The National Football League (NFL) has been in the hot seat lately regarding its involvement in concussion injury prevalence. Youngstown, Ohio, where I live and practice, was recently selected by the NFL to develop a new helmet through their Helmet Challenge initiative. The goal of the NFL helmet challenge is to spark innovation in design and technology with the hope of creating the “next-generation helmet” that can reduce the incidence of concussion injuries.
But will a better helmet cut down on concussions? I think so, but only marginally. Rugby doesn’t require helmets and it has about the same number of concussion incidences as football and hockey, which both require helmets.
I think the NFL is “hard-headed” (pun intended) when it comes to the concussion debate. What is overlooked by the NFL, is that no matter the design of the helmet, even if it is made out of the softest, lightest space-age material, it can’t stop the “impulsive transmission of physics.” And football is a sport that uses physics. It’s not called a “physical game” for nothing.
The problem doesn’t rely solely on the head, but on what connects to the head.
A 2010 study in the journal Pediatrics found that over 200,000 emergency visits that year for children aged 8 to 13 were for concussions. Football and hockey were at the top of the list for sports-related causes and bicycling and playground accidents were the main reason in non-sport activities. The population most often seen in the emergency room for concussion is the pediatric demographic.
Signs and symptoms of a concussion include a loss of consciousness, confusion or amnesia, nausea and/or vomiting, ringing in the ears, slurred speech and unusual fatigue. What is now coming to light through the research is that a concussion is more than just a brain trauma.
Concussions are considered a “Mild Traumatic Brain Injury” or mTBI for short. The medical community for too long had been confused (another pun) by the sequence of cause and effects that occur from a concussion. It was known, but not fully understood, why even low-speed impacts (around 3-8 mph) could elicit dysfunctions similar to those found with concussions.
A concussion is a multifaceted injury that involves cognitive, vestibular, cervical, physical, and psychological dysfunctions. The reason is that the mechanics of a concussion share more in common with a whiplash than a blunt force trauma.
Quoting Dr. John Leddy, the Clinical Director of Orthopaedics at the University of Buffalo:
“I think a lot of practitioners listen to the symptoms and just chalk it up to a concussion, but if they also examined the neck in these people, they might discover that a neck injury is involved...”
To help ignite new research on concussions, an International Consensus on Concussion in Sport Symposium was held in Zurich, Germany in 2012. Here they defined a concussion as:
“a complex pathophysiological process affecting the brain, induced by biomechanical forces. Several common features that incorporate clinical, pathologic and biomechanical injury constructs may be utilized in defining the nature of a concussive head injury. This is caused by a direct blow to the head, face, neck or elsewhere on the body with an “impulsive” force transmitted to the head.”
Dr. John Leddy exposes a stumbling block within medicine that I think is slowly getting addressed. Medical doctors train to listen for symptoms and treat them accordingly. But treating symptoms alone doesn’t always provide a complete picture of what is going on. Symptoms are an effect of a cause. A cause can be remote from its effects.
A notable but tragic analogy of this concept is the 2011 earthquake and subsequent tsunami in Japan. An underwater earthquake 43 miles off the coast of Japan created large shockwaves that traveled 6 miles into the island nation wreaking havoc along its path. I’m not saying treating symptoms can’t be helpful, but just looking at symptoms alone can be short-sided in the grand scheme.
In a lot of concussion situations, the epicenter of the cause is not in the head, but lower down in the body. An “earthquake of the body” can create “shockwaves to the brain.”
We have inertia to thank (or blame) for a concussion. Inertia is the tendency of an object at rest to remain at rest and/or is the tendency of an object in motion to remain in motion. Whether in motion or at rest, different parts of the body have different inertias.
The inertia of the head acts differently than the inertia of the trunk. The difference in inertia is mainly due to the differences in mass. The trunk makes up around 50% of our body mass while the head makes up around 7%. What attaches these two separate masses is the neck.
The muscles, ligaments and cervical bones of the neck are “bridge-like” in design. The neck spans the divide between the head and trunk and helps balance out the differences in inertia. But like a bridge, it has its limits. The clashing of different inertial properties creates stress. For example, if just the torso is suddenly moved, the head will stay at rest because it has a different inertia. This, in turn, puts a lot of stress on the neck to absorb the change in motion.
The majority of the stress is put on the upper cervical spine since this area has the greatest influence on the head. The upper cervical neck has limits in its ability to absorb the change in inertia. If the trunk moves too quickly for the neck to absorb the change, trauma can happen to the neck.
