Category: Concussions in sports

Can we reduce the risk of concussions? How?

Posted 30 September 2013 by prehab

Apparently there is no new evidence that current strategies utilized to prevent concussions are as effectives as we were hoping said Dr. Carrie Esopenko, PhD researcher at Baycrest Canada. In her article, she also sites the latest efforts in the industry and strategies that work and we can all be taking in consideration in our prevention programs, who is doing what and technology available.

Just what are Effective Concussion Risk-Reduction Strategies?

Carrie Esopenko, PhD

Recently, the News has been fraught with headlines that we are facing a concussion epidemic. Every morning, it seems that we are waking up to yet another story about a high profile athlete being sidelined with a concussion. What may be worse is that these news stories are not just limited to high profile athletes. An ever increasing number of youth are also being sidelined with these injuries .So the questions we now face as clinicians, scientists, coaches, trainers, athletes, and parents are: If we know there is a concussion epidemic, what can we do? How can we prevent these invisible injuries, not only in high-profile athletes, but in our children?

There have been many strides in the right direction with respect to prevention of concussions in sport. For example, we see: equipment changes, sport-specific rule changes, and certain states implementing legislation that regulates who can determine when children can return to play following a concussion. Although these changes are definitely good moves, one must wonder, with the increasing number of concussions, are these strategies working? Recently, Benson and colleagues (2013; see citation below), carried out a review of current research examining the effectiveness of concussion risk-reduction strategies. The authors identified a number of risk-reduction strategies discussed in the literature, such as rules changes, legislation, neck strength, and head gear used in contact sports. Unfortunately, they found “little new evidence for successful interventions to reduce concussion” (pg. 5). There is no new evidence that the strategies we are using to prevent concussions are doing what we want them to. However, given the advancement in technology and techniques used in brain science, hope is not all lost that one day we will be able prevent concussion in sports. We must remember that the implementation of concussion legislation is still new, and not all sports have taken the initiative to make rule changes that would decrease head impacts, meaning that not much time has passed to see the effects of these changes.

So let this be the take home message… Although we are more aware of concussions and the prevention strategies we are developing are steps in the right direction, the strategies we have been using to prevent concussions may not be working… yet. More research needs to be done to better understand, not only the synergistic effects these changes have, but concussions themselves, before we truly prevent them.


For an review of current concussion risk-reduction strategies and future directions on how to develop better prevention strategies, check out the following  article:

Benson BW, McIntosh AS, Maddocks D, et al. What are the most effective risk-reduction strategies in sport concussion? Br J Sports Med 2013; 47: 321–326.

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It’s Time We Redefine Concussion Symptoms

Posted 16 August 2013 by prehab

As a concussion researcher, I am constantly surprised by the misunderstanding surrounding concussions. The typical comment I hear from friends, family, parents, and athletes is “I don’t think I’ve ever had a concussion because I have never been knocked out”; or “I’ve hit my head and felt dizzy but I didn’t have a headache, so it must not have been a concussion”. Well the truth of the matter is that less than 10% of sports-related concussions actually involve a loss of consciousness (Guskiewicz, Weaver et al., 2000), and although headache is one of the most commonly reported symptoms (Kontos et al., under review), headaches do not have to occur for a person to have experienced a concussion. Another unfortunate reality is that athletes may not actually understand the signs and symptoms of a concussion, nor the potential negative consequences of them. This means that many athletes will continue playing their sport while having concussion symptoms or returning to play too quickly. According to the Center for Disease Control (CDC), common symptoms of concussion include: headache, fuzzy or blurred vision, dizziness, sensitivity to light or noise, balance problems, fatigue, irritability, sleep issues, difficulty concentrating or thinking clearly, and being more emotional or anxious. But the one thing to remember with these symptoms is that not every individual will experience all of them. Also, an individual may not be able to describe their symptoms well. For instance, a 7 year old may not be able to describe feeling anxious. Finally, these symptoms may not appear all at once, and they may take time to develop. The key point here is that to dispel the myths surrounding concussions, we need better understanding of the variety of symptoms that an individual can experience. The only way this can happen is through better concussion education for athletes, coaches, trainers, and parents. Better concussion education will eventually lead to concussion prevention, which we can all hope, will result in fewer athletes experiencing the negative consequences of concussion.

By Carrie Esopenko, PhD

For a hot off the presses review of concussion management please read:

Littleton A, Guskiewicz K, Current concepts in sport concussion management: A multifaceted approach, Journal of Sport and Health Science (2013),


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Traumatic brain injury may be an independent risk factor for stroke

Posted 7 August 2013 by prehab

Having had a traumatic brain injury or concussion may increase the adds of stroke. Records from emergency rooms in California, collected by the VA Center for Clinical Management and Research, showed that people who had a traumatic brain injury was 30% more likely to have a stroke afterwards than people who didn’t.

Read more details about these fascinating findings.

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Medications. Good or bad for Concussion Treatment

Posted 2 August 2013 by prehab

There is plenty of controversy about the use of medications for post concussion symptoms however there appears to be growing evidence that some of them such as Amantadine, when indicated, may not only help manage symptoms but they may actually improve verbal memory and reaction time, often affected by a concussion.

What kind of experience have you had with medications?

Read the actual study that supports these findings.

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Neurosurgeons Instrumental in management of mild traumatic injury

Posted 3 July 2013 by prehab

More neurosurgeons are becoming interested in evaluation and treatment of concussions. Here is a great article.

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Detecting Injuries on the field NFL style. You can do it too.

