Month: November 2013

2013 Week 12 NFL Concussion Report

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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).  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.

It is now the “witching hour” in the NFL season.  From Week 13 on there are no more byes and every team is playing in the week, giving us a truer picture of the concussions in the league.  As we have noted the past few weeks we have began to see an increase in weekly reports (we added one concussion to last weeks total, found after the fact); weeks 10 and 11 have produced 11 concussions each up from the previous and steady high of 8.  It looks innocent enough but that is a 37.5% increase.  This past week was not different as we found 12 concussions.

The overall number of concussion in the regular season now has eclipsed 100, but this has been the latest in the season it has occurred since we began tracking concussions in 2010.  Interestingly enough the number of actual injuries in the NFL has seen a dramatic rise which brings me back to what some league medical people relayed to me; “we have traded heads for knees.”  I was and am not so sure about that statement as a rule, but it makes logical sense.  From my point of view as an athletic trainer I feel I have seen more broken legs and ACL’s than ever before.  It is difficult to figure out why this is happening, but many theories are out there.

Going forward I anticipate the numbers to stay at or above double digits until Week 17 (when we all know teams don’t report concussions when they are not playing the following week).  With that, I don’t think we will reach the heights of previous seasons; I am concerned about that.  Also, I had a question via Twitter regarding how many of these are 2nd concussions for players; the answer is seven.

Now as we all sit here with Turkey Day hangover (from the food, people – OK maybe from the booze too) here is your Week 12 Concussion Report (indicates previous week numbers):

UPDATED: Craig Stevens found after original publish… Continue reading →

Canadian Journalist Seeks CFL Alums (UPDATE)

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UPDATE (11/28/13): It a appears this post and Tweet have provided Mr. Ott some good contacts!  Thank you.  However… Those willing to speak are Canadian CFL’ers, interestingly enough those that are American former CFL players have not reached out or are unwilling to talk.  This strikes me as odd but not so odd.  I feel that here in the US we still view this as taboo, to talk about concussions/head injuries.  If you would please be so kind as to find some American former CFL’ers Mr. Ott and myself would be very thankful!

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In the wake of ‘League of Denial’ by the Brothers Fainaru, many others are trying to dig deeper into the convoluted mess that we seem to find ourselves.  Of course, this is in regards to professional football.  Interestingly enough I have been contacted to seek such alums to speak with Terry Ott; mainly because there is still a veil of secrecy and some general stonewalling from those that played.  Terry passes along this note;

I am a Canadian journalist 6 months into an investigation on football concussions and brain injury and their aftermath.

My focus is on former players from the Canadian Football League (CFL).

Any former CFL player who is dealing with concussion issues is welcome to contact me at tjo55@yahoo.com

All replies in confidence unless specified by the responding individual.

I will also offer to be a conduit for those that want to speak but feel that confidence is of the utmost importance.

Happy Thanksgiving

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Today is a day reserved for people to give thanks for what they have or had.  This day is for everyone, even if you are not in the United States.  There are many things I am thankful for, none more than my family;

  • My parents, although they are 1000 miles away, Skype allows me to keep in touch with them and they can keep me grounded
  • My wife, without her and her tolerance for who I am and what I do none of this would be possible
  • My kids, the joy of my life, what keeps me going

I have many friends, socially and professionally, they are often the yang to my yin.  I feel thankful that I have surrounded myself with so many influential and honest people.  I have lost touch with some of those I consider to be my closest, but often those are the ones that understand the true bond of friendship.

I am thankful for my new employment, in this uncertain time with jobs at a premium and because the value of an athletic trainer is yet to be fully comprehended by the masses; being where I am now is wonderful and I only hope that I can do my very best to be around for a long time.

I am thankful for technology, it allows me this outlet and an opportunity to bring information to those that choose to click on this blog.  Technology has also helped the greater good of concussions, it is only a mater of time until we finally figure out this complex puzzle that effects just about everyone, every day.

I am thankful to you the reader.  I began with the thought I wouldn’t care if anyone read this stuff, and to an extent I still feel that way, but having so many of you read and comment makes me feel great.  I wanted to make a difference in just one persons life, but with all the correspondence I feel I have done that and then some.

So Thank You!

Eat plenty of good food today and enjoy those people and things your are thankful for!

