Concussions

Illinois Paves the Way for HS Football Policy

Dustin Fink6 Comments

ihsa-1487882592-2402It has been a long time coming… Not a new post on this blog, rather, a proactive and thoughtful policy/plan for high school football safety. This process has not been easy and there is no way I can take full credit for this but I do have some rather exciting news regarding something that I, personally, have been working on for six years.

Today the Illinois High School Association Board of Directors approved a new policy, Policy 13 that states:

Weekly Player Limitations for Football
1. A player shall not play in more than 2 games in any one week, and shall not play in more than one game in a single day. For the purposes of this section, a week is defined as the seven-day period running from Sunday through the following Saturday. (It is recommended that if a player does play in 2 games in a given week, one of those games is only as a one way player. [i.e., only plays on offense or defense or special teams])]
2. Players cannot play in games on consecutive days or be involved in live contact/thud in practice the day after playing in a game.
3. 1 play in a game equals a game played.
NOTE: If a player plays in a game that is stopped due to weather or other circumstances and completed the next day, the player can participate in the resumed game the following day.

Back in 2012 I wrote this piece on what I thought would be a better way to protect our athletes Continue reading →

EIM Concussion Management: Half Way

Dustin Fink9 Comments

Sure, this is the fifth post of 2016 – and its July – however there is a good reason for it. I continue to be an on the field athletic trainer, I continue to educate on concussion, I continue to be active on Twitter but more importantly I am concentrating more on being a father and husband. Blogging ain’t easy, folks; let’s be honest the coverage of concussion has blossomed well since 2009 when this blog started.

All of that being said, I am also in the process of gaining further education in concussion. This is not your typical education about the injury but right were my mantra for the past six years has been:

The injury of concussion is not the true problem; it is the mismanagement of this brain injury that is the real issue.

As noted in March I began the Evidence in Motion Concussion Management Course. This is a 34 week program that was designed to bring collaboration and current information to those that can impact the real problem of this injury, the clinicians.

We have arrived at the half way point in the program, marked by the weekend intensive course – which met in Chicago this past weekend. Many have wanted to know has it been worth it. The answer is unequivocally, YES.

Before I get to the hands on of the weekend let me recap the first half of the program. One word cannot do it justice but in our search for snippets of information and quick reaction, that one word could be “trailblazing”.

Previously I wrote about how the program was basically going in terms of mechanics and what we were doing at the time. Since then I have read more research (current), discussed, and most importantly learned how to better help those that have been concussed.

We finished the Therapeutic Neuroscience Education and moved into the specifics of the concussion and its management. We spent a week on each of the following parts of the concussion continuum:

  • Emergency Department – evolution and how they view the injury
  • Orthopedics – how concussion relates to bones and muscles (neck)
  • Vestibular Rehab – not only the vestib system but really focusing on the eyes
  • Adult/Migraines – a previously unthought of link/predisposition for concussion
  • Vision Rehab – what I feel will be the next area of focus for recovery from concussion
  • Neuropsych/Return to Learn – how we all fit together in these areas as clinicians
  • Speech Language Pathology – unknown to me how these professionals can and will help

Those seven weeks, plus the last week of summary were probably the most challenging Continue reading →

#pinkTBI Summit 2016: A recap

Dustin Fink4 Comments

pinktbiThe meeting at Georgetown University this past weekend was more than fruitful for this athletic trainer. I went in trying to get two things done: one, provide info to you the follower as best as possible and move along the discussion on female concussion and two, to learn something that is applicable to me as a “boot on the ground” athletic trainer.

The first was probably painfully obvious that I accomplished if you follow on Twitter and didn’t mute me and were not interested in this event (you should have been interested). The second objective I did meet by learning some techniques when working with females, not only at incident but with recovery, education and overall attitude.

Certainly I could write 4000 words on this event but that would be boring to you and I am still recovering from the weekend the the docs there asked that I “rest” my fingers. That being said I will give quick synopsis’s of each speaker, info that I took away as an athletic trainer and advocate for education about mTBI/concussion. It is entirely possible that I misrepresented some thoughts and missed some very valuable info for some out there; don’t worry speakers and audience this was done the best possible.

Lets begin, and this will be in chronological order of the event with presenters last name, in bullet form. My hope is that you will use this as furthering your info about the female sequale and in some cases change how you treat.

  • Kerr:
    • The concussion rate is higher in females in males in college and high school sports, particularly in basketball, soccer, and softball/baseball.
    • Research suggests differences in symptoms reported as well as RTP.
    • More research needed at the youth level.
  • Covassin:
    • Showed that neck strength is a confounding effect on possible injury.
    • MOI is different in the sexes: males contact with player while female is contact with ground/equipment.
  • Lincoln:
    • Exposed us to the lacrosse injury and problems that exist, which is important because this is an emerging sport.
    • No head gear in woman’s lacrosse.
  • Casswell:
    • Impact sensors and injury and how it may relate to injury.
    • Different types of injury for females vs. males (building on Covassin).
  • Colantonio:
    • Logitudial study showed about 24% of female pop has had mTBI.
    • Females seek and get less care overall.
    • Reproductive impact after a mTBI need to be understood.
  • Gioa:
    • Static and dynamic symptoms are different in female vs. males – needs research.
    • Academic performance shows no difference between sexes.  Continue reading →

International Summit on Female Concussions and TBI

Dustin Fink3 Comments

I am very excited to inform you and implore you to attend this first of its kind conference. Katherine Snedaker – a good friend and ally – along with her planning committee have done a wonderful job of creating a great place to discuss a subset of this head injury issue.

