Month: September 2012

Michigan Makes 41 – With Editorial

Dustin Fink6 Comments

With Governor Snyder of Michigan about to sign that states concussion legislation it makes them the 41st state by our records with some sort of legislation;

Governor Snyder soon will sign a new bill that will safeguard high school student athletes who suffer concussions.

The bill will require coaches to immediately remove an athlete from practice or a game if a concussion is suspected.

The player could only return when cleared by a doctor.

The measure was approved by the state house last week.

The Detroit Lions and the National Football League are major proponents of the legislation.

Just like the 40 before them this is only a very small step forward in the concussion issue.  We now (I hope) clearly understand that concussions are both an endemic issue with sports/recreation and a present danger.  What these “toothless” bills have done a good job of is raise awareness about the brain injury and effectively make it mandatory to remove a player with overt signs.  Once removed they do have to see a physician to be cleared to return.  That is a great first step, and one that we hope will prevent some cases of catastrophic sequale.

What these bills do not do is Continue reading →

College Football Concussions

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There are times when surveying the injuries of a said sport are handy in discerning a problem or a trend, you see it every week with our data analysis of NFL concussions (also Aussie Rules Football, MLB, NBA and NHL).  One section of sport I learned early on that was difficult – at best – to track were NCAA or lower level concussions.  Not only does HIPAA prevent a lot of that information from coming out, there are so many programs/teams it’s a massive undertaking.

Ask John Gonoude, who attempted this monumental feat last year and was only able to stomach 11 weeks of it before it became an issue.  Then I was sent some articles from Matt Chaney about what has been written about college concussions recently, for a response…  Well you are going to get one.

The first article appeared in the news cycle on September 13th from The Michigan Daily;

After only two weeks of collegiate football, USA Today reported 15 concussions among injured NCAA players. In 2008, the Boston University School of Medicine released a statement linking repeated concussions to Chronic Traumatic Encephalopathy. Describing CTE as “a progressive degenerative disease of the brain,” the university connected CTE to “the development of memory loss, confusion, impaired judgment, paranoid and aggressive behavior, depression, dementia and Parkinsonism.” With thirteen weeks left, the NCAA should take action to reduce the number of concussions and protect players.

The article is good for reporting the issues with concussions, speaking of long-term, but the initial sentence is what is baffling to me.  15 concussions in two weeks, that is absolutely false.  As Chaney opined that should be the number of concussions per team at the current rates.  Heck in week 11 of last year there were 19 alone and the rate of concussions per week in FBS last year through 11 weeks was 16.1/week.  There is no way the NCAA had only 15 concussions through two weeks.

The next article came out last Friday and it was in the BloombergBusinessweek;

Concussions suffered by college football players in games were 26 percent lower last year than seven years earlier, according to a study conducted for the National Collegiate Athletic Association. Continue reading →

The Risk of Professional Football: Do Not Do This At Home

Dustin Fink7 Comments

It is scenes like the ones below that we cringe about while watching our favorite sports.  In football they happen relatively frequent; what once was 2-3 times a year a person getting carted off now has become a weekly occurrence.  In the videos below (certain to be pulled by the NFL so see them while you can), you will notice the rotational forces being the problem for both players.  Also both players exhibited the Fencing Response, if you are not intimate with this, I suggest you learn.

First is Darrius Heyward Bey of the Oakland Raiders.  This hit was not penalized by the way even though principle contact was made by the defender with his helmet to the head.  Bey was carted off and went to the hospital for observation.

In this one Nate Irving of the Denver Broncos was blocked into the returner as he was making a tackle and he too made principal contact with his helmet up high.  This time it was the “hammer” getting K.O.’ed due to rotational forces.  Irving was attended to and later walked off the field under his own power.

One more example of hitting with the helmet, but a case of linear forces going to the head and the drastically different outcome.  Also in Denver, Matt Schaub took a shot to the head from a Denver defender.  This time the forces were mainly (if not all) linear and the QB didn’t lose consciousness, but did lose part of his ear lobe.

