What Does the Derek Sheely Case Foreshadow?

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

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

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

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

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

Advertisements

Next Level… In Concussion Care

As an athletic trainer – an opinionated one at that – I struggle with all the “bells-and-whistles” in this conundrum that is the concussion issue.  If you have visited here or heard me speak you undoubtedly know that mismanagement of concussions is the true issue of this complex paradigm.  Yes, we need to know when a concussion occurs to begin the process in the right direction; however, this can be accomplished by simply making sure you have a trained medical professional on hand when the need arises.  Getting an athletic trainer to cover the most at risk sports at the most at risk times is a great start (and in the authors opinion is the only choice if you want to have collision sports).  Short of that, education over-education is necessary for everyone: players, coaches, parents, officials, teacher etc. to properly identify and accept the nature of concussion in sport – it is a risk.

Even having an allied medical professional, like an athletic trainer (AT) at practices and games does not stop the injury from occurring.  In fact, many products that may claim reduction in concussions or “possible concussions” are toying with fraud; at the very least they are practicing deceptive marketing.  The point being, once we identify a concussion how do we and who do we send the injury to, to avoid the rest of the iceberg lurking under the surface of the water?  Moreover, what tools do we have that can help get the right prognosis, treatment and recovery for the injured (and there are many out there)?

I feel there is a new product (I am not a paid endorser, nor have I been given compensation for this article/opinion) now hitting the market that may get us closer to the panacea that we are all hoping for (note I said “closer”).  Although it may have been presented as some big secret; the C3 Logix: Comprehensive Concussion Care system is not a secret rather it is something I feel is a “game changer” for concussion care.  It is Continue reading

HS Class Uses Blog to Educate

One of the more gratifying things about this blog is the chance to educate anyone about concussions and the athletic training profession.  I truly enjoy going out to speak and even debate this hot topic.  I understand that my thought process is not like everyone else, nor do I expect everyone to see it the way I do; however I do want people to become more educated and understand what we are facing with this problem.

As I was wrapping up my interview for a local TV station about the new IHSA Heat Acclimatization Policy, I received and email from a school here in Illinois that used my blog to become better aware of the concussion issue.  Honestly, nothing makes me smile more than to provide that to teachers and kids.  The email ended with some questions regarding concussions, I will answer them here (not only for everyone to see but to give a little pub to the students and teachers of Cuba High School).

My current events class has been debating and conducting research about concussions. I have had them use your blog for resources and it is very informative. We also just finished watching “Head Games” documentary and had further discussions. Many of my students are athletes and have raised interesting questions specifically towards how our small rural high school can best prevent head injuries. I know you’re a busy guy so we cut our questions to just 3. Any chance of a response would be greatly appreciated. Continue reading

Vermont Looking to Make AT’s Mandatory

Given the current state of funds and resources for schools, it would seem this is a horrible idea.  However, it is actually needed and should be done everywhere;

According to Senate Bill No. 4, or S.4, currently sitting in the House Education Committee awaiting word on movement to the full House of Representatives, schools “shall ensure that a health care provider is present at any athletic event in which a high school athletic team participates in a collision sport.”

Granted I am a skewed voice here, but it makes almost no sense not to have an athletic trainer on site; not only for concussion – which is uber-importnant – but for the day-to-day injuries and prevention of injuries.  In the article it was noted only 14 schools in Vermont don’t have an AT, but finding one to cover will become a high priority if it becomes law;

While no one has expressed a disinterest in having such coverage, the cost has been prohibitive — “substantially huge,” according to Merriam — for many Vermont schools.

“To get even a part-timer, it’d be $10,000 minimum, but we’re looking at upwards of double that in all likelihood,” Thornton said. “I’ve researched this extensively, and it’s a challenge in itself to get one to come to our school.”

In all honesty it’s about the money…  How much would you pay to keep your child as safe as possible?  How much should you invest to keep liability down and safety up for all students?

Would you send you kids to a pool without a life guard?  Why would you send you kids to collision sports with out an athletic trainer?

The Experts Tell Us Why Athletic Trainers Are Needed

You don’t have to take my word for it here, you can watch this video and let the experts in the field tell you;

Although we are not there yet, there are financial barriers, and some misnomers about the profession; athletic trainers should be a must.

As I have clearly stated: “If you cannot afford an athletic trainer you cannot afford to have collision sports, period.”

Hey here is a bonus, athletic trainers are also some of the best at on the field orthopedic injury assessment and injury prevention in the WORLD.  Doctors even defer to the knowledge of an athletic trainer when it comes to sports injuries.

AAN Concussion Guidelines – One Stop Post

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

==========

What does this mean in comparison to the Zurich Statement?  That is a great question; both groups used “consensus” however this group is much more centered on American practices.  Both have similar approaches, both advise nearly the same thing; but which one carries more weight.  I have been told the AAN will be much more “powerful”, respected and learned than Zurich.

