The quote in the title is a Japanese proverb, I have read it most recently in a very good book call “The Red Circle” by Brandon Webb; a biography of a Navy SEAL (you can learn a lot from these heroes). As with most proverbs you can take the meaning and apply it to whatever you want. In this case we are talking about concussions: awareness, education, assessment, recovery, treatment, etc.
One thing that I hope comes through is that I do not feel that I am a “be-all-end-all” expert, rather I am a devoted husband and father that is an athletic trainer that chooses to spend time paying it forward – so to speak. I have been asked many times why this blog is here and there are many answers to said question but the underlying reason is simple: raise awareness and bring together all who care to create more understanding and better protection from this brain injury.
The simple fact is that we have only just begun to really understand the concussion injury, each episode (aptly coined by Xenith) is unique; not only from age-group to age-group but from person to person. We know that males and females react differently, we know that youth and adolescent brains are much more susceptible to lingering effects than an adult brain, we know OR SHOULD KNOW there is no magic pill or course of action to prevent concussions other than living in a bubble, we know that there are very smart people out there with good ideas, we know that information can be controlled by many sources for many reasons, and we really should understand and know that the actual injury is not the elephant in the room, it is how it is handled from the beginning of the process.
Concussions are a process not an event; as soon as the injury occurs what happens next is what shapes the individual brain for eternity, yes eternity.
Where am I going with this? Simple, The Concussion Blog has become a fast growing outpost for people to opine on all things concussion; whether it’s through posts or more importantly in the comment sections. I would like to highlight why I think The Concussion Blog fits into the “none of us is as smart as all of us” mantra. Below are selected comments from across the board, included with them will be the link to the posts they appear in.
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From the “Forest for the trees” post (by Nick Mercer):
Birgit Diederich April 12, 2012 at 18:40
I know you’re in Canada, but this post really resonated with me since my brother plays hockey and has suffered from 2 concussions. I recently read a blog about how Pennsylvania made a law for young athletes so that they are unable to play if they show signs of a brain injury until they are cleared by a doctor. It also said that there is an effort to educate athletes, coaches, trainers and parents about brain injuries after research showed that 40% of athletes return to play too soon after their injury. I think efforts like this need to be made early on, and hopefully this effort can carry on through adulthood.
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A Concerned Mom April 13, 2012 at 07:57
Accidents happen, and there are no guarantees in life. Even if someone is proven negligent, the injured party often can’t be made whole. That’s just life. Sometimes you just have to be thankful the accident wasn’t worse.
However, I’m not sure if “accidents” are our primary problem when it comes to concussions in youth sports. Kids try to play like the professionals, and when you go all out like that, injuries are more likely (it’s a part of the sports saga that’s been kept quiet – no one paid attention to the price professional athletes were paying with respect to brain trauma). When you start looking, you can find concussion stories everywhere, but many parents, coaches, students, and schools are still in the dark (greater awareness may come from the NFL lawsuits).
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Don Brady, PhD, PsyD, NCSP, Licensed Psychologist April 13, 2012 at 10:52
The terms ACCIDENT and FLUKE are misnomers when it describes a sport-related concussion.
Please read the below definition of an accident:
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Definition of ACCIDENT- Merriam Webster (obtained online)
1
a : an unforeseen and unplanned event or circumstance=========================================================================
Sadly, ignorance manifests itself when the adjectives ‘accidental’ or ‘fluke’ are used to describe a presenting concussion/brain injury.
‘ACCIDENTAL’ or ‘FLUKE football injuries and deaths’….. ARE FORESEEN, PREDICTABLE and EXPECTED every year…and clearly are neither improbable nor unforeseen.
Though a so-called ‘small statistical percentage of children’ may die each year…each death is both clinically and humanly significant!!!!
Our children are being placed ‘in harms way’ when they walk onto on the football fields, and for some youngsters their fields become their ‘sports graveyard”…for what logical reasons????
It is becoming more apparent that we are playing Russian Roulette with children’s brains, emotions and other parts of their bodies.
Perhaps parents should read this following mantra to their child:
There are 40 comments in that post alone and are not only informative but help create dialogue, no matter the side you fall on now it is worth the time to read – moving to the next sample.
“In the category of NOT shocking..”
Educator Mom April 18, 2012 at 11:55
Until tracking and reporting is established and required, there will be no change. Our kids will continue to be sacrificed on the altar of sports with little regard to their long-term health and well-being. Every day I run into a parent, teacher, coach, or youth sports organizer who has no idea what the long-term risks are to these kids who experience traumatic brain injuries. I certainly wish someone had educated me, my son, and his coach before my son’s injury. Not only will tracking and reporting establish an environment of education but an environment of accountability. Then maybe…just maybe, we will see change.
