How To Make The Best Home Made Greek Yogurt: A Healthy and Affordable Alternative To Store-Bought


Over the past two months I have made more than 24 batches of non-fat, hormone free, plastic free, organic Greek yogurt that, I dare say, is far better tasting and better for you than than the store bought kind, and, once you get the hang of it, easy to make.

We eat lots of Greek yogurt in my family (one son goes through 3 large containers a week), but recently we Home made Greek yogurtbegan to add up our grocery receipts and we realized that the price has been creeping up to a point where a 32 ounce container of Chobani or Fage Low Fat Greek Yogurt costs between $5.59 and $7.49, depending on the store, and it doesn't go on sale all that often.

Besides the cost, there are a couple of other things about the store-bought Greek yogurt that really bother me. First, there's all that plastic.  Yes, it gets recycled, but it still seems wasteful. Second, the fact that most brands are not organic or growth hormone-free also bothers me.  There are studies that suggest that it isn't such a good idea for boys and men to be consuming female growth hormones.

I like the fact that Chobani is one of the sponsors of the 2012 Olympics, but maybe one reason for the high price is all the extra dollars they are spending on advertising.  Because I like to support companies who are Olympic sponsors, if I can,  I have decided to continue buying some Greek yogurt in the store, but also to make it at home.

Here's my recipe for the BEST Greek Yogurt:

  1. Buy half gallons (64 ounces) of organic milk (it costs me $3.99 at my store).  The milk will keep for about a month in the refrigerator.
  2. Pour the half gallon into a slow cooker set to warm for 3 hours until it is between 140-180 degrees (you need to invest in a good kitchen thermometer).
  3. Cool the milk to about 100 degrees. This will take about an hour. 
  4. As it is cooling, put about ¼ cup of "starter cultures" (Greek yogurt you saved from your last batch or from the store in a very large mixing cup. The starter needs to have live and active cultures that are found in Fage or Chobani yogurt or from your home made batch. Live and Active Cultures are living organisms, or "cultures," added to milk to make yogurt, ; they are called "starter cultures" because when added to milk, they convert the milk into yogurt during fermentation. The two cultures in the phrase "live and active cultures,"  are Lactobacillus bulgaricus and Streptococcus thermophilus.Crock pot for making Greek yogurt
  5. Once the milk has cooled to 100 degrees wisk in ¼ cup of the starter. Then pour the mixture back in the crock pot and maintain the temperature at 100 degrees for the next 8 hours (I wrap my crock pot in towels and a warming pad and leave it overnight).
  6. In the morning, take the coagulated yogurt, which now has the texture of custard, and strain it, a process which takes about 4 hours. I use a large ultra fine strainer lined with coffee filters. Spoon the yogurt into the strainer. Place a large measuring cup under the strainer and a large plate on top to keep out odors from other food in the refrigerator while the yogurt is being strained.
  7. You will end up with 32 ounces of Greek yogurt and 32 ounces of whey liquid, which you can either discard or save to add to fruit smoothies to make protein drinks (which are great as recovery beverages after exercise).

This recipe will be lots of fun to make with your kids. It is packed with protein and great with fresh berries or a little granola any time of the day and has no GMOs.

 

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New Concussion Report's Failure To Discuss Impact Monitoring Unfortunate Omission

The MomsTEAM staff and I are still digging into the Institute of Medicine and National Research Council's three-hundred-some-odd page report on sports-related concussions in youth sports,[1]  but one thing jumped out at me at my first pass: When I did a search in the report for a discussion of impact monitoring devices (a/k/a hit sensors), I found only one brief mention of sensors in the committee's recommendation that the Centers for Disease Control fund large scale data collection efforts for research purposes, including data from impact sensors.

Conspicuous by its absence from the report was any mention of the practical applications for such technology, especially but not limited to helping to identify athletes who may have suffered a concussion so they can be evaluated for possible concussion on the sports sideline.

I know firsthand from working with high school football players while producing "The Smartest Team," that impact sensors hold enormous promise, most significantly as a technological 'end around' the "culture of resistance" to self-reporting concussion symptoms, which the IOM/NRC report correctly recognizes as perhaps the single biggest obstacle to improving concussion safety in contact and collision sports.

But I found the omission especially glaring and surprising given that a number of leading concussion researchers, including the University of Michigan and Michigan Neurosport's Jeffrey Kutcher [2] and Steve Broglio, [3] have both written recently about the benefits of real time impact monitoring, not just for research, where they have been used in gathering biomechanical data for about a decade, but on the sports sideline.

Writing about head impact sensors in a study about emerging technologies in concussion identification and management in the March 2013 issue of the British Journal of Sports Medicine,[2] Dr. Kutcher, a neurologist specializing in the treatment of sports-related concussions and the co-author of the updated, evidence-based concussion management guidelines issued by the American Academy of Neurology,[4] viewed the "development of easily deployable sport equipment-based accelerometer systems" as "providing potentially useful, clinical information"  in at least two ways.  

Shockbox readout on iPad of player impactsFirst, Kutcher said, impact sensors have utility in monitoring impacts during the course of an athletic event for the purpose of screening for potential injury.  While acknowledging that " an on-board accelerometer system may not be able to accurately predict injury," Kutcher said, "it may have utility as a screening device by alerting sideline personnel of an impact that has occurred above a predetermined magnitude that triggers either observation or clinical evaluation of an athlete."

Second, Kutcher also saw a potential clinical benefit for real time impact monitoring systems, one which "stems not from the idea of monitoring impacts for the presence of an acute injury-generating hit, but from the potential advantage of accurately cataloguing the number of hits and post-impact head acceleration being experienced by an athlete over time."

"Some have suggested that the idea of a 'hit count' that is kept for athletes over the course of a game, practice, week, month, season or career," he writes.  Kutcher recognized that the "concept is fairly new and, as yet does not have published data to suggest that any particular level or number of hits has significant clinical meaning for any particular sport or position."  On this point, the IOM/NRC report essentially agreed, stating that "implementing a specific threshold for the number of impacts or the magnitude of impacts per week or per season was without scientific basis."  Nonetheless, he said that "individual athletes may feel there is a benefit to having an estimate of forces their brain experiences over time."

For his part, Dr. Broglio is also on record as seeing merit in the use of impact sensors in facilitating the identification of concussed athletes. While he acknowledged, as do I, that sensors are currently beyond the reach of most football programs, he, like I, saw a day in the not too distant future when use of such instrumentation would be "both practical and feasible."

In case you don't know about Steve, he is, along with Kevin Guskiewicz at the University of North Carolina, and Steve Rowson and Stephan Dumas at Virginia Tech, one of the leading experts on the use of accelerometers in football helmets in biomechanical studies, so he knows whereof he speaks (or to paraphrase the old John Houseman ad for Smith Barney, When Broglio talks, people should listen.)

Teaching tool 

Speaking of Guskiewicz, in a recent article on SI.com  he pointed to a third practical use for impact sensors outside of the research arena: to help coaches and other personnel identify athletes who are sustaining a high number of high force impacts, especially to the top front of their helmets that appear to be the most worrisome from a brain trauma standpoint, as a result of poor tackling or blocking technique.

Since emerging research suggests that repetitive subconcussive impacts may actually have more of a deleterious long-term effect on the brain than those blows that result in concussion, why didn't the IOM/NRC report recommend use of data from impact sensors by football coaches to reduce total brain trauma by modifying behavior, as Guskiewicz has been doing at UNC for years? "If a player is observed repeatedly sustaining larger impacts to the crown of his head," he told SI, "coaches will work with him on adjusting his technique." 

Using impact sensors as a teaching tool isn't just happening at the college level. It is happening in high school football, too. After Purdue researchers[5] found that high school football linemen who sustained a high number of high impact sub-concussive hits over the course of a season were the ones suffering impairment of their visual memory, the information led at least one player to change his blocking technique.

