2013 Week 3 NFL Concussion Report

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).  It also should be noted that due to the league not disclosing actual injuries until Friday night there may be some added to next weeks numbers.

And the rise is beginning, in Week 3 we cataloged eight concussions thus far, bringing the total up to 21 for the season.  It is tough to predict for anyone but our extensive history of collecting the information tells us that single digit weeks are nearly coming to an end.  I say that with some reservation, as the numbers thus far have been well below what we have observed in the past.

Two players found two new ways to get on the Report, however they do represent concussions in NFL players.  First, Isaac Redman capitulated to having a concussion in Week 2 and playing though it.  Although, the Steelers are vehemently denying this occurred, we will take the word of the player in this case, after all they are the only ones who truly can tell someone if they had a concussion.

The second player is rookie linebacker Sio Moore of the Oakland Raiders, Continue reading

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Delaware Youth Concussion Summit – Wrap Up

A regular reader and a very good friend to The Concussion Blog was fortunate enough to attend the Delaware Youth Concussion Summit the past week.  I had asked her to write-up a report and she kindly and succinctly did that for TCB.  Because of Dorothy Bedford I can bring you this information, thank you.  This is also a reminder that if you attend a conference, symposium or summit and feel the information would good for the readers you are more than welcome to submit it so us in a .doc or .docx form and we will publish.  Without further ado here is Dorothy’s contribution;

The Delaware Youth Concussion Summit, an initiative organized by the State Council for Persons with Disabilities Brain Injury Committee, Nemours/Alfred I. DuPont Hospital for Children, and the Brain Injury Association of Delaware, yesterday released its three-point Action Plan regarding the diagnosis, management, and return to activity for the rising number of young people sustaining concussions in sports activities. Participants in the summit and action work groups include leaders and experts in medicine, neuro-psychology, education, sports, advocacy, state agencies, and elected officials.

The Summit aims to further the aims of Delaware’s concussion legislation, signed in August 2011, which mandated both concussion training for all DIAA coaches and awareness training for parents and athletes, and set some rules around written medical clearances before returning to play.

After convening in May 2013, the Summit divided itself into working groups and today announced three focus areas for further action:  Continue reading

Possibly the Most Comprehensive mTBI Guidelines

The Ontario Neurotrauma Foundation has released their updated Guidelines for Concussion/mTBI & Persistent Symptoms: Second Edition, and it may be the most comprehensive/complete to this point.

The guidelines stretch from diagnosis through return with emphasis on “hang-ups” that can come along with recovery, here are the modules;

  • Diagnosis
  • Management
  • Sports Related
  • General Recommendations for Diagnosis/Assessment of Persistent Symptoms
  • General Recommendations for Management of Persistent Symptoms
  • Post-Traumatic Headache
  • Persistent Sleep/Wake Disturbances
  • Persistent Mental Health Disorders
  • Persistent Cognitive Disorders
  • Persistent Vestibular and Visual Disturbances
  • Persistent Fatigue
  • Return to Activity/Work/School

Of special note and to reference is all of these recommendations are for adults.  That being said some of this can be “creatively adapted” for those in high school.

Here is the .pdf for the Sports Related Concussions/mTBI.  All of it is worthy looking over; not only for athletic trainers but doctors as well.

2013 Week 2 NFL Concussion Report

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).

It is early in the year but there are two things that strike me, already.  Mind you that it IS early I have not seen any “gaming of the system” to produce my observations.  This leads me to my first take from two weeks:

  • While watching the game and looking at Twitter/online there have been more in-game concussion evaluations publicized then the past three years.  Often I have heard/read “X player is being taken to the locker room for a concussion evaluation.”  This is indeed a good thing.  I don’t know if this was a directive from the league to make sure people know they are trying (I have asked in previous years to be as transparent as possible with this) but what this does in my mind is let people know this is the proper protocol for all levels.  Certainly there have been players returned to the game after passing the test, which I am fine with.  However, there has been a case of a player being removed, passed the test and then having symptoms on Monday, which is also understandable.

