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#pinkTBI Summit 2016: A recap

Dustin Fink4 Comments

pinktbiThe meeting at Georgetown University this past weekend was more than fruitful for this athletic trainer. I went in trying to get two things done: one, provide info to you the follower as best as possible and move along the discussion on female concussion and two, to learn something that is applicable to me as a “boot on the ground” athletic trainer.

The first was probably painfully obvious that I accomplished if you follow on Twitter and didn’t mute me and were not interested in this event (you should have been interested). The second objective I did meet by learning some techniques when working with females, not only at incident but with recovery, education and overall attitude.

Certainly I could write 4000 words on this event but that would be boring to you and I am still recovering from the weekend the the docs there asked that I “rest” my fingers. That being said I will give quick synopsis’s of each speaker, info that I took away as an athletic trainer and advocate for education about mTBI/concussion. It is entirely possible that I misrepresented some thoughts and missed some very valuable info for some out there; don’t worry speakers and audience this was done the best possible.

Lets begin, and this will be in chronological order of the event with presenters last name, in bullet form. My hope is that you will use this as furthering your info about the female sequale and in some cases change how you treat.

  • Kerr:
    • The concussion rate is higher in females in males in college and high school sports, particularly in basketball, soccer, and softball/baseball.
    • Research suggests differences in symptoms reported as well as RTP.
    • More research needed at the youth level.
  • Covassin:
    • Showed that neck strength is a confounding effect on possible injury.
    • MOI is different in the sexes: males contact with player while female is contact with ground/equipment.
  • Lincoln:
    • Exposed us to the lacrosse injury and problems that exist, which is important because this is an emerging sport.
    • No head gear in woman’s lacrosse.
  • Casswell:
    • Impact sensors and injury and how it may relate to injury.
    • Different types of injury for females vs. males (building on Covassin).
  • Colantonio:
    • Logitudial study showed about 24% of female pop has had mTBI.
    • Females seek and get less care overall.
    • Reproductive impact after a mTBI need to be understood.
  • Gioa:
    • Static and dynamic symptoms are different in female vs. males – needs research.
    • Academic performance shows no difference between sexes.  Continue reading →

International Summit on Female Concussions and TBI

Dustin Fink3 Comments

I am very excited to inform you and implore you to attend this first of its kind conference. Katherine Snedaker – a good friend and ally – along with her planning committee have done a wonderful job of creating a great place to discuss a subset of this head injury issue.

The International Summit on Female Concussions and TBI will be held a month from now at Georgetown University in Washington, DC. This summit is unique because this will only be about sex and gender-based research on females, from pediatrics to the elderly.

As much as we think we know about head injuries and concussions we don’t know squat, globally. Let alone in one gender over the other; females have been painfully overlooked/lack of attention because most of the noise and spotlight is on male dominated sports. Although, females choose to play many of the collision sports (rugby, hockey, lacrosse) there are other issues we know that impact females differently.

The summit is over two days and will eventually culminate in a consensus statement about female issues surrounding and within the concussion paradigm. This is also going to be a first of its kind, and appreciated at least from me.

The Topics (briefly summarized):

  • Menstrual Phase and its impact
  • Age and Sex and its impact on symptoms
  • Domestic Violence
  • Female Soldiers
  • Pediatrics
  • Female Sport Concussions
  • Concussion Recovery male vs. female
  • Female RIO Data
  • Clinical Spectroscopy of Female brain
  • Return to School
  • Social Interactions
  • Ice Skaters
  • Psychology of Concussoin
  • And more

Here are the presenters, moderators and planning committee members (as of this post):  Continue reading →

Vector Mouthguard Season Wrap Up: Product Review and Impressions

Dustin Fink5 Comments

I find myself in a peculiar situation in regards to the Vector Mouthguard; I have indeed benefited from the relationship as mentioned in the first post about this product. However, I have also been honest and blunt with them while dealing with the product. I have made every attempt to be as objective and neutral on any product or research on this blog, in cases where my integrity may have been perceptually challenged I have noted such.

However, I have looked at many blogs about various products and come to the conclusion that this post is going to be an in-depth product review with my honest feedback. You, the reader, will have to trust – hopefully based on my track record – that it is an unbiased assessment. Heck this is just like the YouTube toy reviews that my and your kids watch constantly, minus the video and my ugly mug.

