Pop Warner Changes

It is about time someone took a proactive step in football.  The sport is not the sacred cow everyone thinks it is; football is touchable by the courts and deep pockets, it is “when” not “if” when it comes to disruption of the sport.  However Pop Warner football actually took a very bright and forward step in limiting contact for its players;

Pop Warner is limiting contact in practice as part of an effort to reduce players’ risk of concussion. Pop Warner’s medical advisory board made the announcement this week.

Under the new regulations, coaches must limit contact to no more than one-third of their practice time. It also is banning full-speed, head-on blocking or tackling drills in which players line up more than three yards apart. Coaches can have full-speed drills in which players approach each other at an angle but “not straight ahead into each other.” There also should be no head-to-head contact.

HOWEVER!!!  (Always seems to be that or a ‘but’ with me)…  There still can be contact Continue reading

Limiting Head Trauma is Logical

The research is starting to come in; the problem is that results and conclusions bring more questions that should be answered.  Naturally some will look at early evidence and make a 180 degree change on their attitudes about certain things.  We are talking about concussions and the research associated with it.  Unfortunately there is plenty of anecdotal and observational cases that sear into our memory, this perhaps shape our thought process.  Along with that there is gathering evidence that supports some sort of process change in how we handle this particular injury.

The need to make change is upon us, that cannot be debated; what can be debated is how or what the changes should be.  I recently read an article where Micky Collins of UPMC said something to the effect of current concussion concern is like a pendulum that has swung all the way to the other side.  Although the changes in sports and activities has certainly not taken that full swing the other way, the pendulum is on the way.  His feelings, like mine is that there is no evidence to suggest that a full swing to the other side is warranted, rather there needs to be competent and complete understanding of what we are facing.  Rather than making full sweeping changes that would be akin to digging up your backyard to rid your self of a mole; when placing traps and poisons and maybe only having to dig up a small section would fix the problem.

There are definitely things we can do as parents, players, coaches, researchers, doctors and concerned people in general to make a dent in the issue.  If we find that the changes are not working then taking another aggressive step may be necessary.  I guess the reason for the above rant is to reinforce the need for changes, but the right changes.  (As I wrote the last sentence I realized how do we know if the changes are the “right” ones; I guess we don’t but certainly what is happening now needs attention).

One of the small changes that can be made is very obvious to me; Continue reading

Commentary on Proposal for Limiting Contact in HS Football

It has been over a week now since I wrote the high school sanctioning body in Illinois about making a change to limit contact in high school football.  This was not done to promote myself, nor was it to hammer a sport many – including me – love.  It was an attempt to get out in front of the issue and make proactive changes to protect not only the players but the game of football.  It is a genuine good intention on my part.

Since the letter went out via email and on this blog I have had many responses from many different people and places.  There have been questions and comments about what was written and in this post I will address as many as possible.

Let us begin with the deafening silence on the issue.  As in only one email in response (24 sent out) from the IHSA and its board of directors.  That response was as follows; “Thanks, Dustin”.  Yup that is it.  Not that I was expecting an invitation to HQ to break this down but maybe some questions or comments or stonewalling, nope – nothing.

==========

Cost became a hot topic on this proposal.  Yes, I concede that hiring an athletic trainer will cost you some money, but seriously would you send you kid to a swimming pool without a life guard?  It is the same thing as sudden death, Continue reading

Open Letter and Proposals to IHSA about Concussions

I have been working on this letter for a little while but was really spurred to action by the parent in Maryland, Tom Hearn who discussed his concerns with the local school board.  I have tried and tried to use the “chain-of-command” with these thoughts and ideas, however at every step I got the feeling I would have to go alone on this, so I have.  This letter may or may not reflect the opinions of my employer, high school, athletic training sanctioning bodies, or others I am involved with.  This letter is from a concerned individual who feels I can spread the message effectively by these means.  I have emailed the letter, proposals and the Sports Legacy Institute Hit Count White Paper to all Executive Directors and Board of Directors of the Illinois High School Association.

