The Art of Weight Lifting and Conditioning


Weightlifting and conditioning has been portrayed and advertised as a scientific process that has a specific regiment to gain significant results. Trainers and Strength and Conditioning specialists with extensive educational backgrounds depict a world of order and inevitability that frankly does not exist in practice. What they fail to tell you is that almost the entire curriculum for an Exercise Physiology, Strength and Conditioning, or Kinesiology degree is exclusively pertaining to the theoretical knowledge with no realistic application. Most of the classes go into great depth in regards to basic anatomy and physiology. An in-depth education into these topics is needed as a fundamental basis for the S & C world. Unfortunately for most programs, this is where a majority of the education gives way. The application of this knowledge to the training world is limited as laboratory settings are used to teach only the most basic techniques. They give few exercise examples and applications leaving the future trainers/strength specialists to have to go to outside sources or become “creative” to develop new exercises. A limited arsenal of exercises is fine for the basic client just looking to get into shape or drop a few pounds, but a more specialized regiment is needed for individualized or performance enhancing programs.

After ten years of intensive training with many different high profile trainers and coaches in the strength and conditioning world including two former head strength and conditioning coaches for the Anaheim Ducks NHL, the head strength and conditioning coaches at the University of Oregon, Washington State University and the University of Delaware, I have been exposed to radically different approaches to athletic performance enhancement using all the latest “fads” and “science”. The conclusion I have came to and many of my peers have realized is that although each program is completely based in science, the method in which it is performed is much more an art than most would believe. Many high tech programs are overblown, while many simple methods that have been around for fifty years are effective. Sifting through my extensive knowledge, I have noted several commonalities in successful training regimes. In the ensuing paragraphs, I will explain underlying themes and ideologies that should be part of any training program. I will try to keep the medical terminology relatively light for those who are less familiar with the topic.

10 Underlying Themes of a Successful Weight Training Program
1. Free Weights vs. Machines- The great debate for many newcomers to the weight room is whether it is better to use free weights (ie dumbbells, barbells, etc.) or machines that have a weight stack to the side. For the most part free weights are more beneficial primarily due to the additional planes of movement in comparison with the machines. The increased complexity of motion during the use of free weights forcing your muscles to respond to additional stress. Case in point, think of using a push press vs. squats. The motion of a push press machine requires the contraction of the glutes, quads, and hip muscles from a seated position in a similar manner as the squat. The difference is seen in the limited motion and extension that activates the muscles in a single motion that is “locked” into one plane. In comparison the motion of a squat forces the participant to balance the additional weight on her/his back as each repetition is completed. This additional stress forces leg and back muscles to stabilize the body in two planes in a process known as propriception. Thus unless recovering from an injury in which a protected range of motion is needed, it is advised to use free weights for a majority of the exercises in a given workout. The only exception to “the machine rule” is the use of cable-based machines. In the functionality spectrum (To be explained later, refer to Figure 1), cable-based machines are actually more closely related to the dumbbell exercises in how the body responds to their use.

Working through four planes of motion, DB incline on a swiss ball is an extremely functional exercise.

2. Functionality- In terms of sports training, functionality is by definition purposeful training. If you are to break down the movements of different sports, there are commonalities that carry over between them. Motions such as sprinting, running, jumping, cutting, and striking apply whether a person plays tennis or football. The functionality of strength and conditioning works to mimic these multiple-plane movements. The more functional an exercise is, the closer it imitates the movement on the playing field. Below is what I call the functionality spectrum. On the left hand side of the spectrum the exercises least mimic true “sport motion” counterparts with only one plane of motion activating muscle. On the right side are the exercises that best replicate the “sports motions” described above. To perform each repetition, these functional exercises work on four planes of motion causing all the stabilizer muscles and propriceptors to kick in. To exemplify this concept let’s consider chest exercises. A chest machine, as pictured below, forces the user to push the handles in a consistent motion up and down without any effort to stabilize the weight from shifting laterally side-to-side. Because of the single plane of motion, this exercise limits the muscles that are activated.

Exercises that have low functionality allow the user to lift more weight and also target specific muscles, but the overuse of these machines can cause muscle imbalances that can potentially lead to connective tissue problems. In contrast dumbbell incline on a ball is an extremely functional exercise. The user is forced to account for four planes of motion. Not only does each repetition require the up and down movement, but also side to side stabilization, isolated single arm stabilization, and also abdominal activation to keep balance on the swiss ball. Highly functional exercises are significantly more difficult to perform than their less functional cousins, because the dynamics allow for increased muscle stimulation leading to better results. Visualizing the difference between these two exercises that focus on the same muscle groups, it is easy to see how dumbbell incline on a ball is a more analogous exercise to the unpredictable motion through space used on the field.

