Novak Djokovic steps onto Centre Court today, aiming for his 8th Wimbledon title and 25th Grand Slam victory, adding another milestone to his illustrious career. However, the past few months have posed significant challenges for the Serbian star.

It’s important to note that the following is anecdotal and depends on accurate reporting, but research suggests that management of head impacts can be just as important for both brain and body.

Could this be a case of a predictable coincidence?

10th May 2024 – Novak Djokovic is accidently struck on the head whilst signing autographs when a metal water bottle falls out of a spectator’s bag.

Djokovic reports “That has really impacted me a lot. After that I got medical care, been through half an hour, an hour of nausea, dizziness and blood,” Djokovic said. “I managed to sleep OK. I had headaches. The next day, or yesterday, was pretty fine, so I thought it’s OK. Maybe it is OK, maybe it’s not.”

 

12th May 2024 – Djokovic is unexpectantly knocked out of the Italian Open 6-2, 6-3 by 29th seed Alejandro Tabilo.

Djokovic reported after the game “Today under high stress, it was quite bad – not in terms of pain, but in terms of this balance. Just no coordination. Completely different player from what it was two nights ago.”

 

24th May 2024 – Djokovic is knocked out of the Geneva Open by world no. 44 Thomas Machac, beating the world no.1 6-4, 0-6, 6-1.

So what are some of the challenges athletes might face post-concussion?

Balance, coordination, concentration, vision.

Research suggests that more than half of sports-related concussions result in vestibular-ocular motor dysfunction. In an arena where even the smallest advantages can be the difference between winning and losing, the restoration of these components is critical.

With improved oculomotor function facilitating fast and accurate motor movements, this approach to training can even enhance sensorimotor abilities and hand-eye coordination. Could this be one of the secret weapons that elite athletes possess?

Post-concussion rehabilitating oculomotor function needs to be considered.

In a fast-paced sport like tennis, where top players rely on exceptional hand-eye coordination, it is likely to performance-critical.

Ever wondered why you never made it to Wimbledon? Maybe it wasn’t just technique.

4th June 2024 – Djokovic withdraws at the Quarter-Final stage of Roland Garos following victory over  Francisco Cerundolo due to a meniscal injury in his knee.

Djokovic reported that he had felt the knee before the tournament, but a slip in the second set exacerbated the issue.

 

6th June 2024 – Djokovic announces on his social media that he has had surgery on his knee having sustained a meniscus tear during his last match.

With evidence showing that following a concussion there is a 2.5 times greater risk of sustaining a musculoskeletal injury, a doubling in the risk of lower limb injuries, and the likelihood of a further concussive event occurring, it becomes clearer that challenges can go far beyond the brain.

Regardless of gender, or even the level competition, the risks are relevant. And this increased risk can persist well beyond the typical period for symptom resolution.

While the exact reasons for the changes in risk aren’t definitively known, one theory suggests that deficits in neuromuscular control following a concussion contribute to this increased risk.

However, one thing that does seem apparent is that many lines of thinking are leading us back towards the importance of multimodal, targeted rehabilitation.

So, what to do?

Waiting for symptom resolution alone is no longer appropriate management.

Whether it be visual training, neuromuscular control, balance or coordination; we need to rehabilitate athletes in the quest to both optimise performance and reduce injury risk.

Unsure where to start?

Your Brain Health Level 2 – Comprehensive Concussion Management will delve into the vast array of multimodal assessment options for immediate an on-going evaluation. A 10 hour online course, it is split into easy to manage modules so you can go at your own pace.

Take a deep dive into concussion management today.

Welcome to the Euro 2024 Concussion Awareness Q&A

As we gather to celebrate the beautiful game at Euro 2024, it’s important to shine a light on an issue that affects players at all levels: concussion. Football brings us together, fostering inclusivity, progress, and care within our communities. We owe it to the players who inspire us to ensure their health and safety are prioritised both on and off the pitch.

How common is concussion in football?

While the most frequent injuries in football involve the lower limbs, concussions and other head injuries, though less common, remain a significant concern. Head and neck injuries are rank as the 5th most common type of injury, making up about 5% of all football injuries. Specifically, concussions occur at a rate of approximately 0.5 per 1000 match hours, with an even lower incidence during training sessions.

