Archive | January, 2012

Good Reminder About Rest

31 Jan

Although most point to physical rest as the major component of concussion management the truth of the matter is that all activity that affects brain activity needs to be limited after a concussion.  If we use the “snow globe” analogy; all the flakes in the globe must come to rest before exposing it to further activity.  What excites the “flakes” or brain, honestly, just waking up does this.  That is why I have been hammering on the need for COMPLETE rest after a concussive episode.  It is also why I am a firm believer in getting kids out of school while the brain injury heals.

This information is not new to you that read the blog, but it seems that this management technique is just catching on as a principal protocol, rather than using it if there are setbacks; Continue reading

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Show Critiques (CNN and ESPN)

30 Jan

Yesterday there were two important shows that aired.  One on ESPN, the Outside the Lines presentation on helmets and the other was a documentary by CNN and Dr. Sanjay Gupta.

CNN and Dr. Sanjay Gupta presented an hour-long look into the concussion issue, mainly at the high school level.  Although the main press is with the professionals, the time spent at the high school was a HUGE KEY to making this documentary a success.  Like we have been posting on this blog for the past 18+ months the real issue with concussions begin at or earlier than high school.  This is not only because there are obviously more participants at the HS level, but it is also where kids are learning and learning how to learn.  In short the high school level is where the brain is functioning the hardest.

The presentation was excellent, it not only provided the current (subjectivity) but exploding (CTE) issues in the concussion discussion, but exposed a real solution to the issue. Continue reading

ESPN OTL on Helmets

28 Jan

Also on Sunday, at 9 am EST, Outside the Lines will have a show dedicated to helmets, in particular Riddell.  Although interviewed (not on camera)  for the story my opinions did not make the final cut.  Here is a preview;

Here is a quick written excerpt;

The recent concussion lawsuits by NFL players are once again raising questions about head trauma and helmet safety in professional football. In the eye of the storm is the League’s official helmet-maker, Riddell, who is also being sued and has come under fire from members of Congress for allegedly making deceptive marketing claims regarding helmet protection. Sunday on Outside the Lines, ESPN The Magazine’s senior writer Peter Keating takes a closer look at the safety claims surrounding helmets.

NHL Concussion Report All-Star Break 2012

27 Jan

Each week we (TCB & @nhlconcussions)scour the web to find concussions in the National Hockey League.  We will keep a running tally on that information as the season progresses.  However, it is not easy as the NHL has decided that listing injuries as “upper body” or “undisclosed” is a good indicator of actual injuries occurred.  Our list is believed to be as accurate as possible, even including injuries that have vague listings but through reports and video analysis should be classified as concussions.  We will also be using “Fink’s Rule” to include concussions in the listing.

We last updated you early this month after a very arduous month of December.  Due to the sheer volume and player effected by concussions the All-Star Game will be without many of its “Stars” this year.  I would like to preface this by saying that a lot of the new numbers can be attributed to the better awareness and perhaps the players themselves taking this injury more serious.

That being said we noted via Twitter that last year at this time there were 54 concussions reported/found in the NHL, it is an understatement to say there has been an increase, ROUGHLY A 60% INCREASE.  Hits like this one on Jochen Hecht, are very innocent looking at first glance, but these are the occurring, in my opinion these are more common due to the cumulative effect of subconcussive hits; Continue reading

Follow Up Story On Gupta Show

27 Jan

CNN presented an article today to outline the upcoming show on Sunday;

“You expect a pristine brain. I saw a brain that was riddled with tau proteins. I was stunned at how similar that brain was to the boxers who lived into their 70s,” she said. Tau proteins are the same type of proteins found in brains of Alzheimer’s patients.

We have also highlighted the tragic story of Nathan Stiles here.  Remember to set you DVR if you are looking for more insight into this issue. (Thanks MS for the email).

