A Chuckle and Video

I really don’t have much for this quote found in this article;

“I have a theory on concussions,” he said. “I think the reason there’s so much more of them — obviously the impact and the size of the equipment and the size of the player — but there’s another factor: everyone wears helmets, and under your skull when you have a helmet on, there’s a heat issue.

“Everyone sweats a lot more, the brain swells. The brain is closer to the skull. Think about it. Does it make sense? Common sense?” said Carlyle, who said he’d never talked to a doctor about his premise, which he was introduced to by Jim Pappin, the former Leaf who also played his career helmet free.

“I don’t know if it’s true, but that would be my theory. Heat expands and cold contracts. The brain is like a muscle, it’s pumping, it swells, it’s a lot closer to the outside of the skull.”

Stick to coaching hockey, eh!

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The ESPN article and video (click link or below) regarding the NFL Concussion Litigation; Continue reading

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The Experts Tell Us Why Athletic Trainers Are Needed

You don’t have to take my word for it here, you can watch this video and let the experts in the field tell you;

Although we are not there yet, there are financial barriers, and some misnomers about the profession; athletic trainers should be a must.

As I have clearly stated: “If you cannot afford an athletic trainer you cannot afford to have collision sports, period.”

Hey here is a bonus, athletic trainers are also some of the best at on the field orthopedic injury assessment and injury prevention in the WORLD.  Doctors even defer to the knowledge of an athletic trainer when it comes to sports injuries.

Mayo Clinic Looking into Autonomic Response to Concussion

Neurologists at Mayo Clinic in Arizona have taken a promising step toward identifying a test that helps support the diagnosis of concussion. Their research has shown that autonomic reflex testing, which measures involuntary changes in heart rate and blood pressure, consistently appear to demonstrate significant changes in those with concussion.

Appearing on their website, the information researchers are delving into is a new angle on  concussions.  It is widely known that traumatic brain injured (TBI) patients have autonomic system (ANS) deficits/abnormalities.  However the group from Arizona thought an investigation into concussed patients was worth the effort.  Low and behold their findings are a promising first step in possible assessment and management of the concussion.

One interesting note, was this notion on dizziness;

“Contrary to popular belief, the symptoms of ‘dizziness’ that patients feel just after a concussion may, in some cases, be symptoms of autonomic system impairment rather than a vestibular or inner ear disturbance,” says Bert Vargas, M.D., a Mayo neurologist.

No one is telling you to take blood pressures with assessment (ergo baselines), yet, but with this information could come not only objective testing but biomarkers associated with ANS changes;

“This study shows a possible electrophysiological biomarker that indicates that a concussion has occurred — we are hopeful that with more research this will be confirmed and that this may also be a biomarker for recovery,” he says.

AAN Concussion Guidelines – One Stop Post

Here is the presser for the updated AAN Sports Concussion Guidelines; their guidelines are simple and to the point, via YouTube;

  • No Grading System of concussion
  • 10 day rest period – “key” – Dr. Jeffrey Kutcher
  • Greater risk if you have had a concussion
  • Addressing of youth and recovery
  • Helmets are not the full answer
  • Licensed Health Care Providers should be clearing
  • Repetitive head injuries are bad
  • The discovery and annotation of “Chronic Cognitive Impairment”
  • No single test, CLINICAL assessment
  • “Kids are not little adults.” – Dr. Christopher Giza

Here is the LINK to the Updated Guidelines (can someone give me permission to post it here?)

Here is the LINK to the Sports Concussion Toolkit from AAN

Here is the LINK to the Concussion Quick Check from AAN

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What does this mean in comparison to the Zurich Statement?  That is a great question; both groups used “consensus” however this group is much more centered on American practices.  Both have similar approaches, both advise nearly the same thing; but which one carries more weight.  I have been told the AAN will be much more “powerful”, respected and learned than Zurich.

This is a good debate, regardless, there is ample evidence to sit kids and any concussed individual.  This statement also continues the wave of information that cumulative and repetitive trauma to the brain (still figuring out thresholds) is not good.  Based on this and the Zurich statement the only way that we can collectively abate concussions at this point is exposure limitation.  No where in that last sentence does it state “stop playing sports,” or “get rid of football”.

When dealing with the brain and the injury of the brain less is better, which is ironically simple and a “no brainer”.

Video Thursday

Here are a couple of videos to tide you over until some time next week!

In the first one we can hear how the military began their concussion management protocol.  Although not enough it was way ahead of the curve on concussion management.

