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Minutes From First Illinois Advisory Council on Player Safety

16 Jun

PSPHlogo“Welcome to a historic event.” Is how Associate Executive Director, Kurt Gibson opened the first meeting of its kind in Illinois and for the Illinois High School Association (IHSA). With the vast majority of the Council present it did not take long for all of us to get to “work”.

The Council (which we shortened to PSAC – Player Safety Advisory Council) dove right into the meat of the issues surrounding sports and player safety. Rather than giving a play-by-play I will let you read the minutes from the meeting (LINK HERE);

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MINUTES OF THE PLAY SMART. PLAY HARD PLAYER SAFETY ADVISORY COUNCIL MEETING June 9, 2015

The Play Smart. Play Hard Player Safety Advisory Council met at the IHSA office in Bloomington, Illinois on Tuesday, June 9, 2015, beginning at 10:00 a.m. Committee members present were Dustin Fink, Sara Flanigan, Tory Lindley, Dennis Piron, and Cole Steward. Also in attendance were Associate Executive Director Kurt Gibson; Assistant Executive Director Matt Troha; and guest, Sports Medicine Advisory Committee member Greg Gaa. Not present were members Tregg Duerson, Senator Napoleon Harris, and Allison Hieb.

ITEMS OF GENERAL DISCUSSION:

1. IHSA administrators Kurt Gibson and Matt Troha welcomed the council to the first meeting of the Play Smart. Play Hard Player Safety Advisory Council.

2. The council reviewed its purpose of monitoring current IHSA programs and initiatives, identifying new areas to advance player safety, and helping communicate the Play Smart. Play Hard vision.

3. The council reviewed the following materials from the IHSA’s Sports Medicine Advisory Committee (SMAC): ● minutes of the committee’s April 2015 meeting ● recommendations made by IHSA’s Football and SMAC regarding football contact ● Managing Heat/Humidity Policy recommendation The council’s feedback on the football contact and Heat Policy recommendations are listed below under items.

4. The council discussed Senate Bill 07, which is currently awaiting signature from Governor Rauner. Among other things, SB 07 creates a Concussion Oversight Team in schools to monitor Return to Play and Return to Learn for student-athletes who have sustained a concussion, requires education on concussions and symptoms for coaches and athletic officials, and requires schools to develop school-specific Emergency Action Plans (EAP’s) to address serious injuries that may occur on campus.

5. The council heard reports from Allison Hieb and Cole Steward, the two student members of the council, on concussion from the perspective of student-athletes. Both students shared the perspective of how their schools have addressed concussion with their student-athletes on both the individual and team level. As a part of that discussion, the council suggested that the IHSA consider developing some kind of post-video assessment be created for students to complete. Additionally, the council thought it may be worthwhile for the IHSA to register and track student-athletes from a sports medicine perspective. IHSA staff indicated they would begin the process by working on some kind of checklist that all member schools can utilize.

6. In reviewing the football recommendations made by the IHSA Football and Sports Medicine Advisory Committees, the council expressed their desire to see the IHSA be bolder with its recommendations concerning the amounts of full contact Continue reading

May Mailbag

4 Jun

As the sports season winds down at the high school I am finally getting to the various emails I have received. I do truly enjoy the many stories and questions I get here, often times they are very learned for me; which translates to more information for you the reader.

I picked out one such email and gained permission to reprint it here. The sole purpose of this email is to get feedback about the return to learn aspect of concussions. Tom would like you to give it a read and make comments below.

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Return To Learn in the High School

I am an athletic trainer in a high school in the north suburbs of Chicago. We have a concussion program in place and see about 80 concussion a year in our athletics. I am fortunate to have some control over the return to learn side of concussions in my school. I have found that this is essential in order to properly manage a concussion. I find when physicians only see an athlete once and set accommodations for a determined amount of time, it does a disservice. The same is true if the time between physician evaluations is too long, especially when kids are kept out of school for long periods of time. I find many concussion students don’t need to be out of school, and those that do usually have their symptoms decrease significantly within 1-3 days.  Many times concussions progress rapidly and Continue reading

When and How ‘Not a Concussion’ Becomes a Concussion: Klay Thompson Injury

28 May

The Western Conference Finals not only provided an opportunity for the Golden State Warriors a chance at winning an NBA title it has provided a wonderful opportunity for people to learn more about concussions. The knee-jerk reaction to incidents like we have seen in Games 4 and 5 are often a mix of truth, hyperbole and eye-rolling; however what is clear they are cases that we can use to forge further understanding and education.

Last night in the would be close-out game of the WCF, Klay Thompson shot faked and the defender rose as he [Thompson] ducked and the defender’s knee blasted the side of Thompson’s head right in his right ear.

Unlike his teammate from the game before, Steph Curry, Thompson did not show overt signs, to my trained eyes, of a concussion. His face was “scruntched” in pain and he immediately grabbed for his ear, plus after the incident he immediately rose to his feet and walked straight to the locker room without assistance. As noted in Tuesday’s post signs are paramount when making critical in-game decisions about return to play; if they are there, there should be no doubt about removal.

The next report we received on TV or Twitter was about Thompson having an ear laceration and that they didn’t need to do a concussion evaluation. Which is entirely possible but unlikely, because I do believe they did a concussion “screen” at the time. The Warriors med staff probably didn’t do the full-blown evaluation because five minutes would not have been sufficient for that, but that was enough time to go over any symptoms and quick balance assessment (think roadside sobriety test). It is also important to know that because concussion are mainly subjective that a massive portion of any concussion evaluation is the interview: talking, questions and mental challenges about venue/score/date/etc.  Continue reading

“Contussiongate”*: The Steph Curry Incident

26 May

*I will admit that I could not come up with a catchy title for this post so I ripped this from Mike Freeman’s twitter feed (@mikefreemanNFL) last night:

But not only is this funny but it is about as accurate as it could have been when summing up the Steph Curry incident last night in Game 4 of the Western Conference series. So, thank you Mr. Freeman for your insightfulness and wonderful wordplay.

