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One Man’s (Athletic Trainer) Critical Eye and Observation From Week 1

18 Aug

It’s the beginning of high school football season across this glorious land.  I honestly love nothing more than getting back on the gridiron with the high school kids.  There are so many intangibles that the beginning of any sport brings; and in our massive consumption of football world this sport seems to bring a lot of people together, quickly.  You will see a lot of this “love for the sport” breeding through my posts and rants – the same love I have for all sports.  Seeing kids overcome hurdles and demons and using sport/activity to express their selves is awesome.  Seeing boys and girls using sports as a conduit to become better men and women by learning virtues such as: integrity, commitment, discipline and expecting to succeed.

Over the years I have obviously developed a keen eye for concussion as it relates to sport.  There is no greater sport for this injury to occur at my high school than football.  I have been blessed with coaches and administrators that listen to my input regarding overall safety, particularly when it comes to concussion.  But this past week I noticed something that perhaps I had seen plenty of times before, but it just finally hit me.

It has to do with the practice collisions and how things that start innocently enough can change and create issues.  I must give my head coach massive credit for being on the same wave length and even finishing my sentences when we were discussing my observations.  It shows, to me, that he has the best interest of the players in mind – and he wants a fully healthy team.  Secondly I happened to read a recent research paper about data collection on forces in football (while writing up my Sensor Overload post).

In a simple “technique” tackling drill two players were approximately five yards apart.  To either side of the players were agility bags spaced at about 4 yards.  The purpose of the drill was for the ball carrier to angle run to either bag, while the defensive player was to use proper technique and wrap up the ball carrier – not taking him to the ground.  The players were outfitted in helmets and shoulder pads only.  The players were directed to begin at “3/4″ speed and the ball carrier was to be willing to let the defender use current “proper technique” to achieve the form and fit for a tackle (face mask up, wrap-lift-drive through the man).  It started all well and good, and the players naturally began to increase their speed/effort as they became comfortable with the drill.  The drill lasted five minutes from setup to finish.

Upon completion of the drill – rather near Continue reading

Sensor Overload

12 Aug

With all that is new to the concussion realm, nothing is really new.  This includes: how the injury occurs (traumatic variable force vectors – often unanticipated – jarring the brain case), its recovery (unique and undefinable), its identification (mainly subjective but overtly obvious when objective), overall education and general understanding from day-zero to day-undetermined.

The current “hot topic” for concussions is sensors.  These sensors are nothing new, they have been around for years.  As with most technology the devices are getting smaller and more accurate; natural evolution, if you will, for sensors.  I have had the fortune of testing some products, getting deep information on others, and curiously viewing some brought to my attention.  The constant thought I have is: no product has provided a clear-cut reason for inclusion – at this moment in time.

Are sensors a good idea?

Sure, if and when they become accurate enough for trained individuals to use them without impeding current standards of care.  Further, I also believe that down the road we will be looking for a product that can accurately and systematically determine the gross effects of every blow the brain case takes.  The key being EVERY BLOW.  Not just hits to the head, or at full speed, or only in practice, or in helmeted sports.

The overwhelming information we have on concussions and their occurrence is that we just don’t know a threshold; for mine, yours, your son’s, your daughter’s or anyone.  We have a general Continue reading

DYK Helmets Do Not Stop Concussions: An article that must get traction

25 Jul

I can tell you there is more coming on this issue – from here and other platforms – but this Regressing (part of Deadspin) article really needs to be highlighted here for those seeking accurate concussion information.  I would be remiss if I didn’t – virtually – give Kyle Wagner a “good game” for writing a beauty!

‘Hockey’s About To Get The Bullshit “Anti-Concussion Helmet” Treatment’ appeared 7/23/14, here are some great excerpts.

Lets begin with the opening salvo;

Virginia Tech thinks hockey helmets are bullshit, which is more or less true. In turn, it wants to look at the differences between hockey’s helmets and football’s recently evolved versions, and bring the concussion-stopping advances to hockey. This is pretty much bullshit.

Then the all-important – simplistic – overview of the concussion process (emphasis mine);

The brain floats suspended by fluids in the skull, and when it suffers concussion, it both smacks into the inside of your skull and incurs rotational force, irreparably damaging the brain stem.

Why we wear helmets;

Helmets, meanwhile, are there to protect your skull from fracturing in the impact of a collision. They provide this protection, and the best helmets have interior mechanisms that can offer some small aid in decelerating a collision.