Sanjay Gupta Special Sunday

26 Jan

Dr. Sanjay Gupta, a practicing neurosurgeon and most well-known for his reporting on CNN will be hosting a one hour special on concussions this Sunday at 8pm EST;

Gupta’s special notes that for years, the impact of concussions was more anecdotal. Now there is greater  understanding how dangerous concussions can be for a high school player, whose brain is still developing, to get hit again before a concussion had healed.

Gupta talks to A.J. Flores, one of Waller’s teammates, who had six concussions before he was forced to quit the sport. He suffered from mild traumatic brain injury, which included headaches and emotional irritability.

Coy Wire, a former linebacker for the Atlanta Falcons until 2010, watched the special at Midtown Art Cinema. During a post-screening panel, he said as he learned more about the impact of concussions, he has become more nervous about his post-football future.

Dr. Gupta held a pre-screening recently in Atlanta on Tuesday, here is the write-up/preview.  Set your DVR’s or plan on some time in front of the TV, it will be interesting to see his take on the issue.

Coexistence of Concussion and Football: Parts VII and VIII

26 Jan

I have been asked to write about concussions from time to time.  I attempted a chapter on concussions for a book at some point, over the next few weeks I will post this chapter, as I wrote it, no matter how horrible it is.  After all I am not an author, but at least you can take a look.  This particular chapter deals with concussions in the sport of football.  We all should know this injury can be sustained in any sport.  Because football is the biggest draw of sporting eyes I felt it was best to present it in this way. (Part I, Part II & III, Part IV, Part V & VI) *All sources will be posted after last portion is up.

Helmets and Protective Gear

Gladiators used them to protect against fatal blows on the floor of the Coliseum and in battle, today helmets are used for the same purpose in the military and on the football field.  Helmets were not even mandated in the sport until a rash of skull fractures caused such alarm that President Theodore Roosevelt demanded changes to the game.  This eventually created the National Collegiate Athletic Association (NCAA), and mandates for helmets, which in turn reduced injuries by 31%[i].

One of the biggest myths about helmets and protective gear is that it will prevent concussions, wrong.  It will prevent what they were intended for, skull fractures and nothing more, the helmet sanctioning body; The National Operating Committee on Standards for Athletic Equipment (NOCSAE) makes sure of that with testing.  In fact you cannot play the game of football unless your helmet displays a NOCSAE sticker.  NOCSAE even states in a press release on February 4, 2011 that every player, parent, coach and anyone involved in the sport of football should know that helmets WILL NOT prevent concussions[ii].

Another piece of equipment has staked a claim into reduction and even prevention of concussion, mouth orthotics, which is also false due to the lack of current research and non-disputed journal article, backed by the Zurich statement[iii].  If you don’t believe the statement about mouth orthotics, take a quick look at boxing or MMA, they all wear mouth gear and they continually get knocked out or staggered (signs of concussion) during fights.

There is a simple reason as to why this is, physics.  As we have discussed you do not have to be hit in the head to develop a concussive episode, it only takes unnatural Continue reading

Computer Concussion Testing Issues

26 Jan

Thanks to an alert reader an article was sent to the inbox dealing with neuropsychological testing, specifically the ImPACT test.  The author of the article published on Slate, Christine Aschwanden, provides a very well written reason as to why some are starting to take a much harder look on these types of tests;

On closer inspection, though, the whole thing begins to fall apart. “It’s a huge scam,” says physician Robert Sallis, past president of the American College of Sports Medicine. “They’ve done incredible marketing, and they’ve managed to establish this test as the standard of care with no evidence that it has any benefit.”

Dr. Sallis is not the only one, in fact we receive numerous questions about all the NP tests, and recently we have seen more and more research regarding the downfalls of this type of testing.  Research like this one (sourced in the article) written by physical therapists and a physician are being done by independent parties and seem to reveal there is a problem.  According to one of the developers of ImPACT some of the information is not viable if only because of the particular journal it appeared in; Continue reading

This Trickles Down

24 Jan

Comments like these trickle down to the lower levels, either because the youth look up to players or their comments make ‘sense’ to them as football players;

“If I have a concussion these days, I’m going to say something happened to my toe or knee just to get my bearings for a few plays,” he told HBO’s Andrea Kremer during an interview for Real Sports. “I’m not going to sit in there and say I got a concussion, I can’t go in there the rest of the game.”

