#C4CT Concussion Summit 2014

In a little over three weeks, Brewer Sports International (BSI) along with #C4CT (Coalition for Concussion Treatment) founding partner Amarantus BioScience will be hosting their 2nd Concussion Summit in New York, at the United Nations.  There have been many press releases on this event, and I have mentioned it a time or two on Twitter (and will continue).

Sure, there are many “summits” around concussions and head trauma – which is great as it keeps the dialog going – but few are populated by people with ideas on going forward.  Often, we find ourselves sitting, listening to bright people talk about what was done and can’t be done; rarely do we find the same bright people addressing the issues going forward.  Whether that be with tactical changes or with management or even the possibility of intervention with traumatic brain injury.

This edition of the #C4CT Summit on January 29, 2014 will hear from some people in many fields – you can see the current line-up HERE – focusing on the burgeoning topics of chronic traumatic encephalopathy (CTE), general neuroscience, pharmacology among other topics.

Interestingly enough, yours truly, was invited to sit on a panel and discuss how all of this information has been translated to the high school level – as an athletic trainer.  I was not only surprised by the invitation but feel it is VERY OPPORTUNISTIC for a “boot on the ground” athletic trainer to provide input.  I feel that not only have athletic trainers seemed to be seen and not heard, the vast majority of us practice in the high school setting, where the adolescents are playing sports.  I can assure you I will do my very best to be a quality representative of not only athletic training (it appears I am on the only AT in a speaking role) but those of us working with the most kids/athletes.

Anyhow the cast of speakers/presenters is indeed “star-studded” and even has some opposing view points on where we should be headed; which should make for some quality discussion.  If I can get my technology working and to NYC I will attempt to live blog/tweet the event for those that cannot make it.

Speaking of that, I know that time is short but I encourage anyone who is going to be in NYC during Super Bowl Week try to attend this event.  If there are scribes out there I am sure the wonderful support staff at BSI can arrange for you to cover and meet the star of the show – me, of course – hahahahaha, I kid.  Seriously, you can register HERE and if you have questions feel free to contact them.

I hope to see you all there!

Advertisements

TCB Mail Bag

I trust everyone has had a wonderful Christmas experience (or Hanukkah or Kwanzaa or going to have a good Boxing Day), with that I would like to wish everyone continued successes in whatever endeavor they choose.  Over the Holiday I have received many an email regarding concussions; apparently the down time has given people opportunity to share frustrations or good news.

Today I am bringing you a specific case in which we all can learn from.  At the least we can read this and prepare for similar situations that may arise – whether as a parent, doctor, coach or athletic trainer.  

As always you can write in and with your permission I will re-post anything you would like (and it may suit the audience).  It can be attributed to you or anonymously.  Keep it between 500-2000 words and omit any personal identifying factors if it involves patient care or sensitive information.

Here is our post today – by Anonymous:

==========

Obviously today is Christmas Eve and in most regions of the country kids are not in school for at least the next two weeks. Maybe less, maybe more. All in all it is a great time to rest up that brain and recharge your body. As athletic trainers we also know that sports do not stop for the holidays. For the most part at least. If you remember last year I read an op-ed article that you put on your blog titled “Parental Decisions Can Undercut Good Concussion Laws” or something of that nature. Well, it’s happened again (as it has many times between that time and now but this one is a little more ridiculous than the last) and I’m nauseous!

To be as brief as I can on this without boring you this is the case of a female soccer player who sustained a nasal fracture as well as a concussion when fighting for a header in the air with an opposing player almost a month ago. To be clear, she actually suffered a deviated septum. Anyway, after our AT did a beautiful job of getting this athlete “entered” into our concussion protocol (which Mom still couldn’t get over the fact that she indeed had a concussion; whoda’ thunk it, right?) we all sat in our physician’s office (Mom, AT, myself, physician, athlete) and witnessed the concussion as well as the nasal issue being addressed. The athlete was clearly concussed (clinical exam, balance assessment, and symptom reporting were all abnormal but ImPACT scores remained at baseline) and the athlete was sent for an MRI and referred to an ENT for further evaluation of the nasal issue. Pretty simple. These folks were given the “red carpet” treatment as all of our athletes/parents are and everyone left happy. The consensus was to see the ENT and address that issue then to follow back up with our physician for the resumption of the concussion issue. The athlete ended up having surgery about a week later. She was out for about a week after that. The ENT cleared her to resume play and actually said that there was no concussion. Wow! OK!

