The concussive episode, also known as brain injury, is very difficult to grasp for many people; the main reason being that there is nothing we can see outwardly, nor is there a “set” protocol. Take for example Chris Owusu the Stanford wide receiver who has a brief but intense history of concussions. Jim Trotter of Sports Illustrated took a very good look at his case and the stigma surrounding concussions in football;
It is against that backdrop that Owusu is entering the NFL. One general manager says he has third-round talent, but gave him a seventh-round grade because of the concussions. Most executives view him as a value pick, meaning he has too much talent to pass on altogether but will only use a late-round selection on him.
Two neurosurgeons and a neurological psychologist recently told SI that there is not an A+B=C formula when it comes to past concussions and susceptibility to future concussions. Factors such as severity of the blow, recovery time and frequency of incident play a role in determining the likelihood of someone being predisposed to future concussions.
That is just one of the many questions surrounding concussions, especially with professional, adult athletes. It is true; a fully recovered concussion has not shown to be a factor for future concussions. However, a non-fully recovered concussion predisposes you to further injury at a greater rate. The fine line is finding when one is “fully recovered”. Any brain trauma and injury will also predispose one to long-term effects; just like breaking a finger will predispose one to having a greater risk of arthritis in that finger.
For Owusu the wait will be long and even if he is picked and signed he will have the threat of his past hanging over his head. Because no contract in guaranteed Owusu will have to weigh all of this if/when he sustains another brain injury. This is exactly the stigma of concussions:
- Speak up and lose my job, position, playing time, school all the while doing the right thing, or, keep quiet push through and not be seen as “weak” and risk greater damage to my brain.
It really should not be occurring, everyone needs to understand concussions and take the fear out of it;
“Did I put up a fight a couple of times to get back on the field? Yes, I did, because I love the game so much,” says Owusu. “When you get the game taken away from you like that, it’s something where it opens your eyes and it’s frustrating. I respect what the coaches and the doctors and the medical staff did for me here at Stanford, I really do. They looked out for my overall well-being and did not take any chances. But could I have played? I felt that I could have. Did they do what they felt was in my best interest? In their eyes, I think they did. But it was a frustrating process.”
Even more frustrating is the fact that had he been back out there relatively fast there is a good chance his NFL suitors would be much higher on him. The NFL should be much more “happy” with the fact that Stanford sat him for so long, not worried as they seem to be… Once again the stigma of concussions in full effect.
The Concussion Blog 
The stigma of concussions is one reason I focus so intently on the youth level. It’s in the best long term interest of youth athletes to avoid sustaining concussions at a young age (both for health reasons and for future playing prospects). Unfortunately, many in the current group of coaches for that level are stuck in the dark ages.
“Finding when one is ‘fully recovered'” is what scares me the most.
If it is true that: “a fully recovered concussion has not shown to be a factor for future concussions.” What does that say about the study(ies) finding a significant re-injury rate in youths visiting the emergency room for concussion? I seem to recall something about re-injury occurring within 6 to 12 months of a visit to an emergency room.
Forget fully recovered and think functionally recovered.
As far as the NFL, they are making an economic choice. A player who has a history of concussion is more susceptible to future concussion and the more concussion one has suffered, especially with no or poor treatment, would imply poor long-term outcomes.
Do you think the NFL will ever hold playing from a young age against players? Is it possible they will perceive some risk associated with the players who were hard hitters from the pee wee league (starting at age 6, or even 5 in some instances) through college (especially for the players who were always bigger and stronger than average for their age)?
Oh, and I posted a guardian video that you may want to watch – didn’t you ask these guys for back-up information? I’ll try posted it here so you don’t need to search for it.
http://kdvr.com/2012/04/23/guardian-protects-kids-from-concussions/
I find this video concerning, because it seems like the kids hit harder when they were the guardian cover. They claim it has reduced concussions.
(excuse typo up above … were = wear)
http://uk.reuters.com/article/2012/04/02/uk-football-helmets-idUKBRE83103S20120402
“Hanson sent out 600 samples for teams and players to test during the 2011 season and this year aims to sell about 200,000 of them, for about $60 a piece. None of the players that tested the Guardian last season reported a concussion, Hanson said, and testing by Wayne State University in Detroit found the product reduced the amount of shock felt through a helmet.”
If it helps, great – if it causes players to hit harder – perhaps not so great.
