PLN Portfolio

A personal learning network can be whatever you decide to make it!  For me, my idea of a PLN is a space where you can connect with the front runners of the field you happen to be interested in.  Not only that, you can share, comment, read and engage in great conversations about the newest happenings around the world.  Twitter is a great platform for a PLN because it has a professional side that a lot of young people don’t know about.  It’s another great way to integrate the use of technology into today’s society and higher education.

Twitter can be a more professional and educational platform, if you choose to make it that way.  Building my PLN was (and still is!) a challenge: finding credible accounts that don’t post garbage or spam, and even just finding accounts that are associated with athletic training was hard.  Most of the accounts I follow are sports medicine based, considering that is my area of interest.  Some of the best accounts I follow include: The National Athletic Trainers Association, The Korey Stringer Institute, The Concussion Blog,  Clinical Journal of Sports Medicine Online, Injury Pic Page (because as a future AT I LOVE GORY INJURY PICS),  and The American Medical Society for Sports Medicine, just to name a few!  Building a PLN involves google searches, twitter searches, following credible and interesting accounts then sifting through the accounts they follow, reading through tweets that have been published to decide if an account is worth following, etc.  Long story short, it’s a lot of work but it is most certainly worth it.  This semester I sort of slacked on further building my PLN, but because I spent so much time last semester working towards following great accounts, I was still able to find a plethora of information I’d never seen before.

Here are some of my most memorable tweets, retweets and favorites of the semester:

Image by: Madisen Giordano from Twitter
Image by: Madisen Giordano from Twitter
Image by: Madisen Giordano from Twitter
Image by: Madisen Giordano from Twitter
Image by: Madisen Giordano from Twitter
Image by: Madisen Giordano from Twitter
Image by: Madisen Giordano from Twitter
Image by: Madisen Giordano from Twitter
Image by: Madisen Giordano from Twitter
Image by: Madisen Giordano from Twitter

 

Summary Synthesis

My IDS program is Sports Medicine.  Sports Medicine is an umbrella term that encompasses multiple occupations and fields of study such as kinesiology, exercise physiology, sports nutrition, strength and condition

Image by: Madisen Giordano

ing and athletic training.  My focus in creating this program was encompassing the pre-requisites for a master’s degree in athletic training.  The supplemental classes I chose for my program helped to create a rounded base of knowledge to draw

from in my graduate education.  As a fifth years senior with two associates degrees and tons of credits under my belt already, creating a cohesive degree in the IDS program was my best course of action to move onto the next step.

Here’s the link to my Sports Medicine Program Statement: http://madisengiordano.plymouthcreate.net/uncategorized/sports-medicine-program-statement/

My applied project started off with this grand idea of tracking a fitness journey with measurable data such as weight and body fat percentages.  But, plot

Image by: Madisen Giordano

twist, there is this thing call and IRB application (Institutional Review Board) that totally messed up that idea for me.  The application was about 10 pages of questions that had to be answered in scientific and professional language along with literature searches and supplemental seven to eight-page informed consent forms to be signed by the participants.  Consider my project was only going to include myself and my best friend I decided to put that idea to bed and come up with another project idea.  From the ashes of my first idea rose an even better idea: an Instagram account showing what it’s like to be an active

Image by: Madisen Giordano

college student.  Although I didn’t spend as much time in the gym this semester as I hoped I would, I did spend a lot of time perfecting my eating habits and trying new meal prep recipes.  I also followed some of my friends’ fitness journeys and featured some of their pictures and videos.  I think this project can help other college students realize how important it is to take charge of their health when they have the change.  Health is wealth and exercise is the best medicine!

Here’s the link to my blog post with more information about my applied project: http://madisengiordano.plymouthcreate.net/uncategorized/sports-medicine-program-statement/

Follow this link to check out my Instagram that served as the platform for my applied project: https://www.instagram.com/lats_and_tats/?hl=en

My research article was one of the most interesting pieces I’ve written in my undergrad education.  I wanted to choose a topic I was interested in, to make writing a 10-page paper less of a monumental task.  I knew I wanted to write about concussions, but it wasn’t until I found out that the documentary “League of Denial” was on the library streaming website for free that I decided I would peek into the concussion crisis in relation to the NFL.  Concussions

“football”
CCBY Willy Lange

have always been the most interesting facet of the athletic training world for me, since the brain is the least understood but most important organ in the body.  Recognition, diagnosis and treatment of sports related concussions falls onto the athletic training/sports medicine staff.  I am very passionate about sports, especially football, the concussion crisis and the NFL cover up are real and it’s hard to realize that as a football fan.

Read my full research article here: http://madisengiordano.plymouthcreate.net/uncategorized/the-nfl-machine-2/

Being an IDS major has helped me to realize that I’ve always been interested in an interdisciplinary approach to education.  Having my bachelor’s degree in IDS will certainly open doors for me in the future that others may not have the opportunity for.  My applied project, research article and program courses have prepared me for my immediate future as in intern with Complete Athlete, LLC and for my graduate education that will begin in the Fall of 2018.  The IDS

Image by: Madisen Giordano

program has reminded me to always look at problems from different view-points.  Problems of the world are multi-faceted, as will problems in my field of study.  IDS has put the idea of using information across disciplines to reason and solve a multitude of problems with ease.

I want to take a moment to thank the IDS department, Bonnie Toomey and Dr. Robin DeRosa for having the best support system at Plymouth State and one of the best programs in New England for transfer and non-traditional students.  You all have made finishing my bachelor’s degree an attainable feat and I will always appreciate all the help and support provided.

Applied Project

Here’s the link to my Instagram account that served as the platform for my Senior Seminar Applied Project:

Image By: Madisen Giordano

https://www.instagram.com/lats_and_tats/?hl=en

My semester long project turned out to be one of the most difficult projects I’ve been able to pull off in my five years of undergraduate education.  My original idea for this project was to create a semester long fitness/wellness journey with my best friend Kayleigh.  Once I started uncovering more details about the IRB (Institutional Review Board) process I realize that process was

going to be way too in depth for such a small-scale sample of work.  In about March I decided it would be in my best interest to start a different project.  While I’m not super comfortable with a large change like this in a project that I spent so much time to design, I overcame the adversity and came up with a different project.

