From my home state of Illinois, I give you Oswego High School… Make sure you see the interviews at the end of the video!!!!!!!!!!!
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);
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
Blog follower and prolific commentator here, Don Brady, PhD, PsyD, NCSP is featured on ION TV’s “The Subject Matters” from May of 2014. The video is in two 15 minute chunks:
Dr. Brady is a very good resource and wealth of information. I suggest you take some time to check out his time on ION TV.
Brewer Sports International and Amarantus Bio Science is continuing their efforts to collaborate and discuss the issue of traumatic brain injury, in particular concussion. In this version the focus will be on Alzheimer’s;
The #C4CT Concussion Awareness Summit is being convened on July 31, 2014 to explore the potential link between TBI and Alzheimer’s disease. A diverse working group of clinicians, medical researchers, policy makers, international diplomats, athletes, celebrities, and philanthropic organizations will be assembled to raise awareness, advance clinical research, and develop public policy in order to address this major unmet medical need and public health issue.
The #C4CT Summits have a stated goal to collaborate information and ideas to try and further both understanding and proper response to this issue at hand. I described it as – using a Japanese proverb – “none of us is as smart as all of us.” Which is definitely the case for just about anything in life. However, with so many egos and generally smart people there seems to be a ton of hand-wringing and chest thumping without a lot of resolution. Jack Brewer and Gerald Commissiong are trying to find a way to get everyone on the same page. Evidence of this was asking me to be a panelist during the last UN visit in January. You can see the recap below;
There is still time for you to attend this wonderful event, littered with some great minds and speakers. If you cannot attend you should follow their twitter feed next Thursday (unfortunately I will be away on vacation so I will not be live blogging the event this time around).
The Filed Claim in its entirety can be found HERE.
You will notice the very wide scope and various Defendants. Certainly it will have to go through the process up in Canada however, it will definitely get some attention:
Like this from The Toronto Sun.
Or this from Twitter:
— CFL Report (@CFLReport) July 16, 2014
I would also like to add the follow video of the Commissioner;
Make of this what you will…
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!
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!
I occasionally look for videos for education purposes. Today, I found a really good one, except for the “minor concussion” note early on…
More to come today…
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
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.
The center of the club soccer world resides in England (two teams in Wales) with the Barclay’s Premiere League (BPL). Being the “best” soccer league has allowed the BPL to be televised live here in the States as the sport is showing some growth in participation and in viewership. I have recently found myself watching more matches and even choosing “a side” – as they call it across the pond (it should be noted that soccer it called football everywhere else but here). Through research and general information gathering as I get further into the sport the BPL or other European soccer leagues are not much different in its fandom. Supporters of teams and players are similar to the fanatics that follow football here in America; critical of team play, ownership, players effort and results. One area where the fans and the sport of soccer is well behind, in terms of knowledge, is concussions.
The readers of this blog know quite well that a concussion is simply an event that alters normal brain function. Being primarily subjective it may be hard to distinguish a concussion by simply looking at a player or person. However, the vast majority of sports fans here in America and participants know that there are tell-tale signs of concussion that cannot be disputed. When one of those objective signs is observed it is and should be understood that said player was concussed and requires immediate removal from the game/practice/activity. The reason is simple, concussions are a brain injury and bad. Research has shown that playing through a concussion is very detrimental to short-term and long-term mental health.
Years ago, pre-2004, getting knocked out or displaying signs of a concussion was a mere nuisance and even a “badge of honor” among the top-level sporting participants. It was known back then that something as obvious as someone losing consciousness was not a good thing for the younger participants, however it wasn’t looked upon as it is now. When a sports participant absorbs enough force to effectively “reboot” the body’s central nervous system that is NOT A GOOD thing. As the information about concussion has become more clear through the years if a player is KO’ed that player is removed from play immediately and does not return for the period determined by the medical staff. In the NFL the soonest anyone has returned to practice or game after being knocked out, since 2010 has been six days. Even that may not be enough time for the brain to recover. Heck, in boxing and MMA, fighters that are KO’ed are medically suspended for 90 days.