This is a good debate, regardless, there is ample evidence to sit kids and any concussed individual.  This statement also continues the wave of information that cumulative and repetitive trauma to the brain (still figuring out thresholds) is not good.  Based on this and the Zurich statement the only way that we can collectively abate concussions at this point is exposure limitation.  No where in that last sentence does it state “stop playing sports,” or “get rid of football”.

When dealing with the brain and the injury of the brain less is better, which is ironically simple and a “no brainer”.

Zurich 2012 In Writing

If you all recall I went to Zurich in November to attend the “Concussion Conference”; mainly as an observer, but there was enough time and opportunity to impart my questions/knowledge as a practicing athletic trainer.  Here are the links to DAY 1 and DAY 2 of my live blogging.  By the way, the live blogging was WELL received and continues to provide great insight into what went on.  I hope that I am asked back for the next conference, or any other conference that wouldn’t mind my attendance.

Now the information gathered at the conference has been hashed and rehashed and now appears as the 4th Consensus Statement (tweeted previously).

As part of the initiative the Standardized Concussion Assessment Tool (SCAT) was looked at and changes were made to the 2nd version from 2008.  You can now find the new version by clicking SCAT3.

A new wrinkle was an assessment tool for the younger ages, the group decided on the “Child” version of the new SCAT3, that can also be found by clicking Child SCAT3.

Also included in the addendum of the Consensus Statement was a recognition pocket card, found by clicking Recognition Pocket Card.

All of the above is free and intended to be used as a resource for better concussion assessment and even early management of concussion.  Please read the Statement regarding best practices.  As always this blog is NEVER to be used to diagnose or treat a concussion.  There is a lot to be absorbed and read; one thing is for sure we as athletic trainers and concerned/educated individuals now have the most recent information at our fingertips.  I guess this blog is actually doing some good work 🙂  A side note; how about this appearing during National Athletic Trainers Month?  It might be a coincidence, but I find it serendipitous.

Athletic Trainer Removed from Post for Standing Ground on Concussions

This is one heck of a way to start out National Athletic Trainer Month…

Paul Welliver, a name that should be remembered and learned about.  Welliver is a certified athletic trainer in Maryland and was until a few weeks ago the athletic trainer at Winters Mill High School.  The only one the school has ever known; being outsourced from Maryland SportsCare & Rehab.  The admin at the High School asked his employer to have him no longer provide service for them.  Welliver (at time of post) has not been fired from Maryland SportsCare & Rehab.

Why, you ask?

Because this athletic trainer stood up for what he believed and knows about concussions.  Unfortunately, this scene is all to familiar with us high school athletic trainers.  The story is from Carroll County Times;

The Carroll County Public Schools Supervisor of Athletics Jim Rodriguez and Winters Mill High School Principal Eric King told Welliver’s boss at Maryland SportsCare & Rehab that they did not want him to continue his position at Winters Mill, according to Welliver. After 10 years as the school’s athletic trainer, his last day was Feb. 12. […]

Welliver said on four different occasions in the last 18 months, he refused to begin the protocol that is meant to gradually release student-athletes back into sports participation after a concussion. The protocol, also known as Return to Play, is supposed to begin once a student-athlete returns a medical clearance form after their injury has been classified as a concussion.

In this school district they have a pretty solid concussion policy and protocol  highlighted in the story, however when the one person – and last line of defense for the student-athlete – stands up for the protection of the children he is summarily dismissed;

He said the athletic trainer has to sign off on a student-athlete’s return to full contact and competition following a diagnosed concussion.

Welliver’s refusal to start the protocol all four times was because he was concerned about the safety of the student-athletes, he said. He is worried about their short- and long-term health, he said.

“There are times when I do not believe they should return to the sport,” Welliver said. “It is not safe.” […]

“I treat all those athletes like they are my children,” he said. “Sometimes I spend more time with other people’s children than my own.”

He is exactly correct!  As if he had to really explain it to people who should not be part of the process he did for the article;

“I take into account many factors, including the number and severity of previous injuries and the age and grade of the student,” he wrote on Facebook. “It would be much easier to go along with the pressure of returning the student A.S.A.P., but I have seen way too many poor outcomes after multiple head injuries.” […]

In addition to his decision to keep student-athletes from playing their sport after a concussion based on age, grade and the severity and number of previous concussions they have experienced, he also takes into consideration the sport or sports the athlete would return to. Their return could take longer if they play high-collision sports.

Shockingly, the school district and those that put the separation is motion had no comment.