Enough with the mental hand-wringing and on to the after-season report on the Vector Mouthguard (you can catch up from previous posts with “It’s Actually Happening…“, “Day 1“, “Seeing Is…“, “Practical Application…” and “Ready for Primetime“). The last post about the mouthguard was prior to the first game and our team went on to play 10 games so there were a lot of happenings in regards to the Vector, I could write 3000 5000 words on it but no one would read all of it. I will try to bullet the ups and downs as well as noteworthy case uses. At the end I will attempt to address the common questions I had about this from other professionals, parents, coaches and kids. In advance, thanks for your time and if you have further questions hit up the comment section or my inbox.

Immediately the system had media attention about what we were doing for player safety at the high school as the “strange-looking” mouthguards were on the kids as well as a radar looking device on the sideline. Still in the quasi-euphoric/excitement stage of the process there was this interview that I did (completely independent) and captured the first three weeks of the regular season.

During that time we did have some individual mouthguards that were not functioning as planned/expected and some charging issues with the base units. Through conversations with the tech team at i1biometrics we were able to get everything going that was outside the norm. This is a key piece to note; the customer service was unbelievable and agile. Granted there were not thousands of systems in use and none of them had a loud-mouthed blogger running them, it was still what I can see this company continuing to provide for anyone with this product. A lot of the service could be done remotely or via mail. The grasp of the system and the actual engineers that are part of the solution team make it what it is.

As mentioned I didn’t quite know how or if this was going to change how I “did” things as an athletic trainer. Upon the month-long reflection and review after the season I noticed that I did change what I did. I started using the information provided to put a watchful eye on certain players and to confirm what I did see with my eyes. Or in one case I used it to see what happened to a player that I did not witness but my coaches told me about happening in a game. The system had started to provide me eyes that I don’t have but I never really relied on those eyes, but was happy they were there.

During games I started to Continue reading →

The Case Keenum Case: Why It Matters

Dustin Fink4 Comments

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 →

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

Dustin Fink4 Comments

pink concIf there has ever been a tenacious and relentless person in the concussion space my observation is that it is this one person. Not a researcher, not a physician, not a policy maker…  A mom… Her name Katherine Snedaker.

She has been mentioned many times (Pink Concussions) here and has been a commentor on this blog as well, but what Katherine is pulling off this coming February is nothing short of monumental for the concussion space.

On Saturday February 27th she will be presenting the National Summit on Female Concussion, TBI and Headache, at the Georgetown School of Medicine.

Part of the program will include presentations of abstracts, which they are currently calling for. The Program Committee is accepting abstracts for presentation on “Sex/Gender-based Concussion Research” on concussion, TBI and headache from the areas such as:

  • Pediatrics to Geriatrics: Concussions and other TBIs across the female life cycle
  • Sports and Sports Medicine – Youth, High School, College, Olympics
  • Domestic Violence and Shaken Baby Syndrome
  • Military Service

As you probably can imagine these areas are so under-researched, mainly because head injuries are often associated with sport and male type activities. However, women are part of this issue to – a huge part. Females are also very different than males in many ways but we have recently have come to know that their response to head injury/concussion is not the same as males.

There will be more to follow on this summit – consider this post as a save the date – “ATs are one of our target groups we want,” Katherine said in an emial.

This post is directly aimed at the researchers in the community that want to share their info at this very important and unique event. Please spread the word about this to anyone you know that would be interested.

From the Call for Abstracts link at Pink Concussions:

Click the brain below to upload your abstract in a PDF form.

  • Abstracts submission portal closes 1/5/16 at 11.00pm EST Abstract acceptance letters will be sent 1/15/2016
  • Abstracts must include: Title, Authors, Affiliations, Background, Objective, Methods, Results, Conclusion plus 2 tables or graphs may be included
  • Abstract character count, excluding spaces and the words “Background, Objective, Methods, Results, Conclusion” is 350 words
  • Only reports of original research may be submitted
  • The data may have been published in a manuscript or e-publication

Address questions to either the Scientific Chair, Dr. Dave Milzman at milzmand@georgetown.edu or Executive DirectorKatherine Snedaker, LMSW at Katherine@PINKconcussions.com

You can also access the submission form HERE.

It is my pleasure to promote this event for someone that I call a friend and someone that has battled more than just stereotypes to bring awareness and education.

Illinois Governor Signs Concussion Bill Into Law – UPDATE

Dustin Fink3 Comments

UPDATED: 15:20, see below…

Yesterday Illinois Gov. Rauner signed  SB0007 into law making it Public Act 099-0245 effectively titled Youth Sports Concussion Safety Act bringing a much more robust set of standards when dealing with concussions in Illinois.

