Should You Really Be Behind the Wheel After Concussion?

MINNEAPOLIS – Even after all of their symptoms are gone, people who have had a concussion take longer to regain complex reaction times, the kind you need in most real-life driving situations on the road, according to a preliminary study released today that will be presented at the American Academy of Neurology’s Sports Concussion Virtual Conference from July 31 to August 1, 2020. The preliminary results could have implications for how quickly experts recommend drivers get back behind the wheel after a concussion.

“People who have concussions often have slower reaction times as a result, and do more poorly on tests of thinking skills after their injury than their peers without concussions,” said Julianne D. Schmidt, Ph.D., ATC, of the University of Georgia in Athens. “Our study suggests that complicated driving skills, the kind involving split-second reaction times that could mean the difference between life and death, are the ones that may take the longest to regain after you have a concussion—even when all of your symptoms have resolved.”

The study involved 28 college students with valid drivers’ licenses and an average age of 20, including 14 with concussions and 14 without. Ten of the 14 concussed students experienced concussions while playing sports. All college students were matched by age, sex, and driving experience. Participants completed both a simulated driving reaction time test and a computerized neurocognitive test within 48 hours of their concussion symptoms resolving, which occurred an average of 16 days after the injury.

The driving reaction time test consisted of two simulated driving scenarios. The first scenario involved a stoplight reaction time simulation in which the stoplight changed from green to yellow and participants had to rapidly choose to brake or accelerate. The second scenario involved a child running in front of a vehicle and participants needed to brake or swerve to avoid collision.

The computerized test consisted of four measures of reaction time including simple, complex, and Stroop reaction time, which is the lag that occurs when you are asked to select a word like “blue” that is printed in a different color.

The drivers who had concussions demonstrated slower computerized complex reaction times than those who did not have concussions by an average of 0.06 seconds. When reacting to a change in stoplight color, it took those with concussions 0.24 seconds longer to react, or the equivalent of 15.6 feet in stopping distance, compared to those without concussions. During the driving simulation involving a child running in front of a car, it took those with concussions 0.06 seconds longer to react, or the equivalent of 3.3 feet in stopping distance, compared to those without concussions. Slower reaction time is a strong predictor of crash risk, and these additional split seconds and feet needed to change the vehicle’s movement could be critical for avoiding an accident. Interestingly, only the computerized complex and Stroop reaction times moderately related to the driving stoplight reaction time, and no other relationships were observed, suggesting computerized reaction time measures are not a perfect replacement for measuring real-life driving reaction times.

“Overall, after the symptoms of the drivers with concussions resolved, their reaction times were similar to drivers who didn’t have concussions. However, when we looked specifically at stoplight reaction time, we saw lingering deficits in the drivers who had concussions,” Schmidt said. “This could mean traditional reaction time tests aren’t the best measure of driving responsiveness and readiness. And that could have important public safety implications, considering more than three million people have sports-related concussions in the United States each year.”

High school athletes require longer recovery following concussions

Press Release:

DETROIT – Young athletes are sidelined for at least one month after suffering a concussion, according to a Henry Ford Hospital study that provides new perspective on concussions and brain injuries.

The study’s results were published ahead of the Michigan High School Athletic Association’s recent announcement that the fall high school sports season will begin as traditionally scheduled, with football practices starting on Aug. 10.

The findings published by Orthopedics, a nationally recognized, peer-reviewed journal for orthopedic surgeons, are from a study conducted between September 2013 and December 2016. The study focused on 357 high school adolescents who sustained one or more concussions by analyzing historical data and then comparing it to more recent findings tied to an increase in reported concussions among young athletes.

The average age of the study’s patients was 15-and-a-half years with nearly 62% being males, the most common sport participated in by these athletes was football, followed by hockey and then soccer. From the study’s participants, 14 % reported suffering from amnesia and 33 % reported a history of concussions. Results of the study include:

  • Athletes with only one concussion required just over 30 days of recovery prior to returning to sport (RTS) while others who reported a second or more concussions required more time.
  • The most common sport of injury was football (27.7%). There was a high incidence of previous concussion (33.1%), and 32 athletes sustained a recurrent concussion.
  • Visual motor speed and reaction time scores decreased with recurrent concussions.
  • Male and female athletes with a previous history of concussion, and those with delayed diagnosis, required increased time to RTS.

