Century of School Sports: MHSAA Programs Prioritize Health & Safety
By
Geoff Kimmerly
MHSAA.com senior editor
April 29, 2025
Rank the top 10 conversations anyone would choose to have when it comes to school sports – be it talking up top teams, the latest stars, past champs, etc. – and advances in health & safety probably come in somewhere around No. 27.
But no topic has been or will remain more important to generating and maintaining successful athletic programs at every level of sport – including the high school and junior high/middle school levels administered by the MHSAA.
From the start of organized school athletics in Michigan more than 100 years ago, health and safety have been priorities. Sports safety concerns – especially in football – helped drive the creation of organized sport administration. Longtime policies – like the one ceasing activity for 30 minutes for lightning or thunder – have become part of daily life in athletics. Other measures, like MHSAA-provided insurance coverage to assist families who experience catastrophic injuries in school practices and competitions, aren’t even known by most – but can be life-altering for those who require those benefits.
For most of this century, the MHSAA’s health & safety initiatives have focused on the “4 Hs” coined by retired executive director Jack Roberts – Health Histories, Heads, Heat and Hearts. Those were the drive of much of his work especially over the final decade of his tenure before he retired in 2018 after 32 years.
Current executive director Mark Uyl’s time leading the association has seen the MHSAA begin work in mental health and create a Sports Medicine Advisory Committee (SMAC) during the 2019-20 school year. He also led the MHSAA through its successfully safe return to play amid COVID-19 and the pandemic’s aftermath.
Health and safety information is contained in every preseason coaches meeting, which all coaches (head and assistant) are required to take. The MHSAA also has a strong relationship with the Michigan Athletic Trainer’s Society (MATS), who have a representative serving on every MHSAA sport committee along with the SMAC.
Along the lines of major initiatives, here are highlights:
Histories: Although pre-participation physicals long have been required, the MHSAA took a significant step incorporating student and family history with the introduction of new physical forms in 2011. The current form includes several questions not only about the participant receiving the physical, but also heart-related questions about family members.
Heads: The MHSAA was among the first states to adopt a return-to-play protocol requiring an athlete to be cleared by a doctor, physician’s assistant or nurse practitioner, with that protocol also not allowing the athlete to return to participation until at least the next day after a possible head injury. At the start of the 2015-16 school year, the MHSAA launched the largest state-led sideline testing pilot program for concussions, providing a pair of screening tests so those injuries could be detected during practice and competition. Also since 2015-16, the MHSAA has required member high schools to report all potential head injuries and several details including when they took place (practice or competition) and how long students were treated before returning to activity – another first-of-its-kind initiative nationally. The MHSAA currently works with the University of Michigan Concussion Center to provide the most up-to-date information on the subject.
Heat: Long a megaphone for hydration and other best practices for preventing heat-related illnesses, the MHSAA took a major step with the creation of its “Model Policy for Heat and Humidity” for the 2013-14 school year that designates limits to activities (including a complete stop) based on heat index. While the policy is mandated for MHSAA Tournament activity, several schools have adopted the policy for the regular season as well. The MHSAA continues annually to renew awareness of heat management with its “Heat Ways” preseason guide for fall sports.
Hearts: The MHSAA has focused on providing tools so that as many people as possible are prepared to help during a cardiac event. Beginning with the 2015-16 school year, all varsity head coaches have been required to have CPR certification – and that requirement has been extended to head coaches at all high school and junior/middle school levels, ensuring that at least one person on site for every game and practice is trained in this life-saving technique. The MHSAA also has worked with MI HEARTSafe to in part get more AEDs into schools. Beginning this school year, the MHSAA required schools to build emergency action plans (EAPs) specific to sport and venue. And, as noted above, the preparticipation physical also asks questions about an athlete’s family history of heart health, so medical professionals can identify early situations that may require further investigation.
Mental Health: Annual rules meetings include required training in the be nice. program provided by the Mental Health Foundation of West Michigan. The MHSAA also has worked with Ithaca athletic director Terry Hessbrook to promote his B#4 Foundation and its work in suicide prevention and mental health awareness.
Sports Medicine Advisory Committee: The SMAC, made up of experts from the medical and educational communities, meets twice a year to consider topics and make recommendations relevant to health and safety in school sports.
