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Series from the Pittsburgh Post Gazette on CTE

16 May

Mark Roth of the Pittsburgh Post-Gaette put together an informational series on chronic traumatic encephalopathy; “a brain disease that afflicts athletes”.

In the first part that came out this past Sunday, Roth took a look at the global perception of CTE through the examples of Chris Henry and the possible case of still living Fred McNeill;

Chris Henry was a fleet wide receiver for the Cincinnati Bengals. During his five seasons with the team, he developed a reputation as a talented athlete on the field but a bad boy off it, even though those who knew him well say he was typically quiet and respectful. [...]

Fred McNeill played 12 seasons for the Minnesota Vikings in the ’70s and ’80s. After retiring, he finished law school and became a successful attorney in Minneapolis, helping to win major class-action lawsuits.

Henry would end up dead after an accident that was predicated with some unusual actions by him, McNeill now has full-time care takers as dementia has stripped him of everything he worked hard for.

Roth begins the second piece with those that can be easily called the experts in this area, Bennet Omalu and Ann McKee; Continue reading →

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Downplaying brain injury is not the way to attack this

6 May

Concussions have gained so much attention that the news is almost inundated with story-after-story of occurrences, recovery, litigation and people trying to mitigate the injury.  There seems to be a shortage of press clipping and stories on how to handle this injury.  More often I have witnessed stories downplaying the injury or the oft cited “Heads Up Football“.

The former, downplaying the injury itself, is not a good thing it is exactly what put us in the spot we are in now.  Patrick Hruby also took note of this while reading an article from Andrew Wagaman in the Missourian;

Still, when it comes to the single most head-scratching public statement I’ve seen regarding brain trauma and football, University of Missouri neuropsychologist Thomas Martin takes the pole position. Hands-down. In a piece about youth football and cognitive risks published this week in the Columbia Missourian, Martin compares brain damage to … knee injuries[...]

This blew my mind. I had to read it twice. And then a half-dozen more times. It still blows my mind as I’m typing this. Here’s why people react differently to brain and knee injuries, and why football is in a world of potential trouble: because the potential harm resulting from a brain injury is nothing like that resulting from a knee injury.

If you read Hruby’s article you will see he makes a strong case for this analogy being utterly false; Continue reading →

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A Chuckle and Video

10 Apr

I really don’t have much for this quote found in this article;

“I have a theory on concussions,” he said. “I think the reason there’s so much more of them — obviously the impact and the size of the equipment and the size of the player — but there’s another factor: everyone wears helmets, and under your skull when you have a helmet on, there’s a heat issue.

“Everyone sweats a lot more, the brain swells. The brain is closer to the skull. Think about it. Does it make sense? Common sense?” said Carlyle, who said he’d never talked to a doctor about his premise, which he was introduced to by Jim Pappin, the former Leaf who also played his career helmet free.

“I don’t know if it’s true, but that would be my theory. Heat expands and cold contracts. The brain is like a muscle, it’s pumping, it swells, it’s a lot closer to the outside of the skull.”

Stick to coaching hockey, eh!

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The ESPN article and video (click link or below) regarding the NFL Concussion Litigation; Continue reading →

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ESPN OTL Article Sparking Quite A Debate

8 Apr

On the surface this article may be innocuous to many, but the the minutia of concussion research and information is coming to a head very quickly, especially pertaining to the NFL.  Tomorrow is the first hearings in front of the judge – and the possibility of total dismissal - for the concussion law suits filed by thousands of former NFL players.

ESPN and its Outside the Lines department (in conjunction with Frontline) filed this article taking a look at two of the most prominent people in the concussion research/awareness arena, Dr. Robert Cantu and Chris Nowinski;

Two prominent concussion researchers — including a senior adviser to the NFL — served as paid consultants to law firms suing the league for allegedly concealing the link between football and brain damage, according to interviews and documents obtained by “Outside the Lines” and “Frontline.”

The article written by Steve Fainaru and Mark Fainaru-Wada sheds light on the very issues the research community faces with this problem.  Some of this information can be classified as “not new” to people who participate in the constantly shifting arena of litigation and research, while some information can be deemed as scathing.  There is a very tight and ubiquitous line in this matter;

Researchers often are asked to appear as expert witnesses in legal proceedings related to their fields. The NFL suit, with the potential for billions of dollars in damages, has created a large demand for researchers with expertise in the science of concussions.