Launching National Study of Female Athletes and Concussions

Here is a press release from Kathrine Price Snedaker and Pinkconcussions.com

==========

Press Release

For Release: Wednesday, September 18, 2013 
Launch of National Study of Female Athletes and Concussions
Study begins October 1, to explore Female Athletes’ Experiences with Concussions
Contact:
Katherine Snedaker, MSW, PinkConcussions.com / 203-984-0860 PinkConcussions@gmail.com
Dr. Jimmy Sanderson, Clemson University / 864-656-3996 jsande6@clemson.edu

Norwalk, CT – Men’s football concussions are in the news daily from former and current players, but there’s rarely news about female athletes’ experiences with concussions. Female athletes experience a significant number of concussions, yet they seem too often overlooked when concussions are discussed in mainstream media. Mentioned in the report American Medical Society for Sports Medicine Position Statement: Concussion in Sport 2012data suggest that in sports with similar rules female athletes sustain more concussions than their male counterparts. In addition, female athletes experience or report a higher number and severity of symptoms as well as a longer duration of recovery than male athletes in several studies.

This new study will be focused on female athletes from all sports, and their past and present experiences with concussions. Current and former athletes are eligible for this study conducted by researchers from Clemson University with the advocacy group, Pink Concussions. For this study, female athletes, age 18 and over, who are willing to participate can sign up now at PinkConcussions.com. On October 1, participants will be emailed a link to a twenty-minute online survey about their experiences with sports and non-sport concussions and reporting concussions.

This research study will also explore female athletes’ experiences with reporting concussions, another salient avenue in the concussions dialogue, as many athletes do not report concussions willingly or are mis-diagnosed.

The research also will investigate female athletes’ willingness to have genetic testing that may show links to the repair and recovery of brain cells after concussion. After finishing the survey, participants in the study can opt for an additional study and consider submitting DNA collected by a cheek swab to be tested for variants at the Apolipoprotein E (APOE) gene.  Testing for certain genes has previously documented an association between specific genetic factors and outcomes from injuries such as concussion.

Apolipoprotein E is a protein that is important in the repair and recovery of brain cells that have been damaged due to concussion. The clinical studies point to a relationship between certain genetic signatures and poorer overall concussion response. While additional evidence is needed to better understand the relationship between APOE status and concussion outcomes, the American Academy of Neurology introduced APOE testing into concussion management guidelines this year.  EDIT FROM AAN: The American Academy of Neurology did not “introduce APOE testing into concussion management guidelines this year.”  The AAN stated that apoE4 was a risk factor for cognitive impairment in professionals; but no recommendation was made to conduct apoE testing, and there was no evidence reviewed regarding apoE4 in amateurs. 

The results of this research will help further concussion research by focusing on the communicative element present in this issue, and the results of the study will be helpful for athletes, parents, administrators, physicians, and advocates. This research will be beneficial in shedding light on female athletes’ experiences with concussions and reporting concussions. Often female athletes are omitted from the public discourse surrounding concussions and the results of this research will assist concussion advocates in raising more awareness about concussion issues in sports.

Co-Researchers in this study are Dr. Jimmy Sanderson and Dr. Melinda Weathers in the Department of Communication Studies at Clemson University, along with Ms. Katherine Snedaker, MSW, of PinkConcussions.com.

# # #
For more information about this study, help in recruiting athletes or to participate in the study, please fill the contact form at PinkConcussions.com or contact:

Dr. Jimmy Sanderson
Clemson University
864-656-3996
Katherine Snedaker
203-984-0860

Rules of the Game

I have waited about five days to collect my thoughts on this and honestly let my emotions calm a bit.  As some know I can be a bit outspoken and harsh at times but I wanted to refrain from letting emotion get in the way of an important message.  Yes, this post will be mainly about football, but don’t view it as an attack on the sport so many of us, including me, love.

This season across all the levels of play in football there has been a larger emphasis placed on player safety, most notably contact to and with the head while playing football.  It is a FACT that the helmet in football was designed and remains a protective device not a weapon or offensive piece of equipment.  Using the helmet in the later fashion is and should always be a penalty for both sides of the ball.  This is nothing new; since the mid 1970’s “spearing”, “face tackling” and “butt-blocking” (scroll to page 32 of that link) have been outlawed in the sport.  However, routinely those events on the football field are rarely called, now in 2013 there is an emphasis on these types of infractions.  Now there is a caveat of this type of action on the field called “targeting” which at the college level can have a player ejected if egregious enough. (BTW, that picture is a placard that was made in 70’s)

Before I go further, I would like to say that officiating at the high school and lower levels is a thankless job.  The pay is not life changing and most do it as a hobby.  Sure, I have seen some officials that the game has passed by or is too fast for them, but I have also seen men and women that do Yeoman’s work with nothing more than a handshake for a job well done.  It’s not easy folks, I have done it, but done correctly and consistently it is a thing of beauty.  At the college and pro levels these people do great work and often have other jobs besides being on TV and getting players, coaches and fans mad at them.  I can assure you they are doing the best they can.  But, I feel the game of football resides in their and coaches hands, for survival.

