{"id":8464,"date":"2021-09-02T10:00:00","date_gmt":"2021-09-02T10:00:00","guid":{"rendered":"https:\/\/leadersinsport.com\/performance-institute\/?post_type=article&p=8464"},"modified":"2025-12-15T05:11:45","modified_gmt":"2025-12-15T05:11:45","slug":"concussion-protocols-will-never-be-enough-in-sport-but-treatment-is-available-to-athletes-past-and-present","status":"publish","type":"article","link":"https:\/\/leadersinsport.com\/performance-institute\/articles\/concussion-protocols-will-never-be-enough-in-sport-but-treatment-is-available-to-athletes-past-and-present\/","title":{"rendered":"Concussion Protocols Will Never Be Enough in Sport But Treatment Is Available to Athletes Past and Present"},"content":{"rendered":"\n\n
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\n 2 Sep 2021 <\/p>\n \t\t\t\t\t\t\n\t\t\t\t\t\t\t<\/span>Articles<\/a>\n\n\t\t\t\t\t\t

Concussion Protocols Will Never Be Enough in Sport But Treatment Is Available to Athletes Past and Present<\/h1>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\n \n\t\t\t<\/div>\n\t\t<\/div>\n\n\t<\/div>\n<\/div>\n
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A Leaders Performance Institute article brought to you by our Partners<\/p>\n

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Sport is at a crossroads when it comes to the concussion injuries sustained by athletes.<\/h4>\n
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By John Portch<\/h6>\n

That is the view of Dr Mohammed Elamir, a physician at Aviv Clinics. \u201cThere are a lot of current and former athletes who came through at a time when there wasn\u2019t a concussion protocol model when they were playing junior league or kiddie league,\u201d he tells the Leaders Performance Institute via Zoom. \u201cThey have spent their whole lives \u2013 not just professional careers \u2013 suffering concussions without suitable follow-up protocols that include rest, recovery and evaluation.\u201d<\/p>\n

Aviv Clinics specialize in offering unique hyperbaric therapy for people seeking to improve both physical and cognitive function. There is also a growing retinue of athletes and former athletes seeking out Aviv\u2019s services due to the likely effects of concussion and brain injuries. Dr Elamir works with both on a regular basis. \u201cThe problem with concussion is that it can affect you immediately but it often affects you much later in life,\u201d he continues. \u201cThere are still athletes competing who come from that old model.\u201d<\/p>\n

While concussion protocols are steadily being introduced across sport, from the grassroots through to elite level, these alone cannot address brain injuries that might have already been sustained.<\/p>\n

\u201cIn 20 years, you\u2019re not going to have as many issues but you\u2019re still going to have them because as long as there\u2019s sport, there will be head injuries and concussions. No matter how many concussion protocols you have, no matter how we change the helmets on NFL players, for example. It\u2019s still having an impact, there is still a micro trauma to the brain. That\u2019s why concussion will always be relevant.<\/p>\n

\u201cIt\u2019s important to recognize it early in children \u2013 the career of a professional athlete starts when they\u2019re very young. That\u2019s why it\u2019s so important to talk about, identify and to treat because often, if they\u2019re OK now, there will be issues later on.\u201d<\/p>\n

There are, however, treatments available and Dr Elamir has joined the Leaders Performance Institute to discuss how Aviv Clinics helps concussion sufferers through their cutting edge hyperbaric oxygen therapy.<\/p>\n

The real science<\/strong><\/p>\n

As Dr Elamir explains, Aviv Clinics\u2019 hyperbaric oxygen program works on three levels. \u201cNo 1 is the production of stem cells,\u201d he says. \u201cStem cells are blank slate cells that can become any cells you want them to be. When we see cell death, we want to replace the cells that we lost. When we see decreased blood flow, we want to build new blood vessels. All of those new cells come from the stem cells we produce as a result of the hyperbaric oxygen treatment.<\/p>\n

\u201cThe next step is angiogenesis, the creation of new blood vessels, whether it\u2019s in the brain or in the heart or the muscle. We want to help the blood flow and get that oxygen delivery to the cells in general.<\/p>\n