Those that were watching the game last night and happened to be on Twitter should know the entire process this sequelae; because of that I will be as brief as possible while injecting the overriding issues and thoughts on this.

It all began in about halfway thought the second quarter as the Warriors were getting throttled by the Rockets;

There is not speculation when looking at that vine, Curry hit his head on the court after taking an uncontrolled fall. What is not seen in the vine is Curry laying prone on the floor for a few minutes as the medical staff took a look at him (even noted checking his c-spine). When the world was brought back to the game from commercial we saw Steph getting assistance off the floor to the locker room, where further evaluation was to be done, obviously.

The first point to note in this event is that Curry not only immediately grabbed his head where it contacted the floor but he also was “down” for some time, that is obviously not normal. He hit his head and very hard so of course he would be slow to get up, but it was the amount of time that would and did have me concerned.

Before we go further we should define concussion for all of you out there, if you want the drawn out and dictionary definitions you can find it HERE, but for the simplest and most poignant way: a concussion is a disruption of normal brain function after a traumatic event. Notice there is nothing about getting hit Continue reading

More Concussions in Practices or Games?

22 May

There was a recent study released that has turned some heads in regards to where all the concussions come from in sports. In this JAMA Pediatrics study appearing at the beginning of the month the investigators have concluded that American football practices were “a major source of concussions” for all three levels of participation studied (youth, high school and collegiate).

Often when we see this type of information released there can be confusion due to the limitation of each individual study. The above data reflects a single sport, football, as compared to other data often cited that deals with all sports. Case in point this National Institute of Health study; which reports “athletes tend to have a higher risk of concussion in competition as compared to practice.”

The discussion topic of where concussion occurs more is not only often debated but it is an important set of data because we can control for one side of this equation, practice.

Reading the JAMA article one might be confused about the conclusions if you were to look only at the data and not have complete context of both the sport and participation. The rate of concussion was extremely higher in competition versus practice yet the majority of overall concussions came from practice. This can be explained by noting that there are far fewer games – thus exposure – and fewer participants in games – thus exposure. The sample set for the data (JAMA) was fairly robust: 118 youth football teams, 96 secondary school football programs and 24 collegiate programs. Ages of athletes exposed were 5 to 23, presenting a very good cross-section of the sport at all levels it is being played at. This information was collected in 2012 and 2013, and the researchers collected over 1,100 concussions over that time frame.

The NIH study breaks down the information for 13 different sports in high school and college only. Their findings Continue reading

Play Smart. Play Hard.

12 May

PSPHlogo

Today the Illinois High School Association (IHSA) launched a national initiative for overall student-athlete safety and participation in sport. It is called Play Smart. Play Hard. 

The campaign will focus on education and equipping athletes, parents, coaches and schools on ways to better safeguard the heath and welfare of student-athletes, including minimizing the risk of head injuries.

The main function of this campaign is to have readily available information and tools for player safety; taking on the current issues/risks as well as being forward-thinking and discussing and formulating plans for other issues that are of concern in sports. At the center of Play Smart. Play Hard. are the resources including a Player Safety Toolkit which is directed at concussions at this time. When going to the Play Smart. Play Hard. page (www.playsmartplayhard.org) in the resource tab you can find all the current Illinois and IHSA concussion information as well as the National Federation of State High School Association (NFHS) and Centers for Disease Control (CDC) concussion info.

Play Smart. Play Hard. may have been trumpeted by the IHSA and Illinois but there are many other state high school association supporters of this innovative approach, 27 to be exact, check the site to see if your state is part of it.

As mentioned on the blog yesterday Continue reading

Concussion = Brain Injury (revisited)

10 May

This post originally appeared in February of 2012, it is a good summation of the minutiae surrounding concussion.

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For years we in the medical community have been struggling with the terms “concussion” and “traumatic brain injury”; is there a difference?  The simple answer is no.  As you have seen on the blog, we use the term interchangeably, however just like anything in life semantics make a difference.  The perception of a “concussion” is that of sports and “not really that big of a deal”, and that would be horribly wrong.

As Broken Brain — Brilliant Mind posts today this injury is to the brain and confusion about semantics need to be cleared in order to gain a firm grasp on the issue at hand;

I’ve been giving a fair amount of thought to concussions over the past couple of years. In the course of my tbi rehab, my neuropsych has referred to my mild tbi’s as “concussions” and oddly, I never really thought of them that way. I’m not sure why I didn’t make the connection. I guess I thought, like so many others, that concussions are not that big of a deal — just a bump on the head. Getting your bell rung. Getting dinged. Big deal, right? Then, when my neuropsych talked about all the concussions I’ve had, the light went on.

My mild traumatic brain injuries were concussions. Concussion sounds a lot less dramatic than TBI, but essentially, it’s the same thing (I won’t go into the distinctions that SUNY-Buffalo Concussion Clinic people make).

By the way if you have not been going to BB–BM you should, as his/her perspective on dealing with brain injury is a massive resource.  Needless to say, whether you use the term “concussion” or “brain injury” the results Continue reading

Fish Oil Revisited

9 May

This post originally appeared on the blog in 2011, not much has changed in this area, it is still not definitively known if this is good, bad or indifferent (probably the latter).  However, this is a supplement that is good for all athletes for a myriad of reasons. I have chosen to post this again because it is one of the most popular and commented on post in the blog history.

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After posting about the “7 Ways To Help With Concussion Management” I realized that I had not posted about the possible benefits of Omega-3 fatty acids/DHA supplements for concussion management.

In a July publication of The Journal of Neurosurgery, Dr. Julian Bailes (BIRI) and Dr. Barry Sears (leading authority on anti-inflammatory nutrition, creator of Zone-Diet) found that supplementing rats with O3/DHA after head injuries reduced the observed issues with a concussion; (SOURCE via weightlosingideas.com)

“Animals receiving the daily fish oil supplement for 30 days post concussion had a greater than 98 percent reduction in brain damage compared with the animals that did not receive the supplement,” Dr. Sears said. “It is hypothesized that the omega-3 fatty acids in the fish oil reduced the neural inflammation induced by the concussion injury.”

