In a previous blog post back in April, I speculated on the National Football League’s (NFL) intentions of setting a higher standard for head injuries and how our warriors might learn from their experiences. As previously stated, in December of 2009, the NFL announced stricter guidelines on when players could return to the field after a head injury. The stricter 2009 statement on return-to-play was developed by the NFL’s medical committee on concussions in conjunction with team doctors, outside medical experts, and the NFL Players Association in order to provide more specificity in making return-to-play decisions. The new guidance supplements the 2007 statement on return-to-play that encouraged team physicians and athletic trainers to continue to take a conservative approach to treating concussions and established that a player should not return to the same game after a concussion if the team medical staff determined that he had lost consciousness.

The Plot Thickens In March of 2010, the NFL chose two new co-chairmen -- and a new name -- for its committee on concussions. Dr. Hunt Batjer of Northwestern University, and Dr. Richard Ellenbogen of the University of Washington will lead what now will be called the NFL head, neck and spine medical committee. When I read this, I again wondered if there might be a connection, based on what military studies were showing us about Traumatic Brain Injury (TBI) on the battlefield. I continued to monitor the situation, based on the accumulating information our fighting forces are compiling. You see, we already know that blunt-force trauma, like being struck in the head with another helmet can damage the brain. It creates damage by bruising, stretching or tearing nerve cells. This can result in cell death and also create the triggering of electrical misfirings in our central nervous system. This is also the damage that can be created during the detonation of an improvised explosive device, or IED, the signature weapon of our enemies in Iraq and Afghanistan. During the detonation of an IED, a solid or liquid (depending on the type of explosive material used) is converted into a gas.

This gas momentarily occupies the same volume as the “parent” solid or liquid, leading to an enormous increase in air pressure. These gases exert pressures of about 700 tons per square inch on the atmosphere surrounding the point of detonation at velocities of up to 13,000 miles per hour or 29,900 feet per second. The expanding gas rolls out from the point of detonation like a ripple in the water and is known as the blast pressure wave. As a result, the gases expand, heating and accelerating the air molecules and compressing the air surrounding the explosion. To put that in perspective, imagine Chris Johnson (running back for the Tennessee Titans, who runs a 4.27 forty-yard dash) hitting you at full speed. He is only moving at 28 feet per second and he is just one man. Science shows us that IED blast actually creates 2 shockwaves! The initial blast wave is followed by what is called a “secondary wind” – a huge volume of displaced air that returns to the site of the explosion, also under extremely high pressure. The pressure waves unleashed by explosions can also induce brain damage, even in cases where a soldier’s head did not strike a solid object. A blast strong enough to cause TBI is also powerful enough to produce emotional trauma and post-traumatic stress disorder (PTSD). The combination of mild TBI and PTSD is considered the signature injury of the Iraq War. P. Steven Macedo, a neurologist and former doctor at the Veterans Administration puts it this way when describing the potential threat.

“Concussions from blunt trauma injure the brain by stretching or tearing it. But in Iraq and Afghanistan, something else is going on. "When the sound wave moves through the brain, it seems to cause little gas bubbles to form," he said. "When they pop, it leaves a cavity. So you are littering people's brains with these little holes." This May Shock You Now scientists have uncovered a surprising possible new way by which a blast might affect the brain — electric fields created when bone is hit by a shock wave. Steven Johnson, a theoretical physicist at MITJohnson and his colleagues developed a new computer model of the electrical fields generated in the skull by an improvised explosive device (IED) — the kind often rigged up nowadays in combat zones. The model results suggest the generated electric fields, deemed the piezoelectric effect, could exceed electrical safety guidelines by a factor of 10. In fact, they might be comparable in magnitude to medical procedures employing electromagnetic fields that can disrupt brain function.

As I had speculated in April, I thought the NFL and our warriors could learn something from collaborating. As it turns out, my hunch was correct. Check out this 4-minute video on the ongoing partnership between DCOE and the NFL. The Numbers Don't Lie Now the data is beginning to emerge and what we are learning is eye-opening, to say the least. In August, the NFL released the following statement: “Scientists funded in part by the NFL said they have found evidence connecting head injuries in athletes to a condition that mimics Lou Gehrig's disease. Dr. Ann McKee said she found toxic proteins in the spinal cords of three athletes who sustained head injuries and were later diagnosed with Lou Gehrig's disease, or ALS. Those same proteins have been found in the brains of athletes with chronic traumatic encephalopathy (CTE), a disease linked to head injuries that causes cognitive decline, abnormal behavior and dementia. These findings, are to be published in this month’s issue of the Journal of Neuropathology and Experimental Neurology. McKee is a neurology professor at Boston University who has studied CTE in athletes. She also is director of neuropathology for the Department of Veterans

Affairs at the Bedford VA Medical Center. Take Away Which would you rather tackle, Chris Johnson weighing 200 pounds running at 28 feet per second or an IED at 700 pounds moving at 28,000 feet per second? Some of you reading this may not have received the option and have been exposed…maybe more than once! Many of our warriors are reluctant to seek neurological observation after exposure to IEDs. If you or a member of your unit, family, or someone you know has been exposed to an IED, please urge them to seek professional testing from a board certified neurologist. You may have lived through the initial blast, but the data is suggesting that we stop looking at this in a tactical sense, but become very strategic in our plans for living our lives in the future. Warrior, out!

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