The research team also found that athletes who have suffered concussions have a higher incidence of non-contact lower extremity injuries due to balance issues after concussions which may have implications on the performance, safety and well-being of athletes. These findings will be the focus of the next study also led by Toufic Jildeh, M.D., administrative chief resident in Orthopaedic Surgery at Henry Ford Hospital.

One of the earliest studies on concussion data came from the NFL’s mild traumatic brain injury committee and was published in the journal Neurosurgery in January 2004. Based on data collected between 1996 and 2001, researchers found that NFL players were sidelined for six or fewer days after a concussion.

A related 2019 study also led by Dr. Jildeh and published in American Journal of Sports Medicine showed a similar trend with NFL players being sidelined much longer.

“Historically, the literature reported a concussion prevalence of 4-5%, however recent studies have found that nearly 20% of adolescents have suffered at least one concussion, there’s a huge disparity in terms of reporting over time,” says Dr. Jildeh. Previously, it was thought that young age was a protective factor against concussion and that the neuroplasticity offered fast recovery. However, this thinking has been disproven with more recent studies.

Concussions have been a pressing issue. We want to limit the number of concussions and head injuries in a young athlete,” says Vasilios (Bill) Moutzouros, M.D., chief of Sports Medicine at Henry Ford and a study co-author, adding that younger athletes who suffer a concussion early in life are much more likely to experience longer term effects if they get repeatedly concussed.

Kelechi Okoroha, M.D., a Henry Ford sports medicine surgeon and study co-author, points to the findings as a baseline for young athletes with a history of concussions, “Depending on the number of concussions, the 30-day mark gives us a baseline for how much time adolescent athletes required before returning to sport,” he says.

The study offers a lot of information to reflect on and build on according to Jeffrey Kutcher, M.D., medical director and sports neurologist at the Henry Ford Concussion and Sports Neurology Clinic, and global director of the Kutcher Clinic.

Concussion diagnosis and management requires an individualized and comprehensive neurological approach to ensure we are accurately diagnosing and managing return to play effectively,” says Dr. Kutcher who also serves as advisor to the players’ associations for the National Football League and National Hockey League.

The study concludes that team physicians must be particularly mindful when evaluating an adolescent athlete due to the short and long-term neurocognitive implications, particularly as it pertains to RTS, and that high school athletes sustaining a concussion require careful attention when determining RTS readiness.

Study reveals long-term impact of rugby injuries

Press Release:

Rugby players continue to suffer from their high ‘injury load’ after retirement from the sport, according to the first independent study looking at the health of retired rugby players.

The researchers, led by Durham University’s sport and exercise scientists, are calling for governing bodies to step up efforts to prevent, in particular, recurrent injuries and ensure players are supported post-retirement.

Both elite and amateur rugby union and league players report suffering back pain and severe and regular joint pain which they attribute to the long-term impacts of their cumulative injuries post-retirement.

Concussion was the most common injury amongst rugby players with most suffering at least one concussion during their career and with this injury most associated with reported longer term impact.

Around half of all players had sustained a knee ligament injury with 25 per cent experiencing on-going problems.

Osteoarthritis – a condition that causes joints to become painful and stiff – was twice as common amongst elite rugby players compared to non-contact athletes and was associated with previous injuries and surgery.

The findings, published in the academic journal Sports Medicine, come after the Rugby World Cup in Japan saw a number of issues with high tackles and dangerous play leading to injuries.

Lead for the project, Dr Karen Hind from the Department of Sport and Exercise Sciences at Durham University, said: “It is clear from these findings that playing rugby union or rugby league is associated with lasting impacts in terms of injury and pain. Although there have been initiatives and rule changes to try and make the game safer, the rates of injury across a player’s entire career are still very high. The game is now also faster and players are bigger than they used to be so the impacts are greater.

“Many of the ex-players who took part in this study competed in rugby football over a decade ago when the sport was more about evasion. The injury levels for these individuals are up to nine-fold higher than for former non-contact athletes of a similar age.

“What we need to consider is that the game today is more about players running through opponents rather than evading – this is inevitably going to increase injury risk.”

The study was led by Durham University in collaboration with colleagues from Auckland University of Technology in New Zealand as part of the Global Rugby Health Research Network and the UK Rugby Health Project which built on the original New Zealand Rugby Health Study.