The International Summit on Female Concussions and TBI will be held a month from now at Georgetown University in Washington, DC. This summit is unique because this will only be about sex and gender-based research on females, from pediatrics to the elderly.

As much as we think we know about head injuries and concussions we don’t know squat, globally. Let alone in one gender over the other; females have been painfully overlooked/lack of attention because most of the noise and spotlight is on male dominated sports. Although, females choose to play many of the collision sports (rugby, hockey, lacrosse) there are other issues we know that impact females differently.

The summit is over two days and will eventually culminate in a consensus statement about female issues surrounding and within the concussion paradigm. This is also going to be a first of its kind, and appreciated at least from me.

The Topics (briefly summarized):

  • Menstrual Phase and its impact
  • Age and Sex and its impact on symptoms
  • Domestic Violence
  • Female Soldiers
  • Pediatrics
  • Female Sport Concussions
  • Concussion Recovery male vs. female
  • Female RIO Data
  • Clinical Spectroscopy of Female brain
  • Return to School
  • Social Interactions
  • Ice Skaters
  • Psychology of Concussoin
  • And more

Here are the presenters, moderators and planning committee members (as of this post):  Continue reading →

Thoughts on everything we are hearing and will see: An opinion

Dustin Fink9 Comments

Certainly we are nearing a “too much” point in terms of concussion for most of the country. For others this is just the continuation of what we have been doing for years. From a personal perspective I do like the attention that the discovery process is getting. I am all for people getting all the info possible to make informed decisions.

I want to take this particular space in this post to assert that I am not – nor have I ever – been against any sport including football. I am, transparently, supporting flag and non-tackle football until high school. Yes, no scientific evidence proves this helps/hurts, but in all my work and research I am of the opinion that less dosage of repetitive brain trauma is better for humans.

That is where we stand, the issue really is one of repetitive brain trauma (RBT), not of sports or accidents or leisure activities. As Dr. Omalu clearly stated in his interview with Matt Chaney in 2011 and again today with Mike & Mike (hour 4); the brain does not heal itself. Damaging it, even on the microscopic level can and will leave a lasting impact. This is not just assumption, it is noted in many different studies regarding brain health after activities (see Purdue).

I am confident that with proper healing time and avoidance of re-injury the brain will find a way to function at or even better (proper learning and congnitive functioning) as people get older. The management of not only the “gross” injury of concussion and TBI is one that is getting better and as we get more research the management of the subconcussive hits and exposure, that too will be satisfactory.

What we all must do is take off the “emotional pants” and wade through the muck to find out what is important for us to make decisions for those that are not capable or even legal. Part of this is discourse and discussion (civil would be best). Everyone will be challenged intellectually and morally with this – it’s OK.

I noticed an article written by Irv Muchnick yesterday Continue reading →

Before ‘Concussion’ Omalu was still Omalu

Dustin Fink4 Comments

In two weeks time people will be going to the movies to see the screen adaptation of a forensic pathologist that unintentionally made the giant business of the N.F.L. weak in the knees. In the movie ‘Concussion‘ mega-actor Will Smith becomes a little known West African doctor, Bennet Omalu.

To many Dr. Omlau has been a recent discovery due mainly to this movie but also the discussion surrounding it, including Dr. Omalu’s op-ed piece in the New York Times. To a small circle of people his work and voice has been around much longer.

Early in 2011 Matt Chaney – a tireless cataloger of football catastrophic injuries and outspoken author/journalist – had an interview with Dr. Omalu. In this interview you can see that Dr. Omalu is still the same concerned medical practitioner as he is now.

With permission from Matt, I am publishing the transcript of his interview. Do with this what you will but Dr. Omalu takes on all sorts of issues surrounding the concussion discussion.

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BENNET OMALU

January 15, 2011 by telephone with Matt Chaney

Q. What football likes to do; this is what I learned in 20 years in the anti-doping issue, where we have so-called testing, and protection of players against drug use. Foremost, it’s very clear now, according to a host of experts worldwide, that so-called testing for steroids is bogus. It does not work. It’s invalid. It has huge faults in terms of its applications. Well, point being, football especially—but other sports too, especially the Olympics, and baseball, are learning by their example—football likes to [chuckle]… When it has a problem for which it’s being criticized for, it likes to go out and stable the science. It likes to go out and fund and/or hire scientists, to put together its prevention packages, and act like everything’s hunky-dory. And they do not share their science. They say they have a test, but they do not open it up to [peer review]—

Omalu: [he interrupts] A very good example, because WWE’s guilty of the same thing.

