C+ means more work is needed

On January 12, 2010, the National Athletic Trainers’ Association (NATA), along with 29 other healthcare and sports organizations met and held a summit to address the youth sports safety crisis that is currently affecting youth sport. But… with heightened attention paid to the effects of concussions on athletes… with the new bills passed in many states regarding the treatment of concussion and Traumatic Brain Injury (TBI) in youth athletes… with rule changes and increased disciplinary action for rule violators… with the amount of media exposure paid to the need for preventing preventable sport injuries… we still are not where we should be. The National Athletic Trainers’ Association still knows more can and should be done. Thus on 12/7/2010, the National Athletic Trainers’ Association and the Youth Sports Safety Alliance have given all of these efforts a “C+” for 2010 noting that 48 youth athletes have died in the past year. This injury epidemic can not be stopped by organizations like the National Athletic Trainers’ Association and STOP Sports Injuries alone. It is going to take a complete paradigm shift (a change in the culture of youth sports, if you will) in how youth sports are governed, played and taught. The Sports Legacy Institute has brought research into practice resulting in rule changes in collision sports, increased awareness and a change in the NFL culture and attitude regarding TBI. The culture is changing in college and professional sport, but not at the youth level yet. In a December 8, 2010 New York Times article (Parents Embrace Documentary on Pressures of School), a child psychologist is quoted saying: “When success is defined by high grades, test scores, trophies we know that we end up with unprepared, disengaged, exhausted and ultimately unhealthy kids”. Since sport related injuries are caused by a mistake (intrinsic or extrinsic), having a disengaged, exhausted and unhealthy kid participating in youth sports is just the type of mistake that will give us an injured athlete (contributing to this epidemic).

Timing is everything

Timing is everything. A simple hit to the chest at the right time can be deadly. This is illustrated in the CNN.com article from 12/8/10 where a 16 year old catcher was hit in the chest and collapsed. This is a classic example of commotio cordis. Commotio cordis is a condition where sudden cardiac death occurs when there is a forceful blow to the chest over the left ventricle 10-30 m sec before the peak of the T-wave of the heart contraction cycle. While this is a very rare problem, it is estimated that there is a 90% mortality rate and illustrates the need for an AED to be accessible where ever athletic practices are held.

Important not to cloud the discussion over depression

There has been much deserved attention placed upon concussions and the effects of repetitive sub-concussive hits to the head in sport. While these discussions bring much necessary light to the health and protection of the brain in all levels of sport, it is wrong to attribute all depression and mental illness in athletes to brain trauma. Mental illness affects athletes just like it affects the non-athletic population. Teen and young adult suicide is often a result of untreated depression. Traumatic brain injury (TBI) has been shown to be a factor in depression, but focus (especially media focus) on this being the cause may result in the neglect (or misdiagnosis) of depression, especially in non-athletes or those who are not subjected to head trauma. For the same reason that many possible concussions are not reported, signs or symptoms of depression are also not reported. In their desire to compete, athletes often do not report anything that they feel might keep them out of their game. Athletes have always been told to be tough and to fight through adversity, so they may not want face any perceived acknowledgment of weakness for admitting depression. While it is important recognize that depression may present itself after a concussion or as a side effect of multiple sub-concussive hits to the head, it is also important to not allow the attention paid to concussions cloud the attention that needs to be given to the recognition and treatment for depression. If too much attention is paid to the potential cause of depression and not to the recognition and treatment, it may be too late.

Energy drinks and exercise a bad mix?