It compared the types and number of injuries suffered by 254 male elite rugby code players, amateur rugby code players and non-contact athletes, such as cricketers. The retired athletes ranged in age from 21 to 82 years.

Dr Hind added: “Our study looked at the total number of injuries across a player’s career and our findings suggest a need for better injury recovery given the reported frequency of recurrent injuries.

“A case could be argued for less players on the pitch and providing more opportunity for evasion. Medics also have a role to play in encouraging sensible injury recovery times which clubs need to support.

“Importantly, our findings highlight a need for programmes to support professional players post-retirement, in managing the long term impacts of injuries sustained during their career.”

Jon Sleightholme is a former international rugby player who represented England 12 times at senior level scoring four tries and was part of the team that won the Five Nations Championship in 1996. He also played for England Sevens and at club level for Wakefield, Bath and Northampton, retiring in 2004 after 13 seasons playing at the top level.

He commented: “The long term effects of playing contact sports especially at the elite level clearly have implications for players after their careers have finished. Sometimes those symptoms don’t appear until several years post-retirement.

“What the study highlights for me is the need for long term support and education for ex-players to help them manage these conditions as they get older.”

Dr Fraser Birrell, Consultant & Senior Lecturer in Rheumatology and Director of Science & Research for the British Society of Lifestyle Medicine (who was not involved in this research project), commented: “This is an important study that provides injury data on professional and amateur rugby players compared to non-contact athletes across an entire sporting career.

“We know how beneficial exercise is, but understanding the risks of high-intensity sport and especially the most frequent injury being concussion, helps inform playing guidelines and safety practices.

“It was striking to see that this high burden of injuries was associated with osteoarthritis at more than double the prevalence in professional rugby players (affecting half) compared to non-contact athletes, despite being younger.”

Professor Patria Hume, collaborator on the UK study and lead of the New Zealand study, commented: “The independent UK study has supported preliminary findings from our study in New Zealand, which was part funded by World Rugby, regarding increased concussions and injury during playing years and later osteoarthritis during retirement from sport.”

The UK Rugby Health Project includes ongoing studies investigating blood biomarkers, inflammation, head impacts, concussion and sub-concussions.

Injuries in Golf

golf injury

Injuries occur in all athletic sports quite regularly, certain sporting activities a lot more so than others. Golf is no various than any other sport. The extent of injuries in golf generally are not as serious as in other sports. The circumstance of a 300 pound. defensive lineman slamming right into the side of your knee tearing every possible ligament framework in the knee will certainly never ever happen in the sporting activity of golf. An interesting visual if you integrated the sporting activities of football and golf onto the same playing field, but inappropriate for this paper.

There are two types of injuries categorized by experts in the fields of sports training and also sporting activities medication. Both sorts of injuries are: 1) intense and 2) persistent. The above example of the football gamer is categorized as an acute injury. An intense injury can be specified as the injury in the body occurring instantly after the injury. Describe the football gamer example over for a pointer. (For us older golfers, keep in mind Joe Theisman of the Redskins and Lawrence Taylor’s leg splitting deal with? Severe injury.) Connecting a severe injury to golf is a bit harder. Probably the simplest, and maybe most the common, acute injury in golf, occurs while turning and you struck a rock or something that develops an injury to your wrist. That would certainly be the very best example in the sport of golf of an intense injury. Overall, severe injuries tend to be unusual in golf due to the fact that get in touch with by the body with outside forces is unusual.

My back is always hurting me!

The second sort of injury, persistent, is much more widespread when it comes to the sport of golf. A chronic injury is one that takes place with time. Think about it as a “deterioration” injury. These are generally the result of the body breaking down with time. An excellent sporting activities example beyond golf is when you hear about a baseball bottle having tendonitis in the elbow joint. Tendonitis is an inflammation of the joint resulting from the anxieties positioned upon it from tossing. In time the elbow joint ends up being weary and eventually injured from the variety of pitches thrown. If you are a jogger and, after a specific quantity of time, your knees start to harm, this is generally a persistent injury. When we discuss golf, most of injuries are chronic. They tend to be a straight outcome of the golf swing (much like the bottle’s joint). Typically the chronic injuries in golf show up in the reduced back. If chronic injuries are captured quickly sufficient in the cycle, remainder as well as proper treatment (i.e. massage therapy, chiropractic care) will certainly heal them. However if you wait as well long the body is going to “damage,” and after that you will certainly not be playing any kind of golf for a long period of time. This is where the unfavorable circumstance of surgical procedure and also various other invasive procedures are considered.