Q. Oh, really?

Omalu: This so-called ImPACT testing. That is a fraud, in my opinion. ImPACT testing is not a diagnosis tool. It is a forensic followup [model] to monitoring, to quantify or to evaluate the amount of damage. And to monitor, to see how a patient is improving.

Using the ImPACT testing in the acute phase of injury, to determine the amount of damage, actually makes the damage worse. Am I making sense?

Q. Oh, yes. Yes.

If anything, it actually makes the damage worse. OK.

I can allow you to re-cord if we’re going to talk about the science of concussions. You can re-cord, yes [pronouncing like ‘hit record’] …strictly the science ..… Just ask me questions specifically on the science.

Q. Yes, that’s kinda what I’m—what I’m interested in is the science. Let me say straight up I totally agree with your link of brain damage to football. I’m not even worried about that. I, I am, I totally agree with it, I have expert scientists, especially Chuck Yesalis of Penn State, who loves your literature, he loves your evidence, and he is also an historian on boxing injuries. He is well-familiar—he knows much of the literature that you’ve often referred to from boxing, as far as long-term brain damage—

Omalu: Why don’t you re-cord about, keep your questions strictly of the science. …

 

Continue reading →

Vector Mouthguard Season Wrap Up: Product Review and Impressions

Dustin Fink5 Comments

I find myself in a peculiar situation in regards to the Vector Mouthguard; I have indeed benefited from the relationship as mentioned in the first post about this product. However, I have also been honest and blunt with them while dealing with the product. I have made every attempt to be as objective and neutral on any product or research on this blog, in cases where my integrity may have been perceptually challenged I have noted such.

However, I have looked at many blogs about various products and come to the conclusion that this post is going to be an in-depth product review with my honest feedback. You, the reader, will have to trust – hopefully based on my track record – that it is an unbiased assessment. Heck this is just like the YouTube toy reviews that my and your kids watch constantly, minus the video and my ugly mug.

Enough with the mental hand-wringing and on to the after-season report on the Vector Mouthguard (you can catch up from previous posts with “It’s Actually Happening…“, “Day 1“, “Seeing Is…“, “Practical Application…” and “Ready for Primetime“). The last post about the mouthguard was prior to the first game and our team went on to play 10 games so there were a lot of happenings in regards to the Vector, I could write 3000 5000 words on it but no one would read all of it. I will try to bullet the ups and downs as well as noteworthy case uses. At the end I will attempt to address the common questions I had about this from other professionals, parents, coaches and kids. In advance, thanks for your time and if you have further questions hit up the comment section or my inbox.

Immediately the system had media attention about what we were doing for player safety at the high school as the “strange-looking” mouthguards were on the kids as well as a radar looking device on the sideline. Still in the quasi-euphoric/excitement stage of the process there was this interview that I did (completely independent) and captured the first three weeks of the regular season.

During that time we did have some individual mouthguards that were not functioning as planned/expected and some charging issues with the base units. Through conversations with the tech team at i1biometrics we were able to get everything going that was outside the norm. This is a key piece to note; the customer service was unbelievable and agile. Granted there were not thousands of systems in use and none of them had a loud-mouthed blogger running them, it was still what I can see this company continuing to provide for anyone with this product. A lot of the service could be done remotely or via mail. The grasp of the system and the actual engineers that are part of the solution team make it what it is.

As mentioned I didn’t quite know how or if this was going to change how I “did” things as an athletic trainer. Upon the month-long reflection and review after the season I noticed that I did change what I did. I started using the information provided to put a watchful eye on certain players and to confirm what I did see with my eyes. Or in one case I used it to see what happened to a player that I did not witness but my coaches told me about happening in a game. The system had started to provide me eyes that I don’t have but I never really relied on those eyes, but was happy they were there.

During games I started to Continue reading →

Gridiron Heroes and the Movie

Dustin Fink4 Comments

mv5botqxotq2ntixmv5bml5banbnxkftztgwotazotu3nte-_v1_sy317_cr60214317_al_Being part of the concussion space there are many different things that come to my inbox. Much of that is garbage and thinly veiled attempts at advertising for something that I am not interested in.

A couple of weeks ago I received an email about a movie that I had heard of in passing; Gridiron Heroes. I did not know what it was all about but the co-director, Seth Camillo, encouraged that I see this. He never said it was ground breaking but told me it is “documentary about the important issue of brain and spinal cord injuries that are sustained on the football field.”

I was given the opportunity to screen the film and I must say that I was not disappointed by the hour and 17 minutes. (Trailer below)

It begins with a overview and reason for a foundation called Gridiron Heroes Spinal Cord Injury Foundation; the injury and subsequent paralyzation of Chris Canales. Although rare in occurrence this type of injury does happen on the football field. Instead of being overwhelmed by this difficult situation and blaming the game the Canaleses went about helping others that found them selves in this unfortunate situation.

Catastrophic injury and death should never be tolerated in sport, but like in life there are circumstances where they happen in freak accidents. This is not unlike car accidents that are no fault of anyone and understanding that life comes with some risk. The Gridiron Heroes Spinal Cord Injury Foundation set upon trying to heal and help those that have no clue what is happening and how to come to grips with the “finality” of these injuries.

