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 whosustain TBIs each year in the United States:• 1.1 million treated & releasedfrom an Emergency Dept.• 235,000 hospitalized• 50,000 die• 80,000 experience onset oflong-term effects from a TBI• 5.3 million Americans (2% ofpopulation) living with adisability 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.
Related Conditions• 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. *Mayo Clinic staff 1998-2005 Mayo Foundation for Medical Education and Research.
Symptoms• Unequal pupil size • Emotions out of proportion• Vacant Stare • Slurred or incoherent speech• Tinnitus (ringing in the ears) • Gross observable incoordination• Nausea & Vomiting • Disorientation (time, date, location)• Delayed verbal responses • Any period of LOC• Delayed motor responses • Headaches and Irritability• Confusion & inability to focus • Sleep Disturbances• Memory deficits • Depression may develop *www.headinjury.com/sports.htm, www.mayoclinic.com
Long Term?• ALS – Chronic traumatic encephalopathy• Alzheimers• Various Symptoms of Dementia Guskiewicz KM, et al, 2005
Comparison of concussion grading scales Grade I Grade II Grade III Loss of consciousness Post-traumatic amnesia Loss of consciousness Cantu <5 minutes or <30 minutes, no loss of >5 minutes or amnesia guidelines amnesia lasting consciousness >24 hours 30 minutes–24 hours Colorado Confusion, post- Confusion, no loss of Any loss ofMedical Society traumatic amnesia, no consciousness consciousness guidelines loss of consciousness American Loss of consciousness Confusion, symptoms Symptoms last Academy of (IIIa, coma lasts last <15 minutes, no >15 minutes, no loss Neurology seconds, IIIb for loss of consciousness of consciousness guidelines 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?
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
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
Prevalence of Concussions in Sports• 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. *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