O3/DHA has been documented to help with the inflammatory response of the body, many people use this SAFE and AVAILABLE supplement when training to temper swelling.  It is also has shown great promise for the cardiovascular system, mainly heart health.  Further investigation is underway Continue reading

The Fencing Response

9 May

Originally posted January 7, 2011 this was one of the first places to examine and educate people about the Fencing Response, since that time this post has been viewed nearly 50,000 times. This is a great resource.

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The fencing response is an unnatural position of the arms following a concussion. Immediately after moderate forces have been applied to the brainstem, the forearms are held flexed or extended (typically into the air) for a period lasting up to several seconds after the impact. The Fencing Response is often observed during athletic competition involving contact, such as football, hockey, rugby, boxing and martial arts. It is used as an overt indicator of injury force magnitude and midbrain localization to aid in injury identification and classification for events including, but not limited to, on-field and/or bystander observations of sports-related head injuries.

Source: Hosseini, A. H., and J. Lifshitz. Brain Injury Forces of Moderate Magnitude Elicit the Fencing Response. Med. Sci. Sports Exerc., Vol. 41, No. 9, pp. 1687–1697, 2009.

Concussion by Sport (revisited five years later)

8 May

This was another very early post of this blog back in 2010, September to be exact. As you can tell I was very green to the whole linking of articles and writing. However, this is an important article regarding concussion statistics by sport from five years ago. I would be interesting to do a follow-up to this with what we know now. Looking back at my observations have not changed much in the five years, I may move wrestling above cheerleading but that is about all.

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Concussions are not exclusive to American football, although it is the most covered sport as it relates to concussions.  This is a good time to note that in the United States the next most concussive sport, is soccer, the number one sport in the world.

A reasearch project by University of North Carolina reported concussion rates by 100,000 athlete-exposures Continue reading

The Need for Sleep

8 May

This post appeared in the infancy of this blog back in October of 2010, I have made some editorial changes since that time.

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It used to be that doctors would tell you to keep people awake with head injuries.  That has changed, quite a bit.  Keeping someone awake might be indicated for a possible brain bleed, but concussions need the sleep and recovery time.

Sleeping is first. If you’re not sleeping, forget it,” said Cara Camiolo Reddy, the co-director of the UPMC Rehabilitation Institute brain program and the medical adviser to the Sports Medicine concussion program. Sleep is vital in the recovery process because the injured brain needs rest to begin to heal itself. The concussion program and Camiolo prescribe medications, however, only to post-concussion syndrome sufferers who are three weeks or longer into their injury.

This quote was from and article by Chuck Finder of Scrips Howard News Services and appeared on NewsChief.com today.

In the article you will find that this prescription is not widely accepted by the community that deals with concussion management.  However in my experience it is vital to let the brain rest.  When I am debriefing with the athlete and their parents, the most often question I get is “can you sleep too much?”.  My answer is no. Parents often time are apprehensive if they subscribe to the old method of waking every hour, but I try to educate using the snow globe example. If the must wake their child I encourage it at infrequent and few times as possible.

With my experiences at the schools I’ve been an AT at, the kids and parents that abided by the recommendations of sleep and complete brain rest have recovered at a much quicker rate.  The kids and parents that did not listen often times have delayed recovery.

I know that is not a research study in its most proper form, but the observational evidence tells us, and those in the above article that sleep is indeed needed.

Time to Heal: Tracy Yatsko’s Story (3/22/11)

8 May

Last June, I had the pleasure of speaking at a press conference at Lincoln Financial Field in support of Pennsylvania State Representative Tim Briggs’ proposed concussion management legislation.  I was an eighteen-year old who had been researching concussions in sports for nearly ten months at that point—a task that I engaged in to further educate myself and others on the subject at hand; a project that would essentially close many doors in my past that had been left open for too long.  But as I situated myself beside the podium at this press conference, I had no idea what kind of story the young woman sitting to my left had to say.  Of course, throughout my research, I understood that others have been through worse—much worse—than what I had experienced, but never did I think I would meet someone I could relate to.  It was even more than just relating to, for this individual shared a heartbreaking story to the public.  She was at the press conference for the same reason as myself, and that was to promote the need for concussion legislation in our state, but she did more than that.  Her words were more than the cover to a bill.  Her words were the voice of the sports concussion crisis.

Today, Tracy Yatsko, a twenty-three-year old woman from Tamaqua, Pennsylvania, is still fighting the repercussions of an injury that ended her high school athletic career.  Six years removed from the moment of her last concussion, Yatsko represents the qualities of strength and motivation, for her battle has not been one that has been easy.  Sure, I have heard of stories in which athletes have sustained decisively fatal blows to the head.  But when I talk to this woman, and when I think about her story, the only words that I can describe how I have perceived her story is hell on earth.  Why did this situation in which Yatsko found herself within come to be?

2005 was a year, with regards to concussion awareness, that was still present in the sports’ ‘Era of Good Feelings.’  There was not much to worry about, and though there were stories creeping out of the media regarding concussions in football, there was not much of a worry in other athletic activities.  There really wasn’t much consideration as to what a concussion was.  It was merely an injury that was ignorantly summarized as a headache; a distraction; a joke.  And with such stigma comes tides of the familiar phrase that claims pain to be weakness leaving the body.  Only did we, or rather, do we, come to open our eyes to what a concussion is until the moment of a tragedy personally affects ourselves or those who we consider to be close to us. Continue reading

Mouth Guards (5/5/14) — How is this study not retracted?

19 Mar

It has been nearly a year since I wrote this up, but it has been making the rounds again.  I honestly want to know why this “peer-reviewed” article has not been retracted.  This is one of the most blatant oversights I have witnessed in publications, and that is not hyperbole.  Read the following for yourself:

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Is it a bombshell or is it just a plain dud?  I say bombshell, but not in a good way for anyone involved with this “research”.