A wonderful note in the article, that may be glossed over by most readers, but it very peculiar to many of ‘us’ in the know and actually understand/grasp both the concussion injury and the statistics that are thrown out about them;

If the above numbers seem low to you—a combined 64 concussions for eight college football teams over six seasons, or just about 1.3 per team per season—then you’ve likely read enough to have seen players talking about getting their “bell rung” often enough that those Virginia Tech numbers wouldn’t just represent a decrease in risk by half, but exponentially. If the available data say anything, it’s that they are hugely incomplete.

Further on the above excerpt, 1.3 concussions for AN ENTIRE TEAM for AN ENTIRE SEASON is just asinine, Continue reading

Helmet Minutia: What you need to know

25 Feb

I was dropped a line from a source back home (OK my dad) about reports recently on the news in Denver.  Here is the LINK to the 9news story that prompted my father to send the info.  I found the report very informative and brought forth many angles on the story of helmets.

Meanwhile I also was given information from other coaches and followers about other press-type people asking for helmet information in Missouri, Georgia and Louisiana to name a few.

Who is behind all of this information gathering, I have not had it confirmed, but from the people I have been in contact with, Virginia Tech keeps getting mentioned.  I don’t know if this is because of the Star Rating System or if there is a PR campaign being driven by VT and the researchers.  Regardless this seems interesting to me on many levels.

What you need to know is simple and is as follows (of course in my opinion):

  • Helmets were never designed to prevent concussions
  • Helmet fit is currently the key to proper protection
  • Physics and anatomy/physiology currently limit helmets from providing concussion protection alone  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

NOCSAE Advancing Testing?

27 Jan

Perhaps, pending a vote in June, new standards could be set to get a helmet NOCSAE certified.  The news comes as the research arm has come up with plans for a testing scenario for something beyond linear drops;

The National Operating Committee on Standards for Athletic Equipment (NOCSAE) board of directors has approved the development of a revised football helmet standard that will require helmets to limit certain concussion causing forces.

You can see the full NOCSAE Jan 24 Release by clicking on the link.

It has been a long while since the standards have changed, but the calls for including more “realistic” type of scenarios in place have been loud for some time.  Including your’s truly, who believe that the rotational and angular forces were woefully under represented in any sort of testing.  I have been told by one representative with vested interest in this that for years the issue has been that these type of tests were “not repeatable.”

If everyone can be on the same footing with this and these new ideas actually translate to the “real world” then I am all for it, no matter the cost.  However, if this is something that is pure window dressing and will not actually impact a change – if that is even possible – then we are wasting time and money.

AAP Confirms What We Have Been Saying For Some Time

30 Oct

This past Monday, the American Academy of Pediatrics released their findings of a research project on helmets and mouth guards in high school aged football players, the lead was this;

High-tech helmets and custom mouth guards do not reduce concussion risk for high school football players any more effectively than low-cost helmets or off-the-shelf mouth guards, a new study says.

This is a point we have been trying to hammer home since the inception of the blog; simply Physics does not allow for current technology to reduce or attenuate the true forces that cause concussion in the vast majority of the cases.  Those would be: acceleration, deceleration, rotation and angular vectors that cause the brain to shift inside the skull.

The most important thing about a helmet is that it’s well-maintained (regularly reconditioned) and has a proper fit.  Certainly there is some merit to the newer helmets padding designs for helping with the true linear forces reaching the skull; however helmets are doing what they’re designed for – preventing skull fractures and facial injuries.

It is unlikely that a helmet – as we currently know it – will abate those pesky forces attributed to concussion.  In reality if that is where the fix needs to come from then we will most likely be looking at some sort of apparatus that is attached to the shoulders that basically harnesses the head down.  The issue there, of course, is the range of motion to allow a player to see and move in a safe way.  Regardless this information presented by the AAP is nothing new but wonderful because it comes from a group that has “clout”.

What is more interesting to me – and a bit of an endorsement of our words – is that simple Continue reading

Matt Chaney’s Take on Heads Up Football

24 Oct

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.