Welliver did and does it right based on all accounts, the man – athletic trainer – father Continue reading

NFLPA News

So at 3:15pm EST the NFLPA will hold a news conference to discuss some “goings on”; the biggest nugget in this presser will be the announcement of a 100 million grant for Harvard over 10 years to study them.  All aspects of player health is the word I seem to be getting.  Which is good, because for a long time the former player has been neglected and has led to current and future players taking risks their bodies will not be able to cash in down the road.  I believe you can catch it live on YouTube as well, perhaps someone can provide the link in the comments…

In other NFLPA news, Deadspin and Barry Petchesky wrote about how players are overwhelmingly disenfranchised with the medical care they receive as a big-bad NFL player;

An NFLPA study, the results of which were obtained by the Washington Post, finds that the vast majority of players have serious doubts about the care they’re provided.

The NFLPA asked its players to gauge on a one to five scale how much they trust their team’s medical staff. Seventy-eight percent of respondents said five, meaning they’re not satisfied at all. An additional 15 percent said four, and just three percent responded to the question with a one or a two.

“The most troubling aspect of the survey for me is that lack of belief that the doctors are treating them for their players own health, safety and wellness reasons,” DeMaurice Smith said.

Perhaps this is why the NFL is entrusting the elite Harvard to study such things and happenings to players over a long-term time frame.  Petchesky  also takes part of the article to touch on the conflict of interest (COI) that is VERY rampant on the NFL sidelines concerning medical care.  If you have followed and read here long enough you will know it is something that we have been harping on for over two-year and one of our illustrious commentators, Don Brady, has written a dissertation that includes this problem.

Simple facts are that the team athletic trainers are paid by the team, not the players, and in a majority of NFL clubs the “team doctor” is actually paying for the privilege.  In a business model, it would appear – in my humble opinion – that the teams are making sure their priorities are met when it comes to injuries.  NOW HOLD ON…  There are some very outstanding athletic trainers and doctors that roam the hallowed sidelines of the National Football League, and they are VERY VERY VERY good at what they do, but the appearance – TO THE ACTUAL PLAYERS – is that their medical care may not be in their best interest.

I am not throwing anyone under the bus here, I am merely Continue reading

Hey Student AT’s, looking for a job?

Well here is one open…  Full-time high school athletic trainer at Mount Desert Island High School, in Maine.  Here is the write-up about the position;

An anonymous donation of $20,000 for next year and $10,000 the year after that has helped persuade the Mount Desert Island High School board to approve the hiring of a full-time athletic trainer.

Athletic director Bunky Dow, who recommended the staff addition, said the starting salary would be $32,000.

The high school has been budgeting $12,000 a year to contract with Mount Desert Island Hospital to provide medical coverage for home games in football and several other sports. The high school pays $50 an hour for a physician or registered nurse to be on the sidelines and take care of injured players.

The athletic trainer’s responsibilities will include attending all home games and meets, all football practices and away games and, as the schedule permits, away games in other sports. The trainer will tape up athletes prior to games, provide immediate care for athletes injured during play, administer ImPACT (computerized brain injury assessment) tests to all athletes, follow up with injured athletes and determine when it is safe for them to return to competition.

The trainer also will be responsible for all medical and sports permission forms, for educating students and coaches about injury prevention and other health issues, and for making sure all relevant certifications such as first aid and CPR are up to date.

The school board voted unanimously Jan. 8 vote to approve the athletic trainer’s position.

This looks like a great opportunity for a really motivated athletic trainer to set up a program for a community that is ready and willing to help that person out.  This is exactly a job that I would have taken right out of school, so many possibilities.  In fact I would love to be a full-time AT at a high school one day.

Go and get’em kids!!!

Matt Chaney – Tireless Worker

SpringGame1984Sideline
If you have been around enough you have seen the stylings of Matt Chaney on this blog, he is someone I call a friend.  In some circles that discounts me as a professional, which is both stupid and dumb.  I don’t always agree with Matt, heck him and I have been known to battle via electronic and phone communications.  However, his opinion is a valuable one – often his work is based in so much fact it makes your head spin as to why some of its missed.  Regardless, Matt has published two recent articles on his blog, for all to consume, here are some excerpts.

Part 1, published January 7th;

Historic football excuses thrive in modern debate over brutality

Lawsuits, criticism explode and officials project blame onto individuals

Old talking points of football apology resonate yet as officials tout anti-concussion measures like trainers along sidelines, new rules for safer play, injury reduction and expert consultation—same type of promises heard from gridiron leaders during the Victorian Era

American football gets lambasted in public for maiming and killing, denounced by an influential movement of critics, and game officials pledge safer play based on their new concepts of prevention, including:

*Qualified trainers and doctors will patrol sidelines.

*State-of-art medical response will treat the rare severe casualties.

*Limits will govern length of practices.

*Injury tracking will cut rates already on decline.

*Coaches will properly train players.

*Every player will undergo medical prescreening.

*Experts will lead safety reform in rulemaking and research.

*Referees and coaches will enforce new rules of experts.

*Players will follow new rules of experts.

