Practice Identifying Injuries

As an athletic trainer one of the most important tools we have for ANY injury is our eyes.  In school we take a lot of classes on rehabilitation, taping, evaluation, etc., however the most important classes in my opinion are the ones that help us identify mechanism of injury (MOI).  Those classes would be; anatomy, physics, biomechanics and the variations of kinesiology.

I am not speaking of getting up close to the injured individual to begin an initial evaluation, that is a different part of the job, I am speaking of watching the injury unfold in real-time.  Taking the MOI classes allows us to understand what most bodies can handle and how they should be functioning.  Knowing what each ligament in the body is designed to do (restrict certain movements) or where each tendon/muscle originates and inserts and what type of lever movement it provides can tell a lot when forces are applied.  In the cases of unsuspected or unnatural forces are applied and from where (Physics) in that exact time in body motion (biomechanics) as compared to normal movement (kinesiology) will tell athletic trainers what kind of injury they are going to deal with.  This not only allows for a better “filtering” system for evaluation, but it saves time in making critical decisions.

Yes, we do not see every injury occur, Continue reading

MLB Concussion Update #4

Another three weeks have passed since our last MLB Concussion Update, but we have an official name to add; Craig Gentry of the Texas Rangers.  Gentry was injured while colliding with a player while sliding into second base.

Since our last visit to the MLB, there have been a “knocks” to the head and one “knockout” that have not resulted in the 7-day DL; Jose Bautista, Marlon Byrd and Orlando Hudson, respectively.  The “official” list now is up to six; Continue reading

Ankle Sprain = Lower Neurocognitive Scores?

According to some recent research out of Toronto, to be published in the American Journal of Sports Medicine, led by Michael Hutchison this is the case.  Any athlete suffering an injury showed declines in neurocognitive testing, significantly compared to a control group.

In this study both concussed athletes and other injured athletes were compared to a control group of uninjured athletes;

For the current study, researchers at the University of Toronto gave the 20-minute computer test to 72 student-athletes, including football, hockey, and lacrosse players. Eighteen of those athletes had suffered a concussion in the past three days, and another 18 had been taken out recently by a muscle or tendon injury.

The other 36, used for comparison, were uninjured.

We would all suspect that the concussion group would decline Continue reading

Gov. Quinn FINNALY Set To Sign

The Illinois State Legislature has been working on the concussion bill since January, it has been held up along the way for a couple of amendments but has been sitting on the Governors desk since June 3rd (LINK).  Word is that the Governor is set to sign the bill today at a ceremony in Solider Field (the 30th total according to our records) putting into motion, what I have been trying to tell any school in Illinois that would listen, the requirements for concussions at the high school level.

This bill has remained relatively unchanged since I first posted about it in February; there are two Amendments that you can see in the first link.  In quick synopsis this bill/law will; Continue reading

Prolonged Recovery Indicator?

As an athletic trainer one of the most difficult tasks is convincing the athlete, parent, and coaches that their son or daughter is hurt.  With a concussion everything “looks normal” most times (except for the cases of overt signs).  Even with the signs that present most resolve rather quickly and again those affected by the head injury think everything is OK; it’s not like a bone is broken or there is imaging to SHOW an injury/problem.

For a long time researchers have been trying to identify what sign or symptom relates to prolonged recovery.  Early on, 80’s and 90’s, the thought was loss of consciousness was the indicator; later to be not the case, and the understanding that one does not have to be KO’ed to get a concussion.  Within the community we have used the term feeling “foggy” as a high indicator of prolonged recovery, but that is a very subjective symptom and really unproven, more observational.  This might be changing as a very INITIAL study was released by Dr. Brian Lau of the UPMC in the American Journal of Sports Medicine. Continue reading

Why Did He Go Back To The Pitch?

Gael Clichy of Manchester City sustained an OBVIOUS head injury on July 24th in a match against the LA Galaxy.  Initially he was removed, however not only did he finish the first half, he continued in the second half.

This is a classic example of a situation where an athlete should be removed and not allowed to return until cleared by a physician.  Granted Clichy could have been cleared by a physician, any physician worth their salt when dealing in concussions would NOT have returned this individual with the mechanism of injury and immediate signs, forget what the reported symptoms were by Clichy.

As you can see in the video below Continue reading

Mouth Gear Information

Courtesy of Jonathan Harford via Flickr

Back in November I took on the mouth gear issue by showing some emails that I had with a few of the prominent companies invested in oral/facial protection.  I use the term “mouth gear” to isolate any device that is placed in your mouth, this is a very hot topic, especially since the football season is about to begin.  If you have read that post you know my stance on the issue at hand; buyer beware.

