10/17 Quick Hits

HockeyNow question and answer with Charles Tator (one of the best);

HN: What have we learned about concussions that maybe we didn’t know a decade or two or three ago?

CT: There are about 30 things that we didn’t know just 10 years ago. For example, the adolescent brain seems to be most susceptible to concussion and takes the longest to recover. It’s rather unfortunate because that age is when kids are now big enough and fast enough that they are getting concussions—it’s also the risk-taking age.

Also, women appear to concuss more easily than men; and that holds for sports like hockey and basketball. We’re not really sure why that is but that’s what the data is telling us.

Unfortunately, there are still a lot of unanswered questions about concussions. We still don’t know the exact mechanism—although, rotational acceleration is more important in producing concussions than linear acceleration. And also, we don’t know how to detect a concussion on imaging techniques; for example, there is no telltale sign on a CAT Scan. And the MRI (magnetic resonance imaging) is still not showing us the effects of concussion. We are hopeful that some newer sequences of MRI will be more informative.

A concussion is still a clinical diagnosis, meaning that it depends on a knowledgeable examiner, like a physician, as well as a compliant patient. And not all patients are compliant; there are still people who want to hide the symptoms and signs of a concussion.

HN: How important is recognition of a concussion?

CT: All you have to do is look at Sidney Crosby—the fact that he got his first concussion on a Monday and it wasn’t recognized; and then on the Wednesday, he got his second concussion and it took a year to recover. It’s important to sit out until you’ve fully recovered and follow the six-step process of gradually incorporating more physical activity, so that your brain is ready to take another hit. If you run around the block and get a headache and get dizzy, that means your brain is not ready for the next hit and then you’re subject to the serious consequences of another concussion because your brain has not recovered fully from the first one.

Ex-ESPN exec says “Stop denying brain damage“;  Continue reading

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Archaic Thinking/Management of Concussion Not Just a N. American Issue

I have cataloged this problem many times in many sports across the world.  It seems that perhaps the focus and glare is greatest here with North American sports (mainly football and hockey), but this problem extends further.  This issue perhaps came to a head in the UK over the past week with this article by Tom English;

Barry O’Driscoll played rugby for Ireland in the Five Nations championship of 1971.

As a respected doctor (whose son was team doctor for Ireland and the Lions in the recent past) with a background as an international full-back he became an important figure on the International Rugby Board where for 15 years he held positions on the medical, anti-doping and disciplinary committees. Until late last summer, when he resigned.

Dr. O’Driscoll left his post because of the way the International Rugby Board (IRB) was/is handling concussions on the field and in general.  As an aside, the IRB is a founding partner of the Zurich statement as well.

What would make a highly trained and well-respected doc – with rugby in the blood – step away?  Take a look, specifically at what happened to his nephew;

After one collision too many that day Brian O’Driscoll lost his bearings, was clearly unsteady on his feet and had to be helped from the field, like a boxer assisted from the ring. You did not need experience in pathology to know that the great man was out of it for a moment in time. Yet a few minutes later he was back on the pitch, supposedly as bright as a button and fully recovered.

He was back on the field because ?????;

There is an accompanying rule now – still on trial – and it states that if a player with suspected concussion can pass a series of tests lasting five minutes then he can be allowed back into the fray: the Pitch Side Concussion Assessment (PSCA) – or the five-minute rule.

Even worse the “new” rule was not even in place when his nephew sustained his concussion, leading the good doc to question what the sanctioning body and the medical board was doing;

“Rugby is trivialising concussion,” he says. “They are sending these guys back on to the field and into the most brutal arena. It’s ferocious out there. The same player who 18 months ago was given a minimum of seven days recovery time is now given five minutes. There is no test that you can do in five minutes that will show that a player is not concussed. It is accepted the world over. We have all seen players who have appeared fine five minutes after a concussive injury then vomiting later in the night. To have this as acceptable in rugby, what kind of message are we sending out?

“If a boxer cannot defend himself after ten seconds he has to have a brain scan before he comes back. And we’re not talking ten seconds for a rugby player, we’re talking maybe a minute that these guys are not sure what’s going on. They don’t have to have a brain scan, they have to have five minutes where they have to stand up straight without falling over four times, they have a basic memory test – ‘What’s the score? Who are you playing against? Which half did it happen in? And do you have any symptoms?’