It is common in athletics/sport where practice precedes research. Energy drinks fall into this paradigm. Athletes have long recognized that a little caffeine intake may improve focus and possibly athletic performance. It then seems as if the mentality of [if a little bit is good, a lot must be better] becomes practice. It did not seem long before the energy drink companies were racing to see which drink had the most stimulating results. Physicians recognized the dangers in 2008 when they petitioned for the regulation of energy drinks. There has recently been another call by physicians for the regulation of these drinks (especially with the addition of alcohol). Athletically, where the problem falls is that any true energy that is derived from these drinks comes from their carbohydrate content. The caffeine, guarana and taurine provide only a perceived form of energy by stimulating the brain and generating a stress response so that the body perceives that it has the energy to respond. Since energy drinks are classified as a food supplement, the FDA does not have the authority to require the amount of caffeine put into the label. Here is the problem; the half life of caffeine is approximately 4-6 hours and the amount guarana and taurine do not have to be listed. How many exercises sessions or sports last 4-6 hours. The heart is a muscle that needs rest just like the rest of the muscles in the body. Not much is known on the relationship of the various ingredients in energy drinks or their possible synergistic effects. With the prolific expansion of the energy drink business where a wide variety of stimulating ingredients (studied and unstudied) are added to the various drinks, it may not be coincidence that there seems to be an alarming number of heart arrhythmia problems being diagnosed in athletes today where energy drinks may be a contributing factor. Since energy drinks basically work by generating a stress response, energy drinks will increase the blood pressure, heart rate, urination (leading to dehydration) and anxiety levels in the adult. These same side effects are often magnified to toxic overdose levels in the youth athlete.

Are we doing enough?

Even with all of the new evidence and research surrounding concussions in sport (especially football), are we doing enough? The Arizona Republic had an editorial Monday 11/1/10 emphasizing the need for Alzheimer’s disease funding (Nation must fund Alzheimer’s fight). They (Arizona Republic) projected that there will be more than 7.8 million people over the age of 65 living with Alzheimer’s disease in the year 2030 (up from the current 5.1 million). This is a population that was participating in high school and college athletics in the 1970s and 1980s. When concussions were referred to as “getting your bell rung” or “getting your clock cleaned” and considered a mild injury. To some athletes, this seemed to be a rite of passage. If a head injury did not have signs of a physical injury, the athlete was released to play quickly. Unknown during this period was that concussions are more of a metabolic injury. These are injuries that do not show physical signs of damage to the brain. A question that needs to be considered is: Do these Alzheimer’s disease projections include the results of concussive and non-concussive injuries received by participating in athletics in the 70s and 80s? There is a lot of evidence from research conducted by Boston University (and others) that point to concussive and sub-concussive injuries being a cause of Chronic Traumatic Encephalopathy (CTE). CTE has been linked to dementia that is related to or similar to Alzheimer’s and ALS. New research from Purdue University was reported nationally on 11/1/10 in Sports Illustrated (The Damage Done) and is to published in the Journal of Neurotrauma is bring to light that damage to the brain may be starting at a relatively young age and by hits that everyone takes for granted in football and are nowhere near close to being penalized. Twenty three football athletes from Jefferson High School in Lafayette, Indiana were given the ImPACT neurocognitive test (while their brains were being monitored by an MRI scan) and had their football helmets fitted with accelerometers. These athletes were then followed, measuring the forced to their helmets and 11 were given follow-up ImPACT neurocognitive tests (post injury if necessary) during mid-season. Four football athletes (of the 11) tested showed signs of visual memory loss. With this new information, the question needs to be asked. Are we doing enough to help keep athletes from being part of the projected statistical increase in Alzheimer’s disease?

No Apology Necessary

A physician should not have to apologize for protecting the health of an athlete. Football at the university level, like professional football, is a multi-million dollar business. With all of the emphasis on television, bowl bids, gate receipts and coaching contracts, the athlete is often left as a pawn with the medical staff serving at what seems like his only advocate. Ed Wesley, TCU running back, suffered a concussion against SMU on September 24. After Wesley was diagnosed with a concussion with a brief loss of consciousness, TCU Head Football Coach Gary Patterson confronts and proceeds to berate Dr. Haraldson for not allowing Ed Wesley to return. The day after the game, Coach Patterson told a journalist for ESPN Dallas that Ed Wesley was ”fine 10 minutes after he got hurt”. On October 21, ESPN revisited the story by reporting that Dr. Haraldson apologized to Coach Patterson. Possibly the greatest mistake that a coach can make is to compromise an athlete’s health. A public disagreement between a coach and physician such as this may place athletes in a position where they may not truthfully report injuries. That is a true disservice to the athlete.