The bill/law is basically an extension of the IHSA Policies regarding concussions plus some strengthening for player/participant safety.

Most notably this law now pertains to all sports, not just limited to the high school sports.

There will be more to follow on this as I get more time to delve into the entire bill.

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I have read the bill a few times and here are the other important takeaways from this bill:

  • Any Park District and Youth Sports program must make available concussion information
  • Returning from a concussion in youth sports programs or other organized sports (see club sports) must go through same steps as the IHSA/IESA standards
  • All schools under the State Board of Education must have the following:
    • A concussion oversight team that includes the following:
      • at least one physician
      • if school employs athletic trainer they must be included
      • if school employs nurse they must be included
      • administrator of protocol (essentially someone in charge of paperwork and policies)
      • if wanted any other healthcare provider as outlined in bill (MD/DO, PT, OT, ATC, RN, PsyD)
    • A concussion return-to-play protocol
    • A concussion return-to-learn protocol
    • All members of the concussion oversight team, coaches and officials must have no less than two hours of continuing education, from respective and approved providers, on concussion every two years.
  • If suspected of a concussion and pulled from game or practice the injured must meet minimum requirements to return to play and can only be signed off by a physician or athletic trainer working under a physicians license/direction.
    • If concussed the injured MUST go through the RTP protocol as set forth by each school and the RTP must be approved by the IHSA

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When and How ‘Not a Concussion’ Becomes a Concussion: Klay Thompson Injury

Dustin Fink5 Comments

The Western Conference Finals not only provided an opportunity for the Golden State Warriors a chance at winning an NBA title it has provided a wonderful opportunity for people to learn more about concussions. The knee-jerk reaction to incidents like we have seen in Games 4 and 5 are often a mix of truth, hyperbole and eye-rolling; however what is clear they are cases that we can use to forge further understanding and education.

Last night in the would be close-out game of the WCF, Klay Thompson shot faked and the defender rose as he [Thompson] ducked and the defender’s knee blasted the side of Thompson’s head right in his right ear.

Unlike his teammate from the game before, Steph Curry, Thompson did not show overt signs, to my trained eyes, of a concussion. His face was “scruntched” in pain and he immediately grabbed for his ear, plus after the incident he immediately rose to his feet and walked straight to the locker room without assistance. As noted in Tuesday’s post signs are paramount when making critical in-game decisions about return to play; if they are there, there should be no doubt about removal.

The next report we received on TV or Twitter was about Thompson having an ear laceration and that they didn’t need to do a concussion evaluation. Which is entirely possible but unlikely, because I do believe they did a concussion “screen” at the time. The Warriors med staff probably didn’t do the full-blown evaluation because five minutes would not have been sufficient for that, but that was enough time to go over any symptoms and quick balance assessment (think roadside sobriety test). It is also important to know that because concussion are mainly subjective that a massive portion of any concussion evaluation is the interview: talking, questions and mental challenges about venue/score/date/etc.  Continue reading →

“Contussiongate”*: The Steph Curry Incident

Dustin Fink1 Comment

*I will admit that I could not come up with a catchy title for this post so I ripped this from Mike Freeman’s twitter feed (@mikefreemanNFL) last night:

But not only is this funny but it is about as accurate as it could have been when summing up the Steph Curry incident last night in Game 4 of the Western Conference series. So, thank you Mr. Freeman for your insightfulness and wonderful wordplay.

Those that were watching the game last night and happened to be on Twitter should know the entire process this sequelae; because of that I will be as brief as possible while injecting the overriding issues and thoughts on this.

It all began in about halfway thought the second quarter as the Warriors were getting throttled by the Rockets;

There is not speculation when looking at that vine, Curry hit his head on the court after taking an uncontrolled fall. What is not seen in the vine is Curry laying prone on the floor for a few minutes as the medical staff took a look at him (even noted checking his c-spine). When the world was brought back to the game from commercial we saw Steph getting assistance off the floor to the locker room, where further evaluation was to be done, obviously.

The first point to note in this event is that Curry not only immediately grabbed his head where it contacted the floor but he also was “down” for some time, that is obviously not normal. He hit his head and very hard so of course he would be slow to get up, but it was the amount of time that would and did have me concerned.

