The National Football League (NFL) has a pretty, new poster that boasts a tagline that reads: Let’s Take Brain Injuries Out of Play. Turns out it was all a lot of hot air.

In Sunday’s game, Philadelphia Eagles player Stewart Bradley attempted a tackle that left him stumbling before he collapsed on the field. To an average fan, he appeared obviously hurt and impaired. But the team’s medical staff took him out of play for less than 3 minutes before allowing him back in the game.

It wasn’t until halftime, when he was officially diagnosed with a concussion, that Bradley’s brain and body were given a chance to rest.

According to an article in The New York Times, Eagles Coach Andy Reid and the Eagles’ medical staff all stated that they had not seen Bradley stagger and fall. (Makes you wonder exactly who is watching the players, other than the fans, of course.)

Interestingly, one of the excuses the medical staff gave was that:

…they were apparently tending to quarterback Kevin Kolb — who also was suspected of having a concussion, returned during the quarter, and then was found during halftime to have sustained a concussion.

So they didn’t catch Bradley’s concussion because they were treating Kolb…but Kolb was also returned to play because his concussion wasn’t diagnosed until halftime.

To an outside observer, it seems that the doctor who is able to diagnose concussion so easily during halftime should be made available throughout the game. There’s no safe amount of time a player can “play hurt” when the injury involves the brain. The NFL’s concussion poster ends with these lines: Work smart. Use your head, don’t lead with it. Help make our game safer. Other athletes are watching…

Hey, NFL:  You’re right…we’re watching…and we don’t like what we saw on Sunday. Brain damage is forever.

To read the full New York Times article, click here: The Return of a Stumbling Eagle Raises Concerns

The evolution of the “meaning” of concussion has just taken another step…and it’s a frightening step.

Back in the day, concussion was viewed as a mild bump on the head, getting your “bell rung.” No one paid it much mind; take the hit and get back in the game.

Recently, doctors have warned that concussion is more dangerous than that. In fact, pediatricians have been lobbying to have it renamed, from concussion to the more accurately descriptive “mild traumatic brain injury” (MTBI).

Earlier this year, scientists made the disturbing discovery that people who suffer repeated head injury (such as football players and soldiers) develop a type of brain damage that mimics amyotrophic lateral sclerosis (ALS), or Lou Gehrig’s disease. This was the discovery of a new disease syndrome that causes brain damage, central nervous system damage, dementia, and eventually death. It is called Chronic Traumatic Encephalopathy, or CTE, and it is only caused by repetitive brain trauma.

Today, The New York Times reports that the autopsy of a 21-year-old college football player who died of suicide revealed that he had the early stages of CTE. This young man, Owen Thomas, had no history of depression, but suffered what was called a “sudden and uncharacteristic emotional collapse” before taking his life in April 2010. Thomas is the youngest football player, and first amateur football player, to be found with clear CTE. If he hadn’t killed himself, the brain injury wouldn’t have been discovered for years, if ever. But the circumstances of his death demanded autopsy.

Although there is no way to definitively link his suicide to the brain damage, the connection is certainly possible, if not probable:

“It’s not unreasonable that aspects of his behavior were related to the underlying brain disease that was detected,” said Dr. Perl [Daniel Perl, professor of pathology at Uniformed Services University of the Health Sciences], adding that he was speaking as an experienced neuropathologist and not on behalf of his organization. “This is real.”

Dr. Perl added that this finding showed that CTE is possible earlier, and at impact levels lower than those experienced by professional football players.

Right now, no one knows how many hits…how frequent the hits…or how hard the hits have to be before “several concussions” becomes “irreversible brain damage.”  The only thing that is clear is that we need to do more to protect the brains of young athletes. If CTE was found in the brain of an otherwise healthy 21-year-old man, when did it start? In high school? Junior high? Pop Warner Youth Football?

Just last month, we reported about the virtual explosion in the number of head injuries experienced by children while playing sports: In just 10 years, kids ages 8-13 had double the number of concussion-related hospital emergency visits. Kids ages 14-19 had quadruple the number. Unless we take action now, some of these children may end up with permanent, debilitating brain injury.

What can we do? We wrote about that, too…just last week. (Click here to read that entry: The Head Game of Youth Sports.)  And you know what? We’ll continue to write about concussion and brain injury until there is nothing left to write about. Football season is here…let’s keep all players safe.

If you want to read the full article from The New York Times, click here: Penn Football Player Had Brain Disease, Autopsy Shows

The average cyclist crashes about every 4,500 miles. Kids? Seems like at least once a week. Wearing a helmet has been shown to prevent up to 75% of cyclists’ head injuries… and are required by law in the state of North Carolina for all cyclists under age 16.*

Here’s what you need to know about choosing and wearing a bicycle helmet.

