Terry Ott: 3rd Down, Absence of CTE to go – Part 3

This continuing “Guest Series” is being authored by Terry Ott and will delve into the Canadian Football League and the issues revolving around it and brain injury.  His process began nearly a year ago, but Mr. Ott picked up some steam with the release of“League of Denial”.  He has since found himself running into dead-ends and basically being ostracized for taking a journalistic angle on this as it pertains to the CFL.  We are thankful that we can provide a space for his writings and only hope that someone who is reading this can further his cause. You can read PART 1 HERE and PART 2 HERE.

LEAGUE OF NON-DENIAL, DENIAL HEARS, SEES NO EVIL or KNOCKED OUT, LOADED

QUESTION: Could the Canadian Football League receive and survive a class action law suit brought on behalf of former players suffering from football concussions and related brain injury?

ANSWER: Later.

This year, when the Canadian Football League’s director of communications, Jamie Dykstra, declined to answer what he termed my “loaded” questions about concussions and how the CFL was going to address them, I told Jamie it was unfortunate and that I would have to note the league’s silence in my story. “I know,” he said.

So, I am, noting it, that is. Because, to reference some other talking heads, this ain’t no disco; this ain’t no foolin’ around.

To reiterate, my questions, posted on the Concussion Blog earlier and condensed here concerned among other things, whether baseline testing info from the teams was shared with the league, whether the CFL was looking at any new helmet technology such as MIPS and would the CFL, like the NFL in 2009 confirm that in some cases, a causal relationship between football concussions and brain injury was a possibility.

Even after I appealed to Dykstra that hitting the mute button on such an important issue seemed, well, just wrong, and that my questions were not exactly League of Denial serious as a statement of claim or heart attack, he replied that “we (the CFL) are well aware of what is going on.”

I certainly hope so, yet being “aware,” and actually having a prescient policy would appear to be two different things.

Before Dykstra stopped talking, he had earlier forwarded me some pretty white-bread CFL concussions protocols and when I picked at its crust, was told the league’s policy was “organic.”

Far out. Nice, sexy, trendy new-age word Jamie, but what does it actually mean in the real, sometimes savage head knockin’ world of Canuck pro football?

Since the CFL won’t tell me, let me introduce to you a number of quite plausible if not certain “organic” scenarios for what in some ways seems a Darwinian policy.

Unlike the NFL, the CFL right now Continue reading

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2013 Week 16 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.

This is the last set of numbers I feel most confident about, as you will recall this coming week has proven to be difficult at best when finding concussions in the NFL.  Rather than boring you in this post with the reasons please click on the link above for that information.

In Week 16 there were only 13 concussions found, I say “only” because it seemed to Twitter, broadcasts and me, there were more players that exhibited something on the field that warranted further investigation.  The skeptic in me is also screaming at me to say that playoff eligible teams – especially those that have not clinched – are “gaming” they injury system.  To be fair, concussions are not the only injury being messed around in the “grey area”.  As I said that is the skeptic in me, the recent weeks have placed some better faith in the reporting system this season.

Something must be done to address – at the least acknowledge what we have found – the massive back-end of the season concussions we continue to see on a yearly basis.  The numbers cannot be easily washed away with the narrative that all teams are playing (versus bye weeks) as we have exposed.  It is very stark, the difference: weeks 1-9 there were 67 concussions in weeks 10-16 there have been 92.  When the NFL talks of expanding the schedule to 18 games I fear we will see an even bigger increase in the back half of the season.  There is a possible solution (more of a band-aid) though: two bye weeks.  It will expand the season further, but I don’t think the NFL really minds, in fact I think that is the overall goal.

Further observations of the numbers show the perpetual story of defensive backs being concussed most often.  As of this report the DB’s make up 26% of all concussions (41), the next closes it tight ends at 14% (22).  In fact, running backs (17), wide receivers (21), offensive lineman (21), linebackers (16) and TE’s are somewhat equal.  Even the defensive lineman are close to that grouping with 13.  Making all positions on the field outside of quarterbacks, DB’s and P/K somewhat equal in terms of the injury.

While we would like to see as few as possible, if concussions were equal across all positions (outside of QB, P/K) it would show that the injury is becoming a random incident.  Which is really the best case possible.  However, its not and the DB’s continue to be the most at risk players on the field, yet they also have some of the most restrictive tackling rules in place.

