Clearly the decision to let Mike Vick play this week has come under some scrutiny from many sources. I have been asked many times my thoughts on this issue as well; it is much more difficult to take a stance on something that really none of us know first hand. That being said there is no reason anyone cannot give an opinion on the matter.
Barbara Barker of Newsday sought out two opinions; one from a former player and another from an authority in concussions;
“I’m going to be watching him to see how he responds after he gets hit,” said former Giants linebacker and Hall of Famer Harry Carson, who suffered multiple concussions in the course of his career and has been diagnosed with post-concussion syndrome. “I’m sure he’ll go out there and do well, but if he doesn’t and gets hit the right way, there’s no telling what might happen.”
“Frankly, even from a fan’s perspective and even with someone as good as Michael Vick, I would have been happier to see them err on the side of caution,” Nowinski said. “Another concussion right now is the worst-case scenario. Michael Vick could be the Sidney Crosby of the NFL.”
I believe that there are more than Carson, Nowinski, and myself looking at the results of Vick playing. Will he be OK when it is all said and done this afternoon? Probably, but if not the “I told you so” will be flying like crazy. The Crosby reference is not one to take lightly, as I have mentioned on here it was the machismo belief that he was fine that put him in the situation he is currently in.
As mentioned there is way more things to consider with concussions on the professional level, unfortunately these “things” muddy the water. What are these things?
- Adult making informed decision
- Subjective reporting of the symptoms
- Uneducated awareness of the subtle symptoms (sleep, emotional, etc.) that get confused with “tiredness”
- Who is in control of the athlete (agent, player)
- Current tools
- Does the medical team have the final “go/no-go” based on clinical assessment
- Money
It looks like a convoluted mess when dealing with a professional concussion, the first three are problems that can be dealt with by proper education, the fourth is a matter of control. The fifth issue is one of great concern across the medical community as we are not all convinced what we are using is definitive enough to make the right decisions;
Nowinski thinks there are plenty of reasons that he shouldn’t play, at least for one more week.
“If Michael Vick knew what I knew, he would not be back out there on Sunday,” said Nowinski, who suffered multiple concussions when he was a football player at Harvard and as a pro wrestler. “We have to be humbled by the fact that the tools we have right now are weak when it comes to determining when the window of vulnerability is over after a concussion. In my world, and with the guys that I deal with, there is no shame in erring on the side of caution and making sure you don’t get that second hit.”
Nowinski thinks the NFL is doing “a much better job” of determining when it’s safe to play. But as the NFL notes in its policy, a critical element of managing concussions is “candid reporting of players of their symptoms.”
The sixth issue is something that I have personally been berated for and “talked to about” when writing on it. Granted the players have to be released by an “independent” source, someone who has no ties to the team/player, good in principle. However, the issue with this is that the “independent” source does not know the athlete as intimately as the teams medical staff. In fact the only people who truly know the normal disposition of the athlete is: the athlete him/herself, family, coaches, teammates and the athletic trainer. All the people who are around the concussed on a daily basis. These sources would know if something is “amiss” with the injured individual even subtly. Then why should these people not be able to weigh in on the final decision? Granted a large portion of that group could be controlled or even see things through jaded glasses when trying to help, one person would/should not be, that is the athletic trainer. The issue at the professional level (and in no way am I saying this is the actual case with any concussion in the NFL) is the perception that the part of the medical team that knows the player the best may be influenced to just do the tests, take the players word and pass it along to the independent source for clearance. That is not exactly the wrong thing to do, it would be part of the job; however at some point there needs to be a responsible person that knows the individual on a clinical basis that can discern actual viability for return to play.
For now, at the professional level decisions are going to be made in a vacuum, and because of that Vick can return to play. However that does not mean that it is the right thing to do. Oh, my opinion on the matter, if Rick Burkholder says he is good to go then it should be noted that he should know Vick better than anyone else when it comes to medical issues. That being said if this were a high school or college player in my control, he would continue to be out.
The Concussion Blog 
I have gotten tired of this conversation on ESPN this morning. All they have talked about is the custom mouthguard Vick will wear today. He chose not to wear it a week ago and bit his tongue. They keep inferring that if he had worn this mouthguard a week ago, his condition would be different today..