OPEN LETTER

May 15, 2012

Illinois High School Association
c/o: Marty Hickman, Executive Director
2175 McGraw Drive
Bloomington, IL 61704-6011
(309) 663-7479 – fax

Dear IHSA – Executive Directors, Board of Directors and Sports Med Advisory Board:

I am writing this letter to address the growing concern of concussions in sports, mainly in football.  It should be noted that football is not the only sport with a concussion issue; however this sport combines the highest participation, highest risk, and highest visibility.  This letter should not be construed as an attack on the sport of football, but rather a way to keep the sport continuing to grow.

As a licensed and practicing Athletic Trainer, researcher, commenter, father, and survivor of too many concussions, I feel that in order to keep the sports we love, proactive steps must be taken.  Often being proactive is a painful process and easily dismissed because of the trouble it will cause.  I urge all involved to think about what the future of all sports will be if nothing is done.

The Illinois State Legislature with the IHSA took the initiative by creating a mechanism of concussion education and awareness in response to the mounting scientific evidence of potential long-term impairments resulting from mishandling of this injury.  However, this only represents a first step in the process; passing out a flyer or having parents and athletes initial that they have read the information is one small element of the issue.  Another crucial element of the issue is coaching. We must ensure that those we entrust with the care and leadership of our children understand Continue reading

Are Our Kids Guinea Pigs for Concussions

This is not a “nuclear” question or statement, it is an observation – brought to the forefront by Irv Muchnick of BeyondChron.  Irv has the ability to write and raise questions that many do not want to address nor face, but he does make you think if you take the time to read.  As I heard a wise man once tell me; “read and listen to all sides even if you don’t agree”.  There are many reasons for this I have gathered over time, but the most important is that others seem to provoke more thoughts and further information.

Today Irv posted an editorial about how he thinks our children are now the subject of trial and error in the realm of concussions;

The toothpaste of “concussion awareness” is out of the tube, oozing like spinal fluid. When all the solutions have been implemented and (mostly not) paid for, more or less the same critical mass of bad outcomes will happen anyway. These include, silently, insidiously, the killing of brain tissue over time. And if I happen to be exaggerating a tad, who among us really want to volunteer their sons for the next generation of guinea pigs in the “control groups” of NFL-underwritten “peer-reviewed literature”?

Yes, football promotes some good values, such as teamwork and community. So does Continue reading

Barca Gets It: so it seems

In a tough match against Chelsea, Barcelona defender Gerard Pique took a shot to the head from the keeper that resulted in immediate Fencing Response. (Video below, sorry for the music all I could find)

Not only was he removed from the game the club has taken a stance that I feel all professional clubs should take with ANY concussion, not only the ones resulting in obvious signs like the Fencing Response; Continue reading

Thought We Could Help Out the Player Safety Czar

Below is our suggestions for the NHL regarding the Raffi Torres hit from last night – BTW it was described by me as pure thuggery – regardless after some time thinking we have composed our thoughts in the format used by the league;

Option A

I am Brendan Shanahan of the National Hockey Leagues’ Player Safety.  Tuesday night in Chicago there was an incident that involved Raffi Torres of the Phoenix Coyotes and Marian Hossa of the Chicago Blackhawks.  This particular incident was not penalized at the time but after reviewing the film and interviews we have determined further discipline is warranted.

In the 1st period Raffi Torres hit Hossa in the open ice, but as you can CLEARLY see the puck was not in the vicinity of either player nor was it just immediately played by Hossa.  As Torres delivered the contact he left the ice and his principal point of contact was with his shoulder to the head of Hossa.

This is a clear violation of SO MANY rules; Rule 48 with states […] and Charging which states […] being the main concern.  Also very disturbing is the blatant lack of respect of a fellow player on the ice.

We understand this is playoff hockey but Continue reading

Editorial: NFL Kickoff Removal/Concussions

If you have noticed the sports news cycle you certainly have heard about John Mara and his comments regarding the possible removal of the kickoff in the NFL to protect against injuries, concussions as the main reason.  Mara used the oft cited decline in concussions with the rule change from last year.