More ideas, more thinking, make that critical thinking from other people outside of the experts.
“Chaney: Football’s Legal Fire”
Jake Benford April 25, 2012 at 10:41
The concerns you raise are spot on. This is why so many of us are pushing to have full contact football be eliminated until 1) the athlete is older and 2) the program has enough money to have medical personnel on site, ie: hight school.
Unfortunately, in my experience, the reaction from parents so far is push back, wanting to get their kids back before they are ready. I often have to ask them if I told them their child had a heart injury, would they still be questioning the medical staff.
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joe bloggs April 27, 2012 at 09:27
First , I must agree with several commenters that certified ATCs are a requirement for a school to offer any collision sport. If you can’t afford an ATC then you can’t have collision sports. ATC need to report to be hired and report to school administration not athletic directors or coaches.
Coaches in all sports need serious training. Just because one played the sport 10 or 20 years ago, things do change, does not qualify one to coach a sport or lead children. Further, I see no evidence children under 14 should be playing helmet and pads football. There is no evidence it increases their skills. Forget the rational offered by many parents that my child will get a scholarship or go pro. Genetics have much more to do with someones ability to make the cut than anything else. The physical and psychological profile of a scholarship athlete and a professional athlete is extremely distinct. Tom Brady, 2 time SuperBowl winning QB for the NE Pats, did not play until he was 14 and Jason Pierre Paul, NY Giant rookie standout, until his junior year in high school. The variance in these athletes characteristics is extremely small. If your child does not fit this profile he is little more than a tackling dummy. Spend your money buying lottery tickets to pay for college or better yet put the money in a 529. Coaching is also a significant factor and very few schools have high level coaches.
I have also heard the missive that, “I had multiple concussions, and I am fine.” You are fine now but who knows in a couple of decades. You might have been President instead of being in a municipal job. Harry Carson, HOF NY Giant, has stated clearly that regrets playing and refuses to let his grandson play. Similar thoughts have been expressed by HOF DB Lem Barney and numerous other distinguished players.
I do believe in NP testing as one element along with balance, psycho screens etc. of a protocol to assess and treat athletes. Complex cases should be referred out to a board certified neuropsych but they are few and far between, expensive and may not take sports referrals. It is tough, but we are dealing with a child’s brain. The old maxim when in doubt keep them out. Any coach worth his salt knows when he has great player with pro-potential and knows it is best to keep him off the field in his long-term interest. The world is not going to end because some kid can’t take the field. Coaches and parents need to get real and take it down a notch.
Chaney is correct that youth football is at risk because it is poorly funded, managed and fails to account for its true costs. Insurance companies will not only abandon schools but also equipment makers (it is happening already). Football should be left to programs that are professional at all levels and depending on the outcome of current research certainly left to young adults, if not adults.
Sports are great and most children should play, but it is a game. It is not the NFL, NBA, etc. Have fun, stay fit and stay healthy.
“Stigma of Concussions in NFL Draft”
A Concerned Mom April 26, 2012 at 11:15
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.
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joe bloggs April 26, 2012 at 12:35
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.
These comments scratch the surface, it is very satisfying to see the constant communication about this issue. There really are many out there willing to help and give ideas/feedback. In order to progress and grow we MUST have the discussions and even disagreement, so please feel free to jump in; either by comment or email.
Thanks!
The Concussion Blog 
Dustin,
I love the blog! Keep up the good work! Making headway in my area, slowly, but surely.
Tommy
For the most part, there’s a night and day difference between the comments here, and the comments left at more main stream media outlets. It should be interesting to see what happens if the awareness level ever increases (if people truly become educated about the problem).
http://vitals.msnbc.msn.com/_news/2012/04/13/11183481-opinion-youth-hockey-injuries-border-on-child-abuse
“Parents are in a horrific bind. Their kids want to play contact sports but their coaches want them to emulate the pros. Oversight groups make noises about a safer game, but the concussion rate grows and grows. Parents want their kids to play sports to keep them out of trouble and to encourage habits and virtues that will help them later in life. But they certainly don’t want to see them with headaches, memory loss and learning difficulties later on, either.”
Great writing and excellent information. Thank you!