The above is attributed to all-pro linebacker Brian Urlacher and may be a popular/majority sentiment within the NFL locker room.  Brace yourself for the upcoming rant…

As professional athletes and adults I don’t think that players are exactly wrong in having these feelings, heck it is their job.  Given all the information about the lasting effects of all injuries and concussions players assume the risk.  That being said if they choose to abide by such comments these players should not be filing law suits after the fact.

The real issue is that comments like Urlacher’s Continue reading

Not the First Time… Won’t be the Last

24 Jan

It was only a matter of time before this type of information was brought to the surface.  Players targeting other players because of concussions.  Heck this happens all the time with other injuries; on a Friday night somewhere, nearly every state you will find a player who comments to another to target another players ankle because it is wrapped.

This is a “gladiator sport” and one that almost cherishes such behavior; all part of the game.  Yesterday it came to light that some of the New York Giants were specifically targeting the tragic figure of the 49ers, Kyle Williams, due to his history of concussions;

After the game, reporters crowded around the locker of Jacquian Williams, who’d forced the second fumble, hoping for an angle: Had the Giants noticed something about Kyle Williams’s technique, some weakness in the 49ers punt-return scheme? “Nah,” Williams said. “The thing is, we knew he had four concussions, so that was our biggest thing, was to take him outta the game.”

Devin Thomas, the reserve wide receiver Continue reading

Colorado’s “Jake Snakenberg Act”

23 Jan

The concussion legislation in Colorado went into full effect recently and in this case, a seven year-old, it has paid dividends;

“Two concussions and a scar right here,” said Dylan, pointing to his forehead.

Dylan suffered his first concussion playing football this past summer. He says he suffered another concussion when he ran into the dishwasher at his home.

“I was chasing my brother,” said Dylan.

His mother, Alex Hearn, admits she didn’t understand the full implications of concussions till it happened to her son.

“I think people don’t take it as seriously as they probably need to,” said Alex Hearn.

The new measures Continue reading

What In The What?

21 Jan

So I was reading a Houston Chronicle article sent to us titled “Youth football less dangerous than thought” and came away really confused and to be honest questioning not only the agenda of the article but those interviewed, including two doctors, one high-profile doctor in Houston.

The first quote from Dr. Gary Bock that makes me scratch my head:

“We see more catastrophic injuries among cheerleaders than among any group of athletes,” Brock said. “The risk per hour of activity is seven times greater than with other participatory sports. It cracks me up when parents tell me they won’t let their sons play football but then push their daughters into cheerleading.”

This information would fly in the face of any significant injury tracking that has been done, especially the injury surveillance done by R. Dawn Comstock and her peers (2010-11 Original Summary Report).  The work done by this group is for high school athletes, the only data set we have for athletes that young.  Any other data set for “youth” Continue reading

Another Lawsuit

20 Jan

I received this press release from the law firm representing the newest of the former NFL players filing suit for damages for long-term problems associated with concussions (commentary follows);

Locks Law Firm Files Class Action Suit Against NFL Regarding Head Injuries

and Concussions on behalf of Former Players

Includes Three Former Philadelphia Eagles: Ron Solt, Joe Panos and Rich Miano

Philadelphia – Jan. 19, 2012 – Locks Law Firm attorneys Gene Locks, Michael  Leh, and David  Langfitt filed a class action lawsuit yesterday in Philadelphia against the NFL on behalf of all former NFL players, including seven named  players and four spouses, all of whom are the class representatives. The named players include former Philadelphia Eagles Ron Solt, Joe Panos, and Rich Miano. The suit charges that the NFL and other defendants intentionally and fraudulently misrepresented and/or concealed medical evidence about the short- and long-term risks regarding repetitive traumatic brain injury and concussions and failed to warn players that they risked permanent brain damage if they returned to play too soon after sustaining a concussion.

