Month: June 2011

NHL: Paul Kariya Retires

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“The thing that I worry about,” Kariya said in an interview, “is that you’ll get a guy who is playing with a concussion, and he gets hit, and he dies at centre ice. Can you imagine what would happen to the league if a guy dies at centre ice?”

Paul Kariya was a super-star of his time, after sitting out the last year due to post-concussive events he has decided that 989 points in 989 games was good enough to call it a career.  In a VERY candid way by calling out the NHL for what he sees as a major issue with the sport, article from Mail and Globe and Eric Duhatscheck;

Kariya believes that because there are no visible outward symptoms of concussion, NHL teams tend to play them down to their players. He contrasted it to the treatment levels accorded to a player who suffered a major knee injury. Continue reading →

Another Race Another Concussion UPDATE

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Photo Courtesy of David Craske

SEE UPDATES BELOW—-

INDYCAR has been stricken with another concussion, this time with “star” driver Will Power. Power was tied for the series lead at the time of the crash.  The racing series was very quick to react to this injury, as opposed to Simona de Silvestro, here is a statement just following the Iowa race;

Will Power suffered a minor concussion when his No. 12 Verizon Team Penske car made hard rearward contact with the Turn 2 SAFER Barrier at Iowa Speedway on Lap 90 of the Iowa Corn Indy 250 presented by Pioneer, according to INDYCAR director of medical services Dr. Michael Olinger.

Thanks, once again to @djcraske (now the official TCB-INDYCAR correspondent), here is the video of the crash (begin watching at 14:20): Continue reading →

Irv Muchnick: Two Articles

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Irvin Muchnick is a writer and investigative journalist writing focusing mainly on the WWE.  Muchnick has been heavily involved in the concussion issue in the WWE and its crossover as well.

Irv has written two articles in succession that take a look at the concussion issue and the NFL.  In the first Muchnick examined the recent (March 2010) change in  title of the NFL “head and neck committee”;

In March 2010 the NFL’s concussion policy panel, called the Mild Traumatic Brain Injury Committee, got a new name and new co-chairs. Now known as the Head, Neck and Spine Medical Committee, it is jointly chaired by Dr. H. Hunt Batjer, of Northwestern Memorial Hospital outside Chicago, and Dr. Richard Ellenbogen, of Harborview Medical Center in Seattle. Batjer and Ellenbogen replaced the disgraced Dr. Ira Casson and Dr. David Viano, who in turn had replaced the disgraced Dr. Elliot Pellman.

Though Batjer and Ellenbogen promised to sweep out the Augean stable of league head injury custodians, they have done nothing of the sort. For example, Dr. Joseph Maroon, whose corrupt involvement in this sordid history has been extensively documented by me, remains on the committee.

And in July the two new co-chairs reversed a commitment not to release an ambiguously worded NFL helmet safety study with limited or no value for the broader universe of amateur helmet consumers. In the good coverage of this narrow issue by The New York Times’ Alan Schwarz, Ellenbogen explained that he decided the study was OK “as long as statements were phrased very carefully.” Congressman Weiner blasted this “disturbing step backwards.”

More emphasis has been put on head trauma in the NFL, but I believe that Irv is merely exposing the slow process of “reform change” when it comes to brass tacks.  Although changing a stigma will not happen overnight, it can happen much quicker Continue reading →

New Website & Product for Battle Sports Science

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Battle Sports Science has rolled out a new website and products to help with safety, most notably an awareness and mechanical device that can and will help with issues we face today as; parents, athletes, coaches, and athletic trainers in the area of concussions;

We know all too well too, the agony that sports injuries can bring.  Collectively, we’ve experienced major injuries like concussions and know the fear and frustration it can have on a player and his or her family. It’s what motivated us to start Battle Sports Science in 2009. Years before that though, we were hard at work in the sports safety business. Then and now, the goal remains the same, not just to make good products but to make innovative products that address the day’s greatest sports safety challenges.

To deliver on those lofty goals, Battle Sports Science blends cutting-edge science with a keen understanding of the athlete. Of course, that old competitive spirit is fast at work in what we do too. Giving our best to be the best pushes our efforts and standards everyday. The result is something we’re very proud of, some of the finest sports safety equipment anywhere.