Sticking with the fitness and wellness idea of my original project I decided I would put my knowledge on display on social media.  In all honestly, it did not turn out the way I wanted it to because I wasn’t able to adhere to a gym/workout routine.  This was partly due to my disdain for the fitness facilities here at PSU and also in part to my schedule.  Nothing makes me more uncomfortable than an over crowded gym, and that is exactly the situation here at PSU.  The times I would be free to hit the gym it would be absolutely packed, and I cannot flourish in that sort of environment.

In combination with small home workouts and strict diet modifications I was able to reduce my body weight slightly this semester.  Food is fuel and when you feed your body whole, nutritious foods, it responds in a positive way (more

Image By: Madisen Giordano

energy!!!)  I also underwent fitness testing as well as body composition processes.  I was placed in an overall fitness category of good or average for my age group.  Some of the tests I did was a 1RM (one repetition maximum) back squat and bench press, muscular endurance tests (ACSM push-up, curl-up, wall sit and v-sit) and a VO2 max test.  It was an interesting experience and I really enjoyed it!

My IDS program is Sports Medicine, this project related to my field in many ways.  I have studied nutrition and exercise science extensively, giving me a wealth of knowledge to help other individuals on their fitness and wellness journeys.  Over the summer, I will begin studying for my CSCS (certified strength and conditioning specialist) while working at Complete Athlete, LLC in Derry, NH.  The classes I took this semester and this project have helped to develop a stronger sense of confidence in my knowledge.

Some big take-aways from my Instagram page are:

  • The American College of Sports Medicine recommends 150 minutes of moderate intensity aerobic exercise per week to attain health benefits such as reductions in resting heart rate, LDL cholesterol, body fat and blood pressure as well as increases in HDL cholesterol, improved cardiovascular capacity and function and increases in overall health
  • Health is wealth and exercise is the best medicine!
  • Meal prepping is super easy and can be fun, keeping things fresh and interesting and finding new recipes to try is how I keep myself from getting bored

I hope that this Instagram will help college students kick-start their health by seeing how easy it is to do so.  Over the summer I hope to add more content to my Instagram page, considering I will have time to be at a gym that I love and feel comfortable in and because I will be working directly with high school athletes in a strength and conditioning setting.

The NFL Machine

By: Madisen Giordano
Interdisciplinary Studies: Sports Medicine
Senior Seminar Research Article

Football.  A game that has been woven into the social constructs of American society for decades.  Football is a violent, punishing, u

CCBY: Jonathan Moreau

nforgiving game, but does it lead to detrimental health conditions years after players hang up their cleats and shoulder pads?  Was there something the NFL

 

conveniently ‘forgot’ to tell the thousands of players that rotate through the ranks or were the commissioner and other top officials in the dark about the risks of playing professional football?

As a society, we are currently trying to shift the popular opinion about concussions.  For so many years, concussions were not seen as a serious injury.  It was a rite of passage on the football field to ‘get your bell rung’ or ‘see stars’ as the old timers would say.  Athletes in a variety of sports were suffering a mild to moderate degree of brain injury, and were sent right back onto the field as if nothing had happened.  Thankfully, with time and research, that opinion is slowly changing.  There are still non-believers out there, like the members of the NFL’s first Mild Traumatic Brain Injury Committee (mTBI).

A concussion happens when a blow to the head causes enough force for the brain to move and strike the inside of the skull.  The brain is suspended in a fluid-like substance inside the skull cavity.  While one of the functions of the fluid-like substance is shock absorption, a force strong enough to cause a collision of the brain into the bone will cause brain injury.  Follow this link to see a short video about concussions: https://www.youtube.com/watch?v=55u5Ivx31og  Symptoms of a concussion can have an immediate onset and can last for a few days to months and can range from memory disruptions and mood changes to fatigue and sensitivity to light.  A common misconception is that a person must lose consciousness to be diagnosed with a concussion, but that is quite false.  In 90% of concussions, there is no loss of consciousness.

Stepping forward and reporting a concussion does not happen in professional football, players do not want to be perceived as weak.  The

“Brains”
CCBY: Neil Conway

stigma around concussions is still alive and well.  Traditional coaches and even some players see concussions as a ‘fake’ injury or not serious enough to be treated, when they are one of the most important injuries to treat.  You can break a collar bone and tear an ACL and go through a recovery process that is visible and predictable.  You cannot even see a concussion, except for an MRI or CT scan.

Steve Young, a former quarterback in the NFL (1984-1999) suffered seven concussions during his active playing time.  His seventh concussions knocked him out cold and he’d never play another game of competitive football again.  Steve describes concussions and CTE as “Such a nefarious injury, one that you never feel until it’s too late,” (League of Denial).   Treatment approaches vary from clinician to clinician, but the consensus for the treatment of concussions is plenty of rest, light activity (non-sports related with no risk of further brain injuries), restriction of ‘screen time’ (cell phones, computer, tv, etc.), plenty of fluids and over the counter analgesics for headache symptoms.  Even effective treatment can elicit healing times of weeks to months, the brain is a fickle and delicate organ.

Concussions are unpredictable, and like other injuries they vary from person to person.  There is no research showing definitive answers about who is susceptible for concussions or CTE (chronic traumatic encephalopathy).  There is a clear consensus on diagnosis of concussions, but for that to be followed, there must be contingencies in place for these diagnosis processes

“brains”
CCBY: Lelde Suksta

to be successful.  In the past decade the NFL has changed and re-changed the concussion protocol, working towards a safer playing field for the athletes.  Have these changes made a difference is the question that interested spectators, players and their families would like to know the answer to.  While there is an inherent risk of injury when signing up to play sports, the football players of the past had no idea what could be waiting in their futures, degenerative disease waiting to take over their brains.

