Guidelines for Head injuries in contact sports

In lieu of the recent tragedy that happened to the young football player in Simi Valley I have felt compelled to put this article together. Please share it with all your friends who participate in high action and contact sports. I have been associated with high action and contact sports for over 20 years and it saddens me when I hear of accidents such as this. Most of these accidents are just that, they are rare accidents. However, understanding brain injuries and knowing what to do is an important part of the “recovery” phase.

I recall an article that addressed head injuries in youth sports. On March 14, 1997, an Issue of MMWR of the Centers for Disease Control and Prevention describes two cases of second-impact syndrome that resulted in deaths. One case involved a high school football player in 1991 and the other a college football player. In each case, the player did not require hospitalization, and each player was sent home for close monitoring with no follow up guidelines. The American Academy of Neurology has developed guidelines for preventing second-impact syndrome and reducing the frequency of other cumulative brain injuries. These are different than the “Famed” Colorado guidelines and air on the side of being conservative.

Summary of Recommendations for Management of Concussions in Sports

The most common head injury is the concussion. Concussions are a form of brain injury that should not be taken lightly. The after effects of a concussion, post-concussion syndrome, can linger for days or weeks. Concussions are an unfortunate side effect of collision sports such as football, hockey, lacrosse, motorcycle and bicycle riding. They range in severity from the minor (“I just had my bell rung") to major, life threatening brain contusions ("he was knocked out cold”).

A concussion is defined as a clinical syndrome characterized by immediate and transient post-traumatic impairment of neural function owing to mechanical forces. A concussion occurs when the body is moving rapidly through space and suddenly stops. Keep in mind that the brain is traveling at the same velocity as the rest of the body. When the body suddenly stops, the brain continues to move at the same velocity in the same direction. The brain then hits the skull and bounces back, hitting the opposite side of the skull until it loses momentum. This occurs due to the fact that the brain is floating in the cerebral spinal fluid, and does not actually touch the skull.

When the brain strikes the skull, a portion of it is damaged. When enough damage is done, it begins to operate improperly. This is when the outsider notices the symptoms of the concussion. The effects of these repeated blows to the brain are cumulative, that is, one blow intensifies the effects of the previous. Because of this, an athlete may take what appears to be a slight blow to the head or body and then show the symptoms of the concussion.

There is no standard classification system for concussions. Four of the leading researchers in head injuries maintain their own classification system. The symptoms of each degree of concussion are often very similar, and it is easy to be confused when assessing a head injury. However, the latest protocol that is recognized as the leader is the information by the ANA (American Neurological Association).

Definitions from the ANA and treatment recommendations for each category are presented below.

Grade 1 Concussion

• Definition: Transient confusion, no loss of consciousness, and a duration of mental status abnormalities under 15 minutes.

• Management: The athlete should be removed from sports activity, examined immediately and at 5 minute Intervals, and allowed to return that day to the sports activity only if post concussive symptoms resolve within 15 minutes. Any athlete who incurs a second Grade 1 concussion on the same day should be removed from sports activities until asymptomatic for 1 week.

Grade 2 Concussion

• Definition: Transient confusion, no loss of consciousness, and a duration of mental status abnormalities15 minutes or longer.

• Management: The athlete should be removed from sports activity and examined frequently to assess the evolution of symptoms, with more extensive diagnostic evaluation if the symptoms worsen or persist longer than 1 week. The athlete should return to sports activity only after being asymptomatic for 1 full week. Any athlete who incurs a Grade 2 concussion subsequent to a Grade 1 concussion on the same day should be removed sports activities until asymptomatic for 2 weeks.

Grade 3 Concussion

• Definition: Loss of consciousness either brief (seconds) or prolonged (minutes or longer).

• Management: The athlete should be removed from sports activity for I full week without symptoms if the loss of consciousness is brief or for 2 full weeks without symptoms if the loss of consciousness is prolonged. If still unconscious or if abnormal neurologic signs are present at the time of initial evaluation, the athlete should be transported by ambulance to the nearest trauma hospital. An athlete that has suffered a second grade 3 concussion should be removed from sports activity until asymptomatic for 1 month. Any athlete with an abnormality on CT or MRI brain scan consistent with brain swelling, contusion, or other intracranial pathology should be removed from sports activities for the season and discouraged from future return to participation in contact sports. Source: New standards for head trauma subcommittee, American Academy of neurology 1997


With any head injury the patient needs to be monitored (no matter what the patient says, does or thinks) by a parent, mature teammate or friend. Since a head injury can alter mental function, personality and the ability to make clear and well thought out decisions, sometimes the decisions are left up to the “significant other”. Following any head injury a comprehensive exam should follow to insure the athletes safety. Also, knowing what to do if any injury occurs can mean the difference, at times, between life and death.

Patient instructions following a head injury

Before I tell you what not to do if you SUSTAIN an injury, I need to address a common problem that many athletes do prior to “game time”. Since a concussion is essentially a “bruise to the brain” anything you take prior to participation that could thin the blood is not recommended. If you participate in any high impact sport DO NOT take aspirin, advil, alleve or any other supplement or medication prior to participation due to the fact that this could thin the blood and make ANY bleed worse.

