I am honored and privileged to post an article from Will Carroll regarding concussions. I thank Will very much for his time and contribution!
Changing The Culture
Will Carroll for The Concussion Blog
It’s a quiet, warm Saturday morning in July. Coming up to the Colts Complex on the west side of Indianapolis, it’s normal to see players walking in. It’s not normal for them to be nine years old.
USA Football is rolling out what amounts to a pilot program they are calling the “Protection Tour.” It’s a multi-part seminar for kids, coaches and parents that focus on the concussion issue. Sponsored in part by the NFL, it’s easy to see why they chose this program. USA Football isn’t the typical governing body. They don’t have any form of control over the largest programs, the NFL and NCAA. They don’t even hold any sway over scholastic programs. They’re more a lobbying organization, taking hold of “should bes” like coaching standards and player safety.
The Protection Tour is made of up of three “stations”. In the first and perhaps most important, coaches and players are shown tackling drills that emphasize old fashioned concepts like shoulder contact, athletic position, and wrapping up. These kinds of hits won’t make SportsCenter, but they are safer for everyone. There’s an emphasis Continue reading →
In his remarks he said the helmet he now wears, compared to the one he wore when he started in the league in 2005, has prevented him from “a couple” of concussions, including one against the New York Giants in a playoff game last season.
Rodgers was part of a panel of other quarterbacks that were also Super Bowl MVP’s hosted/moderated by Bob Costas – apparently a charity event. Regardless if there was an actual quote from Rodgers about prevention of concussions from helmets or it was simply inferred by the context, it is not correct and could provide false hope to others.
Helmets were designed to attempt to eradicate skull fractures and brain bleeds, the most heinous of brain injuries that were felling many players at the turn of the 20th century. As technology has progressed we have seen fewer and fewer of this often life-threatening injury; unfortunately it does still occur. The helmet shell along with the interior padding is designed to absorb the massive linear forces that cold fracture a skull or provide enough trauma to rupture vessels in the head.
Concussions are a slight bit different – even though both are brain injuries – a concussion is mainly a neurometabolic and microscopic structural issue. Concussions are set off in a variety of ways but the biggest culprit is angular acceleration/deceleration and rotation of the skull (most commonly those type of collisions in ALL Continue reading →
Looking at the human body, in particular the head, it’s a wonder we exist at all. Our operations center is basically held in place by small bones and strong neck muscles. The human brain weighs between 3.5-5.5kg or 8-12lbs which does not seem like much until you find a 10lb medicine ball and try to balance it on a pole. Once balanced then strike the ball and then you will be amazed at how our body handles extreme forces. Even more convincing would be hitting the pole or lower and look what happens to the ball, our body is simply amazing.
In order to control your skull – in effect your brain – the neck muscles must be good at detecting even the slightest movements and be able to activate in an instant to compensate for sudden trauma to the head or body. It would stand to reason that increasing the strength of your neck would also help with lowering transitional forces to the head.
There is one little caveat with this example, the brain itself. On average the brain weighs 1.5kg or 3.5-4lbs, which makes up the majority of the weight in our head an it is not attached to anything. That is the crux of the problem; a free-floating organ – our most important – that is susceptible to forces anywhere on the body. This is why helmets cannot claim, nor do they, prevent concussions and it is why even with the strongest neck an unanticipated hit (when neck muscles are not tensed or engaged) can and will result in acceleration of the head. Translated that means high potential for concussion.
Since the tragic and untimely death of Junior Seau the concussion issue has begun to fester like a three-day old pimple on a 13 year-old’s greasy face. It is ready to pop and keeping up with all of the pertinent articles and “specials” has been very trying. In this post I will attempt to link up and highlight as many as I can (surely I will miss many, however Concerned Mom in the comment section will have more).
Lets begin with ESPN and the Outside the Lines week-long look at concussions. I have found this to be must see, my DVR is a testament to this; using previous stories and bringing in commentators on the subject have provided information and even fireworks. Yesterday Merril Hoge and Matt Chaney did just that – provide information and create fireworks. You can find the podcast here (panelists begin about 7:30 mark).