2013 Week 11 NFL Concussion Report

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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).  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.

It is official, every team in the League has now reported a regular season concussion.  This is the earliest in a season this has occurred, which is a good thing, in my opinion.  In the past three years there seemed to be at least one team that had not reported a concussion all the way until Week 15 or later.  There have been cases of a team not reporting a single concussion during the entire season.  Knowing what we know about concussions, with the information from players over the years this would seem almost impossible.  The injury of concussion is going to occur in football, why be scared of it.  Just deal with it properly when one is identified.  That brings me to my next rant of the week, Wes Welker.

As we watched on Sunday night, Welker took a shot as he was going to the ground and the ball came lose.  It was postulated that he lost consciousness (it will never be readily admitted to) and was subsequently evaluated on the field.  The Broncos say at that time he was evaluated for a neck injury, which is very plausible.  If the med staff didn’t see the mechanism or sudden results they can only go off what the player was telling them at that moment.  He returned the next series for one play and was finally removed for concussion.  The question is what transpired in that roughly seven minute time.  Possibly the NFL booth observer could have radioed down to take a look.  If that were the case then this communication needs to happen quicker.  Possibly Welker himself realized something was amiss and alerted sideline personnel.  If that were the case then delayed symptoms could be to blame, or finally he had some wherewithal in that moment, or the sideline personnel had the chance to interview other sideline people and get the whole picture.  There is a lot we don’t know and won’t know during that time frame.  The ultimate good thing was that he was removed and classified as a concussion.  In defense of the athletic trainers and docs, I have seen/been part of many cases where delayed reporting happens.  It sucks that I miss them, but it happens, it is the nature of the beast here.  Concussions are primarily subjective, in the case of Welker, it should have been spotted that he was incapacitated during the hit.  But even trained eyes can be blocked out by other players on the field.

As of yesterday it was reported that Continue reading →

Hruby Tuesday Podcast

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Patrick Hruby and I discuss the recent article he wrote about making a decision about letting your children play youth tackle football.  It was a great discussion and I hope people learned something along the way.

LINK

Side note: You will hear a dog barking, my kids, their TV show way too loud, and brutal wind howling through a non-secure window (it was Sunday during the brutal storms that spawned tornadoes – keep those effected by those storms in your thoughts)

2013 Week 10 NFL Concussion Report

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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).  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.

There has been a spike in concussions.  I repeat, there was a spike in the number of concussions this past week.  In all honesty people should not be surprised by this occurrence; what should be surprising to all of us is the fact that it took ten weeks for there to be double-digit concussions in a single week.

Although Week 10 produced 11 concussions it is not near a record for a week.  That distinction belongs to Week 12 of last season, where there was 19 concussions reported.  People should not be worried about the 11 concussions, as it was expected at this point in the season.  We have noticed that in the past three years over 60% of all concussions reported occur between Week 10 and Week 16 (we feel it would be greater if Week 17 reporting were mandatory).

Our simple hypothesis is: cumulative effects of traumatic head trauma (although mostly sub-concussive) predisposes the brain to a concussive event with less force required late in the season.  I cannot think of any other factor that would produce a significant increase in concussions in the back 1/3 of the season.  There is three weeks of byes with 4 weeks of full scheduling.  If you just compare W1-W7 (51 this year) to W10-W16 the numbers are even more spread out.

I would say expect more of the double digits than the single digits from here on out.  That being said, expecting one thing and the seeing the results are another.  Quick note; welcome to the real world Buffalo…  Let us move on the Week 10 numbers (indicate previous week);  Continue reading →

Patrick Hruby Article That Has Everyone Talking

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OK, maybe not everyone but it has struck a chord with many people I know.  Hruby writes a long form piece on making a choice about letting your son/daughter play tackle football at a young age.  Sure he has been critical on football for a few years now, but this article is very informative and somewhat balanced on both sides.