In football, a mistake may be catastrophic

Lest we forget, football is a dangerous game. Most injuries in football like all other sports are a result of a mistake. If injuries are to be prevented, the mistakes must be identified and then eliminated. Eric LeGrand from Rutgers University, unfortunately made the mistake of lowering his head during a kick-off during the 4th quarter of a game against Army. This mistake resulted in the axial loading of the cervical spine and in his case resulting in catastrophic damage to the 3rd and 4th cervical vertebrae. When the cervical spine is straightened by lowering the head, it turns into a segmented column. Axial loading through this segmented column may then result in displacement of one or more vertebra, which in turn damages the spine. New York Times published a thorough article illustrating Eric LeGrand’s injury and then follow up with an article referring to Adam Taliaferro’s cervical spine injury while playing football at Penn State in 2000.

Can we save football from ourselves?

Football is a sport where the excitement of the game is based on simple physics. Much effort is put into increasing the size of the athlete (to increase mass), increasing the athlete’s strength (to increase acceleration) and increasing the speed of the athlete (the velocity of the moving mass). During the course of the game/practice, it is not uncommon that these three properties come into play in the form of a projectile. As has been widely published lately, many of these projectile collisions are violent enough to create a cerebral concussion. The effect of multiple concussive forces has been demonstrated by the development of CTE (Chronic Traumatic Encephalopathy) in athletes. More recently, sub-concussive forces to the head are being studied. The New Your Times published a story regarding the thousands of sub-concussive forces during the course of a season in college football. The Chicago Tribune has also recently published an article referring to the thousands of sub-concussive forces during the course of a high school season. Then on October 7, 2010, USA Today published an article on the seemingly trend of football helmets inadvertently coming off during the course of the game. If we can step back (and think about the concept that injuries are caused by a mistake) and take a look at all of the contributing factors (mass, acceleration, speed, excessive hitting in practice, properly fitting helmet, etc), it is possible to save the game before we destroy it.

Time To Rethink How Practice is Conducted?

Practice gives greater exposure to concussive and sub-concussive forces than the games themselves. As reported in the New York Times, recent studies conducted on three NCAA Division I teams, a football team will encounter more than 2500 significant blows to the head that are in excess of 50g’s of force and approximately 200 head blows that are above 200g’s. These are just the blows that are of significance and are considered great enough for the athlete to sustain a concussion. The sub concussive forces that occur every time there is contact with another athlete or the ground are too great in number to count. The deaths of Chris Henry (Cleveland Bengals) and Owen Thomas (University of Pennsylvania) have shown the importance of limiting the exposure to sub concussive forces to the brain, not just those significant enough to create injury.

There have been some important research findings in the past few months that, if taken seriously, will lead to safer sport. Until recently, purposeful heading of the ball in soccer was considered a non-issue in regards to brain trauma. According to the American Academy of Pediatrics (AAP), the rate of concussions among soccer athletes in both recreation and elite leagues is similar to football and hockey. With the recent evidence of Tau protein formation resulting from multiple sub concussive hits to the head, the AAP has recently (released September 2010) altered their position that the “contribution of purposeful "heading" of the soccer ball to both acute and potential long-term concussive effects, such as cognitive dysfunction, seems less controversial today than previously.” (Clinical Report Injuries in Youth Soccer) The AAP is waiting for more definitive evidence to actually site the relationship between purposeful heading and long term brain damage. But the sport of soccer (or any of the contact and contact/collision sports) should not wait for long term studies to come to fruition before action is taken. Currently Chronic Traumatic Encephalopathy (CTE) can not be definitively diagnosed except through an autopsy of the brain.

Heat Illness is Preventable

Heat illness is preventable [period]. This also means that the associated complications that arise from a heat illness situation are also preventable. There is more to take into consideration than just temperature and hydration. With the proliferation of medications, dietary supplements and energy drinks, it is important to understand the effects and side effects of what the athlete is ingesting. Common side effects with many supplements and energy drinks include diuretic effects and increased core body temperature. This means that more emphasis needs to be placed on hydration and physically cooling the body. Heat illness and dehydration can also play a significant role in a condition known as exertional rhabdomylosis, a rare but serious condition resulting in increased levels of CK (creatine kinase) that may cause muscle and kidney damage. (Exertional rhabdomylosis is a major concern with athletes who carry the sickle cell trait.)

