Post Concussion Syndrome


What is PCS?

With the advent of new information and a somewhat better understanding of traumatic brain injuries (TBI), specifically concussions, it seems like the medical community is headed in the right direction. However, there is still a great deal to learn about the true effects of TBI in relation to long term physiological changes. Post-Concussion Syndrome (PCS) is a long-term condition caused by TBI that is still not widely understood, and is often undiagnosed in athletic and non-athletic populations (2015). Whereas most TBI that result in concussion tend to resolve within 1 to 2 weeks, some concussion symptoms can persist for much longer depending on the severity of the original injury, and on how many times the individual has actually suffered a TBI over their lifetime. PCS, specifically, is roughly defined as any TBI related symptoms that persist for more than 3 months beyond the original injury. While there are some discrepancies about how many symptoms must be present for more than 3 months in order for there to be a proper PCS diagnosis, the general opinion is that there must be at least 2 or more persistent symptoms (2015). As with many TBI’s, these symptoms can include headaches, light/sound sensitivity, difficulty concentrating, balance issues, difficulty sleeping, and host of other persistent symptoms. Complications that can come along with such long-term symptoms can include depression, anxiety, and even post-traumatic stress disorder (PTSD) (2015). PCS can last for several months (3 or more), or can even last for several years depending on the factors that caused the original TBI.

Who is most at risk of developing PCS?

·       Athletes who play contact sports and have suffered multiple concussions over their sports career are at highest risk for suffering a TBI. As with many injuries, once an athlete suffers an initial TBI, they are much more likely to have a recurrence at some point in their future (2010). As such, these athletes are also most susceptible to prolonged concussion-type symptoms and potentially PCS as they receive additional concussions.


·       People who have suffered a particularly severe TBI, such as from a motor vehicle accident or falling from an elevated position are also at risk of prolonged, PCS type symptoms (2014).

·       People who are taking certain medications, such as those used to treat ADHD, are at risk of suffering from PCS (2010).

·       Members of the military who have been exposed to concussive blasts as part of their training or deployment to hostile areas have a predisposition to PCS because of their repeated exposure to such conditions (2011).

What are some ways to possibly avoid prolonged concussion symptoms and PCS?

            As with many injuries, the most immediate treatment option for reducing the amount of time that an athlete or patient suffers from concussion type symptoms is rest. While there is a bit of disagreement about how much and what type of rest is truly best for a person suffering from a TBI, it seems that rest immediately following the injury (i.e. 1-2 days) is the standard in most cases (2007). Such rest does not mean that the patient should lock themselves in a dark room and sleep the entire time, but does mean that the patient should reduce their use of electronics and physical activity during this period. Allowing the brain some time to start the healing process has been shown to reduce the period of time that the concussion symptoms will tend to persist. Recent research has shown that sub-symptom, individually controlled aerobic exercise does have some efficacy in reducing and/or eliminating concussion symptoms in both normal TBI populations and those suffering prolonged symptoms or PCS (2014). Such exercise has also been shown to reduce the incidence of depression and anxiety in patients during the recovery phase of a TBI, and in those suffering from PCS.

What are the treatment options for people suffering from PCS?

·       Treating the symptoms of PCS, such as headaches, and sleep issues through drug therapy has been shown to reduce the stress caused by such symptoms. However, drug therapy should not take the place of physical and psychological treatments.

·       Physical therapy that focuses on improving balance through exercise has been shown to be effective in reducing dizziness and balance issues.


·       Physical therapy that slowly introduces sub-symptom aerobic exercise has shown efficacy in reducing and/or eliminating symptoms in PCS patients.

·       Psychological therapy is effective in reducing and/or eliminating the incidence of depression, anxiety, and PTSD in patients suffering from PCS.

By: Hans Smelker, MS, LAT, ATC

Broshek, D. K., De Marco, A. P., & Freeman, J. R. (2015). A review of post-concussion syndrome and psychological factors associated with concussion. Brain Injury, 29(2), 228-237. doi:10.3109/02699052.2014.974674

Grubenhoff, J. A., Deakyne, S. J., Brou, L., Bajaj, L., Comstock, R. D., & Kirkwood, M. W. (2014). Acute concussion symptom severity and delayed symptom resolution. Pediatrics, 134(1), 54-62. doi:10.1542/peds.2013-2988

Leddy, J., Kozlowski, K., Fung, M., Pendergast, D., & Willer, B. (2007). Regulatory and autoregulatory physiological dysfunction as a primary characteristic of post concussion syndrome: Implications for treatment. Neurorehabilitation, 22(3), 199-205.

Logan, K. (2010). Recognition and management of post-concussion syndrome. Athletic Therapy Today, 15(3), 4-7.

MacGregor, A. J., Dougherty, A. L., Morrison, R. H., Quinn, K. H., & Galarneau, M. R. (2011). Repeated concussion among U.S. military personnel during Operation Iraqi Freedom. Journal Of Rehabilitation Research & Development, 48(10), 1269-1277. doi:10.1682/JRRD.2011.01.0013

Rose, S. C., Fischer, A. N., & Heyer, G. L. (2015). How long is too long? The lack of consensus regarding the post-concussion syndrome diagnosis. Brain Injury, 29(7/8), 798-803. doi:10.3109/02699052.2015.1004756

Swanson, E., Kurowski, B., Hugentobler, J. A., & Quatman-Yates, C. (2014). Feasibility and potential benefits of active rehabilitation for post-concussion syndrome in adolescents. American Journal Of Physical Medicine & Rehabilitation, a94.


Designing a Comprehensive Sideline Concussion Evaluation

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Many people, including fellow medical/healthcare professionals or parents are not familiar with what an Athletic Trainer is or what we in the profession do. I cannot begin to tell you how many times I have had to give my elevator speech to someone to explain how we are not personal trainers, but actually licensed healthcare professionals that work on injury prevention, injury management, and rehabilitation of injury! Which I think is sort of comprehensive when it comes to a job description for an AT. But, even though we are moving to a Professional-level degree with the MastersImage result for athletic trainer rule it does not change the over all view of our abilities. Fortunately, there is research backing up our capabilities in healthcare professions to effectively and properly diagnose. Lombardi et al (2016) published a study that found over the window of 2010 to 2015 across 5 regional high schools that the Athletic Trainer’s and Physician’s (MD or DO) diagnosis were the same 92% of the time! That’s right, a Bachelors educated healthcare professional’s prognosis was the same as an MD’s or DO’s 92% of the time, and when it wasn’t it was a mismatch between sprain and fracture (cool, I do not know a single AT that has an MRI or Radiograph on the sideline, so I will take that small loss).