I am writing this post not to steal his work, rather have it here for posterity sake and include one very interesting quote.  This is what I believe to be the most applicable (for the audience) when it comes to concussion management and assessment (emphasis added by me);

“If I said that one in 10 middle schools has an athletic trainer, I’d probably be overestimating,” Guskiewicz says. “Having a trainer isn’t going to prevent every injury or solve every problem. But it’s important. Some people say this is extreme, but I think that at the high school level, if you can’t afford to hire a certified athletic trainer, then you shouldn’t field contact sports at your school.“

The root cause of concussions is not sports or football, it is simply life.  They happen everywhere; from cabinet doors, to staircases, perhaps headboards, bicycles, trampolines, etc.  To avoid inherent conflicts of interest there needs to be a sole person or persons that have it as their job to keep kids/athletes safe.  We could always do what has been done before and rely upon the coach, but that seems to not be working out too well (conflict of interest).  As a buddy of mine, dad once said; “if you always do what you always did, you will always be what you have always been.”  There needs to be change.  I cannot think of a better point that having athletic trainers to do the work they are educated and trained to do: keep athletes safe.  Yes, there are way more good coaches than bad, but why not give the man/woman some help with medical advice and injury care?  Don’t they have a job to do of coaching a team/individual?

 

 

C3 Logix: Practical Application and Use (It’s Freaking Awesome)

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Last year while in Zürich I was approached by a group of people from the Cleveland Clinic and they had a poster they wanted to show me.  It had numbers, graphs and pictures – your normal poster at a conference – but what caught my eye was an iPad strapped on the back of a patient that was measuring movement.  I asked very basic questions and to be frank I was a bit overwhelmed at the entire company I was keeping in Zürich, so the poster was a blur.

After that chance meeting and getting back to the States I really forgot about the project until the spring when I started to hear more about it in the underground.  This testing platform was starting to get noticed and being from one of, if not currently the most, prestigious concussion care centers only helped matters.  I wanted to learn more; and in August that chance finally presented itself as the company selling the C3 Logix, Just Go Products, was able to connect with me for a webinar.

I was very blown away with what they were presenting to me – which is probably what the development team in Zürich was telling me – so much so that I wrote a glowing post on it.  Since that time I have worked hard to find a way to procure the system for use; if nothing more to test it out and see if my perceptions were reality.  This goal of mine finally became a reality, not only was I able to get the iPad needed and the app, C3 even offered to send out a technician (really that may be underselling David, he is a nerd but a very good nerd) to help me get accustomed to it.

This past Friday I scheduled the winter sports concussion testing for my high school; the freshman and juniors that have not already done so completed a popular version of the computer based neurocognitive testing, while the other freshman and juniors along with seniors were up for the “beta test” on the C3 Logix platform.  With the split we had 30 kids Continue reading →

2013 NFL Week 9 Concussion Report

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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).  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.

The steady number of concussions continue, there were eight reports this week.  There is not really much to say at this point about the frequency or lack of frequency of concussions; the next important date/time frame is the Week 13 report.  That is when all teams will be off their bye’s and the point at which we have traditionally seen a spike in concussions.

However I do find some interesting notes about this and last week.  We noted we would be interested to see how Keith Tandy of the Tampa Bay Buccaneers was listed on the Official Injury Report.  Although there was a very credible tweet regarding his concussion, he was officially listed as “ankle”.   This one example highlights the issue we have discussed with the NFL OIR, it can be difficult to ascertain all concussions just by following that data set alone.  Secondly, we noted last week that the Miami Dolphins were the only team in the league without reporting a concussion from the beginning of training camp.  Well, that has changed as Nolan Carroll was found this week.  This means every team has now reported a concussion at some point.  There are, however, three teams yet to report a regular season concussion: Arizona, Buffalo and Chicago.

Let us present the Week 9 Report (indicate previous weeks numbers);  Continue reading →

Soccer (Football) Suggested Changes

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In the wake of the Hugo Lloris incident there has been plenty of discussion on how to possibly avert such a situation from happening again.  In this particular case it is simple; if a player is knocked unconscious they are removed, no questions asked.  The problem really is the minutia of the game, more explicitly the traditions of the game.  Why not remove emotion and tradition and figure out a way to be better.

Because of this I am going to propose some changes for the international game of soccer.  Being mindful that some places and medical staffs do it correctly – I do not intend to “pick” on any particular league (although my lack of soccer knowledge may be off-putting to some).  There is no rooted soccer tradition in my family, nor do I even pretend to know all the history and because of that I feel that some of these ideas are void of fanaticism.