Before we go further we should define concussion for all of you out there, if you want the drawn out and dictionary definitions you can find it HERE, but for the simplest and most poignant way: a concussion is a disruption of normal brain function after a traumatic event. Notice there is nothing about getting hit Continue reading →

It. Has. To. Stop. (revisited)

Dustin Fink14 Comments

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

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

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

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

Being From IL, People Want To Know What I Think of Law Suit Against IHSA

Dustin Fink6 Comments

Sq 300 JI have been asked by many people what my thoughts are on the first law suit filed against a state high school association in regards to concussion.  With this coming in my “home” state of Illinois, people figured I would have a strong statement or unique perspective.  I have struggled with coming up with exactly what I wanted to say and could not figure out why.  This is in my wheelhouse, commentary on recent and public events; one would think it would have been natural.

Then, I figured out why I couldn’t come up with something…  BECAUSE I ALREADY DID, 29 MONTHS AGO!!!

Almost like I could see into the future.  Below is what I wrote here and sent off to the Illinois High School Association in May of 2012.  Looking back on it I still feel strongly in the proposals and the rationale.  Take a quick look for yourself:

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I have been working on this letter for a little while but was really spurred to action by the parent in Maryland, Tom Hearn who discussed his concerns with the local school board.  I have tried and tried to use the “chain-of-command” with these thoughts and ideas, however at every step I got the feeling I would have to go alone on this, so I have.  This letter may or may not reflect the opinions of my employer, high school, athletic training sanctioning bodies, or others I am involved with.  This letter is from a concerned individual who feels I can spread the message effectively by these means.  I have emailed the letter, proposals and the Sports Legacy Institute Hit Count White Paper to all Executive Directors and Board of Directors of the Illinois High School Association.

OPEN LETTER

May 15, 2012

Illinois High School Association
c/o: Marty Hickman, Executive Director
2175 McGraw Drive
Bloomington, IL 61704-6011
(309) 663-7479 – fax

Dear IHSA – Executive Directors, Board of Directors and Sports Med Advisory Board:

I am writing this letter to address the growing concern of concussions in sports, mainly in football.  It should be noted that football is not the only sport with a concussion issue; however this sport combines the highest participation, highest risk, and highest visibility.  This letter should not be construed as an attack on the sport of football, but rather a way to keep the sport continuing to grow.

As a licensed and practicing Athletic Trainer, researcher, commenter, father, and survivor of too many concussions, I feel that in order to keep the sports we love, proactive steps must be taken.  Often being proactive is a painful process and easily dismissed because of the trouble it will cause.  I urge all involved to think about what the future of all sports will be if nothing is done.

The Illinois State Legislature with the IHSA took the initiative by creating a mechanism of concussion education and awareness in response to the mounting scientific evidence of potential long-term impairments resulting from mishandling of this injury.  However, this only represents a first step in the process; passing out a flyer or having parents and athletes initial that they have read the information is one small element of the issue.  Another crucial element of the issue is coaching. We must ensure that those we entrust with the care and leadership of our children understand Continue reading →

This Is Unacceptable, In My Humble Opinion

Dustin Fink20 Comments

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 →

Jamaal Charles; No Different Then Vast Majority of Competitive Athletes

Dustin Fink8 Comments

Last week when the Chiefs played the Chargers running back Jamaal Charles scored a touchdown and was blasted in the end zone by Brandon Flowers.  A shot that Charles bounced up from and headed to the sideline while Flowers was slow to get to his feet.  The hit was helmet to face mask and the resulting forces were a classic case of what is typically needed to produce a concussion for one or both of the players.  Whether or not it actually did, we will never “officially know.”

The issue is not with the hit or the fact that Charles apparently cleared the screening done on the sideline after such a hit, the issue is with his comments a few days after on the Dan Le Batard show;

“It definitely hurt,” Charles said. “A couple plays later, I just [saw] this light buzz around my eyes and I was trying to catch ’em. But I was like, ‘Let’s get the ball and run again.'”

I am 100% confident that Head Athletic Trainer Rick Burkholder did his job on Sunday – screening Charles after the hit – it was evidenced on Tuesday/Wednesday when Burkholder placed Charles in the protocol as a precaution solely due to the comments Charles made.

Why you may ask?  Simple, by the absolute letter of the definition of concussion – disruption of normal brain function following a traumatic event – Charles admitted he was “not normal”.

Whether or not Charles had a concussion is up for debate among many people, not only externally – us blogging/media type – but likely internally – Charles and med staff.  Here in lies the problem with concussions and the issue of concussions.

As we tried to explain in the University of Michigan post, concussion is most often a subjective injury, we as medical professionals rely upon the athlete or injured to tell us what is going on.  If there are no overt or outward signs (loss of consciousness, wobbliness, gaze, vomiting, etc.) then all we can do is screen the athletes.  And by screening I mean simply asking the athlete if they are OK.

