Why play sports ? – Ask Morgan William


# 2 Morgan William    Toptwitter.com photo


WESTBOROUGH, MA April 1, 2017 In my family playing sports has been a lifelong commitment.  There were plenty of times things did not go as hoped which can be heart breaking for student athletes and heart wrenching for supportive mom’s, dad’s and superfans everywhere.  The physical and psychological benefit of playing sports is well-known just ask any member of the Mississippi State Women’s Basketball team who knocked off the goliath UConn women who had won 111 games without a loss.  In fact, UConn defeated this same Mississippi State team by over 60 points in 2016.  Not so fast.
Congratulations go to 5-foot-5 Morgan William whose winning shot in overtime sealed the win and punched their ticket to the Women’s Division I Semifinal game next week. As exciting as the win may have been, the UConn women will go down in history as having the longest unbeaten streak in history.  The basketball program will be fine going forward – but it stings really bad right now in Storrs, CT.  Why play sports?  The highs and lows of competition teach us about success and failure.  Whether we win or not does not matter as long as we work together and leave nothing on the court – or ice.  Team work builds relationships and discipline – things needed for the real world. Even in Storrs, CT – home the the University of Connecticut amidst the tears and disbelief there is a lesson to be learned.  In this case no team should be taken for granted and no single player can do it all. But last night against UConn it was Mississippi State’s Morgan William’ turn to shine and put on a clinic.

“The training fosters both physical and psychological resilience to stress.”

Women’s sport has grown exponentially since Title IX was introduced that leveled the playing field for female athletes. The physical benefits include improved cardiovascular health and stress-endorphine responses are immeasurable. Psychological benefits include reducing distress, enhancing confidence in abilities and recognizing psychological responses that need the attention of a mental health professional. These benefits have positive implications for long-term health and the prevention of OSI.
Ask any member of the Mississippi State Women’s basketball why they play sports and they will tell you it is for all these reasons and for the chance to end an 111 game winning streak that no one would believe could happen. But it did!

Focused treatment depends on symptom profile

Prescribed rest—both physical and mental—is the standard treatment for concussion. But a growing body of evidence suggests that a more active, targeted approach might provide better outcomes for some patients, reports a special article in the December issue of Neurosurgery, official journal of the Congress of Neurological Surgeons (CNS). The journal is published by Wolters Kluwer.

Chronic Stress – The unbridled malignancy that effects us all

WESTBOROUGH, MA January 31, 2017 There is no way to avoid a stressful life it seems.  Some people are better than others at reducing the impact of stress.  Excercise, healthy eating, regular sleep, and mindfulness reduce the impact of the stress and tension we all experience in our lives.  These behaviors are being taught to children who experience stress just like their parents in many schools. Meanwhile, concussion and more serious brain injuries result in changes in the autonomic nervous system that are sometimes life threatening.  The behavioral response of these afflictions include marked restlessness, anxiety, changes in sleep hygiene, abnormal pain response, and pervasive tension.
In cases of severe brain injury one might see autonomic storming as described in a prior blog. Autonomic storming results from trauma to regions of the brain that control primitive bodily functions like respiration, heart rate, and emotional regulation. This includes profuse sweating, elevated heart rate, rapid changes in body temperature and motor restlessness. These functions are comprised in the autonomic nervous system and are known as the fight-flight mechanism.  The sympathetic nervous system elevates blood pressure, respiratory drive, and gets us ready to fight or run.  Meanwhile, the parasympathetic system puts the brakes on these functions allowing the body to return to its normal resting rate.

“Eventually, chronic stress could be treated as an important risk factor for cardiovascular disease, which is routinely screened for and effectively managed like other major cardiovascular disease risk factors.” Ahmed Tawakol, Harvard Medical School

Ostensibly, stress has the capacity to change this normal resting heart rate and slowly raise our levels making it difficult to truly relax. In the long term, external stress can change our heart functioning including hypertension and cardiac arrhythmia and put us at risk for cardiovascular illness including heart attack and stroke. Lifestyle changes are necessary to avoid long-term health problems from stress. Mindfulness includes deep, regular breathing, guided imagery, and progressive relaxation. It is being introduced in some public schools so that it may become part of the coping mechanisms used by kids when stress sets them off – as it undeniably will do.

Sefton, M. (2015). Heart rate variability: Biofeedback options for post-concussion syndrome,  https://concussionassessment.wordpress.com/2015/08/03/heart-rate-variability-biofeedback-options-for-post-concussion-syndrome/
WebMD (2017) Brain ‘stress ball’ may be key to heart risks. http://www.webmd.com/brain/news/20170111/stress-ball-in-your-brain-may-be-key-to-heart-risks#2, taken January 14, 2017

The stress and frustration at not being ‘well’ – and not knowing why?

