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Sylvia Mackey – Video

27 Mar

In a follow-up, and what I believe to be the same presentation that Elanor Profetto’s video is from a very strong and wonderful woman, Sylvia Mackey, “Mrs. 88″ gives a talk about brain injury.  She also has intimate and troubling experience with what brain injury/disease can do as she took care of the great John Mackey in is twilight.

Keep on learning and listening!

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Eleanor Perfetto, PhD – Video

26 Mar

Been on a video binge lately…  Look for more, but for today please take a listen to Eleanor Perfetto.  There are some points that some may (including me) not agree with entirely, but she has earned the right to be heard!  Not only is she a pharmaceutical epidemiologist, she is the widow of Ralph Wenzel.

Look for more video tomorrow…

A Decent Video

24 Mar

I am finding it hard to find time to post, obviously, but I will get back to this as soon as I can.  For the time being here is a decent video I have had forwarded to me that can be a good example of concussion or mTBI…

I would love to see discussion on this, below!

TCB Commenter Highlighted in Canadian Press

18 Mar

If you visit here enough and take the time to look at the comments at the end of the posts you might notice a person named “Phil”.  He especially took time to comment on the work of Terry Ott and his seven-part series about CTE in the CFL.  Thanks to Terry and this blog we are all able to get the genuine views of a former player in the CFL, Phil Colwell, via The Record from Canada and Terry Ott;

Colwell’s brief CFL career ended in 1981 after a violent on-field collision in a game at Winnipeg Stadium. He was playing for the Toronto Argonauts on that crisp and sunny day in October.

Covering a kickoff, Colwell, a solid six-two, 195-pounder with sprinter speed, was blindsided through the ear hole of his helmet by a Winnipeg player and was knocked out cold. He lay motionless on the field while a trainer ran to his assistance. No penalty was called on the play.

This is the type of story that Ott has sent out to tell from the beginning, placing faces and human behind the issue that has become one of the preeminent problems with football.  Yes, this is not isolated to football but we would be remiss if we didn’t expose and tell the stories of the most oft afflicted in the “head games” we now find ourselves knee-deep in;

Colwell, who graduated from Laurier with a psychology degree, found work with a Scottish government agency but continued to suffer bouts of depression and mood swings. He says accompanying anger issues and self-medicating led to moderate bouts of short-term or primary memory loss. Colwell says he frequently “loses the right words.”

The Scottish doctors he consulted were not familiar with professional football Continue reading

This is Interesting. Share Your Thoughts

6 Mar

I just saw this on Twitter from @NSAFitness, Time to Re-think the Zürich Guidelines? appearing as an editorial in the Clinical Journal of Sports Medicine March, 2014 issue.

I can think of many reasons to re-think Zurich; the two biggest is no inclusion of return-to-learn/work and the obvious lack of coalition in concussions.  It may be a “consensus” but really its a compromise, AT BEST.  Here are some excerpts;

The problems with the guidelines include a lack of diagnostic specificity, management strategies that are not evidence based, and rehabilitation goals that are not attainable. Given these problems, the Zürich Guidelines cannot be endorsed.

Don’t know why we have to be more specific, rather more global would make sense: ANY DISRUPTION OF NORMAL BRAIN FUNCTION AFTER AN UNNATURAL TRAUMATIC FORCE IS APPLIED TO THE PATIENT, would fit just fine.  I will defend the non-evidence based management strategies; how can they be evidence based if we are just now getting to this part of the puzzle (SPOILER ALERT: the concussion problem is due to the Continue reading

Nick Mercer: Recovery is in the Eye of the Beholder

26 Feb

For those new to the blog, Nick Mercer is our only “staff” writer here at The Concussion Blog.  He provides a great layman’s perspective; one from a person recovering from a traumatic brain injury.  If you want to know why he does this – for us and himself – you can read THIS POST.  Thanks Nick for your time and content!

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In recent years, my “recovery” (more on why that word is in quotes later) seems to have gained steam and I’ve noticed more improvement, even though the accident that caused my brain injury occurred over ten years ago. I’m sure there are many physiological and neurological reasons why improvements would take this long, then again, maybe I haven’t improved that much neurologically or physiologically, maybe I just feel better in general and in my attitude toward “recovery”.

For the first nine or so years, I was focusing on trying to fix problems – I wasn’t able to do this or that, I was tired, my vision was messed up – problems that no matter how much I tried to fix, I could always improve upon, so I was reaching for a goal that couldn’t be touched. That kept me going, kept me striving. It also put me in a permanent state of dissatisfaction. There were times, of course, when I was depressed, but there were also times when I was happy. Happy, but dissatisfied.