Common symptoms of a head injury include: headaches, nausea and slight dizziness. There may be swelling and pain at the site of impact. A head injury can cause slow bleeding or other problems inside the head that may not be detected at the initial exam. Make sure you consult any health care provider if any symptoms change or worsen.

Home treatment:

• Do not take any sedatives or sleeping pills
• Do not take aspirin, ibuprofen, motrin, advil, alleve, nuprin or any other medication that can thin the blood
• If needed, the use of acetaminophen (Tylenol) is recommended for pain only
• Do not drink alcohol or tea
• Do not exert yourself or participate in PE (follow guidelines above)
• Do not eat or drink much for the first 24 hours (clear liquids are the best)
• Sleep with head slightly elevated
• Avoid hot tubs and Jacuzzis for the first 48 hours

I hope this information is helpful to anyone involved with high action or contact sports. Be safe so you can play another day! Please pass this on to anyone you may know and have them sign up for our newsletter for more upcoming tips. www.gotcsi.com

The Swine flu

What is “Swine Flu” or H1N1?

According to the Centers for Disease Control and Prevention (CDC) the Swine flu (official name is H1N1) is a new version of the influenza virus. The Swine flu was first detected in the US in April 2009. The reason this strand of influenza virus is called the “Swine Flu” is because laboratory testing showed that many of the genes in this new virus were very similar to the influenza viruses that normally occur in pigs (swine).

How can Swine Flu be transmitted and who can it affect?

Swine flu can be transmitted from person to person just like the regular flu does by coughing or sneezing. It can also be transmitted by touching an object that the virus is on and then touching your nose or mouth.
One thing that is different between the Swine Flu and the seasonal flu is that the Swine Flu does not affect adults older than the age of 64 as much as it does affect children and adults younger than the age of 60. The reason for this is that it has been found that people under the age of 60 do not have the existing antibodies in them which would naturally protect them from the virus.

What are the symptoms of the Swine Flu?

Symptoms of swine flu are like regular flu symptoms and include fever, cough, sore throat, runny nose, body aches, headache, chills, and fatigue. In severe cases the swine flu can progress and symptoms vary depending on the age group. The following is a breakdown on how the symptoms vary in children and adults.

In children, emergency warning signs that need urgent medical attention include:
• Fast breathing or trouble breathing
• Bluish or gray skin color
• Not drinking enough fluids
• Severe or persistent vomiting
• Not waking up or not interacting
• Being so irritable that the child does not want to be held
• Flu-like symptoms improve but then return with fever and worse cough

In adults, emergency warning signs that need urgent medical attention include:
• Difficulty breathing or shortness of breath
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting
• Flu-like symptoms improve but then return with fever and worse cough


Prevention:
Here are some recommendations on how to prevent you from getting sick:
• Practice good hygiene (cover your mouth while coughing/sneezing,wash your hands with warm water and soup prior to eating)
• Avoid close contact with sick individuals
• Drink plenty of water
• Get adequate sleep (7-8 hours/night)
• Avoid alcohol use
• Avoid tobacco use
• Avoid excessive intake of sugars
• Exercise 3-5 days per week
• Get adjusted regularly???

o So you might ask “how can getting adjusted regularly prevent me from getting sick?”

 According to a study performed by Ronald Pero, Ph.D., chief of cancer prevention research at New York's Preventive Medicine Institute and professor of medicine at New York University, the chiropractic patients were found to have a 200% greater immune competence than those people who had not received chiropractic care, and they had 400% greater immune competence than those people with cancer and other serious diseases.

Is there a natural cure for Swine Flu?

Although there are no natural cures for Swine Flu you can take remedies, vitamins, and minerals to help with fighting the virus and its symptoms.
• Treatment for Swine Flu Chest Congestion: Eucalyptus, tea tree and lemongrass oils rubbed on the chest for congestion
• Remedy for Swine Flu & Cold Symptoms:
Vitamin C with bioflavanoids (1000-3000mg/daily); Echinacea tincture daily, Zinc (50-100mg/daily)
• Some say that the flu "begins in the gut and ends in the gut". This means that if you have good digestion, you will increase your resistance to this and other flu strains. Take a probiotic daily. Probiotics have been shown to be an effective natural treatment for swine flu.
• If you do feel the flu symptoms coming on, get adjusted to boost your immune system.
• Here at CSI we have had great success with treating the seasonal flu’s with our detox footbath combined with cold laser therapy.

Should I get vaccinated?

So here are some of the questions you might be asking yourself at this time.
Should I get vaccinated? Will the vaccine protect me? Is there a side effect to the vaccine?

Before I answer those questions let’s take a look at a few interesting facts.

According to the CDC “Most people who have become ill with this new virus have recovered without requiring medical treatment”. http://www.cdc.gov/h1n1flu/qa.htm

They go on to state that “Each year, in the United States, on average 36,000 people die from flu-related (seasonal flu) complications and more than 200,000 people are hospitalized from flu-related causes”.