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Here is one that shows a compilation of big hits found on YouTube.  Watch all the football ones and the vast majority are “clean” hits.  Then take into account all the other sports and think back to my mantra here: “The injury of concussion is not the elephant in the room, rather, it is the mismanagement of the concussion that is problem.”  Then tell me you didn’t throw up in your mouth at the last clip…

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Aussies Study Concussions in Former Collision Sport Athletes

From Sunday Night down in Australia a story of how research on the brains of former footballers may shake up the sport;

Greg Williams is an AFL legend, and one of the hardest men ever to play the game. In his glittering 14-year career, ‘Diesel’ won a premiership, two Brownlow Medals and was named in the AFL’s Team of the Century. .

Shaun Valentine is another tough bloke: like Williams, he copped countless on field wallopings in his career in rugby league. Williams retired at 34, Valentine at just 26. Both men are now struggling with everyday life as they battle the long-term effects of so many blows to the head during their respective careers. Both men are married with children – and both are facing the biggest challenge of their lives.

In what’s been a world first study here in Australia, the results of tests on retired professional players are revealed, and they will send shockwaves through all the codes.

The video (The price of playing the game) tells the story of Williams and Valentine and gives the results of what they know to this point.  Make sure you click the link above to find it.  You will notice that there is no mention of CTE in the Aussie players – yet when they go to the US for the story CTE is the first thing talked about.  It is understood, that currently most researchers in Australia are not ready to accept CTE as a diagnosis or even its existence in former footballers.  The focus is more on dementia Continue reading

Team Gleason PSA – Hey NFLPA Please Read

I received this from an anonymous source and was asked to spread this news, hopefully it will reach those it is intended for…  How bout you watch the video first then go to the Team Gleason website;
Subject: PSA release: NFL Players and Coaches stand together to cure ALS
Hi everyone…I hope this email finds you well…
Just wanted to let you know that beginning today, we at Team Gleason are rolling out a new ALS awareness campaign to be introduced this week in New Orleans for the Super Bowl.
Here’s a link to the video, which takes viewers directly to the Team Gleason website:
This is important, please spread if you get the chance…  This is NOT JUST A FOOTBALL PROBLEM, this is a problem for everyone!

George Visger – A Story to Tell

You have seen him post in the comments and there have been many stories written on him and his plight, but it is nice to get those involved to write about themselves as much as possible.  George Visger a former NFL player has taken the time to send along a couple of notes, it began with this email;

I played for the 81 Super Bowl champion SF 49ers.  During the season I developed hydrocephalus (water on the brain) from concussions, and underwent emergency VP Shunt brain surgery.  Four months after our Super Bowl XVI victory, my shunt failed, I had 2 more brain surgeries 10 hrs apart and was given last rites.  Also given the hospital bills, and forced to sue for Work Comp.  Completed my  Biology degree during brain surgeries 4 thru 7, now on # 9.   The long-term effects of concussive and sub concussive hits can be seen in what it’s done to my family in the following KVIE Channel 6 Sacramento link.

KVIE Channel 6  Sidelined:  Concussions In Sports   121912- http://vids.kvie.org/video/2318744182
After that was sent my way I asked for something he has written and wants to be known, and below is what I received.  Thank you for your time George;
My football and TBI career began in 1970 at age 11, playing for the West Stockton Bear Cubs Pee Wee Pop Warner team in Stockton, CA.  Twenty nine kids on the team, and 3 of us went on to play for the undefeated, nationally ranked, 1975 A.A. Stagg high squad and sign NFL contracts in 1980 (me, Jack Cosgrove, Pat Bowe).  We also had a kid on the squad by the name of Von Hayes, who went onto a multi-year MLB All Star career with the Cincinnati Reds.During my 3rd year of Pop Warner, I knocked myself unconscious in a worthless Bull – In – The – Ring drill and was hospitalized.  This was the only “diagnosed” concussion I sustained, despite playing several games through college and pros where I have no memory of playing. Continue reading

National Concussion Awareness Tour

It is an idea that can catch on, real quick, it has the basic tenet of education/awareness at its core, with the right promotion and teaching/tools I am in agreement this will do some good.  The plan is to have a national concussion awareness month, September, and along with that have a tour across the United States.  Instead of me trying to explain it, here is a promotional video, geared to finding sponsors for this event;

I do not endorse the Shockwave System, I am only endorsing the idea of an awareness tour….  Heck I don’t even know about baseline and/or neurcognitive testing…  However the idea to inform everyone is sound…

How To Choose A Sport

Choosing a sport/activity for your child can be difficult – it shouldn’t be initially – as they progress in age and skill level.  Some believe there are factors that come into play when beginning to “specialize”, including injury risk; this is true.  However, our current culture is making the sporting issue way more difficult than it needs to be.