Here is the Functionality Spectrum illustrated with example exercises

3. “Core” Lifts are best for Adding Strength- For those athletes looking to increase their numbers and strength sticking to the main basic lifts as the core of their workout is compulsory. Even though the base lifts of squatting for legs, barbell benching for chest, and pull-ups for back may not sound as sexy as kettle bell training or “cross-fit”, they are the most practical and useful method to increase strength. It is analogous to the thinking that if you want to become more proficient at calculus, you need to do more calculus problems to best improve your skills. Now just doing the core basic lifts will only help to a certain degree, but when combined with additional lifts and auxiliary lifts strength can increase dramatically. At a certain point for most people that are training seriously, a plateau is reached in which additional strength gains are difficult to obtain. When this occurs alternative exercises and workouts need to be used to break through to the next level. Cross-Training and the “6-Week Change Up” can help to the athlete push through.

4. High Reps to Cut, High Weight for Mass- A general consensus that I have seen through the sports world is that working out with high repetitions and low weight will result in a more toned body over time. The high repetition sets will work endurance of the muscle fibers in a similar way to long-distance running. Much of the time high endurance sets will work in the 8-15+ rep range at 50-75% of the maximum weight for one repetition. It is also true that heavy sets with few repetitions will add more strength and increase muscle bulk. The heavy sets work in a primarily anaerobic state, equivalent to sprinting, pushing the fibers to their limit. Heavy sets will usually work in the 3-8 repetition range at 75-95% of the max. Be aware that many regimens mix both “endurance” and “bulk” sets in a given workout to produce the desired effect. (Future articles will give sample sets and workouts that I have done during lifting regimens in the past.)

5. Six-Week Change Up- Another rule of thumb of successful weight training and conditioning programs is what I like to call the Six-Week Change Up. A lifting routine should have the exercises changed every six to eight weeks. During the sixth to eighth week, the human body begins to accommodate the repetitive stresses. When this occurs the gains of strength/weight loss/toneness usually plateau. The most effective solution is to “change up” the lifts exerting different loads on the exercised muscles. The nascent stresses help to create different dynamics that in turn help to better overload the muscular tissue. After the first few workouts following the “Change-Up”, it is common to feel the muscle soreness that was common during weeks one and two of the training cycle. This is again due to the fact that the muscles are not accustomed to the exercises that they are required to perform. An example of this method would be to do an eight week program that used barbell bench as the main exercise to work out the chest. The “Change-Up” would be to modify this core lift to dumbbell bench or an analogous lift.

6. Muscle Balance- Muscle balance is critical to muscular development whether the athlete is a high schooler or a geriatric just trying to increase their exercise. Over development of certain muscles is one of the most significant and common flaws of a poorly constructed lifting program. Not only will the imbalances affect the quality of a workout, but will more crucially increase the risk of injury. Two of the most common injuries that I have seen in the wake of a poorly constructed program are anterior cruciate ligament tears of the knee and shoulder labrum tears. Though a majority of the injuries happen outside of the weight room, there is a significant correlation between muscle imbalances and the incidence of these two injuries. Here is one anecdotal example; I was a part of a college program in the past that this became a significant issue during an off-season. The strength staff created work outs that required us to perform a significant amount of leg work including squatting, cleaning, box jumps, etc. but absolutely no hamstring work. Once we began the intense 5AM sprinting and agility sessions about one month later (trust me these are about the most physically demanding workouts of your life!), several players immediately went down with hamstring pulls with more frequency than I had experienced in the past. There were also four ACL tears over the ensuing weeks. Because of the frequency of injuries, the coaching staff took notice and the strength staff was in hot water. The workouts were adjusted accordingly to focus more on hamstring development in the weight room, and surprise, by the end of the school year, there were no new lower body injuries.

Generally it is agreed upon that hamstring strength should have a minimum of 60% of the strength of the quadriceps. The push vs. pull muscles of the upper body (ie. the chest muscles vs. upper back muscles) should be relatively equal. Balance of the upper body will not only help your overall upper body strength, but also your running form and flexibility. Upper body balance is especially important for those that regularly play golf and baseball, because upper back and shoulder strains are commonplace. At the biomechanical level muscular balance helps evenly distribute the strain that motion causes on the human body.

