Recommendations

Recently I have had a few more concussions than usual.  Along with that I have had parents really struggling to understand the recommendations I have given them.  The restrictions seem very harsh, they tell me, or they are confused because their doctor did not recommend the same.

Here are some guidelines from St. Vincent Sports Performance of Indianapolis

For someone diagnosed with a concussion, increasing the blood flow to the brain through physical or mental exercise can destroy vulnerable and damaged brain cells, slowing down recovery. The following guidelines help an athlete recover faster from the injury:

» Do not attend school.

» No extended reading.

» No video games.

» No MP3 or iPod use.

» No walking the dog.

» No movies.

» No PSAT or SAT tests.

» No computer use.

» No text messaging.

» No socializing with friends.

» No school functions.

» Use sunglasses in bright environments.

» When the athlete no longer has a headache, he or she can return to school gradually, attending class until symptoms return. After 48 hours pass without any symptoms, a doctor will begin a treatment that allows an athlete to return to the field.

An Overlooked Concussion

And its results.  In the video below you will see tennis professional Victoria Azarenka collapse on the court at the US Open in New York.

http://www.youtube.com/v/pBOy8KZzgVA?fs=1&hl=en_US

Although the conditions were hot, and she had been complaining of abdominal pain earlier in the week, it was later found out that Azarenka sustained a concussion just prior to the match.  While warming up for the match she fell and hit her head.  The doctors and official report blame the fainting on the concussion.

I had missed this story until today, with the thought it was heat related, but after further investigation, it was yet another example of a poorly handled concussion.

NFL Concussions Week 3

This is from the official injury report distributed by the NFL

Players listed with injury of concussion or head that are probable;

  • Kevin Boss, TE, NYG
  • Evan Moore, TE, CLE
  • Jason Witten, TE, DAL
  • Stewart Bradley, LB, PHI
  • Kevin Kolb, QB, PHI

Players listed with injury of concussion or head that are questionable or worse;

  • Carlton Mitchel, WR, CLE
  • Zack Follett, LB, DET
  • Randall Gay, CB, NO
  • Anthony Bryant, DT, WAS
  • Craig Dahl, S, STL
  • Will Davis, LB, ARI

Congressional Hearing

Today there was a hearing on the concussions and how they affect the student-athlete on “The Hill”.

Protecting Student Athletes from Concussions Act is what it will be called.  It is suspected that they will use language similar to Lystedt Law in Washington.

All of this is supported by the NFL and other sanctioning bodies.

CNN.com has a story

Concussion Prevention Begins In School

As I have stated time and time again, education is the key to prevention of any injury.  But none is as important as the head injury.  Education Week published a story by Christina A. Samuels about such prevention.

“Football is such a macho sport. There’s a pervasive mentality in that sport” to ignore injuries, said Mike Carroll, the head athletic trainer at the 1,000-student Stephenville High School in Stephenville, Texas. “I really have to emphasize that this is not something you can walk off.”

Mr. Carroll, who has been at his school for 20 years, doesn’t have to fight too hard with the coaches when it comes to holding students out who have received concussions. But some students are still slow to report their injuries. Recently, one student who was injured Continue reading

Concussions Have Distant Impact

Gretchen Reynolds of the New York Times published a great read on how concussions may affect you later in life, appearing in the Phys Ed section.  The story is based around a research study performed in our backyard, the University of Illinois and cutting edge researcher Steven Broglio.

Many of the concussions had occurred years earlier and at the time of the testing, none of the students felt lingering symptoms. Each was performing adequately in college. In the testing itself, the concussed students scored just as well as the uninjured athletes.

But when researchers looked at the electrical activity of the students’ brains, they found that the concussed athletes showed noticeably less activity in portions of the brain associated with attention. ‘‘They had suppressed attentional resources,’’ said Steven Broglio, a professor of kinesiology and community health at the University of Illinois. He and his colleagues Continue reading

Hockey is Gaining Popularity

And along with the increase in popularity, in terms of playing, comes the increase in injury risk.  A new study found that there was nearly a 250% increase in ER visits due to hockey from 1990 to 2006.

