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. 

Observations in gymnastics

As a way to burn some energy, interact with peers and participate in physical activity we enrolled my 4 year old in gymnastics. The facility runs classes for many age groups and as I was watching I noticed a few things based on my experience as an athletic trainer and strength coach. 

Some of the older girls were working on their springing and jumping and they struggled with landing appropriately. Typically, gymnastics and dance overload the patellafemoral joint based on the inherent movements in their sport, but landing with a valgus knee or overly externally rotated foot is easily corrected. 

The valgus landing is the mechanism for suffering an ACL injury and there are proven exercises to decrease that risk. The externally rotated foot is how the girls gained stability when they landed off balance and this is another easily corrected movement by working on balance. 

Based on my observations, I would recommend that the athletes do some lateral hip strengthening, core stability, squatting and lunging patterns as a way to activate the appropriate muscles and reinforce movement patterns. Then, during practice the instructors can make verbal cues to remind the girls how to land. 

As an interesting note, some of the girls were landing in poor patterns because they lacked the strength to pop up high enough to complete the maneuver before landing. Time spent on developing strength, power and spring would help them gain enough height so they weren't landing off balance. 

While gymnastics is full of grace and strength, the opportunity exists to improve the motion of the girls to lessen the force generated in joints and lead to longer, healthier participation. 

Physical therapy vs. physical training

During a conversation with some colleagues yesterday, we were discussing the true benefits of physical therapy. Personally, I am lucky to work and collaborate with some very talented physical therapists. Still, the reason that people go to physical therapy are different than those who work with strength coaches, personal trainers, and so on. The main goal of PT is to decrease pain, improve range of motion and mobility and restore function. This is not the same as improving function or functional performance, which is a different goal.

Physical Therapy is great for soft tissue therapy and release of adhesions, improving flexibility and joint mobility and improving postural stability and neuromuscular control. They work with patients to regain some pain free motion, firing patterns and control after an injury or a surgery. All too often, however, the patients use physical therapy as a fitness program or a fitness consultant, which is an improper use of their expertise. In an ideal world (one where insurance does not determine treatment decisions) patients would work with a therapist on their specific injury and work with a  qualified fitness professional on maintaining their global health while they recover from their injury. I stress qualified because this changes with the specific injuries and diseases that patients have. A qualified strength coach may not be the best choice for a diabetic with heart disease. This population has specific guidelines and needs that need to be properly understood.

When the therapist and the fitness professional work together to help individuals return to, and improve, their physical capabilities, the patient wins. They are now able to have improved use of their injured limb and maintain and increase their global strength, endurance and capacity for exercise. I personally believe that it is time for treatment programs to focus on the holistic health of the patient and develop programs that help them address and improve all facets of their health. By focusing on one small area, we do patients a disservice. The key with therapy is to address and correct the causes leading to their pain and dysfunction while still exercising around their injury so they are maintaining their fitness and improving other aspects of their physical well-being.

Carnival cancellation and ramifications for IOC

Shocking news out of Brazil, they have cancelled the Carnival celebration this year. 

I can't but imagine that this will be a very unpopular decision with the locals. With the amount of money that has been allocated, spent and consumed on hosting large international competitions, they must be feeling pretty angry. This last summer is preparation for the World Cup there were protests against the massive spending on stadiums in remote areas that will probably not be used again. Add to this the fact that Brazil has struggled to upkeep their own economy and infrastructure and there is a recipe for disenchantment. 

I wonder what this means for the IOC, FIFA and others; they have chosen locations that have not been able to handle the large price tag and development that accompanies the events. Russia spent billions of dollars on hosting the games that will never be recouped. Brazil had the opportunity of hosting the two largest events in subsequent years, but even that task is too daunting. 

The bids for the events amount to billions, but where does the money come from and at what cost? The money is not about erecting facilities for the events, it has to include roadways, parking, electrical and sanitation infrastructure on top of the facility construction. If these additional investments are overlooked the results are obvious; the locals have to foot the additional spending on resources they won't be able to use and their sacrifices are generally not appreciated by their government or others. 

The end result is what is happening now, the government is stretched so thin they don't have the capacity to fund their own national events. And who does this effect? Certainly not the IOC, who will have their games, but the locals who will be left to pick up the pieces and hope that they will be able to pay back the debt some day. 

Thinking long term, what are these large bodies going to do? They want to expand the reach of their games and include new host counties, but the cost of economic disaster can't be worth it. Their will start to be increasing opposition to the games and who is chosen to host. In order to maintain and increase the goodwill they have lost, they are going to have to find a way to make hosting the games more sustainable. I, for one, hope they do. 

http://www.businessinsider.com/brazil-canceled-carnival-2016-1