Archive | November, 2012

2012 NFL Concussion Report Through 12 Weeks

29 Nov

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).

I will save the “soap box” for another day as I will get right to the meat of it.

Numbers are rising, but naturally there are more games as all byes have taken place.  There are more players on the field and more plays so there will be, by logic alone, more concussions.  Our research over the past few years has shown that 55% of all concussions found happen after Week 9.  Both an indication of more games but also prolonged exposure to micro trauma.

This week we say another first, a new high water mark for a weekly find; 19 players were concussed last week, roughly 15% of all concussions to this point.  I have some reasons for this, the most poignant being that I believe the NFL is starting to get it right.  With so many eyeballs on the game now, especially looking at concussions and how it impacts the game they better start to get it right.  I have had multiple sources tell me – which is hard for me to believe but I have heard it more than once – the “crapstorm” that is the NFL medical in-game coverage is now just catching up to what we know.  One person told me that some (stresses some) athletic trainers are still learning about concussion detection, another told me (which I already knew) the doctors being on retainers for the teams are too conflicted.  My most trusted source tells me that players actually have a protocol of their own to evade detection, which they practice from time to time.

Regardless there was a perfect storm this past week to give us the 19 found.  Now onto the stats, 127 regular season concussions – 175 since camp opened.  Notes: due to my 20 month old son “rearranging” my database I rechecked numbers there may be some differences from last week (the #’s are sound)… DB’s and WR’s are now starting to rack up…  ()’s represent last week’s numbers…; Continue reading →

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Possible Biomarker? Possible Definitive Imaging?

27 Nov

Biomarkers are the next frontier in the concussion realm, really any specific and reliable objective measure to confirm a concussion.  Currently we can view concussion a “diagnosis in absence”; meaning if you have head trauma and there is no remarkable imaging the default diagnosis would be concussion.  This can be effective if there were enough signs that warranted the exam or the individual was truthful about symptoms; but what about the population that either does not respect/believe concussions or refuses to accept that they are a brain injury?

That is why the race is on to find either a biomarker or imaging technique that someone can say; “look, see these numbers/images, it means you have a concussion.”  This is great if the process of evidence based practices (EBP) was swift and widely accepted; the sub-issue is that there is ALWAYS “more research to be done”.  The first study deals with not a blood drawn biomarker, rather an imaging measured biomarker.

Dr. Michael Lipton of the Albert Einstein College of Medicine in New York presented this information recently;

In a single-center, case-control study, patients with mild traumatic brain injury (TBI) who had more abnormally high fractional anisotropy (FA) had fewer concussive symptoms and better quality of life a year after their injury than those who had less of the biomarker, [...]

“If abnormally high FA represents neuroplastic effects, and if that’s how people recover from brain injury, it would be possible to use this in translational studies to identify the underlying mechanisms of pathology and to identify therapies that don’t look at how we fix the damage, but how we enhance the brain’s ability to compensate for that damage,” Lipton said during the briefing.

[...]
Overall, all patients had detectable areas of abnormally high FA: some had more, others had less, Lipton said.

But those who had higher levels of abnormally high FA had fewer post-concussive symptoms and better health-related quality of life a year after their injury, he reported.

Higher levels significantly predicted improvements in concussive symptoms (P=0.01), as well as better outcomes in terms of the quality-of-life outcomes of mobility control (P=0.024) and psychological functioning (P=0.007).

This suggests that the “brain is compensating for its injuries,” Lipton said, and that high FA “may be a manifestation of neuroplasticity.” Because the brain does not form new axons, he said, it could be that the connections between existing axons are changing or strengthening.

