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Head Football Coach ‘X’: How to take a stand on player safety

26 Mar

Working on a cause is difficult, especially if you are trying to swim upriver. When the cause is in direct conflict with the juggernaut that is football it becomes even more difficult – even at the high school level. I received and provided counsel to this individual as he fights a good fight in regards to player safety, most notably concussions. I applaud this individuals effort, attention to detail, player first mentality, and his willingness to sacrifice his job. What we have below is a microcosm of the issues we face with concussions; detailed and beyond sufficient for action – that is not being taken except against this author.

This information was obtained mainly through email strings – all identifiable properties have been painstakingly scrubbed to the best of my knowledge. It has been understood and agreed upon by the author that publication of this information may identify him and place him in further jeopardy. He is willing to take that chance and I am willing to provide him a platform. Unless otherwise noted in the post with breaks all of this is his and his alone. We shall begin;

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A Little Context:

At the start of my advocacy for safer measures to be applied to the competitive arena in high school football, I involved many people who I trusted and cared for in helping find my voice. Those people usually ended conversations with the same question:

“Are you willing to Get Fired for this?”

I laughed at the question considering the fact that I am advocating on behalf of measures that enhance Student Athlete Safety. At no point was my advocacy meant to be an argument, so the extent in which there has been resistance to proactive thinking has been quite a disappointing surprise to me.

The last 3 months of my professional career have been a whirlwind as I have gone from Advocate to Agitator. When the time for action came to blaze a trail for the future, and promote all that can be good on behalf of our student athletes, we collectively passed as a school system, even though a safer future for the thousands of kids who choose to play football within it is still very attainable.

Through my advocacy I have felt empowered by the leading researchers in the field of sports injury supporting these ideas. Support from the actual people who could make these changes has been “Hot & Cold” in a way that led to me presenting to the Athletic Administration of our entire school system and then being handed a letter of reprimand. At the current time I am labeled as a “Demanding” Coach and a person “Searching for a Cause”.

What follows is a chronological story of advocacy on behalf of player safety at the high school level as well as an example of how far away we actually are from a safer future for the student athletes who choose to play the sport of football.

Authors Note:

Some of the Main Points of Resistance in this philosophy have been diffused by simple logic when it comes to providing a safer arena for competition.

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ORIGINAL LETTER TO RAISE CONCERNS & TO START MY ADVOCACY
January 8th 2013
To: (School System) Director of Athletics ————————
CC: (School) Principal —————–, (School) Athletic Director ———————, (School) Assistant Athletic Director ——————

Subject: Public Health Issue regarding (School System) Cross-District Scheduling of Football Competition

I am writing to make you aware of a safety issue that our county has unknowingly placed many of our student athletes in through our recent scheduling for football. (School System) Athletics cross district scheduling policy for teams in the newly formed ——– District, while making sense from a convenience and perhaps even a cost basis, exposes athletes at certain smaller schools to a greater risk of serious injury. I share these concerns with other Head Football Coaches within (School System) as was voiced at the —————- 2012 All-District meeting.

(School System) scheduling policy requires each (Small School) District football team, which is made up of schools that have been classified at the 3A and 4A level in the (State League) to compete with three schools at the 5A classification from the (Big School) District for the 2013-2014 scheduling cycle. The 2013-2014 scheduling cycle determines opponents for each school’s next two (2) seasons. ——————— High School (——) is a 3A school that, based upon the recent scheduling for the 2013/14 seasons, is expected to compete with schools classified at the 5A level on six (6) separate occasions, schools at the 4A level 12 times, and similarly sized 3A classified schools 2 times in our next 20 scheduled games.

A schools classification is predicated upon the (State Association) account for each school’s student enrollment. That enrollment produces the available population to field athletic teams. (State Association) has outlined parameters identifying like-sized enrolled schools to view as competition throughout the state. (School System) scheduling policy has ignored these guidelines in which the (State Association) believes our schools can equitably, and safely, compete in the sport of football.

