NFL Concussion Litigation Settled Out of Court

Twitter and my in box is exploding at this very moment…  The NFL and the players who have filed suit against the league have come to a settlement of $765,000,000, Judge Brody’s statement can be found HERE.  This works out to about $170,000/player or estate if there were only 4,500 plaintiffs (numbers are not clearly known).

This is a good thing for the league, and for some players this is well needed cash flow.  If the promise of establishing a better future with study and plans for players hold true it will be a great day.  But excuse me if I’m a bit reserved on the confetti and marching bands…

The 88 plan was supposed to be the answer, then the new Head Neck & Spine Committee, then the Mackey Council within the league (headed by Sean Morey).  There have been many band aids placed on this gashing wound before, perhaps just throwing money at it will clot it up?

Moreover, the fact that the NFL does not have to go through discovery in the litigation process makes those in Manhattan pop the champagne!

Doesn’t it seem a bit coincidental that this has come on the heels of the release of “The United States of Football” and the upcoming release of the Frontline (formerly co-partnered with ESPN)  “League of Denial“?

Perhaps I am skeptical, fine, but who has really won in this?

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The United States of Football

I am staring blankly at this screen, in the dark listening to The Kyle Turley Band play “Final Drive”, trying to make sense of what I just watched.  There have been some great comments from some great people about this film by Sean Pamphilon;

The United States of Football is a passionate, unflinching, and eye-opening look at the concussion crisis in football.  Sean Pamphilon’s heartfelt concern for this issue is palpable, and the film reflects the trust he earned from many football players and families that have been tragically affected by C.T.E.”   (Steve James, director of “Hoop Dreams”)

“Pamphilon’s work is deep, fair, principled and haunting. He gives voice to the unheard, and that voice forces you to think, feel, fear and weep. His film is like the gladiators in it — uncommonly strong.”  (Dan LeBatard–sports personality)

“A compelling and revealing look at the most important issue facing the National Football League.”  (Bob Costas, broadcaster)

Even those do not do justice to what this film is.  Certainly, each person that sees this film – AND YOU SHOULD – will walk away with different takes, but there are some undeniable problems within the business of football.  The sport, at its core, remains beautiful and a test of mans will, Continue reading

That Time of Year Again

The NFL season starts on September 5 and you can be sure that soon all of the talk about brain injuries will focus on football; how do we make the game safer for the athletes, but still keep it the game that fans love (and will pay to watch)? Then there’ll be talk about the culture of the game and how it’s taught and coached at the youth level. Those questions, and other iterations of those themes, will be explored in the U.S. – definitely watch FRONTLINE: “League of Denial” – and maybe a bit in Canada, but the discussion won’t really get going in Canada until the NHL starts again. So from September to April (maybe June), national/international focus on brain injury is sifted through the major sports screen. In those 8-10 months, it’s sports, and virtually sports alone, that drive the discussion on brain injury. Don’t get me wrong, it’s great that people are talking about it, but if brain injury seems to only happen to pro athletes with the very best in medical services to help them recover and the most pressing issue is how soon they can get back on the field or ice , then instead of increasing awareness of a serious injury, these discussions lessen the seriousness and the effect of these injuries to most people who are not privy to those medical services and who will likely need more than a few days or weeks to recover.

In my last post, Continue reading

There Is More Than Football

I know we all think of late August and early September as football season, but there are other sports out there that deserve some attention as well.  I do empathize with the football coaches that constantly tell me we are “picking” on that particular sport – we are not.  It is tough to overlook a sport that garners the most eyes and advertising around here.  That being said there are other sports either just starting, gearing up or in the final stretch that deserve note.

Baseball is grinding to the playoff push and under the radar is the fact that catchers are finally being honest about their heads.  Many have hit the DL this year for concussions, most recently Joe Mauer of the Minnesota Twins.  Certainly there have been others but it is worth noting that late in the season, seeing catchers develop concussions should not, nor will it be a surprise in the future.

