Tag Archives: concussions

Medical breakthroughs in diagnosing concussions

Head injuries have been part of contact sports since the inception of contact sports. I imagine the average gladiator became wobbly after a few trips to the Coliseum.

Yet the NFL head injury settlement of $765 million caught many by surprise, and seemed almost sacrilege to the average fan.

The Afghanistan and Iraq wars gave us another lesson in head injuries. Previous wars had taught doctors the care of high velocity wounds (gunshots, shrapnel). These wars were different, an out-gunned, out-manned and out-trained enemy had to make do and improvise.Football player catching passThey invented the improvised explosive device (IED). This created a fundamental change in war injuries. Previously, injuries were primarily explosively driven projectiles. But IEDs were often explosions that lacked projectiles or our armor stopped the projectile. So the result was a pure concussive injury.

Concussions were the focus during a day-long White House summit in late May. President Obama was among the many speakers at the event, which was attended by researchers, parents, coaches, professional athletes and sportscasters.

The hope is the White House gathering will shine a spotlight on the need for more research on how to identify, respond and prevent brain injuries in children while still promoting the value of team sports.

Concussions have been more than a little difficult to diagnose, treat and give patients good prognostic information. Our most powerful tools to diagnose head injuries – MRIs and CTs – come back looking normal, even in a serious concussion. The problem is, it’s a cellular injury, an injury that is below the resolution of every imaging test we currently employ.

With concussions we are almost at the level of 18th century practitioner (leaches, anyone?). We rub our chins thoughtfully and give sage advice based on someone’s guess at how many minutes the patient was knocked out, or how they looked when they woke up:

We tell patients to “take it easy and try hard to avoid another concussion.” Sometimes it works out, and sometimes everybody is tragically surprised by significant long-term neurological problems.human brainNow, thanks to some research just released, we have a good idea of how to finally bring concussion treatment into the 21st century.

Cellular disease is no mystery to us. We often do blood testing to identify a medical  problem. Damaged heart muscles leak specific proteins (CPK) that we use to differentiate heart damage (heart attack) from heart pain (angina). Liver cells leak enzymes (SGOT, SGPT) when inflamed by hepatitis even though liver scans look pretty normal.

Now we may have a way to identify injured nerve cells resulting from an injured brain.

You may have heard of Tau proteins. They have been discussed in Alzheimer’s disease research for the last 30 years. They are proteins common only to nerve cells, and are defective in Alzheimer’s disease. In case you’re interested, Tau proteins help stabilize the nerve tube structure.

The fact that nerve cells leak Tau proteins when injured is the breakthrough. Using Swedish hockey players, researchers studied significant concussions and found a reliable rise in Tau protein in the blood after serious concussive head injury.

They used hockey players suffering all manner of injuries other than head, as controls.  The test seems to accurately predict a serious concussion from a non-serious one.  People with post-head injury elevations in blood Tau protein, have long-term trouble as a result of the concussion.

Why is this exciting? Because it should lead to better treatment of people with serous concussions.

You see medicine runs on trial and error. To study anything medically, you need to start with a group of individuals with the same problem.

That wasn’t possible when studying concussions, because they all look the same, early on. Now researchers can study groups of similarly severe concussions and figure out what interventions best work to limit long-term complications.

It’s certainly a promising time ahead for the treatment of concussions. I wonder what will happen first; a change in the game of professional football to eliminate concussions or a sideline instant blood test for Tau protein that will let the coach know who is relatively safe to send back in?

Take care.

Dr. B.

Donald Bucklin, MD (Dr. B) is a Regional Medical Director for U.S. HealthWorks and has been practicing clinical occupational medicine for more than 25 years. Dr. B. works in our Scottsdale, Arizona clinic. 

Image courtesy/ FreeDigitalPhotos.net

Head Injuries Remain a Major Concern for Football Players

With the Super Bowl occurring this weekend and bringing the football season to a close, we thought we’d take another look at the issue of head injury and football. Below is a piece from our Dr. Bruce Kaler initially posted last year.

'Football team vs Long Beach City College' photo (c) 2008, Parker Michael Knight - license: http://creativecommons.org/licenses/by/2.0/Head injuries in athletes resulting in concussions occur more frequently than previously thought. We are learning more about the problem and the important consequences.

Each year more than 300,000 athletes in the U.S. suffer some form of traumatic brain injury. High school athletes comprise 60,000 of these injuries. The consequences vary a great deal, occurring both emotionally and intellectually.