Current scheduling policy lacks the awareness of a significant and measurable increased risk of injury to the players at (School) and similar sized schools. What is alarming, and requires immediate awareness, are the findings of the most recent and advanced studies related to head injuries. These studies strongly suggest that (School System) scheduling policy as currently constituted, subjects student-athletes of the smaller schools, not only to a greater risk of injury but to a greater risk of serious head trauma Continue reading →

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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.

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Matt Chaney – Tireless Worker

18 Jan

SpringGame1984Sideline
If you have been around enough you have seen the stylings of Matt Chaney on this blog, he is someone I call a friend.  In some circles that discounts me as a professional, which is both stupid and dumb.  I don’t always agree with Matt, heck him and I have been known to battle via electronic and phone communications.  However, his opinion is a valuable one – often his work is based in so much fact it makes your head spin as to why some of its missed.  Regardless, Matt has published two recent articles on his blog, for all to consume, here are some excerpts.

Part 1, published January 7th;

Historic football excuses thrive in modern debate over brutality

Lawsuits, criticism explode and officials project blame onto individuals

Old talking points of football apology resonate yet as officials tout anti-concussion measures like trainers along sidelines, new rules for safer play, injury reduction and expert consultation—same type of promises heard from gridiron leaders during the Victorian Era

American football gets lambasted in public for maiming and killing, denounced by an influential movement of critics, and game officials pledge safer play based on their new concepts of prevention, including:

*Qualified trainers and doctors will patrol sidelines.

*State-of-art medical response will treat the rare severe casualties.

*Limits will govern length of practices.

*Injury tracking will cut rates already on decline.

*Coaches will properly train players.

*Every player will undergo medical prescreening.

*Experts will lead safety reform in rulemaking and research.

*Referees and coaches will enforce new rules of experts.

*Players will follow new rules of experts.

Sounds familiar, these steps, a practical recitation of talking points for contemporary “safer football” promoted by the NFL and commissioner Roger Goodell, in face of lawsuit frenzy against the league and sport in general, along with festering disgust in the public.

Except the football rhetoric is 119 years old, from 1894, a packaged response during the game’s initial siege against formidable opposition seeking abolishment. Continue reading →

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Coach & AD Magazine Cover Story

17 Jan

cover picIn January’s edition of Coach and Athletic Director Editor-in-Chief, Michael Austin wrote the cover story on concussions; titled “What you’re missing when it comes to brain injuries”.  A very well researched and written article on concussion issues at the high school level.  Austin looked at the changing protocols, safety issues and legal concerns that will be facing the sports of our community schools now and in the future.  Here are some excerpts;

This isn’t just a football problem.  Media coverage focuses on the gridiron, but any time a player’s head is placed in harm’s way, a brain injury is a potential result.  “From what I see, football leads the pack by far but we’re also seeing more girls and boys soccer players sustaining concussions,” says Dr. Michael C. Koester, MD, ATC, who is the director of the Slocum Sports Concussion Program within the Slocum Center for Orthopedics and Sports Medicine in Eugene, Ore. “Interestingly this year, and this could just be a statistical blip, but it’s worth noting we are seeing more girls volleyball players as well.”

That comment struck me as in the fall I saw more junior high school volleyball concussion (5) than high school football concussions (4), I have no idea what that means.

In the area of classification, Austin does a good job of trying to put ‘mild’ to rest with concussions;

Dr. Gerard Gioia, the director of the Pediatric Neuropsychology Program at Children’s National Medical Center and the director of the hospital’s Safe Concussion Outcome, Recovery & Education (SCORE) Program, says the medical community has “dropped the grading system” when it comes to concussions.  He adds a common misnomer is the
suggestion you must have loss of consciousness to sustain a concussion, which is not true.  “You can’t call a concussion
‘mild’ just because someone isn’t knocked out for 10 minutes. Most concussions do not involve a loss of consciousness,” Gioia says.

