Seahawks head coach Pete Carroll announced Sunday night that Russell Wilson will start Seattle's final pre-season game and will be the opening day starter.  There seems to be so much unnecessary talk about the expensive free agent acquisition Matt Flynn being a bust and is the Seahawks version of Cardinals beleaguered QB Kevin Kolb. 

People slow down and relax.  Wilson the undersized 3^rd round draft choice has played himself into a starting role and has the confidence to handle the pressure as seen in the first 3 dress rehearsals this pre-season.  His statistics are clearly better this pre-season (see dropped TD by Terrell Owens).  Russell Wilson also had some help by Matt Flynn developing tendonitis in his throwing elbow recently.  Flynn was a scratch this week against KC due to pre-game complaints that led the staff to sit him. 

Does anybody remember Tom Brady last year throwing more interceptions than usual later in the year?  Rumor has it he had trouble gripping the ball and it led him to getting cortisone injections and practice week rest starting in November.  Now doesn't it make sense the Seahawks would take the pressure off of the newly acquired expensive QB and let him rest a couple weeks and get healthy to then give the capable inexpensive rookie a run for his money? 

Fantasy players, Diehard Hawks fans lend me your ears.  Matt Flynn is guaranteed about 10 times the money Wilson is this year but do not worry about it.  Wilson will get an early welcome to NFL football on the first few Sundays this season and Flynn will be well rested and ready to earn his unproven salary by the 4^th week of this NFL season.  I predict Flynn will be the starter by then and Wilson will get his chance to be a regular rookie in this league attached to a clipboard and wearing a headset...

This season I am looking forward to changing gears and using my clinical skills in evaluating players injuries and the impact it will have on the team.  I plan to discuss these injuries and give relevant prognoses in regard to the specific ailment.  I will be discussing the other backups at his position and the players history of similar injuries which will help you make an educated guess at what to do with your fantasy team or give you ammunition to be your favorite teams G.M. and let the coaching staff know whom should fill the injured players shoes.  

This should be a fun exercise in sports medicine blogging and give me the opportunity to find out how much I really don't know....Here's to another NFL season!  See you all soon.

On October 23^rd 2011 San Diego Chargers offensive lineman Kris Dielman suffered a concussion during a football game against the New York Jets with 12:31 left to play.  He collided with a Jets Linebacker and then hit the turf hard.  He got up, wobbled and went back to playing the rest of the game.  On the flight home just before touchdown in San Diego Dielman suffered a "grand mal" seizure.  He was out for the rest of the season...

The Hype Surrounding the Problem

Concussions are getting much press of late, especially as doctors and science help give us a clearer picture of the short and long-term negative cognitive effects.  Lets talk about what really happens inside the brain when someone suffers a concussion. 

When the head, moving at a significant speed, comes to an abrupt stop, the brain cells inside get stretched, squeezed, and twisted.  In the cells normal state, they function by transmitting electric current.  A part of the cell called the axon acts somewhat like a wire, conducting current between the cells. Ions shift back and forth along the axons in a controlled fashion, transmitting messages from one part of the brain to the other.  When one suffers a concussion, however, the membranes of brain cells get damaged and the cells become leaky.  Ions are able to rush in and out indiscriminately.  Sodium and calcium rush in and potassium rushes out.  The brain needs to restore balance.

Here is a good analogy that I have found:  a concussion occurring is like a submarine hitting a reef and leaks start springing everywhere. Within our cells, there are tiny pumps to help get the ions back in their proper places during this emergency.  However, when a concussion occurs, other havoc is taking place within the cells scaffolding.  They can't repair the "leaks".  It's as if someone is in the cell with a reciprocating saw and cutting through all the supports and struts of the cells' structure.  As calcium rushes in, it can actually activate enzymes to trigger the cell to destroy itself.

In severe cases brain cells simply break apart under the stress.  In milder cases, there is an opportunity to recover.  Just how long this takes is uncertain, most likely 10-14 days and longer for the adolescent brain.  So what happens if, in the middle of the cellular emergency recovery process, the brain suffers another concussion?

From Concussions to Brain Disease

The worst-case scenario after suffering a head injury is suffering another one while still recovering.  This is called Second-impact syndrome.  This condition can lead to brain swelling and even death.  Jake Snakenberg, a Denver-based freshman (high-school) football player, died in 2004 because of second-impact syndrome from a hit he took just one week before the second hit that killed him. 

We can help avoid such an awful situation by avoiding concussions in the first place, and knowing how to identify a concussed player when it does happen. 

Signs and symptoms of a concussion include: thinking deficits, lack of sustained attention, amnesia, confused mental status, dazed look/vacant stare, slurred speech, vomiting, nausea, slow motor or verbal response, emotional liability, memory deficits, poor coordination, dizziness, headache, restlessness, nervous weakness, exhaustion, and irritability.