Now let us look at the Week 16 report (previous weeks numbers): Continue reading

The Abyss of NFL Concussion Reporting: Week 17

As football fans we are either gearing up to root on our favorite teams for a playoff and hopeful Super Bowl run, or the other 20 fan bases time is now spent looking at coaching changes, player acquisitions and the draft.  It has been a fun and exciting season for various reasons.  In terms of concussion data collection it will complete our fourth year and it has been a success once again.

However Week 17 provides for some of the hardest data capturing possible for the NFL.

During the season when teams play the following week they must report injuries and then they are listed on the NFL Official Injury Report prior to the game being played.  This mechanism, even with its overt flaws, is the launching point for our data.  With the regular season ending there are only eight teams that must report injuries the following week, effectively eliminating 3/4’s of the league.

This where you the reader can come in – and I am once again doing my yearly begging – if you note a concussion via a broadcast or twitter or the interwebs, please pass it along to us.  Although @nflconcussions does a tremendous job, he too probably welcomes the help.

So here is your homework for Week 17:

  • Watch games and enjoy games – root on your interests
  • If a concussion is noted send it via Twitter (@concussionblog) or email (theconcussionblog.comcast.net) in this format:
    • Player, Team, link/credit/notes
    • EX: Joe Schmoe, NYG, broadcast 3Q
    • EX: Joe Schmoe, KC, @examplehandlehere *link*
    • EX: @concussionblog RT: @examplehandlehere ……
  • I welcome any questions regarding the concussions during the games, but unless I catch it on RedZone or you have a video link I will be unable to answer to specifically.

Think of this as “OUR” project for the end of the NFL season, crowd sourcing style!

Thanks in advance.

Terry Ott: 3rd Down, Absence of CTE to go – Part 2

This “Guest Series” is being authored by Terry Ott and will delve into the Canadian Football League and the issues revolving around it and brain injury.  His process began nearly a year ago, but Mr. Ott picked up some steam with the release of“League of Denial”.  He has since found himself running into dead-ends and basically being ostracized for taking a journalistic angle on this as it pertains to the CFL.  We are thankful that we can provide a space for his writings and only hope that someone who is reading this can further his cause. You can read PART 1 HERE.

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THE LINEBACKER’S HEAD GAMES

Article 19 of the Universal Declaration of Human Rights, adopted in 1948, states that:

“Everyone has the right to freedom of opinion and expression; this right includes freedom to hold opinions without interference and to seek, receive and impart information and ideas through any media and regardless of frontiers.”[6]

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Former star CFL player Leo Ezerins was a ferocious linebacker through the 80s and won a Grey Cup while playing for the Hamilton Tiger Cats in 1986.

In that game, in which Hamilton was in some sports books a 22 point dog to the vaunted Edmonton Eskimos, Ezerins and company absolutely stomped and annihilated  the Eskimos, a seek and  destroy mission that in the first half forced half a dozen sacks, several forced fumbles and recoveries and a total offense by Edmonton of basically, nadda.

Here, are some highlights:

Ezerins was perhaps the 80s CFL’s answer to former Pittsburgh Steeler wild-man and Hall of Famer Jack Lambert, taking no prisoners and showing no quarter on the gridiron.

And right now, Leo is not too happy with me. I kinda feel bad about that, and here’s how it happened.

You see, Ezerins is currently the executive director of the CFL Alumni Association which boasts around 1000 participants.

The Alumni Association attempts to bring former players together in friendship, events and sometimes even modest philanthropy. Some members have been directly involved in examinations of former player
health and safety issues as well, including concussion research. Obviously, the CFL Alumni does some good work.

And so last October, I sought Ezerins out via e-mail, inquiring as to Continue reading

Interesting Take On Tackling

I have been fortunate to be in some great email “groups” with information that surrounds the playing of sports.  Of course I have been attracted to concussion and those ancillary problems surrounding the brain injury.  It not only furthers, the some time outrageous, fodder but it also provides some critical thinking.