But some researchers said they have turned down such requests despite the potentially lucrative payoff out of concern the perceived conflict could compromise their research.

Conflict of interest (COI) is something we all need to pay attention to, although it applies to this current article, the COI in this field is rampant and often unchecked.  This is nothing new, players have talked about COI, other journalists have noted it, and one of our prominent commentators (Dr. Don Brady) on the site has even devoted some of his dissertation to COI.

It would seem this is nothing “new” in the world Continue reading →

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Latest Research on Concussions; Rather No Concussions = Changes

7 Mar

Certainly the research is flying in; mostly the investigations are now looking at either ways to detect the injury or objective ways to determine recovery.  There are a bunch of other designs and angles out there but the most important are the above.  Although it would be great if we had an objective way of determining concussion, it is really not the pressing issue (with solid education and conservative approach to injury – sit them out).

As I have stated over and over, the BIGGEST issue we face with concussions is the mismanagement of concussion from the beginning; therefore the need to identify when it is safe to return is more paramount in my opinion.

The newest research is out from the Cleveland Clinic, it looked at 67 college football players, more specifically it looked at their blood, report from WKYC;

In a study of 67 college football players, researchers found that the more hits to the head a player absorbed, the higher the levels of a particular brain protein that’s known to leak into the bloodstream after a head injury.

Even though none of the football players in the study suffered a concussion during the season, four of them showed signs of an autoimmune response that has been associated with brain disorders.

There we go again, telling and showing people that the hits that don’t elicit a concussive response are also a culprit in the brain injury crisis we are facing.  Coaches, particularly in soccer and football, will tell us that we are wrong and that it is either unproven or not a possibility because of how “safe” they practice or the equipment they have.

Back to the research, the group looked for the S100B protein that should only be in the brain;

Typically, S100B is found only in the brain; finding S100B in the blood indicates damage to the blood-brain barrier. While the exact function of S100B is not known, it is used in many countries to diagnose mild traumatic brain injury when other typical signs or symptoms are absent.

Studies in Janigro’s lab revealed that once in the bloodstream, S100B is seen by the immune system as a foreign invader, triggering an autoimmune response that releases auto-antibodies against S100B. Those antibodies then seep back into the brain through the damaged blood-brain barrier, attacking brain tissue and leading to long-term brain damage.

They also did some PET scans to Continue reading →

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Athletic Trainer Removed from Post for Standing Ground on Concussions

1 Mar

This is one heck of a way to start out National Athletic Trainer Month…

Paul Welliver, a name that should be remembered and learned about.  Welliver is a certified athletic trainer in Maryland and was until a few weeks ago the athletic trainer at Winters Mill High School.  The only one the school has ever known; being outsourced from Maryland SportsCare & Rehab.  The admin at the High School asked his employer to have him no longer provide service for them.  Welliver (at time of post) has not been fired from Maryland SportsCare & Rehab.

Why, you ask?

Because this athletic trainer stood up for what he believed and knows about concussions.  Unfortunately, this scene is all to familiar with us high school athletic trainers.  The story is from Carroll County Times;

The Carroll County Public Schools Supervisor of Athletics Jim Rodriguez and Winters Mill High School Principal Eric King told Welliver’s boss at Maryland SportsCare & Rehab that they did not want him to continue his position at Winters Mill, according to Welliver. After 10 years as the school’s athletic trainer, his last day was Feb. 12. [...]

Welliver said on four different occasions in the last 18 months, he refused to begin the protocol that is meant to gradually release student-athletes back into sports participation after a concussion. The protocol, also known as Return to Play, is supposed to begin once a student-athlete returns a medical clearance form after their injury has been classified as a concussion.

In this school district they have a pretty solid concussion policy and protocol  highlighted in the story, however when the one person – and last line of defense for the student-athlete – stands up for the protection of the children he is summarily dismissed;

He said the athletic trainer has to sign off on a student-athlete’s return to full contact and competition following a diagnosed concussion.

Welliver’s refusal to start the protocol all four times was because he was concerned about the safety of the student-athletes, he said. He is worried about their short- and long-term health, he said.

“There are times when I do not believe they should return to the sport,” Welliver said. “It is not safe.” [...]

“I treat all those athletes like they are my children,” he said. “Sometimes I spend more time with other people’s children than my own.”