One of the newest products is due to hit the shelves August 1st, the Impact Indicator a real-time accelerometer implanted in a chin guard.  This product has been worked on for years and developed as a cost-effective way to provide another “tool” to heighten the awareness about concussions.  Not only that, this product is something that will help with the identification Continue reading →

TCB Question: Facial Fractures

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After a great weekend in Lexington I came away with tons of questions, thought-provoking ones.  One question that I cannot seem to answer is in regards to facial fractures and how they relate to concussions.  Now before you go and vote below think about this.  Can you sustain a facial fracture, i.e. orbit, zygomatic, maxilla, mandible (anything other than nasal), and NOT get a concussion? Vote below then click on “read more” for my thought process…

Continue reading →

T&C Story: Upgrading Protocols

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In the May/June issue of Training & Conditioning there was a wonderful article about keeping current with protocols, especially with concussion protocols, written by Phil Hossler, MS, ATC;

In response to the heightened amount of attention currently focused on the issue, it is critical for athletic trainers to upgrade their policies and procedures for dealing with this injury. It is no longer acceptable to simply record, evaluate, and monitor a concussed athlete. We must now develop a “portfolio” mentality when handling concussions, which entails a more collaborative and documented approach.

This is a very good point and one that athletic trainers should be cognizant of; during our “off-season” of sorts is a great time to get things in order.  Just as emergency action plans (EAP) are necessary for documentation and implementation of emergency procedures, Continue reading →

Doubts About Concussion “Products”

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Julie Deardorff or Chicago Tribune posted a story about how products within the concussion realm have some doubts cast upon them.  From the helmets – to the mouthpieces – to the supplements – to the tests; Deardorff takes a health angle on them;

s concerns mount over the dangers of concussions, especially in youngsters whose brains are still developing, so does the demand for products that purport to help diagnose the mild traumatic brain injury, reduce the risks or prevent it from happening altogether.

But although the harm from head injuries is increasingly well-documented by science, the validity of such claims so far is not.

One of the most telling portions of the story is from Elizabeth Pieroth;

“Regardless of what tool you use, good concussion management is about educating parents and families about how to manage injury,” said Pieroth, who works with Northwestern University athletes and is the concussion specialist for the Chicago Bears, Blackhawks, Fire and White Sox.

“You don’t need to be so fearful that you put your kid’s head in bubble wrap,” she said. “It’s just like any other injury — you need to understand when enough is enough. If your child had three ACL surgeries, he’d likely be done with the sport. Parents need to make the same decisions about concussions.”

This should be the take home message here; concussions will happen, how it is managed is the bigger and broader issue.  There is currently (and none on the horizon) not a “magic bullet” for diagnosis or management.  The key, from the CDC is “When in doubt sit them out.”

Live From Lexington

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Welcome to the intended live feed from the 2nd Annual Sports Concussion Summit here in Lexington, Kentucky.  We are at Cardinal Hill Rehabilitation Hospital, a beautiful facility.  Attendance looks to be very good, about “60 or so” according to Jonathan Lifshitz, host of the event.  I will be updating this post as we go along with a time, follow @concussionblog on Twitter for updates.

7:05am CST:  Jonathan Lifshitz, PhD opens up the conference, a big “walk-in” group, I still think I may be the only one not from KY here.

7:10am CST: Dr. Lifshitz had a great perspective on announcers and how the terminology of the game regarding head injuries has to slowly begun to change.

——

7:50am CST: Dan Han, PsyD “Contemporary Perception on CHI: Multidisciplinary Initiatives”

