More High School Statistics

A research study performed by Dr. William P Meehan, III was recently released.  The interesting aspect of this study was that it took into effect the “relatively new” neurocognitive testing and how it impacted those that were concussed.

UPI.com Story

Here is the quick breakdown of the study;

  • 544 Concussions during 2008-2009
  • 76% of concussions were a result of contact with another player
    • Did not break down how many were actual contact to the head
  • 93.4% of the concussions produced in a headache
  • ONLY 4.6% of the concussions (25) resulted in loss of consciousness
  • 83.4% of those concussed had resolution within one week
  • 1.5% had symptoms longer than a month
  • 25.7% of the concussed used neurocognitive testing
  • Using the neurocognitive testing resulted in a longer time out as compared to not using it.

This is some good information for all to digest.  I have some questions/thoughts on it (imagine that); specific daily breakdowns of symptom resolution, confusion and fogginess symptoms, specific mechanism of injury (blow to the head, no contact to head but whiplash, etc.)

The first thought is one that I would be most interested in, because of the graded return to play guidelines all should be following.  If symptoms were gone in 5 days, I would expect that player to be out a minimum of 10 days due to return to play guidelines.

What we do need to keep remembering with these types of research projects, it is subjective in nature, and reliability of an injured athlete is questionable at times, but it is improving.

Gunner Voicing Concussion Concern

Sean Morey, originally from Toronto, was an NFL wide receiver until 2009, however his primary responsibility was a special teams gunner.  He’s the guy that sprints down the field and turns his body into a wrecking ball in an attempt to thwart the punt or kickoff returner.

He suffered a number of concussions during his playing days — so many he can’t recall the total– and as co-chair of the NFL Players Association concussion and traumatic brain injury committee, Morey’s mandate is to educate his brethren on the dangers of such traumatic head injuries.

As Morey has become more and more educated about the long-term effects of concussions, he and his wife are fearful of what the future will bring him and his family.

“What I stress out about at night is what it’s going to be like in 20 years,” Cara Morey told Yahoo Sports. “I don’t even like to think about it because it’s so scary. But sometimes, I find myself thinking about what he’s going to be like and how he’s going to change.”

Dementia, Alzheimer’s disease, Amyotrophic Lateral Sclerosis, or severe depression. Any of these could be waiting around the corner as Morey ages, due to the repetitive head trauma he suffered as a professional football player.

“Most players with untreated head injuries are on their deathbeds by their early 50s,” neurologist and author Dr. Eric Braverman said.

But Morey is doing something about that possible issue, Continue reading

Hats Off

If you have watched any football over the past year, you may be thinking to yourself, “Helmets sure are coming off players a lot more.”  And you would be correct.  Although there is not a statistic for this, week after week, from the high school level up to the professional level,hats keep coming off.

“I’ve never seen it to the extent it’s taking place this year, at the college level and the pro level,” said Colts president Bill Polian, a member of the NFL’s competition committee. “I’m terribly concerned that we’ve got some sort of issue with the chinstraps or the helmet and we’ve got to look at that.”

The Indianapolis Star ran a story about such issues today.  However, I am about to talk out loud for a moment on this, and your comments/emails would be appreciated on this matter.

================

Sure, it looks scary and IS more dangerous to play the sport of football without the helmet on, but is it really a bad sign?  The NFL has implemented a good rule that if a ball carrier loses his helmet during action, the play is blown dead and the ball spotted at the point of interruption, as a safety measure.  Getting hit in the head without your headgear could be deadly.  But the fact that helmets are flying off may not be that bad… Hear me out… Continue reading

NFL Concussion Report Week 15

The Concussion Blog Original, NFL Concussion Report, is a weekly compiling of the reported head injuries in the National Football League.  Concussions are added to the list each week from multiple sources to give you the reader a picture of what is happening on the field.  Each week we will bring you the list of players along with relevant statistics.  If we have missed a concussion or put one on here erroneously, let us know.

Another high-profile week for concussions as Aaron Rodgers of the Green Bay Packers sustained a concussion, for the second time in 9 weeks.  As we have discussed this is just another opportunity for the NFL and the Packers to use current concussion management to “get it right”.  If Rodgers has no symptoms, no balance issues, no sleep disturbances and has tested back to baseline then he can and should return.  If any of the above are not “normal” then he should sit out.

