Former AFL’er Opens Up

Daniel Bell was like any kid growing up in Australia, he wanted to play on the hallowed grounds of the AFL.  As his journey began playing youth footy he was wearing a helmet for extra head protection.  That ended when at the age of 15 he felt both out-of-place on the field with something many others were not wearing and his perception he (more specifically his head) was targeted due to the helmet.  Now Bell is struggling to get through a day without issues related to head trauma.

“Players who hear Daniel’s story will realise the importance of being open and honest with their doctors.”

Earlier on Thursday, Bell said his motivation for raising the issue was to encourage clubs to embrace “brain training”, similar to the treatment he is receiving at Elite Minds, for players that suffer concussion.

“Now, you let [concussion] settle down and then you play again. You don’t do that with a hamstring; you do rehab to improve the muscle to get it back to where it was at,” he told SEN on Thursday morning. Continue reading

Colorado Legislation Most Far-Reaching

The Colorado legislation on concussions was a step further than most when it was going through the chambers, it is now set to be the most far-reaching on the books when signed by the Governor.  As reported by 9news of Denver most of the legislation deals with the high school student and fails to protect or educate sports outside of this realm.  Colorado is going further, by addressing the middle school aged kids and non-school sanctioned sports;

Colorado becomes the 13th state to require concussion training in youth sports. But unlike the majority of the other states that require training only for school-related athletics, Colorado would also include younger activities such as Little League baseball and Pop Warner football. Democratic Gov. John Hickenlooper planned to sign the training into law Tuesday.

The Colorado legislation is named after Jake Snakenberg who lost his life after returning too soon from a concussion.

This is something that we have addressed here on this blog, especially as it relates to Illinois.  It is a good START to address a particular section of the youth playing sports, but it would be nearsighted to not include mechanisms for other student-athletes not participating in school sports, for what ever reason.

Speaking of Illinois, HB200 that moved to the senate is now in the process of being melded with SB150 to include park districts, which is another step in the right direction.  But Colorado has taken the lead on this, including younger participants and club sports is a MUCH better starting point.

I am proud to be a Colorado Native, and hope that this will fall on the legislation of Illinois as well.

Thanks to my mom for sending this along!

7 Day DL For MLB

As we also reported back in October Major League Baseball has instituted a concussion specific disabled list.  Previously the shortest stint was a 15 day version, putting the teams in limbo with players that had a concussion.  As we have seen with research a vast majority of those concussed recover in a 7-10 day time frame, this would have precluded teams in MLB from putting a player on the DL.  Essentially playing a man-down until the player recovered, or it was determined that the resolution of the injury would be longer than 15 days.

The new DL and guidelines is definitely a good thing for awareness, and it should allow more teams to be transparent with the concussion episode.

“The one thing you don’t want to do is put someone in position the day after or two days later all of a sudden by saying, ‘Are you feeling OK?”’ Morneau said. “The worst thing you can do with a concussion is rush back to play. You’re diagnosed and you have a week and if it clears up like most people hope it does and they usually do, with most people it’s short-term, that’s the best-case scenario.”

In my opinion this will now allow all concussions to immediately addressed in MLB, Continue reading

NFL New Guidelines

As reported earlier, the National Football League will be using standardized testing for concussions, as well as tightened down return to play protocol.  Gary Mihoches of USAToday wrote about it this evening;

The league will utilize “standardized” sideline procedures for assessing whether players have sustained concussions during a game or practice and whether they have crossed the “No Go” threshold for removal.

The Associated Press reported that 154 concussions occurred during games and practices in the first eight weeks of last season.

The meat and potatoes of the article is the actual test that will be used.  Both the baseline test and the post injury test will be used allowing for a clear comparison of the player.  This tool makes is much more quantifiable for those treating the injury, as well it provides “black and white” answers to the player.  This test can be administered in 15-20 minutes and will encompass cognitive and balance assessments, it was derived from the SCAT2 from the Zürich Conference.

