Don Sanderson Symposium on Sport Concussions – Second Annual

Yesterday I attended my first Don Sanderson Symposium on Sport Concussions, at York University in Toronto. Don Sanderson was a York University student playing for the Whitby Dunlops hockey club. He was playing in a regular league game in December when he got in a fight, and his helmet came off. When his head hit the ice at the end of the fight, he went unconscious for 30 seconds, he was rushed to the emergency department in a coma. He stayed in the coma for 21 days until he succumbed to his injury in January. His mother has dedicated her time to the Donald Sanderson Memorial Trust Fund, that raises money for concussion education. The event at York was in part funded by this organization.

Dr. Lauren Sergio (York U Neuroscientist) emphasized that concussions don’t only come from hits to the head. Hard shoulder to shoulder hits, quick decelerations, and anything causing whip lash can lead to a concussive force within the head. The concussion comes from the brain hitting the skull from the inside, not an object from the outside. Dr. Sergio also explained the serious nature of what is called Second Impact Syndrome. It is this syndrome that makes concussion risk management so important. Basically, the brain is always being regulated to have the same amount of blood flow no matter the conditions. So whether you’re hungry, tired, cold, hot, or exercising intensely there is always the same amount of blood flow to the brain. When the brain suffers a concussion this system is compromised and causes an increase of blood flow to the brain. Taking a second concussive force to the brain while there are still symptoms causes an increase of pressure to the brain. This can lead to serious brain trauma or likely death.

Dr. Sergio also talked about some of the questions that are coming out of the current research. Why do some people seem more susceptible to concussions and some get more severe symptoms than others? There could be a biomechanical threshold (the body can only handle so much), the amount of torsion the neck undergoes could be a factor, genetics, the number of hits leading up to the big hit, as well as age and gender could all play a roll. Lastly, Sergio talks about new research that she is involved with that might help trainers on the sidelines. Concussion screening tests, right now, test cognitive function and motor ability separately. This new research looks to testing cognitive and motor skills in combination. Apparently those suffering from dementia will focus on cognitive skills when asked to do both in combination (stop walking in order to talk), while athletes will focus on motor skills.

Next Matt Dunigan, former quarterback (and hall of famer) in the CFL spoke about his experiences with 12 concussions. Fifteen years after retirement, he is still suffering from many symptoms, most notably his personality change. It is a struggle for him to let loose and have fun, as well as control his emotions. He spoke about being a parent to a football player, who has suffered 2 concussions. Dunigan pulled him out of football in order to save his son’s athletic career (Dolan now plays NCAA baseball). Dunigan was an athlete that would go back into play even though the “field was sideways”, or had difficulty seeing the field. No one stopped him, and no one took him out the game. Dunigan’s career ended with a concussion, a routine hit, with symptoms that never went away.

The last expert to speak was Dr. Paul Echlin. For those of you who attended the Concussion Symposium in February at BodySmith, Dr. James Carson who spoke has worked along side Dr. Echlin in prominent concussion research. Dr. Echlin reminded us that the brain is a unique organ that has translation (forwards and backwards) and rotational abilities. Here is a list of astonishing stats that has come from Echlin’s research:

• 300,000 to 2.5 million sport related concussions were reported in the USA last year
• the Canadian sport with the most reported concussions is hockey
• Echlin’s research team counted 7 times more concussions than what were reported in the Junior hockey games that they researched

• 69% of concussions came from hits to the head

• 80% of those hits were intentional

• there is only a 7% reporting rate
• 90% of those with concussions did not lose consciousness

Dr. Echlin finished his lecture talking about management. A doctor must diagnose a concussion, not even your team trainer. If you believe that your athlete, son, or daughter has suffered a concussion do not leave them alone. Do not wake them up in the night (this will offset the healing process). And lastly and most important, if symptoms drastically worsen, take your player, child to the emergency department. The leading doctors (Echlin and Carson) instruct their concussion patients to go to “jail”, no TV, gaming devices, telephone, or computer. But be sure your athlete or child is not left too alone, as it is easy for them to slip into a depression. At the end of your concussion healing process, make sure to get a doctor to clear you for play.

The final two speakers at the symposium were two students that are patients of Dr. Echlin. The first girl was from Bishops University and she had the best line to sum up how those with concussions often feel. She explained: “Don’t ask (your teammate with a concussion) when they will be coming back to play”. So many athletes are sad and depressed about having to sit out and miss games, especially with an invisible injury that neuroscientists are only just starting to understand.