Recovery vs Functional Recovery from a concussion
Cited from Sport Related Concussions (Brady, D. and Brady, F., 2011- NASP)
1– Although athletes may appear to have fully recovered from concussion, their brain may require more effort or energy to
complete a task than was required prior to sustaining a concussion (Gronwall, 1989). Because the brain has been injured, the use of the concept of “functionally recovered” is encouraged over “recovered.” Individuals recovering from concussions may typically display fatigue along with difficulty with concentration, memory, new learning, organization, insight, irritability, and emotional self-control (Wrightson & Gronwall, 1999). The developing brain of a child or adolescent appears to take a longer period of time to functionally recover from sustaining a concussion than does the brain of an adult.
2— Unfortunately, at the present time, functional recovery from a concussion typically focuses on when an athlete is resuming participation in sports, ignoring how well the student part of the student-athlete is able to adequately function within the classroom, home, or social setting.
Nice article.
Thanks for passing it along!!!
Here is a question as well: Player gets drafted this year and is documented that has concussions. He plays this year and ends up with a concussion and symptoms just wont resolve. Who is responsible for continued care if the player can no longer continue in the NFL? Am willing to bet their will be clauses in contracts and wonder how many will take heed of clauses? Just a thought.
Wrote about this a couple of weeks ago, from a slightly different angle.
http://columnwriting.potomacschool.wikispaces.net/JacobLichtenbaum8
Feel free to check it out and tell me what you think!
~Jacob
Nice job Jacob. What scares the hell out of me is that the key players involved in the concussion debate continue to focus on the immediate effects of the injury. mTBI is like any other trauma to the body, at least initially. You get localized tissue damage, a corresponding inflammatory process and healing. The problem with this situation in concussion is that the brain has an entirely different system in place when it comes to inflammatory mediators and neuroglia. they estimate that about 25-35% of concussions go on to become Post-Concussion Syndrome (PCS). The more aggressive the initial injury or a small injury followed by another before total resolution increases your odds of PCS. These are the cases that lead to Chronic Traumatic Encephalopathy, early cognitive decline and Alzheimer’s Disease. Concussions seem to have an additive effect on brain function. The initial trauma also causes cervical spine injury that has its own set of long term problems. And, very often, initial trauma changes the normal activation of the vestibular or balance system.
The bottom line is that the ONLY way to truly rehabilitate every athlete who sufferes a concusion is to look at this globally, with a keen eye on the neurochemical factors that add up to become PCS.
Cheers
I think everyone is on the right track here…
Professional athletes and adolescent/youth athletes need to be completely seperate. HOWEVER (in my best Chaney impression), the verbage and support for the lower levels must come from the top. I have explained this many of time.
Bryan and Dr. Brady are both correct in the assessment of the computerized testing, it is needed, but what we have now is showing far from “gold standard”… It is just a tool in the tool box, but still missing is the emotional and sleep aspect of siad baselines…
Dr. Benford is very accurate on his comments as well, and Monica brings up a very insightful question…
I really appreciate all the comments and discussion, THIS IS EXACTLY WHAT IS NEEDED.
The biggest underlying statement (one I plan on blogging about soon) is the ABSOLUTE NEED FOR CERTIFIED ATHLETIC TRAINERS for any collision sport participation at any level. It shouldnt be an option it should be an requirement.
Concerned Mom,
Dustin has done a great job on debunking the claims of mouthguard manufactures. Search the archieves and it will become clear that the claims have no weight.
I couldn’t find any articles on the guardian helmet covers – but based on what Dustin has said about mouthguards, I have a general understanding that the concussion problem is not one that will be fixed by technology alone.
This is correct… The Guardian thing is innovation, BUT the actual applicability in most settings is difficult. I have been working with the Guardian company as well to explain the issues that I and a lot of people have but really its not being listened to…
The below is cited from an online NASP publication entitled
Sport-Rekated Concussions: Myths & Facts
(Brady & Brady, 2011)
Myth: An athlete needs to be hit on the head to sustain a concussion.
Fact: Because concussions can result from head [brain] trauma experienced via collisions, falls, or when a whiplash force is applied to the body (Cantu, 1996), an athlete does not have to sustain a blow to the head for a concussion to occur (Evans, 1994). A recent study estimated that 1.6 million to 3.8 million concussions occur annually (Langlois et al, 2006).