Insurance: All the way back in 1940-41, the MHSAA became one of the first state associations nationally to provide accident benefit insurance to its constituents. The insurance provided over the years has evolved into a catastrophic claims policy beginning with the 1970-71 school year, and then in 2015-16 to include benefits specific to head injuries. The MHSAA’s insurance policy continues to cover deductibles and co-pays left unpaid by other policies for head injuries resulting during school practices or competitions, and at no cost to either schools or families.
There have been other notable moments over the years. Often, the MHSAA has taken action on health and safety issues before other governing bodies have produced mandates – for example, during the 1999-2000 season, MHSAA ice hockey players were required for the first time to wear neck guards that did not become mandatory nationally until this past winter.
More recently, the MHSAA instituted acclimatization rules specific to football and also limits on the amount of practice contact – to the minute – allowed per week. The MHSAA also has chimed in on air pollution created by wildfires, mosquito-borne eastern equine encephalitis and other situations that could potentially impact school sports, and partners with the United Dairy Industry of Michigan to provide nutrition information and awareness at events and on the MHSAA website.
These aren’t the first subjects that come to mind when fans talk about school sports – and that’s fine. But it’s our job, with school administrators, coaches and officials, to always have them front of mind – and we gladly do so to keep sports as safe as possible for hundreds of thousands of athletes whose achievements remain our favorite topics of conversation as well.
Previous "Century of School Sports" Spotlights
April 23: Patches Signify Registered Officials' Role in MHSAA Story - Read
April 16: Student Advisory Council Gives Voice to Athletes - Read
April 9: State's Storytellers Share Spring Memories - Read
April 2: Sharp Leadership Synonymous with MHSAA Success - Read
March 25: Athletic Directors Indispensable to Mission of School Sports - Read
March 18: 2025 Finals Begin Next Half-Century of Girls Hoops Championships - Read
March 11: Boys Basketball's Best 1st to Earn MHSAA Finals Titles - Read
March 5: Everything We Do Begins with Participation - Read
Feb. 25: Slogans & Logos Remain Unforgettable Parts of MHSAA History - Read
Feb. 19: MHSAA Tickets Continue to Provide Fan-Friendly Value - Read
Feb. 11: We Recognize Those Who Make Our Games Go - Read
Feb. 4: WISL Conference Continues to Inspire Aspiring Leaders - Read
Jan. 28: Michigan's National Impact Begins at NFHS' Start - Read
Jan. 21: Awards Celebrate Well-Rounded Educational Experience - Read
Jan. 14: Predecessors Laid Foundation for MHSAA's Formation - Read
Jan. 9: MHSAA Blazes Trail Into Cyberspace - Read
Dec. 31: State's Storytellers Share Winter Memories - Read
Dec. 17: MHSAA Over Time - Read
Dec. 10: On This Day, December 13, We Will Celebrate - Read
Dec. 3: MHSAA Work Guided by Representative Council - Read
Nov. 26: Finals Provide Future Pros Early Ford Field Glory - Read
Nov. 19: Connection at Heart of Coaches Advancement Program - Read
Nov. 12: Good Sports are Winners Then, Now & Always - Read
Nov. 5: MHSAA's Home Sweet Home - Read
Oct. 29: MHSAA Summits Draw Thousands to Promote Sportsmanship - Read
Oct. 23: Cross Country Finals Among MHSAA's Longest Running - Read
Oct. 15: State's Storytellers Share Fall Memories - Read
Oct. 8: Guided by 4 S's of Educational Athletics - Read
Oct. 1: Michigan Sends 10 to National Hall of Fame - Read
Sept. 25: MHSAA Record Books Filled with 1000s of Achievements - Read
Sept. 18: Why Does the MHSAA Have These Rules? - Read
Sept. 10: Special Medals, Patches to Commemorate Special Year - Read
Sept. 4: Fall to Finish with 50th Football Championships - Read
Aug. 28: Let the Celebration Begin - Read
Women & ACL Injuries: Know Risks, Steps for Prevention
August 10, 2021
Whether you’re a casual jogger or elite athlete, you’re at risk for an injury to your anterior cruciate ligament (ACL). If you’re a woman, you are at even greater risk for these injuries.
But there are steps you can take to prevent them.