Follow this link to see some hard hits that would concern neurologists and athletic trainers:  https://www.youtube.com/watch?v=mYgY_gYn5ew

In 2002, Dr. Bennet Omalu, a forensic neuropathologist, did an autopsy on a retired NFL player by the name of Mike Webster.  Mike played in the NFL for 17 years (15 years with the Pittsburg Steelers, 2 years with the Kansas City Chiefs) playing the position of center or guard.  Mike literally used his helmeted head as a battering ram.  He was a relentless player nicknamed ‘Iron Mike,’ but after his long NFL career, his life began to spiral out of control.

Dementia pugilistica, a clinical disease with a combination of symptoms resembling Alzheimer’s and Parkinson’s disease.  This form of dementia was originally only recognized in boxers and was also called ‘punch-drunk syndrome.’  After Dr. Omalu’s autopsy of Mike Webster and closer examination of his brain, Dr. Omalu concluded that instead of punch-drunk syndrome, Mike Webster had gridiron dementia (also referred to as CTE), ‘drunk’ from the repeated blows to the head.  This disease does not occur in all contact sport athletes or football players. Those effected by the disease see progressive symptoms and deteriorating conditions.

When he passed away, Mike Webster was homeless, broke and starving.  He had been arrested for forging prescriptions for Ritalin, a drug that helped keep his thoughts together.  His NFL earnings were gone, his marriage fell apart, and his relationships with his kids crumbled.  He was not the Mike Webster he once was, and he knew that.  Tragically, Mike isn’t the only former NFL player to suffer like this, and in other cases even more tragic, ended in horrific suicides.

Read the tragic story of Terry Long’s demise after his battle with CTE here: http://www.espn.com/nfl/news/story?id=2307003

Former Commissioner Paul Tagliabue formed the NFL’s mTBI committee in the mid 90’s assigning Dr. Elliot Pellman (a rheumatologist), team physician for the New York Jets, as chair-person of the committee.  This committee was tasked with researching the long-term effects of concussions and head injuries on football players.  Dr. Pellman was an avid believer that concussions

“#NFL”
CCBY: Saltank

were not serious injuries and that they had no long-term effects.  Dr. Pellman and the other members of the mTBI committee published papers and journal articles, notorious for saying there was no connection between hitting your head in football and cognitive problems later in life.

After completing Mike Webster’s autopsy and brain analysis, Dr. Omalu published a paper with some of the most recognizable names in the neuroscience field about CTE (chronic traumatic encephalopathy).  They submitted their paper to the journal Neurosurgery, the paper was accepted and published.  Not long after Dr. Omalu’s paper was published, the NFL’s mTBI Committee released a statement requesting Dr. Omalu retracted his findings because they were not based on scientific fact, they even eluded that he wasn’t practicing medicine, but instead he was practicing voodoo.  According to Dr. Omalu, “You can’t go against the NFL, they’ll squash you” (League of Denial).

Listen to a TEDTalk about concussion prevention here: https://www.ted.com/talks/kim_gorgens_protecting_the_brain_against_concussion

But Dr. Omalu wasn’t squashed, and his research findings were presented in 2007 during an NFL summit on brain injuries (this summit came after a change in NFL commissioner from Tagliabue to Roger Goodell in 2006).  While the NFL did not invite Dr. Omalu, (he was basically shunned by the NFL) his research partner Dr. Julian Bailes was invited and decided to present their work.  Commissioner Roger Goodell sat in the crowd, listening, baffled by the information Dr. Bailes was presenting.  This summit brought about some change, stricter concussion protocols and recognition criteria.  Changes for the future of the NFL are great, but what about the former NFL players and their families that are suffering every day?

Chronic traumatic encephalopathy is a degenerative neurological condition that attacks the brain cells.  Years of chronic concussions and sub-concussive (blows to the head that do not rise to the clinical definition of concussion) hits create the deposition and transformation of a protein in the brain.  Tau protein deposition in certain areas of the brain characterize and differentiate CTE from other forms of dementia.  This condition causes fine motor function decline, cognitive and memory impairments, inability to control mood and emotions, decline in basic decision-making and self-care/personal hygiene skills, ultimately leading to a major depressive state and in many cases, suicide.

A study done by Kerr et al looks at a cohort of former NFL players and the rate of nondisclosure in relation to concussions.  In the sample of 829 former players, 417 players reported that they had suffered at least one concussion that they did not report to the medical staff.  Fifty percent of this study DID NOT REPORT a concussion, a serious brain injury, to the medical staff.  As a future athletic trainer, I see that statistic and say, “What the actual **** is going on here…?”  Second impact syndrome is a fatal condition that can occur when an athlete who suffered a concussion returns to play before the initial concussion is healed and suffers from another concussion.  Second impact syndrome is serious, athletes die, but the NFL knowingly sends its players back onto the playing field after hits that warrant entering the concussion protocol.  Where does the negligence end?! (Although the NFL has made strides to correct these issues, there is no doubt that nondisclosure is still a part of the game).  Part of the problem in the NFL (until very recently) is the ‘self-reported’ piece that was classically connected to concussions.  Players shouldn’t have the opportunity to self-report a head injury, unless it is missed by the medical staff.  Click here for the full journal article: http://journals.sagepub.com/doi/pdf/10.1177/0363546517728264

Athletic trainers, team physicians and neurologists are now all present at NFL games.  Third party neurologists sit in the booths, analyzing every play and collision for signs of possible concussions.  Is this making the game safer?  Does this put the minds of parents whose children’s’ dream is to play professional football at ease?  The presence of medical staff should add a layer of protection to player safety, but when the hands of the medical staff are tied by rules of the NFL, coaches or owners, who is going to protect the safety of these players?  Concussion research, even though plentiful at this point, is still in its infancy relating to the NFL and CTE.  Will developing research in this field destroy football?  Nothing, not even looming degenerative brain disease in its players will stop the NFL from expanding and making more money.

The effects surrounding concussions are not just medical; there are financial and social ramifications of even mild and well managed concussions.  Navarro et al studied the non-medical short-term outcomes related to concussions in the NFL.  This study was focused on player longevity, performance and financial losses following concussions, the sample was

“The Sack”
CCBY: Daniel Moore

taking from 5,894 eligible NFL players over an 11-year span.  Of the eligible players only 307 sustained concussions requiring them to enter the concussion protocol and were listed as DNP (did not participate).  Right off the bat this number is staggeringly low, 307 concussions in 11 years…. doesn’t seem possible.

