SLI Press Release Primer

Coming up at 3:30 EST in New York City as part of the Super Bowl week the Sports Legacy Institute will being having an announcement about an initiative that could help with concussion issues.  It is no secret this will deal with the Hit Count ideas floated two years ago.  Below is the re-post of the February 3, 2012 announcement:

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Sports Legacy Institute did in fact release their white paper today; it simply brings to the surface something that they along with others have been saying with more frequency.  Their initiative to create a Hit Count is a bold step and on that is welcomed, especially in light of the very current research from Purdue.

You can find the article on the SLI website (here) or you can read the final white paper .pdf here; there is a very good background for this idea and the simple yet powerful citation of research already performed in this area.  Their idea is mapped out very well, again the devil will be in the details as it all begins to be sorted out;

There are technological and monetary limitations to a pure Hit Count, as Hit Count systems currently are only sold for helmeted sports, and there are costs involved.  A Hit Count is not as simple as a pitch count, where coaches only need a pencil and paper.

However, hits to the head can be accurately estimated, and methods can be developed to approximate the brain trauma exposure during games and during practice based on known variables, like position.  With these estimations, rule changes and practice guidelines can be provided to ensure few, if any, athletes exceed a proposed limit.

Little League pitch counts are limits on the number of “pitches thrown per day” and mandate up to three days of rest after exposure to elbow trauma to allow the ulnar collateral ligament to recover.

A Hit Count should explore the following guidelines:

  1. Minimum threshold to be considered a “Hit”
  2. Maximum Hits per day (all counts stratified by age)
  3. Maximum Hits per week
  4. Maximum Hits per season
  5. Maximum Hits per year
  6. When the technology is available, should there be a “Total Force” threshold derived from number of hits times mean force per hit
  7. Minimum required days of rest after a minimum brain trauma exposure

In football, a Hit Count might lead to fewer practices that involve helmets and pads or the limits on the use of high impact drills. In soccer practice, it may mean tracking headers in practice and games. This policy is probably most critical to the youngest athletes, who may be at the greatest risk, and should receive less brain trauma than older athletes.

As noted the implementation of this may be difficult to get an accurate hit count for each individual, it is not like a pitcher where they are the only one on the field performing the specific task.  However, that being said and the limitations discussed in the white paper, simply reducing the number of full contact days will reduce the overall number of hits.

Until research can identify a more specific number we must Continue reading

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

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 and PART 3 HERE and PART 4 HERE and PART 5 HERE and PART 6 HERE.

It has been my pleasure to post the stylings of Mr. Ott over the past few weeks.  The guy has worked hard on this basically “paying it forward” so perhaps one person will run with the information.  I admire his spirit and “sticktoitivness”, thank you, Terry!

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AND IN THE END…THE CULTURE MUST CHANGE AND/OR THE FALL OF THE FOOTBALL EMPIRE

“In this sort of feminized atmosphere we exist today guys who are masculine and muscular…kind of old-fashioned guys run some risks.” -Brit Hume, Jan. 13, 2014

You know, I don’t really care much for the brand of “news” that FOX espouses and yet this is the second, and last time I will quote from it.

Because what Brit Hume recently said deserves to be discussed. Even though his comments may be a mile wide and only an inch deep and were not referring to the “manly” sport of football, they may in fact strike to the heart of the civil war now going on in pigskin circles regarding concussions and brain injury.

On one side of the debate are what the League of Denial authors rightly called the deniers, and the other side would seem to be the whistle-blowers. The deniers see the whistle-blowers as silly sissy Marry la-la’s trying to wreck football and the whistle-blowers see the deniers as Neanderthal numbskulls, old-fashioned guys well past their sell date.

Perhaps these are the risks that can befall the old guard, the deniers. That of being accused of being out of touch, thick, ignorant of the facts, or worse.

But does that make the whistle-blowers, those alleged soft, girly man, nanny-state purveyors “feminized”?

Well, if it means caring about football and employing common sense in a brutal arena, then sign me up for NOW, now, man.

Because pro football as we now know it is in danger-yes, real danger.

Danger of being law-suited and legislated out of acceptable existence.

And, as I have previously pointed out, shutting up about it is just plain dumb and ensures football will be KIA.

The lawyers smell money – that’s real money – and the government will most assuredly act, and maybe even in a Draconian fashion, if pro football does not get its brain injury prevention and after care act together very soon.

The NFL and their broadcast partners are joined at the hip. For the most part, this ain’t good because neither hand wants Continue reading

Terry Ott: 3rd Down, CTE to go – Part 6 – UPDATED

CBC 5th EstateThis 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 and PART 3 HERE and PART 4 HERE and PART 5 HERE.

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UPDATE 21:19 1/22/14 – rectified link to CBC The Fifth Estate “Head Games” (see below)

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HELLO, IS THERE ANYBODY IN/OUT THEREJUST NOD IF YOU CAN HEAR ME, IS THERE ANYONE AT HOME?