At the high school level in our state I know that officials have been told to watch out for targeting and the use of the helmet above the shoulders; this has helped at the cost of adjudicating the other, more established rules from the 70’s.  I have seen four flags in five games for “targeting”/”spearing” above the shoulders; I have seen zero flags for “spearing” when it was below the shoulders.  I didn’t write down every occurrence of these types of tackles in each of my games, however, I can vividly recollect at least 10 instances of spearing on both teams.  Side note here, if I see one of our players do it they get quite the ass chewing from me on the sidelines.

People need to realize that tackling with the head-down is not a safety measure for the person getting tackled, it is a safety measure for Continue reading

Interesting Find This Morning

NFL Screen Shot 9.17.13The title and the article is nothing new, we have known for some time that computer based neurocognitive testing is not perfect.  Some have even concluded that these type tests are not worth the time and money.  More and more I am hearing from professionals that feel that they HAVE to give this tests or others like it, even though it’s not precise enough in cases.

What is interesting to me is the website it appeared on, NFL.com, the one league that has propelled this product more than any other.

The timing of this article is also curious to me as well.  Lately I have been getting many emails regarding computer based testing and the need for it and my overall thoughts on them.  Perhaps there is a wave of skepticism regarding this tool, which is nothing new, or perhaps there have been more and more issues with these tests, now that they are being used by so many.

There is no doubt there has been an impetus upon Continue reading

What Are the Experts Saying About Guardian Caps

This post has no intention of being inflammatory, rather it is a post designed to hold a conversation and create a counter point.  I have been bombarded with information regarding this product; since early 2011 I have not been “on board” with this.  It is important to note that this product and its PR firm have been good at communicating with me and have listened, but I do find some of the press regarding this product and similar ones is a bit off base.  We do need to understand that what reporters and people say – not affiliated with the product – cannot be controlled buy the company.  So that being said I have found and have some opinions on the recent spike of press.  Take it for what you want.  Just know that I am trying to provide information for everyone to make their own decisions.

It began in 2011 rolling into 2012 when Guardian Caps shot me an email about their product.  And from the beginning I was not sold on the promises or the theory.  It’s quite simple in my estimation; you can wrap an egg up in 45 pounds of bubble wrap and if you shake it hard enough the yolk will still move or even break.  Essentially that is a concussion in an “egg-shell”.  Sure, the bubble wrap will stop all linear forces from cracking the shell and even prevent it from moving with those linear forces, but what is it doing to for the acceleration and deceleration of the concussion?  Moreover, even though it may be very light, we are adding mass to the head, thus we are creating a fulcrum change and balance change.  If you read here enough you know what I am talking about.

However, I have seen fellow athletic trainers rave about this and plenty of teams/coaches/schools adopt this product and even consult me on it, so I thought I would do my best to get the most information possible, on my own.  This company was willing to provide me with all the information they thought I needed, so good for them.  It really came to a head recently, while in the midst of the NOCSAE statement on 3rd party add-on’s, I received this email from the company;

Dustin,

I wanted to drop a line about both the Aug 9th article “NOCSAE Press Release Clarifies” and a short picture of our product and company as a whole.  Thanks for all your hard work with The Concussion Blog.  It is a valuable resource and you do a great job presenting an educated, unbiased view.

About NOCSAE certification:

  • If companies want to sell equipment that alters the original tested/certified helmet THEY or the individual must re-certify each helmet model it is placed on – adult and youth separate but not sizes.

2013 Week 1 NFL Concussion Report

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).