I may not be the best parent, certainly I’m not the first to accomplish this feat, but I do try to be A PARENT and not a friend.  When it comes to sports I let my children choose what they want to play.  My son is now 7, getting ready to get neck-deep in sport and the culture of sports.  He has shown some above average skills in a few sports, and loves one sport; however I will not force him to be exclusive, nor will I be crushed if he chooses not to play.  I will encourage him and my other kids to play MULTIPLE sports and do multiple things, for their entire life.

Alas, there are some families that are weighing the issue of choosing, say football over soccer, or vice versa; tennis or hoop, etc.  Injury risk can be a massive component in this decision so getting all the information is best before choosing, just like making informed decisions.  When discussing concussions and catastrophic injuries the sports we play do matter.

Mom’s Team has a video from Dr. Lyle Micheli, Director, Division of Sports Medicine at Children’s Hospital Boston, which can be found HERE.  It does bring up some good points but Continue reading

Outreach: BMX Athlete – Jay Fraga, His Story, His Words

We are beginning a new program here at TCB.  This one is called “Outreach”; the purpose is to publicize the good (we hope the vast majority) and sometimes the not so good of concussion management and experiences across this vast planet.  One thing I realized real quick in Zürich is that the stories of the bad are relatively the same, usually highlighted in the media.  Meanwhile the stories of good are different and helpful and not heard at all.  I am asking our readers to send in stories of your cases (please be mindful identifying specifics) so we can share.  There are vast stories in the comment section but I would like to bring forward as many as possible.

The stipulations are simple: 500-2000 words with specific situations that we all can learn from and benefit from, email them to us at theconcussionblog@comcast.net and consent to possible editing as I see fit.  It would be nice if you included a bio or frame of reference, but if you would like to remain anonymous that is fine to (however, it would be good if you included something like “licensed doctor in _____ (state)” or coach, athletic trainer, mom, dad, etc.

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By Jay Fraga, Former BMX Athlete, Husband, Father, Sports Lover

If you’ve ever had a bad hangover, I think we can all agree that it’s a relief when the day is over, you sleep, and it’s gone when you wake up the next day.

I have had a hangover for as long as I can remember. It’s been there for more than a year and a half. If you can recall the misery and suffering involved in one day with a hangover, maybe you can begin to imagine what it’s like to try to live day-to-day feeling like that.

Then again, maybe you can’t.

My last concussion was approximately 8 months after a previous one that I got crashing in a bike race.  I wasn’t especially symptomatic from the previous one, but all of my doctors virtually agree that I hadn’t yet healed when I was injured again this last time. The scientific community has a number of guidelines for concussion, but the one thing everyone can agree on is that layering a second concussion on top of a previously unhealed concussion is very, very dangerous.

In spite of our knowledge about how dangerous multiple concussions are, we see NFL players being cleared to go out onto the gridiron a week or two after sustaining not one, but two concussions in a three-week span of time, while proclaiming that they feel great, and their coach stands by, nodding approvingly.  Fantastic.

For those of us who struggle to live daily with Post Concussion Syndrome, seeing these stories play out in the news is especially painful.  There is nothing more painful than regret, and many of us watch helplessly as we watch players and coaches, who are in absolute denial, speak nonchalantly and hollowly about a subject that we are intimately acquainted with. We watch knowing full well that there’s a pretty good chance that these players will soon be joining our ranks, where the challenge isn’t a championship at the end of the season, but rather to live like a normal human being and be able to enjoy life. And it feels like there’s nothing that we can do about it.

If we want to change things in sports, we have to understand how athletes operate.  Athletes are wired a little bit differently.  Those who have learned how to overcome –  through the process of competition, loss, reflection, coaching, training, more competition, rising above, winning, and then ultimately understanding how to win, have a different belief set.  They think of themselves as machines that are able to prevail through anything.  Competition becomes a necessary part of their diet, and   Continue reading

Concussion Video Day

Here are a couple concussion videos that I have found recently…

This first one from Mayo Clinic is an AWESOME example of what happens at the lower levels when you try to push through a concussion and keep doing what you were doing;

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I was watching this video and looking at good example of how NOT to hit.  Most of these hits are from 2010 or before, and you know what, I really feel like we seeing less and less of these hits in the game.  Perhaps the rules actually being enforced are making a change?