Sounds familiar, these steps, a practical recitation of talking points for contemporary “safer football” promoted by the NFL and commissioner Roger Goodell, in face of lawsuit frenzy against the league and sport in general, along with festering disgust in the public.

Except the football rhetoric is 119 years old, from 1894, a packaged response during the game’s initial siege against formidable opposition seeking abolishment. Continue reading

Coach & AD Magazine Cover Story

cover picIn January’s edition of Coach and Athletic Director Editor-in-Chief, Michael Austin wrote the cover story on concussions; titled “What you’re missing when it comes to brain injuries”.  A very well researched and written article on concussion issues at the high school level.  Austin looked at the changing protocols, safety issues and legal concerns that will be facing the sports of our community schools now and in the future.  Here are some excerpts;

This isn’t just a football problem.  Media coverage focuses on the gridiron, but any time a player’s head is placed in harm’s way, a brain injury is a potential result.  “From what I see, football leads the pack by far but we’re also seeing more girls and boys soccer players sustaining concussions,” says Dr. Michael C. Koester, MD, ATC, who is the director of the Slocum Sports Concussion Program within the Slocum Center for Orthopedics and Sports Medicine in Eugene, Ore. “Interestingly this year, and this could just be a statistical blip, but it’s worth noting we are seeing more girls volleyball players as well.”

That comment struck me as in the fall I saw more junior high school volleyball concussion (5) than high school football concussions (4), I have no idea what that means.

In the area of classification, Austin does a good job of trying to put ‘mild’ to rest with concussions;

Dr. Gerard Gioia, the director of the Pediatric Neuropsychology Program at Children’s National Medical Center and the director of the hospital’s Safe Concussion Outcome, Recovery & Education (SCORE) Program, says the medical community has “dropped the grading system” when it comes to concussions.  He adds a common misnomer is the
suggestion you must have loss of consciousness to sustain a concussion, which is not true.  “You can’t call a concussion
‘mild’ just because someone isn’t knocked out for 10 minutes. Most concussions do not involve a loss of consciousness,” Gioia says.

Regarding the state legislation and protocols;

“The No. 1 goal is to get the student-athlete back to school without symptoms or ramifications before even thinking about a return to the sport,” Fink says. For coaches anxious to have the player return to the field, Fink tells them every athlete Continue reading

Another Upcoming Concussion Symposium – January 25th

Time is short on this, I understand, but I just was dropped a note about this symposium being held in Chicago.  Once again yours truly has “commitments”, this time it is a wrestling dual tournament – where my services are needed more.  Regardless, when I looked at the faculty list and the speaking topics my interest was piqued.  BIG NOTE here it is only $25 for athletic trainers to attend ($60 for physicians).

The lecture is going to be directed by Julian Bailes, MD and David Firm, MD, PhD, both unheralded leaders in the field of brain injury.  What is more interesting than that is the fact that two relative “quiet” doctors will be presenting their information.  Both of these men are “controversial”; one is seen as an extreme outsider by the NFL and the powers that be in their corner – Dr. Bennett Omalu the other has had his share of issues, mainly in the press (see Irv Muchnick), for previous perceived mishandling of concussions in the NFL and WWE – Dr. Joseph Maroon.

Unlike the symposium I posted about yesterday, there are no athletic trainers on the speaking panel, to me that is a shame as the athletic trainer is the front lines on concussions in sports (mainly HS up).  Here are the topics, Continue reading

Concussion Symposium March 2nd

I received the following press release about a Concussion Symposium coming up in March.  The faculty is not your “usual suspects” rather some very good and known people in the medical field.  If you get the chance to head down to Texas for that Saturday I believe you will not be wasting your time or resources.  I would love to make it, however I have a prior commitment; that being said someone take good notes for me.

I would also like to add that having athletic trainers on the program list legitimizes this symposium in my mind.  Here is the presser;

==========

Austin, Texas (PRWEB) January 10, 2013

Concussion Compliance presents “Bridging the Gap on Best-Practices in Concussion Management.” This day-long exchange, sponsored by St. David’s HealthCare, brings together leading medical experts and practitioners to discuss the issues dominating today’s best-practice concussion management and how to incorporate the guidelines as well as the use of several tools into clinical practice.

The national symposium will be held March 2, 2013, at the Norris Conference Center, Austin. Registration is now open

“Communication and education that crosses traditional boundaries are key factors to providing good concussion treatment for our young athletes,” said Theodore Spinks, M.D., chair of the symposium program planning committee. He is a board certified neurosurgeon seeing patients in Austin, Round Rock, and Georgetown, Texas. Dr. Spinks currently serves on the CDC Expert Panel for Pediatric Mild Traumatic Brain Injury. He also served on the Texas Medical Association Committee on Concussions in Athletes during the last session of the Texas Legislature.

The symposium program provides an overview of the current best practices and consensus statements on concussion management, the latest scientific research, an update on tools available to practitioners, and perspectives from experts in concussion management.