Matt Chaney has been doing a great job of circulating information – mainly about football – and from time to time I get some links that I feel would be best shared for “group thought process”.  A quick aside: Chaney’s blog has been removed from cyberspace due to some confounding issues on the user end, but he will dredge up his information in the coming weeks and re-launch his blog.  Back to the post…

Here is how Chaney describes this forthcoming link:

–super piece by a very interesting writer, an outstanding athlete-scribe, Doug Brown in Canada, former CFL D-lineman… he nails NFL rule-making as lousy lipstick on the pig… great points on the folly of ‘proper form’ or Heads Up or ‘safe tackling’ especially in the head-on avenues of football contact, or the ‘allies’ on-field, as Brown refers…. the tunnel effect of forward contact… though I don’t see any wall-in by other players as necessary for a head-on collision; it’s all about angles of intersecting opponents, and all you need are two principals incoming, ballcarrier and tackler, each with his mission…. boom!…. Doug Brown

I share his sentiments on the article, it brings to light some of the things we CANNOT get rid of in current football.  But does that make the game “unsafe”?  That is the penultimate question; further if it is a problem how can it even be solved?

Here is an excerpt from Doug Brown’s article that appeared in the Winnipeg Free Press;

When an offensive and defensive player meet in an alley, the options for tackling from an angle, or putting your head to the side of the ball carrier are absent. Instinct and self preservation in football tells a ball carrier to lower his head and shoulder pads when he anticipates a collision. Hitting a ball carrier above Continue reading

TCB Mail Bag

I trust everyone has had a wonderful Christmas experience (or Hanukkah or Kwanzaa or going to have a good Boxing Day), with that I would like to wish everyone continued successes in whatever endeavor they choose.  Over the Holiday I have received many an email regarding concussions; apparently the down time has given people opportunity to share frustrations or good news.

Today I am bringing you a specific case in which we all can learn from.  At the least we can read this and prepare for similar situations that may arise – whether as a parent, doctor, coach or athletic trainer.  

As always you can write in and with your permission I will re-post anything you would like (and it may suit the audience).  It can be attributed to you or anonymously.  Keep it between 500-2000 words and omit any personal identifying factors if it involves patient care or sensitive information.

Here is our post today – by Anonymous:

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Obviously today is Christmas Eve and in most regions of the country kids are not in school for at least the next two weeks. Maybe less, maybe more. All in all it is a great time to rest up that brain and recharge your body. As athletic trainers we also know that sports do not stop for the holidays. For the most part at least. If you remember last year I read an op-ed article that you put on your blog titled “Parental Decisions Can Undercut Good Concussion Laws” or something of that nature. Well, it’s happened again (as it has many times between that time and now but this one is a little more ridiculous than the last) and I’m nauseous!

To be as brief as I can on this without boring you this is the case of a female soccer player who sustained a nasal fracture as well as a concussion when fighting for a header in the air with an opposing player almost a month ago. To be clear, she actually suffered a deviated septum. Anyway, after our AT did a beautiful job of getting this athlete “entered” into our concussion protocol (which Mom still couldn’t get over the fact that she indeed had a concussion; whoda’ thunk it, right?) we all sat in our physician’s office (Mom, AT, myself, physician, athlete) and witnessed the concussion as well as the nasal issue being addressed. The athlete was clearly concussed (clinical exam, balance assessment, and symptom reporting were all abnormal but ImPACT scores remained at baseline) and the athlete was sent for an MRI and referred to an ENT for further evaluation of the nasal issue. Pretty simple. These folks were given the “red carpet” treatment as all of our athletes/parents are and everyone left happy. The consensus was to see the ENT and address that issue then to follow back up with our physician for the resumption of the concussion issue. The athlete ended up having surgery about a week later. She was out for about a week after that. The ENT cleared her to resume play and actually said that there was no concussion. Wow! OK!

Fast forward to last week during exams and the athlete did not follow-up with the AT during exams like she was instructed to do. She THEN shows up to a game on Saturday with a face shield and tries to plead her case to enter the game. The AT did her job and did not allow the athlete to play. Mom was irate. Athlete conceded. Coach was with the AT. So athlete did not go through the GRTP process and as of today the mother refuses to follow-up with our physician for final clearance after all of the objective information is noted. She is choosing to Continue reading

ABC’s ‘This Week’: Football’s Concussion Crisis

First I want to lead this off by saying it is not a “crisis” just for the NFL, or football, this is an issue for everyone.  Once again this provides me the opportunity to say; the injury of concussion is not the problem/elephant in the room, rather it is the mismanagement of those injuries that have created this problems we are facing.