The movie interviews former professional players – most notably Decon Jones’s raw and honest opinions, “players in the game” like Alan Schwarz, as well as those afflicted regarding the sport and where it sits in their eyes. The movie even takes on the issue of repetitive brain trauma and concussion.

This movie is not about tearing down the game/sport it is about facing the realization that football can be a risky endeavor for some and that instead of ignoring and looking past the issues, taking them on is the better way to approach this.

I am not a movie reviewer, per say, but I can tell you that this is worth your time and money (all profits from the film go to the Gridiron Heroes Spinal Cord Injury Foundation). This would be appropriate for anyone that is around football a lot like coaches and parents. It is not intended to scare but to inform, mainly about the foundation, but about the sport.

Seth Camillo and Andy Lauer did a fine job of telling a trying story not only of Chris Caneles and those like him, but of the sport of football.

You can get the movie on iTunes, Amazon Instant Video, Walmart Entertainment, Google Play and Dish Network.

If you have seen it feel free to comment on it, here.

The Case Keenum Case: Why It Matters

Dustin Fink4 Comments

Adam Schefter said it well on ESPN this morning “This is an abject failure,” in referring to this:

As you may have already have seen and heard about this incident in the St. Louis and Baltimore game yesterday I will not go through all the mechanics of what happened and why this was so utterly ridiculous.

What I would like to focus on with this post is why this matters.

As evidenced by Twitter there are many fans – I would hazard more than who tweeted – who could care less about this. The overriding theme is that the players are professionals and this is no big deal because they are paid to play and they know the risks.

I tend to agree with this, but only at the professional level, they are adults and have as much info as possible. However, in the moment of injury and the few seconds following it the player must be protected from themselves and from further injury. This is why the vaunted and much promoted concussion and injury surveillance protocols are in place.

If there are not people in place to make the decisions that a player cannot make of sound mind, in that moment, then why even have it. Although this is one failure and there have been cases of players being removed due to the policies in place; this one incident goes to show nothing is perfect, even in the face of a most obvious situation.

At some point the players are going to have to put their foot down and demand that the medical personnel take care of them; playing time and winning the game be damned.

This failure on a spectacular level also has ramifications beyond the NFL and even the sport of football.

Allowing Keenum to play, not even missing a snap, sends the wrong message to other players of the sport or sports that are not at the professional level. Can you imagine Continue reading →

Call for Abstracts: National Summit on Female Concussion, TBI and Headache

Dustin Fink4 Comments

pink concIf there has ever been a tenacious and relentless person in the concussion space my observation is that it is this one person. Not a researcher, not a physician, not a policy maker…  A mom… Her name Katherine Snedaker.

She has been mentioned many times (Pink Concussions) here and has been a commentor on this blog as well, but what Katherine is pulling off this coming February is nothing short of monumental for the concussion space.

On Saturday February 27th she will be presenting the National Summit on Female Concussion, TBI and Headache, at the Georgetown School of Medicine.

Part of the program will include presentations of abstracts, which they are currently calling for. The Program Committee is accepting abstracts for presentation on “Sex/Gender-based Concussion Research” on concussion, TBI and headache from the areas such as:

  • Pediatrics to Geriatrics: Concussions and other TBIs across the female life cycle
  • Sports and Sports Medicine – Youth, High School, College, Olympics
  • Domestic Violence and Shaken Baby Syndrome
  • Military Service

As you probably can imagine these areas are so under-researched, mainly because head injuries are often associated with sport and male type activities. However, women are part of this issue to – a huge part. Females are also very different than males in many ways but we have recently have come to know that their response to head injury/concussion is not the same as males.

There will be more to follow on this summit – consider this post as a save the date – “ATs are one of our target groups we want,” Katherine said in an emial.

This post is directly aimed at the researchers in the community that want to share their info at this very important and unique event. Please spread the word about this to anyone you know that would be interested.

From the Call for Abstracts link at Pink Concussions:

Click the brain below to upload your abstract in a PDF form.

  • Abstracts submission portal closes 1/5/16 at 11.00pm EST Abstract acceptance letters will be sent 1/15/2016
  • Abstracts must include: Title, Authors, Affiliations, Background, Objective, Methods, Results, Conclusion plus 2 tables or graphs may be included
  • Abstract character count, excluding spaces and the words “Background, Objective, Methods, Results, Conclusion” is 350 words
  • Only reports of original research may be submitted
  • The data may have been published in a manuscript or e-publication

Address questions to either the Scientific Chair, Dr. Dave Milzman at milzmand@georgetown.edu or Executive DirectorKatherine Snedaker, LMSW at Katherine@PINKconcussions.com

You can also access the submission form HERE.

It is my pleasure to promote this event for someone that I call a friend and someone that has battled more than just stereotypes to bring awareness and education.

Dear @DangeRussWilson… From a High School Athletic Trainer

Dustin Fink3 Comments

Dear Russell Wilson;

Mid-morning yesterday I get a text from a former coach that simply states “Water that helps concussions…thanks Russell Wilson”.