Now back to answering the questions about vaccination.

• One thing to keep in mind is that viruses are great at mutating and changing into a different strain, so it is difficult to come up with a vaccine that effectively will prevent you from getting sick. And if you do decide to get the vaccine you are not 100% guaranteed to be safe from the virus.
• Once you do take the vaccine there might be side effects. The last ‘Swine Flu outbreak’ in the U.S. was in 1976 and according to the statistics from that outbreak:
o More people died from the vaccination than from swine flu
o 500 cases of Guillain-Barre Syndrome (GBS) were detected.
 GBS is auto immune disorder, affecting the peripheral nerves and causing paralysis, inability to breathe, and even death.
• http://www.cdc.gov/h1n1flu/vaccination/gbs_qa.htm
o The vaccine may have increased the risk of contracting GBS by eight times.
o The vaccine was withdrawn after just ten weeks when the link with GBS became clear.
o The US Government was forced to pay out millions of dollars to those affected
Having said all this, I am not trying to down play the seriousness of the flu but before you go out there and inoculate yourself with a vaccine, educate yourself and learn the truth.

Dr. Amir Mahmud

HOW MUCH WATER DO YOU NEED?

By: Dr. Terry Weyman

It’s HOT. With the heat, talks of dehydration and heat related illness come to the headlines. Southern California's hot fall football games, firefighters working the fires, cycling and Triathlons, Fall Motocross races, soccer games and other fall sports. To stay safe you need to understand and comprehend water intake and the requirements each body has to function on a normal level. In the news several months ago, there was a report about 10 people who were taken to the hospital for heat related illness at a rock concert over the weekend. With the fires blazing last week, firefighters need to maintain a high level of fluid intake to maintain body function. Body water and athletic performance are directly connected, and when understood, can be the difference between a winning performance and or/ survival.

Your body needs about 1 ml of water for every calorie that you expend. For example, if you burn 4,000 to 5,000 calories per day (moderate to aggressive athletic workouts), you would need between 4 to 5 liters of fluid to replace what was lost and to keep the biochemistry in proper balance. Monitoring body weight before and after training is the best way to keep up with your body’s fluid needs, which sweating increases. If you don’t believe that hydration can affect athletic performance ask Lance Armstrong. He lost 15 lbs due to dehydration following the first time trial of the Tour de France in 2002 and suffered the next few days more than usual.

Although a 2% weight loss due to dehydration may not cause any “symptoms”, it does decrease physical and mental performance.

Water Loss as % of Body Weight
2% - Difficulty in controlling normal body temperature
3% - Reduced muscular endurance time
4%-6% - Reduced strength, power, endurance and heat cramps
6% - Severe heat cramps, heat exhaustion and heat stroke

During exercise, especially in the heat, some of the water that naturally circulates through your body is used by your sweat glands. Inadequate fluid balance can result in a chain reaction that can be severely detrimental to your health. The first step in this reaction is a decrease in blood volume, which increases the heart rate in an attempt to get the fluids to the vital organs. The body’s next reaction is to constrict the blood vessels in order to maintain proper blood pressure. However, this reaction will cause the body temperature to rise due to the heat produced by the working muscles which can’t be transported to the skin’s surface. This leads to heat illnesses such as heat cramps, exhaustion and heat stroke.

To avoid this chain reaction you must stay properly hydrated during your exercise. The recommended fluid intake for exercise or training is 8 to 12 ounces fifteen minutes before you begin your exercises. During your training, drink 4-6 ounces every 10 to 15 minutes. After you have completed your training, you should consume 16 ounces for every pound lost (weigh yourself before and after exercise to determine weight loss). If you are working out longer than 60 minutes, a sports drink may be helpful in delaying fatigue by providing additional energy for working muscles. It will also be helpful in the overall chemistry balance since it will be replacing needed electrolytes that are lost during the sweating process. A 5 to 8% concentration of carbohydrates (as seen in most sports drinks) has been shown to be absorbed quickly. The small amount of electrolytes can also aid in the absorption of water from the intestines. A great product on the market for electrolyte replacement is a powder called Endura, made by a company called Metagenics. You can find this product at some bike shops or at health care facilities. Remember, this simple equation. First hour, water only. Second hour a mix of water and sport drink, third hour sport drink (electrolyte replacement). Due to the salts and sugars in the sports drinks, drinking too early can clog the sodium and calcium channels causing the athlete to go into a state of early dehydration. You can also increase the risks of cramping by drinking a sport drink too early.

With the heat of the summer here, be smart in your training. Do not exercise during the hottest times of the day (10-3), stay hydrated and properly warm up and cool down. To avoid heat illness and decrease your overall performance, remember this: an athlete should never be thirsty!

Dr. Terry Weyman is the clinic Director for the Chiropractic Sports Institute. All the Doctors at CSI specialize in the care of the active person. For further information they can be contacted at www.gotcsi.com