Last week I was inundated with emails regarding this “new” research about mouth guards and concussions.  There were roughly 16 emails in a one hour time span; some wanting comment, some telling me I have been wrong all along, some promoting the research.  This was a “huge” development in my area and my little corner in the blogosphere.  To fully understand perhaps some history is needed (“mouth gear” search on this blog) when it comes to my feelings on mouth gear and concussions.  Here are some selected comments attributed to me;

The basic fundamentals we should be cognizant of here are: concussion is a BRAIN injury, the BRAIN floats inside skull, Physics dictates that the BRAIN will move depending on the forces applied to the skull/head (not always from a blow to that area), mouth gear cannot stop the BRAIN from moving, mouth gear cannot attenuate any forces to the skull/head that are not in the oral region, mouth gear does nothing for the skull/head when forces are placed on it in rotational, angular, acceleration or deceleration fashion.

Now that we have that all out-of-the-way this is the General Dentistry article I was asked to comment on.  On face value and from a “peer-reviewed” angle itseems all good.  A significant finding between custom mouth gear (noted as LM MG in article) and over the counter “boil and bite” mouth gear (noted as OTC MG).  However once you take a deeper look there are some peculiar problems, in my humble opinion – that comes later.

First, we should look at the possible limitations of this study that seems well populated and well thought out (honestly these were my first concerns before finding the real issue):

  • Were the injuries controlled for by football position? (we have documented this issue here)
  • Were the injuries controlled for by size of players/school they were playing?
  • Were the injuries controlled for by playing time? (more exposure more risk)
  • Were the injuries controlled for by game vs. practice?
  • Were all the injuries seen and recorded by a single MD or was it the ATC at each school?
  • Did any of the players have a previous history of concussion?
  • Was the study controlled based on practice habits of the teams? (do some hit more than others)
  • How do we know that every player complied with the “no wedging or chewing” rule? (this plays a massive role later)
  • The study says that all 412 subjects wore the same exact helmet, I find that: A) hard to believe and B) was the fit on every player the relatively the same?
  • Who funded this research? (no disclosure)

As you can see there is a litany of reasons I would have dismissed this research, if I were peer reviewing because those limitations are extremely real and realistic Continue reading

Borland, Now What?

18 Mar

If you are interested in sports or the brain trauma/concussion debate you probably did not miss the news about Chris Borland’s abrupt retirement from the NFL and the San Francisco 49ers.  In case you missed it, he broke this news to Outside the Lines on ESPN.

Since he made his decision there has been quite the discussion regarding why and what this means in the long-term; not only for football but for the awareness angle of this injury he has cited for his reason for hanging them up.

But what does it really mean, beyond the #hottakes from all over the internet?

When Borland decided it was his time walk away he knew there would be great interest, well had to know.  It has not been the norm to see a 24-year-old to retire due to concerns over long-term effects of repetitive brain trauma.  Most people in his position, now and going forward, are probably more concerned about making a living playing a game they love and a good one at that.  But think about the ripple effect of this news.

First, remember when Jake Locker decided to retire?  Hardly now, I bet.  Or Patrick Willis, from the same 49er team?  A bit more memorable because of his stature, I bet.

But both of those decisions were pale in comparison to the news from Borland, who until he retired I and many hardly knew him outside of very devout followers of the league and team.  The reaction was a combination of mass hysteria and shock with everyone waiting to chime in their opinion.  We saw nothing like that from the other two more “high-profile” players before Borland.  Why was this… Continue reading

Taylor Twellman Story (9/21/2010)

2 Mar

Originally posted on The Concussion Blog in September of 2010.  I would be interested to see Taylor talk about this in a reflecting manner and see if anything has changed with him and his thoughts on concussions in the sport he loves.

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Just ask Taylor Twellman, a soccer player from the New England Revolution how unpredictable they are.  In 2008 near the top of his game and the American leagues he ran full speed into the goal keeper, creating a whiplash effect on his body, most namely the skull.

To this day Twellman has not had a single day without some post-concussive effects.  He was only just recently, June, released to begin light activities.  Granted this is a professional athlete that has a career to think about, his health remains his number one priority.

Monique Walker of Boston.com ran a story about him and his not so quick recovery from concussion.

For our adolescent population this can be even more devastating, a delay in recovery could mean a decline in grades, an emotional disconnect from teammates, and a social decline in school.  All while the brain and personality are still developing.

If you get your “bell-rung” make sure you communicate that with someone who can help.

The World’s First Peer-Review Medical Journal with a Primary Focus on Concussion

12 Dec

Concussion information is moving at a warp speed, it seems, compared to the long history of other medical issues that we face and hear about – cancer, heart disease, diabetes, etc.  In fact, concussion is not an acknowledged speciality of the medical field, yet there are more and more monies and time being devoted to this current issue.

It was only a matter of time before some smart people figured out a way to create a journal dedicated to concussion.

Current Research: Concussion has been published and fits this bill, to a “t”.  This peer-reviewed journal is being published by Canadian publishing house Pulsus Group Inc., who has published other journals such as: Current Research: Internal Medicine, Current Research: Cardiology, Pain Research & Management, Canadian Journal of Gastroenterology & Hepatology, and more.

Full disclosure, I have known about this journal for some time and have been chomping at the bit to let all of you know about this possible resource and place of publication for concussions.  Alas, since I have been included in the publishing (more on this later) I was not allowed to divulge this information until now.

What makes this publication so interesting is not only the emergence of a tailored journal for concussion but that the online content is open access.  Anyone and everyone can read this information; from the usual suspects of academia and research to the mom’s and dad’s who care to garner more evidence-based technical education.

Although the publishing and brain-child of the journal hail from Canada the editorial board is rife with very prominent figures, north and south of the border:  Continue reading

Being From IL, People Want To Know What I Think of Law Suit Against IHSA

8 Dec

Sq 300 JI have been asked by many people what my thoughts are on the first law suit filed against a state high school association in regards to concussion.  With this coming in my “home” state of Illinois, people figured I would have a strong statement or unique perspective.  I have struggled with coming up with exactly what I wanted to say and could not figure out why.  This is in my wheelhouse, commentary on recent and public events; one would think it would have been natural.