As Tom Talavage, the lead author of the Purdue study, told Frontline in a 2011 interview, he thought at least 50 percent of the high impact hits linemen and linebackers were sustaining were due to poor technique.  "Some of the players that we have on our team have not very good technique, to be quite honest. And what you'll find is, they will launch into a play, and they will lead with their helmet. Other players will more correctly keep their head up, try to get their arms up as a blocking technique, or when they're rushing, they will try to get their arms up as a means to push the offensive lineman out of the way. Those technique differences lead to a very large difference in the total number of blows experienced and where those blows are experienced on the head."

Talavage said that when one of the offensive lineman who was found to have been functionally impaired after sustaining a high number of subconcussive blows, impairment that persisted beyond the season, decided to change his technique, he experienced a drastic reduction in the number of blows he experienced to the top front of his head and a moderate reduction in the total number of blows. 

The result was that, after the second season, "his neurocognitive testing never detected any deficits, and from an imaging perspective we saw substantially less change in his fMRI activity. There's still some, because he's still getting hit, but his technique changed the distribution."

Research suggests that the cumulative effect of subconcussive impacts increases the risk of long-term neurodegenerative diseases such as CTE, PD, AD, MCI and ALS. While researchers continue to look for the concussion "holy grail" in the form of specific impact thresholds above which concussions are highly likely and/or the number of impacts or the magnitude of impacts per week or per season that substantially increase the risk of long term brain injury, why not use technology available right now to do what we can to reduce total brain trauma by using impact data to identify kids who need more coaching so they can learn how to tackle and block without using their helmets?

Red herrings

Given what so many respected scientists are saying about the use of impact sensors, why, again, is there no mention in the IOM/NRC report of any of these uses?

Was it because the committee was under the impression that the impact sensor systems that have come on the market in recent years are intended to diagnose concussions.  Was it out of concern that equipping players with sensors would provide a false sense of security and foster a belief that if the sensor didn't go off, the player didn't suffer a concussion?

The fact is that sensors are not intended to be diagnostic, or to replace sideline observers, game officials, coaches, and teammates, who, if they observe an athlete exhibiting signs of concussion, can trigger a sideline screening for concussion using one or more assessment tools (eg. SCAT3, King-Devick,  Maddocks questions). They are simply intended to be another tool in the concussion toolbox or, put another way, another set of eyes. Like those assessment tools, the fact that a sensor triggers an alert - or fails to set off an alert - is not intended to rule an athlete in or out of action or in any way diagnose concussion

The biggest challenge, of course, to widespread deployment of sensors now is their cost. The NFL and college football programs may be able to afford the technology, but coming up with the money to equip teams at the youth and high school level will require creative funding solutions, at least until the cost per player comes down, as it inevitably will over time.

The Institute of Medicine and National Research Council could have given impact sensors a big boost had the report at least discussed their use.  Unfortunately, the lack of any such discussion will just end up making it that much more difficult to get the message out about the benefits of real-time impact monitoring, and places an additional obstacle in the path to their use.

It was a barrier that they simply didn't need to raise.  


1. Institute of Medicine (IOM) and National Research Council (NRC). 2013.Sports-related concussions in youth: Improving the science, changing the culture. Washington, DC: The National Academies Press.

2. Kutcher J, McCrory, Davis G, et al. What evidence exists for new strategies or technologies in the diagnosis of sports concussion and assessment of recovery?Br J Sports Med2013;47:299-303.

3. Broglio SP, Martini D, Kasper L, Eckner JT, Kutcher JS.  Estimation of Head Impact Exposure in High School Football: Implications for Regulating Contact Practices. Am J Sports Med2013;20(10). DOI:10.1177/036354651302458 (epub September 3, 2013). 

4. Giza C, Kutcher J, Ashwal S, et al. Summary of evidence-based guideline update: Evaluation and management of concussion in sports: Report of the Guideline Development Subcommittee of the American Academy of Neurologists. Neurology 2013;DOI:10.1212/WNL.0b013e31828d57dd (published online ahead of print March 18, 2013).

5. Talavage TM, Nauman E, Breedlove EL, et al. Functionally-detected cognitive impairment in high school football players without clinically diagnosed concussion.J Neurotrauma. 2013;doi:10.1089/neu.2010.1512 (e-publ April 11, 2013)

Brooke de Lench is Founder and Publisher of MomsTEAM.com, author of Home Team Advantage: The Critical Role of Mothers in Youth Sports, and the producer/director of the PBS documentary, "The Smartest Team: Making High School Football Safer."  

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High School Football Playoffs: Not A Time For Concussion Safety To Take Back Seat To Winning


As the 2013 high school football season enters the home stretch, with teams fighting to stay alive in the playoffs, or preparing for traditional end-of-the-season games on Thanksgiving morning, the risk of concussion is an ever-present concern. 

Football player holding his head

But now is not the time to put winning ahead of safety.

Even in the best of times, studies show that high school football players face what one recently called a ‘culture of resistance' to reporting to sideline personnel that they are experiencing concussion symptoms.

Concerns by parents that players will fail to report symptoms, and, if injured, return to play before they brains are fully healed, are only magnified at the end of the season, when the football careers of the vast majority of seniors will be ending, and when the absence of a key player can make the difference between ending that career with loss or advancing in the playoffs.

In their desire to win, and because they are likely to be tired, and, frankly, a little beat up from the long season, players may also become sloppy in their tackling technique, increasing the risk of helmet-to-helmet contact of the kind that has resulted in the death or catastrophic injury of a number of players this football season.

Safety first

It is thus more important than ever that game officials, coaches, sideline medical personnel, and parents put safety first by:

  • Watching with extra vigilence for signs of concussion in players;
  • Ensuring that players displaying concussion signs undergo a careful screening for concussion and other more serious neurological injuries on the sideline; 
  • Prohibiting players with suspected concussion from returning to the field that day, no matter how much they want to play or how important they may be to the team;
  • Refusing to allow players to rush back after concussion too quickly by making sure that only return after they report being symptom free, have successfully completed a program of gradually increased exercise without symptoms returning, and only after obtaining written medical clearance from a doctor with concussion expertise. 

Resisting the temptation to treat player safety differently in the playoffs and in that final game is critical.  We can never let our guard down, and put winning ahead of safety.

Perhaps one of the moms featured in our documentary, "The Smartest Team," put it best, when she asked the following rhetorical question: "The football game and making the playoffs or the championship, that's one night. Are you gonna take that, or are you gonna take a lifetime of success?"


Brooke de Lench is the Founder and Publisher of MomsTEAM.com, author of Home Team Advantage: The Critical Role of Mothers in Youth Sports, and producer/director of the PBS documentary, "The Smartest Team: Making High School Football Safer."

 

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Olympic Hockey Star Julie Chu: Commitment + Honor + Unity = CHU


On Monday, I was able to catch up with three-time Olympic medalist Julie Chu, member of the U.S. Women's National Ice Hockey team, who just happens to be living and training for the XXII Olympic Winter Games in Sochi, Russia in my neck of the woods outside Boston.

I decided it was a great time to ask her to reflect back on her hockey journey over the past twelve years, and to hear about how she and her team are preparing for the challenge of replacing the Canadian women atop the podium this time around.

I was thrilled to learn that Julie is being supported in her fourth quest for that elusive gold medal by one of MomsTEAM's favorite companies, Procter & Gamble, makers of Bounty paper towels, "The Family of Picker Uppers." (Sounds like all of us moms, right? Picking up kids, from practices, games, school, and the mall, not to mention their equipment; and, of course, cleaning up their messes! The things we do for love!) 