Granted the forces changed but also as I stated in my previous post about the decline, reducing the exposure will reduce the incidence.  It would be like taking driving privileges from 16 year old’s and allowing them to drive at 16 1/2.  The number of accidents and fatalities will drop.  It should be noted that in our data collection of concussions we found only two concussions due to kickoffs, the previous season we found six.  Hardly a monumental decrease, but none-the-less a decrease and if they wanted to reduce the chances they did do that.

I am pro-football; with the proper precautions put in place (see athletic trainers and education).  I am even more pro professional football as it is played by adults that should now have all the relevant information regarding player safety.  Continue reading

The NFL Bounty-gate

Why is it that every happenstance of trouble gets tagged with ‘gate’?  I digress…  You may have noted that The Concussion Blog has been rather quiet on the issues surrounding the New Orleans Saints – namely Greg Williams – and their “pay-for-injuring” program.  There are some reasons for this: full information, previous experiences, not totally concussion related, etc.  However after hearing the talking heads around the country delve into the matter more after the explosive audio released (NSFW) yesterday, by Sean Pamphilon, I feel it is time to comment.

Perhaps this problem does not register very high on my meter because I have played sports, or that I have been in football meeting and locker rooms, or that I know and talk with several current and former NFL players.  Regardless this ‘gate’ was neither Continue reading

Rypien Led Lawsuit

With the most recent filing it brings the total number to approximately 960 former players; Mark Rypien might be the biggest known name as a former Super Bowl MVP but there are other players in the suit as well.  Doug Farrar of Yahoo! Sports wrote about the recent suit, noteworthy in the article are the quotes from Tony Mandarich.  Mandarich claims this is not a money grab and has joined the suit because he feels the NFL knew of lasting damage during his playing days and it was never disclosed;

“My main objective is, if they knew about it, they should have been disclosed to us,” Mandarich said. “It would have probably prompted more action like [there is] today in the NFL.”

Mandarich estimated that he suffered six or seven concussions during his six-year career, and as a result, he’s become yet another cautionary tale in the battle to further concussion awareness.

“I don’t want to say recently, but for years I have taken medication for [depression],” Mandarich told Weber. Mandarich also said he also suffers from short-term memory loss and affected speech.

The last comment hits home for me, Continue reading

Published Article in CJoSM Supports ‘Hit Count’

I was forwarded this information from a very astute and prominent concussion researcher for my take and information.  The Clinical Journal of Sports Medicine published an article regarding the under-reporting of concussions.  The authors are: Greenwald, Richard M. PhD; Chu, Jeffrey J. MS; Beckwith, Jonathan G. MS; Crisco, Joseph J. PhD.

It is important to note that the authors (as it is disclosed) have an interest in the Head Impact Telemetry System created by Simbex and limited currently to Riddell helmets.  With that out-of-the-way the article exposes the bigger problem with concussions with competitive athlete; the subjective nature of the injury and the self-reporting;

We typically cannot “see” a brain injury, and even with increased public and medical awareness about the serious nature of any brain injury, a “warrior mentality” inspires many athletes to continue to play. Contemporary, more stringent guidelines proscribing a same-day return to play may actually fuel underreporting of symptoms by some athletes. It is therefore critical that improved techniques for identifying athletes at increased risk of developing brain injury be implemented at all levels of play.

Prevention of brain injury should be a priority. Athletes in contact sports are exposed to head impacts, Continue reading

How Can This Be?

A group of researchers including R. Dawn Comstock released data, published earlier this year, regarding concussions what was initially found is not surprising, or shouldn’t be;

Of 14,635 high-school sports injuries reported during the 2008-10 school years, 1,936 (13.2 percent) were concussions, according to an epidemiological study published in January in the American Journal of Sports Medicine. This was nearly twice the rate reported in earlier studies of high-school athletes.

Part of the reason the increase exists is because of the inclusion of boys hockey and lacrosse, however taking that away there would be a significant increase otherwise.  This too can be attributed to the increased awareness and better assessment of concussions.  It is of my opinion that we are just now on the verge of finding the “true” rate of concussions, for many years it has been under-reported due to the lack of understanding/awareness (also an issue with general and serious injury tracking as well, see Matt Chaney)

What makes this research “eye-opening” is what the researches found about recovery; Continue reading

Concussion – After Injury Care

Most cases of concussion resolve spontaneously over time, we have had discussions on here that vary from 72 hours to 6 months or longer – however, people/researchers are trying to find a way to help along recovery.  Most of this is an inexact science, to say the least, it is almost the ol’ adage of “throw crap on the wall and see if it sticks.”