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At the same time  a group led by Dr. Yulin Ge found and published in Continue reading →

Nick Mercer: The Education of Nick

26 Nov

When I try to think of an idea for a post, I look to sports, news, pop culture, and usually find something that gets my mind firing. Sometimes, actually more often than not for my most recent posts, my idea seemingly comes out of nowhere, but once I get a hold of it, off I go. So, while trying to think of the subject for this post, although there were a lot of stories of concussed athletes – not the least of whom is Alex Smith of my favourite team in any sport, the San Frncisco 49ers – I have decided to take another tack and look more at society. I’ve written a bunch in this vein, so you could simply call this tactic ‘going to the well’, but there is just so much fodder here. Plus, it gives me a wider audience than  1000 words on Colin Kaepernick would have (nonetheless, he played an awesome game on Monday!). There have been countless stories over the past 2 years about concussion in pro sports, youth sports, and recreational sports. Every time a new story comes around, a catalog of articles are written, a fury of interviews are given, and an exhaustive supply of statistics are produced. As I’m the only one working alone on this blog, the only resource at my disposal, or at least the only original resource I have, is my experience as someone who’s had a severe traumatic brain injury.

Starting my blog (concussiontalk.com) was one of my best ideas. It gives me a place where I can share my views and vent my frustrations, all under the guise of thoughtful, and dare I say, good, writing. I have, not so subtlety, been able to integrate some pop culture events into my posts. From the start, the point of my blog was to write about brain injury in sports, notably football and hockey, because in July or August of 2010, it seemed a bit different, and as such, it would be interesting to write about. If anything, I’ve deviated from this, Continue reading →

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Educational Debate; what to actually teach?

26 Nov

WARNING some content may be considered “nerdy”, as there are very big words, even words I had to look up (OK you got me I have to look up many words longer than 5 letters).  I may even go on a diatribe that may lose you.  I do feel it is important for athletic trainers to read as well as our educators.

Awareness is the key with concussions – as I see it in this moment in time – understanding what one is and the proper management are probably the biggest issues we can educate on currently.  That does not mean the rest of the information is forgotten or omitted rather, grasping the nature of concussions is of special attention.  Once people start to understand/respect concussions some of the fear will be removed and fewer people will brazenly dismiss this brain injury.  Decisions need to be made about exactly what to educate each audience about; granted it would be nice to explain all of it – every minute detail – to every audience, that is unlikely to get people to understand.  The information about concussions – while remaining consistent – must be tailored to each subset for better understanding.  One can always go out and find more information, but the basics must be the same for everyone.  For example; disseminating the general signs and symptoms of concussion, the appropriate definition of a concussion, and immediate management of a suspected concussion.  This information should be the same for everyone.

And I think we are doing a good job all around on this; from the CDC, to NFHS, to state level, to this blog.

Last night was an opportunity to learn more about concussions and the thought process of teaching about concussions, to at least athletic trainers, on twitter.  During Thanksgiving I mentioned – and was pushing people – to understand what the Fencing Response is (pubmed) as Julian Edelman of the New England Patriots demonstrated this after getting hit in the game (unfortunately I cannot get a film/.gif of this currently) (thanks to a reader here is the LINK to the video).

It was then suggested to me by fellow athletic trainer and current educator Dr.Theresa Miyashita ‏(@DrMiyashita) that I should “be careful-the fencing response Continue reading →

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2012 NFL Concussion Report Through Week 11

22 Nov

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).

Getting hit in the head by a friend – not hard enough to cause concussion symptoms – say 15 times on a weekly basis is probably not something you would enjoy.  Eventually after about 10 or so weeks of that, theory suggests that there has been enough “micro” damage that the threshold for “macro” damage has been reduced.  Further, if your friend hit you with the same force he/she has been doing previously you may get concussion symptoms, thus a concussion.

If the force was at the same “low-level” as the previous hits – that did not cause a concussion – then why now do you have a concussion?

Looking at it from another angle; if you hit concrete with a hammer – not with so much force it actually cracks – say 15 times a week for 10 or so weeks, will the concrete finally crack and break at some point?  I would venture to guess, yes.

This is now some of the focus on the research in concussions, trying to identify the actual causation/pathology for such cases.  Speaking from a logical perspective; getting hit in the head over and over and over and over and…  Well, over seems to cause damage, no?

This is possibly why we are seeing greater numbers of concussions in the later part of the season; sure awareness is better, but players have been exposed to hundreds and thousands of hits late in the season.  There was a good white paper written on how to possibly abate this issue in Youth Sports, composed by The Sports Legacy Institute.  It is not practical in the NFL, nor do I think that professional adults need to have this in place, unless they choose to – in its place the NFLPA negotiated fewer “hitting” days outside of games in the recent CBA.