Lets begin with some video footage of athletes wearing mouth gear;

  • The first KO is textbook mechanism of injury that the mouth gear companies say they can protect against; a blow to the jaw, where the jaw bone (mandible) would slam into the skull.
  • The third KO is a blow to the jaw, in a rotational axis, again companies claim they can protect against concussive injuries when a blow is received on the jaw.
  • The fourth KO is a straight right to the jaw.
  • The fifth KO a left to the jaw in a rotational axis.
  • Should I keep going????  I think you get the point.

It’s not so much that the companies in question Continue reading

Fink’s Rule

Fink’s Rule”: when there is a diagnosed fracture of the face and jaw (excluding the nasal bone) the forces absorbed during the injury will be beyond a threshold to elicit a concussive episode.  This would indicate to the clinician that the person should ALSO be evaluated for a concussion.

Alternate definition: when the terms “jaw injury”, “head contusion” , or “concussion-like symptoms” are present in an injury report one should be aware that forces were elicited to the head, and an assessment for a concussion should be indicated.

Is Rugby Staring Down The Barrel

We have highlighted the “slow” response to the concussion issue that rugby has struggled with in the recent past.  Sure the International Rugby Board (IRB) has given monies for research and looked into their policies, traditionally the sports outside of North America have not been as concerned with the issue.  Heck the first article taking the sport to task was the one linked above.

Just like the previous article the Irish Times has once again brought it to the forefront.  After framing the story with the law suit filed by the former NFL players the IT looks at rugby;

Within the last year professional Irish rugby players Bernard Jackman and John Fogarty have both retired from the game due to ongoing issues with concussion, while the International Rugby Board (IRB) last month issued a new “more robust” set of guidelines regarding the recognition and treatment of concussion in players.

Players are not permitted to wear heavily-padded protection, which was being promoted by Australian back Berrick Barnes, who recently took time out of the game because of repeated concussions, but now hopes to play in this summer’s World Cup. Continue reading

Orlando Hudson

Yesterday in Florida, Orlando Hudson (of the San Diego Padres) made a terrific effort and catch in foul territory, however what happened after will be a point of discussion. CLICK HERE FOR VIDEO (from

Hudson made the catch and his momentum caused him to collide with the wall (padded), striking his head/shoulder first.  It was apparent that Hudson was out after the catch, later to be confirmed by his manager;

“It was a scary moment,” manager Bud Black told the Associated Press. “When a guy goes unconscious, you’re worried. Any sort of collision with a wall or a teammate is just a sickening feeling in your stomach, and I think we all had that.”

The athletic trainers ran onto the field to assess the situation, once there, it was deemed necessary to stabilize his neck and put him on a spine board for medical evacuation.  As he left the field Hudson was moving all extremities and even gave a thumbs up.  Reports later had Hudson walking and changing his clothes just after being removed from the field, while wearing his neck brace.  He later went to the hospital for a full exam including imaging (which has come back as normal).

This is a perfect example of what can happen on the baseball field and the great reaction of the medical team, however judgement is still out on how the player and team handle the actual situation.  Continue reading


NOCSAE is teaming up with the CDC to make an effort to get the parents educated in the area of concussions.  The CDC has made a great effort with the coaches and health care providers by producing material specific to those areas.  Although there has been some material for parents this effort will be focused on the moms and dads;

The National Operating Committee on Standards for Athletic Equipment (NOCSAE) and the Centers for Disease Control and Prevention (CDC) are teaming up to launch “Heads Up to Parents,” a new educational initiative designed specifically to provide parents with the facts about how to protect, prevent and respond to youth and high school athlete concussions. The partnership, made possible by a grant from NOCSAE to the CDC Foundation, builds on the CDC’s successful “Heads Up” initiative featuring free tools for coaches, athletes, parents and healthcare professionals that provide important information on preventing, recognizing and responding to a concussion.

If there is not an athletic trainer or doctor Continue reading

ESPN Looks At Virgina Tech Study

Gregg Easterbrook, writing for Page 2 on in his Tuesday Morning Quarterback wrote an article about the rating system for helmets that Dr. Stefan Duma presented in late spring.  As we covered it here; explaining that his data was in concert with our observational data on helmets.  In the Easterbrook article titled “Virginia Tech helmet research crucial“;

Now all that has changed. Researchers at Virginia Tech have produced the first brand-by-brand, model-by-model ranking for the likely concussion resistance of helmets. A star-rating system modeled on crash safety rankings for automobiles, the rankings clearly identify the best and worst helmets. Virginia Tech researchers give high marks to these helmets: the Riddell Speed, Riddell Revolution, Riddell Revolution IQ; the Schutt Ion 4D and Schutt DNA; and the Xenith X1. The Virginia Tech researchers give medium grades to the Schutt Air XP and Schutt Air Advantage. The Virginia Tech rankings warn players not to wear these helmets: the Riddell VSR4 and the Adams A2000.