He is exactly correct!  As if he had to really explain it to people who should not be part of the process he did for the article;

“I take into account many factors, including the number and severity of previous injuries and the age and grade of the student,” he wrote on Facebook. “It would be much easier to go along with the pressure of returning the student A.S.A.P., but I have seen way too many poor outcomes after multiple head injuries.” [...]

In addition to his decision to keep student-athletes from playing their sport after a concussion based on age, grade and the severity and number of previous concussions they have experienced, he also takes into consideration the sport or sports the athlete would return to. Their return could take longer if they play high-collision sports.

Shockingly, the school district and those that put the separation is motion had no comment.

Welliver did and does it right based on all accounts, the man – athletic trainer – father Continue reading →

Quick Hits on a Cold Thursday

31 Jan

American Medical Society of  Sports Medicine Position Statement…

I had seen this but caught it again in a below article, the AMSSM released its position statement on concussions recently.  Most of those involved in writing this were in Zurich last November and this comes out about two months before the consensus statement is released in the British Journal of Medicine.  (pssssst – it is also going to have a release in Australia, in conjunction with the AFL Concussion Conference and first round of games and I am still looking for a sponsor)

I found one piece of this position statement very encouraging and made me smile for all the hard work others have done;

Return to Class

* Students will require cognitive rest and may require academic accommodations such as reduced workload and extended time for tests while recovering from concussion.

The rest of the statement is not really “Earth shattering” but there are interesting points in there;

* In sports with similar playing rules, the reported incidence of concussion is higher in females than males.

* Certain sports, positions, and individual playing styles have a greater risk of concussion.

* Youth athletes may have a more prolonged recovery and are more susceptible to a concussion accompanied by a catastrophic injury.

* Balance disturbance is a specific indicator of concussion but is not very sensitive. Balance testing on the sideline may be substantially different than baseline tests because of differences in shoe/cleat type or surface, use of ankle tape or braces, or the presence of other lower extremity injury.

* Most concussions can be managed appropriately without the use of neuropsychological testing.

* There is increasing concern that head impact exposure and recurrent concussions contribute to long-term neurological sequelae.

* Some studies have suggested an association between prior concussions and chronic cognitive dysfunction. Large-scale, epidemiological studies are needed to more clearly define risk factors and causation of any long-term neurological impairment.

* Primary prevention of some injuries may be possible with modification and enforcement of the rules and fair play.

* Helmets, both hard (football, lacrosse, and hockey), and soft (soccer, rugby), are best suited to prevent impact injuries (fracture, bleeding, laceration, etc) but have not been shown to reduce the incidence and severity of concussions.

* There is no current evidence that mouth guards can reduce the severity of or prevent concussions.

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X-Games, D on coverage…

Anyone catch the X-Games this past weekend?  Action sports are on the rise and the X-Games Continue reading →

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UCLA Tau PET Study

23 Jan

If you paid attention yesterday you saw that a very preliminary study was unveiled about identification of tau proteins in the brain.  This is significant on two fronts

  1. up until now this has been non-existent with current imaging technology
  2. tau is the #1 culprit in chronic traumatic encephalopathy

If, in fact, this PET scan can find and map out the tau in living brains this would be a “watershed” moment in the treatment of CTE.  This would be because we have not been able to treat CTE, the only way to find CTE is via a posthumous examination.

I believe this is very exciting, but remember like all things in life, caution is needed – the study was only five former NFL’ers and to fully confirm the information gathered the researchers could be waiting a long time, hopefully.

A quick side note here, Dr. Bennett Omalu is a co-author on this study, which isn’t ironic as some have suggested, rather a product of his good work in this area.  For those in the “know” surrounding research in concussions and CTE finds this part of the story – Omalu – “interesting”.

What a great start, and I am willing to be scanned if anyone wants to pass that along!  I would even write a blog about my experiences with it.

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Concussions 201

23 Jan

The Concussion Blog, has for years, presented you with the basics of concussions and other issues surrounding this particular brain injury.  Most of it was factual information/research that I opined about.  Others were original information that was seen here first.  Regardless our aim – and continues to be – is to keep everyone aware and educated about this topic.

I was passed along a great article on concussions, it was beyond the “basics” but not so in-depth that you get lost in the mumbojumbo;

In other words, concussions are not caused by a brain doing back flips within the skull. In fact, miniscule amounts of movement might be to blame.

