The Concussion Blog

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.

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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.

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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.

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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”?

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*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.

*Drops Mic*

#stongtake