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.

Second Impact Syndrome

After looking at the “fencing response” that occurs in serious head injuries, it is also important to look at the hidden dangers of concussions and multiple concussions. I am not alone in the thought that there is no such thing as a mild brain injury. Especially at the high school level, football (as well as other) athletes often hide the fact that they may have had a slight concussion. The culture of sport needs to be changed so that if an athlete receives a cerebral concussion, they do not return to play until released based upon recognized neurological guidelines. There are several return to play guidelines which basically means that that there is not a general consensus among physicians. The guidelines developed from Dr. Cantu and from the Colorado Medical Society are considered to be on the more conservative when compared to the others. But, when we are talking about life, quality of life and even the possibility of death, conservative is what we need. At the very least, the injured athlete should not return to play until they are asymptomatic for 1 week. The video below illustrates the importance of recognizing concussions and providing the necessary care and rest.

en garde - the Fencing Response

En garde… The fencing position has become a notable response in serious head injuries. Dr. Lifshitz, an assistant professor at UK's Spinal Cord and Brain Injury Research Center, along with other researchers used YouTube to find this response in athletes. Using the postings on this social media site allowed these researchers to examine the head injuries in many different sports and activities. YouTube often has the same incident of injury, but with various angles. A description of this response may be found in The Medical News. Tim Tebow, quarterback for the University of Florida exhibited this response at the moment of his head injury on Saturday (9/26). ESPN article with video.

Correct the mistake!

For the most part, exercise induced injuries are caused by a mistake. Granted, you may have a fastball hit you in the head, have contact with another athlete or have an unintended meeting with the ground. But if you are involved in an exercise or sport and you injure without contact, this injury was caused by a mistake. Now if we want to prevent injuries (which had better be our top priority), we need to learn how to identify the mistake and correct it. If we can not (or do not want to take the time) do this, this injury will reappear again. How many athletes have shin splints (medial tibial stress syndrome) year after year? Why are acl injuries at an epidemic level in female athletes? Is it a coincidence that there are so many hamstring strains in power sports? Questions, Questions… Shin splints can be prevented, acl injuries can be prevented, hamstring strains can be prevented. All it takes is educating the athlete about the need for conditioning and strengthening the body and not just body parts. (Maybe I should say educating the athlete, parent and coach about the need for conditioning and strengthening the body and not just body parts.)