Some interesting findings of this study include: players who sustain reported concussions have significantly shorter overall careers in the NFL than their counterparts, a mean overall salary reduction of $300,000 – $1,300,000 per year, and performance reductions in offensive scoring positions (possibly due to less playing time).  The study sites that more research is warranted, but there is a connection between publicly reported concussions and reductions in career length and compensation.

All the media coverage of the NFL is high-profile, every decision made is news-worthy.  The NFL is one of the most lucrative businesses in the world, grossing $14 billion in 2017.  With all this money comes power, high profile lawyers and promoters.  The NFL will stop at nothing to protect itself and its revenue, but will it go the distance to protect its most important assets… the athletes.

More than 70 former NFL players had a lawsuit drawn up alleging that the NFL lied to them about the dangers of playing football.  The players and even the public were starting to catch on that there had to have been a major cover up going on in the NFL, with the amount of vehement denial coming from their officials.  The NFL eventually settled the lawsuit for $765 million in damages paid to the plaintiffs for medical bills and extended care.  The settlement did not come with an admission of a connection between football and long-term brain injury, but the NFL didn’t need to confirm that for everyone to understand there is indeed a link.  Former linebacker Harry Carson of the New York Giants said, “The NFL just gave everybody 765 million reasons not to want to play football…” (League of Denial).

When this large lawsuit went public, the US Congress started considering the NFL’s concussion crisis.  Roger Goodell was put on the spot in 2009 in a judiciary hearing where Representative Linda Sanchez lit up the NFL, comparing it to Big Tobacco.  Sanchez said, “The NFL reminds me of the tobacco companies pre-90’s where they were saying, no there’s no link between smoking and damage to your health or ill health effects” (League of Denial).  This comment was a turning point for Commissioner Goodell and NFL executives, they couldn’t be compared to Big Tobacco, bad for business.

Before the next season Commissioner Goodell released new rules on concussion protocols and return to play regulations.  The changes are made in the name of player safety, and money was donated to fund more research on the effects of football on the brain.  Commissioner Goodell donated $1 million to Boston University’s CTE Research Center and promised leading researchers in the CTE field something even better than $1 million, access to brains.  Goodell promised to encourage families of deceased NFL players to donate their brains to BU.  Funding research for the future is the answer to the current crisis.  Education on concussions should be provided to athletes and parents of all ages as well as coaches before every season.  Athletic trainers are educated on recognizing concussions, this is a reason why AT’s should be mandated on every sideline at every athletic event.

As the concussion issue grows, the uncertainty of the safety of contact sports in youth athletes grows right along with it.  Developing brains should not be introduced to extreme stressors, as it can affect growth a

“Football 10.18.08”
CCBY: Mike Hoff

nd functioning in many ways.  Commissioner Goodell started the HEADS-UP initiative to bring about change in the way the nations’ youth learns the game.  Speaking directly to the youth population, football concussions aren’t the only

concussions to be worried about.  Most childhood concussions come from bicycle accidents, even when helmets are being used.  Along with bicycling, other contact sports such as lacrosse and hockey add to the concussion concern for youth athletes.  Prevention is the first line of defense in concussions, prophylactic equipment such as helmets and mouth guards are essential for young, developing athletes to keep their brains functioning correctly.

The high publicity of the NFL concussion crisis is making strides in the right direction.  Its brought about talks of change, projects initiated to raise awareness in young athletes about concussions, and education on how to play the game correctly.  As a lifetime fan of football, realizing its dangers wasn’t an easy pill to swallow.  Although players should know the inherent risk, it is not possible to foresee every situation and every outcome.  Developments in technology will continue to add to the understanding of the brain and the conditions that affect it.

What does all this mean for the future?  How will concussions effect sports?  We do not know the answers to these questions as of now, but we do know the research is out there.  Very smart people in white coats are in labs looking at microscope slides of brain tissue mulling over how to create concise tests that diagnose a concussion or design of the perfect helmet to prevent concussions.  Professional athletes across the sports are pledging their brains to CTE research; hockey players, Olympic bobsledders, and rugby players alike.  In a previous paragraph I stated that prevention was the first line of defense in concussions, but that wasn’t true.  Education is the first line of defense and should be wide spread, this topic is something that should be covered in every year of school.  You only have one brain and it should be of the utmost importance to protect it.

 

 

 

 

Work Cited

Fainaru-Wada, M., & Public Broadcasting Service (U.S.) (Directors). (2014). Frontline – League of Denial : The NFL’s concussion crisis[Motion picture on Online video]. Kanopy Streaming.

 

Fainaru-Wada, M., & Fainaru, S. (2014). League of denial: The NFL, concussions, and the battle for truth. New York: Three Rivers Press.

 

HEADS UP to Health Care Providers. (2015, February 16). Retrieved May 7, 2018, from https://www.cdc.gov/headsup/providers/index.html

 

Kerr, Z. Y., Register-Mihalik, J. K., Kay, M. C., Defreese, J., Marshall, S. W., & Guskiewicz, K. M. (2017). Concussion Nondisclosure During Professional Career Among a Cohort of Former National Football League Athletes. The American Journal of Sports Medicine,46(1), 22-29. doi:10.1177/0363546517728264

 

Navarro, S. M., Sokunbi, O. F., Haeberle, H. S., Schickendantz, M. S., Mont, M. A., Figler, R. A., & Ramkumar, P. N. (2017). Short-term Outcomes Following Concussion in the NFL: A Study of Player Longevity, Performance, and Financial Loss. Orthopaedic Journal of Sports Medicine,5(11), 232596711774084. doi:10.1177/2325967117740847

 

Omalu, B. (2008). Play hard die young: Football dementia, depression and death. Lodi, CA: Neo-Forenxis Books.

 

What Is a Concussion? (n.d.). Retrieved May 8, 2018, from https://concussion.weillcornell.org/about-concussions/what-concussion

 

RA Second Draft

Football.  A game that has been woven into the social constructs of American society for decades.  Football is a violent, punishing, unforgiving game, but does it really lead to detrimental health conditions years after players hang up their cleats and shoulder pads?  Was there something the NFL conveniently ‘forgot’ to tell the thousands of players that rotate through the ranks or was the commissioner and other top officials in the dark about the risks of playing professional football?