Regarding the state legislation and protocols;

“The No. 1 goal is to get the student-athlete back to school without symptoms or ramifications before even thinking about a return to the sport,” Fink says. For coaches anxious to have the player return to the field, Fink tells them every athlete Continue reading →

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Concussion Symposium March 2nd

15 Jan

I received the following press release about a Concussion Symposium coming up in March.  The faculty is not your “usual suspects” rather some very good and known people in the medical field.  If you get the chance to head down to Texas for that Saturday I believe you will not be wasting your time or resources.  I would love to make it, however I have a prior commitment; that being said someone take good notes for me.

I would also like to add that having athletic trainers on the program list legitimizes this symposium in my mind.  Here is the presser;

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Austin, Texas (PRWEB) January 10, 2013

Concussion Compliance presents “Bridging the Gap on Best-Practices in Concussion Management.” This day-long exchange, sponsored by St. David’s HealthCare, brings together leading medical experts and practitioners to discuss the issues dominating today’s best-practice concussion management and how to incorporate the guidelines as well as the use of several tools into clinical practice.

The national symposium will be held March 2, 2013, at the Norris Conference Center, Austin. Registration is now open

“Communication and education that crosses traditional boundaries are key factors to providing good concussion treatment for our young athletes,” said Theodore Spinks, M.D., chair of the symposium program planning committee. He is a board certified neurosurgeon seeing patients in Austin, Round Rock, and Georgetown, Texas. Dr. Spinks currently serves on the CDC Expert Panel for Pediatric Mild Traumatic Brain Injury. He also served on the Texas Medical Association Committee on Concussions in Athletes during the last session of the Texas Legislature.

The symposium program provides an overview of the current best practices and consensus statements on concussion management, the latest scientific research, an update on tools available to practitioners, and perspectives from experts in concussion management.

  •     Featured Topics – The Physician’s Perspective; An Athletic Trainer’s Perspective; Head to Head: Cognitive Testing; Beyond Cognition: Balance Testing; A Look Into the Future: Vision Testing; Neurosurgical Management of Head Injuries and Concussion; Implementation of Best Practices Into Clinical Practice
  •     Keynote Speaker – Dr. Steven Erickson will present on the latest best practices in concussion management. Dr. Erickson is the medical consultant for Major League Baseball caring for the umpires and serves on the Major League Baseball Medical Advisory Committee and the Major League Baseball Mild Traumatic Brain Injury Committee.
  •     Reading of Proclamation from Governor Perry’s Office – March Concussion Awareness Month in Texas
  •     Exhibit Hall – Featuring the newest in technology, practice services, practice information, and pharmaceuticals

In addition, Governor Perry has Continue reading →

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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 →

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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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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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Book Review: Concussions and Our Kids – Dr. Robert Cantu

17 Sep

Due out tomorrow, Tuesday, September 18th, is Dr. Robert Cantu’s most recent writing on brain trauma; more specifically the concussion and how it relates to the ‘kids’.  Dr. Cantu is THE expert when it comes to concussions, heck his CV is so expansive it would take up like 7 pages on here.  The man knows his stuff; collaborating with Mark Hyman I believe he has written a book that is worth the read for everyone interested in this topic.  By writing this book they not only address the concussion issue but the “iceberg below the surface” the youth athletes and their care.  Obviously the millions that partake in sport and recreation are not privy to the top of the line medical staffs that the professional and high college athletes have at their disposal.

With Dr. Cantu’s wealth of knowledge there was a chance this book could have been written above the audience – so to speak – but after reading it twice I have found it to be perfectly succinct and to the point.  There is no beating around the bushes and you definitely get the feeling of where Dr. Cantu stands on this pressing issue.  All of that being said there are some points that I disagree with, but remember my favorite Japanese Proverb: “None of us is as smart as all of us.”

The book begins with the most important topic, in my opinion, “what is a concussion?”, delving into the brain and its physiology.  Don’t be scared, it is a well written chapter and explains to the layman how and what we feel determines a concussion.  Highlighting that section is the explanation of linear and rotational acceleration and why one is way more important than the other.  If you have read here enough you will note that the rotational aspect of the traumatic force to the brain bucket is the most troublesome, Cantu agrees.  In this chapter Cantu also discusses the term “rest”, and what we are all trying to convey, especially to the youth.  Rest is both physical AND cognitive, meaning not using your brain.