“Among athletes, women are more than twice as likely to have an ACL injury than men,” says Nithin Natwa, M.D., a sports medicine specialist and primary care physician at Henry Ford Health System. “Once you have an ACL injury, you are at greater risk for having further soft tissue injuries in the future. That’s why it is important to prevent these injuries and follow your treatment plan if injured.”
What Is An ACL Injury?
An ACL injury is a strain or tear in the ACL, one of the four major ligaments that support the knee so it can flex and bend. The ACL is a strong band of tissue that helps connect your thigh bone (femur) to your shin bone (tibia). “An ACL injury usually occurs without contact when you turn suddenly while running or land off-balance on one leg. These actions overload the knee joint and cause the ACL to be torn,” says Dr. Natwa.
In the United States, 100,000 people have ACL injuries each year. Anyone can experience an ACL injury, though athletes participating in sports like football, basketball, soccer and gymnastics are at highest risk. And summer is a peak time for outdoor sports injuries.
Seek immediate care if you have any of these signs of an ACL injury:
• An audible “pop” in the knee
• Intense knee pain and rapid-onset swelling (within hours)
• Loss of range of motion
• An unstable feeling or locking of your knee
The most common treatment for ACL injuries is surgery followed by physical therapy. After treatment, you can expect to return to normal activities in 6 to 9 months. However, peak athletic performance can take up to two years.
Why Are Women At Higher Risk For ACL Injuries?
According to Dr. Natwa, the differences in athletic training techniques for males versus females have left women at greater risk for ACL injuries. “There has been more emphasis on overall conditioning and mechanics for boys participating in sports compared to girls,” he says.
As a result, women are at greater risk for ACL tears and sprains due to:
• Differences in neuromuscular control: Without conditioning from an early age, women may not have the same ability to land and perform athletic motions that men do. For example, women are at higher risk for an ACL injury after landing from a jump.
• Strength imbalance for muscles that support the knee: Female athletes tend to have more defined quadriceps muscles but weaker hamstrings than men, putting them at greater risk for injury.
According to Dr. Natwa, there are many theories about women’s risk for ACL injury that lack scientific evidence, including:
• Width of the pelvis: Some people have suggested that the wider width of a woman’s pelvis puts more pressure on the knee joint and increases the risk for injury. However, this difference has not been shown to impact a women’s risk for ACL tears or sprains.
• Knee anatomy: The ACL runs through a section of the femur called the intercondylar notch. Women tend to have a narrower notch than men. Regardless of gender, individuals who possess smaller notch dimensions appear to be at greater risk for injury than individuals with larger notches.
• Hormones: Men and women have different hormone levels. But there is currently no concrete evidence that female hormones place women at higher risk for ACL injures.
Steps To Prevent ACL Injuries – Conditioning Early, Often
“The best way to prevent ACL injuries is to begin and maintain regular conditioning exercises at an early age,” Dr. Natwa says. “The more frequently you engage in proper exercises, the lower your risk for injury.”
Consult with a sports medicine specialist, physical therapist or athletic trainer to develop a training routine to prevent ACL and other injuries. Your training program should include exercises that:
• Strengthen the muscles that support your knee: Add strength training to build up your calves, hamstrings and quadriceps muscles. These muscles help stabilize your knee as you move. By strengthening these muscle groups evenly, you can lower your risk for injury.
• Improve overall neuromuscular control: Focus on adding neuromuscular exercises that train your nerves and muscles to react and communicate. For example, you may work on your balance by standing on one leg or sit upright on an exercise ball for short periods of time. And core exercises can strengthen the muscles that support your abdomen and back and help improve your posture as you move. These moves can strengthen your joints and help you learn appropriate balance and technique.
“Exercise really is the best medicine. It can improve your balance and agility as you participate in a sport or prevent injury as you move through your daily activities,” says Dr. Natwa. “Consider adding these exercises to your wellness program.”
Dr. Nithin Natwa is a sports medicine doctor who sees patients at Henry Ford Macomb Health Center in Chesterfield and Henry Ford Macomb Orthopedics and Wound Care in Clinton Township.
Want to learn more? Henry Ford Health System sports medicine experts are treating the whole athlete, in a whole new way. From nutrition to neurology, and from injury prevention to treatment of sports-related conditions, they can give your athlete a unique game plan. To find a sports medicine physician at Henry Ford, visit henryford.com or call 1-800-436-7936.