Parents who rushed out to buy football helmets this year on claims that the head gear could prevent concussions were buying promises that couldn't be kept, says Toronto neurosurgeon Charles Tator. "Thank God the manufacturers had to withdraw that claim. I've talked with a lot of very talented engineers, and they reassure me that we will never have a helmet that can prevent concussions, because they can happen inside the skull," Tator said at the Petro-Canada Sport Leadership conference.
With concussions a hot-button item in sport medicine these days, there's been a surge in so-called solutions to the concussion problem. While the increase in attention to the problem is welcome, it also opens the door to charlatans, the brain specialist said.
Natural food sellers offer herbal 'remedies' for concussion. There's no scientific proof that they work, he said, any more than the helmets which allegedly prevent concussions. Treatments and methods of assessment are advertised despite the absence of scientific validity.
"It's frustrating because we [scientists]don't have the answers," Tator said. "We don't even know where in the brain the concussion is centred. We don't know the mechanism of it. We don't have the treatment for concussion. We have management principles.
"For Sidney Crosby we don't have medicine; we don't have a physiotherapy routine. There is only time, that's it – and don't go back too early."
He called Crosby a marvellous role model for listening to advice not to rush back until all concussion symptoms were gone and didn't reappear in a game situation.
"He knows how important that is, because he already went back too early once."
Last week, a story appeared about Stanford University football players who were transmitting data to team personnel on the sidelines on head impacts. They wore mouthguards equipped with accelerometers and gyrometers. Next week in Toronto, another force-measuring device will be launched. The Impact Indicator is a chinstrap-mounted device with lights that change colour when a player absorbs a severe hit and should be removed from game.
Some other concussion-fighting theories raise Tator's skepticism. One recent claim postulated that concussion could be prevented by wearing tight garments around the neck and thus keeping a greater volume of fluid or blood around the brain. Allegedly, the increased pressure and increased fluid would keep the brain from 'sloshing' inside the skull in a potential concussion scenario. "It seems kind of far-fetched," Tator said.
The research was done on rats "and we don't know the relationship between whatever injury was given to the rats and a concussion. Is the rat really a good model for concussion? Did anyone ask the rat if he was experiencing dizziness?"
He said the research was probably "1 per cent along the way, to establishing that as a true neural protection remedy for humans. But they've got 99 per cent of the way to go."
The more scientific research that's done, the more doctors realize they've got much more to learn about brain injury, he said. Old theories of concussions involving tearing of nerve fibres in the skull "are not strong" he said, and are being surpassed by a new theory that concussion involves a chemical injury in the brain.
Under the old theory, "we should be able to detect some evidence of that [fibre]tearing in an MRI – and we don't."
He said even images on a new-generation of MRI "isn't compatible with tearing of nerve fibres... Old theories suggest tiny hemorrhages. The new MRI machines that can detect even a speck of blood show no evidence of bleeding in a concussion."