The article was written in response to the Stevan Ridley “Fencing Response” producing injury this past weekend and Dave Siebert colored this situation perfectly; Continue reading →

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Claiming Ignorance No Longer Allowed for Parents says Doctor

16 Jan

Thanks to the good – and tireless – work of Matt Chaney I get sent plenty of emails about the happenings on the concussion front from a media perspective (stories and whatnot).  A lot of them have vast information, but for a while I thought they were all reaches and looking to “grab the headline” to get readers.  Sure, there have been plenty I have posted on here, but what is becoming concerning is the amount of pubs I get, not only from Chaney, but others that are starting to tell the story of major issues.

We all know and should have known that concussions were going to be a concern for all sports, but the tide is shifting against the most popular sport we have in ‘Merica.  It is a fundamental problem we must wrap our collective heads around if we want to enjoy football and all sports for that matter.

One such article that caught my attention is centered around parents no longer having the ability to be naive about the sports we and our kids play.  With all the information out there parents no longer have the ability to claim ignorance about concussions;

Dr. Joseph Ciacci loves football, but he fears it. He can’t get enough of the game he prevents his son from playing.

He is in the business of repairing brains. He has seen too much to maintain neutrality.

“The more you know about the issue, the more you think about the issue, the less inclined you are to take a chance,” the UCSD neurosurgeon said. “Because you can’t claim ignorance.”

It’s one thing, Ciacci says, to enter a mine field inadvertently, but quite another to do so when you recognize the risks. Ciacci has had an intimate understanding of those risks since 1977, when his own football career ended with a severe spine injury sustained while covering a high school kickoff.

Amid an avalanche of disturbing new data and harrowing case histories, Ciacci is trying to steer his older son toward water polo.

When you read the above article note how Tim Sullivan did excellent work by interviewing the family in 2011 and 2012 about the same subject.  Although this story is from May, it gives good perspective about the thoughts many of us are dealing with.

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Possible Biomarker? Possible Definitive Imaging?

27 Nov

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

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

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

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

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

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

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

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

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

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

Ding, ding, ding!

16 Nov

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

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

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NFL Makes Case For No Indpendent Neuro

15 Nov

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

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

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

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

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What Is Going On In Arizona?

30 Oct

I only lead the story that way because this past weekend there have been two “interesting” situations involving potential concussions of football players, with ‘Arizona’ on the jersey.

Yesterday I posted about Matt Scott, University of Arizona QB (Dan Diamond also has a follow-up to his story here) and today after Monday Night Football Larry Fitzgerald of the Arizona Cardinals is under the microscope.  I too was watching and was mystified at the handling of the situation.  Watching on television you could clearly see a mechanism of injury that would predispose a player to a head injury, then as he rose to his feet – to this highly trained observer – he appeared gazed and “not all there”.  Apparently I was not the only one to see it that way;

When he got up from the field picking grass out of his facemask and looking woozy, there were fewer questions about whether it was a dirty play by Brown—it wasn’t—than how much time Fitzgerald would miss due to a possible concussion.[...] Continue reading →

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Concussion Trending Stories

24 Oct

This morning I looked for the trending stories on concussions and the top three are as follows.

Concussions Bring More Scrutiny in Youth Football

  • Naturally this is stemming from the Pop Warner fallout; the game that resulted in five concussions and discipline against the adults that were coaching the game.
  • It brings up the debate of should kids that young be playing collision football.

As evidence mounts that repetitive head injuries can have a cumulative effect, and leagues at all levels take steps to improve player safety, parents said games where one team is physically overmatched should be stopped right away. Football is tough enough when the sides are fair, some parents said.

  • Massive size and skill advantages not with standing is it really a good idea to have our 5-12 year old’s go out there and be put in a situation where head trauma is not only present, but likely?

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Dale Jr. Cleared to Return

  • I have been sort of quiet on this particular concussion; mainly because I feel it was handled correctly.
  • If you follow racing sports you will notice that concussions are relatively low for the amounts of accidents that occur on a track at high-speed.  A couple of theories on that, one and most importantly Continue reading →

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Pop Warner Game Results In Discipline

22 Oct

On September 15th there was a Pop Warner football game for 10-12 year-old’s; it did not end so well for the Tantasqua team, getting drubbed 52-0.  However, that was not the only story line of the game.  Evidently five players suffered a concussion is this ONE game, which resulted in discipline;

The five children missed various numbers of school days because of their injuries, and one has not returned to the field.

