The “Mild” Concussion


This post was written originally in 2011, but has been re-posted numerous times, it will continue to be posted until we all get the message…


Hogwash!  There is NOTHING mild about a concussion, period.  However media, teams, players and even medical staffs continue to use this nomenclature with this injury.  It is simply counterproductive to label this injury with a “mild” tag, and hampers the effort of everyone trying to increase awareness.

When public speaking I often times compare a mild concussion to being mildly pregnant. It is rather simple you are concussed or you are not, just like being pregnant.

Granted, those that have extensive training in the area of injuries, and particularly head injuries, understand the term “mild” when it is in concert with concussion.  This subset of the population is not the one that needs the education, rather it is the general public, which includes players, coaches and parents.  A common problem amongst people who are educated in a particular field is that they forget about both who they are servicing and the education level of people other than their peers.  It’s a fine balance to educate without talking down to others, but understanding the stigmas of the topics help with that effort.

One serious stigma is the “mild” tag that is placed on concussions.  Those that watch and participate in sports are so used to using that clarification when assessing and addressing injuries as a whole, that perhaps it carries over to the traumatic brain injury just sustained by the athlete.  We as athletic trainers and doctors Continue reading

It’s Been Awhile…

Thanks for sticking with The Concussion Blog, I know it has been over a week (almost two) since I last posted.  I am sure you don’t want to read a blabbering sob story, well you are going to get my story.  When I began this blog I found it very “therapeutic” to write about what is going on, and over time you the reader have seemed to enjoy the content.  I always have been very strident in making sure there was fresh information out there; if nothing else to write my feelings.  Over the past 10 days or so I have missed the opportunity to “press” and express my opinion.  Thanks to others out there you have been able to keep up with some current information, but I am back for the foreseeable future!…  With the occasional hiatus…

Where have I been, that is simple, football two-a-days began on the 8th and that took a majority of my time however there was more, A LOT MORE, going on behind the scenes.  It seemed I was in a groove after last weekend but my world shook with some inconvenient timing and predicaments.

Early last week I was in deep discussions Continue reading

Summer Vacation Ramblings

Over the past few years during the months of June and July there is relatively “slow” news coming out about concussions and research.  Never fear I will keep my ear to the ground.  However since it tends to be slower now – keep checking the comment section Concerned Mom seems to find them all – I will be posting random things; maybe humor, maybe thoughts on other things (I will not wade into politics).  I most likely will stick to thinks I know.

Here is my first contribution to the “Ramblings” section, a YouTube video that makes me laugh!

This Trickles Down

Comments like these trickle down to the lower levels, either because the youth look up to players or their comments make ‘sense’ to them as football players;

“If I have a concussion these days, I’m going to say something happened to my toe or knee just to get my bearings for a few plays,” he told HBO’s Andrea Kremer during an interview for Real Sports. “I’m not going to sit in there and say I got a concussion, I can’t go in there the rest of the game.”

The above is attributed to all-pro linebacker Brian Urlacher and may be a popular/majority sentiment within the NFL locker room.  Brace yourself for the upcoming rant…

As professional athletes and adults I don’t think that players are exactly wrong in having these feelings, heck it is their job.  Given all the information about the lasting effects of all injuries and concussions players assume the risk.  That being said if they choose to abide by such comments these players should not be filing law suits after the fact.

The real issue is that comments like Urlacher’s Continue reading

Misinformation: Hockey

I must admit I am being a bit “Pollyannaish” about using the correct terms and classifications of concussions.  But seriously it needs to stop, for the sake of the kids and general public.  All these terms do is muddy the water about concussions.

Case 1: Chris Pronger – “Concussion-Like Symptoms”;

Pronger has what general manager Paul Holmgren called “concussion-like” symptoms and is out indefinitely.

Braydon Coburn, when asked whether it had been easier to wrap his head around just three more weeks without the captain as opposed to the “indefinite” absence announced on Friday, said: “I don’t know. I don’t even know what day it is.”