This again gives me a chance to wonder aloud why high schools will not adopt a reduction in exposure/hit days for football?  I have generated a proposal on this for the Illinois High School Association that has yet to be brought to a vote.

Back to the NFL and the concussions found this past week, SIXTEEN of them, nearly doubling the average up to this point; the numbers have tied a single week high for the past three years.  Perhaps its a reaction to the week 9 issues, especially the heightened attention after three starting quarterbacks were sent out with concussions.

Now on to the stats for the week – 108 regular season & 156 since camp opened.  Notes: DB’s now make up 25% of all the regular season concussions (8 last week)…  Offense continues to outpace the defense…  Current numbers/stats are getting close to being in line with last year…  The least concussed positions are QB and DL…  The ()’s represent last week’s figures; Continue reading →

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Outreach: BMX Athlete – Jay Fraga, His Story, His Words

20 Nov

We are beginning a new program here at TCB.  This one is called “Outreach”; the purpose is to publicize the good (we hope the vast majority) and sometimes the not so good of concussion management and experiences across this vast planet.  One thing I realized real quick in Zürich is that the stories of the bad are relatively the same, usually highlighted in the media.  Meanwhile the stories of good are different and helpful and not heard at all.  I am asking our readers to send in stories of your cases (please be mindful identifying specifics) so we can share.  There are vast stories in the comment section but I would like to bring forward as many as possible.

The stipulations are simple: 500-2000 words with specific situations that we all can learn from and benefit from, email them to us at theconcussionblog@comcast.net and consent to possible editing as I see fit.  It would be nice if you included a bio or frame of reference, but if you would like to remain anonymous that is fine to (however, it would be good if you included something like “licensed doctor in _____ (state)” or coach, athletic trainer, mom, dad, etc.

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By Jay Fraga, Former BMX Athlete, Husband, Father, Sports Lover

If you’ve ever had a bad hangover, I think we can all agree that it’s a relief when the day is over, you sleep, and it’s gone when you wake up the next day.

I have had a hangover for as long as I can remember. It’s been there for more than a year and a half. If you can recall the misery and suffering involved in one day with a hangover, maybe you can begin to imagine what it’s like to try to live day-to-day feeling like that.

Then again, maybe you can’t.

My last concussion was approximately 8 months after a previous one that I got crashing in a bike race.  I wasn’t especially symptomatic from the previous one, but all of my doctors virtually agree that I hadn’t yet healed when I was injured again this last time. The scientific community has a number of guidelines for concussion, but the one thing everyone can agree on is that layering a second concussion on top of a previously unhealed concussion is very, very dangerous.

In spite of our knowledge about how dangerous multiple concussions are, we see NFL players being cleared to go out onto the gridiron a week or two after sustaining not one, but two concussions in a three-week span of time, while proclaiming that they feel great, and their coach stands by, nodding approvingly.  Fantastic.

For those of us who struggle to live daily with Post Concussion Syndrome, seeing these stories play out in the news is especially painful.  There is nothing more painful than regret, and many of us watch helplessly as we watch players and coaches, who are in absolute denial, speak nonchalantly and hollowly about a subject that we are intimately acquainted with. We watch knowing full well that there’s a pretty good chance that these players will soon be joining our ranks, where the challenge isn’t a championship at the end of the season, but rather to live like a normal human being and be able to enjoy life. And it feels like there’s nothing that we can do about it.

If we want to change things in sports, we have to understand how athletes operate.  Athletes are wired a little bit differently.  Those who have learned how to overcome -  through the process of competition, loss, reflection, coaching, training, more competition, rising above, winning, and then ultimately understanding how to win, have a different belief set.  They think of themselves as machines that are able to prevail through anything.  Competition becomes a necessary part of their diet, and   Continue reading →

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Tuesday Quick Thoughts

20 Nov

Ed Reed was suspended by the NFL for repeat offenses of the leagues mandate on blows to the head.  Some former players are taking serious umbrage with this decision by Ray Anderson, NFL Executive VP of Football Operations.  Fortunately I had the opportunity to listen to an interview with Anderson on Mike & Mike this morning.

