Published Article in CJoSM Supports ‘Hit Count’

I was forwarded this information from a very astute and prominent concussion researcher for my take and information.  The Clinical Journal of Sports Medicine published an article regarding the under-reporting of concussions.  The authors are: Greenwald, Richard M. PhD; Chu, Jeffrey J. MS; Beckwith, Jonathan G. MS; Crisco, Joseph J. PhD.

It is important to note that the authors (as it is disclosed) have an interest in the Head Impact Telemetry System created by Simbex and limited currently to Riddell helmets.  With that out-of-the-way the article exposes the bigger problem with concussions with competitive athlete; the subjective nature of the injury and the self-reporting;

We typically cannot “see” a brain injury, and even with increased public and medical awareness about the serious nature of any brain injury, a “warrior mentality” inspires many athletes to continue to play. Contemporary, more stringent guidelines proscribing a same-day return to play may actually fuel underreporting of symptoms by some athletes. It is therefore critical that improved techniques for identifying athletes at increased risk of developing brain injury be implemented at all levels of play.

Prevention of brain injury should be a priority. Athletes in contact sports are exposed to head impacts, the incidence of which can be mitigated to some degree by rules, education, and equipment. Head impacts will, however, continue to occur in sport. We propose the widespread monitoring of head impact exposure (eg, number, severity, location, and cumulative effect of impacts) at all levels of football, and other sports where practical, as a method of providing objective feedback to medical personnel regarding the head impact exposure an athlete experiences during practices and games, thus potentially enhancing the identification of brain injury by reducing the underreporting of events and symptoms by athletes who may be disposed to conceal the same from coaches and medical personnel.

Obviously there will be a massive limiting factor in cost for small schools and the youth sports, but if there needs to be actual monitoring to identify the true issue and find all the injuries; if you don’t have the money then maybe you shouldn’t be playing the sport?

Granted the idea of objective measures appeals to all involved but FIRST you must have someone there to know what to do once the system of choice (BTW there is a market for this) identifies a potential injury.  This is where the Certified Athletic Trainer comes in.  Before dumping money in systems, tools, and other things for concussions the NUMBER ONE PRIORITY is to get an athletic trainer on the sidelines.  This not only helps the coaches with concussions but with all injuries.  Not only that the athletic trainer is educated in PREVENTION of injuries.

The article later goes on to support the thought of the SLI Hit Count, which is an obvious evolution of concussion information.  If teams cannot get proper monitoring for this and ALL INJURIES, then perhaps tackle football, rugby, lacrosse, all collision sports should not be played, for the safety of the athlete…  Often a STUDENT-ATHLETE.

13 thoughts on “Published Article in CJoSM Supports ‘Hit Count’

  1. Joe Bloggs March 21, 2012 / 08:57

    This is not a Journal Article; it is an editorial. There is no research. It might as well say paid advertisement for Simbex/Riddell. I guess the wars are spinning down so Simbex needs to milk a new cow. I notice after $35MM in DoD, the authors have produced virtually nothing of clinical value regarding blast injuries.

    Skip hit counts, just don’t get hit at all. Reading the “article” that is the logical conclusion.

    Even Simbex knows, one hit can be enough in some individuals.

  2. A Concerned Mom March 21, 2012 / 10:39

    Could the shockbox helmet sensor possibly be an affordable alternative?

    It will probably take years to see major modifications to youth and high school sports (just look at the reluctance to legislation governing non-school sponsored sports … with church groups fighting it in some instances due to liability concerns). Perhaps impact sensors could help protect youth players in the mean time (not necessarily from a single concussive event, but from multiple events in a short time frame). Additionally, the knowledge gained by using them could open some eyes with respect to the number of head impacts in certain sports (coaches might decide that running elementary kids through tackle drills 6 hours per week isn’t such a good idea).

    Competition from various impact sensor providers could result in technological advancements and reduced costs. Hopefully, schools won’t just get pressured to spend money on ImPACT and HITS.

    It seems like input from ATs trained in injury prevention could result in greater injury prevention than use of technology alone. I suspect we already have the knowledge to significantly reduce injuries, it’s just not being widely implemented.

  3. joe bloggs March 21, 2012 / 11:48

    Concerned Mom,

    The price is similar to Simbex. It is unclear what data it is offering that is of clinical use. The HITS system has been used for years in research and it still can’t offer an inference regarding the severity of the injury or even its presence. I recall one research describing data on one million hits cataloged by the HITS system with only 8 diagnosed concussions. It told me quickly either HITS did not work as planned or that the concussion diagnosis was flawed or both. My conclusion was both.

    What accelerators tells you it the forces being applied to the helmet not what is going on in the skull. It all sounds very high tech but it is probably missing much more complex biophysical forces resulting in brain injury.

    • A Concerned Mom March 21, 2012 / 15:09

      Just curious, what do you think should be done with youth sports (elementary, middle/high school, college) based on the information uncovered to date? What modifications and/or additional studies would you like to see?

      Thanks for the feedback and additional information.

      • joe bloggs March 21, 2012 / 16:03

        Children under 14 should not engage in helmet and pads football. Coaching is too poor, equipment is too shoddy, and medical care is nearly non-existent. There is no evidence that playing earlier in pads and helmets makes better players. High school needs better and more consistent coaching and medical care that reports to a doctor. ADs should not be beholden to a coach which in most cases is little more than a glorified gym teacher.

        College and Pro follow different lines because the nature of risks. Further, increased resources offers different opportunities to address the issues.

        Each sport needs to be analyzed but the variability in coaching and availability of medical care. Once risks are identified rules can be put forward for the responsible age for children to engage in a sport.

