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.
Just because some want to curtail COLLISION sports for kids as young as FIVE years old does not mean that this makes them obese;
“We have a much bigger obesity problem with our youths,” she said. “To see them out there playing sports is helpful to our society in terms of health consequences. We’re facing an obesity epidemic that is far greater than the concussion epidemic. To suggest youths reduce exercising would be a disservice.”
That “she” is Dr. Jennifer Weibel, in an article titled “Will head injuries be death knell for football?“. That quote may be a bit out of context, admittedly (Dr. Weibel had very good information and quotes in the article previous to this closing quote of the article), however this comment and suggestion just STEAMS me like no other.
The assumption of this type of thinking is if we take away tackle football for kids that haven’t even fully developed musculoskelatally – let alone their vulnerable jello like brains floating with more space in the skull; where forces applied to the brain bucket have a more compounding effect on the movement of this vital organ – they will magically be obese. As if there is NO OTHER option for kids to be fit and do something. Hey parents, there is a place called a park where your kids can run free, or get this there are other sports that can provide movement. Even more – shockingly – the sport of football can be played with out collisions as part of the objective; it is called flag football. I know, its hard to believe that something exists where kids can learn and develop a love for the game in a safer manner.
I get it, having Johnny or Sally occupy themselves in a safe environment so you can get on with your busy life and do “your thing” is part of culture. I even encourage *gasp* my kids to play electronics. But they are also heavily encouraged to be active during the day before or after electronics. I don’t want to scream from the pulpit, because I am not even close to someone who people should model their life after. All I am trying to convey is that there are OTHER options besides a game which not only requires violent collisions (effecting all of the body not just the brain), but it DEMANDS it. And with the mouth-breathing former HS studs that are dads now, cussing kids for not “sticking their nose” in there on a tackle why wouldn’t kids be shying away from the sport. There are great youth coaches out there, but they are not nearly as plentiful as the high school level; where there are some real “winners” coaching up young adults in safe and “awesome” drills like Oklahoma or Bull in the Ring. The culture of machismo has to end, we are not making our kids “pussies” if they don’t play tackle football at age 5, 6, 7, or 8; we are making them safe so society and mentors can judge them that way later.
Concussions, the actual injury, is not the problem. They occur in life (of my 13 only 4 came from organized sports), the true problem is the mismanagement of concussion.
Bringing me to my next rant; before you stare down your finger blaming others, perhaps you should look at who the thumb is pointing at. This goes for EVERY STAKEHOLDER** in this concussion business: athletes, parents, coaches, athletic trainers, doctors, sanctioning bodies, big business of ALL sports, et al.
(**UPDATED this quote, although used many-a-time by me should be correctly attributed to, in this case, to @SportsDocSkye, Dr. Johnathan Hanson of the UK)
I was recently asked if I could speak to one particular group of individuals about concussions, who would it be. My options were: parents, kids, athletic trainers, officials, coaches, or doctors. I chose doctors in this situation, and my reasoning was simple in my mind; doctors, because this is where it gets screwed up the most. Look above, in my opinion the problem we have now is because of mismanagement and where do concussed individuals go for their injury… Doctors.
As was pointed out to me, we all make grievous mistakes, but the care for a concussion may not begin with doctors in every circumstance but EVERY concussion should end with a doctor, period. Hell, we as health care providers were complicit in this mismanagement as recently as the early 2000’s. The common concussion protocols of that time were awful knowing what we know now – wait 15 minutes and if the player says they are OK let them return. However we have drastically changed that and even had Consensus Statements made on the subject, yet there are many, many, many doctors still using the old, outdated, archaic methods. This must stop. The changes began in 2004 and the more recent “accepted guidelines” were established in 2008 – five freaking years ago. What would people be saying about cardiac care if doctors were FIVE YEARS behind on current care? How long does it take to get the change in there? While in training to become a doctor, so I have been told, there is cursory course work on concussion that is included with traumatic brain injury, very basic is what was described to me. Guess what, with the media presence on this and the actual injury pathology this is not a basic sequale. Estimates provide that 10-20% of concussion cases are non-resolving with “no treatment”; meaning that a good chunk of those injured require further management beyond the “sleep it off/rest for a day or so” (how bout the medical people who still think that concussed individuals need to be woken every hour or so, hahahahahaha).
Sure management my be as simple as restricted schooling/work/mental and-or physical activity, but that information is not being disseminated to the patients at an alarming rate outside of those that find care with doctors outside of those trained in concussion care (Sports Medicine) or those that took the time to read up on the CURRENT information.
Not everyone has an athletic trainer or sports medicine doctor available to them, but EVERYONE can find ‘a’ doctor (MD/
OD correction DO) for care. Those that are not up to speed on the information about concussions are making it difficult to abate this concussion problem we are having. In my experience these are the “family docs” or “ER docs” that really need to clean it up. So, because of all of the above and then some I would love to get an audience of doctors that are not up to speed on concussions.
While I am at it can we PLEASE STOP CALLING CONCUSSIONS “MILD/MINOR”, please? When you become pregnant do we say “she is only mildly pregnant”?
*Taking a breath*
Listen, there is way too much minutia out there with concussions. We are in the infant stage with concussions and long-term problems, we have to walk before we run. As complex as a concussion is, it really can be simple to view it in the context of sport and life.