  •     Featured Topics – The Physician’s Perspective; An Athletic Trainer’s Perspective; Head to Head: Cognitive Testing; Beyond Cognition: Balance Testing; A Look Into the Future: Vision Testing; Neurosurgical Management of Head Injuries and Concussion; Implementation of Best Practices Into Clinical Practice
  •     Keynote Speaker – Dr. Steven Erickson will present on the latest best practices in concussion management. Dr. Erickson is the medical consultant for Major League Baseball caring for the umpires and serves on the Major League Baseball Medical Advisory Committee and the Major League Baseball Mild Traumatic Brain Injury Committee.
  •     Reading of Proclamation from Governor Perry’s Office – March Concussion Awareness Month in Texas
  •     Exhibit Hall – Featuring the newest in technology, practice services, practice information, and pharmaceuticals

In addition, Governor Perry has Continue reading

Matthew Gfeller Neurotrauma Symposium

Loudermilk_picsIn Zurich I had the chance to speak to many people; I enjoyed my brief time speaking with Jason Mihalik – fellow athletic trainer.  He reminded me of the previous Symposium in North Carolina and the upcoming second version.  I asked him to send along an email and I would put it up on the blog.  Here it is, and he is right, make sure you register NOW, it fills fast.

———-

It is with great excitement that my colleagues and I will be hosting the Second Matthew Gfeller Neurotrauma Symposium at the University of North Carolina at Chapel Hill on March 8-9, 2013. We have lined up another great list of local, regional, and national speakers. For additional information regarding a schedule of topics, invited faculty, and links to negotiated hotel rates, please visit us at http://tbicenter.unc.edu, and click on “TBI Symposium” in the header. A direct link to register for the symposium is as follows: http://tinyurl.com/c576kdu.

Our first symposium sold out 2 months prior to the scheduled event, so register early! Current Early Bird rates in effect until January 8, 2013 are as follows:   Continue reading

NFL Makes Case For No Indpendent Neuro

Finding a true “independent” health care provider for concussions in the NFL is a sticky situation; the NFLPA says they want one and the League is saying no.  Of course there are various reasons as to why the League would not want an independent neuro there; cost being one issue, the other issue is that the players may actually be in greater peril – and I agree.  Dr. Richard Ellenbogen co-chair of the NFL Head, Neck and Spine Committee explained this in an article in USAToday;

“No one knows the players as well as the athletic trainers, period.

“Having said that, some teams already have neurosurgeons on the sidelines. Having a doc show up just for a game takes away from the all-important baseline exam and continuity of care. It would be like getting operated upon by a surgeon who did not see you pre-operatively. Is that safer than having someone who saw you beforehand? The baseline is all important in making an assessment if a player is OK after a hit.”

Concussion are so subjective, most cases do not involve overt signs and it is incumbent upon the player to report what is going on.  Trust is a HUGE factor for players – of all ages – but more so in the NFL where they are making a living by playing football.  Although the tests are there and meant to be as objective as possible it is still a clinical diagnosis overall.  The only health care professional Continue reading

The Debate of When To Pull A Player

This past week there were some prime examples of concussions, including mechanism of injury and how they are currently handled – some say mishandled – in the National Football League.  Now the debate rages on about when exactly a player should be pulled for evaluation.

In many cases this is absolutely obvious, for example Johnathan Baldwin of the Kansas City Chiefs last night in Pittsburgh.  As he laid out for a catch his head bounced off the ground and he immediately showed a fencing response and was “limp” on the field in a semi-prone position.  He “came to” and tried to get to his feet, key word being “tried”, as he was wobbly and needed help from a teammate and the official to stand.  The official then summoned the athletic trainers to aid in getting him off the field; it was obvious that Baldwin needed to be evaluated for a concussion (side note: the Chiefs are calling his injury a “neck”, which he could have hurt on that play but once again its an attempt to muddy the water, IMO).

To the credit of the NFL medical staffs these types of situations are rarely missed anymore, especially with the observer in the press box helping with the identification of potential head injuries.  I would dare say that these type of situations are missed more often at college, high school and youth level football games than the professional level; which is way more disturbing.

However, the debate remains about those players that don’t show overt signs of Continue reading

An Opportunity Presents Itself

Concussions have been on the “front burner” for a few years now, yet not everyone has the clear and consistent message about this injury.  There continues to be gaps in how the injury is covered by the media, accepted by the leagues and understood by the general sport loving public.  Yesterday was arguably the most high-profile week for concussions in American sport as three well-known quarterbacks exited the game with concussion.  Due to the attention that will be given, I am deeming this a “teachable moment” for everyone.

Several opportunities have been presented to get the message correct and out there this year; in week 2 and week 5 there were 12 concussions.  Last year, week 11 produced 14 and week 14 had 16 concussions yet not nearly the “attention”.  Two seasons ago there was the “watershed” moment of NFL concussions not to mention the 15 concussions in week 16.  Yet the message continues to be clouded.

