Month: June 2012

Comments About Wagner/Deadspin Article

Dustin FinkLeave a comment

The comments on this blog have been on point but I was able to find some other very informed comments regarding the information provided in the Deadspin article via Football Outsiders;

by MJK :: Thu, 06/21/2012 – 6:46pm

Interesting article, but there’s some things in it that are decidedly wrong, and others that are completely ridiculous. The idea that increasing intracranial pressure through trapped blood accumulation could somehow “cushion” the brain and reduce the impact force of the brain as it “sloshes” in side the skull was obviously dreamed up by someone that has no grounding in biomechanics whatsoever. First, many head “mild” injuries (the ones that don’t involve skull fracture or haematoma) occur because of rotation of the head, not linear impacts, and suppressing brain motion relative to the skull won’t do a thing to help that. Secondly, CSF is essentially water from a physical response standpoint–and if you have an object floating in water, increasing the pressure in the water doesn’t do a single thing cushion the object floating in it.

The other major issue that I can see is, based on the doctors and biologists I’ve talked to, the accumulation of tau protein associated with CTE can take a minimum of many months, and more generally several years, to occur after the head traumas that triggered it. Also, apparently once you hit a critical threshold level of tau buildup, it becomes self propagating, even if you don’t have any additional head trauma. So monitoring the increase in tau protein wouldn’t be a good way to decide when to hang up the cleats…you could quit when you were still at a “healthy” level, it could take a couple of years to accumulate more, hit the threshold, and you could still end up with early onset of dementia or other lasting brain injury.

The article also touches briefly on, but glosses over, an alternative diagnosis technique that does show promise…diffusion tensor imagine MRI. Although poorly understood, there’s some really promising research about using it to track the biomechanical insults that could lead to long term tau protein buildup.

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by akn :: Thu, 06/21/2012 – 7:25pm

This entire article sounds like the author took the researchers’ grant proposal and Continue reading →

Noteable Retirement in Rugby

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News of a significant retirement in the sport of rugby (Union or League) rarely makes the press in America, however the first I have found attributed to concussions made its way stateside, via Chicago Tribune and Reuters;

Former England back-rower Michael Lipman has quit the Melbourne Rebels after suffering severe headaches and “haziness” following a concussion during the Super Rugby season.

Lipman had informed his team mates this week, Melbourne’s The Age newspaper reported, but the decision had been brewing for some time, a Melbourne Rebels spokesman said on Wednesday.[…]

“The bottom line is that throughout my career I’ve had so many bangs to the head and I’ve had so much concussion … the last couple have been the icing on the cake,” Lipman told The Age.

“I’ve just had too many. Enough’s enough and when you’re body’s talking to you like it is now, you’ve got to listen to it and be sensible Continue reading →

States Listening

Dustin Fink4 Comments

We have stated on here that legislation is only a small step in the way of stemming the concussion issue.  Awareness is the of the highest priority for the general public (and partly for the medical providers) and both Maryland and Indiana reported some good news today.

In Maryland the State Board of Education discussed the information that Parent Advocate Tom Hearn presented in May.  The Baltimore Sun has the report;

Thomas Hearn, a Montgomery County parent whose son received a concussion playing football at Walt Whitman High School, has testified before the state school board and Montgomery County school board, asking members to consider requiring parents to get more training in recognizing the signs of concussions and limiting the number of contact practices. He said the new state law doesn’t go far enough.

High school students can still have contact practices twice a day and five days a week, Hearn said. While there are no reliable statistics on how many of the 115,000 athletes in public schools in the state suffer concussions while playing sports, he suggested that if you extrapolate from the experience of Virginia school systems that have kept careful records, there may be as many as 6,000 a year in Maryland.

“Between now and the start of football season in August, you need to consider why you shouldn’t at least adopt the NFL and Ivy League limits for Maryland high school football,” Hearn said in his testimony before the board last month.

In 2011, the NFL limited practices with contact to about one a week. While the NCAA does not have the limits, the Ivy League adopted rules last July that permitted no more than two practices with contact a week.