Thus, it is safe to say that Athletic Trainers are spot on when it comes to concussion diagnosis. But, this brings us to discussing how then can an AT best design their sideline assessment to accurately capture a concussion diagnosis and potentially save lives… After all, according to the 5th International Consensus Statement on Sports Related Concussions (2017):

“SRC is considered to be among the most complex injuries in sports medicine to diagnose, assess and manage. (McCroy et al, 2017)”

Creating the perfect, timely, and most comprehensive sideline assessment of concussions is not easy, by any means. As we are beginning to learn, no single test is perfect and no single test should be used alone to establish a patient’s/athlete’s concussion diagnosis (McCroy et al, 2017; Broglio et al, 2014). Thus, the Athletic Trainer must develop a battery of tests that can be confidently and quickly administered to established the patient’s status on the sideline. After a good deal of review of the items out there, here is what I have come up with and implemented at my clinical setting:

Let’s set the stage with the AT is covering a football game when they see one of the Student-Athletes experience one of the multiple mechanism of injuries (MOIs) consistent with concussion, even better allow me to describe a likely one: The Wide Receiver takes off the line a clears his defender. He gets open about 20 yards off the line and the quarterback launches the football to him. The ball is a little high so he leaps into the air to catch the ball with his upper torso rotated to align with the catch. He receives the ball in the air with his eyes back where the ball was coming from. He does not see the opposing team’s Free Safety coming in who makes the hit before the Wide Receiver makes it back to the ground. The Wide Receiver hits the ground with his shoulders then helmeted-head and does not get up. Or any of these real-life examples:

Image result for concussion sideline gif

Image result for concussion sideline gif

Image result for concussion sideline gif

With this scene set, we have a few of the rotational-translations to the skull MOIs occurring, once on the initial hit to the Wide Receiver, another occurs when his head hits the field and there is potential of a third on rebound. Moral of the story, that is a solid MOI for concussion.

So here goes the sideline eval:

The Athletic Trainer does the AT-Jog out to the patient who is still on the ground and establishes consciousness (Glascow Coma Scale or GCS) and cognitive awareness with some light history questions.

  1. Check the patient’s neck in accordance with the SCAT5 procedures in order to rule out any fractures.
  2. Ask the patient if they have any numbness or tingling into the hands or feet, ask them to move them if possible in order to rule out neurological damage.
  3. At this point if there are no concerns we can move them to the sideline, if there are concerns then we are activating EMS/EAPs respectively.
  4. On the Sideline the AT would start by taking vitals for Heart Rate, PulseOx, BP, etc. This will be important for serial testing to know if the patient is getting worse or circling the drain as it were.
  5. Once vitals are done, its time for Post Concussion Symptom Scores (PCSS) and Maddox Questions. These are part of the SCAT5 and can be used to established symptom sets.
    1.  If they have no symptoms at this time, then the patient would be exertionally tested for a few minutes to see if the symptoms return. This could include burpees, sprints, change of direction, and other drills that should elicit symptoms in a potentially concussed patient.
      1. If this elicits symptoms they will continue to the sideline battery assessment.
      2. If they have no symptoms after exertional testing, then they are returned to play with no diagnosis of concussion.
    2. If they do have symptoms then we continue along to our sideline battery
  6. The sideline battery consists of a Cranial Nerve Assessment to rule out more Image result for concussion evaluationserious injuries, the remainder of the On-Field SCAT5, and the VOMS Screening.
    1. At my institution, VOMS was chosen over the King-Devick Test only because of the cost associated to the King-Devick Test, in my own personal opinion I must stress that I believe the K-D Test to be very strong and much faster than VOMS, it also produces more objective data than VOMS that can be used to justify diagnosis of concussion.
  7. If the patient is no longer demonstrating ANY symptoms or deficits in assessments, they will be exertionally tested as before, if they pass exertional testing without symptoms then they will be returned to play with no diagnosis of concussion.
  8. If the patient fails any of the evaluations or the AT feels there is something not right, then they will be moved to Off-Field assessments and serial tested for potential degradation of status.

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I personally believe this is an ideal and comprehensive sideline evaluation for concussion. Due to the fact that some sports have limited injury time and the nature of game play, it is important for ATs to be both timely and comprehensive in their evaluation of a patient for concussion. No matter what, the AT should feel confident in their sideline assessment and practicing the routine will always help in making it flow easy and timely.


By: Jeremy D. Howard, MS, LAT, ATC, CSCS, CES, PES, ITAT


Broglio, S.P., Cantu, R.C., Gioia, G.A., Guskiewicz, K.M., Kutcher, J., Palm, M., and Valovich McLeod, T.C. (2014). National athletic trainers’ association position statement: Management of sport concussion. Journal of Athletic Training, 49(2), 245-265.

Lombardi, N.J., Tucker, B., Freedman, K.B., Austin, L.S., Eck, B., Pepe, M., and Tjoumakaris, F.P. (2016). Accuracy of athletic trainer and physician diagnosis in sports medicine. Orthopedics, 39(5), e944-e949.

McCroy, P., Meeuwisse, W., Dvorak, J., Aubry, M., Bailes, J., Broglio, S., …, and Vos, P.E. (2017). Consensus statement on concussion in sport– the 5th international conference on concussion in sport held in Berlin, October 2016. British Journal of  Sports Medicine, 0, 1-10.

Concussion Baseline Neurocognitive Test Systems: Who’s the Best???

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I know the Football season is already in full swing, but this topic is an important one for parents, athletes, coaches, teachers/professors, and healthcare professionals to be aware of… The Baseline Neurocognitive Test for Concussions. But what is a Neurocognitive Test? The word itself ‘Neurocognitive’ sounds like something those guys and gals with the 1,000 lbs heads would use in daily conversation, not something a parent, coach, or athlete should know.

According to, ‘Neuro’ means: “pertaining to a nerve or nerves or the nervous system” while ‘cognitive’ means: “of or relating to the mental processes of perception, memory,judgment, and reasoning, as contrasted with emotional and volitional processes.” 

In other words, the naming convention for the test suggests that we are testing the patient’s neurological function and mental processing. Well, when it is broken down like that, it makes sense why this is important. After all, both the International Consensus Statement on Sport Related Concussion and the National Athletic Trainers’ Association (NATA)’s Position Statement on Sport Related Concussion suggest that all athletes should have a Neurocognitive/Neuropsych Baseline test completed prior to their season, in order to use this information as amplifying data in the recovery process of a concussed athlete (McCroy et al, 2017; Broglio et al, 2014). These are some major players in the concussion world that are taking a pretty sturdy stand for the necessity of this sort of testing to help protect athletes from long term brain damage or death.