Hoge drew my ire earlier this week with his admonishing of Kurt Warner’s statement of being a father, however yesterday he did have a very valid point about the management of concussions. I have said is ad nausea here: the elephant in the room is the management of concussions, however Hoge sounded a bit “underconcerned” about the actual injury. Which is where Chaney had very valid points about the exposure of concussions to the youth. They are both right in my estimation; the management is the larger issue but we are seeing too many too young people being effected by concussions. There needs to be work in both areas and remember this is not just a football issue.
We have the duty to protect our kids and if that means flag football for 5-13 year-olds then I am cool with that. If we find after making such a drastic change that has not been enough then we can take it further if needed. I feel that a change like this will allow a few things: 1) more time to let the brain develop and thus allowing research to catch up to what we know. 2) employ more medical providers in a position to find, assess and manage concussions (see athletic trainers). And 3) begin a culture shift about the seriousness of concussions, after all this is a brain injury.
Even with the recent events of the Junior Seau passing the issue of concussions, CTE, safety, and longevity of the sport have been very much a hot topic. What hasn’t happened, until recently, is the overt and valuable opinions of those that played in the public forum. Yesterday while traveling to the high school I was listening to the radio and hearing what Kurt Warner had to say about his thoughts as a father watching his sons play football. Basically he stated that AS A FATHER he had concerns and was worried for his children, mainly because of safety and the long-term effects of playing. He himself stated he is “worried” about his health going forward as well.
All genuine and pertinent information from a former player that carries a lot of weight, and I didn’t have one problem with it. Even though he stated he didn’t want his kids to play (as a father) he is not the first, Harry Carson made the same statements about his grandchildren. What caught me completely off-guard was the reaction from former player, teammate of Warner and NY Giant (same team as Carson), Amani Toomer;
“What this reminds me of is the guy at the basketball court, who once he gets done playing takes the ball and ruins the game for everybody else,” Toomer said Thursday on NBC SportsTalk. “I think Kurt Warner needs to keep his opinions to himself when it comes to this. Everything that he’s gotten in his life has come from playing football. He works at the NFL Network right now. For him to try and trash the game, it seems to me that it’s just a little disingenuous to me.”
Disingenuous? He is a father concerned about the safety of his children, how in the world is that disingenuous? Yes the sport Continue reading →
It seems that I often am applauding the efforts north of the border in Canada, it really seems that they have put a concerted COMBINED effort to seek out and implement innovative ideas. I don’t think it says much about the United States other than we are all trying to do our best in our own little areas. There is little consortium or conglomeration of effort, rather “‘A’ has found this”, “‘B’ has discovered this”, “‘C’ is saying this”, etc, etc, etc…
It may be the same up north but with the population centers mainly in fewer areas in Canada it seems that the Toronto, Ottawa, Montreal, and Vancouver areas seem to all be on the same page. This could also be because of the overall influence of the Brain Injury Association of Canada and its influence on such things.
This idea is not from the BIAC, but it has some solid foundations none the less, including our partner in concussion awareness stopconcussions.com with Kerry Goulet and Keith Priemeau at the lead. They have created a vision and group of like-minded individuals to create what they are calling Sports Concussion Care Clinic. Here it is in a press-release; Continue reading →
The Energy and Commerce Subcommittee on Health spent some time on Monday holding a hearing on traumatic brain injury (TBI). We all know that the spectrum of this injury can range from the severe to the mildest forms (mTBI) also know as concussions. The government has been involved with TBI since 1996 funding further research and subsidizing awareness/education programs with the passage of the Traumatic Brain Injury Act of 1996;
What the Traumatic Brain Injury Act of 1996 Mandates
Public Law 104-166 charges CDC with implementing projects to reduce the incidence of traumatic brain injury. Specifically, the legislation mandates that CDC shall:
Develop a uniform reporting system for traumatic brain injuries.
Conduct research into the identification of effective strategies for preventing traumatic brain injury.
Implement public information and education programs for preventing TBI and for broadening public awareness about the public health consequences of TBI.