I want to repeat here what I posted to https://theconcussionblog.com/2012/04/26/stigma-of-concussions-in-nfl-draft/. We cannot yet measure full recovery, “functioning” is not a good enough measurement. Compensation factors can have us appear to be functioning when we are not yet actually recovered. The dilemma of risk is at the heart of this excellent blog and the work of stopconcussions.com. How can contact sports continue and young people have the growth experiences and potential for success unrivaled through participating in these sports without the risk of injuries to the brain? We all want these sports to continue and we want our players and loved ones safe. Is it possible to reduce all concussions to high risk ‘accident’ and eliminate those where intent is involved? Is that enough? That violence has been part of the sport culture is what is being challenged. If you have to handicap an opponent to win at anything are you the winner? Big money is involved in winning no matter how it is done and that is part of the problem. Has anyone’s prowess been displayed when it is judged at the expense of another player’s safety and potential? Just be removing the intentional violence factor the sport will become more of a sport and more of a challenge to the development of minds and bodies to excel. This blog will contribute to better diagnostics and treatment and one day we will have a remedy for recovery from concussion.
In keeping with the none of us is as smart as all of us, it’s good to see other groups forming to address youth sports safety (wonder what could be done to facilitate communication between various groups, or if such communication already exists):
http://www.knowconcussion.org/2012/04/27/concussion-consortium-meets-to-bring-awareness-to-youth-sports-safety/
“On Wednesday, April 25, more than 30 professionals participated in a conference of the Maryland-based Concussion Consortium to bring awareness to sports-related concussions. The pioneering task force, formed more than a year ago by Robert G. Graw, Jr., M.D., CEO and Chief Pediatrician of Righttime Medical Care, includes orthopedists, emergency physicians, pediatricians, neurologists, neurosurgeons, neuropsychologists, neuro-optometrists, athletic coaches, trainers, physical and rehabilitative therapists, school administrators and nurses from Anne Arundel, Montgomery, Howard and Baltimore Counties in Maryland.”
http://myheadfirst.wordpress.com/
“The results of Coaching Our Kids to Fewer Injuries: A Report on Youth Sports Safety show parents and coaches are naïve to serious conditions like overuse injuries, dehydration and concussions.”
Interesting perspective:
http://www.cmaj.ca/site/earlyreleases/11april12_hockey-concussion-is-it-child-abuse.xhtml
“Meanwhile, one critic says Hockey Canada’s failure to implement even more stringent anti-concussion measures constitutes nothing short of “child abuse.”
Drawing a parallel to equipment changes made in the 1970s to prevent eye injuries, Emile Therien, former president of the Canada Safety Council, says the sport faces similar consequences if changes aren’t made. “If we hadn’t made changes to the equipment back then, there’s no doubt in my mind the game wouldn’t exist today. Parents just wouldn’t enroll their kids. It would be child abuse. And that’s what it is today; it’s child abuse.””
http://news.bostonherald.com/blogs/sports/high_school/?p=4870
“DiBona suffered a concussion in what was supposed to be a non-contact drill. The severity of the concussion forced the 6-foot-2, 235-pounder to reconsider his options and he decided to step away from the sport. At Tuesday’s press conference, Iowa head coach Kirk Ferentz said DiBona would stay in school and work toward getting his degree, but made no mention of a concussion.”
I hope the college players who end up having to quit due to injuries, especially concussions as the can be associated with depression, get adequate medical care and are screened for any problems adjusting to their new situations.
Speaking up for “child” and youth health in team sport – good to see.
http://finance.yahoo.com/news/matt-dunigan-voice-injury-prevention-130000289.html
“”ThinkFirst Canada is honored to have Matt Dunigan speaking up for child and youth health in team sport. Canada can and must do a better job at protecting our greatest resource, our children, by reducing the burden of head and brain injuries like concussion” said Rebecca Nesdale-Tucker, Executive Director and CEO, ThinkFirst-Pensez d’Abord Canada.”
Surprised to see “pleased” and “airlifted” in the same sentence.
http://news.uk.msn.com/uk/articles.aspx?cp-documentid=161232769
“The statement read: “Harriers are pleased to be able to say that striker Anthony Malbon was awake and speaking to those around him as he was airlifted to hospital.”
http://minnesota.twins.mlb.com/news/article.jsp?ymd=20120427&content_id=29792886¬ebook_id=29798762&c_id=min&asid=64736a56
“I had my bell rung,” Parmelee said. “I was a little dazed when it happened but the concussion part never crossed my mind. But I did the testing and the docs said I’m doing real good. I’m feeling great.””
Nothing changes if nothing changes seems to possibly apply here:
” Twins Parmelee hit by pitch”
“But team doctors ruled out a concussion,
as he only suffered a black eye and a headache as a result of the pitch, which hit the bottom of his helmet.
“I had my bell rung,” Parmelee said. “I was a little dazed when it happened but the concussion part never crossed my mind. But I did the testing and the docs said I’m doing real good. I’m feeling great.”
Parmelee was out of the lineup against the Royals on Friday, as Twins manager Ron Gardenhire said he’s still day to day.