The limits are intended to reduce the number of concussive hits players experience. Tackles or hits also can produce subconcussive injuries that do not have symptoms but over time have been shown to increase the risk of long-term health issues.

State school board members said they Continue reading →

Quick Hits 6/26/12

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NFL Tells Rooks Not to Hide Concussions:

Cleveland Browns’ team physician spoke at the rookie symposium to warn the incoming players not to hide symptoms of concussions;

At the rookie symposium, Shickendantz said the league cares about the players’ well-being.

“Our only agenda is your health and safety,” he said. “It’s about you, not about us.”

The reality is it’s about everyone. It’s true that players sometimes avoid getting checked out by team doctors because they don’t want to be removed from games, and it’s true that’s a very bad idea. But it’s also true that sometimes players are mistakenly cleared to return to games even when they have been checked out by team doctors, and that’s a bad mistake.

Check out Michael David Smith’s quick take on Shickendantz being the selected speaker.  It will be very difficult to change the culture at the professional level (see money), it needs to begin at the youth level.

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Steve Young Speaks About Concussions:

He may have took the time to address the concussion issue, however Steve Young really said nothing about concussions.  Even downplaying his own concussions during his career.  However he does feel the NFL is on the right path;

“I saw a quote from one of the players who suspected that in 20 years it wouldn’t be football any more,” Young said. “I think that scared everybody.”

However Young believes the NFL is taking proper steps to make sure today’s players won’t be as affected in the future by concussions.

“The league is getting serious about it and they know that it is important,” he said. “Now they have a whole way of dealing with it and there’s a protocol for how it’s handled. I talked to Aaron Rodgers and Tom Brady about this recently and both felt very strongly that they’re getting the best care. Once you have a concussion, it is very hard to get back on the field.”

The last comment about getting back on the field is extremely Continue reading →

In Case You Missed It…

Dustin Fink4 Comments

Last week I tweeted about a story on Deadspin.  It was a very well written article, one that should make us hopeful and fearful at the same time; at the very least it is thought-provoking.  Even after reading it several times I still feel that Kyle Wagner absolutely did everyone a service by publishing this piece;

The question, after a decade of brain-slicing autopsies, is when any of this will help players before they’re dead. Doctors can’t just crack open living patients’ skulls and lop off slices of their brains to stick under a microscope.

But new research at UCLA is using a cutting-edge biomarker that can attach itself to tau protein tangles so that they show up on PET scans of living subjects. Dr. Gary Small is currently running a pilot study on retired NFL players, imaging their brains in place. If he is successful, his work would reorient the science of head injuries around saving lives instead of merely contextualizing deaths.

“I’ve always sort of thought of tau imaging as the holy grail on the issue of chronic brain damage, especially CTE,” said Dr. Julian Bailes, one of the founders of the Brain Injury Research Institute (BIRI).[…]

PET imaging tech is half a century old, and though FDDNP is relatively new, it’s still been around for years. So it’s strange to think about the marker being on the cutting edge of a fairly recently discovered brain disease. If the marker can find and pinpoint CTE, why hadn’t anyone tried it before now? And for that matter, why isn’t it already in use?[…] Continue reading →

Katherine Snedaker: Parent Advocate – Sportscapp.com

Dustin Fink3 Comments

Photo by Julia Arstrop Photography 2011I was asked to post this on The Concussion Blog, in full.  I appreciate what another Parent Advocate is doing for raising the awareness of concussions.  Katherine is doing a fine job and checking in on her is a must.

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10 ways to lower your Child’s Concussion Risk

BY Katherine Snedaker of www.Sportscapp.com ON June 20, 2012 

Concussions are a part of youth sports at every level from elementary school years to college. Playing at the local playground, riding bikes or just being a kid can put your child at risk for a concussion. However,  any parent can reduce their child’s risk of concussion with some simple steps:

1. Educate yourself on the signs and symptoms of a concussion along with the other members of your family so that an educated adult is always available during a practice or a game or by phone for your child to call.  Always check in with your child on the car ride home from any sporting activity or play date, and ask their day, and how they are feeling. If your child complains that he/she hit their head, you should  know the correct questions to ask to see if there could be an issue with a head injury.