Then, I figured out why I couldn’t come up with something…  BECAUSE I ALREADY DID, 29 MONTHS AGO!!!

Almost like I could see into the future.  Below is what I wrote here and sent off to the Illinois High School Association in May of 2012.  Looking back on it I still feel strongly in the proposals and the rationale.  Take a quick look for yourself:

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I have been working on this letter for a little while but was really spurred to action by the parent in Maryland, Tom Hearn who discussed his concerns with the local school board.  I have tried and tried to use the “chain-of-command” with these thoughts and ideas, however at every step I got the feeling I would have to go alone on this, so I have.  This letter may or may not reflect the opinions of my employer, high school, athletic training sanctioning bodies, or others I am involved with.  This letter is from a concerned individual who feels I can spread the message effectively by these means.  I have emailed the letter, proposals and the Sports Legacy Institute Hit Count White Paper to all Executive Directors and Board of Directors of the Illinois High School Association.

OPEN LETTER

May 15, 2012

Illinois High School Association
c/o: Marty Hickman, Executive Director
2175 McGraw Drive
Bloomington, IL 61704-6011
(309) 663-7479 – fax

Dear IHSA – Executive Directors, Board of Directors and Sports Med Advisory Board:

I am writing this letter to address the growing concern of concussions in sports, mainly in football.  It should be noted that football is not the only sport with a concussion issue; however this sport combines the highest participation, highest risk, and highest visibility.  This letter should not be construed as an attack on the sport of football, but rather a way to keep the sport continuing to grow.

As a licensed and practicing Athletic Trainer, researcher, commenter, father, and survivor of too many concussions, I feel that in order to keep the sports we love, proactive steps must be taken.  Often being proactive is a painful process and easily dismissed because of the trouble it will cause.  I urge all involved to think about what the future of all sports will be if nothing is done.

The Illinois State Legislature with the IHSA took the initiative by creating a mechanism of concussion education and awareness in response to the mounting scientific evidence of potential long-term impairments resulting from mishandling of this injury.  However, this only represents a first step in the process; passing out a flyer or having parents and athletes initial that they have read the information is one small element of the issue.  Another crucial element of the issue is coaching. We must ensure that those we entrust with the care and leadership of our children understand Continue reading

Why Can’t We All Just Get Along?

6 Dec

In a time when I truly feel strongly that we should collaborate rather than look down noses’ at other peoples work and words within the concussion realm there seems to be none of that with a recent report from TSN, Canada.  Although I did get a chance to read, I really didn’t have the perspective that, say, a Canadian would.  Insert Terry Ott, who has penned some very interesting articles here, in regards to concussion coverage and information — particularly in Canadian Football — from north of the border.

I believe Mr. Ott presented a very fair summation of the information provided — mainly the Tator quote — via TSN.  It has been very interesting to see how different places handle the concussion issue, from North America to Europe to Australia.  For the most part it mainly has to do with the “biggest #&^!” in the room.  Which is not always the best way to accomplish the same overall goal: tackling the concussion issue — head on!  (see what I did there?)

Remember, “None of us is as smart as all of us.” -Japanese Proverb

Now for Terry

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TSN CANADA REPORT DEMONSTRATES DIFFERENT NORTH/SOUTH CONCUSSION PERSPECTIVES

HAMILTON

Dec. 6. 2014

TERRY OTT

In Canada, The Concussion Blog has come an awfully long way in the past 18 months.

Prior to its ongoing addressing of the concussion crisis in the Canadian Football League the site was definitely for seekers of specificity of brain injury and prevention, but certainly not pertaining to the CFL. Canuck readers were limited.

All of that changed last July when The Concussion Blog broke the story of the first concussion related lawsuit filed in Canada by former CFL player Arland Bruce. The Concussion Blog is now required reading for many interested parties of Canadian football and the northern medical community researching brain injury.

And now, Canadian-based The Sports Network (TSN) which previously had cast a rather jaded TV and radio eye on the Arland Bruce concussion lawsuit now seems to be seriously pursuing the story with a Dec. 3 piece by Continue reading

2014 NFL Concussion Report: Week 12

1 Dec

The Concussion Blog Original, NFL Concussion Report, is a weekly compiling of the reported head injuries in the National Football League (posted when time allows).  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).  You can also view our white paper with original research about concussion reporting in the NFL from 2010-2012 HERE.

Where has this post been?

It has been 11 weeks since this report last was published, a long time.  For those that looked forward to this weekly post, I am sorry, time has not allowed me to be on the ball for weekly information.  However, that does not mean we have not been cataloging the concussions within the NFL.

Lets be honest, the constant concussion information has been almost to a point of overload for many, this includes me.  The weekly contribution on NFL concussions has been “lacking” due to where I have been, so please amuse me while I explain.  When the blog started it was for the dissemination of obscure, yet pertinent, information on concussions.  This included the founding of the NFL Concussion Report (first of its kind) which was, is and will be used for public research.  At times other media outlets have used this report for reference and in a naive manner I think that those that really care and can affect change look in on this from time to time.

With greater coverage from media, social media and the policy changers a lot of my “niche” has been filtered away from me.  I have been in the process of finding another angle/branch of this massive issue to keep people informed.  My biggest contribution going forward will be providing commentary about research and developments in the concussion realm.  I will be continuing to champion original research and testing products that come to the market for further opinion.

In reality I have gone no where, but I have published less.  So that is where this post and I have been.  Thanks for listening, now to the meat of this post.

82

Eighty-two is the number of concussions found in the NFL through 12 weeks of regular season football.  This number is significant.  Not significantly high, rather it continues the trend from last season of having overall lower numbers.  Depending on what color glasses you look through this can be a good thing or a strange thing.

Certainly we would all like to see lower numbers, it would mean some of the changes within the sport at the highest level have been working.  It would be tough to discern which exact method was doing this but less concussions would be a good thing.

However, if you were paying attention you would have noticed that it took 11 weeks (71) for the NFL to surpass the number of concussions found in the five weeks of the preseason (68).  It would be even more peculiar that through 10 weeks of regular season football there were five teams that had not reported a single concussion.