How do head injuries occur?

Head injuries often happen during aerial challenges. Collisions involving head-to-head contact, elbow-to-head, knee-to-head, foot-to-head, and head-to-ground impacts are the primary culprits.

Are some positions more likely to sustain a concussion?

Yes, defenders are most prone to concussions (33%), followed by midfielders (30%), forwards (24%), and goalkeepers (13%). These injuries are most common in the final and initial 30 minutes of a match, particularly in midfield areas where collisions and aerial duels are frequent.

Is there a difference between the male and female game?

Indeed, studies show that head and neck injuries occur more frequently in female players compared to their male counterparts (17% vs. 14%).

What are the impacts of concussion on football players?

Growing concerns have emerged following studies indicating that former professional footballers are 3.5 times more likely to die from neurodegenerative diseases than the general population. Conditions like dementia, Parkinson’s, motor neuron disease, and Chronic Traumatic Encephalopathy (CTE) are linked to repeated head impacts.

One of the lesser-reported impacts of a concussion is that athletes are reported to have a 2.5 times greater risk of sustaining a subsequent musculoskeletal injury following an initial concussion.

What about concussion substitutes?

The International Football Association Board (IFAB) approved the trial of permanent concussion substitutes in 2021. This measure was implemented in the Premier League and Women’s Super League, with FIFA initially trialling it in international competitions such as the FIFA Club World Cup™.

What else are authorities doing to protect players?

Authorities are continuously working to safeguard players. In 2021, new heading guidelines were introduced by The FA, Premier League, EFL, the PFA and the LMA, recommending that a maximum of 10 higher-force headers are carried out in any training week. In May 2024, the FA have begun phasing out deliberate heading in matches for all grassroots youth football from U7 to U11.

How can Your Brain Health help?

Your Brain Health is dedicated to promoting effective concussion management strategies within the football community. Through education, such as the online Level 1 course “Concussion – Are You Ready?”, players, coaches, and officials can learn to protect themselves and others, ensuring the long-term health and safety of everyone involved in the sport.

Together, by staying informed and proactive, we can ensure that football continues to be a source of joy, unity, and safety for all. Enjoy the matches, support your teams, and let’s keep our players safe on the road to glory at Euro 2024!

The ICC T20 Cricket World Cup has kicked off in the USA and West Indies, thrilling us with every boundary, wicket, and catch. So lets take a look at a crucial and growing aspect of player safety in the sport: concussions.

How common is concussion in cricket?

Concussions in cricket are less frequent than injuries to the hamstring, lumbar spine, and trunk. However, they still occur. Data indicates an annual concussion incidence of 0.9 per 100 players, or 2.3 males and 2.0 females per 1000 days in the elite game.

In England, during the 2023 domestic season, there were 17 reported concussions, each resulting in an average of 10 days lost per concussion.

How do head impacts occur in cricket?

The primary cause of head impacts in cricket is batters being struck by the ball from fast bowlers, accounting for 67% of such incidents. Other causes include close fielders being hit by the ball, collisions with other players or the boundary fence, the head striking the ground, and wicketkeepers being hit by the bat!

Is there a difference in Men’s and Women’s cricket?

Yes, there is a difference. In elite cricket, concussion rates are 0.4 per 1000 player hours for men and 0.5 for women. Interestingly, 53% of head impacts in women’s matches result in concussions, compared to 32% in men’s matches.

What is the impact of concussion in cricket?

Post-concussion, symptoms like balance issues, impaired concentration, and vision problems can affect performance relating to cricket. Repeated head impacts and concussions are linked to chronic traumatic encephalopathy (CTE), though there are no known cases in cricketers so far.

In 2021, Derbyshire wicketkeeper Harvey Hossein retired from cricket following a series of concussions.

What are the concussion protocols in cricket?

In 2019, the International Cricket Council (ICC) mandated concussion protocols, requiring players to pass a series of assessments before continuing play.

What about concussion substitutes?

Since August 2019, the ICC has allowed concussion substitutes in Test matches. If a player is diagnosed with a concussion, they can be replaced by another player who can fully participate.

Marnus Labuschagne became the first concussion substitute in the history of international cricket, replacing Steve Smith during the Lord’s test of the 2019 Ashes series. He went on to score 59 in the fourth innings to help Australia salvage a draw.

