Why Are We Here? Confusion and muddy water

With all the work that has been done up to this point with concussions I truly believe that we should have a better grasp on this injury.  Recently, we have seen some very confusing information come forward, I feel the message has been mixed and may lead to further issues when handling concussions.  Patrick Hruby, in his article on Sports on Earth, takes a very critical look at the Collins research as well as other studies that have pointed to the players being the problem in this concussion issue.

It is not the players fault, it’s not the referees fault, it’s not the coaches fault, it’s not the sports fault.

I do think that football and collision sports do require some sort of “full” practices in a controlled environment.  Although the actual speed of a game is difficult to replicate in a practice, full-go is needed for players to understand the closing speeds, angles and decision-making of the sport.  Without a full grasp on this the player may be at further risk for overall injury in sport.  It would be insane to have a football, hockey Continue reading

Opinion on Zurich Statement

I think I have had enough time to digest the information in the 4th Consensus Statement; it is enough time for me to give an opinion.  WARNING: My opinion may differ than yours and you may even take umbrage with what I say.  However I am going to give my honest opinion.  To keep it as succinct as possible I will go in bullet form along with the statement itself.

In general I feel that we as the community in the “know” are muddying the waters more when it comes to concussions.  I think there are reasons for this; litigation and emotion mainly.  I still strongly feel that concussion identification and immediate assessment by trained personnel is non-complex; its simple.  Sure others may think it is hard; I think changing the oil in the car is hard and complicated – a mechanic would find that a mundane task.

Secondly, the now undeniable MASSIVE issue with concussions is not the injury itself, rather, the mismanagement of concussion; which includes but not limited to assessment, rest, rehabilitation, return to learn and return to play.  The newest consensus statement address some of this for the first time.  Now, the paper…


  • The definition of concussion is more clear for the practitioner.
  • Starting to address the psychological aspects of concussions – about time.
  • Clearly states if no trained health care provider present that if any signs/symptoms present players must sit out.
  • Clearly states that if concussion present, no RTP same day for ANYONE!
  • Not really a fan of all the sideline assessments out there.  No where does it say its mandatory for any of these; rather they are tools at our disposal to help identify concussions.
    • Here is a novel approach people: use your training and ability to be in-tune with the athletes to make a solid clinical judgement.  Oh, wait, not every sport team has an athletic trainer available?  <–THIS IS THE PROBLEM WITH IDENTIFICATION AND ASSESSMENT.
    • The Statement also clearly makes it a point that clinical judgement is the standard of care when it comes to all of this.
  • Although currently there is not an objective measure of the injury on the brain they have opened the idea it may be coming.
  • Neuropsych testing was a good section, the take-home point here is that baselines are not part of best practices and that they should not be used as a clearance device, except in the case of a trained neuropsych using the information.
  • Loved the discussion on “rest”, really thought about it a lot since it came up in Zürich.  The term “rest” is so Continue reading

Boston Globe Opinion: James Carroll

It certainly is not the first opinion piece that has graced the papers in recent year, nor will it be the last, but James Carroll’s opinion piece does take a reflective look at the sport and issue we now face;

Even as a high school kid, I knew that more honor was to be had in playing through an injury than in the few passes I actually ever caught.

As I learned when my parents later took me to the doctor, I had suffered a concussion. That was nothing to the embarrassment I felt when they made me tell Coach I’d be sitting out practice for a week. His sneer flooded me with shame. That simply, I’d been plunged into the macho heart of football — a gladiator ethos which has lately drawn scrutiny because, indeed, of brain concussions.

This attitude must change when it comes to playing with concussions.  The entire game or mindset does not need to be completely rewritten, rather the view-point of one specific injury needs to be changed up.  Can you imagine what Bo Shemblecher or Woody Hays would have thought about spreading 5 wide receivers out and only have the QB in the backfield in shotgun?  Certainly they would have thought the game was coming to an end.

Naturally since the sport of football is so popular any type of tinkering or changing the game many people, especially those established in the sport, feel they are personally taking something away.

Listen, concussions are not good, in the short-term or long-term, and its and injury that will be part of football and of other sports too.  Some changes are necessary to protect the player – Continue reading

Good Idea, but Take Care of Own First

I get why its being done.  In fact I agree with the principle behind the letters to the states, however it is tough to ask for someone to do something that you yourself have a difficult time doing/policing.  The NFL and NCAA sent out letters to 19 Governors asking them to consider concussion legislation (via USAToday);

NFL Commissioner Roger Goodell and NCAA President Mark Emmert are urging 19 governors to support legislation this year aimed at cutting down on concussions in youth football.

Goodell and Emmert sent letters Thursday to governors of states — such as Florida, Ohio and Wisconsin — they said do not have something akin to Washington state’s “Zackery Lystedt Law,” named for a middle school football player who sustained brain damage after he got a concussion and returned to play.