Ron Solt, age 50, Continue reading

Action Sports an Issue Too

19 Jan

With the Winter X Games upon us, it is a good time to highlight that action sports, mostly unsupervised, are a concussion issue.  A faithful reader and father of a very good athlete summed it up this way;

The major scary part is millions of kids are out there, and ignoring the head slams and concussions because that is what is cool to do in action sports. Videos like this simply tell them to get back up…while in football the changes being made will hopefully make it OK to wait to return to play.

This father is exactly right, Continue reading

Mailbag Open

18 Jan

With the NFL season winding down it has become evident with multiple searches on the internet that the concussion issue is also slowing down.  It would be rather non-existent (circa 2009) if it were not for the NHL.  Because of this there will be more posts in the future dealing with not only hockey but other parts of this issue.

One of our favorite thing is to receive mail and answer questions.  Many times you see them in the comment section but if you would like to contribute or ask questions feel free.  We will keep all information anonymous; your question could be important for someone else as well.  We have done it before, with great success, and if I cannot get a thorough answer we have many resources/people we can bounce the question/comment off of.

If you have questions email them to us!

Video Wednesday

18 Jan

Here are some videos to occupy you on a cold winter day:

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The root of the problem in hockey: lack of respect. Continue reading

Tuesday Quick Hits (UPDATED)

17 Jan

Bending the rules for a star is not uncommon, heck we see it almost every week in the NFL as players are initially reported to have “dirt in the eye”, or “back spasms”, etc.  However it is rare that you see an overt “relaxing” of rules to possibly allow them to play.  It has happened in the UK in Premiere League Soccer, the team is Arsenal Manchester United and the player is Rio Ferdinand (bold my emphasis);

Ferdinand claimed on Twitter that he ‘could not remember’ what happened during United’s 3-0 victory over Bolton at Old Trafford on Saturday.

He also admitted  he had suffered concussion, which under previous FA rules meant he would automatically miss the next 10 days.

But the FA have relaxed the guidelines and Ferdinand, 33, will now be put through a thorough medical examination.

Thanks to twitter both @SportsDocSkye and @SportsDoc_Chris find that the article as I have presented it and was reported in the link is inaccurate.  I appreciate them following and correcting this issue (also my stupidity when it comes to European Futbol).  The issue that needs correcting is that the current FA concussion guidelines follow the Zurich statement and a player will follow graduated return to play, meaning the 10 day issue is moot…

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I was reading an editorial in the Star Tribune about how the concussion laws could be a detriment to coaches and teams, when I came across some good Continue reading

Quiet Weekend

16 Jan

Other than some good football games and the occasional college basketball game the weekend was pretty quiet in terms of concussions.  There were a few players that were taken out of games for quick checks; subsequently only three were listed as concussions:

All three were easy to see on the field plus another in my opinion; Jimmy Graham had a two separate incidents of slamming his head against the turf in San Francisco and not “being himself”, it was OK because we found out later that it as just “back spasms” (see sarcasm).

As the football season winds down we will be focusing on NHL and NBA concussions, the former being a hot issue the later just getting the first concussion of the season: Continue reading

Good Idea, but Take Care of Own First

13 Jan

I get why its being done.  In fact I agree with the principle behind the letters to the states, however it is tough to ask for someone to do something that you yourself have a difficult time doing/policing.  The NFL and NCAA sent out letters to 19 Governors asking them to consider concussion legislation (via USAToday);

NFL Commissioner Roger Goodell and NCAA President Mark Emmert are urging 19 governors to support legislation this year aimed at cutting down on concussions in youth football.

Goodell and Emmert sent letters Thursday to governors of states — such as Florida, Ohio and Wisconsin — they said do not have something akin to Washington state’s “Zackery Lystedt Law,” named for a middle school football player who sustained brain damage after he got a concussion and returned to play.