It has long been clear that multiple blows to the head can lead to mental impairment.  Those familiar with boxing refer to this as punch drunk.  It has been only in the past decade that scientists have identified the problem in American football players.  They have also been able to identify, on autopsy, pathological markers for the disease, now called Chronic Traumatic Encephalopathy or (CTE). 

Former NFL players are suffering severe depression, memory loss, erratic or aggressive behavior, and early dementia because of repeated blows to the head.  A disturbing number of former NFL players have committed suicide or died after suffering mental disturbances, and many of them worried that they have the disease, have arranged to donate their brain to science.  One of the more recent players was Dave Duerson, a former all-pro safety with the Chicago Bears, who shot himself in the chest (not the head) and left instructions to give his brain to the NFL brain bank for study. A tragic illustration of the need to raise awareness beyond the rank and file of players and into the hands of the populace.  As in many other cases, an autopsy determined that Duerson had CTE.  A study in 2009 by the NFL found that former players between the ages of 30 and 49 were being diagnosed with severe memory-related diseases at approximately nineteen times the rate of the general population. 

Many studies show that around 15% of NFL players suffer a 'diagnosed' concussion every season.  These are staggering numbers.  In the past such head injuries were often ignored, until recently many players were resuscitated with smelling salts so they could re-enter the game, its now clear these blows have a lasting effect and in some tragic cases a deathly effect. 

Although we have this data, it hasn't dissuaded anyone form playing in the NFL.  Are the tremendous rewards offered to these athletes helping to compensate for the potential risk?  We understand now why they play on Sunday, or do we?

A friend of mine, and former teammate at the University of Washington Cam Cleeland had it great, or so he thought.  A second round draft pick of the New Orleans Saints in the 1998 NFL draft who went on to play 8 seasons in the League and retired in 2006.  Shortly after retiring he found himself in a persistent mental fog with occasional bouts of dizziness.  He began gaining weight and lacked energy.  He had bouts of anger and would fly off the handle at a moments notice.  He felt depressed and frustrated. 

He says, "Fans just see Sundays" they don't see the hits the players take in practice, during mini-camps, training camps and during practices during the long NFL regular season.  He suffered from eight diagnosed concussions over his college and NFL career.  There is no doubt that these head injuries and how they were medically handled played a role in the 3 years of fog Cam found himself in when he was done playing. 

Cam has been able to find a doctor, Daniel Amen who has been able to help him get his post football mental health challenges back in order.  Dr. Amen helped Cam by encouraging weight loss, regular exercise, mental exercises and nutritional supplements.  Cam says he has no regrets about playing football except he wishes his concussions were properly diagnosed and he was able to give his fragile brain the right amount of time for recovery. 

Is the Adolescent Brain More Fragile Than the Adult Brain?

These hits seem to be more severe for the adolescent brain.  A study in Neurosurgery showed that high school players that suffered two or more concussions had reported much higher rates of mental problems including headaches, dizziness and sleeping issues. 

Football concussions are also most likely to affect these developing areas such as the frontal lobes, responsible for many higher cognitive functions such as self-control and abstract reasoning.  The still developing adolescent brain requires more time than an adult brain requires to recover from a brain injury. 

An interesting piece of data has shown players with a history of concussions have statistically significantly lower grade point averages than athletes without a history of concussion.  Young football players are suffering concussions at higher rates than NFL players and many of these kids will not ever play the sport competitively again after high school, but are still having lasting consequences. 

Because children have relatively heavier heads and rapidly developing brains, this makes the frequency and severity of head injuries in children even higher, making recovery time even more important for them, according to Ann McKee, a neurologist at Boston University.  Dr. McKee has performed postmortem research on the brains of children, NFL players and soldiers. 

What can we do to protect our children from the fate of many retired NFL players living with mental health issues?

Develop a Plan

If you are willing to let your child play football you need to make a checklist.  Start by asking these questions to your son's high school football head coach and/or athletic director.

1.  Do you administer a pre-season ImPact test to all players?  The ImPact test is a twenty-minute neuro-cognitive assessment test. ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) is the first, most-widely used, and most scientifically validated computerized concussion evaluation system.  The day following a concussion a player is run through a posttest.  This helps the medical professional measure the decline in performance triggered by the injury. 

2.  Do you have a certified athletic trainer/medical personnel on the sideline during games?  Practice?  If not at practice do all the coaches have training on recognizing concussion symptoms and what to do if a player exhibits these signs?

3. Do you have a system in place for educating the players on the risks of head injuries?  Are all the players aware of what concussion symptoms look like and do they realize they can help monitor one another?  The coaches, players and parents should all sign a contract that shows they are all-in on concussion awareness and prevention.