Following that tweet, I noticed something else;

So, two teams had reported a concussion following that first tweet.  And one week later, in week 12, Tampa Bay and New York Jets reported a concussion.  That only leaves Atlanta as the only team without a regular season concussion.

It’s because of these little nuggets of information and coincidence that one could possibly be jaded about the concussion reporting numbers.  There are other anecdotal tales of players being removed for concussion protocol and then returning to the field that also fuel this fire.  However, the later is not something that “bothers” me, in fact, it is a good thing, in my humble opinion.

The number “82” represents the lowest concussion total the past five years to this point in the season, by 20 or slightly over 25%.

Trends

Even with lower numbers there are trends that continue to hold, as seen in the past four years.  The most Continue reading

NFHS Develops Concussion Guidelines for Football

13 Nov

In what has been a long time coming the National Federation of State High School Associations (NFHS) has released the long-awaited guidelines from their concussion summit in July.  The NFHS is basically the governing body that most, if not all, states look to when implementing rule changes in sports, policies for participation and for sports medicine advice/guidelines.  Many states do not act, even with good information, with out the NFHS “seal of approval”.

This has been evidenced in the past when it comes to concussion “mitigation”, in terms of undue risk – contact limitations.  There have been many states that have not waited for the NFHS (California, Arizona, Wisconsin come to mind) while there are others that sat on their hands regarding this topic.  Regardless of where your state is/was it now has some guidelines to follow when it comes to the controversial topic of impact exposure.

Before I post the full press release from the NFHS, I would like to highlight the recommendations from the 2014 NFHS Recommendations and Guidelines for Minimizing Head Impact;

  • “Live” and “Thud” are considered full-contact
    • I really like that there is a clear definition
  • Full-contact should be allowed in no more than 2-3 practices a week; 30 min a day and between 60-90 minutes a week.  Only glossed over was the fact that theNFHS strongly suggests that there should not be consecutive days of full-contact.
    • A great place to start, although there are a vast majority of programs, around here, that do not do more than 2-3 times a week.
    • The time limits are great.
    • Unaddressed is the specific back-to-back days of games to practice.  For example a Monday game and Tuesday full-contact practice.  Sure common sense should prevail, but there will be plenty of loophole finding on this issue.
  • Recognition of preseason practices needing more contact time to develop skills.
    • Obviously a sign that these guidelines are taking everything into consideration.
  • During 2-a-days only one session should be contact.
    • THANK YOU!
  • Review of total quarters played for each player
    • This has been one of my biggest points of contention with any concussion policy.  The risk for injury during a game is much higher and kids that play multiple levels have an exponentially higher risk.
    • Although nothing more was stated than above, this should get people talking and moving.  The issue, of course, will be monitoring this.  Regardless, the fact that this important point is included is a massive thumbs up!
  • Considerations for contact limits outside of traditional fall football season
    • Acknowledging the ever-growing practice of off-season practices.
  • Implementing a coach education program
    • Ideal for understanding all of this and the issues we face.
  • Education of current state laws and school policies (if schools don’t have one they should)
    • Putting pressure on the institutions to take some onus.
  • Emergency Action Plans (EAP) and Athletic Trainers should be utilized
    • AT’s should be at both games and practices.
    • EAP’s should be in place and the best person for taking care of an EAP is an AT.
    • The first “governing” body that has firmly suggested the use of athletic trainers for football at all levels in practice and games.  This is truly noteworthy, and appreciated.

Auspiciously omitted from this document was USA Football’s “Heads Up” tackling program.  They referenced the USA Football definitions of level of contact and coaching courses; but never mention the embattled “Heads Up” program.  I must say, my confidence in the NFHS has skyrocketed after reading this, and a lot has to do with the people on the task force.  I am looking squarely at: Mark Lahr, Tory Lindley, Steve McInerney and John Parsons.  Those gentleman are of the highest quality and character when it comes to athlete safety.

Here is the full press release…  Continue reading

This Is Unacceptable, In My Humble Opinion

24 Oct

Yesterday I wrote about concussions and the difference between professionals and adolescents using Jamaal Charles as an example.  What happened last night on the professional field with millions watching was completely unacceptable, professional athlete not withstanding.

Late in the third quarter of the game, last night, San Diego’s defensive back Jahleel Addae (#37) ran into a pile to finish the tackle on the Denver running back.  He was running at full speed and led with his left shoulder, but as he made contact with the RB his head dropped and he also made (incidental) helmet to helmet contact with the runner.  This type of collision is very frequent and looked innocuous…  Until you saw the after math…

Addae was bounced back, still on his feet, and began “short circuiting” for the national audience to see.  He begins to look around, kind of, and stumble, kind of, and lose full control of his extremities, all of them.  As a medical professional and athletic trainer I would have documented this OBJECTIVE finding as “unsteadiness and disorientation”.  It looked like a boxer/MMA fighter catching a fist/kick in the face late in a boxing match; the type of reaction that any referee in those sports would stop a match for and award a TKO to the other guy.

It happens from time to time in this and other sports, that is not the issue here.  The issue is that Addae returned to the game (oh, it gets worse).  Here is the tweet from last night (h/t to Brady Phelps’ Vine);

https://twitter.com/concussionblog/status/525487638481235968

From what I can piece together this play was the last of the 3rd quarter and reports had him taking the field on the first play of the 4th quarter.  HE DIDN’T MISS A SINGLE SNAP!  Even with the long commercial break between quarters there is a maximum of 4 minutes, but if my DVR time was correct it was between 2 and 3 minutes.  This is not nearly enough time for a full concussion evaluation, by anyone.

“Maybe he was screened, like you said yesterday, Fink.”