The synopsis, in my opinion, was that the League is now looking at hits to the head and neck as an aggravating offense and will take serious steps to eliminate this type of hit from the game.  More striking was Mr. Anderson’s statement (paraphrased) that; we know now that hits to head are not only a problem we know now that they are life altering, he emphasized that the evidence was now clear to this.

Ray Anderson kept hammering home that “times have changed” and hits like Ronnie Lott made and that were common place years back have no place in today’s game.  He also mentioned that fines are not working as they had hoped, so other measures will need to be taken, including suspensions.

I really feel that the NFL is playing good lip service to this issue, and really are taking baby-steps to change the culture of football.  Now getting on to Continue reading →

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Ding, ding, ding!

16 Nov

I recently read a story in the Globe and Mail, “Stampeders backpedal on concussion talk” about Calgary QB Drew Tate who was hit in a head-to-head collision in the 2nd quarter of play on Sunday, November 11. At halftime, Tate said that he had his “bell rung” and couldn’t remember the first half of play, generating this comment from Eric Francis of the Calgary Sun, “All the questions Monday will and should revolve around the apparent silliness of letting Tate play after his halftime admission to TSN.” (emphasis added) Not to worry though, according to Tate all that really happened is that he was “dinged” and “felt some fuzziness”, besides, as Tate says, “As far as talk about a concussion, I didn’t get what the fuss was because I felt fine and just wanted to play.” The Stampeders administered concussion tests during the game, after the game, and Monday morning. Tate was ruled to be symptom free.

It seems fairly clear that Tate was concussed. However, not according to Dave Dickenson, Calgary’s offensive coordinator and a former QB, whose diagnosis was that  he “can tell when I look into someone’s eyes if they are concussed or not,” and he didn’t see any symptoms. Nevertheless, Chris Nowinski knows a thing or two about concussions, concussion management, and the Continue reading →

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2012 NFL Concussion Report Through Week 10

16 Nov

The Concussion Blog Original, NFL Concussion Report, is a weekly (not so much this year) 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).

It seems that one time each season there is a “watershed” moment on concussions in the NFL.  Week 10 was that week for 2012 (so far) as three starting quarterbacks were sidelined with concussion – Alex Smith, Mike Vick, and Jay Cutler.

Perhaps unnoticed in the coverage of the QB’s were the 9 other concussions that occurred, including three players having their second concussion – Cliff Avril, Brandon Meyers and Ryan Clark.  It would be Amari Spievey second as well, if you are counting the preseason concussions.

Certainly noticed by me was an ABSOLUTE first in NFL concussion history, which really should be noted.  Again, with all my research on concussions this is the first time this has occurred in the NFL.  This is the very first time that Continue reading →

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Hunter Hillenmeyer Discusses NFL Concussion Issue

15 Nov

With the NFL we struggle to grasp the issues that surround concussion and players.  In a perfect world the athletic trainers would yank a player at every instance of possible concussion and run a sideline evaluation.  If the player clears, great, but he missed some plays and if he didn’t they did a great job getting him off the field.  It’s not that easy people, heck I struggled for two years to have this type of mechanism at my high school (been in effect for the past three years).

Perhaps the best way to understand the issue better we should listen to the candid and sobering comments from a former player – who had his career end because of concussions – Hunter Hillenmeyer.

On the Boers and Bernstein Show on 670 The Score of Chicago they spent a good chunk of time talking to Hillenmeyer.  I strongly urge you to listen to THIS PODCAST.  Hillenmeyer discusses: the biggest issue I fear on the NFL sidelines – conflict of interest (about 6:20 mark), being labeled concussion prone (8:35), talking about talking with current players about concussions (8:50) and much more.

I have reached out to Hillenmeyer to invite him to write something up for the blog to follow-up this interview.  He has opened up before;  will see how that goes.