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This Is How You Teach About Concussions

Stephania Bell of ESPN absolutely knocked this teachable moment on concussions out of the park.  I really appreciate her discussing not only the qualifiers/labels on concussions – BTW Eagles just as there is no such thing as a “mild” concussion there is no such thing as a “significant concussion” they are all significant brain injuries – but the recovery time associated with concussions.  Thank you for listening Stephania and thank you for this great segment!

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FWIW, from my sources around the league the NFLPA may want a specialist on the sideline, but the owners are resistant to this for two primary reasons: 1. cost and 2. unfamiliarity with the players.  The second would be more of a player issue rather than an owner issue, however it seems we will not see any owner override his MD’s on the sideline.  Again this all boils down to possible conflicts of interest.

Let Us Hear From Woods about “Woodsgate”

TCB follow-up to Robert “Woodsgate” and this is not the first time the PAC-12 has been under the microscope here at TCB, if you recall “Lockergate” a few years back.

There are hundreds if not thousands of hits on any given weekend in football that will result in concussions across the football landscape, many go unnoticed, except by the trained medical staff (mainly athletic trainers); certainly we see a very limited number on national TV.  However last week Robert Woods of USC was drilled in the head while blocking that resulted in OVERT signs of brain trauma.  Before we go further we should define what a concussion is, in its simplest terms:

  • A concussion, at the very base level, is a pathological event that results from forces to the brain that cause disruption of normal brain activity.  These “disruptions” can occur immediately or in a delayed response.  Regardless, any disruption of normal physical, cognitive or emotional behavior would fit this criteria.

The new standard of care for concussions across all levels is that if someone exhibits signs of a concussion they should be removed from play for a proper evaluation.  If there is no one there to do a proper evaluation (see youth and HS levels) then that player may not be returned to the game and cannot return to sport without a medical clearance from a physician.

As I have stated many a time most evaluations on the sideline are either a case of detective work – weeding through the subjective nature of the injury – or not needed because of the overt signs and clinical presentation.  I say this as an expert, one who deals with concussions in sport on almost a daily basis.  Observation is the most trusted source for concussion detection; whether it be observation  Continue reading

Sarcatasball!!!

With the attention that concussions and injuries are garnering there are usually views of the situation that bring levity and humor.  You can only nod your head and laugh along with the masses, and understand that its part of the process.  This was the case in point for the South Park episode on this subject, Sarcastaball.

The opening of the episode does take a sarcastic look at the issue on and off the field with players, after that it just gets funny!  The episode is NSFW, but good for some laughs.  Click link at your discretion.

SARCASTABALL from South Park

Ever Wondered About the Adolescent Brain?

We have discussed quite often about the adolescent brain and why concussions/brain trauma is much more troublesome for this set of the population.  Trying to explain this part has been difficult for me as I really grasp the concepts of it, rather than the practical application of the information.  Thanks to TED (a nonprofit devoted to Ideas Worth Spreading. It started out (in 1984) as a conference bringing together people from three worlds: Technology, Entertainment, Design. Since then its scope has become ever broader. Along with two annual conferences — the TED Conference in Long Beach and Palm Springs each spring, and the TEDGlobal conference in Edinburgh UK each summer — TED includes the award-winning TEDTalks video site, the Open Translation Project and TED Conversations, the inspiring TED Fellows and TEDx programs, and the annual TED Prize) we can listen to Sarah-Jayne Blakemore perfectly illustrate the adolescent brain.

Sarah-Jayne works  for the Developmental Group at the UCL Institute of Cognitive Neuroscience focuses on the development of social cognition and executive function during adolescence. Our research involves a variety of behavioral (psychophysics, eye-tracking, motion capture) and neuroimaging (MRI, fMRI and MEG) methods. We are based at the UCL Institute of Cognitive Neuroscience in Queen Square, London, UK.

This is one of the most serious brain labs in the world.

Reflection on the Weekend

While away on a family vacation I don’t get to the researching/data mining I usually do, inevitability there are events and happenings that occur that get push back in coverage.  The nice thing is that the media and other sources are doing a wonderful job of highlighting the issues that come about.  There are a few instances of concussion related news that I would like to now opine on.