The coaches, Southbridge’s Scott Lazo and Tantasqua’s Erik Iller, were suspended for the remainder of the season and placed on probation through the 2013 season after a lengthy hearing Thursday conducted by Central Mass. Pop Warner.

The association presidents, Lazo’s brother, Doug Lazo of Southbridge, and Iller’s wife, Jen Iller of Tantasqua, also were placed on probation through the 2013 season because they attended the game and failed to take action, according to the hearing committee.

In addition, Continue reading →

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There Needs To Be More Of This

17 Oct

In Minnesota they are taking strides to get to the bottom of the issue of concussions, and frankly why more are not doing this is strange.  Why not gather the most data possible;

For the first time, solid numbers are being collected in Minnesota on how concussions really affect high school athletes.

The Minnesota Department of Health is tracking concussions at 42 high schools. Through the first seven weeks of the fall sports season, 373 student athletes have been diagnosed with a concussion.  According to one expert, the number seems to be on par with previous years.  This study is now providing a number for the issue.

The study reveals how many kids are getting hurt and how long the injuries are keeping them out of sports and out of school.  The medical professionals tracking student concussion in Minnesota don’t want the numbers to scare parents into pulling their kids out of sports, but rather make them aware of the symptoms and consequences.

Hey here is a bright idea; National Athletic Trainers Association why don’t you create a reporting platform similar to what is being done in Minnesota?  I would say state high school associations could do the same thing but AD’s and coaches are already bombarded by plenty of other things.

To grasp the total issue you must grasp the total problem; although unlikely perhaps concussions are not nearly the issue that some are making it?  Why not find out?

Someone get it done, and if needed I can collect the data; just need some resources and backing.

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James Harrison A Head Trauma Spokesperson?

17 Oct

James Harrison, the oft criticized football player – rather punisher – of the Pittsburgh Steelers has now found time to make comments regarding safety of players brains.  I will admit that this tact is much more productive than blaming “soft” rules for his repeat offenses of the illegal hitting rules.  I suppose he would be a very good “test subject” for a new product that may provide protection of the head;

After enduring what he estimated as “double digit” bouts with concussion-like symptoms throughout his decade-long career, Harrison began using a special layer of padding inside his helmet last fall and is pleased with the results.

“I haven’t seen any spots or had any blackouts,” Harrison said Tuesday.

Although the article and the statements from Harrison seem more like an advertisement, it is clear and important to remember that the CRT technology does not and will not prevent concussions.  Interior padding is something helmet companies have been working on over the years; it is the place on this piece of equipment where changes can have an impact – rather reducing impact.

Before everyone runs out to get the CRT technology, which in my opinion has real and definite helpful qualities for its other uses, we need to remember that concussions are mainly a result of Continue reading →

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They Get It, But Don’t Get It

15 Oct

Having an athletic trainer at the high school, especially a school that has collision sports, is not only handy it is a down right necessity – for various reasons.  The most poignant being emergency care of injured athletes; it goes deeper than that.

Athletic Trainers are not only trained for medical emergencies but we are all trained for the routine and “normal” injuries that occur on the playing field/court.  Each day in my training room I see 4-5 new faces with new ailments that need tended to; this would be the coaches problems if I weren’t there.  Or, in some cases these “normal/routine” injuries are off to doctors offices – often general practitioners that see more illness than injury – for a time and money cost for the family.

I could write a 4,000 word post on the need for athletic trainers at high schools, but I feel most of you understand, and for the most part the schools understand.  I am not talking about the athletic trainer that comes to a school once a week to see injuries (the lowest level of coverage and inadequate in my opinion), I am speaking about the need for the everyday athletic trainer.  In the case of “they get it, but don’t get it” I give you the Washoe County school system in Nevada (BTW, they are not the only ones, but a good example); Continue reading →

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Cantu Interview with SportsLetter

8 Oct

Thanks to a heads up serial emailer I was able to not miss this interview of Dr. Robert Cantu, appearing in the SportsLetter – it appears to be written by David Davis.  There were some very good questions and answers, below is a sampling;

SL: When did you first realize that concussions in youth sports were becoming a major problem?

RC: When I was a sideline physician for a high school football team over 30 years ago.  That’s when it occurred to me that we needed some written guidelines for returning our young athletes to the field of play after they suffered a head injury.  That’s what led me to write the first Return to Play Guidelines back in 1986.

I’m a strong supporter of youth sports, but no head trauma is good head trauma.  You cannot condition the brain to taking blows. If you subject the brain to enough head trauma, permanent brain damage may happen.