There was absolutely no reason for a cursory “screen” in this situation, Addae showed a clear and overt sign of neurological impairment, in concussion recognition jargon: a sign.  When any player shows a sign there is no screen it means Continue reading

Jamaal Charles; No Different Then Vast Majority of Competitive Athletes

23 Oct

Last week when the Chiefs played the Chargers running back Jamaal Charles scored a touchdown and was blasted in the end zone by Brandon Flowers.  A shot that Charles bounced up from and headed to the sideline while Flowers was slow to get to his feet.  The hit was helmet to face mask and the resulting forces were a classic case of what is typically needed to produce a concussion for one or both of the players.  Whether or not it actually did, we will never “officially know.”

The issue is not with the hit or the fact that Charles apparently cleared the screening done on the sideline after such a hit, the issue is with his comments a few days after on the Dan Le Batard show;

“It definitely hurt,” Charles said. “A couple plays later, I just [saw] this light buzz around my eyes and I was trying to catch ’em. But I was like, ‘Let’s get the ball and run again.'”

I am 100% confident that Head Athletic Trainer Rick Burkholder did his job on Sunday – screening Charles after the hit – it was evidenced on Tuesday/Wednesday when Burkholder placed Charles in the protocol as a precaution solely due to the comments Charles made.

Why you may ask?  Simple, by the absolute letter of the definition of concussion – disruption of normal brain function following a traumatic event – Charles admitted he was “not normal”.

Whether or not Charles had a concussion is up for debate among many people, not only externally – us blogging/media type – but likely internally – Charles and med staff.  Here in lies the problem with concussions and the issue of concussions.

As we tried to explain in the University of Michigan post, concussion is most often a subjective injury, we as medical professionals rely upon the athlete or injured to tell us what is going on.  If there are no overt or outward signs (loss of consciousness, wobbliness, gaze, vomiting, etc.) then all we can do is screen the athletes.  And by screening I mean simply asking the athlete if they are OK.

GAMING THE SYSTEM

I heard Mark Schlereth on Mike and Mike this morning saying something to the effect of; “there has to be more than just asking the player if they are ‘OK’?”.  The truth of the matter is that there is not really anything other than that; although just asking one question is not due diligence.  In my experience I ask more questions and even try to trick athletes into giving up any ruse they are trying to pull on me.  I have a to questions and line of questioning that has produced many responses that then warranted them to be fully examined with a sideline evaluation, even for the best “liars” (I won’t share them here because it can be used for people to study and then find a way around it).

The more complex yet simple reason we as athletic trainers feel confident with screening, even with limited questions, is that we know the athlete.  Their usual demeanor, behavior and general presentation.  People often ask me how long it takes me to know if someone has a concussion.  When they are my players, the ones I am around on a daily basis, usually it takes me Continue reading

Terry Ott: Concussion Coverage from Canadian Media is Woefully Lacking

22 Oct

The original purpose of The Concussion Blog was – and still is – to inform those that choose to look about concussions.  Part of this goal has been looking deeper into issues and “lip service” given to the brain injury we know as concussions.  In 2010, when the blog began, this was a novel idea and much of what was written here was “breaking news”.  Along with that, opinions that I shared on the issue were meant to be coming from someone with vast and dynamic experience in concussions.  The initial thought was this was to be a “clearinghouse” for concussion information – and it succeeded.  As years have passed and the media here in the United States has slowly caught on and passed along, mostly, the correct messages TCB has been slower.  However, that does not preclude us from posting information/opinion that we feel needs noticed.  Examples of this have been our white paper on NFL Concussions, the mouth gear controversy and general editorials on published research.

In the past year TCB has been lucky enough to have a journalist spend his own time investigating a part of the global concussion story, in Canada.  Terry Ott, as you may have noticed many of his articles here on the blog.  To be clear, this was all his work and I have become his one and only outlet for his sleuthing and writing.  As he can attest to I don’t always agree with his tact or his tone, but his information is important, especially because in Canada there seems to be a void in the information that would be important to most.  We here at TCB are glad to file his reports as long as he and others understand this is a conduit for discussion and discovery.  I have zero intention of “killing a sport” or “getting someone in trouble”, rather shedding light on some of the problems and issues we face when dealing with concussions.

All of that being said I present to you Ott’s latest (hopefully last here because someone in Canada needs to pick him up) on the concussion issue as it relates to the Great White North.

==========

WHEN IT COMES TO FOOTBALL CONCUSSIONS, CANADIAN MEDIA BADLY OFFSIDE

Recent New York Times Article Throws Flag

Hamilton, Ontario

October 22, 2014

For the past year readers of The Concussion Blog have learned about the nascent football concussion awareness movement going on in the Great White North, mostly pertaining to how the Canadian Football League, and the mainstream media, have handled-for lack of a better word-the issue.

Years behind the National Football League on the matter, the CFL nonetheless saw the first concussion-related lawsuit come its way last July, accompanied by media attention, much of which was a critical and sometimes downright hostile questioning and smack-down of former 2013  CFL’er Bruce’s groundbreaking statement of claim against the nine member teams of the CFL, neurosurgeon Dr. Charles Tator, Tator associate Leo Ezerins, and several other parties.

The lawsuit, among other things, alleges that the CFL member teams, and specifically some of Dr. Tator’s published research on TBI and CTE-partly funded by the CFL-mislead Mr. Bruce into believing he was not vulnerable to serious and long-term consequences from concussions he received while playing for the BC Lions. None of the allegations have been proven in court and Tator has filed a defense-covered here previously-that asks for the suit against him to be dismissed, with costs.

Yet other than one small article on former 80s era CFL player Phil Colwell, whose brief story and concussion-related problems appeared in his hometown KW Record paper in Ontario, last spring, your correspondent has been unable to place a single word in any other publication in Canada.

If it were not for Andrew Bucholtz of the Yahoo! Canada CFL 55 yard Line Blog sometimes linking to my stories here, few outside of the Concussion Blog’s sphere ever would have known about what did, and what continues to go on in Canada regarding football concussions and especially, their aftermath. Besides a small mention in the Vancouver Sun by journalist Mike Beamish when the Bruce story hit, no one in Canada besides Bucholtz saw the story as important enough to follow-up, and he has done fine work on his own regarding the concussion problem. As of now, I don’t believe Andrew is on many CFL General Manager or team PR weasel Christmas card lists.  (TSN, the CFL’s television carrier did do a piece on their website about the lawsuit in September that mentioned The Concussion Blog, but it was subsequently removed from their archive shortly after my last story for this site last month, and for reasons so far presumed, but actually unknown at this time to this writer. And I have not seen another story in the Canadian media on the lawsuit since.)