Knowledge of heat illness prevention and recognition is important knowledge for all levels of sport coaching. A football coach the state of Kentucky was arrested (also acquitted) for negligent homicide in the heat illness death of one of his athletes. Two Middletown, CT football coaches were charged with reckless endangerment (charges were also dropped) after an athlete collapsed from dehydration. While these cases resulted in the respective charges being dropped, this emphasizes the need to prevent preventable conditions such as heat illness.

Lou Gehrig's Disease May Be Connected to Concussions

There is no more important time than now to stress the importance of using a neurocognitive concussion test, like the ImPACT test, on all contact and contact/collision athletes. This means starting at the youth/club level and continuing through the elite and professional levels. There has been an effort to educate the sport culture about the danger of increased intracranial pressure caused by of Second Impact Syndrome (SIS). Now as this education effort is taking place, we find that SIS is not the only danger if an athlete is allowed to return-to-play before a head injury has been resolved. Chronic traumatic encephalopathy (CTE) has been identified by the Tau protein in the brains of former professional football athletes. This is a condition where repetitive concussive and sub-concussive forces to the head have resulted in depression and dementia-like symptoms. Dr. Ann McKee (Boston University Center for the Study of Traumatic Encephalopathy) was instrumental in discovering the Tau protein which is evident in CTE. She and the Boston University Center for the Study of Traumatic Encephalopathy are also instrumental in the very recent discovery (to be published next week in the Journal of Neuropathology & Experimental Neurology) which possibly has a significant connection between head injury and ALS (Lou Gehrig’s disease. In this study, another protein has been identified (TDP-43) creating a connection between ALS and head injuries. With evidence mounting concerning the effects of repetitive traumatic forces to the brain, if sport is to survive the athlete must be protected. Developing a concussion protocol and requiring neurocognitive testing must not be a thought for a sport league or athletic program. It must be a reality. What a coincidence that a concussion may have had a role in Lou Gehrig’s roll in securing a spot on the NY Yankees as well as in the disease that ultimately took his life.

See New York Times article:
Study Says Brain Trauma Can Mimic A.L.S.

Heat Stroke - Return to play?

The temperature in Phoenix got up to 113 degrees today and a question was bought up as to when it is safe to exercise again after heat stroke. Great question! Researching the answer, I found an article in the New York Times (After Heat Stroke,When is it Safe to Exercise?) asking this same question. For years, it has been thought at heat stroke is caused by damage to the hypothalamus in the brain. There are many textbooks that are still professing this (which is a solid reason to question the use of textbooks). But this does not account for the damage to the cerebrum and cerebellum (along with the absence of damage to the hypothalamus) that has been identified in MRI scans of the brain in people who have been diagnosed with heat stroke.

Heat is the most severe physiological stress placed on the body during exercise. The entire paradigm of athletic performance and athletic injury prevention centers on warming the body in preparation for exercise. This means that athletes are intentionally placing their body into hyperthermia each time they exercise. Heat stroke occurs when the body loses its ability to cool itself when placed into hyperthermia. There is not a single cause of heat stroke likewise there can obviously not be a single determination of when it is safe to resume exercise after heat stroke. Heat stroke does not just affect the brain it also affects the other life sustaining vital organs.

What is known is that it is not necessary how hot the body gets during heat stroke, but how long it stays over heated. During this period of hyperthermia, blood is directed towards the skin in an attempt to cool. This deprives the internal organs of oxygenated blood which may or may not result in permanent damage. In many ways, this may be considered a metabolic cascading injury similar to cerebral concussions. Various medical organizations including the American College of Sports Medicine and the National Athletic Trainers’ Association have position statements concerning heat stroke, but there still is not a definitive answer to when an athlete can “return to play”.

TOPS to prevent SCD caused by HCM

What do SCD and HCM have in common other that just being letters of the alphabet. HCM (hypertrophic cardiomyopathy) is the leading cause of non-traumatic SCD (sudden cardiac death) in athletes. HCM is generally considered a genetic disease that involves abnormal hypertrophy of the left ventricle. What is often misunderstood is that this genetic disease may have an unknown origin. The HCMA is a non-profit organization dedicated to patients with HCM and is a good resource for information. There are 11 genes that are known to cause HCM. There are also more than 500 known mutations (defect in the DNA code) of these genes that are connected to HCM. This is why it is such a diverse disease. HCM may be a result of a de novo mutation. This means that the genetic mutation may occur spontaneously in an athlete with no family history of HCM. This video from Barnes Jewish Hospital in St. Louis, MO provides a good description of HCM.

