Introduction

• By The Numbers

• Concussion Defined

• Signs And Symptoms

• Newton Applied

• Your Obligations

• Resources

Disclaimers

• Founder - The Institute of Sport Science & Athletic Conditioning

• Director - Dominate Your Game!• State of NV Director - NSCA• State of NV Chair - NAS• Judge - INBA• Graduate student, Exercise Science - Concordia

University• Sport Science Consultant - Xyience Nutrition

What is a Concussion?

• *Not a medical course*

• No universally accepted all-encompassing definition

• "…a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces." (Cantu RC 2006)

• Traumatic Brain Injury (TBI)

Of the estimated 1,500,000 people who

sustain TBIs each year in the United States:

• 1.1 million treated & released from an Emergency Dept.

• 235,000 hospitalized

• 50,000 die

• 80,000 experience onset of long-term effects from a TBI

• 5.3 million Americans (2% of population) living with a disability as a result of a TBI

What happens to your brain

• Initiated by a mechanical occurrence

• Causing a mechanical incident

• Resulting in a chemical / biological episode

STAGE 1:

The brain slams against the skull:

• Blood vessels tear, causing bleeding

• The axons that carry impulses from neuron to neuron stretch unnaturally, garbling their signals

• The neurons fire simultaneously, causing a miniseizure.

*Neuropsychologist David Hovda, UCLA’s Brain Injury Research Center

STAGE 2:

• As they fire, K+ rushes out of them and Ca+ rushes in, clogging the neurons’ mitochondria.

• To fuel the absorption of new potassium, the neuron consumes glucose.

• Metabolizing glucose creates lactate, an acid that damages cell walls.

STAGE 3:

• The calcium-clogged mitochondria do not get needed O2.

• This causes a neuronal energy crisis. Blood flow drops and cells begin to die.

• Contusion and Edema • Skull Fracture• Intracranial Hematoma

– Subdural or epidural– A blood vessel ruptures – Collection of blood compresses

brain tissue.

• Left: Arrows indicate an epidural hematoma, a collection of blood between the skull and the outer covering of the brain, which is compressing the right frontal lobe. • Right: Arrows highlights tumors in both sides of the brain.

Related Conditions

*Mayo Clinic staff 1998-2005 Mayo Foundation for Medical Education and Research.

Symptoms

• Unequal pupil size

• Vacant Stare

• Tinnitus (ringing in the ears)

• Nausea & Vomiting

• Delayed verbal responses

• Delayed motor responses

• Confusion & inability to focus

• Memory deficits

*www.headinjury.com/sports.htm, www.mayoclinic.com

• Emotions out of proportion

• Slurred or incoherent speech

• Gross observable incoordination

• Disorientation (time, date, location)

• Any period of LOC

• Headaches and Irritability

• Sleep Disturbances

• Depression may develop

Long Term?

• ALS

– Chronic traumatic encephalopathy

• Alzheimer's

• Various Symptoms of Dementia

Guskiewicz KM, et al, 2005

Comparison of concussion grading scales

  Grade I Grade II Grade III

Cantu guidelines

Post-traumatic amnesia <30 minutes, no loss of

consciousness

Loss of consciousness <5 minutes or

amnesia lasting 30 minutes–24 hours

Loss of consciousness >5 minutes or amnesia

>24 hours

Colorado Medical Society

guidelines

Confusion, no loss of consciousness

Confusion, post-traumatic amnesia, no loss of consciousness

Any loss of consciousness

American Academy of Neurology guidelines

Confusion, symptoms last <15 minutes, no loss of consciousness

Symptoms last >15 minutes, no loss

of consciousness

Loss of consciousness (IIIa, coma lasts seconds, IIIb for

minutes)

Types

• Impact– Head hitting an object– Object hitting head

• Non-Impact– Whiplash– Sudden change in direction

The Physics

• Newton’s Three Laws of Motion

• Conservation of Momentum & Energy

• Centripetal Force

First Law

• An object at rest or in motion will stay at rest or in motion in the same direction and speed unless an outside force acts upon it.

• Inertia

• Driving in a car

• Standing on Earth?