All the while, I was pushing myself physically, in the pool, the gym, walking to and from work. I was also pushing myself mentally, through work, and through reading a lot, especially non-fiction books. My sister had told me for years that I should try Pilates, that she thought it would be good for me. I always had some excuse Continue reading

Repost: Matt Chaney’s Take on Heads Up Football

21 Feb

The following was posted here on TCB 10/24/13, I feel with the traffic it has been garnering that it should be reposted at the top of the cue for the time being.  It is worth comment and questions…

The post below is from Matt Chaney’s Blog, re-posted (in part) here with his permission.  We are posting it here not as an endorsement, rather as an opposing view that is worth the read.  Our commentary on this article by Chaney will be below this post.  We encourage everyone to see the entire post on his blog.  You can view it by clicking on the hotlink, it is titled; ‘Heads Up Football’: Truth, Tales and Legal Consequences.  *Chaney has moved his blog and we are efforting the current link of his original article.  However, he does read the comments from time to time so if you have question leave it here and he may get to it.

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By Matt Chaney

Posted Wednesday, October 23, 2013

Peter King posits bogus hitting technique as Safer Football in Sports Illustrated

—geezuz, the further we go in this latest football crisis, the worse many people become, willingly, on behalf of the sexy blood sport… and so Peter King of SI skips along, telling us bona fide prevention is possible for football’s irreversible head-ramming… a new post by the Hall of Fame football scribe portrays Heads Up ‘proper contact’ as legitimate; King purports this theoretical headless hitting can be instilled by coaches, enforced by referees, adopted by players… I’d like to see King demonstrate on a football field, suited-up himself for forward collisions governed by physics and bullet-head helmets; he’d ram, too, or get his ass kicked… look, folks, players cannot govern or stop ramming on a football field; rather, forces of the crazy game dictate human behavior… forget talk and trust your eyesight, especially naïve parents and kids, to understand Heads Up ‘technique’ is invalid, unreliable, a lienothing new: it’s mere rehash of musty old ‘head up’ form hitting, proven invalid since the 1960s… here’s King, introducing his discussion:

What’s been eye-opening to discover is the trickle-down effect from the NFL to youth football. As the pro league emphasizes safety more and more, so do high schools around America. … Coaches are concerned; 41 of 49 polled [by SI] said they have modified training techniques because of increased education about concussions and head trauma.

—sure, trickle-down effect will reform football danger, once again… solution for brain trauma in the collision game is just around the corner… like trickle-down ‘steroid awareness’ for football’s immense problem with anabolic substances…  King continues:

Several high school coaches emphasized the NFL teaching new tackling techniques, such as “Heads Up Football,” which teaches coaches to train kids to tackle with heads up—instead of using the helmet as a battering ram. Said Middlebury Union (Vt.) coach Dennis Smith: “In any drills we’re doing—whether it be fundamental drills at the beginning of practices, especially defensive practices—we’re always stressing head up. You have to be able to see what you’re tackling.” … Said Brandon (Miss.) coach Brad Peterson: “We always start the year, whether spring or fall, with walking through the proper techniques of tackling.” … The coach of E.O. Smith High in Storrs, Conn., Jody Minotti, said he knows he can’t prevent every concussion, but he trains his players to minimize the risks. “We do less contact throughout the week and we teach proper tackling,” said Minotti. “We preach in practice all of the time, ‘Bite the ball. Bite the ball.’ That means keep your head up and don’t ever lead with your helmet. We film tackling, we talk about tackling whenever we’re watching film.”

—huh, these coaches don’t address the facemask dilemma, the prime fault of football rules behind the charade of Continue reading

Where is Tech Going With Concussions

7 Feb

Technology is ever-expanding in all areas of our life; in my short time we have gone from land line phones and massive desktop computers that could play “Lemonade Stand” to handheld personal computers that is also a phone.  The point being that technology is amazing.  In the previous post we discussed how MRI now can actually see damage to the white matter in the brain after concussion.  Until that information was presented the changes in the brain were only theorized about.

Yes, it is true that we are trying to find an objective measure, but people need to understand that this objective measure is not necessarily needed to find the concussion.  An athletic trainer with their years of education and experience are pretty dang good at finding concussions; with or without the help of “tools.”  The need for objective measures is for the TRUE PROBLEM of the “concussion crisis”; the mismanagement of the injury – mainly returning too early.