Fast forward to last week during exams and the athlete did not follow-up with the AT during exams like she was instructed to do. She THEN shows up to a game on Saturday with a face shield and tries to plead her case to enter the game. The AT did her job and did not allow the athlete to play. Mom was irate. Athlete conceded. Coach was with the AT. So athlete did not go through the GRTP process and as of today the mother refuses to follow-up with our physician for final clearance after all of the objective information is noted. She is choosing to Continue reading

Hot And Heavy Monday

With Rob Gonkowski and Wes Welker injuries there is a ton a debate today on the interwebs about concussions and other injuries in the NFL.  I figured I would link up some information that would help with the background and even further thinking for the topic de jour.  It would also help if you read my editorial on Everyone Pumping Their Brakes.

+++++

1st for posterity sake, here is the current NFL Concussion Protocol, found at the NFL Players Association website.  It is worth reviewing and I am sure the NFLPA is monitoring this closely.

+++++

2nd is a link to Concussion Myths from Nationwide Children’s.  Although aimed at youth participants and parents, these myths are very prevalent all the way up to the professional ranks.  One would assume that it should not be predicated there, but alas it is.  Read this and pass it along to all that you know concerned about concussions.

+++++

3rd is a link to some very interesting research about ACL injuries.  It seems the authors are thinking that cognitively impaired individuals (females in this research), may be predisposed to ACL injuries.  I just came across this but it makes logical sense to me.  Here is why; part of a concussive episode the brain can be effected in a way that impairs your spatial awareness and reaction time.  This research could be a waterfall for expected injuries and recovery as well.

+++++

4th is a MMQ article on ACL injuries in the NFL.  There have been 50 thus far this year, an all-time high, but only half are due to contact.  Perhaps the above link may be more poignant after reading this and putting your thinking cap on…

A Very Interesting Finding That Deserves a Mental Bookmark

Yes this is in mice, the human skull is much more dense/thick.  However the important take away from this video is; that there may be help for injured brain cells that can passively find their way to particular areas.  This definitely warrants keeping an eye on, it could become a treatment.

Sidebar, who ever unlocks this key first will be a rich person…

PUMP THE BRAKES, Everyone!

I am a bit on edge this fine, foggy-impending-wintery-weather, day.  No, it’s not the great coffee I am drinking now and the nice jog I had clearly didn’t ease my current frustration.  This forthcoming “strongtake” may get my ass in hot water with some readers, but so be it.

People need to calm down, slow down, take a step back, reflect and realize some important things.  Before I go further understand that I have tried to be as “neutral” as possible – a simple athletic trainer that sees concussions on an intimate level from occurrence to recovery.  I have had 13 myself.  This post is something that apparently has boiled up from all the press clippings I have read and feedback I am getting.  Not one person, entity, sport, or profession is my target here; these are observations and opinions (in my most succinct way possible).

First of all, concussions are not a football problem, they are not a soccer problem, they are not a doctors problem, they are a societal problem.  Rightly so, football in America gets the mass attention, because it happens there more than any other sport out there (don’t waste my time with the skewed numbers of other sports and genders).  With that being said because of the higher incidence in football that does not mean the sport as a whole needs to be banished.  You know very well where I stand on this but I will spell it out for those new here.

Professional football is a different animal from the other forms of the sport, mainly because they are grown adults making informed decisions about their health.  And they get paid to do it, other than providing immediate safety for the concussed players and proper information about the injury, short and long-term, they can and should be able to make their own decisions.  However, this does not indemnify those players or the sanctioning bodies from having some casual responsibility for the emulation of the game at the lower levels.  A clear line must be drawn between amateur and professional medical care; for concussions and all other injuries.  Remember that the professionals have much greater medical care available to them, and if you think that is unfair well too bad, that’s life and where the money is.  Professional football holds a certain responsibility to inform its fans and future players of the risks and rewards of the sport.

As for the lower levels, with proper coaching and medical care/coverage I feel there is a place for this sport as we know it.  Unfortunately as we trickle down in age the participation numbers go way up and at the bottom, youth, is where we have the greatest disconnect from coaching and medical coverage/care.  Because of this and other factors I am of the ilk that kids should wait until the arbitrary age of 14 or freshman in high school to begin full collision football.  Believe it or not this has to do with more than just concussions, in my opinion.  And here is where my first beef is coming from.  Continue reading

Patrick Hruby Article That Has Everyone Talking

OK, maybe not everyone but it has struck a chord with many people I know.  Hruby writes a long form piece on making a choice about letting your son/daughter play tackle football at a young age.  Sure he has been critical on football for a few years now, but this article is very informative and somewhat balanced on both sides.

I am writing this post not to steal his work, rather have it here for posterity sake and include one very interesting quote.  This is what I believe to be the most applicable (for the audience) when it comes to concussion management and assessment (emphasis added by me);

“If I said that one in 10 middle schools has an athletic trainer, I’d probably be overestimating,” Guskiewicz says. “Having a trainer isn’t going to prevent every injury or solve every problem. But it’s important. Some people say this is extreme, but I think that at the high school level, if you can’t afford to hire a certified athletic trainer, then you shouldn’t field contact sports at your school.

