Re: What we can do to prevent concussions?

[Guest guest]

In my opinion, one of the best and simplest methods to diminish the chance of

concussions is proper helmet fit. There has been an increase in head injuries in

the professional and collegiate levels mostly in 3 positions: quarterbacks,

receivers and defensive backs. If we take a look at how players in these

positions wear their helmets they are very loose with chin straps very loosely

snapped and helmets more prone to fall off. It's well known that an improper or

loosely fitted helmet will not protect as well against head injuries.

Focusing on the basics can also work well to help decrease the chance of head

and neck injuries. Proper and safe tackling positions as well as proper and safe

ball carrying positions should be drilled every day.

Neck strengthening, mobility and flexibility exercises can help against neck

injuries to a degree but the strongest neck in the world isn't going to keep a

player from suffering CNS injury if they don't wear their helmet properly or

tackle/carry the ball safely.

Casey Gallagher CSCS

Snohomish, WA USA

What we can do to prevent concussions?

we talk about sport-related concussions guidelines and sidelines test but we

never talk about what we can do to prevent concussions.

How do you physically and mentally prepare your High School/Elementary

Student

Athlete to prevent concussions? do you have any a specific core training

program, weight training program, specific neck exercises?

Students will appreciate your help

Iglesias

Iglesias MS, ATC-L, EMT-B

Athletic Trainer/Sports Performance Coach

Ossining High School

Ossinng, NY, 10562

[Guest guest]

Hi ,

Here is an article on creatine and its possible effects in reducing concussion

risk:

http://www.webmd.com/brain/news/20001102/creatine-may-limit-brain-damage

Admittedly, it is from 10 years ago, and the research is in rats, but I there

may be something to it. I know many are hesitant to suggest supplements to high

schoolers, but the fact is that creatine has been studied so much and proven

effective and safe that I don't think that should be a problem. I'm not

suggesting you push it, but you can at least put it out there. Just a thought.

Brock Leggins, CSC

SNorwalk, IA

Supertraining

From: kyiglesias@...

Date: Tue, 8 Feb 2011 04:10:49 -0800

Subject: What we can do to prevent concussions?

we talk about sport-related concussions guidelines and sidelines test but

we

never talk about what we can do to prevent concussions.

How do you physically and mentally prepare your High School/Elementary Student

Athlete to prevent concussions? do you have any a specific core training

program, weight training program, specific neck exercises?

Students will appreciate your help

========================

[Guest guest]

Brock,

I believe the question by was about prevention of concussion, not on

diminishing the effects of concussion.

Giovanni Ciriani - West Hartford, CT - USA

On Tue, Feb 8, 2011 at 9:12 PM, Brock Leggins <brockleggins@...>wrote:

>

>

> Hi ,

> Here is an article on creatine and its possible effects in reducing

> concussion risk:

> http://www.webmd.com/brain/news/20001102/creatine-may-limit-brain-damage

>

> Admittedly, it is from 10 years ago, and the research is in rats, but I

> there may be something to it. I know many are hesitant to suggest

> supplements to high schoolers, but the fact is that creatine has been

> studied so much and proven effective and safe that I don't think that should

> be a problem. I'm not suggesting you push it, but you can at least put it

> out there. Just a thought.

>

> Brock Leggins, CSC

> SNorwalk, IA

>

> Supertraining

> From: kyiglesias@...

> Date: Tue, 8 Feb 2011 04:10:49 -0800

> Subject: What we can do to prevent concussions?

>

>

>

> we talk about sport-related concussions guidelines and sidelines test but

> we

>

> never talk about what we can do to prevent concussions.

>

> How do you physically and mentally prepare your High School/Elementary

> Student

>

> Athlete to prevent concussions? do you have any a specific core training

>

> program, weight training program, specific neck exercises?

>

> Students will appreciate your help

> ========================

>

>

[Guest guest]

Casey,

 do you do any specific exercises with you athletes?

Thank you

Iglesias MS,ATC-L, EMT-B

Ossining, NY

________________________________

From: casey gallagher <gallagher2201@...>

Supertraining

Sent: Tue, February 8, 2011 1:38:14 PM

Subject: Re: What we can do to prevent concussions?

 

In my opinion, one of the best and simplest methods to diminish the chance of

concussions is proper helmet fit. There has been an increase in head injuries in

the professional and collegiate levels mostly in 3 positions: quarterbacks,

receivers and defensive backs. If we take a look at how players in these

positions wear their helmets they are very loose with chin straps very loosely

snapped and helmets more prone to fall off. It's well known that an improper or

loosely fitted helmet will not protect as well against head injuries.

Focusing on the basics can also work well to help decrease the chance of head

and neck injuries. Proper and safe tackling positions as well as proper and safe

ball carrying positions should be drilled every day.

Neck strengthening, mobility and flexibility exercises can help against neck

injuries to a degree but the strongest neck in the world isn't going to keep a

player from suffering CNS injury if they don't wear their helmet properly or

tackle/carry the ball safely.

Casey Gallagher CSCS

Snohomish, WA USA

What we can do to prevent concussions?

we talk about sport-related concussions guidelines and sidelines test but we

never talk about what we can do to prevent concussions.

How do you physically and mentally prepare your High School/Elementary Student

Athlete to prevent concussions? do you have any a specific core training

program, weight training program, specific neck exercises?

Students will appreciate your help

Iglesias

Iglesias MS, ATC-L, EMT-B

Athletic Trainer/Sports Performance Coach

Ossining High School

Ossinng, NY, 10562

[Guest guest]

Giovanni,

do you practice any prevention technique/s with your athletes?

Thank you

Iglesias - Ossining - NY

________________________________

From: Giovanni Ciriani <Giovanni.Ciriani@...>

Supertraining

Sent: Wed, February 9, 2011 10:12:23 AM

Subject: Re: What we can do to prevent concussions?

 

Brock,

I believe the question by was about prevention of concussion, not on

diminishing the effects of concussion.

Giovanni Ciriani - West Hartford, CT - USA

On Tue, Feb 8, 2011 at 9:12 PM, Brock Leggins <brockleggins@...>wrote:

>

>

> Hi ,

> Here is an article on creatine and its possible effects in reducing

> concussion risk:

> http://www.webmd.com/brain/news/20001102/creatine-may-limit-brain-damage

>

> Admittedly, it is from 10 years ago, and the research is in rats, but I

> there may be something to it. I know many are hesitant to suggest

> supplements to high schoolers, but the fact is that creatine has been

> studied so much and proven effective and safe that I don't think that should

> be a problem. I'm not suggesting you push it, but you can at least put it

> out there. Just a thought.

>

> Brock Leggins, CSC

> SNorwalk, IA

>

> Supertraining

> From: kyiglesias@...

> Date: Tue, 8 Feb 2011 04:10:49 -0800

> Subject: What we can do to prevent concussions?

>

>

>

> we talk about sport-related concussions guidelines and sidelines test but

> we

>

> never talk about what we can do to prevent concussions.

>

> How do you physically and mentally prepare your High School/Elementary

> Student

>

> Athlete to prevent concussions? do you have any a specific core training

>

> program, weight training program, specific neck exercises?

>

> Students will appreciate your help

> ========================

>

>

[Guest guest]

Slight off topic related spinal injuries in rugby, however, some of the

information may be pertinent:

==============

From the Supertraining archives:

There is a lack of research about what contributes to this pattern.

Here are some potential contributors:

1. Lack of experience in the skills required in the contact phases of

the game. Trial games are likely to pit players with widely varying

levels of experience and skill against each other - often players

find themselves marking opponents who will end up playing in a

different grade from themselves during the season. A mismatch in

ability or experience has been identified in some research papers as

being a potential risk factor for spinal injuries occurring in the

scrum. In the United States, researchers who completed a twenty year

survey of rugby related spinal injuries concluded that '8 of the 35

cervical spine injuries (22.8%) that involved front-row players were

documented cases of mismatches of experience " (Wetzler et al, 1996).

Factors that increase the likelihood of this occurring include:

(a) Players are probably more likely to take up a new position at the

start of the season.

( New players generally enter the sport at the start of the season.

2. Lack of continued practice at the skills involved in the contact

phases of the game.

(a) Players do not usually practice tackling, scrummaging, rucking or

mauling in the weeks leading up to the season. This may lead to them

being more likely to be placed in physical positions which result in

injury.

3. Lack of impact conditioning - players often perform aerobic,

anaerobic, speed, strength and power training over the off-season.

Conditioning the body to cope with the impacts that are a major part

of rugby is ignored by the majority of players (although this is

beginning to change). Players, even those who have trained to

increase their aerobic fitness and strength are generally at

their 'softest' at the beginning of the season.

4. The first matches of the season are often trials, where players

are likely to play as hard as possible in the attempt to make the

team they aspire to. So there is no 'progressive overload' in terms

of impact.

5. Harder grounds at the beginning of the season - which again

increases impact forces when players hit the ground after tackles and

during rucks and mauls.

What can we do to change this pattern?

1. Educate coaches and players about the importance of progressively

preparing their bodies for the impacts that are part of the game.

Moving directly from 'no impact' to 'full on games' may mean that

players are less able to cope with any impacts that do occur during tackles,

scrums, rucks and mauls.

2. Players should practice the skills involved in tackling and

scrummaging again at the start of each season prior to starting the

playing season proper. This could easily be incorporated into

preseason fitness training that is commonly held at clubs. This would also

assist those players who lack experience in impact to gain this experience in

more controlled environment than a game.

3. Attempt to minimise the 'mismatching' of players of different

levels of skill during trials (I appreciate that this is not always

easy -especially in areas/clubs/schools that struggle to make

numbers).

4. Consider building up to full impact in scrums over the series of

trial matches (possibly starting with static scrums in the first

trial match or two of the season).

5. Continue to ensure that the laws regarding dangerous play are

strictly enforced.

6. Ensure that there is a clearly designated person responsible for

first aid at all levels of the sport in the event of a serious injury

occurring, and that processes are in place for minimising harm to

players who sustain an injury. This will be incorporated within the

delivery of general injury prevention information to clubs and

schools for the 2001 year.

7. Consider starting the club season slightly later in the year.

We need better research information to be able to make strong

recommendations about what the best interventions may be. Without

such information we run the risk of worsening the situation when we

make recommendations.

Other ideas about potential contributing factors to this pattern?

References:

Alsop, J, Chalmers, D, , S, Quarrie, ., Marshall, S &

Sharples, K. (2000)Temporal patterns of injury during a rugby season.

J of Science & Medicine in Sport, 3(2): 97-109.

Armour, K., Clatworthy, B. & Bean, A. (1997). Spinal injuries in New

Zealand rugby and rugby league - a twenty year survey. New Zealand

Medical Journal, 110: 462-465.

Palairet, T & Xiong, Xianghu. A study of rugby and rugby league

spinal injuries in New Zealand between 1996 to 2000. Presented at the

Spinal Network Conference, September, 2000.