NFL Makes Case For No Indpendent Neuro

15 Nov

Finding a true “independent” health care provider for concussions in the NFL is a sticky situation; the NFLPA says they want one and the League is saying no.  Of course there are various reasons as to why the League would not want an independent neuro there; cost being one issue, the other issue is that the players may actually be in greater peril – and I agree.  Dr. Richard Ellenbogen co-chair of the NFL Head, Neck and Spine Committee explained this in an article in USAToday;

“No one knows the players as well as the athletic trainers, period.

“Having said that, some teams already have neurosurgeons on the sidelines. Having a doc show up just for a game takes away from the all-important baseline exam and continuity of care. It would be like getting operated upon by a surgeon who did not see you pre-operatively. Is that safer than having someone who saw you beforehand? The baseline is all important in making an assessment if a player is OK after a hit.”

Concussion are so subjective, most cases do not involve overt signs and it is incumbent upon the player to report what is going on.  Trust is a HUGE factor for players – of all ages – but more so in the NFL where they are making a living by playing football.  Although the tests are there and meant to be as objective as possible it is still a clinical diagnosis overall.  The only health care professional Continue reading →

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Concussion Video Day

15 Nov

Here are a couple concussion videos that I have found recently…

This first one from Mayo Clinic is an AWESOME example of what happens at the lower levels when you try to push through a concussion and keep doing what you were doing;

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I was watching this video and looking at good example of how NOT to hit.  Most of these hits are from 2010 or before, and you know what, I really feel like we seeing less and less of these hits in the game.  Perhaps the rules actually being enforced are making a change?

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Outside the Lines Today

15 Nov

Outside the Lines on ESPN will be featuring Stephania Bell today at 3pm EST to discuss the ongoing issues of head trauma in football.  Another panelist will Matt Chaney, whom has put in great work in the area of injury surveillance and provides the antithesis of “safer-football”.

Set your DVR’s…

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This Is How You Teach About Concussions

14 Nov

Stephania Bell of ESPN absolutely knocked this teachable moment on concussions out of the park.  I really appreciate her discussing not only the qualifiers/labels on concussions – BTW Eagles just as there is no such thing as a “mild” concussion there is no such thing as a “significant concussion” they are all significant brain injuries – but the recovery time associated with concussions.  Thank you for listening Stephania and thank you for this great segment!

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FWIW, from my sources around the league the NFLPA may want a specialist on the sideline, but the owners are resistant to this for two primary reasons: 1. cost and 2. unfamiliarity with the players.  The second would be more of a player issue rather than an owner issue, however it seems we will not see any owner override his MD’s on the sideline.  Again this all boils down to possible conflicts of interest.

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Defining success in rehab: exhaustion

14 Nov

Admittedly, I didn’t understand or even appreciate the importance of my physiotherapy rehab after my brain injury. When the doctors first told me that I’d be going to the Miller Centre (the rehab hospital in St. John’s, NL) I was really excited! At least I’d be out of the hospital! I couldn’t sleep. When I was eventually able to eat food it was terrible. I was bored to say the least. I was newly dealing with my double vision, so I couldn’t read. I figured, when I got to rehab, I’d be able to go to the rehab gym all day, at least it was something to do. They’d never seen me at rehab. I’ll be awesome! “Sure I can’t walk now, but you let me at that place for a few weeks and I’ll be running the stairs and doing burpees in the hall in no time!” “I’ll run home one day and won’t need to go back.” It’ll only be a few weeks, a few months tops.

At first, my motivation to get there was to get out of that GD hospital and get the whole ‘brain injury’ thing over. It sucked and there was a bunch of stuff I’d rather be doing. I had a co-op job in Ottawa for my master’s program that I had to get to. Most of my friends from Queen’s were in Ontario, so I’d see them a lot on weekends, whenever. That was the goal. Bang this rehab out and get back to life. An inconvenience. A pretty big inconvenience, and a good story, but an inconvenience is all it was.