“Now I remember why I gave up speaking to journalists. They are a species of foul vermin. I wouldn’t hire people like that to guard my sewer. Journalists are morons. They’re idiots. They’re ignorant and stupid.” – The late, great, irascible Lou Reed.

Well, up here in the Great White North, the question of (seriously) addressing the serious problem of concussions in the Canadian Football League would appear to be a deaf, dumb and blind one, boy.

Or, maybe as popular as baked beans on a bus trip.

For whichever way you want to turn this thing loose, up here, it’s locked up, tight.

As I’ve written before in this series, although there has been some pretty good reporting, especially by the CBC where on their website they still carry many reports and videos about concussions, about the only report on concussions and the CFL’s role that I can find is a 2008 CBC Fifth Estate report entitled, “Head Games.”

Below is the web promo, description and link but that link does not work. (The Concussion Blog originally linked to this report several years ago when the link did work.)

CBC The Fifth Estate – “Head Games” broadcast in 2008:

“They have been called the greatest football team in the history of the CFL — the Edmonton Eskimos of the 1970s and ’80s that won five consecutive Grey Cups. But, for some of the star players on that team, the years of triumph ended ingloriously in early deaths, from heart attack, suicide and misadventure. The tragedy of those early deaths was often compounded by alcohol or drug addictions, probably caused by another, less visible, killer. Recent research by neuroscientists now shows the link between on-the-field concussions and brain damage; a permanent injury that can lead to depression, suicide and severe aberrant behaviour. The damage is so profound, the researchers say, that post-mortem examinations of the brain tissue of five former professional football players can be compared only to the tissue found in the brain tissue of advanced Alzheimer’s cases.” CBC The Fifth Estate – Head Games

This 2008 report was actually ahead of its time, and again, the only one that I know of that cornered the CFL and asked some tough, prescient questions. The former commissioner had that old deer/headlamps face a few times and newspapers at the time took a toot but then everyone went back to a snore. Comfortably numb.

But now, there is a proviso on the Fifth Estate website advising thatprior programs from 2003 were inadvertently re-posted in 2013 and therefore, contact customer service, yada, yada, yada, and blah-blah.

Yet interestingly – I said interestingly – the only Fifth Estate link that I could not get to work was…TA DAH: Head Games.

I am alleging nothing-although I may later sort of spatially speculate-but there are some conspiracy theorists out there who are very suspicious.

One of them is Phil Colwell, the former CFL running back who Continue reading

Terry Ott: 3rd Down, CTE to go – Part 5

MIPSThis 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 and PART 3 HERE and PART 4 HERE.

IS “MIPS” A FOUR LETTER WORD AND (Every)THING YOU ALWAYS WANTED TO KNOW ABOUT SNAKE-OIL*

*But were unaware to ask

“The cold truth is that football players are in jeopardy.”  — Bill O’Reilly, he of the No Spin (End) Zone, Jan. 8. 2014


The Concussion Blog supremo Dustin Fink once mused to me that football, in its infancy a hundred years ago or there about, was meant to be played by (slower) men about five foot nine and weighing an average 150 pounds or so and at a time when a 200LB plus player was basically a monster, a freak.

You can appreciate the Dustin statement inference by referencing high school physics in that net (G) force equals mass times acceleration and also appreciate that now, with players routinely 50-150 pounds heavier then when the first Roosevelt was in the White House, and many now with world-class speed, the G forces generated on impact by today’s pro and college football players are exponentially greater than in Knute Rockne’s days and the resulting collisions on the field can be life threatening in the short, and long-term.

Life in big-time football today is both Darwinian-only the strong survive, and if lucky thrive, and inherently  Hobbesian-nasty, brutish and short.

But since literally millions of boys and young men seek football playing dreams, what to do?

Well, since just about all aspects of football equipment has undergone a radical revolution-footwear, pads, uniforms, gloves and eye protection-how about an update on the most important piece of football gear-the helmet.

A little history lesson: President and Rough Rider Teddy R was a big football fan, and when 9 players died in 1913 as a result mostly of skull fracture injuries, he, along with Knute Rockne advocated for a shift from three yards Continue reading

The OTL Investigation on ‘Heads Up’ Football

It may have slipped some of your reading or viewing, but ESPN’s Outside the Lines did a piece on the USA Football Heads Up Program.  The article and video were presented last Sunday morning – I cannot find a YouTube version of the OTL show but you can find that part HERE.  The seven minute presentation is great for a quick overview of the issues ESPN has found.

For more in-depth coverage you should read the article by Steve Fainaru and Mark Fainaru-Wada, the same authors that penned League of Denial.  There are some wonderful points brought to light by the Fainaru’s;

The program teaches concussion awareness and proper helmet fitting, but its central tenet is the soon-to-be trademarked Heads Up Tackling program. When executed properly, proponents say, Heads Up Tackling literally takes the head out of the game. Players are taught to keep their heads up and lead with their shoulders when tackling.

[…]

But critics view Heads Up as a cynical marketing ploy — a repackaging of old terminology to reassure parents at a time the sport is confronting a widening health crisis.