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SL: In your practice today, what are the most common myths — the most common misconceptions — about concussions among youth athletes?  Is it that there has to be a contact sport involved?

RC: I think the number-one most serious misconception is that you have to be rendered unconscious to have suffered a concussion.  More than 90 percent of athletic concussions occur without any loss of consciousness.  There are 26 symptoms associated with concussions, and loss of consciousness is only one of those.

Another very common myth is that concussions become exponentially worse as you accumulate them, so that your first one will be more mild than your second, and your third will be worse than your second one.  That’s just not reality.  The concussions happen to be whatever they are based on the forces involved.  I’ve seen many individuals whose first concussion was much more severe than subsequent ones.

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SL: How is a concussion involving a youth athlete different than a concussion involving an adult athlete? Continue reading →

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Monday Quick Hits

1 Oct

Some interesting notes, not from this past Sunday, rather the week prior as two stories caught our eye.  The first is dealing with Houston Texan quarterback Matt Schaub and the handling of his injury evaluation after he got hit in Denver;

The Houston Texans were questioned by the league about the team’s handling of quarterback Matt Schaub’s return to action after one play in last week’s win over the Denver Broncos after he suffered a jarring blindside hit by linebacker Joe Mays, sources said.[...]

The recommendation from the league’s Head, Neck and Spine Committee is that a player involved in a significant collision should be removed from the field so the doctor can utilize the NFL Sideline Concussion Tool, which has six basic cognitive tests, all of which must be passed by the player. On average, a medical source said, the test takes about eight to 10 minutes to administer.

As I was watching the game I wondered out loud how he was not being evaluated for a concussion.  The blow was to his head and he grabbed his head and writhed in pain on the field.  The sideline assessment can take as short as four minutes but usually is longer as they take the player back in the tunnel or locker room for assessment.  Last Monday Will Carroll asked what I thought and I told him that I was very concerned that nothing was done, especially with how vigilant the league is trying to be.

With the conversation with Will I also theorized why, Continue reading →

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Refeleciton Is Not Always A Bad Thing

12 Sep

Being honest about who you are and what you care for is needed for us to succeed and move forward.  As time passes we all morph and adjust to what is around us; including our likes, dislikes and passions.  For some, changes can be very profound and upon reflection they can even be “out of body” compared to who you were previously.

Patrick Hruby, a wonderful writer for many outlets has had one of those moments when it comes to football, this is his words via Dave Pear’s Blog;

The hotel restaurant was closed. So we ate at the bar. It was early August, and I was in town visiting a former NFL lineman. Call him Max. It’s better not to use his real name.
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During his time in football, Max was hit in the head. A lot. He since has endured nine brain surgeries. He has trouble remembering things. Serious trouble, like the main character in the movie “Memento.” Max and I were both carrying notepads, but for different reasons.
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At the other end of the bar, two guys discussed mixed martial arts.
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“I’ll tell you what — ever since MMA came around, I can’t watch boxing,” said one. “It’s too boring.”
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There was a game on. Saints-Cardinals. The first contest of the NFL preseason. Max had his back to the television. Once upon a time, he was an avid hunter. He owned a successful business. Today, he’s unemployed. Pretty much broke. Lives in a trailer outside his brother’s house. He probably shouldn’t drive, probably shouldn’t own guns. He gets angry. Has a hard time sleeping. He misses his family. His estranged wife and children are afraid of him.
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On the television behind the bar, a Cardinals receiver caught a pass. A Saints defender dutifully drilled him, slamming the receiver’s helmet into the turf. I wanted to look away. The guys at the bar cheered. I was drawn to the replay, slow-motion and high-definition, the whiplash bounce of the receiver’s skull. I wondered how much of the play he would even remember.
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Max turned his head. He had an appointment scheduled for the next morning at a nearby brain clinic. The doctors know him by name.
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“Look at that hit,” he said. “In the old days, I would have gone, ‘Oh, man, great hit.’ Now, I see it differently. I can’t watch this s—.”
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Neither can I.

I, like Hruby have had those moments, sometimes at my job watching a high school aged kid get the snot-bubbles knocked out of him.  I cannot fault him on his inner struggle, nor can I even dream that he is wrong for thinking it.  Perhaps I have become too good at Continue reading →

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Panacea: nearly impossible in the concussion realm

30 Aug

Definition of PANACEA: a remedy for all ills or difficulties.  Even though there are many products and claims out there finding a panacea for the concussion issue is impossible at this point.  Recently we have been examining the faulty claims made by companies about how they feel they can solve the concussion issue, mainly in sport.  Realistically it is an exercise in misinformation and even borderline fraud; and the reason why is simple.

