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#tbt Mouth Guard BS Research!

21 Aug

This was originally posted in May, not a long throwback, but since football started I have been hit up with this question a lot.  So here is the “truth” about this research.  I love the effort and attempt to find a reason; however when you have a critical and FUNDAMENTAL flaws then present it in a way that could be considered fraudulent I have a major problem.  I would also like to add that this research has not been pulled by the publisher.  This is exactly how we get in trouble, the Academy of General Dentistry needs to address this, now, as this peer-reviewed “science” is getting run in media…

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The basic fundamentals we should be cognizant of here are: concussion is a BRAIN injury, the BRAIN floats inside skull, Physics dictates that the BRAIN will move depending on the forces applied to the skull/head (not always from a blow to that area), mouth gear cannot stop the BRAIN from moving, mouth gear cannot attenuate any forces to the skull/head that are not in the oral region, mouth gear does nothing for the skull/head when forces are placed on it in rotational, angular, acceleration or deceleration fashion.

Now that we have that all out-of-the-way this is the General Dentistry article I was asked to comment on.  On face value and from a “peer-reviewed” angle it seems all good.  A significant finding between custom mouth gear (noted as LM MG in article) and over the counter “boil and bite” mouth gear (noted as OTC MG).  However once you take a deeper look there are some peculiar problems, in my humble opinion – that comes later.

First, we should look at the possible limitations of this study that seems well populated and well thought out (honestly these were my first concerns before finding the real issue):

  • Were the injuries controlled for by football position? (we have documented this issue here)
  • Were the injuries controlled for by size of players/school they were playing?
  • Were the injuries controlled for by playing time? (more exposure more risk)
  • Were the injuries controlled for by game vs. practice?
  • Were all the injuries seen and recorded by a single MD or was it the ATC at each school?
  • Did any of the players have a previous history of concussion?
  • Was the study controlled based on practice habits of the teams? (do some hit more than others)
  • How do we know that every player complied with the “no wedging or chewing” rule? (this plays a massive role later)
  • The study says that all 412 subjects wore the same exact helmet, I find that: A) hard to believe and B) was the fit on every player the relatively the same?
  • Who funded this research? (no disclosure)

As you can see there is a litany of reasons I would have dismissed this research, if I were peer reviewing because those limitations are extremely real and realistic to control for in this type of study.  I wrote to the public relations group handling this research and was unable to get a straight answer on those questions I raised.  In the meantime I sent out the article to some better than average “stat nerds” and awaited a response.

While waiting I noticed something really troubling, as in a fatal flaw with the research.  In some places an oversight like this is intolerable, because Continue reading

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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

Arkansas Looks Into Hit Limits

18 Jun

Over two years ago I sent an open letter and proposals to the Illinois High School Association (IHSA) regarding hit limits in football.  Some took this as a “candy ass” approach and one that was not needed.  I disagreed with that assessment, in fact, I felt that what I wrote at the time was proactive and could be a way for this state to be a leader in the area of protection in concussions;

I am writing this letter to address the growing concern of concussions in sports, mainly in football.  It should be noted that football is not the only sport with a concussion issue; however this sport combines the highest participation, highest risk, and highest visibility.  This letter should not be construed as an attack on the sport of football, but rather a way to keep the sport continuing to grow.[...]

Recent evidence suggests that even the subconcussive hits – those that effectively “rattle” the brain but do not produce signs or symptoms – become problematic as the season wears on, let alone a career.  As the researchers in this field gain focus and more specific diagnostic tools, I feel we will see damning evidence that will put collision sports in jeopardy as they are currently constructed – the key being “as they are currently”.  There can be a change, both positive and proactive, that will signal to everyone that the IHSA is taking this matter seriously and can set a nationwide standard.

Needless to say it was brushed aside and was ignored, except for a kind email saying things were happening behind the scenes.  Now, two years and one month later there could be a 12th – TWELVE – states that have contact limits in place for high school football; as Arkansas looks into the matter;

According to reports, the Arkansas Activities Association has passed a recommendation to ask school superintendents to cut full contact practice time to just three times during game weeks. With one of those being the game itself, it leaves just two days of tackling if the proposal passes.

Jason Cates is the lead trainer for Cabot High School, and the former President of the Arkansas Athletic Trainers’ Association, he says, “Something has to be done.”

“The more studies that are showing that hit counts do count and add up.”

The Arkansas proposal limits the full contact days to three, opposed to the two I proposed, but it seems to me that others have seen the light.  That light is both the end of the tunnel and the oncoming freight train.  Kids need Continue reading

Hit Count Symposium

16 Jun

If you have a son or daughter in Little League Baseball you probably have heard of a pitch count.  Basically it is a set number of pitches a pitcher can throw in a certain time period.  The reasoning seems simple and sound, in my opinion; to protect the overuse of the arm/elbow.  Sure, there are many coaches out there in the baseball world that know what they are doing and will only throw players when they are fully rested.  On the other hand there a plenty of coaches out there that either don’t know or knowingly put players at risk when it comes to overuse of the pitching arm.

