Keeping their heads in the game

The Lady Vols will eschew a day off Tuesday and instead use the time for shooting drills and a chance to practice in the arena for the first time in a week. After a layoff of nine days between games because of final exams Tennessee will host in-state school Middle Tennessee on Thursday evening.

"We're going to shoot," Pat Summitt said after practice Monday in Pratt Pavilion. "The posts go firsts and then the guards will shoot. All we're doing is getting shots in. Shooting and free throws. These next two days are going to be really light. We started tapering today."

Thompson-Boling Arena has been in use for the past several days for the setup and performances of The Living Christmas Tree – an oversized, decorated tree with perches for singers and an accompanying stage show. The holiday event ended Monday evening.

"We haven't been in there," Summitt said. "We'd like to feel like we had a home court advantage at some point."

The fall semester exam period ends Thursday, and that evening No. 7 Tennessee, 6-1, will play Middle Tennessee, 5-3. The Blue Raiders were upset by Western Carolina on Sunday but feature one of the best players in the country in Alysha Clark, who is averaging 22.0 points per game.

Summitt has been frustrated with her team's inconsistency from one game to the next – and especially on the road – and the break between games has been used to work extensively on defense.

The players met among themselves before practice Monday, and the result was a productive session.

"They brought energy," Summitt said. "They were very focused. I thought they communicated better. The communication has not been as strong as today. This was a good sign. I thought overall it was one of our better practices of late.

"As I told them right now as a basketball team we're not ready to go through this stretch we're getting ready to go through unless we get better. We've got to get better to be successful with what we have coming up. There has to be a sense of urgency, and today we looked like we had a sense of urgency to get better."

The Lady Vols were nearly at full strength – Amber Gray remains out with a concussion – but two more players went down with tweaked knees in Vicki Baugh and Glory Johnson, one day after Kelley Cain and Cait McMahan took tumbles and hurt their knees.

Baugh, who is coming back from a surgically repaired left knee after tearing her ACL last April, went down without contact in what Jenny Moshak said was a good response by the knee.

"She's structurally sound," said Moshak, who was in the weight room with Gray at the time of the incident. "She said she felt her knee kind of give out, but it's going to do that as a protective mechanism if it's not in a great position, if it's not quite up to par with strength, so it will do that. Our priority is to get her strong."

Baugh was pulled from the court, as was Cait McMahan, to save the opportunity for them to be in the weight room after practice. In both cases it's the rehab protocol as they come back from major surgery – practice mixed with periodic rest and weight training to strengthen the quad.

"Same with Cait," Moshak said. "If it's talking to her so much out here I still want them to be able to compete in the weight room. That is ultimately the thing that keeps them on the court."

Moshak welcomed news of a limited practice Tuesday, but she may still withhold McMahan because of the pounding from repetitive shooting in terms of jumping and landing.

"It's still a lot of repetition, but it will be lighter on their bodies," Moshak said.

Cain was able to return to practice Monday after tweaking the patellar tendon on Sunday.

"It's talking to her but there's no swelling, structurally she's sound," Moshak said. "Everything did what it was supposed to do."

That's significant with Cain because it means her realigned right kneecap – it was prone to dislocation before surgery because of a congenital condition – functioned as it should and allowed the knee to track correctly.

"Exactly," Moshak said.

The other player who went down Monday was able to stay in practice. Johnson collided with a teammate and got hit in the side of her right knee. The impact knocked her to the floor, but she was able to walk off under her own power.

"She's just very sore so we'll treat her," Moshak said.

So far the incidents in practices and games have been scares without any major blows to the roster.

"We have dodged some bullets, but at the same time they're strong," Summitt said. "Their quads are strong. Jenny feels good about where we are with the people that have been injured."

Blows to the head have been another matter this season. Four Lady Vols have sustained concussions from September to December.

The first was Shekinna Stricklen, who caught an elbow to the nose – a non-displaced fracture that did not require surgery – from a practice player in a scrimmage in September. The next two occurred in November when Cain was hit with a practice player's elbow in practice, and Alicia Manning absorbed a blow to the head in a game. The fourth occurred last Thursday in practice when Gray collided head to head with a practice player.