In Arizona, Team of Physicians for Students (TOPS) is an organization that has a dedicated mission to help prevent sudden cardiac death from hypertrophic cardiomyopathy. TOPS provides a free pre-participation physical exam (for 8th grade through community college athletes) that includes an EKG for all participants with a follow-up echocardiogram if indicated. In 2009, there were 10 athletes that were not cleared for cardiac reasons. This means that there 10 potential cardiac emergencies that were identified before a catastrophic event occurred. Nationally, the Anthony Bates Foundation has a similar mission.

86 Percent Of Disadvantaged Preschoolers Lack Basic Motor Skills

Can we call it socioeconomic discrimination? There are many factors that lead to the creation of disadvantaged neighborhoods. Researchers at The Ohio State University suggest (86 Percent Of Disadvantaged Preschoolers Lack Basic Motor Skills) that children are not only “at risk” academically in underprivileged neighborhoods, but they may also be “at risk” physically. This study reports that 86% of the preschool participants scored below the 30th percentile labeling them developmentally delayed. The results were even more profound in object control skills (involving objects such as a ball or a bat). In object control skills females scored at the 11th percentile and males at the 22nd percentile. The preschool participants in this study are in a critical time in their physical maturation process. Any delay in development places these children at a disadvantage when competing with peers who are proficient in their locomotor skills. Exercise related injuries are caused by a training mistake. Not having the opportunity to learn the basic locomotor skills, is a mistake. A mistake that if not corrected will create injury. Organizations such as the Youth Sport Safety Alliance have been created to combat injuries in youth sports, but their effectiveness will be stymied by a class of youth athletes who have not been taught how to hop skip and jump correctly. Contrary to conventional belief (and ask any Physical Educator), locomotor skills are not naturally developed. They have to be taught and practiced. When it comes to youth and high school sport, success tends to be more prevalent in higher socioeconomic neighborhoods. In other words, “money talks”. We can call it socioeconomic discrimination if disadvantaged children are denied the opportunity to learn the basic locomotor skills involved in physical maturation.

Academic health (not just physical health) is important in concussion management

This is a great way to look at concussion management and how they affect the “student” athlete. (Big Ten medical staffs will examine concussion policies next week) Even though we are very careful to be correct in referring to athlete as a "student", are we also being careful in considering their “student status” when they are injured? The potential physical damage that comes from the mistreatment (misdiagnosis, inappropriate return-to-play, etc) can be very devastating. The academic side effects are also very important to consider. Injury to the brain can very easily alter an athlete’s academic career. College level academics are stressful and difficult enough for a healthy brain. There are papers to write, textbooks to read and exams to take. Injure the brain and these difficulties magnify. This means that academics must be considered in the treatment protocol. Realistically, only a small fraction of college athletes ever reach the professional and elite level. For this reason, academic health should have the same level of priority as physical health.

STOP Sports Injuries

The youth sport injury epidemic has spawned another collaboration of medical and exercise related organizations in an effort to combat it. The “STOP Sports Injuries” campaign is an effort to use social media in an effort to fight the youth sport injury epidemic at a grass roots level. The pieces are in place to launch this effort on Facebook and Twitter. Dr. James Andrews (President, American Orthopedic Society for Sports Medicine) and Heisman Trophy winner Sam Bradford are on a media blitz right now. Below is a video of their interview on Channel 5 in Washington D.C.

The silent injury epidemic should no longer be silent.