As a society, we are currently trying to shift the popular opinion about concussions.  For so many years, concussions were not seen as a serious injury.  It was a rite of passage on the football field to ‘get your bell rung’ as the old timers would say.  Athletes in a variety of sports were suffering a mild to moderate degree of brain injuries, and they were sent right back onto the field as if nothing had happened.  Thankfully, with time and research, that opinion is slowly changing.  There are still non-believers out there, like the members of the NFL’s first Mild Traumatic Brain Injury Committee (mTBI).

A concussion happens when a blow to the head causes enough force for the brain to move and strike the inside of the skull.  The brain is suspended in a fluid-type substance inside the skull cavity.  While one of the functions of the fluid-like substance is shock absorption, a force strong enough to cause a collision of the brain into the bone will cause brain injury.  Symptoms from a concussion can have an immediate onset and can last for a few days to months and can range from memory disruptions and mood changes to fatigue and sensitivity to light.  A common misconception is that a person must lose consciousness to be diagnosed with a concussion, but that is quite false.  In 90% of concussions, there is no loss of consciousness.

Stepping forward and reporting a concussion does not happen in professional football, players do not want to be perceived as weak.  The stigma around concussions is still alive and well.  Traditional coaches and even some players see concussions as a ‘fake’ injury or not serious enough to be treated, when they are one of the most important injuries to treat.  You can break a collar bone and tear an ACL and go through a recovery process that is visible and predictable.  You cannot even see a concussion, except for an MRI or CT scan.  Treatment approaches vary from clinician to clinician, but the consensus for the treatment of concussions is plenty of rest, light activity (non-sports related with no risk of further brain injuries), restriction of ‘screen time’ (cell phones, computer, tv, etc.), plenty of fluids and over the counter analgesics for headache symptoms.  Even effective treatment can elicit healing times of weeks to months, the brain is a fickle and delicate organ.

Concussions are unpredictable, and like other injuries they vary from person to person.  There is no research showing definitive answers about who is susceptible for concussions or CTE (chronic traumatic encephalopathy).  There is a clear consensus on diagnosis of concussions, but for that to be followed, there must be contingencies in place for these diagnosis processes to be successful.  In the past decade the NFL has changed and re-changed the concussion protocol, working towards a safer playing field for the athletes.  Have these changes made a difference is the question that interested spectators, players and their families would like to know the answer to.

In 2002, Dr. Bennet Omalu, a forensic neuropathologist, did an autopsy on a retired NFL player by the name of Mike Webster.  Mike played in the NFL for 17 years (15 years with the Pittsburg Steelers, 2 years with the Kansas City Chiefs) playing the position of center or guard.  Mike literally used his helmeted head as a battering ram.  He was a relentless player nicknamed ‘Iron Mike,’ but after his long NFL career, his life began to spiral out of control.

Dementia pugilistica, a clinical disease with combination of symptoms resembling Alzheimer’s and Parkinson’s disease.  This form of dementia was originally only recognized in boxers and was also called ‘punch-drunk syndrome.’  After Dr. Omalu’s autopsy of Mike Webster and closer examination of his brain, Dr. Omalu concluded that instead of punch-drunk syndrome, Mike Webster had gridiron dementia, ‘drunk’ from the repeated blows to the head.  This disease does not occur in all contact sport athletes, but in the population that it does effect, it is progressive, and deteriorative.

When he passed away, Mike Webster was homeless, broke and starving.  He had been arrested for forging prescriptions for Ritalin, a drug that helped keep his thoughts together.  His NFL earnings were gone, his marriage fell apart, and his relationships with his kids crumbled.  He was not the Mike Webster he once was, and he knew that.  Tragically, Mike isn’t the only former NFL player to suffer like this, and in other cases even more tragically ended in horrific suicides.

Former Commissioner Paul Tagliabue formed the NFL’s mTBI committee in the mid 90’s assigning Dr. Elliot Pellman (a rheumatologist), team physician for the New York Jets, as chair-person of the committee.  This committee was tasked with researching the long-term effects of concussions and head injuries on football players.  Dr. Pellman was an avid believer that concussions were not serious injuries and that they had no long-term effects.  Dr. Pellman and the other members of the mTBI committee published papers and journal articles, notorious for saying there was no connection between hitting your head in football and cognitive problems later in life.

After completing Mike Webster’s autopsy and brain analysis, Dr. Omalu published a paper with some of the most recognizable names in the neuroscience field about CTE (chronic traumatic encephalopathy).  They submitted their paper to the journal Neurosurgery, the paper was accepted and published in the journal.  Not long after that the NFL’s mTBI Committee released a statement requesting Dr. Omalu retracted his findings because they were not based on scientific fact, they even eluded that he wasn’t practicing medicine, but instead he was practicing voodoo.  According to Dr. Omalu, “You can’t go against the NFL, they’ll squash you.”

But Dr. Omalu wasn’t squashed, and his research findings were presented in 2007 during an NFL summit on brain injuries (This summit came after a change in NFL commissioner from Tagliabue to Roger Goodell).  While the NFL did not invite Dr. Omalu, (he was basically shunned by the NFL) his research partner Dr. Julian Bales was invited and decided to present their work.  Commissioner Roger Goodell sat in the crowd, listening, baffled by the information Dr. Bales was presenting.  This summit brought about some change, stricter concussion protocols and recognition criteria.  Changes for the future of the NFL are great, but what about the former NFL players and their families that are suffering every day?

Chronic traumatic encephalopathy is a degenerative neurological condition that attacks the brain cells.  Years of chronic concussions and sub-concussive (blows to the head that do not rise to the clinical definition of concussion) hits create the deposition and transformation of a protein in the brain.  Tau protein deposition in certain areas of the brain characterize and differentiate CTE from other forms of dementia.  This condition causes fine motor function decline, cognitive and memory impairments, inability to control mood and emotions, decline in basic decision making skills, ultimately leading to a major depressive state and in many cases, suicide.