It seemed like a natural for Bounty to be teaming up with Julie and her mom, Miriam, in celebrating all the moms who are only too happy to clean up after their kids' messes around the house if it means they can spend a little more time training in order to unlock their full potential as athletes.  In the spirit of the Olympics, I say, "Let the spills begin!"

Julie Chu and family

More on Bounty and how moms can get involved in a minute, but first, a little bit of history and more about what Julie is thinking as she prepares for the Olympics.  I have been following Julie's career ever since we first met in Lake Placid in 2002, where she was training for her first Olympics in Salt Lake City.  At nineteen, she was one of the youngest, if not the youngest players on the team.

I had made the trip to Lake Placid to interview a number of athletes who were practicing and/or trying out for various teams.  Over dinner with Julie and Angela Ruggiero, who was keeping a journal of her journey to Salt Lake for MomsTEAM at the time, I got to know Julie; about her work ethic, interesting upbringing, supportive family (especially her amazing mom), and her passion for ice hockey. Later, while I was hanging out at the Olympics in the AT&T Friends and Family Center, I also had a chance to get to know her mom, Miriam Chu, as well. It was no wonder to me that Miriam raised an Olympic athlete.

 

 

Missing ingredients? 

During our conversation, I asked Julie about the new coach of the Women's National Team, Katey Stone, one of the most successful coaches in the history of Division I women's ice hockey as the longtime head coach of the Harvard Crimson. Julie had nothing but good things to say about her former college coach, the first woman to lead the U.S. women since hockey became an Olympic sport in 1998. We agreed that she might just be what the team needed to break the Canadian women's hold on the gold medal, and bring the Olympic title back to America for the first time since the U.S. struck gold at the Nagano Olympics in 1998.

When I asked Julie what she has been doing differently this time around to prepare for Sochi, she said that the biggest difference was that she and her teammates "have been committed to their off-ice conditioning and have been more accountable to what they are doing to train during their non-Olympic years. This is just important as time on the ice."  I knew how fortunate they are strength and conditioning coach Mike Boyle, who has worked with many elite athletes, in their corner! (Here's a video of Mike talking with Julie's former teammate, Angela Ruggiero)

 

Special memory

When I asked Julie about her plans for the future after the Olympics, she gave me a really great answer: "I am only focusing on the Olympics right now. I can think about my future after the Olympics. We will be there to win, and we will all have some time to have fun while in Sochi, but our main goal is to win the gold."

I think that Julie's perspective is a great one to share with kids: focus on your goals, but make sure you have fun along the way. For me, I always tell my sons that if they focus on the summit they are trying to reach, and not get too distracted from that goal, their path will be clear.

Angela Ruggiero, Caitlin Cahow, Julie Chu and teammate

Julie will always hold a special place in my heart, along with the entire 2002 Women's Hockey Team, for surprising me with a cake and, along with my triplet sons, serenading me with "Happy Birthday" on the day I turned 50 at the Olympics in Salt Lake City. It has been a pleasure following Julie and many of her teammates, including Caitlin Cahow and Angela, these past twelve years. To watch how they have progressed in their sport has been a phenomenal experience. (Here's a picture of Caitlin, Angela, and Julie I took at Fenway Park before the 2010 Winter Classic)

Bring it on, moms! 

Given all the thrills they have given me, it seems as if the least I can do in return is to support Julie and Bounty in their search for moms across the country who know that, sometimes when you have healthy, active kids, things can get a little messy!

Whether your kids are doing cartwheels down the hall or firing a slap shot into the fireplace, Bounty is saluting moms who don't sweat the mess!

So, from now until the 2014 Sochi Winter Olympics, sports moms everywhere can log on to Twitter and share with @Bounty stories about how they have helped their aspiring athletes to train in the home despite the mess.

For every story shared with @Bounty using the #BringIt hashtag, Bounty will donate $1.00 to the P & G Team USA Youth Sports Fund to help other athletes pursue their Olympic dreams.

Moms can also join the Bring It conversation and stay up-to-date on Julie's journey to Sochi by visiting Facebook.com/Bounty or Twitter.com/Bounty.

Bring on the world! 

To get ready for the Games, the U.S. Women's National Team will be traveling around the country, participating in the Bring On the World Tour. For complete information on the Tour, including ticket information for Tour events and the entire game schedule, click here. 

Julie Chu celebrating goal

The final roster for the 2014 U.S. Olympic Women's Ice Hockey Team, which will include 18 forwards/defensemen and three goaltenders, will be announced during the second intermission of the NHL Winter Classic on January 2014 in Ann Arbor, Michigan, live on NBC.

Follow the U.S. Women's National Team throughout its journey to Sochi @USAHockey on Twitter or by liking the U.S. Women's National Hockey Team's page on Facebook.

 


Brooke de Lench is the Founder and Publisher of MomsTEAM.com, the author of "Home Team Advantage: The Critical Role of Mothers In Youth Sports (HarperCollins), and producer/director of the PBS documentary, "The Smartest Team: Making High School Football Safer." She can be reached @ delench@MomsTEAM.com 

 

 

 

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NOCSAE and Helmet Sensors: An Ounce Of Prevention

There is still confusion about the recent position, or should I say positions, taken by NOCSAE over the past month, first deciding that the certification of any helmet with a third-party add-on would be viewed as automatically void, then, this past week, making a 180-degree U-turn and leaving it up to the helmet manufacturers to decide whether affixing impact sensors to the inside or outside of a helmet voided the certification.  Unless you read my article on NOCSAE's original decision and Lindsay Barton's this past week on its clarification, and perhaps even if you did, you are probably scratching your head and wondering what the heck is going on!

Well, I am scratching my head, too.

To put this into perspective, there are currently five impact sensors designed to attach to the inside or outside of a football helmet.  Each weighs less than 2 ounces, each with cutting-edge technology, and each designed as another tool in the concussion toolbox for sideline personnel monitoring our kids for possible concussion.

Which has me and others wondering why NOCSAE isn't asking the helmet manufacturers to explain to them and the rest of us how a 2-ounce piece of plastic stuck to a 4+ pound football helmet has them so worried? I'm not a biomechanical engineer, but I don't understand how it could possibly affect the integrity of their helmets. When I asked Albert King, an actual biomechanical engineer from Wayne State with lots of experience testing helmets, he agreed, saying he viewed NOCSAE's original ruling as arising more out of liability concerns than concerns about helmet integrety.  While admittedly, King hadn't done any actual helmet testing, he, like I, found it difficult to believe that a 2 ounce sensor could so degrade a football helmet's ability to protect a player against skull fracture (which, after all, is what the NOCSAE certification ensures) that it would void the warranty.  And Schutt tested helmets equipped with Shockbox sensors in its lab last summer before players were permitted to wear the helmets, guess what they found? No, pardon the pun, impact on helmet performance whatsoever that would even remotely suggest that the NOCSAE certification was void.  

So what the heck is going on here? Whether the NOCSAE rulings were intended to put the brakes on the market for helmet sensors to give the helmet manufacturers time to catch up, it is hard to see how it won't have exactly that effect.  Riddell, of course, doesn't need to play catch up. Not surprisingly, it has leveraged 10 years' worth of experience with helmets equipped with HITS sensors into bringing on to the market a relatively affordable helmet equipped with what it calls its InSite Response System.

While no other helmet manufacturer was willing to tell me, either on or off the record, that had their own impact sensor-equipped helmets in the product development pipeline similar to Riddell's, it doesn't take a rocket scientist to guess that they are, or at least should be, viewing impact sensor technology as an important new safety measure with the potential to significantly improve the odds that a concussion will be identified on the sports sideline, one that, like Riddell, they should all be embracing.  