This video is from YouTube and I was tipped off by Dave Pear to its existence.

It is 11 minutes in length but there are some good sound bites in it.  If you can wade your way through the minutia you will see that the repeating issue is what I have stated above.  Basically doing nothing to fix the real problem.

Guest Series by, Terry Ott – Part 1: 3rd Down, “Absence of CTE” to go.

This “Guest Series” is being authored by Terry Ott and will delve into the Canadian Football League and the issues revolving around it and brain injury.  His process began nearly a year ago, but Mr. Ott picked up some steam with the release of “League of Denial”.  He has since found himself running into dead-ends and basically being ostracized for taking a journalistic angle on this as it pertains to the CFL.  We are thankful that we can provide a space for his writings and only hope that someone who is reading this can further his cause.

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THIRD DOWN, “ABSENCE OF CTE” TO GO

The Canadian Football League claims to be the oldest professional football circuit in existence, dating back to the late 1800s.

Last year, the 100th Grey Cup league championship was played in Toronto before 50,000 fans and millions more on TV.

The league, which used to advertise that their “balls were bigger,” has recently signed a new, lucrative-for Canada-television deal, and a 18 game regular season is currently seen in the United States on three cable sports networks

In 2014, the CFL returns to one of their previous core markets in the nation’s capital, and there is talk and hope of further expansion to eventually reach at least 10 teams, bad, nation-wide, is a real possibility.

Three new stadiums have recently been built and another is on the way.

The level of play has never been better and the brand and ownership-albeit with one individual owning two teams-unlike some prior years, is strong.

The future for the CFL would seem to be bright, but…

KNOCKED OUT

Former CFL player Phil Colwell doesn’t watch the Canadian Football League.

He doesn’t live in Canada anymore, and has pretty much lost touch with all of the players he knew and played with between 1980 and 1983.

When he left the game early due to a series of injuries and questionable coaching decisions, he intended to leave it completely behind. But while he may have left the game, the game as the old saying goes, has never left him.

“Philthy” Colwell, the strapping, bearded, homegrown and swift running back then in his mid 20s, was knocked out in a game in 1981 while playing for the Toronto Argonauts, suffering a devastating concussion that to this day he says he has very little recollection of and that was most likely the participator of his premature departure from football.

Colwell had played high school football, starred for three years for his Canadian college team, and played a form of semi-pro “junior” football and even drew some interest from the New England Patriots after playing in the short lived Can Am Bowl series, before making it to the CFL’s Hamilton Tiger Cats in 1980 and appearing in the Grey Cup as a rookie.

He later shared a field with former Houston Oilers star Billy “White Shoes” Johnston and former LA Ram quarterback Vince Feragamo when they briefly came north with the Montreal Alouettes. Colwell’s quarterback when he was in Toronto was former University of Tennessee super star Conredge Holloway.

Notwithstanding the galaxy of football talent he kept company with, Colwell says that at every level of football he participated in, he knows took many concussive hits in what then was considered to be “just part of the game.”

You got “dinged,” you got “your bell rung,” and then you went right back to same game including a particularly nasty incident while playing junior football in Sarnia, Ontario, when he Continue reading

2013 Week 15 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.

There were three “firsts” this past week in the NFL Concussion Report, one of them had never occurred before in our data collection.  In the incident where Cincinnati punter Kevin Huber was demolished by Terence Garvin (fined $25k) our very first P/K was logged as a concussion.  I know, you wont see Huber’s name with “concussion” or “head” on the Official Injury Report from the NFL but this case is a classic instance of Fink’s Rule being put into effect (second “first”);

when there is a diagnosed fracture of the face and jaw (excluding the nasal bone) the forces absorbed during the injury will be beyond a threshold to elicit a concussive episode.  This would indicate to the clinician that the person should ALSO be evaluated for a concussion.

Alternate definition: when the terms “jaw injury”, “head contusion” , or “concussion-like symptoms” are present in an injury report one should be aware that forces were elicited to the head, and an assessment for a concussion should be indicated.

