NFL concussion data

The NFL released their concussion data and reported a 58% increase in the number of concussions sustained this football season. There was also an increase in the number of head to head collisions that led to a concussion. While it is good that athletes are being screened and picked up at a higher level, it is concerning that rule changes to limit head to head contact do not seem to working as of yet.

The new standard in youth football is to teach heads up contact. This means that athletes look at their opponent, engage their neck muscles and use their chest and shoulders to initiate contact. This tackling style has led to a decreased incidence of concussion in youth athletes. I think this focus on tackling is fantastic and I am hoping that it changes how athletes tackle when moving up their playing career. I am concerned, however, that professionals are not modeling proper tackling behavior.

If professionals do not use proper technique, how can we expect younger athletes to do so? When they watch their idols playing every weekend and using their head to make contact how can we tell them on Monday that they did it wrong? For concussion education and tackling technique to make an impact it has to be both a top down and bottom up approach. The rules need to be upheld and proper technique needs to be stressed in order for substantial change to occur. I fear that if we don't stress the importance of technique at every level that we will continue to see head to head contacts and concussion rates that don't change over time.

http://www.athleticbusiness.com/athlete-safety/nfl-report-concussions-spiked-in-2015.html?eid=277204494&bid=1297447

Managing concussions at the youth level

Most States have concussion management programs in place, but they focus on high school athletes. This has left some confusion for non athletes or younger students who suffer a concussion. There is nothing special about the management of concussion for athletes or non athletes. It is rest until symptom free with a graded return to activity. The majority of students recover in 7-10 days and do not require any school accommodations.

The challenge is in handling the outliers. What to do with the ones that don't get better. We know that girls take longer to heal than boys and that younger students take longer than older students. We do not know definitively why this is the case, but there is some speculation.  If any individual sustains a head impact and a concussion is suspected it should be evaluated by a qualified medical professional. If they are taking longer to heal then accommodations for school may be suggested. This can be in the form of half days, limited homework and testing, the use of a tutor or physical changes like lower light and decreased computer screen use. All of these can be put in place by the school, but should be overseen by the physician.

I don't think that anything different needs to be done to handle concussions across the board, but more education and policy development may be needed so that everyone understands what to do.

http://www.athleticbusiness.com/civil-actions/legislation-would-toughen-concussion-law.html?eid=277204494&bid=1290676

Aggressive conditioning

Cal recently admitted that negligence of the school contributed, in part, to the death of a football player who died during a conditioning drill. As unfortunate as this event was, it forces us to keep in mind the potential dangers that exist when conditioning athletes.

Dr. Casa out of the Korey Stringer Institute at Connecticut has been very vocal that death due to heat stroke is 100% preventable. If the right policies are in place and adhered to, athletes can have their core temperatures brought under control in adequate time. And, while, the death of this young man seems to be heart related, the same principles apply. Aggressive conditioning with heavy individuals who have not been training adequately can be a deadly combination. The goal of training and conditioning is to apply a load, then recover from that load in order to progress. This means that gains are made over time in a planned manner. Varying the intensity of workouts is a very appropriate mechanism to change that load, but when workouts for any sport or competition significantly exceed a person's ability to handle it, a dangerous situation may exist.

There have been a few deaths in past years that have been the result of excessive conditioning of athletes, not to mention the other issue of rhabdomyolysis. Athletes want to be pushed and many of them excel with the pressure to achieve, but coaches, athletic trainers and fitness professionals need to remember that acute overload can lead to disastrous outcomes and plan accordingly.

http://www.athleticbusiness.com/civil-actions/cal-admits-negligence-in-football-player-s-death.html?eid=277204494&bid=1297447

Assessment of dysfunction

I saw an athlete today complaining of ongoing hamstring tightness and strains that I have seen in the past. Based on the exam I noticed he had very tight hamstrings and restricted movement. He also displayed a quad dominant squat pattern with patellofemoral overload and some instability with single leg squats. 

Based on his presentation we discussed a multi faceted program to improve his mobility and decrease his constant strains. We started doing 1 leg drops for movement and stability ball curls for hip and hamstring strength. We reviewed squatting and single leg squatting to engage his glute muscles to alleviate knee pain and we perform multi directional lunges for hip mobility. As an added bonus we worked on planks to strengthen his core and ensure that he can maintain adequate alignment. 

Since his hamstring is the main link between the pelvis and lower body it is easy to get tight and strained. In order to combat this we need to build a strong stable base for the pelvis and core muscles. When these are stronger the hamstring his not under the same amount of tension trying to provide stability. 

We will recheck his progress but this program should improve his strength and improve his motion leading to less recurrent strains.