What are the helmet regulations?

Modern cricket helmets are designed to offer enhanced protection but cannot eliminate concussion risk entirely. Helmets must comply with the British Standard BS7928:2013, a mandate from the ICC to improve player safety. The introduction of neck guards has also been developed which have now been mandated by both Cricket Australia and the ECB.

What are the guidelines at an amateur club or school?

While elite teams have trained medical staff to manage head impacts, concussions also occur at the community level. In Australia, 28% of cricket-related hospital admissions were as a result head injuries.

Research indicates that players often lack awareness about guidelines, testing, and helmet regulations, highlighting the need for ongoing education. Australian Guidelines now recommend clubs and schools appoint a concussion officer to manage concussions.

How can Your Brain Health help?

Your Brain Health offers education on concussion, including the online Level 1 course “Concussion – Are You Ready?” This 45-minute course is designed for those at elevated risk of concussion or who wish to become designated concussion officers.

We were delighted that Simon Shepard was joined by Associate Professor James McLoughlin alongside Liz Jemson-Ledger as the latest guests in the final of our 2024 concussion webinar series.

Watch back as we discussed:


* How patients with persistent concussion symptoms often present

* What interventions can have a positive impact on outcomes, including real life case studies

* The importance of early intervention in preventing persistent symptoms

We explored all of this, and much more besides, in what was an interesting and lively update on the current research in concussion care, followed by a live Q&A.

Webinar: Management of Persistent Concussion Symptoms

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You’re at the top of your game, both mentally and physically, tackling life head-on. Then, bam! You suffer a concussion, and suddenly, everything feels off.

Headaches, dizziness, memory loss – the usual suspects.

But what about those silent saboteurs lurking at the bottom of the SCAT score sheet?

Anxiety, irritability, sadness – the uninvited guests crashing the post-concussion party.

 

The link between concussions and mental health struggles isn’t a mere coincidence; it’s a well-established fact. Studies reveal that over 65% of concussion survivors battle with depression and anxiety post-injury. And if you’re among the unlucky 20-30% stuck with lingering symptoms for more than two weeks, those odds skyrocket to a staggering 76%.

Now, let’s put things into perspective. The World Health Organization defines mental health as ‘a state of mental well-being, that enables individuals to cope with difficulties in life, understanding their abilities, and working towards the betterment of themselves as well as for the community.’  But what happens when a concussion disrupts this delicate balance?

In adolescents, a history of concussion in the past year increases the risk of suicidal thoughts and actions. Considering that suicide ranks as the second leading cause of death among U.S. teens, and an estimated mind-boggling 33 million children worldwide suffer concussions yearly, the gravity of mental health post-concussion becomes painfully clear.

Mental health matters. And post-concussion, it really matters.

 

So, what’s going on inside our heads after a knock to the noggin? Let’s explore four potential culprits:

First up, the physical aftermath of a concussion have been proposed to affect the neural mechanisms of mood regulation circuits. When your brain’s emotional control centre takes a hit, it’s no wonder your mental health takes a nosedive.

Secondly, concussions aren’t just about physical pain; they’re a psychological rollercoaster. Factors like social isolation, fear of re-injury, and decreased participation, compounded by concerns over selection or contracts, as well as the dread of letting teammates down, can create a downward spiral into mental health challenges. This combination can morph into a vortex of despair, leading to significant mental health consequences.

Thirdly, your family and personal mental health history might increase your susceptibility to poor mental health post-concussion. It’s like having a genetic predisposition to a double whammy of emotional turmoil.

And let’s not forget the sleep-depression connection. With persistent concussions throwing your sleep regulation out of whack, it’s no surprise that executive function, working memory and processing speed take a hit, dragging your mental health down with them.

 

Now, here’s the kicker: despite the glaring mental health implications, a whopping 50% of concussions reportedly go undiagnosed. With no definitive test in sight, concussion remains a clinical diagnosis. So, when a patient waltzes into your office with nothing but mental health symptoms, are you equipped to connect the dots?

Tools like GAD-7, PHQ-9, and the Pittsburgh Sleep Quality Index might just hold the key to unlocking the silent suffering of concussion survivors.