I eventually realized that to get back to my old self, physically, was going to take longer than a few months. My motivation was then much harder Continue reading →

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Parent Advocate: Tracey Mayer

13 Nov

Parent Advocate, Tracey Mayer will be offering up her writings to The Concussion Blog as a resource to the readers, especially the parents out there.  As time allows she will be submitting posts for you to read.  I truly hope that everyone gets a chance to read about concussions from yet another perspective.  Thank you Tracey!  I thought I would pass along this note from Tracey Mayer she sent me the other day:

It’s been a bit over four years since Drew’s injury.  Last night I was thinking holy crap; it was me against the world when I refused to let him return to the field.  Honestly, there was no one on my side—not even my husband.

Clearly, concussion awareness was in its infancy stage at that time.  Back then, I rarely recall seeing any media coverage on concussions, and now I read at least 8-10 articles per day.  I was flipping through the mail yesterday and came across a newsletter from Rush with an article about resting the brain after a concussion – how it is necessary to take at least 2 weeks off from school, etc.   I cannot imagine what things would have been like if there had been even a smidge of academic support when Drew was hurt.  Even more, I can only imagine what might have happened to him had I not dug my heels in and held firm about him not returning to football.

Parents, you know your children better than anyone.  If something doesn’t seem right, most likely it isn’t.  Trust your gut – it costs nothing and generally holds value.  Your child has one brain—the vital organ that runs his or her body.  Protect it at any cost.

Tracey is right, we have come a long way in a very short time, alas we are only scratching the surface on the issue.

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Good Reminder About Rest After Concussion

13 Nov

This blog post was made a while back, from time-to-time I will republish them with associated comments that resulted.  This topic is about “rest” after the injury.  Most if not all medical professionals now prescribe this method, but as we found out in Zurich recently, the research behind exactly what “rest” is and for how long is unknown.  What is known allowing the brain to settle down for a period of time is highly beneficial.

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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;

“There is so little we really know about concussions,” said Dr. Mary Dombovy, vice president of Unity Neurosciences, which includes physical medicine and rehabilitation, neurology and neurosurgery. “We’re learning more as time goes by. What we’re learning is it’s not just physical exertion that is making the brain work harder. School tasks, studying for tests, trying to write a paper, these things are very stressful for people who’ve had a concussion.”

It is not that it is stressful, per se, it is that the brain is FUNCTIONING to do those tasks and like getting on crutches for a broken leg, the only way to get the brain on “crutches” is to not give it any stimulation.  Along with that comes how long and what to do when symptoms have gone, to me it is obvious that this is where you then begin the Zurich RTP protocol (the current concussion management protocol I use).

What I am having a hard time fathoming is Continue reading →

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The Debate of When To Pull A Player

13 Nov

This past week there were some prime examples of concussions, including mechanism of injury and how they are currently handled – some say mishandled – in the National Football League.  Now the debate rages on about when exactly a player should be pulled for evaluation.

In many cases this is absolutely obvious, for example Johnathan Baldwin of the Kansas City Chiefs last night in Pittsburgh.  As he laid out for a catch his head bounced off the ground and he immediately showed a fencing response and was “limp” on the field in a semi-prone position.  He “came to” and tried to get to his feet, key word being “tried”, as he was wobbly and needed help from a teammate and the official to stand.  The official then summoned the athletic trainers to aid in getting him off the field; it was obvious that Baldwin needed to be evaluated for a concussion (side note: the Chiefs are calling his injury a “neck”, which he could have hurt on that play but once again its an attempt to muddy the water, IMO).

To the credit of the NFL medical staffs these types of situations are rarely missed anymore, especially with the observer in the press box helping with the identification of potential head injuries.  I would dare say that these type of situations are missed more often at college, high school and youth level football games than the professional level; which is way more disturbing.

However, the debate remains about those players that don’t show overt signs of Continue reading →

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Concussion Round Table

12 Nov

Last week The Aspen Institute hosted a round table discussion on “Playing Safely: The Future of Youth Football” to address growing concern about the epidemic of concussions on our youth.  It should be noted that professional athletes are both more mature (in size and brain development) and are adults who can make informed consent decisions.  The issue this panel discussed was for the youth football.