Case 2 (my biggest pet peeve): Daniel Paille – “Mild Concussion”; Continue reading

Mike & Mike and My Thoughts Going Forward

There are some of us that had hoped that the “World Wide Leader” in sports would have used its platform last night to further the discussion on the concussion issue.  Yes, as the commenters pointed out in the other post, they did broach the subject of Kris Dielman at half time.  Mainly to emphasize that the league was looking into this and the policy going forward.

On Mike & Mike this morning the hosts were joined by Chris Carter and really talked about it.  Not only the problems with the injury, but how the game is being changed.  You can LISTEN HERE.

No matter the side of the fence you fall on – player safety is number one – for professional players, college players and especially the adolescents.  There is no hard and fast answer to this, but it is worth discussing as they did this morning.  Times have changed, we have learned so much more about brain injuries and perhaps the injury of concussion is getting more severe as time goes on (size, speed, etc.).

I have been accused by coaches and parents that concussions are being sensationalized, not only by the media but by me.  They really feel this way and there is not an issue with that; Continue reading

Observations: Nick Mercer

I watch Jersey Shore. I am neither proud nor ashamed of that. I just watch it. I doubt I’d watch it the same way if I hadn’t done a biology degree. Everything from examining ecosystems and watching vigilance behaviour to detailing the lives of fruit flies was based on objective observation. It is with that eye of an unimpassioned observer that I tend to watch any reality show, especially those shows that are trying to depict life in an ‘open’ environment. It’s fairly obvious that, although not scripted, Jersey Shore takes place in a well controlled, or at least well influenced environment. The Situation (Mike) – a nickname he seemingly gave himself – recently slammed his head into a wall. Purposefully I might add!

He went to hospital,was diagnosed with whiplash, given a foam neck brace and told to lay low for a week (not go out to clubs – a near nightly occurrence on the show). The Situation was never a favourite member of the house; he always drew attention and animosity to himself. He is also depicted as being aggressive, arrogant and naive. About to get into a fight, he got himself riled up and threw his head into the wall. After the shock and concern about his immediate well-being had subsided Continue reading

Mouth Gear Information

Courtesy of Jonathan Harford via Flickr

Back in November I took on the mouth gear issue by showing some emails that I had with a few of the prominent companies invested in oral/facial protection.  I use the term “mouth gear” to isolate any device that is placed in your mouth, this is a very hot topic, especially since the football season is about to begin.  If you have read that post you know my stance on the issue at hand; buyer beware.

Lets begin with some video footage of athletes wearing mouth gear;

  • The first KO is textbook mechanism of injury that the mouth gear companies say they can protect against; a blow to the jaw, where the jaw bone (mandible) would slam into the skull.
  • The third KO is a blow to the jaw, in a rotational axis, again companies claim they can protect against concussive injuries when a blow is received on the jaw.
  • The fourth KO is a straight right to the jaw.
  • The fifth KO a left to the jaw in a rotational axis.
  • Should I keep going????  I think you get the point.

It’s not so much that the companies in question Continue reading

To Peer Review or Not To Peer Review

The answer is and has been very one-sided, most everyone trying to make a mark are peer reviewing their research to get publicized.  Heck, when I was in graduate school I was told that is the only way anyone would honor your information.  Basically if you wanted to be respected it was/is a must to be cited in a journal, a well-respected peer-reviewed publication.  Over time I have really become jaded on the whole process, too much money, too much conflict of interest, and too much glad-handing to get in a lot of the journals.  We can even take a look at something we all have come across, “Global Warming”; research in that area is basically hand-picked to make it into publication, and if you are not serving an agenda, one side or the other, you will not appear in certain rags.

At a time when I am trumpeting my information about concussions in the NFL last year and the helmet data it cannot not be more obvious to me.  I have asked many sources to help with putting a “peer-review” piece together and I have been given a myriad of different excuses as to why it won’t show.  Usually, a research piece that has been completed would be easy for some to just say; “yup put my name on it and we will write it together.”  However the reasons I have heard amaze me; Continue reading

No Such Thing As A “Mild” Concussion

Hogwash!  There is NOTHING mild about a concussion, period.  However media, teams, players and even medical staffs continue to use this nomenclature with this injury.  It is simply counterproductive to label this injury with a “mild” tag, and hampers the effort of everyone trying to increase awareness.