2. Educate your child about concussions. There are simple, painless videos for the media savvy teenager of today. Studies show that kids are more likely to report concussions when they know what a concussion is. The earlier the diagnosis, the sooner a child can begin the rest needed to heal a concussion.

3. Check your child’s sports equipment at the beginning, middle and end of each season. While there is Continue reading →

Not Funding Athletic Trainers = Bad Idea

Dustin Fink2 Comments

If you have athletic trainers in place then you suddenly remove them it can create a disastrous situation for the school or district. Why? It is rather simple, the coaches, parents, kids and admins of the schools have become accustom to the nationally recognized allied health care provider being around for injury consultation, evaluations, and prevention measures including helping with conditioning. Not only that in the hot months of early football the athletic trainer is the neutral guardian against heat emergencies like heat stroke. The athletic trainer at high schools, especially those with collision sports, are necessary; not only for concussion but for all other injuries mainly the catastrophic type that occur everywhere on any given day. In essence the athletic trainer is akin to a lifeguard at a community pool.

Would you send your kids to a pool without a lifeguard?

By removing what has been used for some time, ALL of the burden will fall upon the school districts and coaches, certainly a liability that is not needed in this day and age.

This is happening – in an area that WAS ahead of the curve when it came to athletic trainers and high schools – Winston-Salem and Forsyth counties in North Carolina.

The certified athletic trainers assist coaches and players year-round at practice and games in evaluating injuries and working with their rehabilitation.

Considering that 4,231 high school students played in at least one sport in the 2011-12 academic year in Forsyth County schools, the program covered 27 percent of all students enrolled, according to school system data.

Continue reading →

Maryland State Board of Education Meets Tomorrow

Dustin Fink6 Comments

Tom Hearn, a parent advocate of Maryland provided initial testimony to the Montgomery County Board of Education earlier this spring.  He had a further opportunity to provide testimony/information to the State Board of Education back on May 22nd.  Due to that testimony (seen below) there has been a discussion item placed on the agenda for tomorrows regularly scheduled meeting.

I must say that Mr. Hearn has been working his tail off and I am very interested to see how his approach is handled, as most states have not involved the BoE.  Mr. Hearn does take up the contact limits in practices; making Maryland and Illinois as the only two states that have been given such a proposal.  Here is the testimony (minus the attachments);

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May 22, 2012
Maryland State Board of Education
Public Comment Testimony of Tom Hearn
Regarding Concussions in High School Football and Other Sports
 
 
Good afternoon, Members of the Maryland State Board or Education and Acting Superintendent Sadusky.  I am Tom Hearn and I am a parent of a student at Walt Whitman High School in Montgomery County, Maryland.
 
I wanted to talk with you about concussions in high school football and other sports.  As discussed further below, I am requesting that the State Board take three actions to improve the safety of Maryland high school sports athletes:
 
1.     Adopt regulations similar to those adopted by the Massachusetts Department of Health for youth sports concussions; in Massachusetts, the Department of Health has gone through extensive notice and comment rulemaking procedures to develop workable policies and procedures to manage the risk to student athletes of sustaining sports concussions.  The result is a set of state-of-the art best practices that are a suitable starting point for the State Board to align with those practices.
 
2.     Impose limits on full contact practices per week in high school football given that the NFL and Ivy League have adopted similar limits in light of emerging medical research; and
 
3.     Reorganize responsibility for sports concussion safety away from the Maryland Public Secondary School Athletic Association, which currently has the lead, to a new department within the Department staffed by a lead public health professional or sports safety professional, such as a certified athletic trainer with experience managing sports health in a large school system, who reports directly to the State Board.
 
Background
 
It may not be highlighted in the job description, but collectively you are the senior safety officers for public high school sports in Maryland, and this may be the most important position that you play.
 