Conrad Wilson wrote up a good article on technology that is emerging, focusing on balance Continue reading

Research That Should Stop You In Your Tracks

6 Feb

OK, that title may be hyperbole, but the new research out of Canada should make you take a step back and realize what our fine researchers are now able to discover.  Considering the context of hockey it shouldn’t be shocking that this was found in Canada (since posting we have been informed that work was done on both sides of the border), but really for a long while now some of the best work on concussions is coming from the North, for whatever reason (no disrespect to the US scientists).

Now that I effectively pissed off a few readers with the last comment, here is what was found by Dr. Paul Echlin and team:

  • concussions alter the white matter of the brain
  • structural damage can now be seen
  • MRI was used
  • this is both males and females
  • brain vascular changes were noted in males only, but resolved at two months
  • comparison with control counterparts showed that concussed individuals had white mater changes at end of season (upon being fully resolved from injury)

From the CTV News article (video at jump);  Continue reading

2013 End of Season NFL Concussion Report

31 Jan

The Concussion Blog Original, NFL Concussion Report, is a weekly compiling of the reported head injuries in the National Football League.  Concussions are added to the list each week from multiple sources to give you the reader a picture of what is happening on the field.  Each week we will bring you the information along with relevant statistics.  If we have missed a concussion or put one on here erroneously, let us know (we will also be using Fink’s Rule to classify a concussion/head injury).  It also should be noted that due to the league not disclosing actual injuries until Friday night there may be some added to next weeks numbers.

It has been weeks since you have seen us post about the concussion numbers in the NFL.  A quick explanation; at the end of the year with trouble finding Week 17 numbers we search for a few days, then we sit on numbers and cross check with sources which takes time.  Finally going through and I.D.ing other factors like helmets and new parameters takes some time.  It also helps that the past few years the NFL waits until Super Bowl Week to release their numbers.

Let us first opine about the released NFL numbers via NY Times;

In the preseason and the regular season, players sustained 228 concussions, down from 261 in 2012, when concussions rose 4 percent compared with the previous year. Helmet-to-helmet contact caused almost half the concussions this season, down from 53 percent in 2012. But more concussions occurred when players hit their heads against an opposing player’s knee or the ground.

The whole number for the season is only nine off from what we collected here.  Which tells me that what we are doing is as accurate as you can find anywhere outside of the NFL (actual players notwithstanding).  But where were the missed nine?  I happen to think its a combination of preseason and Week 17.  So, we are happy with our collection system.

The 13% drop is both accurate and inaccurate in our estimation.  Hows that you ask?  In the regular season Continue reading

#C4CT Concussion Summit: 2014 Edition – Live Blog

29 Jan

And so it begins from the United Nations here in New York City.  Check-in has begun, and everyone is arriving; the Brewer Sports staff is feverishly working to make things go as smooth as possible (looking at you Kristi, Lindsay and PJ).  As evidenced by this being posted you can see that the wi-fi is working (at least here in the reception area) and I am ready to blog away.

Throughout the day this post will be updated by me with a time stamp and pertinent information.  The most recent information will be at the bottom of the post.  So, click on the “Continue Reading” and scroll down, enjoy! Continue reading

Interesting .pdf Making Rounds Now – Addendum

16 Jan

AFCA pdfI was tipped off by a fellow athletic trainer in a state where this .pdf (click first link below) is being circulated around.  I find it interesting in the wake of the American Football Coaches Association meeting that this is being titled the way it is.

Concussions in Football is how it is titled on the info packet, but the subject line that my source received was “Our Game is Under Attack”.

ARE YOU SERIOUS?

First, let me say I have read it – three times – and find nothing wrong about what is being presented.  Even with the opening HUGE FONT reason/opinion Dr. Sandra Bond Chapman has for continuing playing youth football.  I respect that opinion and cases can be made for such a strong statement, in fact it is lore at this time.

But to claim the sport itself is under attack because some may be looking beyond the lore of benefits is a bit much, in my opinion.  I have explained many a time here on the blog that what I see it as – and my reason for presenting information – is to keep the game around.  The game is not under attack because of concussions, if the game was under attack it is because of the way it handles injuries – namely concussions – and the possible ramifications.  The document is correct in stating not all brain injury is permanent, yet we don’t have any long-term data (solid longitudinal) on the effects of this sport or others that are collision based outside of boxing.

I honestly believe that if every sport coach, parent or kid looked at this document and Continue reading

How Do We Know If Anything Is Working at NCAA Level?

14 Jan

In the NFL we have publicly disclosed injuries, including concussions, so we can (and have) track the numbers that are reported to see if there is a change in outcomes.  Certainly there are flaws with the reporting system as we have discussed many times but at least we can get a set of consistent numbers (we hope) from year to year.

