Bulletin Board

January 29, 2015

Brain Changes Linger Following Concussion
Are high school and youth athletes returning to play too soon after suffering a concussion? Data from recent research suggests that the answer is yes. A study published in the Dec. 12 issue of The Journal of Neuroscience found that structural changes in a child's brain persist for months following a concussion, even after symptoms have subsided.

Researchers from the University of New Mexico performed diffusion tensor imaging (DTI) on the brains of 15 children between the ages of 10 and 17 who had recently (less than three weeks earlier) suffered a concussion, along with 15 non-concussed counterparts. Comparing test scores between the children in the two groups, researchers noted discrepancies in white matter--the long fibers that carry information from one area of the brain to another.

Approximately four months later, a subset of the concussed children returned for follow-up visits. At this time, none of the subjects reported symptoms, but DTI found that changes in white matter that were noted at the first visit persisted. "These findings may have important implications about when it is truly safe for a child to resume physical activities that may produce a second concussion, potentially further injuring an already vulnerable brain," Andrew Mayer, PhD, one of the study authors and Research Associate Professor at UNM's The MIND Research Network, told the Society for Neuroscience.

Similar studies have been carried out with adult subjects, but this is the first to involve the scholastic population. Researchers noted that when comparing this study's brain images to concussed adults' brain images, the changes in white matter were more severe.

"The magnitude of the white matter changes in children with mild traumatic brain injury was larger than what has been previously been reported for adult patients with mild traumatic brain injury," Mayer said. "This suggests that developmental differences in the brain or the muscular-skeletal system may render pediatric patients more susceptible to injury."

To view the abstract of the study, "Diffusion Abnormalities in Pediatric Mild Traumatic Brain Injury," go to: www.jneurosci.org and search the study title.


Protective Eyewear Preventing Injuries
The NFHS rule requiring protective eyewear for high school field hockey players, which took effect before the 2011-12 school year, has been receiving mixed reactions. A chief complaint among detractors is that the added equipment gives athletes a false sense of security and causes them to play more aggressively, making the game more dangerous instead of safer.

But a recent review of regional and national injury databases found that what is commonly referred to as the "gladiator effect" doesn't hold water in this case. Published in Pediatrics in December, the study analyzed data from the 2009 and 2010 field hockey seasons in states that already required protective eyewear and states that did not. Researchers found no statistical difference in concussion rates among players in either group of states, indicating that wearing protective eyewear did not result in more aggressive play and therefore more injuries.

In states without the protective eyewear requirement, players suffered significantly more eye, face, and head injuries, suggesting that the eyewear helps prevent injuries. Researchers analyzed data from 180 high school teams, each with an average of 20 players. In states that required protective eyewear, teams had an average of one eye, face, or head injury per 106 practices and games. In states without eyewear requirements, the rate was one injury per 72 practices and games.

Players in states without the protective eyewear requirement were 5.33 times more likely to suffer an eye injury than those in states where eyewear was a requirement. Also in states without the requirement, a larger percentage of injuries required more than 10 days to return to play--32 vs. 17 percent.

Although there continues to be individuals who don't like the addition of eyewear to the game, the study's results should help strengthen the new rule. "Whenever new pieces of protective equipment have been introduced to a sport, there's always a group of people saying, 'You're going to ruin the culture of the sport,'" Dawn Comstock, PhD, one of the study authors and a principal investigator at the Center for Injury Research and Policy at The Research Institute at Nationwide Children's Hospital told the Kennebec Journal. "The introduction of the football helmet ... the face mask ... the introduction of ice hockey helmets ... Every sport resists change when there's an introduction of protective equipment. It's nothing new. [But] if you look at every sport, it has evolved over time, including field hockey."

"We encourage players to adopt protective eyewear early, at a young age, regardless of the contact/collision sport they play," Peter Kriz, MD, another study author and Assistant Professor at Brown University, told Reuters Health. "Wearing this gear will become second nature, and they will transition easier to other sports requiring facial protection."

The abstract of the study, "Effectiveness of Protective Eyewear in Reducing Eye Injuries Among High School Field Hockey Players," can be found by searching the study title at: http://pediatrics.aappublications.org.


Reducing Shoulder Impingement
The key to resolving pain and restoring function in athletes who play overhead sports and have mild impingement symptoms may be as simple as a six-week program consisting of just four exercises. Those are the findings outlined in a study completed by researchers from Ghent University Hospital in Belgium. The research appeared in the July issue of The American Journal of Sports Medicine.

The study recruited 47 athletes who were experiencing mild impingement symptoms and participated in volleyball, swimming, or tennis--all sports that require repetitive, powerful overhead arm movements. The mean age of the participants, which included 22 women and 25 men, was 24.6 years old.

Forty of the participants followed through on completing the six-week training program on their own. It consisted of four exercises focusing on scapular muscle balance: Prone extension, forward flexion in a side lying position, external rotation in a side lying position, and prone horizontal abduction with external rotation.

Researchers measured several parameters before and after completion of the program. They included:

- Pain and functionality via the Shoulder Pain and Disability Index (SPADI) questionnaire
- Maximum voluntary isometric contraction via electromyography
- Muscle activation levels, muscle ratio data, and muscle onset timing in the upper trapezius, middle trapezius, lower trapezius, and seratus anterior during arm elevation in the scapular plane.

Following completion of the six-week program, participants reported decreased pain and increased functionality with dramatically improved SPADI scores (the average decreased from 29.86 to 17.03). There was also an increase in maximum voluntary isometric contraction in the trapezius muscles and decreased activation levels during arm elevation.

"The results of this study are very promising since limiting shoulder symptoms in active overhead athletes suffering from persistent mild symptoms might serve as an injury prevention measure, limiting continued low-grade shoulder pain, fear avoidance, and ultimately surgical management requirement," the researchers concluded.

To view the abstract of the study, "Scapular Muscle Rehabilitation Exercises in Overhead Athletes With Impingement Symptoms: Effect of a 6-Week Training Program on Muscle Recruitment and Functional Outcome," go to: http://ajs.sagepub.com and search the study title.


NSCA Awards Coaches
At the NSCA's Coaches Conference in January, Andrea Hudy, MA, CSCS, USAW, LMT, Associate Director of Strength and Conditioning at the University of Kansas, was named the 2013 College Strength Coach of the Year. Tony McClure, CSCS*D, Assistant Performance Training Coach at New Mexico State University, was named the 2013 Assistant Strength Coach of the Year. The winners earned their awards for exhibiting excellence in dedication to the strength and conditioning profession.

Hudy, who is responsible for training the men's and women's basketball teams at Kansas, is one of few female head strength coaches at the NCAA Division I level and the only female strength coach working with a D-I men's basketball team. Hudy wrote about training the Jayhawks for us in an article titled "A Higher Level," which appeared in the May/June 2012 issue of T&C. Hudy also shared her expertise in our annual strength coach roundtable, "Strong Foundation," which ran in the November 2010 issue.

McClure has been working with teams at New Mexico State since 1999, specializing in speed and agility training. He currently works with the volleyball, softball, men's and women's tennis, men's and women's golf, equestrian, and women's swimming and diving teams. The volleyball squad most recently won the 2012 Western Athletic Conference Tournament and advanced to the NCAA Division I Tournament, while the men's golf team has won six conference championships and the women's golf team has won five conference championships during McClure's time at the school.

To read "A Higher Level" or "Strong Foundation," search the title of the article on the T&C Web site at: www.Training-Conditioning.com.

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