Video

Before ‘Concussion’ Omalu was still Omalu

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

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

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

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

==========

BENNET OMALU

January 15, 2011 by telephone with Matt Chaney

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

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

Q. Oh, really?

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

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

Q. Oh, yes. Yes.

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

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

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

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

 

Continue reading →

Gridiron Heroes and the Movie

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

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

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

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

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

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

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

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

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

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

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

The Case Keenum Case: Why It Matters

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

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

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

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

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

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

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

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

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

Seeing Is… Starting… To Believe (Video Link)

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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 →

It Is Actually Happening, Impact Sensors At My School.

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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 →

This Is Unacceptable, In My Humble Opinion

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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 →

#C4CT Concussion Awareness Summit Reconvenes Next Week

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Brewer Sports International and Amarantus Bio Science is continuing their efforts to collaborate and discuss the issue of traumatic brain injury, in particular concussion.  In this version the focus will be on Alzheimer’s;

The #C4CT Concussion Awareness Summit is being convened on July 31, 2014 to explore the potential link between TBI and Alzheimer’s disease.  A diverse working group of clinicians, medical researchers, policy makers, international diplomats, athletes, celebrities, and philanthropic organizations will be assembled to raise awareness, advance clinical research, and develop public policy in order to address this major unmet medical need and public health issue.

The #C4CT Summits have a stated goal to collaborate information and ideas to try and further both understanding and proper response to this issue at hand.  I described it as – using a Japanese proverb – “none of us is as smart as all of us.”  Which is definitely the case for just about anything in life.  However, with so many egos and generally smart people there seems to be a ton of hand-wringing and chest thumping without a lot of resolution.  Jack Brewer and Gerald Commissiong are trying to find a way to get everyone on the same page.  Evidence of this was asking me to be a panelist during the last UN visit in January.  You can see the recap below;

There is still time for you to attend this wonderful event, littered with some great minds and speakers.  If you cannot attend you should follow their twitter feed next Thursday (unfortunately I will be away on vacation so I will not be live blogging the event this time around).

Filed Claim: Arland Bruce III v. CFL Entities

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Bruce

The Filed Claim in its entirety can be found HERE.

You will notice the very wide scope and various Defendants.  Certainly it will have to go through the process up in Canada however, it will definitely get some attention:

Like this from The Toronto Sun.

Or this from Twitter:

I would also like to add the follow video of the Commissioner;

Make of this what you will…

Sylvia Mackey – Video

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In a follow-up, and what I believe to be the same presentation that Elanor Profetto’s video is from a very strong and wonderful woman, Sylvia Mackey, “Mrs. 88” gives a talk about brain injury.  She also has intimate and troubling experience with what brain injury/disease can do as she took care of the great John Mackey in is twilight.

Keep on learning and listening!

The OTL Investigation on ‘Heads Up’ Football

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It may have slipped some of your reading or viewing, but ESPN’s Outside the Lines did a piece on the USA Football Heads Up Program.  The article and video were presented last Sunday morning – I cannot find a YouTube version of the OTL show but you can find that part HERE.  The seven minute presentation is great for a quick overview of the issues ESPN has found.

For more in-depth coverage you should read the article by Steve Fainaru and Mark Fainaru-Wada, the same authors that penned League of Denial.  There are some wonderful points brought to light by the Fainaru’s;

The program teaches concussion awareness and proper helmet fitting, but its central tenet is the soon-to-be trademarked Heads Up Tackling program. When executed properly, proponents say, Heads Up Tackling literally takes the head out of the game. Players are taught to keep their heads up and lead with their shoulders when tackling.

[…]

But critics view Heads Up as a cynical marketing ploy — a repackaging of old terminology to reassure parents at a time the sport is confronting a widening health crisis.

There is a reason I have been “relatively” quiet on this topic; it’s because they are doing some very good things in the way of education and helmet fitting.  As you may know I am huge on the topic of awareness when it comes to concussions.  I have stated many times that the injury itself is not the “ice burg we can see above the water” rather it’s the mismanagement of the concussion that is the massive ice chunk we cannot see from the surface.

That being said, with the actual tackling technique being taught I too feel this is a repackaging of an old mantra.  Rules were even put in place as early as the 70’s to accomplish this task of taking the head out of the game.  Face tackling, spearing and butt blocking all have been on the books as penalties to help avoid using the head as a weapon.

