I have been asked to write about concussions from time to time.  I attempted a chapter on concussions for a book at some point, over the next few weeks I will post this chapter, as I wrote it, no matter how horrible it is.  After all I am not an author, but at least you can take a look.  This particular chapter deals with concussions in the sport of football.  We all should know this injury can be sustained in any sport.  Because football is the biggest draw of sporting eyes I felt it was best to present it in this way. (Part I, Part II & III, Part IV, Part V & VI, Part VII & VIII) *All sources will be posted after last portion is up.

Concussion Chain of Command

As with most everything on a sporting field there is a “chain of command” for procedures and decisions.  This is also very true for injuries; concussions are a hot topic for this schematic because we are basically still feeling out the process.

Generally speaking with all other injuries on a football field as the player is removed from the game for evaluation the athletic trainer will initially asses and make a real-time decision about contingencies for return or to remove the player.  In most division-I and II programs there is a supervising physician on at least the home team sideline.  At the upper levels team doctors will also travel with teams, more as a trust factor for the coaches and medical staff.

After the assessment by the athletic trainer the physician will perform a cursory evaluation as well and the two medical professionals will “compare notes” to make a more sound decision.  It should be noted that an athletic trainer will perform the same exact testing that the doctor will; skills in the orthopedic evaluation realm are equal between these health care providers.  Moreover, if the supervising physician is a general practitioner then the skill set of the athletic trainer for orthopedic evaluation will be far superior in almost all cases.

After the physician makes a determination for further diagnostics Continue reading →

I have been asked to write about concussions from time to time.  I attempted a chapter on concussions for a book at some point, over the next few weeks I will post this chapter, as I wrote it, no matter how horrible it is.  After all I am not an author, but at least you can take a look.  This particular chapter deals with concussions in the sport of football.  We all should know this injury can be sustained in any sport.  Because football is the biggest draw of sporting eyes I felt it was best to present it in this way. (Part I, Part II & III, Part IV, Part V & VI) *All sources will be posted after last portion is up.

Helmets and Protective Gear

Gladiators used them to protect against fatal blows on the floor of the Coliseum and in battle, today helmets are used for the same purpose in the military and on the football field.  Helmets were not even mandated in the sport until a rash of skull fractures caused such alarm that President Theodore Roosevelt demanded changes to the game.  This eventually created the National Collegiate Athletic Association (NCAA), and mandates for helmets, which in turn reduced injuries by 31%[i].

One of the biggest myths about helmets and protective gear is that it will prevent concussions, wrong.  It will prevent what they were intended for, skull fractures and nothing more, the helmet sanctioning body; The National Operating Committee on Standards for Athletic Equipment (NOCSAE) makes sure of that with testing.  In fact you cannot play the game of football unless your helmet displays a NOCSAE sticker.  NOCSAE even states in a press release on February 4, 2011 that every player, parent, coach and anyone involved in the sport of football should know that helmets WILL NOT prevent concussions[ii].

Another piece of equipment has staked a claim into reduction and even prevention of concussion, mouth orthotics, which is also false due to the lack of current research and non-disputed journal article, backed by the Zurich statement[iii].  If you don’t believe the statement about mouth orthotics, take a quick look at boxing or MMA, they all wear mouth gear and they continually get knocked out or staggered (signs of concussion) during fights.

There is a simple reason as to why this is, physics.  As we have discussed you do not have to be hit in the head to develop a concussive episode, it only takes unnatural Continue reading →

I have been asked to write about concussions from time to time.  I attempted a chapter on concussions for a book at some point, over the next few weeks I will post this chapter, as I wrote it, no matter how horrible it is.  After all I am not an author, but at least you can take a look.  This particular chapter deals with concussions in the sport of football.  We all should know this injury can be sustained in any sport.  Because football is the biggest draw of sporting eyes I felt it was best to present it in this way. (Part I, Part II & III, Part IV) *All sources will be posted after last portion is up.

Classification of Concussions

Often we hear of “minor” injuries or sometimes they are referred to in degrees; 1^st, 2^nd, 3^rd to give a sense of how bad it is or prognosis of recovery.  These classifications not only serve to give the audience a perspective, but they are also necessary for the medical diagnosis and rehabilitation.  Over years and years of injury surveillance, record keeping, surgeries, and rehabilitation on injuries of joints and muscles we can clearly define orthopedic injuries with these connotations.  Concussion, not so much.