“There’s a little bit of swelling in his head, when he got hit, and little black eye, but he’s actually OK,” Gardenhire said. “He’s out there running around, and doing pretty good. Just have to go day by day with him. Says he feels good. I’ll let the doctors and trainers tell me.”
Concerned Mom, thank you for posting the information about the Concussion Consortium.
A quote from that site, “I felt that bringing together all of the knowledge and experience of those who have been working on this scientific issue for years, as well as those who are so involved with children’s health in the local community, would provide an opportunity for learning and coordination of resources for families,” said Dr. Graw. “As we learn more about the complexity and frequency of brain injuries, it is important to increase access to local expertise and ramp up the dialogue on the subject.”
This is certainly a direct outcome of the blogs and demands made by all who openly address the serious issue of brain injury. Still keeping with the topic, ” None of us is as smart as all of us”, and knowing that mainstream healthcare is at least 20 years behind scientific and clinical data, I wonder if this meeting of professionals consulted the expertise of a significant cross section of concussed people to make their discussion relevant. Professionals are trained to be the observers, and as “experts”, advise us while leaping over the wealth of knowledge that the injured themselves can provide. Having been a health care professional for many years I know the value and the downside of that perspective. But brain injury, more than other condition, cannot be understood from the outside looking in. The detailed reality of living with brain injury is unimaginable to those who have not lived it and we still deal with institutionalized denial. Most professionals who seek, or claim, expertise in brain injury are still in the dark though they have been discussing this amongst themselves for decades. There are many exceptions, Dr. Cantu among them. As long as those in power to make decisions about everything from diagnostics to safety equipment are leaving injured people on the fringes, we will continue to get what we have always got, insufficient change to meet the needs. One of the significant values I see in of the leadership of stopconcussions.com and Dustin’s blog is the active role of people who live with injury leading the professionals to better decisions. That trend has yet to go mainstream in Canada or the US. Re: “forget fully recovered and think functionally recovered”. There are methods to measure functional recovery, they are very costly and it is still difficult to find a professional with the equipment to test. Lynne
http://www.sportsconcussions.org/ibaseline/component/k2/item/16-concussions-add-up-and-may-permanently-change-brain-function.html
“The overall research award at the 21st American Medical Society for Sports Medicine Annual Meeting in Atlanta, GA was presented to Dr. William Meehan on April 24, 2012.”
““Our research suggests that the cumulative effects of repeat concussions on brain function may be permanent,” said Dr. Meehan.”
Great writing, great thinking, great discussion. It’s always great to see what is happening here. Thanks to you Dustin and everyone here for their contribution.
I’m struggling to articulate my thoughts, but one of the concerns I’ve had with respect to the information becoming available about the dangers and damage caused by concussive and sub-concussive hits, is the anxiety such information may cause in athletes who have participated in high contact/collision sports for a number of years. It’s necessary for everyone to be aware of the need to prevent brain trauma, and the seriousness of concussive injuries, yet I also feel athletes need to be hopeful. I happened to come across an article that focuses on making positive brain changes. I hope those dealing with concussive injuries are provided with the information and care they need to make the best of their situations and to promote optimal outcomes.
http://www.sportsconcussions.org/ibaseline/changing-brains-for-the-better.html
“MADISON – Practices like physical exercise, certain forms of psychological counseling and meditation can all change brains for the better, and these changes can be measured with the tools of modern neuroscience, according to a review article now online at Nature Neuroscience.
The study reflects a major transition in the focus of neuroscience from disease to well being, says first author Richard Davidson, professor of psychology at University of Wisconsin-Madison.”
http://www.knowconcussion.org/2012/04/30/novel-treatment-provides-concussion-relief-to-former-glenwood-star/
“Relox Medical officials believe that the intravenous magnesium dilates blood vessels in the brain and allows more blood to reach areas affected by a stroke. The pure oxygen that patients breathe during the infusion theoretically provides a burst of energy in the brain. That energy may reactivate dormant cells that weren’t killed by the stroke but stopped functioning normally after the stroke.
Company officials believe that patients who have suffered concussions or traumatic brain injuries may benefit from the treatments in a similar way.”
There is so much more to be hopeful about with the increase in factual information, establishing where there is a lack of solid information, and critically, any lack of sensitivity and knowledge by practitioners. This new information doesn’t seem to be hurting any part of the sports industry, or the billions being spent on new school sports arenas, at least not in the US. Children and adults have a far better chance to be diagnosed and receive immediate care than was ever the case. .The other important factor in furthering hopefulness is are truly open blogs that foster a flow of information and opinions from many quarters. Information alone will not constructively alter outdated beliefs and behaviors unless people communicate about.