Head Injuries and Figure Skating

So as we all know, ice is hard. There is no way around that. My question for you all is where is the limit for having head injuries in FS? There are many incidents that happen just out of the blue by accident, whether it be by a skater by themselves or a collision(like the regrettable Hanyu/Han incident.) Maybe you think there isn't one?

Also, I've heard about the "three times and you're out" saying about multiple head injuries. Does this apply to concussions and worse or all head impacts together? For example, a skater hits their head, but just swelling occurs.

I fell once broke my wrist and ended up with a black eye. I was only doing those 8 figures, nothing schmensy,but I can't call myself a figure skater...I only did spins and some jumps...long time ago.

Concussions are serious and what we know about them is changing every year. The biggest thing to note is that the greatest danger with concussions is that the effects are cumulative, if you go back to sport too soon you risk further damage and the effects (especially long term) become worse with each successive concussion. The most powerful research coming out right now links repeatitive concussions to Increased incidence of ALS (aka Lou Gehrigs disease). There is a researcher who has families of former football players who die of ALS donate parts of their brain tissue and she identifies specific plaques in the brain.

The only way to asses the severity of a concussion is to see a doctor and Only a doctor can say when it is safe to go back to sport. I fell on ice (not skating, on the street) two years ago and had a minor concussion, I ended up having to have a CT scan and had symptoms (dizziness and nausea especially when reading or using computers) for 2 weeks. Thankfully it was okay in the end but the difference is that I'm not a high level athlete. With concussion the only thing you need is mental rest. There are no special exercises, you just need rest and depending on the severity that means no reading, computers, homework, etc... Several years ago the hockey player Sidney Crosby took a long break because of concussion.

How people do is often specific to that person but the fact is that prognosis gets worse the more concussions you have. I know a division I hockey player who had to make the decision to stop playing before his senior year because he was having symptoms that never went away (he had 3+concussions in 2 years). It isn't fair but the most important thing is safety. Is it really worth all the glory if 10 years later you can't function? (Thoughts I was thinking after the stupidity at COC last year).

Any swelling in the brain is bad news, and when we talk about head trauma we use the terms cou-countercoup. The coup is the movement of the brain toward whatever surface it impacts and the countercoup is the bounce back the other way. So with head injury you actually have two point of impact. The reason it is so important to get assessed if you suspect concussion is that there may be no definitive symptoms, even if it is more severe. (As was the case with the actress Natasha Richardson several years ago who hit her head in a minor skiing accident).

(My credentials are that I have a degree in human physiology and a doctorate in physical therapy).

It's nasty when two skaters crash with their heads but I think the worst that can happen is when a blade hits the head. When you know that this can happen you can not appreciate close side by side camel spins in pair skating like before.

Concussions have always been at the forefront of athletic injuries, causing significant loss of function, and in some cases permanent damage to the athlete. There are specific protocols for managing concussions that are recommended by physicians, sports medicine specialists. However you need the cooperation of athletes, parents, coaches, teams, leagues/ governing bodies, schools to implement the safe return of an athlete to competitive action. I've seen excellent and poor management of concussions at the school recreational level all the way to the elite level (Han/Hanyu).

Regrettably, even at the elite senior level, mismanagement of concussions could occur. I feel certain that the incident that occurred could have been managed better. After watching videos and consulting with ISU medical, I have concluded that LOC preparedness, on the medical side could be better implemented. Skating governing bodies,and coaches should heed medical advice. Yuzuru Hanyu and Han Yan, should not have been allowed back on the ice.

However, I have seen, great improvements at the local and minor levels of sport in identifying concussions and ensuring appropriate management has taken place. I only hope these measures will be taken seriously at all levels.

One thing to be aware of is that a negativre concussion evaluation immediately after the incident doesn't necessarily mean the person shouldn't be evaluated again for a few days after. Nori Aoki who is an outfielder for the SF Giants baseball team was deemed fine after being hit on the helmet with a pitched ball. A day or so later he was overcome with fatigue and dizziness and they concluded that he had, in fact, had a concussion. Head injuries are scary. I have always believed Hanyu should not have been allowed to skate - even though he was protesting he was fine. It always seemed to me that his team (and himself) were more concerned about him winning than ensuring his health was okay. I do think Brian Orser should have overruled Hanyu - if that's what happened - and kept him off the ice. Thankfully it turned out okay but no one could have predicted that at the time and it's always better to be overly cautious.

noskates said:

One thing to be aware of is that a negativre concussion evaluation immediately after the incident doesn't necessarily mean the person shouldn't be evaluated again for a few days after. Nori Aoki who is an outfielder for the SF Giants baseball team was deemed fine after being hit on the helmet with a pitched ball. A day or so later he was overcome with fatigue and dizziness and they concluded that he had, in fact, had a concussion. Head injuries are scary. I have always believed Hanyu should not have been allowed to skate - even though he was protesting he was fine. It always seemed to me that his team (and himself) were more concerned about him winning than ensuring his health was okay. I do think Brian Orser should have overruled Hanyu - if that's what happened - and kept him off the ice. Thankfully it turned out okay but no one could have predicted that at the time and it's always better to be overly cautious.