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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 Heads Up, ‘proper contact,’ ‘head up technique,’ ‘anti-butting’ or whatever term… this toothless policy and language have been a football mandate since 1976, for high schools and the NCAA… the rules specifically ban Continue reading

Live Discussion on Concussion

19 Sep

I will be on HuffPost Live today as they discuss concussions…  You can find the archive link here…

Helmet To Helmet: Changing Football

Rules of the Game

18 Sep

I have waited about five days to collect my thoughts on this and honestly let my emotions calm a bit.  As some know I can be a bit outspoken and harsh at times but I wanted to refrain from letting emotion get in the way of an important message.  Yes, this post will be mainly about football, but don’t view it as an attack on the sport so many of us, including me, love.

This season across all the levels of play in football there has been a larger emphasis placed on player safety, most notably contact to and with the head while playing football.  It is a FACT that the helmet in football was designed and remains a protective device not a weapon or offensive piece of equipment.  Using the helmet in the later fashion is and should always be a penalty for both sides of the ball.  This is nothing new; since the mid 1970’s “spearing”, “face tackling” and “butt-blocking” (scroll to page 32 of that link) have been outlawed in the sport.  However, routinely those events on the football field are rarely called, now in 2013 there is an emphasis on these types of infractions.  Now there is a caveat of this type of action on the field called “targeting” which at the college level can have a player ejected if egregious enough. (BTW, that picture is a placard that was made in 70’s)

Before I go further, I would like to say that officiating at the high school and lower levels is a thankless job.  The pay is not life changing and most do it as a hobby.  Sure, I have seen some officials that the game has passed by or is too fast for them, but I have also seen men and women that do Yeoman’s work with nothing more than a handshake for a job well done.  It’s not easy folks, I have done it, but done correctly and consistently it is a thing of beauty.  At the college and pro levels these people do great work and often have other jobs besides being on TV and getting players, coaches and fans mad at them.  I can assure you they are doing the best they can.  But, I feel the game of football resides in their and coaches hands, for survival.

At the high school level in our state I know that officials have been told to watch out for targeting and the use of the helmet above the shoulders; this has helped at the cost of adjudicating the other, more established rules from the 70’s.  I have seen four flags in five games for “targeting”/”spearing” above the shoulders; I have seen zero flags for “spearing” when it was below the shoulders.  I didn’t write down every occurrence of these types of tackles in each of my games, however, I can vividly recollect at least 10 instances of spearing on both teams.  Side note here, if I see one of our players do it they get quite the ass chewing from me on the sidelines.

People need to realize that tackling with the head-down is not a safety measure for the person getting tackled, it is a safety measure for Continue reading

What Are the Experts Saying About Guardian Caps

13 Sep

This post has no intention of being inflammatory, rather it is a post designed to hold a conversation and create a counter point.  I have been bombarded with information regarding this product; since early 2011 I have not been “on board” with this.  It is important to note that this product and its PR firm have been good at communicating with me and have listened, but I do find some of the press regarding this product and similar ones is a bit off base.  We do need to understand that what reporters and people say – not affiliated with the product – cannot be controlled buy the company.  So that being said I have found and have some opinions on the recent spike of press.  Take it for what you want.  Just know that I am trying to provide information for everyone to make their own decisions.

It began in 2011 rolling into 2012 when Guardian Caps shot me an email about their product.  And from the beginning I was not sold on the promises or the theory.  It’s quite simple in my estimation; you can wrap an egg up in 45 pounds of bubble wrap and if you shake it hard enough the yolk will still move or even break.  Essentially that is a concussion in an “egg-shell”.  Sure, the bubble wrap will stop all linear forces from cracking the shell and even prevent it from moving with those linear forces, but what is it doing to for the acceleration and deceleration of the concussion?  Moreover, even though it may be very light, we are adding mass to the head, thus we are creating a fulcrum change and balance change.  If you read here enough you know what I am talking about.

However, I have seen fellow athletic trainers rave about this and plenty of teams/coaches/schools adopt this product and even consult me on it, so I thought I would do my best to get the most information possible, on my own.  This company was willing to provide me with all the information they thought I needed, so good for them.  It really came to a head recently, while in the midst of the NOCSAE statement on 3rd party add-on’s, I received this email from the company;

Dustin,

I wanted to drop a line about both the Aug 9th article “NOCSAE Press Release Clarifies” and a short picture of our product and company as a whole.  Thanks for all your hard work with The Concussion Blog.  It is a valuable resource and you do a great job presenting an educated, unbiased view.

About NOCSAE certification:

  • If companies want to sell equipment that alters the original tested/certified helmet THEY or the individual must re-certify each helmet model it is placed on – adult and youth separate but not sizes.