In sports vernacular, collectively you are the Blind Side left tackle for the 15,500 students who play public high school football and the 100,000 or so other high school athletes.
 
No one ever died from a bad academic education, but high school student athletes die Continue reading →

Mr. Rodgers Not Exactly Correct

Dustin Fink3 Comments

If you follow me on twitter you know that I made a comment about the recent statement from Aaron Rodgers – concussed Super Bowl MVP – about helmets;

In his remarks he said the helmet he now wears, compared to the one he wore when he started in the league in 2005, has prevented him from “a couple” of concussions, including one against the New York Giants in a playoff game last season.

Rodgers was part of a panel of other quarterbacks that were also Super Bowl MVP’s hosted/moderated by Bob Costas – apparently a charity event.  Regardless if there was an actual quote from Rodgers about prevention of concussions from helmets or it was simply inferred by the context, it is not correct and could provide false hope to others.

Helmets were designed to attempt to eradicate skull fractures and brain bleeds, the most heinous of brain injuries that were felling many players at the turn of the 20th century.  As technology has progressed we have seen fewer and fewer of this often life-threatening injury; unfortunately it does still occur.  The helmet shell along with the interior padding is designed to absorb the massive linear forces that cold fracture a skull or provide enough trauma to rupture vessels in the head.

Concussions are a slight bit different – even though both are brain injuries – a concussion is mainly a neurometabolic and microscopic structural issue.  Concussions are set off in a variety of ways but the biggest culprit is angular acceleration/deceleration and rotation of the skull (most commonly those type of collisions in ALL Continue reading →

Part of Recovery is a Visual Component

Dustin Fink2 Comments

More and more information coming in is dealing with the recovery/therapy for the 10-15% of those concussion patients that have symptoms linger longer than 7-10 days.  Just like the initial management of concussions none of it is tried and tested in the scientific world; however results are positive with many things.  For example we have discussed “Wiihabilitation”, vestibular training, and immediate activity (Buffalo Protocol); thanks to the inbox we can examine a tool for vision enhancement and visual therapy.

As with most products that send me email I ask they present in a story, something we can understand and identify.  After they send the email I then read and provide feedback if changes are needed to be on the blog; as well as follow up with their product.  Per my usual stance I am not endorsing this product, merely providing more information for readers that are looking for help/ideas.  You can think of it as screening products.

Without further ado here is the information about Dynavision;

Cincinnati, OH (May 30, 2012)—Jen Umberg never saw it coming. It was May 23, 2011, during a terrible storm in Cincinnati. Winds were gusting and she was trying to get inside. But before she could, she was hit in the head by her neighbor’s hose box that flew from next door.  Momentarily knocked unconscious and 4 1Ž2 feet from where she was, all she could think about was, what just happened?

“I felt the most intense pain of my life,” Umberg remembers, “I thought I had been shot by a bullet.”

Umberg was left with a concussion at the same time she was rehabbing from foot surgery a few weeks prior.  Two months after her accident, Jon Divine MD, her doctor and the Head Team Physician for The University of Cincinnati Bearcats, directed her to begin rehab at UC with their athletes using the Dynavision D2.  As part of her neurological evaluation, Joe Clark PhD used Dynavision to measure and train/retrain visual, cognitive and peripheral deficits.

“He developed a plan for a Novacare athletic trainer to use with me,” Umberg said, “ When my progress plateaued Continue reading →

Concussions: Not Just Male; Not Just Football

Michael Hopper18 Comments

Here at The Concussion Blog, we talk all things concussions. Concussions are brain injuries and they are definitely something we must continue to learn more about and continue to educate the youth and the parents. Dustin and I are both Certified Athletic Trainers at the high school level and I really believe that puts us on the “front lines” when it comes to concussions and concussion education. But I think something that gets lost in the whole concussion issue that a concussion is NOT a football problem; it is a SPORTS concern. This article will once again present another sport that brings its own risks of concussion and it needs to be brought forward once again. Cheerleading, girls basketball, and girls soccer are all prime examples of concussion sports that slide underneath many people’s radar. Continue reading →

Pop Warner Changes

Dustin Fink21 Comments

It is about time someone took a proactive step in football.  The sport is not the sacred cow everyone thinks it is; football is touchable by the courts and deep pockets, it is “when” not “if” when it comes to disruption of the sport.  However Pop Warner football actually took a very bright and forward step in limiting contact for its players;

Pop Warner is limiting contact in practice as part of an effort to reduce players’ risk of concussion. Pop Warner’s medical advisory board made the announcement this week.