Provide technical assistance, either directly or through grants and contracts, to public or nonprofit entities for planning, developing, and operating projects to reduce the incidence of traumatic brain injury.
Present a report to Congress that describes the incidence and prevalence of traumatic brain injury.
Funding for all these activities was authorized at $3 million for each of the fiscal years 1997, 1998, and 1999.
The Act has been amended many times, the last, in 2008.
There have been many attempts to create a concussion “game changer”, something that will bring the assessment and/or recovery into better focus and provide more concrete answers for all of us. One thing many people keep forgetting is that the human brain is not only very complex but it is also very individual. Creating blanket statements, guidelines, and recommendations are very difficult; unless of course you use a multidisciplinary approach that touches on every part of the concussion sequale.
If you have read long enough and seen the comment section you will know that we have been clamoring for a more comprehensive, evidence-based, set of recommendations that broach all four parts of a concussion: physical, cognitive, sleep, and social/behavioral. Perhaps the Ontario Neurotrauma Foundation has done just that (.pdf at end of post and in “Current Concussion Management Page” or you can go to the ONF website);
ONF is pleased to publicly release the Guidelines for Mild Traumatic Brain Injury (MTBI) and Persistent Symptoms. The Guidelines were generated through a consensus process using existing evidence and clinical expertise. 10 to 15% of people who sustain MTBI do not recover well or as expected. The guidelines are therefore aimed at treating and reducing the impact of persistent symptoms following MTBI in adults. On behalf of the project team that oversaw this work, ONF welcomes feedback on the Guidelines to firstname.lastname@example.org
There have been other guidelines, one we hold as the standard (note not gold standard) Continue reading →
The co-chair of NFL Head, Neck & Spine Committee, Hunt Batjer, reported yesterday in Chicago that concussions dropped 50 percent on kickoffs as compared to previous years. Speaking at a forum about NFL health and safety Batjer confirmed what we had said with our observational data;
“We just got the data recently, it looks to me like a decreased number of runbacks played a role. It did not affect a lot of the other injuries paradoxically.”
Recently I have been introduced to “League of Fans”, a sports reform project founded by Ralph Nader to encourage social & civic responsibility in sports industry & culture. Although the name sounds non-germane on the surface if you dig deeper into their core principles you will see they are starting to delve into the concussion issue.
One of their first salvos is an open letter to Gary Bettman, Commissioner of the National Hockey League – oft criticized by me and the blog as well. Below is the letter signed by Ralph Nader and Ken Reed (reproduced with permission of League of Fans);
Sports Legacy Institute did in fact release their white paper today; it simply brings to the surface something that they along with others have been saying with more frequency. Their initiative to create a Hit Count is a bold step and on that is welcomed, especially in light of the very current research from Purdue.
You can find the article on the SLI website (here) or you can read the final white paper .pdf here; there is a very good background for this idea and the simple yet powerful citation of research already performed in this area. Their idea is mapped out very well, again the devil will be in the details as it all begins to be sorted out;
There are technological and monetary limitations to a pure Hit Count, as Hit Count systems currently are only sold for helmeted sports, and there are costs involved. A Hit Count is not as simple as a pitch count, where coaches only need a pencil and paper.
However, hits to the head can be accurately estimated, and methods can be developed to approximate the brain trauma exposure during games and during practice based on known variables, like position. With these estimations, rule changes and practice guidelines can be provided to ensure few, if any, athletes exceed a proposed limit. Continue reading →
I tweeted about it and want to put a link here on the site for those looking for information. This article by Jonah Lehrer does a wonderful job of not only explaining the concussive injury but also explaining why there may be an issue going forward with the sport of football. Here is an excerpt;
But we do know what happens once it’s broken. In the milliseconds after a concussion, there is a sudden release of neurotransmitters as billions of brain cells turn themselves on at the exact same time. This frenzy of activity leads to a surge of electricity, an unleashing of the charged ions contained within neurons. It’s as if the brain is pouring out its power.