The root cause of concussions is not sports or football, it is simply life.  They happen everywhere; from cabinet doors, to staircases, perhaps headboards, bicycles, trampolines, etc.  To avoid inherent conflicts of interest there needs to be a sole person or persons that have it as their job to keep kids/athletes safe.  We could always do what has been done before and rely upon the coach, but that seems to not be working out too well (conflict of interest).  As a buddy of mine, dad once said; “if you always do what you always did, you will always be what you have always been.”  There needs to be change.  I cannot think of a better point that having athletic trainers to do the work they are educated and trained to do: keep athletes safe.  Yes, there are way more good coaches than bad, but why not give the man/woman some help with medical advice and injury care?  Don’t they have a job to do of coaching a team/individual?

 

 

C3 Logix: Practical Application and Use (It’s Freaking Awesome)

Last year while in Zürich I was approached by a group of people from the Cleveland Clinic and they had a poster they wanted to show me.  It had numbers, graphs and pictures – your normal poster at a conference – but what caught my eye was an iPad strapped on the back of a patient that was measuring movement.  I asked very basic questions and to be frank I was a bit overwhelmed at the entire company I was keeping in Zürich, so the poster was a blur.

After that chance meeting and getting back to the States I really forgot about the project until the spring when I started to hear more about it in the underground.  This testing platform was starting to get noticed and being from one of, if not currently the most, prestigious concussion care centers only helped matters.  I wanted to learn more; and in August that chance finally presented itself as the company selling the C3 Logix, Just Go Products, was able to connect with me for a webinar.

I was very blown away with what they were presenting to me – which is probably what the development team in Zürich was telling me – so much so that I wrote a glowing post on it.  Since that time I have worked hard to find a way to procure the system for use; if nothing more to test it out and see if my perceptions were reality.  This goal of mine finally became a reality, not only was I able to get the iPad needed and the app, C3 even offered to send out a technician (really that may be underselling David, he is a nerd but a very good nerd) to help me get accustomed to it.

This past Friday I scheduled the winter sports concussion testing for my high school; the freshman and juniors that have not already done so completed a popular version of the computer based neurocognitive testing, while the other freshman and juniors along with seniors were up for the “beta test” on the C3 Logix platform.  With the split we had 30 kids Continue reading

Tottenham Hotspurs; More Like Tottenham Hotmess

The center of the club soccer world resides in England (two teams in Wales) with the Barclay’s Premiere League (BPL).  Being the “best” soccer league has allowed the BPL to be televised live here in the States as the sport is showing some growth in participation and in viewership.  I have recently found myself watching more matches and even choosing “a side” – as they call it across the pond (it should be noted that soccer it called football everywhere else but here).  Through research and general information gathering as I get further into the sport the BPL or other European soccer leagues are not much different in its fandom.  Supporters of teams and players are similar to the fanatics that follow football here in America; critical of team play, ownership, players effort and results.  One area where the fans and the sport of soccer is well behind, in terms of knowledge, is concussions.

The readers of this blog know quite well that a concussion is simply an event that alters normal brain function.  Being primarily subjective it may be hard to distinguish a concussion by simply looking at a player or person.  However, the vast majority of sports fans here in America and participants know that there are tell-tale signs of concussion that cannot be disputed.  When one of those objective signs is observed it is and should be understood that said player was concussed and requires immediate removal from the game/practice/activity.  The reason is simple, concussions are a brain injury and bad.  Research has shown that playing through a concussion is very detrimental to short-term and long-term mental health.

Years ago, pre-2004, getting knocked out or displaying signs of a concussion was a mere nuisance and even a “badge of honor” among the top-level sporting participants.  It was known back then that something as obvious as someone losing consciousness was not a good thing for the younger participants, however it wasn’t looked upon as it is now.  When a sports participant absorbs enough force to effectively “reboot” the body’s central nervous system that is NOT A GOOD thing.  As the information about concussion has become more clear through the years if a player is KO’ed that player is removed from play immediately and does not return for the period determined by the medical staff.  In the NFL the soonest anyone has returned to practice or game after being knocked out, since 2010 has been six days.  Even that may not be enough time for the brain to recover.  Heck, in boxing and MMA, fighters that are KO’ed are medically suspended for 90 days.

This leads me to the bloody mess that occurred in Everton, England yesterday.  Continue reading

AAP Confirms What We Have Been Saying For Some Time

This past Monday, the American Academy of Pediatrics released their findings of a research project on helmets and mouth guards in high school aged football players, the lead was this;

High-tech helmets and custom mouth guards do not reduce concussion risk for high school football players any more effectively than low-cost helmets or off-the-shelf mouth guards, a new study says.