The next two chapters deal with collision sports Continue reading →

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Guest Post from Chartis

29 Aug

This is another in the guest posts I have received from various sources.  Once again I am not endorsing Chartis, rather providing what I feel is a very good article on the safety of kids in sports.

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Keeping Kids Safe in All Types of Sports

By Dr. William Spangler

 

When you hear about concussions and head injuries in youth sports, football and hockey typically come to mind. Increasingly, coaches, parents and athletes all across the nation have grown increasingly attuned to the risks associated with these sports and the paramount need for safety protocols during both practices and games.

When it comes to non-contact sports, however, the risks for concussions and other injuries are often overlooked. Activities such as cheerleading, gymnastics, swimming, volleyball, and skiing—to name a few—have considerable potential for serious head injuries. In fact, the sport of cheerleading, with its daring stunts and busy, year-round practice schedules, has become the leading cause of catastrophic injury in young female athletes, according to the 29th Annual Report from the National Center for Catastrophic Sports Injury Research at the University of North Carolina at Chapel Hill.

While cheerleading and other non-contact sports may not require the same level of protective equipment as do football and hockey, it is essential that coaches, family members, and young athletes alike are able to recognize the signs and symptoms of concussions and possess the know-how to respond appropriately should such signs and symptoms occur.

 

Here are some tips to keep in mind when working with youth athletes participating in all kind of sports, including non-contact sports: Continue reading →

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Banning of football as a whole is NOT the answer

7 Aug

The goal of a writer is to bring eyes to their information/opinion to draw eyes for advertisers who in turn pay for the publishing of the article – in a very cut and dry manner.  With the troubles facing sports, particularly football, more and more articles have hit the interweb; often the most cited are those that trample on our beliefs of sport.

George Will penned an article that did just that as he opined that football should be ended because it cannot be “fixed”, a growing belief amongst some.  I am here to tell you that although football has its issues and concussions are high on the list, this is the case with many other sports; hockey, lacrosse and soccer being some off the top of my head.  Will does have some salient points;

After 20 years of caring for her husband, Easterling’s widow is one of more than 3,000 plaintiffs — former players, spouses, relatives — in a lawsuit charging that the NFL inadequately acted on knowledge it had, or should have had, about hazards such as CTE. We are, however, rapidly reaching the point where playing football is like smoking cigarettes: The risks are well-known.[...]

Furthermore, in this age of bubble-wrapped children, when parents put helmets on wee tricycle riders, many children are going to be steered away from youth football, diverting the flow of talent to the benefit of other sports.[...]

The lawsuits have nothing to do with the risk of injury, they have everything to do with whether the league knew about the long-term risks during that time and did not disclose that to the players.  The injury of concussion can occur outside of sports, in fact the majority of concussions come from recreational activities like: skate boarding, back yard touch football, playgrounds, bike riding and driving.  Even if the lawsuits are a reason for Continue reading →

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Echoing “Concussion Prevention” Concerns

2 Aug

On Paul Anderson’s (@PaulD_Anderson) NFL Concussion Litigation blog a guest post went up the other day taking on the ever-growing concern of concussion “prevention” products.  The article was written by Andrew M. Belcher, MD (@the_jockdoc) and plainly explains it is buyer beware, as concussions are more than protection for the skull;

So then what we really need to prevent concussions are seatbelts and airbags for our brains inside of our skulls.  Here’s one more example to make it clear.  Shaken baby syndrome is caused by shaking a screaming baby back and forth to make them stop crying.  Even though their head never hits anything, the shaking leads to brain damage.  Would wearing a baby helmet have helped?  Of course not.  So how can a helmet possibly eliminate concussions in football.  It can’t.  Any protective device that claims to prevent concussions in a contact sport is false advertising and may be giving athletes a false sense of security.  How can athletes be well informed of the risks they are taking when the advertising by equipment manufacturers minimizes the risks?  The only way to prevent concussions is not to step on the field in the first place.