Although both the NFL and NCAA have outlined “guidelines” and mechanisms for concussions themselves, they do have a hard time enforcing them.  A quick glance at just this blog unearths some serious issues: Kris Dielman, Mike Vick, Huffgate, and Bonnergate just to highlight a few.  Just think how difficult that is for an entire state with more than one level and one sport to worry about.  The NCAA should be able to help, but even there they are “recommendations/guidelines”, there are no teeth to the rules.

Legislation is good, but only good for one reason in my opinion: awareness.  That is it, because there are ways to skirt the Continue reading

More Mythbusting

12 Jan

Appearing in Patch.com’s RoyalOakPatch, Dr. Neal Alpiner of the Beaumont Children’s Hospital debunked six common myths about adolescent concussions;

Myth No. 1: Most athletes know when they’ve experienced a concussion.
Not so, said Alpiner.

“That ‘wow’ moment is rare,” he said. “It’s really important that teammates, trainers, coaches and parents understand the seriousness of concussions. This includes the symptoms and the need for timely medical treatment. Athletes may not recognize changes in their own behavior and thinking.”

Myth No. 2: Concussions are always a result of high impact.

Myth No. 3: If a young athlete doesn’t lose consciousness, he did not suffer a concussion.

Myth No. 4: Boys are at greater risk than girls for concussions. Continue reading

Coexistence of Concussion and Football: Part V and VI

12 Jan

I have been asked to write about concussions from time to time.  I attempted a chapter on concussions for a book at some point, over the next few weeks I will post this chapter, as I wrote it, no matter how horrible it is.  After all I am not an author, but at least you can take a look.  This particular chapter deals with concussions in the sport of football.  We all should know this injury can be sustained in any sport.  Because football is the biggest draw of sporting eyes I felt it was best to present it in this way. (Part I, Part II & III, Part IV) *All sources will be posted after last portion is up.

Classification of Concussions

Often we hear of “minor” injuries or sometimes they are referred to in degrees; 1st, 2nd, 3rd to give a sense of how bad it is or prognosis of recovery.  These classifications not only serve to give the audience a perspective, but they are also necessary for the medical diagnosis and rehabilitation.  Over years and years of injury surveillance, record keeping, surgeries, and rehabilitation on injuries of joints and muscles we can clearly define orthopedic injuries with these connotations.  Concussion, not so much.

Concussions initially began with a similar “grading” of severity authored by Robert Cantu, MD in 1986[i] adopted by the American College of Sports Medicine and further defined by various other organizations; Colorado Medical Society Guidelines – 1991[ii] (adopted by the NCAA), American Academy of Neurology – 1997[iii].  The issue as time went on was there was not a consensus of which grading system was the appropriate practice of care, the problem existed until three years ago when most health care providers began to accept and conform to The 3rd International Conference on concussion in sport, held in Zurich, Switzerland[iv].  The key word being “most” as this information, widely accepted and worked on by the leaders in this issue, has not been seen or adhered to by physicians.

The consensus statement[v] was built upon the two previous meetings in Vienna (2001) and Prague (2004) as the exclusive panel began the process of trying to obtain a common ground on the concussion epidemic.  The take home message from this in terms of classification is that a concussion is a concussion.  Due to the varying factors and injury evolution differing from individual to individual the experts determined that “mild”, “moderate”, “severe”, “simpe”, and “complex” should not be used to diagnose or classify the actual injury.  To this day doctors, players, athletic trainers continue to use those terms when describing the injury, which is improper.

There is nothing mild or simple about a concussion, this injury is a significant insult to the brain and its function; therefore a concussion is a concussion.