With the late addition of Chad Clifton last week and the eight new concussions this week we are ready to present your Week 15 NFL Concussion Report;

Regular Season

  • 127 Regular Season Concussions
  • 9.07 Concussions/Week (9.10 W14)
  • .60 Concussions/Game (.60 W14)
  • 154 Projected Concussions (154 W14)
  • 14.60% Incidence Rate (14.61% W14)
  • 9.09% Epidemiological Incidence (9.10% W14)

Total Concussions

  • 135 Reported Concussions/Head Injuries
  • Team Breakdown

Helmet in Volleyball

So I was flipping through the channels during the NFL game, and I stopped on the NCAA Volleyball Semi-Finals and noticed something extremely odd on the court. It appeared that a player, the Libero for Cal, was wearing something on her head. About three seconds later they cut to her and she was wearing a soft helmet. I assumed she had suffered previous concussions and someone had successfully implemented a proactive method for preventing further injury.

So I did a quick Google search on Robin Rostratter and found the story behind the helmet.

“It allows me to play aggressive and not worry about hitting my head again,” said Rostratter, believed to be the only Division I volleyball player to wear a helmet. “If I dive or collide with someone else, it gives that extra cushion that will help protect my head. It doesn’t affect the way I play other than mentally I know hitting my head is something I don’t have to worry about.”

The Championships are being contested in Kansas City and the Kansas City Star ran the story.

Rostratter has a very long and tenuous history of concussions. The problems began before entering college, but her two most recent concussions were the catalyst to don the helmet. In her freshman year, she dove and hit her head on the floor, causing symptoms that lasted for weeks.  Then right before the Tournament last year, her head collided with a teammate’s knee, ending her season. In preparation for this season, she wore the helmet, became used to it, and continues to wear it even though she is not required to.

“She was told this fall she didn’t need it, but she had gotten so used to it, she asked her teammates how they’d feel if she wore it, and they said, whatever makes you comfortable, do it.”

With concussions being such a hot-button topic in sports this year, Rostratter — who leads the Bears in digs and service aces — has been a symbol for concussion prevention.

“Since we’ve been on TV a few times earlier in the year,” Feller (Rich, head coach) said. “I’ve gotten about a dozen e-mails or phone calls from moms or dads or coaches with a similar story in volleyball, and soccer or a couple of other sports. There are people out there interested.”

Count us among the interested, and the athletic trainer needs a big “WAY TO GO” for ingenuity and thoughtfulness. Rostratter may be a positive trend setter in concussion prevention and management. Good Luck to the Bears, as they are handling USC as I type.

Heath Miller Has Setback

labeled for reuse

Heath Miller, TE for the Pittsburgh Steelers, sustained a concussion in Week 13 after a vicious hit was practicing as recently as yesterday.  However, today @jimwexell tweeted: Heath’s having headaches. I expect him to miss Sunday. Troy limping more this week. Wouldn’t comment.

After practicing yesterday, Miller did not practice today.  For further information on Miller you can visit SteelCityInsider.

Did they rush Miller back to quickly?  No need to even speculate, as concussion recovery is based largely on the injured individual’s symptom reporting.  It is good to see that Miller did report the headaches, or worsening of the headaches, to the team.

Concussion on Broadway

By: Adam Avenali, labeled for reuse

It was not Mark “Sanchize”, or Eli “The Other” Manning, rather an actress in the new and EXPENSIVE Broadway show “Spiderman“.  On December 2nd, actress Natalie Mendoza sustained a concussion while performing in an early preview showing.  She continued after the injury and tried the next day as well with worsening symptoms.  Now after 10 days of rest, she is ready to return and take her spot back as the lead for the part Arachne.

TheaterMania

Concussions can happen anywhere to anyone, and with the icy weather here in Central Illinois, it reminds me to remind you that if you hit your head, be smart… see a doctor or other trained medical professional for advice.

Concussions – Where We Have Been, Where We Are

From time to time, I like to reflect and refresh on many things, but this is a good time to look at concussions; where we have been and where we currently are.  Today I will take a very quick look into the management of concussions.