That led me immediately to the interwebs to find out what he was talking about and it took me about 3.576 seconds to get results. You were touting a product that supposedly helped with your concussion, I mean head injury, I mean injury that occurred last year in the playoffs. When I saw this I LOL’ed, seriously I laughed out loud. I thought this was a joke. Alas, it was not.

Then I get to school and another coach asked me about it as well, not so much would it work rather how big of an “idiot” you were (not my words). It was reassuring to know that this coach as well as the other two that stopped me before practice completely understood that this was not possible with what we know. But the fact that they were a little confused, even for the slightest moment, give me pause about what you and others can do with your platform.

I was glad all of this was taking place during school hours and practice so the kids wouldn’t have questions – actually statements about how you know more than me and where to get this. What I didn’t realize was that the parents of the kids had seen this; and wouldn’t you know I had my first email about it at 5pm.

I started to hope this would get out of the news cycle but late last night it picked up steam and this morning, more emails and Continue reading →

Vector Mouthguards – Day 1

Dustin Fink1 Comment

Don’t get to excited, I don’t think I will give you daily updates about the Vector Mouthguards but I do feel that the first day is important on many fronts, including: customer service, supplies, and ease of use out of “box”.

I had previously met with the kids individually and emailed the parents to open a line of communication about what was coming and what we could expect. I also told everyone about my expectations for this system. I received many questions from the kids that I could easily answer (looks, weight, how it works, “will my braces mess it up?”). The parents really only cared about performance and many were excited about it, even the parents of the kids that were not selected to wear them.

We ended up getting enough money to outfit 40 players so I had so select a group of kids that I thought would be a good cross section for what I wanted to know from this. I chose the following people: all varsity starters on both sides of ball except for QB, the 2’s that would be getting the most work on the scout team, players that would play both JV and Varsity, and the remaining were players that are probably not going to see much action – mainly on their own volition in practice or games (if you know what I mean). Within that group I have 4 players that have previous history of concussion, including two that have multiple concussions in their past. This I feel represents the kids that will see the most possible impact throughout the season.

I received the shipment yesterday and included were the mouthguards (lanyards number stickers), the chargers, a computer, the antenna for the system with a tripod and a carrying case for it. All was set up and ready to rock after getting the players and mouthguards into the system.

Today, Tanner Nussbaum from the Green Bay area drove down to help with the fitting and getting system up and running, and hew as on time and ready with all answers to any questions I had conjured up over night. We had the 40 players meet at 1:30 for fitting and computer inputting with final instructions, the last players were done after an hour and 20 minutes. It all went rather smoothly, minus some Continue reading →

OTL Extra: The Discussion About Girls Tackle Football

Dustin Fink2 Comments

ICYMI, on Wednesday Outside the Lines had a feature on the girls football league and the larger issue of concussions in football. The aired show was very good and good discussion was had by all that included Doug Casa, Jane McManus and one time TCB contributor Matt Chaney.

Below is the video of the OTL Extra (third video) of this episode and worth your 12 minutes of time…  Would love to hear some discussion on this…

Minutes From First Illinois Advisory Council on Player Safety

Dustin Fink2 Comments

PSPHlogo“Welcome to a historic event.” Is how Associate Executive Director, Kurt Gibson opened the first meeting of its kind in Illinois and for the Illinois High School Association (IHSA). With the vast majority of the Council present it did not take long for all of us to get to “work”.

The Council (which we shortened to PSAC – Player Safety Advisory Council) dove right into the meat of the issues surrounding sports and player safety. Rather than giving a play-by-play I will let you read the minutes from the meeting (LINK HERE);

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MINUTES OF THE PLAY SMART. PLAY HARD PLAYER SAFETY ADVISORY COUNCIL MEETING June 9, 2015

The Play Smart. Play Hard Player Safety Advisory Council met at the IHSA office in Bloomington, Illinois on Tuesday, June 9, 2015, beginning at 10:00 a.m. Committee members present were Dustin Fink, Sara Flanigan, Tory Lindley, Dennis Piron, and Cole Steward. Also in attendance were Associate Executive Director Kurt Gibson; Assistant Executive Director Matt Troha; and guest, Sports Medicine Advisory Committee member Greg Gaa. Not present were members Tregg Duerson, Senator Napoleon Harris, and Allison Hieb.

ITEMS OF GENERAL DISCUSSION:

1. IHSA administrators Kurt Gibson and Matt Troha welcomed the council to the first meeting of the Play Smart. Play Hard Player Safety Advisory Council.

2. The council reviewed its purpose of monitoring current IHSA programs and initiatives, identifying new areas to advance player safety, and helping communicate the Play Smart. Play Hard vision.

3. The council reviewed the following materials from the IHSA’s Sports Medicine Advisory Committee (SMAC): ● minutes of the committee’s April 2015 meeting ● recommendations made by IHSA’s Football and SMAC regarding football contact ● Managing Heat/Humidity Policy recommendation The council’s feedback on the football contact and Heat Policy recommendations are listed below under items.

4. The council discussed Senate Bill 07, which is currently awaiting signature from Governor Rauner. Among other things, SB 07 creates a Concussion Oversight Team in schools to monitor Return to Play and Return to Learn for student-athletes who have sustained a concussion, requires education on concussions and symptoms for coaches and athletic officials, and requires schools to develop school-specific Emergency Action Plans (EAP’s) to address serious injuries that may occur on campus.