Those qualifying tags could be used to Continue reading

Grantland Article – Jonah Lehrer

10 Jan

I tweeted about it and want to put a link here on the site for those looking for information.  This article by Jonah Lehrer does a wonderful job of not only explaining the concussive injury but also explaining why there may be an issue going forward with the sport of football.  Here is an excerpt;

But we do know what happens once it’s broken. In the milliseconds after a concussion, there is a sudden release of neurotransmitters as billions of brain cells turn themselves on at the exact same time. This frenzy of activity leads to a surge of electricity, an unleashing of the charged ions contained within neurons. It’s as if the brain is pouring out its power.

The worst part of the concussion, however, is what happens next, as all those cells frantically work to regain their equilibrium. This process takes time, although how long is impossible to predict: sometimes hours, sometimes weeks, sometimes never. (The latest guidelines suggest that most concussed subjects require at least 10 days to recover, with adolescents generally needing a few days more.) While the brain is restoring itself, people suffer from a long list of side effects, which are intended to keep them from thinking too hard. Bright lights are painful; memory is fragile and full of holes; focus is impossible.

The healing also has to be uninterrupted. In the aftermath of a traumatic brain injury, the brain remains extremely fragile. Because neurons are still starved for energy, even a minor “secondary impact” can unleash a devastating molecular cascade. All of a sudden, brain cells that seemed to be regaining their balance begin committing suicide. The end result is a massive loss of neurons. Nobody knows why this loss happens. But the loss is permanent.

Teenagers are especially susceptible to these mass cellular suicides. This is largely because their brains are still developing, which means that even a slight loss of cells can alter the trajectory of brain growth. Football concussions are also most likely to affect the parts of the brain, such as the frontal lobes, that are undergoing the most intense development. (The frontal lobes are responsible for many higher cognitive functions, such as self-control and abstract reasoning. The immaturity of these areas helps explain the immaturity of teenagers.)

We have stated over and over here Continue reading

Tuesday Quick Hits

10 Jan

We have been offering suggestions to the NHL on how to change the game for the past few weeks (see here and here), as you go through the searches more and more people are doing the same, especially up north.  The Globe and Mail with author David Shoalts proposed most of the same information we had;

  • Culture change (respect)
  • Equipments
  • Treatment
    • “The NHL should tap into the long list of reputable concussion experts willing to help and develop a sensible plan for treating concussions. Then it should get the National Hockey League Players’ Association to join it in strongly encouraging the players to follow it.”
  • Rule changes (see outlawing all head contact)
  • Game changes (see speed)
  • Fighting

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2011 Concussion Report – End of Regular Season

10 Jan

The Concussion Blog Original, NFL Concussion Report, is a weekly compiling of the reported head injuries in the National Football League.  Concussions are added to the list each week from multiple sources to give you the reader a picture of what is happening on the field.  Each week we will bring you the information along with relevant statistics.  If we have missed a concussion or put one on here erroneously, let us know (we will also be using Fink’s Rule to classify a concussion/head injury).

The 2011 NFL season had a lot of different story lines; from Tebow to Green Bay’s run to San Francisco coming from nowhere.  However the biggest story, as far as we are concerned, was the concussion issue.  Looking back at last year we posted our final numbers for 2010 and some thoughts going forward.

Of the suggestions proposed in the wrap-up last year the only issue addressed (kind of) was the awareness component.  This is actually not measurable, however with the increase in the number of concussions this year I would confidently say that it was better.  As for Continue reading

New Schutt Helmet: Vengeance (Rev.)

9 Jan

As I eluded alluded to on Twitter the rumors are true, the Illinois helmet maker Schutt has released a new helmet.  The company is very excited about its newest entry in the football helmet world.  Below is the final version of the, revised 1/11/12 press release;

San Antonio, Texas – Monday, January 9, 2012 – NFL and college-level football players will soon have the opportunity to face their foes head-on with Vengeance – the newest and most technologically-advanced helmet released by Schutt Sports. Schutt announced it will debut the helmet, which includes four new impact-absorbing features, for the first time at the American Football Association Conference (AFCA) this Sunday, Jan. 8. Continue reading

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