7. Cross-Training- Cross-training is the use of multiple training platforms that are seemingly unrelated to a specific sport as part of a regimen. Even for those athletes that play exclusively one sport, study after study has shown that cross-training significantly improves athletic performance and reduces injury in comparison to the use of solely sport specific activities. Here is one such study Most injuries occur when the body is contorted into strange positions with similarly strange impacts and loads. Crossing-training is one solution to injury prevention, because at a fundamental level it forces muscular tissue to adapt and improves an athlete’s propriception. Muscle fibers have to support loads that would otherwise not be faced. Cross training also helps to break up the monotony of workouts and keeps the mind stimulated. My personal example would be the use of cross-training in the off-season for college football. In addition to the heavy lifting and difficult running, I loved to cross train. The three main exercises I used were boxing, basketball, and swimming. The former two have many parallels to football specific motions. Boxing helped develop the quick twitch needed to deliver the blow to an opposing player, and basketball helped to develop hand-eye coordination along with calf strength. Although superficially it does not seem to have much relevance, swimming was my favorite form of cross training for football . The unique motion used for swimming would challenge my endurance regardless of the running shape I was in. Water presents a medium that allows for continuous resistance allowing for strength development through the entire range of motion while also working out the lactic acid “kinks” that the normal workouts would cause. (Growing up in Southern California, I grew up loving the water, thus on those cold stormy winter days thousands of miles from home, swimming would help to bring a little sunshine into my life!) During the season I noticed an increased flexibility and stamina thanks to the swimming that helped to get me out of tight situations on the field. This is just one example, but it applies to also sports whether it is cross country and weight training or hockey cross-trained with tennis. The more diverse of a skill set you have athletically, the better chance you have of performing to your full potential on game day.

Be realistic, don't try to become the ex-govenator over night!

8. Stay Away from Unknown/ Olympic Lifts- This is one piece of advice I cannot emphasize enough. If you want to stay healthy avoid any lift that you have not received proper training in, and if you take part in recreational athletics stay away from Olympic lifts altogether. Olympic lifts include snatches, cleans, push jerks and their many related variations. I cannot tell you how many times I have gone to the gym and seen some weekend warrior trying to become the next Arnold Schwarzenegger doing power cleans with improper form. Not only do you look ridiculous to your peers, it is EXTREMELY easy to get injured. When the exercise is done properly little strength gain comes from it, because the lift is used mostly for explosive movement and triple point extension of the main joints. Since I hung up the cleats, I have not performed any Olympic lifts except for demonstration purposes only.

9. Flexibility- Whether you are a professional power lifter or a rock climber, the single fastest way to improve you athletic ability is to improve your flexibility. This can be done with a simple routine of less than five minutes once per day. Diligence is essential for consistent improvement. If you are a runner increased flexibility will increase your stride. If you are a swimmer, increased flexibility will act to lengthen your stoke, and for all sports increased flexibility will help prevent injury when the body is contorted in an awkward manner. Even if nature has endowed you with the flexibility of a rock (I definitely fell in this category not even being able to touch my toes entering high school), it can be dramatically improved. Today I can do a full regular split (Russian splits are another story!), a night and day improvement from what I once was. This flexibility allowed me to make crisper cuts out of routes and out run safeties with my large stride.

Stretching is a secret to injury prevention and improved athletic performance

10. Listen to Your Body- Last but not least, listen to your body. No one knows your body better than you. Learn to distinguish the difference between muscle soreness caused by the buildup of lactic acid after a great work out and connective tissue soreness due to inflammation that signifies overuse or a potential injury. Work through muscle soreness, but when things just don’t feel right take it into account and change your workouts accordingly.

Incorporating these themes into your workout will help in route to achieving your goal. At the end of the day the old adage, “No Pain, no gain” is omnipotent. Training to shed the pounds or add strength takes months and years, not days. Keep that in mind to form realistic and achievable expectations. Stay positive and mentally strong and I promise that you will see results. Good luck!

If you have any questions, feel free to post them in the comments section, and I will be more than happy to answer them ASAP.

Sources

Boyle, Michael. Functional Training for Sports. Champaign: Human Kinetics, 2004.

Effects of specific versus cross-training on running performance

Trevor Mooney played at the University of Delaware as a Tight End #84 

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Trevor Mooney’s Commitment to Helping Others


by Trevor Mooney

Throughout my academic career, I have maintained a passion for and commitment to helping others. As a former student of Washington State University, I used to tutor children in reading twice a week at Sunnyside Elementary School in Pullman, Washington. After transferring to the University of Delaware, from which I recently graduated with my B.S., I continued to maintain a strong dedication to the community by undertaking a variety of people-focused projects. To find out more about some of my past charitable endeavors, please read below.