GAMING THE SYSTEM

I heard Mark Schlereth on Mike and Mike this morning saying something to the effect of; “there has to be more than just asking the player if they are ‘OK’?”.  The truth of the matter is that there is not really anything other than that; although just asking one question is not due diligence.  In my experience I ask more questions and even try to trick athletes into giving up any ruse they are trying to pull on me.  I have a to questions and line of questioning that has produced many responses that then warranted them to be fully examined with a sideline evaluation, even for the best “liars” (I won’t share them here because it can be used for people to study and then find a way around it).

The more complex yet simple reason we as athletic trainers feel confident with screening, even with limited questions, is that we know the athlete.  Their usual demeanor, behavior and general presentation.  People often ask me how long it takes me to know if someone has a concussion.  When they are my players, the ones I am around on a daily basis, usually it takes me Continue reading →

Constantly Learning and Watching: There is a Time to Act

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It has been a truly busy season – in regards to injuries – where I perform my “day job”.  I was going over some records that I keep and this season has been the busiest in my 15 years.  In fact, when discussing with peers they too have had a high volume of injuries in the training room.  I would say it is karma; last season we were as slow as I could remember.

Part of what I do in my job is to evaluate the injuries and determine if there are any that could have been prevented.  Certainly preseason preparation – weights and conditioning – is a huge factor and we did that here, but there is always a place to learn and watch to make adjustments.  In reviewing the injuries (over 50 – not all concussions) I’ve encountered that required medical care beyond the athletic training room the results were “good”.  Only three were incidents that I considered “preventable”, one of which I posted about weeks ago. That is less than 10% of injuries that could have been prevented, which is good, not great, but good.  In years past I have seen numbers as high as 25-30% of injuries that I deemed “preventable”.  I take pride in doing my job and if I can prevent every single incident and only have injuries that occur on a “random” basis I will take it (has yet to happen in my 15 years).

Before we go further, I would like to give a glimpse into how I review injuries.  We will use a tib/fib fracture we had this year; this player was injured in a game and to me that is “un-preventable”.  However, a few years back we had a tib/fib fracture that occurred in practice – a practice with only “uppers” on and players were not supposed to take anyone to the ground – that incident was considered “preventable” to me.  If players and coaches were vigilant to the rules of practice that player would never have been rolled up on during a tackle.  Concussions are similar…

I feel that concussions can be “prevented” in practice with contact limits and proper technique during drills.  The other two incidents, thus far, I deemed preventable occurred in practices and were concussions.  One player was hit by a teammate during a non-contact soccer drill as a “joke” and the other did not use good judgement and ran into a pile and was rocked.

The take home here is that most injuries are part of sports and we must accept this.  Also, athletic trainers have much more to worry about and analyze than most think.

All of the observation and learning also pertains to return to play; whether that be orthopedic rehabilitation or concussion return to play protocol.  We, as athletic trainers, must express our voices when there is something going on that is a player safety issue.  This can be as simple as modifying team warm-ups all the way to the case I had yesterday.

One of the concussed kids was on his final step for RTP (full contact practice), he is Continue reading →

Weighing in on Michigan Situation

Dustin Fink62 Comments

If you follow college football or listen to sports radio there is a good chance that you have been exposed to the story of Michigan quarterback, Shane Morris, and the apparent failure to keep him from the field after sustaining a head injury.  The official story from the University is that it was a communication error.

Believe it or not, that could be exactly correct.  Now, were there some possible missteps along the way by ALL involved, yes.  Is there one single person or policy in place that is to blame, no.  I offer some perspective before everyone eviscerates their choice of target in this case, lets take a look at how this could have went sideways.

The Player

Morris was roughed up a bit as the game progressed; he is a sophomore QB that was just elevated to the starting position on a premiere football program.  Certainly he displayed some orthopedic distress as he was limping heavily after a play – how many times have we seen players play through ankle/knee/leg/foot injuries and some times even celebrated for doing so.  Morris was playing through pain trying to help his team, but what happened next need not happen; however the player himself has a lot to do with how it will and did go down.

After Morris was hit in the head he attempted to get up and was obviously unsteady on his feet, he even waved off the medical team.  I have been told by a good source that he even told the sidelines it was his ankle that was the issue, not his head.  Which is entirely plausible, but due to the mechanism of the previous play would be unlikely the main reason for his wobbliness.