Parents routinely apply small plastic lights to the front and back of their child's bike helmets that flash during the day and night. They weigh about 2 to 3 ounces. If a helmet company told them it voided their warranty, do you think they would listen? I don't think so. I think parents are smart enough to know that an add-on that helps keep their child from having an accident in the first place is worth the risk - which, I submit, is virtually non-existent, that the addition of the lights will cause the helmet to crack in two in the event of an accident. Heck, I have a 1.7 ounce mirror on my bike helmet, and a light in the front and back, which add a total of 6.2 ounces to its weight.  I bet there are many parents who do the same, and the add-ons keep their kids safer.

One of our readers asked, "Do the helmet makers know that sensors are used in other industries to make products safer? The auto industry has been using sensors in crash test dummies for decades; today's crash test dummies have almost 200 sensors"!

Not only that, but what about the thousands of football players, from Pop Warner to college, who have been wearing helmets for the last decade equipped with the HITS system? If the extra weight of those sensor arrays put those players at unreasonable risk of having their helmets crack (which, again, is ALL that the NOCSAE standard certifies), wouldn't we have known about it by now? Is there any evidence to suggest that a single one of those players' helmets cracked in half, much less that they sustained a concussion as a result of the added weight?

The question boils down to this: Isn't our kids' safety worth it? Would you buy a car today if all it did was meet safety standards in effect in 1973? If the technology (no matter what the helmet companies may say, is pretty much the same as it was 40 years ago (a hard polycarbonate shell that does a remarkably good job of preventing skull fractures, with some padding that attenuates some of the forces that cause concussion (linear acceleration) but does nothing to prevent the rotational forces that, experts believe, are far more dangerous)? Clearly, we wouldn't.  But NOCSAE is suggesting that we not take advantage of new technology designed to help keep our kids safe, or that, if we do, we do so at our own risk (there's that pesky question of liability again!). 

Do I know with absolute certainty that sensors installed in or on helmets not only won't increase risk? No. Do I know with absolute certainty that helmet sensors will improve the rate at which concussions are identified on the sports sideline? No, but I am willing to bet they do, even in advance of the peer-reviewed studies that scientists say are needed to prove just that.

Parents and school boards will need to make the ultimate decision on whether to apply a 2 ounce piece of plastic to helmets to alert the sideline to hits that no one on the sideline saw and to possible concussions that, sad to say, go undetected because kids simply don't report experiencing symptoms.  I'm betting that those heavy helmets can handle a tiny piece of plastic, and that sensor-equipped helmets will make the game safer than helmets without sensors.

And, most important, after following a high school football team for the filming of the new PBS documentary, "The Smartest Team,"  I know from personal experience in working with the great kids in Newcastle, OK that, given a choice, they will choose to equip their helmets with sensors. I can only imagine what they will say when I tell them the helmet companies do not think a 2 ounce piece of plastic will maintain the integrity of the shell.

 

 

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Improving Concussion Safety in High School Football: Promising Developments, But A Long Way To Go

It has been a good two weeks for parents looking to make high school football safer, with a number of promising developments. But it is not time to declare victory, and many questions remain to be answered.

More Lystedt laws 

First, on the legislative front, three more states (TennesseeGeorgia and Montana) enacted Lystedt concussion safety laws, bringing to 45* (plus the District of Columbia) the number now requiring that schools (and, in some cases, as with Georgia, independent youth sports organizations using public fields):  

  1. educate youth athletes and their parents, and, in some cases, coaches, about the signs and symptoms of concussions, the dangers of continuing to play with concussion, and acknowledge receipt of a concussion information form as a condition for playing sports;​​
  2. remove from play any youth athlete suspected of having suffered a concussion and not allow them return to play that day; and​​​​
  3. require written clearance from a licensed health care professional trained in the evaluation and management of concussions before an athlete can return to play.Tackle practice with Bobby Hosea

Two more states (South Carolina and West Virginia) are moving towards passage of Lystedt laws.  [Update: Both states have since enacted Lystedt laws, bringing the number of states with such laws to 47, plus D.C.]

What about the remaining three states (Arkansas, Wyoming and Mississippi)?

In the case of Arkansas, its legislature recently appropriated $1 million for a pilot concussion management project, and, under guidelines issued by the Arkansas Activities Association, the state's governing body for high school sports, student-athletes suspected of having suffered a concussion must be removed from play immediately, cannot return to play within 24 hours after concussion, and only then after obtaining a written release from a medical professional current in concussion management clearing the athlete to begin a mandatory 5-day graduated return to play protocol. 

Wyoming's youth sports concussion safety law (Chapter 190), signed into law in March 2011, requires the state Superintendent of Public Instruction to develop a model protocol and to assist school districts in developing protocols for addressing risks associated with concussions and other head injuries from school athletics, and that school districts adopt protocols to address risks associate with concussion and other head injuries, including providing training to coaches and trainers, restricting a student's participation in sports after suffering a concussion or head injury, and distributing educational information to students and parents, but does not, among other things, require removal of athletes from games or practices if they are suspected to have suffered a concussion, or require medical clearance before return to play.

That leaves Mississippi as the only state in the country without any legislation or athletic association rule on concussion safety, enacted or pending. 

Effectiveness of laws remains to be seen 

As a March 2013 study in the prestigious British Journal of Medicine [1] notes, "Despite the interest generated through media exposure and public education programmes, there appears to be remain widespread misconceptions about the diagnosis and management of concussions, as well as knowledge gaps among athletes, parents, and coaches."
It is too soon to say how effective the new laws, all of which have been enacted since May 2009, will be in improving concussion knowledge and treatment. The results of the only survey so far [2] found that, a year after passage of the original Lystedt law, 85% of Washington State adults  85% were aware of the law, and over 90% had a good understanding of the definition, diagnosis and potential severity of a concussion.   Dr. Kevin Guskiewicz, Kenan Distinguished Professor and Director of the Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center at The University of North Carolina at Chapel Hill, for one, believes that the laws will make a positive difference, improving concussion safety.

Simply passing laws, of course, won't be enough, by themselves, to improve the safety of contact and collision sports such as football, lacrosse, hockey and soccer. Such laws need to "be open to ongoing review and amendment as new scientific knowledge about sports concussions is discovered and the best and most effective ways to implement such laws are learnt." [1]

Limiting full-contact practices 

Perhaps just as noteworthy, the last two weeks have seen the governing bodies for high school football in three states (ArizonaWashington, and Texas) move to limit contact practices.  MomsTEAM has long been an advocate for sensible limits on full-contact practices, as part of a multi-pronged approach to comprehensive concussion risk management we call the Six Pillars featured in our new high school football documentary, The Smartest Team.  

Intuitively at least (more about that point in a moment), it makes sense to limit the number of times football players are exposed to the kind of impact forces that can result in concussions or brain damage from the cumulative effect of impacts which, according to at least two recent studies,[3,4] may lead - emphasis on the word "may" - to short-term, and potentially long-term cognitive and emotional problems, or, in an unknown, but believed to be very small, percentage of cases, to degenerative neurological conditions such as chronic traumatic encephalopathy.  

First up, Arizona, where the Executive Board of the Arizona Interscholastic Association voted on April 15, 2013 to limit contact practice (padded athletes in contact with each other) in the pre-season to no more than 1/2 of practices, and to no more than 1/3 of practice time in the regular season.  In doing so, the state claims to be the first in the nation to reduce off-season and in-season contact practices.  While I think it is right in making that claim with respect to in-season contact practices, it appears that Iowa beat Arizona to the punch on pre-season contact practices (a shout out to one of MomsTEAM's Facebook followers, Kevin Fleming, for alerting us to the action taken in the Hawkeye State), and that doesn't count the 19 states that already ban off-season full-contact practices altogether.

What can't be denied is that Arizona has been out front on concussion safety in a number of respects in recent years. In 2011, it became the first - and, as far as MomsTEAM is aware, the only - state in the country to require high school athletes to take and pass a concussion education course in order to play sports.  According to the AIA, the course, called Brainbook, has been completed by more than 150,000 students.  