Summer heat does not make one immediately think of ice rinks and hockey pucks, but Canada’s most popular sport will soon be getting into camp to prepare for the upcoming season.  When the puck does finally drop in early October (Go Avs!) the NHL looks to improve on their better handle on concussions.  But, the bigger reason for preparing for the hockey season is the upcoming Ice Hockey Summit II, held at the Mayo ClinicContinue reading

Interview with Director of US of Football

Recently released film “United States of Football” takes a look at where we are in the sport, in particular the biggest issues facing the sport.  Here is an interview with director Sean Pamphilon;

If you get the chance I feel this movie would be worth watching.  In fact if anyone out there can somehow procure me a copy or find a theater close to me I would love to see it as well.  Here is the official trailer;

Bob Costas calls this; “A compelling and revealing look at the most important issue facing the National Football League.”

Next Level… In Concussion Care

As an athletic trainer – an opinionated one at that – I struggle with all the “bells-and-whistles” in this conundrum that is the concussion issue.  If you have visited here or heard me speak you undoubtedly know that mismanagement of concussions is the true issue of this complex paradigm.  Yes, we need to know when a concussion occurs to begin the process in the right direction; however, this can be accomplished by simply making sure you have a trained medical professional on hand when the need arises.  Getting an athletic trainer to cover the most at risk sports at the most at risk times is a great start (and in the authors opinion is the only choice if you want to have collision sports).  Short of that, education over-education is necessary for everyone: players, coaches, parents, officials, teacher etc. to properly identify and accept the nature of concussion in sport – it is a risk.

Even having an allied medical professional, like an athletic trainer (AT) at practices and games does not stop the injury from occurring.  In fact, many products that may claim reduction in concussions or “possible concussions” are toying with fraud; at the very least they are practicing deceptive marketing.  The point being, once we identify a concussion how do we and who do we send the injury to, to avoid the rest of the iceberg lurking under the surface of the water?  Moreover, what tools do we have that can help get the right prognosis, treatment and recovery for the injured (and there are many out there)?

I feel there is a new product (I am not a paid endorser, nor have I been given compensation for this article/opinion) now hitting the market that may get us closer to the panacea that we are all hoping for (note I said “closer”).  Although it may have been presented as some big secret; the C3 Logix: Comprehensive Concussion Care system is not a secret rather it is something I feel is a “game changer” for concussion care.  It is Continue reading

NOCSAE Press Release Clarifies

NOCASE sent me the most recent press release; pertaining to the aftermarket/third-party additions to helmets. Here it is in full;

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Certification to NOCSAE Standards and Add-on Helmet Products

OVERLAND PARK, Kansas – August 8, 2013 – The National Operating Committee on Standards for Athletic Equipment (NOCSAE) has released the following statement regarding equipment certified to NOCSAE standards and add-on helmet products.

“Products designed to be added to a football helmet are being marketed and sold; some are intended to measure impacts, while others are expressly marketed as improving a helmet’s performance. Some products claim the ability to protect against concussions. Regardless of the truth of such claims, the addition of those products to a certified helmet changes the model, by definition, under the NOCSAE standards.

“For many years NOCSAE standards have defined a helmet model as a helmet “intended to be identical in every way, except for size.” Any changes, additions or alterations of the model, except for size, color or graphics, even if made by the original manufacturer, require that a new model name be created and a separate certification testing process begin for that new model. This concept of limiting certification to a specific model is commonly found in national and international helmet standards.

  • NOCSAE itself does not certify any product, it does not “approve” or “disapprove” of any product, and has no authority to grant exemptions or waivers to the requirements imposed by the standards it writes.
  • The addition of an item(s) to a helmet previously certified without those item(s) creates a new untested model. Whether the add-on product changes the performance or not, the helmet model with the add-on product is no longer “identical in every aspect” to the one originally certified by the manufacturer.
  • When this happens, the manufacturer which made the original certification has the right, under the NOCSAE standards, to declare its certification void. It also can decide to engage in additional certification testing of the new model and certify the new model with the add-on product, but it is not required to do so.
  • Companies which make add-on products for football helmets have the right to make their own certification of compliance with the NOCSAE standards on a helmet model, but when that is done, the certification and responsibility for the helmet/third-party product combination would become theirs, (not the helmet manufacturer). That certification would be subject to the same obligations applicable to the original helmet manufacturer regarding certification testing, quality control and quality assurance and licensure with NOCSAE.
  • Products such as skull caps, headbands, mouth guards, ear inserts or other items that are not attached or incorporated in some way into the helmet are not the types of products that create a new model as defined in the NOCSAE standards and are not items which change the model definition.”

