Will Carroll’s Med Check

3 Nov

If you don’t follow Will you really should.  He runs a weekly Med Check on injuries in the NFL, he often utilizes this blog for information regarding concussions.  Will has been all over the concussion issue, not just recently, rather for as long as I have known him.  I appreciate his dedication to sports medicine, athletic trainers (even though his publications say “trainer” he knows and represents the differences), and injuries in general.

In his most recent Med Check he opened up with some very poignant information and editorial;

Mike Florio of NBC has offered both reasonable coverage and interesting suggestions, but inside the game, there’s been quite a bit of pushback. Instead of using their bully pulpit to rally for change to how we treat injuries, ex-players like Merrill Hoge and Mike Golic are against any changes. They go to “back in my day” stories, calling players that come out of games “quitters.” That Hoge, a player who had his career ended early due to concussions, takes this position is amazing. Hoge was cleared to play just five days after a severe concussion and when he suffered another, he ended up being resuscitated on the way to the hospital. He never played again. Would those things have happened under current rules? Probably not, but Hoge isn’t willing to work to make sure that someone doesn’t go through what cost him so much (or brought him so much in the suit against the doctor that cleared him.) Perhaps the self-reflection or irony part of his brain is what was damaged. What’s clear is that these kinds of views are damaging the game itself, pushing it closer to that line where it cannot police itself and will be viewed, as Malcolm Gladwell suggested, as human dogfighting by some. It doesn’t have to be this way and it’s time for some ex-players — I’m looking at you, Troy Aikman — to step up.

Thanks Will!!!  You can follow him @injuryexpert on Twitter.

7 Responses to “Will Carroll’s Med Check”

  1. webgal November 3, 2011 at 21:59 #

    Is that a testosterone thing? Is it a sort of “I had to go through this and now they have to” attitude. It does seem odd that a brain injury would not inspire a player to step up and speak up to protect present and future players. I have friends who played in college and are now bodies full of bolts from all the surgeries they’ve had. It’s entertainment but it’s not entertainment if everyone can’t play a whole season without a season-ending injury.

  2. Don Brady, PhD, PsyD, NCSP, Licensed Psychologist November 4, 2011 at 02:11 #

    Perhaps these observations are reflecting the onset of a new ‘public relations’ trend of minimizing concussions by former NFL players…time will tell?

    I recall earlier this football season hearing another sport media journalist and former NFL player also downplay the effects of concussions.

    Re M. Hoge…it is my understanding that his successful concussion-related lawsuit resulted in a settlement of over $1,000,000

    • Joe Bloggs November 4, 2011 at 09:30 #

      If you saw the assualt on CTE yesterday by the NHL led by Rueben Echymendia and Ketcher, you can safely assume the guns are out. Of course, the leagues wish to minimize the problem since they are being sued and it threatens the long-term viability of the professional game. It is in the leagues interest not to let hockey or football turn into boxing.

      First, the criticism was justified because Chris Nowinski speaks of things he does not know so professional sports mouth pieces lit him up. Suffice to say, Ketchmer arguments were well reasoned. Most people have plaques and tangles. Tau and Abeta 42 deposits are likely evidence of some sort of brain malfunction that in many cases to not reach a threshold to produce problems in everyday life.

      It stands to reason that NFL and NHL will focus on the scientific issues surronding the small n size, lack of power and lack of effect size as well as sampling issues in CTE research to distract from whether sub-concussive and concussive injuries have long-term effects in professional athletes.

      What the NFL and NHL refuse to do proper research. Screen the entire universe of current and retired players for psychiatric and cognitive deficits (throw in general health) to see if their is an association with player professional collision sports and statistical significant clinical manifestation of illnesses one would not expect in the the general population. The CDC mortality study of the 90s and UMich study 2009 point to serious issues that to date have not been properly researched or addressed. It would imply professional collision sports are bad for addiction, mental health, brain health, cardiac health and orthopedic health. With data, these issues could be addressed at the professional level and inferences drawn for the college and youth levels.

      Spin and reliance on outdtaed shillobeths are not going to get us anywhere expect on a path to boxing.

  3. Don Brady, PhD, PsyD, NCSP, Licensed Psychologist November 5, 2011 at 10:33 #

    Some thoughts re the “small” n, etc. comment along with excerpts from my 2004 Dissertation re NFL Players’ Knowledge of Concussions

    1- McClelland (1996): the absence of evidence is not evidence of absence.

    2- Clinical significance has value as does statistical significance.

    The use of both quantitative and qualitative research is encouraged to assist in assessing the long term effects of concussions.