For years as a health care provider we were guided by early work of Dr. Robert Cantu and others for guidance with concussions.  The information that was first published as early as 1986 and endorsed/accepted by the American Academy of Pediatrics and American Academy of Family Physicians in 1999.

TABLE 1
Concussion Grading Scales


Concussion grades and definitions
Guideline 1 2 3
Cantu5 No loss of consciousness Loss of consciousness for fewer than 5 minutes Loss of consciousness for more than 5 minutes
Post-traumatic amnesia for fewer than 30 minutes Post-traumatic amnesia for more than 30 minutes Post-traumatic amnesia for more than 24 hours
Colorado Medical Society6 No loss of consciousness No loss of consciousness Loss of consciousness of any duration
No post-traumatic amnesia Confusion Post-traumatic amnesia Confusion
American Academy of Neurology7 No loss of consciousness No loss of consciousness Loss of consciousness of any duration
Concussion symptoms for fewer than 15 minutes Concussion symptoms for more than 15 minutes

TABLE 2
Management of First Concussion Based on Grade


Concussion grades and management recommendations*
Guideline 1 2 3
Cantu5 Athlete may return to play if asymptomatic for one week (if athlete is totally asymptomatic, return to play on same day may be considered). Athlete may return to play if asymptomatic for one week. Athlete may not return to play for at least one month; athlete may then return to play if asymptomatic for one week.
Colorado Medical Society6 Athlete may return to play if asymptomatic for 20 minutes. Athlete may return to play if asymptomatic for one week. Athlete should be transported to a hospital emergency department; athlete may return to play one month after injury if asymptomatic for two weeks.
American Academy of Neurology7 Athlete may return to play if asymptomatic for 15 minutes. Athlete may return to play if asymptomatic for one week. Athlete should be transported to a hospital emergency department; if athlete had brief loss of consciousness (i.e., seconds), may return to play when asymptomatic for one week; if athlete had prolonged loss of consciousness (i.e., minutes), may return to play when asymptomatic for two weeks.

*—In each guideline, “asymptomatic” means that the athlete with a concussion has no somatic, behavioral or cognitive symptoms at rest or with exertion.

Since I have begun the endeavor of concussion education, most of the people (coaches, teachers, parents) and professionals (doctors, athletic trainers, therapists) I talk with can recall the above information, or are using the above guidance to this day.  It is not “wrong,” nor will it harm the individual (except for early return), but the more education and research we gain in this area warrants the changes.  I believe that it is very important that everyone get on the same page.  Let’s take a closer look as to what has changed:

  • No more grading
    • ALL concussions are severe/major and serious and shall be treated as such (more a media issue)
  • Loss of consciousness is not an indicator of severity Continue reading

Baseball Player Returns From Concussion

 

Image via Wikipedia

No it is not Justin Morneau, who had his plight with a concussion very well documented, (he will be returning as well) rather Jason Bay.  The overlooked “high profile” player that suffered a concussion in July also.  It was when the New York Mets were in Los Angeles and he ran into the Dodger Stadium wall giving him daily headaches.

 

“It was always about the headaches,” Bay said. “I got so used to having headaches, I didn’t know I had one. . . . Since the end of September, I haven’t had one headache issue.”

But according to the New York Post story the testing never “officially” indicated that he had a concussion.

“By all accounts, I haven’t played baseball, either,” Bay said. “But the workouts we go through are much more strenuous than baseball, and it’s one of those things, it’s not like a hamstring or an elbow where you try to rehab and make it stronger.”

And he said there are no further tests pending to determine whether he actually is healthy.

“I feel fine, but as far as testing and stuff, they couldn’t find anything wrong in the first place, so there’s no baseline to test it against,” Bay said.

It is good to see another player plagued by a concussion feeling 100 percent and ready for action.

AB-25

California is on the move in terms of legislation, which is almost “breaking news” in athletic training circles. Currently and traditionally, the California state legislators have had issues listening to and helping the athletic training community. However, this is one issue that the state is moving forward on.