But what about the NCAA, where there are many more players: 126 FBS teams at about 80 players per team means 10,080 players in FBS alone.  Or, about 8,387 more football players than the NFL – this number does not include FCS, DII, DIII or even the NAIA or Juco football schools.

Timothy Bella of Al Jazeera America (I guess the NSA has my IP address now and yours too if you go to links, ha) has produced a great article on this problem of tracking concussions at the NCAA level;

For this college football season, America Tonight has been tracking all the publicly reported concussions in the 10 FBS conferences and the independent teams. Auburn was one of 42 FBS programs to not publicly report a single concussion this season, accounting for exactly one-third of the 126 FBS programs. The group includes Rose Bowl and Big Ten champion Michigan State and Big 12 champion Baylor.

In fact, in the 10 conferences and the independents, coaching staffs and media outlets only reported 192 concussions at all among more than 10,000 players, according to data compiled from early August 2013 to Dec. 27, 2013, in the America Tonight Concussion Map. That’s an average of fewer than two reported concussions per team.

That number is STRIKINGLY low – due to reasons outlined in article – but 192 concussions is less than the 217 concussions we found in the NFL from preseason through the end of the regular season.

I provided many thoughts to Bella about why this may be occurring, including the teams with higher press presence Continue reading

The OTL Investigation on ‘Heads Up’ Football

14 Jan

It may have slipped some of your reading or viewing, but ESPN’s Outside the Lines did a piece on the USA Football Heads Up Program.  The article and video were presented last Sunday morning – I cannot find a YouTube version of the OTL show but you can find that part HERE.  The seven minute presentation is great for a quick overview of the issues ESPN has found.

For more in-depth coverage you should read the article by Steve Fainaru and Mark Fainaru-Wada, the same authors that penned League of Denial.  There are some wonderful points brought to light by the Fainaru’s;

The program teaches concussion awareness and proper helmet fitting, but its central tenet is the soon-to-be trademarked Heads Up Tackling program. When executed properly, proponents say, Heads Up Tackling literally takes the head out of the game. Players are taught to keep their heads up and lead with their shoulders when tackling.

[...]

But critics view Heads Up as a cynical marketing ploy — a repackaging of old terminology to reassure parents at a time the sport is confronting a widening health crisis.

There is a reason I have been “relatively” quiet on this topic; it’s because they are doing some very good things in the way of education and helmet fitting.  As you may know I am huge on the topic of awareness when it comes to concussions.  I have stated many times that the injury itself is not the “ice burg we can see above the water” rather it’s the mismanagement of the concussion that is the massive ice chunk we cannot see from the surface.

That being said, with the actual tackling technique being taught I too feel this is a repackaging of an old mantra.  Rules were even put in place as early as the 70′s to accomplish this task of taking the head out of the game.  Face tackling, spearing and butt blocking all have been on the books as penalties to help avoid using the head as a weapon.

The problem being that those are not called very often, when they are called they are inconsistent at best, and what has it done for the game over nearly 40 years?  I am not nearly as critical as others;  Continue reading

#C4CT Concussion Summit 2014

7 Jan

In a little over three weeks, Brewer Sports International (BSI) along with #C4CT (Coalition for Concussion Treatment) founding partner Amarantus BioScience will be hosting their 2nd Concussion Summit in New York, at the United Nations.  There have been many press releases on this event, and I have mentioned it a time or two on Twitter (and will continue).

Sure, there are many “summits” around concussions and head trauma – which is great as it keeps the dialog going – but few are populated by people with ideas on going forward.  Often, we find ourselves sitting, listening to bright people talk about what was done and can’t be done; rarely do we find the same bright people addressing the issues going forward.  Whether that be with tactical changes or with management or even the possibility of intervention with traumatic brain injury.

This edition of the #C4CT Summit on January 29, 2014 will hear from some people in many fields – you can see the current line-up HERE – focusing on the burgeoning topics of chronic traumatic encephalopathy (CTE), general neuroscience, pharmacology among other topics.

Interestingly enough, yours truly, was invited to sit on a panel and discuss how all of this information has been translated to the high school level – as an athletic trainer.  I was not only surprised by the invitation but feel it is VERY OPPORTUNISTIC for a “boot on the ground” athletic trainer to provide input.  I feel that not only have athletic trainers seemed to be seen and not heard, the vast majority of us practice in the high school setting, where the adolescents are playing sports.  I can assure you I will do my very best to be a quality representative of not only athletic training (it appears I am on the only AT in a speaking role) but those of us working with the most kids/athletes.