The speaking list was both wide and deep including: DeMaurice Smith, NFLPA, Dr. Gerry Gioa, Chris Nowinski and Dr. Robert Cantu amongst others in attendance;

At the Aspen Ideas Festival in June, a panel featuring concussion experts and former NFL players considered the health safety risks of playing football. Since then, concerns have sharpened, with many parents of young boys saying that tackle football should not start before age 14. At the same time, football also plays a role in addressing the epidemic of physical inactivity. Our roundtable dives deep into the state of football at the youth/community level with a discussion on reforms — and implications on the game up to the professional level.

With awareness beginning to gain traction and definitive research in the area starting to bear fruit this round table Continue reading →

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An Opportunity Presents Itself

12 Nov

Concussions have been on the “front burner” for a few years now, yet not everyone has the clear and consistent message about this injury.  There continues to be gaps in how the injury is covered by the media, accepted by the leagues and understood by the general sport loving public.  Yesterday was arguably the most high-profile week for concussions in American sport as three well-known quarterbacks exited the game with concussion.  Due to the attention that will be given, I am deeming this a “teachable moment” for everyone.

Several opportunities have been presented to get the message correct and out there this year; in week 2 and week 5 there were 12 concussions.  Last year, week 11 produced 14 and week 14 had 16 concussions yet not nearly the “attention”.  Two seasons ago there was the “watershed” moment of NFL concussions not to mention the 15 concussions in week 16.  Yet the message continues to be clouded.

Regardless where you stand on the concussion issue (you should be concerned), particularly in the NFL, it would be a good time to get the basic information out there and link up some further information if you choose to look.  I will try to lay this out in the most helpful manner; to the point with as much fact as possible (I will notify when its opinion).  I will do it bullet point style;

  • FROM CDC: of the roughly 3.6M concussions that go the emergency room in the US, over 50% are due to recreational activities/wheeled sports.  Estimates have been made that 30-50% of all concussions are undisclosed or unreported.
  • Concussions occur in all sports, the exposure and rate is much higher in: American football, rugby, Aussie Rules, men’s lacrosse, ice hockey.
  • Current research/theory suggests Continue reading →

2012 NFL Concussion Report Week 9

8 Nov

The Concussion Blog Original, NFL Concussion Report, is a weekly (not so much this year) 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 NFL is at the theoretical half way point in the season as most teams have eight games in and a few have nine completed.  Usually this spot is a weekly tracking post; never fear I have been keeping track just haven’t found the time to post about it.

The NFL told me last week in Zürich that the eye-in-the-sky is being used and used often, Dr. York told the audience that in Week 6 there were 192 communications alone under this system.  That breaks down to 13 times per game on average; so the discussion seems to be there, but are the results?  It is far too soon to tell, but I am encouraged by the raw stats – knowing what was being discussed would be much more insightful.

Generally speaking the only “alarming” observation I am noting is the massive increase in offensive lineman concussions.  Suppose the theory of cumulative hits eventually creates a lower threshold for an observed concussion then this example/observation would be example number one;  after week 5 there were three OL concussions and after week 9 there are 10.

Other than Larry Fitzgerald amazingly missing only one play and Calvin Johnson admitting  Continue reading →

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It’s going to happen, learn from it

8 Nov

Yesterday evening, as I was about to talk to receive a call from someone from the Mayo Clinic about their Concussion Program to discuss how I could be involved, I was thinking about what it is about brain injury that I want to share with people. I’ve said it in a more muddled way before, in posts and talking to others, but that never translates properly into how important I think the point is. Another problem is that we, as a society, haven’t truly realized the prevalence and lasting consequences of brain injury until recently. The effects of brain injury had barely been recognized when it became an epidemic in sports and, not long after, a pandemic. Concussions are going to happen. Brain injury is going to happen. Of course we should look for ways to prevent it and ways to treat it, but perhaps most importantly, we should be responsible adults and stop kidding ourselves that this sort of thing is curable.

This post is not strictly about sports, but I will use sports as an example. Last year in the NFL there were 171 concussions among 1696 players. Approximately 10% of all active players in the league suffered concussions. ‘Wow! Even 1 is too many! That’s shocking!’…No it’s not! The average size of an NFL player varies by position, but to generalize, it’s about 6’2″ and 250 lbs. Average! We’re still not talking about power and the force with which they collide! The NHL is smaller but still above 200 lbs and similar height. However, these guys hit each other at higher speeds in many more games. Obviously, these are adult statistics, but these are adult statistics for people who have been playing the respective game for a long time and know what they’re doing. The youth level in either sport is filled with kids of varying size and drastically varying skill levels.