Lindsay Barton wrote a great summation of current ideas for therapy for lingering effects of concussion, in some cases being classified as PCS, or post concussion syndrome, for Mom’s Team.  I do like his list which includes;

  • Craniosacral therapy
  • Chiropractic Neurology
  • Vestibular Rehabilitation
  • Amantadine
  • “Buffalo Protocol”
  • Epsom Salts

The first three are very “hands on” Continue reading

Family Travels Long Road of Recovery – TCB Suggestion

Brooke de Lynch of Mom’s Team sent over this article and video about a family and their dealings with post-concussion syndrome and the long recovery after a very “innocent” looking hit.  It begins as most complex cases often do, with incorrect initial management;

On the evening of Friday, February 12, 2010, my then 15-year-old daughter Heidi was hit on the head by the stick of a teammate as she was warming up in goal before a hockey game.

It was not a catastrophic brain injury requiring a trip by ambulance to the hospital. But the blow did result in a concussion; one that turned out to be far more severe, complicated and long-lasting than initially thought.

Because multiple mistakes were made in the immediate aftermath of the injury by all parties – including by me, her mother – which exacerbated her symptoms, that cold winter’s night marked the beginning of what would turn out to be a fourteen-month long search for answers to the enigmatic riddle that is post-concussion syndrome.

Another great perspective from a mom, this time about a girls hockey player.

Listen, all cases are not as drawn out like this one, in fact stats tell us that some 75-90% of all cases of mTBI/concussion recover in 7-10 days.  Remember that the “recover” portion of that last sentence is from symptoms AT REST.  This brings me to my soap box moment of the day… Continue reading

Mom Seeking Answers and Insight

There are great websites out there to visit to find information about injuries and concussions, I hope this is a good resource for all of you.  We are not the be-all-end-all rather just a piece of the puzzle when it comes to awareness.  There is a great site that is devoted to the Mom’s of the world called “Mom’s Team“, headed by Brooke de Lynch.  A serial emailer sent along a recent letter a concerned mom had about a concussion her son endured while playing tackle football – her son’s age… 8;

The following is a redacted version of a letter one mom of a concussed young football player recently sent to her state legislators in a Midwestern state:

Dear _________________:

As the mother of an eight-year-old who sustained a concussion during bantam football practice, I believe it is essential for the provisions of our state’s youth sports concussion safety law to be applied to all children participating in contact and collision sports held on school grounds. The injuries which occurred on my son’s team of approximately 25 third- and fourth-graders clearly demonstrate that concussion information is necessary for these players, their parents, and their coaches.

The letter is very compelling and articulate, it is worth the jump and read Continue reading

This is a Problem!

Opening up the email today I saw several articles sent in from various readers, a lot are very intriguing and wish I could comment on all of them, like the recent Grantland article about football collapsing, from the view of economists Tyler Cowen and Kevin Grier.  As you all know this blog is a hobby/devotion based upon free time away from job and family so I try to do my best.

HOWEVER, once in a while there are articles that I must find time for; hopefully good, but in this case a complete head scratcher.  I would like to thank a fellow athletic trainer, Brett Gustman, from Virginia for sending this my way.

———-

If your doctor tells you that because your heart is exposed to greater danger due to some factor, he would suggest that you not eat Big Mac’s any more; would you listen to him/her?  How bout your doctor told you that going jogging on a broken ankle is a bad idea; would you listen?

How about a doctor telling you Continue reading

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

Good Idea, but Take Care of Own First

I get why its being done.  In fact I agree with the principle behind the letters to the states, however it is tough to ask for someone to do something that you yourself have a difficult time doing/policing.  The NFL and NCAA sent out letters to 19 Governors asking them to consider concussion legislation (via USAToday);

NFL Commissioner Roger Goodell and NCAA President Mark Emmert are urging 19 governors to support legislation this year aimed at cutting down on concussions in youth football.

