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Ohio House Bill 143 could end boxing, karate matches for many

I am a professor of neurology and a certified athletic trainer. I’m involved in the concussion and mild traumatic brain injury program for the athletes in the University of Cincinnati. While I am not a spokesperson for the University in any way, I do have an opinion on the diagnosis and management of athletes with […]

I am a professor of neurology and a certified athletic trainer. I’m involved in the concussion and mild traumatic brain injury program for the athletes in the University of Cincinnati. While I am not a spokesperson for the University in any way, I do have an opinion on the diagnosis and management of athletes with head injury. Recently a law in Ohio is being considered for adoption that concerns athletes and how to manage traumatic brain injury.

A draft of the bill can be found here.

I am very concerned that as written the bill will be very bad for certain types of sports and take out of the athletic trainer their/our ability to engage in best medical care and clinical judgments. These concerns have been conveyed to the sponsoring congressperson in the state.

Below is a redacted summary of the dialogue between myself and the representative’s office as well as a physician who was involved in the bill.


Dear Honorable O’Brian,
Concerning the above referenced pending legislation, I have great concerns that it does not take into consideration the broader athletic community. I am a professor of neurology, expert on bleeding in the brain and a certified athletic trainer.
With this background I believe the legislation will end all boxing, karate, MMA and UFC competitions.
For example, as a 3rd degree blackbelt I teach martial arts and monitor sparring matches. If a person is knocked down, I as an athletic trainer will “suspect” a head injury. As I read the legislation, I will need to end the competition. That is not tenable on many levels. I have other examples, but the vague language will have devastating effects on the sports med community and based on my 15 years of study on head injury it does not address the issues of brain trauma adequately. Please recall I educate trainers on many issues of head injury and concussion, so I am passionate about helping athletes, families and trainers, but your bill will not help them.
Respectfully submitted
Joseph F. Clark
Professor of Neurology
University of Cincinnati


Subject: RE: Legislation on Concussion Education

Mr. Clark:

Representatives O’Brien and Stinziano asked that I follow up with your email.

While we understand your concerns with difficulty our legislation could impose upon those young athletes who suffer injuries typically sustained while competing in martial arts/physical contact activities, this  legislation is designed to bring a level of congruence to how Ohio addresses brain injuries.

House Bill 143 respectfully adopts current OHSAA regulation, including an educational component, to ensure parents, coaches, and young athletes are aware of the signs and dangers of potential and diagnosed concussions. The vague language was purposefully included in the bill to allow athletic trainers and coaches to address a suspected injury at their discretion while keeping the athlete’s well being in mind.

While drafting this legislation, we consulted with several interested parties who ultimately support the current version of HB 143. They are as follows:
=Dr. REDACTED – Medical Director, Sports Concussion Program -Dr. REDACTED-  Director, Spine Research Laboratory, Section Head, Head and Spine Injury Research Center for Spine Health – REDACTED, M.P.H., President Board of Trustees, Brain Injury Association of Ohio

We also were in contact with REDACTED, the  Clinical Research Coordinator III at the Department of Pediatric Rehabilitation for Cincinnati Children’s Hospital Medical Center regarding our legislation as well. I believe it was the topic of conversation at a March 14th town hall meeting of which Rep. Stinziano was present and the group seemed enthusiastic about the bill’s intent.

We respect your opinion on our legislation, however, we feel that HB 143 is still necessary due to the hundreds of compelling personal stories of those ill-affected by undiagnosed or improperly treated head injuries in Ohio and the general overall support of the legislation.

Please feel free to contact me if you have any additional questions or concerns.

Thank you,

Legislative Aide
Representative Sean O’Brien
65th Ohio House District


Subject: FW: Legislation on Concussion Education

Have you looked closely at the wording of the proposed legislation and thought through what it would do to athletic trainers? Please see the email thread below as they claim you were consulted.
I would really appreciate your thoughts on this because I think this legislation will be very harmful to sports in general.

Yours truly,


To: Clark, Joseph (clarkjf)
Subject: RE: Legislation on Concussion Education

Dr. Clark,

It would be helpful to know your specific concerns.  The legislation, as it stands now, allows assessment and clearance by an athletic trainer.  The OATA has been involved at every step, and this legislation has its full support. What concern do you have outside that?
I’m sorry you feel this is harmful legislation.  This has been shown to be beneficial in other states with similar legislation, and it is a great step forward for health of our young athletes.  If you have suggestions for additions to the bill, I’m happy to hear them.

Assistant Professor of Internal Medicine and Pediatrics Medical Director,


Subject: RE: Legislation on Concussion Education

My concerns are lines 23 to 46.

Interscholastic is vague and could imply club sports. So wrestling, boxing clubs, karate teams and clubs etc.
Every time a karate, boxing, MMA etc person is knocked down they may have had a concussion. As it reads now that will end the competition that day for that person. Written clearance for return to competition is not feasible for these activities; see below.

So any time I might want to do a vision test or very brief evaluation during a match, it means I am doing that because I “suspect” a ding might have occurred. That means the athlete is out and even if the evaluation is normal.  A written return is moot because if a person has a “suspected” concussion they must be removed from play. For the above mentioned competitions that means they lose the match. No consideration has been given to one on one sports.

If I were to organize a karate competition I will have to recommend against that coming to Ohio, because as an ATC, I will need to end every match if a person is knocked down in a way where I would want to do an awareness evaluation. The wording of the bill is quite poor on this subject. Let’s take this to a logical extreme, ATCs may now refrain from doing on or near field evaluations because it will mean they “suspected” a concussion. So as I have claimed, the bill will be bad for the athletes.

Who exactly from the OATA has been involved? The person I was referred to in Children’s Hospital I cannot find. I’m in Adult and Pediatric neurology so I’m confused.



Dr. Clark,

I’m not sure you understand the intent or design of the bill.  Yes, it is designed for club sports, specifically.  This group is likely the highest need for concussion education and awareness.

When a person, in any sport, is injured, signs of concussion (headache with mental status change, etc.) must be exhibited for concussion suspicion.  If those are present, the athlete should not go back to sport until evaluated by an AT or physician with experience in concussion management.  Not everyone who gets knocked down shows concussion signs.  A person with signficant concussion training/experience will relatively quickly be able to distinguish this injury from other, non-neurological, issues.

I hope this clarifies some issues for you.  Further, I’ll direct you to the OATA website (, where you can find links to your leadership and ask further questions about the AT perspective.

Assistant Professor of Internal Medicine and Pediatrics


What frustrates me on this subject is that both the people who have communicated with me refer to the bill’s intent, but not the wording. I looked at the wording and have come to a conclusion. As far as I can see, I have no further recourse and have stopped banging my head on this wall. It will be interesting to see what happens in the future.

I do want to say that I redacted the names of private citizens but did not remove the names of elected officials. Other than that, I did not change the words of the communications sent to me.

Dr. Joseph Clark is a professor of neurology at the University of Cincinnati and the author of My Ambulance Education. He writes regularly at

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