So a couple of questions we must ask when it involves chronic injuries in relation to golf are: exactly how do they occur, and also how do we stop them? Persistent injuries occur as a result of the body ending up being tired and at some point “breaking down.” The muscles, tendons, and also tendons of your body are called for to perform the task of swinging a golf club. Over time this task creates fatigue within your body. As the body remains to tiredness, or get tired, the body obtains sore. This is the initial indicator of a developing chronic injury. If you continue with the task you’re joining, with soreness in the body, eventually your body will break down. This “break down” will remain in the form of possibly a pulled muscular tissue, muscle tightness, tightness, or some other kind of inflammation. Every one of the above examples are a result of frameworks in your body breaking down from fatigue and overuse. Even if just on one swing you feel “your back head out,” nine out of 10 times it is a persistent injury, and that last swing was the “item of straw that damaged the camel’s back.”

Just How to stop Chronic Injuries in Golf

We all understand that the golf swing is a repeated motion, indicating the body is executing the very same activity over and over once again. This develops tiredness in the body over time. As well as if with time our body can’t sustain the number of swings we are taking, it is ultimately mosting likely to break down. There are 3 variables we have when it comes to the prevention of chronic injuries in golf. Top is workloads. Workloads can be specified as the variety of swings that the body takes with a club over a provided time period. That time frame can be 7 days or a whole trip period. Second is effectiveness of your technicians. When we claim “effectiveness of auto mechanics” we are talking about just how biomechanically correct your private swing is. “Why is this essential?” you ask. Let me tell you. I believe a lot of us would certainly agree that the tour players have very “effective” swings; their swings are smooth and also look practically simple and easy. A swing similar to this asks less out of the body to carry out and also requires much less effort from the muscles; hence fatiguing degrees in the body are lower. Some amateur swings resemble they take a great deal of work to do, and also in reality they do! These kinds of swings ask a great deal more out of the body as well as exhaustion it faster. The final variable is what we term “golf strength.” Golf toughness is a step of the called for levels of adaptability, strength, endurance, balance, and power to successfully support the technicians of the swing. Big quantities of golf stamina enable the body to sustain an efficient swing. Reduced levels of golf toughness do not provide the assistance required for the swing.

Workloads, Swing Mechanics, as well as Golf Strength

All three of these variables work together to determine if you are a candidate for a chronic golf injury. Golf strength is basically the structure upon which your swing is constructed. This variable suggests the number of times you can turn a golf club with your current auto mechanics prior to you show up injured. If you have high degrees of golf stamina then no matter exactly how effective of a swing you have, you will certainly have the ability to play for rather some time before you get aching. The other hand can also be claimed. If you have reduced levels of golf toughness, no matter your swing auto mechanics, you will turn up sore in a shorter quantity of time.

Secondly, let us check out swing auto mechanics. If you are a gamer that has an extremely reliable swing that puts really little anxiety on the body, you will definitely be able to play numerous rounds prior to your body starts howling at you. Again, if you have poor mechanics, it is going to take its toll on your body and also your game.

Ultimately, we have workloads (i.e. variety of swings). The variety of swings one makes need to match up with levels of golf toughness as well as swing mechanics. The golf swing is a “stress factor” of the body and breaks it down in time. If you have an efficient swing, each swing does much less “damage” to the body. If you have a poor swing, the body has to function harder, therefore fatiguing it quicker. Along with this is golf toughness. If you have high levels of golf toughness, you can turn the club extra (i.e. workloads) prior to you obtain tired. Reduced levels of golf strength present the situation of the body’s fatiguing faster. “So what is the magic formula?” you ask. My initial suggestion is twofold: 1) work with your swing to boost the efficiency of it, and 2) increase your degrees of golf toughness in order to support your swing. For the time being, compare your swing and also golf stamina levels to identify what work degrees you can get out of your body.

The Feet are Important

The feet are the foundation of the body and are so important in golf. Their side-to-side movement helps facilitate the swing and they carry us for all those miles around the golf course. We need to make sure that the feet are in good condition. Podiatry has a role to play in golf. Consider seeing a podiatrist if things are not right with your feet. Podiatrists use golf orthotics to support the foot. Not having the feet right can affect the back, the golf swing and every other part of the body. Podiatry Tube has some videos on Podiatry’s role in golf.