        Kids will “play” sports (but let’s remember these are games) and children will get concussions whether it is contact or non-contact. We certainly do not want to encourage sedentary lifestyles which introduces other health issues like Type 2 diabetes and obesity. On the other hand, the professionalization of children’s sports under the supervision of people who are not professional has caused serious health and social problems.

        Time, research and discipline should get this squared away.

  4. Dustin Fink March 21, 2012 / 16:24

    Joe once again hammers it on the head, pun intended!

    • A Concerned Mom March 21, 2012 / 19:19

      Thanks to both of you for providing so much good information.

  5. Picot March 22, 2012 / 06:19

    Joe, Your forgetting one thing, football the younger kids is fun and prepares them for the faster game. Finding better ways to protect them is vital. Impact testing required by the states is triage/aftercare. One state official agreed that there are little resources to fund these new regulations let alone simbex systems with all the programs.

    • Dustin Fink March 22, 2012 / 06:49

      That is why flag football is an option until high school. Armoring up the youth not only changes the game but makes them more aggressive…
      Until there are products that can scientifically and empirically attenuate concussions in the sporting world the young brain will be at greater risk…

      • Mark March 24, 2012 / 06:09

        The reality is, the games will go on. Pop Warner is going to be played this fall and next fall and so on. Wishing it would be stopped because some kids are harmed is not going to stop it. Determining why only some kids have this problem is the key. Investment in research is the only realistic option at this time.

      • A Concerned Mom March 24, 2012 / 08:02

        On a positive note, I believe Pop Warner did announce that they plan to limit the amount of time spent on tackle drills during practices. It should be interesting to see if USA Football plans to do the same.

        Based on my personal observations with my son’s Bantam league, there were approx. 100 kids in the program separated into groups of 20 to 30 kids (by grade level, 1st &2nd, 3rd & 4th, and 5th & 6th). Out of all those kids, the concussions and the whiplash injury were in the 3rd & 4th grade group (3 concussions in a group of 25 kids or less). Two of the concussed kids were new to the program and had never played before. My son was the only 3rd grader to get a concussion. He’s just about as tall as his ten year old brother and out weighs him by 10 lbs. He had just finished swimming long course, so he was pretty well conditioned. Since he was new to football, he made more tackling mistakes than the kids who had played before. One of the concussed 4th graders was almost 10 and is a big kid too. The two boys who were concussed later on in the season took longer to recover (4 plus weeks). Helmets weren’t checked for inflation until after the 3rd concussion. Kids were encouraged to hit as hard as possible. Generally, they participated in tackle drills three times per week.

        Now, I would say that some kids may have a lower threshold for injury, and some may be predisposed to longer recoveries. However, I suspect that practice procedures need to be studied. A recent youth impact study showed that these younger kids are generating higher impacts than anyone imagined. Based on the Perdue studies, the kids who don’t become symptomatic may be sustaining damage that would be visible on fMRI. I think Cantu has even said that non one really knows what tackle football is doing to kids’ brains.

  6. Joe Bloggs March 24, 2012 / 10:03

    Concerned Mom,

    Data is beginning to be collected that suggests that brain injury in children is, like adults, cumulative and compounding. That is, more hits more damage, more hits more severe damage. Furthermore, this data will suggest that the damage is an an area of the brain that develops through the teens. It may explain in some boys their poor academic performance and behavioral issues during high school. It may also explain in part males failure to enter and or complete college. While this is at an early phase and requires many more subjects, it does support theories that have been recently presented.

    The problem with practices is that the player skill is more variable, coaches are largely unexperienced and/or clueless and medical care is not at a high standard.

    You suggestion that fMRi be used is a nice idea but to execute a matched pair study in a population so variable would be cost prohibitive and take years. UPMC recieved $2MM+ from NIH to conduct an experiment to establish concurrent validity of fMRi and ImPact and ten years the study is either not complete or remains unpublished but Irv Muchnick unearthed documents that showed recruitment was exterely difficult.

    • A Concerned Mom March 24, 2012 / 11:18

      I’ll never sign a release for either of my sons to play tackle football again. Only one played for less than 7 weeks, and I was considering pulling him from the program-I count failing to do so as my biggest parenting mistake to date-I was concerned about the other kids making fun of him and that he would feel like a failure.

      Some parents seem suspicious of the new concerns about concussions (kids have, after all, played these sports for a long time, and some of the dads also played and believe they didn’t sustain any damage-even when they continued to play after a “ding”). The kids do really enjoy games (many didn’t seem to enjoy practice), and a lot of parents are pretty committed to their kids playing.

      I imagine youth tackle football will continue to be played. At the very least, requiring parents, coaches and athletes to be informed about concussions while limiting full contact tackle drills would seem to be better than what’s currently being done. (Is it Georgia where a youth concussion bill has stalled due to administrative and liability concerns? As if a lack of informed consent isn’t a problem at all.)

      As a parent, I’m not pleased with the lag time in making the public aware of the damage caused by concussive and subconcussive hits (two of the three youth coaches were dads, I’m sure they don’t want to believe the way they conducted practices was protentially harmful to their sons). I can see that it would be both difficult and expensive to set up studies (even the youth impact study was limited to about 7 participants and 15 or so exposures…plus it tells us nothing about groups that might run more agressive practices…how much time was spent in tackle drills, were the kids encouraged to hit as hard as possible, etc.). If I had a child in an impact and fMRI study, and there was any evidence of damage, I would pull him from the program. There would probably be some eithical concerns about measuring damage in kids’ brains and failing to take steps to prevent additional damage.

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