This leads me to the bloody mess that occurred in Everton, England yesterday. Continue reading
I will be on HuffPost Live today as they discuss concussions… You can find the archive link here…
I have posted many a video about concussions here on the blog but this one (thanks to Tommy Dean) may be the best for its pure simplicity and message about management;
People need to understand that concussions don’t have to involve a hit to the head. I have seen throngs of people on Twitter and other places not grasping this. Perhaps none more so in the product development sector; those very intuitive people with good ideas that think protecting the head will reduce concussions. Be it a helmet addition, or better helmet, or those that want to remove helmets from the game, what they fail to grasp is that linear hits to the head with linear forces alone do not constitute the majority of concussion sequale. The concussion comes as a result of a constellation of factors; the biggest of which is the acceleration/deceleration of the head, followed closely by the shearing (due to angular and rotational forces) of the head. If you notice most mechanisms of injury one would easily note that knocks to the head with limited movement of the head itself, are not the vast majority of concussions seen. The hits a person takes in sports and LIFE that are unanticipated and have multiple vectors is where we get a lot of concussions from.
For a better visual, if I were to say to you I am going to punch you in the face from the right side, and you had a chance to brace for it, there is a good chance you could absorb that blow with little to no problems. However if I were to not say a word and walk up and hit you in the same spot with the same force, the chances you will be “hurt” are much greater. When you anticipated the hit you would have braced and made the force almost strictly linear, with little rotation due to your neck muscles… Where as, the sucker punch would move your head sideways and back; quickly accelerating your head then suddenly it would be decelerated by the spine range of motion limits.
I hope this has provided some positive learning for everyone…
What I believe was at the same conference as the previous video by Dr. Jeffrey Kutcher; former coach Lloyd Carr speaks about concussions;
Coach Carr was the head football coach at the University of Michigan from 1995 – 2007, it is worth listening to this perspective. Although coaches can be to blame for much of the “complaining” when it comes to the necessary changes in any sport as it relates to concussion, their input is very worthy.
We can sit in our offices and come up with “dream” ideas, but these are the men/women that must implement all the “bright” ideas. There is something to be said for those that have “been-there-done-that”, so as long as it is both constructive and respectful. I believe that Coach Carr did a good job of this.
A quick side note; this was in 2011 and he spoke of leading with the head, now the NCAA and NFL will possibly eject players for leading with the crown of the helmet (a very hot debate, and will be once the season begins).
Here is a video from YouTube of Dr. Jeffrey Kutcher titled “How to Minimize Concussion Damage”
Dr. Kutcher, M.D., is director of the Michigan NeuroSport Program. He spoke at Play Smart: Injury Prevention on and off the Field, a 2011 National Public Health Week “Live Injury Free” event at University of Michigan School of Public Health. His topic was TBIs–Traumatic Brain Injuries (concussions) among young athletes.
The University of Pittsburgh Medical Center and the University of Pittsburgh did something that has not been done up to this point; an intensive study on youth football. Using geography as its selector the prestigious group looked into Pop Warner football and concussion rates. The sample size is impressive, over 11,000 athletic exposures over an entire season of play (2011).
However, instead of heralding the work more questions have been raised about the conclusions drawn by lead researcher Micky Collins, PhD. I don’t want to “lead the witness” before you had the chance to hear yourself, watch Dr. Collins below;
Interestingly enough Dr. Collins’ points regarding the depth and breadth of this investigation are spot on, it was both needed and welcome. It is good to have a starting point and something to say “this is where we came from” at all levels of sport – with regards to concussions. After that, I personally Continue reading
The Mayo Clinic is hosting their second Ice Hockey summit, October 8th and 9th in Rochester, Minnesota. The title on this one is “Action on Concussions”;
The prevalence and consequences of concussion at all levels of ice hockey are concerning. Reduction of concussion risk, as well as improved concussion diagnosis and management require a collaborative effort from medicine, psychology, sport science, coaching, engineering, officiating, manufacturing, and community partners. This quality scientific program focuses on education and generates an evidence-based action plan designed to make a difference.
Registration fee is $275-350 and space is limited so make your plans now, and click above. Continue reading
For a long time the “father” of CTE, the first pathologist to find/identify the disease in an American football player, Bennet Omalu has been relatively quiet; going about his normal business and continuing his work with CTE. Last week he was highlighted on the ESPN Outside the Lines/PBS Frontline story about the Junior Seau death aftermath.