Now the chilling part: the VSR4 — Virginia Tech’s second-lowest-rated helmet — was the most common helmet in the NFL Continue reading

Ivy Leauge Puts In Contact Rules For Football

The Ivy League has decided to become proactive in the area of contact practices in football.  Currently the NCAA limits the number of full contact days to 5 per week;

According to the new rules, teams will be able to hold only two full-contact practices per week during the season, compared with a maximum of five under N.C.A.A. guidelines. On the other days of the week, practices cannot include contact or live tackles, and no player may be “taken to the ground.”

During the preseason, teams will be able to hold only one full-contact session during two-a-day practices.

This decisions has been made after a long study, and coaches feel as though the changes will not impact the game or current practices, with the added bonus of having “fresher” players on game day.


Suit Filed Against NFL?

According to 75 players have filed suit against the NFL for hiding the dangers of repetitive head trauma, specifically concussions;

According to the lawsuit, filed today in L.A. County Superior Court and obtained by TMZ, the players and their wives claim, “The NFL knew as early as the 1920’s of the harmful effects on a player’s brain of concussions; however, until June of 2010 they concealed these facts from coaches, trainers, players and the public.”

The centerpiece of the argument is the now infamous study published in 2004;

The suit claims the NFL commissioned a study in 1994, titled “NFL Committee on MIld Traumatic Brain Injury” and published a report in 2004, concluding there was “no evidence of worsening injury or chronic cumulative effects” from multiple concussions.

The NFL has posted a quick blurb on their website with the story as well, and NFL Spokesman Greg Aiello had this to say;

“We have not seen the complaint but would vigorously contest any claims of this kind,” Aiello told

In Depth Article For Fans of Combat Sports

In the blog Head Kick Legend (part of the SB Nation) author David Castillo broke down what concussions mean to fans of combat sports.  However it goes beyond sports like MMA and boxing, it paints a great picture for the reader as to what is going on; not only in the brain at a axonal level, but throughout sports.

It is a very extensive read, but worth your time if you are struggling to figure out what is happening at the cellular level;

So what exactly happens to the brain when it’s rattled? In a mild concussion, a split second hurricane of neural events occurs in which too much calcium impairs the mitochondria cells (the power centers), and leaves the brain lacking in the ability to sufficiently restore glucose in the brain. The younger you are, the more susceptible you are to long term damage. And this damage manifests itself with many different symptoms: dizziness, sensitivity to light, mood disorders, vomiting, confusion, slurred speech, and fatigue. But to dig even deeper on exactly what is being done to the brain upon trauma, experiments with axons have been highlighted off the work of Douglas Smith at the University of Pennsylvania.

Smith builds miniature brains out of rat neurons, which are then ‘hit’ with controlled puffs of air to simulate brain trauma at a molecular level. The axon is like a paperboy, sending neurological news, Continue reading

More Research From AAIC

A recent study to be presented by Chris Randolph in Paris at the Alzheimer’s Association International Conference will be “piggybacked” on the information that came out yesterday.  In a Bloomberg News report by Elizabeth Lopatto there was a small preview of what Randolph will be disclosing, and it is not good news for those that are trying to bury their head in the sand;

The study, to be presented today by Christopher Randolph of Loyola University in Chicago, found that athletes who play American football showed symptoms of mild brain dysfunction at an earlier age than nonplaying peers. In addition, there was more illness among the retired athletes than in those who were about the same age.

“You don’t play football without getting a concussion,” said Cornelius Bennett, a former linebacker for the Buffalo Bills and head of the retired National Football League Players’ Association. “We’re taught in football that if you can’t play, you lose your job, and if you don’t report concussions, you have a better chance of keeping your job.”

Very interesting, the information and the quote from Bennett; the primary issue seems to be centered around professional football.  What we need to understand is Continue reading


“These days, we take pride in being tough enough to inflict pain on others. If an older usage were still in force, whereby being tough consisted or enduring pain rather than imposing it on others, we should perhaps think twice before so callously valuing efficiency over compassion.”

– Tony Judt, Ill Fares the Land

This is a quote more about society in general than it is about sports in particular, but society and sport are so interconnected that the distinction is almost meaningless. I know I’m not breaking new ground by saying that the brain injury issue facing contact sports has a major communication problem, but the point is so important that it’s difficult to overstate.

Take hockey, for example. Any responsible kids’ minor hockey league coach will remind the players that hits to the head are big no-no’s. During the course of a game a player may hit an opposing player in the head (maybe intentionally, maybe not) – the hitter is penalized, the coach may get mad at him or bench him, but, as is so often the case, the hitter is noticed by other coaches for his hard -hitting, aggressive style of play. Due to a reckless and dangerous hit that contradicts everything the coach taught him and goes against the rules of the game, that player is noticed and rewarded by being picked for all-star teams and the coach is encouraged to give him more minutes. At higher levels, it’s more than other coaches and teams noting this aggressive player and his feared style of play. It’s also sponsors and TV networks, accentuating the pressure on the coach to showcase this player and the new hard-hitting and dangerous style of play.