Anyhow the cast of speakers/presenters is indeed “star-studded” and even has some opposing view points on where we should be headed; which should make for some quality discussion.  If I can get my technology working and to NYC I will attempt to live blog/tweet the event for those that cannot make it.

Speaking of that, I know that time is short but I encourage anyone who is going to be in NYC during Super Bowl Week try to attend this event.  If there are scribes out there I am sure the wonderful support staff at BSI can arrange for you to cover and meet the star of the show – me, of course – hahahahaha, I kid.  Seriously, you can register HERE and if you have questions feel free to contact them.

I hope to see you all there!

2013 Week 16 NFL Concussion Report

27 Dec

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).  It also should be noted that due to the league not disclosing actual injuries until Friday night there may be some added to next weeks numbers.

This is the last set of numbers I feel most confident about, as you will recall this coming week has proven to be difficult at best when finding concussions in the NFL.  Rather than boring you in this post with the reasons please click on the link above for that information.

In Week 16 there were only 13 concussions found, I say “only” because it seemed to Twitter, broadcasts and me, there were more players that exhibited something on the field that warranted further investigation.  The skeptic in me is also screaming at me to say that playoff eligible teams – especially those that have not clinched – are “gaming” they injury system.  To be fair, concussions are not the only injury being messed around in the “grey area”.  As I said that is the skeptic in me, the recent weeks have placed some better faith in the reporting system this season.

Something must be done to address – at the least acknowledge what we have found – the massive back-end of the season concussions we continue to see on a yearly basis.  The numbers cannot be easily washed away with the narrative that all teams are playing (versus bye weeks) as we have exposed.  It is very stark, the difference: weeks 1-9 there were 67 concussions in weeks 10-16 there have been 92.  When the NFL talks of expanding the schedule to 18 games I fear we will see an even bigger increase in the back half of the season.  There is a possible solution (more of a band-aid) though: two bye weeks.  It will expand the season further, but I don’t think the NFL really minds, in fact I think that is the overall goal.

Further observations of the numbers show the perpetual story of defensive backs being concussed most often.  As of this report the DB’s make up 26% of all concussions (41), the next closes it tight ends at 14% (22).  In fact, running backs (17), wide receivers (21), offensive lineman (21), linebackers (16) and TE’s are somewhat equal.  Even the defensive lineman are close to that grouping with 13.  Making all positions on the field outside of quarterbacks, DB’s and P/K somewhat equal in terms of the injury.

While we would like to see as few as possible, if concussions were equal across all positions (outside of QB, P/K) it would show that the injury is becoming a random incident.  Which is really the best case possible.  However, its not and the DB’s continue to be the most at risk players on the field, yet they also have some of the most restrictive tackling rules in place.

Now let us look at the Week 16 report (previous weeks numbers): Continue reading

The Abyss of NFL Concussion Reporting: Week 17

27 Dec

As football fans we are either gearing up to root on our favorite teams for a playoff and hopeful Super Bowl run, or the other 20 fan bases time is now spent looking at coaching changes, player acquisitions and the draft.  It has been a fun and exciting season for various reasons.  In terms of concussion data collection it will complete our fourth year and it has been a success once again.

However Week 17 provides for some of the hardest data capturing possible for the NFL.

During the season when teams play the following week they must report injuries and then they are listed on the NFL Official Injury Report prior to the game being played.  This mechanism, even with its overt flaws, is the launching point for our data.  With the regular season ending there are only eight teams that must report injuries the following week, effectively eliminating 3/4′s of the league.

This where you the reader can come in – and I am once again doing my yearly begging – if you note a concussion via a broadcast or twitter or the interwebs, please pass it along to us.  Although @nflconcussions does a tremendous job, he too probably welcomes the help.

So here is your homework for Week 17:

  • Watch games and enjoy games – root on your interests
  • If a concussion is noted send it via Twitter (@concussionblog) or email (theconcussionblog.comcast.net) in this format:
    • Player, Team, link/credit/notes
    • EX: Joe Schmoe, NYG, broadcast 3Q
    • EX: Joe Schmoe, KC, @examplehandlehere *link*
    • EX: @concussionblog RT: @examplehandlehere ……
  • I welcome any questions regarding the concussions during the games, but unless I catch it on RedZone or you have a video link I will be unable to answer to specifically.

Think of this as “OUR” project for the end of the NFL season, crowd sourcing style!

Thanks in advance.