And a week ago, after reading in the Winnipeg Free Press a flattering tome on Dr. Tator from last July that appeared just before he was named as a defendant in the Bruce lawsuit, your correspondent reached out to the paper inquiring whether they would entertain a slightly different take on Tator’s research and related concussion issues via an Op-Ed.

However, after being ping-ponged back and forth between editors at the paper, I was told by an Op-Ed editor that the concussion issue was not “topical,” despite the Jevon Belcher CTE story breaking that week and despite the fact that Winnipeg is home to a CFL franchise. But rather, I was informed,  “Ebola” was of more import to their readers than what is essentially a real world and serious public health concern right now that surely can not be adequately explained by just one or two opinions, opinions which are even controversial within the medical and research community.

Likewise a kiss-off from my hometown CBC News website, whose editor, after some initial back and forth, just stopped responding to my e-mails and never published a piece I wrote on concussions in July even though it partly concerned the former Hamilton Tiger Cat, Phil Colwell.

TVO, the Canadian version of PBS, runs a show called The Agenda-and hell, the guy that hosts it has Hamilton roots!-that never met a contentious or important issue it did not glom on to and yet after receiving one return e-mail from a producer back in July commenting on my “unique” insights, I never heard another word.

Even the nice gal who runs TVO’s documentary film division, after initially offering to ask around if any of the filmmakers she had association with would be interested in the concussion story, none of my further e-mails were answered.

And, after being shut-out by nearly every institution purporting to be doing valid research into football concussions in Canada, I endured a recent 6 week runaround afforded me by the University of Western Ontario in London, Ont. which is supposed to be “partnering” with the Canadian version of the Sports Legacy Institute, but certainly did not do much for their reputation for cooperation with journalists trying to ask valid questions.
So after over a month of BS and excuses, I got nadda from them. I actually felt bad for the PR lady who drew the short stick to deal with me, and then she just stopped responding altogether.
To say that some of my dealings with the Canadian media and medical academia would be a joke, would only serve to denigrate comedy.

So obviously, the question is, why?

A veteran of the sports medicine community in Canada speaking on condition of anonymity said that many in the medical community were “afraid” of upsetting Dr. Tator, who carries much weight in medical academia and research grants around these parts.

The source said that many in the closed community are “buzzing” about Tator  being named in the Bruce lawsuit but do not want to be featured in any story seeming to critique the doctor the TSN story described as “renown.”

However, the New York Times apparently does not have a problem featuring a different Canadian medical professional who, unlike Dr. Tator, does not believe CTE  from football concussions is still open for (serious) debate.  Continue reading

Weighing in on Michigan Situation

1 Oct

If you follow college football or listen to sports radio there is a good chance that you have been exposed to the story of Michigan quarterback, Shane Morris, and the apparent failure to keep him from the field after sustaining a head injury.  The official story from the University is that it was a communication error.

Believe it or not, that could be exactly correct.  Now, were there some possible missteps along the way by ALL involved, yes.  Is there one single person or policy in place that is to blame, no.  I offer some perspective before everyone eviscerates their choice of target in this case, lets take a look at how this could have went sideways.

The Player

Morris was roughed up a bit as the game progressed; he is a sophomore QB that was just elevated to the starting position on a premiere football program.  Certainly he displayed some orthopedic distress as he was limping heavily after a play – how many times have we seen players play through ankle/knee/leg/foot injuries and some times even celebrated for doing so.  Morris was playing through pain trying to help his team, but what happened next need not happen; however the player himself has a lot to do with how it will and did go down.

After Morris was hit in the head he attempted to get up and was obviously unsteady on his feet, he even waved off the medical team.  I have been told by a good source that he even told the sidelines it was his ankle that was the issue, not his head.  Which is entirely plausible, but due to the mechanism of the previous play would be unlikely the main reason for his wobbliness.

Athletic trainers as medical professionals are not omnipotent but we sure are close (ha) when it comes to injuries on the field/court of play.  We do rely upon input from other human beings to make quick and decisive decisions.  Doing so, in some instances, can end up creating a delay in proper treatment as it did in this case.  Morris’ insistence that he was ‘OK’ immediately after the hit was taken for face value in that very short period of time.  Considering the confluence of all the other factors for player safety – his ankle, his immediate response to the sideline, his demeanor – he was not ripped from the field.  To be honest here, I have never seen a coach, teammate, athletic trainer or other – in the college or professional ranks – step on a field to remove a player that got up and “shook it off”; usually it takes the player going down and staying down for that to happen, if he/she does not leave the field under their own volition.  Because of this, it is on the player to make sure they are seeking the proper care for their own well-being.

After the next play, Morris was removed for evaluation of his injuries.  Part of that evaluation included his head and the team Continue reading

The Journal of Law, Medicine and Ethics Issue Worth Bookmarking

24 Sep

Twitter is such a wonderful thing!  You can get so much information is such a short time; sure there is a ton of unsolicited information that one may have to weed through, but the benefits outweigh the bad – at least for us here at The Concussion Blog.

Such an instance was getting a tweet at me about a journal and a particular issue.  The Journal of Law, Medicine and Ethics, Volume 42:3 to be exact.  In this volume all of the pages are filled with concussion related issues, after all it was titled: Concussion and Sports.

I cannot speak to the “prestige” or “reach” of this particular journal, however I can post the link here (above) for you to bookmark for some reading on where the tone of med-legal is going in relations to concussion and sport.

Topics include:

  • Youth Concussion Laws
  • Requiring receipt of concussion related materials (a study)
  • Coach Support
  • Informed Consent

At the link you can download, free, the journal and its articles.  It might be worth some time to investigate and look into what we may be facing.

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