EIM Concussion Management: Half Way

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

IL Advisory Council on Player Safety Meeting Minutes 3/31

It is a little late but the Illinois Advisory Council on Player Safety (or PSAC as we call it) met at the end of March to keep this tremendous ball rolling. The minutes are below but the take home from my perspective was:

  • The group as a whole is very committed to being proactive (noted by the including of the psychological safety, push for athletic trainers/MDs, changing of outdated restraints for injuries)
  • Input from all in attendance was exceptional and it is nice to have varying “stakes” at one table looking out for players.
  • Personally I think I get way to passionate about this and think things can be changed in a New York minute, but I am learning about how these processes work.
  • There seemed to be a commitment to continue this committee going beyond the one year trial period, which is good because we are doing good work behind the scenes.
  • I really appreciate the IHSA and Kurt Gibson for overseeing this process/committee and taking notes and hearing our presentations/concerns.

Here are the minutes.

PSAC Meeting Minutes for March 31, 2016

You can also find the minutes and previous minutes at the Play Smart Play Hard Website by going to the Advisory Council tab. We already have added a resource for the “Health & Well Being” of the athlete on the Resources tab. While you are there take a minute to Take the Pledge for playing smart and playing hard.

As always, I am open to comments, questions and inquires about the PSAC. You can drop them here or in the inbox.

#pinkTBI Summit 2016: A recap

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

Gridiron Heroes and the Movie

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 HeroesI 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.

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

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

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

Ready For Primetime

This post is a continuation of the ongoing in the wild review of the Vector Mouthguard System. You can see the previous posts about what I have experienced to this point by clicking on the hot links. As always if you have questions please comment, email or tweet I will do my best to answer.

The system has been on site and in the hands of the kids and I for the past nine days; the good is far outweighing the bad at this point. However, there is plenty of things that I have yet to figure out or apply, rather figured out how to apply. Tomorrow is the first game action, a point in this trial that I am both scared and excited about for the Vector Mouthguards. Time for the bright lights.

I am not scared or apprehensive about the overall performance of the data that I have been seeing thus far. One thing that I can firmly state at this point is that the perceived accuracy and consistency of impacts below 50g is all that I hoped and more. As the practices have progressed and I have reviewed the hitting drills by film, the hits of the interior lineman and linebackers seem to show on almost every play where there is full effort. This would match up with my line of thinking about football (as a reminder I have my system set up to report impacts of 10g or greater), this is a collision sport. I guess at this point I wonder if I am collecting a lot of “noise” in the system because the amount of hits it is recording. I do want to see the overall number of hits collected by the kids but if the 10-20g range of linear impacts are doing nothing other than that, it makes me think. On the other side I do want to have that data in case a kid were to be injured and it was a very low threshold.

The not so awesome thing at this time is the frequency of the anomalies I have seen. The last number I remember seeing for total hits that the system had captured was nearly 2,000 (4o players for 8 days of practice, about 6/player/day) and that number seems about right to me. But, the real issue is of that nearly 2,000 data set there are 12 hits that have exceeded 80g on the monitor and none of them “looked” like an 80g hit on film, in fact some there was no contact. Granted this can happen with technology, some part of an algorithm that didn’t weed out this report. Upon review I was able to identify four of these instances: one was previously mentioned with a player yelling (I have since reboiled the mouthguard and have not seen from that sensor), one was a player whipping out his mouthguard and kicking it while it still had some spit on it, and the other two were the cause of a coach tapping – rather slapping – the mouthguard on the helmet after taking it out of a players mouth to mess with me. In regards to the last two instances the good thing is that this only happens one time because the mouthgurad deactivates when the slobber is off.

Continue reading

Practical Application of Data: VMG

Before practice the coach, I should say coaches, wanted a report from me about what I had seen and how the system was going. I showed them the video from the previous day and where on the head the hits were registering for our worst offenders of dropping their heads at contact (verified). I also noted that some of our starters were getting more hits collected than the average teammate.