Greater Newark Boys & Girls Club

As part of the Boys & Girls Club of Delaware, Greater Newark Boys & Girls Club remains committed to helping a diverse array of youth reach their full potential. Focusing specifically on Delaware’s Newark area, Greater Newark Boys & Girls Club offers a variety of options, including athletics and aquatics programs, teen and learning centers, tutoring services, and before- and after-school child care. A partner with many of the state’s school districts, Greater Newark Boys & Girls Club maintains an excellent reputation for making a significant impact on its members’ early academic careers.

Santiago de Compostella Catholic Church

Established in 1979, the Santiago de Compostella Catholic Church has become an integral part of the Lake Forest, California, community. The church provides a number of volunteer opportunities, including liturgical ministries, where individuals can serve as an altar server, lector, usher, and Eucharistic minister, among other roles. Additionally, the Santiago de Compostella Catholic Church offers faith enrichment, as well as educational and community ministries.

Supplement to the Brain Trauma


This video encapsulates the struggles that may one day face those athletes in the NFL who have had considerable brain damage. It is a chilling sight to see those that are of such a young age having the early onset of Alzheimer’s Disease.

Written by Trevor Mooneywho played at the University of Delaware.

Head Trauma in the NFL


A thesis on hidden dangers lurking behind America’s favorite game

In June of 2007 a leading forensic pathologist named Bennet Omalu scrutinized two brains exhibiting similar damage. When examined under a microscope, the damage to both brains was extensive, including neurofibrillary tangles, plaques and severe scar tissue. It was determined that the pathology of the brains was comparable to what would be present in an eight-five year old with beginning stages of Alzheimer’s disease. But to the contrary, the brains were those of two recently deceased football players who were both in their mid-forties and retired. Their names were Andre Waters and Justin Strzelczyk (Farrey, “Pathologist Says Walters’ Brain Tissue had Deteriorated” 1). The damage to the brain tissue was not caused by natural aging, but due to the debilitating nature of years of professional football.

Football has permeated our culture with unrivaled magnitude. From an analogy in a presidential speech to Saturdays and Sundays solely dedicated to the sport, football is an American obsession. The same violence and pain that both players and fans thrive off of delivers devastating effects to a person’s body. Today’s game witnesses hits that measure upwards of 120 G’s (Farrey, “The Case for HGH” 2). That amount of force is equivalent to a severe car crash. In a game that has evolved from a relatively unknown sport to a multi-billion dollar business, motivation to succeed in this competitive and aggressive environment has led to bigger, stronger and faster athletes. These elements increase the force behind collisions and the severity of head injuries in football. With the deaths of four former NFL athletes who displayed similar neurological symptoms, irrational behavior and brain damage, the issue has become a focus of the media.

The impact of some hits has the force as a severe car wreck.

Researchers believe there is a link between brain damage and multiple concussions which athletes receive playing football. Even with the mounting evidence in favor of long-lasting brain damage due to concussions, the NFL is still skeptical about the validity of the claims made by outside researchers. To better understand the ongoing debate about the head trauma issue, it is important to understand the physiology and damage caused by traumatic head injuries, including concussions and pituitary damage. The short and long-term effects of damage to the brain have recently become a significant issue in the media. Over the past decade the NFL has been diverting the issue, but now with new leadership time may see change.

Each year nearly three hundred thousand sports-related head injuries occur in the United States (Guskiewicz et al., “Cumulative Effects Associated with Recurrent Concussion in Collegiate Football” 2553). The most common type of sports injury to the head is known as Mild Traumatic Brain Injury or MTBI for short. This encompasses all concussive type injuries, and many use the term interchangeably for concussion.

In contact sports such as football, basketball, soccer, baseball and boxing, moderate to high amounts of concussions may occur during play. The rate of reported concussions in the NFL tends to be nearly double that of reported concussions in high school football. This is of significance in that it indicates the difference in speed of the game at the professional level. According to one study, twenty-five percent of all football players report suffering three or more concussions in a season (Nowinski 10). In contrast, a study endorsed by the NFL stated that only four percent of high school players suffer from a concussion during the course of a season. In reality as many as ninety percent of concussions go unreported (Nowinski 33). One of the big discrepancies of the NFL-endorsed study and many other studies is that the information stems from trainers who can only report on concussions that players admitted to sustaining. At all levels, participants tend to ignore symptoms such as “seeing stars” or “having their bell rung” for various reasons, including the heat of battle and being ignorant of the true symptoms of a concussion.