“These questions should serve as a landmark for when you examine them six hours later to see if they’re getting worse or if they’re bleeding into their brain. That’s why you ask them, not to see if they can go back on. They are already concussed at that point. You don’t need to ask questions to find that out. If six hours later their responses are worse than they were earlier you say ‘Wait a minute, this shouldn’t be the case, is this guy going to bleed?’ That’s why you ask the questions and so it has always been. But we’re going in the other direction now. We’re going from being stood down for three weeks to one week to five minutes with players who are showing exactly the same symptoms. The five-minute rule came out of the blue. I couldn’t be a part of it so I resigned from the IRB. It saddened me, but I couldn’t have my name attached to that decision.”

As you can clearly see some places are not quite ready to accept the real issue of concussions – not the actual injury – the mismanagement of the injury once it occurs.  If the IRB places the new “five-minute pitch side rule” into place they are going in the absolute wrong direction.

If any player in any sport shows clear signs of concussion they should be removed and not allowed back in, period.  Even Zurich, which the IRB is part of states this.  Dr. O’Driscoll is merely saving his reputation by stepping aside, and in my opinion it is the exact correct move.

 

Is Rugby Staring Down The Barrel

We have highlighted the “slow” response to the concussion issue that rugby has struggled with in the recent past.  Sure the International Rugby Board (IRB) has given monies for research and looked into their policies, traditionally the sports outside of North America have not been as concerned with the issue.  Heck the first article taking the sport to task was the one linked above.

Just like the previous article the Irish Times has once again brought it to the forefront.  After framing the story with the law suit filed by the former NFL players the IT looks at rugby;

Within the last year professional Irish rugby players Bernard Jackman and John Fogarty have both retired from the game due to ongoing issues with concussion, while the International Rugby Board (IRB) last month issued a new “more robust” set of guidelines regarding the recognition and treatment of concussion in players.

Players are not permitted to wear heavily-padded protection, which was being promoted by Australian back Berrick Barnes, who recently took time out of the game because of repeated concussions, but now hopes to play in this summer’s World Cup. Continue reading

Footballer’s Migraine: What is that?

As we highlighted in “More Education Needed Down Under” the prevailing thought in Australia/New Zealand about head injuries is that concussion is a very bad word.  In fact the medical society is even using a term “footballer’s migraine” (FM), that is over 40 years old, to describe lasting effects of being hit in the head.  The Sydney Morning Herald and Nicky Park has just posted a story about the condition;

Footballer’s migraine, a condition that has forced Wallaby Berrick Barnes to take an indefinite break from rugby, remains a mystery to sports medicine experts.

Shane Brun from Sports Medicine Australia says the link between recurring migraine and continuous blows to the head is cloudy.

Symptoms of “footballer’s migraine” are the same as a standard migraine – throbbing head, sensitivity to light, nausea and ringing in the ears.

Of course FM remains elusive, it is extremely outdated, proposed by W.B. Matthews in 1972 the condition has been radically surpassed Continue reading

More Education Needed Down Under

If you have followed our attempts at charting the Australian Rules Football concussions you have noticed my overt tone of frustration.  I have even proposed a “cover up”; that may be way more conspiracy than truth.  I do believe that I have found out a reason as to why we are not seeing more concussions in Australia in all sports, lack of knowledge.

In a Sydney Morning Herald story today about a rugby player there are some very SCARY things the doctors are presenting down under;

Doctors have cleared Berrick Barnes of concussion from last Saturday, instead diagnosing him with a less serious condition called footballer’s migraine, which might also explain some of his previous head injuries that have been put down to concussion.

Waratahs team doctor Sharron Flahive said that Barnes sustained a minor knock to the back of the head while playing against the Lions, suffered a delayed reaction of dizziness, and then had such a heavy loss of memory that he could not remember what year it was, which week of the season he was in, or if he had played for the Waratahs last year.

We are going to take this piece by piece; dizziness and loss of memory are obvious signs of abnormal brain function and should have classified this player with a concussion.  But in Australia they are classifying head injuries as “footballer’s migraine” (by the way FM is a term from research in 1972, 40-year-old information), wait until you see what else the Dr.’s are saying. Continue reading

Education is the key

Courtesy of Uncle Saiful via Flickr

A report just released about rugby and concussions sponsored by Dr. Michael Cusimano of Toronto, tells us that education is the key, versus helmets and mouth gear.

A new review has suggested that mouth guards and headgear have little or no impact on reducing concussions in rugby players. However, educational programs that promote proper playing techniques and enforcement of rules do result in a significant reduction in concussions and head, neck and spinal injuries.

This information will be published in Neurosurgery this month.  Even though this information is tailored to the sport of rugby, this should be a lesson to all other sports.

LINK

Coming next week, information on the seemingly controversial topic of mouth guards…