  • 1.7M documented TBI; 52,000 deaths per year, 275,000 Hospitalizations (CDC Numbers)
  • 75% of TBI (1.3M) are concussions/mTBI/mDAI; 300,000 are DOCUMENTED sports concussions
  • 0-4, 15-19 and 65+ y/o’s most likely to sustain a TBI
  • Females have significantly higher odds of poor outcomes
  • Documented TBI (see above) not the real issue; the undocumented TBI is the proverbial iceberg under the water
  • Diffuse Brain Injury
  • Secondary to stretching forces on the axons
  • Moderate DAI = “Classic Concussion” (unconsciousness, possible basal skull fracture)
  • Persistent confusion, retrograde & anterograde amnesia, mood/personality changes
  • Severe DAI = Brainstem Injury (high mortality rate)
  • And TCB Contributor Tracy Yatsko gets some run on a video!!!  Man girl you get around :)!
  • Postconcussional Disorder
    • LOC > 5 min or anterograde amnesia or new onset of seizures within 6 months after CHI
    • Just learned a lot about seizures; many go unnoticed
  • AND attention or memory deficit
  • Plus 3 or more symptoms present for at least 3 months following CHI
  • Significant impairment in social or occupational functioning
  • Academic achievement decline
  • HUGE Multidisciplinary Concussion Program at University of Kentucky, well on the way to being a leader in concussions

    • —–

    8:50am CST: Greg Wheeler, MD “Treatment of Sports-related concussions and return-to-play clearance” Continue reading →

    Matt Chaney: Parts 3 & 4

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    Following up on Part 1 and Part 2 of Matt Chaney, “pseudo-contributor”, looks at both “reform” and “research studies” as they relate to the NFL.  Chaney, although very outspoken on the matter has some very valid points, all worth just thinking about, at the very least.  His sources are some of the best and his writing is exceptional.

    In Part 3 titled “Football Brain Trauma Can Twist Personality, Spur Violence“, he takes a look at how changes in mood and overall “being” are being avoided; with such strong words/connotations of “mental disease”, “depression”, “suicide”;

    Doctors and medical researchers have long agreed boxing can cause brain damage in athletes and lead to personality disorders and outbursts, through repetitive impacts both concussive and sub-concussive.

    A 1973 study on postmortem evidence of 15 ex-pro boxers who suffered “punch-drunk syndrome” documented their “violent behavior and rage reaction” through interviews of relatives. Several of the boxers died in psychiatric wards.

    Decades earlier, boxers who became demented and deranged were known as “slug nutty,” according to a 1928 report by Dr. Harrison Martland.

    Meanwhile, yet today, the NFL and loyalist experts loathe admitting that tackle football even causes long-term impairment, much less off-field violence by players and chaos for families.

    In his latest, Part 4 titled “Research of NFL Brain Trauma Sputters Along“, he takes a look at the research involved, mainly longitudinal Continue reading →

    INDYCAR Concussion Question UPDATE

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    UPDATE 6/24 12:28 CST: According to @djcraske de Silvestro has NOT been cleared to race in Iowa this weekend, and will not attempt.  Repeating, after this story, Simona de Silvestro will not be cleared to race in Iowa, even though she did 24 hours following the concussion…

    UPDATE #2 6/24 12:35 CST: RT@djcraske Credit to both her & HVM Racing. She went to medical on own accord, they ran IMPACT tests – denied. Next race July 10.

    UPDATE #3 6/24 12:41 CST: And the image of de Silvestro was blocked for use, sorry honest mistake…

    UPDATE #4 6/24 1:11 CST: Thanks to @djcraske, once again for allowing me to use one of his pictures!!!

    If you recall prior to the Indy 500, during qualifications, Ho-Pin Tung was disallowed to race after a concussion during an accident.  Also during that qualification, the new “darling” of IndyCar Simona de Silvestro, had an accident but reports only had (only in air quotes) 2nd and 3rd degree burns to contend with.  However if you look at the two crashes you will notice that both were of considerable force, and some have even commented that the de Silvestro crash was seemingly worse.  (These are people affectionately know as “gear heads” who follow the sport much closer than I).

    Thanks do @djcraske and his very intimate following of INDYCAR he had these observations;

    Now, that accident was nothing of her doing whatsoever. Something obviously broke in the left rear, and she was a passenger. 99.9999% of the world’s population would’ve left skidmarks in their drawers after something like that. She suffered 2nd/3rd degree burns on her hands, and must wear gloves for one year. To her credit, she qualified for the 500.

    During the 500, she whitewalled Turn 1 on Lap 3 or so, and struggled with the car. She was in/out of the pits often, and finally retired after 44 laps, finishing 31st.