The other part of this article that I find intriguing is the number you see above.  Continue reading

Footy Concussion Report Round 1

The Concussion Blog has decided to take up another project, tracking the concussions of another collision sport, one with very good media coverage, albeit not in North America.  Aussie Rules Football and its professional league AFL have had an issue with concussion in the past and as we have seen on videos here, they can be scary.  With the help of Herald Sun we will be compiling the concussions on a weekly basis.

Round 1 began with an announcement 48 hours prior to the opener about concussions, and without fail the season began with some high-profile injuries.  The fan base in Australia is rabid for their national game, we are not so much, so I will be learning about the sport as we go along.  We will see that there will be controversy as well with concussion decisions (see below).

If there are some international followers, I know you are out there, or some that know the sport well feel free to send information as it becomes available.  Before we begin with the list here are the particulars about the teams;

  • 17 Teams
  • 18 players on the field
  • 1 designated substitute
  • 3 designated interchangables
  • 22 actives, for a total of 374 players in the AFL
  • 22 game schedule in “home-and-away” portion of season over 24 weeks

I have no clue on positions other than defenders, midfielders and some person called a “ruckman”, so we will not be classifying by position unless our friends down under can educate me.  I will be watching some games Continue reading

2011 NATM Tribute Videos

We would like to thank all that submitted letters on behalf of Athletic Trainers during the month of March.  And for those that read and found out more about the profession, thank you.  There is more than words out there…  Remember to thank your local Athletic Trainer for all that they do.

I think it is a good time for some video education via the NATSC Video Contest.  Some are serious in nature, but most are humorous; all the while educating the audience about Athletic Training.  Without further delay here are some of the best…

First a serious submission from Hope College;

Next a music video from Ohio University;

Up next is a video magazine submission from Boston University;

This one is from Franklin College, is that Ice Ice Baby?;

A very professionally done submission from Michigan University;

And finally my All-Time favorite “Smooth Professional” from James Madison from last year;

Concussion Research Up North

Dr. Patrick Neary of the University of Regina has begun to research further the pathophysiological effects of a concussion in hopes of earlier and better detection.  Anne McIlroy, a science reporter for the Globe and Mail has written about Dr. Neary’s efforts as of late;

Ultimately, Dr. Neary would like to develop new diagnostic techniques that a trainer [athletic] or doctor could use in a dressing room and that would identify a concussion in a player like Pittsburgh Penguin star Sidney Crosby, who said he felt no symptoms after being blindsided in game on Jan. 1. Four days later, he was crushed against the glass by a Tampa Bay Lightning defenceman. He hasn’t played a game since.

We have seen that there is a cascade of effects going on with a concussion, and Dr. Neary and his team are trying to pinpoint certain events, such as blood flow.  Although none of the information has been published there is some interesting findings that were reported;

The differences in cerebral blood flow between a concussed and a healthy brain are subtle and there is a wide range of natural variability between individuals. So, Dr. Neary devised two small challenges to help him identify signs of a concussion.

He asks the athletes to hold their breath for 20 seconds, then to breathe normally for 40 seconds, and to repeat the exercise five times. In healthy individuals, this results in significant increase in blood flow to the brain, but not, it appears, in concussed athletes.

In the second challenge, similar to the first, he asks them to hyperventilate for 20 seconds. This normally decreases the flow of blood to the brain, but the drop is more dramatic in concussed individuals.

A peer at the National Research Council, Ryan D’Arcy is working on the electrical portion of the equation;

Concussions can also alter the electrical activity of the brain.

The National Research Council’s Ryan D’Arcy is working on a portable device that he hopes will be able to detect some of these differences. In particular, he wants to know how a concussed brain responds to different kinds of stimuli, including tones and verbal statements.

All of this research will lead to better awareness, detection and management.

NHL Concussion Report 3.28.11 (UPDATED)

Each week we scour the web to find concussions in the National Hockey League.  We will keep a running tally on that information as the season progresses.  However, it is not easy as the NHL has decided that listing injuries as “upper body” or “undisclosed” is a good indicator of actual injuries occurred.  Our list is believed to be as accurate as possible, even including injuries that have vague listings but through reports and video analysis should be classified as concussions.