So, you may ask yourself or a healthcare professional, “why do I need to use a computer-based test for this? If someone has brain damage they should know it and be able to tell someone as such.” Well, interestingly enough researchers have found deficits in neurocognitive function for up to 36 hours beyond a patient reporting they no longer have symptoms on a computer-based neurocognitive test (Broglio et al, 2014), meaning that even though the patient believes they are fine and healthy, they actually have mechanical and metabolic damage to the brain. Thus, the patient may not know they are still technically concussed. Worse yet, there is a major issue with underreporting of concussion symptoms due to fears of losing their place on the team, not thinking its a serious injury, or even simply because the athlete wants to play (Meier et al, 2014). This is why computer-based neurocognitive tests are vital to the health and long-term well being of our athletes.

Image result for concussion dangers

Now, that I hopefully have your attention, let’s dig into the meat and potatoes of what Neurocognitive Test is best. Though I am credentialed through ImPACT, I will only present factual and unbiased research and data to present the following overview of each system on the market today.

So, on the market today any healthcare professional looking to start using a neurocognitive test will have to chose between some very solid products, these include:

1) Immediate Postconcussion and Cognitive Testing test battery (ImPACT),

2) CogSport

3) Automated Neuropsychological Assessment Metrics (ANAM)

4) HeadMinder Concussion Resolution Index (CRI)

Image result for impact concussion testLet’s start with the ImPACT Test. First and foremost, ImPACT is currently the only neurocognitive test to be approved by the FDA (Moran, 2016), that is a very strong start when it comes to establishing a leader. Further, according to Resch et al (2013) ImPACT is the most widely used computer-based neurocognitive test on the market at 93%. Once, again this is not my bias, this information is all cited in the references! But, what about the true stats on the product? Does it do what it is supposed to do? Let’s see… According to Resch’s review of studies they found ImPACT to have a sensitivity (True Positive) of 81.9%-91.4% depending on the study’s population and a specificity (True Negative) of 69.1%-89.4%. Reliability Coefficients (Does it consistently test the same) were listed as ranging from 0.46-0.74 which comes out to be moderate to strong in reliability. Finally, there is validity (true representation of what is being tested), here Resch’s research found the ImPACT test to have a range of 0.31-0.59 which translates to the test being weak to moderate in validity. So, the test is not perfect, there is demonstrated weakness in it’s validity, and it can be moderate in its reliability, but the specificity and sensitivity are very strong scores for the test, at least according to Resch’s research!

Now, let’s chat CogSport. Resch’s research only had Image result for cogsport concussion testone study addressing CogSport and Sensitivity and Specificity, which they stated found that 70.8% of the tested athletes demonstrated deficiencies in their tests. while this is not necessarily as comparable to the research done on the ImPACT, it is valid information to know. With regard to Reliability, there were a few studies done and the ranges were from 0.14 (very weak)-0.94 (strong), this is a good deal of variability in the reliability. However, Resch’s research article does stress that each category did hit the bare minimums, at least, to qualify in the categories of measure. Finally, addressing validity Resch’s review of the literature found a range of 0.23-0.83 depending on the research study, also a huge swing.

Image result for ANAM concussion testThen there is the ANAM. This is a test, I had to take prior to going to Afghanistan with the Army. Resch’s research and review of literature found the ANAM’s specificity and sensitivity to be as follows: Specificity ranged from 86% to 100% and sensitivity was ranged from 1%-15% based on subtest being gauged. When it comes to the reliability of the test, Resch’s research review found that there was range from 0.14-0.86. Another one that is a little wide. This bring s the topic to the validity of the test, here Resch’s group found that of the studies conducted on the test there was a range from -0.01 to 0.65.

The final test to look at is the CRI. Resch et al (2013)’s research looked at the same Image result for HeadMinder Concussion Resolution Index (CRI)subset data for this test as the others after reviewing all the pertinent research on this neurocognitive test. With regard to sensitivity and specificity, the two articles reviewed on this test did not use control groups; thus, no specificity is established. However, the sensitivity was rated at a range of 69% to 78.6%. Reliability ranged from 0.03 to 0.66, and the validity for this test was found to be 0.37 to 0.70.

Unless you are a reseacher this may not have made much sense to you. But let’s see if this helps: The Specificity and Sensitivity ranges place the ANAM and ImPACT at the top of the list, the Reliability ratings of the tests placed CogSport and ANAM to be highest overall, but ImPACT had the closest overall range, and the validity ratings placed all tests above the ImPACT, though once again, the ImPACT had a closer overall range. What seems to be paramount to understand here is that ImPACT performed well across all variables, not always the best, but well, and is the only one that is FDA-approved.

Before selecting a neurocognitive test to use, do the research and compare the tests to see what is best in your own eyes!


By: Jeremy D. Howard, MS, LAT, ATC, CSCS, CES, PES, ITAT


Broglio, S.P., Cantu, R.C., Gioia, G.A., Guskiewicz, K.M., Kutcher, J., Palm, M., and Valovich McLeod, T.C. (2014). National athletic trainers’ association position statement: Management of sport concussion. Journal of Athletic Training, 49(2), 245-265.

McCroy, P., Meeuwisse, W., Dvorak, J., Aubry, M., Bailes, J., Broglio, S., …, and Vos, P.E. (2017). Consensus statement on concussion in sport– the 5th international conference on concussion in sport held in Berlin, October 2016. British Journal of  Sports Medicine, 0, 1-10.

Meier, T.B., Brummel, B.J., Singh, R., Nerio, C.J., Polanski, D.W., & Bellgowan, P.S.F. (2014). The underreporting of self-reported symptoms following sports-related concussion. Journal of Science and Medicine in Sport, XX, 1-6.

Moran, M. (2016). FDA-approved devices assess cognition after possible brain injury in youth. Clinical Research News. Accessed from

Resch, J.E., McCrea, M.A., and Cullum, M.C. (2013). Computerized neurocognitive testing in the management of sport-related concussions: An update. Neuropsychology Review, 23,335-349.

The Concussive Blast

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As a Soldier, this topic is near and dear to my heart! After learning so much about concussions I have began to think back to war movies such as  Saving Private Ryan (click on the link and watch at around 4:30 in to the video), where Tom Hanks character (Captain Miller) is taking the beachhead on D-Day, as he is exciting the water a concussive blast hits and everything slows down, ambient noise goes away, and he is essentially numb to what is going on around him. Reflecting back now, I realize this was a portrayal of a concussion associated to a concussive blast. Just think about how often they showed his shaking hand after this, now it could be associated to some PTSD from the action they saw in Anzio but still it’s a good point to think about. Often in this blog we broach the topic of concussion from the athletics perspective, but rarely do we approach the topic from the military perspective.  So, this week’s topic is sure to take on the challenge!