    During the Texas Twin 275’s, she didn’t have much of a car there, finishing back in 27th & 28th place. Still, some said she was still a little spooked after the Indy accident.

    Fast forward to last weekend’s race at Milwaukee. The Milwaukee Mile is one of the trickest ovals in INDYCAR, because it really does drive like a road course. During practice, this happens: Continue reading →

    NHL Clarifies Rule 48

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    The NHL today sent out a note that they have cleaned up the wording on Rule No. 48, the rule put in place at the Winter GM Meetings that “kind of” started the penalization of head hits in professional hockey.  The statement reads (from NHL.com);

    Rule 48 previously provided the on-ice officials with the ability to call a major penalty for any targeted head hit from the lateral or blind side, but the re-written rule no longer includes the words lateral or blind side, and the major penalty provision has been replaced by the minor penalty provision.

    “Now, the confusion some of the players have expressed in the past as to what direction they’re approaching a player, what direction a player is facing, east, west, north, south, that has all been taken out,” said Brendan Shanahan, NHL Senior V.P. of Player Safety and Hockey Operations. “Anywhere on the ice, coming from any direction, you target the head and make it a principle point of contact, you’ll be subject to a two-minute penalty on the ice for Rule 48. You’ll also be — as with all two-minute penalties or non-calls — subject to supplementary discipline.”

    This should, stress on the word “should”, eliminate any hits being made to the head with anything other than a high stick or puck Continue reading →

    Athletic Trainers Needed not Need to be Cut

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    With the ever-growing current of law suits regarding about everything in life (see hot coffee) when a school district has the chance to diminish some of the risk why not take it.  Sure it is going to cost something up front, but why not be protected and give the coaches and administration some stress relief?  What is the cost for peace of mind?

    The website PennLive.com recently ran a story, from the Patriot-Ledger and Stefanie Loh, about how the need for athletic trainers far outweighs the cost associated with the profession (thank you Chainsaw);

    “We’ve been working on that for a while now, trying to really emphasize it,” said Janik, the head athletic trainer at King’s College in Wilkes-Barre. “But it’s tough, especially with all the budget cuts.”

    With school districts across the state forced to cut corners to accommodate shrinking budgets, there are already indications that some might resort to eliminating athletic training positions to make ends meet.

    The state in the story is Pennsylvania, where a recent study found that 81 percent of the high schools had access to an athletic trainer.  However eliminating that position may save some much-needed money, but what about those that are getting hurt, Continue reading →

    Irv Muchnick: NYT Blacks Out Omalu

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    Irvin Muchnick is a writer and investigative journalist writing focusing mainly on the WWE.  Muchnick has been heavily involved in the concussion issue in the WWE and its crossover as well.

    Irv has been and will continue to be looking at how the media and other entities cover the concussion issue.  Recently he has taken a close look at the New York Times and Alan Schwarz as it relates to concussions (LINK);

    An examination of the Newspaper of Record’s coverage over the last six months suggests that the answer is it is leading us to a world made safe for the National Football League and its $9-plus billion in annual revenues.

    Pay plenty of lip service to the alleged mental health toll for the thousands upon thousands of professional and amateur athletes employed by the NFL or in its orbit – but also make sure all the opinion-making honor and Continue reading →

    Natasha’s Law: TX HB2038

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    The Texas Governor has signed the concussion legislation into law, it is called Natasha’s Law; named after Natasha Helmick a very strong advocate for this legislation.

    We happened upon this legislative piece when we were examining the Illinois process, and felt it was very good and forward thinking.  The highlights again include;

    • Concussion Management Team
    • Removal from Play
    • Waiver and Graded Protocol to Return to Play
    • Specific Education/Training for all HCP’s
    • State Wide Tracking/Logging of Concussions

    The full text of the TX Bill can be seen at that link.  Texas is now the 21st state with enacted legislation.