Very succinct and spot on, concussions are not mainly caused by linear forces to the skull; they are created by acceleration and deceleration of the brain INSIDE the skull.  Products that claim that they prevent concussions are borderline fraudulent, as there is NO study available that any current product can prevent concussions.  Sure, some can attenuate certain (see linear) forces to the head region, but other than a HANS device there is nothing in sport that limits the acceleration/deceleration or rotational properties of brain trauma.  In fact, increasing the weight of the head can increase mass, therefore by the laws of Physic’s, increase the overall force.

There is no guessing where I stand on the claims put forth by Continue reading →

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ATSNJ Sports Safety Summit Update

30 Jul

You have certainly seen me publicizing the Athletic Trainer Society of New Jersey and their 3rd Annual Sports Safety Summit, it is for a good reason.  Eric Nussbaum and his staff do a VERY, VERY good job!  I would travel that way for this event anytime, however I will be a keynote speaker in Iowa the day after (guess UPS and their “Logistics” can’t fix that for me).

But wait, there is some great news for anyone interested is seeing what all the hype is about, Eric emailed me yesterday to tell me that the Summit will be broadcast live, for FREE!  You will not be able to get CEU’s this way, but at the very least you can hear all the great information from the wonderful panel they have assembled.

Here are the deets:

  • All people will need to do is log onto their site, (www.concussiontv.com) and register.
  • On the day of the event (August 1st) you simply log in to view.

Click the link at the top to get the information.  Here is a run down of the presenters: Continue reading →

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Changing the Culture: Will Carroll – Special Contributor

25 Jul

I am honored and privileged to post an article from Will Carroll regarding concussions.  I thank Will very much for his time and contribution!

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Changing The Culture

Will Carroll for The Concussion Blog

It’s a quiet, warm Saturday morning in July. Coming up to the Colts Complex on the west side of Indianapolis, it’s normal to see players walking in. It’s not normal for them to be nine years old.

USA Football is rolling out what amounts to a pilot program they are calling the “Protection Tour.” It’s a multi-part seminar for kids, coaches and parents that focus on the concussion issue. Sponsored in part by the NFL, it’s easy to see why they chose this program. USA Football isn’t the typical governing body. They don’t have any form of control over the largest programs, the NFL and NCAA. They don’t even hold any sway over scholastic programs. They’re more a lobbying organization, taking hold of “should bes” like coaching standards and player safety.

The Protection Tour is made of up of three “stations”. In the first and perhaps most important, coaches and players are shown tackling drills that emphasize old fashioned concepts like shoulder contact, athletic position, and wrapping up. These kinds of hits won’t make SportsCenter, but they are safer for everyone. There’s an emphasis Continue reading →

Mr. Rodgers Not Exactly Correct

20 Jun

If you follow me on twitter you know that I made a comment about the recent statement from Aaron Rodgers – concussed Super Bowl MVP – about helmets;

In his remarks he said the helmet he now wears, compared to the one he wore when he started in the league in 2005, has prevented him from “a couple” of concussions, including one against the New York Giants in a playoff game last season.

Rodgers was part of a panel of other quarterbacks that were also Super Bowl MVP’s hosted/moderated by Bob Costas – apparently a charity event.  Regardless if there was an actual quote from Rodgers about prevention of concussions from helmets or it was simply inferred by the context, it is not correct and could provide false hope to others.

Helmets were designed to attempt to eradicate skull fractures and brain bleeds, the most heinous of brain injuries that were felling many players at the turn of the 20th century.  As technology has progressed we have seen fewer and fewer of this often life-threatening injury; unfortunately it does still occur.  The helmet shell along with the interior padding is designed to absorb the massive linear forces that cold fracture a skull or provide enough trauma to rupture vessels in the head.