4.  Is the equipment fitted properly to the athlete?  Proper sized ear pads, mouth guards and chinstraps are all a must.  The team should have a trainer or coach that fits this equipment to each athlete individually.  Experts are skeptical of 'anti-concussive' equipment and parents should be too. 

5.  Does the coaching staff spend ample time educating players on the technique and mechanics to proper tackling?  This is really the only way to help prevent and limit head injuries.  Avoidance of helmet to helmet hitting is a must and needs to be avoided at all costs and disciplined if it happens.  Is hitting limited throughout the week to help eliminate unnecessary risk of repeated blows to the head?

This checklist is not perfect and you cannot expect it to be a foolproof plan in avoiding head injuries, yet it does promote awareness and education along with a proactive approach to the protection of our children as they pursue the valuable and enjoyable aspects indwelled in the sport of football.

Should I Let My Son Play Football?

I found an article in the Los Angeles Times written in October of 2011, which piqued my interest.  I found it interesting that a young man at Arizona State University, quarterback Steven Threet, was quitting football at the age of 21.  Steven had noticed his short-term memory escaping him after 4 concussions and feared that another concussion could keep him from sipping coffee without shaking by the time he was 35 years old. 

Reading this story prompted me to ask other former NFL players to air their thoughts with regard to letting their own children play.  Here is what some of them had to say:

Benji Olson was a two-time consensus All-American offensive lineman at the University of Washington and was drafted in 1998 by the Tennessee Titans.  He played guard for the Titans for 10 years and played in a Superbowl in 2000.  He is letting his son play flag football until he gets older and then that is it.  He feels it is a very touchy subject when it comes to your own children, and being that he realizes all the risks involved and having experienced many injuries that limit him now at only 36 he stands firm with his choice. 

Dennis Homan who played wide receiver in the NFL from 1968 to 1972 played in Super Bowl V had a great perspective that his college coach at Alabama shared with him.  Dennis was coached by the great Bear Bryant and asked Coach Bryant his thoughts on when a player should start playing football and the former coach told him 9^th grade.  Because a child's brain is still developing and shouldn't play contact sports until they are a little older.  I really liked this advice because concussions are now the hype and the buzz.  40 years ago this wasn't the case.  Coach Bryant was ahead of his time. 

Another NFL player Chris Coleman, wide receiver for 3 years with the Tennessee Titans has three boys.  He is very aware of the dangers concussions pose and is very cautious with his children.  He has encouraged them to play some of the less violent sports, but it appears all three are just like their dad and love the sport.  He supports them but takes an active role in watching them and communicating with their coaches.  He trusts their coaches but wouldn't hesitate to pull the players himself if he felt he had to. 

These are just a few opinions from former players and all offer great advice and differing opinions on the challenging decisions parents have to make for their children.

One of the reasons I decided to write this article was based on a parent I had in my chiropractic office and questions she had about her son who recently had a concussion.  Interestingly enough this boy didn't even play football.  He was riding his bike and was hit by a car while crossing the street in a crosswalk.  Sure he had a helmet on and he is OK, but he had a concussion.  The concussion led him to see a neurologist and to have some additional tests, which showed he was good to go.  But his mom didn't think he was ready to go back to playing hockey just yet.  She noticed him being more emotional since the accident and that was the biggest difference she noted.  She wasn't sure if it was because she was not letting him go back to quench his passion for ice hockey or if it was because a young rapidly developing brain had some very minor damage in the frontal lobes which houses higher level cognitive thought and self-control functions.

Time passed and her son recovered and she realizes she made the right choice to rest her son's adolescent brain for as long as possible.  She loves hockey and has been following Sidney Crosby and his concussion nightmare that just won't go away.  She doesn't want that scary reality to be her sons.  Despite the flack, this hockey mom proactively watched over her precious developing adolescent so he has a better chance at a lifetime of enjoying the things he loves and will grow to love. 

All of the literature search and publication review has stirred a passion in me to help educate mothers and fathers, coaches and players to be aware of the potential for brain injury and just how you might be able to prevent it.  The more I dialogue on the topic of concussions many of my friends and patients alike ask me the question "Well Tony you played in the NFL and now you are a doctor of chiropractic and you have a son.  Are you going to let him play?"  I find this to be one of the most difficult questions to answer.  I tell them I just don't know. 

But I will tell you this, I was watching a replay of the NFC championship game between San Francisco and New York just the other day and I was engrossed and had the chills after a big sack by Justin Smith.  Experiencing that moment of chills made me realize just what I might be taking away from (or benefiting) my son if I don't let him play the game that I love. 

Tony Coats D.C.

Contact: tony@drcoats.com