"I think it's one of those things right now," said Moshak, the team's chief of sports medicine. "I think they're practicing hard. I think it's very physical, and I think sometimes you suffer with that type of intensity."

The Lady Vols team physician, Dr. Rebecca Morgan, agrees.

"It's the way this sport goes," Morgan said. "They're playing really hard right now. I think it's the way it goes when you're playing at this intensity. It's just one of those things. We've been unfortunate."

The treatment of concussions has also changed, especially as more has become known about their severity and long-term effects, in part from the much-cited research of Dr. Kevin M. Guskiewicz, who heads the sports concussion program at North Carolina.

"If you are in sports medicine the volume of information we've gotten about concussions has increased so much," Morgan said.

Part of that information has revealed how significant the long-term consequences can be for athletes not properly treated, as a portion of Guskiewicz's work has focused on retired players. The result has been that athletes are not released for competition as soon as they used to be.

"They're much more conservative," Moshak said. "They don't label the grade of the concussion until it's all over and you look back. There is no such thing as getting your bell rung anymore. That message says it's light. There's no such thing as a light concussion."

Another concern has become the "second impact injury," in which an athlete returns to competition not fully healed from the first concussion and absorbs another blow to the head. In rare cases that impact can be fatal.

"It's unusual but hard to screen who is vulnerable," Morgan said.

Also, allowing an athlete to compete before full recovery can set up the player for another injury since balance, coordination and agility are compromised with a concussion.

When a player suffers a concussion, there is no set timetable for recovery. The brain heals on its own time and it varies from person to person.

"Don't push somebody back before they're ready," Morgan said, is the guiding force for medical personnel.

Moshak mentioned an analogy that Morgan uses in which she compares a faulty computer that keeps shutting down to the human brain.

"Over time you can reboot it, but it's basically an electrical dysfunction in the brain," Moshak said. "The computer has to reboot. Sometimes it reboots and gives you an error message. It's not ready, and it's got to reboot again.

"So you sit until you have no signs and symptoms. We have a very strict concussion protocol."

Part of that protocol requires establishing a baseline performance. An athlete is tested for agility, coordination and balance for a physical baseline. For a mental measurement a paper-and-pencil quiz is administered to test recall and memory. For example, a series of numbers is recited aloud, and the athlete must write them down in the sequence they were stated.

The third component of the baseline is acquired through a computer program called "ImPACT," information about which can be found at Concussion Management.

"We have almost a computer game that they play to see what their baseline is pre-concussion," Moshak said. "We test everybody at the beginning of the year – paper and pencil, balancing and this computer program."

If an athlete suffers a head injury, she must complete all those tests and achieve the baseline level before being allowed to play. She also must pass a cardio test without return of symptoms. If an athlete fails at any point in the series of tests, she goes back to the beginning. Moshak administers all of the tests and records the results.

The final step is a physical examination by Morgan, who is the only one who can release the athlete.

Gray is the latest Lady Vol going through the protocol to return to the court.

In Gray's case she banged heads with Alberta Auguste as both pursued a loose ball that landed between them during Thursday's practice session. Auguste was OK. Gray ended up on the floor.

"Sometimes it depends on the position of the head, where the blow is, where the brain is sitting, whether there's a rotational force," Moshak said. "There are all these factors involved, which is why one person gets up and walks away and the other stays down. It could be who saw and braced for it."

The healing process for a brain requires rest and that means limiting reading and television and avoiding video games and fluorescent light when possible. A professional athlete can more readily do so, but a student-athlete has to go to class.

"Studying may slow her down from getting back on the court," Moshak said, but in college the student has to continue to function. "I can't tell her not to go to class."

Given the trauma of knee injuries that Tennessee has dealt with over the years, Summitt sees concussions as overall lesser blows to the team. That has been apparent this season as three of the four players who sustained them have returned, and a fourth has been out for less than a week so far.

"I'd rather it be a concussion than a knee," Summitt said. "We're talking weeks, not months."

It is also rare for concussions to end an athlete's season.

"Concussions aren't, hopefully, season-ending," Moshak said. "They notoriously shouldn't be. And the problem with a concussion that a coach has to realize – and Pat is very good about this – there's no way to guess. There is no way to tell. It could take a day. It could take a month. It could take a year."


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