Look at those numbers and think about any NHL or NFL game you’ve seen, even if it was just highlights. Really think about it. Seriously, think about it. Thanks to all of the attention on brain injury, including concussions, in these past few years, it’s now blatantly clear that there are going to be these types of injuries. What’s truly surprising is that there aren’t more!

Better concussion policies. Better equipment. Better treatment. What seems to have been forgotten is common sense. People getting hit in the head is not some new phenomenon Continue reading →

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TCB Recognized

6 Nov

Recently the site visits to The Concussion Blog have been up, mainly because of the Zurich conference, however we have noticed a decent trend of the blog becoming a landing spot for concussion information.  It is nice to be recognized and really is painful for me to post about such “accolades” but I do appreciate it.  Some people take time to review content and put this blog along side some other very good resources.

Yesterday kwikmed.org (one of only two licensed online pharmacies) place TCB alongside some other very good websites, on their “24 World Class Sports Training and Sports Injury Resrouces.”

Yes, this does look like a small advertising ploy – so don’t go to the main website – but there are some terrific other websites on this list worth taking a look at.

Thanks to everyone who chooses to take time and visit here!

Sincerely,

Dustin Fink

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Hammering Home The Need For Athletic Trainers

6 Nov

I published this 10/22…  Since there has been higher volume as of late, I feel it is a good time to repost.  There is also another article by John Doherty that supplements this, HERE.

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In findings released today in New Orleans it is becoming more clear that athletic trainers play a vital role in secondary level athletics.  Using reports from 2006-2009 in various injury reporting systems there has been significant findings about injuries and concussions;

Overall injury rates were 1.73 times higher among soccer players and 1.22 times higher among basketball players in schools without athletic trainers. Recurrent injury rates were 5.7 times higher in soccer and 2.97 times higher in basketball in schools without athletic trainers. In contrast, concussion injury rates were 8.05 times higher in soccer and 4.5 times higher in basketball in schools with athletic trainers.

Not having an athletic trainer predisposes the athletes to greater risks, not from the usual sporting activity, but playing with injuries that can develop into greater problems.  Athletic Trainers also have the educational background and grasp of prevention of injury; either through (but not limited to) nutrition/hydration or conditioning of the body.

Athletic Trainers are also on the forefront for concussion awareness, education and assessment, often the first allied health care professional to see the problem and identify it.  As much as I hammer home Continue reading →

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Please Explain

6 Nov

It is a common thought that crosses my mind when I see questionable actions around a concussion situation.  Unfortunately I don’t have the power to get the answers, so I basically post them on here for others to see.

This is not the case in Australian Rules Football; if you are team and you receive a “please explain” regarding an injury (mainly concussions) you are probably treading on thin ice.

There is a mechanism in AFL that formally puts teams and doctors on notice when things just don’t add up.  Take for example the handling of a concussion by the North Melbourne Roos;

Interim Kangaroos chief executive Cameron Vale emailed AFL operations manager Adrian Anderson on Monday after the Roos were told to respond to a ”please explain” issued by the league last week.

The Kangaroos have been under investigation over the manner in which they handled Hansen after he received a heavy knock against Essendon in round 20, and also for the way they have responded to AFL investigators Brett Clothier and Abraham Haddad in recent weeks.

The AFL has been unimpressed with the club’s handling of the issue, although the Kangaroos have bristled at suggestions football manager Donald McDonald had influenced the testimony of key figures involved.

The letter is not the first step, rather the end step in a process that allows the medical board of the AFL to investigate how the practices of player protection is put in place.  Is it oversight?  You bet and I feel that the AFL does something much-needed in all professional sports.  Really, it is only applicable to the pros because of the resources, however it could translate to large colleges as well.

In Zurich I spoke to Dr. McCrory about what they do in regards to this, here are the basics; Continue reading →

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