The head coach made it a point to tell the assistants to address the players that were leading with their head to correct that during our form tackling and to reinforce during live action to get the eyes up. Then after that was all done he came to my training room and asked me about how many hits and how big some of the players were getting.

I had noticed the previous two days what these 30 and 40g hits looked like and they were above “normal” collisions but not “make the crowd go oooh” type hits. He inquired about the big hit that the LB/RB took in that drill mentioned in the earlier post. I told him it was below 50. He wanted a number of hits that the kids had taken, for what other than his information I had no idea, and boy was I wrong and in a good way.

It was pretty simple the RB/LB combo players had taken the most with an average 22 in two days (day one shortened due to lightning), next were the RB only with an average of 15, then the DL with 14 and the OL with 11. Not as many as I expected, but then again our coach is very limited in hitting drills. In a five-minute segment they maybe get off 12 plays at the most and there are no more than six of those a day.

This is a good point to also tell you that these are “thud” drills, we have had one five-minute of live all season so far to go along with our 1’s vs. 1’s for four plays at the end of the day.

At most you could see 72 impacts a day, if you were in on every single rep of thud action in a practice. The starters probably see about 70% of the reps so we could expect to see at most 51 impacts in a practice. And in day two most any starter registered was Continue reading

Seeing Is… Starting… To Believe (Video Link)

Inside DrillWith one day of the Vector Mouthguards in the book – a lightning shortened one – and a warp speed implementation it was time to get this puppy up and running.

The players had not lost a mouthguard overnight, which is quite amazing because they always seem to lose their other ones, and all were on the chargers overnight. The clock struck 5:30 and it was go-time. The antenna receiver on the sidelines and players not wondering what it was going to feel like, just getting to practice.

As the system fired up the tiny computers in their helmets were reporting to my laptop, one green light after the other, it was working as promised. A few of the mouthguards took a minute to “warm up” with spit, I guess, but when it was time to hit I had nearly all on-line. Of the 40 issued, 32 were communicating with 2 of them on injured personnel (not concussion), we will get more in-depth about that later.

As practice started I did not want to be tethered to the computer so I could do my job as an athletic trainer so I left the base station and went about my business. The way our coach practices is in five-minute segments, flying around. It is high intensity and constant moving on my part to keep a keen eye on where it is needed and on who it is needed. I basically forgot it was over there other than the occasional parent or media asking what that “radar” looking thing was.

At the first water break I stepped over to see the computer and the hits it had captured. I was able to scroll through all the registered hits in about two seconds and only stopped on any that were above 40g. The graph like output of the system makes this a breeze. I also had noted that every hit is time stamped so when there was a hit that I thought should be captured I made note of the time and cross referenced that in the system, and yes they were there.

As the team went to a segment with inside run drill work it happened to be next to my base station for filming purposes. I yelled up to the camera operator and asked if the film time stamps and he said no. Because I had two students with me I was able to hold the tablet and look at that between reps. After every play the screen changed with more impacts; the DL, LB and RB getting the lions share of the notices. I was impressed at the speed and accuracy of the information given to me in real-time. But, one of the LB’s who was delivering the hits on D was also rotating on O as a RB and his mouth guard was not communicating, I was a bit concerned. Was this really going to keep the data in the mouthguard until it was able to communicate, like they promised? Was I going to miss out on some of his hits. And just then…  He was smashed by the defense right to the left earhole. He was none worse for wear but it was a noteworthy hit as the team yelled out due to the collision like all other teams do when that happens. He was just fine and I didn’t even take a step towards him.

As practice progressed all was going well, I was taking notes on times of hits and they all looked good and none that I found concerning in viewing them live or on the data. That’s when I scrolled across a player that had taken the largest hit seen, a Continue reading

Vector Mouthguards – Day 1

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

It Is Actually Happening, Impact Sensors At My School.