Arizona was also the first to require that a player whose football helmet becomes dislodged during play to come out of the game to allow for a sideline concussion assessment and an inspection of the helmet to insure that it is fitting properly before being allowed to return to play. That rule served as a model for a similar rule enacted by the NFHS in 2012.  (A properly fitted helmet, by the way, is one of the steps football programs can take to minimize concussion risk we feature in The Smartest Team, not because a properly fitted helmet necessarily reduces the risk of concussion, because, at this point at least, there are no peer-reviewed studies to prove that one does, [1,5,6] but because there is at least some evidence [7] that an improperly fitted helmet does put an athlete at increased risk of head injury). Arizona's Lydstedt law is also one of the few to allow parents to remove players from practice or game action in case of suspected concussion. (As The Smartest Team documentary demonstrates, and as I argue in my book, Home Team Advantage, it is often parents, especially mothers, who are most concerned about the safety, not just of their child, but every child on the team).

In announcing the limits on contact practices, Dr. Javier Cardenas, chair of the AIA Sports Medicine Advisory Committee, which recommended the new rule limiting contact practices, said, "I am proud of the leadership the AIA has demonstrated.  By taking such unprecedented action, they are demonstrating the level of concern that exists to keep Arizona's kids safe. It makes me proud to be an Arizonian."  You should be proud, Arizona! 

Texas rule: sleeves off the coach's vest? 

Next up, Texas. On April 21, the Medical Advisory Committee of the University Interscholastic League (UIL), which, despite its strange name, is the governing body for high school sports in Texas, unanimously recommended limiting football programs to 90 minutes of full-contact, game-speed practices (with tackling and blocking to the ground) per player per week during the regular season and playoffs.

According to news reports, the recommendation, which is expected to be approved by the UIL Legislative Council when it meets in June and must be signed by the Texas Commissioner of Education to become effective, was in response to a bill introduced in the Texas House that would have limited full-contact practices to one per week, and which was later amended to provide for 60 minutes of full-contact practice time per week. (That bill has now been withdrawn by its sponsor.)

The Medical Advisory Committee, however, was careful not to place similar restrictions on spring football or preseason practices, where the majority of teaching and instruction on blocking and tackling techniques takes place. As things stand, Texas currently allows 18 days of off-season football, among the most in the nation. It should come as no surprise that Mississippi, the only state without a concussion safety law, allows the most: an astounding three weeks!

Interviewed for the story by the Dallas Morning News, most coaches thought that the new rules would not drastically change what they were doing already because their players didn't tackle to the ground during in-season practices anyway. "I don't think there a whole lot of people that are full-contact, live game speed like that much anymore," said one.  An article in another Texas newspaper reported much the same: that the new rules wouldn't result in much a change in current practice, which is to limit full-contact practice (as defined by the proposed rule) to about 15 minutes a week (although it is perhaps telling that the reason, said coaches, was to make sure that there were enough healthy starters come Friday night).

Some expressed concern that the rule would "open the door for more injuries," although it seemed that the concern - at least as far as I could tell from the comments to the articles online - was more about bureaucrats taking decision-making out of the hands of coaches, as reflected by the comment of one coach who grumbled in an interview with Lubbockonline.com, "I don't know what's wrong with the way it's been.  The coaches are the commanders on the ground and they probably know more about what they need than someone in Austin who's been behind a textbook."  

Washington State: No more camping out? 

Last, came word on Monday, April 22, 2013 that the Washington Interscholastic Athletic Association had voted to limit high school football practices during the offseason, reducing to 10 the number of full-contact practices a team could hold after the end of spring sports and to 20 the total number of coach-supervised practices before pre-season football.  According to the Belleville Reporter, common practice in the Seattle area had been for schools to engage in ten days of spring football, passing camps or seven-on-seven tournaments in the summer and a team camp at a local college which included controlled scrimmages with other schools. Seven-on-seven competitions and team camps are covered by the new 10 day limit.  

"We'll have to get creative," one coach told the Reporter, admitting that the new rules would make it "harder to do a team camp and full spring ball," but that it would be far from the death-blow that some around the state were making it out to be. 

Contact limits: throwing baby out with bathwater?

As many of MomsTEAM visitors and readers of this blog know, I spent a lot of time last year closely following a football team in Oklahoma for The Smartest Team, attending practices, scrimmages, and games.  Among the experts who parachuted into Newcastle to help set up a comprehensive concussion risk management program was Coach Bobby Hosea, whose heads-up tackling technique is being implemented at all levels of the game.[8]  After watching Bobby spend a full day working with the players on learning how to tackle, and talking to players about limits on full-contact practices, I came away with mixed feelings about limiting the amount of days of tackling.  

While I think, on balance, that the recent movement to limit full-contact practices will, in theory at least, make the game safer, there are a number of reasons why caution should be the byword.   

First, as the authors of a March 2013 review of current risk-reduction strategies in the British Journal of Sports Medicine (1) caution, in enacting rules such as limits on full-contact practices, high school athletic associations and state legislatures "need to carefully consider potential injury 'trade-offs' associated with the implementation of injury-prevention strategies, because every change may have certain advantages and disadvantages. That is, by reducing one risk or danger, additional risks may be created."

In other words, could limits on full-contact practices create additional risk of injury to players because they haven't spent enough time practicing proper tackling?  There are those who believe limits on full-contact practices, taken too far, could do just that, among them experts like Coach Hosea and Dr. Guskiewicz.  

As Bobby and other coaches say about practice, "If you want to be better at playing an instrument, you need more practice, not less. A new lanquage? More not less. So, why are we limiting practice?"  For his part, Dr. Guskiewicz believes that one of the principal reasons it is better for athletes to start playing tackle football before high school is in order to learn how to tackle, and that delaying the start of tackle football until age 14, as recommended by some experts, may perversely result in more head injuries at the high school level, not less.  He argues that, while there are trade-offs, contact and collision sports are relatively safe for younger athletes as long as the coaching emphasis is on protective skill development. He notes that there are very few catastrophic injuries at the youth level, with most occurring among 16-17-18-year-olds who are playing contact and collision sports without having developed such protective skills. "We need to find ways to keep our kids physically active so they don't become couch potatoes," Guskiewicz says.

What do the players themselves think about limiting full-contact practices? Well, my completely unscientific survey of Newcastle players suggest that they are concerned that it might expose them to more, not less injuries. One told me that he felt that "if you went out at practices, didn't have contact, didn't have near the amounts of impacts you receive in the game, it would almost be a surprise to you when you got to Friday night." 

It may be true, as Forbes magazine blogger Bob Cook argues in his story on the movement to limit full-contact practices during the off-season and in-season, that coaches who oppose such limits are old-school in that "none of [them] grew up during a time when anybody gave a rat's petute about concussions, [and] are going to have to adjust, for better or worse, to contact and practice restrictions in the name of saving their sport."

But, let's not go totally overboard here, folks, and end up throwing the baby out with the bathwater.  

Concussion "holy grail": a long way off 

Which brings me to my second note of caution, which is that medical science has not, despite throwing millions of dollars at the problem, thus far been able to come close to establishing a impact force threshold for concussions, [1,9] and is likely an even longer way off from establishing a threshold for the number of sub-concussive hits a player has to sustain before the risk of short-term, much less long-term, brain injury becomes unreasonably high.

I agree that it makes intuitive sense to reduce total brain trauma. It is hard to argue with that. But whether a headlong rush to limit contact is the best approach, and is backed up by the science, that's something else entirely.**

I will have more to say on this subject after completing a comprehensive review of the peer-reviewed medical literature on impact thresholds, and conducting a detailed critique and analysis of the arguments being advanced in support of imposing strict limits on the number of hits. But what I, and MomsTEAM's Senior Health and Safety Editor Lindsay Barton, have seen so far suggests that a cautious approach is indeed warranted. 