A study done by Kerr et al looks at a cohort of former NFL players and the rate of nondisclosure in relation to concussions.  In the sample of 829 former players, 417 players reported that they had suffered at least one concussion that they did not report to the medical staff.  Fifty percent of this study DID NOT REPORT a concussion, a serious brain injury, to the medical staff.  As a future athletic trainer, I see that statistic and say, “What the actual **** is going on here…?”  Part of the problem in the NFL (until very recently) is the ‘self-reported’ piece that was classically connected to concussions.  Players shouldn’t have the opportunity to self-report a head injury, unless it is missed by the medical staff.

Athletic trainers, team physicians and neurologists are now all present at NFL games.  Third party neurologists sit in the booths, analyzing every play and collision for signs of possible concussions.  Is this making the game safer?  Does this put the minds of parents whose children’s’ dream is to play professional football at ease?  The presence of medical staff should add a layer of protection to player safety, but when the hands of the medical staff are tied by rules of the NFL, who is going to protect the safety of these players?  Concussion research, even though plentiful at this point, is still in its infancy relating to the NFL and CTE.  Will developing research in this field destroy football?  Nothing, not even looming degenerative brain disease in its players will stop the NFL from expanding and making more money.

The effects surrounding concussions are not just medical; there are financial and social ramifications of even mild and well managed concussions.  Navarro et al studied the non-medical short-term outcomes related to concussions in the NFL.  This study was focused on player longevity, performance and financial losses following concussions, the sample was taking from 5,894 eligible NFL players over an 11-year span.  Of the eligible players only 307 sustained concussions requiring them to enter the concussion protocol and were listed as DNP (did not participate).  Right off the bat this number is staggeringly low, going to back to the other study that was discussed, reported nondisclosure of concussions.

Some interesting findings of this study include: players who sustain reported concussions have significantly shorter overall careers in the NFL than their counterparts, a mean overall salary reduction of $300,000 – $1,300,000 per year, and performance reductions in offensive scoring positions (possibly due to less playing time).  The study sites that more research is warranted, but there is a connection between publicly reported concussions and reductions in career length and compensation.

More than 70 former NFL players had a lawsuit drawn up alleging that the NFL lied to them about the dangers of playing football.  The players and even the public was starting to catch on that there had to have been a major cover up going on in the NFL, with the amount of vehement denial coming from their officials.  The NFL eventually settled the lawsuit for $765 million in damages paid to the plaintiffs for medical bills and extended care.  The settlement did not come with an admission of a connection between football and long-term brain injury, but the NFL didn’t need to confirm that for everyone to understand there is indeed a link.  Former linebacker Harry Carson of the New York Giants said, “The NFL just gave everybody 765 million reasons not to want to play football…”

RA First Draft

Football.  A game that has been woven into the social constructs of American society for decades.  Football is a violent, punishing, unforgiving game, but does it really lead to detrimental health conditions years after players hang up their cleats and shoulder pads?  Was there something the NFL conveniently ‘forgot’ to tell the thousands of players that rotate through the ranks or was the commissioner and other top officials in the dark about the risks of playing professional football?

As a society, we are currently trying to shift the popular opinion about concussions.  For so many years, concussions were not seen as a serious injury.  It was a rite of passage on the football field to ‘get your bell rung’ as the old timers would say.  Athletes in a variety of sports were suffering a mild to moderate degree of brain injuries, and they were sent right back onto the field as if nothing had happened.  Thankfully, with time and research, that opinion is slowly changing.  There are still non-believers out there, like the members of the NFL’s first Mild Traumatic Brain Injury Committee (mTBI).

A concussion happens when a blow to the head causes enough force for the brain to move and strike the inside of the skull.  The brain is suspended in a fluid-type substance inside the skull cavity.  While one of the functions of the fluid-like substance is shock absorption, a force strong enough to cause a collision of the brain into the bone will cause brain injury.  Symptoms from a concussion can have an immediate onset and can last for a few days to months and can range from memory disruptions and mood changes to fatigue and sensitivity to light.  A common misconception is that a person must lose consciousness to be diagnosed with a concussion, but that is quite false.  In 90% of concussions, there is no loss of consciousness.

Stepping forward and reporting a concussion does not happen in professional football, players do not want to be perceived as weak.  The stigma around concussions is still alive and well.  Traditional coaches and even some players see concussions as a ‘fake’ injury or not serious enough to be treated, when they are one of the most important injuries to treat.  You can break a collar bone and tear an ACL and go through a recovery process that is visible and predictable.  You cannot even see a concussion, except for an MRI or CT scan.  Treatment approaches vary from clinician to clinician, but the consensus for the treatment of concussions is plenty of rest, light activity (non-sports related with no risk of further brain injuries), restriction of ‘screen time’ (cell phones, computer, tv, etc.), plenty of fluids and over the counter analgesics for headache symptoms.  Even effective treatment can elicit healing times of weeks to months, the brain is a fickle and delicate organ.

The NFL Machine

Concussions.  An injury to the brain that had, until recently, typically gone untreated and unreported in more cases than not.  Professional football is ‘America’s pastime,’ ‘America’s game’…. but is football also

CCBY: Jonathan Moreau

the leading cause of degenerative brain disease in more than a few retired NFL players?  The league will do whatever it takes to protect itself, the end justifies the means,

right?  Has the NFL been telling lies or, not telling the whole truth to its players since its inception in 1920?  Really… who knows.  But, there is medical fact existing in this world today that demonstrates a possible link between football and degenerative brain disease.  It exists, it is credible and published but Dr. Ira Cassen co-chair of the NFL’s mild traumatic brain injury committee refuse to see any validity in these research studies.  The families of deceased former NFL players and current players alike want the NFL to pay for their long-term health conditions,

“Brains”
CCBY: Neil Conway

including any incidence of degenerative brain disease.

The information found in the sources below is baffling at some points.  The books, articles and film strongly support the notion that the NFL has known about the possible devastating effects of prolonged engagement in football.  Lives and families were ruined, and this body of research shows more than one example of the long term effects of concussions.