5. The council heard reports from Allison Hieb and Cole Steward, the two student members of the council, on concussion from the perspective of student-athletes. Both students shared the perspective of how their schools have addressed concussion with their student-athletes on both the individual and team level. As a part of that discussion, the council suggested that the IHSA consider developing some kind of post-video assessment be created for students to complete. Additionally, the council thought it may be worthwhile for the IHSA to register and track student-athletes from a sports medicine perspective. IHSA staff indicated they would begin the process by working on some kind of checklist that all member schools can utilize.

6. In reviewing the football recommendations made by the IHSA Football and Sports Medicine Advisory Committees, the council expressed their desire to see the IHSA be bolder with its recommendations concerning the amounts of full contact Continue reading →

May Mailbag

Dustin Fink5 Comments

As the sports season winds down at the high school I am finally getting to the various emails I have received. I do truly enjoy the many stories and questions I get here, often times they are very learned for me; which translates to more information for you the reader.

I picked out one such email and gained permission to reprint it here. The sole purpose of this email is to get feedback about the return to learn aspect of concussions. Tom would like you to give it a read and make comments below.

———-

Return To Learn in the High School

I am an athletic trainer in a high school in the north suburbs of Chicago. We have a concussion program in place and see about 80 concussion a year in our athletics. I am fortunate to have some control over the return to learn side of concussions in my school. I have found that this is essential in order to properly manage a concussion. I find when physicians only see an athlete once and set accommodations for a determined amount of time, it does a disservice. The same is true if the time between physician evaluations is too long, especially when kids are kept out of school for long periods of time. I find many concussion students don’t need to be out of school, and those that do usually have their symptoms decrease significantly within 1-3 days.  Many times concussions progress rapidly and Continue reading →

When and How ‘Not a Concussion’ Becomes a Concussion: Klay Thompson Injury

Dustin Fink5 Comments

The Western Conference Finals not only provided an opportunity for the Golden State Warriors a chance at winning an NBA title it has provided a wonderful opportunity for people to learn more about concussions. The knee-jerk reaction to incidents like we have seen in Games 4 and 5 are often a mix of truth, hyperbole and eye-rolling; however what is clear they are cases that we can use to forge further understanding and education.

Last night in the would be close-out game of the WCF, Klay Thompson shot faked and the defender rose as he [Thompson] ducked and the defender’s knee blasted the side of Thompson’s head right in his right ear.

Unlike his teammate from the game before, Steph Curry, Thompson did not show overt signs, to my trained eyes, of a concussion. His face was “scruntched” in pain and he immediately grabbed for his ear, plus after the incident he immediately rose to his feet and walked straight to the locker room without assistance. As noted in Tuesday’s post signs are paramount when making critical in-game decisions about return to play; if they are there, there should be no doubt about removal.

The next report we received on TV or Twitter was about Thompson having an ear laceration and that they didn’t need to do a concussion evaluation. Which is entirely possible but unlikely, because I do believe they did a concussion “screen” at the time. The Warriors med staff probably didn’t do the full-blown evaluation because five minutes would not have been sufficient for that, but that was enough time to go over any symptoms and quick balance assessment (think roadside sobriety test). It is also important to know that because concussion are mainly subjective that a massive portion of any concussion evaluation is the interview: talking, questions and mental challenges about venue/score/date/etc.  Continue reading →

“Contussiongate”*: The Steph Curry Incident

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*I will admit that I could not come up with a catchy title for this post so I ripped this from Mike Freeman’s twitter feed (@mikefreemanNFL) last night:

But not only is this funny but it is about as accurate as it could have been when summing up the Steph Curry incident last night in Game 4 of the Western Conference series. So, thank you Mr. Freeman for your insightfulness and wonderful wordplay.

Those that were watching the game last night and happened to be on Twitter should know the entire process this sequelae; because of that I will be as brief as possible while injecting the overriding issues and thoughts on this.

It all began in about halfway thought the second quarter as the Warriors were getting throttled by the Rockets;

There is not speculation when looking at that vine, Curry hit his head on the court after taking an uncontrolled fall. What is not seen in the vine is Curry laying prone on the floor for a few minutes as the medical staff took a look at him (even noted checking his c-spine). When the world was brought back to the game from commercial we saw Steph getting assistance off the floor to the locker room, where further evaluation was to be done, obviously.

The first point to note in this event is that Curry not only immediately grabbed his head where it contacted the floor but he also was “down” for some time, that is obviously not normal. He hit his head and very hard so of course he would be slow to get up, but it was the amount of time that would and did have me concerned.

Before we go further we should define concussion for all of you out there, if you want the drawn out and dictionary definitions you can find it HERE, but for the simplest and most poignant way: a concussion is a disruption of normal brain function after a traumatic event. Notice there is nothing about getting hit Continue reading →

More Concussions in Practices or Games?

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There was a recent study released that has turned some heads in regards to where all the concussions come from in sports. In this JAMA Pediatrics study appearing at the beginning of the month the investigators have concluded that American football practices were “a major source of concussions” for all three levels of participation studied (youth, high school and collegiate).

