Triple Salchows, Accurate Looking, and the Role of Exercise in Concussion Rehab

Although it was a typically sunny day in Colorado Springs, it was cold beside the ice rink in the Olympic Training Center. On assignment with the Good Athlete Project, a fellow coach and I stood against the glass watching elite athletes make toe loop, axel, and salchow jumps look easy. We stood there in awe, wondering how many hours it must have taken them to reach that level of expertise. Soon, a pair of young skaters approached our end of the rink. The female partner had successfully completed a triple loop off a throw twice before, but on the third attempt her toe caught and she hit the ice, hard.

In addition to bumps and bruises on the body, it is safe to assume that there was some effect on her brain.

The high speeds she reached (due to the speed of their approach and rotational inertia) might have approached 360 RPM. The impact incurred upon landing (ice is unforgiving…) would have certainly produced the shearing effect and minor structural damage in the brain we call “concussion.” With or without symptoms, it is safe to assume this level of impact would have had some negative effect on her brain. Degree and frequency determine how dangerous these falls can actually be (a nearby coach estimated a skater falls 20-30 times per session), but the obvious fact remains: figure skating is dangerous. I say this not to demonize the sport, but to reinforce the idea that concussions are not limited to contact sports. And since the vast majority of the 2.5 million people who visited the emergency room for TBI (traumatic brain injury) went for falls unrelated to sport, it is clear that concussions are a human issue.

If concussions are indeed a human issue, we should take care to look at the issue accurately. Football, the NFL in particular, has received the bulk of the concussion concern, with some calling for its elimination. Hockey, rugby, and wrestling are under increasing critique. While we should look closely at these notably high-contact sports, we should not stop there; a responsible approach will aim to protect all athletes.

And since sports are a potential mechanism for concussion, we need to increase preventative strategy during practice and competition, limiting the number of overall impacts incurred throughout a season. Governing bodies need to continue to implement and reassess the rules of all games. Local institutions should mandate preemptive strength and conditioning programs which protect the core, neck, and head. Upon injury, we should continue to improve our readiness and strategy for quick and conservative identification of concussion; and when a concussion has been diagnosed, mandate participation in diligent and directed rehabilitation under the guidance of a professional. If sports are not going anywhere, productive allocation of resources will be aimed at making the games safer, not misguided attempts at their elimination.

Physical Educators play a huge role in prevention with improvement and widespread implementation of strength and conditioning programs. Recent research suggests that there might be a role for Physical Educators in rehabilitation as well, as exercise has been linked to improvements in TBI patients. NYU professor and author of Healthy Brain, Happy Life, Wendy Suzuki, paired with Teresa Ashman to design an experiment to measure these effects. Their results were encouraging. Participants who exercised two times per week for eight weeks demonstrated significant improvement in mood and quality of life, and scored lower on measures of depression and fatigue (Lee, Ashman, & Suzuki, 2014). There seems to be an opportunity here for Physical Educators. The opportunity will begin to take shape after asking 5 essential questions:

  1. How often do Physical Educators communicate with the school’s Athletic Training Staff?
  2. Are you familiar with your school’s Return-to-Play protocol following concussion?
  3. How strong is the relationship between your school’s Athletic Training Staff, Athletic Department, and Physical Education Department?
  4. If exercise were to be used in Return-to-Play recovery protocol, who would be the experts on campus? (I hope the answer is you!)
  5. What opportunities are there in the existing school day for individualized exercise programs? Before school (zero hour)? During free periods? After school strength programs?

Recognizing the potential of exercise in the rehabilitation of concussion is essential, acknowledging that there are exercise experts on campus (PE teachers) is key, but answering those 5 questions will begin to build a path toward implementation. It works. The next step is to figure out how it works for you, at your school. Each school will be unique.

Among many benefits, exercise has been repeatedly linked to improved cognitive function (Cotman & Engesser-Cesar, 1985; Voss, et al, 2013), decreased stress and anxiety (Herring, O’Connor, & Dishman, 2010; Adlard & Cotman, 2004), and now demonstrates positive effects on those effected by TBI. Physical Educators can play an important role on both ends of the injury spectrum: prevention and recovery. That is, if they chose to take full advantage of their platform.

 

The skater’s partner helped her up off the ice and she dusted herself off. She did not appear symptomatic. Her coach called out to her. She took a moment and gave a quick “thumbs up” before skating on, prepping for her next attempt. She’s probably fine. The minor damage she could have incurred will more than likely fully heal. But it’s worth taking a look. Accurate looking, cautious care, deliberate thinking… that’s the whole idea.