According to a Congressional Report in 2007 by Wilson, Improvised Explosive Devices, or IEDs, have become the primary weapon of the enemy forces in Operation Enduring Freedom (OEF), Afghanistan and Operation Iraqi Freedom (OIF), Iraq. Wilson (2007) cites that IEDs have been the leading cause of combat casualties in each theater with 70% in Iraq and 50% in Afghanistan. While citing daily uses of this asymmetric threat to our Warfighters would be a violation of Operational Security (OPSEC), I think with such high percentages of casualties associated to this platform of destruction it is fair to say that many of our American Warfighters have been exposed to the threat!

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But why is this important when speaking on the subject of concussion? Well, I am glad you asked this ‘head-scratcher’. You see, according to MacDonald et al (2014) concussive blasts have been associated to TBIs in military personnel. Further, we know from Broglio et al (2014) in the National Athletic Trainer’s Association Position Statement, that a concussion is a mild traumatic brain injury, or mTBI. Thus, when we when we take the time to synthesize this data, it becomes far easier to understand, from the healthcare professional’s perspective just what Tom Hank’s character was enduring on D-Day.

Unfortunately, many Warfighters from all branches (Army, Marines, Navy, Air Force, and Coast Guard) have been exposed to this threat. In-fact according to the Defense and Veterans Brain Injury Center (2017), the total TBIs sustained in the Department of Defense (DOD) from the year 2000 through 2016 was 361,092! Further, of the 253,330 TBIs that occured from 1 January 2000 through 20 August 2012, 77% were categorized as mTBIs, the same as the athletic concussion we are more familiar with (Fischer, 2013). Those are some major numbers…

What this author finds truly troubling is that there are common symptoms between both TBI and Post-Traumatic Stress Disorder or PTSD by its more common moniker. This can make diagnosis of the two challenging for healthcare providers, especially as they can have a similar mechanism of injury.

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To add just a little more fuel to the fire in this discussion there has been an interesting link drawn between TBI and PTSD, could having one make  a Warfighter more susceptible to contract the other?  Summerall and McAllister (2010) drew a conclusion that a history of TBI could make one more susceptible to PTSD, and there it is…

Many people are familiar, now, with the NFL and CTE research of Dr Omalu as theImage result for ptsd tbi movie Concussion brought attention to the concern. When I think about the casual link being seen between a history of concussion, a mTBI, and this potentially leading to CTE, I cannot help but draw the conclusion that it must be on a similar spectrum as the link we are seeing between a history of military-related TBI and PTSD. This author and Sports Medicine Professional believes additional research should target this population to see if any findings from either side can assist the other, NFL or military. In the need to do better by not just our athletes but our Service Member and Warfighters; after all, not all wounds are visible!

By: Jeremy D. Howard, MS, LAT, ATC, CSCS, CES, PES, ITAT


Broglio, S.P., Cantu, R.C., Gioia, G.A., Guskiewicz, K.M., Kutcher, J., Palm, M., and Valovich McLeod, T.C. (2014). National athletic trainers’ association position statement: Management of sport concussion. Journal of Athletic Training, 49(2), 245-265.

Defense and Veterans Brain Injury Center. (2017). DOD worldwide numbers for TBI. retrieved from

Fischer, H. (2013). U.S. military casualty statistics: Operation new dawn, operation iraqi freedom, and operation enduring freedom. CRS Report for Congress.

Mac Donald, C.L., Johnson, A.M., Wierzechowski, L., Kassner, E., Stewart, T., Nelson, E.C., Werner, N.J., Zonies, D., Oh, J., Fang, R., and Brody, D.L. (2014). Prospective assessed clinical outcomes in concussive blast vs nonblast traumatic brain injury among evacuated US military personnel. Journal of the American Medical Association, 71(8), 994-1002.  

Summerall, E.L. and McAllister, T.W. (2010). Comorbid posttraumatic stress disorder and traumatic brain injury in the military population. Psychiatric Annals, 40(11), 563-580.

Wilson, C. (2007). Improvised explosive devices (IEDs) in Iraq and Afghanistan: Effects and countermeasures. CRS Report for Congress.


Subtle Difference Between Head-Up and Head-Down Tackling

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Allow me to set the scene, I have been working Collegiate Football for a bit now and the other morning, before the sun had risen, I was covering a practice. There I was with my water bottles watching the Defense work on a tackling drill, and I was amazed how subtle a difference it is between the ideal head-up and the horrible head-down tackling style.Image result for head down tackling

The importance of the drill is vital. A head-down tackle, or spear tackling by its more common moniker, lines up everything perfectly for a world of pain and hurt for the athlete and is the leading reason why the sport of Football experienced a major change in tackling rules in 1976 (Heck et al, 2004).  The following excerpt is from the 2004 Position Statement by the National Athletic Trainers’ Association addressing the issue with Head-Down Tackling:

“Axial loading of the cervical spine resulting from head-down contact is the primary cause of spinal cord injuries. Keeping the head up and initiating contact with the shoulder or chest decreases the risk of these injuries.”

But think about the popularity being built around spear tackling through things such as professional wrestling:

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Or, what about spear tackling in Rugby?

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Well, that also lends itself to the discussion on the issue in American Football. In previous blogs we have discussed just how wearing equipment can give an athlete a false sense of security against injury and how those athletes then tend to adopt dangerous behaviors that predispose them to catastrophic injury. American Football, unlike Rugby or Professional Wrestling, uses equipment designed to prevent the skull and other portions of the body from being damaged. However, the equipment does not and cannot prevent the axial load from a spear style tackle being transmitted down through the spine and leading to many horrible outcomes, such as quadriplegia (Heck, 2004).

One of the major issues brought to light in the 2004 position statement on tackling was that many officials were not enforcing the rule that had gone into effect in 1976. I know your probably thinking to yourself, this research article came out in 2004 and it is now 2017… working on 2018 for that matter. There is no way this is still an issue in the sport. Well, according to College Sports Scholarship (2017), there was a study conducted by Tulane University and the Louisiana Office of Public Health found some shocking results…

“600 football players from 16 southeastern Louisiana high schools and found that 29 percent thought that using the top of their helmets to tackle was legal, 32 percent thought head-butting an opponent was legal and 35 percent thought it was permissible to barrel over an opponent headfirst.”