Granted, those that have extensive training in the area of injuries, and particularly head injuries, understand the term “mild” when it is in concert with concussion.  This subset of the population is not the one that needs the education, rather it is the general public, which includes players, coaches and parents.  A common problem amongst people who are educated in a particular field is that they forget about both who they are servicing and the education level of people other than their peers.  It’s a fine balance to educate without talking down to others, but understanding the stigmas of the topics help with that effort.

One serious stigma is the “mild” tag that is placed on concussions.  Those that watch and participate in sports are so used to using that clarification when assessing and addressing injuries as a whole, that perhaps it carries over to the traumatic brain injury just sustained by the athlete.  We as athletic trainers and doctors need to reassess how we describe this particular injury.

During my public speaking I often relate being “mildly” concussed to being “mildly” pregnant…  You are either concussed or not, just like you are pregnant or not.

Some may say that “the symptoms are mild”, or that the Continue reading

NHL Post Season Concussion Report #4 UPDATE

Throughout the year we have been chronicling concussions in the National Hockey League and now the sport is in the post season.  We will be noting any concussion we can find; that are both ACTUALLY listed and suspected.

UPDATE: Thanks to @ewheeler1976 Patrice Bergeron was a concussion actually listed, well it wasn’t until today that it changed from a “upper body injury” to “mild concussion”.  Have I mentioned what I think about “mild” concussions?  This brings the post season total to 11 known and a couple that are questionable.

There have been no “concussions” in the past week, not really surprising.  While searching for injury information and finding videos of players during the game while they were hurt I noticed something.  Any lower body injury and upper body injury not including the head was easy to find; even on  However, when looking for head injuries or suspected head injuries they were very difficult to find; usually need someone independent putting it on YouTube.  I just thought I would throw that out there…

This week there have been two suspicious listings first is Adam McQuaid with a “sprained neck”, Continue reading

Lightning Get Struck Twice

Last night the Tampa Bay Lightning took a one game to none lead over the number one seed Washington Capitals.  However in that game two players for the Lightning were removed with head injuries.  The most publicized and dramatic of the injuries was Simon Gagne as seen in the video below;

Gagne has had a concussion history beginning in 2002, but was pretty clear until 2007 when with the Flyers he missed 26 games; only to miss another 44 the following year with more concussion issues.  After Gagne’s head bounced off the ice like a basketball and he was clearly unconscious it would be easy to assume he sustained yet another concussion.

As if losing one of their wingers was not enough, Pavel Kubina was taken to the boards by Jason Chimera in a hit that should be Continue reading

Comprehensive NHL Concussion Study

A research study was released yesterday from the University of Calgary that took a look at reporting concussions.  This study was also helped along by the NHL, so we must acknowledge that, from The Globe and Mail;

One in five National Hockey League players who sustained a concussion during a shift in the regular season went back on the ice that same game, a study by the league and players association has found.

It also showed a significant number of those players who returned to the ice ended up missing more than 10 days of play afterwards because of concussion symptoms, which include headache, dizziness, nausea, blurred vision and sensitivity to light.

The results of the study were very obvious and dramatic and really highlighted the under-reporting that plagues all sports.  With this information we will now Continue reading

Parents In Action

Gil and Michelle Trenum of Prince William County, Virginia have taken what was the most horrible day in their life and are doing something about it.  After Michelle so genuinely shared her story about her son, Austin — here exclusively with The Concussion Blog — her and her husband refused to believe something could not be done about it.  The Trenum’s have put forth a tremendous effort in connecting with some very “stout” individuals in the concussion research and management area.  It was not to find out why this happened so much, as it has been an effort to not let this happen again, to any parent or any kid.

Joe Conroy of reported on a recent school board meeting, where Gil Trenum is a board representative, at this meeting was Dr. Gereld Gioia, cheif of the Division of Pediatric Neurosugery at Children’s Medical Center in Washington D.C.;

“A lot of people are asking ‘Why now? What’s so special about these times?’” said Gioia, who was invited by Brentsville District School BoardrepresentativeGil Trenum. “We have a perfect storm coming together in the sense that we better understand the brain, we have the resources at our disposal now that we can be informed about this injury, concussions, which are really a type of mild traumatic brain injury.