WESTBOROUGH, MA February 5, 2017 There is growing frustration in my practice about the lack of “treatment” for concussion and postconcussion syndrome or PCS.  There are many people whose lives have been changed because of one or more than one concussion occurring in close succession.  I am currently seeing a number of cases of individuals who suffer with the symptoms of PCS and are miserable. Over time they have grown hypervigilant about every sign or symptom they experience attributing them to the concussion from long ago. Long term symptoms include headaches, poor memory, low endurance, neck and body pain, tinnitis, feeling like being in a mental fog. I might add that the stress of PCS diectly contributes to changes in mood including: depression and anxiety. People with PCS are at higher risk of substance abuse while recovering.
5-15 percent of peple who sustain a concussion can expect to have symptoms that excede the normal 7-10 day window.  Those who report symptoms greater that 3-6 months are diagnosed with PCS.  I’ve been reading the blog of one PCS sufferer who is eloquent in her description of the impact of concussion on her young adult life. She shares her frustration and fear over not getting better and just as importantly no being understood.  I hear that to many times – nobody listens and nobody understands just how much they suffer. Many grow accusatory and suspicious that the primary physician is denying them the medical care or diagnostic tests they need to find answers and utlimately to recover.
Sometimes vague physical symptoms create an overwhelming emotional response that may come from lingering resentment felt when seeing doctors who seem unable to understand their needs. I always recommend that patients practice a script so that when seeing the specialist they are able to present themselves and their suffering, including all symptoms, in a cohesive understandable manner. Strangely the outward appearance of lingering concussion may appear to be solely a psychiatric condition rather than someone who is recovering from a brain injury. Some physicians unfairly believe prolonged symptoms may be linked to ongoing litigation and are magnified as a way of deriving greater compensation.
In a published blog from September 2016 I have addressed secondary trauma that may confound the recovery from brain injury when it occurs concurrently. Coincident acute stress may exacerbate the physical symptoms and duration of symptoms following concussion and make healing an arduous process.
“A history of migraine headaches may be a predictor of post concussive headaches. Other stressors like divorce, loss, financial problems, motor vehicle crash and others may change the trajectory of recovery.” Sefton, 2016
If someone you know suffers from PCS the effects to a family system can be dramatic too especially when the head of household can no longer go to work.  Whether it is a professional, elite student athlete or a salesman injured in a car crash there is an experience of stigma associated with the invisible injury of concussion. It is increasingly understood that concussion interferes with the efficiency of central nervous system functioning slowing it down.  This is why cognitive rest is recommended so automatically for those newly diagnosed. When the cognitive demand excedes the mental resources available there is a “energy mismatch” that puts a stall on the recovery.
Evidently, there’s no monolithic prescription for treating PCS, which results in much of the work, research, and accountability for getting better being placed onto the patient. It’s a process of trial and error, albeit a very long, frustrating one” according to one blogger who has had PCS for over 2 years. Hockey gal blog

Understanding Concussion: People are still not getting it

WESTBOROUGH, MA January 30, 2017 I am surprised that in a time that scientific knowledge about the long-term impact of concussion is understood and clinically proven that people are still not taking it seriously.  I am asked to evaluate student athletes and frequently am asked whether or not the athlete may return to play before they have begun a return to play protocol.  The protocol about which I write comes in sequence to the athlete being symptom free.  When this happens he or she may begin a return to play protocol that consists of systematic activities designed to slowly stress the athlete in an effort to be certain that no symptoms will return as the athlete exerts himself over a 5 step sequence that ends in a full contact practice.  The reason for this is to reduce the risk of further, prolonged injury and potentially lethal second impact syndrome to the athlete.
Even at the highest level NFL athletes are being held out with “upper body” injury only to be returned to the game within minutes. Viewers are led to believe that the athlete was brought to a darkened, sound proof room for a careful cognitive status exam to rule out the effects of concussion.  The NFL now utilize the services of independent physicians and a trainer in the sky booth watching for hits and injuries that may be indicative of concussion. And yet athletes with obvious signs of concussion are still being minimized.  I find this outrageous when so much is known about brain injury its long term impact on health. According to Aaron Gordon of Vice Sports, “Ladarius Green of the San Diego Chargers suffered a concussion in practice before the team’s regular season opener. However, he still played in the first two games of the season before experiencing another concussion. He missed one game before returning Week 4 against the Browns.”

Gordon, A. (2106). https://sports.vice.com/en_us/article/is-the-nfls-concussion-protocol-working

“The brain…” a second look at what we know to be true

“The brain, which resides in a jacket of water inside the rigid skull, keeps moving, and rotates forward and backward on the fulcrum of the brain stem.” Jane Brody
NY Times article Feb 13, 2007
Boxer Mike Trowell died in a Glasgow Scotland hospital after sustaining a blow to the head in the first round of a match in 2016
WESTBOROUGH, MA February 5, 2017 This blog was first posted in 2013 and has received little comment. I think it remains important 3 years later because it reveals my understanding of concussion that holds true today.  No athlete should return to play before his or her brain is fully healed AND he has been able to successfully undergo the standardized return-to-play protocol established by the CDC in Atlanta nearly 10 years ago.  In late 2016, Irish Boxer Mike Trowell died shortly after a fight in Glasgow on September 30.  He was knocked down in the first round and visibly injured.  After a standing 8 count he was allowed to continue his match when he was again knocked down in the fifth round. At this point he became unresponsive and was transported to the trauma center where he died after being pulled from life support. He had been having severe headaches for days before his final fight.
Our knowledge of the risk of second impact syndrome (SIS) is grounded in the science that has emerged from autopsy studies of the brains of athletes who have died after years of playing contact sports. The incidence of second impact syndrome is quite rare but it occurs with regularity.  When the brain is not fully healed it can be highly susceptible to a second trauma that results in rapid swelling of the cerebral cortex and the loss of cellular transport that allows for autoregulation of cerebral pressure and normal perfusion.  Read the information below that I first published in 2013.