You would think that a rule created in 1976 for the sport to prevent major injuries would be a little better well known to the athletes playing the game. Oh, but wait… Maybe that is just the athletes, we all know not all athletes know all the rules… Sadly, there is more, the study also addressed the coaches, and here is what they found:

“Of the coaches at those 16 schools, only two said they’d shown a blocking and tackling safety video distributed free by the Louisiana High School Athletic Association, three refused comment, five said they hadn’t had time to show it and six believed showing the tape to their players would curb their aggressiveness.”

That’s right, potentially life-saving sport techniques that have been proven to keep athletes safe and in the game couldn’t be instructed due to a lack of ‘time’ and the fear that it would curb their aggressiveness… Image result for head down tackling

The moral of the story here is that proper technique is vital! Coaches play an important role in teaching proper technique and helping us, as Athletic Trainers, by not letting their athletes conduct dangerous styles of play.

Let me make this statement here, this is not an attack on coaches, but it needs to be said. No coach should ever use an excuse of a lack of time or a fear of curbing the athletes aggressiveness when it comes to the safety of their athletes. If you are a parent, an athlete, or a healthcare practitioner that deals with student athletes, the question should be posed to the coaching staff. If you are a coach you should put in the due diligence to help keep your athlete in the fight and playing the game! After all, the difference may be subtle, but it is an important one!

By: Jeremy D. Howard, MS, LAT, ATC, CSCS, CES, PES, ITAT


College Sports Scholarships. (2017). Spearing in football. Retrieved from

Heck, J.F., Clarke, K.S., Peterson, T.R., Torg, J.S., and Weis, M.P. (2004). National athletic trainers’ association position statement: Head-down contact and spearing in tackle football. Journal of Athletic Training, 39(1), 101-111.


Does Youth Football Need Tackling?

Image result for no tackling in youth football

BLUF: All concussion cannot be prevented, the most effective reduction measure would be to remove tackling from Youth Football until the age of 16, but that would bring about a good deal of social pressure.

Let me preface this article with stating that I want to preserve the integrity of the sport in all of its athleticism and visual appeal. So, bear with me here… Don’t just read the title of this blog post and never come back, because it is my intent to present to you a few different sides of the story, with that ammunition in hand you can come to your own conclusion on tackling in youth football. Image result for tackling youth football gif

If all youth football tackles looked as textbook as this one ———————–> Then, many of the problems we are about to discuss would not be a major concern. This kid is looking where the the tackle is going to be made and does not use the head as a weapon.

Unfortunately, we end up seeing a few more tackles like this… It’s just brutal to watch.Image result for spear tackling youth football gif

It is estimated that there are approximately 3,000,000 youth players of football, this number simultaneously dwarfs and puts to shame the 2,000 professional football athletes, 100,000 collegiate football athletes, and of course the 1,300,000 high school football athletes (Kontos et al, 2013). Of the 23,000 annual Emergency Department football related non-fatal TBIs, 90% occur in the adolescent (youth) ages of 5-18 years (Syd & Johnson, 2012). Arguably, the biggest point to discuss is that multiple researchers have found youth athletes with histories of concussion have presented with lingering neurological and cognitive deficits for up to 3 years (Syd & Johnson, 2012)… that’s 36 months, 156 weeks, or 1,095 days.

Many discussion have come down the line to help with what the CDC has labelled as an epidemic of concussion (Kontos et al, 2013). Some of these concepts scientists and researchers have included the dreaded and debated removal of tackling, hit counts for athletes, rotating specialty players, rule changes on starting positions, season length concerns, and a slew of other potential fixes (Syd & Johnson, 2012).  But, why are these considerations of such importance in this population? Let’s dive in a little deeper to the developing brain of the youth athlete and see what research has found…

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According to Kontos et al (2013) post concussion, youth athletes demonstrate far worse outcomes then other populations. Referring back to Syd and Johnson (2012), concussions are traumatic disruptions of the brain’s physiology and that children can experience deficits in cognitive function for up to 3 years! They pose this to be due to neuromaturation processes being disturbed due to the injury. We are all ready well versed from previous topics that this same population is in danger of Second Impact Syndrome, and some researchers have even found CTE in a 20 year old’s brain post-mortem  with no history of concussion, just sub-concussive impacts… That’s serious. Image result for developing brain

Another point for risk factors in this population that is brought up is the developing brain of the youth athlete. We know that kiddoes grow 2-4 inches per year in puberty, this can lead to under developed muscles that frame and support the spine, neck, and head, the immature nature of the myelin sheaths of both the CNS and PNS can effect nerve transmissions, cranial bones are less protective, and the body is still acquiring cognitive and physical skills (Norton et al, 2013). In this state of development, it is clear that any damage to the brain’s physiology could potentially arrest development down the line, this makes the 3 year cognitive deficits make a little more sense, though sad.

The question becomes, how do we make the sport safe for our kiddoes (youth athletes)Image result for different size children of same age yet maintain the integrity of the sport for what it is? Can we truly remove tackling from the sport? Syd and Johnson (2012) suggested that due to the major differences in athlete size up until the age of 16 (see picture below for reference), and considering only 6% of American Football players will go on to play Collegiate ball while only 0.08% will ever make it to pro-level, that we could tentatively remove tackling from youth football. They suggest teaching the skills and drills of tackling sub-16 years old, gradually bringing them to full contact football. This would fall in-line with current best practices recommended by the American Academy of Pediatrics recommendations for ice hockey and body checking. But, would making this change be received well?

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I highly doubt it!  I can just feel the mob coming now…

So, what do we do that can make the sport safe but still receive social support for the changes? Syd and Johnson’s (2012) suggestion to remove tackling from youth football was not their only recommendation and they acknowledged that making the posed change would not receive great support.

They also posed other rule changes such as decreasing season games, as most injuries occurred in game and not practice. The reinforcing of head’s up tackling drills in practice in order to build the baseline of skills for tackling was also mentioned. Not permitting the athletes to start in the 3 point stance, rather having them up in the 2 point stance to prevent head-down (spear) tackling, was also mentioned, and of course the ever elusive ‘hit-count’ concept. We use a pitch count on pitchers at all levels for their well being and longevity, why can’t we adapt this to a hit count concept for players?

Could these adaptations be more socially well received? I find this to be far more likely than removing tackling all together. I do think that limiting live-action practice/games for youth will be vital and using these times to expand on proper form to ensure the heads up tackling method is always used will better prepare our youth athletes for moving on to high school athletics, then to collegiate, and if they are lucky… pro ball!