Though concussions have been identified for thousands of years, people are still unaware of what concussions actually are. A concussion is not defined as an actual physical injury, but by loss of brain function induced by physical trauma (Nowinski 25). The NFL defines a concussion as a “traumatically induced alteration of awareness or consciousness, including but not limited to a loss of consciousness, a sensation of being dazed or stunned and by symptoms commonly associated with post—concussion syndrome, including loss of balance, headaches, amnesia, sleep disturbances, vertigo, and hearing loss.” Some common signs of a concussion are confusion, amnesia, headache and irritability (Nowinski 124).

In fact “seeing stars” is a mild form of a concussion. The frightening truth is that according to one study ninety-two percent of players and coaches believe that a “bell ringer” is a different injury than a concussion (Nowinski 32). No wonder so many concussions are going undetected! In my own career, I have never been “diagnosed” with a concussion, but I know of at least six or seven times in which I have become dazed and confused following a hit. It is an all too familiar story for many others. Study after study has shown that repeated concussions can put a person at greater risk for developing serious disorders such as dementia, Alzheimer’s disease or Parkinson’s disease. Links have been found that determined neurological illness is proportionate to how many concussions a person has sustained (Nowinski 9).

Sudden accelerations, decelerations and blows to the head cause concussions. The fluid surrounding the brain, called cerebrospinal fluid, acts as a cushion and protects the brain from light trauma. More severe forces will cause injury however. The wave of energy from the impact “passes through the brain tissue and can crush, stretch, and shear brain cells and the nerve fibers connecting them that are also known as axons” in a process known as the neurometabolic cascade of concussion (Nowinski 27). The rotational forces of a concussion cause dysfunction over a widespread area of the brain, most affecting midbrain structures such as Substaintia Negra, Ventral Tegmental Area (VTA) and diencephalons (Jorge et al. 44).

Immediately following a concussion many changes in the brain neurochemistry occur. First is the impairment of neurotransmission. Neurons inability to communicate with one another lead to difficulty in tasks such coordination and memory recall. More specifically loss of the regulation of ions that are released in the synaptic channels results in less efficient neurotransmitter release. The disorganization of the neurotransmission creates wasted energy expenditure for cellular metabolism in the brain.

Decreased blood flow lasts for approximately seven to ten days, the period of time in which the brain is most susceptible to re-injury. Consequently second degree or Type II concussions, the most common form of reported concussions, require at least one week of abstinence from a sport. Eventually the ions of the brain become balanced and blood flow returns to normal.

Animal studies have revealed that numerous neurons can die with even a slight change in blood flow (Guskiewicz et al., “Cumulative Effects Associated with Recurrent Concussion in Collegiate Football” 2551). After concussions there is a noticeable spike in blood glucose levels in the brain. Because of a lack of blood flow the brain goes through anaerobic respiration, leaving a byproduct that tends to be lactic acid (Chen et al. 84). A build up of lactic acid can cause additional damage to the brain. While our current understanding is that mild concussion does not cause brain cell death, it can cause the deterioration of the fatty covering of brain cells known as myelin, resulting in less efficient and slowed transmission (Nowinski 44).

The unique symptoms of each concussion can be related to the affected brain areas. Certain symptoms such as headache, nausea and incoordination can be attributed to dysfunction of the brainstem. Other symptoms such as confusion, amnesia and disorientation can be attributed to dysfunction of the frontal lobe and more specifically the cerebral cortex (Nowinski 35). Symptoms such as irritability, fatigue and sleep disturbance may be delayed in onset. What makes concussions difficult to evaluate is that many areas of the brain may be affected, but symptoms manifest at different stages. One doctor explains, “With brain injury, after the initial injury, the damage is not done –after the initial injury, it can continue. That’s what is so challenging about these injuries” (Nowinski 31).Concussions are the most common of MTBI. The Cantu grading system continues to be the gold standard for assessing concussions. Concussions are graded by severity. The mildest form of concussion, grade I, has symptoms of post-traumatic amnesia of less than thirty minutes and no loss of consciousness (Burke 2). Usually a player can return to a game or activity after a fifteen-minute rest.

The Cantu Guidelines separates concussions into three separate grades.

A grade II concussion is the most common concussion witnessed by trainers. It has symptoms of amnesia lasting thirty minutes to twenty-four hours and a loss of consciousness for less than five minutes. A grade II concussion is more dangerous and requires at least one week of rest. A grade III concussion is the most severe form with symptoms of amnesia for over twenty-four hours and a loss of consciousness of over five minutes. A player could be restricted from the sport for several weeks in order to prevent serious brain injury. For each of the three cases the treatment plan is quite simple. The athlete needs to get adequate sleep and refrain from physical activity for the allotted time needed to recover.