Over the years I have researched many, tried a few and heard all about impact sensors, and for the time the blog has been going you have all known I have had a “standoffish” approach to them. That is not because I don’t think they may have a place but it is because of what they can actually do and how reliable they actually are.

I have made it well-known that the “most applicable” system I have seen is the HITs system that is exclusive to Riddell helmets. It is not the best because of factors that include: cost, helmet exclusivity, and it – like all other sensor systems – is not without scientific flaws.  However, what makes HITs near the top is the information that can be gained as well as the feedback/real-time information. There are other types of impact sensors you will see “certified this, certified that” but many of them attach to the helmet making the NOCSAE warranty invalid as well as some helmet manufacturer warranties. Most, if not all do not take center of mass into effect either, making some of the objective numbers askew. As you can see I have had issue trying to adapt to one or the other, enough so that I would be willing to try it out on our teams.

I and our school cannot afford the HITs system and we promote the use of any helmet that fits properly on each kid, because of that I have been looking for other sensors and complete systems that may actually be of help to me as an athletic trainer. I did remember that I have always been intrigued by a mouthguard sensor and when the Vector Mouthguard started making its debut in colleges I started doing more and more research about it. That led me to a conversation – a very honest and blunt one – with CEO Jesse Harper.

After that conversation I did even more dirt digging on what I could and asked many people about the system and what it purportedly could do and all the scientific and mechanical engineering stuff I could comprehend. I came away satisfied, satisfied enough to invest some time and resources to try to procure this system for use in the Fall. Basically, I am ready to dive into this sensor phenomena head-on (pun not intended), finally.

Key Support

Before getting this event set in motion, school administration needed to be apprised of the plan and they would ultimately have to say yes. That conversation occurred in May when I approached the Principal and Athletic Director about this.

It did not take long to explain the benefits of this, not only from a player safety issue but from a coaching aspect as well. They both liked the idea of us looking out for player safety and showing it by being innovative, if nothing else than in perception.

They only had one statement/question for me, “there are not any drawbacks to this, unless we are missing something?”

Hurdle cleared.

Fund Raising

With most any product, good ones, the biggest barrier for most is going to be cost; that was no different here. Starting in early May I started to ask around for donations and support for this system. Although I really only had to get enough for the Continue reading

Minutes From First Illinois Advisory Council on Player Safety

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);



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.


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

Triumph Over Trauma

In the beginning it was hard to find a lot of people to share real world examples of what I was trying to describe here on the blog. It is one thing to have the knowledge and experience but entirely another to parse that down to something people can grasp and understand.

Luckily I happened across a great person and advocate that was able and willing to share some stories that made this blog a little more personable. Her name is Tracy Yatsko and she is definitely not just a face in the crowd.

Recently she has joined the blog space with her very own called “Triumph over Trauma” and as she describes in her tag line;

Triumph Over Trauma is a website/blog devoted to concussion victims, survivors, and their families to hopefully lead them into the right direction of recovery, give them hope through stories of others who have struggled yet triumphed, and give them the one thing the concussion community lacks or can’t find: Support.

As mentioned she has been featured here at The Concussion Blog with a wonderfully written story about her from one time contributor John Gonoude and one of her first PSA’s about concussions.

If you have the time you should head over to her blog and see if you can help in any way!

May Mailbag

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

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

*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

Play Smart. Play Hard.


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

It. Has. To. Stop. (revisited)

This is one of my more outspoken and shared opinion pieces about concussions, it originally was penned in August of 2013.


There is a lot of belief and trust each and every one of us has in those that are medical professionals.  The further you go up the chain in those professionals our trust is greater and our belief is stronger that they know more.  The sad fact that in some instances those near or at the top of the chain don’t know enough and are putting people, in this case a kid, in danger; not only in the near future but the long-term.