So it begins, our fourth season of compiling a report on the NFL concussions.  We were the first to bring you this report and ones like it, but over the years it has evolved.  We feel that this listing is the best one can get outside of the league itself.  We are using a variety of data mining techniques such as (but not limited to);

  • NFL Official Injury Report – obviously the official listings, but not all are always on there.  Players only missing practice due to the injury or may not play will be listed.  This was a problem when we began in 2010 as players would be cleared on a Monday or Tuesday and not hit the OIR.  Recently, to the credit of the league, all players that have had a concussion disclosed have been listed.  Another issue with the OIR is that if a player had co-injuries often times both are not listed.  Finally, the OIR has been known not to list concussions otherwise listed in media.  An example of the possible confusion played out between week 1 and 2 of this year; Jeff Cumberland was reported to have been removed from a game due to concussion on twitter (then changed to “chin”) and reported as “chin” in the OIR.
  • CBS Sports NFL Injury List – often not that different from the OIR, but has at times listed injuries that have been “undisclosed” on the OIR.  This outlet also provides ideas of injuries before the official injury is listed on the OIR
  • Twitter – various sources are good at cataloging concussions, most notably is @nflconcussions.  However, the feeds of teams and reporters are used to clue us in on concussions.
  • Other sources – this would be inclusive of simple observation of a trained professional in concussions – Dustin Fink, MS ATC, Fink’s Rule, team sources and in some cases players themselves have been used by this method.  Again is the classic example of Jeff Cumberland in Week 1, video shows the MOI with the reaction/signs of the player on the field.  This leads us to include Jeff Cumberland in our numbers.

This report initially was released on Thursday, Continue reading

So Simple It’s Stupid

I have posted many a video about concussions here on the blog but this one (thanks to Tommy Dean) may be the best for its pure simplicity and message about management;

People need to understand that concussions don’t have to involve a hit to the head.  I have seen throngs of people on Twitter and other places not grasping this.  Perhaps none more so in the product development sector; those very intuitive people with good ideas that think protecting the head will reduce concussions.  Be it a helmet addition, or better helmet, or those that want to remove helmets from the game, what they fail to grasp is that linear hits to the head with linear forces alone do not constitute the majority of concussion sequale.  The concussion comes as a result of a constellation of factors; the biggest of which is the acceleration/deceleration of the head, followed closely by the shearing (due to angular and rotational forces) of the head.  If you notice most mechanisms of injury one would easily note that knocks to the head with limited movement of the head itself, are not the vast majority of concussions seen.  The hits a person takes in sports and LIFE that are unanticipated and have multiple vectors is where we get a lot of concussions from.

For a better visual, if I were to say to you I am going to punch you in the face from the right side, and you had a chance to brace for it, there is a good chance you could absorb that blow with little to no problems.  However if I were to not say a word and walk up and hit you in the same spot with the same force, the chances you will be “hurt” are much greater.  When you anticipated the hit you would have braced and made the force almost strictly linear, with little rotation due to your neck muscles…  Where as, the sucker punch would move your head sideways and back; quickly accelerating your head then suddenly it would be decelerated by the spine range of motion limits.

I hope this has provided some positive learning for everyone…

What Does the Derek Sheely Case Foreshadow?

Inherent risks, of life and sport, are a constant issue none more controversial than concussions.  The truth of the matter is that concussions will occur in life without sports so playing: hockey, lacrosse, basketball, baseball, water polo or any sport comes with differing amount of risks/chances of concussion.  By playing those sports we should understand those risks and be willing to accept the chances of injury, particularly concussion.

As we have stated close to eleventybillion times now; the actual injury of concussion is not the issue of this crisis, rather it is the mismanagement of the injury that is the problem.  In other words it’s not the sports fault for concussions, it the people’s fault for not taking this brain injury serious.  Even worse, it is people in positions of power that have caused many to be “mishandled” after injury, bringing us to where we are today.

This is where Derek Sheely comes in; this young man died on a football field in Maryland as a result of head trauma and the purported facts in the case are very scary;

  • Four hour contact practice
  • “Preseason practices at Frostburg served more as a gladiatorial thrill for the coaches than learning sessions for the players… Practice involved virtually unlimited, full-contact, helmet-to-helmet collisions.”
  • Named coach in lawsuit explicitly told players to lead with their head and use their hat when tackling
  • Apparent lack of preventative medical care by an athletic trainer
  • And this quote: “Stop your bitching and moaning and quit acting like a pussy and get back out there Sheely!”

We have yet to have full discovery in this case and most likely there will be a settlement Continue reading