The worst part of the concussion, however, is what happens next, as all those cells frantically work to regain their equilibrium. This process takes time, although how long is impossible to predict: sometimes hours, sometimes weeks, sometimes never. (The latest guidelines suggest that most concussed subjects require at least 10 days to recover, with adolescents generally needing a few days more.) While the brain is restoring itself, people suffer from a long list of side effects, which are intended to keep them from thinking too hard. Bright lights are painful; memory is fragile and full of holes; focus is impossible.
The healing also has to be uninterrupted. In the aftermath of a traumatic brain injury, the brain remains extremely fragile. Because neurons are still starved for energy, even a minor “secondary impact” can unleash a devastating molecular cascade. All of a sudden, brain cells that seemed to be regaining their balance begin committing suicide. The end result is a massive loss of neurons. Nobody knows why this loss happens. But the loss is permanent.
Teenagers are especially susceptible to these mass cellular suicides. This is largely because their brains are still developing, which means that even a slight loss of cells can alter the trajectory of brain growth. Football concussions are also most likely to affect the parts of the brain, such as the frontal lobes, that are undergoing the most intense development. (The frontal lobes are responsible for many higher cognitive functions, such as self-control and abstract reasoning. The immaturity of these areas helps explain the immaturity of teenagers.)
I was approached by a reader to figure out what concussions are “theoretically” costing owners/teams in terms of salary. His thought, a good one, was to illustrate the economic impact to the NFL and owners that an investment in a completely independent concussion “think tank” could save money in the long run. The last time we ran the numbers was in week 13, we are efforting the final numbers for 2011.
There were some limitations in determining this overall impact to the owners:
Finding exact contract information for each player
Determining exact loss of game time due to concussion
Exactly accurate listings of injury
To our knowledge there is no published information on this topic, therefore this presentation of information is the first of its kind, and we truly understand that this is not 100% accurate, but it does give an idea of what is happening in terms of concussion and lost salary.
Based upon our findings the average salary for a concussed player/game in the NFL through 13 weeks was Continue reading →
According to NFL.com the league is going to let the head athletic trainer or head team physician to use video replay in assisting with injuries. There are stipulations and monitoring from the league for its usage;
The league made it clear that the use of this equipment is for medical purposes only and not to gain any competitive advantage. The NFL plans to monitor the use of the video monitors and will determine if its availability will be expanded next season.
The league issued the following guidelines surrounding the equipment’s use:
» The equipment may only be used by a team physician or the head athletic trainer. Under no circumstances may coaches, players, or others have access to this equipment.
» The medical staff may only review video of a play to assist it in treating a player who suffered (or may have suffered), an injury during that play.
» The head team physician or the head athletic trainer must notify the league officiating observer in the press box prior to accessing the field video monitor.
We have clearly stated here that one of the best tools the athletic trainer has is his/her eyes and understanding the mechanism of injury. That is why we as AT’s Continue reading →
Have I mentioned that I really LOVE you readers? In case you have missed it, I do love all of you; you make this blog better every day. In the mailbag today was an article forwarded to me from a family about lacrosse. The article is from Inside Lacrosse the January issue, written by Terry Foy. The article is a question and answer with Dr. Robert Cantu and has wonderful-insightful questions and answers.
Because I cannot in good conscience rip off the entire article I will provide the questions by Inside Lacrosse and some quotes, but mostly summations of the answers by Cantu. Make sure you visit the article for all the information.
How familiar are you with men’s and women’s lacrosse?
Just like our stance on woman’s lacrosse, Dr. Cantu is very adamant about putting head-gear on players in that subset of the sport.
Are helmets one of the primary actors in diminishing the amount of concussions in lacrosse?
Depending on the actual cause of the injury helmets can help in decreasing the amount. Dr. Cantu’s information provides him with data that show most woman’s lacrosse concussions come from stick strikes to the head. He is correct in estimating that putting helmets on woman would decrease concussions in that case. He does echo what we have been telling you from day one; helmets do not prevent the primary reason for concussions in collision sports (rotational forces).