In order of importance;

  • Allow for a medical substitution for head injuries (this can be both a temporary and/or permanent replacement for the fixture)
    • After play is stopped for a head injury the team should immediately sub for that player; this gives the player less of an ability to fight to stay on the pitch.  It will also allow the medical team to properly evaluate the player in an environment more fitting (locker room).
    • If player cannot continue due to head injury then the sub stays permanent for the fixture.  If the player is deemed fit, then a re-entry is given to the initially injured.
    • This substitute would not count against the maximum of three subs/match, in either case above.
    • In the event of multiple incidents of head injury then another medical substitution would be allowed.
    • The referee would be in control of the above medical substitutions.
    • All medical subs would be subject to FA review; as to prevent gamesmanship of the rule.
    • This medical substitution would be for head injuries only.
  • If a player shows signs of a concussion, i.e.: loss of consciousness, Continue reading →

We’ve Tried To Tell You; Sleep Is Good

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There has been a post about sleeping after a concussion on here before; there has been plenty of commenting on the subject.  However thanks to fellow blogger Broken Brilliant here is a video about why sleep is important.  BB left the video in the comment section of the Return-to-Learn post below but it is worth its own post…

If your remember about the cascade of metabolites during a concussion, this makes a lot of sense.  The timing of this video is very funny to me; I just had a parent engage me in a debate about sleeping after a concussion just last night.  This mom, with her nursing degree, was adamant that ALL head injuries should be woken.  The debate finally came to an end when I used the snow globe analogy; she will be getting back to me today.

Not only is it proper and safe for someone to sleep after sustaining a concussion only, this video explains the necessity and how the brain eliminates waste during our sleep cycle.

What About Return-to-Learn?

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Two important groups released information about concussions and youth recently.  The Institute of Medicine recently released its Sports-Related Concussions in Youth: Improving the Science, Changing the Culture, addressing concussions for the youth (obviously by the title).  This was on the heels of the American Academy of Pediatrics release of their second report on concussions, addressing the return-to-learn aspect.  I offered some opinions on both of the reports via Twitter, but was really underwhelmed by the information in both documents.  It seems to me that even though the car is pointed in the right direction the gas pedal is being confused with the brake pedal.  At best I feel the community is driving though the rear-view mirror.

A loyal follower and some time contributor, Dorothy Bedford, a self-described “parent activist in concussion education, awareness and advocacy, and newly retired school board member in Princeton NJ,” has penned the following post regarding return-to-learn and the AAP paper.  This is not your typical parent; “I come by the interest in return-to-learn honestly, both from my daughters’ concussion and from the point of view of a school board member – with the opportunity to help protect the brains of all students.”

With all of that said, below is her post.  Thank you, Dorothy.  As a reminder, the inbox is always open to contributors.

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The Pediatricians Weigh In on Returning-to-Learning – A Mixed Review

The American Academy of Pediatrics has released its second major clinical report on concussions. It’s a good first step which will help many pediatricians begin to address the second most important issue in concussion management (after “remove from play,” and before “return to play”).  On the other hand, ten pages limits the territory it can cover; there’s little new for the ATC who takes a broad view of concussion recovery; the report wildly underplays the complementary role of the neuropsych, and omits any discussion of some important symptoms. I think the most important contribution this report makes will be nudging school administrators to action, especially those who have been inattentive or resistant to dealing with concussions in the classroom and gradual return to learn. It’s hard to ignore the AAP.  I will confess, since its release my reaction has swung up and down with each re-reading. Five days later, I hope this will be a balanced review. I like to keep the conversation open.

“Returning to Learning Following a Concussion” was published on October 27 (full report here: http://pediatrics.aappublications.org/content/early/2013/10/23/peds.2013-2867.full.pdf+html)  complementing AAP’s 2010 clinical report on “Sport-Related Concussions in Children and Adolescents”. The lead author on both reports is Dr. Mark Halstead, a specialist in non-operative sports medicine at Washington University in St. Louis. Neuropsychologist Dr. Gerald Gioia of National Children’s Medical Center was a consultant. Dr Gioia is a co-author of the CDC’s Physician’s ACE Return to School form, which should be in the hands of every student athlete and their parents for any concussion-related visit to a doctor (http://www.cdc.gov/concussion/headsup/pdf/ACE_care_plan_school_version_a.pdf ). Six other professional societies have endorsed this report.