First and most concerning was the Olympic woman’s soccer match between the United States and New Zealand and this;

Not only can you clearly see the keeper get hit in the head and having a violent deceleration, then her head smashes the turf, not only that she was CLEARLY unconscious after this hit, yet she was allowed to continue.  If the governing bodies of sports want to get a handle on the concussion issue then cases like this must be handled with supreme independence and a player should be removed.  Take a look at this picture and tell me she should have continued…

I will be as obnoxious and abrasive as possible with this next statement:

IF ANY PLAYER IS KNOCKED OUT FOR WHAT EVER REASON THEY SHOULD BE REMOVED FROM ACTIVITY, PERIOD.  SCORE AND CIRCUMSTANCES SHOULD NOT HAVE A BEARING ON THIS DECISION.  SAID PLAYER SHOULD NOT RETURN TO ACTIVITY UNTIL CLEARED BY A PHYSICIAN AFTER AT LEAST 24 HOURS.

We are talking about a disruption of the brains activities so “gross” Continue reading

Recounting Tragedy: Austin Trenum Story

As the blog began in 2010 there were many things I hoped to accomplish by doing this project; I never dreamed this place would help springboard a family to recovery after the most horrible day of their lives.  However, looking back I am glad the blog was here for them and will remain here, for them and anyone else who need answers.

I am speaking of the Trenum family, specifically the tragic death of their son Austin, and how they chose to cope and “push on” after that dark day in September 2010.  In one of the most powerful pieces I have read, Patrick Hruby worked with Michelle and Gil to recount the last few days of Austins life; as well as what has happened since.  Due to my intimate history and wonderful bond with the Trenum’s I felt speechless after reading Hruby’s work in the Washingtonian;

It was Sunday, September 26, 2010. Michelle Trenum woke up around 8 am. Gil was out of town, returning that afternoon from a weekend drill with his Navy Reserve unit in New Jersey. Walker, ten, their youngest, was on the living-room couch, hiding under a blanket. He jumped up when Michelle walked in. Boo!

“Austin’s awake,” Walker said. “He’s in the basement playing a video game.”

That’s odd, Michelle thought. Austin never got up early on Sundays. Not voluntarily.

Not only will you be able to feel for the Trenum’s you Continue reading

Swedish Boxing Study

In April a Swedish study was released on boxing and biomarkers in the cerebrospinal fluid (CSF); findings were not only somewhat successful for possibly getting a biomarker test, it shed light on the controversial subconcussive blows and cumulative effects as well.

Sanna Neselius, Helena Brisby, Annette Theodorsson, Kaj Blennow, Henrik Zetterberg and Jan Marcusson did perform the largest study of active boxers known, what was less known until this one study is how long and what level the CSF biomarkers are in samples of each boxer.  The most curious part of the study is that only ONE of the boxers ever reported symptoms associated with concussion yet the results show increased levels of certain biomarkers in 80% of the boxers that would be indicative of “acute axonal and neuronal damage.”

The studied biomarkers were; Continue reading

Further Investigation of AFL Inquiry of “hidden concussion”

If you recall our post earlier today there was a link about the AFL wanting more information about an injury that occurred in the Carlton/Collingwood match.  It resulted in some peculiar signs from Kade Simpson.

AFL.com.au writer Damian Barrett wrote about this; noting that medical personnel would have some serious consternation with it;

AFL MEDICAL professionals loathe it when non-medical people critique their work.

Some get so incensed they verge on apoplexy.

So we make this observation with bated breath – some decisions made by AFL doctors during a football match seem to be influenced by the state of that game.

Rightly or wrongly, Collingwood has twice this year put back onto the field players who had already sustained damage, only for those players, Luke Ball and Scott Pendlebury, to later be diagnosed with serious problems.

Out of the weekend’s round 15 matches, two clubs, Carlton and Essendon, were questioned over their handling of stricken players, respectively Kade Simpson and Kyle Reimers.

The hit on Simpson by Collingwood’s Sharrod Wellingham was horrific, and left the Blue midfielder with a broken jaw and arm spasms.

The AFL meds aren’t the only ones, the docs (and athletic trainers) here are very wary of any observation resulting in “sideline medicine”.  However, not only am I a trained medical professional specializing in concussions but the brain injury of concussion is subjective.  Meaning simply that you can assess or observe a concussion from signs produced from the insult to the brain.

In this particular case Simpson did in fact show clear, overt signs of a concussion; yet was allowed to return to play.  How do I know, heck all of you should be able to observe it yourself, look… Continue reading