I provide these videos as a LEARNING TOOL for the audience:

  • Fencing Response
  • Rotational Forces
  • Linear Forces

And I also would like to note this type of tackling behavior should not ever be part of a youth or high school level program.  Launching and or using the crown of the helmet should be penalized, early and often.  So all you non-professionals do not try this at home.

2012 NFL Concussion Report Week 2

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The Concussion Blog Original, NFL Concussion Report, is a weekly compiling of the reported head injuries in the National Football League.  Concussions are added to the list each week from multiple sources to give you the reader a picture of what is happening on the field.  Each week we will bring you the information along with relevant statistics.  If we have missed a concussion or put one on here erroneously, let us know (we will also be using Fink’s Rule to classify a concussion/head injury).

EDIT: Francis Coye of OAK was added after report, making 12 concussions in Week 2.

There has been interest in the concussion “count” from the NFL for various reasons, I for one am interested in seeing how the culture change and fine system are effecting the overall numbers in the league.  I am also very interested in how the teams/league are reporting the injury.

When this started we used the Official Injury Report (OIR) from the NFL, but quickly found – via data searches – that many of the concussions were not listed because the players were going to play/practice thus not listed.  In 2010 we relied heavily on the general media to ferret out concussions from teams.  From recollection it was about 50% of concussions were found this way.

Last year we found that there was a sharp decline in the discrepancy of OIR listed and media listed concussions, most were on the OIR, a good sign.  Not only because they were more open with the disclosure, but it indicated that the player may not play in the upcoming week; the proper protocol.  Looking back it was about only 25% of concussion that were not on the OIR.

This year is a bit of question thus far; simply because the OIR’s in the past on Wednesday (when OIR’s are due) would list the injury and the status.  As of week one and two there has been listings of the player and the status, but the injury has not been listed.  The injuries are listed later in the week or by Sunday so we have been trying to confirm an actual injury count though the methods of 2010.

Because of this change in methods, there may be times when a previous week is adjusted due to fining a concussion after the fact.  Case in point last week; we listed 10 concussions, however after the injuries were finally filled in there was an addition, Richard Goodman of San Diego.  That brought the number to 11 from week one.  In the cases where there is a change in overall numbers I will make note of it.

In a side note, we are also collecting helmet data – identifying the helmet worn during concussion – and there appears to be fewer players wearing the very old style helmets (Riddel VSR4 and Schutt AiR Advantage).  Along with that we have noticed quite a spike in the Rawlings Quantum being worn (few concussed thus far).  Other helmet that has seen an increase of time on the field are the Schutt Vengeance (worn by Eli Manning) in its first year of existence and the Riddell 360 (second year).  We have also noted the Simpson helmet on the field as well.

Now on to the stats for week two, the total concussions found was 11, bringing the regular season total to Continue reading →

Relating

Nick Mercer1 Comment

I’ve written two blog posts (attempted posts, really) about relating to people since my brain injury. They now sit in the ‘Posts’ section as drafts Relating 1 and Relating 2. I was happy with my first one until I realized that I just kept talking about my brain injury and recovery, very slowly meandering to a vague point. So I started a second post. That one was more direct and I was writing some good stuff! At least that’s how it felt at the time. That time, however, as I was really going at the crux of the post, I realized that I couldn’t truly relate to what I was writing. Bringing me to my this third and hopefully final attempt.

In my previous 2 drafts I concentrated my writing on why I found it difficult to relate to people since my brain injury, about how many of their experiences weren’t my experiences. In the midst of that narration, I began a spiel about how the comparison of the feelings from one experience to another, different experience, is based on a false premise. While writing that, I started to figure out Continue reading →

Fink on the Nickel

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Will Carroll is not only a talented writer, for Sports Illustrated, he also has is very own podcast.  It is a unique show as it melds sports and technology – one of the few podcasts I catch when they come out.  Will took the time to interview me about two weeks ago about the concussion issue in the NFL, and although it was only about 15 minutes in length we could have talked for hours.