Wetzler, W., Akpata, T., Albert, T., , T. & Levy A. (1996) A

retrospective study of cervical spine injuries in American Rugby,

1970 to 1994. The American J of Sports Medicine, July, 1996.

-----------

Abstracts posted by the late Dr Siff:

J Sci Med Sport 1999 Jun; 2(2):153-62

The nature and circumstances of tackle injuries in rugby union.

BD, Quarrie KL, Milburn PD, Chalmers DJ.

This study describes the nature and circumstances of injury occurring

in rugby union tackles (33% of 569 injury events) using data from the

Rugby Injury and Performance Project (RIPP) and provides

supplementary information on the nature of tackles involving injury

from analysis of videotape of tackle injury events.

The most common tackle injuries in the RIPP data were sprains/strains

(41%) followed by haematomas/bruising (26%). The most frequently

injured body sites were the head/neck/face (22%) and the knee (17%).

The ball carrier and tackler were injured in tackles in similar

proportions in both RIPP and New Zealand Rugby Football Union (NZRFU) video

tackle incidents. Both players were most often in motion in the tackle at the

time of injury with approximately 70% of injuries occurring when the injured

player was running or diving/falling to the ground. Tackle injury was most often

caused by impact with another player rather than impact with the ground. The use

of protective padding may reduce the risk of impact injury. The

majority of tackle injuries were associated with stopping tackles to the trunk

which were from the front (63%), rather than from the side or behind. Thus

consideration should be given to coaching strategies or to rule changes which

reduce the likelihood or prohibit front-on tackles.

------------

Garraway WM; Lee AJ; Macleod DA; Telfer JW; Deary IJ; Murray GD:

Factors influencing tackle injuries in rugby union football

Br J Sports Med, 1999 Feb, 33:1, 37-41

Abstract

OBJECTIVES: To assess the influence of selected aspects of lifestyle,

personality, and other player related factors on injuries in the

tackle. To describe the detailed circumstances in which these tackles

occurred.

METHODS: A prospective case-control study was undertaken in which the

tackling and tackled players ( " the cases " ) involved in a tackle

injury were each matched with " control " players who held the same

respective playing positions in the opposing teams. A total of 964

rugby matches involving 71 senior clubs drawn from all districts of

the ish Rugby Union (SRU) were observed by nominated linkmen who

administered self report questionnaires to the players identified as

cases and controls. Information on lifestyle habits, match

preparation, training, and coaching experience was obtained. A

validated battery of psychological tests assessed players' trait

anger and responses to anger and hostility. The circumstances of the

tackles in which injury occurred were recorded by experienced SRU coaching staff

in interviews with involved players after the match.

RESULTS: A total of 71 tackle injury episodes with correct matching

of cases and controls were studied. The following player related

factors did not contribute significantly to tackle injuries: alcohol

consumption before the match, feeling " below par " through minor illness, the

extent of match preparation, previous coaching, or practising tackling. Injured

and non-injured players in the tackle did not differ in their disposition

toward, or expression of, anger or hostility. Some 85% of tackling players who

were injured were three quarters, and 52% of injuries occurred when the tackle

came in behind the tackled player or within his peripheral vision. Either the

tackling or tackled player was sprinting or running in all of these injury

episodes. One third of injuries occurred in differential speed tackles--that is,

when one player was travelling much faster than the other at impact. The player

with the lower momentum was injured in 80% of these cases.

Forceful or crunching tackles resulting in injury mostly occurred head on or

within the tackled player's side vision.

CONCLUSIONS: Attention should be focused on high speed tackles going

in behind the tackled player's line of vision. Comparative

information on the circumstances of the vast majority of tackles in

which no injury occurs is required before any changes are considered

to reduce injuries in the tackle.

======================

S Afr Med J 1977 Apr 2;51(14):473-5

Rugby injuries to the cervical spinal cord.

Scher AT.

An analysis of the orthopaedic injuries in 20 patients who sustained

injury to the cervical spinal cord while playing rugby has been made.

Eight (40%) of the players were injured during scrums and the

remainder were injured during tackling. The incidence of and

mortality due to spinal cord injuries sustained during rugby are

discussed. Analysis of the scrum injuries shows a specific type of orthopaedic

injury indicating a flexion-rotation mechanism. No specific mechanism of injury

in the group injured during tackling could by demonstrated. It is concluded that

the rugby scrum provides an ideal occasion for dislocation of the cervical spine

and is potentially the most hazardous facet of the game.

--------------

S Afr Med J 1978 Jun 17;53(25):1015-8

The high rugby tackle--an avoidable cause of cervical spinal injury?

Scher AT.

The type and circumstances of injury to 14 rugby players with

cervical spinal cord damage sustained during a tackle have been

analysed. Two specific mechanisms of injury were evident. Four

players were injured when their heads collided with fixed objects

while they were attempting to tackle an opponent. Ten players were

injured while being tackled and 5 of them were tackled around the

neck. The risk of trauma to the cervical spine caused by the force

applied to the neck in a high tackle is discussed. The susceptibility

of the ligaments of the cervical spine to the rotational force

exerted during a high tackle is stressed. An amendment to the rules

of rugby, which would reduce cervical trauma, is suggested.

---------------

Clin Sports Med 1998 Jan;17(1):195-206

Rugby injuries to the cervical spine and spinal cord: a 10-year

review.

Scher AT.

Department of Radiology, Tygerberg Hospital, South Africa.

A 10-year review (1987-1996) of injuries sustained to the spine and

spinal cord in rugby players with resultant paralysis has been

undertaken. This article reviews that the incidence of serious rugby

spine and spinal cord injuries in South Africa has increased over the 10-year

period reviewed, despite stringent new rules instituted in an attempt to

decrease the incidence of these injuries.

The mechanisms of injury, as previously reported, remain the same as

well as the phases of game responsible for injury of the tight scrum,

tackle, rucks, and mauls. Two new observations are reported: the

first is related to the occurrence of spinal cord concussion with

transient paralysis, and the second is related to the increased

incidence of osteoarthritis of the cervical spine in rugby players.

-------------------

Clin Sports Med 1987 Jan;6(1):87-99

Rugby injuries of the spine and spinal cord.

Scher AT.

Dept of Radiology, University of Witwaterstrand Medical School,

Johannesburg,

S Africa.

This article analyzes the type and circumstances of injury in 50

rugby players who sustained cervical spinal cord injury with

paralysis. Specific mechanisms of injury occurring during certain

phases of the game are identified as being responsible for the majority of

injuries. Each phase of the game is discussed in detail, emphasizing the

vulnerability of the cervical spine to certain maneuvers, the dangers of illegal

play, and the importance of preventive measures to decrease the incidence of

these

catastrophic injuries.

-------------------

Br J Sports Med 1991 Mar;25(1):57-60

Catastrophic rugby injuries of the spinal cord: changing patterns of

injury.

Scher AT.

Dept of Radiology, Tygerberg Hospital, South Africa.

In reports from the UK and New Zealand, it is noted that the

incidence of rugby injuries to the cervical spinal cord has dropped

and that the percentage of players injured in the tackle has

similarly decreased. In contrast, this does not appear to be the pattern in

South Africa and an analysis has therefore been made of 40 rugby players

sustaining injuries to the spinal cord during the period 1985 to 1989. The

radiological appearances on admission have been correlated with the

circumstances of injury, associated orthopaedic injuries and neurological

deficits.

The tackle was responsible for the majority of injuries, causing more

than the scrum. Tackles were also responsible for more cases of

complete, permanent quadriplegia than the scrum. The commonest cause

of injury in players being tackled was the high tackle around the

neck, while the commonest cause of injury in players making the

tackle was the dive tackle. This survey has shown that the tackle is

now the major cause of spinal cord injury in South African rugby, in

contrast to earlier analyses in which the scrum was identified as the

most common cause.

------------------

S Afr Med J 1991 May 18;7 9(10):614-5

Paralysis due to the high tackle--a black spot in South African

rugby.

Scher AT.

The high tackle around the neck is illegal but still commonplace in

South African rugby. An analysis of 40 rugby players who sustained

spinal cord injury during the period 1985-1989 revealed that 8 were

injured by a high tackle. The case histories and radiographs of these

8 players were analysed. The majority sustained flexion-rotation injuries after

being tackled from the side. Another mechanism of injury was hyper-extension

during a tackle from the rear. Disturbingly, 4 of the 8 players sustained

complete permanent paralysis. This was consequent upon the orthopaedic injuries

sustained--specifically facet dislocations or 'tear-drop' fractures, both

injuries carrying with them a high risk of serious spinal cord injury. It is

concluded that foul play in the form of the high tackle is still a major cause

of serious spinal cord injury in South African rugby.

-------------------

Am J Sports Med 1991 Sep-Oct;19(5):485-8

Spinal cord concussion in rugby players.

Scher AT.

Dept of Radiology, University of Stellenbosch, South Africa.

During an analysis of a group of 40 rugby players who had sustained

cervical spinal cord injury, 9 players were identified who had

sustained only transient paralysis. These players showed no

radiologic evidence of any injury to the cervical spine. We did a

retrospective analysis of the clinical and radiological findings in

this group of rugby players. The cervical spine radiographs were

analyzed for evidence of spinal stenosis, congenital anomalies, and

degenerative disk disease.

Using the ratio method of assessment for spinal stenosis, we found

spinal canal narrowing maximally at C-3 and C-4 in five of the nine

players. In the remaining four players, one showed evidence of

osteoarthritic change at two levels while another had congenital

fusion of two vertebral bodies. In two players, no radiologic

evidence of any abnormality was detected. The mechanism of transient

disturbance of the spinal cord function after trauma is discussed

here.

-------------------

S Afr Med J 1990 Jun 2;77(11):557-8

Premature onset of degenerative disease of the cervical spine in

rugby players.

Scher AT.

Dept of Radiology, University of Stellenbosch, S Africa

Rugby players and other individuals with the changes of degenerative

disease of the cervical spine are at risk of spinal cord trauma after

hyperextension injury. In an attempt to assess whether rugby players

are prone to the development of premature degenerative disease,

radiographs of the cervical spines of 150 rugby players were compared

with a control group of 150 male hospital patients.

The study revealed that rugby players showed premature and advanced

changes of degenerative disease when compared with the control group.

These changes were most marked in the cervical spines of the tight

forwards. Rugby players so affected are therefore more likely to

present with the symptoms and signs of cervical osteo-arthrosis and

are at greater risk of hyperextension injury to the cervical spinal

cord.

=============

Carruthers

Wakefield, UK

>

> Casey,

>  do you do any specific exercises with you athletes?

>

> Thank you

>

>

>

> Iglesias MS,ATC-L, EMT-B

> Ossining, NY

>

>

>

> ________________________________

> From: casey gallagher <gallagher2201@...>

> Supertraining

> Sent: Tue, February 8, 2011 1:38:14 PM

> Subject: Re: What we can do to prevent concussions?