The Good:

For pediatricians in areas with thin or no sports medicine/neuropsych coverage, this report is going to be very important,  Continue reading →

Tottenham Hotspurs; More Like Tottenham Hotmess

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The center of the club soccer world resides in England (two teams in Wales) with the Barclay’s Premiere League (BPL).  Being the “best” soccer league has allowed the BPL to be televised live here in the States as the sport is showing some growth in participation and in viewership.  I have recently found myself watching more matches and even choosing “a side” – as they call it across the pond (it should be noted that soccer it called football everywhere else but here).  Through research and general information gathering as I get further into the sport the BPL or other European soccer leagues are not much different in its fandom.  Supporters of teams and players are similar to the fanatics that follow football here in America; critical of team play, ownership, players effort and results.  One area where the fans and the sport of soccer is well behind, in terms of knowledge, is concussions.

The readers of this blog know quite well that a concussion is simply an event that alters normal brain function.  Being primarily subjective it may be hard to distinguish a concussion by simply looking at a player or person.  However, the vast majority of sports fans here in America and participants know that there are tell-tale signs of concussion that cannot be disputed.  When one of those objective signs is observed it is and should be understood that said player was concussed and requires immediate removal from the game/practice/activity.  The reason is simple, concussions are a brain injury and bad.  Research has shown that playing through a concussion is very detrimental to short-term and long-term mental health.

Years ago, pre-2004, getting knocked out or displaying signs of a concussion was a mere nuisance and even a “badge of honor” among the top-level sporting participants.  It was known back then that something as obvious as someone losing consciousness was not a good thing for the younger participants, however it wasn’t looked upon as it is now.  When a sports participant absorbs enough force to effectively “reboot” the body’s central nervous system that is NOT A GOOD thing.  As the information about concussion has become more clear through the years if a player is KO’ed that player is removed from play immediately and does not return for the period determined by the medical staff.  In the NFL the soonest anyone has returned to practice or game after being knocked out, since 2010 has been six days.  Even that may not be enough time for the brain to recover.  Heck, in boxing and MMA, fighters that are KO’ed are medically suspended for 90 days.

This leads me to the bloody mess that occurred in Everton, England yesterday.  Continue reading →

2013 Week 8 NFL Concussion Report

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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).  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.

This year is now catching up with 2010 in terms of concussions reported in the regular season.  Interestingly, this week was difficult to ferret out the numbers.  There will be at least two concussions not listed on the NFL Official Injury Report due to these reasons;

I will be interested to see how Ramon Foster and Keith Tandy are listed later today.  This leads me to the tweet from Hamza Abdullah about him being knocked out (concussion) and then the team/league reported it as “poked in the eye”.  Certainly times have changed from 2007 to now, however the need to “game” the system is always a clear and present danger with concussions.  Once they enter the protocol the unrealistic thoughts are that a player is more scrutinized.  Perhaps by some, but not here, our take is that we are pleased when players are reported.  Again it’s not the injury that is the issue, rather the mismanagement of the injury.

I would also like to note that 31 of the 32 teams have now reported a concussion in either the preseason or the regular season.  Only one team has yet to report a single concussion: Miami.

All of my “tin-hat” awareness done let us move on to the current numbers, concussions/head injuries through Week 8 (indicates previous weeks values);  Continue reading →

Posted for Posterity (UPDATED)

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This picture is from the CDC and Prevention Morbidity and Mortality Weekly Report Oct. 7, 2011, Volume 60, No. 39.

CDC numbers

 

UPDATE 12:00p CST: As noted in the comment section these numbers represent ONLY emergency room/department visits; there are tons of concussions that do not go to an ER for all activities.  It may be more poignant in organized team sports with an athletic trainer.  Not all concussions need to be sent to an ER.  I don’t send concussions to an ER unless there is deterioration or the caregivers are not comfortable with the instructions.  The second point I want to make is (brought up on twitter) this is for “non-fatal traumatic brain injuries”, which is a pretty big sampling of brain injury.  Here is the deal a concussion IS A BRAIN INJURY and no brain injury is a “good thing” and if this were to drill down to just “concussion” I feel the numbers would show more disparity.  Reason being; in cycling there are probably much more TBI’s that rate much higher on the severity scale – especially those going to an ER.