Athletic trainers as medical professionals are not omnipotent but we sure are close (ha) when it comes to injuries on the field/court of play.  We do rely upon input from other human beings to make quick and decisive decisions.  Doing so, in some instances, can end up creating a delay in proper treatment as it did in this case.  Morris’ insistence that he was ‘OK’ immediately after the hit was taken for face value in that very short period of time.  Considering the confluence of all the other factors for player safety – his ankle, his immediate response to the sideline, his demeanor – he was not ripped from the field.  To be honest here, I have never seen a coach, teammate, athletic trainer or other – in the college or professional ranks – step on a field to remove a player that got up and “shook it off”; usually it takes the player going down and staying down for that to happen, if he/she does not leave the field under their own volition.  Because of this, it is on the player to make sure they are seeking the proper care for their own well-being.

After the next play, Morris was removed for evaluation of his injuries.  Part of that evaluation included his head and the team Continue reading →

#tbt: Eye Opener from 2012: Was it overlooked?

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Originally titled “Bombshell Found in Sports Illustrated Vault” this post appeared on July 4, 2012…  To this day, it may be one of the most poignant articles I have written about the road we have been down.  I believe that this post still rings true, two years later, in regards to all the information we knew that we didn’t know…  

Considering where – 2014 – and what has transpired – League of Denial – this article may have been glossed over and was WAY AHEAD OF ITS TIME from SI.  I often find myself wondering why we are not learning from the past to make proactive measures going forward…

Enjoy the read from the past (excellent RT @protectthebrain);

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Thanks to @ConcernedMom9 I was sent an article from Sports Illustrated written by Michael Farber.  Before I tell you the year and provide the link I want so share some quotes from it;

“People are missing the boat on brain injuries,” says Dr. James P. Kelly, director of the brain-injury program at the Rehabilitation Institute of Chicago and an assistant professor of neurology at Northwestern University Medical School. “It isn’t just cataclysmic injury or death from brain injuries that should concern people. The core of the person can change from repeated blows to the head.

“I get furious every time I watch a game and hear the announcers say, ‘Wow, he really got his bell rung on that play.’ It’s almost like, ‘Yuk, yuk, yuk,’ as if they’re joking. Concussions are no joke.”

That sounds very similar to what we are discussing now in 2012.

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•Of the 1.5 million high school football players in the U.S., 250,000 suffer a concussion in any given season, according to a survey conducted for The American Journal of Public Health.

•A player who has already suffered a concussion is four times more likely to get one than a player who has been concussion-free. Quarterbacks, running backs, receivers and defensive backs are most vulnerable, […] that special teams players were at the highest risk per minute spent on the field.

•Concussions are underreported at all levels of football. This is partly because of the subtlety of a mild concussion (unless a player is as woozy as a wino, the injury might go undetected by a busy trainer or coach) but primarily because players have bought into football’s rub-dirt-on-it ethos. “If we get knocked in the head, it’s embarrassing to come to the sideline and say, ‘Hey, my head’s feeling funny,’ ” says San Francisco 49er quarterback Steve Young, who has suffered at least a half dozen concussions. “So I’m sure we’re denying it.”

•Football’s guidelines for players returning after concussions are sometimes more lenient than boxing’s. The New Jersey Boxing Commission requires a fighter who is knocked out to wait 60 days and submit to an electroencephalogram (EEG) before being allowed back into the ring.

•According to Ken Kutner, a New Jersey neuropsychologist, postconcussion syndrome is far more widespread than the NFL or even those suffering from the syndrome would lead us to believe. […] Kutner says that the players fear that admitting to postconcussion syndrome might cost them a job after retirement from football.

Hmmm, we all thought this was information new to us – new being 2008.

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That, however, doesn’t console Lawrence and Irene Guitterez of Monte Vista, Colo. “He just thought it was something trivial,” Irene says of her son, Adrian, who was a running back on the Monte Vista High team three years ago. “He had a headache and was sore, but it seemed like cold symptoms. He wasn’t one to complain. He wouldn’t say anything to anybody. He wanted to play in the Alamosa game.”

He did play. At halftime Guitterez, who had suffered a concussion in a game two weeks before and had not yet shaken the symptoms, begged teammates not to tell the coaches how woozy he felt. When he was tackled early in the third quarter, he got up disoriented and then collapsed. Five days later he died.

Years later another Colorado high school football player, Jake Snakenberg, would unfortunately repeat history; leading to the concussion legislation passed in that state.

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Do you have a guess on the year… Continue reading →

Back to Basics: Current Concussion Management

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What follows below are recommendations that have been on this blog for many years.  I came up with them when it started in 2010 and not much has happened to change what was written.  In fact, more and more these ideas have been accepted, showing that it was ahead of its time in 2010.

