Concussions: It’s not the injury

I don’t know how to make this much more clear.

And, believe me about 5 minutes after this goes up my twitter and inbox will be jammed full of criticism.

The injury of concussion: abnormal function of the brain after a traumatic event to the body/head (see all signs and symptoms), is not the “problem” we are facing.

The massive issue and “problems” we are facing in this crisis stem from the improper (see poor or none) and mismanagement of concussion and/or mild traumatic brain injury (mTBI).

Removing concussions from sports is nearly impossible, heck any physical activity has the risk of concussion (see my two concussions standing up and hitting my head on an open cabinet).  If everyone would take the focus away from “stopping” concussions and work on a safe, effective, and universal injury management technique (see ACL rehab protocols) for concussions this “problem” would cease to be a problem.

OK, fire away…

17 thoughts on “Concussions: It’s not the injury

  1. Pliska February 6, 2013 / 14:02

    You are correct.

  2. joe bloggs February 6, 2013 / 19:06

    I have no problem with anyone suffering from acute events. This board has been firm that if you don’t have medical care then a school should not have a sports program. Very young children require much more intensive monitoring because recovery is very difficult to measure. There is very little data to base judgments. Young women are almost as bad as the focus has been on male athletes. Conservatism must rule decisions. We have almost no reliable data on subconcussive blows so again youth sports should be managed conservatively. If the sport focuses on inducing repetitive head trauma, children should not participate.

    As far as football and to a lesser extent all revenue sports, the economic incentives make it difficult for medical staff to perform their jobs. Coach keeps his job by winning. He does not care what happens to the athlete as long as he keeps his job. For example, USC puts Robert Woods back in and he may or may not have suffered permanent damage. NCAA has coach’s back, fans have coach’s back, the NFL has coach’s back. There is no penalty and coach keeps his job. Woods may or may not get drafted but the NFL knows he has a concussion history and was put back in a game. A good scout knows he is damaged goods and not likely to have a long career (see Jahvid Best). Even better case, Matt Scott from Arizona, end up puking but throws a TD. Coach is lionized, player is tough guy and all is well. NCAA stays silent. The kid will carry his own medical costs as he is unlikely to be drafted.

    The NFL is even worse. Laurent Robinson, Jahvid Best, Clint Sessions, and even RG III. Yes, RGIII was put back quickly in the line-up after a concussion foreshadowing continued bad medical care that cost him his knee. Since its Griffin’s plant foot his career will be shortened. The NFLPA does nothing. It just talks. Independent Neurological Consultants selected by whom and reporting to whom. Next the health Czar, can you imagine the quack they will find to run this program. Keep in mind, the NFLPA does not give a damn what happens to these guys as long as it has an out to deny former players disability or pensions. It only took the NFLPA 5 years to do anything about SDs Dr. Chao and he nearly killed Kris Dielman.

    The first step in problem is provide medical care. Second, medical care is truly independent meaning, it does not report to coach or an AD. Third, athletic programs bear the long-term liability of the injuries players suffer.

    Everyone should realize the purpose of Lystadt laws was not to protect children, it was to seal the liability of the NFL for promoting a dangerous product to children and distribute the liability to local entities. It is brilliant.

  3. George Visger February 6, 2013 / 19:30

    That makes about as much sense as saying lets not try to “prevent” accidental poisenings, but lets come up with a safe, effective management program for kids who “have” eaten rat poisen.

    And I thought I was brain damaged.

    How about implementing more of The Visger Rules. Rules I was asked to submitt to Dr Rich Ellenbogen of the NFL’s Head, Neck and Spine Injury Group in 2010. If more of my suggestions had been implemented, fewer players and their families would be facing what my 49er room mate and my family have suffered since 1981 (see below).

    KVIE Channel 6 Sidelined: Concussions In Sports 12/19/12

    Channel 13 News Sacramento 10/29/12 Terry Tuatolo interview

    NPR: A Brain, A Life, Battered by Football

    Visger Rules – Recommended Changes to NFL Rules | The Sport Digest Dec 16, 2010 … George Visger, who played defensive tackle for the University of Colorado in the 1977 Orange Bowl, and won a Super Bowl championship in 1981…/visger-rules-recommended-changes-to-nfl-rules/ – Cached

    George Visger
    SF 49ers 80 & 81
    Survivor of 9 NFL Caused Emergency VP Shunt Brain Surgeries
    Benefactor of ZERO NFL Benefits

    • Dustin Fink February 6, 2013 / 23:01

      Gonna have to disagree with you George… Prevention is different than exposure limitation… Prevention of concussions via equipment is both futile and an exercise in money grab only – at this point…

      The analogy of accidental poisoning is not salient to this debate. One chooses to play sports, and should, having a plan in place to handle the injury is the key missing here… You of all people should understand this… Your plan is a good discussion point…

  4. G.Malcolm Brown February 6, 2013 / 20:01

    Well HECK,,,why even try preventing concussions..?.—- stop and take that deep breath yourself..

    Glade you stated your views…yes not letting players return to play without recovery is now seen as important,( recently),,as the second/HIT event is sometimes fatal…

    However prevention is the logical answer…– reduce the number of first events , then repair and getting ready for RTP would not be an issue..!

    Good luck with your tweeter..,

    G. Malcolm Brown

    • Dustin Fink February 6, 2013 / 22:56

      Listen you cannot prevent concussions, it’s a Pyhsics impossibility… However, reduction of exposure and limiting incidences of are and is possible…

      • G.Malcolm Brown February 7, 2013 / 06:52

        Dustin Fink,

        We all have the same goal….safe recovery,healthy lives,,
        I tend to point at the causes,,you rightly work on cures..