This is a point we have been trying to hammer home since the inception of the blog; simply Physics does not allow for current technology to reduce or attenuate the true forces that cause concussion in the vast majority of the cases.  Those would be: acceleration, deceleration, rotation and angular vectors that cause the brain to shift inside the skull.

The most important thing about a helmet is that it’s well-maintained (regularly reconditioned) and has a proper fit.  Certainly there is some merit to the newer helmets padding designs for helping with the true linear forces reaching the skull; however helmets are doing what they’re designed for – preventing skull fractures and facial injuries.

It is unlikely that a helmet – as we currently know it – will abate those pesky forces attributed to concussion.  In reality if that is where the fix needs to come from then we will most likely be looking at some sort of apparatus that is attached to the shoulders that basically harnesses the head down.  The issue there, of course, is the range of motion to allow a player to see and move in a safe way.  Regardless this information presented by the AAP is nothing new but wonderful because it comes from a group that has “clout”.

What is more interesting to me – and a bit of an endorsement of our words – is that simple Continue reading

Matt Chaney’s Take on Heads Up Football

The post below is from Matt Chaney’s Blog, re-posted (in part) here with his permission.  We are posting it here not as an endorsement, rather as an opposing view that is worth the read.  Our commentary on this article by Chaney will be below this post.  We encourage everyone to see the entire post on his blog.  You can view it by clicking on the hotlink, it is titled; ‘Heads Up Football’: Truth, Tales and Legal Consequences.

==========

By Matt Chaney

Posted Wednesday, October 23, 2013

Peter King posits bogus hitting technique as Safer Football in Sports Illustrated

—geezuz, the further we go in this latest football crisis, the worse many people become, willingly, on behalf of the sexy blood sport… and so Peter King of SI skips along, telling us bona fide prevention is possible for football’s irreversible head-ramming… a new post by the Hall of Fame football scribe portrays Heads Up ‘proper contact’ as legitimate; King purports this theoretical headless hitting can be instilled by coaches, enforced by referees, adopted by players… I’d like to see King demonstrate on a football field, suited-up himself for forward collisions governed by physics and bullet-head helmets; he’d ram, too, or get his ass kicked… look, folks, players cannot govern or stop ramming on a football field; rather, forces of the crazy game dictate human behavior… forget talk and trust your eyesight, especially naïve parents and kids, to understand Heads Up ‘technique’ is invalid, unreliable, a lienothing new: it’s mere rehash of musty old ‘head up’ form hitting, proven invalid since the 1960s… here’s King, introducing his discussion:

What’s been eye-opening to discover is the trickle-down effect from the NFL to youth football. As the pro league emphasizes safety more and more, so do high schools around America. … Coaches are concerned; 41 of 49 polled [by SI] said they have modified training techniques because of increased education about concussions and head trauma.

—sure, trickle-down effect will reform football danger, once again… solution for brain trauma in the collision game is just around the corner… like trickle-down ‘steroid awareness’ for football’s immense problem with anabolic substances…  King continues:

Several high school coaches emphasized the NFL teaching new tackling techniques, such as “Heads Up Football,” which teaches coaches to train kids to tackle with heads up—instead of using the helmet as a battering ram. Said Middlebury Union (Vt.) coach Dennis Smith: “In any drills we’re doing—whether it be fundamental drills at the beginning of practices, especially defensive practices—we’re always stressing head up. You have to be able to see what you’re tackling.” … Said Brandon (Miss.) coach Brad Peterson: “We always start the year, whether spring or fall, with walking through the proper techniques of tackling.” … The coach of E.O. Smith High in Storrs, Conn., Jody Minotti, said he knows he can’t prevent every concussion, but he trains his players to minimize the risks. “We do less contact throughout the week and we teach proper tackling,” said Minotti. “We preach in practice all of the time, ‘Bite the ball. Bite the ball.’ That means keep your head up and don’t ever lead with your helmet. We film tackling, we talk about tackling whenever we’re watching film.”

—huh, these coaches don’t address the facemask dilemma, the prime fault of football rules behind the charade of Heads Up, ‘proper contact,’ ‘head up technique,’ ‘anti-butting’ or whatever term… this toothless policy and language have been a football mandate since 1976, for high schools and the NCAA… the rules specifically ban Continue reading

“League of Denial” (Part 2)

Coming to a bookstore and TV near you today is “League of Denial” a book and documentary about one of the dirty little secrets the NFL has been avoiding for some time.  Fortunately, I have been provided with advance copies of both; the Frontline film was easy to digest, as for reading a book, well we can just say I am trying to read as fast as possible.

I was reminded quickly, yesterday via Twitter, that I may lack valuable perspective when it comes to concussion information (and that I am not normal – this is not breaking news).  Will Carroll of Bleacher Report let me know that this information will be new to a lot of people out there.  He is exactly right, not only that, this documentary will be easily digestible for the fan of football.  For any person just wading into this, when you tune into PBS tonight to view “League of Denial” you will be absolutely hooked from the start.