Female athletes at risk for nutritional deficiencies

female athlete

Press Release:

Two decades of research among female athletes over the age of 13 years shows that a lack of nutrition knowledge about what they need to eat to stay healthy and compete may contribute to poor performance, low energy and nutrient intake, and potential health risks, according to a Rutgers Robert Wood Johnson Medical School study.

Mary Downes Gastrich, associate professor at the school, who recently published a review study in the Journal of Women’s Health, talks about why female athletes often do not meet their nutritional requirements and energy needs, ranging from a lack of education and poor time management skills to chronic dieting and disordered eating behaviors.

What were the main reasons found for nutritional deficiencies and low energy?

In our comprehensive literature review, prior studies have found a lack of general knowledge of nutrition among athletes, coaches and other sports team specialists. Other factors included poor time management and food availability, disordered eating behaviors such as chronic dieting or a drive for lower body weight. Some female athletes may purposefully restrict their calorie intake for performance or aesthetic reasons, while others may unintentionally have low energy expenditure due to increased training or lack of education on how to properly fuel themselves for their sports’ demands.

In addition, specific sports, such as gymnastics, distance running, diving, figure skating and classical ballet emphasize a low body weight; thus, making these athletes at greater risk for inadequate calorie consumption, poor body image, disordered eating or a serious mental health disorder diagnosis of an eating disorder such as anorexia nervosa or bulimia nervosa.

What nutritional deficiencies did the studies show?

Current studies suggest that female athletes’ diets are often not optimal for the types and amounts of carbohydrates, fats and total energy intake. However, we found that most female athletes — other than those who participate in sports promoting leanness, such as dancing, swimming and gymnastics — may be consuming adequate protein needs.

When the energy and nutrients from the foods consumed does not match the level of energy expenditure in the sport and nutrient needs for proper body function and growth, it can affect female athletes’ bone health and reproductive system. Deficiencies in vitamin D, zinc, calcium, magnesium and B vitamins can occur from exercise-related stress and inadequate dietary intakes. Recent reports suggest that up to 42% of female athletes have insufficient vitamin D levels and up to 90% fall short of the adequate intake for calcium. These two deficiencies can increase the risk of bone stress fractures and also place these athletes at risk for osteoporosis later in life.

Diminished bone mineral density can increase the risk of fracture from repetitive stress on the bones during training and competition. The age that sport training begins is an important factor influencing bone mineral density. A study of teen and young adult female elite gymnasts found that the earlier the age of strenuous exercise, the more negative the effect on bone acquisition later on in life.

Female athletes with insufficient diets, who regularly miss menstruation or have a low body mass index should supplement their diet with the recommended 1500?milligrams of calcium a day as well as other dietary supplements, including vitamin D for bone health and optimal calcium absorption. However, for safety reasons, all athletes should consult their physician and/or a registered dietitian nutritionist before taking any dietary supplements.

In addition, insufficient iron consumption may lead to iron deficiency anemia, which is more common in females participating in intense training, like distance running, due to the potential for additional loss of iron through urine, the rupture of red blood cells and gastrointestinal bleeding.

What is “disordered eating” and what role does it play?

To optimize their performance, some female athletes often strive to maintain or reach a low body weight, which may be achieved by unhealthy dieting. Such “disordered eating” can include various unhealthy eating behaviors, including chronic dieting, excessive calorie counting, food-related anxiety and use of laxatives, which could potentially result in a more serious clinical diagnosis of an eating disorder.

Prior work has shown a higher prevalence of eating disorders among female athletes competing in leanness sports, such as dancing, swimming and gymnastics, compared with female athletes competing in non-leanness sports, such as basketball, tennis or volleyball.

What can be done to improve nutrition in female athletes?

Our review from prior studies suggests that the nutrition status of female athletes needs to be more closely monitored due to greater risks of disordered eating, low energy availability and its effects on performance, as well as lack of accurate sports nutrition knowledge.

Interdisciplinary teams — including physicians, registered dietitian nutritionists, psychologists, parents and coaches — would be beneficial in screening, counseling and helping female athletes improve their overall diet, performance and health. These teams should be regularly trained on the negative health effects of inadequate calorie intake on both performance and long-term health. Early detection of low energy availability is essential in preventing further health issues, and diagnosed stress injuries should be considered a red flag, signaling further evaluation.