“There aren’t more concussions than years ago, but we have more knowledge about them and their symptoms,” Gioia said.

In the article is the issue that I have been trying to make more and more of, removal from school and cognitive activities.  However, this time it is Dr. Gioia explaining Continue reading

Golic Out Of Touch (rare for him)

Well that is an opinon, I rather like Mike Golic about most things.  However, we differ on this; why is presenting a learning tool in a video game a ‘bad idea’?

Perhaps when that small percentage of kids playing the game lose their star in the video game for a concussion they may realize that this injury is serious.  I am willing to bet heavily on the fact that those gamers know that when a player in the video game sustains an ACL tear he will not be back in the game for some time.  It is time to change the stigma of concussions, if it takes unconventional methods, like using Madden as a vehicle, then so be it.

NFL Kickoff Change

A lot has been made of this change in the kickoff rules, mainly by those that think the game will “inherently” change because of this.  I am not so sure we are looking at a doomsday scenario like that.  Rather, I do feel that limiting the full speed collisions over the season will in fact reduce the chances of concussions in that particular “subset” of the game.

I must admit that while tracking the concussions in the NFL last season specific plays and situations were not part of data collection.  However, it is empirically noted that the full speed nature over great distance have resulted in many concussions.  There have been a variety of stories about players getting drilled during special teams.  In fact, most of the “journeyman” that appear on the concussed list sustained those injuries during that phase of the game.  The specific nuances of the rule were described by Rich McKay in New Orleans;

Playing Rule Proposal No. 2 was the kickoff.  That rule passed and ended up in a form we called Playing Rule Proposal No. 2A.  2A ended up having the following elements: the kickoff will be from the 35-yard line; Continue reading

Pugilistic Sports and Concussions

Dementia Pugilistica, otherwise know as chronic traumatic encephalopathy, has its roots in the Sport of Kings, boxing.  Given that this sport and its derivatives; MMA, UFC, etc., goal is to inflict brain trauma there is surprisingly less heard about their dealings with concussions.  There could be a lot of reasons why this may be; expected, inherent work condition, informed consent, less watched, or their general dealings with head trauma.

Quietly, these sports and their sanctioning bodies have instituted some of the more strict rules when recovering from a knock out, or concussion.  Generally each state and province sanctioning body has a “medical suspension” induced on a fighter that is KO’ed or even shows signs of a concussion, most are 30 days.  Although specific wording in each groups medical suspension varies, the base of it provides that a fighter CANNOT fight for 30 days after the incident.  Less commonly known is that this also includes sparring and training; however this clause is not in most rules, it is inferred.  That is unless you are the UFC.

As highlighted by Morgan Campbell of the UFC has a policy in place, as explained by UFC Canada President Tom Wright; Continue reading

NHL Taking It Slow: Commentary

As the general managers meet in Florida for the last day, what has come from the meeting the past two has been “tightening of the ship.”  Rather than take sweeping changes and possibly modifying the game to ends that make the owners and their proxy, general managers, uneasy the standards/statements made thus far have at least let us know they are fully aware.  And it has shown that money or fear of losing money drives the ship.

On Monday the league announced that the protocol for a player showing concussion signs will be removed from the bench for a thorough evaluation by a doctor.  I opined that this was a good first step, what I didn’t mention was that I didn’t like how the connotation from the media and even the league that the athletic trainer may be at fault.  Taking the player from the bench is a “no-brainer”; the instinct to hop the boards when your shift is called far outweighs the honest answers a player may be inclined to give to the athletic trainer behind the bench.  Also, removing the player from outside influences, say peers and coaches, makes this move both warranted and good “window dressing.”  This particular move does nothing for the player that will give dishonest answers in an effort to return to the game, the hopes are that using the SCAT2 model, to the ‘T’, will identify more concussions.  Is it a move in the right direction?  Yes!  Just remember before others go on a rampage saying the athletic trainer would not be qualified to do this; the SCAT2 was developed by and for athletic trainers to use, on a hockey bench there is neither the time or space to do such an evaluation.  Part of the umbrage I take as well is the influences of the coaches, peers and players themselves when the injured is still on the bench.  The athletic trainer has never been viewed as an overriding authority on the bench/sidelines in professional sports, which is a shame because that is their profession and that is what they are trained to do.