If you recall Huber spent the hours after the game getting his jaw wired shut and discovering he had a neck fracture.  Although there is no confirmation of a concussion from the league, team or player at this point, we will include in our data set, like we have done in previous seasons for other players.  It’s very difficult to imagine, while watching that train wreck, that Huber did not experience any brain trauma.

The third “first” of the week came just yesterday as we received news that Andrew Whitworth – another CIN Bengal – was concussed in practice.  Looking back on records for this year, this is the first concussion that occurred in practice this season.  It is important to note this, as previous seasons have had more concussions in practice.  It would make sense that the CBA rules of decreased contact days have really helped (2 – 2012, 5 – 2011).

Another notable number is: 200.  That is the total number of concussions we have logged since the opening of training camp.  In 2010 there was 172 concussions found from training camp through the playoffs, in 2011 there was 225 and in 2012 we found 237.  As you can see the overall number seems to be trending back to what we have seen the past few years.  Regular season numbers appear to be down by a factor of one week, again a very good reason to catalog the data and see the overall picture.

In hopes of not burying the lede here; for those interested in the comparison of weeks 1-3 and 13-15 – weeks in which every team was playing – and the effect of late season “wear and tear” on the brain here you go: 21 vs. 44.  Further, in the first nine weeks there was 67 concussions in the next six we have seen 79 concussions.  It seems pretty obvious to me that there is a cumulative effect here.

Quick reminder, Continue reading

#tbt Post: Friday Night Lights

This “throwback Thursday” thing is kinda cool for a guy that has a ton of stuff on this site that new people may have missed.  With that I will attempt to drudge up some “oldies-but-goodies” for you the audience.  I am certain I will re-read some of this and laugh at myself or have changed in the way of thinking but I will leave it as it was originally printed.

This weeks post comes from the very first month of this blog, September, 2010.  Back then, when the concussion information on the world-wide web was hard to find I was blogging my experiences on the field as an athletic trainer.  It is funny reading back on these as you can see my knowledge grow as well as how policies were set.  Enjoy, including the REALLY horrible writing style (wow, it was bad).

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Lets just begin by saying we did not have to travel to an emergency department last friday.  That being said there were some lost opportunities for the team to get an underdog victory.  The kids played hard, in a hard-hitting game, so the Continue reading

Terry Ott: CFL Follies

If you recall a few weeks ago I posted a request for some help for a journalist, Terry Ott of Canada.  It was simple, if anyone who reads this is a former Canadian Football (CFL) player or knows a former CFL’er, could they contact Mr. Ott for a story he is doing on concussions in that subset of professional football.  The good news was that people responded, albeit a small number, it was more than he was able to find doing his journalistic thing.  It made me happy that this blog could help out someone looking for information, because that is why it occupies a space.  But…………..

In the post below, that Mr. Ott wrote, you will see that by using this blog it may have stonewalled any help from the CFL, its Players’ Association or the Alumni Association.  Mr. Ott titled this post “CFL Follies” and I cannot think of a better title for what you are about to read.

Without further ado, Mr. Ott;

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I’d imagine that most reading this Blog will have heard of League of Denial.

But, I doubt you have heard of League of Non Denial, Denial.

Because after three months of dodge-ball dealing with the CFL about the concussion issue past, present and future, I was, after some initial boiler-plate information given in October, told today that my follow-up questions were “loaded” and would not be addressed by the CFL. (The questions are at the bottom of this post, and you can make up your own mind if they were “loaded,” or not.)

In addition, the CFLPA will no longer respond to my Continue reading

2013 Week 14 NFL Concussion Report – UPDATED

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.

UPDATED 16:57 CST – Nate Solder, OL, NE added

67 versus 65 66.

Once I explain those numbers some of you will be dumbfounded and even shocked.  If you have been here long enough, that comparison will make a lot of sense to you.

In the regular season weeks 1-9 there were a total of 67 concussions found.  Over a nine week span there was an average of 7.44 concussions found per week.  In weeks 10-14 – FIVE WEEKS – there have been 65 66 concussions found and average of 13.o 13.2 concussions found per week.  Almost a double of the numbers.