AB 25 as it has been written expands on the NFHS rule that was used this year;

The bill would make the federation’s high school requirement a state law. It also would require parents or guardians of athletes to receive and sign a fact sheet about concussions and head injuries before practices, games or meets begin each year. Athletes of both sexes would be affected, regardless of the sport.

The widest-ranging aspect, however, is that AB 25 would extend the requirements to junior high schools, elementary schools and youth sports of all types by requiring compliance by nonprofit groups that use school or other public facilities or grounds.

I have not seen the exact language of the bill, but if they are following the NFHS guidelines, this supports and recognizes athletic trainers and their responsibilities regarding concussions.

Another great aspect is the addition of making the parents/caregivers responsible for the medical costs, absolving the schools from such payments.

Source Miami Herald (yeah across the country)

New Link

I have added the Illinois Athletic Trainer’s Association link to this website because I am a member come 2011…  It has been a long time since I have been with the IATA, but I have missed my association with them and promise to help them and the profession as much as possible.  First thing is first, a concussion policy for the state.  Proud to be a member once again!

Announcing Upcoming Event

Youth Concussion Education Forum, a 4-part live webcast series on January 24-27, 2011, will provide the latest information on youth sports-related concussion for coaches, athletic directors and parents of youth athletes.  The goal of this online forum is to give parents and coaches the opportunity to hear directly from concussion experts directly in a live, interactive setting, to ask questions, and to gain information on the latest developments in concussion research, legislation, diagnosis and treatment, and creating a concussion response plan both in the home and in the school.  One webcast will run each day, each focusing on one particular area of the subject.  Given the potential long-terms effects of youth concussions and recent discoveries, this online event is timely, relevant, and extremely necessary.  As an online series schools, youth leagues, and parents have the opportunity to hear the latest developments regardless of where they are located.  In support of concussion research and treatment development, 25% of forum registration proceeds will be donated to concussion research.

If you are interested in attending this webcast Continue reading

NHL Concussion Report 12/13/10

This is the list of current players on the injured list for concussions or suspected head injuries (^=new);

  • Shaone Morrisonn, BUF
  • Raitis Ivanans, CAL
  • Peter Mueller, COL
  • Kyle Cumiskey, COL
  • Matthew Lombardi, NAS
  • Bryce Salvador, NJ
  • Ian Laperriere, PHI
  • Kurt Sauer, PHX
  • David Perron, STL
  • Andy McDonald, STL^
  • Christian Ehrhoff, VAN^

Two new additions this week that brings the total concussions to 38 thus far.  I have seen reports of 73 concussions were reported last season, but as we saw last week with my rant about hockey injury reporting, who knows?  What is clear is that at this pace we will see more than 73 this season.

Reported Concussions Up Since 2009

The AP is reporting a 21% increase in concussion/head injury reporting since 2009.  The numbers were attained via the NFL (although exactly how is unknown) for numbers from the preseason through Week 8 (ESPN.com Story).

According to NFL data obtained by The Associated Press, 154 concussions that happened in practices or games were reported from the start of the preseason through the eighth week of the 2010 regular season.

That is an increase of 21 percent over the 127 concussions through the eighth week of the 2009 season, and a 34 percent jump from the 115 reported over the same span in 2008.

These numbers are different from this blog’s reporting of NFL concussions (we have 72 reported concussions in that same time span, see chart).  There is a reason for this, the numbers presented in the article take into consideration those that are listed in multiple weeks for the same injury.  If you look at the raw injuries the numbers on this site are firm, and as far as we are concerned, correct.  An example would be Randall Gay being listed for four weeks for the same injury, or another would be Kevin Boss being listed in Week 2 and 3….you get the point.

What is not debatable is that the numbers make sense.  They used the same procedure for 2008 and 2009, and I am certain that when we do the same for the past seasons we will see the same increase.

There may not be more concussions this year, just that they are being reported, which is a start.  However we are still seeing teams that omit, forget, or not classify a concussion for various reasons.  The most recent example of this would be Chad Clifton of the Packers, his official listing was “knees” but he did sustain a concussion and was not listed.  Joseph Addai also was reported to have sustained a concussion with his neck injury in Washington, but has yet to be listed as such.