    3- Objectivity of science

    “The notions of science neither being truly objective nor value free have also been enunciated by Patton (1990). Although objectivity has been viewed by many as the cornerstone of scientific investigation, Patton (1990) emphasized the absurdity of the objective versus subjective debate among philosophers and experimentally-based researchers when he clearly and succinctly pointed out
    the ideals of absolute objectivity and value-free science are impossible to obtain in practice and are often of questionable desirability in the first place because they ignore the intrinsically social nature and human purposes of research. Subjectivity…has such negative connotations in the public mind that to openly advocate the value of subjective insight into a research is to undermine the credibility of one’s work (p. 55).
    Patton (1990) urged the avoidance of these constructs in order to bypass useless debates, while at the same time advocating for the investigator to commit to “comprehending the world as it is while simultaneously utilizing credible research strategies which are balanced in reporting both confirming and disconfirming evidence” (p. 55). He emphasized as well the importance of the investigator maintaining a neutral position, and strongly cautioned and reminded the reader that: (a) instrumentation designed by humans is subject to inherent biases of the researcher; and (b) no single research methodology adequately explains away differing causal variables.
    .

    4- Further Implications and Suggestions for Future Research

    The atypically high response rate for active and retired NFL players is noteworthy, and suggests this topic is of significant interest to current and former players

    Furthermore, additional and expanded studies pertaining to the NFL players’ knowledge of, and personal experiences with, concussions are highly encouraged. As prior traumatic brain injury has been linked to Parkinson’s and Alzheimer disease (Fleminger, S., Oliver, D., Lovestone, S., Rabe-Hesketh, S., & Giora, A., 2003; Jordan, 1998), longitudinal studies of NFL players are encouraged to investigate closely this possibility. Future research that utilizes various qualitative methods of data collection (Patton, 1990) with the football players who have sustained concussions is also advocated

    • Joe Bloggs November 5, 2011 at 12:43 #

      My point is/was anecdotally and inferentially that collision sports seem to have long-term consquences. Let’s prove it and stop going around in circles. Some of the issues both mechanically and medically could be dealt with through the availability of non-biased data from well designed studies. We lack consistent rigerous science to form objective decisions.

      Don is your disertation posted. I would be interested in reading it.

      • Don Brady, PhD, PsyD, Licensed Psychologist November 9, 2011 at 00:30 #

        Joe,

        Appreciate your interest.

        My 2004 Dissertation research re Active and Retired NFL Players’ knowledge of concussions is not posted.

        Please watch for an email from Dustin for further info pertaining to your request.

  4. Don Brady, PhD, PsyD, NCSP, Licensed Psychologist November 6, 2011 at 00:23 #

    Joe,

    1- I think long term consequences have been ‘proven’. See my below Dissertation excerpt below my response to you.

    Furthermore and from my perspective, it unfortunately appears that some sport-related persons are playing the science game…their science is ‘good science’ while those who disagree have ‘bad science’. And sometimes the ‘good science’ changes its beliefs…as the foundation of some ‘good science’ is as solid as smoke.

    For example, there have been over 25 RTP guideliness, and they have been criticised for lacking a scientific foundation…
    So why should we accept any present guidelines…that lack a scientific basis?
    Are you aware of the basis of the 15 minute sit-out rule in an recent RTP guideline ?

    Due to a history of conflicts of interests (COIs) emerging within concussion policy making, I am cautious about accepting expert panel perspectives that don’t support their findings with unbiased and quality research.

    I was fortunate to have an M.D. mentor who shared the following advice re expert panels:

    A parallel concern pertaining to COIs being exhibited by members of expert panels and blue ribbon committees was recently voiced by a clinical professor of medicine at the SUNY Upstate Medical University Hospital located in Syracuse, NY. Anton Joachimpillai (2004) stated that:
    from his clinical perspective derived from almost 50 years of practicing medicine, expert panels and blue ribbon committee findings should be both cautiously accepted and
    critically reviewed as he has frequently found that committee members promulgate self-
    serving, and thus biased interests (personal communication, March 9, 2004).

    ===========================================================================
    Dissertation excerpt: NFL Players’ Knowledge of Concussions

    Chapter Five

    Discussion, Conclusions, and Recommendations
    The preponderance of credible experimental and clinical evidence pertaining to the adverse effects of concussion indicates that the brain is injured as the result of a concussion. The adverse and destructive consequences of a concussion may follow a continuum from subtle to grossly overt. Altered cell functioning and cell death along with subtle to more visible neurological, neurocognitive, psychological, and other medical problems reflect a diverse range of lifelong negative consequences of a concussion. Symptomatic concussions may also create a fertile environment for the Second Impact Syndrome and possible death of the concussed athlete.
    Since a concussion results in brain injury, the term functional recovery–rather than recovery–should be employed when discussing an athlete’s “recovery” from a concussion. The term recovery implies full recovery of the brain from the sustained injury with no residual effects. Functional recovery implies partial and sufficient recovery of the brain to resume various daily life activities. Gronwall (1991) pointed out that typical postconcussion test scores should not be viewed as a return to a typical and pre-concussion level of functioning. It is possible that the concussed person expended an unusually higher amount of energy to achieve these scores. Furthermore, the cumulative effect of concussions supports inferential conclusions that the brain sustains further permanent injury when multiple concussions occur. That there have been numerous professional athletes who sustained multiple and, eventually, premature career-ending concussions, provides further support and clinical evidence for the adverse cumulative effect of concussions.

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