On Tuesday, there was no move by the league to ban hits to the head, like the IIHF and OHL have done.  Rather the league will enforce Continue reading

“Concussion is not the bogeyman”

This is a tried and true quote from Micky Collins of the University of Pittsburgh Medical Center’s Sports Medicine Concussion Program.  As I have stated many times the injury itself is more than likely rather benign, IF TREATED CORRECTLY.  That is exactly what Collins is preaching; management of the initial injury is of the most importance.

“As we peel the onion on this injury and we started doing more and more research and more and more clinical work, it’s like, wow, this is really something that needs to be dealt with, and you have to do it very carefully,” said Micky Collins…

Researchers and doctors figured out that, despite their serious nature, concussions can be effectively treated. If managed correctly, Collins said, the potential for long-term effects can be mitigated.

Ignoring the signs and symptoms of a concussion is the first step to mistreating the injury, therefore the awareness of what a concussion is and the subsequent treatment will make it easier to handle.  Clinicians and “front-line” professionals have been given more technology and research to help with the detection of the concussion.  However, the MOST IMPORTANT tool Continue reading

NHL GM’s To Meet

Boca Raton, Florida will be the site for the “Spring” meetings of the National Hockey League’s General Managers as they discuss League issues.  I bet you cannot think of what might be the hottest topic.  Last March the GM’s came up with Rule 48; penalizing players for blind side hits to the head.  As USA Today and Kevin Allen note those types of hits are down, but the concussions are up;

“The concussions resulting from hits to the head, whether you categorize them as legal or illegal, are actually down this year,” said Bill Daly, the NHL’s deputy commissioner. “For whatever reason, we are getting more concussions, either from accidental contacts or secondary contacts, by a player hitting his head on the ice, after being hit legally body to body or hitting his head against the boards.”

Concussions were going to be on the docket this week, however there seems to be more urgency since the Chara/Pacioretty incident in Montreal last week.  The hit was ruled “part of the game” and as one of our writers, Nick Mercer put it, those hits are exactly the ones causing the concussions across the league.

What the GM’s need to understand is that there is a myriad of events occurring that are causing the numbers to rise.  Continue reading

SD a Signature Away & IL Makes Changes

We highlighted, a while back, South Dakota pushing a bill through the state legislature, but as of today it only needs the Governor’s signature.  It is not without some questions, like the Illinois bill.

Senate Bill 149, also known as concussion legislation, is now on its way to the Governor’s desk for his signature. But those who support the bill say there’s still more to be done.

Kelli Grant of discussed the “shortfalls” with the bill, granted this move is a great start.  The main issue, just like Illinois is that the proposed bill only INCLUDES high school athletes sanctioned by the state association.  There is no mechanism for sports that are “club” or for those kids younger than high school age.

I was interviewed yesterday by a local TV station (WAND), about the bill in Illinois and how it can help the young athletes, and I made the same point that the article from South Dakota was making.  It is a great start, for both SD and IL, but if lawmakers are truly concerned for the safety of youth athletes more should be done.


Specifically speaking on Illinois, Continue reading

Professional Athlete With Proper Perspective

We all know that head injuries can be sustained anywhere at anytime, obviously concussions occur at a higher rate in sports.  Non “mainstream” sports in America have their share of concussions as well, in fact sports like soccer, rugby and woman’s hockey have an extremely high incidence rate of concussions.  Perhaps some of the professional players in the more “recognized” sports can take a clue from a professional soccer player.

After Tyler Twellman has his career soccer career cut short by reoccurring symptoms of concussions other players are starting to realize there is more to life than soccer.  Take for example Chad Marshall, of the Columbus Crew;

The next head injury Chad Marshall suffers could be the last of the hulking Crew defender’s Major League Soccer career.Marshall is expected to play tonight in an exhibition game against New England after missing time because of concussion-like symptoms following a head injury on Feb. 21. He said the end is possible every time he takes a blow to the head.