The sounds of the crowd, visuals of big hits grab your football part of the brain IMMEDIATELY, over those sounds you will quickly discover the problem NFL players have faced with brain injuries playing their sport.  Harry Carson saying “and then they are gone” when talking about former players.  A bold statement that the level of denial was “just profound.”  An NFL lawyer saying “we strongly deny those allegations that we withheld information or misled the players.”  And more video and sound of punishing hits that used to fill the highlight reel bring the opening curtain of this very important documentary.

This problem is real – it’s not just real for the professionals – and from the get go Frontline makes you understand, vividly and personally, why this is.  After listening to old radio calls of the Steel Curtain it all begins with the story of Mike Webster and the forensic pathologist who studied his brain, Bennet Omalu.

The discovery of a possible reason one of the most respected and lauded players in Pittsburgh sports pantheon fell from grace and eventually found and early demise.  If the football portion of your brain does not connect to what is being presented then I would haphazardly guess that you are not ingrained within the fabric of football.

As Harry Carson explains how the game was played and to some extent how it’s still played you can begin to understand the issue at hand.  This is hammered home when Robert Stern, PhD tells the audience blows to the brain are at forces 20 times greater than the force of gravity (20 G’s); or as he so eloquently put it “driving into a brick wall at 35mph”, 1,000 times or more in a season.

In the first 11 minutes of this 2 hour presentation you are at full attention and want to understand the “whats”, “whys” and “whos”.  If you are not engaged and ready for further explanation I can only say that you don’t care or want to bury your head in the sand.

Contributions in the film include Continue reading

Athletic Training Podcast

You may have seen it on Twitter, I have recently finished a podcast with Chris Lenker over at ATPodcast.net (@ATPodcast).  I had a great time just shooting the breeze about who I am and why I started the blog.  My dog Eli even gets in the action with some random barking in the background.  Chris tells me it was a good podcast, but to be honest I think he just asked a question and let me ramble for no apparent reason, ha.

Please if you get the chance and the time give it a listen, Chris and his podcast does a wonderful job for the profession of athletic training.  Help him out by going to his iTunes link HERE.

I would appreciate all feedback on this, there is a wicked rumor that people may want more of this type of interaction between fellow athletic trainers.  And Chris almost has me convinced that I should be doing some of these on a regular basis.  I don’t know if anyone would even want to hear more than what they have.  Feel free to let us know!

“League of Denial” (Part 1)

Coming to a bookstore and TV near you tomorrow is “League of Denial” a book and documentary about one of the dirty little secrets the NFL has been avoiding for some time.  Fortunately, I have been provided with advance copies of both; the Frontline film was easy to digest, as for reading a book, well we can just say I am trying to read as fast as possible.

In all honesty, if you have followed any part of this issue nothing revealed in either medium (thus far in the book) is seen as “BREAKING NEWS” rather an illustration of what has been happening with the research arm and policy makers of the National Football League, with regards to concussions.

“League of Denial” the Book:

In what I have been able to read thus far both Steve Fainaru and Mark Fainaru-Wada have done a good job of telling the hidden secret.  The Fainau’s went as deep as they possibly could without the help of the league itself, even as far as getting one of the original researchers to recount some of the possible misgivings in the past.

By utilizing the real stories of players that met an early demise (Mike Webster most notably) the information has an emotional connection with the reader.  While reading this you understand why this information may have been so valuable to the families and friends of those that could have been effected by repeated head trauma.

It doesn’t take a brain surgeon to tell you that repetitive brain trauma is bad for you, but the problem here is Continue reading

The “Other” PBS Film

ICYMI there is another film not named “League of Denial” that PBS is showing that deals with concussions.  This one however is “a proactive look” at concussions in a high school setting.  As Founder, Editor, Journalist, Producer of MomsTEAM; Brooke de Lench put it in a recent post on the release of this film;

We also careful to explain on “The Smartest Team” website that the documentary is no more than an “audio-visual blueprint,” and “an introduction to a set of principles (the Six Pillars) to guide development of a sound concussion risk management program based on the latest research and opinions of experts; to provide a solid foundation on which to build such a program;” that we see it “only as as a jumping off point for what we hope will be the beginning of a multi-year and continuing process involving parents, coaches, players, athletic directors, school boards, booster clubs, and health care professionals, motivated by a desire to preserve all that is good about youth and high school football, to work as a team to implement best practices in concussion risk management.”