NOCSAE Press Release Clarifies

9 Aug

NOCASE sent me the most recent press release; pertaining to the aftermarket/third-party additions to helmets. Here it is in full;

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Certification to NOCSAE Standards and Add-on Helmet Products

OVERLAND PARK, Kansas – August 8, 2013 – The National Operating Committee on Standards for Athletic Equipment (NOCSAE) has released the following statement regarding equipment certified to NOCSAE standards and add-on helmet products.

“Products designed to be added to a football helmet are being marketed and sold; some are intended to measure impacts, while others are expressly marketed as improving a helmet’s performance. Some products claim the ability to protect against concussions. Regardless of the truth of such claims, the addition of those products to a certified helmet changes the model, by definition, under the NOCSAE standards.

“For many years NOCSAE standards have defined a helmet model as a helmet “intended to be identical in every way, except for size.” Any changes, additions or alterations of the model, except for size, color or graphics, even if made by the original manufacturer, require that a new model name be created and a separate certification testing process begin for that new model. This concept of limiting certification to a specific model is commonly found in national and international helmet standards.

  • NOCSAE itself does not certify any product, it does not “approve” or “disapprove” of any product, and has no authority to grant exemptions or waivers to the requirements imposed by the standards it writes.
  • The addition of an item(s) to a helmet previously certified without those item(s) creates a new untested model. Whether the add-on product changes the performance or not, the helmet model with the add-on product is no longer “identical in every aspect” to the one originally certified by the manufacturer.
  • When this happens, the manufacturer which made the original certification has the right, under the NOCSAE standards, to declare its certification void. It also can decide to engage in additional certification testing of the new model and certify the new model with the add-on product, but it is not required to do so.
  • Companies which make add-on products for football helmets have the right to make their own certification of compliance with the NOCSAE standards on a helmet model, but when that is done, the certification and responsibility for the helmet/third-party product combination would become theirs, (not the helmet manufacturer). That certification would be subject to the same obligations applicable to the original helmet manufacturer regarding certification testing, quality control and quality assurance and licensure with NOCSAE.
  • Products such as skull caps, headbands, mouth guards, ear inserts or other items that are not attached or incorporated in some way into the helmet are not the types of products that create a new model as defined in the NOCSAE standards and are not items which change the model definition.”

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I read it simply as this;  Continue reading

Princeton, New Jersey Makes Peculiar Move

7 Aug

In a very unusual move by a school board the Princeton Regional School District – servicing one high school, one middle school and four elementary schools – has made it mandatory to wear head-gear in sports not known for head-gear.  In a proactive move the board has voted to make this a must in their school district;

The requirement, one that is not used teamwide for those sports anywhere else in New Jersey, will be mandatory initially for the sixth grade only, officials said. For children in grades seven to 12, the headgear is optional, although parents or guardians will have to sign a form saying they have declined to have their children wear it.

Still, officials were clear this week that with each year, the headgear would become mandatory one subsequent grade level at a time, so that all athletes in those sports eventually will have to wear it if they want to play.

This move strikes me as both good and forward thinking and as a waste of money as well.  Let us examine, first with the not-so-good ideas/thoughts.

First, the premise for this move was in part due to concussions (although they did also state it is for facial and oral injury protection as well) and the thinking on this is wrong in my humble opinion.  Many researchers, doctors, athletic trainers agree that helmets do not prevent concussions.  Sure there is disagreement on whether they protect – for focal-direct-linear forces they do have validity in this premise (as you will see below) – but the general consensus on concussion attenuation is exposure limitation.

Secondly, the addition of head-gear in soccer Continue reading

HITs Takes a Hit… Maybe

1 Aug

Solid research is produced over a long period of time with validation and verification of standards.  When using tools there must be a set of numbers that validate what data is being collected – in short to make sure the data is “good”.  This has been a problem with many things in the concussion realm, most notably with computerized concussion testing.  However last night I received an email with an abstract regarding the Head Impact Telemetry system or HITs.

Before we go further you will need to familiarize yourself with a couple of statistical terms: absolute error and root-mean square error.

Absolute Error is the amount of physical error in a measurement, period.  The example I found was when using a ruler on the metric side the absolute error of that device is +/- 1mm.

Root-Mean Square Error is a frequently used measure of the differences between values predicted by a model or an estimator and the values actually observed.  This measure is used to compile the deflection of errors in predictions and is good summation of accuracy, which only holds true for a particular variable not between variables.  In other words RMSE shows us how accurate the data is compared to its model/validation.  If this number is high it can show that either the model was incorrect or that the data was compiled incorrectly.