Great work from the AP, however your true reporting will be here on Friday, as always.

Aaron Rodgers’ Concussion

The QB for the Green Bay Packers is no spring chicken when it comes to concussions.  Aaron Rodgers suffered his second concussion of the season (first in Week 5), and this time he was unavailable for the media after the game.  A second concussion does not disqualify him for “x” amount of time, it really means nothing.

However… Subsequent concussions, 2nd-3rd-4th, typically take more time from which to recover.  If you remember what is happening in a concussion, the neurons that are injured tend not to recover and the brain has to develop a different route for the synapses, not unlike road construction.  The further you damage your brain the more “road construction” there is, and the longer it takes to process the information.  There is no longer a specific number of concussions that disqualify you, rather it is an evaluation and symptom management that help with that decision.  As long as the brain is fully recovered from the previous concussion, you can return to sports.

We don’t know how Rodgers will handle this one and if the team will follow the correct protocol.  We can only hope they will.  What was evident, after his head was bounced off the turf like a basketball, is that he did not have full body function.  If you watch that incident, you will see him trying to get up, and not being able to get out of a seated position for a second or two.

Good luck to Rodgers and all that have been concussed this season, we are watching how you handle it.

UPDATE:  Rodgers has not received medical clearance and has been ruled out for Sunday night’s game at New England.

THE Leaders in Concussion Management

In many services and industries, the perceived leaders are the ones that can give the most resolute answers and proper actions.  Among perceived leaders there are some that have such a high profile, even though they do not have the education or experience, they can move mountains with their words.

With the concussion issue gaining attention, mainly through the NFL, one would perceive they are, or should be, a leader in this area, and they are.  Not only has the League and Commissioner Goodell said the right things, but they have evaluated their past and made steadfast changes in the right direction.

“We are changing the culture of the NFL with regards to concussions and, as a result, we are changing the culture of all athletics at all levels,” said Goodell. ” … We know that we set the standards in sports, and we accept that responsibility that comes with that. When we change our approach, other take notice and follow.”

However, with most things being the high-profile person will only get you so far unless you have the backing and partnership of a quality “right hand man.”

At the National Athletic Trainers’ Association (NATA) Youth Sports Safety Summit this past week, the NFL made it official that they will be partnering with the NATA to help create and pass legislation for all states about concussions and their management. (USAToday Story)

Not that athletic trainer’s are superior to doctors in the concussion area, but the athletic trainers are most likely to see a concussion in sports FIRST.  The educational background of an athletic trainer is more than qualified for holding up any state/federal law protecting the youth.  Having a plan is great, but the “boots on the ground” must be both capable and in support of such plans, and we as athletic trainers are.

Alan Schwarz: Helmets

The most profound writer about the head injury issue in sports is by far this man, Alan Schwarz.  I posted yesterday about the AP story from New York about the meeting of NFL minds addressing helmets and concussion safety.  As we all know and see on a daily basis here, I am a hack job when it comes to writing! (haha)  With that being said here is a link to the NY Times story by Alan Schwarz.

The league’s head, neck and spine committee invited helmet manufacturers, physicists, military biomechanists and more to a Manhattan hotel ballroom, where ideas and various brainstorms wafted like flakes in a snow globe. The question was what might stick.

“There are different approaches — that was clear,” Commissioner Roger Goodell said. The Pittsburgh Steelers’ neurosurgeon, Dr. Joe Maroon, added, “The problem is there’s still more questions than answers.”

NFL Concussion Report Week 14 UPDATE

The Concussion Blog Original, NFL Concussion Report is a weekly compiling of the reported head injuries in the National Football League.  Concussions are added to the list each week from multiple sources to give you the reader a picture of what is happening on the field.  Each week we will bring you the list of players along with relevant statistics.  If we have missed a concussion or put one on here erroneously, let us know.