Often when we see this type of information released there can be confusion due to the limitation of each individual study. The above data reflects a single sport, football, as compared to other data often cited that deals with all sports. Case in point this National Institute of Health study; which reports “athletes tend to have a higher risk of concussion in competition as compared to practice.”

The discussion topic of where concussion occurs more is not only often debated but it is an important set of data because we can control for one side of this equation, practice.

Reading the JAMA article one might be confused about the conclusions if you were to look only at the data and not have complete context of both the sport and participation. The rate of concussion was extremely higher in competition versus practice yet the majority of overall concussions came from practice. This can be explained by noting that there are far fewer games – thus exposure – and fewer participants in games – thus exposure. The sample set for the data (JAMA) was fairly robust: 118 youth football teams, 96 secondary school football programs and 24 collegiate programs. Ages of athletes exposed were 5 to 23, presenting a very good cross-section of the sport at all levels it is being played at. This information was collected in 2012 and 2013, and the researchers collected over 1,100 concussions over that time frame.

The NIH study breaks down the information for 13 different sports in high school and college only. Their findings Continue reading →

Play Smart. Play Hard.

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Today the Illinois High School Association (IHSA) launched a national initiative for overall student-athlete safety and participation in sport. It is called Play Smart. Play Hard. 

The campaign will focus on education and equipping athletes, parents, coaches and schools on ways to better safeguard the heath and welfare of student-athletes, including minimizing the risk of head injuries.

The main function of this campaign is to have readily available information and tools for player safety; taking on the current issues/risks as well as being forward-thinking and discussing and formulating plans for other issues that are of concern in sports. At the center of Play Smart. Play Hard. are the resources including a Player Safety Toolkit which is directed at concussions at this time. When going to the Play Smart. Play Hard. page (www.playsmartplayhard.org) in the resource tab you can find all the current Illinois and IHSA concussion information as well as the National Federation of State High School Association (NFHS) and Centers for Disease Control (CDC) concussion info.

Play Smart. Play Hard. may have been trumpeted by the IHSA and Illinois but there are many other state high school association supporters of this innovative approach, 27 to be exact, check the site to see if your state is part of it.

As mentioned on the blog yesterday Continue reading →

Concussion = Brain Injury (revisited)

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This post originally appeared in February of 2012, it is a good summation of the minutiae surrounding concussion.

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For years we in the medical community have been struggling with the terms “concussion” and “traumatic brain injury”; is there a difference?  The simple answer is no.  As you have seen on the blog, we use the term interchangeably, however just like anything in life semantics make a difference.  The perception of a “concussion” is that of sports and “not really that big of a deal”, and that would be horribly wrong.

As Broken Brain — Brilliant Mind posts today this injury is to the brain and confusion about semantics need to be cleared in order to gain a firm grasp on the issue at hand;

I’ve been giving a fair amount of thought to concussions over the past couple of years. In the course of my tbi rehab, my neuropsych has referred to my mild tbi’s as “concussions” and oddly, I never really thought of them that way. I’m not sure why I didn’t make the connection. I guess I thought, like so many others, that concussions are not that big of a deal — just a bump on the head. Getting your bell rung. Getting dinged. Big deal, right? Then, when my neuropsych talked about all the concussions I’ve had, the light went on.

My mild traumatic brain injuries were concussions. Concussion sounds a lot less dramatic than TBI, but essentially, it’s the same thing (I won’t go into the distinctions that SUNY-Buffalo Concussion Clinic people make).

By the way if you have not been going to BB–BM you should, as his/her perspective on dealing with brain injury is a massive resource.  Needless to say, whether you use the term “concussion” or “brain injury” the results Continue reading →

Fish Oil Revisited

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This post originally appeared on the blog in 2011, not much has changed in this area, it is still not definitively known if this is good, bad or indifferent (probably the latter).  However, this is a supplement that is good for all athletes for a myriad of reasons. I have chosen to post this again because it is one of the most popular and commented on post in the blog history.

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After posting about the “7 Ways To Help With Concussion Management” I realized that I had not posted about the possible benefits of Omega-3 fatty acids/DHA supplements for concussion management.

In a July publication of The Journal of Neurosurgery, Dr. Julian Bailes (BIRI) and Dr. Barry Sears (leading authority on anti-inflammatory nutrition, creator of Zone-Diet) found that supplementing rats with O3/DHA after head injuries reduced the observed issues with a concussion; (SOURCE via weightlosingideas.com)

“Animals receiving the daily fish oil supplement for 30 days post concussion had a greater than 98 percent reduction in brain damage compared with the animals that did not receive the supplement,” Dr. Sears said. “It is hypothesized that the omega-3 fatty acids in the fish oil reduced the neural inflammation induced by the concussion injury.”

O3/DHA has been documented to help with the inflammatory response of the body, many people use this SAFE and AVAILABLE supplement when training to temper swelling.  It is also has shown great promise for the cardiovascular system, mainly heart health.  Further investigation is underway Continue reading →

The Fencing Response

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Originally posted January 7, 2011 this was one of the first places to examine and educate people about the Fencing Response, since that time this post has been viewed nearly 50,000 times. This is a great resource.