Watch this space. 

*****

*Update: Since this blog post was written, two more states (South Carolina and West Virginia passed Lystedt laws, bringing the total to 47).

** Update: In a study published after this blog was written,[9] by researchers at the University of Michigan agreed that caution in imposing limits on full-contact practices for precisely the reasons I have outlined. While finding that reducing  result in an 18% to 40% reduction in head impacts respectively over the course of a high school football season, reports a new study, Concussion experts agreeLimiting or eliminating contact practices in football would [1]  which says that, until the risk factors for chronic traumatic encephalopathy (CTE) are better defined, and research shows that reducing the time spent learning to tackle in practice will not lead to increased risk of concussions in games, policymakers should proceed with caution in imposing such limits. 

While describing the goal of reducing the overall number of head impacts that high school football players sustain in a season as "logical" and "appealing," lead author, Steven P. Broglio, PhD, ATC, of Michigan NeuroSport and Director of the NeuroSport Research Laboratory at the University of Michigan, concluded that, "until the risk factors for CTE are better defined by carefully designed and controlled research," and research determines "what the advisable limit to head impact exposure should be," employing contact limits or establishing "hit counts" will remain "educated guesses, at best."

 


Brooke de Lench is Producer/Director of the new high school football documentary, "The Smartest Team," Founder/Publisher of MomsTEAM.com, and the author of Home Team Advantage: The Critical Role of Mothers in Youth Sports (HarperCollins)


Footnotes: 

1. Benson B, McIntosh A, Maddocks D, et. al. What are the most effective risk-reduction strategies in sport concussion? Br J Sports Med 2013;47:321-326.  

2. Shenouda C, Hendrickson P, Davenport K, Barber J, Bell KR. The effects of concussion legislation one year later - what we have learned: a descriptive pilot survey of youth soccer player associates. PM R 2012;4:427-435. 

3. Talavage T, Nauman E, Breedlove E, et. al. Functionally-Detected Cognitive Impairment in High School Football Players Without Clinically-Diagnosed Concussion. J Neurotrauma 2010; DOI: 10.1089/neu.2010.1512.

4. March N, Bazarian JJ, Puvenna V, Janigro M, Ghosh C, et. al. Consequences of Repeated Blood-Brain Barrier Disruption in Football Players. PLoS ONE 2013;8(3): e56805. doi: 10.1371/journal.pone.0056805. 

5. McCrory P, et al. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. Br J Sports Med 2013;47:250-258.

6. Giza C, Kutcher J, Ashwal S, et al. Summary of evidence-based guideline update: Evaluation and management of concussion in sports: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology 2013;DOI:10.1212/WNL.0b013e31828d57dd (published online before print March 18, 2013)(data is "insufficient to support or refute the superiority of one type of football helmet in preventing concussions).

7. Torg J, Boden B, Hirsch H, Fowler J, Gaughan J, Comstock RD, Tierney R, Kelly P. Athletic Induced mTBI and Catastrophic Intracranial Injuries: Determining Helmet Efficacy and Predisposing Injury Profiles. Presentation Paper OSSM 2012.

8. Alan Schwarz, "Teaching Young Players A Safer Way To Tackle." New York Times, December 25, 2010 (http://www.nytimes.com/2010/12/26/sports/football/26tackling.html?pagewa...)

9.  Broglio SP, Martini D, Kasper L, Eckner JT, Kutcher JS.  Estimation of Head Impact Exposure in High School Football: Implications for Regulating Contact Practices.  Am J Sports Med 2013;20(10). DOI:10.1177/036354651302458 (epub September 3, 2013).

Updated September 25, 2013

 

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Newcastle-Moore, Oklahoma Tornado Hit Close To Home

Two things have weighed heavily on my mind the past two weeks: the tornadoes that have ravaged the Oklahoma City area, and the professional and amateur storm chasers who risk their lives to follow them.  

On May 20, 2013, as I watched coverage of the EF-5 Newcastle-Moore tornado on CNN, I was worried about the football community in Newcastle, a town I had grown to know, respect and appreciate over the 8 months I spent visiting last year while producing and directing The Smartest Team documentary.  

I knew the twister was coming because, that afternoon, I had been emailing with Kerali Davis - the mom whose e-mail inspired me to make the documentary - when she said she had to go pick up her son at school because a tornado emergency had been declared. It was from Tweets by Kerali and other Newcastle Racers parents and players that I learned later that evening that they were all safe. As we all now know, Moore, which borders Newcastle to the northeast, was not nearly so lucky. 

It's hard for someone who has lived my entire life in the Northeast to imagine what it must be like to live right smack dab in the middle of "tornado alley"; to know that at any moment, with precious little warning, you might be forced to literally run for your life, to find shelter underground, and to pray that you, your pets, your friends, your homes, and your communities will be spared. 

It's also difficult for me to understand why anyone would want to chase such deadly storms, both the amateurs who come from all over the country during tornado season and the professionals who chart the paths of tornadoes in order to warn those in danger to seek shelter. 

I have come to know the folks in Oklahoma as some of the most resilient, no-nonsense, "roll-up your sleeves, get the job done" kind of people I have ever met. They are survivors. It is in their very nature. Perhaps it is because some are descendants of the great Native American tribes who have survived after nearly being wiped out as settlers moved west.   Perhaps it is because they are the children and grandchildren of Oklahomans who rode out the Dust Bowl in the 1930's.   Perhaps it's because they are so accustomed to violent, deadly weather.  All I know is, no matter how hard the tornadoes hit their area, that they would pick themselves up, dust themselves off, and get to work rebuilding their communities and their lives.

I saw this same can-do spirit in the response of the Newcastle football community to the challenge concussions posed to their program. The football parents, players, coaches, trainers, and administrators all knew that something had to be done to reduce the number of concussions.   But unlike when a tornado strikes, they didn't simply hunker down and ride out the storm.  Instead, like the storm chasers, they decided to be pro-active: to meet the challenge head on, to take steps to reduce the risk of concussion, to identify and manage those that couldn't be prevented, to make the game safer for everyone on the team.  In doing so, Newcastle is setting an example for the rest of the country on how to make football safer. 

Wearing football helmet with tornado in background

The people of Oklahoma are also setting an example for the rest of us in how to respond to disaster with courage and resilience. One especially valuable lesson in survival was set by the football team at South Moore High School. It is well known that the majority of deaths from a tornado are the result of a head injury; yet many don't think to keep a helmet (whether it be a football, baseball, motorcycle, hockey, or bike) on hand as part of a family's tornado emergency preparedness kit.   According to a  May 22 story in The Daily Beast, a quick thinking coach the school undoubtedly saved a lot of lives by having his players grab helmets at the tornado approached.  

The story got me thinking: perhaps there's a use for all those old football helmets after their days of protecting kids on the gridiron are over, although, as the picture at right shows, it seems like the folks in Newcastle seem to have already gotten the message!  [A side note: I received this pic from one of the Newcastle football moms, but I'm not sure from whom.  If you know, please let me know so I can give proper credit.  In the meantime, speaking of weather safety, does your sports team have a bad weather policy? It's never too late to put one in place.]

Hitting even closer to home 

Besides my connection to Newcastle through its football program, I had another as well.  Chris Curtis was a storm chaser and longtime manager of the West Concord Five and Ten in my hometown of Concord, Massachusetts.   The Five and Dime has been one of my favorite stores since I moved to Concord with my family twenty-five years ago, a place where I could get everything from shoelaces for my kids' sneakers to Halloween costumes to sewing needles and what used to be quaintly called 'notions.'  Over the years Chris helped us find what we needed for school or household projects.  

