concussion: looking out for those who are injured

Monday, November 13, 2017

As the NFL again takes flak this week for its head injury awareness with potential injuries to the Seahawks’ Russell Wilson, the Colts’ Jacoby Brissett and the Falcons’ Devonta Freeman, it’s important to remember that concussion symptoms can be subtle and have a delayed onset. The concept that a brief assessment on the sideline is sufficient to say yeah or nay on the diagnosis fails to meet the criteria set in the most recent consensus statemen from the 5th international conference on concussion in sport, held in Berlin in late 2016.

The bottom line for initial assessment is that all athletes, regardless on level of competition, should be removed from the field of play, if concussion is suspected. If the diagnosis is not in doubt, for example a player who is knocked out, briefly confused or has difficulty with balance, the player should not return to the game. If the diagnosis isn’t confirmed but suspicion exists, then the player needs to undergo sideline testing. But there is not one perfect test that can confirm or deny the diagnosis. Sideline screening can be done but it takes at least 10 minutes for most testing to be completed. While it can occur on the sideline, it is often better to find a quiet place to interview and examine the potentially injured player.

From the consensus guidelines:

“In cases where the physician may have been concerned about a possible concussion, but after the sideline assessment (including additional information from the athlete, the assessment itself and/or inspection of videotape of the incident) concussion is no longer suspected, then the physician can determine the disposition and timing of return to play for that athlete.”

And also from the same guidelines, an athlete with a sport related concussion should not be allowed to return to play on the day of injury.

There is a caveat that symptoms may be delayed and repeated evaluations are warranted. The problem is that the symptoms can be very subtle, from difficulty concentrating, to sleep disturbances, to changes in personality. The ability for the brain to function and process information may be affected so that concussed high school and college athletes may drop a full grade point in their classes for the ensuing semester.

As hard as it is to diagnose subtle head injury, it’s just as hard to decide when the brain has healed enough to allow the athlete to return to play. There is no test that confirms brain healing and most athletes recover within a month. Practically, return to play strategies take about a week if the athlete remains symptom free. That said, concussion symptoms may last for months.

Unfortunately for those who decide whether a Seahawk or Colt or Falcon can return to play, instant replay allows fans at home and in the stadium to witness the consequences of a hit to the head and judge for themselves whether the possibility of a concussion might exist. And when a referee sends a player off because of concussion concern, it’s incumbent upon the team’s medical staff to follow through with a thorough assessment. The player may not know what happened or realize that they were concussed; it’s up to the coaching and medical staff to protect the brain, even if the player actively refuses that help.

Until that is the standard of care, the NFL will continue to get flak.

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russell wilson is dangerous

Sunday, August 30, 2015

“I banged my head during the Packers game in the playoffs, and the next day I was fine,” says Wilson. “It was the water.” -Rolling Stone Magazine

“I didn’t have a head injury, but what I was trying to say is I think it helped prevent it,” he said. “I think your brain consists of like 75, 80 percent water, so I think that just being hydrated, drinking the Recovery Water, really does help.” -Huffington Post

‏@ DangRussWilson: I believe ‪@ Recovery_Water helped prevent me from getting a concussion based on a bad hit! 4:21 PM – 26 Aug 2015 -twitter

There are lessons to be learned from the latest quotes from Russell Wilson, the quarterback of the Seattle Seahawks. Science is hard work and it takes time, effort and skill to design a research study so that the results can be interpreted in a meaningful way. What Mr. Russell described was an anecdote, a story that links one event to another, without proving any relationship between the two. In the Rolling Stone story, he also mentioned a teammate who drank the water and recovered from a knee injury. It seems that Mr. Russell wants to put many orthopedic and neurosurgeons out of work.

According to the Huffington Post, the company that makes Recovery Water did not tout head injury prevention as a benefit of drinking their special water but they did say that their product “helps to jumpstart recovery from injury and muscle related stress while also decreasing symptoms of fatigue.” If only this could be proven, think of the many people who labor and use their bodies as tools, who could benefit from this product. If only there was research to support their claims. The company’s website offers studies to back their claims.

The next lesson has to do with reading the original text and deciding how good the science might be. Off to the World Wide Web for the four research studies listed by Reliant Recovery Water. Before we start, it is important to know that Reliant Recovery Water is a wholly owned subsidiary of Revalesio Corporation, a biotech company in Tacoma, Washington.

Link #1 Consumption of Revalesio Sports Beverage Alters Markers of Exercise. Performance and Cardio-respiratory Fitness in Healthy Males 

This is an abstract (summary) of the data collected on 25 men who drank either regular water or Revalesio Sport Beverage for two weeks and ran on a treadmill. The results show that in highly trained athlete, there was an increase in VO2max (oxygen consumption), a good thing, but the benefit was not statistically significant. In less fit athletes, there was a trend to decreased rating of perceived exertion, meaning the running didn’t seem as difficult.

The authors of the study work at Revalesio Corporation and perhaps cannot be considered independent and without potential conflict.

Link #2 is the same study but now as a poster presentation at an American College of Sports Medicine meeting. The purpose of scientific posters is to present work to an audience who is walking through a hallway or exhibit.

The information and data have not been independently reviewed.

Link#3 Oral consumption of electrokinetically modified water attenuates muscle damage and improves postexercise recovery

Published in 2013, in the Journal of Applied Physiology, they studied 40 untrained people, twenty who drank Recovery Water for 18 days and twenty who drank regular water. On the 19th day, the subjects did 3 sets of 20 bicep curls and had blood tests to measure chemicals that can be associated with muscle damage and inflammation. Measurements of muscle soreness and range of motion were also completed. They found that those who drank the specialized water had lower muscle damage markers in the blood but “…did not show any significant differences in muscle strength or soreness between the experimental and placebo-control groups after exercise. Both the EMW and placebo-control groups did demonstrate strength deficits of ∼22% at 48 h, followed by an equal recovery with residual strength deficits of 12–13% at 96 h postexercise.”

In 2014, there was a correction: The authors thank Dr. Andreas Kalmes (Revalesio Corporation) for assistance with manuscript preparation.

Link#4 Daily Controlled Consumption of an Electrokinetically Modified Water Alters the Fatigue Response as a Result of Strenuous Resistance Exercise

The same authors tested 40 relatively fit people who did not do any upper body lifting and gave twenty regular water and 20 Recovery Water for 18 days. They measured the maximum amount of weight each person could bicep curl, as well as rating of perceived exertion and fatigue. The people who drank the regular water had 20% less maximum strength measured after their lifting. And those who used the special water felt like they didn’t work as hard.

The authors thanked Dr. Andreas Kalmes (Revalesio Corporation) for help with editing.

Recovery water is plain water with a little potassium, magnesium and calcium added. Revalesio uses their technology to bubble oxygen through it to increase oxygen concentration. The preparation is relatively unstable and needs to be refrigerated.

It may be that Recovery Water is the next greatest thing since sliced bread but the scientific evidence that has been published and available for review is based on less than a hundred people who did bicep curls. As well, the literature cited on the company’s website was performed or written in house, leaving the potential bias and conflict of interest, The appearance of independence is lost.

As for Russell Wilson, it is fine for him to endorse any product he chooses, but he should not step outside his role as a quarterback and discuss how water prevents concussion. He is a quarterback who is not a scientist. He is a celebrity and now he is dangerous. Russell’s words carry weight. Many people, including kids, wear his jersey, imitate his on field mannerisms and hang on his every word. He has the power of his pulpit and should not abuse it.

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