“Every time I get hit in the head or kicked in the face, my mind immediately goes there,” said Marshall, who has suffered from concussion-like symptoms following head injuries at least seven times in his playing career. “It would be tough to hear someone say I had to stop. But I’m someone who wants to go on and have a family and be able to play with my children without having to stop and go sit down.”

With soccer, and especially as a defender the chances of sustaining a head injury are pretty good.  Granted there is not “full contact” Continue reading

“Ear Infection” for Mike Miller

It is being reported that Mike Miller of the Miami Heat is out for a third straight game, over a week’s time, with an “ear infection”.

Miller is still dealing with the effects of an ear infection and was not cleared to travel with the Heat on Wednesday afternoon’s flight to Chicago. He has missed Miami’s last two games, including Tuesday’s home victory against the Sacramento Kings. Miller also missed last Wednesday’s game at Toronto after he was tested for concussion symptoms last week.

This is a very curious designation of injury for Miller, in lieu of what we and other have reported that happened last week.

Miami Heat guard Mike Miller was taken to an Indianapolis hospital for tests and observation Tuesday night after suffering a blow to the head for the third consecutive game.  Miller will not travel with the Heat to Toronto and will not play against the Raptors Wednesday night.

Perhaps he was infected when he was in Indy?  Or, wait…  While in the hospital, Miller contracted the ear infection.  If you cannot detect the sarcasm, I am sorry, but Miller and the Heat are raising some eyebrows.  Now it is completely possible that Miller has actual observable conditions of an ear infection (fluid in the tympanic membrane) but the fact Continue reading

Illinois State Wrestling Take 2

After we chronicled the events in the Class A 160 pound weight class and the curious surroundings we have found an example in the same tournament on the same days with a DRASTICALLY different outcome.

Not unlike Andy Hoselton of Prairie Central who had an unblemished record going in, Nick Fontanetta of Crystal Lake South was hoping for a State Championship, his weight class is 112 pounds.  After advancing to Saturday’s semi finals with as much ease as possible this happened;

But disaster struck the Gators’ junior in his Saturday morning match against Joliet Central Trayvon Zabala.

The Steelmen sophomore caught Fontanetta in a vulnerable position, and his violent takedown sent the Gators’ standout to a local hospital.

Granted Fontanetta did go to a hospital and Hoselton did not, based upon reports (all inquiries about the EXACT circumstances of the Hoselton/Cain match have not be returned) both wrestlers sustained a head injury.

“He suffered a concussion,” South coach Ross Ryan said.

Speaking about Fontanetta, but rather than being allowed to return, the junior was not give the OK to return to the mat and thus Continue reading

Better concussion policy: NFL, NHL or MTV?

When MTV takes more decisive action than the NFL or NHL, perhaps it’s time to look at who makes the final decision in pro sports. ‘Pro’ being the operative word.

MTV’s The Challenge isn’t technically a sport. Unless you hear ESPN’s Bill Simmons and Dave Jacoby talk about it. They’re probably on to something – it should be the fifth main sport. If you haven’t seen the show (it’s not in-season, but it is here), this season – The Challenge: Cutthroat – provided a good example of why everyone should pay attention to concussions. Seriously. MTV.

It’s not like Jersey Shore (but there is drunk fighting and debauchery), it’s more like Survivor meets a gym (30 contestants, 9 challenges). Unlike the quirky challenges in which ‘castaways’ compete, the competitions in The Challenge are extremely physical. Case in point was a team challenge this season in which the contestants had to dive/jump from a moving platform into a pond and then swim a circuit. Chet, a member of the red team, landed awkwardly on the water, and once on the shore he was attended to by paramedics, brought to hospital, diagnosed with a concussion and told he wasn’t allowed to compete anymore.

What made Chet’s removal an easy decision for MTV was at least partly because Chet wasn’t a professional MTV contestant. His career was not The Challenge (at least, I hope not). Whatever his eventual career choice Continue reading