Concussions 201

The Concussion Blog, has for years, presented you with the basics of concussions and other issues surrounding this particular brain injury.  Most of it was factual information/research that I opined about.  Others were original information that was seen here first.  Regardless our aim – and continues to be – is to keep everyone aware and educated about this topic.

I was passed along a great article on concussions, it was beyond the “basics” but not so in-depth that you get lost in the mumbojumbo;

In other words, concussions are not caused by a brain doing back flips within the skull. In fact, miniscule amounts of movement might be to blame.

The article was written in response to the Stevan Ridley “Fencing Response” producing injury this past weekend and Dave Siebert colored this situation perfectly; Continue reading

Educational Debate; what to actually teach?

WARNING some content may be considered “nerdy”, as there are very big words, even words I had to look up (OK you got me I have to look up many words longer than 5 letters).  I may even go on a diatribe that may lose you.  I do feel it is important for athletic trainers to read as well as our educators.

Awareness is the key with concussions – as I see it in this moment in time – understanding what one is and the proper management are probably the biggest issues we can educate on currently.  That does not mean the rest of the information is forgotten or omitted rather, grasping the nature of concussions is of special attention.  Once people start to understand/respect concussions some of the fear will be removed and fewer people will brazenly dismiss this brain injury.  Decisions need to be made about exactly what to educate each audience about; granted it would be nice to explain all of it – every minute detail – to every audience, that is unlikely to get people to understand.  The information about concussions – while remaining consistent – must be tailored to each subset for better understanding.  One can always go out and find more information, but the basics must be the same for everyone.  For example; disseminating the general signs and symptoms of concussion, the appropriate definition of a concussion, and immediate management of a suspected concussion.  This information should be the same for everyone.

And I think we are doing a good job all around on this; from the CDC, to NFHS, to state level, to this blog.

Last night was an opportunity to learn more about concussions and the thought process of teaching about concussions, to at least athletic trainers, on twitter.  During Thanksgiving I mentioned – and was pushing people – to understand what the Fencing Response is (pubmed) as Julian Edelman of the New England Patriots demonstrated this after getting hit in the game (unfortunately I cannot get a film/.gif of this currently) (thanks to a reader here is the LINK to the video).

It was then suggested to me by fellow athletic trainer and current educator Dr.Theresa Miyashita ‏(@DrMiyashita) that I should “be careful-the fencing response Continue reading

Robert “Woodsgate” in Utah

I don’t know if many of you were able to watch the USC/Utah football game last night but there was a very disturbing incident that had to deal with a head injury.

I don’t want to pirate the link from SB Nation so CLICK HERE to see the .gif of the hit and aftermath (its important to my commentary).  So to me, Woods gets hit in the head, immediately displays a Fencing Response, looks “lifeless” then returns to his feet only to stumble and eventually fall flat on his face – I seriously doubt he was drinking at the moment.

Then, unbelievably this happens;

According to reporters in the press box, Woods was then seen trying to convince USC trainers he’s up for returning to the field immediately. The Trojans took the field in Utes territory with Woods back in — Samantha Steele reported Woods went through a complete concussion test, but is “good to go.”

How in the world does a high level college football medical staff completely miss this?  How is he even allowed to return, heck the officials were looking right at him on his face plant.  Did I mention that when he got up from the “drunken stooper” he was walking to the wrong bench?

This is not good people…  Granted I was not down there to evaluate him, but the signs CLEARLY indicated a head trauma.  If you were watching the St. Louis Rams game Quinten Mikell had a similar incident, although he was KO’ed and did not return.

I will be very interested to see what the reasoning was behind putting him back in the game, other than “he is our best player”.

The Risk of Professional Football: Do Not Do This At Home

It is scenes like the ones below that we cringe about while watching our favorite sports.  In football they happen relatively frequent; what once was 2-3 times a year a person getting carted off now has become a weekly occurrence.  In the videos below (certain to be pulled by the NFL so see them while you can), you will notice the rotational forces being the problem for both players.  Also both players exhibited the Fencing Response, if you are not intimate with this, I suggest you learn.

First is Darrius Heyward Bey of the Oakland Raiders.  This hit was not penalized by the way even though principle contact was made by the defender with his helmet to the head.  Bey was carted off and went to the hospital for observation.

In this one Nate Irving of the Denver Broncos was blocked into the returner as he was making a tackle and he too made principal contact with his helmet up high.  This time it was the “hammer” getting K.O.’ed due to rotational forces.  Irving was attended to and later walked off the field under his own power.

One more example of hitting with the helmet, but a case of linear forces going to the head and the drastically different outcome.  Also in Denver, Matt Schaub took a shot to the head from a Denver defender.  This time the forces were mainly (if not all) linear and the QB didn’t lose consciousness, but did lose part of his ear lobe.

I provide these videos as a LEARNING TOOL for the audience:

  • Fencing Response
  • Rotational Forces
  • Linear Forces

And I also would like to note this type of tackling behavior should not ever be part of a youth or high school level program.  Launching and or using the crown of the helmet should be penalized, early and often.  So all you non-professionals do not try this at home.

Further Investigation of AFL Inquiry of “hidden concussion”

If you recall our post earlier today there was a link about the AFL wanting more information about an injury that occurred in the Carlton/Collingwood match.  It resulted in some peculiar signs from Kade Simpson. writer Damian Barrett wrote about this; noting that medical personnel would have some serious consternation with it;

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

Some get so incensed they verge on apoplexy.

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

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

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

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

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

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

Fencing Response Awareness

This past Saturday Kenny Shaw of Florida State took a hit that resulted in immediate medical attention.  Although the protocol called for neck precautions the reaction of Shaw upon getting hit led to many observers to see a common indicator of a concussion.  As Shaw was “sandwiched” between the defenders his arm involuntarily became flexed in a position that has been identified as the Fencing Response.

Video from YouTube and commenter Aaron…

Discovered by students under the mentorship of Jonathan Lifshitz, PhD of the University of Kentucky Spinal Cord and Brain Injury Research Center.  This finding and observation in a game was highlighted by an article in; Continue reading

Another Blogger Thinks More Education Is Needed

Sporting Jules, presumably from Colorado was watching the Broncos/Bills preseason game last night and had some immediate observations on a hit that was penalized.  Rookie safety Rahim Moore of the Broncos hit wide receiver Donald Jones on the sideline that resulted in a flag.  Jules wrote about it on her blog;

By “hit/tackled,” I could have said “helmet-to-helmet hit” or “unbelievably illegal shot to the head,” and I wouldn’t have been wrong.

Two things bothered me greatly in this play’s immediate aftermath:

  • Despite the fact that Jones fell to the ground with his arms in a stiff posture and his helmet partially knocked off by the hit, local Broncos announcers never ever uttered the word “concussion.”  Instead, several minutes later, Continue reading