When I happened to mention to him last year that I was going to Oklahoma to film The Smartest Team, I learned that Chris was a storm chaser. Every May, for more than a decade, he had spent two weeks in the area, doing the dangerous work of following tornadoes and relaying information to local authorities so they could send out warnings to those in the tornado's path.  He became my advisor for all things Oklahoma.

West Concord (MA) Five and Ten

On May 19th, Chris chased the tornado which struck Shawnee, Oklahoma. The next day he was witness to the "horrific" destruction in Moore.  After driving to Texas, he wrote a first-hand account of what he saw for the Boston Globe before going to bed. 

I can only imagine how difficult it must have been for Chris to sleep that night, his heart probably still racing from the day's events, fueled by adrenaline, probably playing over in his mind the scenes of destruction he saw on a scale few of us have ever seen.  Sadly, Chris's dispatch for the Globe was the last thing he ever did. He died in his sleep; friends say the heart of this "gentle-giant" simply gave out.

My prayers go out to Chris Curtis's family and to all those in Oklahoma who have lost so much from the tornadoes. The tornado that struck on May 20th may be recorded as the Newcastle-Moore tornado, but its connection to Concord was something I will never forget.

 

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"Crash Reel": Not Just A Documentary About Traumatic Brain Injury But Teaches Important Life Lessons, Too

For the past month I have been trying without success to find the time to join the makers of the newCrash Reel poster documentary, "Crash Reel," at one of their premiere screenings. It is a movie I have been very eager to see for a number of reasons. Finally, over the weekend, I was able watch the film, which airs tonight on HBO at 9:00 p.m. EDT.

I am so glad I finally was able to see the film.  Not only did it exceed all of my expectations, but, it evoked in me a mix of both wonderful and sad memories from my past.

The film is chock full of very powerful life lessons, many that I think will be obvious ones parents will want to share with children, but many they don't even know they need to share.

For those of you who don't already know about the movie, "Crash Reel" is about former professional snowboarder Kevin Pearce and his inspiring recovery from a severe, life-threatening traumatic brain injury (TBI) sustained in a crash before the 2010 Vancouver Olympics.

On one level, it is a straightforward tale about how, working with a team of medical and psychological caregivers, Pearce has been able to recover from his injuries.

But "Crash Reel" is about so much more.

It is about the risks too many young athletes feel they have to take to succeed in their sport.

It is a film about the importance of family and having faith in each other, and how each can play a pivotal role in the journeys of the others, in both sickness and in health.

It is about what we can learn from people we might be tempted to think are the ones least likely to be in a position to give sage advice: in this case, one of Kevin's three brothers, David, who was born with Down Syndrome. It made me wish that David had been around to help my family after one of my sons suffered a bad concussion while snowboarding.

I remember when Kevin was injured during a training run while preparing for the Olympic qualifying trials just weeks before the 2010 Olympics, when he caught an edge and slammed face first on the halfpipe structure while attempting to do a "double cork," a twisting double back flip trick. I recall listening to the morning news the day after his accident with disbelief and profound sadness.

I had been rooting for Kevin since he beat the supposedly "unbeatable" phenomenon Shaun White, and was hoping to see him standing on the podium in Vancouver, perhaps standing on a step above his onetime close friend, Shaun.

As some of you know from my previous blogs, I have always been a huge Winter Olympics fan, no doubt due to the fact that my dad lived on Stratton Mountain in Vermont, where I grew up as a "mountain rat."

I was at Stratton when my step-brother and Jake Burton Carpenter and their friends developed the first snowboards in the 1970s and watched as they rocketed down the mountain at breakneck speeds and launched for what were, at the time, heart stopping jumps off of four-foot ramps.

When I made plans to to attend the 2010 Olympics, I purchased tickets early to make sure that I was there to watch the snowboarding events and the halfpipe finals, just as I had done for the men's and women's finals of the Snowboarding GS at Park City, Utah during the 2002 Winter Olympics.

Snowboarding is one of my favorite Olympic sports to watch and my friends and I were sure Kevin would be on the podium.

The flip that Kevin was trying when he was injured had not yet been mastered. It was one that many of the men who would be competing at the Olympic trials were trying to add to their routines. His fall, like so many catastrophic falls or crashes, did not look to be as horrific as it turned out to be. (Dale Earnhardt's fatal crash at the Daytona 500 a few years back comes to mind)  Sadly, some of the falls that look like the athlete will jump to their feet end up killing or severely injuring them.

As someone who has been covering the sport-related concussion beat for the past 13 years, I wondered at the time whether Kevin was still recovering from a previous head injury days or weeks that made his injury worse. I have since learned that indeed he may have had a concussion just three weeks prior. That injury, coupled with the mental and physical pressure he was under in his attempt to beat Shaun White and others may have made a bad situation even worse. We now know that when athletes are tired they are more prone to accidents.

The valuable lesson from "Crash Reel" for parents is to never assume one head injury has healed before letting your child resume a sports activity. Many times we see a snow sport athlete take a hit to the head or body that creates a whiplash effect, and don't think much of it until we learn they indeed have been severely injured. This lesson was brought home to me after film star Natasha Richardson fell during a ski lesson ten months before Kevin's accident and ended up dying a short time later from a brain bleed. It was also brought home when professional freestyle skier Sarah Burke took a fall on the same half pipe at Park City, Utah on which Kevin was injured.

Perhaps one of the most thought provoking statements for parents in the movie came from Kevin's father toward the end of the film:

"After the accident I felt very responsible, it was all the money involved, in all the sponsorships, it wasn't just Kevin. There should be limits I think just like there is in car racing. Finally they had to limit the sizes of the engines in the racing cars because people were killing themselves. It's the same in many halfpipes. If you make the rails higher, which makes it more dramatic for the spectators and the television and the media, the athlete will go, I mean he will push it to the limits. It's in the athletes make-up. I felt at some level we were all to blame."

These are tough issues I work with every day, mostly with football parents.

We finish watching "Crash Reel" knowing that Kevin and his family have emerged from his near tragedy stronger than ever. We hear him talking with snowboarder Trevor Rhoda, who has sustained two TBIs and now has a serious brain injury, in the aftermath of which he has been mean to his mom.

Kevin Pearce and his mom in woods in "Crash Reel"Kevin tells Trevor that, "Being mean to them [moms] is not helping." And, as he leaves Trevor and walks down a long path with his own mom, Kevin tells her, "This has changed my life. Now I can help change other people's lives." And we know that Kevin will do just that, and that "Crash Reel" and his advocacy on traumatic brain injury will have a great impact on the young athletes of this country..

The only thing that I wish had been included in the movie was a scene showing all of the people who were at Cascade Mountain the day two Americans placed in the top three at the finals during the Olympics. Shaun White won the gold and Scotty Lago won the bronze. To his credit, White absolutely nailed his first run; we all know that things didn't end so well for Lago, who was sent home early.

What I wanted the viewers to see was all of the signs people were holding that read, "I Ride For Kevin." Each of us standing along the run that day were thinking of Kevin as he lay in a hospital bed.

As we all begin to gear up to purchase tickets to Sochi for the next Olympics in February of 2014, I wonder how all of the top USA hopefuls are doing practicing at the Mount Hood superpipe. The height of the walls has now been capped at 22 feet. For me, I won't be watching any more snowboard events until, for safety's sake, the rails are lowered just a bit, maybe not all the way back to the four feet that I once thought was too high, but low enough to reduce the risk of injury of the kind that Kevin suffered in attempting a move that simply pushed the envelope too far and involved too much risk.

If you do nothing else with your kids this summer I suggest you watch "Crash Reel" with them, and, if you add it to your DVR or TIVO queue, I bet they will watch it over and over with their friends.


Brooke de Lench is the Founder and Publisher of MomsTEAM.com,  author of "Home Team Advantage:The Critical Role of Mothers In Youth Sports," and Producer and Director of the new high school football concussion documentary, "The Smartest Team."