>

>  

> In my opinion, one of the best and simplest methods to diminish the chance of

> concussions is proper helmet fit. There has been an increase in head injuries

in

> the professional and collegiate levels mostly in 3 positions: quarterbacks,

> receivers and defensive backs. If we take a look at how players in these

> positions wear their helmets they are very loose with chin straps very loosely

> snapped and helmets more prone to fall off. It's well known that an improper

or

> loosely fitted helmet will not protect as well against head injuries.

>

>

> Focusing on the basics can also work well to help decrease the chance of head

> and neck injuries. Proper and safe tackling positions as well as proper and

safe

> ball carrying positions should be drilled every day.

>

>

> Neck strengthening, mobility and flexibility exercises can help against neck

> injuries to a degree but the strongest neck in the world isn't going to keep a

> player from suffering CNS injury if they don't wear their helmet properly or

> tackle/carry the ball safely.

>

>

> Casey Gallagher CSCS

> Snohomish, WA USA

> What we can do to prevent concussions?

>

> we talk about sport-related concussions guidelines and sidelines test but we

> never talk about what we can do to prevent concussions.

>

> How do you physically and mentally prepare your High School/Elementary Student

> Athlete to prevent concussions? do you have any a specific core training

> program, weight training program, specific neck exercises?

>

> Students will appreciate your help

>

> Iglesias

>

> Iglesias MS, ATC-L, EMT-B

> Athletic Trainer/Sports Performance Coach

> Ossining High School

> Ossinng, NY, 10562

>

>

[Guest guest]

,

We would do some simple neck strengthening exercises with either a partner or a

towel where resistance is added to the natural neck movements - lateral flexion,

flexion, extension and rotation. These could be done lying on a bench prone,

supine or sitting upright. Our wrestlers would do some rather aggressive neck

exercises out of a bridge position and we would even do neck ups. For neck ups a

wrestler would lie prone with his hands behind his back and forehead on the mat.

Posting off his forehead the wrestler would raise his hips off the floor as high

as he could. This could also be done lying supine as well. We would also spend a

good deal of time keeping the head and neck in safe positions for tackling,

hitting and wrestling movements.

The above exercises would be performed with the intent on limiting the chance of

neck injuries. I'm not aware of many exercises designed to limit head injuries

except for tumbling.

Wrestlers would also do a lot of tumbling drills. I remember watching attending

a conference where Santa spoke about tumbling and its importance in

athletics. His point was that if an athlete can fall in any direction and

reactively suck their head into their shoulders (turtling the head) and roll

through a fall it can decrease the chance of head, neck and even shoulder and

elbow injuries. This is something I completely agree with. Tumbling may not be

terribly effective for collision sports but it might help in one or two specific

incidences, which is reason enough for me to add tumbling as part of a practice.

Casey Gallagher CSCS

Snohomish, WA USA

What we can do to prevent concussions?

we talk about sport-related concussions guidelines and sidelines test but we

never talk about what we can do to prevent concussions.

How do you physically and mentally prepare your High School/Elementary Student

Athlete to prevent concussions? do you have any a specific core training

program, weight training program, specific neck exercises?

Students will appreciate your help

Iglesias

Iglesias MS, ATC-L, EMT-B

Athletic Trainer/Sports Performance Coach

Ossining High School

Ossinng, NY, 10562

[Guest guest]

I find this discussion very interesting. In my opinion there are no exercises

that will prevent concussions. However we can prevent concussion through

understanding the biomechanics and physioligical aspects of concussions. I will

try to summarize several pages with excerpts from the text book ( Rosen's

Emergency Medicine, 7th ed Biomechanics of Head Trauma).

*******************************************************************

" The brain is suspended in the cerebrospinal fluid (CSF), which provides some

buffering for the brain during trauma. " The brain itself does not come in

contact with the skull.

Biomechanics of Head Trauma

Direct Injury

Direct impact head injury occurs when the head is struck by an object or its

motion is arrested by another object.....

The skull initially bends inward at the point of contact. If the force is

sufficient, a skull fracture can occur. The cranium absorbs some of the applied

energy, and some energy is transmitted to the brain by shock waves that travel

distant to the site of impact or compression.

These shock waves distort and disrupt intracranial contents and temporarily

alter regional intracranial pressure as they propagate. In general, the more

rapidly a force is applied, the greater the damage it causes.

Isolated direct impact injury is rare; direct impact usually sets the head in

motion, resulting in simultaneous direct and indirect injury.

In indirect brain injury, the cranial contents are set into motion by forces

other than the direct contact of the skull with another object.

The brain moves within the skull, and bridging subdural vessels are strained.

Subdural hematomas may result. Differential acceleration of the cranial contents

occurs, depending on the physical characteristics of the brain region. As one

brain region slides past another, shear and strain injuries are produced. This

movement results in diffuse injuries, such as diffuse axonal injury or

concussion. Additional injury occurs as the movement of the intracranial

contents is abruptly arrested and the brain strikes the skull or a dural

structure

Primary brain injury is mechanical irreversible damage that occurs at the time

of head trauma and includes brain lacerations, hemorrhages, contusions, and

tissue avulsions. On the microscopic level, primary injury causes permanent

mechanical cellular disruption and microvascular injury.[14] No specific

intervention exists to repair or reverse primary brain injury

The circumstances and extent of the primary injury are not the only contributors

to the final neurologic outcome after head injury. The traumatic event also

produces injury at the functional and anatomic cellular level, which begins soon

after the impact and continues for several hours and even days after injury.

Secondary brain injury results from intracellular and extracellular derangements

that are probably initiated at the time of trauma by a massive depolarization of

brain cells and subsequent ionic shifts.

Brain Swelling and Cerebral Edema

Two primary types of brain swelling occur after head injury. Congestive brain

swelling results from an increased intracranial blood volume. Hyperemia occurs

early after trauma and can persist for the first few days after injury.

Cerebral edema is an increase in brain volume caused by an absolute increase in

cerebral tissue water content. Diffuse cerebral edema may develop soon after

head injury; however, its presence and extent do not always correlate with the

severity of head injury.

******************************************************************

My thoughts:

The problem with concussions is that we cannot see the brain after it has been

concussed. As long as the skull is not fractured and the skin is intact

everything seems fine. Perhaps the best way to describe what happens to the

brain is to use the analogy of a contused muscle.

After an initial contusion of a muscle there may be no visible damage but soon

there after we may see bruising and a black and blue area in the region of the

contusion. Later we may see some swelling and inflammation in the area. The

next day we may feel sore and the muscle will be stiff and painful. It may take

several days of cold and hot packs an PT to have the muscle return to full use.

Obviously how long it takes for the muscle to recover will depend on the amount

of force that caused the contusion in the first place.

As similar sequence of events occur in the brain.

Proper head gear can lessen some of the effects of head trauma but not

completely. If the head is going in a certain direction and something causes it

to stop suddenly the brain continues to move within the cerebral fluid until it

hits the skull causing a concussion. The faster the head was moving at the time

and the abruptness of the stop will determine the degree of concussion.

Once a brain has been concussed it takes less force to cause a second

concussion. A third concussion will require even less trauma. The brain damage

from even one concussion can last a lifetime. It is generally recommended that

any athlete who has had 3 concussion should be barred from any sport in which

head trauma might occur. More than 3 concussion can cause permanent

irreversible brain damage.

Ralph Giarnella MD

Southington Ct. USA

________________________________

From: casey gallagher <gallagher2201@...>

Supertraining

Sent: Thu, February 10, 2011 1:29:18 PM

Subject: Re: What we can do to prevent concussions?

,

We would do some simple neck strengthening exercises with either a partner or a

towel where resistance is added to the natural neck movements - lateral flexion,

flexion, extension and rotation. These could be done lying on a bench prone,

supine or sitting upright. Our wrestlers would do some rather aggressive neck

exercises out of a bridge position and we would even do neck ups. For neck ups a

wrestler would lie prone with his hands behind his back and forehead on the mat.

Posting off his forehead the wrestler would raise his hips off the floor as high

as he could. This could also be done lying supine as well. We would also spend a

good deal of time keeping the head and neck in safe positions for tackling,

hitting and wrestling movements.

The above exercises would be performed with the intent on limiting the chance of

neck injuries. I'm not aware of many exercises designed to limit head injuries

except for tumbling.

Wrestlers would also do a lot of tumbling drills. I remember watching attending

a conference where Santa spoke about tumbling and its importance in

athletics. His point was that if an athlete can fall in any direction and

reactively suck their head into their shoulders (turtling the head) and roll

through a fall it can decrease the chance of head, neck and even shoulder and

elbow injuries. This is something I completely agree with. Tumbling may not be

terribly effective for collision sports but it might help in one or two specific

incidences, which is reason enough for me to add tumbling as part of a practice.

Casey Gallagher CSCS

Snohomish, WA USA

What we can do to prevent concussions?

we talk about sport-related concussions guidelines and sidelines test but we

never talk about what we can do to prevent concussions.

How do you physically and mentally prepare your High School/Elementary Student

Athlete to prevent concussions? do you have any a specific core training

program, weight training program, specific neck exercises?

Students will appreciate your help

Iglesias

Iglesias MS, ATC-L, EMT-B

Athletic Trainer/Sports Performance Coach

Ossining High School

Ossinng, NY, 10562

[Guest guest]

In a message dated 2/11/2011 2:53:13 P.M. Eastern Standard Time,

Giovanni.Ciriani@... writes:

..

If the head hits a rigid object (ground, another body etc.) at a certain

speed, the internal damage to the brain will be the same, no matter how

strong neck or shoulder muscles are.

Consider the ProCap concept for football:

Adam Fusfeld wrote the following in his article:: " Would NFL Players Risk

Looking Like Dorks For Better Head Protection "

" Two years before the season of the concussion, designer Bert Straus

invented a _football_

(http://www.businessinsider.com/would-nfl-players-risk-looking-like-dorks-for-be\

tter-head-protection-2010-12#) helmet designed to

prevent concussions, called the Gladiator, that features an extra layer of

foam on top of the hard plastic. Straus claims the exterior layer of foam

would absorb violent hits better, and significantly reduce concussions.

The concept is reminiscent of the ProCap design that a handful of players

sported in the early 90s. Though anecdotal evidence suggests the helmet was

successful in limiting concussions, it never caught on.

The Gladiator aims for a more aesthetically pleasing design, but it's just

marginally better. Which is exactly why it's unlikely to catch on in the

NFL. While lineman are often willing to ditch form for function, skill

position players – the ones most likely to get jarred by a vicious blow to the

head – are not. They would probably claim the bigger helmets limit their

speed to avoid having to wear it.

There's also the toughness factor. The same NFL doctrine that mandates

players play without sleeves in the snow, immediately pop up after getting

hit, and play through the injuries that result from those hits, would prevent

them from donning a helmet that looks like it comes from outer space in the

name of protection.

That points back to the problems with the concussion discussion as a

whole. While onlookers want as safe a playing field as possible, players don't

seem to care. They step on the field well aware of the dangers – that's why

they occasionally compare themselves to soldiers– and willingly subscribe

to the league wide dogma that every play could be their last. "

Ken Jakalski

Lisle High School

Lisle, Illinois USA

[Guest guest]

Ralph,

In principle you are right that there are no exercises that can prevent

concussions. What counts is the speed at which the head hits, and the sudden

deceleration (negative g's) that results.