Because the NFL changed their rules to protect from head injuries, do you think lacrosse, aside from adding helmets on the women’s side, needs to adjust any rules to create the same protection? Continue reading →
Recently there has been a spike in awareness and number of concussions in the National Hockey League. Last year we began compiling the injuries in our database to see where the sport stands (we also do NFL, NCAA football, and Aussie Rules Football). When Sidney Crosby sustained his initial concussion in the Winter Classic last year it seemed that NHL has begun to take notice.
It was refreshing to see The Star of the NHL deal with the brain injury with some transparency, although he endured some criticism what Crosby did was set into motion the awareness of concussions. Last season prior to the new year it was very difficult to find actual listed concussions; they were veiled in “upper body” or “undisclosed” listings. In some cases the injury was improperly reported as a neck or shoulder injury; a sign that the concussion was either a) not understood (unlikely) or b) needed to be hidden.
Before you read on it is important to understand the position of the blog and this author about concussions.
Concussions, brain injuries, are an inherent part of collision sports. There is very little in the way of equipment that can prevent concussions, the only way to impact a positive change (see decrease) is to address the culture and mechanics of sports. This does not mean that professional sports should be outlawed, rather subtly changed to protect those that play, not only for the immediate time, but for the long-term health of the athletes. With this; Continue reading →
Yesterday we posted the press release regarding the hearing on concussions and the marketing of sports equipment. Soon after that post I received many communications about what was said and my feelings on the subject. Before we get into how exactly I feel regarding this one short hearing I think you should take the time to see it for your self. It is a long hearing with five witnesses, so you will have to have a lot of time, HOWEVER IF YOU ONLY HAVE 10 MINUTES IT CAN BE SUMMED UP FROM THE 30:20 MARK TO THE 40:45 MARK.
In those ten minutes you hear exactly what is wrong with current the current concussion situation, not from doctors, senators, or the “high-ranking” researchers, rather from former student-athletes that lost their playing careers due to this brain injury. Alexis Ball and Steven Threet paint a picture of the athlete, Continue reading →
The Commerce Committee held a hearing on sports equipment labeled as “anti-concussion” or concussion prevention technology. The issue is not that some products make the claim but there is no independent research to back up any of the claims. I believe that this is an important issue, one we have highlighted regarding mouthguards previously.
Here is the press release;
WASHINGTON, D.C.—At a Commerce Committee hearing today, Chairman John D. (Jay) Rockefeller and Senator Tom Udall (D-N.M.) highlighted two important points about sports concussions that are often overlooked: that concussions are a serious problem even for young athletes; and that sports equipment is often marketed as “anti-concussion” without sufficient proof.
“We now understand that this is not an injury only NFL players can suffer. And it’s not just a football problem either,” Rockefeller said. “More than 10,000 high school girl soccer players sustain concussions each year. What’s even more troubling is that sports equipment manufacturers are exploiting our growing concerns about sports concussions to market so-called ‘anti-concussion’ products to athletes and their parents. The American public has a lot of legitimate questions about the risk of concussions in sports and they deserve honest answers.” Continue reading →
In light of Tracey Meyer’s post about her son and his plight with a concussion, in particular the academic setting, I feel it is a good time to highlight the work of Don and Flo Brady. Don is part of the National Association of School Psychologists, and with is wife wrote an article about Sport-Related Concussions.
Suggestions for Returning to Play, School, Home, and Socializing
The complex, varying, and individual central nervous system response to a brain insult and resultant concussion injury not only justifies but also requires a comprehensive assessment from a readily available and qualified multidisciplinary team of healthcare providers (McKeag, 2003). The utilization of a multidisciplinary team is particularly essential since consequences of a concussion include both neurological and nonneurological effects. Suggested members of this healthcare team may include the following: physician, neurologist, neurosurgeon, psychologist, neuropsychologist, school psychologist, teachers, school administrators, optometrist, ophthalmologist, coaches, athletic trainer, speech pathologist, occupational therapist, and physical therapist. Equally important is the Continue reading →
The National Hockey League began its preseason media blitz yesterday with a heightened awareness on the head injury in the sport of hockey. Last season the NHL adopted Rule 48, banning blind side contact to the head, it was later expanded at the Winter General Manager Meetings to include lateral contact.