Concussions will occur, rather than trying to connect dots that may not be there, manage the injury properly and continue on. People should avoid disrupting the brain as much as possible via traumatic forces. It’s not a GOOD thing to sustain a brain injury, heck any injury is not a good thing, amiright? If (really when) someone has a concussion that causes some major disruption in ADL’s (acts of daily living) perhaps they should take stock if they should continue the actions that created the concussion. A concussion ended my football days, my snow skiing days (want to go back), but the ones I got hitting my head on cabinets haven’t stopped me from living.
After reading many blogs regarding concussions, I am reminded time and time again of a couple of historical quotes from intelligent men. Albert Einstein said that nothing can stop knowledge except education and John F. Kennedy said “never trust experts”. As people focus on litigation,job creation, research grants etc.— truth is that common sense is not prevailing in most cases and money (greed and Egos) have become the big focus. At this time regarding concussions — the major priority should be the caring and recover of our suffering injured fellow humans. This is the measure of humanity in the complex problem surrounding concussions and PTSD. On Oct.2, I posted important dietary concerns , EFAs, and manipulation of eicosanoids in the hope that a few researchers would pick up on the information and return soldiers and athletes to health. Instead of opening the minds of intelligent people — all that happened is that egos and education got in the way of “experts” who cannot even comprehend what dietary manipulation of eicosanoids even means. One last time I will basically give the outline of what a person with brain injury should do to repair there brain. First and foremost one must repair their transport system so that raw materials can bypass the inflammmatory blockages. #1 Stop eating foods that impair the transport system — sugar,processed carbs,transfats.and processed oils.In other words avoid all processed foods. Good choices include: free range eggs (brain needs more cholesterol than any part of body),sardines in water,fresh vegetables,wild fish,antibiotic free or organic chicken and grass fed beef. Avoid fruit with maximum of 1 apple or pear per day. Changing you eating habits is the hardest part! #2 3 capsules per day of evening primrose oil 1000mg per cap = 3000mg per day – 1cap per meal with food.(I recommend only Efamol EPO from the UK because it is the only one to pass toxicology testing and due to Rigel seed has 33% more GLA — avoid EPO from China (most on market due to pesticide content. #3 Take 1-1000 mg capsule of cod liver oil —make sure it is the whole triglyceride from nature and not mans factory made ethyl esters. Recommend only Nordic Naturals or Green Pastures fermented or Carlsons cod liver oil (NOT the one that says Gems or Super — these are ethyl esters) #4 Co-factors to increase PGE1 — major nutrients required are B3,B6,B12, magnesium,zinc,selenium, calcium,and vit c. In other words take a good multi that has high mineral absorption. I take a product called Vitality that has Oligo technology and distributed by a USA firm called Melaleuca. #5 Thin blood and protect against LCPUFA oxidation. I use and recommend Provex CV which is clinically proven in humans and has 2 patents for heart disease and was tested by Dr. John Folts — the recognized world leading cardiologist in platelet aggregation. 3 to 6 months of this regime and throw in a teaspoon or so of quality extra virgin coconut oil per day for ketones (energy to repair) and over 90% will recover and quickly. The key is disciplne and bypassing delta 6,5,4 desaturization and reducing inflammation.Anyone wishing my help that is suffering can reach me at firstname.lastname@example.org. I have no financial ties to Efamol or Nordic Naturals or Carlsons and only charge MDs for my time and not patients. Take charge and heed Einstein and Kennedys words.
Still no data…
This is the stuff of shark fin cancer cures, cleansing and late night infomercial bowel purges.
If one is interested in quotations:
“There appears to be no law against anybody who wishes to pose as a physician, and to sell his inexperience and his quack nostrums. Vendors of every sort of cure-all abound, as well as creatures who work on the superstitions and pretend to cure by charms and hocus-pocus. In the market there is such a swarm of these charlatans of healing that they bring the whole medical profession into contempt.”
A Day in Old Athens, by William Stearns Davis (1910)
Stop wrapping hope in dreams in pseudo-scientific nonsense.
If you have data show it, otherwise sell it to the DoD. Oh sorry, they even dropped the alt-medicine after hundreds of millions of dollars wasted on everything from Reike to yoga to cure TBI.
Bravo, Dustin!! Thank you for putting in writing what so many of us in the field are thinking.
I believe you meant “DO” rather than “OD” when referring to physicians.
Well done, Dustin. Great job focusing the beam on what needs to be focused on.
Great job Dustin! PLEASE keep up the good work! Just the other day I had my son into a new neurologist to consult for a pain relief procedure that was not available at his pediatric neurologist’s office. This doctor repeatedly told my son over and over that his concussion/brain injury was “MINOR” because he did not suffer loss of consciousness. My heart brok for my child as he listened to that. I don’t think my son thinks it is minor when he deals with the issues related to his brain injury ever day for nearly three years now. I don’t think he thinks it is minor every time he misses school and can no longer take the classes he wanted to take or pursue; or when he sits by himself night after night because his friends have long since left him behind. And then these doctors pass on the word “minor” to the schools and that’s all the schools need to ignore the many issues these students face when they return to school.
Keep shouting it from the rooftops! Our young people (and adults too) cannot afford for us to be quiet.
Supposedly it takes 17 years to turn over a dogmatic practice in medicine. We will see with cholesterol, those guidelines changed three weeks ago. Look at Pap smears, those guidelines changed in 2009 and many women still do not know this.
Hopefully we get better at changing, learning, and adapting.
The patients don’t know but the doctors do, is that right? If so, my point is more honed in!
Thank you for the kind words, everyone! I appreciate it, spread the post… All comments welcome here!
Great job Dustin! I think many of us involved with this issue agree with you. Keep up the great work.
Reblogged this on Broken Brain – Brilliant Mind and commented:
Good thoughts and real reasoning