Concussions are a slight bit different – even though both are brain injuries – a concussion is mainly a neurometabolic and microscopic structural issue.  Concussions are set off in a variety of ways but the biggest culprit is angular acceleration/deceleration and rotation of the skull (most commonly those type of collisions in ALL Continue reading →

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Neck Strengthening Should Be Addressed

8 Jun

Looking at the human body, in particular the head, it’s a wonder we exist at all.  Our operations center is basically held in place by small bones and strong neck muscles.  The human brain weighs between 3.5-5.5kg or 8-12lbs which does not seem like much until you find a 10lb medicine ball and try to balance it on a pole.  Once balanced then strike the ball and then you will be amazed at how our body handles extreme forces.  Even more convincing would be hitting the pole or lower and look what happens to the ball, our body is simply amazing.

In order to control your skull – in effect your brain – the neck muscles must be good at detecting even the slightest movements and be able to activate in an instant to compensate for sudden trauma to the head or body.  It would stand to reason that increasing the strength of your neck would also help with lowering transitional forces to the head.

There is one little caveat with this example, the brain itself.  On average the brain weighs 1.5kg or 3.5-4lbs, which makes up the majority of the weight in our head an it is not attached to anything.  That is the crux of the problem; a free-floating organ – our most important – that is susceptible to forces anywhere on the body.  This is why helmets cannot claim, nor do they, prevent concussions and it is why even with the strongest neck an unanticipated hit (when neck muscles are not tensed or engaged) can and will result in acceleration of the head.  Translated that means high potential for concussion.

Rock Center once again takes a look into the concussion realm Continue reading →

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Concussion Article Links – MUST READ

9 May

Since the tragic and untimely death of Junior Seau the concussion issue has begun to fester like a three-day old pimple on a 13 year-old’s greasy face.  It is ready to pop and keeping up with all of the pertinent articles and “specials” has been very trying.  In this post I will attempt to link up and highlight as many as I can (surely I will miss many, however Concerned Mom in the comment section will have more).

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Lets begin with ESPN and the Outside the Lines week-long look at concussions.  I have found this to be must see, my DVR is a testament to this; using previous stories and bringing in commentators on the subject have provided information and even fireworks.  Yesterday Merril Hoge and Matt Chaney did just that – provide information and create fireworks.  You can find the podcast here (panelists begin about 7:30 mark).

Hoge drew my ire earlier this week with his admonishing of Kurt Warner’s statement of being a father, however yesterday he did have a very valid point about the management of concussions.  I have said is ad nausea here: the elephant in the room is the management of concussions, however Hoge sounded a bit “underconcerned” about the actual injury.  Which is where Chaney had very valid points about the exposure of concussions to the youth.  They are both right in my estimation; the management is the larger issue but we are seeing too many too young people being effected by concussions.  There needs to be work in both areas and remember this is not just a football issue.

We have the duty to protect our kids and if that means flag football for 5-13 year-olds then I am cool with that.  If we find after making such a drastic change that has not been enough then we can take it further if needed.  I feel that a change like this will allow a few things: 1) more time to let the brain develop and thus allowing research to catch up to what we know.  2) employ more medical providers in a position to find, assess and manage concussions (see athletic trainers). And 3) begin a culture shift about the seriousness of concussions, after all this is a brain injury.

As Chaney later told me; Continue reading →

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Thoughts on Warner, Toomer and Concussions

4 May

Even with the recent events of the Junior Seau passing the issue of concussions, CTE, safety, and longevity of the sport have been very much a hot topic.  What hasn’t happened, until recently, is the overt and valuable opinions of those that played in the public forum.  Yesterday while traveling to the high school I was listening to the radio and hearing what Kurt Warner had to say about his thoughts as a father watching his sons play football.  Basically he stated that AS A FATHER he had concerns and was worried for his children, mainly because of safety and the long-term effects of playing.  He himself stated he is “worried” about his health going forward as well.

All genuine and pertinent information from a former player that carries a lot of weight, and I didn’t have one problem with it.  Even though he stated he didn’t want his kids to play (as a father) he is not the first, Harry Carson made the same statements about his grandchildren.  What caught me completely off-guard was the reaction from former player, teammate of Warner and NY Giant (same team as Carson), Amani Toomer;

“What this reminds me of is the guy at the basketball court, who once he gets done playing takes the ball and ruins the game for everybody else,” Toomer said  Thursday on NBC SportsTalk. “I think Kurt Warner needs to keep his opinions to himself when it comes to this. Everything that he’s gotten in his life has come from playing football. He works at the NFL Network right now. For him to try and trash the game, it seems to me that it’s just a little disingenuous to me.”