Trainers have used the Cantu Grading System for over twenty years, but more personal concussion assessments based on computer tests are becoming increasingly popular (Oelke). The idea of grading concussions is losing steam. Although widely used, many doctors, including Dr.Cantu, are beginning to support the notion of not grading concussions until symptoms have disappeared. This will allow for a more accurate assessment of the injury (Nowinski 138).

The trainers and team physicians are responsible for determining when a player seems fit to return to play. If someone is allowed to compete too early or is forced back into play too soon, the athlete is at risk for a devastating injury called second-impact syndrome. Permanent damage or even death can result from the condition (Burke 3). Christopher Nowinski, author of Head Games: Football’s Concussion Crisis, explains, “a football concussion, although it may not cause bleeding and rarely requires an ambulance, is at least as significant as that concussion that was sustained in a car accident, if not more so, because the athlete is more likely to experience secondary impacts.” (64) For example, in a 2007 New York Times article, Ted Johnson, a former Patriots linebacker, stated he was not given enough time to recover from a 2002 concussion. Against the team trainer’s advice, Bill Belichick ordered him to play through the concussion. Within minutes Johnson had a subsequent concussion. Over the next three years Johnson sustained several more concussions and now has bouts of severe depression that he attributes to his days of playing football. Even though an anecdotal story, this sequence of events is only too familiar throughout the NFL (Keating, “NFL Retools Approach to Concussion Research” 2).

The long-term effects of concussions have been thrown into the spotlight by the recent deaths of the retired football athletes. Termed “post-concussion syndrome,” the symptoms that are experienced long after the initial effects of the injury have subsided include episodes of dizziness, fatigue, headaches, irritability and depression. These symptoms may take weeks to resolve or may be permanent and last a lifetime. Damage from concussions can cause psychiatric disorders and loss of long-term memory. Depression is one of the most significant and emotionally debilitating effects of a concussion. Injuries occurring early in adulthood can lead to symptoms of major and minor depression lasting indefinitely (Holsinger et al. 18).

MTBIs consistently are associated with damage to the prefrontal cortex and basal ganglia. In teenagers this area of the brain is especially vulnerable when a concussion occurs, because the frontal lobe has not fully developed. In cases of concussive injury, a middle schooler’s brain may take nearly three times as long to recover from injury as an adult’s (Nowinski 45). The prefrontal cortex of the frontal lobe is responsible for decision-making and reasoning. Those with major depression consistently have “significantly reduced left prefrontal gray matter volume”(Jorge et al. 45). Imaging studies have described the association between prefrontal damage and Major Depression Disorder (Chen et al. 86). Damage to the prefrontal cortex can leave a person feeling “mentally-clouded.” The basal ganglia is used in motor control. When this area is injured fine motor movement can be affected.

MTBI’s and concussions can create cerebral atrophy in the temporal and parietal lobes, in addition to the frontal lobe, creating a significant reduction in brain mass (Guskiewicz et al., “Association between Recurrent Concussion and Late-Life Coginitive Impairment in Retired Professional Football Players” 4). The average brain could lose as much as one-third of its mass; losing 400 grams from the original 1200 grams of brain mass.

Damage to brain structures due to MTBIs can increase the likelihood of developing Parkinson’s disease, Alzheimers disease or dementia pugilistica. Genetic susceptibility also seems to be a factor as to whether these amnesia-related diseases develop. Former football player, Justin Strzelczyk, was diagnosed with dementia pugilistica. This a disorder that is characterized by scarring of brain tissue and neurofibrillary tangles throughout the cerebrum and cerebellum. As its name implies, boxing is notorious for this serious disorder and has nearly been outlawed several times because of the brain damage the sport can cause. This disease is also common in wrestlers who have suffered multiple concussions. Interestingly enough dementia pugilistica tends to onset twelve years to sixteen years after the beginning of a boxer’s career (Guskiewicz et al., “Association between Recurrent Concussion and Late-Life Coginitive Impairment in Retired Professional Football Players” 3). This time period is similar to that of many football players who begin displaying symptoms of the disease when in their late thirties and early forties. Symptoms of the disease include memory problems, dementia and lack of coordination. Further damage caused by amyloid proteins, the plaques and vascular degeneration can lead to Alzheimer’s disease. Alzheimer’s disease is a more advanced form of dementia pugilistica. The difference is that in the case of dementia pugilistica the plaques and scarring occur predominantly near the surface of the brain. In Alzheimer’s disease, the plaque is present in deeper layers of the brain. NFL veterans have a thirty-seven percent greater chance of developing Alzheimer’s disease than the average person (Nowinski 65). A former NFL football player, Andre Waters’ brain had deteriorated to the onset of Alzheimer’s, unthinkable for a man of forty-four years of age (Keating, “Concussions Research Remains Question for NFL” 1).