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The fencing response is an unnatural position of the arms following a concussion. Immediately after moderate forces have been applied to the brainstem, the forearms are held flexed or extended (typically into the air) for a period lasting up to several seconds after the impact. The Fencing Response is often observed during athletic competition involving contact, such as football, hockey, rugby, boxing and martial arts. It is used as an overt indicator of injury force magnitude and midbrain localization to aid in injury identification and classification for events including, but not limited to, on-field and/or bystander observations of sports-related head injuries.

Source: Hosseini, A. H., and J. Lifshitz. Brain Injury Forces of Moderate Magnitude Elicit the Fencing Response. Med. Sci. Sports Exerc., Vol. 41, No. 9, pp. 1687–1697, 2009.

Concussion by Sport (revisited five years later)

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This was another very early post of this blog back in 2010, September to be exact. As you can tell I was very green to the whole linking of articles and writing. However, this is an important article regarding concussion statistics by sport from five years ago. I would be interesting to do a follow-up to this with what we know now. Looking back at my observations have not changed much in the five years, I may move wrestling above cheerleading but that is about all.

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Concussions are not exclusive to American football, although it is the most covered sport as it relates to concussions.  This is a good time to note that in the United States the next most concussive sport, is soccer, the number one sport in the world.

A reasearch project by University of North Carolina reported concussion rates by 100,000 athlete-exposures Continue reading →

The Need for Sleep

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This post appeared in the infancy of this blog back in October of 2010, I have made some editorial changes since that time.

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It used to be that doctors would tell you to keep people awake with head injuries.  That has changed, quite a bit.  Keeping someone awake might be indicated for a possible brain bleed, but concussions need the sleep and recovery time.

Sleeping is first. If you’re not sleeping, forget it,” said Cara Camiolo Reddy, the co-director of the UPMC Rehabilitation Institute brain program and the medical adviser to the Sports Medicine concussion program. Sleep is vital in the recovery process because the injured brain needs rest to begin to heal itself. The concussion program and Camiolo prescribe medications, however, only to post-concussion syndrome sufferers who are three weeks or longer into their injury.

This quote was from and article by Chuck Finder of Scrips Howard News Services and appeared on NewsChief.com today.

In the article you will find that this prescription is not widely accepted by the community that deals with concussion management.  However in my experience it is vital to let the brain rest.  When I am debriefing with the athlete and their parents, the most often question I get is “can you sleep too much?”.  My answer is no. Parents often time are apprehensive if they subscribe to the old method of waking every hour, but I try to educate using the snow globe example. If the must wake their child I encourage it at infrequent and few times as possible.

With my experiences at the schools I’ve been an AT at, the kids and parents that abided by the recommendations of sleep and complete brain rest have recovered at a much quicker rate.  The kids and parents that did not listen often times have delayed recovery.

I know that is not a research study in its most proper form, but the observational evidence tells us, and those in the above article that sleep is indeed needed.

Time to Heal: Tracy Yatsko’s Story (3/22/11)

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Last June, I had the pleasure of speaking at a press conference at Lincoln Financial Field in support of Pennsylvania State Representative Tim Briggs’ proposed concussion management legislation.  I was an eighteen-year old who had been researching concussions in sports for nearly ten months at that point—a task that I engaged in to further educate myself and others on the subject at hand; a project that would essentially close many doors in my past that had been left open for too long.  But as I situated myself beside the podium at this press conference, I had no idea what kind of story the young woman sitting to my left had to say.  Of course, throughout my research, I understood that others have been through worse—much worse—than what I had experienced, but never did I think I would meet someone I could relate to.  It was even more than just relating to, for this individual shared a heartbreaking story to the public.  She was at the press conference for the same reason as myself, and that was to promote the need for concussion legislation in our state, but she did more than that.  Her words were more than the cover to a bill.  Her words were the voice of the sports concussion crisis.

Today, Tracy Yatsko, a twenty-three-year old woman from Tamaqua, Pennsylvania, is still fighting the repercussions of an injury that ended her high school athletic career.  Six years removed from the moment of her last concussion, Yatsko represents the qualities of strength and motivation, for her battle has not been one that has been easy.  Sure, I have heard of stories in which athletes have sustained decisively fatal blows to the head.  But when I talk to this woman, and when I think about her story, the only words that I can describe how I have perceived her story is hell on earth.  Why did this situation in which Yatsko found herself within come to be?

2005 was a year, with regards to concussion awareness, that was still present in the sports’ ‘Era of Good Feelings.’  There was not much to worry about, and though there were stories creeping out of the media regarding concussions in football, there was not much of a worry in other athletic activities.  There really wasn’t much consideration as to what a concussion was.  It was merely an injury that was ignorantly summarized as a headache; a distraction; a joke.  And with such stigma comes tides of the familiar phrase that claims pain to be weakness leaving the body.  Only did we, or rather, do we, come to open our eyes to what a concussion is until the moment of a tragedy personally affects ourselves or those who we consider to be close to us. Continue reading →