Michael,
Do you remember what they actually said about the custom mouthguard being able to change the outcome of Vick’s symptoms. That was a very intense helmut to helmut hit!
Barry
Vick just left the sideline after taking another shot to the head. He sat on the turf holding his head for a bit before getting up..
Michael,
I tuned in to Mike and Mike after Merril Hodge was on Monday morning after the comment on the custom mouthguard that you talked about above.
What I did notice as they replayed that helmut to jaw hit , that hit didn’t have anywhere near the biomechanical force of the helmut to helmut hit a week earlier.
Because it appeared that less biomechanical force resulted in him sitting on the turf holding his head before getting up. That may imply that he actually didn’t recover 100% from the concussiion the week before. They say it is easier to concuss a brain still in a state of concussion. I’m sure the Docs are under a lot of pressure to get Michael Vick back on the field.
Barry
Who is the indpendent neurologist. In all likelihood, it is someone affiliated with University of Pittsburgh Medical Center, Joe Maroon et al., or on the NFL payroll. Everything will now be a head or neck injury and everyone who is a marquee player will miraculously clear in days to paly, thanks to Joe Maroom and Impact. Vick, Rothlisberger and the list goes on.
We will need to wait for a marquee player to be killed during/following a game for anything to change. Many former marquee players die or as a could as dead a decade after retirement but who cares because they got to the show.
Does anyone know what type of Mouthguard Michael Vick was wearing????
And is there any credability to the possibility that this new type of mouthguard could possibly reduce the risk of concussion.
No Idea on MG, and no MG cannot attenuate concussions any more than a band-aids on the forehead…
Can these newer mouthguards that we see in Michael Vick’s mouth on this past Sunday afternoon after his concussion last week.
Or like the bright green one Glen Davis wore after that concussion Davis had because of Dwight Howard’s elbow to his jaw in game 5 of the 2009 NBA playoffs.
Why do we see athletes wearing mouthguards especially after they have a concussion?
I think Marc Sevard and Patric Bergeron had them on when they returned from their concussions as well.
If the medical staffs of these professional teams don’t understand that a mouthguard can play absolutely no role in concussioin prevention, then “why” are we seeing these athletes wearing these mouthguards?
Can the mouthguard material itself “absorb” force applied to it going to the brain or does it just absorb force applied to going to just the teeth to prevent orofacial injuries?
?
Barry,
No oral device has been found to reduce or decrease the chance of concussion, PERIOD. Why are people wearing them, I have no idea, perhaps they think it can make a difference? Maybe when they sustained a concussion they also sustained an oral-facial injury? You will have to ask them.
As for your last comment; “Can the mouthguard material itself “absorb” force applied to it going to the brain or does it just absorb force applied to going to just the teeth to prevent orofacial injuries?” – Again no research suggests that any oral device can capture/absorb enough forces to stop the head from moving. In order to sustain a concussion the head must be translated or be in a position where the skull will accelerate or decelerate quickly and the brain continues on it inertial path, causing injury to the brain. If the force of the blow was low enough just to translate the jaw, but not high enough to move the head in a fashion consistent with concussion then most likely an concussive injury would not occur.
I had the opportunity to sit in on a lecture by Chris Nowitski this summer. He is an outstanding and engaging public speaker. His quote in your article is the best I have heard on the problems we face in the field when it comes to concussions.
“We have to be humbled by the fact that the tools we have right now are weak when it comes to determining when the window of vulnerability is over after a concussion. In my world, and with the guys that I deal with, there is no shame in erring on the side of caution and making sure you don’t get that second hit.”
Thanks again Dustin!
Dustin,
I agree that a mouthguard can not prevent a concussion.
One of the reasons for me asking the questions to your readership was to see if anyone actual knows the answer first hand by knowing medical and or dental staff of these teams.
It was actually at a press conference earlier last week that the coach of the Eagles was asked by a reporter if Vick was wearing a mouthguard when he was hit. The coach replied he was not but he will be wearing (and I am quoting the coach) a “mouthpiece” when he plays this week. I don’t think the intention of the reporters question was intended to inquiry about the fact that Vick bit his tongue and bleed after the helmut collision.