If the head hits a rigid object (ground, another body etc.) at a certain

speed, the internal damage to the brain will be the same, no matter how

strong neck or shoulder muscles are. However, if strengthening certain

muscles can help decrease the speed at which the head hits the object, then

by definition the trauma will be less. It would be interesting having a

better understanding of what percentage of concussion accidents have

strength of neck or of another body part be a factor in the speed at which

the head hits.

Giovanni Ciriani - West Hartford, CT - USA

On Thu, Feb 10, 2011 at 5:16 PM, Ralph Giarnella <ragiarn@...> wrote:

>

>

> I find this discussion very interesting. In my opinion there are no

> exercises

> that will prevent concussions. However we can prevent concussion through

> understanding the biomechanics and physioligical aspects of concussions. I

> will

> try to summarize several pages with excerpts from the text book ( Rosen's

> Emergency Medicine, 7th ed Biomechanics of Head Trauma).

>

> *******************************************************************

> " The brain is suspended in the cerebrospinal fluid (CSF), which provides

> some

> buffering for the brain during trauma. " The brain itself does not come in

> contact with the skull.

>

> Biomechanics of Head Trauma

> Direct Injury

>

> Direct impact head injury occurs when the head is struck by an object or

> its

> motion is arrested by another object.....

> The skull initially bends inward at the point of contact. If the force is

> sufficient, a skull fracture can occur. The cranium absorbs some of the

> applied

> energy, and some energy is transmitted to the brain by shock waves that

> travel

> distant to the site of impact or compression.

>

> These shock waves distort and disrupt intracranial contents and temporarily

>

> alter regional intracranial pressure as they propagate. In general, the

> more

> rapidly a force is applied, the greater the damage it causes.

>

> Isolated direct impact injury is rare; direct impact usually sets the head

> in

> motion, resulting in simultaneous direct and indirect injury.

>

> In indirect brain injury, the cranial contents are set into motion by

> forces

> other than the direct contact of the skull with another object.

>

> The brain moves within the skull, and bridging subdural vessels are

> strained.

> Subdural hematomas may result. Differential acceleration of the cranial

> contents

> occurs, depending on the physical characteristics of the brain region. As

> one

> brain region slides past another, shear and strain injuries are produced.

> This

> movement results in diffuse injuries, such as diffuse axonal injury or

> concussion. Additional injury occurs as the movement of the intracranial

> contents is abruptly arrested and the brain strikes the skull or a dural

> structure

>

> Primary brain injury is mechanical irreversible damage that occurs at the

> time

> of head trauma and includes brain lacerations, hemorrhages, contusions, and

>

> tissue avulsions. On the microscopic level, primary injury causes permanent

>

> mechanical cellular disruption and microvascular injury.[14] No specific

> intervention exists to repair or reverse primary brain injury

>

> The circumstances and extent of the primary injury are not the only

> contributors

> to the final neurologic outcome after head injury. The traumatic event also

>

> produces injury at the functional and anatomic cellular level, which begins

> soon

> after the impact and continues for several hours and even days after

> injury.

> Secondary brain injury results from intracellular and extracellular

> derangements

> that are probably initiated at the time of trauma by a massive

> depolarization of

> brain cells and subsequent ionic shifts.

>

> Brain Swelling and Cerebral Edema

> Two primary types of brain swelling occur after head injury. Congestive

> brain

> swelling results from an increased intracranial blood volume. Hyperemia

> occurs

> early after trauma and can persist for the first few days after injury.

>

> Cerebral edema is an increase in brain volume caused by an absolute

> increase in

> cerebral tissue water content. Diffuse cerebral edema may develop soon

> after

> head injury; however, its presence and extent do not always correlate with

> the

> severity of head injury.

>

> ******************************************************************

>

> My thoughts:

> The problem with concussions is that we cannot see the brain after it has

> been

> concussed. As long as the skull is not fractured and the skin is intact

> everything seems fine. Perhaps the best way to describe what happens to the

>

> brain is to use the analogy of a contused muscle.

>

> After an initial contusion of a muscle there may be no visible damage but

> soon

> there after we may see bruising and a black and blue area in the region of

> the

> contusion. Later we may see some swelling and inflammation in the area. The

>

> next day we may feel sore and the muscle will be stiff and painful. It may

> take

> several days of cold and hot packs an PT to have the muscle return to full

> use.

> Obviously how long it takes for the muscle to recover will depend on the

> amount

> of force that caused the contusion in the first place.

> As similar sequence of events occur in the brain.

>

> Proper head gear can lessen some of the effects of head trauma but not

> completely. If the head is going in a certain direction and something

> causes it

> to stop suddenly the brain continues to move within the cerebral fluid

> until it

> hits the skull causing a concussion. The faster the head was moving at the

> time

> and the abruptness of the stop will determine the degree of concussion.

>

> Once a brain has been concussed it takes less force to cause a second

> concussion. A third concussion will require even less trauma. The brain

> damage

> from even one concussion can last a lifetime. It is generally recommended

> that

> any athlete who has had 3 concussion should be barred from any sport in

> which

> head trauma might occur. More than 3 concussion can cause permanent

> irreversible brain damage.

>

> Ralph Giarnella MD

> Southington Ct. USA

>

>

> ________________________________

> From: casey gallagher <gallagher2201@...>

> Supertraining

> Sent: Thu, February 10, 2011 1:29:18 PM

>

> Subject: Re: What we can do to prevent concussions?

>

> ,

>

> We would do some simple neck strengthening exercises with either a partner

> or a

> towel where resistance is added to the natural neck movements - lateral

> flexion,

> flexion, extension and rotation. These could be done lying on a bench

> prone,

> supine or sitting upright. Our wrestlers would do some rather aggressive

> neck

> exercises out of a bridge position and we would even do neck ups. For neck

> ups a

> wrestler would lie prone with his hands behind his back and forehead on the

> mat.

> Posting off his forehead the wrestler would raise his hips off the floor as

> high

> as he could. This could also be done lying supine as well. We would also

> spend a

> good deal of time keeping the head and neck in safe positions for tackling,

>

> hitting and wrestling movements.

>

> The above exercises would be performed with the intent on limiting the

> chance of

> neck injuries. I'm not aware of many exercises designed to limit head

> injuries

> except for tumbling.

>

> Wrestlers would also do a lot of tumbling drills. I remember watching

> attending

> a conference where Santa spoke about tumbling and its

> importance in

> athletics. His point was that if an athlete can fall in any direction and

> reactively suck their head into their shoulders (turtling the head) and

> roll

> through a fall it can decrease the chance of head, neck and even shoulder

> and

> elbow injuries. This is something I completely agree with. Tumbling may not

> be

> terribly effective for collision sports but it might help in one or two

> specific

> incidences, which is reason enough for me to add tumbling as part of a

> practice.

>

> Casey Gallagher CSCS

> Snohomish, WA USA

>

> What we can do to prevent concussions?

>

> we talk about sport-related concussions guidelines and sidelines test but

> we

> never talk about what we can do to prevent concussions.

>

> How do you physically and mentally prepare your High School/Elementary

> Student

> Athlete to prevent concussions? do you have any a specific core training

> program, weight training program, specific neck exercises?

>

> Students will appreciate your help

>

> Iglesias

>

> Iglesias MS, ATC-L, EMT-B

> Athletic Trainer/Sports Performance Coach

> Ossining High School

> Ossinng, NY, 10562

>

>

[Guest guest]

My experience with concussions has to do with soccer an football. In both

sports it is usually a case of two players coming from opposite directions whose

heads meet in the same place. The situations are often unforseen and

unanticipated. In football the helmets might on the one hand soften the blow

but on the other the fact that a player has a helmet might cause him to think

that he can run into some one even faster with impunity. In soccer it might be

two player trying to head the same ball simultaneously whose skulls collide or

in the case of a goalie diving for a ball and a forward trying to kick the ball

the foot meets the head. In any of these scenarious I don't see were a specific

exercise or strenghtening activity would be of any help.

Ralph Giarnella MD

Southington Ct. USA

________________________________

From: Giovanni Ciriani <Giovanni.Ciriani@...>

Supertraining

Sent: Fri, February 11, 2011 2:16:24 PM

Subject: Re: What we can do to prevent concussions?

Ralph,

In principle you are right that there are no exercises that can prevent

concussions. What counts is the speed at which the head hits, and the sudden

deceleration (negative g's) that results.

If the head hits a rigid object (ground, another body etc.) at a certain

speed, the internal damage to the brain will be the same, no matter how

strong neck or shoulder muscles are. However, if strengthening certain

muscles can help decrease the speed at which the head hits the object, then

by definition the trauma will be less. It would be interesting having a

better understanding of what percentage of concussion accidents have

strength of neck or of another body part be a factor in the speed at which

the head hits.

Giovanni Ciriani - West Hartford, CT - USA

On Thu, Feb 10, 2011 at 5:16 PM, Ralph Giarnella <ragiarn@...> wrote:

>

>

> I find this discussion very interesting. In my opinion there are no

> exercises

> that will prevent concussions. However we can prevent concussion through

> understanding the biomechanics and physioligical aspects of concussions. I

> will

> try to summarize several pages with excerpts from the text book ( Rosen's

> Emergency Medicine, 7th ed Biomechanics of Head Trauma).

>

> *******************************************************************

> " The brain is suspended in the cerebrospinal fluid (CSF), which provides

> some

> buffering for the brain during trauma. " The brain itself does not come in

> contact with the skull.

>

> Biomechanics of Head Trauma

> Direct Injury

>

> Direct impact head injury occurs when the head is struck by an object or

> its

> motion is arrested by another object.....

> The skull initially bends inward at the point of contact. If the force is

> sufficient, a skull fracture can occur. The cranium absorbs some of the

> applied

> energy, and some energy is transmitted to the brain by shock waves that

> travel

> distant to the site of impact or compression.

>

> These shock waves distort and disrupt intracranial contents and temporarily

>

> alter regional intracranial pressure as they propagate. In general, the

> more

> rapidly a force is applied, the greater the damage it causes.

>

> Isolated direct impact injury is rare; direct impact usually sets the head

> in

> motion, resulting in simultaneous direct and indirect injury.

>

> In indirect brain injury, the cranial contents are set into motion by

> forces

> other than the direct contact of the skull with another object.

>

> The brain moves within the skull, and bridging subdural vessels are

> strained.

> Subdural hematomas may result. Differential acceleration of the cranial

> contents

> occurs, depending on the physical characteristics of the brain region. As

> one

> brain region slides past another, shear and strain injuries are produced.