Under the new regulations, coaches must limit contact to no more than one-third of their practice time. It also is banning full-speed, head-on blocking or tackling drills in which players line up more than three yards apart. Coaches can have full-speed drills in which players approach each other at an angle but “not straight ahead into each other.” There also should be no head-to-head contact.

HOWEVER!!!  (Always seems to be that or a ‘but’ with me)…  There still can be contact Continue reading →

Another DL Stint for Bay

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Jason Bay had another bit of bad luck; as he was attempting to catch a fly ball he slid and hit his head on the left field wall.  It was utterly obvious to the trained observer that Bay was again not right; it took some extra help and “ginger” walking to get him off the field.  Unfortunately this wasn’t his first; nor did the last one recover quickly…  Fortunately, he and the Mets are very aware of concussions and the issues surrounding them;

On Friday night, hours after Jason Bay’s head torpedoed into the left field wall at Citi Field – his brain rattling in his skull as he endured his second concussion in less than two calendar years – Terry Collins shared a conversation with his wife on their car ride out of Flushing. They talked about Bay and decisions he may need to make that were no longer just about baseball, but about quality of life. It evinced the sports’ progressive perspective on concussions.

“We sat there and we talked about what would we do in a situation like that Continue reading →

An Oldie But A Goodie

Dustin Fink23 Comments

As the lecture and speaking season is in full swing for professionals I feel it is a good time to dig up a post that unfortunately needs repeating, it is about “Mild Concussions”.

Hogwash!  There is NOTHING mild about a concussion, period.  However media, teams, players and even medical staffs continue to use this nomenclature with this injury.  It is simply counterproductive to label this injury with a “mild” tag, and hampers the effort of everyone trying to increase awareness.

Granted, those that have extensive training in the area of injuries, and particularly head injuries, understand the term “mild” when it is in concert with concussion.  This subset of the population is not the one that needs the education, rather it is the general public, which includes players, coaches and parents.  A common problem amongst people who are educated in a particular field is that they forget about both who they are servicing and the education level of people other than their peers.  It’s a fine balance to educate without talking down to others, but understanding the stigmas of the topics help with that effort.

One serious stigma is the “mild” tag that is placed on concussions.  Those that watch and participate in sports are so used to using that clarification when assessing and addressing injuries as a whole, that perhaps it carries over to the traumatic brain injury just sustained by the athlete.  We as athletic trainers and doctors need to reassess how we describe this particular injury.

During my public speaking I often relate being “mildly” concussed to being “mildly” pregnant…  You are either concussed or not, just like you are pregnant or not.

Some may say that “the symptoms are mild”, or that the “prognosis of the injury is mild”, in terms of being sidelined.  The first may be Continue reading →

ATSNJ Presents 3rd Annual Sports Safety Summit

Dustin Fink1 Comment

I was lucky enough to get out to New Jersey last year for their second edition of this, and boy was it worth my time and resources.  Eric Nussbaum and the ATSNJ does a great job in getting some of the “hottest” speakers to come and help athletic trainers learn.  This year is no different; the first half of the day will be centered on concussions and the latter half will be various other issues we are facing as athletic trainers: sudden cardiac death, MRSA, heat illnesses, etc.

Sports Safety Summit Brochure, 2012

You can see the brochure above and you can go to their website for further information about this event.  I highly suggest your attendance, and I will make every effort to get out that way again this year.