Because mental health matters, today and every day.

Muscle capacity, Yo-Yo, Counter movement jump. Tick

Heart, lungs, liver and kidneys. Tick

Gait analysis, technical analysis, biomechanics. Tick

Now the brain.

 

Such a drag, and something that bores the players. A common response from colleagues who work in sport when discussing concussion baseline testing.

But before resigning our interest let’s consider the why, the what and the how.

 

Why

In simple terms screening is a reference point, an opportunity to gain some insight.

Is it the best a person can be? No.

Is it how the person is functioning on that particular day – no more no less.

Sporting endeavour can require exceptional musculoskeletal capability, cardiovascular attributes that blow the mind (let alone the lungs), and technical nuances that provide a foundation for consistent performance –understanding some of the data that that underpins these super human feats can be valuable.

Additionally, sport can require cognition, balance, emotional control, eyes that work accurately and at speed.

It makes sense that gleaning a rounded view on these factors may have its uses too.

Whether used as a reference point for comparison in a time of challenge (concussion being one of the more obvious possibilities); or to provide an understanding of functional capabilities (something that can be used to identify areas to be worked on), or simply used as a comparison between peers (one that may provide a layer of insight when it comes to talent identification) the insights gained are there to help.

 

What

Tests come and tests go, sometimes led by research, sometimes by fashion.

As the brain does so many things, a better baseline test is one that is multimodal.

And the insights are not simply a list of numbers and objective markers. Understanding the subjective and the history is important too. If you know that someone suffers from migraines, or is challenged by poor sleep quality, that can only help if evaluating symptoms post a possible concussive episode.

How is the persons mental health? Do they have any learning challenges? Is ADHD an issue? Further things that help complete a holistic picture.

 

How

Well, that will be down to you – there are a range of tests that can be used.

Considering the amount of time that is spent looking at muscle balances, joint range, speed, power and technique, it is ironic that looking at the very organ that controls these things is considered such a chore.

Do you understand BEST practice when it comes to concussion management?

We think we do.

That’s why we’ve come up with our BEST practice model of concussion care.

Baseline screening

We have removed time and cost limitations by designing fast and cost-effective multimodal screens that focus on key measures monitored and compared at an individual level to inform best care following a concussion.

Education

We have developed a world class programme of three critical courses for anyone involved in concussion management. From parents and teachers through to medical practitioners wanting evidence-based updates. Knowing the most up to date developments saves lives.

Support

We facilitate support by providing opportunities for global networking within our custom designed online community of experts. Knowledge around concussion continues to evolve rapidly from the fields of neurology, vestibular, musculoskeletal and sports rehabilitation. Collaboration and sharing are key to innovation and best practice moving forward.

Technology

We are at leading the way in the selective use of the very best technological advances. From specific software, apps, virtual reality, eye-tracking, balance, movement, heart rate and cognitive testing devices, we know what people need and when.

For the eagle eyed amongst you, you’ll have spotted why we call it BEST practice. If you didn’t, have another read. It’ll be good fodder for your brain.

BEST practice. It’s not something enough people know about when it comes to concussion management.

Odd really, given that ignorance isn’t bliss, it costs lives.

We were delighted that Millie Bishop was joined by Nicola Hunt alongside Head of Medical and Research at Neuroflex, Dr David Stevens as the latest guests in our 2024 concussion webinar series.

Watch back as we discussed:

* The development and research behind Vestibular-Ocular motor technology

* How the technology works

* How NeuroFlex can be used in practise to improve clinical care and patient outcomes.

We explored all of this, and much more besides, in what was an interesting and lively update on the current research in concussion care, followed by a live Q&A.

Neuroflex: Utilising Technology to Support Vestibular-Oculor Assessments

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You might not like cricket, but as the song goes, at Your Brain Health we love it!

A game that requires considerable physical characteristics, is also one where the players need to consider balance, visual and cognitive capabilities.

With this in mind, we are delighted to announce a project with Middlesex Cricket that will look to enhance both player welfare and performance development across the Men’s and Women’s game.

The collaboration will incorporate two key components; education and technology.