It is infered from the reporter question that they are talking about concussion and not tongue laceration prevention.
If I could, I’d like to ask you this question, as I’m curious.
You said that in order to sustain a concussion the head must be translated. I am assuming that in order for the head to translate that the neck (that area full of muscles between our skull and shoulders) must allow the head to move. How does an athlete who sees a hit coming flex or brace his neck muscles. For example, if I wanted to flex my bicep muscle, my forearm would be perpendicular to my bicep. If I don’t make a fist with my hand then my bicep muscle will remain flacid or soft. However, if I make a strong fist it is only then that the muscles of my forearm will flex as well as my bicep muscle will contract/flex and become more rigid.
Do you know what an athlete would need to consciously be doing to flex/brace his neck muscles. I am assuming that being able to do that would make it harder to translate thereby make it harder to concussion the head.
Barry,
Sorry for the delay in response I have been giving this question much thought and research… And I don’t know the actual answer but I can try, and invoke discussion…
I would say “bracing” of the neck is primarily done by isometric contractions. Neck muscles are in a constant state of contraction because it has to hold our head up. I would also think just prior to a collision the neck is contracted in an opposite direction of the impending contact. It would be very interesting to truly understand this… I do have a contact that I will point to this question…
df
As Dustin replied, it is an interesting question. For the most part, a person (average or professional) appears to sustain concussions when biomechanical forces are unexpectedly applied. Think about how many ‘defenseless’ wide receivers are concussed, because they focus on the ball, not the incoming tackle (same for quarterbacks). With that being said, when a known mechanical force is coming, isometric contractions will help to stabilize the head (if not other physiological responses to the impending threat), and potentially reduce the magnitude of force transmitted to the brain.
In the event of an unexpected (blind-side) hit, I doubt anything can protect you. Teaching players to constantly be in a protected position would impair theit ability to compete.
Dr Lifshitz,
I want to first aoplogize to you for my lack of understanding of muscle and anatomic physiology and voluntary isometric neck muscle contractions or just isometric contractions.
Please be patient with my response because I am not 100% sure of how to communicate to what I am looking for in a reply to my question.
The trouble I am having is trying to understand the answer in simplier vocabulary about what an athlete should be telling his body to do.
Can I put it another way.
My bicep muscle is on my Humerus bone.
If I put my right elbow on my desk in front of me with my hand pointing upward and my bicep muscle at a say it is a 60 degree angle to the desk that I jusy put my elbow on.
If I do not make a fist, then my bicep muscle is flacid or soft.
If I take my left open hand and hit/push it laterally to my bicep muscle then my bicep muscle will roll over my humerus bone.
If however, I make a “hard fist and squeeze it real tight” with my right hand then my right forearm muscles will flex and my right bicep muscle will contract/flex/ and become more rigid.
If now I take my left open hand and hit/push it laterally to my flexed more rigid bicep then I need to apply a much much harder force to move my bicep to roll over my humerus bone.
With respect to the neck muscle stabilization question.
If my neck is braced it will take more biomechanical force to rotate my more fixed head via my neck muscle bracing than it would if my neck muscle was soft not as rigid. In other words it should take more force to rotate a fixed head and less force to rotate a more mobile less fixed head.
Your reply to me to this question is
if an athlete can anticipate a hit (and there are many times an athlete knows the hit is coming he has to get ready for it)
You said “when a known mechanical force is coming, isometric contractions will help stabilize the head”
IF I COULD STOP HERE AND MY THOUGTHS ARE IN CAPITAL LETTERS NOW:
HOW DO I “ISOMETRICALY CONTRACT” MY NECK MUSCLES .
HOW CAN YOU TELL ME IN THE SAME TYPE OF WORDS THAT I JUST USED TO TELL YOU HOW MY BICEP MUSCLE CONTRACTED “ALLOWING IT TO BECOME MORE RIGID WHICH RESULTED IN THE NEED TO APPLY MUCH MORE BIOMECHANICAL FORCE TO MOVE THAT FLEXED BICEP MUSCLE OFF THAT HUMERUS BONE”???????????