By: Jeremy D. Howard, MS, LAT, ATC, CSCS, CES, PES, ITAT


Kontos, A.P., Elbin, R.J., Fazio-Sumrock, V.C., Burkhart, S., Swindell, H., Maroon, J., & Collins, M.W. (2013). Incidence of sports-related concussions among youth football players aged 8-12 years. The Journal of Pediatrics, 163, 717-720.

Norton, C., Feltz, S.J., Brocker, A., & Granitto, M. (2013). Tackling long-term consequences of concussion. Nursing, 50-55.

Syd, L., & Johnson, M. (2012). Return to play guidelines cannot solve the football-related concussion problem. Journal of School Health, 82(4), 180-185.

Helmets Vs Concussion

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Bottom Line Up Front (BLUF): Helmets don’t stop concussion!

Working in a Sports Medicine Department for a collegiate athletics program and being a Soldier in the United States Army and Florida Army National Guard, I cannot begin to tell you how many times I have heard an athlete, coach, parent, Soldier, etc. make a statement along the lines of, “My helmet will keep me safe from concussion.” Image result for death

The sad part here, is that this bit of misinformation could be lethal

The National Athletic Trainers’ Association, in their Position Statement on Concussions (2014), has began pushing for Athletic Trainers to support the use of certified helmets. The go-to in the field now is the National Operating Committee on Standards for Athletic Equipment, or NOCSAE, and according to them:

“Serious brain and neck injuries leading to death, permanent brain damage or quadriplegia (extensive paralysis from injury to the spinal cord at the neck level) occur in football. The toll is relatively small but persistent, averaging 1.44 fatal or severe, nonfatal brain or spinal cord injuries annually for every 100,000 players. HELMETS DO NOT PROTECT THE NECK, and none of these injuries can be completely prevented due to the tremendous forces occasionally encountered in football collisions; but they can be minimized by manufacturer, coach and player compliance with published rules of play, proper coaching, and in the case of head and brain injuries, compliance with accepted equipment standards.”

It is safe to take this quote to the bank! NOCSAE takes on certifying athletic headgear for various sports in its ability to protect from skull fracture or other dangers to theImage result for concussion gif external portions of the head, it has no chance of protecting the brain against any of the proposed mechanisms of injury that have been known to cause concussion, the coup-contrecoup, axonal torsion, concussive blast, or even non/sub-concussive cumulative impacts. No matter how much padding you put around the head it wont stop a concussion!

So, where does this lead us? The 5th International Consensus Statement on Sports Related Concussions, held in Berlin (2017), addressed the use of protective equipment in an attempt to stop concussion. When it came to helmets, here is what they had to say:

“The evidence examining the protective effect of helmets in reducing the risk of SRC is limited in many sports because of the nature of mandatory helmet regulations.”

Further, compare this to the National Athletic Trainers Association’s Position Statement on Concussion, and here are their thoughts on helmets:

“…although such helmets help to prevent catastrophic head injuries (eg, skull fractures), they do not significantly reduce the risk of concussions”

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Looking at two predominant official statements by major players in concussion research and seeing what they think, It seems clear that super-sizing helmets or the wear of any headgear will not truly stop the frequency of concussions!

Another major concern, is that research suggests that athletes wearing protective headgear may have a false sense of security against injury or even be more prone to use their head as a weapon, a dangerous thing in sport that can put them in danger of far worse injury than a concussion (Swartz et al, 2015). Swartz’s research posed a training concept for tackling in practice only without headgear on, they designed a process of slowly increasing intensity from static training through walking to tackle, to full speed once ready, and their research showed great potential in decreasing head-down tackling in football athletes! The group with the helmet-less tackling training decreased their head impacts by 30%.

Knowing this information, we may start to ask, “Well, if helmets don’t protect against concussions, then why does my son/daughter need to wear one?” That is a valid question, but we must always remember that while helmets don’t protect against concussions, they do keep our children and Warfighters safer from skull fractures!

Image result for concussion military blast

In the end, helmets are a necessary evil. They may not prevent or reduce concussions, but they do help in decreasing skull fractures and lacerations. It takes proper training in tackling form, concussion education, rule enforcement, and good sportsmanship to limit the rate of concussions. Remember tackle with your head up!


By: Jeremy D. Howard, MS, LAT, ATC, CSCS, CES, PES, ITAT


Broglio, S.P., Cantu, R.C., Gioia, G.A., Guskiewicz, K.M., Kutcher, J., Palm, M., and Valovich McLeod, T.C. (2014). National athletic trainers’ association position statement: Management of sport concussion. Journal of Athletic Training, 49(2), 245-265.

McCroy, P., Meeuwisse, W., Dvorak, J., Aubry, M., Bailes, J., Broglio, S., …, and Vos, P.E. (2017). Consensus statement on concussion in sport– the 5th international conference on concussion in sport held in Berlin, October 2016. British Journal of  Sports Medicine, 0, 1-10.

National Operating Committee on Standards for Athletic Equipment [NOCSAE]. (2011). Statement of shared responsibility. Retrieved from

Swartz, E.E., Broglio, S.P., Cook, S.B., Cantu, R.C., Ferrara, M.S., Guskiewicz, K.M., and Myers, J.L. (2015). Early results of a helmetless-tackling intervention to decrease head impacts in football players. Journal of Athletic Training, 50 (12), 1219-1222.

The Q-Collar for Concussion Reduction

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BLUF (Bottom Line Up Front): Concussion is an internal problem, not external.

Annual speaking, Sports Related Concussion, or SRC, occurrence rated are approaching endemic levels. With an estimated range of 1.6-3.8 million per year (Broglio et al, 2014) occurring in sport and 300,000 annual visits to the Emergency Department according to the CDC (1997), many researchers and clinicians have started looking at various preventative measures. Let me assure you there are some pretty wild concepts of Concussion Prevention being discussed and not all is legitimately supported by valid, unbiased, and peer-reviewed research. Image result for gif head airbag

The first approach most people think about addresses that often a concussion occurs from a blunt force trauma to the head (though there are other mechanisms of injury for concussion this is the most commonly known). Along this lines of thinking many of the concussion prevention products addressed are typically based on padding the head. An example is an air bag system developed for cyclists that deploys when a fall is sensed by the system.

Another external fix for the concussion endemic is the Full 90 Soccer Headgear. The link leads to YouTube where there is a video of an NBC News on the Full 90 headgear Image result for full 90 concussion bandfor Soccer. The designer posed the idea and claims that it will decrease concussions by something like 50%… Dr. Cantu (we will cal him the man when it comes to Concussion research), tears the product to pieces. Aside from Dr. Cantu’s expert opinion, just listen to the video and it is ripe with inconsistency on the product preventing concussion. The video highlights  Natasha Helmick, a women’s soccer player that played on the Olympic Development Team before being forced to quit the sport from a high frequency of concussions (5 after starting to wear the Full 90). Worse off… she had to drop out of college due to the long-term effects of her extensive concussion history.