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Of course coaches and athletes will try to push through whatever injury. But it is the responsibility of the medical staff to say a clear 'No' in such situations. Since there was no doctor at the rink, my guess is that the medical staff wasn't sufficiently prepared - only for putting on a bandage or cooling spray.

Having said that, Brian as a former athlete really should have known better how to treat an head injury.
Seeing Hanyu traumatize his brain by falling every jump really makes me cringle.

While I understand that athletes are used to push through pain, head injuries have to be treated a lot more cautiously than other injuries. Because while one usually can estimate themselve how severe a fall on a knie or arm is, head injuries can have no symptoms and than all of the sudden worsen very quickly.
Also the brain doesn't regenerate ( or only veeeeery slowly) therefore whatever damage is made usually cannot be reversed. The doctors can only try to prevent the damage from 'spreading' by not letting more brain tissue die. But once brain tissue is dead, it won't regenerate the way a broken bone is going to heal.

Seren posted a pretty accurate description of the risk of head injuries. Thanks for that!

Eclair said:

Of course coaches and athletes will try to push through whatever injury. But it is the responsibility of the medical staff to say a clear 'No' in such situations. Since there was no doctor at the rink, my guess is that the medical staff wasn't sufficiently prepared - only for putting on a bandage or cooling spray.

Having said that, Brian as a former athlete really should have known better how to treat an head injury.
Seeing Hanyu traumatize his brain by falling every jump really makes me cringle.

While I understand that athletes are used to push through pain, head injuries have to be treated a lot more cautiously than other injuries. Because while one usually can estimate themselve how severe a fall on a knie or arm is, head injuries can have no symptoms and than all of the sudden worsen very quickly.
Also the brain doesn't regenerate ( or only veeeeery slowly) therefore whatever damage is made usually cannot be reversed. The doctors can only try to prevent the damage from 'spreading' by not letting more brain tissue die. But once brain tissue is dead, it won't regenerate the way a broken bone is going to heal.

Seren posted a pretty accurate description of the risk of head injuries. Thanks for that!

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I'm curious as to why you say that Brian Orser, as a former athlete, should have known how to treat a concussion. A doctor knows how to treat a concussion. Brian Orser is not a doctor. I really don't think it's fair to blame him. Yes he's an adult but he's not really in a position to act in loco parentis, however much it may appear that way in the K&C. I really think the blame lies with the ISU, who either didn't have clear rules in place or didn't enforce them, and didn't have adequate medical staff on hand. I also find it problematic that Team Japan didn't have their own doctor.

papagena said:

I'm curious as to why you say that Brian Orser, as a former athlete, should have known how to treat a concussion. A doctor knows how to treat a concussion. Brian Orser is not a doctor. I really don't think it's fair to blame him. Yes he's an adult but he's not really in a position to act in loco parentis, however much it may appear that way in the K&C. I really think the blame lies with the ISU, who either didn't have clear rules in place or didn't enforce them, and didn't have adequate medical staff on hand. I also find it problematic that Team Japan didn't have their own doctor.

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Brian orser may not be a doctor but he is an Olympic coach training athletes. Concussions are something that you learn in eighth grade public school health; anyone who has ever been involved in a sport or athletic activity where they may be at risk (e.g....skating!!!) should know how dangerous they can be. And yuzuru was clearly in no state to skate... That bandage on his head and glazed look in his eyes are seriously so disturbing. Orser should have overruled. I'm surprised he isn't haunted more by it, they're just lucky it wasn't worse.

When I saw the title of the thread, I thought of Paul Binnebose. He was a U.S. pairs skater with Laura Handy in the 90s. They had won a silver at Junior Worlds and a bronze at Nationals. He fell at practice during a lift and had a devastating head injury. He had several skull surgeries and was in a medically induced coma. Amazingly--although he still suffers from facial paralysis--he recovered enough to be back on the ice coaching. He lives in the Denver area with his wife and two children.

aromaticchicken said:

Brian orser may not be a doctor but he is an Olympic coach training athletes. Concussions are something that you learn in eighth grade public school health; anyone who has ever been involved in a sport or athletic activity where they may be at risk (e.g....skating!!!) should know how dangerous they can be. And yuzuru was clearly in no state to skate... That bandage on his head and glazed look in his eyes are seriously so disturbing. Orser should have overruled. I'm surprised he isn't haunted more by it, they're just lucky it wasn't worse.