Regardless where you stand on the concussion issue (you should be concerned), particularly in the NFL, it would be a good time to get the basic information out there and link up some further information if you choose to look.  I will try to lay this out in the most helpful manner; to the point with as much fact as possible (I will notify when its opinion).  I will do it bullet point style;

  • FROM CDC: of the roughly 3.6M concussions that go the emergency room in the US, over 50% are due to recreational activities/wheeled sports.  Estimates have been made that 30-50% of all concussions are undisclosed or unreported.
  • Concussions occur in all sports, the exposure and rate is much higher in: American football, rugby, Aussie Rules, men’s lacrosse, ice hockey.
  • Current research/theory suggests Continue reading

Hammering Home The Need For Athletic Trainers

I published this 10/22…  Since there has been higher volume as of late, I feel it is a good time to repost.  There is also another article by John Doherty that supplements this, HERE.

——–

In findings released today in New Orleans it is becoming more clear that athletic trainers play a vital role in secondary level athletics.  Using reports from 2006-2009 in various injury reporting systems there has been significant findings about injuries and concussions;

Overall injury rates were 1.73 times higher among soccer players and 1.22 times higher among basketball players in schools without athletic trainers. Recurrent injury rates were 5.7 times higher in soccer and 2.97 times higher in basketball in schools without athletic trainers. In contrast, concussion injury rates were 8.05 times higher in soccer and 4.5 times higher in basketball in schools with athletic trainers.

Not having an athletic trainer predisposes the athletes to greater risks, not from the usual sporting activity, but playing with injuries that can develop into greater problems.  Athletic Trainers also have the educational background and grasp of prevention of injury; either through (but not limited to) nutrition/hydration or conditioning of the body.

Athletic Trainers are also on the forefront for concussion awareness, education and assessment, often the first allied health care professional to see the problem and identify it.  As much as I hammer home Continue reading

Please Explain

It is a common thought that crosses my mind when I see questionable actions around a concussion situation.  Unfortunately I don’t have the power to get the answers, so I basically post them on here for others to see.

This is not the case in Australian Rules Football; if you are team and you receive a “please explain” regarding an injury (mainly concussions) you are probably treading on thin ice.

There is a mechanism in AFL that formally puts teams and doctors on notice when things just don’t add up.  Take for example the handling of a concussion by the North Melbourne Roos;

Interim Kangaroos chief executive Cameron Vale emailed AFL operations manager Adrian Anderson on Monday after the Roos were told to respond to a ”please explain” issued by the league last week.

The Kangaroos have been under investigation over the manner in which they handled Hansen after he received a heavy knock against Essendon in round 20, and also for the way they have responded to AFL investigators Brett Clothier and Abraham Haddad in recent weeks.

The AFL has been unimpressed with the club’s handling of the issue, although the Kangaroos have bristled at suggestions football manager Donald McDonald had influenced the testimony of key figures involved.

The letter is not the first step, rather the end step in a process that allows the medical board of the AFL to investigate how the practices of player protection is put in place.  Is it oversight?  You bet and I feel that the AFL does something much-needed in all professional sports.  Really, it is only applicable to the pros because of the resources, however it could translate to large colleges as well.

In Zurich I spoke to Dr. McCrory about what they do in regards to this, here are the basics; Continue reading

Parental Decisions Can Undercut Good Concussion Laws

We are beginning a new program here at TCB.  This one is called “Outreach”; the purpose is to publicize the good (we hope the vast majority) and sometimes the not so good of concussion management across this vast planet.  One thing I realized real quick in Zurich is that the stories of the bad are relatively the same, but unheard.  Meanwhile the stories of good are different and helpful and not heard at all.  I am asking our readers to send in stories of your cases (please be mindful identifying specifics) so we can share.  There are vast stories in the comment section but I would like to bring forward as many as possible.

The stipulations are simple: 500-2000 words with specific situations that we all can learn from and benefit from, email them to us at theconcussionblog@comcast.net and consent to possible editing as I see fit.  It would be nice if you included a bio or frame of reference, but if you would like to remain anonymous that is fine to (however, it would be good if you included something like “licensed doctor in _____ (state)” or coach, athletic trainer, mom, dad, etc.

As Dr. Kissick stated in Zurich it is high time we start sharing as much information as possible.  I will do my best to weed through the “complaints” and “uninformed” from the group; be a “gate-keeper” if you will.  Trust me (as you have witnessed on this blog) I will get information out!

———-

By Tommy Dean, ATC, LAT

You can’t turn on the TV today or open the newspaper without hearing about concussions. It seems like over the last few years there have been more superstar athletes who have suffered this injury, especially from those who played “back in the day” and are now coming forward and bringing their multitude of recent struggles to the forefront that have been caused by multiple concussions.