In this episode, titled “Big Dog” Will discusses the NFL, MLB and concussions; my interview can be found at the 47 minute mark.

Ever Wondered About the Adolescent Brain?

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We have discussed quite often about the adolescent brain and why concussions/brain trauma is much more troublesome for this set of the population.  Trying to explain this part has been difficult for me as I really grasp the concepts of it, rather than the practical application of the information.  Thanks to TED (a nonprofit devoted to Ideas Worth Spreading. It started out (in 1984) as a conference bringing together people from three worlds: Technology, Entertainment, Design. Since then its scope has become ever broader. Along with two annual conferences — the TED Conference in Long Beach and Palm Springs each spring, and the TEDGlobal conference in Edinburgh UK each summer — TED includes the award-winning TEDTalks video site, the Open Translation Project and TED Conversations, the inspiring TED Fellows and TEDx programs, and the annual TED Prize) we can listen to Sarah-Jayne Blakemore perfectly illustrate the adolescent brain.

Sarah-Jayne works  for the Developmental Group at the UCL Institute of Cognitive Neuroscience focuses on the development of social cognition and executive function during adolescence. Our research involves a variety of behavioral (psychophysics, eye-tracking, motion capture) and neuroimaging (MRI, fMRI and MEG) methods. We are based at the UCL Institute of Cognitive Neuroscience in Queen Square, London, UK.

This is one of the most serious brain labs in the world.

Book Review: Concussions and Our Kids – Dr. Robert Cantu

Dustin Fink6 Comments

Due out tomorrow, Tuesday, September 18th, is Dr. Robert Cantu’s most recent writing on brain trauma; more specifically the concussion and how it relates to the ‘kids’.  Dr. Cantu is THE expert when it comes to concussions, heck his CV is so expansive it would take up like 7 pages on here.  The man knows his stuff; collaborating with Mark Hyman I believe he has written a book that is worth the read for everyone interested in this topic.  By writing this book they not only address the concussion issue but the “iceberg below the surface” the youth athletes and their care.  Obviously the millions that partake in sport and recreation are not privy to the top of the line medical staffs that the professional and high college athletes have at their disposal.

With Dr. Cantu’s wealth of knowledge there was a chance this book could have been written above the audience – so to speak – but after reading it twice I have found it to be perfectly succinct and to the point.  There is no beating around the bushes and you definitely get the feeling of where Dr. Cantu stands on this pressing issue.  All of that being said there are some points that I disagree with, but remember my favorite Japanese Proverb: “None of us is as smart as all of us.”

The book begins with the most important topic, in my opinion, “what is a concussion?”, delving into the brain and its physiology.  Don’t be scared, it is a well written chapter and explains to the layman how and what we feel determines a concussion.  Highlighting that section is the explanation of linear and rotational acceleration and why one is way more important than the other.  If you have read here enough you will note that the rotational aspect of the traumatic force to the brain bucket is the most troublesome, Cantu agrees.  In this chapter Cantu also discusses the term “rest”, and what we are all trying to convey, especially to the youth.  Rest is both physical AND cognitive, meaning not using your brain.

The next two chapters deal with collision sports Continue reading →

2012 NFL Concussion Report Week 1

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The Concussion Blog Original, NFL Concussion Report, is a weekly compiling of the reported head injuries in the National Football League.  Concussions are added to the list each week from multiple sources to give you the reader a picture of what is happening on the field.  Each week we will bring you the information along with relevant statistics.  If we have missed a concussion or put one on here erroneously, let us know (we will also be using Fink’s Rule to classify a concussion/head injury).

Week one is in the rear view mirror and there are some very interesting stories across the landscape of football.  Most related to play and performance; individual and team wise.  I am intrigued as many are in those stories and my favorite team, the Denver Broncos, but I also have been doing something for the past few years that I feel can help everyone grasp the concussion issue.