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I read it simply as this;  Continue reading

Princeton, New Jersey Makes Peculiar Move

In a very unusual move by a school board the Princeton Regional School District – servicing one high school, one middle school and four elementary schools – has made it mandatory to wear head-gear in sports not known for head-gear.  In a proactive move the board has voted to make this a must in their school district;

The requirement, one that is not used teamwide for those sports anywhere else in New Jersey, will be mandatory initially for the sixth grade only, officials said. For children in grades seven to 12, the headgear is optional, although parents or guardians will have to sign a form saying they have declined to have their children wear it.

Still, officials were clear this week that with each year, the headgear would become mandatory one subsequent grade level at a time, so that all athletes in those sports eventually will have to wear it if they want to play.

This move strikes me as both good and forward thinking and as a waste of money as well.  Let us examine, first with the not-so-good ideas/thoughts.

First, the premise for this move was in part due to concussions (although they did also state it is for facial and oral injury protection as well) and the thinking on this is wrong in my humble opinion.  Many researchers, doctors, athletic trainers agree that helmets do not prevent concussions.  Sure there is disagreement on whether they protect – for focal-direct-linear forces they do have validity in this premise (as you will see below) – but the general consensus on concussion attenuation is exposure limitation.

Secondly, the addition of head-gear in soccer Continue reading

Rugby Being Put Through Wringer in Scotland

Scottish rugby has become somewhat of a surrogate for the problems in rugby when dealing with the current concussion issue.  Scotland certainly is not the only place this has become and issue (even though the IRB would like to tell you so); and this issue of concussions and sport seem similar in nature to what we have seen here in the States with American Football.

The uproar all began when a former player, Roy Lamont, made it known that he thinks/knows that players were both “sandbagging” and deliberately deceiving concussion test in order to remain playing;

Players regularly pass the tests. In many cases that is because they cheat,” revealed Lamont. “Players all talk about it. A test is done at the start of the season as a baseline test, and players who suffer from concussion have to return to that level to be passed fit to play.

“But some players will deliberately do stuff in the baseline test so that their results are low, making it easier to pass after concussion. And I’ve seen players carrying concussion into games. They’d come off a fairly straightforward tackle, but be sitting on the ground, starting into space for a few seconds.”

Interestingly Lamont’s comments were in response to an incident where a player was not sent off for concussion even though he exhibited overt signs;  Continue reading

HITs Takes a Hit… Maybe

Solid research is produced over a long period of time with validation and verification of standards.  When using tools there must be a set of numbers that validate what data is being collected – in short to make sure the data is “good”.  This has been a problem with many things in the concussion realm, most notably with computerized concussion testing.  However last night I received an email with an abstract regarding the Head Impact Telemetry system or HITs.

Before we go further you will need to familiarize yourself with a couple of statistical terms: absolute error and root-mean square error.

Absolute Error is the amount of physical error in a measurement, period.  The example I found was when using a ruler on the metric side the absolute error of that device is +/- 1mm.

Root-Mean Square Error is a frequently used measure of the differences between values predicted by a model or an estimator and the values actually observed.  This measure is used to compile the deflection of errors in predictions and is good summation of accuracy, which only holds true for a particular variable not between variables.  In other words RMSE shows us how accurate the data is compared to its model/validation.  If this number is high it can show that either the model was incorrect or that the data was compiled incorrectly.

Appearing in the online version of the Journal of Biomechanics researchers from Wayne State (one of the notable places for head impact testing) found that a difference in helmet size on the Hybrid III head model has called into question the validity of the HIT system (abstract);

On-field measurement of head impacts has relied on the Head Impact Telemetry (HIT) System, which uses helmet mounted accelerometers to determine linear and angular head accelerations. HIT is used in youth and collegiate football to assess the frequency and severity of helmet impacts. This paper evaluates the accuracy of HIT for individual head impacts. Most HIT validations used a medium helmet on a Hybrid III head. However, the appropriate helmet is large based on the Hybrid III head circumference (58 cm) and manufacturer’s fitting instructions. An instrumented skull cap was used to measure the pressure between the head of football players (n=63) and their helmet. The average pressure with a large helmet on the Hybrid III was comparable to the average pressure from helmets used by players. A medium helmet on Continue reading