Concussions...the never fading injury.

This week, the issue has been on my mind of concussions. First off, there was a lawsuit filed yesterday by 31 former NFL players against the NFL for lack of protection against them having concussions on the field. As far as this tidbit is concerned, my feeling is there wasn't much information or study on the injury back when most of these players were on the field and were getting concussed. It's not right that theses men were treated and evaluated like they were back then knowing now what we know about concussions, but who's really to blame. They were grown men when this happened so they could have made the choice not to play.  Don't get me wrong, I do care that these guys were injured, but I don't see myself suing McDonald's or Burger King if I have a heart attack due to the types of food they serve. Secondly, after reluctantly attending concussion training, now mandated by the State of Texas for all athletic trainers in high schools, this issue and injury has got me really thinking hard. Are we educating the general public enough?

Concussions are considered Mild Traumatic Brain Injuries or MTBIs for short.  They can occur in ANY sport and are often misdiagnosed.  The Brain basically sits in fluid inside of the skull so any sudden jerk or impact could cause a concussion.  The misdiagnosis comes from people, and sometime doctors thinking that if a CAT Scan of the brain comes back with no signs of trauma, the athlete is fine.  Well, this is a falsehood, because CAT Scans only see injury 3% of the time, so 97% of them are missed of this is the only tool used to diagnose.

Physical things one should look for if they suspect a concussion are loss of consciousness, dizziness or unbalanced, blurred vision, headache, nausea, even dilated pupils.  Mentally, one should look for confusion, loss of memory of time periods, irregular sleep patterns, edginess, light sensitivity, noise sensitivity, lack of ability to concentrate, mood swings and even depression.

The effects of concussion can last from a week or two to months.  An athlete really needs to be clear of all symptoms before they should attempt going back to practice or competitions, especially by their doctor.  If they are released too soon, there is a risk of second impact syndrome in which the athlete experiences some or all of the symptoms again, and then they are  back to square one in recovery . Younger athletes seem to be more susceptible to this.    If a concussion is not allowed to heal properly there can be long term or lasting effects that could last a life time.

In saying all of this, as parents, coaches or even athletic trainers like myself, we need to pay more attention when our kids get hit and then start showing the signs.  Nobody's brain or mind something we should lose to sports.  Lets let them heal and hopefully they will live a long, healthy life.

Baseball's In The Air

It's that time of year when America's number one pass time starts and people pack the stands to see their favorite teams swing the bat. Yes, I'm talking about baseball. Everyone sits down with their favorite drink in one hand and nachos or a hot dog in the other waiting to see those pro players hit the field and see their next hall-of-fame moment.

As no matter what level of play there is always a chance that players will get hurt at some point. One injury that seems to plague some pitchers is a Tommy John injury. Basically, this is a tear in the ulnar collateral ligament in the elbow ranging from partial to complete. When this occurs, players usually say they heard or felt a snap followed by immense pain. Usually they will tell you they can't go on pitching.

The pain occurs at the medial condyle of the distal end of the humerus and can be easily palpated there. Another way to tell is to have the athlete hold their hand palm up and then apply pressure to the outside of the elbow while holding their wrist (valgus stress.) If the elbow bends inward, this is a pretty sure sign of a UCL tear. At this point the athlete will have to see an orthopedic surgeon for a further exam and an MRI.

To fix this injury the surgeon goes into the elbow and drills a hole in the medial condyle of the humerus and the proximal end of the ulna. Then, after removing a tendon from elsewhere in the body (i.e. foot, forearm, wrist, hamstring), the surgeon creates a figure eight and loops the tendon through the holes previously drilled. The rehabilitation and return to play is approximately 12 months and full recovery happens 85 to 90 percent of the time.

It most commonly occurs in baseball pitchers but can occur in other sports too. Often pitchers come back throwing faster and more accurately than before the surgery. This is most likely due to the fact that such attention is paid to the strengthening and rehabilitation of the the arm of the athlete.

Just remember next time you go watch you favorite pitcher, they are putting it on the line every time to win the game!

Don't Forget to Hydrate

When the weather starts to warm up in the spring time, athletes tend to forget they need more water when training and competing. As the climate warms there can be a whole gamut of issues that arise, all the way from muscle strains to heat illnesses. It is estimated that when the body loses 2% of it's weight in fluids, you start dealing with heat cramps, nausea, confusion an dizziness. So how can we figure out what that is, first for the athlete and then for ourselves?

It is suggested by most experts that in a normal day of non-exercise and Utopian environment to consume 8-8oz. glasses(1/2 gallon) of water if you weigh 150 pounds. When dealing with an athletic population, this simple, run of the mill, equation won't work.

The better way to judge the fluid intake is to weigh before and immediately after a workout. Take the differences in weight and this shows how much water will need to be consumed. Lets say there is a 2 lb. loss of weight. A gallon of water weighs 8.34 lbs, so for every 2 lbs of weight lost during a work out, approximately 32 ounces of fluids will be needed to replace those lost. As an Athletic Trainer, I suggest water and electrolyte drinks to replace those fluids (more water than electrolytes). Try to stay away from caffienated drinks such as tea, soft drinks and even coffee while trying to rehydrate.

With theses simple tips, easing into the warmer parts of the year with workouts will not be quite as much of a shock to the body of an athlete or you own!