The Concussion Blog was the first and has become the “go-to” source for chronicling the concussion in the NFL.  The task was very difficult at first – finding the information and doing my best to confirm; via Official Injury Report or media accounts.  I will tell you that I am not privy to actual information from the league or teams, rather I am an information compiler and data miner.  This is not done to “damage” the sport, rather as a public service and something of a “check and balance” of the information, even if it is just a blog.

Each week I will present to you the numbers that I have found (or sent to me) and give you an idea of what his happening on the concussion front in the NFL.  This information is just that, information throughout the year (with occasional editorials on events and the numbers).

For a quick background you can look at the 2010 and 2011 final posts on this subject, I have as well provided a preview of sorts to this upcoming season that will tell you what I am thinking going in.

Looking back on last week some general things stuck out with me; the very quick and definitive reporting of game day injuries, the absolute misidentification of Darrelle Revis’ concussion, and the seemingly increase in violent hits.  The first two are given now-a-days, the third may merely be a subjective observation.  However, I wasn’t the only one, Jim Rome made a tweet referencing this as well on Sunday.  Perhaps we are all so in tune with the issue it seems magnified.  A quick side note it did appear to me that players were actually trying to use more shoulder/body rather than lowering their head on collisions (James Harrison didn’t play last week).

On to the numbers from this past week; total concussions found 10 (pending any new on injury report) that is on top of the 48 in the preseason (the rates below are EXACTLY identical to those rates through 15 weeks last year); Continue reading →

NFL players: They’re not doing it for their health

Nick Mercer1 Comment

With the NFL season getting started last Wednesday night, player health, at all levels, comes to the front of my mind. I have recently been thinking about health insurance with respect to sports. Living in Canada, it is definitely less of concern than in the U.S., but I thought I would share some thoughts about the college and pro levels of sport.

There is no way that I’m the first person, after all this time, to talk about what colleges and pro teams are doing about health insurance for players. I know there are a bunch of questions about whether or not concussions are pre-existing conditions, and other reasons players can’t be insured, but it should be a legitimate issue at the college and pro-level for contact sports. The NFL, NHL and NCAA have enough financial wherewithal to encourage some forward thinking insurance company to insure the players who are, perhaps unwittingly, putting their future well-being in jeopardy on the field of play.

As has been reported countless times, concussions are caused in a number of ways and the symptoms are diverse. So why should it be forced into the same insurance categories as other injuries with the “pre-existing” condition clause? If there was enough demand for some type of concussion insurance, a new category for a specific league/sport could be created. Taking care of players once Continue reading →

Refeleciton Is Not Always A Bad Thing

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Being honest about who you are and what you care for is needed for us to succeed and move forward.  As time passes we all morph and adjust to what is around us; including our likes, dislikes and passions.  For some, changes can be very profound and upon reflection they can even be “out of body” compared to who you were previously.

Patrick Hruby, a wonderful writer for many outlets has had one of those moments when it comes to football, this is his words via Dave Pear’s Blog;

The hotel restaurant was closed. So we ate at the bar. It was early August, and I was in town visiting a former NFL lineman. Call him Max. It’s better not to use his real name.
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During his time in football, Max was hit in the head. A lot. He since has endured nine brain surgeries. He has trouble remembering things. Serious trouble, like the main character in the movie “Memento.” Max and I were both carrying notepads, but for different reasons.
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At the other end of the bar, two guys discussed mixed martial arts.
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“I’ll tell you what — ever since MMA came around, I can’t watch boxing,” said one. “It’s too boring.”
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There was a game on. Saints-Cardinals. The first contest of the NFL preseason. Max had his back to the television. Once upon a time, he was an avid hunter. He owned a successful business. Today, he’s unemployed. Pretty much broke. Lives in a trailer outside his brother’s house. He probably shouldn’t drive, probably shouldn’t own guns. He gets angry. Has a hard time sleeping. He misses his family. His estranged wife and children are afraid of him.
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On the television behind the bar, a Cardinals receiver caught a pass. A Saints defender dutifully drilled him, slamming the receiver’s helmet into the turf. I wanted to look away. The guys at the bar cheered. I was drawn to the replay, slow-motion and high-definition, the whiplash bounce of the receiver’s skull. I wondered how much of the play he would even remember.
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Max turned his head. He had an appointment scheduled for the next morning at a nearby brain clinic. The doctors know him by name.
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“Look at that hit,” he said. “In the old days, I would have gone, ‘Oh, man, great hit.’ Now, I see it differently. I can’t watch this s—.”
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Neither can I.