Appearing in the online version of the Journal of Biomechanics researchers from Wayne State (one of the notable places for head impact testing) found that a difference in helmet size on the Hybrid III head model has called into question the validity of the HIT system (abstract);

On-field measurement of head impacts has relied on the Head Impact Telemetry (HIT) System, which uses helmet mounted accelerometers to determine linear and angular head accelerations. HIT is used in youth and collegiate football to assess the frequency and severity of helmet impacts. This paper evaluates the accuracy of HIT for individual head impacts. Most HIT validations used a medium helmet on a Hybrid III head. However, the appropriate helmet is large based on the Hybrid III head circumference (58 cm) and manufacturer’s fitting instructions. An instrumented skull cap was used to measure the pressure between the head of football players (n=63) and their helmet. The average pressure with a large helmet on the Hybrid III was comparable to the average pressure from helmets used by players. A medium helmet on Continue reading

Old Coach Point of View

26 Jul

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).

Schutt Puts Technology to Work on Helmet Label

25 Jul

Schutt Helmets out of Litchfield, Illinois has taken the warning label to new levels.  You know, those tags that seem to be in the way when we buy something new – often discarded as quickly as possible;

The new Schutt warning label will feature a permanent, interactive graphic called a QR Code, which can be scanned by any mobile device. Scanning the new Schutt warning label will launch CDC’s new “Heads Up” concussion app, making it very easy for millions of football players, fans, coaches and parents to get the information they’re looking for.

“There is no organization in the country that is more highly recognized for their unbiased and objective work on concussions than CDC,” said Robert Erb, CEO of Schutt Sports. “By using this QR Code on our warning label, we’ll make the very best information from the very best source available immediately – and permanently – on our helmets. We briefly thought about just using a simple hangtag, but we know very few actually get read. Most are thrown away. We wanted to do something more useful than that and really produce something positive in the marketplace.”

Players, coaches and parents can read the new warning label – which has the same text as before – but can now also scan the QR Code, which will launch the “Heads Up” app on their mobile device or make it easy for the user to download the app.

I do applaud the effort to educate in the easiest possible way, as well as use of the CDC.  When people start to take the time to truly understand about concussions (and all the equipment involved in any sport) we will begin to see a paradigm shift.

You can view the images below and read the full press release;  Continue reading

Virginia Tech Responds to NOCSAE Press Release

24 Jul

Yesterday we posted the NOCSAE statement regarding the Virginia Tech Helmet Ratings, as with most things in life this is only one side of the story.  NOCSAE is doing what they feel is in their best interest; likewise the rating system and its researchers – namely Stefan Duma – are doing what they thing is good work.

Fortunately for everyone out there this blog reaches far and wide and provides an outlet for openness and comments from all that choose to do so.  As I have stated many times I try to bring a balanced source for information regarding concussions.  With that being said, Stefan Duma reached out to us to clear up some of the information from NOCSAE, from his and the Virginia Tech Helmet Ratings.  Below is the email I received from Stefan;  Continue reading

Speaking of Helmets, NOCSAE Press Release

23 Jul

I was forwarded this NOCSAE press release from a very prominent AT in the NCAA, and although the sender declined to comment, it was his intention to get mine.  I feel it would be good to comment and publish this press release here.  You can find the press release, dated July 3, 2013 HERE.

The purpose of the information provided by NOCSAE was to clear up some perceived and often misunderstandings about the Virgina Tech Helmet Ratings for football helmets.  Like NOCASE, I encourage the research into helmets, the first line of defense against blunt force trauma to the head in collision sports (rodeo included).  However, there are some things that may need explaining.

Now by no means am I taking sides here, I feel Stefan Duma and his cohorts do a tremendous job, as well as the current helmet makers.  I feel that everyone is doing their part to provide Continue reading

Helmets Aren’t the Answer

17 Jul

So says a group of researchers from Wisconsin.  After gathering data on over 1300 football players the overall theme was that there was no correlation between expensive helmets and reduction of concussion incidence.  On first inspection the design of the study looks sound, especially since high school athletic trainers were involved, and the results appeared to be sound according to Timothy McGuine;

“We found the actual incidence of concussion was not more for players wearing the newest helmets versus wearing helmets 3, 4 or 5 years old,” McGuine said. “We also looked at [concussion] severity by helmet model. No difference there, either.”