Additional damage can affect structures such as the substantia negra, ventral tegmental area (VTA), and hippocampus. The substantia negra is responsible for the production of dopamine and is involved in movement. Damage to this critical midbrain structure has been linked to Parkinson’s disease. People who have suffered moderate to severe head trauma are eleven times more likely to develop Parkinson’s disease (“Mayo Clinic Researchers Discover Significant Link Between Head Injury and Parkinson’s Disease” 1). A notable example of head trauma and the development of Parkinson’s disease is Muhammad Ali. The VTA is the brain’s reward center. Dopamine is also released there. Once damaged, incidents of depression are quite common. Thehippocampus is needed for long-term memory formation. Studies have demonstrated links between damage to this area of the brain with emotional outbursts and irrational behavior (Guskiewicz et al., “Association between Recurrent Concussion and Late-Life Coginitive Impairment in Retired Professional Football Players” 6).

Andre Waters and football Hall of Famer, Mike Webster, displayed similar deterioration of brain tissue. Both had the alerting amyloid plaques that are eerily reminiscent of those of the elderly diagnosed with Alzheimer’s disease. Each player became increasingly erratic with their display of emotion and logically irrational. In 1991, while still playing in the NFL, Andre Waters attempted suicide by ingesting rat poison and cold medications (Omalu et al., “Chronic Traumatic Encephalopathy in a National Football League Player: Part II” 1088). Even after years of psychotherapy, Waters made several suicide attempts. In more recent years, consumed with suicidal thoughts, he continued his self-destructive behavior. In 2007 he succeeded in committing suicide by ingesting antifreeze.

Mike Webster struggled with his psychological well being in his later years. He was unemployed, drowning in debt and occasionally homeless. A physician diagnosed him as having dementia pugilista. Mike Webster fought severe depression and succumbed to heart failure in 2002 at the age of 50 (Omalu et al., “Chronic Traumatic Encephalopathy in a National Football League Player” 130). Interestingly enough the physician wrote “chronic concussive brain injury” on his death certificate; indicating that his brain injuries had contributed to Webster’s death (Nowinski 73). Justin Strzelczyk did not have as extensive of brain damage as did Mike Webster, but he exhibited signs of irrational behavior and reckless driving that led to his death in 2004. He was in a head on collision with a semi-tractor trailer.

The most recent case in the media of irrational behavior leading to death involves the murder suicide of wrestler Chris Benoit. The acrobatic moves of professional wrestlers cause much stress to the athletes’ bodies, especially to the neck and head. Benoit even had to undergo fusion of vertebrae in his neck in 2001 (Keating, “Head-Trauma Researchers Want to Study Benoit’s Brain” 2). In the months leading up to the wrestler’s death, his behavior became increasingly odd. For example a neighbor stated that he walked around his property with a rosary around his neck. Chris’s father, Michael Benoit replied to this with, “That would have been completely out of character. He was not religious.”(Keating, “Study Suggests Brain Damage May Have Affected Benoit” 2) After murdering is wife and son, Chris Benoit placed a bible by each of their sides shortly before taking his own life. The irrational behavior is a result of altered brain chemistry. There is another piece to the puzzle left after a MTBI. Not only is the brain affected by traumatic brain injury, but the pituitary gland, which is vital to proper endocrine system function, is also affected.

After MTBI’s occur, medical staff consistently analyze symptoms of concussions. The function of the pituitary gland is almost always overlooked. Neuroendocrine dysfunction following traumatic brain injury is under-diagnosed, under-treated and may adversely affect the rate of recovery (Kelly et al. 934). Today at the college and professional levels it is not standard practice to test pituitary function, even though it is critical to homeostasis in the body (Oelke). The pea-sized pituitary gland is vital to a properly functioning endocrine system. Most commonly MTBIs affect the gonadal and growth hormone axes. The gondal axis is responsible for releasing gonadtropins that cause the release of the sex hormones, testosterone and estrogen. The growth hormone axis controls the release of growth hormone. But MTBI’s can also lead to deficiencies of hormones such as Thyroid (T4) and can induce diabetes insipidus (Benvenga, et al. 1357).

The pituitary gland is relatively well protected by the sphenoid bone of the skull, but the stalk of the gland, connecting to the hypothalamus, is susceptible to damage. Case reports of chronic pituitary dysfunction or hypopituitarism exist in which there was spontaneous recovery of the gland, but this does not seem to be the normal pattern for patients (Kelly et al. 932). Generally once the gland is damaged the effects are life lasting.