But the problem doesn’t start in the NFL. It starts at the youth level. It starts at home.

Every Saturday and Sunday families gather to watch collegiate and NFL games, bringing society together on common ground for a day or two. In a way, however, this culture can also tear us apart. When kids and parents see elite athletes take punishing hits and stumble off the field only to be returned by the medical staff just minutes later it raises questions and causes confusion about concussions.

What must be understood is that there is not one of these injuries that will be treated the same. Your son or daughter at home is NOT the same as RGIII or Melissa Gilbert (Dancing with the Stars). We are talking about the adult, or fully developed brain of an elite athlete who gets paid to do what they do versus the still developing brain of an adolescent who may not yet be legal to drive a vehicle. This is in no stretch of the imagination an apples-to-apples comparison.

What’s disconcerting to me as a certified athletic trainer and a father of two Continue reading

Zurich Day 2… And We Are Live

I have figured out the power situation so I will be trying to update the blog ASAP after each session…  For the time being make sure to follow on Twitter…

==========

1030 CST: Session 7, final session: The Sharp End

First debate between Dr. Cantu (yes) and Dr. Herring (no): is no RTP same day the best management paradigm?  Is keeping a player out one week long enough and is the graduated RTP protocol sufficient…

THERE WILL BE NO RTP on same day in the new statement!!!

Change of direction on Session 7, questions with panel answers, pro-con (if available)

Do 3 concussions end your career?

  • its comedy hour
  • Aubrey – treat each athlete individually
  • Dvorak – it has to be based on timing and complexity of each recovery – case-by-case basis
  • Putukian – if we can’t agree on dx how can we agree on a number
  • Overall theme is it is individualized, not all concussions are the same (Cantu)

Who is best qualified to make the sideline decision?

  • Cantu – multiple members working under a physician can make the call
  • Herring – concerning to him that some information is intrinsic to doctors so need to be careful
  • better question is who best qualified – person with most experience
  • Dvorak – looking at spectrum of games played, doctors are best qualified in most instances, but are they there in all matches?  We should aim all this to the “grass roots” as the professional level there is more than adequate coverage.
    • comedy about football versus american football
  • Ellenbogen – those that know the athletes should be making the decision, maybe a parent in youth sports, or athletic trainers, understanding the patients baseline is important
  • Putukian – balancing act, in a perfect world its a team approach (Athletic Trainer mention), and she says in the US the athletic trainer should be making the decisions on the sidelines…
  • Aubrey – Hockey Canada has a safety person (volunteer) in lieu of an athletic trainer
  • Cantu – brings up possibly training school teachers in concussion
  • Herring – if you are team physician do you need someone else to make the decision if you are on the sideline?  Panel – no

Is there a role for grading concussions?

  • Cantu – not perfect, but informing patient is important about severity and duration of recovery, after the fact
  • McCrory – we have moved from grading, look at the recovery – perhaps look at the SCAT/serial testing
  • Putukian – looking at history is more important than arbitrary “grade”
  • Herring – may help with continual care from one place to another, but again important to understand history

Should we be returning on the same day of concussion?

  • Aubrey – what about the NHL player in the playoffs (rhetorical question)
  • Cantu – no once recognized
  • McCrory – what about the players that clear the SCAT, so no concussion, but you know something is amiss?
  • Putukian – example of hockey player with delayed symptoms
  • McCrory – concussion is often an evolving injury
  • Ellenbogen – it is a traumatic brain injury, is the game worth it?  No.
  • Panel – consensus is NO RTP same day
  • McCrory to Aubrey about playoff example – what about a regular season, and Aubrey is being very honest, and he feels the player push back is greater
  • Ken Dryden from the audience – why are we treating professional athletes different from the youth or non-elite athlete
    • We are starting to move away from that, all athletes should be treated the same

Should there be helmets in woman’s lacrosse and field hockey?

  • Cantu – yes, because of stick and ball causation of concussion
  • Putukian – no, change nature of the game, no reports of intercranial bleeds in women’s lacrosse, weary of unintended consequences (BTW, probably has the most experience with this)
  • Cantu and Putukian discussing this topic
  • Change gears – what about football?
    • Dvorak not in FIFA’s plans to recommend, many reasons including the false security of wearing head gear
  • Audience Q: should we discourage the use of the head bands/head gear
    • Dvorak – your own prerogative but data does not support the use of them as recommendation (Czech goalie wears one)
    • McIntosh – Rules are more important at this time

Should there be age restriction on tackling in American football, heading in soccer and checking in ice hockey?