There is a reason I have been “relatively” quiet on this topic; it’s because they are doing some very good things in the way of education and helmet fitting.  As you may know I am huge on the topic of awareness when it comes to concussions.  I have stated many times that the injury itself is not the “ice burg we can see above the water” rather it’s the mismanagement of the concussion that is the massive ice chunk we cannot see from the surface.

That being said, with the actual tackling technique being taught I too feel this is a repackaging of an old mantra.  Rules were even put in place as early as the 70’s to accomplish this task of taking the head out of the game.  Face tackling, spearing and butt blocking all have been on the books as penalties to help avoid using the head as a weapon.

The problem being that those are not called very often, when they are called they are inconsistent at best, and what has it done for the game over nearly 40 years?  I am not nearly as critical as others;  Continue reading

Terry Ott: 3rd Down, Absence of CTE to go – Part 4

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 and PART 3 HERE.

THE CURIOUSLY TITLED AND ENIGMATIC BRAIN STUDY, AND THE SEEMINGLY RHETORICAL QUESTION OF ’14

“We can’t solve problems by using the same kind of thinking we used when we created them.” –Albert Einstein, who knew a thing or two about brains.

Dr. Tator: Not absent

Dr. Ann McKee, professor of neurology and pathology and co-director of the Center For The Study Of Chronic Traumatic Encephalopathy at Boston University once mused in a television interview that she wondered if most if not all professional football players had some degree of CTE.

After all, the brains of former football players examined by the Center so far has found the existence of CTE was near one hundred percent.

Whether one agrees with the now famous Dr. McKee in totality regarding the prevalence of CTE in former players, her and her team are world-class doctors and researchers who have brought the serious issue of football related brain trauma into the collective consciousness of tens of millions of observers.

Most believe that the BU work on CTE was the main catalyst for the National Football League to eventually in 2009 admit that there was a cause and effect between football play and CTE and was also the key preponderance of the evidence that made for a 765 million dollar settlement between the league and former players who claimed neurological damage from playing football.

Here in the Great White North, Dr. Charles Tator, of the University of Toronto, has been referred to as the grandfather of brain research and sort of the Canuck version of BU-like CTE research.

Dr. Tator, a neurosurgeon, originally specialized in spinal cord injuries, but was leader of a study of the brains of 6 former Canadian Football League players that was published in May, 2013.

Despite the fact that Dr. Tator’s study found a fifty percent incidence of CTE among the subjects, the study was entitled “Absence of chronic traumatic encephalopathy in retired football players with multiple concussions and neurological symptomatically”

The detailed study places much weight on the small number of brains Continue reading

Thank You! Good Luck Going Forward.

The reason for this post is simple; Thank You!

To the reader, the commentators, the links, the views, the emails, the tweets, the everything.

When this blog started in September of 2010 I had no clue.  No clue on what I was doing.  No clue on how to write.  No clue on the audience.  No clue on if it would impact anyone.  No clue if it would last.

If not for all of you on the other side of this screen, none of this would have happened.  In terms of bandwidth and views this blog is very small compared to the juggernauts of the interwebs, but over time it has had place and a voice.  Not only for me, but for you.

I could sit here and spew the stats, the accolades and such but, why?  There is no need, this blog was never founded on that or is continued for that.  This blog is a space for information and opinions from an athletic trainers perspective about concussions.  Looking back on the “Disclaimer” page I wrote over three years ago I feel I have attained what I wanted to accomplish and WILL CONTINUE TO PURSUE.

So, as you ring in 2014 let us all try to make this the best year yet!

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

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

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

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

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

2013 Week 12 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.

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

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

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

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

UPDATED: Craig Stevens found after original publish… Continue reading

Happy Thanksgiving

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

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

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

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

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

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

So Thank You!

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

2013 Week 11 NFL Concussion Report

The Concussion Blog Original, NFL Concussion Report, is a weekly compiling of the reported head injuries in the National Football League.  Concussions are added to the list each week from multiple sources to give you the reader a picture of what is happening on the field.  Each week we will bring you the information along with relevant statistics.  If we have missed a concussion or put one on here erroneously, let us know (we will also be using Fink’s Rule to classify a concussion/head injury).  It also should be noted that due to the league not disclosing actual injuries until Friday night there may be some added to next weeks numbers.

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

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

As of yesterday it was reported that Continue reading

Hruby Tuesday Podcast

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

LINK

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

2013 Week 10 NFL Concussion Report

The Concussion Blog Original, NFL Concussion Report, is a weekly compiling of the reported head injuries in the National Football League.  Concussions are added to the list each week from multiple sources to give you the reader a picture of what is happening on the field.  Each week we will bring you the information along with relevant statistics.  If we have missed a concussion or put one on here erroneously, let us know (we will also be using Fink’s Rule to classify a concussion/head injury).  It also should be noted that due to the league not disclosing actual injuries until Friday night there may be some added to next weeks numbers.

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

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

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

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