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.

Running Shoe Regulations for Competition Updated

running shoe regulations

Media Release from World Athletics:

World Athletics today announces further revisions to its rules governing shoe technology, which are designed to give certainty to athletes preparing for the postponed Tokyo 2020 Olympic Games and to preserve the integrity of elite competition.

These amendments, approved by the World Athletics Council and introduced further revisions to its rules governing shoe technology, with immediate effect, are based on significant ongoing discussions with the Working Group on Athletic Shoes, established this year, and with the shoe manufacturers.

They include changes to the maximum height of spiked shoes for track and field events and the establishment of an ‘Athletic Shoe Availability Scheme’ for unsponsored elite athletes. The maximum height for road shoes (40mm) remains unchanged.

The purpose of these amendments is to maintain the current technology status quo until the Olympic Games in Tokyo across all events until a newly formed Working Group on Athletic Shoes, which includes representatives from shoe manufacturers and the World Federation of the Sporting Goods Industry (WFSGI), have had the opportunity to set the parameters for achieving the right balance between innovation, competitive advantage and universality and availability.

The amendments include:

  1. Clarification of the position for new shoes that have been approved to date;
  2. As an ongoing obligation, athletes, their authorised representative or their shoe manufacturer must continue to submit shoe specifications and, if requested, new shoes for examination by our independent expert;
  3. Approved shoes to be made available prior to an international competition for distribution to any uncontracted elite athlete via an Athletic Shoe Availability Scheme. The Working Group on Athletic Shoes will develop this scheme including timelines, elite athlete criteria, numbers of pairs of shoes required and method of distribution.
  4. Confirmation that the manufacturer commits to making the new shoe available via a scheme to provide shoes to unsponsored elite athletes for free and/or for purchase depending on whether they are qualified or an unqualified athlete who benefits from a place at World Athletics Series events or Olympic Games;
  5. Provision of information concerning the availability of the shoe for other unsponsored elite athletes who need a pair of shoes prior to competition. This is in keeping with the principle of shoes being reasonably available to athletes. As a priority item, in its forthcoming meeting we will work with the working group and World Federation of Sports Goods Industry to design an ‘Athletic Shoe Availability Scheme’ to deliver this. The scheme will cover process, criteria, numbers of pairs of shoes required, method of distribution and when the shoe needs to be available from (our position, which has been generally accepted by manufacturers, is for one month prior to international competition). 


The maximum height of the track spike shoes have been amended as set out in the table below:

EventMaximum thickness of the sole (As per rule 5.5, notes (i), (ii), (iii) and figures (a) & (b) to rule 5.5, and rule 5.13.3).Further rule requirement
Field events (except triple jump)20mmApplies to all throwing events, and vertical and horizontal jumping events except the triple jump. For all field events, the sole at the centre of the athlete’s forefoot must not be higher than the sole at centre of the athlete’s heel.
Triple jump25mmThe sole at the centre of the athlete’s forefoot must not be higher than the sole at centre of the athlete’s heel.
Track events (including hurdle events) up to but not including 800m20mmFor relays the rule applies to the distance of the leg being run by each athlete.
Track events from 800m and above (including steeplechase events)25mmFor relays the rule applies to the distance of the leg being run by each athlete. For race walking events the maximum thickness of the sole is the same as that for road events.
Cross country25mm 
Road events (running and race walking events)40mm 
Events under rule 57 of the technical rulesAny thickness 

World Athletics CEO Jon Ridgeon said the previous rule changes, announced in late January, were designed to give the athletes clarity before the Tokyo Olympic Games, which were originally due to take place in July-August this year.

However the later postponement of the Olympic Games for a full year, due to the global pandemic, had given the governing body more time to consult with stakeholders and experts and develop amended rules that will guide the sport through until late 2021.

“We have a better understanding now of what technology is already in the market and where we need to draw the line to maintain the status quo until after the Tokyo Olympic Games,” Ridgeon said. 

“In developing these rules we have been mindful of the principles of fair play and universality, maintaining the health and safety of athletes, reflecting the existing shoe market in these challenging economic times, and achieving a broad consensus with the shoe manufacturers who are major investors in our sport.

“These transitional rules give us more time to develop a set of working rules for the long term, which will be introduced after the Olympic Games next year, with the aim of achieving the right balance between innovation, competitive advantage and universality.”

Working Group on Athletic Shoes

The new Working Group on Athletic Shoes (WGAS) met for their first meeting last Wednesday (22 July). It is tasked with scoping and overseeing studies around shoe technology, exploring definitions to provide clarity to athletes about the shoes they are able to compete in, creating a robust certification and control process and providing expert advice and recommendations to the World Athletics Competition Commission on the future direction of World Athletics’ Rules and Regulations concerning elite athlete shoes for the long-term which may or may not be different to the current rules. The structure and composition of the WGAS can be found here.

Running in Tarahumara culture

Press Release:

“Running in Tarahumara (Rarámuri) Culture,” just published in Current Anthropology (v61, no. 3 (June 2020): 356-379) studies the Tarahumara Native Americans of northern Mexico. For over a century, the Tarahumara have been famous for their long distance running traditions and abilities, with many accounts claiming they have superhuman athletic abilities that partly result from being uncontaminated by westernization. Now an international team of researchers (including a champion Tarahumara runner) combine their own observations with detailed interviews of elderly Tarahumara runners to dispel these stereotypical myths, which they term the “fallacy of the athletic savage.” Lieberman and colleagues use accounts by Tarahumara runners to detail the various ways Tarahumara used to run for hours to hunt animals, and they describe how the Tarahumara still run traditional long distance races that, for men, involve chasing a small wooden ball and, for women, a hoop. While these many different kinds of running have important social dimensions, running is also a spiritually vital form of prayer for the Tarahumara. Further, contrary to the fallacy of the athletic savage, Tarahumara runners –both men and women– struggle just as much as runners from other cultures to run long distances, and instead of being the natural “superathletes” that some journalists have claimed, they develop their endurance from regular hard work and other endurance physical activities such as lots of walking and dancing.

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Daniel E. Lieberman, Mickey Mahaffey, Silvino Cubesare Quimare, Nicholas B. Holowka, Ian J. Wallace, and Aaron L. Baggish, “Running in Tarahumara (Rarámuri) Culture: Persistence Hunting, Footracing, Dancing, Work, and the Fallacy of the Athletic Savage,” Current Anthropology 61, no. 3 (June 2020): 356-379.