As we get nearer the playoffs there will be MANY more “undisclosed” or “upper body” injuries that will encompass the head.  The general reasoning is the “old school” method of not letting the opponent know where to target.  However, with rules in place to protect the head and hits that effect the head than listings like these are archaic in this authors mind.  Granted that some reporters do not know about or want to speculate about injuries sustained, there are some obvious indications that, to me, get overlooked.

The biggest case recently has been the Johan Franzen case, where after a game he told reporters that he has sustained a concussion, but now is listed as a groin injury.  Never the less we have added four players to the list, bringing the total to 89 90; Continue reading

Chicagoland Concussion Meeting

Yesterday I had the opportunity to attend the Association of Chicagoland Sports Physicians Concussion Update presented by AthletiCo, in Oakbrook Terrace, Illinois. I was invited by my medical director, along with our sports medicine physical therapist; the three of us went north to listen to three very good presentations, network and get ideas for our hospital (the food was also great).

Heading in I knew the primary audience for this meeting was physicians MD and DO, in fact I believe that of the 70 or so people I think there were only 5 athletic trainers and 3 physical therapists. It seemed the room was evenly split between practicing physicians and residents, with some very knowledgeable and exceptional physicians in attendance. I was extremely encouraged to see all the “young” physicians willing to learn about concussions, some of whom didn’t even focus on Sports Medicine, but they wanted information.

There were three presentations on the night; Chicago and Illinois legislation regarding concussions, Vestibular Rehabilitation for treatment of concussions and Point-Counterpoint of Neurcognitive Testing; possibly the three most poignant topics in the area.

Continue reading

AFL Has New Changes, Inducing Questions

The Australian Football League has stated that they have “new” rules on concussions.  However Kim Hagdom of seems to disagree.  Before we get to what was said by the AFL operations chief, take a look at this video;

Yup, a lot of hits in this game Down Under have the extreme potential for head injuries.  However, the AFL says it is under control;

Anderson clarified his ruling with a strict “if a player is clearly concussed he will not be allowed back onto the playing field”.

If a player is “clearly concussed” there’s never been any doubt that he wouldn’t go back into a match or continue in a game.

As Hagdom also penned; what happens when they are not so “clearly” concussed.  Or, even better what is the definition of “clearly Continue reading

Excellent New Study

Although the initial intent of this research study was to examine all injuries of high school athletes in nine sports, the study uncovered some raw numbers on concussions, as reported by Mike Szostak of the Providence Journal.  R. Dawn Comstock began the injury surveillance survey in the 2005-2006 school year and the findings released go through the 2009-2010 season;

The number of concussions suffered by athletes increased 44.8 percent during that four-year period to about 190,385, from about 131,419.

Concussion as a percentage of total injuries increased to 14 percent in 2009-2010, from 9.1 percent in 2005-2006.

That is an eye-opening number, but some of the increase can be attributed to greater awareness.  In the article I could Continue reading

NFL Kickoff Change

A lot has been made of this change in the kickoff rules, mainly by those that think the game will “inherently” change because of this.  I am not so sure we are looking at a doomsday scenario like that.  Rather, I do feel that limiting the full speed collisions over the season will in fact reduce the chances of concussions in that particular “subset” of the game.

I must admit that while tracking the concussions in the NFL last season specific plays and situations were not part of data collection.  However, it is empirically noted that the full speed nature over great distance have resulted in many concussions.  There have been a variety of stories about players getting drilled during special teams.  In fact, most of the “journeyman” that appear on the concussed list sustained those injuries during that phase of the game.  The specific nuances of the rule were described by Rich McKay in New Orleans;

Playing Rule Proposal No. 2 was the kickoff.  That rule passed and ended up in a form we called Playing Rule Proposal No. 2A.  2A ended up having the following elements: the kickoff will be from the 35-yard line; Continue reading

CPR Changes

Yes, I know this is a blog devoted to concussions, however as an athletic trainer it is our job to educate the public about, well, pretty much anything associated with injuries in sports.  With the increased attention on heart issues in sports, with some unfortunate deaths recently, I feel it necessary to disseminate this information.