This finding is absolutely logical based upon today’s helmet technology.  McGuine is correct the exterior shell has achieved its goal to a tune of 99.9999% – prevention of skull fractures – however, the issue of concussions is really something a helmet was/is not designed to combat.

Think about this; the brain rests within fluid inside your skull, the primary protection for our brain, thus allowing our “noodle” to move “freely” for everyday tasks like walking, running, jumping.  In fact, it is an amazing process Continue reading

Ice Hockey Summit II

5 Jun

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

Zurich 2012 In Writing

12 Mar

If you all recall I went to Zurich in November to attend the “Concussion Conference”; mainly as an observer, but there was enough time and opportunity to impart my questions/knowledge as a practicing athletic trainer.  Here are the links to DAY 1 and DAY 2 of my live blogging.  By the way, the live blogging was WELL received and continues to provide great insight into what went on.  I hope that I am asked back for the next conference, or any other conference that wouldn’t mind my attendance.

Now the information gathered at the conference has been hashed and rehashed and now appears as the 4th Consensus Statement (tweeted previously).

As part of the initiative the Standardized Concussion Assessment Tool (SCAT) was looked at and changes were made to the 2nd version from 2008.  You can now find the new version by clicking SCAT3.

A new wrinkle was an assessment tool for the younger ages, the group decided on the “Child” version of the new SCAT3, that can also be found by clicking Child SCAT3.

Also included in the addendum of the Consensus Statement was a recognition pocket card, found by clicking Recognition Pocket Card.

All of the above is free and intended to be used as a resource for better concussion assessment and even early management of concussion.  Please read the Statement regarding best practices.  As always this blog is NEVER to be used to diagnose or treat a concussion.  There is a lot to be absorbed and read; one thing is for sure we as athletic trainers and concerned/educated individuals now have the most recent information at our fingertips.  I guess this blog is actually doing some good work :)  A side note; how about this appearing during National Athletic Trainers Month?  It might be a coincidence, but I find it serendipitous.

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

National Concussion Awareness Tour

18 Dec

It is an idea that can catch on, real quick, it has the basic tenet of education/awareness at its core, with the right promotion and teaching/tools I am in agreement this will do some good.  The plan is to have a national concussion awareness month, September, and along with that have a tour across the United States.  Instead of me trying to explain it, here is a promotional video, geared to finding sponsors for this event;

I do not endorse the Shockwave System, I am only endorsing the idea of an awareness tour….  Heck I don’t even know about baseline and/or neurcognitive testing…  However the idea to inform everyone is sound…

Matthew Gfeller Neurotrauma Symposium

12 Dec

Loudermilk_picsIn Zurich I had the chance to speak to many people; I enjoyed my brief time speaking with Jason Mihalik – fellow athletic trainer.  He reminded me of the previous Symposium in North Carolina and the upcoming second version.  I asked him to send along an email and I would put it up on the blog.  Here it is, and he is right, make sure you register NOW, it fills fast.

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It is with great excitement that my colleagues and I will be hosting the Second Matthew Gfeller Neurotrauma Symposium at the University of North Carolina at Chapel Hill on March 8-9, 2013. We have lined up another great list of local, regional, and national speakers. For additional information regarding a schedule of topics, invited faculty, and links to negotiated hotel rates, please visit us at http://tbicenter.unc.edu, and click on “TBI Symposium” in the header. A direct link to register for the symposium is as follows: http://tinyurl.com/c576kdu.

Our first symposium sold out 2 months prior to the scheduled event, so register early! Current Early Bird rates in effect until January 8, 2013 are as follows:   Continue reading

Zurich Day 2… And We Are Live

2 Nov

I have figured out the power situation so I will be trying to update the blog ASAP after each session…  For the time being make sure to follow on Twitter…

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1030 CST: Session 7, final session: The Sharp End

First debate between Dr. Cantu (yes) and Dr. Herring (no): is no RTP same day the best management paradigm?  Is keeping a player out one week long enough and is the graduated RTP protocol sufficient…

THERE WILL BE NO RTP on same day in the new statement!!!

Change of direction on Session 7, questions with panel answers, pro-con (if available)

Do 3 concussions end your career?