But, why doesn’t this idea of throwing on padding to the head stop or decrease concussions? As I mentioned in the BLUF, concussion are an internal problem, they are caused when the brain either rotates and causes axonal torsion or from a coup-contra coup impact against the inside of the skull. The brain is not snuggly fit in the skull, there is room to move.

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Image result for gif brain movement in skull


But, if external padding doesn’t work… then what will? Well, I mentioned in the BLUF once again that concussions are an internal problem. While we cannot go in and screw down the brain we can work externally to address the internal problem. In-fact, Q30 Technology, has developed just such a promising product, the Q-Collar. According to Myer et al (2016), the inspiration for this product came with the realization that there are less concussions occurring at higher altitudes.

“We postulated that acclimatisation to altitude may have influenced an
increased intracranial blood volume, resulting in a tighter fit of the brain within the cranium. The proposed physiological response to decreased relative ambient oxygen (thus increasing intracranial flow and volume) was speculated to have protected the athletes at higher elevations against sports-related TBI. “

The product mimics these natural outcomes by placing pressure over the jugular vein, Image result for q-collarnot the artery, thereby increasing the density and viscosity of the fluids protecting the brain. The effects are less sloshing of the brain back-and-forth during impacts. This is an awesome idea when looking at the levels of G-forces experienced in sport during impacts. According to Broglio et al (2011), over an 8 year period of 4 years of starting high school football and 4 years starting college football, a player is expected to have over 8,000 head impacts, with a mean g-force of 20.9g-22.25g and a cumulative of 183,834g assaulting the brain. That’s a LOT of Gs!!!

Image result for g-force brain

The Q-Collar address this concern, and the research by Myer et al (2016) stated that thy found promising outcomes in animal models:

“This approach demonstrated an 83% reduction in amyloid precursor protein positive axons—a widely accepted biomarker of TBI— during a 900 g impact protocol studied in animals.”

When conducted on human models, the study found positive outcomes to decreasing these cumulative loads being placed on the brain. After an intervention of the Q-Collar being placed on 32 athlete for a season of game play, they found that the intervention group of 32 (Q-Collar Football Players), had significantly less brain diffusivity (a marker of brain injury) than the control group (30 Football Players without Q-Collar), this was found to be rather accurate with statistical measurements. They concluded that the Q-Collar may help decrease potential for injury to the brain!

Right now, you cannot get your athlete or self a Q-Collar, they are still in the research phase and have not moved to mass sales and distributions, but go check out their pages to stay abreast in their outcomes: Facebook , LinkedIn, and Website.

Here is a key take-away though, concussion cannot be prevented! What we can work on is reduction of occurrence of the injury through proper concussion education, form training, rule enforcement, rule change to protect the athletes, training on peripheral vision, and items such as the Q-Collar. Internal interventions to internal problems!


By: Jeremy D. Howard, MS, LAT, ATC, CSCS, CES, PES, ITAT


Broglio, S.P, Cantu, R.C., Gioia, G.A., Guskiewicz, K.M., Kutcher, J., Palm, M., & Valovich McLeod, T.C. (2014). National athletic trainers’ association position statement: Management of sport concussion. Journal of Athletic Training, 49(2), 245-265.

Broglio, S.P., Eckner, J.T., Martini, D., Sosnoff, J.J., Kutcher, J.S., & Randolph, C. (2011). Cumulative head impact burden in high school football. Journal of Neurotrauma, 28(10), 2069-2078.

Kelly, J. (1997). Sports-related recurrent brain injuries — United States. CDC Morbidity and Mortality Weekly Report, 46(10), 224-227. Accessed from

Myer, G.D., Yuan, W., Foss, K. D. B., Thomas, S., Smith, D., Leach, J., Kiefer, A.W., Chris, …, & Altaye, M. (2016). Analysis of head impact exposure and brain microstructure response in a season-long application of a jugular vein compression collar: a prospective, neuroimaging investigation in American football. British Journal of Sports Medicine, 0, 1-11.

Concussions and the Classroom

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The uniqueness of the brain, its developmental process, and its functions are not lost on healthcare providers when it comes to concussion. Concussions are defined as a traumatic brain injury (TBI) which impair neurological and cognitive (mental) functions (McCroy et al, 2017). Youth-athletes that sustain a concussion have been a recent area of focus in concussion research due to the nature of the developing brain at those ages and the unknown long-term consequences that could be associated to sustaining a brain injury at that young age (McAbee, 2015).

Traditional treatment options for concussed student-athletes asked for a 24-48 hour rest period to allow for symptoms to lessen then once the patient had returned to their baseline on neurocognitive tests (ImPACT, ANAM, CRI, etc.) they could initiate a graduated return-to-play (RTP) protocol that over six steps slowly exposed the patient to increasing levels of physical stress to see if symptoms could be elicited to qualify the patient to be fully returned to activity.

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However, more recent research has looked at the importance of slowly re-integrating the patient into the classroom. As an example of this, Halstead et al (2013), as part of the American Academy of Neurology, suggested that premature return to the classroom for a concussed student could present with major cognitive difficulties including learning new tasks or remembering old tasks. This is of major concern for any student-athlete or parent of a student-athlete as there is potential for decline in GPA associated to these issues. Decline of GPA can affect acceptance to college/university for a high school student, potentially throw off SAT/ACT scores, and have the ability to disqualify a student for potential grants and scholarships!  For the collegiate student-athlete, a decline in grades and GPA could affect their eligibility to play, standings on the team, and Image result for concussion learningboth athletics and academic scholarships. All of these potentially affect the long-term goals of student.

This concern for the student-athlete has become such a major issue in the field that for the first time in 20 years of international consensus statements being published, the fifth consensus statement in Berlin published an example Return-to-School graduated protocol (McCroy et al, 2017). This example protocol, shows potential academic accommodations that can be given to a student-athlete to facilitate the best possible environment for their recovery and long-term health and well-being. However, each concussion is unique, in-fact, research in 2014 suggested that there are actually six different clinical trajectories, of which each have different academic accommodation needs specific to the trajectory (Collins et al, 2014).

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I know you may be thinking, “What about 504 Accommodations?” Well, TBI is one of the 13 qualified disabilities for an official 504 academic accommodation to be set into Related imagemotion. The issue surrounding this is that the symptoms associated to a concussion typically subside after 7-10 days (McCroy et al, 2017), and due to state-variance in the 504 process the student-athlete may already be recovered by the time the official 504 is put into effect to protect their recovery needs. Further, collegiate student-athletes do not fall under the 504 or IEP process, these student-athletes have a separate process at the institution of learning.