WHAT SHOULD AN ATHLETE NEED TO CONSCIOUSLY BE DOING TO FLEX/BRACE HIS NECK MUSCLES TO ALLOW HIS HEAD BE MORE RIGIDLY ATTACHED TO HIS SHOULDER .
I AM ASSUMING THIS CAN ONLY OCCUR BY CAUSING NECK MUSCULATURE TO CONTRACT AND BECOME MORE RIGID.
now back to the rest of what you said
“(if no other physiological responses to the impending threat)”
IF I COULD STOP HERE AND MY THOUGHTS ARE IN CAPITAL LETTERS AGAIN NOW:
ARE YOU NOW REFERRING TO THAT “FIGHT OR FlIGHT RESPONSE” PHYSIOLOGY EG WHEN YOUR BODY PUMPS OUT ALL THAT ADRENALINE WHICH RAISES YOUR HEART RATE AND MAKES YOU MORE CAPABLE OF FIGHTING BACK AND WHATEVER ELSE IT CAN DO TO OUR BODIES LIKE MAKE YOU FEEL STRONGER TOO.
WHAT EXACTLY SHOULD WHAT YOU SAID IN PARENTHESES MEANS TO ME.
COULD YOU POSSIBLY EXPLAIN IT IN SIMPLER TERMS IF IT IS POSSIBLE SO I COULD UNDERSTAND WHAT THAT MEANS WRT BRACING THESE NECK MUSCLES
again now back to the rest of what you said
“and potentially reduce the magnitude of force transmitted to the brain.”
IF I COULD STOP HERE FOR MY FINAL TIME AND MY THOUGHTS ARE IN CAPITAL LETTERS AGAIN:
THIS LINE I UNDERSTAND,
SO IN SUMMARY, IF AN ATHLETE SEES THE HIT COMING “WHAT SHOULD HE BE TELLING HIMSELF OR TELLING HIS BODY TO DO TO FLEX/BRACE TO MAKE HIS NECK MUSCLES MORE RIGID SO THAT HIS HEAD WILL BE IN FACT MORE RIGIDLY ATTACHED TO HIS SHOULDERS (LIKE MY BICEP MUSCLE BEING MORE RIGIDLY ATTACHED TO MY HUMERUS BONE)
AND AS A RESULT OF THIS BRACING PROBABLY BE ABLE TO RESIST MORE BIOMECHANICAL FORCE TO RESULT IN HOPEFULLY LESS OF THAT ROTATION AT THE NECK.
Barry
“No oral device has been found to reduce or decrease the chance of concussion” Cantu makes this same statement, then follows with. Just because the research has not been done, does not mean a corrective appliance can’t help, it’s just an area that has not been researched using an orthotic appliance. Studies show, common tooth protecting guards are ineffective in any real change in those prone to concussion. The Eagles team dentist is certified to make the same adaptive mouth guard used by the Patriots. Whether Burkholder saw the need to fit Vick, that is another question. If on his first concussion, Vick damaged his jaw cartilage resulting in TMD and symptoms of temporal mandibular joint dysfunction, or the boxers “Glass Jaw”, there is a chance one of these appliances could reduce tmd symptoms that can be similar to pcs. Yet, we wait for the research to clear the air, until then we can only hope trainers will see the benefit of orthotically aligning the jaw in those prone athletes with tmd. Common guards cannot correct or align the jaw, but they are better than nothing at all.
Mark,
Re: Cantu; I can say the same about a band aid on the forehead… Why don’t you add that your product was out and “established” when Cantu made the comment, therefore your technology would be included in on the original statement. Meaning if you connect the dots, just like the articles you provided, your device WILL NOT do anything for concussions… You need to stop the facade, you are bordering on fraudulent claims.
Don’t say I didn’t warn you.
Dustin,
Are you having any luck on an answer to my question on September 27, 2011
How does an athlete contract his neck muscles?
Another way to ask it:
How does an athlete brace his neck muscles?
Or what I am asking for is a basic answer to;
Do you know what an athlete would need to consciously be doing to flex/brace his neck muscles.
This question is based on the assumption that stronger necks can help defuse concussive forces.
Barry