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Stacey
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    samsmith2424


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    Post by samsmith2424 Mon Jun 10, 2013 3:40 am

    My son (21) was thrown in a competition and landed on the side of his forehead quite hard. After landing he felt his body shake but no one else observed anything. He withdrew from the rest of the competition.

    My question is when should he return to randori and nage komi. He feels fine now (a few hours after), but has a slight headache and a bit nauseous, which might also be because it was a long hot day. Is a few days break sufficient?
    rjohnston411
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    Post by rjohnston411 Mon Jun 10, 2013 3:56 am

    If he continues to feel disoriented, nauseous and headache-y check in with a doctor. I am no expert, but I know people who have had concussions. Wait maybe a day or two then if it is still there, get him looked at.
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    Post by judoratt Mon Jun 10, 2013 4:09 am

    Sounds like some classic symptoms of a concussion. I would advise seeing a doctor before resuming training. Good luck!
    Stacey
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    Post by Stacey Mon Jun 10, 2013 7:57 am

    He should be evaluated by a physician competent in concussion and post concussion syndrome. The worst thing he can do is think he's alright, go back to the mat, and sustain another knock to the head. If he already has a concussion, the next knock to the head doesn't have to be anywhere near as bad as the first to do more damage.

    Here's what the CDC has to say about concussion in sports:

    http://www.cdc.gov/concussion/sports/index.html
    Cichorei Kano
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    Post by Cichorei Kano Mon Jun 10, 2013 8:10 am

    samsmith2424 wrote:My son (21) was thrown in a competition and landed on the side of his forehead quite hard. After landing he felt his body shake but no one else observed anything. He withdrew from the rest of the competition.

    My question is when should he return to randori and nage komi. He feels fine now (a few hours after), but has a slight headache and a bit nauseous, which might also be because it was a long hot day. Is a few days break sufficient?

    How long ago did this happen ? Is it correct that this was just hours ago, if I read your post correctly ?

    As Stacey suggested, he MUST be evaluated by a physician competent in this matter.

    To think that everything is fine now just because he has a slight headache and is a bit nauseous is incorrect. He needs neurologic evaluation to exclude epidural or subdural bleeding, which are some of the most dangerous and potentially lethal issues. The shearing force that occurs due to the differential acceleration of the brain and other tissues vs. the skull upon impact with the mat can cause the tearing of an interacerebral vessel. Blood that may seep through can only go one way as the skull cannot give way. Numerous fatal accidents have occurred in this way both in judo and other sports where the person thinks he is OK, goes to sleep and never wakes up again, as the pressure on the brain continues to increase over night.

    For his and your sake, go consult a physician competent in concussions and neurolgical injuries, and specifically request that he/her excludes any potential epidural or subdural bleeding. If there are any injuries in judo to which this applies, than this is the onee kind of stuff where you should not be engaging in self-diagnosis. Taking up training again is the least of your worries at this point in time.
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    Post by samsmith2424 Mon Jun 10, 2013 4:42 pm

    Thank you for your replies. They were very helpful especially CK's.
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    Post by finarashi Mon Jun 10, 2013 4:50 pm

    I was involved with a case of Jorma Korhonen who in Hamilton posted with his head to prevent a throw. Afterwards he felt fine. When several months had gone by and the right hand had strength problems he had finally a proper examination. There were fractures in his neck vertebrae. So all the time there was a pontial of something going awry and him ending to stretcher.

    Anything involving head is pontentially serious and needs to be examined by competent medical staff.
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    Post by BillC Mon Jun 10, 2013 5:12 pm

    http://download.lardlad.com/sounds/season4/clipshow10.mp3
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    Post by samsmith2424 Mon Jun 10, 2013 8:18 pm

    Update:

    I read CK's post at 11:15 pm last night (Sunday) and then was a bit more concerned. I tried to call my son on his phone as his lives 5 minutes walk from me,as there was no answer (the phone was on silent) I went to his flat and got him to come back to stay the night with me.He had no headache then. I woke him up at 4am as I had read that that is a good thing to do and then he was up at 6am.

    He then went to the General Practitioner (Doctor) this morning. However, the doctor said that as he has no memory loss than it wasn't concussion. He did not seem concerned that my son said his neck hurt slightly as he said this was from bracing the muscles before and at the time of the fall. He checked that he could move his neck and just told him to move his head and found no problem there.He also said it was natural that he was very tired and should take the day off. (I was not with him when he saw the doctor.)