WHAT TO LOOK FOR IN A HELMET

• Helmets must meet the U.S. Consumer Product Safety Commission standard. Look for one of the following stickers: CPSC sticker, or ASTM’s F1447 sticker, or Snell’s B-95 sticker. (CPSC and ASTM standards are identical; Snell’s is even tougher, but you’ll rarely see these.)
• Choose color with visibility in mind: white is still best, next in line come other bright colors that are easily seen by drivers.
• Choose a helmet that is totally smooth, with no points that can snag. A good helmet is designed to protect your head in case the worst possible event occurs: if you are hit by a car. It needs to be smooth to “glide” along pavement (instead of catching in a way that bends your neck), and to prevent any protrusion from catching under the bumper of a car.
• If you ride a mountain bike, look for models that offer protection from trailside hazards.
• If you have unusual needs–or if you simply want help with your helmet choice–ask for help at a specialized cycling store, which will have a wider range of products and the expertise to help. For example, there are helmets to fit unusually large heads…padding to fit unusually small heads…helmets with “ponytail ports” for people with long hair…helmets with no large top vents for people with sparse or no hair.

WHAT TO AVOID

Avoid anything that prevents you from wearing a helmet properly, or which violates the definition of a “good helmet” listed above. In particular:

• AVOID dark colors
• AVOID extreme aero shapes, which provide a convenient “lever” for knocking the helmet aside in a fall
• AVOID squared-off, ridged, ribbed, or spiked shapes
• AVOID helmets without a standards sticker on the inside
• AVOID helmets with thin straps (more likely to break)
• AVOID helmets that don’t allow good visibility
• AVOID helmets that don’t fit properly
• AVOID helmets with strap adjustments that are too complicated for comfortable, everyday use

WHEN TO REPLACE A HELMET

• For sure, if the last time you bought a helmet was before 1999, the last time the U.S. government updated safety standards.
• Replacement recommended every 5 years, but can go longer if you don’t ride often.
• For sure, if the helmet has a crack or dent.
• Recommended after any crash–some damage may not be visible.
• If your helmet shows bubbling or other signs of heat damage

HOW TO WEAR A HELMET

For a video on how to do a helmet fit test, click here: Helmet Fit Test Video

For an illustration of the right and wrong ways to wear a helmet, click here: “Do you know the right way to wear a helmet?” or here: “Easy Steps to Properly Fit a Bicycle Helmet”

• A helmet is properly worn level on the head–not tilted forward or backward.
• The helmet should sit low on the forehead, one or two finger-widths above the eyebrows.
• The strap should be fit snugly–not loose, not too tight for comfort.
• Once on the head, try to move it with your hands. The helmet shouldn’t move more than an inch in any direction no matter how hard you try.

SPECIAL INFORMATION ABOUT HELMETS FOR KIDS

• Every child who rides alone or on the back of an adult’s bike needs a helmet. However, until a child reaches age 1 year, the neck muscles aren’t strong enough to support a helmet. If you have questions about riding with a toddler, talk with your child’s pediatrician about the best protection.
• Replace a helmet as often as you need to assure a good, safe fit. Consider a helmet at least as important as shoes.
• Some child helmets have several foam inserts of different thicknesses. These can be changed out to accommodate a growing head. (And the different thicknesses do NOT affect the protection offered by the helmet.)
• Teach your child that bike helmet is for biking or skating with in-line skates only. Skateboarding requires a different helmet.
• VERY IMPORTANT WARNING: A child SHOULD NOT wear a bike helmet on the playground. Children have died due to crush or strangulation when the helmet got caught on climbing equipment. For more information about this topic, click here: “Wear Bike Helmets On Bicycles – Not On Playgrounds”

HOW TO GET YOUR CHILD TO WEAR A HELMET

• Start by being a good role model: Wear a helmet yourself while riding!
• Make wearing a helmet a requirement right from the first day your child starts riding a 2-wheeler. If you make it an important rite of passage, it will feel more like something to be proud of. (Do you remember the day your training wheels were finally taken off? That kind of pride.)
• Explain why wearing a helmet is important.
• Talk with the parents of your child’s friends to let them know that you require your child to wear a helmet…and that you would like their help in applying that rule. This is a great opportunity to ask if they also require their children to wear helmets–kids are more likely to wear helmets if their friends also do.
• Point out cyclists wearing helmets as you’re driving, or if you watch bike races on television.

FAMOUS LAST WORDS…

From actual people who crashed:

• “I didn’t think I needed a helmet–I was only going about a mile.”
• “I don’t know what happened. The brakes locked on a turn and I flipped over the front wheel.”
• “I wasn’t expecting that rock to be there.”