Last week there was a down-turn in concussion/head injury numbers, however that was not the rule, as Week 13 brought more than average numbers, 11.  The total reported concussions/head injuries since training camp opened is now 126, 118 of them from the regular season.  Both Miami and San Diego scratched the concussion column last week leaving only Tamp Bay and Buffalo with no reported regular season listings.  On those lines we have a new leader in the team reports, Carolina.  You will see on the listing that both Austin Collie and Will James were added in Week 13, they had been listed previously, however they were reported to have sustained another head injury.  Here are the stats;

UPDATE: Thanks to a follower for cluing me in on the Chad Clifton concussion…  He is listed but it is listed at “knees”…  So how many other teams and players have used another injury to supersede a concussion?  Joseph Addai?  The stats have not changed to reflect this addition, it will make next week’s report.

Regular Season

  • 118 Concussion/Head/Headache/Migraine Listings
  • 9.1 Concussions/Week (8.9 W13)
  • .60 Concussions/Game (.50 W13)
  • 154 Projected Concussions (152 W13)
  • 14.61% Incidence Rate (14.35% W13)
  • 9.10% Epidemiological Incidence (8.94% W13)
  • Team Break Down
    • 9 – Carolina
    • 8 – St. Louis
    • 7 – Philadelphia, Oakland, Cleveland, Pittsburgh Continue reading

ESPN’s NHL Concussion Coverage

Jason Molenda via Ice Oaisis, Labeled for Reuse

As  football winds down in the next few weeks hopefully the generally good media coverage on concussions doesn’t go away.  ESPN.com is doing a feature this week on concussions in the NHL.  Most of it is very good and similar to the NFL coverage but the video featured in the article brings up an equipment issue that not everyone would associate with concussions…  shoulder pads.

The video does a good job covering the issue but to summarize; after 7 years of “research” the NHL is beginning to pad the hard shell cups used in the shoulder pads in an effort to hopefully reduce the ability to use them as weapon.  I used air quotes around research because I haven’t seen the scientifically based data supporting this change, but on the surface and based on common sense “research” it seems like a good idea. 

I am going to dig around in the literature and if I find something that will substantiate this it will come in another/later post.  An interesting side note, the NFL realized some veteran players were never going to change their pads so the league “worked” with the athletic trainers to bring their pads into compliance.

Now if the NHL would only do something about the “helmets” used in hockey…..

NFL Head, Neck & Spine Committee

Courtesy of Flickr, Labeled for Reuse

The newly revamped committee met on Wednesday in New York to discuss issues related to concussions.  The main issue was helmet design and how that could affect the concussion issue.  There were representatives from all football helmet makers; Riddell, Schutt, Xenith being the major players, and from entities like NASCAR and the military.  The NFL also included Protective Sports Equipment, the company developing a soft shell helmet with a flexible face mask that claims it can reduce forces better than traditional equipment.

The topics ranged in their all-day meeting (NFL Commissioner Roger Goodell spent a couple of hours) from testing standards, to sensors/research at the NFL level, to my favorite topic – position specific helmets.  Position-specific helmets should be produced and used.  Statistics show DB’s and WR’s are far more concussed than any other position, and it’s not that there may be more of them on the field, it’s because of the speed at which they collide.

Most, if not all, agree that the helmet-to-helmet hits are a huge concern, and if that can be eliminated, then the chances of concussion would be greatly reduced.

Finally the best topic, I feel, was that the committee was in agreement that there should not be an “official” helmet of NFL.  Since 1990 Riddell has had that distinction, even providing discounts to teams.  The main obligation of the NFL, and you can see this on the field today, is that ONLY Riddell can have their name on helmets.  Riddell will tell all of us that NFL players are not obligated to use their product and are free to choose whatever helmet they like, but that is just a blanket statement.  Riddell has been able to corner the market at the highest level and use it to its advantages.  The other manufacturers have different approaches and maybe not better, but are novel and may provide an advancement.

If the NFL changes its agreement with Riddell and allows all helmet makers to “officially” be on the field, it will signal a beginning.

AP Story via CBSLocalNewYork

Busy, Busy, Busy!

Courtesy of Flickr, Labeled for Reuse

The football season is over in high school and will be completed soon in college and the pros, however that does not mean the concussion risk is gone.  Yes, it will be reduced slightly, but awareness is continued and the importance of an athletic trainer is underscored more.  During the winter months we will spend time blogging about the life of an athletic trainer – what I do, and what we, as athletic trainers, can do for schools. Continue reading