    The doctor said he could do randori etc on Friday but not before.

    I was a bit surprised by the doctor's reaction.
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    Post by Stacey Tue Jun 11, 2013 3:16 am

    samsmith2424 wrote:Update:

    I read CK's post at 11:15 pm last night (Sunday) and then was a bit more concerned. I tried to call my son on his phone as his lives 5 minutes walk from me,as there was no answer (the phone was on silent) I went to his flat and got him to come back to stay the night with me.He had no headache then. I woke him up at 4am as I had read that that is a good thing to do and then he was up at 6am.

    He then went to the General Practitioner (Doctor) this morning. However, the doctor said that as he has no memory loss than it wasn't concussion. He did not seem concerned that my son said his neck hurt slightly as he said this was from bracing the muscles before and at the time of the fall. He checked that he could move his neck and just told him to move his head and found no problem there.He also said it was natural that he was very tired and should take the day off. (I was not with him when he saw the doctor.)

    The doctor said he could do randori etc on Friday but not before.

    I was a bit surprised by the doctor's reaction.

    Have your son read the CDC website on sports related concussion. LOC is not the gold standard for whether a person has a concussion or not. Merely being able to move your neck is not an indication that it's simple muscle strain.

    In all cases, a person who's sustained a head injury should be seen by somebody competent in concussion medicine. It concerns me that the doc apparently believes that there's no concussion without LOC. I've had a number of concussions, some with LOC, most without. they were still concussions, and had to be treated as such.

    I'd be concerned, both with whether he's got a concussion, as well as the competence of the doctor who claims that no LOC = no concussion.
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    Post by samsmith2424 Tue Jun 11, 2013 3:42 am

    Thanks Stacey. It is difficult for me to know how much variation in practice there is in dealing with such injuries. I would be interested in CK's opinion.

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    Post by Cichorei Kano Tue Jun 11, 2013 4:28 am

    samsmith2424 wrote:Thanks Stacey. It is difficult for me to know how much variation in practice there is in dealing with such injuries. I would be interested in CK's opinion.

    As you can imagine, it would be unprofessional and inappropriate for anyone of us who can only read comments to dispute or say much about the results of a professional who has actually examined the person and who carries the professional and medical responsibility for his/her opinions.

    I have a complete syllabus on judo neurotraumatology, which was a separate module in one of the programs I did and which is entirely devoted to these kind of problems, but unfortunately I am not the author of it, it is not in the public domain, and therefore I am not allowed to attach that here for your consultation due to copyright protection.

    There have been numerous incidents of people in sports with head injuries, being evaluated by standard medical personnel such as nurses or GPs, where people were subsequently transported to hospital or simply told to go home, where the outcome in the end was fatal. The 2009 incident involving movie actress Natasha Richards was a typical case of this. See inter alia:

    http://www.guardian.co.uk/culture/2009/mar/19/natasha-richardson-dies-skiing-accident

    http://en.wikipedia.org/wiki/Natasha_Richardson

    I have also explained such injuries many times before on this forum. I have specifically said that it is totally wrong for people to think that only hitting something hard with your head causes major injuries and that it is actually the acceleration of your head, and the differences in acceleration between the different structures in your head that produce shearing forces, even when wearing a helmet or hitting tatami.

    Many, if not most of the fatalities in judo are due to similar causes. A quick look into the numerous children's judo-related deaths in Japan provided additional documentary evidence for this, and the Judo Accident Victims Association website might be a good resource to look at:

    http://judojiko.net/eng/

    To get back to your question, and taking into account what I just wrote ... this is why experts in this matter in their courses continuously hammer on the fact that anyone known to have sustained such an injury should not just be evaluated by nurses, or GP's, nor be transported just to "a hospital", but SHOULD BE EVALUATED BY A PHYSICIAN QUALIFIED IN NEUROTRAUMATOLOGY AND BE TRANSPORTED TO A HOSPITAL THAT HAS NEUROSURGERY DEPARTMENT.

    Even if such a person would be in a standard hospital, then in the case of epidural or subdural hematoma, the outcome is still often fatal. When hematoma occur in the brain they can only move the brain inwards hence causing pressure on areas that may be critical for survival such as breathing center. Even removing part of the skull to release part of that pressure may not be enough. It is a very, very serious issue in which one cannot be careful enough, which the many reports of sports-related fatalities illustrate.
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    Post by rjohnston411 Tue Jun 11, 2013 4:55 am

    This sort of injury makes me very leery about competing in Judo. Stories like this and what happened to The Russ on Bullshido frighten me. You can fix a bad shoulder or knee but brain damage is basically permanent.