Disingenuous?  He is a father concerned about the safety of his children, how in the world is that disingenuous?  Yes the sport Continue reading →

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Innovative Concussion Care Concept

18 Apr

It seems that I often am applauding the efforts north of the border in Canada, it really seems that they have put a concerted COMBINED effort to seek out and implement innovative ideas.  I don’t think it says much about the United States other than we are all trying to do our best in our own little areas.  There is little consortium or conglomeration of effort, rather “‘A’ has found this”, “‘B’ has discovered this”, “‘C’ is saying this”, etc, etc, etc…

It may be the same up north but with the population centers mainly in fewer areas in Canada it seems that the Toronto, Ottawa, Montreal, and Vancouver areas seem to all be on the same page.  This could also be because of the overall influence of the Brain Injury Association of Canada and its influence on such things.

This idea is not from the BIAC, but it has some solid foundations none the less, including our partner in concussion awareness stopconcussions.com with Kerry Goulet and Keith Priemeau at the lead.  They have created a vision and group of like-minded individuals to create what they are calling Sports Concussion Care Clinic.  Here it is in a press-release; Continue reading →

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House Hearing on TBI

20 Mar

The Energy and Commerce Subcommittee on Health spent some time on Monday holding a hearing on traumatic brain injury (TBI).  We all know that the spectrum of this injury can range from the severe to the mildest forms (mTBI) also know as concussions.  The government has been involved with TBI since 1996 funding further research and subsidizing awareness/education programs with the passage of the Traumatic Brain Injury Act of 1996;

What the Traumatic Brain Injury Act of 1996 Mandates

Public Law 104-166 charges CDC with implementing projects to reduce the incidence of traumatic brain injury. Specifically, the legislation mandates that CDC shall:

  • Develop a uniform reporting system for traumatic brain injuries.
  • Conduct research into the identification of effective strategies for preventing traumatic brain injury.
  • Implement public information and education programs for preventing TBI and for broadening public awareness about the public health consequences of TBI.
  • Provide technical assistance, either directly or through grants and contracts, to public or nonprofit entities for planning, developing, and operating projects to reduce the incidence of traumatic brain injury.
  • Present a report to Congress that describes the incidence and prevalence of traumatic brain injury.

Funding for all these activities was authorized at $3 million for each of the fiscal years 1997, 1998, and 1999.

The Act has been amended many times, the last, in 2008.

The House heard from witnesses about Continue reading →

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Now This is a Possible Game Changer

15 Mar

There have been many attempts to create a concussion “game changer”, something that will bring the assessment and/or recovery into better focus and provide more concrete answers for all of us.  One thing many people keep forgetting is that the human brain is not only very complex but it is also very individual.  Creating blanket statements, guidelines, and recommendations are very difficult; unless of course you use a multidisciplinary approach that touches on every part of the concussion sequale.

If you have read long enough and seen the comment section you will know that we have been clamoring for a more comprehensive, evidence-based, set of recommendations that broach all four parts of a concussion: physical, cognitive, sleep, and social/behavioral.  Perhaps the Ontario Neurotrauma Foundation has done just that (.pdf at end of post and in “Current Concussion Management Page” or you can go to the ONF website);

ONF is pleased to publicly release the Guidelines for Mild Traumatic Brain Injury (MTBI) and Persistent Symptoms.  The Guidelines were generated through a consensus process using existing evidence and clinical expertise. 10 to 15% of people who sustain MTBI do not recover well or as expected. The guidelines are therefore aimed at treating and reducing the impact of persistent symptoms following MTBI in adults.  On behalf of the project team that oversaw this work, ONF welcomes feedback on the Guidelines to info@onf.org

There have been other guidelines, one we hold as the standard (note not gold standard) Continue reading →

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More Touchbacks = Less Concussions, NFL Reports

16 Feb

The co-chair of NFL Head, Neck & Spine Committee, Hunt Batjer, reported yesterday in Chicago that concussions dropped 50 percent on kickoffs as compared to previous years.  Speaking at a forum about NFL health and safety Batjer confirmed what we had said with our observational data;

“We just got the data recently, it looks to me like a decreased number of runbacks played a role. It did not affect a lot of the other injuries paradoxically.”