As has been mentioned in this site before, youth sport injuries are at an epidemic level (Youth Sport Safety Alliance). This is a silent epidemic that hopefully is not remaining silent any longer. The physical, social and psychological benefits that come from youth exercise and sport are too numerous to list. Once the emphasis of sport left that of being a benefit to the athlete and became a benefit to over zealous coaches and parents, the injury epidemic (in my opinion) began. Orthopedic injuries that are incurred during the adolescent years may (and often will) have a direct impact on the growth and integrity of the joint affected. Youth sport should be providing benefits instead of providing detriments due to the unnecessary and preventable (chronic and/or acute) injuries. For this to happen, it may take a complete shift in the current youth sports paradigm. In the quest to become “great” in a particular sport, the youth athlete is being robbed of the opportunity of becoming a “great” athlete. Every young athlete has a desire to reach the top of their sport, pushing the athlete too hard and treating them like mini adults may very well deny the athlete of this desire. There is a reason that college and professional athletes (who are well conditioned and have reached physical maturity) have limits on practice times and are provided mandated recovery periods. This reason is so that the athlete may avoid preventable injuries and function at a competitive level. Youth athletes who are still maturing, should not have to wait until they are in college before their sport activities are adapted in an effort to aid in injury prevention and improved performance. If sport and practice adaptations (in an effort to prevent avoidable injuries) are not made at this level, the youth athlete may never have the opportunity to become a college level athlete. Coaches and parents need to do their part in stopping this epidemic by providing age appropriate and developmentally sound instruction along with allowing the child to develop a life-long love for sport is a place to start. Parents need to insist that the coach remains current with age-level coaching techniques and injury prevention. Coaches need to insist that the child be provided an environment that includes a combination of rest and play. Both should educate themselves on the exposure to injury in their particular sport as well as read “Warrior Girls” by Michael Sokolove and “Game On” by Tom Farrey. It is no secret that exercise related injuries are caused by a mistake. For an athlete to excel, these mistakes need to be identified and then eliminated. It is not in my opinion the purpose of youth sports to create the mistake.

Cramps in the legs and back may be more serious.

Cramps in the legs and low back during exercise may not be just a benign case of fatigue. These cramps may be a result of exertional rhabdomyolysis, a rare but potentially deadly complication when an athlete with sickle cell trait over exerts. Sickle cell trait is different from sickle cell disease in the fact that the athlete only carries one gene of sickle cell hemoglobin and instead of the two that result in disease. They also have one gene for normal hemoglobin. During intense exercise (especially without proper hydration) the sickle hemoglobin may change the shape of the red blood cell causing it to sickle and decreasing its ability to transport oxygen. Without oxygen during exercise exertional rhabdomyolysis may result. Since cardiac muscle has some skeletal muscle properties, this muscle breakdown will affect the heart as well as the skeletal muscles (mainly legs and back). According to the Columbia Tribune (Missouri), 7 of the 19 non-traumatic NCAA football deaths have been attributed to complications of the sickle cell trait. There has been enough concern, that the NCAA has recommended testing for the sickle cell trait in their pre-participation physicals. With dehydration being a complicating factor with the sickle cell trait, it may be a good idea for testing for this condition be apart of interscholastic sport as well as collegiate. National Athletic Trainers' Association (NATA) Consensus Statement.

Youth Sport Safety Alliance

Youth sport is in a crisis state due to the rising number of injuries that are sustained. This crisis has reached the point where it has become imperative that action must be taken in an effort to protect the athlete. In January, 2010, the “Alliance to Address Youth Sports Safety” summit was held to examine this crisis and to raise awareness of the health care concerns of the youth athlete. This summit was spearheaded by the National Athletic Trainers’ Association and supported by 29 health and sport organizations. With in excess of 7 million interscholastic high school athletes participating in sport, there are close to three fourths of a million sport-related injuries. In 2008 and 2009 there were 120 sport related deaths from conditions such as: brain injury, heat illness and sudden cardiac arrest. This is a true crisis state! From this summit the Youth Sport Alliance has issued a call to action. Information gleaned from the collective knowledge of the professionals in this alliance is valuable and needs to be processed out in an effort to raise awareness of the youth athlete injury crisis. Only by raising awareness, will the current sport paradigm be altered in a way to make the health of the athlete the center of importance.