At the same time other leagues were continuing with their rules of no head contact; International Ice Hockey Federation (international sanctioning body of the sport), the NCAA, and possibly the biggest contributor of NHL talent the Ontario Hockey League. The NHL with the ingrained “tough guy” mentality of the general managers and the deep seeded tradition of the game seem to be missing the point.
Matt Chaney has been busy this summer with work, but he found some time to forward a bunch of links regarding concussions. There were a lot dealing with the state laws and the mandates now in place across the sporting landscape, all with very valid opinions. Some dealt with his area of expertise, steroid and PED detection. However there was one that I must share with you; a link to a NASP Communique (National Association of School Psychologists)
The link was very resourceful but the gem was the attached .pdf that dealt with the myths we commonly hear with concussions. Due to the rudeness of ripping off all the information below you will see the myths they took on, and for the actual facts please click on the .pdf link above;
Professionals agree on the definition of a concussion.
A more accurate term for concussion is a head injury rather than a brain injury. Continue reading →
The Ivy League has decided to become proactive in the area of contact practices in football. Currently the NCAA limits the number of full contact days to 5 per week;
According to the new rules, teams will be able to hold only two full-contact practices per week during the season, compared with a maximum of five under N.C.A.A. guidelines. On the other days of the week, practices cannot include contact or live tackles, and no player may be “taken to the ground.”
During the preseason, teams will be able to hold only one full-contact session during two-a-day practices.
This decisions has been made after a long study, and coaches feel as though the changes will not impact the game or current practices, with the added bonus of having “fresher” players on game day.
Welcome to the continually updated live feed from the Athletic Trainers Society of New Jersey 2nd Annual Concussion Summit. I would like to thank the ATSNJ in particular; John Furtado, Eric Nussbaum, and Mary Jane Rogers for the help in getting things set up. We are at the Wyndham Princeton Forrestal Conference Center & Hotel in a stunning amphitheater, attendance is anticipated to be high. I anticipate updating this post as soon as possible after each speaker. Follow @concussionblog for updates.
6:25am CST: Crowd flowing in with provided breakfast in hand.
6:33am CST: Jason Mihalik, PhD “Biomechanics of Concussion”;
Concussion is a FUNCTIONAL injury not structural injury
Brian injury a major public health concern (showing a pyramid with the head injuries on the bottom, unseen or caring on their own)
Welcome to the intended live feed from the 2nd Annual Sports Concussion Summit here in Lexington, Kentucky. We are at Cardinal Hill Rehabilitation Hospital, a beautiful facility. Attendance looks to be very good, about “60 or so” according to Jonathan Lifshitz, host of the event. I will be updating this post as we go along with a time, follow @concussionblog on Twitter for updates.
7:05am CST: Jonathan Lifshitz, PhD opens up the conference, a big “walk-in” group, I still think I may be the only one not from KY here.
7:10am CST: Dr. Lifshitz had a great perspective on announcers and how the terminology of the game regarding head injuries has to slowly begun to change.
7:50am CST: Dan Han, PsyD “Contemporary Perception on CHI: Multidisciplinary Initiatives”
The NHL today sent out a note that they have cleaned up the wording on Rule No. 48, the rule put in place at the Winter GM Meetings that “kind of” started the penalization of head hits in professional hockey. The statement reads (from NHL.com);
Rule 48 previously provided the on-ice officials with the ability to call a major penalty for any targeted head hit from the lateral or blind side, but the re-written rule no longer includes the words lateral or blind side, and the major penalty provision has been replaced by the minor penalty provision.
“Now, the confusion some of the players have expressed in the past as to what direction they’re approaching a player, what direction a player is facing, east, west, north, south, that has all been taken out,” said Brendan Shanahan, NHL Senior V.P. of Player Safety and Hockey Operations. “Anywhere on the ice, coming from any direction, you target the head and make it a principle point of contact, you’ll be subject to a two-minute penalty on the ice for Rule 48. You’ll also be — as with all two-minute penalties or non-calls — subject to supplementary discipline.”
This should, stress on the word “should”, eliminate any hits being made to the head with anything other than a high stick or puck Continue reading →