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To be clear, I think it was appalling that Hanyu skated and that he continued to skate after each one of those 5 falls he took. The question is, who had the power and authority to make him stop?

If you're relying on the argument that Orser was an adult athlete who should have seen the kid wasn't fit to skate and stopped him - well frankly, there were a lot of other adults backstage with in depth knowledge of skating - the judges, the tech specialists, the ISU officials, the Team Japan officials - and any one of them could have stepped in.

If you're laying the blame on Orser because you think that as Hanyu's coach he had some kind if special obligation, then you really have to examine what their relationship is.

Put it this way: if Jason Brown had gotten injured instead of Hanyu, I think it's quite likely that Kori Ade would have stepped in and Jason would not have skated - not because she's a better person than Bruan Orser, but because she and Jason have both said that she's like a second mom to him. Unless you know that Hanyu and Orser have a similar parent- like relationship, I don't think you can assume that Orser felt he had the power to overrule Hanyu.

That's precisely why I think the ISU should have had and enforced clear rules.

By the way, I didn't learn about concussions in middle school or high school.

Jeez, read this thread and you'd think Yuzuru collided with the barrier or something, not with ANOTHER SKATER who, IMO, was in worse shape than Yuzuru was...

Poor Han Yan. The fact that he passed out backstage and couldn't even begin to spin (unlike Hanyu who had no problems spinning) is being overlooked by the fans so desperate to cast their tragic hero...

I think anything involving the head should automatically rule the skaters unfit to compete. We wouldn't know the extent of a head injury until it is properly examined by medical practitioners. I'm glad the ISU has introduced new guidelines on this matter, although IMO they can definitely do better.

The collision between Han Yan and Hanyu was so sickening, it'll give me nightmares for a long time.

Well thankfully, IIRC, the new rule set after this season said that the referee can decide whether or not a skater can compete after an injury. It should be a more neutral POV than a coach, a country official, the skater or anything. But definitely there should be a limit, head injuries are no joke and must be examined carefully, aside form the fact that the skater has to stop his/her activity for a few weeks and take it easy. A head injury, regardless of how hard the hit was, should always mean WD.
As far as I know, if it's just a one time thing and the person never lost consciousness, has a good eye response (that the pupils contract at the same time) and a general state of alert, then it's not likely it will have long-term consequences. Look at the football (american football) players, thousands of them have sustained concussions, but you rarely see one who had to retire because of it or had after-effects once their careers ended. The thing is that it must not be repetitive, that's where truly serious neurological damage can take place.

But still, the person has to rest, wait until the symptoms wear out (if there are any) and even then, he/she has to be careful and under constant surveillance for a few days. Skating and jumping around for four and a half minutes definitely doesn't fit that category, thankfully neither Yan or Hanyu hit their heads with all the falls they took. If what the forum regarding the incident said was right, they both fell unconscious at some point and that's a serious attention grabber. In every paramedic course, they'll tell you that if the person passes out, an ambulance must be called right away and head for the hospital.

We've all seen episodes in pairs, where a lift goes wrong and the woman takes a very hard fall, sometimes falling unconscious. Even if figure skating is not a contact sport, it can happen, but precisely because it's not a contact sport, the athletes are in less risk of repeatedly suffering from head trauma (unlike say, boxing).
And I remember Binnebose accident, I saw it once on YT, it was horrible. It's a miracle he survived and was still able to skate at all. Sure, facial paralysis is not the best outcome, but considering the injury he sustained, it could have been A LOT worse.

karne said:

Jeez, read this thread and you'd think Yuzuru collided with the barrier or something, not with ANOTHER SKATER who, IMO, was in worse shape than Yuzuru was...

Poor Han Yan. The fact that he passed out backstage and couldn't even begin to spin (unlike Hanyu who had no problems spinning) is being overlooked by the fans so desperate to cast their tragic hero...