    Validity of Neurocognitive Tests

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    Matt Chaney has blogged about it many times, we have posted about it, now it is beginning to find its way into the mainstream media; validity of the neurocognitive tests more specifically ImPACT.  Dr. Chris Randolph of the Loyola University Health System has become one of the “loudest” when it comes to this issue, the main concern being the false-positives.  This is when the testing indicates that the affected athlete is “OK” but is still having post concussive effects.  From USAToday and Robert Preidt;

    Randolph analyzed the scientific literature and could not find a prospective, controlled study of the current version of the most common baseline concussion test, called ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing). Athletes take the 20-minute test on a computer. Continue reading →

    NC Concussion Awareness Act

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    The Governor of North Carolina is expected to sign the Gfeller-Waller Concussion Awareness Act into law today.  Posted today in the News Observer online edition is the quick recap;

    The act applies to public high schools and middle schools and requires them to provide education on concussion awareness to student athletes, parents, coaches, volunteers and first responders; requires players who exhibit signs of a concussion to be removed from play or practice and not return until being cleared by a medical professional; and requires schools to develop an emergency plan to deal with serious injuries.

    The bill is named after two high school athletes who died as a result of concussions.

    Matthew Gfeller was a sophomore at Winston-Salem Reynolds, and Jaquan Waller was a junior at Greenville Rose. They died as a result of concussions received while playing football.

    This brings the total (that we have compiled) to 20 states with enacted legislation.  If you know of more please send it to us!

    Irv Muchnick: NFL Too Big To Fail

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    Irvin Muchnick is a writer and investigative journalist writing focusing mainly on the WWE, writing a book titled “Chris and Nancy: The true story of the Benoit murder-suicide and pro wrestling’s cocktail of death.“  Muchnick has been heavily involved in the concussion issue as it relates to WWE and its crossover as well.

    Posted June 10th on Beyond Cron, Irv looks at a possible reason why the concussion issue is a real problem in an article titled “NFL Too Big to Fail – That’s our real national concussion problem“;

    In sports, as in everything, we love our scandals served on a tabloid plate: the jock DUI’s, the strippers taunted with $100 bills, the sexting, the dog-fighting rings, and most recently, the “amateur” football players for whom the National Collegiate Athletic Association prohibition against “extra benefits” turns out to cover not just cars but also tattoos.

    What we don’t enjoy so much is contemplating life and death. That is why the sports-industrial complex can succeed in feeding the public appetite for the concussion pandemic by substituting pablum for information. Most of us just want this thing to go away, and the National Football League and its circle of friendly media have devised an easy way out: state legislation making youth football “safer” – with the assistance of a “solution” that, it just so happens, was packaged and sold by NFL doctors.

    The underlying theme is that the NFL doctors are distancing themselves from independent researchers that have put holes into the neurocognitive testing and management of concussions.  The most prominent name is Dr. Benett Omalu; Continue reading →

    Military Once Again Trying To Lead Pack

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    A military study done at Washington University in St. Louis, Missouri and abroad looking that the brains of blast injured servicemen from Iraq and Afghanistan shows a ‘early first step’ toward possibly having the imaging technology to discover concussions;

    Using a highly sensitive type of magnetic resonance imaging, researchers studied 63 servicemen wounded by explosions in Iraq or Afghanistan and found evidence of brain injuries in some that were too subtle to be detected by standard scans. All the men already had a diagnosis of mild traumatic brain injury (synonymous with concussion), based on symptoms like having lost consciousness in the blast, having no memory of it or feeling dazed immediately afterward.

    As reported in the New York Times Dr. David Brody and his colleagues have posted a study in the New England Journal of Medicine looking at the diffusion tensor imaging (DTI) a function of a standard MRI.  This type of imaging study does not take any longer to perform but can look even ‘deeper’ in the brain for subtle changes; Continue reading →

    NOCSAE Press Release

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    From NOCSAE;

    OVERLAND PARK, KANSAS, June 13, 2011 – The National Operating Committee on Standards for Athletic Equipment (NOCSAE) Summer Board Meeting will take place in Chapel Hill, N.C., June 17. During this meeting, the organization will review a report from the new Scientific Advisory Committee and consider and approve research grant requests. The agenda also will include consideration and discussion of a new youth football helmet standard, a new women’s lacrosse helmet/head protection standard, a new defensive position head/face protection standard for baseball and softball, as well as potential modifications and clarifications to existing standards.