Although both the NFL and NCAA have outlined “guidelines” and mechanisms for concussions themselves, they do have a hard time enforcing them.  A quick glance at just this blog unearths some serious issues: Kris Dielman, Mike Vick, Huffgate, and Bonnergate just to highlight a few.  Just think how difficult that is for an entire state with more than one level and one sport to worry about.  The NCAA should be able to help, but even there they are “recommendations/guidelines”, there are no teeth to the rules.

Legislation is good, but only good for one reason in my opinion: awareness.  That is it, because there are ways to skirt the Continue reading

To Peer Review or Not To Peer Review

The answer is and has been very one-sided, most everyone trying to make a mark are peer reviewing their research to get publicized.  Heck, when I was in graduate school I was told that is the only way anyone would honor your information.  Basically if you wanted to be respected it was/is a must to be cited in a journal, a well-respected peer-reviewed publication.  Over time I have really become jaded on the whole process, too much money, too much conflict of interest, and too much glad-handing to get in a lot of the journals.  We can even take a look at something we all have come across, “Global Warming”; research in that area is basically hand-picked to make it into publication, and if you are not serving an agenda, one side or the other, you will not appear in certain rags.

At a time when I am trumpeting my information about concussions in the NFL last year and the helmet data it cannot not be more obvious to me.  I have asked many sources to help with putting a “peer-review” piece together and I have been given a myriad of different excuses as to why it won’t show.  Usually, a research piece that has been completed would be easy for some to just say; “yup put my name on it and we will write it together.”  However the reasons I have heard amaze me; Continue reading

Varsity Season Over, Lesson Learned

Last night was our last varsity game, though we have one more JV game in about 30 minutes (thanks to my student for getting it all set up).  From a concussion standpoint, we ended the varsity season with a total of 4 concussions.  Over a nine-game schedule that is less than .5 per game.  The rate would be 45 players divided by concussions for a rate of 11.45 on the season, slightly higher than current rates.

That is what leads me to this post.  In our last game, we faced a team that has athletic trainers by the name of John Storsved and Steven Broglio, PhD.  Both are active in the athletic training community, working at nearby state universities.  Dr. Broglio is working with the HITS program (helmet sensors) at the University of Illinois.  John is the Clinical Instructor for athletic training at Eastern Illinois.  Prior to the game, the three of us were engaged in “nerd” talk about the increase in concussion rates.

We have all observed more concussions this season and were discussing possible causes of this alarming trend.  Although didn’t reach a consensus on a singular cause, we did all agree that awareness has increased across the board.  Parents, coaches, and student-athletes are allowing more access to the “unseen/unreported” concussions of the past.  But one topic we did spend some time on was the violence and velocity of the hits kids are taking and delivering these days.  This too could be a reason for an increase in concussions.  This leads me to my editorial for the day.

NFL players are getting paid millions to, in effect, destroy their bodies, brains included.  However, I feel that kids are emulating what they see on Sundays by taking to the field on Fridays.  The lowering of the head is something that coaches DO NOT teach, yet we see the best football players in the world continually do it, without penalty.  Last night I saw and heard a perfect example from one of our players.

He was blocking late on a play where there was a scrum and launched himself into the pile head first to make a block/hit.  It WAS NOT flagged (should have been), and he came off to the sidelines.  I asked this player what he was thinking and why he did that. His response…”They do it in the NFL.”

Enough said.

Did You Know?

That in girls/womans lacrosse (contact sport) that below is the only required protection…

Thats right, only an eyemask and mouth guard.  This is a great sport to maybe do a study on adding more protection and the increase in head injury.  The thought is that with just the eyemask and strict rules about contact to the head the player is safe.

My two cents are that if you keep the strict rules but add head protection then the incidence of head injuries from balls, sticks and falls will be reduced.

Friday Night Lights (Week 6)

Had the morning off today and really was just sittn’ around thinking about things.  One topic that I had with myself was about the concussions I have seen at school.

I told a mother the other day that I did not believe that there were more concussions, just that they are now being reported more frequently.

Then I caught myself typing in the previous post about how I felt there are “more concussions than usual”.

During my 15 minute conversation with myself, while watching some Ryder Cup, I am firmly convinced that there are not more concussions than usual.  Last year at this time I had 4, and the previous year I had 3, this year is 6 at the beginning of October, so it looks like an increase…  BUT, at least two were spotted and reported to us by teammates, and another was one that I was highly suspicious of, due to knowing the personality of the individual.  So in reality we have a steady number as the past, if there was not heightened awareness from all involved.

That brings me to the point of the self conversation…  135,000 ER concussions reported in under 18-year-old individuals, I would venture to guess that there is 10x that total each year…  Which means we are missing roughly 1.2 million concussions, and there are 1.2 million kids struggling with post-concussion syndrome. Continue reading

Cart Goes Behind Horse

Emily Babay wrote a piece that appeared on the WashingtonExaminer.com website today.  The title was “Concussion considered in teen athlete’s suicide” which is a scary thought.  If you read the article you will notice she is trying to connect the Owen Thomas news and recent death of Kenny McKinnley to the unfortunate suicide of a Washington teen.

I find several issues with this reporting, bordering on irresponsible, Continue reading