 

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New Concussion Study Highlights Need For More Education, Stricter Return To Play Guidelines

A new study in the journal Pediatrics contains some good news and bad news.

First, the bad news: the study reports that less than 50% of high school athletes understand the possible long-term consequences of concussions.  More troubling was the study's finding that 69% of players who suffered a loss of consciousness and 81% of those who experienced signs and symptoms of concussion were allowed to return to play the same day, contrary to current guidelines for the management of concussions, which strongly recommend a more conservative approach to managing concussions in youth athletes, including a ban on allowing athletes with concussion signs or symptoms to return to play in the same game or practice.

The good news is that the study's authors at Children's Hospital in Boston come out strongly in favor of jettisoning the old concussion grading systems and instead following the approach taken under the Prague consensus statement in which concussions are classified as either simple or complex based on the child’s symptoms and how long they take to clear.  The authors also come out in favor of baseline and post-injury neuropsychological testing, wherever possible, and, finally, call for adoption of the Prague "step-wise" return to play guidelines which call for a child, once his or her symptoms have cleared - both at rest and with exertion - to only gradually return to sports play, during which time the athlete should continue to be closely monitored.

I have been speaking and writing about the need for more concussion education and the need for stricter return to play guidelines for years, but, as the Pediatrics article makes abundantly clear, far too many athletes, parents, coaches, athletic trainers and team physicians, despite all the attention concussions have been getting lately in the media, still don't seem to be getting the message.

There are still too many parents who are, sad to say, willing to sacrifice their child's safety and — in the case of concussions, their long term health — at the altar of a winning performance, a touchdown scored, a scholarship won, a pro contract inked.

It is not only fathers who fall into this unfortunate category. There are also many moms:

  • Who are over-invested in their child's athletic success;
  • Who enjoy too much basking in the reflected glory of their child's athletic achievements;
  • Who are content to let their child's very identity become wrapped up in sports; and
  • Who are unwilling — or unable — to make the decisions that I had to make: to end their child's dream of playing high school sports, to take away something their child cherished, and, in doing so, put their child's very future at risk by allowing him or her to return to contact sports while still experiencing post-concussion symptoms or despite a history of multiple concussions.

Some parents admit that they allow their children to play in such circumstances even though they know about the potential for adverse long-term health consequences, like major depression and permanent cognitive impairment.

Too many parents — and their children — still think that concussions only occur with a loss of consciousness and/or that it isn't dangerous to play with a concussion.

Too many young athletes — from 9-year old cheerleaders to star middies on high school lacrosse teams — are still failing to self-report their symptoms to the coach, sideline medical staff, their friends or even their parents, forcing clinicians to try to manage concussions without all the facts.

Kids fail to self-report because, too often, they are told by their parents, but far more often by their coaches, and, more subtly, by the very culture of sports itself, that they should remain silent:
  • to avoid jeopardizing their spot in the starting lineup
  • to avoid being labeled a "sissy" by their coach and/ or their parents
  • to demonstrate to the coach and their teammates that they can "take a hit like a man,"
  • to show that they can be as tough as their professional heroes
  • because they believe that the glory of individual and team success, the promise of a college scholarship, or the lure of a lucrative professional career, is somehow worth the risk of lifetime impairment.

Unfortunately, there are also still far too many coaches in this country - whether it be in youth gymnastics, football, field hockey, soccer, lacrosse, basketball, or skiing - who berate and ostracize players complaining of concussion symptoms, who call them "wimps," who yell at doctors and athletic trainers for refusing to let a player with concussion symptoms go back into the game, and have kicked kids off of the team for refusing to play for two weeks because of a concussion. I hear these stories all too often.

The bottom line, then, is that there are lot of myths about concussions and many reasons why youth athletes are still being unnecessarily put at risk when it comes to concussions, including the very culture of sports and of our competitive society.  I nevertheless continue to believe that the number of concussions, and particularly their long-term consequences, can be reduced if parents, in particular, demand of both themselves and of the sports program to whom they entrust their children that reasonable precautions be taken to protect them against harm. In other words, that parents demand that the entire team to whom they entrust their children's safety — including the national governing body for the child's sport, the state association, the athletic or club director, the athletic trainer (if there is one), and especially the coaches - be part of the concussion solution, not part of the concussion problem.

I have summarized what I feel should the the rights of parents in a Concussion Bill of Rights under which every parent has the right to expect that:

  1. A concussion education and safety meeting is held for parents and athletes before every season;
  2. The coach is a part of the concussion solution not part of the concussion problem;
  3. The program has adopted and enforces conservative guidelines for evaluating and managing concussion;
  4. The athletic department has a certified athletic trainer (ATC) on staff;
  5. Every child in a contact sport undergoes pre-season baseline and post-injury neuropsychological testing;
  6. Parents or guardians receive written notice of injuries and must give written consent before their child is allowed to return to play;
  7. Every child is provided with a safe helmet;
  8. An ambulance and paramedics are present at all high school football games, and, if they are not, procedures in place on how to properly contact EMS ;
  9. Coaches and officials are required by law to be trained and certified in basic safety and emergency procedures, including the recognition of concussion signs and symptoms;
  10. Sports officials are given the right to send any athlete who they reasonably suspect has suffered a concussion during play to the sideline for further evaluation;
  11. High school athletic programs require that each athlete undergo a comprehensive pre-participation physical examination (PPE); and
  12. The national governing body for their child's sport has taken steps to address concussions, both in terms of education and prevention.
Sadly, the Pediactrics article makes it clear that we have a long, long way to go in making these goals a reality for our children.  Adopting and following them all, while it won't make youth sports a concussion-free zone, will make it as safe as it can reasonably be.

I continue to believe that our children deserve no less.

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FTC Says No Proof That Mouthguard Reduces Concussion Risk: Not Surprising To MomsTEAM

For years, it seems, MomsTEAM has been getting e-mails from mouth guard manufacturers touting their products as reducing the risk of concussion, despite the lack of any peer-reviewed scientific studies to support their claims.  Three youth football players watching action

Last year, as readers of my blog may recall, I even got into a bit of a tete-a-tete with the co-author of one of the many books about concussions that have come out in recent years, when, at the end of an otherwise favorable review of the book, I took the authors to task for including a story about how one college athlete with a multiple concussion history was allowed to take the basketball court (after switching schools) because she agreed to wear a "customized mouthguard designed for greater shock absorption."  I believed then - and continue to believe -  that the story sent the wrong message: that mouthguards can prevent concussions.

So it was with a certain degree of satisfaction that I read yesterday of an announcement by the Federal Trade Commission that it had reached a settlement barring Brain-Pad, a mouthguard manufacturer, and its President, Joseph Manzo, from making unsupported claims that its mouthguard reduced the risk of concussion from lower jaw impacts, reduced the risk of concussions generally, or have been clinically proven to do either. 

In announcing the settlement, the FTC's Director of the Bureau of Consumer Protection, noted that, "Mouthguards can help to shield a person's teeth from being injured, and some can reduce impact to the lower jaw.  But it's a big leap to say these devices can also reduce the risk of concussion. The scientific evidence to make that claim just isn't adequate."

The action by the FTC was immediately applauded by Senators Tom Udall (D-N.M.), who has been outspoken in recent years on the subject of concussion safety.  Udall told the Hill newspaper that, while "increased awareness of the dangers associated with sports concussions is extremely important, as the Brain-Pad settlement proves, some companies seem to be taking advantage of the fears of parents, coaches, and athletes." 

MomsTEAM has been reminding parents for years that mouth guards should be worn to protect against dental injuries, not because they reduce concussion risk.  It is reassuring that the FTC, the government agency charged, among other things, with evaluating health claims by advertisers to make sure they are supported by the evidence, is doing its job, too.

For my earlier blog on the mouth guard/concussion controversy, click here.

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