Before you go blaming the bye weeks on this discrepancy, make sure you note that there were three weeks in the beginning of the season when no teams had byes, and in the most recent five-week sample there has been only two.  Breaking down to just the week in which every team was playing the numbers are even more stark;

Weeks 1-3:  21 for an average of 7.0/week

Weeks 13-15 (WE ARE NOW IN WEEK 15, still awaiting those numbers): 30 31 for an average of 15.0 15.5/week an absolute doubling of concussions in the later part of the season.

Before everyone goes off and screams to the hills about a problem, there isn’t a problem.  This is normal for the NFL and normal according to published studies.  This is also a theory of the Sports Legacy Institute that seems to be playing out.  The idea of a ‘hit count’ for the brain.  A theoretical threshold the brain has before the ‘subconcussive hits’ become concussive episodes.  In simple terms the hits that were not producing a concussion for a player in weeks 1-3 are now producing the injury in weeks 13 and beyond.  The theory goes that the brain protection system (whatever that is) has weakened due to the repetitive nature of their profession and the brain is therein more vulnerable.

For further discussion I will now produce the Weeks 1-3 vs. Weeks 13-15 from 2010 to today (Key = total/per week vs. total/per week):

  • 2010: 21/7.0 vs. 30/10.0
  • 2011: 26/8.67 vs. 34/11.33
  • 2012: 30/10.0 vs. 35/11.67
  • 2013: 21/7.0 vs. 30+/???

By statistics alone one can see that concussions increase as the season wares on, this is not reason to panic, rather a point where we can try to figure something out.  This is the primary reason for this Continue reading

#tbt Post: AAN Concussion Guidelines

This “throwback Thursday” thing is kinda cool for a guy that has a ton of stuff on this site that new people may have missed.  With that I will attempt to drudge up some “oldies-but-goodies” for you the audience.  I am certain I will re-read some of this and laugh at myself or have changed in the way of thinking but I will leave it as it was originally printed.

This week’s #tbt post comes from March of this year (original LINK – you can go there if you want to see original comments).

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Here is the presser for the updated AAN Sports Concussion Guidelines; their guidelines are simple and to the point, via YouTube;

  • No Grading System of concussion
  • 10 day rest period – “key” – Dr. Jeffrey Kutcher
  • Greater risk if you have had a concussion
  • Addressing of youth and recovery
  • Helmets are not the full answer
  • Licensed Health Care Providers should be clearing
  • Repetitive head injuries are bad
  • The discovery and annotation of “Chronic Cognitive Impairment”
  • No single test, CLINICAL assessment
  • “Kids are not little adults.” – Dr. Christopher Giza

Here is the LINK to the Updated Guidelines (can someone give me permission to post it here?)

Here is the LINK to the Sports Concussion Toolkit from AAN

Here is the LINK to the Concussion Quick Check from AAN

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What does this mean in comparison to the Zurich Statement?  That is a great question; Continue reading

Please… Let This Be an Anomaly UPDATED

Updated (19:43 CST with a new email, see below…

There are tons of you that write in, and I do my best to respond.  Then there are some of you that I get an email and I immediately investigate, this email received from a fellow athletic trainer has me scratching my head and hoping this is not the norm (emphasis mine);

Good Morning Dustin:

I was at a wrestling meet to watch my son on Saturday and one of the wrestlers girlfriend was there.  She is in college and her major is biology and exercise science and I am not sure where she goes to school. I see her book is Athletic Injury Management and then I see her study guide.  I see on the study guide a section on concussion and grading of concussions.  I told her that she should inform her instructor that the information is wrong as there is no grading system for concussions anymore.  She said that is what her instructor had said however they still teach the grading because coaches understand the grading and it is to appease the coaches so they know how severe the concussion is.  I just shook my head.

So in some colleges it sounds like grading of concussions is still being taught and if I had to hazard a guess, it is by instructors that do not teach athletic training students.

I just wonder how many other colleges are still teaching the grading systems because that is what coaches understand.

This is an outrage to me.  Why are we convalescing to the coaches “feelings and education”.  Why are we not, as the allied healthcare professional, educating the coaches on what is happening around them.

Sure, the conversations are uncomfortable at first, Continue reading

Brain Injury and Snowboarding: The Crash Reel

Let us take a moment and shift from American Football (thus show) to bring you information about head injuries in other sports.  We have commented before that is not a certain sport problem, rather a societal problem.  Concussions and brain injury occur in every aspect of life, there is no way everyone can be placed in a bubble.