Every brain and individual is exactly that; unique.  How can a product or protocol even come close to addressing the billions of people on this planet, let alone the millions that play sport.  Bluntly, the only panacea for mTBI is to live in a bubble and don’t move, seriously, don’t move.

Peter Keating of ESPN has been on the forefront of the concussion issue in the NFL and everywhere else since at least 2007 and as part of the World Wide Leader’s series on concussions he recently wrote what me and other feel is a pure journalistic masterpiece.  Before anyone starts claiming that I am against neurocognitive testing remember that I utilize this platform as well.  The most decisive point I can make is that what we have now at our disposal are just a myriad of tools that can help us do the job.

Let us break down the Keating article a bit here;

Concussions have become big business in the football world. With 1,700 players in the NFL, 66,000 in the college game, 1.1 million in high school and 250,000 more in Pop Warner, athletes and families across the country are eager to find ways to cut the risks of brain injury, whose terrifying consequences regularly tear across the sports pages. And a wave of companies offering diagnostic tools and concussion treatments are just as eager to sell them peace of mind.[...]

There’s just one problem. Many scientists who are unaffiliated with ImPACT don’t think the thing works.

“Through amazing marketing, the ImPACT guys have made their name synonymous with testing,” says William Barr, an associate professor of neurology and psychiatry at New York University and former team neuropsychologist for the New York Jets. “But there’s a growing awareness that ImPACT doesn’t have the science behind it to do what it claims it does.”

Marketing is a huge business, affecting the thoughts and processes of potential customers drive sales, period.  The issue becomes Continue reading →

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Rugby Union to Install New Concussion Rule

21 Aug

As part of the new rules in Premiership Rugby the installation of a “concussion bin” will begin September 1st.  Union and the sport of rugby took some criticism when recently played matches included some players that seemed to be dazed or even incapacitated after a hard knock.  Because of this the new rule was created;

If a team doctor or referee suspects that a player may have suffered concussion during an Aviva Premiership match, that player will be required to leave the field for five minutes to undergo cognitive tests.

If that initial suspicion is confirmed in a pitch-side assessment, the concussed player will not be allowed to return and the temporary substitution will be made a permanent one.

Not only does the team medical official have the ability to have the player removed the referee can be more aggressive in getting a player off the field.  The hope is that this will catch more players that have suffered a concussion and make sure they are removed, but if you remember the NHL tried this at the end of the 10-11 season and it was basically abandoned the following year.

Not only do I think this is a productive idea, but it is one that should be adopted by the sports that have limited substitutions, such as soccer and Aussie Rules.  Five minutes are sufficient to get the job done, but more time would be better.  Alas, this is a step in the right direction.

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Jane Leavy’s Article on Ann McKee

20 Aug

In the category of must read, this piece on Grantland by Jane Leavy is one the mouth-breathing, booger-eating, Neanderthal types who thing science is ruining the game, should become acquainted with (if they can even read).  Dr. McKee and people like me are not trying to take away the sports you love.  In fact we are trying to save them, football included.

Dr. McKee is a fan, just like most of us;

Every football Sunday, she parks herself in front of the TV in her authentic Packers foam Cheesehead ($17.95 at packersproshop.com) and Rodgers’s no. 12 jersey and prays that none of the men on the field end up on a dissection table. To date, she has found ravages of CTE, the neurodegenerative brain disease that has become her life’s work, in over 70 athletes, nearly 80 percent of those she has examined. Among them: 18 of the 19 NFL players she has autopsied; three NHL enforcers; and a boy just 17 years old. McKee, who received $1 million in funding from the VA as well as a home for her lab, has also documented evidence of CTE in combat veterans exposed to roadside bombs.1

“The coolest thing about Ann is she spends all day doing autopsies on NFL players and can’t wait for the weekend to put on her Packer sweatshirt and climb into bed with a big bag of popcorn and a beer,” says Gay Culverhouse, former president of the Tampa Bay Buccaneers, who now advocates on behalf of former players.

“Well, I don’t usually do it in my bed,” McKee says.

Dr. McKee relishes her job, no matter how anyone sees it; Continue reading →

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