AS ALWAYS: PLEASE CONSULT A MEDICAL PROFESSIONAL FOR A CONCUSSION, USING THIS BLOG ALONE FOR TREATMENT OF A BRAIN INJURY IS NOT RECOMMENDED.

We can discuss rehabilitation from a concussion at a later time, but the theory of this being a spontaneous and passive recovery for a vast majority of incidences continues.  It has been my experience that the “less is more approach” is best with concussions, initially.  Being, that after injury the less you do to stimulate the brain and rattle the brain the better and faster the outcomes will be.  When the injury lingers on beyond 10-14 days (usually due to too much activity in the initial phases) that is where rehab and a more dynamic approach to recovery is needed.

Please enjoy and remember that back in 2010 this was not mainstream nor widely accepted.  I hope that four years later this is commonplace.

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Sport-Related Concussion, Don and Flo Brady (NASP Communique)

INITIAL STEPS

After an initial concussion the individual should subscribe to REST, not just physical rest, but COMPLETE and UTTER rest.

  • NO TV
  • NO Texting
  • NO Computers
  • NO Radio
  • NO Bright Lights
  • NO Loud Noises
  • NO Reading

COMPLETE brain rest, in other words, SLEEP!  This should be adhered to for at least 24 hours or when the medical professional that you seek (and you should) tells you otherwise.

SCHOOL AGED INDIVIDUALS

Rest should be continued until all signs and symptoms have resolved.  Rest in this demographic should Continue reading →

Where is Tech Going With Concussions

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Technology is ever-expanding in all areas of our life; in my short time we have gone from land line phones and massive desktop computers that could play “Lemonade Stand” to handheld personal computers that is also a phone.  The point being that technology is amazing.  In the previous post we discussed how MRI now can actually see damage to the white matter in the brain after concussion.  Until that information was presented the changes in the brain were only theorized about.

Yes, it is true that we are trying to find an objective measure, but people need to understand that this objective measure is not necessarily needed to find the concussion.  An athletic trainer with their years of education and experience are pretty dang good at finding concussions; with or without the help of “tools.”  The need for objective measures is for the TRUE PROBLEM of the “concussion crisis”; the mismanagement of the injury – mainly returning too early.

Conrad Wilson wrote up a good article on technology that is emerging, focusing on balance Continue reading →

Have To Keep Educating & Holding People Accountable

Dustin Fink4 Comments

The education of concussions is great, the legislation is in the right place but there is absolutely no accountability for instances where athletes are “failed”.  Before I go on, I am not perfect, I have and will continue to miss some things here and there (I missed an ACL in football which bothers me).  In fact, looking at the pressure I put on myself and hoping the world puts on my chosen profession of athletic training it may be a bumpy road.  However, missing obvious problems of health and welfare of athletes when one is an athletic trainer is inexcusable.  I implore anyone out there that feels I have missed something to call my ass to the carpet as well.

This brings me to something that I found in my inbox recently and it made me sick and should be handled.  This particular incident occurred in a state that has similar mechanisms for concussions as here in Illinois.  To create the back story on the “mechanisms” in play you should understand the state legislation and high school association concussion education;

  • Players, parents and coaches all have been given information regarding concussions
  • Officials have been given authority to remove player for concussion signs or suspicion including mechanism of injury (MOI)
  • Once removed they cannot return unless cleared by approved medical professional (IL is ATC, MD, or DO only)

With that information here is the email from a fellow athletic trainer – emphasis added is mine – (obviously stripped of identifying information);

Still have a long road ahead of education.

I was at a basketball game Friday night as a spectator and watched a player bounce [their] head off the floor.  Opponent had set a screen and athlete ran right into [defender], bounced off and landed on floor bouncing head off the floor.  The player then rolled around on the floor grabbing head and could tell [athlete] was in pain.  Time was called by the officials to attend to the player.   MOI would strongly Continue reading →

Hit Count® Has Come To Fruition

Dustin Fink10 Comments

Prevention of concussion is a bit of an oxymoron; nothing we know about concussions can stop them from occurring while in action.  HOWEVER, there is one way to prevent concussions – limiting exposure to the collisions that create a concussion.  Moreover, research suggests – as well as observations – that being exposed to subconcussive hits can have detrimental effects on brain function.  The subconcussive hits may even predispose someone to getting a concussion later on; this is obvious if you look at the data we have collected on NFL concussion over the past four years, (305 concussions in weeks 1-9 vs. 377 concussions in weeks 10-17) greater than a 20% increase as the season wears on.