Traumatic brain injury can result in short term symptoms as well as problems that are more serious and may not surface until several years later. What kind of problems develop depend on what portion of the brain is affected, the severity of the blow, the number of repeated blows to the head, preexisting conditions of the individual, and personality traits of the injured person.

The more blows to the head that occur – even small ones – increase the risk for mental deficiencies. Significant head trauma to a football player occurs hundreds of times a week during practice and games. Exploring options for protective equipment in contact sports and teaching fundamental techniques in sports that can reduce head trauma are paramount to reducing the number of injuries and the serious consequences.

A study in 2000 surveyed 1,090 former NFL players and found more than sixty percent had suffered at least one concussion in their careers. Twenty six percent had three or more. The survey revealed that players who had concussions reported more problems with memory, concentration, speech impediments, headaches, and other neurological problems than those who had not. Because these professional players had spent many prior years playing football in high school and college, the frequency of head trauma is likely under-reported. Head trauma is a problem for many of the non-contact sports as well.

Other common medical problems are being discovered as we examine concussions more closely. Depression, insomnia, attention deficit and personality changes all occur with similar frequency among high school athletes. These kinds of problems have been found to be more frequent in those who have had even one episode of head trauma.

Long-term problems may take eight years or more to develop or worsen. Immediate symptoms that require removal from sports activities include amnesia, poor balance, headaches, dizziness, or other neurologic deficits, regardless of how quickly they subside on the sidelines. It is widely accepted that concussion symptoms can reappear hours or days after the injury, indicating that the player had not healed properly from the initial blow. This requires strict guidelines that conservatively allow adequate time for healing to occur.

But the question remains – how much healing time is enough? A health care provider should be involved in examining and investigating these head injuries to ensure the best outcome. Even one episode of head trauma makes the athlete more vulnerable to serious consequences for the next episode, which in many contact sports is inevitable.

Both professional and college sports authorities are changing their recommendations regarding contact sports. One recommendation is reducing the numerous head blows by enforcing practices that involve no contact. Research has shown the number of head blows during a college football season totals in the thousands for an individual player. Many football collisions have forces comparable to driving a car into a concrete wall at 40 miles per hour.

Teaching better techniques to reduce the head leading contact in tackling and blocking and providing better equipment can help reduce the negative effects. Football helmet manufacturing and testing are not closely regulated. New helmet technology and better monitoring of equipment after repeated impact can reduce the consequences of head impact.

Repeated head trauma resulting in serious consequences of traumatic brain injury should be no surprise. We can do more to protect athletes of all ages. Athletes themselves should be encouraged to seek medical attention for head injures – even if they seem mild and there is no loss of consciousness. Severity of symptoms and initial imaging studies can detect serious problems early, and be the basis for ongoing treatment and peace of mind.

Dr. Bruce Kaler

Update: Head Injuries Remain a Major Concern for Football Players

Head injuries in athletes resulting in concussions occur more frequently than previously thought. We are learning more about the problem and the important consequences.

Each year more than 300,000 athletes in the U.S. suffer some form of traumatic brain injury. High school athletes comprise 60,000 of these injuries. The consequences vary a great deal, occurring both emotionally and intellectually.

Traumatic brain injury can result in short term symptoms as well as problems that are more serious and may not surface until several years later. What kind of problems develop depend on what portion of the brain is affected, the severity of the blow, the number of repeated blows to the head, preexisting conditions of the individual, and personality traits of the injured person.

The more blows to the head that occur – even small ones – increase the risk for mental deficiencies. Significant head trauma to a football player occurs hundreds of times a week during practice and games. Exploring options for protective equipment in contact sports and teaching fundamental techniques in sports that can reduce head trauma are paramount to reducing the number of injuries and the serious consequences.

A study in 2000 surveyed 1,090 former NFL players and found more than sixty percent had suffered at least one concussion in their careers. Twenty six percent had three or more. The survey revealed that players who had concussions reported more problems with memory, concentration, speech impediments, headaches, and other neurological problems than those who had not. Because these professional players had spent many prior years playing football in high school and college, the frequency of head trauma is likely under-reported. Head trauma is a problem for many of the non-contact sports as well.

Other common medical problems are being discovered as we examine concussions more closely. Depression, insomnia, attention deficit and personality changes all occur with similar frequency among high school athletes. These kinds of problems have been found to be more frequent in those who have had even one episode of head trauma.

