2. Introduction
• By The Numbers
• Concussion Defined
• Signs And Symptoms
• Newton Applied
• Your Obligations
• Resources

3. 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

4. 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)

5. 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

7. What happens to your brain
• Initiated by a mechanical occurrence
• Causing a mechanical incident
• Resulting in a chemical / biological
episode

8. 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

9. 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.

10. 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.

11. 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.

12. 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

13. Long Term?
• ALS
– Chronic traumatic encephalopathy
• Alzheimer's
• Various Symptoms of Dementia
Guskiewicz KM, et al, 2005

14. 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 of
Medical 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)

15. Types
• Impact
– Head hitting an object
– Object hitting head
• Non-Impact
– Whiplash
– Sudden change in direction

17. The Physics
• Newton’s Three Laws of Motion
• Conservation of Momentum & Energy
• Centripetal Force

18. 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?

20. Conservation of Momentum &
Energy

21. 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

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

24. 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)

26. 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.

27. 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)

28. 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

29. Which exerts more Gs?
Jet Barrel Roll Football Collision

30. • Average?
• About 9 Gs

31. • Average: 6’ tall, 200 lbs.
• Average Speed: 40 yard in 4.8 seconds
• 150 Gs!!

32. By way of comparison…

34. Damon vs. Jackson
(2003 AL Playoffs)

35. 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

36. 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

37. 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

38. 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

39. 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

40. A Recent Article…
• Helmets will never prevent concussions
• ~ Seatbelts will never prevent automobile
fatalities
• So, just stop?
• Maybe not a rule or player issues…

41. 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

42. 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.

43. Believe it or not…
*Courtesy of National Geographic Channel

44. 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

47. Questions?