Goodell and Emmert sent letters Thursday to governors of states — such as Florida, Ohio and Wisconsin — they said do not have something akin to Washington state’s “Zackery Lystedt Law,” named for a middle school football player who sustained brain damage after he got a concussion and returned to play.

Although both the NFL and NCAA have outlined “guidelines” and mechanisms for concussions themselves, they do have a hard time enforcing them.  A quick glance at just this blog unearths some serious issues: Kris Dielman, Mike Vick, Huffgate, and Bonnergate just to highlight a few.  Just think how difficult that is for an entire state with more than one level and one sport to worry about.  The NCAA should be able to help, but even there they are “recommendations/guidelines”, there are no teeth to the rules.

Legislation is good, but only good for one reason in my opinion: awareness.  That is it, because there are ways to skirt the Continue reading

What Are Concussions Costing NFL Owners?

I was approached by a reader to figure out what concussions are “theoretically” costing owners/teams in terms of salary.  His thought, a good one, was to illustrate the economic impact to the NFL and owners that an investment in a completely independent concussion “think tank” could save money in the long run.  The last time we ran the numbers was in week 13, we are efforting the final numbers for 2011.

There were some limitations in determining this overall impact to the owners:

  • Finding exact contract information for each player
  • Determining exact loss of game time due to concussion
  • Exactly accurate listings of injury

To our knowledge there is no published information on this topic, therefore this presentation of information is the first of its kind, and we truly understand that this is not 100% accurate, but it does give an idea of what is happening in terms of concussion and lost salary.

Based upon our findings the average salary for a concussed player/game in the NFL through 13 weeks was Continue reading

Sport of Lacrosse: A view from Dr. Cantu

Have I mentioned that I really LOVE you readers?  In case you have missed it, I do love all of you; you make this blog better every day.  In the mailbag today was an article forwarded to me from a family about lacrosse.  The article is from Inside Lacrosse the January issue, written by Terry Foy.  The article is a question and answer with Dr. Robert Cantu and has wonderful-insightful questions and answers.

Because I cannot in good conscience rip off the entire article I will provide the questions by Inside Lacrosse and some quotes, but mostly summations of the answers by Cantu.  Make sure you visit the article for all the information.

  • How familiar are you with men’s and women’s lacrosse?
    • Just like our stance on woman’s lacrosse, Dr. Cantu is very adamant about putting head-gear on players in that subset of the sport.
  • Are helmets one of the primary actors in diminishing the amount of concussions in lacrosse?
    • Depending on the actual cause of the injury helmets can help in decreasing the amount.  Dr. Cantu’s information provides him with data that show most woman’s lacrosse concussions come from stick strikes to the head.  He is correct in estimating that putting helmets on woman would decrease concussions in that case.  He does echo what we have been telling you from day one; helmets do not prevent the primary reason for concussions in collision sports (rotational forces).
  • Because the NFL changed their rules to protect from head injuries, do you think lacrosse, aside from adding helmets on the women’s side, needs to adjust any rules to create the same protection? Continue reading

Recent Trend

The real job of this author not only includes being an athletic trainer for a local high school, but also doing rehabilitation on the entire spectrum of the population.  However, from time-to-time I am called upon to be a physician extender in a sports medicine doctors office.  The past few weeks I have been doing that more frequently and have noticed a very surprising trend.

Granted there is no “scientific evidence” of this trend, rather just my observation and upon asking questions to the doctor and the rest of the regular staff, they too have noticed relatively the same thing.

As we have progressed in the concussion era the doctor that we work for has been near the front on the concussion issue.  To his credit he used all the resources in the program to develop this progressive attitude and has taken all of his information along with others and developed a comprehensive concussion program.  When he started many, including some athletic trainers in the sports med program were in disagreement with the longevity and “conservative” nature of the treatment/management.  That quickly subsided with much of the evidence we have seen in the recent year, but it never really translated to acceptance among local coaches, school administrations, and players/parents.

All of the original skepticism about concussion care has slowly been washed away and this doctor has been accepted as one of the “go-to” guys in the area for this injury.  This is not the trend I speak of, although it is very nice to see; all the hard work of the athletic trainers has begun to sink in.