        How can we get a few pix to you..? They are “young” and might need more info to fill in your questions..

        G. Malcolm Brown

      • Dustin Fink February 7, 2013 / 08:10

        feel free to email them to me… you can find the email address in the “contact us” link at main page…

  5. arocker34 (@arocker34) February 7, 2013 / 07:19

    Hard plastics especially in the helmets are the main cause of the serious injuries and concussions in football today. Players are bigger and stronger, the defensive backfields are hitting the receivers with brutal tackles. Going back to leather as protection, especially helmets made of leather will force the players not to hit as hard for their own protection.

    • Dustin Fink February 7, 2013 / 08:12

      you obviously have not been reading the comment sections… going back to the leather helmets would increase skull fractures, neck fractures, and subdural hematomas… All of which are way worse than concussions – those you possibly lose your life…

      • Matt Chaney February 7, 2013 / 10:26

        Excellent discussion, folks. I clarify that while return to leather or no helmets would likely increase skull fractures, which are virtually nil in tackle football of recent decades, the opposite would be case for neck fractures and subdural hematomas, both of which clearly escalated on advent of modern hard-shells with facemasks. In fact, injuries below neckline apparently led causes in collision death prior to the late 1950s, when, yes, the AMA began sniffing at football dangers for doctors’ declaring that head-on colliding induced by modern helmets constituted a health menace for head and neck injuries of “absolute contraindication” or no medical remedy. Today, modern antibiotics and trauma care keep waves of players alive who would’ve died previous to World War II, including some 100 known cases in 2011, led by scores of internal-injury casualties requiring life-saving surgery and/or delicate ICU healing (see my Among references puncturing the myth of rampant head and neck injuries previous to the 1950s, see football historian Tom Bentjey, a mathematics PhD who posts game injury cases of distant past, such as the premier list for 1905 deaths, at his site Also see this 1916 report from The Harvard Crimson:

        Fifteen Football Fatalities in 1916
        December 04, 1916

        According to figures just given out by the Associated Press, 15 fatalities occurred during the 1916 football season, which closed with the Thanksgiving Day games. There were 15 deaths last year, 13 in 1914; 14 in 1913, and 13 in 1912. The number of fatalities this season, though higher than the average of the past few years, in no way reflects against intercollegiate football, since only one of the victims was a college player. In almost every case death resulted because of physical unfitness and not a single life was lost where a physician’s examination was demanded before the contestant was permitted to enter the game. Two of the deaths were caused by broken necks, but in the majority of cases victims died form internal injuries. Last year only three of 15 who dies from football injuries were college players.

  6. Dustin Fink February 7, 2013 / 12:21

    Solid work as usual Chaney… Any death is not good in sports, but its unfortunately more common that most thing – hence the myth busting… Just for reference what are the number of participants in 1916 versus now? (not nitpicking Matt, just continuing the pot stirring)…

    And I will stand corrected on the neck fx and sdh…

    • Matt Chaney February 7, 2013 / 13:12

      Ha, Ms. Valek’s comment in a question trumps about anything to say here; I wondered the very same before my making my insert above. Long-short, Joana, it appears money drove football’s continuance beyond the base form played circa 1869-1879 by rough young men, as both colleges and Golden Press realized profit potential and took it from there, including fabricating myth of always a safer game, but always…. Obviously numbers of participants a century ago were a fraction of today, Dustin, for your key question regarding rates, and I cannot answer at moment, even ballpark estimate; perhaps James Sayle Watterson (2000) or Michael Oriard (1993) have representative figures in their great texts on the period. (Regarding modern football in helmet and facemask, note that ‘youth football’ outside schools did not become a pervasive business with millions of child players until post 1980. Coaching great Marv Levy recently commented on the distinction. And I believe I recently read somewhere in sport-med literature a figure of about 1.5 million total players circa 1970, but cannot find that particular cite at moment.)

      • Matt Chaney February 7, 2013 / 13:22

        And I agree with arocker34 on brutality of modern play, versus the old, slower, less open-field game of Teddy Roosevelt’s time in Oval Office. Football video of the period clearly shows that even brain and spinal injuries were often caused, if not mostly, by victims’ suffering crushings in piles and scrums, not predominant head-ramming. I myself played thousands of more hours of sandlot or ‘bone crush’ football than my times in helmet and pads from the 1960s-1980s, and certainly avoided head-on contact in the former, as did everyone I played with or against the unorganized realm. I would take my health chances anytime with playing football 1905 versus the kill sport among speeding giants we have now, for which only modern med prevents annual fatality massacres.

  7. Joana Valek February 7, 2013 / 12:23

    As a European born female reading all these comments – I am amazed how did anyone ever come up with that brutal sport in the first place ?

  8. Francois Beauvais February 10, 2013 / 09:25

    I am not a professional athlete; I didn’t even play high level sports. Still, I’m at my seventh known concussion. Here is the specialists’ prevention plan: stop playing high risk sports. What’s a high risk sports? At my stage, they consider softball as being a high risk sport. So I agree, there is no way to prevent concussion. So what’s the solution? To start, doctors have to be better in giving the diagnosis and the treatment because for 90% of us, we have to go on with our lives on 2 Tylenols. Our local physicians are not well trained or informed on concussion and we are left alone in trying to get the proper diagnosis.

  9. Marco February 11, 2013 / 17:52

    Yes, comprehensive policy, procedure, and concussion programs are needed to manage concussions throughout the return to physical activity process, and it is the most important consideration in concussion care.

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