Interesting Take On Tackling

26 Dec

I have been fortunate to be in some great email “groups” with information that surrounds the playing of sports.  Of course I have been attracted to concussion and those ancillary problems surrounding the brain injury.  It not only furthers, the some time outrageous, fodder but it also provides some critical thinking.

Matt Chaney has been doing a great job of circulating information – mainly about football – and from time to time I get some links that I feel would be best shared for “group thought process”.  A quick aside: Chaney’s blog has been removed from cyberspace due to some confounding issues on the user end, but he will dredge up his information in the coming weeks and re-launch his blog.  Back to the post…

Here is how Chaney describes this forthcoming link:

–super piece by a very interesting writer, an outstanding athlete-scribe, Doug Brown in Canada, former CFL D-lineman… he nails NFL rule-making as lousy lipstick on the pig… great points on the folly of ‘proper form’ or Heads Up or ‘safe tackling’ especially in the head-on avenues of football contact, or the ‘allies’ on-field, as Brown refers…. the tunnel effect of forward contact… though I don’t see any wall-in by other players as necessary for a head-on collision; it’s all about angles of intersecting opponents, and all you need are two principals incoming, ballcarrier and tackler, each with his mission…. boom!…. Doug Brown

I share his sentiments on the article, it brings to light some of the things we CANNOT get rid of in current football.  But does that make the game “unsafe”?  That is the penultimate question; further if it is a problem how can it even be solved?

Here is an excerpt from Doug Brown’s article that appeared in the Winnipeg Free Press;

When an offensive and defensive player meet in an alley, the options for tackling from an angle, or putting your head to the side of the ball carrier are absent. Instinct and self preservation in football tells a ball carrier to lower his head and shoulder pads when he anticipates a collision. Hitting a ball carrier above Continue reading

TCB Mail Bag

26 Dec

I trust everyone has had a wonderful Christmas experience (or Hanukkah or Kwanzaa or going to have a good Boxing Day), with that I would like to wish everyone continued successes in whatever endeavor they choose.  Over the Holiday I have received many an email regarding concussions; apparently the down time has given people opportunity to share frustrations or good news.

Today I am bringing you a specific case in which we all can learn from.  At the least we can read this and prepare for similar situations that may arise – whether as a parent, doctor, coach or athletic trainer.  

As always you can write in and with your permission I will re-post anything you would like (and it may suit the audience).  It can be attributed to you or anonymously.  Keep it between 500-2000 words and omit any personal identifying factors if it involves patient care or sensitive information.

Here is our post today – by Anonymous:

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Obviously today is Christmas Eve and in most regions of the country kids are not in school for at least the next two weeks. Maybe less, maybe more. All in all it is a great time to rest up that brain and recharge your body. As athletic trainers we also know that sports do not stop for the holidays. For the most part at least. If you remember last year I read an op-ed article that you put on your blog titled “Parental Decisions Can Undercut Good Concussion Laws” or something of that nature. Well, it’s happened again (as it has many times between that time and now but this one is a little more ridiculous than the last) and I’m nauseous!

To be as brief as I can on this without boring you this is the case of a female soccer player who sustained a nasal fracture as well as a concussion when fighting for a header in the air with an opposing player almost a month ago. To be clear, she actually suffered a deviated septum. Anyway, after our AT did a beautiful job of getting this athlete “entered” into our concussion protocol (which Mom still couldn’t get over the fact that she indeed had a concussion; whoda’ thunk it, right?) we all sat in our physician’s office (Mom, AT, myself, physician, athlete) and witnessed the concussion as well as the nasal issue being addressed. The athlete was clearly concussed (clinical exam, balance assessment, and symptom reporting were all abnormal but ImPACT scores remained at baseline) and the athlete was sent for an MRI and referred to an ENT for further evaluation of the nasal issue. Pretty simple. These folks were given the “red carpet” treatment as all of our athletes/parents are and everyone left happy. The consensus was to see the ENT and address that issue then to follow back up with our physician for the resumption of the concussion issue. The athlete ended up having surgery about a week later. She was out for about a week after that. The ENT cleared her to resume play and actually said that there was no concussion. Wow! OK!

Fast forward to last week during exams and the athlete did not follow-up with the AT during exams like she was instructed to do. She THEN shows up to a game on Saturday with a face shield and tries to plead her case to enter the game. The AT did her job and did not allow the athlete to play. Mom was irate. Athlete conceded. Coach was with the AT. So athlete did not go through the GRTP process and as of today the mother refuses to follow-up with our physician for final clearance after all of the objective information is noted. She is choosing to Continue reading

ABC’s ‘This Week’: Football’s Concussion Crisis

24 Dec

First I want to lead this off by saying it is not a “crisis” just for the NFL, or football, this is an issue for everyone.  Once again this provides me the opportunity to say; the injury of concussion is not the problem/elephant in the room, rather it is the mismanagement of those injuries that have created this problems we are facing.