Rather the trend I am beginning to see is something mirrored in the national/international press Continue reading

Law Suit Overview by NYT

Ken Belson took a stark look at the law suits facing the NFL about head and brain trauma, over a dozen at this time.  The plaintiffs in these cases are going to fight an uphill battle, from resources to even getting the case to trial;

Taken together, the suits filed in courts across the country amount to a multifront legal challenge to the league and to the game itself. While the retired players, including stars like Jim McMahon and Jamal Lewis, face a time-consuming and difficult battle, the N.F.L. will have to spend heavily on lawyers to fend off the chance that juries might award the retired players millions of dollars in damages.

The league must also grapple with unflattering publicity as former players claiming to be hobbled by injuries and, in some cases, suffering from financial problems sue their former employer, the steward of America’s most popular sport. The stakes will only get higher if any of the cases go to trial, where details may emerge about what the N.F.L. knew about concussions and when, how it handled that information, and whether it pushed manufacturers to make the safest helmets possible.

Belson makes some valid points on behalf of both the players and the league; Continue reading

The Concussion Tipping Point

In The Tipping Point by Malcolm Gladwell, he notes that there are 3 rules of epidemics (in this case, the galvanizing of support for concussion awareness/understanding): 1) the Law of the Few, 2) the Stickiness Factor, 3) the Power of Context. Concussions and all brain injury are issues that need to become epidemics to gain any real level of support. Support that is now seriously lacking. I will try to apply each of these 3 rules to concussion/brain injury understanding and awareness.

1) The Law of the Few. Gladwell talks about a Paul Revere’s midnight ride and further breaks down this rule into 3 parts (Mavens, Connectors and Salesmen). It seems to me that telling people they need to know learn something or they should support something, inevitably spawns a level of resentment, however subconscious this is and however well-meaning someone is to a cause. Guilt is not a sales technique that will keep people interested and it doesn’t encourage people to spread the message. With the huge sports media and others constantly bringing up the issue, concussions have been a prevailing issue in hockey and football, Continue reading

Crosby has patience, what about the sports media?

It was really exciting seeing Crosby score his first (and second) goal and play so well the entire night!

One thing that many in the sports media overlook, however, is the importance of fatigue with brain injury. I don’t know how much fatigue has effected Crosby, but I would caution them that even though he can play well, with lots of energy for a game or a few games, there could very well be days when his body kind of shuts down or doesn’t react as quickly as he’d like. Before the hockey commentators anoint him scoring champion, I wouldn’t be surprised to see him miss a game or two based on fatigue or other concussion symptoms.
This is by no means a medical assessment, Continue reading

NYU Expert Panel Discussion

Last Tuesday the New York University and its Langone Medical Center hosted a panel discussion about the ethics and responsibility of who handles injuries on the field of play, including/focusing on concussions.  The list of those taking part in the activity is very lengthy, here is a sampling; Harry Carson, Chris Nowinski, Brendan Shanahan and other MD/DO/important people in this area.

What come from the panel re: concussions was not breaking news rather one of erasing a stigma;

  • Understand the issues: A great deal has been learned about concussions in the last 10 years, but they are complex and can be difficult to diagnose, especially on the field. While medical, sports and equipment experts are working to evolve technology, guidelines and rules to keep contact sports safe – equipment alone does not protect the brain from being jarred during contact.
  • Awareness is vital: The more players, trainers, coaches, parents and sports organizers understand about the real – and often hidden – dangers of head injuries, the more likely the right decisions will be made on the practice field, sideline or locker room. Professional leagues, retired players and other advocacy groups also help the medical community develop best practices and support better awareness in youth and recreational programs. The media and internet play a key role in providing information on the potential long-term dangers of head injuries.
  • Everyone is responsible: All panelists agreed – no matter what the age or level of play – when a potential injury to the brain is involved there is no gray area: athletes must be removed from play and receive appropriate medical attention despite any desire of the athlete, and even a parent, to continue playing.

The only issue I take with this press release and “take away message” is the very fist sentence of the first bullet point.  Concussions are Continue reading