 

The education will focus on a proactive approach to the management of concussion. Whilst not as big a challenge as seen in a number of sports, the development of scoop shots and the acrobatic feats that are seen in the field mean that there is a possibility. The days of rest and return are now past us, and the word rehabilitate now sits firmly at the centre of the pathway.

 

Pete Waxman, Head of Medical Services said of the partnership:

“Knowledge around concussion management has advanced significantly over the past few years and it is imperative that we are at the forefront of understanding and implementing a proactive approach’.

 

As part of the partnership, the club will also be introducing NeuroFlex; a technology that uses eye and head tracking VR technology to both evaluate and train the performance of the Vestibular Ocular Motor System – crucial for balance, visual acuity and co-ordination. The approach will be part of the club’s multimodal screening programme and, in addition to the enhanced concussion pathway, will be used to develop performance markers across both Middlesex and Sunrisers squads.

 

James Fleming, Head of Athletic Performance feels the technology could support performance gains:

“We have seen new research coming out of the US showing the visual differences in certain baseball players. Our role is to develop the physical skills of our players, and if visual training can be then it is something I am keen on to give us a competitive edge.”

 

David Bartlett of Your Brain Health commented:

“We are committed to developing a global network of clinicians who are dedicated to improving brain health. It is exciting to have formed a partnership with the Sports Science and Medical teams at Lord’s, the Home of Cricket, to be part of that community.”

Ten years is a long time.

When it comes to both the landscape relating to the management of concussion and the advancing role of the Athletic Trainer within sporting organisations in the United States a lot has happened.

As such, it was great to read the latest position statement from the National Athletic Trainers’ Association (NATA) on the management of concussion.

One that provides an excellent update that bridges the condition and the profession.

One that considers the last decade of clinical evidence.

One that, if we reflect that the last position statement from the NATA was offered in 2014, is something that is overdue.

It is an essential read for all Athletic Trainers who want to consider an alignment between recent advances and current practice.

We have summarised the key points below.

Biopsychosocial Model:

The paper emphasizes a holistic approach to concussion management.

Beyond physical aspects, consider psychosocial factors (e.g., mental health, social support).

Personalized care is crucial.

 

Education and Prevention:

From athletes, to coaches, to parents improving education in this area is essential.

The paper underscores the authority of licensed medical professionals in decision-making.

Preventive measures, such as proper technique and equipment, play a vital role.

 

Assessment Advances:

The assessment process has evolved, including an update on the optimal value of baseline screening measures.

A comprehensive evaluation includes symptom assessment, cognitive testing, balance assessment, vestibular-ocular and mental health screening.

Athletic trainers should be proficient in these areas.

 

Prognostic Recovery Indicators:

Factors affecting recovery post-concussion are explored.

Initial symptom severity, early care seeking, and other individual characteristics influence outcomes.

Monitoring these indicators can inform key management decisions.

 

Mental Health Considerations:

Pre- and post-injury mental health are critical.

Screening for mental health conditions is recommended.

Establish referral networks for athletes with mental health needs.

 

Return to Academics:

Returning to school after a concussion requires careful planning.

Individualized support, academic adjustments, and communication with educators are essential.

Monitor academic progress during recovery.

 

Physical Activity and Rehabilitation:

Early controlled aerobic exercise benefits recovery.

Targeted rehabilitation interventions address persistent symptoms, including vestibular and cervicovestibular rehab protocols.

Gradual return to physical activity is part of the process.

 

Return to Sport:

Updated return-to-sport guidelines emphasize a stepwise approach.

Clinically directed aerobic exercise is part of treatment.

Individualized decisions consider the athlete’s well-being.

The above points can be quite daunting for some, when considering the complex and challenging nature of concussion and potential serious health implications.

The authors encourage Athletic Trainers to:

‘engage with domain-specific stakeholders who have expertise beyond the scope of AT clinical practice when feasible. Despite the updates provided herein, concussion science and care will continue to evolve, including in the areas of diagnostic and treatment capabilities. To best facilitate a successful outcome for their patients, ATs are encouraged to stay abreast of scientific advances and thoughtfully modify clinical policies within their scope of practice to provide evidence-based care whenever possible.’

And Your Brain Health is here to help Athletic Trainers!

We provide education with our specific level courses in addition to clinical support and networking through our Community Platform.

If you are an Athletic Trainer who works in this area please do reach out.