Professional Snowboarder and one time Olympic hopeful, Kevin Pearce, had his bout and run-in with the dangers of any sport.  It will be portrayed in a documentary called “The Crash Reel“;

An escalating rivalry between Kevin and his nemesis Shaun White in the run-up to the 2010 Olympics leaves Shaun on top of the Olympic podium and Kevin in a coma following a training accident in Park City, Utah.  Kevin’s tight-knit Vermont family flies to his side and helps him rebuild his life as a brain injury survivor.  But when he insists he wants to return to the sport he still loves, his family intervenes with his eloquent brother David speaking for all of them when he says, “I just don’t want you to die.” Kevin’s doctors caution him that even a small blow to the head could be enough to kill him. Will Kevin defy them and insist on pursuing his passion?  With his now impaired skills, what other options does he have?  How much risk is too much?

The film is set to release this week and judging from the trailer (seen below) it may be worth watching as we get to see many things;

Watching from the injury to his comeback it will be important to look at how his caregivers (family mainly) deal with the struggles of a high-level “professional” athlete trying to do what he wants to do.  It will also give us a glimpse into the mindset of a professional athlete and why they choose to take the risks they do.  No one should overlook the sacrifices and how hard it is for one to recover from serious brain injury.  Good luck to Kevin and his endeavors.

h/t Broken Brilliant

My Concussion Return to Play Protocol Based on Heart Rates

A very specific and objective way to monitor Return to Play. We need more of this to be shared in the community. It may not fit your budget or model, but at least we have some examples to look at… Great Job @IronmanLongRunr

In Training

Concussion is obviously a major buzz word, and if you’re in a medical profession and or working with athletes it is more than that, it is something we have to work with. Unfortunately, it is something that we still don’t know a lot about. We are steadily learning more and adjusting how we treat and handle them on a regular basis. There are many good guidelines out there for coaches, PE teachers, athletic trainers, nurses, doctors, etc. to use, and they are good, but they could be better.

In June of 2012 New York State passed The Concussion Management Awareness Act which went into effect on July 1st, 2012. This law led to the development of The Guidelines for Concussion Management in the School Setting. These guidelines were based on the 2008 Zurich Consensus Statement on Concussion in Sport. A new consensus statement came out in…

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Hot And Heavy Monday

With Rob Gonkowski and Wes Welker injuries there is a ton a debate today on the interwebs about concussions and other injuries in the NFL.  I figured I would link up some information that would help with the background and even further thinking for the topic de jour.  It would also help if you read my editorial on Everyone Pumping Their Brakes.

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1st for posterity sake, here is the current NFL Concussion Protocol, found at the NFL Players Association website.  It is worth reviewing and I am sure the NFLPA is monitoring this closely.

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2nd is a link to Concussion Myths from Nationwide Children’s.  Although aimed at youth participants and parents, these myths are very prevalent all the way up to the professional ranks.  One would assume that it should not be predicated there, but alas it is.  Read this and pass it along to all that you know concerned about concussions.

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3rd is a link to some very interesting research about ACL injuries.  It seems the authors are thinking that cognitively impaired individuals (females in this research), may be predisposed to ACL injuries.  I just came across this but it makes logical sense to me.  Here is why; part of a concussive episode the brain can be effected in a way that impairs your spatial awareness and reaction time.  This research could be a waterfall for expected injuries and recovery as well.

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4th is a MMQ article on ACL injuries in the NFL.  There have been 50 thus far this year, an all-time high, but only half are due to contact.  Perhaps the above link may be more poignant after reading this and putting your thinking cap on…

A Very Interesting Finding That Deserves a Mental Bookmark

Yes this is in mice, the human skull is much more dense/thick.  However the important take away from this video is; that there may be help for injured brain cells that can passively find their way to particular areas.  This definitely warrants keeping an eye on, it could become a treatment.

Sidebar, who ever unlocks this key first will be a rich person…

2013 Week 13 NFL Concussion Report UPDATED

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.

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John Jerry, OL, MIA added to the list after initial post, see corrections the stats, narrative will remain unchanged.