    NOCSAE is an independent and nonprofit standard-setting body with the sole mission to enhance athletic safety through scientific research and the creation of performance standards for protective equipment. Formed in 1969, NOCSAE is a leading force in the effort to improve athletic equipment and, as a result, reduce injuries. NOCSAE efforts include the development of performance and test standards for football helmets and facemasks, baseball and softball batters and catchers helmets, baseballs and softballs, ice hockey helmets, soccer shinguards, lacrosse helmets and facemasks and polo helmets.

    NOCSAE is a primary source for research funding in all sports medicine and science related areas and is the leading nongovernmental funding source for sports concussion related research. Since 2000, NOCSAE has devoted more than $2.5 million toward this research by the foremost experts in sports medicine and science to develop and advance athlete safety. Since 1995 NOCSAE has dedicated more than $4 million in concussion-related research involving some of the nation’s leading academic and research institutions.

    You can contact Rebecca Rausch at rebecca.rausch@fleishman.com for further information.

    NSCC June 2nd Meeting

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    As we posted the National Sports Concussion Cooperative held a meeting in Chapel Hill, North Carolina on June 2nd.  Thankfully the NSCC logged the event with photos and video.  If you have time you can head over to their Facebook page to view the videos.

    http://www.facebook.com/ConcussionCooperative

    From what I have seen thus far it was a very early stage in information, more of a sharing of thoughts, and this is really the point of such meetings.  Getting all the players together to discuss and develop is not an easy task.  Thanks for the update!

    Footballer’s Migraine: What is that?

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    As we highlighted in “More Education Needed Down Under” the prevailing thought in Australia/New Zealand about head injuries is that concussion is a very bad word.  In fact the medical society is even using a term “footballer’s migraine” (FM), that is over 40 years old, to describe lasting effects of being hit in the head.  The Sydney Morning Herald and Nicky Park has just posted a story about the condition;

    Footballer’s migraine, a condition that has forced Wallaby Berrick Barnes to take an indefinite break from rugby, remains a mystery to sports medicine experts.

    Shane Brun from Sports Medicine Australia says the link between recurring migraine and continuous blows to the head is cloudy.

    Symptoms of “footballer’s migraine” are the same as a standard migraine – throbbing head, sensitivity to light, nausea and ringing in the ears.

    Of course FM remains elusive, it is extremely outdated, proposed by W.B. Matthews in 1972 the condition has been radically surpassed Continue reading →

    Kansas Act

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    The Kansas Governor has recently signed in to law the Head Injury Prevention Act, which is an effort to make those aware of concussion issues.  The Act, like other states, has the mechanism for removal and return to play/clearance.  The Kansas State High School Activities Association (KSHSAA) has put forth the recommendations outlined in the Act that each school must follow.  The highlights include;

    • If removed they “should not” return the same day
    • If removed they need a “health care provider” written clearance
    • Health care provider is: MD or DO
    • Information and Release Waiver that must be signed prior to competition
    • KSHSAA included the Zurich graded RTP protocol

    Link to the KSHSAA Concussion Guidelines.

    Kansas is the 19th state to sign legislation.  Thank you to reader Justin C. for sending this information in!

    TCB Contributor Speaks

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    Nick Mercer a contributor of The Concussion Blog and author of ConcussionTalk was recently in Newfoundland giving a talk about recovery from concussions.  He was part of Newfoundland and Labrador Brain Injury Association meeting.  We value what Nick has to say and feel that if you have time you should view the following videos (3 parts).  And visit his blog for the videos of Dr. Falah Maroun, neurosurgeon.

    PART I

    Continue reading →

    MLB Concussion Update #2

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    Denard Span of the Minnesota Twins has been befallen by a concussion on June 3rd.  However it’s not that we are more than a week late to report this news, it’s that Span played following the concussion, from FS North;

    Span collided with Royals catcher Brayan Pena when he tried to stretch a triple into an inside-the-park home run last Friday. He stayed in the game and played again Monday against Cleveland but was kept out of Minnesota’s lineup for three straight games, including Thursday’s series opener against Texas.

    The reasoning for him playing is unclear at this point, but it seems that Span was unaware of the symptoms, or at the very least did not report them right away.  Span had a spell of “dizziness” in 2009 that made him miss a lot of the month of June.  This may have been the Continue reading →