The quote in the heading of this piece is a quote that was taken from an article written by Jane Brody of the NY Times entitled Hard-Knock Lessons From the Concussion Files. In it, Ms. Brody reviews a published article in the New England Journal of Medicine by  Allan Roper, M.D. and Kenneth Gorson, M.D., neurologists from Saint Elizabeth’s Medical Center in Boston.  As we know, concussion is a serious public health problem and is especially hard on younger athletes.  Female athletes are particularly vulnerable to concussion and tend to have longer recover times. Concussion is sometimes considered an invisible injury largely due to the absence of frank signs of injury on the outside of the head.  It is now the standard of care that athletes not return to play until entirely symptom free.  This can take a week or longer and requires rest.  People sometimes fail to appreciate the cognitive demand of school and work.  Over taxing this system may prolong symptoms of concussion and extend an athlete’s down time.  If an athlete returns to play before he or she is fully healed there is a substantially higher risk of having a second concussion before the first is fully healed.  This can result in a protracted course and months of being on the sideline.  What is worse is the possibility of second impact syndrome, a life threatening condition that results from the brain’s inability to autoregulate perfusion pressure while injured.  It is rare but occurs more frequently than one might think.
Michael Sefton – October 2013

Brain, Concussion and Stress: Health effects and post-concussion syndrome

Amygdala highlighted is over active when stress exists and raises the body’s threat level as shown in this BBC graphic
WESTBOROUGH, MA January 15, 2107 The human cost of stress has been well-studied and the effects of stress are a well-known cause of cardiovascular illness including heart attack and stoke.  It is now known that the brain plays a big role in all of this. The human stress response elevates heart functioning – especially blood pressure and normal heart rhythms in unhealthy ways.  Stress activates the amygdala in the brain by tricking it – as if some great threat exists.  People believe that the body’s autonomic nervous system can be thrown off after a concussion slowly becoming irregular resulting from an abnormal stress response. There is a deactivation of inhibitory neurons in the brain resulting in greater sympathetic activity. This involves progressive relaxation and guided imagery that can slowly lower the tension felt in the body.
Symptoms of concussion are known to elevate the sympathetic nervous system over time. Known as the fight-flight mechanism, stress activates the mechanism in the brain that prepares us each for battle.  This level of tension can only last for so long without needing a break. That is where the parasympathetic system comes in putting the brakes on the body allowing it to rest. The brain stem regulates heart rate and respiratory drive as well.  These functions are vital to survival and comprise the autonomic nervous system.
Study: Overactive system of emotional drive
Many believe that an overactive system in the brain results in the elevation of the autonomic nervous system. A Harvard study followed 300 patients for several years and found that those with an overactive amygdala were more likely to have cardiovascular disease and be at greater risk for stroke and heart attack. The amygdala is a tiny organ responsible for the emotions such as fear or pleasure.  It also plays a role in the systemic inflammatory response that may prolong the symptoms associated with concussion. “Heart experts said at-risk patients should be helped to manage stress” according to a BBC publication taken from Lancet.
The protocol I use involves paced breathing and heart rate entrainment as a way of putting the brakes on stress. But it takes time and American’s want instant fixes. Mindfulness requires self-monitoring and personal reflection.  If more people understood the health cost of stress and were able to identify high stress lifestyles then they might make behavioral changes that can lower the risk for cardiovascular disease later on.

The protocol quickly assists in helping patients find a balance or resonance between sympathetic and parasympathetic systems in the body using controlled, paced, breathing and prototypic progressive relaxation” according to Michael Sefton, Ph.D., Director of Psychological and Neuropsychological services at Whittier Rehabilitation Hospital in Westborough, MA.

In several blog posts I have illustrated the potential negative health effects of high stress and physical functioning for which I am providing biofeedback at Whittier Rehabilitation Hospital in Massachusetts. This process helps put the brakes on the stress response and quiet the body.  The effects of concussion slowly elevate autonomic response adding to tension and physical malfunctioning. The biofeedback protocol helps lower the human cost of stress and the body’s inflammatory response and may lower feelings of tension and anxiety.  In doing so a rise in physical and emotional well-being may be expected.

BBC report http://www.bbc.com/news/health-38584975, taken January 14, 2017
WebMD post,  http://www.webmd.com/brain/news/20170111/stress-ball-in-your-brain-may-be-key-to-heart-risks#2, taken January 14, 2017
Sefton, M. (2016) Coincident stress may contribute to post concussion symptoms, blog post, https://concussionassessment.wordpress.com/2016/09/26/coincident-stress-may-contribute-to-pcs/, taken January 14, 2017