> This

> movement results in diffuse injuries, such as diffuse axonal injury or

> concussion. Additional injury occurs as the movement of the intracranial

> contents is abruptly arrested and the brain strikes the skull or a dural

> structure

>

> Primary brain injury is mechanical irreversible damage that occurs at the

> time

> of head trauma and includes brain lacerations, hemorrhages, contusions, and

>

> tissue avulsions. On the microscopic level, primary injury causes permanent

>

> mechanical cellular disruption and microvascular injury.[14] No specific

> intervention exists to repair or reverse primary brain injury

>

> The circumstances and extent of the primary injury are not the only

> contributors

> to the final neurologic outcome after head injury. The traumatic event also

>

> produces injury at the functional and anatomic cellular level, which begins

> soon

> after the impact and continues for several hours and even days after

> injury.

> Secondary brain injury results from intracellular and extracellular

> derangements

> that are probably initiated at the time of trauma by a massive

> depolarization of

> brain cells and subsequent ionic shifts.

>

> Brain Swelling and Cerebral Edema

> Two primary types of brain swelling occur after head injury. Congestive

> brain

> swelling results from an increased intracranial blood volume. Hyperemia

> occurs

> early after trauma and can persist for the first few days after injury.

>

> Cerebral edema is an increase in brain volume caused by an absolute

> increase in

> cerebral tissue water content. Diffuse cerebral edema may develop soon

> after

> head injury; however, its presence and extent do not always correlate with

> the

> severity of head injury.

>

> ******************************************************************

>

> My thoughts:

> The problem with concussions is that we cannot see the brain after it has

> been

> concussed. As long as the skull is not fractured and the skin is intact

> everything seems fine. Perhaps the best way to describe what happens to the

>

> brain is to use the analogy of a contused muscle.

>

> After an initial contusion of a muscle there may be no visible damage but

> soon

> there after we may see bruising and a black and blue area in the region of

> the

> contusion. Later we may see some swelling and inflammation in the area. The

>

> next day we may feel sore and the muscle will be stiff and painful. It may

> take

> several days of cold and hot packs an PT to have the muscle return to full

> use.

> Obviously how long it takes for the muscle to recover will depend on the

> amount

> of force that caused the contusion in the first place.

> As similar sequence of events occur in the brain.

>

> Proper head gear can lessen some of the effects of head trauma but not

> completely. If the head is going in a certain direction and something

> causes it

> to stop suddenly the brain continues to move within the cerebral fluid

> until it

> hits the skull causing a concussion. The faster the head was moving at the

> time

> and the abruptness of the stop will determine the degree of concussion.

>

> Once a brain has been concussed it takes less force to cause a second

> concussion. A third concussion will require even less trauma. The brain

> damage

> from even one concussion can last a lifetime. It is generally recommended

> that

> any athlete who has had 3 concussion should be barred from any sport in

> which

> head trauma might occur. More than 3 concussion can cause permanent

> irreversible brain damage.

>

> Ralph Giarnella MD

> Southington Ct. USA

>

>

> ________________________________

> From: casey gallagher <gallagher2201@...>

> Supertraining

> Sent: Thu, February 10, 2011 1:29:18 PM

>

> Subject: Re: What we can do to prevent concussions?

>

> ,

>

> We would do some simple neck strengthening exercises with either a partner

> or a

> towel where resistance is added to the natural neck movements - lateral

> flexion,

> flexion, extension and rotation. These could be done lying on a bench

> prone,

> supine or sitting upright. Our wrestlers would do some rather aggressive

> neck

> exercises out of a bridge position and we would even do neck ups. For neck

> ups a

> wrestler would lie prone with his hands behind his back and forehead on the

> mat.

> Posting off his forehead the wrestler would raise his hips off the floor as

> high

> as he could. This could also be done lying supine as well. We would also

> spend a

> good deal of time keeping the head and neck in safe positions for tackling,

>

> hitting and wrestling movements.

>

> The above exercises would be performed with the intent on limiting the

> chance of

> neck injuries. I'm not aware of many exercises designed to limit head

> injuries

> except for tumbling.

>

> Wrestlers would also do a lot of tumbling drills. I remember watching

> attending

> a conference where Santa spoke about tumbling and its

> importance in

> athletics. His point was that if an athlete can fall in any direction and

> reactively suck their head into their shoulders (turtling the head) and

> roll

> through a fall it can decrease the chance of head, neck and even shoulder

> and

> elbow injuries. This is something I completely agree with. Tumbling may not

> be

> terribly effective for collision sports but it might help in one or two

> specific

> incidences, which is reason enough for me to add tumbling as part of a

> practice.

>

> Casey Gallagher CSCS

> Snohomish, WA USA

>

> What we can do to prevent concussions?

>

> we talk about sport-related concussions guidelines and sidelines test but

> we

> never talk about what we can do to prevent concussions.

>

> How do you physically and mentally prepare your High School/Elementary

> Student

> Athlete to prevent concussions? do you have any a specific core training

> program, weight training program, specific neck exercises?

>

> Students will appreciate your help

>

> Iglesias

>

> Iglesias MS, ATC-L, EMT-B

> Athletic Trainer/Sports Performance Coach

> Ossining High School

> Ossinng, NY, 10562

>

>

[Guest guest]

Casey,

thank you very much for all the info. We do neck strengthening  exerices using

a

neck machine, we do isometrincs with manual resistance, and also we use a

elastic bands.

- Ossining - NY.

________________________________

From: casey gallagher <gallagher2201@...>

Supertraining

Sent: Thu, February 10, 2011 1:29:18 PM

Subject: Re: What we can do to prevent concussions?

 

,

We would do some simple neck strengthening exercises with either a partner or a

towel where resistance is added to the natural neck movements - lateral flexion,

flexion, extension and rotation. These could be done lying on a bench prone,

supine or sitting upright. Our wrestlers would do some rather aggressive neck

exercises out of a bridge position and we would even do neck ups. For neck ups a

wrestler would lie prone with his hands behind his back and forehead on the mat.

Posting off his forehead the wrestler would raise his hips off the floor as high

as he could. This could also be done lying supine as well. We would also spend a

good deal of time keeping the head and neck in safe positions for tackling,

hitting and wrestling movements.

The above exercises would be performed with the intent on limiting the chance of

neck injuries. I'm not aware of many exercises designed to limit head injuries

except for tumbling.

Wrestlers would also do a lot of tumbling drills. I remember watching attending

a conference where Santa spoke about tumbling and its importance in

athletics. His point was that if an athlete can fall in any direction and

reactively suck their head into their shoulders (turtling the head) and roll

through a fall it can decrease the chance of head, neck and even shoulder and

elbow injuries. This is something I completely agree with. Tumbling may not be

terribly effective for collision sports but it might help in one or two specific

incidences, which is reason enough for me to add tumbling as part of a practice.

Casey Gallagher CSCS

Snohomish, WA USA

What we can do to prevent concussions?

we talk about sport-related concussions guidelines and sidelines test but we

never talk about what we can do to prevent concussions.

How do you physically and mentally prepare your High School/Elementary Student

Athlete to prevent concussions? do you have any a specific core training

program, weight training program, specific neck exercises?

Students will appreciate your help

Iglesias

Iglesias MS, ATC-L, EMT-B

Athletic Trainer/Sports Performance Coach

Ossining High School

Ossinng, NY, 10562

[Guest guest]

Dr.Giarnella,

Thank you so much for the great information.

- Ossining -NY

________________________________

From: Ralph Giarnella <ragiarn@...>

Supertraining

Sent: Thu, February 10, 2011 5:16:06 PM

Subject: Re: What we can do to prevent concussions?

 

I find this discussion very interesting. In my opinion there are no exercises

that will prevent concussions. However we can prevent concussion through

understanding the biomechanics and physioligical aspects of concussions. I will

try to summarize several pages with excerpts from the text book ( Rosen's

Emergency Medicine, 7th ed Biomechanics of Head Trauma).

*******************************************************************

" The brain is suspended in the cerebrospinal fluid (CSF), which provides some

buffering for the brain during trauma. " The brain itself does not come in

contact with the skull.

Biomechanics of Head Trauma

Direct Injury

Direct impact head injury occurs when the head is struck by an object or its

motion is arrested by another object.....

The skull initially bends inward at the point of contact. If the force is

sufficient, a skull fracture can occur. The cranium absorbs some of the applied

energy, and some energy is transmitted to the brain by shock waves that travel

distant to the site of impact or compression.

These shock waves distort and disrupt intracranial contents and temporarily

alter regional intracranial pressure as they propagate. In general, the more

rapidly a force is applied, the greater the damage it causes.

Isolated direct impact injury is rare; direct impact usually sets the head in

motion, resulting in simultaneous direct and indirect injury.

In indirect brain injury, the cranial contents are set into motion by forces

other than the direct contact of the skull with another object.

The brain moves within the skull, and bridging subdural vessels are strained.

Subdural hematomas may result. Differential acceleration of the cranial contents

occurs, depending on the physical characteristics of the brain region. As one

brain region slides past another, shear and strain injuries are produced. This

movement results in diffuse injuries, such as diffuse axonal injury or

concussion. Additional injury occurs as the movement of the intracranial

contents is abruptly arrested and the brain strikes the skull or a dural

structure

Primary brain injury is mechanical irreversible damage that occurs at the time

of head trauma and includes brain lacerations, hemorrhages, contusions, and

tissue avulsions. On the microscopic level, primary injury causes permanent

mechanical cellular disruption and microvascular injury.[14] No specific

intervention exists to repair or reverse primary brain injury

The circumstances and extent of the primary injury are not the only contributors

to the final neurologic outcome after head injury. The traumatic event also

produces injury at the functional and anatomic cellular level, which begins soon

after the impact and continues for several hours and even days after injury.

Secondary brain injury results from intracellular and extracellular derangements

that are probably initiated at the time of trauma by a massive depolarization of

brain cells and subsequent ionic shifts.

Brain Swelling and Cerebral Edema

Two primary types of brain swelling occur after head injury. Congestive brain

swelling results from an increased intracranial blood volume. Hyperemia occurs

early after trauma and can persist for the first few days after injury.

Cerebral edema is an increase in brain volume caused by an absolute increase in

cerebral tissue water content. Diffuse cerebral edema may develop soon after

head injury; however, its presence and extent do not always correlate with the

severity of head injury.

******************************************************************

My thoughts:

The problem with concussions is that we cannot see the brain after it has been

concussed. As long as the skull is not fractured and the skin is intact

everything seems fine. Perhaps the best way to describe what happens to the

brain is to use the analogy of a contused muscle.

After an initial contusion of a muscle there may be no visible damage but soon

there after we may see bruising and a black and blue area in the region of the

contusion. Later we may see some swelling and inflammation in the area. The

next day we may feel sore and the muscle will be stiff and painful. It may take

several days of cold and hot packs an PT to have the muscle return to full use.

Obviously how long it takes for the muscle to recover will depend on the amount

of force that caused the contusion in the first place.

As similar sequence of events occur in the brain.

Proper head gear can lessen some of the effects of head trauma but not

completely. If the head is going in a certain direction and something causes it

to stop suddenly the brain continues to move within the cerebral fluid until it

hits the skull causing a concussion. The faster the head was moving at the time

and the abruptness of the stop will determine the degree of concussion.