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I guess it because his injury was less scandalous, not saying that it should in any way mean he was less injured, it just means that there was less blood. I know perfectly well that the amount of blood is not proportional to the seriousness of the injury (specially in head injuries where a small cut can mean a lot of blood but a skull fracture doesn't), but that's the indicator some may take. What both of them did was terribly wrong (and stupid), not a reason for any of them to be called a hero.

xibsuarz said:

As far as I know, if it's just a one time thing and the person never lost consciousness, has a good eye response (that the pupils contract at the same time) and a general state of alert, then it's not likely it will have long-term consequences. Look at the football (american football) players, thousands of them have sustained concussions, but you rarely see one who had to retire because of it or had after-effects once their careers ended.

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Unfortunately that isn't the case. The lasting and cumulative brain damage sustained by American football players are so well-known and so controversial in the US that the New York Times has a page for the topic, currently with 527 news articles. Earlier this year the NFL settled a class-action lawsuit filed by former players regarding the long-term effects of the concussions they sustained while playing (including chronic traumatic encephalopathy, a neurodegenerative disease); it's estimated that over 20,000 players could be eligible for compensation. As a part of the lawsuit, players with diagnoses of CTE and ALS (Lou Gehrig's disease), both believed to be due to repeated concussions, have spoken out about their conditions. A former star, Junior Seau, was diagnosed with CTE and committed suicide a few years ago; other players have died and left their brains to researchers studying CTE, who have found that former football players have a very high rate of incidence. Several successful players decided to walk away from their careers rather than signing new contracts this season, voicing fears of head injuries from repeated impacts and concussions. A recent study found significant mental consequences for players who began playing tackle football (which has the highest rate of head impacts) as children. Families are even beginning to sue school districts and children's leagues. You can find a good summary of the issues here: http://www.nytimes.com/2015/03/22/opinion/sunday/a-football-players-safe-exit.html

And concerns, and studies, are beginning to extend beyond American football to other sports--especially football (soccer), where heading the ball is a constant part of the sport and head collisions of the kind we saw at CoC are scarily frequent.

ribbit said:

Unfortunately that isn't the case. The lasting and cumulative brain damage sustained by American football players are so well-known and so controversial in the US that the New York Times has a page for the topic, currently with 527 news articles. Earlier this year the NFL settled a class-action lawsuit filed by former players regarding the long-term effects of the concussions they sustained while playing (including chronic traumatic encephalopathy, a neurodegenerative disease); it's estimated that over 20,000 players could be eligible for compensation. As a part of the lawsuit, players with diagnoses of CTE and ALS (Lou Gehrig's disease), both believed to be due to repeated concussions, have spoken out about their conditions. A former star, Junior Seau, was diagnosed with CTE and committed suicide a few years ago; other players have died and left their brains to researchers studying CTE, who have found that former football players have a very high rate of incidence. Several successful players decided to walk away from their careers rather than signing new contracts this season, voicing fears of head injuries from repeated impacts and concussions. A recent study found significant mental consequences for players who began playing tackle football (which has the highest rate of head impacts) as children. Families are even beginning to sue school districts and children's leagues. You can find a good summary of the issues here: http://www.nytimes.com/2015/03/22/opinion/sunday/a-football-players-safe-exit.html

And concerns, and studies, are beginning to extend beyond American football to other sports--especially football (soccer), where heading the ball is a constant part of the sport and head collisions of the kind we saw at CoC are scarily frequent.

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Ok, sorry. I had not seen that page from The Times. Now that I think of it, they do take a lot of hits to the head on daily basis, some incredibly hard, talk about danger. Wrong reference from my part. Thank you for the information, I'm very interested in this, from what it says, it's the repetitive head trauma the one they want to avoid (and seriously they should, good for Borland for doing it, even if it was tough). I will definitely check it out in detail in my spare time. Thank you

Yes, it is becoming quite the issue here in football as well. There is a player from one club who has had seven concussions AND a broken neck in two years and insists he'll keep playing in spite of the club, the fans, other players, the administration etc pleading with him to retire.

Another player retired last week; he had a big head-clash concussion a few weeks ago, and found himself having the same conversations with his wife, unable to remember that he had already spoken with her on that subject. He said openly that that terrified him, and he didn't want to risk any further damage.

And head injuries can be silent killers. Allen Simonsen was involved in a terrible crash on the first lap of the Le Mans 24hr race a couple of years ago. He got out of the car under his own power, and sat with the marshals. He was laughing and telling jokes. Then, as time went by, he got quieter. He decided to lie down. He got quieter, and quieter, and then closed his eyes, never to open them again.

I said it at the time and I will say it again: I wonder how many of the people who called Hanyu a hero for skating that night would still have done so had Yuzuru closed his eyes and died in the kiss and cry, the green room, the press conference? It could have happened. And that's why concussion needs to be taken very seriously. That's why I'm glad that the USFS and Josh's team seem to be taking his concussion seriously.