Posted 18 March 2013 by prehab

Here is a good example of how many people can be in the look out for injury. Weather it is by instant replay with high end technology or by simply asking family members, school’s assistants and volunteers to take a video of every game and share with the medical team. Any additional information such as mechanics of injury, especial circumstances and instant replay adds a lot of detail to an injury’s proper assessment. Should it be your son or daughter, wouldn’t you want the most information possible? Absolutely. Keep the cameras rolling and just like the NFL help your team.


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Immune system compromised after a concussion: Pills may be in the making as a cure

Posted 10 March 2013 by prehab

The processes in which a brain deals with a concussion are many and therefore a variety of treatments are being formulated by many scientists currently involved in research. The latest research points to the immune system and is something to be concerned about, according to a new study published in the Journal Plos One, last week.

As reported by Popular Science, Sub-concussive jostling to the brain could lead to a series of events that ends with cells in the immune system attacking the brain, says Jeffrey Bazarian, a physician at the University of Rochester Medical Center and a co-author on a new study about brain injury as an autoimmune response.

Here is Bazarian and his colleagues’ idea. After a head hit, even if it doesn’t result in a concussion, the blood-brain barrier that separates the brain from the rest of the circulatory system opens up, releasing a brain protein called S100B into the blood. High levels of S100B in the blood are already known as marker for head injury; in Europe, emergency rooms give head injury patients S100B tests to decide whether they need a CAT scan.

We may be onto something here if further research efforts can shed additional light on this issue that may result in a possible pill or vaccine to block the Immune response. Furthermore, testing for S100B may be an ingenious idea for the pediatric population, if safe. It can be a useful measure to prevent unnecessary CAT scans known be harmful to the developing brain.

Here is the full study in PDF for additional information on Bazarian and colleague’s findings.

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New Technology Helps Diagnosing Concussions

Posted 6 March 2013 by prehab

Great advances in technology makes diagnosing concussions possible. High definition fiber tracking is a promising technology to directly measure breaks in brain fibers that control function. This technology will allow for biological diagnosis of brain injury.

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Big Decision Ahead? Let Your Subconscious Choose

Posted 26 February 2013 by prehab

Recent evidence points at the brain helping you make decisions subconsciously. Utilizing  brain scans connected to test subjects learning about objects like cars and other items, and paired to their corresponding cortices, researchers found that parts of the brain responsible for decision-making and learning not involved in the above task—were recognized to be working as usual. Literately your brain can be working on your paper, choosing a car for you or practically making decisions on earlier given choices while you are either engage in unrelated activities or sleeping. Here is a great article Written by Brian Krans | Published on February 19, 2013 by Healthline News.

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Brain injuries in youth may leave a long lasting trace

Posted 18 February 2013 by prehab

Younger children are more resilient! Or are they? As I read more and experience different recovery rates in youth, the notion that children are more resilient, or that they heal faster, may apply more to anatomical injuries of an orthopedic background. I see my own children healing in record time and young clients with sport related injuries that barely need rehabilitation post injury. But when it comes to brain injury, it appears as if it was the opposite. Keith Yeates, a neuropsychologist at Nationwide Children’s Hospital and professor of pediatrics at the Ohio State University, says there are many reasons why children may be more susceptible to long-term effects after TBI or concussion.

“The pathophysiology of the injury tends to be a little bit different in kids because there are differences in the composition of the brain and there are differences in the size of children’s heads relative to the size of their body,” he says. “Their necks are less strong so they are subjected to different deceleration forces. And from a psychological perspective, young kids still have a lot to learn. They don’t have the stored knowledge and acquired skills like adults to fall back on.”

As emergency medicine evolves in the area of traumatic brain injury there is an opportunity to change the pathophysiology that takes place post injury. After head injury there is a storm of neurotransmitters that overwhelms, stresses, and challenges the developing brain. If it can be attenuated, all involved providers as a team, may see a better future of concussion treatment. In the meantime even with the limitations in imaging and evaluative methods, we may be looking at a possible “scaring” effect that may explain the traceable behavior changes and deficits that tend to reappear later on in some of our young patients. Let’s not rely on their resiliency when there are so many unknowns.

“Children who sustained a severe TBI at a younger age are more likely to have a range of deficits that include deficits in their thinking skills, deficits in their academic skills, and also social problems,” says Yeates in a recent study published in Rehabilitation Psychology. “They tend to have trouble making or keeping friends. And they’re at greater risk for certain types of emotional and behavioral problems.”

Mayer and colleagues examined the brains of 15 children who had recently experienced a concussion using DTI. They administered cognitive testing four months later and repeated the scanning. They found that structural changes in the children’s white matter remained months after the injury—even after cognitive and other symptoms had disappeared.

I continue in the quest for better understanding about the subtle changes these young athletes present after concussions. As I hope that imaging evolves at a faster pace, I realize how much more conservative I need to get. Designing and formulating rehabilitation strategies mostly concentrated on limitation of stressing mechanisms needs to be customized.

What is the biggest challenge to concussion management? Improving awareness about what the new evidence is showing to parents and members of the potential management team. They only realize they are part of the team when a youngster gets hurt but if information flows well before an injury, we may be looking at better odds. Pediatricians, neurologists, physical therapists, trainers, coaches, parents and their own teammates are that team. Let me underscore the value of their teammates. Their peer pressure can cause the athlete to prematurely return to sport or avoid reporting the injury altogether.

There is plenty of research funding now by the NFL, NCAA and other organizations to improve the efficacy of the rehabilitation process but until then rehabilitation professionals should lead the way before young athletes are further exposed to catastrophic injury. As a parent, I’m not taking any risks and that is how I see every case, and so should every one in their care. Click here to access the Dr. Yeates’ study published in Rehabilitation Psychology 2012

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