The American Heart Association is instituting changes to the way CPR is taught and performed.  For the most part, these changes and clarifications were made to make it easier for anyone caught in an unfortunate situation of cardiac arrest.  A lot of this was discussed back in October, as it was highlighted on various media outlets.  As of April 1, these changes will be in effect for all instructors (yours truly included), meaning the way you once knew CPR is changing.

The basic premise is “Quality Compressions: at correct depth with full recoil and at a rate of 100 beats per minute.” So for those of us that are trained what does this mean?

Here is my Cliff’s Notes version (there are other changes/clarifications but not as vital as the following):

  • A-B-C (airway-breathing-circulation) is out and we now will follow C-A-B
    • Rather than delay compressions, the most important part of a cardiac incident, if someone is unconscious or has a witnessed arrest the first-responder should check for a pulse (no longer than 10 seconds)
    • Upon determining there is no pulse, compressions begin IMMEDIATELY
      • Rate of 100 bpm
      • Depth of 2″
      • Cycles of 30:2 continue, but now begin with compressions
  • “Hands Only” CPR
    • Is acceptable for laypersons or those that are not proficient/confident or feel unsafe giving rescue breathing
    • Rate continues to be 100 bpm
      • “Push hard and fast with complete recoil in center of chest”
  • Removal of “look-listen-feel” when dealing with airway and breathing
    • After compressions have begun rescue breathing should be immediate, initiated with a head-tilt-chin-lift or jaw thrust, no more observing or determining if there is breathing

The above changes were made to reduce “hands-off” time and increase the amount of compressions over time.  The other aspect is that the latent time when using A-B-C and L-L-F was detrimental to survival and could have been a barrier for bystanders performing resuscitation efforts.  The adult compression to ventilation is the same, as are the child and infant from the previous update in 2007.

Not changed but continued to be emphasized was the need for early defibrillation, as this has become a key component to survival.  Most public gathering spots now have AED’s, and their use is almost automated allowing even the most untrained person to use this device.  As it relates to current events, it is unknown if AED’s were used in any of the cases.

As mentioned there are other changes and points that the new guidelines provide, so the suggestion should be to get re-certified as soon as you can.  And rather than wait the principal two-years for renewal, a yearly update may be good to stay on top of the new process.  The AHA has plenty of exhaustive research to back up the changes, but it is really a common sense approach; lessening the down time and allowing anyone to perform chest compressions is a benefit.

2011 NATM Tribute Letter: Paul LaDuke Jr.

During the month of March we will continually highlight the work of an athletic trainer.  This series will incorporate open letters about the men and women of the profession from other professionals, the aim is to have at least one a week.  If there are others out there; parents, coaches, teachers, doctors, lawyers, athletes or anyone that would like to form a letter please do so and send it to

I have saved this letter for publishing toward the end of the month, because we should be thinking about what an athletic trainer does every month, and every day if you are lucky enough to have one around.  Paul LaDuke Jr. is a full-time athletic trainer for a public high school in Pennsylvania and has “uber” years devoted to athletic training.  Not only does he provide daily coverage, he has recently created a blog entitled “Promote The Profession” devoted to Athletic Training.  Paul has been a wonderful resource and “reality check” for me during my process.  It is an honor that he took time to write this letter;

What is it like to be an Athletic Trainer? Continue reading

Awesome Article From Michigan

When concussions trickle into the classroom and “life”, what do we do?  Well if you have read this blog long enough I trust that you know the answer.  If you have not, or are a true skeptic about the lasting effects of a concussion, most prominently in the classroom of the adolescent individual perhaps you should read this article by Holly Klaft of Jackson Citizen Patriot seen on

Klaft takes a look at a high school athlete that had a couple of concussions, Bennett Thomson;

Bennett’s concussion occurred during a varsity soccer game against Northwest High School in September when he and an opponent both went up for a header. The other player came down on top of Bennett’s head, splitting it open.

Bennett was treated and then went home.

Then the headaches started and he couldn’t focus. Concentrating on schoolwork became difficult. Continue reading

Pugilistic Sports and Concussions

Dementia Pugilistica, otherwise know as chronic traumatic encephalopathy, has its roots in the Sport of Kings, boxing.  Given that this sport and its derivatives; MMA, UFC, etc., goal is to inflict brain trauma there is surprisingly less heard about their dealings with concussions.  There could be a lot of reasons why this may be; expected, inherent work condition, informed consent, less watched, or their general dealings with head trauma.