Sports Legacy Institute has announced a certification program to further the Hit Count® initiative during a press release during Super Bowl week in New York City, today (along with the SLI Hit Count White Paper – see link below press release);

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Sports Legacy Institute Launches Hit Count® Certification Program in Collaboration with Leading Concussion Experts and Head Sensor Device Companies to Make Contact Sports Safer

Using Hit Count® Certified Products to Monitor and Minimize Brain Trauma Could Eliminate 500 Million Head Impacts in Football a Year, with the Goal of Reducing Risk of Concussion and Long-Term Brain Damage

New York City – January 27, 2014 – The non-profit Sports Legacy Institute (SLI) announced a major advance in the effort to prevent concussions and brain damage in contact sports today with the launch of the Hit Count® certification program after two years of development, which was unveiled at a press conference at the 2014 Super Bowl Media Center in New York City.

Hit Count® builds on the progress that head sensor device companies have made in developing devices that can measure acceleration of the head. Current products used on the field are focused on  alerting coaches, medical professionals, and parents when a potential concussive impact occurs.

Inspired by Pitch Counts baseball, which set limits to the number of times a player throws from the  mound to prevent arm injury, Hit Count® Certified Devices will have a second function that measures and “Counts” impacts that exceed the Hit Count® Threshold, set by a committee of  leading scientists, with the goal of minimizing brain injury.

“Research using sensor devices has revealed that each year in the United States, there are over 1.5 billion impacts to the heads of youth and high school football players,” said Chris Nowinski, Founding Executive Director of SLI who launched the Hit Count® initiative in 2012 with SLI Medical Director Dr. Robert Cantu. “Most hits are unnecessary and occur in practice. By utilizing  Hit Count® certified products as a teaching tool for coaches and a behavior modification tool for athletes, we can eliminate over 500 million head impacts next season.”

Committee member Gerry Gioia, PhD, of Children’s National Medical Center and Continue reading →

University of Oregon Novel Study

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I found a very interesting email about research being done at the University of Oregon.  It was so well written I thought I would just place it on the blog…

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In what may be the first study of its kind, the University of Oregon’s Motion Analysis Laboratory released a fascinating and chilling new video that illustrates the dramatic effect a concussion can have on high school athletes’ ability to control balance while walking.

Using computer generated images from reflective markers worn by the subjects, the video shows the gaits of two high school students – one a healthy subject and the other a victim of a concussion from a helmet-to-helmet collision in football practice two days prior – to emphasize the poor control and balance of the concussed athlete.

The full study included 40 high school athletes – 20 who were diagnosed with a concussion from sports including football, soccer, volleyball and wrestling, and 20 similar healthy athletes – who were tested over a two-month period. The results showed that the concussed athletes had trouble maintaining balance and walking speed while also responding to auditory cues as long as two months following the concussion.

Research on concussion recovery time, like what is being done at the University of Oregon, may help improve safety and better pinpoint when it is safe for to return to field or court.

Interesting .pdf Making Rounds Now – Addendum

Dustin Fink3 Comments

AFCA pdfI was tipped off by a fellow athletic trainer in a state where this .pdf (click first link below) is being circulated around.  I find it interesting in the wake of the American Football Coaches Association meeting that this is being titled the way it is.

Concussions in Football is how it is titled on the info packet, but the subject line that my source received was “Our Game is Under Attack”.

ARE YOU SERIOUS?

First, let me say I have read it – three times – and find nothing wrong about what is being presented.  Even with the opening HUGE FONT reason/opinion Dr. Sandra Bond Chapman has for continuing playing youth football.  I respect that opinion and cases can be made for such a strong statement, in fact it is lore at this time.

But to claim the sport itself is under attack because some may be looking beyond the lore of benefits is a bit much, in my opinion.  I have explained many a time here on the blog that what I see it as – and my reason for presenting information – is to keep the game around.  The game is not under attack because of concussions, if the game was under attack it is because of the way it handles injuries – namely concussions – and the possible ramifications.  The document is correct in stating not all brain injury is permanent, yet we don’t have any long-term data (solid longitudinal) on the effects of this sport or others that are collision based outside of boxing.

I honestly believe that if every sport coach, parent or kid looked at this document and Continue reading →

TCB Mail Bag

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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:

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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

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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.

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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.

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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.

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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.

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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…

Tottenham Hotspurs; More Like Tottenham Hotmess

Dustin Fink6 Comments

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 →

“League of Denial” (Part 2)

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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 →