Once a brain has been concussed it takes less force to cause a second

concussion. A third concussion will require even less trauma. The brain damage

from even one concussion can last a lifetime. It is generally recommended that

any athlete who has had 3 concussion should be barred from any sport in which

head trauma might occur. More than 3 concussion can cause permanent

irreversible brain damage.

Ralph Giarnella MD

Southington Ct. USA

________________________________

From: casey gallagher <gallagher2201@...>

Supertraining

Sent: Thu, February 10, 2011 1:29:18 PM

Subject: Re: What we can do to prevent concussions?

,

We would do some simple neck strengthening exercises with either a partner or a

towel where resistance is added to the natural neck movements - lateral flexion,

flexion, extension and rotation. These could be done lying on a bench prone,

supine or sitting upright. Our wrestlers would do some rather aggressive neck

exercises out of a bridge position and we would even do neck ups. For neck ups a

wrestler would lie prone with his hands behind his back and forehead on the mat.

Posting off his forehead the wrestler would raise his hips off the floor as high

as he could. This could also be done lying supine as well. We would also spend a

good deal of time keeping the head and neck in safe positions for tackling,

hitting and wrestling movements.

The above exercises would be performed with the intent on limiting the chance of

neck injuries. I'm not aware of many exercises designed to limit head injuries

except for tumbling.

Wrestlers would also do a lot of tumbling drills. I remember watching attending

a conference where Santa spoke about tumbling and its importance in

athletics. His point was that if an athlete can fall in any direction and

reactively suck their head into their shoulders (turtling the head) and roll

through a fall it can decrease the chance of head, neck and even shoulder and

elbow injuries. This is something I completely agree with. Tumbling may not be

terribly effective for collision sports but it might help in one or two specific

incidences, which is reason enough for me to add tumbling as part of a practice.

Casey Gallagher CSCS

Snohomish, WA USA

What we can do to prevent concussions?

we talk about sport-related concussions guidelines and sidelines test but we

never talk about what we can do to prevent concussions.

How do you physically and mentally prepare your High School/Elementary Student

Athlete to prevent concussions? do you have any a specific core training

program, weight training program, specific neck exercises?

Students will appreciate your help

Iglesias

Iglesias MS, ATC-L, EMT-B

Athletic Trainer/Sports Performance Coach

Ossining High School

Ossinng, NY, 10562

[Guest guest]

In a message dated 2/12/2011 11:37:38 A.M. Eastern Standard Time,

roy.roy2@... writes:

What about putting some sort of durable memory foam on the OUTSIDE of

helmets?

Again, that is exactly what some companies have attempted to do, as I

alluded to in a previous post.

" Two years before the season of the concussion, designer Bert Straus

invented a football helmet designed to prevent concussions, called the

Gladiator, that features an extra layer of foam on top of the hard plastic. "

As with the ProCAP, players won't wear it. That was a key in Fusfeld's

article: " Would NFL Players Risk Looking Like Dorks For Better Head

Protection? "

The answer appears to be NO.

Ken Jakalski

Lisle High School

Lisle, Illinois USA

[Guest guest]

Hi Ralph!

In a message dated 2/12/2011 11:37:10 A.M. Eastern Standard Time,

ragiarn@... writes:

Reading your article, Ken, brings to mind the early years of introduction

of the

bicycle helmet for bicycle racing

Thanks for those insights. One of the unique discussions relative to

exterior foam helmet padding for football, like the ProCAP, centered around

the issue of whether or not the soft outer shell would, in effect, absorb the

impact and thereby transfer it to the neck. Many felt that the current

helmet (smooth and curved) allows for " glancing " impacts that are less

traumatic to the neck.

Ken Jakalski

Lisle High School

Lisle, Illinois USA

[Guest guest]

Hi !

In a message dated 2/12/2011 11:36:53 A.M. Eastern Standard Time,

deadliftdiva@... writes:

While I think this law is well intentioned, I think the coaches and

trainers will end up getting sued by parents whose child is forced to sit down

-

and as coaches etc will have to err on the side of caution OR get sued for

NOT holding someone out, this will end up badly in practice.

This reminds me of a policy we had in our state several years back

regarding the use of asthma inhalers, which at the time our advisory committee

for

cross country and track considered an " ergogenic " aid. This always struck

me as ironic in that most coaches had no idea exactly what an " ergogenic

aid " was in the first place.

In the old policy, an athlete could not show up for a race with an asthma

inhaler-- period. If he did, he wouldn't be allowed to run. As a meet

manager for many state regional and sectional level competitions in these

sports, that policy was pretty problematic for me. How could we justify our

decision if an athlete did not run with his or her inhaler, and ended up going

into serious distress during the race?

I presented my case to our state association, and the state did change

that position on inhalers. Under the " new " policy, an athlete could have an

inhaler and take a puff before the race, but not during the race. Think

about that logic for a moment.

Then, they changed that policy. An athlete could run with an asthma

inhaler and use it before or during a race, provided the athlete showed the meet

manager a note from the doctor prior to competition.

No note, and the athlete would be allowed to run with an inhaler. That

again was problematic for me. As meet manager, I was obligated to prohibit

an athlete from running if he or she did not provide me with a written note

from a physician allowing that runner to use a prescribed bronchodilator.

My argument was that the name on the inhaler itself was, in effect, a note

from the doctor. The state did accept this, and now there are no

restrictions on inhalers.

Ken Jakalski

Lisle High School

Lisle, Illinois USA

[Guest guest]

Reading your article, Ken, brings to mind the early years of introduction of the

bicycle helmet for bicycle racing. Initially it was greeted by bicycle racers

with scepticism and complaints that it would slow them down, prevent their heads

from cooling etc etc. Their were multiple designs from the leather hairnet to

the beer cooler ( all styrofoam with cloth cover).

Perhaps the turning point in acceptance of the bicycle helmet occurred when Greg

Lemond won the Tour De France by 8 seconds over Fignon of France. Greg

started the last stage of the race (a time trial) 50 seconds behind

Fignon. For a relatively short time trial (I beleive it was 25 miles) it was

felt that it was impossible to make up 50 seconds.

Greg wore an aerodynamic helmet and used aerobars. Fignon wore no

helment prefering to have his flowing hair and would have nothing to do with the

aero bars. Greg won the final stage by an imposible 58 secdons.

Nowadays bicycle helmets have almost become a fashion statement and bicycle

racers have embraced them because they have found that a helmeted head is more

aerodynamic than the bare head.

The bicycle helmet is primarily styrofoam with a plasic covering. The styrofoam

crushes on impact lessening the transferance of the blow to the head.

There was also a time when baseball players would not be caught dead wearing a

batting helmet. Many concussions have been prevented from baseballs hitting

someones head.

Ralph Giarnella MD

Southington Ct. USA

________________________________

From: " CoachJ1@... " <CoachJ1@...>

Supertraining

Sent: Fri, February 11, 2011 5:26:37 PM

Subject: Re: What we can do to prevent concussions?

In a message dated 2/11/2011 2:53:13 P.M. Eastern Standard Time,

Giovanni.Ciriani@... writes:

..

If the head hits a rigid object (ground, another body etc.) at a certain

speed, the internal damage to the brain will be the same, no matter how

strong neck or shoulder muscles are.

Consider the ProCap concept for football:

Adam Fusfeld wrote the following in his article:: " Would NFL Players Risk

Looking Like Dorks For Better Head Protection "

" Two years before the season of the concussion, designer Bert Straus

invented a _football_

(http://www.businessinsider.com/would-nfl-players-risk-looking-like-dorks-for-be\

tter-head-protection-2010-12#)

helmet designed to

prevent concussions, called the Gladiator, that features an extra layer of

foam on top of the hard plastic. Straus claims the exterior layer of foam

would absorb violent hits better, and significantly reduce concussions.

The concept is reminiscent of the ProCap design that a handful of players

sported in the early 90s. Though anecdotal evidence suggests the helmet was

successful in limiting concussions, it never caught on.

The Gladiator aims for a more aesthetically pleasing design, but it's just

marginally better. Which is exactly why it's unlikely to catch on in the

NFL. While lineman are often willing to ditch form for function, skill

position players – the ones most likely to get jarred by a vicious blow to the

head – are not. They would probably claim the bigger helmets limit their

speed to avoid having to wear it.

There's also the toughness factor. The same NFL doctrine that mandates

players play without sleeves in the snow, immediately pop up after getting

hit, and play through the injuries that result from those hits, would prevent

them from donning a helmet that looks like it comes from outer space in the

name of protection.

That points back to the problems with the concussion discussion as a

whole. While onlookers want as safe a playing field as possible, players don't

seem to care. They step on the field well aware of the dangers – that's why

they occasionally compare themselves to soldiers– and willingly subscribe

to the league wide dogma that every play could be their last. "

Ken Jakalski

Lisle High School

Lisle, Illinois USA

[Guest guest]

There's a new law being considered for high school football here in Colorado

that would require any player who may have a concussion to be held out of the

game and/or practice until a doctor has agreed they may play. It is supposed to

require that trainers and coaches are made aware of the symptoms and then act on

behalf of the player to withhold them from the competition.... part of the

current problem is that it's not just football players but girls playing soccer

and other sports who are getting hammered, the level of aggressive contact

having become more prevalent recently. Videos of girls knocking each other to

the ground or elbowing each other in the face seem to crop up a lot lately?

While I think this law is well intentioned, I think the coaches and trainers

will end up getting sued by parents whose child is forced to sit down - and as

coaches etc will have to err on the side of caution OR get sued for NOT holding

someone out, this will end up badly in practice. As it already is, injury is a

problem not only for the athlete, but for the professionals who have to handle

both the sometimes pushy parents who want the child to get a scholarship or good

rating vs. the realistic treatment of the athlete's injury or condition and

their needs to perform by winning games etc. Sometimes parents put pressure on

coaches to 'forget' about the child's knee or other nagging injury for their own

reasons too...

Everybody around a good player seems to believe he is the next NFL star, and any

effort to protect the kid's being able to think and perform beyond a field

sometimes is clouded beyond belief by these unrealistic expectations. The

economy also has made the desperation for scholarships a much higher rate than

usual it seems? Colleges too are looking for any excuse to narrow the field when

they view players, and much is put on keeping this positive impression forward

when the scouts visit.

From what I saw of injury rates when I was helping out at a school not that long

ago, some skill positions in particular seems a revolving door by way of injury

- and there was always another kid, pushed forward by his folks, and anxious for

the glory of playing the marquee positions. Competition being as aggressive

before the kids even played another team also played a part, the practices could

be very brutal. IMHO, no team should go through EIGHT quarterbacks in ONE

season....

Kids also try very hard to mask their injuries, just like these kids would try

to mask the signs of overtraining - e.g. stealing small weight discs from the

training room and putting them in their clothes to hide weight loss at the

weekly weighins... or evading questions when they clearly weren't feeling up to

training and not eating or sleeping well.