We need to look at what we, as hockey, football, rugby or any contact sport fan, value in sports. If it’s fluidity of play and athleticism, then we need to make our values known. If it’s aggressive, strong, and tough players enduring pain, then we need to make that Continue reading

Alzheimer’s Association Lets It Be Known

There has been a lot of press regarding the predisposition of the brain after playing in the NFL; for years the league has tried to keep a lid on it, claiming there is not sufficient evidence to support a NFL career and increased risk of degenerative brain function.  The NFL is not the only one with this issue; the military has also been intrigued by service and brain predisposition, however the military has been trying to helps its veterans by working hard on the issue.

All of this could change with the press release from Alzheimer’s Association, meeting this past weekend in Paris for their International Conference.  The Alzheimer’s Association is the world’s leading voluntary health organization in Alzheimer care, support and research.  The press release is titled “Brain Injury May More Than Double Dementia Risk in Older Veterans, with the subtext of: Additional Study Suggests that Former Athletes with Concussions have Increased Risk of Cognitive Impairment, with Earlier Onset;

PARIS, July 18, 2011 – Older veterans who experienced traumatic brain injury showed a more than two-fold increase in the risk of developing dementia, according to new research presented today at the Alzheimer’s Association® International Conference 2011 (AAIC 2011) in Paris. Continue reading


This post was written on Saturday 7/16/11 in reflection of meeting the Trenum’s.

Well I arrived to the Hotel and Conference Center around 2pm EST today the first thing on my list to do was to text Michelle Trenum to arrange a meeting if possible.  As if it were fate, the Trenum Family was on their way to vacation in Maine and made arrangements to go out of their way to meet up.  The Trenum’s are from Prince William County, Virgina and if you have followed this blog you will know their story and how we have helped here at The Concussion Blog.  Ever since I received the email from Michelle I have had Austin on my mind with just about everything I do in regards to concussions.  I must say there are even times I look at my own children and can only imagine the pain this family has endured.

Gill, Michelle, Cody and Walker were in the lobby of the hotel as I walked up, as I turned the corner I saw Gill and pointed to him and I was greeted with a smile and a feeling of comfort.  Michelle rose and came over and introduced herself, but before that could happen Walker and Cody both jumped in to make sure they extended a hand to introduce themselves.  There was absolutely no awkwardness, it was as if I was seeing long-lost family, I was at ease, and excited to just talk about Austin and what has transpired since last year.  I did not want to take too much of their time Continue reading

Live From Princeton

Welcome to the continually updated live feed from the Athletic Trainers Society of New Jersey 2nd Annual Concussion Summit.  I would like to thank the ATSNJ in particular; John Furtado, Eric Nussbaum, and Mary Jane Rogers for the help in getting things set up.  We are at the Wyndham Princeton Forrestal Conference Center & Hotel in a stunning amphitheater, attendance is anticipated to be high.  I anticipate updating this post as soon as possible after each speaker.  Follow @concussionblog for updates.

6:25am CST: Crowd flowing in with provided breakfast in hand.


6:33am CST: Jason Mihalik, PhD “Biomechanics of Concussion”;

  • Concussion is a FUNCTIONAL injury not structural injury
  • Brian injury a major public health concern (showing a pyramid with the head injuries on the bottom, unseen or caring on their own)
  • Things that feed into Traumatic Brain Injury:
  • Cognition, Concussion History, Postural Stability, Mechanism of Injury, Physical Exam, Symptomatology, Knowledge/Attitude
  • Injury Prevention (anticipation, infractions, play type, closing distance)
  • Kinds of impacts that cause concussion; research obviously done primarily on animals beginning in the pre 40’s.  The coup-contracoup model was found by using animal models
  • Research moved from animal models to human analogs; wax skulls/gelatinous brains Continue reading
  • CRR App

    Concussion Recognition & Response App is what it is called, however what it can do can be very helpful for those looking to help an athlete in need after a possible head injury.  With any medical app’s for smart phones it DOES NOT replace a clinical evaluation by a medical professional.  That being said any “layman” using this technology will easily be able to discern if the current injury need to go to an ER or sit out until evaluated by proper medical personnel.

    The app was designed and constantly evaluated by a whole team of researchers and physicians, the two of note are Jason Mihalik, PhD and Gerad Gioia, MD.  The intended purpose of the app is to help those less informed, without proper health care available (see athletic trainer/MD) identify if a person is exhibiting signs and Continue reading