  • its comedy hour
  • Aubrey – treat each athlete individually
  • Dvorak – it has to be based on timing and complexity of each recovery – case-by-case basis
  • Putukian – if we can’t agree on dx how can we agree on a number
  • Overall theme is it is individualized, not all concussions are the same (Cantu)

Who is best qualified to make the sideline decision?

  • Cantu – multiple members working under a physician can make the call
  • Herring – concerning to him that some information is intrinsic to doctors so need to be careful
  • better question is who best qualified – person with most experience
  • Dvorak – looking at spectrum of games played, doctors are best qualified in most instances, but are they there in all matches?  We should aim all this to the “grass roots” as the professional level there is more than adequate coverage.
    • comedy about football versus american football
  • Ellenbogen – those that know the athletes should be making the decision, maybe a parent in youth sports, or athletic trainers, understanding the patients baseline is important
  • Putukian – balancing act, in a perfect world its a team approach (Athletic Trainer mention), and she says in the US the athletic trainer should be making the decisions on the sidelines…
  • Aubrey – Hockey Canada has a safety person (volunteer) in lieu of an athletic trainer
  • Cantu – brings up possibly training school teachers in concussion
  • Herring – if you are team physician do you need someone else to make the decision if you are on the sideline?  Panel – no

Is there a role for grading concussions?

  • Cantu – not perfect, but informing patient is important about severity and duration of recovery, after the fact
  • McCrory – we have moved from grading, look at the recovery – perhaps look at the SCAT/serial testing
  • Putukian – looking at history is more important than arbitrary “grade”
  • Herring – may help with continual care from one place to another, but again important to understand history

Should we be returning on the same day of concussion?

  • Aubrey – what about the NHL player in the playoffs (rhetorical question)
  • Cantu – no once recognized
  • McCrory – what about the players that clear the SCAT, so no concussion, but you know something is amiss?
  • Putukian – example of hockey player with delayed symptoms
  • McCrory – concussion is often an evolving injury
  • Ellenbogen – it is a traumatic brain injury, is the game worth it?  No.
  • Panel – consensus is NO RTP same day
  • McCrory to Aubrey about playoff example – what about a regular season, and Aubrey is being very honest, and he feels the player push back is greater
  • Ken Dryden from the audience – why are we treating professional athletes different from the youth or non-elite athlete
    • We are starting to move away from that, all athletes should be treated the same

Should there be helmets in woman’s lacrosse and field hockey?

  • Cantu – yes, because of stick and ball causation of concussion
  • Putukian – no, change nature of the game, no reports of intercranial bleeds in women’s lacrosse, weary of unintended consequences (BTW, probably has the most experience with this)
  • Cantu and Putukian discussing this topic
  • Change gears – what about football?
    • Dvorak not in FIFA’s plans to recommend, many reasons including the false security of wearing head gear
  • Audience Q: should we discourage the use of the head bands/head gear
    • Dvorak – your own prerogative but data does not support the use of them as recommendation (Czech goalie wears one)
    • McIntosh – Rules are more important at this time

Should there be age restriction on tackling in American football, heading in soccer and checking in ice hockey?

  • Cantu – his words speak for themselves, youth sports needs to look at how the game is played because of the differences between older
  • McCrory – in Australia you cannot get to the gladiatorial aspect of Aussie Rules until they are “of age” (13 if I heard correctly)
  • Ellenbogen – risk of activity, most concussions via CDC information is from wheeled sports and recreation, does not make sense at this time to him, advise accordingly
  • Cantu – youth sports don’t have the good data, personally he does not believe learning a sport at age 5 will make you elite, it is a genetic disposition in his opinion
  • Putukian – it makes sense to decrease exposure, US Lacrosse has put age 13 on checking, her take on soccer is that there is no data to support this when using proper sized ball and equipment
  • Dvorak – young soccer players learn sport first, and fundamentals of “football” its not “headball”, studies done on heading ball and with study there was no increase in biomarkers they were looking at it.  They don’t force kids to head ball until skills are sufficient.
  • Herring – false warranty?  Arbitrary age is concerning, take head out of the game rather then taking the game away from youth athletes.  The limit to exposure is accurate, but complete removal of the sport may not be necessary.
  • Cantu – sport needs to be safer for younger athletes
  • Aubrey – ice hockey has set limits on age for body checking, research is very important, it will help make decisions

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Dr. Jamie Kissick speaking on “From Consensus to Action”

  • Knowledge is power
  • “There is an app for that”
  • Knowledge Translation (KT) Concepts Continue reading
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