Perhaps we've been thinking about concussion prevention the wrong way. Rather than trying to protect the head from the outside with large, padded helmets, new research indicates that a more promising approach may be to focus on the environment inside the skull.
At the National Strength and Conditioning Assocation (NSCA)'s 2015 National Conference, Dr. Greg Myer, director of research in the sports medicine division at Cincinnati Children's Hospital, presented data indicating that a collar capable of restricting bloodflow out of the skull might be an effective way to prevent concussions. The rationale is that by keeping more blood inside the skull, you essentially cushion the brain so that it's less likely to move around during impact.
The approach, if viable, would turn concussion prevention on its head (no pun intended). Considering that decades of helmet development and adjustment have not turned the tide against concussions, it might be exactly what the field needs.
The Problem With Helmets
It's not that helmets don't work. For the purpose they were designed to serve—preventing skull fractures—helmets are very effective. Protective headgear is an effective buffer against outside forces. The problem is that although many concussions are caused by an external force, the injury itself happens within the skill.
"Our brain already has a protective shield called a skull," explains Dr. Myer. "The brain moving inside the skull is where we think the damage is occurring."
When an impact hits your head or your body makes a sudden change of direction, your brain smacks against the inside of your skull. This phenomenon, known as the Slosh Theory, was discovered by Dr. David Smith, founder and chairman of TBI Innovations. It's believed that a violent "slosh" is what actually damages brain fibers and causes a concussion.
Thus, if a concussion is caused, not by a blow to the head, but by the brain sloshing into the skull, all of the external protective gear in the world won't be able to stop it. The only way to prevent a concussion would be to somehow prevent movement of the brain within the skull. And according to Smith and Myer, there may soon be a way to do that.
Protecting the Brain From the Inside
Dr. Smith spent considerable time researching animals that experience extreme head impacts and come away unfazed. He found that woodpeckers, which repeatedly smash their heads into trees, have long tongues that wrap around their necks when they peck, potentially shutting off their jugular vein, thereby increasing the volume of blood in their brain and restricting its movement.
Humans obviously can't wrap their tongues around their necks. But we all have an omohyoid muscle in our neck, which may control blood flow through the jugular vein in a similar fashion. Smith theorizes that the muscle could be manipulated in such a way as to increase blood volume within the brain.
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Enter the Q-Collar
Smith and his TBI Innovations colleagues, Dr. Julian Bailes and Dr. Joseph Fisher, sought to create a device that simulated the function of the omohyoid muscle. The result of their efforts was the Q-Collar, which wraps around the neck and places slight pressure on the jugular vein—i.e., the spot on your neck where you take your pulse.
Pressure on the jugular compresses the vein, slowing down the flow of blood leaving the brain. Smith says the device doesn't increase blood pressure within the brain. Instead, it causes an extra 3 to 5 cubic centimeters of blood—roughly the amount that flows into your brain when you lie down or yawn—to stay in the brain, filling up empty spaces.
"If you maximize the blood volume inside the brain, you can actually make it more of a single unit so it's not sloshing inside," Myer asserts. "It's like an airbag wrapped around the brain that makes it a single unit with the skull, and then it doesn't reverberate back and forth."
Dr. Myer is currently conducting research on the effectiveness of the Q-Collar. The research is not finished, but he says that so far the results are promising. Testing has shown that the collar appears to be safe and does not cause a meaningful increase in pressure in the head, which could become problematic. "We've done a lot of safety testing and haven't found any negative outcomes to date," he says.
One concern is that keeping more blood in the brain might deprive other areas of the body and impair performance. But 3 to 5 cc is a small fraction of the total blood in the body and comprises only 1 to 3 percent of the volume of blood in the brain.
Myer cautions that more research needs to be done on the Q-Collar, but he says that one day contact sport athletes and even soldiers may be wearing it as a protective device.
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