This trauma can result in a vertebral subluxation. A vertebral subluxation creates a weakness in the bridge of the neck. An uncorrected subluxation will only lead to a higher chance of injury in the future, both to the spine and to the head.
Within the head itself, there are different inertias as well. Of that 7% head mass, only 2% is brain tissue. The brain is suspended inside the skull by cerebrospinal fluid and connective tissue. This provides a cushion and space between the hard bony skull and the soft squishy brain. But this cushion has limits.
A sudden change in motion of the head puts stress on the connective tissue and CSF to suspend and protect the brain. If the change in motion is too great for the neck to absorb the shockwave, the brain can literally “smack” against the skull causing trauma and injury to the brain.
Speed alone does not cause a concussion. For example, in a 24 hour period, the earth spins on its axis at roughly 1,000 mph. This means that all of us on planet Earth are also traveling at 1,000 mph. How are we not aware of this cosmic speed? Because we are relative to it. Similar to how we can fly on an airplane at 500 mph and feel free to roam about the cabin with no problem.
It is not speed alone that can cause a concussion, but how quickly the change in speed occurs. If you have ever been on an airplane, you have probably felt your stomach jump up into your chest during turbulence and when taking off or landing. The quick change in speed is called acceleration-deceleration.
This is how and why a concussion can occur at even 3 mph. If there is a gradual increase in speed from 0 to 3 mph, the body has the ability to adapt to the change in speed. But if the change from 0 to 3 mph happens very quickly, the chance of sustaining injury increases.
At its core, football and other contact sports have a high incidence of concussions because they are sports that involve acceleration-deceleration mechanics. Football is a sport of opposing physics. The team that is on the offensive wants to accelerate in a certain direction. The team that is on the defensive wants to decelerate the offense in the completely opposite direction. When you add speed and mass to the equation, it is any surprise how these clashing forces can set off a chain reaction that can result in a concussion?
A concussion results from an acceleration-deceleration traumatic event. Football is a game of acceleration-deceleration mechanics. Unless you can design a helmet that can shrink the size of the human head while simultaneously strengthening the cervical spine, no amount of innovation will prevent concussions to the extent that is proposed.
The only way to really reduce concussions in football, or any contact sport, is to ultimately reduce the amount of contact. That realization is easier said than done. We as humans love to be spectators in controlled violent acts or to put it nicely, contact sports. The Roman Gladiator is alive and well today in the NFL, NHL and the UFC.
What are some things you can do to decrease the chances of a concussion? The most obvious way is to abstain from contact sports. Any contact sport could be boiled down to the definition of “attempting to change an object's speed and/or direction.” This is the acceleration-deceleration formula.
Besides the obvious, potential things to modify are improving neck strength and impact anticipation. A study demonstrated that greater neck strength and bracing the muscles for impact could reduce the magnitude of stress to the head. Another study showed that the odds of sustaining higher magnitude head impacts are reduced with better cervical strength and lower angular displacement following impact.
Now before I come off as hypocritical, I am not anti-contact sport. Throughout my elementary, middle school and high school years, I played football and wrestled and enjoyed competing. But I think there needs to be a compromise. I don’t assume to know what that looks like for each individual sport, but trying to just treat the negative effects without adjusting the cause is not the solution.
In my opinion, trying to redesign the helmet solely is an example of treating the effects of a much larger cause. Overall, if you want to make the game safer, you need to make it smarter and the athletes healthier.
Improving the mechanics of the game and the biomechanics of its players will result in a safer sport and a healthier athlete.
The best defense is a good offense. The more a solution is proactive instead of preventative, the better the results.
From a Chiropractic perspective, the goal of Chiropractic is to help improve the relationship between the upper cervical spine and the integrated Nerve System. This is achieved by correcting a vertebral subluxation through an adjustment.
Neck strength has the potential to improve when the bony structures that anchor the muscles and ligaments are in better alignment. Neurological reaction times can also be at their peak when obstructions to nerve impulses are reduced. The absence of a subluxation can help reduce the incidence of concussions by improving biomechanics and the correction of a subluxation can improve healing from post-concussion syndrome.
Jarek Esarco, DC, CACCP is a pediatric, family wellness and upper cervical specific Chiropractor. He is an active member of the International Chiropractic Pediatric Association (ICPA). Dr. Jarek has postgraduate certification in Pediatric Chiropractic through the ICPA. Dr. Jarek also has postgraduate certification in the HIO Specific Brain Stem technique through The TIC Institute. Dr. Jarek is happily married to his wife Regina. They live in Youngstown, Ohio with their daughter Ruby.