While part of the increase is undoubtedly the result of more children playing the sport — the number of high school students playing ice hockey in school-sanctioned leagues increased 88 percent — the uptick in injuries might also be due to an increase in the intensity of the sport , the researchers said.

Of those injuries 9% of them were concussions.  And nearly 25% of injuries were to the face or head or teeth, increasing the call for face shields.

MyHealthyNewsDaily Artilce

Concussions Are Unpredictable

Just ask Taylor Twellman, a soccer player from the New England Revolution how unpredictable they are.  In 2008 near the top of his game and the American leagues he ran full speed into the goal keeper, creating a whiplash effect on his body, most namely the skull.

To this day Twellman has not had a single day without some post-concussive effects.  Continue reading

Concussions By Sport

Concussions are not exclusive to American football, although it is the most covered sport as it relates to concussions.  This is a good time to note that in the United States the next most concussive sport, is soccer, the number one sport in the world.

A reasearch project by University of North Carolina reported concussion rates by 100,000 athlete-exposures Continue reading

News Story

Patrick Hayslip of the Denton Record-Chronicle in Texas wrote a story about the current issues of concussions.  He also noted the ImPACT system as a good starting place.  He ended the article discussing that the Texas legislature will consider concussion laws.

READ ON

Concussions may be most notably associated with hard-hitting sports such as football and ice hockey. However, Dr. Michael Auvenshine said that, not only are they the most frequent cause of death in contact sports, other sports such as gymnastics have proven equally as deadly.

NFL Concussion Injuries Week 2

Players listed as having a concussion or head injury that are Probable;

  • Nick Sorensen, S, CLE
  • DeMarcus Ware, DE, DAL
  • Matt Moore, QB, CAR
  • Brandon Ghee, CB, CIN

 

Players listed as having a concussion or head injury that are Questionable, Doubtful, or Out;

  • Jacob Lacey, CB, IND
  • Kevin Boss, TE, NYG
  • Clifton Ryan, DT, OAK (listed as migraines)
  • Charly Martin, WR, CAR
  • Stewart Bradley, LB, PHI
  • Kevin Kolb, QB, PHI
  • Hunter Hillenmyer, LB, CHI

 

See you next week for updates…

News Story from Jacksonville

Greg Olson (not the Chicago Bear tight end) of the Jacksonville Journal-Courier posted an educational piece about concussions and kids titled; “New Focus put on Concussions in Kids, Teens

There were about 502,000 emergency room trips for concussions among 8- to 19-year-olds from 2001 to 2005, with about a third of those being 8- to 13-year-olds, according to a study in the medical journal Pediatrics.

Chicago Bear Out For Season

Hunter Hillenmeyer was placed on a season ending Injured Reserve.  According to the Chicago Tribune Hillenmyer believes that he is suffering from the continual effects of a concussion sustained in the preseason.

However there is a unique quality to this particular case, and that is the fact the Hillenmyer is one of the NFL players that have made the decision to donate their brain for NFL research.  This of course will happen after he has a long and wonderful life.  The NFL and others are interested in the long-term effect of multiple concussions and how they may relate to Traumatic encephalopathy.

Hillenmyer is also one of the most active advocates for player safety, where his personal focus has been concussions.

Research

A diagram of the forces on the brain in concussion
Image via Wikipedia

This JAMA article is from 2003, but it does well to expose what we are currently seen with the concussion.  It is good to note that this study was with college aged individuals with a developed brain.  This study did not deal with the developing brain of adolescents.

Conclusions  Collegiate football players may require several days for recovery of symptoms, cognitive dysfunction, and postural instability after concussion. Further research is required to determine factors that predict variability in recovery time after concussion. Standardized measurement of postconcussive symptoms, cognitive functioning, and postural stability may enhance clinical management of athletes recovering from concussion.