This video is from YouTube and I was tipped off by Dave Pear to its existence.

It is 11 minutes in length but there are some good sound bites in it.  If you can wade your way through the minutia you will see that the repeating issue is what I have stated above.  Basically doing nothing to fix the real problem.

2013 Week 15 NFL Concussion Report

20 Dec

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).  It also should be noted that due to the league not disclosing actual injuries until Friday night there may be some added to next weeks numbers.

There were three “firsts” this past week in the NFL Concussion Report, one of them had never occurred before in our data collection.  In the incident where Cincinnati punter Kevin Huber was demolished by Terence Garvin (fined $25k) our very first P/K was logged as a concussion.  I know, you wont see Huber’s name with “concussion” or “head” on the Official Injury Report from the NFL but this case is a classic instance of Fink’s Rule being put into effect (second “first”);

when there is a diagnosed fracture of the face and jaw (excluding the nasal bone) the forces absorbed during the injury will be beyond a threshold to elicit a concussive episode.  This would indicate to the clinician that the person should ALSO be evaluated for a concussion.

Alternate definition: when the terms “jaw injury”, “head contusion” , or “concussion-like symptoms” are present in an injury report one should be aware that forces were elicited to the head, and an assessment for a concussion should be indicated.

If you recall Huber spent the hours after the game getting his jaw wired shut and discovering he had a neck fracture.  Although there is no confirmation of a concussion from the league, team or player at this point, we will include in our data set, like we have done in previous seasons for other players.  It’s very difficult to imagine, while watching that train wreck, that Huber did not experience any brain trauma.

The third “first” of the week came just yesterday as we received news that Andrew Whitworth – another CIN Bengal – was concussed in practice.  Looking back on records for this year, this is the first concussion that occurred in practice this season.  It is important to note this, as previous seasons have had more concussions in practice.  It would make sense that the CBA rules of decreased contact days have really helped (2 – 2012, 5 – 2011).

Another notable number is: 200.  That is the total number of concussions we have logged since the opening of training camp.  In 2010 there was 172 concussions found from training camp through the playoffs, in 2011 there was 225 and in 2012 we found 237.  As you can see the overall number seems to be trending back to what we have seen the past few years.  Regular season numbers appear to be down by a factor of one week, again a very good reason to catalog the data and see the overall picture.

In hopes of not burying the lede here; for those interested in the comparison of weeks 1-3 and 13-15 – weeks in which every team was playing – and the effect of late season “wear and tear” on the brain here you go: 21 vs. 44.  Further, in the first nine weeks there was 67 concussions in the next six we have seen 79 concussions.  It seems pretty obvious to me that there is a cumulative effect here.

Quick reminder, Continue reading

Terry Ott: CFL Follies

19 Dec

If you recall a few weeks ago I posted a request for some help for a journalist, Terry Ott of Canada.  It was simple, if anyone who reads this is a former Canadian Football (CFL) player or knows a former CFL’er, could they contact Mr. Ott for a story he is doing on concussions in that subset of professional football.  The good news was that people responded, albeit a small number, it was more than he was able to find doing his journalistic thing.  It made me happy that this blog could help out someone looking for information, because that is why it occupies a space.  But…………..

In the post below, that Mr. Ott wrote, you will see that by using this blog it may have stonewalled any help from the CFL, its Players’ Association or the Alumni Association.  Mr. Ott titled this post “CFL Follies” and I cannot think of a better title for what you are about to read.

Without further ado, Mr. Ott;

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I’d imagine that most reading this Blog will have heard of League of Denial.

But, I doubt you have heard of League of Non Denial, Denial.

Because after three months of dodge-ball dealing with the CFL about the concussion issue past, present and future, I was, after some initial boiler-plate information given in October, told today that my follow-up questions were “loaded” and would not be addressed by the CFL. (The questions are at the bottom of this post, and you can make up your own mind if they were “loaded,” or not.)

In addition, the CFLPA will no longer respond to my Continue reading

2013 Week 14 NFL Concussion Report – UPDATED

13 Dec

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).  It also should be noted that due to the league not disclosing actual injuries until Friday night there may be some added to next weeks numbers.

UPDATED 16:57 CST – Nate Solder, OL, NE added

67 versus 65 66.

Once I explain those numbers some of you will be dumbfounded and even shocked.  If you have been here long enough, that comparison will make a lot of sense to you.