  • Cantu – his words speak for themselves, youth sports needs to look at how the game is played because of the differences between older
  • McCrory – in Australia you cannot get to the gladiatorial aspect of Aussie Rules until they are “of age” (13 if I heard correctly)
  • Ellenbogen – risk of activity, most concussions via CDC information is from wheeled sports and recreation, does not make sense at this time to him, advise accordingly
  • Cantu – youth sports don’t have the good data, personally he does not believe learning a sport at age 5 will make you elite, it is a genetic disposition in his opinion
  • Putukian – it makes sense to decrease exposure, US Lacrosse has put age 13 on checking, her take on soccer is that there is no data to support this when using proper sized ball and equipment
  • Dvorak – young soccer players learn sport first, and fundamentals of “football” its not “headball”, studies done on heading ball and with study there was no increase in biomarkers they were looking at it.  They don’t force kids to head ball until skills are sufficient.
  • Herring – false warranty?  Arbitrary age is concerning, take head out of the game rather then taking the game away from youth athletes.  The limit to exposure is accurate, but complete removal of the sport may not be necessary.
  • Cantu – sport needs to be safer for younger athletes
  • Aubrey – ice hockey has set limits on age for body checking, research is very important, it will help make decisions

—–

Dr. Jamie Kissick speaking on “From Consensus to Action”

  • Knowledge is power
  • “There is an app for that”
  • Knowledge Translation (KT) Concepts Continue reading

What Is Going On In Arizona?

I only lead the story that way because this past weekend there have been two “interesting” situations involving potential concussions of football players, with ‘Arizona’ on the jersey.

Yesterday I posted about Matt Scott, University of Arizona QB (Dan Diamond also has a follow-up to his story here) and today after Monday Night Football Larry Fitzgerald of the Arizona Cardinals is under the microscope.  I too was watching and was mystified at the handling of the situation.  Watching on television you could clearly see a mechanism of injury that would predispose a player to a head injury, then as he rose to his feet – to this highly trained observer – he appeared gazed and “not all there”.  Apparently I was not the only one to see it that way;

When he got up from the field picking grass out of his facemask and looking woozy, there were fewer questions about whether it was a dirty play by Brown—it wasn’t—than how much time Fitzgerald would miss due to a possible concussion.[…] Continue reading

Wildcat QB Puking After Hit, AND PLAYS ON!?!?!?!?

A few weeks ago we had ‘Woodsgate’, and in a game where USC was playing we now have ‘Scottgate’.  Arizona quarterback Matt Scott took a kick to the head and was immediately witnessed and reported throwing up.  Concussions are mainly a subjective injury, meaning we cannot “see” what is going on, however, there are times when a player/person exhibits signs of a traumatic head injury.

It has been my experience as an athletic trainer and one who deeply studies concussions that signs are often the best information we can get as clinicians/health care providers.  I have never been around a player that has had overt signs such as: balance disturbance, slurred speech, wandering eyes or VOMITING and not had a concussion.

Oh, Scott was returned to play…

I could and have gone on about this many times (see the ‘Woodsgate’ link above or another Pac-12 team and ‘Lockergate’ a few years back), but I believe Dan Diamond did an excellent piece on this for Forbes;

Congratulations, University of Arizona. Your football team just scored a big win over USC–partly because your quarterback played through an almost-certain concussion.

To be fair, it was your biggest victory in two whole years. And the NCAA’s not going to penalize you, so why protect your player? It’s not like we’ve learned anything about football and head injuries.[…]

By keeping Scott on the field, Arizona had little to lose, other than the game; the NCAA’s concussion policy is toothless and links to some of their head-injury resources don’t even appear to be working on their website. (Try clicking on “Behind the Blue Disk: NCAA’s Approach to Concussions.”)

And despite everything we know about head injuries, the culture of complicity extends to those who cover the sport. I didn’t actually watch the game, but was told that the announcers were blasé about Scott playing through his big hit. The initial write-ups on ESPN and elsewhere didn’t mention the sequence of events; others even celebrated Scott’s toughness. “Arizona Wildcats upset USC Trojans behind Matt Scott’s heart,” wrote SB Nation’s Kevin Zimmerman.  Continue reading

They Get It, But Don’t Get It

Having an athletic trainer at the high school, especially a school that has collision sports, is not only handy it is a down right necessity – for various reasons.  The most poignant being emergency care of injured athletes; it goes deeper than that.

Athletic Trainers are not only trained for medical emergencies but we are all trained for the routine and “normal” injuries that occur on the playing field/court.  Each day in my training room I see 4-5 new faces with new ailments that need tended to; this would be the coaches problems if I weren’t there.  Or, in some cases these “normal/routine” injuries are off to doctors offices – often general practitioners that see more illness than injury – for a time and money cost for the family.

I could write a 4,000 word post on the need for athletic trainers at high schools, but I feel most of you understand, and for the most part the schools understand.  I am not talking about the athletic trainer that comes to a school once a week to see injuries (the lowest level of coverage and inadequate in my opinion), I am speaking about the need for the everyday athletic trainer.  In the case of “they get it, but don’t get it” I give you the Washoe County school system in Nevada (BTW, they are not the only ones, but a good example); Continue reading