In this article by Brad Biggs there is also a good sub-story about Hunter Hillenmeyer and his dealings Continue reading →

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League of Fans Open Letter

7 Feb

Recently I have been introduced to “League of Fans”, a sports reform project founded by Ralph Nader to encourage social & civic responsibility in sports industry & culture.  Although the name sounds  non-germane on the surface if you dig deeper into their core principles you will see they are starting to delve into the concussion issue.

One of their first salvos is an open letter to Gary Bettman, Commissioner of the National Hockey League – oft criticized by me and the blog as well.  Below is the letter signed by Ralph Nader and Ken Reed (reproduced with permission of League of Fans);

An Open Letter to NHL Commissioner Gary Bettman: 

It’s Time To Ban Fighting

  Continue reading →

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SLI “Hit Count” Initiative

3 Feb

Sports Legacy Institute did in fact release their white paper today; it simply brings to the surface something that they along with others have been saying with more frequency.  Their initiative to create a Hit Count is a bold step and on that is welcomed, especially in light of the very current research from Purdue.

You can find the article on the SLI website (here) or you can read the final white paper .pdf here; there is a very good background for this idea and the simple yet powerful citation of research already performed in this area.  Their idea is mapped out very well, again the devil will be in the details as it all begins to be sorted out;

There are technological and monetary limitations to a pure Hit Count, as Hit Count systems currently are only sold for helmeted sports, and there are costs involved.  A Hit Count is not as simple as a pitch count, where coaches only need a pencil and paper.

However, hits to the head can be accurately estimated, and methods can be developed to approximate the brain trauma exposure during games and during practice based on known variables, like position.  With these estimations, rule changes and practice guidelines can be provided to ensure few, if any, athletes exceed a proposed limit. Continue reading →

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Grantland Article – Jonah Lehrer

10 Jan

I tweeted about it and want to put a link here on the site for those looking for information.  This article by Jonah Lehrer does a wonderful job of not only explaining the concussive injury but also explaining why there may be an issue going forward with the sport of football.  Here is an excerpt;

But we do know what happens once it’s broken. In the milliseconds after a concussion, there is a sudden release of neurotransmitters as billions of brain cells turn themselves on at the exact same time. This frenzy of activity leads to a surge of electricity, an unleashing of the charged ions contained within neurons. It’s as if the brain is pouring out its power.

The worst part of the concussion, however, is what happens next, as all those cells frantically work to regain their equilibrium. This process takes time, although how long is impossible to predict: sometimes hours, sometimes weeks, sometimes never. (The latest guidelines suggest that most concussed subjects require at least 10 days to recover, with adolescents generally needing a few days more.) While the brain is restoring itself, people suffer from a long list of side effects, which are intended to keep them from thinking too hard. Bright lights are painful; memory is fragile and full of holes; focus is impossible.

The healing also has to be uninterrupted. In the aftermath of a traumatic brain injury, the brain remains extremely fragile. Because neurons are still starved for energy, even a minor “secondary impact” can unleash a devastating molecular cascade. All of a sudden, brain cells that seemed to be regaining their balance begin committing suicide. The end result is a massive loss of neurons. Nobody knows why this loss happens. But the loss is permanent.

Teenagers are especially susceptible to these mass cellular suicides. This is largely because their brains are still developing, which means that even a slight loss of cells can alter the trajectory of brain growth. Football concussions are also most likely to affect the parts of the brain, such as the frontal lobes, that are undergoing the most intense development. (The frontal lobes are responsible for many higher cognitive functions, such as self-control and abstract reasoning. The immaturity of these areas helps explain the immaturity of teenagers.)

We have stated over and over here Continue reading →

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