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There was a late addition to the Week 12 report as Tennessee tight end Craig Stevens appeared after last weeks post, bringing the 12 week regular season total to 102.  However, Week 13 has provided another weekly high in terms of concussions, for which Will Carroll was correct with his conjecture.  Although current listings only show 10 (new) concussions/head injuries we found 16 this week, including some peculiar omissions;

  • Darrelle Revis – as noted by @nflconcussions, is listed as chest/shoulder but he admitted to being unconscious on the play where he was hurt.  This is an automatic inclusion for concussion.
  • Mike Jenkins – although cleared to play, and he did against DAL, he was removed during the game with “concussion-like” symptoms.  Guess he may be “pregnant-like”, or perhaps they rushed him through?  Regardless NFL protocol states that a player cannot be cleared to play unless he has recovered from the previous injury.  This means that even if this were an exacerbation of the previous concussion, it will be listed as his second, in two weeks.

If you have been reading this weekly post, from the beginning, we have been warning you about the inevitable-exponential increase in concussions that occur late in the season.  We have documented this over the past three years and again are seeing this unfold (8, 8, 11, 11 in weeks 8-11).  Yes, it is partly because all teams are playing in during the week (no more byes) but, it is also due to the repetitive nature of being hit in the head.  If you recall weeks 1-3 all teams were playing as well and there were 21 total in that time frame.  This past week we have seen 76% of the concussions we saw in the first three weeks, combined.  If concussions were truly a random event that was not compounded by cumulative effects we should see “statistically” similar numbers.  In order for that to happen the NFL would have to report only 4-7 more concussions over the next two weeks, unlikely.

In fact the 16 found concussions this week are tied for second all time for most in a week; behind Week 12 of 2012 (19) – weeks 11 of 2012 and 14 of 2011 also had 16 found concussions.  With all of that said the pace for this years concussion numbers is below the basement of 2010 and WELL BELOW last years total.

Now on to the breakdown of concussions for Week 13 (indicates previous weeks numbers):  Continue reading

PUMP THE BRAKES, Everyone!

I am a bit on edge this fine, foggy-impending-wintery-weather, day.  No, it’s not the great coffee I am drinking now and the nice jog I had clearly didn’t ease my current frustration.  This forthcoming “strongtake” may get my ass in hot water with some readers, but so be it.

People need to calm down, slow down, take a step back, reflect and realize some important things.  Before I go further understand that I have tried to be as “neutral” as possible – a simple athletic trainer that sees concussions on an intimate level from occurrence to recovery.  I have had 13 myself.  This post is something that apparently has boiled up from all the press clippings I have read and feedback I am getting.  Not one person, entity, sport, or profession is my target here; these are observations and opinions (in my most succinct way possible).

First of all, concussions are not a football problem, they are not a soccer problem, they are not a doctors problem, they are a societal problem.  Rightly so, football in America gets the mass attention, because it happens there more than any other sport out there (don’t waste my time with the skewed numbers of other sports and genders).  With that being said because of the higher incidence in football that does not mean the sport as a whole needs to be banished.  You know very well where I stand on this but I will spell it out for those new here.

Professional football is a different animal from the other forms of the sport, mainly because they are grown adults making informed decisions about their health.  And they get paid to do it, other than providing immediate safety for the concussed players and proper information about the injury, short and long-term, they can and should be able to make their own decisions.  However, this does not indemnify those players or the sanctioning bodies from having some casual responsibility for the emulation of the game at the lower levels.  A clear line must be drawn between amateur and professional medical care; for concussions and all other injuries.  Remember that the professionals have much greater medical care available to them, and if you think that is unfair well too bad, that’s life and where the money is.  Professional football holds a certain responsibility to inform its fans and future players of the risks and rewards of the sport.

As for the lower levels, with proper coaching and medical care/coverage I feel there is a place for this sport as we know it.  Unfortunately as we trickle down in age the participation numbers go way up and at the bottom, youth, is where we have the greatest disconnect from coaching and medical coverage/care.  Because of this and other factors I am of the ilk that kids should wait until the arbitrary age of 14 or freshman in high school to begin full collision football.  Believe it or not this has to do with more than just concussions, in my opinion.  And here is where my first beef is coming from.  Continue reading