Concussions initially began with a similar “grading” of severity authored by Robert Cantu, MD in 1986[i] adopted by the American College of Sports Medicine and further defined by various other organizations; Colorado Medical Society Guidelines – 1991[ii] (adopted by the NCAA), American Academy of Neurology – 1997[iii].  The issue as time went on was there was not a consensus of which grading system was the appropriate practice of care, the problem existed until three years ago when most health care providers began to accept and conform to The 3^rd International Conference on concussion in sport, held in Zurich, Switzerland[iv].  The key word being “most” as this information, widely accepted and worked on by the leaders in this issue, has not been seen or adhered to by physicians.

The consensus statement[v] was built upon the two previous meetings in Vienna (2001) and Prague (2004) as the exclusive panel began the process of trying to obtain a common ground on the concussion epidemic.  The take home message from this in terms of classification is that a concussion is a concussion.  Due to the varying factors and injury evolution differing from individual to individual the experts determined that “mild”, “moderate”, “severe”, “simpe”, and “complex” should not be used to diagnose or classify the actual injury.  To this day doctors, players, athletic trainers continue to use those terms when describing the injury, which is improper.

There is nothing mild or simple about a concussion, this injury is a significant insult to the brain and its function; therefore a concussion is a concussion.

Those qualifying tags could be used to Continue reading →

I have been asked to write about concussions from time to time.  I attempted a chapter on concussions for a book at some point, over the next few weeks I will post this chapter, as I wrote it, no matter how horrible it is.  After all I am not an author, but at least you can take a look.  This particular chapter deals with concussions in the sport of football.  We all should know this injury can be sustained in any sport.  Because football is the biggest draw of sporting eyes I felt it was best to present it in this way. (Part I, Part II & III) *All sources will be posted after last portion is up.

Detecting a Concussion

Although the injury is “invisible” there are ways to identify and detect a concussion.  In fact this is one of the few injuries where modern technology – x-ray, MRI, CT scan – cannot “see” the injury, rather those diagnostic tools are used to rule out much more severe injuries; such as skull fractures or bleeding on/in the brain.  Medically speaking any blow to the body and/or head that results in signs and symptoms is classically diagnosed by a physician as a concussion[i].

In the field as an athletic trainer trying to root out those concussed conditions are slightly more difficult, weather conditions and things like lighting notwithstanding, the individual and those surrounding him/her make detecting a concussion very difficult at times.

Most athletes are competitive by nature and have a very hard time coming off the field for any reason, let alone an injury; something that would show weakness.  Now try getting that athlete off the field when there is nothing for the general public, coach, or teammates to see.  A lot of what goes on with detection as an athletic trainer has to do with observation of the actual hit/hits, but usually being outnumbered 40-50:1 makes watching every play and every hit nearly impossible.  This makes second-hand information VERY important; Continue reading →

I have been asked to write about concussions from time to time.  I attempted a chapter on concussions for a book at some point, over the next few weeks I will post this chapter, as I wrote it, no matter how horrible it is.  After all I am not an author, but at least you can take a look.  This particular chapter deals with concussions in the sport of football.  We all should know this injury can be sustained in any sport.  Because football is the biggest draw of sporting eyes I felt it was best to present it in this way. (Part I)

What is a Concussion

Simply put; a concussion is a disruption of normal brain function.  More specifically a concussion is a traumatic brain injury, which has developed due to unnatural forces applied to the brain, resulting in symptoms indicative with the injury.

Webster Dictionary[i] defines concussion as (noun);

1. 1.      A shaking or agitation; a shock; caused by the collision of two bodies.
2. 2.      (Med.) A condition of lowered functional activity, without visible structural change, produced in an organ by a shock, as by fall or blow; as, a concussion of the brain.

In terms of football and sports, concussions can be further defined as it has been at About.com[ii];

“Concussions are traumatic head injuries that occur from both mild and severe blows to the head. Some head injuries may appear to be mild but research is finding that concussions can have serious, long-term effects, especially repeat head injuries or cumulative concussions.

A concussion is typically caused by a Continue reading →

I have been asked to write about concussions from time to time.  I attempted a chapter on concussions for a book at some point, over the next few weeks I will post this chapter, as I wrote it, no matter how horrible it is.  After all I am not an author, but at least you can take a look.  This particular chapter deals with concussions in the sport of football.  We all should know this injury can be sustained in any sport.  Because football is the biggest draw of sporting eyes I felt it was best to present it in this way.

The sport of American Football is rooted in the traditions and fabric of this fine country.  It begins as early as dad or mom can hold their child and watch the game which we have grown to love.  The passion shown by fans across America, particularly amongst the college football teams is down-right near pandemonium at times.  For most people in small college towns the football team is its identity and source of pride.  From Boise to Tuscaloosa people watch with anticipation and understanding of the game that allows them to gain some semblance of glory and excitement with the players. Along with all the glory and excitement that comes with watching and playing the sport come risks, mainly associated with injury.

The casual fan has learned a lot about injuries, Continue reading →