trainers will point out if a guy is feeling or looking odd. Also, in the NHL, teams have spotters in all the NHL arenas and practice facilities, so that if they see something that they think is suspicious of a concussion hit, they will call down by radio and let the team know a guy might be concussed.
But it doesn’t stop there. If the players, the coaches, the trainers and the spotters don’t see a possibly concussed player, there is a group of athletic trainers in the NHL league office command center that are watching every single game that’s happening live. They also have the ability to call the teams and make them take a player off the ice for an evaluation.
If a player is indeed diagnosed with a concussion, that is when the ‘protocol’ starts.
The first part of the process is to rest and then look for a players symptoms to begin to resolve, but not necessarily be resolved entirely. Then the player will begin some light physical activity.
Nervig said that research has shown that light physical activity, as long as it doesn’t cause an increase in the symptoms that a player is feeling, will actually help the player’s metabolic processes in their body to begin their healing process.
If symptoms don’t get worse, that activity level gets increased a little bit more and the team can use heart rate data to determine the percentage of a player’s normal workload
“We know every player’s heart rate and can track 30% or 70% or 80% of a player’s regular workload and so we will gradually increase the amount of work that they’re doing,” Nervig said. “We continue to make sure that their symptoms aren’t getting worse and are hopefully improving, and we will rehab a guy the same as if they had any other injury.”
Once a player clears through those stages, and their healing and recovery indicates that it’s safe to do, coaches and trainers will clear them back into practice, but for non contact. They put a different color jersey on them so the others know to avoid colliding with that player.
Nervig said that even if a player may do fine sprinting and skating, going back on the ice with 20 other people can be difficult sometimes. Their brain receives so much input and has to process things faster at game speed, so just tossing a player ‘back to the wolves’ can put a lot of stress on that player’s brain.
But then, once a player is doing well with that, they start increasing the contact level a bit then they will have to be cleared by the neuropsychologist to make sure that everything inside their head and how they’re processing is working outside of just skating and playing. Once that happens, a player has cleared the protocol and will continue regular play.
Having athletic trainers on sports teams, especially contact sports, has transitioned from a luxury to a need in large part because of concussions.
Hart, who played hockey in high school, did not have an athletic trainer and he, like many who played high school sports, believes he 100% had at least one undiagnosed concussion. He can remember getting hit from behind during a game and having a headache all week after.
On the other hand, Greg Hermosillo, a junior and student at the University of Nebraska-Lincoln, had a minor concussion when he was younger. He used to play football and also boxed outside of school In his case though, his concussion was diagnosed and he had to take time off from contact sports and had to rest and avoid bright lights. Hermosillo said he thinks he was thankful because if he was not forced to take that time off, it may have gotten worse.
Not all athletes have access to athletic trainers, but as the media, professional sports leagues like the NHL and NFL, and seasoned athletic trainers continue to shed light on concussions, concussions will become more recognizable and more players will be at lower risk of long-term injury.