The fine line between performance and dangerous

The February 10 edition of the New York Times has a feature titled “Tempting Fate”. Athletes will naturally try to perform at their best and attempt new skills. Somewhere there is a fine line between superior performance and reckless or dangerous performance. The elite athlete has found this line which has allowed them to achieve their level of greatness. Even so, it only takes a minute mistake that causes one to cross that fine line and there is exposure to injury. Kevin Pearce is an example of this. While practicing a new trick(double cork) on the Halfpipe, Shaun White made a slight mistake resulted in a fall that that is similar to Kevin Pearce's fall that caused a traumatic brain injury. This TBI may also injure any chances for Kevin to ever participate in this sport again. Athletes will always push themselves to achieve greatness in their sport. It is important that in their effort to improve and achieve greatness, these athletes are given an environment that is safe for them to perform. In our current social climate that demands excitement and entertainment in everything we do, sometimes the welfare of the athlete seems to become only a secondary concern. On Friday, 2/12/10, the opening day of the 2010 Winter Olympics, there has already been an accident that claimed the life of luge athlete from the Republic of Georgia. The sad comment here is that the athletes have previously complained that the course was too fast and dangerous.

There is no such thing as a mild brain injury.

Time magazine has provided the influence of a major news magazine in educating athletes, potential athletes, parents and fans on inherent dangers of repetitive blows to the head in contact/collision sports like football. The feature "The Problem with Football: How to Make It Safer", provides a good solid scientific analysis of the cumulative effects of repetitive concussive forces that the brain goes through hit after hit, day after day on the football field and is presented in a literary manner that is easy for the nonscientist to comprehend. As more information is disseminated with regards to multiple concussive impacts and their relationship to chronic traumatic encephalopathy (also referred to as CTE), more coaches, parents and athletes will gain understanding and be able to make informed decisions when given the options presented to them by healthcare providers.

Within this article, there is a video well worth the 9 ½ minutes in length. This is Your Brain on Football.

While this article (along with the majority of current media attention) is centered on the sport of football, it is important to note that cerebral concussion injuries do occur in other sports. Coaches and parents need to assist in recognizing the signs and symptoms of a concussion since many athletes will not report the injury. There is no such thing as a mild brain injury.

Athletic Injuries More Frequent in Females

I have long professed to my athletic injury classes that injuries are sport specific and not gender specific. At first, this article Athletic Injuries More Frequent in Females made me question myself, but then I realized what it was really saying. I still am convinced that injuries are sport specific. I totally agree that female athletes have been given the short straw (intentionally and unintentionally) when it come to strength training and their ability to obtain it. Injuries are preventable and are caused by a mistake. Apparently one of these mistakes may be a faulty research model that assumes that there are no intrinsic biological differences between males and females. I still feel that injuries are sport specific. I also feel that injuries are a result of a mistake. This article brings both of these concepts together.

Time to rethink football?

After watching the episode of Real Sports with Bryant Gumbel(on HBO) highlighting “Concussions in the NFL", I looked into the topic further and I think I like what I just read. There was an article, “Ten Point Plan to Save Football” (written by Chris Nowinski), which was referred to in this program. Searching for this article, I came across the Sports Legacy Institute. This is an organization founded by Chris Nowinski (Co-Director, Center for the Study of Traumatic Encephalopathy, Boston University School of Medicine) and Dr. Robert Cantu (Clinical Professor of Neurosurgery, Boston University School of Medicine). The Sports Legacy Institute was founded in 2007 when new medical research indicated that sport is in a national crisis concerning brain trauma. This article (Ten Point Plan to Save Football), is a good read and a beginning of further discussion and (more importantly) action. It is not just the exciting violent collision that creates dangerous consequences and a concussed athlete, but multiple lesser blows (or collisions) to the head that creates a cumulative effect that results in brain injury. After twenty-five years in the field of athletic training, I am a firm believer that there is no such thing as a “mild brain injury”. There are some points in this article which is (in my opinion) common sense and some of which will face steep opposition. American football is an “institution” in this country and has long been revered for its punishing violence and the sheer toughness of the athletes that play the game. Athletes are getting bigger, stronger and faster. Technology has produced better equipment and padding in an effort to protect the athletes. I think that it is important to note here that as athletes get bigger, stronger and faster; the forces in which they collide become greater. Also, as technology creates better protection, athletes become less inhibited when it comes to using their bodies as projectiles. As the mass gets larger and moves at a faster speed, the force of contact becomes more violent. Helmets and padding produce great protection for the exterior body surfaces, but do little for reducing the momentum of the brain inside of the cranium. This is the very reason that the entire paradigm of how the sport of football is taught and played must be rethought. The “Ten Point Plan to Save Football” article is a great place begin the shift in this paradigm.