While watching the video, I can’t tell exactly what’s making the loud cracking noises – is it helmet to helmet, facemask to facemask, or helmet to shoulder pads, or some variation thereof. It’s possible the guardian could provide some protection for certain impacts (which would be great), but I don’t think it could do much for a facemask to facemask impact. My concern is that any benefit provided by impact reduction could be offset by more aggressive coaching and behavior. Two comments in the video that concerned me were:
“don’t have headaches like they typically have” … typically have … does that mean players and coaches assume it’s normal to get headaches after impacts?
“hit guys harder and it wouldn’t even hurt my head” again, was it normal for his head to hurt prior to wearing the guardian?
This video does illustrate that when kids are coached to hit hard, there is a lot of contact with the ground, often with the added weight of the tackler.
http://cnn.com/video/?/video/health/2012/01/24/eitm-concussions.cnn
CNN’s Gupta did a video on concussions a few months ago that covers some of the points brought up by Dr. Brady.
Terrific discussion! I have concerns whenever this amorphous creature ( brain injury) is described as if truly understood. Every concussion has the potential to have injured the tissues of the brain within the skull. But accurate measurement of actual cell damage and degree of significance to an individual’s ability to function and/or truly recover from another concussion is yet non-existent. If someone is functionally recovered have they fully recovered enough that the next concussion won’t be far worse? Injury involves cell damage and a disruption in brain chemistry. The ability to function may actually be too narrow an approach to measure recovery given the complexity that makes an individual. Compensating mechanisms can have it appear that functioning is occurring “normally” when that is not so. If it takes twice as long for someone to clean their room or do the laundry or homework, yet they do it, we call that functioning. But it may be an indication that the compensation mechanisms are at play, but not cell or chemical recovery. How do we know when a brain is fully recovered? There are as yet no truly objective measurements since injury is in the cells and no one is testing brain chemistry as yet. Parents can measure changes in personality, attention, depression and these are maybe better indicators of recovery even when a child, or adult, is back “functioning” at school or work. This isn’t rocket science, we know far more about rocket science, but there was a time when we didn’t. Only by facing how little we do know will the experts refine our knowledge. Lynne Perkins, M.A., M. Sc,
“Concussion-like symptoms” ….
http://www.nfl.com/news/story/09000d5d828b3a03/article/bears-rookie-shea-mcclellin-disputes-concussion-reports
” “I don’t know where the reports came from. I had one concussion in 2010. I didn’t miss a game. I missed one practice; they kept me out. In 2009, it wasn’t really a concussion. I had concussion-like symptoms, but I was sick before that. It was more precautionary, and it wasn’t really a concussion.”
In essence, McClellin said he had only one actual concussion.
“I changed my helmet up this last year and I haven’t had a problem since,” he said. “So I’m good to go; no worries for me.” “
http://rwevansmd.com/Publication.html
“Cantu spoke with Jim Trotter for an article in the latest Sports Illustrated and conceded the possibility of instituting “preemptive measures to keep concussed players out of the NFL” (Trotter’s words) “definitely could be something in the future” (Cantu’s). The doctor also said, however, that “the concrete data isn’t there right now” to warrant doing such a thing. But it’s at least, apparently, something that’s being considered.
“What’s going to help in the future is we’ll not only be able to look at [a player’s] history of concussions, but we’ll be able to see structural changes on imaging studies that aren’t available now,” Cantu said. “Or there will be bio markets in the blood or spinal fluid that will allow us to identify individuals who have already had brain injuries that we can’t detect right now. These things will greatly aid making those judgment calls.””
Irv Muchnick’s thoughts on prevention of TBI through strengthening neck muscles:
http://concussioninc.net/?p=5557
” … one of the obvious corollaries of this school of thought would seem to be that youngsters should not be playing tackle football until they have grown sufficiently to be able to develop such a strong neck base, which keeps their brains from richocheting against the walls of their skulls on every routine collision.”
Just thought this was interesting:
http://www.sportsconcussions.org/ibaseline/nfl-draft-highlights-concussion-issues.html
“Owusu was taking part in a Stanford School of Medicine research project when he suffered at least one of his concussions. Researchers recorded impact data from players wearing high-tech mouthguards in an effort to gain a better understanding of the forces that cause the injury.”