Philadelphia Eagles Medical Staff Under Fire

The Eagles’ team doctors and medical staff was cleared of wrong-doing when dealing with on the field concussions.  NFLPA Medical Director Dr. Thom Mayer determined that the medical staff followed proper procedures.  The return-to-play guidelines for the NFL are not un-similar to general guidelines for all athletes.

The issue arose when Stewart Bradley took a hit and struggled to get to his feet, and when he did, he did his best interpretation of a “punch-drunk” boxer.  That was an OBVIOUS sign of a mTBI/Concussion and should have been disqualified from further activity.  However, the medical staff did not see any of this as they were tending to a previous head injury sustained by Kevin Kolb.  Both players returned to play in the 2nd quarter and did not play again after the half.

According to the linked article, courtesy of ESPN and Sal Paolantonio, both players regressed in their initial on the field evaluation during half time, and were sidelined.

Andy Reid, the Eagles head coach, was also supportive of the initial decision for them to return-to-play.  Now the team will not practice either player until Friday at the earliest and continue to monitor their injuries.

As one can see there are issues with the RTP of concussions, at all levels.  But more importantly we can see that the injury known as a concussion is very different in presentation and resolving.  The great thing is that more and more people are aware, the next step is getting a policy in place that everyone can agree on.

Greater Awareness Leads to Increase in Hospital Visits

Some North County hospitals, like those in the rest of the country, are seeing a spike in emergency room visits by young athletes who may have concussions, a sign that parents and students are taking head injuries more seriously than ever before.

North County Times, out of San Diego, CA ran this story about the increase in visits to the hospital for possible concussions.

They also cited a Pediatrics study, recently found in the journal, saying that hospital visits for possible concussion has doubled-tripled in the ten-year span of the study (1997-2007).

Awareness is getting better!

NFL Concussions Week 1

To begin the season we have three players on IR with concussions;

  • Jay Thomas, CB, OAK
  • Mike Furrey, WR, WAS
  • Freddy Keiaho, LB, JAX

 

Preseason concussions listed as doubtful or lower on injury report;

  • Nick Sorensen, S, CLE
  • Brandon Ghee, CB, CIN
  • Jacob Lacey, CB, IND

 

And the reported concussions from Week One;

  • Kevin Kolb, QB, PHI
  • Stewart Bradley, LB, PHI
  • Kevin Boss, TE, NYG
  • Matt Moore, QB, CAR

 

Related Link…  NFL Doctor: Four concussions not a trend

More will be reported as the injury reports come out on Tuesday and this should be updated.  The next post on this subject will be the next injury report and we will list all the reported “head” and “concussion” injuries.

Why the increase in concussions?

Bar graph of the incidence of mild traumatic b...
Image via Wikipedia

Back when I played if you had a headache you were almost expected to return to play, no questions asked, in all sports.  This did not just go for the boys, the girls had to be tough too.  There was very little in the way of concussion prevention/education for sports, particularly at the high school setting.  Very few schools in the early to mid 90’s had athletic trainers or medical professionals dedicated to the high school, and even fewer that had AT’s that were progressive in head injury management.

Have have you seen the specimens we call kids these days on the playing fields/courts?  Sure when you were in school you had the “fast” or “big” friend that played sports, how many of us had the “huge-fast” or the “monster” friend?  How bout the style of play in sports?  I am positive that we were aggressive in sports, but not to the level we see it today.  The graph is from Langlois JA, Rutland-Brown W, Wald MM (2006). “The epidemiology and impact of traumatic brain injury: A brief overview”. Journal of Head Trauma Rehabilitation 21 (5): 375–8, and indicates that concussions are by far a bigger problem for the developing brain than adults.

There are a variety of reasons why we have seen an increase, but I do not believe we are seeing all of the brain injuries.  It is a great start and a wonderful job being done all over the place in terms of education.  The research of the brain, the concussion, and the long lasting effects of this injury and concurrent injuries is  getting better each year.  Along with that the recommendations from the medical professional and concussion societies are getting more and more protective of the individual.

One thing is for certain, we will continue to see the increase until we as professionals have attained a firm grasp on the mechanism and lasting effects on the growing brain.

Recent WebMD Article