 

*this article was originally published on SlowChatHealth

 

  • Voss M.W., Vivar C., Kramer A.F., van Praag H. (2013). Bridging animal and human models of exercise-induced plasticity. Trends in Cognitive Science 17(10) 525-544.
  • Herring M.P., O’Connor P.J., and Dishman R.K. (2010). The Effect of Exercise Training on Anxiety Symptoms Among Patients: A Systematic Review. Archives of Internal Medicine, 170: 127-133.
  • Adlard P.A., and Cotman C.W. (2004). Voluntary Exercise Protectts against Stress-Induced Decreases in Brain-Derived Neurotrophic Factor Protein Expression. Neuroscience 124: 985-992.
  • Cotman C.W. and Engesser-Cesar C. (2002). Exercise Enhances and Protects Brain Function. Exercise and Sport Science Reviews 30: 75-79.
  • Lee Y.S., Ashman T., Shang A., and Suzuki W. (2014). Brief Report: Effects of Exercise and Self-Affirmation Intervention after Traumatic Brain Injury. NeuroRehabilitation 35: 57-65.

 

Tim Tebow: the Survey

Rumors of the New York Mets calling Tim Tebow into the big-league have begun. He continues to improve in the minor leagues (he just made the Double-A All-Star team), and it seems his number is almost destined to be called. That news is already sparking low-level debates akin to the nearly constant controversy that came alongside his NFL career. With more debate looming, we decided to run a small study (n=25) in an attempt to identify patterns within the way we, as sports fans, judge the popular athlete.

Methods

Over the course of twenty days in June/July 2018, we collected twenty-five responses (three responses collected by phone, nineteen collected in person, and three via social media correspondence) to a brief survey consisting of the following questions.
1. How familiar are you with Tim Tebow? (1-10):
2. How much do you like Tim Tebow as a person? (1-10):
3. How good is Tim Tebow as an athlete? (1-10):
4. Use one word to describe Tim Tebow:
5. Use one (more) word to describe Tim Tebow:
6. Did you know he was playing baseball now? (Y/N):
7. Do you think he got that opportunity because of his stardom? (Y/N):
For the final question, participants were given a scenario: A prospect in the Mets organization, by many accounts, is strong, humble, hardworking, and his coach says “I’d never bet against him. Whatever the obstacle is, he’s going to be relentless in overcoming it.”
8. Based on the description, would you play the other prospect over Tim Tebow? (Y/N):

The catch in our study is that the description of that anonymous prospect is a description of Tim Tebow. The quote is from his college football coach, Urban Meyer. We understand that the questioning is tricky, and the participants were left anonymous and not told of this “catch”, to avoid any possible embarrassment. After collection, we analyzed the results in attempt to identify why, in a local population, people had such conflicting ideas about Tim Tebow.

Results

Participants had a fairly high awareness of Tebow, responding with an average awareness of 6.8 on a scale of 10 (with a range of 4-10). There was significant range in the opinions of Tebow as a person (2-10), with many leaning low and responding with an average score of 5.76. Regarding Tebow the athlete, there was a smaller range (4-10), with many leaning high and responding with an average score of 7.24.

Tebow Avg Rating from Survey
Average rating of Tim Tebow as a person (column one) and as an athlete (column two).

Questions 4 and 5 looked for adjectives describing Tim Tebow. Descriptions fell mainly between two categories: 21% were coded as Hardworking (effort, work ethic, relentless, perseverant), and 31% were coded as Religion & Associated Values (prayer, abstinent, and Tebowing, among others). Lame came in third with 12%, Strong was in 10% of the descriptions, and Kind, Motivated, Successful, Football, and Dumb were in 7% of the descriptions or fewer [Fig Two]

Tebow Definitions from Survey
Adjectives describing Tim Tebow broken down by frequency.

92% (23/25) of participants said they would select the other athlete to play over Tim Tebow, even though 60% (15/25) of participants mentioned the same or very similar qualities to those given in the scenario (strong, humble, hardworking). 93% (14/15) of the participants who mentioned one of those qualities still chose to play the “prospect” over Tebow.
The most notable date comes in the examination of those participants who rated Tebow a 5 or below as a person. In that subgroup (n=15), participants found Tebow unlikable, on average, with a score of 4.33. Even within that group, Tebow was rated 7.0 as an athlete. Similarly surprising, members of that subgroup also used terms like relentless, hardworking, winner, and strong in their descriptions of him. Still, all of those participants (15/15) selected the anonymous prospect to play over Tebow.