 

 

Fainaru-Wada, M., & Public Broadcasting Service (U.S.) (Directors). (2014). Frontline – League of Denial : The NFL’s concussion crisis[Motion picture on Online video]. Kanopy Streaming.

 

This motion picture field holds a plethora of information about the concussion crisis and CTE and how the NFL covered it up for years and ears.  The neglect shown in this film really shoes how the NFL will do anything to protect the billion-dollar empire, with disregard for medical science fact.  There have been many efforts by current commissioner Roger Goodell to close the gap of neglect, but for some it is just too little too late.  The NFL still denies the link between football and degenerative brain disease, when it is medically clear there is some sort of link.

 

 

Fainaru-Wada, M., & Fainaru, S. (2014). League of denial: The NFL, concussions, and the battle for truth. New York: Three Rivers Press.

 

Along with the film of the same title, this book delves into the “NFL Machine” from the perspective of two sports journalists.  The Fainaru brothers investigate the scandalous concussion crisis and portray the secrets kept by top NFL administrators including the past and present commissioners.  This book truly shows that the NFL will stop at nothing to protect their reputation, but more importantly, their revenue.

 

 

Kerr, Z. Y., Register-Mihalik, J. K., Kay, M. C., Defreese, J., Marshall, S. W., & Guskiewicz, K. M. (2017). Concussion Nondisclosure During Professional Career Among a Cohort of Former National Football League Athletes. The American Journal of Sports Medicine,46(1), 22-29. doi:10.1177/0363546517728264

 

This source provides a look at a large number of retired players failing to disclose concussions during their active careers in the NFL.  In the past, concussion symptoms were typically self-reported, now (although the protocols still aren’t what they should be) athletic trainers, medical staff and independent neurologists recognize and diagnose concussions much more frequently.  Undiagnosed concussions can lead to serious consequences such as permanent brain damage and even death.  This article shows how important athletic trainers and trained medical staff are on the sidelines.  And that isn’t just for football, every contact sport should have athletic trainers at the ready to diagnose concussions and keep athletes save.

 

Navarro, S. M., Sokunbi, O. F., Haeberle, H. S., Schickendantz, M. S., Mont, M. A., Figler, R. A., & Ramkumar, P. N. (2017). Short-term Outcomes Following Concussion in the NFL: A Study of Player Longevity, Performance, and Financial Loss. Orthopaedic Journal of Sports Medicine,5(11), 232596711774084. doi:10.1177/2325967117740847

 

This journal article provides insight into viable information collected across an 11-year span in the NFL showing the non-health related effects of reporting concussions.  The incidence of reported concussions is staggeringly low compared to the number of players that have moved through the NFL in that 11-year span.  This article tells of reductions in playing time, career length and financial compensation in players that report having a diagnosed concussion.  One would expect initial play time to decrease, but this article is showing a steady decrease in playing time over the years following reporting of a concussion.  This further solidifies the fact that the NFL has been covering up concussions and their long-term effects for years.

 

 

Omalu, B. (2008). Play hard die young: Football dementia, depression and death. Lodi, CA: Neo-Forenxis Books.

 

Dr. Bennet Omalu was the first to discover the possible link between football and degenerative brain disease.  Dr. Omalu was shunned by the NFL after publishing his findings on the condition of former Pittsburg Steelers linebacker Mike Webster.  The NFL’s MTBI (Mild Traumatic Brain Injury) released a statement requesting Dr. Omalu to retract his paper.  They attacked Dr. Omalu’s work and made false statements about his personal life to discredit his research.  This all ties into the title of the film and book “League of Denial,” further proving the clear fact that the big wigs in the NFL would do anything to protect what they’ve build.

Prospectus

Save the Brain

Let’s take a moment of silence for all the concussions that either went undiagnosed or misdiagnosed in the past year.  If I were to research that number, I might make myself sick.  As a future sports medicine professional, the concussion crisis scares the living day lights out of me; as it should scare all of you.  Concussions are no joke, they are serious and can be life threatening.  Their short term and long term effects

“The Sack”
CCBY: Daniel Moore

can have detrimental repercussions over the life span of a person.  In my research article I will be

 

taking a look at several different previously researched topics, including: causes and effects of concussions, long term effects, second concussion syndrome, CTE (chronic traumatic encephalopathy), concussion protocols in the NFL, diagnosis/treatment of concussions, prevention, and at risk populations.  I am also hoping to take a look at how professional athletes weigh out the risks and benefits of playing contact sports for a living.  Listen to one of my favorite TEDTalks here:  https://www.ted.com/talks/kim_gorgens_protecting_the_brain_against_concussion

This topic is an area of passion for me.  As a future athletic trainer, diagnosis and treatment of concussions will be an enormous part of my job description.

“Brains”
CCBY: Neil Conway

Not only that, looking into the future of my academic career I hope to pursue a PhD in Sports Medicine and I am already planning my doctoral dissertation to be connected to concussions.  In the sports world we have moved past ‘concussions are bad’ and we are currently looking at a crisis where protocols are not being taken seriously, specifically in the NFL.  I am hoping that this research article will shed some light on how bad this crisis really is and some ways we can hope to slow down its progress.

Over the course of the next month, every week I will be using library data bases to locate research articles on concussions.  In addition to that I will also search the internet for TEDTalks and professional media about the concussion crisis.  After all my data is gathered, I will schedule interviews with anywhere from two to five students of the university that have suffered from a multitude of concussions and how that has affected their day to day life, and what their worries for the future are.  After working in these interviews I may schedule some time to talk to some certified athletic trainers here at the university to gauge their theories on concussion recognition, diagnosis protocols, and treatment procedures.  With all of this media and data gathered the remaining time in the semester will be spent writing and organizing my article to my likeness.

 

College Girl Healthy Lifestyle Instagram

In the midst of an IRB debacle, the idea of a blog (Instagram page) with exercise videos, form comparison videos, pictures of food, recipes, etc. on my favorite topic of fitness flourished.  What easier way to get my point across (the point being an active healthy lifestyle is the best medicine and the best prevention) than literally put it all out there.  The idea is to post on my platform one to three times a week just purely about the active lifestyle I live and how easy it really is, even as a dedicated college student.

