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SPORTS MEDICINE: Guidance from NFHS for resuming sports remains incomplete

SPORTS MEDICINE: Guidance from NFHS for resuming sports remains incomplete


On Tuesday, IHSAA Commissioner Bobby Cox sent a memo to school superintendents, principals, and administrators regarding “guidance for reopening high school athletics.”

In the communication, Cox noted schools — and therefore sports — remain closed until June 30. Then he continued, “Beginning on July 1, 2020, and with the approval of your local school board and/or Superintendent, IHSAA member schools may conduct athletic activities … Furthermore, if additional local or statewide restrictions are not reinstituted, the beginning of the fall season is set for Aug. 3, 2020.”

From those words, one could assume a resumption of business as usual.

If only it were that simple.

The IHSAA and IHSA are members of the National Federation of State High School Associations, which essentially sets the rules and issues the guidance that the individual state associations enforce and follow. Consequently, rather than issuing recommendations from his office regarding sports and COVID-19, Cox cited instructions published by the NFHS’ Sports Medicine Advisory Committee on May 15.

That document opened with questions directed to the state associations, that must be answered before the fall season may commence. For instance, if schools remain closed, will an effort still be made to resume high school sports?

Following those initial questions, the NFHS offered seven points of emphasis to be followed during a phased return to full resumption of sports:

1. Decreasing exposure to respiratory droplets by using facemasks: students who prefer to wear a cloth facemask should be allowed to do so. Furthermore, masks are recommended during practice for all athletes except swimmers and distance runners during the first two phases of resumption. During phase three, athletes should continue their use when on the bench, in a locker room, or in a training room. Coaches, officials, and other “contest personnel” may wear them at all times.

2. Specific guidelines regarding testing, mass gatherings and response to a team member becoming ill with COVID-19 remain under review and will be issued at a later date.

3. Recurrent outbreaks are “a near certainty” and “state associations must be prepared for periodic school closures and possibility of some teams having to isolate for two to three weeks while in-season.”

4. Schedules should be altered in order to require minimal travel, thus reducing time spent in buses and vans and minimizing the likelihood of an outbreak in one locale being spread to another.

5. Further guidance is being formulated for singing and the playing of wind instruments, due to the extent of the spread of respiratory droplets that occurs with those activities.

6. The following individuals are particularly vulnerable: those age 65 or older; those with high blood pressure, chronic lung disease, diabetes, obesity, and asthma; and those who are immunocompromised, such as cancer patients undergoing chemotherapy. Later in the document, the NFHS recommended against the vulnerable participating at all during the first two phases of resumption. Thereafter, if and when they do participate, they “should practice physical distancing.”

I’m not sure how that is going to work for athletes who are vulnerable. By the start of phase three, their level of conditioning will be far behind that of teammates who have completed the first two phases.

7. “Until a cure, vaccine or very effective treatment is readily available, or so called ‘herd immunity’ is confidently reached, social distancing and other preventive measures, such as face covering will be a ‘new normal’ if workouts, practices and contests are to continue.”

The document then referenced previous guidance the NFHS issued that would allow providing a “one-year extension” on the pre-participation physical evaluations completed for the 2019-20 school year.

However, on May 13, the American College of Cardiology’s Sports & Exercise Council issued a consensus statement that contradicts the NFHS advice. At the very least, athletes should be tested for COVID-19 anti-bodies, because even in asymptomatic cases of the infection, there may have been silent damage to the heart.

On May 16, Orthopedic surgeons with Washington University in St. Louis issued their own guidelines regarding the resumption of youth sports. Their very first recommendation reads, “Athletes, coaches, and officials/referees/umpires MUST undergo a healthcare screening prior to starting any activity (practice, scrimmage or games).”

The edicts from the NFHS and Washington University in St. Louis both reference daily screening of coaches and players prior to participating. In the early phases of return, that would include temperature taking and asking a specific set of questions regarding symptoms and possible recent exposure to COVID-19. The assumption is that an athletic trainer will conduct the screening. If the school has only one athletic trainer, good luck with those logistics.

Both sets of guidelines go on to acknowledge the value of athletic trainers, particularly at this moment. Starting on July 1, they will be screening for COVID-19 symptoms, monitoring athletes for heat illness, and dealing with the inevitable injuries that will arise from the enforced inactivity of March, April, May, and June. This year then, more so than ever, athletic trainers will be among the most valuable members of the athletic staff as high schools attempt to navigate this anticipated re-start.

For the complete NFHS guidelines, go to

For the Washington University guidelines, go to

John Doherty is a licensed athletic trainer and physical therapist. This column reflects solely his opinion. Reach him at Follow him on Twitter @JDohertyATCPT.


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