    I hope he's okay.
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    Post by Cichorei Kano Tue Jun 11, 2013 7:36 am

    rjohnston411 wrote:This sort of injury makes me very leery about competing in Judo. Stories like this and what happened to The Russ on Bullshido frighten me. You can fix a bad shoulder or knee but brain damage is basically permanent.

    I hope he's okay.

    Luckily, in terms of proportion, the number of injuries that take a fatal turn in jûdô is still very low. BUT, for those parents and siblings and children, whose loved happens to be in this small proportion, the effects are devastating. In terms of chance, statistically speaking, it is unlikely that there is something serious going on in the person among whom the original post was, but the same conclusion was also reached in the case of Natasha Richardson and many others. Almost precisely one year ago I lost a friend due to the same injury, this case as a result of a motor accident. He fell to the road and, hit is head. His wife had been following him in a car. It was said that he was bleeding from his ears and eyes, but they thought he was going to be OK, so an ambulance took him brought him to a hospital, and then later to a hospital, and of course within 2 days he was dead. This may sound all normal to lay people, perhaps even to some paramedics, but it is completely insane. Those symptoms suggested serious neurotrauma with subdural or epidural bleeding and skull fractures. What should have been done is immediately insist on Medivac/helicopter ambulance to come to the scene and take the person to a university hospital with neurosurgery trauma department. He might still have a chance. Now, there was no way he was going to survive. In fact, to transport a person like that by an ordinary ambulance to a basic hospital is rightout crazy, but can you blame the people who meant well but simply didn't know any better. Can you ? Just try answering that question. A person is dead, who might have been saved, but also might have not, but now certainly did not stand a chance. I find it hard to say where our responsibility starts and end. Is it sufficiently responsible to just call 911 ? For some, for others not. I have no idea how many calls are made to 911 with that degree of specification where the caller insists on having a trauma helicopter sent instead of an ambulance and where the caller insists that the patient needs to be transported to a neurotraumatology center. I honestly don't know, but I always deeply regret the loss of a human life which perhaps should not have been lost.

    That being said, one should also not exaggerate. I am not sure if the degree of fatal injuries in jûdô is really higher in competition than in clubs. Many of the fatal accidents in children did not occur in competition but in ordinary club training or in preparation for competition. The one serious injury where I suspect the incidence is increased in competition may be neck/spinal fractures, even though incidence luckily is low. The one thing that I have observed as seriously increasing the injury risk in judo competitions are when there is a large gap in experience between two players.
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    Post by BillC Wed Jun 12, 2013 7:27 am

    This just posted today at CNN: http://thechart.blogs.cnn.com/2013/06/11/heading-a-soccer-ball-may-be-bad-for-the-brain/?hpt=hp_t3

    In similar studies of subconcussive impact, the association tends to be: The more hits to the head, the more damage to the brain. Basically, "...the more you head the ball, the worse cognition gets," said Lipton. "But we found that's not the case."

    In Lipton's study, published Tuesday in the journal Radiology, players had to reach a certain number of headers before the brain scan reflected damage. After that threshold was reached, brain function dropped precipitously.

    ...

    The suggestion is that the brain's intrinsic ability to repair itself works, to a point. After that point, however, the brain cannot keep pace and becomes overwhelmed.

    "That tells us that pathological change happens at a lower level than clinical manifestation of problems," said Lipton.

    In short, there is a tipping point - and that point is different for everyone.


    Which seems to imply that overtraining and players taking little knocks to the head is something else one needs to consider as a coach? Related to the separate threads on the subject of abuse and "train until you die." Makes sense, the overtrained body does not heal, the overtrained brain is no different?
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    Post by genetic judoka Wed Jun 12, 2013 7:56 am

    BillC wrote:Makes sense, the overtrained body does not heal, the overtrained brain is no different?
    I'll have to remember that when taking both fluid mechanics and thermodynamics at the same time next semester.
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    Post by BillC Wed Jun 12, 2013 8:23 am

    genetic judoka wrote:
    BillC wrote:Makes sense, the overtrained body does not heal, the overtrained brain is no different?
    I'll have to remember that when taking both fluid mechanics and thermodynamics at the same time next semester.

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