Interpretation

Many of the responses do not seem to align. There are a large number of participants who prefer an unnamed player over Tim Tebow based only on an anonymous description. That description, as we mentioned, is of Tebow himself. This is confusing, since Tebow averaged a 7.4 rating as an athlete. We believe that participant judgement of Tebow as a person often outweighed their view of him as an athlete. This becomes especially obvious in the examination of those participants who rated Tebow a 5 or below as a person. In that subgroup (n=15), participants found Tebow unlikable, on average, with a score of 4.33. Even within that group, Tebow was rated 7.0 as an athlete. They describe him as relentless, hardworking, winner, and strong; still, as mentioned, all of those participants (15/15) selected the anonymous prospect to play over Tebow.

The prefrontal cortex is the locus of logic in the brain, and we shift activation to and from the PFC as situations demand. The amygdala is the locus of emotion, with fear stimulating perhaps the most activation. The amount of activation in the PFC versus the amygdala might be able to suggest the degree to which logic or emotion is being employed in a given situation. In a 2010 study, Masaheko Haruno and Christopher D. Frith used MRI to gain insight into the way people process information during social interaction. In economic games, prosocial participants “defined as those who like to maximize the sum of resources for the self and the other, while simultaneously minimizing the difference between the two” (Haruno & Frith, 2010) had greater activation of the dorsal amygdala when they felt that outcomes of those games were inequitable. That is, during the moments when participants judged “unfair” actions of their peers, the amygdala (emotion) was activated to a greater degree than the PFC (logic). Additional studies demonstrate similar results, with high activation in the insula, which is also associated with emotion processing. These experiments demonstrate one very ‘human’ result: people respond based on the degree to which they feel, relying on emotion, rather than (or at least as much as) logic.
In this study, it was found that many are “rub[bed] the wrong way” by Tebow (as noted in follow-up discussion with participants). A few participants do not like the way Tebow behaves, but had a difficult time providing specifics. Many more cited his beliefs regarding religion and abstinence. He makes people feel like they would not want him to play for their team, even though they rate him a 7/10 as an athlete, and describe him using words like strength, athletic, and hardworking.
A study published in Science in 2008 might be able to shed further light on the discussion. Herrmann, Thöni, and Gächter, from the University of Nottingham, gave participants a set number of tokens to either keep for themselves or contribute to the pot, in whichever quantities they liked. Tokens contributed to the pot experienced a small multiplier before being evenly distributed back to participants. In the experiment, the best possible outcome for a person would be to keep all of their tokens and have all other participants contribute all of their tokens; the worst outcome would be to contribute all of one’s tokens and all other participants keep all tokens. An additional component: participants in the Nottingham study were allowed to punish the other participants as they saw fit. Some were punished for not contributing enough toward the communal pot. Interestingly, the inverse was also true. Researchers found that participants penalized others for giving too much. Interpretation suggests that there was a distaste for those in the group who set a high standard of contribution – in other words, a distaste for those who set a standard they themselves were not willing to uphold.

Is it possible that we feel as though Tim Tebow is setting a standard that demands too much of us?
Limitations

Our survey has a quasi-experimental design and is not large enough to be predictive of a full population. We made an attempt to stay neutral during the interviews and not influence the responses. In the few surveys we conducted via Instagram, it is likely our name and handle influenced the responses (the Good Athlete Project; @coach4kindness). Chicago was the site of most of the data collection. This decision was made primarily for ease of collection. That might also have been a benefit to the survey, since Chicago is outside of Tebow’s primary markets of Florida, Denver, and New York. Still, we believe the responses we received are indicative of the conceptual divide that exists in common conversation and in media: appreciation for the athletic and competitive ability of Tim Tebow. This study did not fall under a high level of scientific scrutiny; rather, a survey was conducted in attempt to identify patterns within perceptions of Tim Tebow to shed light on the way we, sports fans, tend to think.

Conclusion

Despite less than rigorous scientific criteria, we believe this study supports previous studies that suggest human beings judge and punish with more emotion than logic, and that perhaps our emotion-fueled judgement is harsher for those who raise performance and behavior standards to levels we ourselves to not feel comfortable with.
With all of this in mind, we should probably default to the Mets’ ability to assess baseball talent when Tim Tebow gets his chance. If he ever does. After all, logic would suggest that what we see through our screens cannot possibly compare to what MLB talent scouts are seeing in person. Emotion might conflate our ability to accurately assess, as well as make decisions regarding who should play. Sports analysts, internet personalities and armchair quarterbacks, take note.