The Smartest Team” is a documentary of a high school in Oklahoma that was looking for a better way to combat concussions, and sought out de Lench and MomsTEAM.  During this film you will see the use of Continue reading

Delaware Youth Concussion Summit – Wrap Up

A regular reader and a very good friend to The Concussion Blog was fortunate enough to attend the Delaware Youth Concussion Summit the past week.  I had asked her to write-up a report and she kindly and succinctly did that for TCB.  Because of Dorothy Bedford I can bring you this information, thank you.  This is also a reminder that if you attend a conference, symposium or summit and feel the information would good for the readers you are more than welcome to submit it so us in a .doc or .docx form and we will publish.  Without further ado here is Dorothy’s contribution;

The Delaware Youth Concussion Summit, an initiative organized by the State Council for Persons with Disabilities Brain Injury Committee, Nemours/Alfred I. DuPont Hospital for Children, and the Brain Injury Association of Delaware, yesterday released its three-point Action Plan regarding the diagnosis, management, and return to activity for the rising number of young people sustaining concussions in sports activities. Participants in the summit and action work groups include leaders and experts in medicine, neuro-psychology, education, sports, advocacy, state agencies, and elected officials.

The Summit aims to further the aims of Delaware’s concussion legislation, signed in August 2011, which mandated both concussion training for all DIAA coaches and awareness training for parents and athletes, and set some rules around written medical clearances before returning to play.

After convening in May 2013, the Summit divided itself into working groups and today announced three focus areas for further action:  Continue reading

Possibly the Most Comprehensive mTBI Guidelines

The Ontario Neurotrauma Foundation has released their updated Guidelines for Concussion/mTBI & Persistent Symptoms: Second Edition, and it may be the most comprehensive/complete to this point.

The guidelines stretch from diagnosis through return with emphasis on “hang-ups” that can come along with recovery, here are the modules;

  • Diagnosis
  • Management
  • Sports Related
  • General Recommendations for Diagnosis/Assessment of Persistent Symptoms
  • General Recommendations for Management of Persistent Symptoms
  • Post-Traumatic Headache
  • Persistent Sleep/Wake Disturbances
  • Persistent Mental Health Disorders
  • Persistent Cognitive Disorders
  • Persistent Vestibular and Visual Disturbances
  • Persistent Fatigue
  • Return to Activity/Work/School

Of special note and to reference is all of these recommendations are for adults.  That being said some of this can be “creatively adapted” for those in high school.

Here is the .pdf for the Sports Related Concussions/mTBI.  All of it is worthy looking over; not only for athletic trainers but doctors as well.

Rules of the Game

I have waited about five days to collect my thoughts on this and honestly let my emotions calm a bit.  As some know I can be a bit outspoken and harsh at times but I wanted to refrain from letting emotion get in the way of an important message.  Yes, this post will be mainly about football, but don’t view it as an attack on the sport so many of us, including me, love.

This season across all the levels of play in football there has been a larger emphasis placed on player safety, most notably contact to and with the head while playing football.  It is a FACT that the helmet in football was designed and remains a protective device not a weapon or offensive piece of equipment.  Using the helmet in the later fashion is and should always be a penalty for both sides of the ball.  This is nothing new; since the mid 1970’s “spearing”, “face tackling” and “butt-blocking” (scroll to page 32 of that link) have been outlawed in the sport.  However, routinely those events on the football field are rarely called, now in 2013 there is an emphasis on these types of infractions.  Now there is a caveat of this type of action on the field called “targeting” which at the college level can have a player ejected if egregious enough. (BTW, that picture is a placard that was made in 70’s)

Before I go further, I would like to say that officiating at the high school and lower levels is a thankless job.  The pay is not life changing and most do it as a hobby.  Sure, I have seen some officials that the game has passed by or is too fast for them, but I have also seen men and women that do Yeoman’s work with nothing more than a handshake for a job well done.  It’s not easy folks, I have done it, but done correctly and consistently it is a thing of beauty.  At the college and pro levels these people do great work and often have other jobs besides being on TV and getting players, coaches and fans mad at them.  I can assure you they are doing the best they can.  But, I feel the game of football resides in their and coaches hands, for survival.

At the high school level in our state I know that officials have been told to watch out for targeting and the use of the helmet above the shoulders; this has helped at the cost of adjudicating the other, more established rules from the 70’s.  I have seen four flags in five games for “targeting”/”spearing” above the shoulders; I have seen zero flags for “spearing” when it was below the shoulders.  I didn’t write down every occurrence of these types of tackles in each of my games, however, I can vividly recollect at least 10 instances of spearing on both teams.  Side note here, if I see one of our players do it they get quite the ass chewing from me on the sidelines.