This has a relation to the concussion world; well, Sports Legacy Institute hopes so.  In an effort to be PROACTIVE about issues surrounding concussions and especially the youth players of collision sports SLI has created an initiative to limit, log and research “hits” absorbed.  I have blogged about it here when the initiative began.

Like many things that are new and different, people often dismiss or fail to grasp what is being attempted or cannot see what may be accomplished by doing them.  In regards to the Hit Count, it to is simple; limit the number of hits one sustains while playing sports – collision sports to begin with.

I may not be the worlds biggest advocate for sensor technology as we currently know it, however this approach is different and unique.  It is something that should be paid attention to, if not for the currently proposed reasons, at the very least the research capability.  How can we know if we don’t know.  In other words; how can we measure if we are making a difference with any of our so-called “advances in concussion issues” if there is not something to measure it against.  For a small niche in the medical community that is all about “baselines” and return to “normal” our peers seem to get all squirmy when people want to find this baseline.

The Hit Count most likely will not be the panacea which our culture so desperately wants but this is at least a step in the right direction.  Below you can see the full press release on the Symposium.  I cannot attend on July 15th, but I have been afforded two (2) transferable registrations.  Please contact me if you will be in the area and are looking to attend.  Without further ado:

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For Immediate Release —Thursday, June 12, 2014

Media Contact: Chelsea McLeod (781) 262-3324 or cmcleod@sportslegacy.org

Sports Legacy Institute Announces 2014 Hit Count® Symposium to be Held on Tuesday, July 15, at the Boston University School of Medicine to Advance Discussion on Use of Head Impact Sensors in Sports to Prevent Concussions

Co-Chaired by Dr. Robert Cantu and Dr. Gerry Gioia, event will gather researchers, athletic trainers, coaches, parents, athletes, medical professionals, and administrators to explore how Hit Count® Certified sensors can be used to improve brain safety  Continue reading

The OTL Investigation on ‘Heads Up’ Football

14 Jan

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

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

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

[...]

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

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

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

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

Interesting Take On Tackling

26 Dec

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

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

Here is how Chaney describes this forthcoming link:

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

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

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

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

“League of Denial” (Part 2)

8 Oct

Coming to a bookstore and TV near you today is “League of Denial” a book and documentary about one of the dirty little secrets the NFL has been avoiding for some time.  Fortunately, I have been provided with advance copies of both; the Frontline film was easy to digest, as for reading a book, well we can just say I am trying to read as fast as possible.

I was reminded quickly, yesterday via Twitter, that I may lack valuable perspective when it comes to concussion information (and that I am not normal – this is not breaking news).  Will Carroll of Bleacher Report let me know that this information will be new to a lot of people out there.  He is exactly right, not only that, this documentary will be easily digestible for the fan of football.  For any person just wading into this, when you tune into PBS tonight to view “League of Denial” you will be absolutely hooked from the start.

The sounds of the crowd, visuals of big hits grab your football part of the brain IMMEDIATELY, over those sounds you will quickly discover the problem NFL players have faced with brain injuries playing their sport.  Harry Carson saying “and then they are gone” when talking about former players.  A bold statement that the level of denial was “just profound.”  An NFL lawyer saying “we strongly deny those allegations that we withheld information or misled the players.”  And more video and sound of punishing hits that used to fill the highlight reel bring the opening curtain of this very important documentary.

This problem is real – it’s not just real for the professionals – and from the get go Frontline makes you understand, vividly and personally, why this is.  After listening to old radio calls of the Steel Curtain it all begins with the story of Mike Webster and the forensic pathologist who studied his brain, Bennet Omalu.

The discovery of a possible reason one of the most respected and lauded players in Pittsburgh sports pantheon fell from grace and eventually found and early demise.  If the football portion of your brain does not connect to what is being presented then I would haphazardly guess that you are not ingrained within the fabric of football.

As Harry Carson explains how the game was played and to some extent how it’s still played you can begin to understand the issue at hand.  This is hammered home when Robert Stern, PhD tells the audience blows to the brain are at forces 20 times greater than the force of gravity (20 G’s); or as he so eloquently put it “driving into a brick wall at 35mph”, 1,000 times or more in a season.

In the first 11 minutes of this 2 hour presentation you are at full attention and want to understand the “whats”, “whys” and “whos”.  If you are not engaged and ready for further explanation I can only say that you don’t care or want to bury your head in the sand.

Contributions in the film include Continue reading

UPMC Blazes Trail… Comes up with curious results

7 Jun

The University of Pittsburgh Medical Center and the University of Pittsburgh did something that has not been done up to this point; an intensive study on youth football.  Using geography as its selector the prestigious group looked into Pop Warner football and concussion rates.  The sample size is impressive, over 11,000 athletic exposures over an entire season of play (2011).

However, instead of heralding the work more questions have been raised about the conclusions drawn by lead researcher Micky Collins, PhD.  I don’t want to “lead the witness” before you had the chance to hear yourself, watch Dr. Collins below;

Interestingly enough Dr. Collins’ points regarding the depth and breadth of this investigation are spot on, it was both needed and welcome.  It is good to have a starting point and something to say “this is where we came from” at all levels of sport – with regards to concussions.  After that, I personally Continue reading

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

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.

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

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

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

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

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

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

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

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

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

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

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

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

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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