Where do we go from here? In the case of the process taking far too long to be beneficial for the student-athlete’s recovery, there can be developed a local policy to abbreviate the process or establish a collegiate level process unique to the student-athletes. Administrators can work together to establish a plan of action, if your high school, college, university, or academy has an Athletic Trainer then they should be involved in the process, along with a Team Physician, Neurologist, Pediatrician, Guidance Counselor, Academic Advisor, School Nurse, Teachers/Professors, intervention specialist, etc. All of these stakeholders can bring a unique approach/intervention to the care of the concussed student-athlete and pre-establishing this group can lead to an effective abbreviated process.

From the Athletic Trainer’s perspective implementation should look like this:

  1. Concussion Diagnosis
  2. 24-48 Hours of Cognitive and Physical RestImage result for concussion learning
  3. Notify Team of Concussion Players
  4. Implement Academic Accommodations
  5. Daily Symptom Checks
  6. Full Return to School/Learning/Academics
  7. Baseline on Computerized Neurocognitive Test
  8. Initiate Return to Play Protocol
  9. Return Athlete to Sport

As can be seen, the student-athlete must complete their academic accommodations and be fully returned to school prior to initiating the graduated Return to Play Protocol. This is important as the use of academic accommodations should be seen as the patient still being technically symptomatic for concussion. Overall, we must put in the due diligence to take care of this vulnerable population. The research still is unsure of what potential long term effects could come with a history of concussion, particularly when referencing the youth-athlete population. It’s always better to play it safe then to risk the health and well-being of the student-athlete!


By: Jeremy D. Howard, MS, LAT, ATC, CSCS, CES, PES, ITAT



Collins, M.W., Kontos, A.P., reynolds, E., Murawski, C.D., & Fu, H.H. (2014). A comprehensive, targeted approach to the clinical care of athletes following sport-related concussion. Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA, 22 (2), 235-246.

Halstead, M.E., McAvoy, K., Devore, C.D., Carl, R., Lee, M., & Logan, K. (2013). Returning to learn following a concussion. Pediatrics, 132(5), 948-957.

McAbee, G.N. (2015). Pediatric concussion, cognitive rest and position statements, practice parameters, and clinical practice guidelines. Journal of Child Neurology, 30(10), 1378-1380.

McCroy, P., Meeuwisse, W., Dvorak, J., Aubry, M., Bailes, J., Broglio, S., …, and Vos, P.E. (2017). Consensus statement on concussion in sport– the 5th international conference on concussion in sport held in Berlin, October 2016. British Journal of  Sports Medicine, 0, 1-10.


CDC Concussion Game App

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So, before I begin this blog I must admit that I am over the age of 6-8 and I know that may come as a surprise to some of you; however, I still downloaded this app to see how great the product was with regard to concussion education for children.Image result for cdc rocketbladez

The Center for Disease Control (CDC)’s HEADS UP created a great application for creating culture change in concussion education in our nation’s youth. The name of this application is Rocket Blades and its intent is to teach 6-8 year olds about:

  1. Different types of injuries that can lead to a concussion.
  2. The importance of self-reporting concussion symptoms.
  3. The importance of rest in concussion recovery.

The game opens with an introduction of the “team” of athletes and game’s explanation. It even stresses that though the team may wear helmets, they can still get a head injury if they fall. Then it shows an animation showing how when the head hits a surface that the  brain still shakes back and forth inside the skull. Let me start with this is an awesome learning point for the kiddoes, one of the biggest issues come across in the field is that most people, athletes, coaches, and even some healthcare professionals cannot identify the majority of concussion symptoms or believe that it either a concussion requires a hit to the head, requires being knocked out, or that helmets will protect from concussion (Sullivan et al, 2009).

Image result for cdc heads up rocketbladez

The game has various levels of play, it starts out easy… yes I know I am not a 6-8 year old kiddo, but the levels do get progressively harder! Once the skater gets going if he or she crashes then the game player has the option to select to sit out the team’s avatar to rest or to go on and play the concussed skater. What really stuck out to me in the game was that once the skater is concussed if the player chooses not to sit the skater and continue playing him or her, the screen begins to get blurry and react slower to the player’s commands. This is a great demonstration as to the effects of trying to play through a concussion.

Showing these effects of trying to play through a concussion are ideally meant to build a strong culture around concussion education. This will hopefully help with the major issue in underreporting of concussions, some estimates are that only 33.5% of concussed athletes will report their symptoms (Llewellyn et al, 2014). This underreporting issue can lead to major concerns for potential Second Impact Syndrome, a pathology that kills 50% of those who get it. See our blog on Second Impact Syndrome to learn much more.

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I truly do not know what is worse, the issues surrounding Second Impact Syndrome in our youth population or the fact that there is still so much unknown about the long term effects of a concussion in the developing brain of a youth-athlete.

Overall, I think to advise parents I would suggest to have your kids download the app Image result for cdc heads upand play it to learn. The game is actually even fun for us older folks! The only issue I have with regard to this game is that it is currently only available for the IOS (apple) platform. So, us Android fans will have to wait until it is available for our platform too.

But there is still hope for all of us who use the Android platform, the CDC does have other applications or even online courses designed to help educate all levels (parents, kids, and practitioners) on concussions. Here is a link if you would like to reference those:

Overview of the App:Image result for cdc heads up


  • Fun
  • Educational
  • Captivating
  • Free!


  • IOS only 😦
  • That’s it


My take away for any parent in this post, is that education is important for our kiddoes to ensure a culture change occurs surrounding concussions symptom identification and self reporting of symptoms to someone who can help. After all, 33.5% is unacceptable, that’s 66.5% of unreported concussions…


By: Jeremy D. Howard, MS, LAT, ATC, CSCS, CES, PES, ITAT



Llewellyn, T., Burdette, G.T., Joyner, A.B., & Buckley, T.A. (2014). Concussion reporting rates at the conclusion of an intercollegiate athletic career. Clinical Journal of Sports Medicine, 24(1), 76-79.

Sullivan, S.J., Bourne, L., Choie, S., Eastwood, B., Isbister, S., McCrory, P., & Gray, A. (2009). Understanding of sport concussion by the parents of young rugby players: A pilot study. Clinical Journal of Sports Medicine, 19, 228-230.

Williamson, I.J.S. & Goodman, D. (2006). Converging evidence for the under-reporting of concussions in youth ice hockey. British Journal of Sports Medicine, 40, 128-132.