\u201cStep three occurs on a cellular level. The powerhouse of every cell is something called the \u2018mitochondria\u2019. If we can improve the number and function of the mitochondria then we can improve the efficiency of all our cells. If we talk about the brain and low metabolism, if we can help blood flood and help those mitochondria \u2013 help the metabolism and function of those cells \u2013 then we can help the function of our brain cells. The same thing goes for muscles. If you can improve the biogenesis, the creation of new mitochondria and help their function, you can help the performance of a muscle. Whether we\u2019re talking about retired or current athletes, that\u2019s where the program can help them in different ways.\u201d<\/p>\n

Hyperbaric oxygen therapy is gaining in renown, largely due to the tent-like monochambers favored by athletes in recent times. However, Doctor Shai Efrati, the Co-Founder and Chief Medical Director of Aviv Clinics has said, \u201cthat\u2019s not hyperbarics \u2013 it\u2019s not the real science.\u201d<\/p>\n

Instead, Aviv uses multi-space chambers that create the conditions for their unique protocol for stimulating stem cell production. \u201cWe go up to a pressure level called two atmospheres,\u201d says Dr Elamir. \u201cThe whole chamber is pressurized with regular air, 21 percent oxygen just like we\u2019re breathing right now. You\u2019re giving the 100 percent oxygen as a medicine and that allows us to fluctuate the oxygen concentration in the body. You\u2019re breathing 100 percent oxygen for 20 minutes at a time during a two-hour window; 20 minutes on, five minutes off, 20 minutes on, five minutes off.<\/p>\n

\u201cWhen the mask is on for 20 minutes, your oxygen concentration is 15 times higher; you take the mask off and it goes back to normal. The body perceives that oxygen level as a low-oxygen state relative to that high oxygen state; and that is really important because when the body senses a low-oxygen state or thinks it\u2019s in one. It\u2019s anticipating cell death. Then the body produces stem cells and it also wants to usher more blood to the organs to create new blood vessels; and that is a key distinction to our protocol. We\u2019re making the body think it\u2019s in a low-oxygen state by getting it used to high oxygen and getting it back to normal. It\u2019s having that fluctuation that triggers these healing mechanisms in the body.\u201d<\/p>\n

Making and maintaining improvements<\/strong><\/p>\n

When a prospective patient arrives, Aviv Clinics will conduct a thorough, three-day assessment, including a neuro-psychological evaluation. \u201cIt starts with a conversation just asking \u2018what have you noticed over your life whether it\u2019s concentration issues or memory issues, or emotional changes?\u2019\u201d says Dr Elamir. \u201cWe want to know about their memory and processing speed, executive function and fine motor skills.<\/p>\n

\u201cWe perform two specific scans of their brain to evaluate the effects on their career of concussion. One is a specialized profusion MRI that measures blood flow to the brain and can detect microvascular changes in small blood vessels that may be caused by traumatic brain injury or concussion.<\/p>\n

\u201cWe will see structural changes or cell death as a result of those microvascular changes \u2013 not enough to cause a stroke but enough to cause cognitive changes, sleep issues, concentration, memory, even just focus. A lot of our retired players say \u2018I can\u2019t focus, I can\u2019t think straight, I have this fogginess about me\u2019. That\u2019s a result of those microvascular changes.<\/p>\n

\u201cThe other scan is called a SPECT [single-photon emission computerized tomography] scan, which analyses the metabolism of the brain.\u201d A SPECT scan is essential for detecting decreased metabolism of the brain. \u201cThere might not be cell death, but if there\u2019s low-functioning cells, low activity, then the cells are alive but not quite functioning the way that they should. That\u2019s also as a result of traumatic brain injury and concussion.<\/p>\n

\u201cWe take these two scans and we sit down with the athlete and we say \u2018this is what\u2019s happened to you over the years; structure and blood flow, cell death, and low function\u2019. Identifying those areas of low function is critical because I can\u2019t bring dead cells back to life. I can grow new blood vessels \u2013 and that\u2019s what we do with our program \u2013 so we can help to prevent future cell death, but those areas of low metabolism, low functioning are often causing the symptoms. That\u2019s when we improve their metabolism and their functioning.\u201d<\/p>\n