Quietly, these sports and their sanctioning bodies have instituted some of the more strict rules when recovering from a knock out, or concussion.  Generally each state and province sanctioning body has a “medical suspension” induced on a fighter that is KO’ed or even shows signs of a concussion, most are 30 days.  Although specific wording in each groups medical suspension varies, the base of it provides that a fighter CANNOT fight for 30 days after the incident.  Less commonly known is that this also includes sparring and training; however this clause is not in most rules, it is inferred.  That is unless you are the UFC.

As highlighted by Morgan Campbell of the UFC has a policy in place, as explained by UFC Canada President Tom Wright; Continue reading

NHL Concussion Report 3.21.11

Each week we scour the web to find concussions in the National Hockey League.  We will keep a running tally on that information as the season progresses.  However, it is not easy as the NHL has decided that listing injuries as “upper body” or “undisclosed” is a good indicator of actual injuries occurred.  Our list is believed to be as accurate as possible, even including injuries that have vague listings but through reports and video analysis should be classified as concussions.

We are down to only one NHL team that has not had a reported concussion.  As of last week there were three; Carolina, Ottawa and San Jose.  Carolina is the only team this season to not have a player concussed, and with generally 10 games remaining the Hurricanes have escaped thus far.

Today we can present there have been 84 listings (will be updated through Monday if needed), some of which we have gone “CSI” on and read reports-watched video and took the liberty of classifying them as concussions/head due to mechanism of injury and listed symptoms.  Regardless we feel that this list is very comprehensive and accurate.  Some statistics that we have for you this week; Continue reading

NHL Concussion Protocol and Goalies

What a great question that Greg Wyshynski wrote about at Yahoo!

Former goalie and NHLPA executive Glenn Healy believes the new 15-minute-wait protocol either doesn’t consider goalkeepers or is simply unfair to teams who see their goalie suffer head injuries.

From HNIC, Healy said:

“They haven’t really thought through all of the situations. And I’ll give you an example: Let’s take a look at goalies. What is a concussion, first off? Here’s Jonas Hiller in the All-Star Game. Is he concussed? I don’t know. He played for two games and hasn’t played in a month. I guess he was.”

To take the guesswork out of it for Heals, the Anaheim Ducks and Hiller have both been adamant that he’s suffering from vertigo rather than a concussion.

Healy showed highlights of Curtis McElhinney Continue reading

NHL Concussion Protocol In Effect

Vernon Fiddler of the Phoenix Coyotes was removed from the ice and bench after a hit that resulted in him becoming ‘dazed’;

“I came in the dressing room, and that’s the protocol now and that’s what the trainer said when I got hit,” Fiddler said. “You like for it to be quiet and not a bunch of action around.”

Burrows received a five-minute major penalty for boarding and a game misconduct.

Fiddler returned to the game less than 10 minutes later.

“They asked me a bunch of questions, just a typical neuro-psyche test, and I just did what I was asked,” Fiddler said. “He just asks you a few questions about the game, what day it is.”


John Cena of WWE Will Return

One of the top performers in the WWE is John Cena; when he is hurt the WWE holds their breath.  This past Monday Cena reported that he sustained a concussion; from an unknown mechanism.  Rick Rockwell reported on this at

Cena, stated via his Twitter page that he’s not sure how the injury happened but that he passed a post concussion exam and will be able to return to action. “CeNation. Sorry I have been away. Concussion on mon night from either del rio kick or mic shots. Took and passed IMPACT exam, rtg for fri! A computer test that measures overall brain function.(insert intelligence joke here) all wwe superstars as well as mlb nfl nba nhl nascar”

Granted it appears that Cena has been medically taken care of, what needs to be noted is that if the WWE is basing return to ring solely on the ImPACT, they are setting themselves up for a problem.  As we have and will highlight more, neurocognitive testing is a tool used in part with all other aspects of concussion management to make return to play decisions.  Cena and the WWE would be best to keep him out of harms way until WrestleMania, as Rockwell suggests.