The brain is not something to be messed with. It's easy to damage and impossible to fix.

papagena said:

I'm curious as to why you say that Brian Orser, as a former athlete, should have known how to treat a concussion. A doctor knows how to treat a concussion. Brian Orser is not a doctor. I really don't think it's fair to blame him. Yes he's an adult but he's not really in a position to act in loco parentis, however much it may appear that way in the K&C. I really think the blame lies with the ISU, who either didn't have clear rules in place or didn't enforce them, and didn't have adequate medical staff on hand. I also find it problematic that Team Japan didn't have their own doctor.

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I know Brian is no doctor. That's why I said that it was clearly a mistake of the medical staff for allowing Hanyu to skate.
But while it's probably the first time the incompetent medical staff saw a concussion, as someone who has been in the sports scene for so long, it surely wasn't the first concussion Brian had seen and therefore he should have known the risks and how careful one has to be with head injuries.

I'm worried that at the time noone felt responsible for saying No - not the juges, tech specialists, referee, medical staff, coaches. If I was the referee or jugde I would have refused to judge him. It's this kind of: it's not my concern, I'm no expert and therefore can't think for myself, someone else is going to handle it -mentality that let those things happen.

karne said:

Yes, it is becoming quite the issue here in football as well. There is a player from one club who has had seven concussions AND a broken neck in two years and insists he'll keep playing in spite of the club, the fans, other players, the administration etc pleading with him to retire.

Another player retired last week; he had a big head-clash concussion a few weeks ago, and found himself having the same conversations with his wife, unable to remember that he had already spoken with her on that subject. He said openly that that terrified him, and he didn't want to risk any further damage.

And head injuries can be silent killers. Allen Simonsen was involved in a terrible crash on the first lap of the Le Mans 24hr race a couple of years ago. He got out of the car under his own power, and sat with the marshals. He was laughing and telling jokes. Then, as time went by, he got quieter. He decided to lie down. He got quieter, and quieter, and then closed his eyes, never to open them again.

I said it at the time and I will say it again: I wonder how many of the people who called Hanyu a hero for skating that night would still have done so had Yuzuru closed his eyes and died in the kiss and cry, the green room, the press conference? It could have happened. And that's why concussion needs to be taken very seriously. That's why I'm glad that the USFS and Josh's team seem to be taking his concussion seriously.

The brain is not something to be messed with. It's easy to damage and impossible to fix.

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Completely agree with you! I was shocked he or Han were allowed to skate after such a sickening collision and then they were held up as examples of courage rather than as examples of folly afterwards. Especially Hanyu, who the Eurosport boys couldn't mention for the rest of the season without referral to his courage and how he was out cold (usually ignoring Han of course!). Yes, it did require spirit to skate after an injury and the bandage around the head added drama but my overwhelming feeling at the time was "WHO IS ALLOWING THIS TO HAPPEN?". No amount of competing to get points to qualify for any competition final was worth it!!!! And I say this as a Hanyu admirer.

With the seriousness of head injuries in sport too often tragically illustrated, there has to be a standard set at this kind of event where a medical expert is charged with making a binding decision as to allow/not allow someone to skate following a potential concussion. Somebody has to take that responsibility to avoid potential tragedy.

@eclair - I absolutely agree with you that Hanyu should not have been skating. I find it perplexing that you would assume that the medical personnel were incompetent and that Orser was more qualified to judge than they were.

If you go back & read articles written within a short time of the event, you will see that the Japan Skating Federation did not bring a team doctor along. Other doctors (reportedly from Team USA and Team Canada) evaluated Hanyu for concussion before he went back on the ice. I have not found any statements by those doctors confirming what advice they gave.

Orser's statement in the CBC article below should make it clear that he doesn't have the expertise you claim he should have, despite his years of experience as an athlete and coach. A doctor is trained to evaluate and make these decisions on the fly, under intense pressure. A coach is not. It seems to me Orser did what he thought was best in a situation he was not prepared for. It's clear in retrospect that he and everyone else involved guessed wrong.

The daily mail article includes a statement by Hanyu about the incident. The isaekkiya article contains a decent analysis of the situation, including ISU rules at the time of the accident.

http://www.dailymail.co.uk/wires/af...-says-Olympic-figure-skating-champ-Hanyu.html

http://www.cbc.ca/m/sports/figuresk...n-still-wins-silver-at-cup-of-china-1.2828773

https://isaekkiya.wordpress.com/2014/11/10/the-blame-game/