Thursday, March 4, 2010

More Concussion stuff

Got a chance to hear Dr. Kevin Guskiewicz from U.N.C. speak on the topic of New Research in Athletic Brain Injury. Doing some really cool research. Placed software in football helmets and receiving real time data about the forces coming through the head during contact in games. In some instances it was 150G's! Also troubling was the highest forces were delivered through the top of the head.

Dr. Guskiewicz further validated exercise testing as a diagnostic tool in return to play decisions. It will be positive he says, long after cognitive testing is normal.
My particular protocol is a series of short sprints with very short rest periods; a 5m rest, then a series of longer sprints with short rest periods.

He also spoke of the importance of the cervical muscles in dissipating forces through the helmet. Which brings up a good topic- is there such a thing as a good neck strengthening exercise? Or, is it something that can only be developed by controlled & progressive contact?


Kevin Moody said...


Your exercise protocol is an interesting concept. Kind of like interval training vs. moderate continuous training that we have traditionally utilized.

As to cervical musculature strengthing, I would be an advocate for it. I have seen a much greater # of female concussed athletes (soccer, basketball & hockey) vs. male (football, soccer, basketball & hockey). The usual mechanism of injury with the girls is an elbow or ball to the head and a fall back to the ground. If the cervical & upper back musculature can be strengthened to absorbed some of the force of such an injury mechanism, all the better.

Did Dr. Guskiewicz go into balance testing - specifically the BESS? I have found that most high school athletes (without concussions) have less than ideal balance and to use the whole BESS test is not valid. I will use the tandem stance on a stable surface only.

Any Thoughts?

Kevin Moody

Joe Przytula said...

He didn't mention balance testing- but if I understand you correctly you're saying you would probably need a baseline test, just like IMPACT.

Curious, what type of cervical strengthening do you use Kevin?

JH said...

Physics tells us that the larger the mass of an object the better it can handle forces and in greater amounts. Muscle size is something to consider but must also consider athletic performance as well.

Also, I was covering a wemen's Bball game about 2 weeks ago when a player was hit in the head. Definitely concussed with symptoms including, nausea, impaired vision, headache, dizziness, pressure behind her right eye. Immediately activated EMS. A few hours after she went ot the ER she returned. She said they did not do any scan, gave her an anti-nausea medication and pain reliever for the headache.

My reaction was what in the heck were they thinking? Anyone have any other persoective on the treatment given by the ER?


Kev said...

I share the same thoughts as Kevin Moody: the concussions I see in females tend to be more severe in terms of persistence of symptoms; I don't use BESS because baseline testing isn't practical and I agree it's not valid due to poor balance in some kids anyway.

JH: The methods and madness of ER's and concussions is talked about quite alot at the NATA Think Tanks if you're an ATC. From my experience ED's don't handle concussion stuff very well. If they choose to image they seem to base everything off that CT scan and ignore the inevitable post-ED visit persistence of symptoms. ED's can be very frustrating in their approach to concussed patients.

I've been using the ImPACT program now for 4 years. I am very happy to have some legit objective data to attach to my gut feeling. It's not a panacea but it is very helpful in helping to manage the athlete in terms of RTP.

Kevin Moody said...


Since I only visit the high schools 2x/week for 1hr/visits it is impractical to do baseline balance testing. Do you do any type of balance testing?

The schools do not utilize me for their strength & conditioning programs, however to develop the upper trunk musculature I would recommend pulls, shrugs & presses. To specifically target the cervical muscles with post concussed athletes I have used manual PNF patterns and then given the athelete theraband to continue a home program.

If I'm correct I believe that the wrestling bridging exercises have received a negative review due to undue cervical stress. However, back when I wrestled in the stone age, they obviously were an integral part our program and I can't recall any cervical spine injuries.

Kevin Moody

Jonathan said...

I've recently added a new tests to my repertoire. I have the athlete sit down. They start with their index finger on their nose as I quickly dart my finger across their face randomly, they must meet my index finger, return to their nose, and then meet my finger again. I'm already to the next spot before they touch their nose. I move very quickly, randomly, in all directions. Close to the face, far away, low, high, diagonal, just darting all over the place. Some of the responses after the test have been: "I had to really concentrate to get to your finger," "the fast eye movement hurts my head." It has helped me to evaluate those athletes who downplay the level of their PCSs, actually have good balance, and perform well on the SAC test. It's hard to hide from this one.

Joe Przytula said...

Kevin- Jeez, we used to bridge all the time in high school & college wrestling, and at 50 I'm none the worse- a little arthritis between C-4&5, but who doesn't at our age? Too bad it's contraindicated.

Interested on how other's approach cervical strengthening.

Don't do balance testing except for sideline immediate post injury.