People need to realize that tackling with the head-down is not a safety measure for the person getting tackled, it is a safety measure for Continue reading

What Are the Experts Saying About Guardian Caps

This post has no intention of being inflammatory, rather it is a post designed to hold a conversation and create a counter point.  I have been bombarded with information regarding this product; since early 2011 I have not been “on board” with this.  It is important to note that this product and its PR firm have been good at communicating with me and have listened, but I do find some of the press regarding this product and similar ones is a bit off base.  We do need to understand that what reporters and people say – not affiliated with the product – cannot be controlled buy the company.  So that being said I have found and have some opinions on the recent spike of press.  Take it for what you want.  Just know that I am trying to provide information for everyone to make their own decisions.

It began in 2011 rolling into 2012 when Guardian Caps shot me an email about their product.  And from the beginning I was not sold on the promises or the theory.  It’s quite simple in my estimation; you can wrap an egg up in 45 pounds of bubble wrap and if you shake it hard enough the yolk will still move or even break.  Essentially that is a concussion in an “egg-shell”.  Sure, the bubble wrap will stop all linear forces from cracking the shell and even prevent it from moving with those linear forces, but what is it doing to for the acceleration and deceleration of the concussion?  Moreover, even though it may be very light, we are adding mass to the head, thus we are creating a fulcrum change and balance change.  If you read here enough you know what I am talking about.

However, I have seen fellow athletic trainers rave about this and plenty of teams/coaches/schools adopt this product and even consult me on it, so I thought I would do my best to get the most information possible, on my own.  This company was willing to provide me with all the information they thought I needed, so good for them.  It really came to a head recently, while in the midst of the NOCSAE statement on 3rd party add-on’s, I received this email from the company;

Dustin,

I wanted to drop a line about both the Aug 9th article “NOCSAE Press Release Clarifies” and a short picture of our product and company as a whole.  Thanks for all your hard work with The Concussion Blog.  It is a valuable resource and you do a great job presenting an educated, unbiased view.

About NOCSAE certification:

  • If companies want to sell equipment that alters the original tested/certified helmet THEY or the individual must re-certify each helmet model it is placed on – adult and youth separate but not sizes.

So Simple It’s Stupid

I have posted many a video about concussions here on the blog but this one (thanks to Tommy Dean) may be the best for its pure simplicity and message about management;

People need to understand that concussions don’t have to involve a hit to the head.  I have seen throngs of people on Twitter and other places not grasping this.  Perhaps none more so in the product development sector; those very intuitive people with good ideas that think protecting the head will reduce concussions.  Be it a helmet addition, or better helmet, or those that want to remove helmets from the game, what they fail to grasp is that linear hits to the head with linear forces alone do not constitute the majority of concussion sequale.  The concussion comes as a result of a constellation of factors; the biggest of which is the acceleration/deceleration of the head, followed closely by the shearing (due to angular and rotational forces) of the head.  If you notice most mechanisms of injury one would easily note that knocks to the head with limited movement of the head itself, are not the vast majority of concussions seen.  The hits a person takes in sports and LIFE that are unanticipated and have multiple vectors is where we get a lot of concussions from.

For a better visual, if I were to say to you I am going to punch you in the face from the right side, and you had a chance to brace for it, there is a good chance you could absorb that blow with little to no problems.  However if I were to not say a word and walk up and hit you in the same spot with the same force, the chances you will be “hurt” are much greater.  When you anticipated the hit you would have braced and made the force almost strictly linear, with little rotation due to your neck muscles…  Where as, the sucker punch would move your head sideways and back; quickly accelerating your head then suddenly it would be decelerated by the spine range of motion limits.

I hope this has provided some positive learning for everyone…

What Does the Derek Sheely Case Foreshadow?

Inherent risks, of life and sport, are a constant issue none more controversial than concussions.  The truth of the matter is that concussions will occur in life without sports so playing: hockey, lacrosse, basketball, baseball, water polo or any sport comes with differing amount of risks/chances of concussion.  By playing those sports we should understand those risks and be willing to accept the chances of injury, particularly concussion.

As we have stated close to eleventybillion times now; the actual injury of concussion is not the issue of this crisis, rather it is the mismanagement of the injury that is the problem.  In other words it’s not the sports fault for concussions, it the people’s fault for not taking this brain injury serious.  Even worse, it is people in positions of power that have caused many to be “mishandled” after injury, bringing us to where we are today.

This is where Derek Sheely comes in; this young man died on a football field in Maryland as a result of head trauma and the purported facts in the case are very scary;

  • Four hour contact practice
  • “Preseason practices at Frostburg served more as a gladiatorial thrill for the coaches than learning sessions for the players… Practice involved virtually unlimited, full-contact, helmet-to-helmet collisions.”
  • Named coach in lawsuit explicitly told players to lead with their head and use their hat when tackling
  • Apparent lack of preventative medical care by an athletic trainer
  • And this quote: “Stop your bitching and moaning and quit acting like a pussy and get back out there Sheely!”