Neck Strengthening Should Be Addressed

Dustin Fink2 Comments

Looking at the human body, in particular the head, it’s a wonder we exist at all.  Our operations center is basically held in place by small bones and strong neck muscles.  The human brain weighs between 3.5-5.5kg or 8-12lbs which does not seem like much until you find a 10lb medicine ball and try to balance it on a pole.  Once balanced then strike the ball and then you will be amazed at how our body handles extreme forces.  Even more convincing would be hitting the pole or lower and look what happens to the ball, our body is simply amazing.

In order to control your skull – in effect your brain – the neck muscles must be good at detecting even the slightest movements and be able to activate in an instant to compensate for sudden trauma to the head or body.  It would stand to reason that increasing the strength of your neck would also help with lowering transitional forces to the head.

There is one little caveat with this example, the brain itself.  On average the brain weighs 1.5kg or 3.5-4lbs, which makes up the majority of the weight in our head an it is not attached to anything.  That is the crux of the problem; a free-floating organ – our most important – that is susceptible to forces anywhere on the body.  This is why helmets cannot claim, nor do they, prevent concussions and it is why even with the strongest neck an unanticipated hit (when neck muscles are not tensed or engaged) can and will result in acceleration of the head.  Translated that means high potential for concussion.

Rock Center once again takes a look into the concussion realm Continue reading →

Diffuse Tensor Imaging

Dustin Fink3 Comments

ABC News was reporting a breakthrough on imaging of the brain, diffuse tensor imaging.  As one can see DTI was one of our first posts on this site in 2010 – so it is not new as the beginning of the article claims.  However the report describes why this research is different from the previous efforts;

While the data showing that diffuse tensor imaging can distinguish unique brain abnormalities has been previously reported, the researchers took their study one step further and found that a new way of looking at the information from these scans — an approach known as functional anisotropy, or FA for short — can reveal whether the brain may have swelling.

Intriguingly, in a separate group of patients included in the study, people with concussions still had evidence of brain injury over one year after their head injury.

“The unique thing about this study is that there are brain abnormalities [still present] at multiple time points,” said Dr. Jeff Bazarian, an associate professor of neurology and neurosurgery at the University of Rochester in Rochester, N.Y. “This highlights that the brain is abnormal on a cellular level for a long time.”

If and when massive control groups can be sought out to back up this information (highly probable in my opinion) we will then begin to understand what trauma to the brain is doing in real-time and how long the effects are lasting.  This indeed would be a breakthrough with many applications: immediate evaluation and objective findings, serial testing, return to play, and thresholds.

In general, Lipton said, this study raises awareness that even seemingly benign head injuries can lead to widespread brain abnormalities.

“A concussion which is seemingly quite mild is accompanied by real changes,” he said.

Your brain needs exercise and nutrition too

Nick Mercer5 Comments

The benefits of exercising, keeping fit and eating healthily have been impressed on us (society, specifically North American society in which I live) for a long time. Unfortunately, it hasn’t exactly caught on. It came close when Jared lost a bunch of weight eating subs everyday. Although Jared is to be commended for deciding to eat healthier and smaller portions, that campaign ended up being a better marketing gimmick than a healthy eating trend. Magazines, ranging from fitness to news, have urged us to exercise and eat healthily as well, but these attempts have generally failed when the timelines to do this fall outside of one week – a month at the longest. Magazines also compete with each other to give “the best” advice. However, “the best” advice is no match for “the easiest” advice and as magazines compete with each other, conflicting diets and exercise routines can very easily overwhelm someone whose commitment to keeping fit equates to their commitment to picking up a magazine. I should be fair, some of these routines actually work and give good advice about being healthy. Another option is using common sense. We’ve been cautioned about remaining sedentary and eating unhealthily and the negative consequences that has for our heart, one of our vital organs. But what about another vital organ, the brain?

The importance of exercise and nutrition (the first two articles) for brain health cannot be understated. Exercise, notably aerobic exercise, is like practice for your brain’s neural pathways. The better trained your neural pathways are, the stronger and more efficient they are. Not only that, aerobic exercise also improves the adaptive abilities of the brain. When I was brain injured, some pathways in my brain were disturbed, but my brain has found new routes in which it Continue reading →