I, like Hruby have had those moments, sometimes at my job watching a high school aged kid get the snot-bubbles knocked out of him.  I cannot fault him on his inner struggle, nor can I even dream that he is wrong for thinking it.  Perhaps I have become too good at Continue reading →

Hey NYJ and Darrelle Revis READ THIS!

Dustin Fink7 Comments

When I saw the tweet from Greg Rosenthal yesterday “ ‏@greggrosenthal  The NFL should fine coaches for the use of the term “mild concussion.”  All I could think of was this post.

Originally posted in 2010

There is NOTHING mild about a concussion, period.  However media, teams, players and even medical staffs continue to use this nomenclature with this injury.  It is simply counterproductive to label this injury with a “mild” tag, and hampers the effort of everyone trying to increase awareness.

Granted, those that have extensive training in the area of injuries, and particularly head injuries, understand the term “mild” when it is in concert with concussion.  This subset of the population is not the one that needs the education, rather it is the general public, which includes players, coaches and parents.  A common problem amongst people who are educated in a particular field is that they forget about both who they are servicing and the education level of people other than their peers.  It’s a fine balance to educate without talking down to others, but understanding the stigmas of the topics help with that effort.

One serious stigma is the “mild” tag that is placed on concussions.  Those that watch and participate in sports are so used to using that clarification when assessing and addressing injuries as a whole, that perhaps it carries over to the traumatic brain injury just sustained by the athlete.  We as athletic trainers and doctors need to reassess how we describe this particular injury.

During my public speaking I often relate being “mildly” concussed to being “mildly” pregnant…  You are either concussed or not, just like you are pregnant or not.

Some may say that “the symptoms are mild”, or that the “prognosis of the injury is mild”, in terms of being sidelined.  The first may be correct the second is a slap in the face of those that study and deal with concussions on a daily basis.  So the symptoms are mild; no headache, slight vision issues, just “foggy”…  SO WHAT!!!  The insult to the brain that occurred has created a problem, Continue reading →

Two Excellent Researchers Discussion Concussions

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If you get the chance you should take the time to read the research that has been done by David Hovda, PhD and Kevin Guskiewicz, PhD, ATC; not only is it good information but it has been some of the leading information.  These two gentleman do a great job of explaining the issues and making them more tangible for everyone.

On September 6th, both Hovda and Guskiewicz had a real-time chat about concussions on ScienceLive;

ScienceLive, Science magazine’s weekly web discussions with experts in various fields, will examine the issue of sports- and combat-related head injuries during a web chat at 3 p.m. Eastern today. Guests include Kevin Guskiewicz of the Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center at The University of North Carolina at Chapel Hill and David Allen Hovda, the Director of the UCLA Brain Injury Research Center.

You can click the link above to go and read the replay of the chat, a must for those looking for information and would be a good idea if you have kids playing sports now.  Below are selected comments from the chat; Continue reading →

New Study; Posting for Reference

Dustin Fink2 Comments

This information was not only new, but really took up time on the airwaves with its information.  For some this may be a head scratching, but for most in the know it was really confirmation of what the popular line of thinking has been.  Really, if you think about this in a vacuum, brain trauma is bad, and increased exposure over long periods of time is real bad.