* While your child’s brain depends on a helmet, don’t forget that your child depends on you and your healthy brain. The HensonFuerst traumatic brain injury team has seen too many people suffer permanent, catastrophic brain damage from bicycle accidents.

INFORMATION SOURCES:

Bicycle Helmet Safety Institute

U.S. Consumer Product Safety Commission

SafeKids USA

Insurance Institute for Highway Safety: Helmet Laws by State

ASTM International: Standards Worldwide

REI: How to Choose a Bicycle Helmet

National Highway Traffic Safety Administration

Wikipedia: Bicycle Helmet

“Tuesdays with Morrie” is the heartbreaking story of the final life lessons imparted by a beloved teacher dying of amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease. Today, the New York Times reports on an astonishing bit of science that expands the tragedy:  Some people diagnosed with ALS may not have the disease. Concussions and other brain trauma may cause neurological decline and death in a way that mimics ALS.

“Doctors at the Veterans Affairs Medical Center in Bedford, Mass., and the Boston University School of Medicine, the primary researchers of brain damage among deceased National Football League players, said that markings in the spinal cords of two players and one boxer who also received a diagnosis of A.L.S. indicated that those men did not have A.L.S. at all. They had a different fatal disease, doctors said, caused by concussionlike trauma, that erodes the central nervous system in similar ways.” [from the New York Times article]

This is not to say that ALS does not exist…it simply highlights a new syndrome, a cascade of damage to the brain an nervous system that begins with trauma.

The researchers (in an article to be published tomorrow on the website for the Journal of Neuropathology & Experimental Neurology) refer specifically to athletes and men in combat, who suffer repeated head injury during their training and careers. Although Lou Gehrig is not specifically mentioned, the study raises questions about whether his eponymous disease actually caused his death. It may have been caused by his multiple head injuries. As recounted in the New York Times:

In 1924, during a postgame brawl with the Detroit Tigers, Gehrig swung at Ty Cobb and fell, hit his head on concrete, and was briefly knocked out. While playing first base against the Tigers in September 1930, Gehrig was hit in the face and knocked unconscious by a ground ball. He was knocked out again by an oncoming runner in 1935.

Those are the four incidents in which Gehrig’s being knocked unconscious was notable enough to be reported in newspapers. He most likely sustained other concussions that were never noticed or considered meaningful — for example, when he was hit in the head with a pitch during a 1933 game against Washington but continued playing — either in baseball or while serving as a halfback for Commerce High School in New York and later Columbia University.

This sure makes helmets look like a brilliant invention.

We’ve been writing a lot lately about the importance of recognizing concussion and allowing athletes–especially young athletes–time to heal. Playing through injury is no longer a sign of strength…now, it’s smarter to value brain over brawn.

Finally, finally, finally!  Professional locker rooms across the country will be undergoing minor redecoration, with players’ health in mind.

The National Football League (NFL) has released its official, new poster, which clearly lists symptoms of concussion and potential long-term effects. In one section, the poster says that traumatic brain injury (TBI) can lead to “…problems with memory and communication, personality changes, as well as depression and the early onset of dementia.”  This is the most honest and blunt statement of the hazards of football by the NFL since, well…ever.

According to an article in the New York Times, players welcome the posters:

“That poster is shocking,” said Domonique Foxworth, a cornerback for the Baltimore Ravens. “It gives people facts before they take risks. But it’s not exactly a new revelation.”

Matt Birk, the Ravens’ center, said: “To put it out there in writing in locker rooms, at least it’s publicly acknowledging that, ‘Hey, this is real.’ There’s risks in everything you do, and this one is real. You can’t sweep it under the rug anymore.”

On the poster (which may or may not be different from what is said on the field), players are told that “playing through” a concussion could cause permanent brain damage. The advice is to report symptoms, get checked out by medical staff, and then take time to recover.

Although this is a great and long over-due first step, the New York Times reports that a lawyer for the NFL wrote a memo discrediting connections between football head trauma and long-term cognitive decline. The article continues:

The letter, obtained by The New York Times, explained, “We can point to the current state of uncertainty in scientific and medical understanding” on the subject to deny players’ claims that their neurological impairments are related to football.

Sadly, that adds credence to the football league’s “chew ‘em up and spit ‘em out” reputation when it comes to players’ health. The problem is that if a player wrecks his knee, he loses his job…but if he wrecks his brain, he could lose his memory, his family, his entire sense of self. We’re glad to see that the posters provide solid medical information. Maybe, eventually, the message will sink in. The next step is to make sure players are respected for taking it slow after concussion.

To read the full New York Times story, click here: NFL Concussion Poster