The problem being that those are not called very often, when they are called they are inconsistent at best, and what has it done for the game over nearly 40 years?  I am not nearly as critical as others;  Continue reading →

ABC’s ‘This Week’: Football’s Concussion Crisis

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First I want to lead this off by saying it is not a “crisis” just for the NFL, or football, this is an issue for everyone.  Once again this provides me the opportunity to say; the injury of concussion is not the problem/elephant in the room, rather it is the mismanagement of those injuries that have created this problems we are facing.

This video is from YouTube and I was tipped off by Dave Pear to its existence.

It is 11 minutes in length but there are some good sound bites in it.  If you can wade your way through the minutia you will see that the repeating issue is what I have stated above.  Basically doing nothing to fix the real problem.

Tottenham Hotspurs; More Like Tottenham Hotmess

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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 →

So Simple It’s Stupid

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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…

Old Coach Point of View

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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).

Kutcher Concussion Talk 2011

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Here is a video from YouTube of Dr. Jeffrey Kutcher titled “How to Minimize Concussion Damage”

Dr. Kutcher, M.D., is director of the Michigan NeuroSport Program. He spoke at Play Smart: Injury Prevention on and off the Field, a 2011 National Public Health Week “Live Injury Free” event at University of Michigan School of Public Health. His topic was TBIs–Traumatic Brain Injuries (concussions) among young athletes.

UPMC Blazes Trail… Comes up with curious results

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The University of Pittsburgh Medical Center and the University of Pittsburgh did something that has not been done up to this point; an intensive study on youth football.  Using geography as its selector the prestigious group looked into Pop Warner football and concussion rates.  The sample size is impressive, over 11,000 athletic exposures over an entire season of play (2011).

However, instead of heralding the work more questions have been raised about the conclusions drawn by lead researcher Micky Collins, PhD.  I don’t want to “lead the witness” before you had the chance to hear yourself, watch Dr. Collins below;

Interestingly enough Dr. Collins’ points regarding the depth and breadth of this investigation are spot on, it was both needed and welcome.  It is good to have a starting point and something to say “this is where we came from” at all levels of sport – with regards to concussions.  After that, I personally Continue reading →

Ice Hockey Summit II

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The Mayo Clinic is hosting their second Ice Hockey summit, October 8th and 9th in Rochester, Minnesota.  The title on this one is “Action on Concussions”;

The prevalence and consequences of concussion at all levels of ice hockey are concerning. Reduction of concussion risk, as well as improved concussion diagnosis and management require a collaborative effort from medicine, psychology, sport science, coaching, engineering, officiating, manufacturing, and community partners. This quality scientific program focuses on education and generates an evidence-based action plan designed to make a difference.

Registration fee is $275-350 and space is limited so make your plans now, and click above. Continue reading →

Bennet Omalu Recent Talk

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For a long time the “father” of CTE, the first pathologist to find/identify the disease in an American football player, Bennet Omalu has been relatively quiet; going about his normal business and continuing his work with CTE.  Last week he was highlighted on the ESPN Outside the Lines/PBS Frontline story about the Junior Seau death aftermath.

Even more recently Dr. Omalu was invited to speak at the 2013 Football Veterans Conference – a sport specific event put on by Dave Pear and his blog;

Well, we just wrapped up our 2013 Football Vets’ Conference in Las Vegas at the South Point Resort and it was our best yet! In two packed days, we covered everything retired football players need and want to know, from concussion lawsuits to CTE to visual rights and everything in between. Our sessions were packed and no one wanted to miss a single discussion. And thanks to the amazing Jennifer Thibeaux, all of our discussions from Friday are already processed and uploaded so you won’t have to miss a minute of it either!

Thanks to Dave we can bring you the entire talk by Omalu – although over an hour its worth your time.

……….

“Concussions Happen” Video

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This is a re-post, sort of, of a video created by Bryson Reynolds a neuroscience graduate student.  His area of study is concussions and mTBI.  He shortened the original video for easier consumption, it still holds the essence of what makes it a good too for us to use; stark and striking objective mechanisms of injuries, across all sports.

It is barely over a minute in time, again this is a great teaching tool for those trying to understand the mechanisms of concussion.  If I counted correct only 4 of the clips show head-to-head contact.  THIS IS EXTREMELY NOTEWORTHY, as concussions occur without direct blows to the head.  Also note the concussions (presumed by the filmmaker due to descriptions of the original videos) that occur due to contact with the ground or ball.  Perhaps the most disturbing videos are the last two, youth sports.