Conservation of Momentum & Energy

Second Law

• The acceleration of an object depends directly upon the net force acting upon the object, and

inversely upon the mass of the object. • F=ma

Third Law

• For every action, there is an equal and opposite reaction.

Centripetal Force

• “Center Seeking”

• F=mv2/r

• Force pulls object inward

• However, object wants to continue in a straight line (Newton’s First Law)

• Therefore, object feels force of being pushed out – Centrifugal Force (Newton’s Third Law)

Head Injury Criterion (HIC)

• HIC is a measure of the likelihood of head injury arising from an impact, defined as:

Large accelerations may be tolerated over very short periods of time.

HIC continued…

• At a HIC of 1000, one in six people will suffer a life-threatening injury to their brain

• In one study, concussions were found to occur at HIC=250 in most athletes. (Viano D C, 2006)

Newton Applied

• Though average adult head is approximately 5 kg

• Not isolated object (depending on direction of force)

• Total body weight and velocity

• Conservation once again

Which exerts more Gs?

Jet Barrel Roll Football Collision

• Average?

• About 9 Gs

• Average: 6’ tall, 200 lbs.

• Average Speed: 40 yard in 4.8 seconds

• 150 Gs!!

By way of comparison…

Damon vs. Jackson(2003 AL Playoffs)

Newton Applied Again

• Jackson: 12 mph• Damon: 14 mph• = Closing Velocity: 26 mph• = 90 Gs• = Baseball traveling 180 mph• PLUS: Rotational velocity• PLUS: Impact with ground• Multiple sights of bleeding/damage

*Courtesy of FSN, 2007

• Collegiate Stats (per 1,000 athletes)

– Football: 3.52 per game/practice

– Ice Hockey: 2 per game/practice

– Men’s Soccer: 1.13 per game/practice

– Women’s Soccer: 1.8 per game/practice

– A study of collegiate football players showed that players with >3 concussions had 3x the rate of depression.

Prevalence of Concussions in Sports

*Courtesy of the NCAA

What Can You Do?

• Recognize conditions prone to TBIs

• Be aware of your athletes’ movements

• Analyze your athletes’ patterns

• Special attention to children

– Marshmallow on top of piece of spaghetti

What Can You Do?

• Be observant of your clients’ environments

• Insist that your clients use all protective gear needed

• Do not allow a return to training without physician’s specific release

• Understand TBIs can occur through different mechanisms

More importantly…

• Know your athletes before the season begins. This provides the staff (coaches, ATCs, etc.) an opportunity to:

• Assess concussion risk factors

• Provide education to athletes on the signs and symptoms of concussions

• Administer baseline concussion testing

• Establish an emergency procedure protocol to follow in the event of a concussion

A Recent Article…

• Helmets will never prevent concussions

• ~ Seatbelts will never prevent automobile fatalities

• So, just stop?

• Maybe not a rule or player issues…

So, what does this all mean?

• Sport Science has improved athletes exponentially over the last decade

• As strength coaches, we are doing our jobs

• However, have game rules & the equipment kept up with this progress?

• Our responsibility to keep our athletes safe

As an Interesting Side Note…• Study looked at the neuroprotective effects of Creatine (Cr)• 39 children and adolescents, aged between 1 and 18 years of age,

with TBI• Cr was administered for 6 months, at a dose of 0.4 g/kg in an oral

suspension form daily. • By comparison, that is equal to 45.5 grams daily for a 250 pound

individual• Improved results in several parameters, including duration of post

traumatic amnesia (PTA), duration of intubation, and intensive care unit stay.

• Significant improvement was also recorded in the categories of headache, dizziness, and fatigue aspects in all patients

• All with no negative side effects

*Sakellaris G, Nasis G, et al. Prevention of traumatic headache, dizziness and fatigue with creatine administration. A pilot study. Acta Paediatr. Jan 2008;97(1):31-34.

Believe it or not…

*Courtesy of National Geographic Channel

Resources

• http://www.cdc.gov/concussion/sports/resources.html• http://www.springerlink.com/content/r859713q00204262• http://www.ncbi.nlm.nih.gov/pmc/articles/PMC155415/• http://www.ncbi.nlm.nih.gov/pubmed/16239884

Questions?