I believe we need a change in the overall philosophy and attitude of the high

school sports and yes, the levels well below that in order to correct this new

trend in brain injury. I think some of the damage is occurring much earlier than

we realize, with the comments I've heard from parents that if their child isn't

playing in the pads games early in grade school, they are now facing sitting and

not playing when they hit high school - if they can get on a team at all.

The Phantom

aka Schaefer, RMT/CMT, competing powerlifter

Denver, Colorado, USA

Re: What we can do to prevent concussions?

In a message dated 2/11/2011 2:53:13 P.M. Eastern Standard Time,

Giovanni.Ciriani@... writes:

..

If the head hits a rigid object (ground, another body etc.) at a certain

speed, the internal damage to the brain will be the same, no matter how

strong neck or shoulder muscles are.

Consider the ProCap concept for football:

Adam Fusfeld wrote the following in his article:: " Would NFL Players Risk

Looking Like Dorks For Better Head Protection "

" Two years before the season of the concussion, designer Bert Straus

invented a _football_

(

http://www.businessinsider.com/would-nfl-players-risk-looking-like-dorks-for-bet\

ter-head-protection-2010-12# ) helmet designed to

prevent concussions, called the Gladiator, that features an extra layer of

foam on top of the hard plastic. Straus claims the exterior layer of foam

would absorb violent hits better, and significantly reduce concussions.

The concept is reminiscent of the ProCap design that a handful of players

sported in the early 90s. Though anecdotal evidence suggests the helmet was

successful in limiting concussions, it never caught on.

The Gladiator aims for a more aesthetically pleasing design, but it's just

marginally better. Which is exactly why it's unlikely to catch on in the

NFL. While lineman are often willing to ditch form for function, skill

position players – the ones most likely to get jarred by a vicious blow to the

head – are not. They would probably claim the bigger helmets limit their

speed to avoid having to wear it.

There's also the toughness factor. The same NFL doctrine that mandates

players play without sleeves in the snow, immediately pop up after getting

hit, and play through the injuries that result from those hits, would prevent

them from donning a helmet that looks like it comes from outer space in the

name of protection.

That points back to the problems with the concussion discussion as a

whole. While onlookers want as safe a playing field as possible, players don't

seem to care. They step on the field well aware of the dangers – that's why

they occasionally compare themselves to soldiers– and willingly subscribe

to the league wide dogma that every play could be their last. "

Ken Jakalski

Lisle High School

Lisle, Illinois USA

[Guest guest]

I believe we need more of a penalty for spearing (head first contact) in high

school football. If we start kicking kids out for doing this (and I mean at ANY

level, including practice) then maybe it will stop being a fashion. There are

rare times when it is inadvertent (such as you trip and then end up head first)

but that's pretty easy to see versus the attempt to punish another player by

using your helmet.

I'm also for heading off the ugly behavior on the basketball court where the

brutality has been getting steadily worse - people muscling each other to the

floor or being elbowed in the face/head consistently.

Unnecessary roughness should have no place on the field or well, the rest of

life really. We need better sportsmanship and less nasty talk and walk out

there.

The Phantom

aka Schaefer, RMT/CMT, competing powerlifter

Denver, Colorado, USA

[Guest guest]

What about putting some sort of durable memory foam on the OUTSIDE of helmets?

-- Roy Zornow

New York City

[Guest guest]

That same law has been enacted here in Connecticut has seems to be working. I

have held several players (including my son) from sport because of concussions.

Parents who try to sue a coach for sitting their child because of a possible

concussion have very little to fear since the law basically back them up. With

the present awareness of concussions coaches would be foolish to allow a player

to play if he/she suspects an athlete of having a concussion. Even without the

law that Colorado is contemplating the lawyers will have a field day if an

athlete suffers long term damage because of a missed concussion. I am not sure

that there are more concussions now than in the past, but rather a greater

awareness of concussions and what the long term consequences are.

Ralph Giarnella MD

Southington Ct. USA

________________________________

From: " deadliftdiva@... " <deadliftdiva@...>

Supertraining

Sent: Sat, February 12, 2011 9:50:07 AM

Subject: Re: What we can do to prevent concussions?

There's a new law being considered for high school football here in Colorado

that would require any player who may have a concussion to be held out of the

game and/or practice until a doctor has agreed they may play. It is supposed to

require that trainers and coaches are made aware of the symptoms and then act on

behalf of the player to withhold them from the competition.... part of the

current problem is that it's not just football players but girls playing soccer

and other sports who are getting hammered, the level of aggressive contact

having become more prevalent recently. Videos of girls knocking each other to

the ground or elbowing each other in the face seem to crop up a lot lately?

While I think this law is well intentioned, I think the coaches and trainers

will end up getting sued by parents whose child is forced to sit down - and as

coaches etc will have to err on the side of caution OR get sued for NOT holding

someone out, this will end up badly in practice. As it already is, injury is a

problem not only for the athlete, but for the professionals who have to handle

both the sometimes pushy parents who want the child to get a scholarship or good

rating vs. the realistic treatment of the athlete's injury or condition and

their needs to perform by winning games etc. Sometimes parents put pressure on

coaches to 'forget' about the child's knee or other nagging injury for their own

reasons too...

Everybody around a good player seems to believe he is the next NFL star, and any

effort to protect the kid's being able to think and perform beyond a field

sometimes is clouded beyond belief by these unrealistic expectations. The

economy also has made the desperation for scholarships a much higher rate than

usual it seems? Colleges too are looking for any excuse to narrow the field when

they view players, and much is put on keeping this positive impression forward

when the scouts visit.

From what I saw of injury rates when I was helping out at a school not that long

ago, some skill positions in particular seems a revolving door by way of injury

- and there was always another kid, pushed forward by his folks, and anxious for

the glory of playing the marquee positions. Competition being as aggressive

before the kids even played another team also played a part, the practices could

be very brutal. IMHO, no team should go through EIGHT quarterbacks in ONE

season....

Kids also try very hard to mask their injuries, just like these kids would try

to mask the signs of overtraining - e.g. stealing small weight discs from the

training room and putting them in their clothes to hide weight loss at the

weekly weighins... or evading questions when they clearly weren't feeling up to

training and not eating or sleeping well.

I believe we need a change in the overall philosophy and attitude of the high

school sports and yes, the levels well below that in order to correct this new

trend in brain injury. I think some of the damage is occurring much earlier than

we realize, with the comments I've heard from parents that if their child isn't

playing in the pads games early in grade school, they are now facing sitting and

not playing when they hit high school - if they can get on a team at all.

The Phantom

aka Schaefer, RMT/CMT, competing powerlifter

Denver, Colorado, USA

Re: What we can do to prevent concussions?

In a message dated 2/11/2011 2:53:13 P.M. Eastern Standard Time,

Giovanni.Ciriani@... writes:

..

If the head hits a rigid object (ground, another body etc.) at a certain

speed, the internal damage to the brain will be the same, no matter how

strong neck or shoulder muscles are.

Consider the ProCap concept for football:

Adam Fusfeld wrote the following in his article:: " Would NFL Players Risk

Looking Like Dorks For Better Head Protection "

" Two years before the season of the concussion, designer Bert Straus

invented a _football_

(

http://www.businessinsider.com/would-nfl-players-risk-looking-like-dorks-for-bet\

ter-head-protection-2010-12#

) helmet designed to

prevent concussions, called the Gladiator, that features an extra layer of

foam on top of the hard plastic. Straus claims the exterior layer of foam

would absorb violent hits better, and significantly reduce concussions.

The concept is reminiscent of the ProCap design that a handful of players

sported in the early 90s. Though anecdotal evidence suggests the helmet was

successful in limiting concussions, it never caught on.

The Gladiator aims for a more aesthetically pleasing design, but it's just

marginally better. Which is exactly why it's unlikely to catch on in the

NFL. While lineman are often willing to ditch form for function, skill

position players – the ones most likely to get jarred by a vicious blow to the

head – are not. They would probably claim the bigger helmets limit their

speed to avoid having to wear it.

There's also the toughness factor. The same NFL doctrine that mandates

players play without sleeves in the snow, immediately pop up after getting

hit, and play through the injuries that result from those hits, would prevent

them from donning a helmet that looks like it comes from outer space in the

name of protection.

That points back to the problems with the concussion discussion as a

whole. While onlookers want as safe a playing field as possible, players don't

seem to care. They step on the field well aware of the dangers – that's why

they occasionally compare themselves to soldiers– and willingly subscribe

to the league wide dogma that every play could be their last. "

Ken Jakalski

Lisle High School

Lisle, Illinois USA

[Guest guest]

I wonder what the impact curves are with the extra outer layer of

padding. I wore a helmut like this in the early mid 60's in college --

after getting a severe concussion in high school. There would have to

be enough motivation to get players to try these. Naturally it will

eventually boil down to money -- that is players getting hurt when

state of the art equipment is available, or insurance rates or??? How

long did it take hockey players to adopt helmuts -- and why

Jerry " the dork " Telle

Centennial CO USA

On Feb 12, 2011, at 10:05 AM, CoachJ1@... wrote:

> As with the ProCAP, players won't wear it. That was a key in Fusfeld's

> article: " Would NFL Players Risk Looking Like Dorks For Better Head

> Protection? "

[Guest guest]

When I coached high school wrestling I was essentially the athletic trainer, S & C

coach as well as the assistant. During my time we had two wrestlers suffer

concussions. One I didn't catch until we were at a tournament and he looked

terrible his first match. After his match I talked to him and observed he was

showing signs of a concussion. I pulled him from the tournament and didn't allow

him to participate until he got a doctor's clearance. It still bothers me that I

didn't notice this wrestler's symptoms sooner - he had a rather innocuous

landing from a take down during practice - and this was over 10 years ago. The

second wrestler's concussion was much more obvious and easy to spot since it was

a very hard fall from a match and he was able to see the damage to his brain

from an x-ray.

I think that coaches and young players get caught up in the emotion of the

game/match and there becomes this " win at all costs " mentality. We always told

our wrestlers that we didn't care about the wins or losses but we knew they did.

When a coach can teach by their actions - by actions I mean that a coach shows

that the athlete's health is more important than the competition by doing things

like sitting a player who might even be suspected of having a concussion - that

there is more to the game than the win and there is more to life than the game

their players might be less willing to hide or mask a serious injury like a

concussion.

Any law written to protect the health and well being of a young athlete would be

supported by me. When a concussion is suspected, I would always err on the side

of caution for the sake of the athlete. Such a law would also help to remove

some of the brow beating by over zealous parents since the state or athletic

association would require a doctor's release.

, I couldn't agree more that a fundamental philosophical shift needs to

occur at the youth and high school levels to protect young people better.

Casey Gallagher CSCS

Snohomish, WA USA

Re: What we can do to prevent concussions?

In a message dated 2/11/2011 2:53:13 P.M. Eastern Standard Time,

Giovanni.Ciriani@...<mailto:Giovanni.Ciriani%40Gmail.com> writes:

.