CCBY: Madisen Giordano

This project is important because the majority of college students don’t actually know what it means to be healthy; some might not even see why working out regularly and eating healthy is good for you.  This project is going to help bridge the gap between wanting to get into a healthy lifestyle and actually doing it.  Its not about how much I can squat or how many calories I eat throughout the day, there’s no counting or starving or any of that jazz.  I simply want to put my lifestyle on display and sort of explain why building the foundation for a healthy life should start much before we are of college age.  I am hoping that this Instagram page will be seen by more than Plymouth State students.  I hope that it will give that little extra push to people that are trying to change their lifestyle.  Living an active and healthy life will bring more than just health benefits, it will also bring happiness, and decreases feelings of anxiety and depression, which is what keeps me going every day.

 

CCBY: Madisen Giordano

The deliverable portion of my project will be my Instagram page.  Here’s the link to my Instagram https://www.instagram.com/lats_and_tats/ Fitness, food and staying healthy are some of my absolute passions and I love that I have the opportunity to share that with the world.  

While changing things after I’ve already got my mind set isn’t my favorite thing in the world, I think this project has the potential to portray the message I am trying to send a lot clearer.  The importance of living a healthy lifestyle cannot be said enough, there are many components of a healthy lifestyle, but once you make the change, you’ll never want to go back.

 

 

 

 

Opportunity

Picture this: after five years of undergraduate schooling, you finally have the chance to APPLY everything you’re interested in to a project of YOUR DESIGN….wait hold on; this is in fact real life.  As a senior in the Interdisciplinary Studies Program, I am staring that opportunity down with a collected idea and a plan of action.  Along with the ‘applied project,’ there is another aspect to this capstone class in the form of a ‘research article,’ on whatever peaks your personal interest.  For this I also have a developed idea and look forward to immersing myself in research.

My applied project is focused on building and maintaining a healthy lifestyle, and how easy it can be no matter how busy someone may be.  Essential my best friend and I will be embarking on a fitness journey.  While I am very familiar with going to the gym between personal experience and my academic studies, my gym partner is not.  Along the way I w

Lift CCBY: Marino González

ill be showing her different workout routines, proper form for various resistance training exercises, and help her to develop a sense of confidence in her abilities.

Together we will be grocery shopping and meal planning/prepping and going to the gym.  After spring break our goal is to start training for a Spartan Race or Tough Mudder that we plan to compete in post-graduation.  I hope to have some deliverable data, body weight and fat percentage decreases, stamina and endurance increases, and achieve the personal aesthetic goals we have for ourselves.

For my research article, I plan on taking a closer look at concussions.

Brain CCBY: Adam Okoye

The concussion crisis is currently at the forefront of the sports medicine field.  Over the past decade research on concussions and their effects has grown exponentially and being a future athletic trainer, a lot of my interest lies in concussion prevention, diagnosis and treatment.  Having the opportunity to do a self-directed research paper is really incredible.

I have incredible gratitude for the absence of topic assignments, sign-up lists and generic project parameters.  The Interdisciplinary Studies Program has a strong philosophy of student centered learning and every assignment I have within these classes reminds me of that.  I love having the opportunity to research topics and do projects I am passionate about.  It feels less like school work and more what my career will be focused around.

Where it all Began

“But Coach, I don’t know how to play goalie!!!” A thirteen year old me screamed to my middle school field hockey coach as she and my teammates suggested tossing me in the net at practice. I didn’t even know how to strap into the pads or how to hold the stick. The fear and excitement of something new was taking over. At this point in time I had been in love with the sport for four years and I thought I knew everything there was to know abo

Playing goalie for a game during my senior year of high school
Photo by: Madisen Giordano

ut it….Well I was dead wrong.

My previous position was defense and I thought how much different could it be really, besides getting the ball shot directly at you….. By the end of that season not only was the team I played for undefeated Tri-County Champions, I recorded a shut out season. That one season of playing goalie in middle school led me here, to Plymouth State University where I was a goalie on the field hockey team for a brief period of time my freshman year. More importantly that one season of middle school field hockey ingrained the love of everything sports related into my soul. I continued to play field hockey all four years of high school (not as a goalie though) and if I hadn’t I don’t think I would be on the same path that I am now. I would’ve gone to law school, like I told my dad I would do at the age of eight.

 

Kristen Morris ’15 and I on PSUFH team day in August of 2012
Photo by: Madisen Giordano

Field hockey connected me to the person that would change the direction of my education and my life, the athletic trainer that worked at my high school. Two weeks into my junior year I knew what I wanted to pursue in college, it wasn’t until the end of my senior year that I knew Plymouth State was going to be my home. Spending my freshman year here at PSU as an athletic training major was the most enlightening experience I’ve ever had. Plot twist: I did not return to PSU for my sophomore year. I spent the next three years at Northern Essex Community College sifting through majors and programs figuring my life out. After graduating with two associates degrees in 2016 I decided to take a year off to research the best way to finish my bachelors degree. With the help of my amazing advisor/mentor Dr. Linda Levy, I ended up here in Plymouth State’s Interdisciplinary Studies Program.

During this year off from school I spent time reconnecting with my love of sports as well as researching undergraduate and graduate degree programs.  While I was in school at Northern Essex in 2015 I was named an assistant varsity coach for the Pelham High School field hockey team.   As the season went on I realized how important athletic trainers are to

Thoroughly enjoying my senior season for Pelham High School.
Photo by: Madisen Giordano

sports teams, especially high school sports.  After being named the head coach of the Pelham Memorial School field hockey team during my year off from school in 2016 I solidly knew I was going to continue to pursue an education in athletic training to give back to the athletic community that shaped me into the leader and student I am today.

I tailored my program, Sports Medicine, to cover all the prerequisites for the graduate school program I had my eye on: PSU’s MS in Athletic Training Professional Program.  As of a few weeks ago my application was accepted and I can truly from the bottom of my heart thank the Plymouth IDS Department and my middle school field hockey coach for moving me in the direction of my goal of becoming a certified athletic trainer.

A group of Pelham athletes I had the pleasure of coaching in 2016 Photo by: Madisen Giordano