In the regular season weeks 1-9 there were a total of 67 concussions found.  Over a nine week span there was an average of 7.44 concussions found per week.  In weeks 10-14 – FIVE WEEKS – there have been 65 66 concussions found and average of 13.o 13.2 concussions found per week.  Almost a double of the numbers.

Before you go blaming the bye weeks on this discrepancy, make sure you note that there were three weeks in the beginning of the season when no teams had byes, and in the most recent five-week sample there has been only two.  Breaking down to just the week in which every team was playing the numbers are even more stark;

Weeks 1-3:  21 for an average of 7.0/week

Weeks 13-15 (WE ARE NOW IN WEEK 15, still awaiting those numbers): 30 31 for an average of 15.0 15.5/week an absolute doubling of concussions in the later part of the season.

Before everyone goes off and screams to the hills about a problem, there isn’t a problem.  This is normal for the NFL and normal according to published studies.  This is also a theory of the Sports Legacy Institute that seems to be playing out.  The idea of a ‘hit count’ for the brain.  A theoretical threshold the brain has before the ‘subconcussive hits’ become concussive episodes.  In simple terms the hits that were not producing a concussion for a player in weeks 1-3 are now producing the injury in weeks 13 and beyond.  The theory goes that the brain protection system (whatever that is) has weakened due to the repetitive nature of their profession and the brain is therein more vulnerable.

For further discussion I will now produce the Weeks 1-3 vs. Weeks 13-15 from 2010 to today (Key = total/per week vs. total/per week):

  • 2010: 21/7.0 vs. 30/10.0
  • 2011: 26/8.67 vs. 34/11.33
  • 2012: 30/10.0 vs. 35/11.67
  • 2013: 21/7.0 vs. 30+/???

By statistics alone one can see that concussions increase as the season wares on, this is not reason to panic, rather a point where we can try to figure something out.  This is the primary reason for this Continue reading

#tbt Post: AAN Concussion Guidelines

12 Dec

This “throwback Thursday” thing is kinda cool for a guy that has a ton of stuff on this site that new people may have missed.  With that I will attempt to drudge up some “oldies-but-goodies” for you the audience.  I am certain I will re-read some of this and laugh at myself or have changed in the way of thinking but I will leave it as it was originally printed.

This week’s #tbt post comes from March of this year (original LINK – you can go there if you want to see original comments).

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Here is the presser for the updated AAN Sports Concussion Guidelines; their guidelines are simple and to the point, via YouTube;

  • No Grading System of concussion
  • 10 day rest period – “key” – Dr. Jeffrey Kutcher
  • Greater risk if you have had a concussion
  • Addressing of youth and recovery
  • Helmets are not the full answer
  • Licensed Health Care Providers should be clearing
  • Repetitive head injuries are bad
  • The discovery and annotation of “Chronic Cognitive Impairment”
  • No single test, CLINICAL assessment
  • “Kids are not little adults.” – Dr. Christopher Giza

Here is the LINK to the Updated Guidelines (can someone give me permission to post it here?)

Here is the LINK to the Sports Concussion Toolkit from AAN

Here is the LINK to the Concussion Quick Check from AAN

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What does this mean in comparison to the Zurich Statement?  That is a great question; Continue reading

Hot And Heavy Monday

9 Dec

With Rob Gonkowski and Wes Welker injuries there is a ton a debate today on the interwebs about concussions and other injuries in the NFL.  I figured I would link up some information that would help with the background and even further thinking for the topic de jour.  It would also help if you read my editorial on Everyone Pumping Their Brakes.

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1st for posterity sake, here is the current NFL Concussion Protocol, found at the NFL Players Association website.  It is worth reviewing and I am sure the NFLPA is monitoring this closely.

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2nd is a link to Concussion Myths from Nationwide Children’s.  Although aimed at youth participants and parents, these myths are very prevalent all the way up to the professional ranks.  One would assume that it should not be predicated there, but alas it is.  Read this and pass it along to all that you know concerned about concussions.

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3rd is a link to some very interesting research about ACL injuries.  It seems the authors are thinking that cognitively impaired individuals (females in this research), may be predisposed to ACL injuries.  I just came across this but it makes logical sense to me.  Here is why; part of a concussive episode the brain can be effected in a way that impairs your spatial awareness and reaction time.  This research could be a waterfall for expected injuries and recovery as well.

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4th is a MMQ article on ACL injuries in the NFL.  There have been 50 thus far this year, an all-time high, but only half are due to contact.  Perhaps the above link may be more poignant after reading this and putting your thinking cap on…

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