If the head hits a rigid object (ground, another body etc.) at a certain

speed, the internal damage to the brain will be the same, no matter how

strong neck or shoulder muscles are.

Consider the ProCap concept for football:

Adam Fusfeld wrote the following in his article:: " Would NFL Players Risk

Looking Like Dorks For Better Head Protection "

" Two years before the season of the concussion, designer Bert Straus

invented a _football_

(

http://www.businessinsider.com/would-nfl-players-risk-looking-like-dorks-for-bet\

ter-head-protection-2010-12#<http://www.businessinsider.com/would-nfl-players-ri\

sk-looking-like-dorks-for-better-head-protection-2010-12#>

) helmet designed to

prevent concussions, called the Gladiator, that features an extra layer of

foam on top of the hard plastic. Straus claims the exterior layer of foam

would absorb violent hits better, and significantly reduce concussions.

The concept is reminiscent of the ProCap design that a handful of players

sported in the early 90s. Though anecdotal evidence suggests the helmet was

successful in limiting concussions, it never caught on.

The Gladiator aims for a more aesthetically pleasing design, but it's just

marginally better. Which is exactly why it's unlikely to catch on in the

NFL. While lineman are often willing to ditch form for function, skill

position players – the ones most likely to get jarred by a vicious blow to

the

head – are not. They would probably claim the bigger helmets limit their

speed to avoid having to wear it.

There's also the toughness factor. The same NFL doctrine that mandates

players play without sleeves in the snow, immediately pop up after getting

hit, and play through the injuries that result from those hits, would prevent

them from donning a helmet that looks like it comes from outer space in the

name of protection.

That points back to the problems with the concussion discussion as a

whole. While onlookers want as safe a playing field as possible, players don't

seem to care. They step on the field well aware of the dangers – that's why

they occasionally compare themselves to soldiers– and willingly subscribe

to the league wide dogma that every play could be their last. "

Ken Jakalski

Lisle High School

Lisle, Illinois USA

[Guest guest]

I believe that what is beginning to happen in the NFL re: concussions will

definitely have a trickle down effect. As th NFL takes concussions and

prevention of concussions seriously the colleges and high schools will also

follow their lead. The fines being levied on players in the NFL who use their

helmets for tackling and in particular helmet to helmet tackles are already

having their impact.

The ongoing study of brain damage in retired NFL players is opening a lot of

eyes. It is one thing to go through the rest of your life with a broken knee

but going through life with a broken brain is an unacceptable risk.

Thanks to the MRIs MRAs and PET scans we are now getting a better look at the

real and lasting damage done to brains by even one concussion. Surgery can fix

or replace a broken knee or hip but not a brain.

Ralph Giarnella MD

Southington Ct. USA

________________________________

From: casey gallagher <gallagher2201@...>

Supertraining

Sent: Sat, February 12, 2011 8:33:06 PM

Subject: Re: What we can do to prevent concussions?

When I coached high school wrestling I was essentially the athletic trainer, S & C

coach as well as the assistant. During my time we had two wrestlers suffer

concussions. One I didn't catch until we were at a tournament and he looked

terrible his first match. After his match I talked to him and observed he was

showing signs of a concussion. I pulled him from the tournament and didn't allow

him to participate until he got a doctor's clearance. It still bothers me that I

didn't notice this wrestler's symptoms sooner - he had a rather innocuous

landing from a take down during practice - and this was over 10 years ago. The

second wrestler's concussion was much more obvious and easy to spot since it was

a very hard fall from a match and he was able to see the damage to his brain

from an x-ray.

I think that coaches and young players get caught up in the emotion of the

game/match and there becomes this " win at all costs " mentality. We always told

our wrestlers that we didn't care about the wins or losses but we knew they did.

When a coach can teach by their actions - by actions I mean that a coach shows

that the athlete's health is more important than the competition by doing things

like sitting a player who might even be suspected of having a concussion - that

there is more to the game than the win and there is more to life than the game

their players might be less willing to hide or mask a serious injury like a

concussion.

Any law written to protect the health and well being of a young athlete would be

supported by me. When a concussion is suspected, I would always err on the side

of caution for the sake of the athlete. Such a law would also help to remove

some of the brow beating by over zealous parents since the state or athletic

association would require a doctor's release.

, I couldn't agree more that a fundamental philosophical shift needs to

occur at the youth and high school levels to protect young people better.

Casey Gallagher CSCS

Snohomish, WA USA

Re: What we can do to prevent concussions?

In a message dated 2/11/2011 2:53:13 P.M. Eastern Standard Time,

Giovanni.Ciriani@...<mailto:Giovanni.Ciriani%40Gmail.com> writes:

..

If the head hits a rigid object (ground, another body etc.) at a certain

speed, the internal damage to the brain will be the same, no matter how

strong neck or shoulder muscles are.

Consider the ProCap concept for football:

Adam Fusfeld wrote the following in his article:: " Would NFL Players Risk

Looking Like Dorks For Better Head Protection "

" Two years before the season of the concussion, designer Bert Straus

invented a _football_

(

http://www.businessinsider.com/would-nfl-players-risk-looking-like-dorks-for-bet\

ter-head-protection-2010-12#<http://www.businessinsider.com/would-nfl-players-ri\

sk-looking-like-dorks-for-better-head-protection-2010-12#>

) helmet designed to

prevent concussions, called the Gladiator, that features an extra layer of

foam on top of the hard plastic. Straus claims the exterior layer of foam

would absorb violent hits better, and significantly reduce concussions.

The concept is reminiscent of the ProCap design that a handful of players

sported in the early 90s. Though anecdotal evidence suggests the helmet was

successful in limiting concussions, it never caught on.

The Gladiator aims for a more aesthetically pleasing design, but it's just

marginally better. Which is exactly why it's unlikely to catch on in the

NFL. While lineman are often willing to ditch form for function, skill

position players – the ones most likely to get jarred by a vicious blow to the

head – are not. They would probably claim the bigger helmets limit their

speed to avoid having to wear it.

There's also the toughness factor. The same NFL doctrine that mandates

players play without sleeves in the snow, immediately pop up after getting

hit, and play through the injuries that result from those hits, would prevent

them from donning a helmet that looks like it comes from outer space in the

name of protection.

That points back to the problems with the concussion discussion as a

whole. While onlookers want as safe a playing field as possible, players don't

seem to care. They step on the field well aware of the dangers – that's why

they occasionally compare themselves to soldiers– and willingly subscribe

to the league wide dogma that every play could be their last. "

Ken Jakalski

Lisle High School

Lisle, Illinois USA

[Guest guest]

I believe that what is beginning to happen in the NFL re: concussions will

definitely have a trickle down effect. As th NFL takes concussions and

prevention of concussions seriously the colleges and high schools will also

follow their lead. The fines being levied on players in the NFL who use their

helmets for tackling and in particular helmet to helmet tackles are already

having their impact.

The ongoing study of brain damage in retired NFL players is opening a lot of

eyes. It is one thing to go through the rest of your life with a broken knee

but going through life with a broken brain is an unacceptable risk.

Thanks to the MRIs MRAs and PET scans we are now getting a better look at the

real and lasting damage done to brains by even one concussion. Surgery can fix

or replace a broken knee or hip but not a brain.

Ralph Giarnella MD

Southington Ct. USA

________________________________

From: casey gallagher <gallagher2201@...>

Supertraining

Sent: Sat, February 12, 2011 8:33:06 PM

Subject: Re: What we can do to prevent concussions?

When I coached high school wrestling I was essentially the athletic trainer, S & C

coach as well as the assistant. During my time we had two wrestlers suffer

concussions. One I didn't catch until we were at a tournament and he looked

terrible his first match. After his match I talked to him and observed he was

showing signs of a concussion. I pulled him from the tournament and didn't allow

him to participate until he got a doctor's clearance. It still bothers me that I

didn't notice this wrestler's symptoms sooner - he had a rather innocuous

landing from a take down during practice - and this was over 10 years ago. The

second wrestler's concussion was much more obvious and easy to spot since it was

a very hard fall from a match and he was able to see the damage to his brain

from an x-ray.

I think that coaches and young players get caught up in the emotion of the

game/match and there becomes this " win at all costs " mentality. We always told

our wrestlers that we didn't care about the wins or losses but we knew they did.

When a coach can teach by their actions - by actions I mean that a coach shows

that the athlete's health is more important than the competition by doing things

like sitting a player who might even be suspected of having a concussion - that

there is more to the game than the win and there is more to life than the game

their players might be less willing to hide or mask a serious injury like a

concussion.

Any law written to protect the health and well being of a young athlete would be

supported by me. When a concussion is suspected, I would always err on the side

of caution for the sake of the athlete. Such a law would also help to remove

some of the brow beating by over zealous parents since the state or athletic

association would require a doctor's release.

, I couldn't agree more that a fundamental philosophical shift needs to

occur at the youth and high school levels to protect young people better.

Casey Gallagher CSCS

Snohomish, WA USA

Re: What we can do to prevent concussions?

In a message dated 2/11/2011 2:53:13 P.M. Eastern Standard Time,

Giovanni.Ciriani@...<mailto:Giovanni.Ciriani%40Gmail.com> writes:

..

If the head hits a rigid object (ground, another body etc.) at a certain

speed, the internal damage to the brain will be the same, no matter how

strong neck or shoulder muscles are.

Consider the ProCap concept for football:

Adam Fusfeld wrote the following in his article:: " Would NFL Players Risk

Looking Like Dorks For Better Head Protection "

" Two years before the season of the concussion, designer Bert Straus

invented a _football_

(

http://www.businessinsider.com/would-nfl-players-risk-looking-like-dorks-for-bet\

ter-head-protection-2010-12#<http://www.businessinsider.com/would-nfl-players-ri\

sk-looking-like-dorks-for-better-head-protection-2010-12#>

) helmet designed to

prevent concussions, called the Gladiator, that features an extra layer of

foam on top of the hard plastic. Straus claims the exterior layer of foam

would absorb violent hits better, and significantly reduce concussions.

The concept is reminiscent of the ProCap design that a handful of players

sported in the early 90s. Though anecdotal evidence suggests the helmet was

successful in limiting concussions, it never caught on.

The Gladiator aims for a more aesthetically pleasing design, but it's just

marginally better. Which is exactly why it's unlikely to catch on in the

NFL. While lineman are often willing to ditch form for function, skill

position players – the ones most likely to get jarred by a vicious blow to the

head – are not. They would probably claim the bigger helmets limit their

speed to avoid having to wear it.

There's also the toughness factor. The same NFL doctrine that mandates

players play without sleeves in the snow, immediately pop up after getting

hit, and play through the injuries that result from those hits, would prevent

them from donning a helmet that looks like it comes from outer space in the

name of protection.

That points back to the problems with the concussion discussion as a

whole. While onlookers want as safe a playing field as possible, players don't

seem to care. They step on the field well aware of the dangers – that's why

they occasionally compare themselves to soldiers– and willingly subscribe

to the league wide dogma that every play could be their last. "

Ken Jakalski

Lisle High School

Lisle, Illinois USA