Even more recently Dr. Omalu was invited to speak at the 2013 Football Veterans Conference – a sport specific event put on by Dave Pear and his blog;
Well, we just wrapped up our 2013 Football Vets’ Conference in Las Vegas at the South Point Resort and it was our best yet! In two packed days, we covered everything retired football players need and want to know, from concussion lawsuits to CTE to visual rights and everything in between. Our sessions were packed and no one wanted to miss a single discussion. And thanks to the amazing Jennifer Thibeaux, all of our discussions from Friday are already processed and uploaded so you won’t have to miss a minute of it either!
Thanks to Dave we can bring you the entire talk by Omalu – although over an hour its worth your time.
Here is a TEDx Talk with Kevin Guskiewicz
There are some good moments and some moments that make one scratch their head. Take a watch (bout 17 minutes) and comment below…
This is a re-post, sort of, of a video created by Bryson Reynolds a neuroscience graduate student. His area of study is concussions and mTBI. He shortened the original video for easier consumption, it still holds the essence of what makes it a good too for us to use; stark and striking objective mechanisms of injuries, across all sports.
It is barely over a minute in time, again this is a great teaching tool for those trying to understand the mechanisms of concussion. If I counted correct only 4 of the clips show head-to-head contact. THIS IS EXTREMELY NOTEWORTHY, as concussions occur without direct blows to the head. Also note the concussions (presumed by the filmmaker due to descriptions of the original videos) that occur due to contact with the ground or ball. Perhaps the most disturbing videos are the last two, youth sports.
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!
You don’t have to take my word for it here, you can watch this video and let the experts in the field tell you;
Although we are not there yet, there are financial barriers, and some misnomers about the profession; athletic trainers should be a must.
As I have clearly stated: “If you cannot afford an athletic trainer you cannot afford to have collision sports, period.”
Hey here is a bonus, athletic trainers are also some of the best at on the field orthopedic injury assessment and injury prevention in the WORLD. Doctors even defer to the knowledge of an athletic trainer when it comes to sports injuries.
Neurologists at Mayo Clinic in Arizona have taken a promising step toward identifying a test that helps support the diagnosis of concussion. Their research has shown that autonomic reflex testing, which measures involuntary changes in heart rate and blood pressure, consistently appear to demonstrate significant changes in those with concussion.
Appearing on their website, the information researchers are delving into is a new angle on concussions. It is widely known that traumatic brain injured (TBI) patients have autonomic system (ANS) deficits/abnormalities. However the group from Arizona thought an investigation into concussed patients was worth the effort. Low and behold their findings are a promising first step in possible assessment and management of the concussion.
One interesting note, was this notion on dizziness;
“Contrary to popular belief, the symptoms of ‘dizziness’ that patients feel just after a concussion may, in some cases, be symptoms of autonomic system impairment rather than a vestibular or inner ear disturbance,” says Bert Vargas, M.D., a Mayo neurologist.
No one is telling you to take blood pressures with assessment (ergo baselines), yet, but with this information could come not only objective testing but biomarkers associated with ANS changes;
“This study shows a possible electrophysiological biomarker that indicates that a concussion has occurred — we are hopeful that with more research this will be confirmed and that this may also be a biomarker for recovery,” he says.
Here is the presser for the updated AAN Sports Concussion Guidelines; their guidelines are simple and to the point, via YouTube;
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
What does this mean in comparison to the Zurich Statement? That is a great question; both groups used “consensus” however this group is much more centered on American practices. Both have similar approaches, both advise nearly the same thing; but which one carries more weight. I have been told the AAN will be much more “powerful”, respected and learned than Zurich.
This is a good debate, regardless, there is ample evidence to sit kids and any concussed individual. This statement also continues the wave of information that cumulative and repetitive trauma to the brain (still figuring out thresholds) is not good. Based on this and the Zurich statement the only way that we can collectively abate concussions at this point is exposure limitation. No where in that last sentence does it state “stop playing sports,” or “get rid of football”.
When dealing with the brain and the injury of the brain less is better, which is ironically simple and a “no brainer”.
Here are a couple of videos to tide you over until some time next week!
In the first one we can hear how the military began their concussion management protocol. Although not enough it was way ahead of the curve on concussion management.
Here is one that shows a compilation of big hits found on YouTube. Watch all the football ones and the vast majority are “clean” hits. Then take into account all the other sports and think back to my mantra here: “The injury of concussion is not the elephant in the room, rather, it is the mismanagement of the concussion that is problem.” Then tell me you didn’t throw up in your mouth at the last clip…