Here is a recap from CTVNews in Canada;

Former NFL players appear to be at an unusually high risk of dying from Alzheimer’s, Parkinson’s or Lou Gehrig’s disease, suggests a new study that once again highlights the dangers of the game of football.

The study, which appears in the journal Neurology, found that the death rate from those three diseases among a group of former NFL players was about three times what one would expect from the general population.

The study looked at 3,439 former players who had at least five playing seasons from 1959-1988 with the NFL. The average age of the study participants was 57 and only 334 players – about 10 per cent of them – have now died.

Researchers compared the players’ deaths to a comparable group of American men and found that in 10 of the former NFL players, either Alzheimer’s, Parkinson’s or Lou Gehrig’s disease (also called ALS) was listed as the cause of death.

That’s about three times the general rate for American men, the researchers reported.

I would also like to take this time to make sure we are not vilifying the NFL or football for that matter.  Sure the sport has plenty of brain injury, but concussions and repetitive blows to the head are not unique to the gridiron.  Soccer for one is a sport that is both understudied and had potential for chronic cases.  In the sport of baseball the catcher position is an area of concern.  Hockey, rugby, rodeo, Aussie Rules all have a place in this discussion.

Mostly, remember that kids are now exposed to sports at a much younger age then this study group, and the group also was playing before the 90’s – before everyone got bigger, faster and stronger.

All-Pro Safety Coming to Grips with Past

Dustin Fink1 Comment

Rodney Harrison was a FEARED defensive back playing the safety position.  Cut from the same cloth as Hall of Famer Ronnie Lott, Harrison not only protected the end zone, he made dang sure you knew he was there.  Often he was seen absolutely destroying opponents on the gridiron, a human missile intent on separating the offensive player from the ball.  Most of his action was prior to what I have coined the “concussion era” in football – 2010 to present.

Sure we knew about concussions before then, sure we as medical professionals – especially athletic trainers – took them very serious, but until then the spotlight was not on this injury as it is now.  Harrison and other lethal defenders around his time – Steve Atwater – were not scrutinized nor were they penalized for those now deemed dangerous hits.  It was part of the game, and in some cases those types of hits are still perfectly legal and punishing.  Now Harrison who is approaching his 40th birthday is, well, his quote sums it up;

“I’m scared to death of what may happen to me,” the 39-year-old said.

On the Dan Patrick Show Harrison spoke freely about concussions and mostly his; Continue reading →

NFL Season Is Upon Us: what did preseason tell us about concussions?

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Tomorrow night the guilty pleasure of many of us, the National Football League, will begin.  Whether you are rooting for a certain team (Denver Broncos) or player or have fantasy football implications the next six months becomes an investment for many of us.  I love football and will continue to love the sport, however I do feel that some changes need to be made – most importantly at the lower levels where our children and grandchildren play.

The Concussion Blog was the first to attempt to track concussions in the NFL beginning in 2010; we are not an official source nor do we have the capacity to have the actual/internal numbers.  However, with the various outlets and search engines we have been able to catalog a good portion of the brain injuries in the league.  Many have jumped on board to also document the injuries (looking at @nflconcussions) which has been a good resource as well.  We do not publicize our list, but you can follow them and get the names as he/she finds them they will be close by the end of the year.

Accountability, that is the primary reason for doing this task; professional players are a different animal when it comes to playing with any injury, let alone a concussion.  Gaining an overall picture of the numbers of concussion at the highest level (see most paid attention to) it is hopeful we can gain an understanding of the true epidemic.  Although a national clearing house of sport related concussions would be awesome, it is very difficult with millions playing and much fewer understanding and reporting the injury correctly.

The secondary reason is for observational data that can possibly be researched for underlying issues or things we don’t often see on raw numbers.

All of that being said we should be posting a number and stat update weekly based upon injuries found.  They will look something like this.  We have also been keeping track of preseason concussions the past two years and we are ready to release our stats for 2012.  The first question on most people’s mind is: were there more or less?

In terms of raw numbers the answer is Continue reading →