There is also a physical exam as part of the three-day assessment. \u201cThat connection between the brain and the body can be affected by traumatic brain injury and concussion. They\u2019ll undergo assessment with our physical therapists and physiologists and run through gait analysis, strength, body composition, fine motor skills and hand-eye coordination evaluations to see if there\u2019s been a decline as a result of traumatic brain injury. Diet and nutrition is also important so they\u2019ll see a dietician. That way, with the retired athlete, we\u2019re helping them to recover, heal, improve what they lost, with the current athletes, we\u2019re still recovering, we\u2019re still healing, but if we can help their performance, that is also something we can do.\u201d<\/p>\n

Once patients start their treatment, they will attend 60 sessions, one each day Monday to Friday, for 12 weeks. During each visit, they will complete all components of their treatment and spend two hours inside the hyperbaric oxygen suite. There is also a shorter eight-week 40-session protocol for athletes who simply wish to improve their performance.<\/p>\n

As patients progress through the 12-week program they retain full access to all their Aviv specialists. The initial assessments are then repeated at the end of the program and again at the six-month stage. Each month, post-treatment, an Aviv physician will make a check-in call to ensure their improvements are being maintained.<\/p>\n

\u201cWhether it\u2019s six months or six years down the line, we maintain contact with them and if we notice a decline we can have a refresher or a maintenance, says Dr Elamir. \u201cThere is a separate maintenance program after the original core program. It\u2019s not as rigid as the 12 weeks \u2013 it can be two weeks, eight weeks, anywhere in between depending on their needs. They will have full access to the whole clinical, medical, physiological team to make sure that they\u2019re maintaining their improvement.\u201d<\/p>\n

Get yourself evaluated<\/strong><\/p>\n

While Dr Elamir is regularly in touch with a variety of sports leagues and is encouraged by the progress being made across elite sport, he also explains that a lot more still needs to be done to move sport through its current crossroads when it comes to brain injuries and concussion.<\/p>\n

\u201cThere\u2019s a trickle-down mentality,\u201d he says. \u201cAs the professional ranks adopt technologies it slowly works its way to the collegiate level and down to the children. I think we also need to go from the ground up. Children especially need to be the most heavily protected in terms of conservative rules and concussion protocols. As we mentioned earlier, it\u2019s the cumulative effect over time, especially from a young age.<\/p>\n

\u201cI have one slide in a presentation that compares a healthy 14-year-old and an 86-year-old with Alzheimer\u2019s and a 14-year-old with severe traumatic brain injury from a concussion, and his brain looks more like the Alzheimer\u2019s patient\u2019s than the healthy 14-year-old. That\u2019s where we have a lot more room to get these protocols implemented and to be even more conservative at the child level.\u201d<\/p>\n

As we begin to wrap things up, the Leaders Performance Institute asks what Dr Elamir hopes will be the most important takeaway for any coach, practitioner or even athlete with concerns about concussion injuries.<\/p>\n

\u201cThe biggest thing to stress is whether you are feeling perfectly fine and you\u2019ve never had a concussion or you\u2019ve had 100 concussions, always consider a treatment to help heal your brain because you do not know necessarily what has happened, whether it\u2019s been sport or a car accident.<\/p>\n

\u201cGetting evaluated is a win-win situation. If you get evaluated and everything\u2019s fine on your scan and your scores are great \u2013 great \u2013 it\u2019s confirmation that you\u2019re doing everything right. But if we discover something, which we often do, people think \u2018I want to do this process for healthy ageing\u2019 and, sure enough, we discover some significant pathologies in the brain or cognition issues.<\/p>\n

\u201cAlways get evaluated \u2013 you\u2019re never too healthy to get evaluated.\u201d<\/p>\n

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Our latest Performance journal has landed, with Gareth Southgate, Head Coach of the England men’s football team<\/strong> leading the way with his reflections on defining and developing resilience. Elsewhere we spoke to the Arizona Diamondbacks<\/strong> of Major League Baseball, as well as the world-renowned New Zealand Rugby<\/strong>, and British Wheelchair Basketball<\/strong>, who runs some of the finest programmes in the sport. Edd Vahid of Premier League club Southampton FC<\/strong> also penned a column focusing on talent pathways.<\/em><\/p>\n