For more information about concussions here are some helpful links:

• www.thinkfirst.ca
• www.csro.com
• www.shootforacure.org
• www.athletictherapy.org
• Return to Play guidelines: see page 758

Jen Mark BSc., CAT(C), CSCS

www.dynamicliving.me

Saving a Life

Would you know what to do if you were the first to come along a car accident? What if you are out in the backyard and someone falls down the stairs? Do you knowhow to save their life?

If you witness someone falling and hitting their head, you need to act fast. You can really save them a lot of pain and further damage by doing a few things before the paramedics arrive.

First, block their head. A neck fracture is more serious than a concussion, which can lead to a loss of breathing and eventually a loss of a heart beat. By blocking the head, you are ensuring that they do not move their spinal column.

If someone falls and does not get up, put your hands on their head and hold it to the ground. Tell them not move their head and only answer your questions verbally. People tend to nod for yes and no, which will move their spine. Try not to panic the person, reassure them that this is all for precaution.

Ask them if they have any pain in their neck or back. Ask them if they feel any numbness or tingling into their arms or legs. Ask them to gently move their fingers then toes. And ask them if they can squeeze your hand. If they answer yes to any questions, and/or cannot move their fingers and toes, you need to keep blocking their head while someone else calls 911 – telling the dispatch that you suspect a spinal injury. You can slowly get to the top of their head, get on your knees and hold their head near (but not covering) their ears.

If the person is cold, ask someone to put a blanket over them, if your outside in the sun, someone could stand over them with an umbrella.

Keep talking to them, reassuring them, and keep them calm. By doing this you may prevent further damage, and save their life!

MLB Concussion Policy

Finally a professional sports organization has put together a concrete policy to handle brain trauma. Major League Baseball has created a system to protect their players, which is something that hockey and football as failed to do. Mind you, there were only 8 concussions in all of baseball in the 2010 season, while the NFL had 1 concussion in 60% of all their games.

The players must be seen by a doctor and have neurological testing done and submit a Return to Play protocol to the doctors belonging to MLB, not the team. This is key, since doctors (as anyone) can be influenced or pressured by the owners and coaches to return a player sooner than is safe. The doctors for MLB will likely be less bias and have the players/umpires best interest in mind. In order for the player to return to the game, they must pass neurological testing. They must also miss at least 7 days of training/games, regardless of symptoms.

I’m glad to see that someone is finally looking out for professional athletes. Congratulations to the MLB players association for getting this done. There is no reason why the NFL or NHL or even NBA should not adopt this system. There has already been one player to use this policy, a Blue Jay! He returned today after running into a third baseman’s knee while sliding head first, last Sunday.

Let’s watch and see what happens over the next few months. Will exceptions be made for higher priced athletes? Can the MLB doctors be bought or influenced the same as the team doctors (I am not implying this happens with all team doctors, but it does happen).

So let’s rejoice in a step forward for professional sports. I imagine that other leagues will follow suit soon enough.

Check out my poll on concussion in the right panel, under “pages”.

Concussions in the Classroom

Exceptions need to be made for invisible injuries.

High schools across the country are filled with student athletes. Some play within the school system and some are involved in sports above the high school level. Students that participate in contact sports have a special risk; concussions. The percentage of student athletes who get concussions will likely never be known since most do not report any symptoms. But what about those who do report how they feel? Are we protecting them enough in the classroom? Is it worth it for these athletes to explain to their teachers what has happened?

I’ve noticed that most coaches and players don’t fully understand concussions, even though they are around the sport and probably see them all the time. What about teachers in the schools? Especially those that have nothing to do with sport or fitness? It seems many of them are not sensitive to the injuries that are invisible.

Often with concussions it is difficult for the student to concentrate without getting a headache. There is often a sensitivity to lights and noise, which happens in high schools and elementary schools. The prescribed treatment for concussions is to stay home and do nothing; no TV, no video games, and no school work – they need to let the brain rest. I have had many athletes who have had to take a week off or more from school. That week is generally filled with sleeping and being in the dark. This is what is best for a concussion to heal properly. Upon returning to school the student needs to catch up with school work and get comfortable being in the classroom again. Teachers need to allow this transition time – allow for more time on assignments and perhaps guidance.

When a student returns to school around exam time, they need those extensions in order to regain confidence and do well academically. Teachers need to allow the student to finish their term papers in an appropriate amount of time and allowed to study for each exam accordingly. We are not talking about adults, who are often less affected by concussions. Student athletes are a special bred. They are in the middle of their learning and their brain is forming into a mature adult brain.

We need to help our student athletes achieve greatness on the field and in the classroom. Teachers need to be sensitive to head traumas and help students through these often difficult times. Exceptions are made in the “real” working world and we need to have them in the classroom.

Jen Mark BSc., CAT(C), CSCS
jen@bodysmithinternational.com