Long-term problems may take eight years or more to develop or worsen. Immediate symptoms that require removal from sports activities include amnesia, poor balance, headaches, dizziness, or other neurologic deficits, regardless of how quickly they subside on the sidelines. It is widely accepted that concussion symptoms can reappear hours or days after the injury, indicating that the player had not healed properly from the initial blow. This requires strict guidelines that conservatively allow adequate time for healing to occur.

But the question remains – how much healing time is enough? A health care provider should be involved in examining and investigating these head injuries to ensure the best outcome. Even one episode of head trauma makes the athlete more vulnerable to serious consequences for the next episode, which in many contact sports is inevitable.

Both professional and college sports authorities are changing their recommendations regarding contact sports. One recommendation is reducing the numerous head blows by enforcing practices that involve no contact. Research has shown the number of head blows during a college football season totals in the thousands for an individual player. Many football collisions have forces comparable to driving a car into a concrete wall at 40 miles per hour.

Teaching better techniques to reduce the head leading contact in tackling and blocking and providing better equipment can help reduce the negative effects. Football helmet manufacturing and testing are not closely regulated. New helmet technology and better monitoring of equipment after repeated impact can reduce the consequences of head impact.

Repeated head trauma resulting in serious consequences of traumatic brain injury should be no surprise. We can do more to protect athletes of all ages. Athletes themselves should be encouraged to seek medical attention for head injures – even if they seem mild and there is no loss of consciousness. Severity of symptoms and initial imaging studies can detect serious problems early, and be the basis for ongoing treatment and peace of mind.

Dr. Bruce Kaler

Head Injuries in Young Athletes

Nearly 1.2 million young athletes play football in the United States each week. Fifty percent of them are likely to have a concussion some time in their high school playing career. Thirty-five percent will have more than one head injury. Which one will be mild, improving uneventfully, and which will result in severe disability is impossible to predict.

Cosmos vs. Diablas football game in Golden Gate Park, San Francisco, CA _K8P0872photo © 2007 Mike Baird | more info (via: Wylio)

We have learned over the last few years that these injuries are more frequent and have an effect on the injured athlete for a much longer period of time than previously thought. Recent research tells us these young people are at much greater risk to develop problems later from seemingly mild head injuries.

More young people are participating in organized sports than ever. There are intrinsic differences in the young athlete that make them more vulnerable to injury because both the brain and body are still growing and have not reached their full mature potential. Approximately 60,000 sports-related head injuries occur to high school athletes each year. High school football has been compared to notoriously dangerous jobs such as coal mining.

Part of the challenge for responsible adults working with young athletes is the athlete’s lack of maturity and experience. It creates greater liability for injury and difficulty in even recognizing subtle yet important signs. Young athletes often hide their injury or pain because of the eagerness to return to play, avoid embarrassment, not let their team down or try to meet unrealistic expectations. This is particularly important with head injuries as there may be no visible sign of the injury. The athlete may deny their symptoms of headache, confusion, dizziness with a determined attitude to return to play.

Research over the last couple years has pointed to the importance of subtle signs which may be the only clue. Even seemingly mild blows to the head may lead to more serious injury. Certainly repeated small injuries increase the risk of serious complications.

The exact cause of concussions is not well understood but there are some recognizable patterns in symptoms and behavior. Common symptoms of post concussion syndrome include:

• Headache
• Dizziness
• Fatigue
• Memory loss
• Light sensitivity
• Difficulty concentrating

X-ray skullphoto © 2010 Erich Ferdinand | more info (via: Wylio)

Behavior can be minimally or profoundly affected by head trauma. Personality change, irritability or anxiety is not unusual. Other changes can be difficulty regulating emotions, poor coordination, or temporary learning disability. The precise cause of symptoms remains unclear and is a source of disagreement among researchers.

More emphasis on preventing these common but serious injuries is needed. This must include attention to good technique and understanding how to play the game well. Knowing the rules and use of proper protective equipment is also mission-critical.

We have learned that rest of both mind and body is important to allow the brain to heal. There is no exact formula for this. Each person must be cautiously evaluated on a case-by-case basis. Working together with your healthcare provider to formulate a plan for rest and transitional activity can ensure a rapid recovery and help prevent future injury.

– Bruce Kaler, M.D.