We have yet to have full discovery in this case and most likely there will be a settlement Continue reading

There Is More Than Football

I know we all think of late August and early September as football season, but there are other sports out there that deserve some attention as well.  I do empathize with the football coaches that constantly tell me we are “picking” on that particular sport – we are not.  It is tough to overlook a sport that garners the most eyes and advertising around here.  That being said there are other sports either just starting, gearing up or in the final stretch that deserve note.

Baseball is grinding to the playoff push and under the radar is the fact that catchers are finally being honest about their heads.  Many have hit the DL this year for concussions, most recently Joe Mauer of the Minnesota Twins.  Certainly there have been others but it is worth noting that late in the season, seeing catchers develop concussions should not, nor will it be a surprise in the future.

Summer heat does not make one immediately think of ice rinks and hockey pucks, but Canada’s most popular sport will soon be getting into camp to prepare for the upcoming season.  When the puck does finally drop in early October (Go Avs!) the NHL looks to improve on their better handle on concussions.  But, the bigger reason for preparing for the hockey season is the upcoming Ice Hockey Summit II, held at the Mayo ClinicContinue reading

Next Level… In Concussion Care

As an athletic trainer – an opinionated one at that – I struggle with all the “bells-and-whistles” in this conundrum that is the concussion issue.  If you have visited here or heard me speak you undoubtedly know that mismanagement of concussions is the true issue of this complex paradigm.  Yes, we need to know when a concussion occurs to begin the process in the right direction; however, this can be accomplished by simply making sure you have a trained medical professional on hand when the need arises.  Getting an athletic trainer to cover the most at risk sports at the most at risk times is a great start (and in the authors opinion is the only choice if you want to have collision sports).  Short of that, education over-education is necessary for everyone: players, coaches, parents, officials, teacher etc. to properly identify and accept the nature of concussion in sport – it is a risk.

Even having an allied medical professional, like an athletic trainer (AT) at practices and games does not stop the injury from occurring.  In fact, many products that may claim reduction in concussions or “possible concussions” are toying with fraud; at the very least they are practicing deceptive marketing.  The point being, once we identify a concussion how do we and who do we send the injury to, to avoid the rest of the iceberg lurking under the surface of the water?  Moreover, what tools do we have that can help get the right prognosis, treatment and recovery for the injured (and there are many out there)?

I feel there is a new product (I am not a paid endorser, nor have I been given compensation for this article/opinion) now hitting the market that may get us closer to the panacea that we are all hoping for (note I said “closer”).  Although it may have been presented as some big secret; the C3 Logix: Comprehensive Concussion Care system is not a secret rather it is something I feel is a “game changer” for concussion care.  It is Continue reading

Livestream Event on Concussions

Part of understanding concussions is weeding through all the hyperbole and finding the common threads of the issue and then digging deeper.  Of course you will eventually come up with your own opinion and how you choose to understand concussions becomes subjective, like that of the injury.  Over the past six years of my borderline obsession of concussion education I have listened and read MANY different takes on concussions, and to this day I still do.  Although my grasp on concussions is fairly firm, I am not naive enough to close my mind to more information and possible change in opinion.

Coming up on Thursday, August 1st, SportsUnlimited.com (looks like a sporting goods website/store) will be hosting a livestream event on football concussions with the intent to educate the audience;

Concussions in football and other sports have received much national attention in recent years because of their prevalence in the sport, misunderstanding of the medical condition, and concern for youth and adult players’ potential brain injuries. The reasons for the attention are valid and through this SportsU LiveStream, we aim to bring more knowledge to you about the issue, allowing us to better understand concussions and how we can use current technology, techniques, and tests to play a safer game.

The host/moderator of the event will be Mr. Lou Rusnock and he will open the floor to questions for their guests for the event: Dr. Russell H. Amundson, MD a neurosurgeon at Einstein Medical Philadelphia and Robert Erb, Presidnet/CEO of Schutt Sports.

I do not see a pre-registration for the event and you can go to THIS LINK at 4pm Eastern time on 8-1-13 to watch/take part.

Old Coach Point of View

What I believe was at the same conference as the previous video by Dr. Jeffrey Kutcher; former coach Lloyd Carr speaks about concussions;

Coach Carr was the head football coach at the University of Michigan from 1995 – 2007, it is worth listening to this perspective.  Although coaches can be to blame for much of the “complaining” when it comes to the necessary changes in any sport as it relates to concussion, their input is very worthy.

We can sit in our offices and come up with “dream” ideas, but these are the men/women that must implement all the “bright” ideas.  There is something to be said for those that have “been-there-done-that”, so as long as it is both constructive and respectful.  I believe that Coach Carr did a good job of this.

A quick side note; this was in 2011 and he spoke of leading with the head, now the NCAA and NFL will possibly eject players for leading with the crown of the helmet (a very hot debate, and will be once the season begins).