Compared to a physician (MD/DO) I would say my medical skills are pale in comparison, and rightfully so; their schooling and experience far outpace what I have learned in the medical field.  Because of this the athletic trainer (I) am not held as in high regard when it comes to decisions about the care of an athlete; which I am fine with… 97.43% of the time (I just made up that number, ha).  However there are times when a MD/DO – those making the final and binding (in parents and patients minds) decisions – make a mistake.  This is not just some Monday morning quarterbacking either, its FACT.

Just recently I had an athlete take a blow to the body and head in a practice, and they immediately came to me distressed.  How distressed?  Well that is one advantage I have over a MD/DO, especially the ER doc, I know the kids and have the resources of his/her peers as well as coaches who have known the kid for many years.  In this case the Continue reading

Concussion = Brain Injury (revisited)

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


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

The Fencing Response

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.


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)

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.


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

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


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)

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

The World’s First Peer-Review Medical Journal with a Primary Focus on Concussion

Concussion information is moving at a warp speed, it seems, compared to the long history of other medical issues that we face and hear about – cancer, heart disease, diabetes, etc.  In fact, concussion is not an acknowledged speciality of the medical field, yet there are more and more monies and time being devoted to this current issue.

It was only a matter of time before some smart people figured out a way to create a journal dedicated to concussion.

Current Research: Concussion has been published and fits this bill, to a “t”.  This peer-reviewed journal is being published by Canadian publishing house Pulsus Group Inc., who has published other journals such as: Current Research: Internal Medicine, Current Research: Cardiology, Pain Research & Management, Canadian Journal of Gastroenterology & Hepatology, and more.

Full disclosure, I have known about this journal for some time and have been chomping at the bit to let all of you know about this possible resource and place of publication for concussions.  Alas, since I have been included in the publishing (more on this later) I was not allowed to divulge this information until now.

What makes this publication so interesting is not only the emergence of a tailored journal for concussion but that the online content is open access.  Anyone and everyone can read this information; from the usual suspects of academia and research to the mom’s and dad’s who care to garner more evidence-based technical education.

Although the publishing and brain-child of the journal hail from Canada the editorial board is rife with very prominent figures, north and south of the border:  Continue reading

This Is Unacceptable, In My Humble Opinion

Yesterday I wrote about concussions and the difference between professionals and adolescents using Jamaal Charles as an example.  What happened last night on the professional field with millions watching was completely unacceptable, professional athlete not withstanding.

Late in the third quarter of the game, last night, San Diego’s defensive back Jahleel Addae (#37) ran into a pile to finish the tackle on the Denver running back.  He was running at full speed and led with his left shoulder, but as he made contact with the RB his head dropped and he also made (incidental) helmet to helmet contact with the runner.  This type of collision is very frequent and looked innocuous…  Until you saw the after math…

Addae was bounced back, still on his feet, and began “short circuiting” for the national audience to see.  He begins to look around, kind of, and stumble, kind of, and lose full control of his extremities, all of them.  As a medical professional and athletic trainer I would have documented this OBJECTIVE finding as “unsteadiness and disorientation”.  It looked like a boxer/MMA fighter catching a fist/kick in the face late in a boxing match; the type of reaction that any referee in those sports would stop a match for and award a TKO to the other guy.

It happens from time to time in this and other sports, that is not the issue here.  The issue is that Addae returned to the game (oh, it gets worse).  Here is the tweet from last night (h/t to Brady Phelps’ Vine);

From what I can piece together this play was the last of the 3rd quarter and reports had him taking the field on the first play of the 4th quarter.  HE DIDN’T MISS A SINGLE SNAP!  Even with the long commercial break between quarters there is a maximum of 4 minutes, but if my DVR time was correct it was between 2 and 3 minutes.  This is not nearly enough time for a full concussion evaluation, by anyone.

“Maybe he was screened, like you said yesterday, Fink.”

There was absolutely no reason for a cursory “screen” in this situation, Addae showed a clear and overt sign of neurological impairment, in concussion recognition jargon: a sign.  When any player shows a sign there is no screen it means Continue reading