In the late 1990’s, Dr. Daniel Kelly observed in several patients the classic signs of pituitary failure; depression, fatigue and poor concentration (Lieberman et al. 2753). After publishing his findings in 2000 at least eight subsequent studies have followed in the footsteps of his research. The studies were able to confirm what he suspected, a link between traumatic brain injury and hormonal dysfunction. Deficiencies of growth hormone and testosterone (directly related to gonad hormone release) were most common. Twenty percent of the MTBI patients were deficient in growth hormone and nearly fifteen percent were deficient in testosterone. These are startling numbers for just one trauma. In the context of football MTBIs happen multiple times.

A 2004 Turkish study of boxers found forty-five percent had hypopituitarism Farrey, “The Case for HGH” 2). These numbers are representative of head trauma in the National Football League. A natural decrease of hormonal output occurs as the human body ages. After output peaks in our twenties there is a steady decrease until we are old and gray. Damaging the gland can speed up the aging process exponentially.

Several retirees of the NFL report similar symptoms as those defined by Dr. Kelly. Also signs of decreased human growth hormone (HGH) such as loss of lean muscle, bone density and increases in fat are common. “Retired Jacksonville Jaguars lineman Jeff Novak, who stays in touch with many of his former teammates: ‘I know a lot of guys with several of those symptoms’” (Farrey, “The Case for HGH” 3). It is no wonder that a majority of ex-NFL veterans don’t live to reach the age of sixty-five (Colston 2).

Supplementation of hormones is a reality for many ex-NFL players. Though controversial, hormone therapy has been shown to help offset some of the physical ailments brought about by a TBI and a damaged pituitary gland.

The most effective solution in a doctor’s arsenal against hormonal deficiency is to supplement with artificial ones. Though still considered controversial, some of the retirees are not waiting for the final approval by the medical board. Brad Leggett, a former New Orleans Saint center, has taken HGH prescribed by a doctor. Prior to treatment he was miserable and surviving on painkillers to combat an aching back. Seven years ago he decided to visit an endocrinologist and have his hormone levels checked. He was found to be deficient in testosterone and growth hormone. Since then Leggett has been given supplements of testosterone and growth hormone under the supervision of a doctor. Leggett is a living example of the results, “ ‘the aches and pains I had from playing football, I don’t have anymore’” (Farrey, “The Case for HGH” 2).

Despite the numerous studies and countless anecdotal accounts the NFL continues to deny the existence of a definitive link between mild traumatic brain injuries and long lasting effects (Milhoces 3). The NFL has conducted concussion studies. In a study headed by Dr. Pellman, then chairman of the MTBI committee, results “confirmed” “there was no evidence of worsening injury or chronic cumulative effects of multiple MTBIs in NFL players” (Keating, “See No Evil: The NFL Won’t Face Concussion Facts 2). Dr. Pellman believed that the conflicting results were inaccurate and unscientific, because surveys were used over more scientific methods. The NFL has run its own studies using samples that were not representative. Dr. Pellman authored a recent study that appeared in the prestigious medical journal Neurosurgery. It was severely biased, leaving out hundreds of neurological tests conducted on NFL players. In turn medical reviewers denounced the study, as it seemed “to be at odds with virtually all published studies dealing with concussions” (Nowinski 89).

Wayne Cherbet shortly after receiving a devastating concussion against the New York Giants.

The approach for treating NFL athletes is questionable at best. Today doctors pay for the “right” to treat players making aggressive treatment a much simpler option. Dr. Delaney explains, “At the professional level, if you practiced the most conservative guidelines, you probably wouldn’t be a pro doc very long” (Nowinski 91). Wayne Chrebet of the New York Jets was a victim of overly aggressive care, ironically given by Dr. Pellman. In a game versus the Giants, Chrebet fell to the turf from a hit and was out cold. Once he became conscious, Pellman asked if Chrebet felt well enough to play. Chrebet although dazed answered yes. Controversially Pellman put Chrebet back into the game even though pictures and video had documented that Wayne Chrebet had obviously had a serious concussion (Nowinski 88). Unfortunately for Chrebet additional concussions followed in the next few weeks. He was forced to retire within one year because of “post-concussion syndrome.”

Several outside researchers have attempted to gain cooperation from the NFL. For example Dr. Guskiewicz of North Carolina University applied for funding from the NFL, along with many others. Usually if rejected by an organization, he would receive a multiple page letter explaining how to reapply and improve his chances. The NFL rejected his application but gave no further information on how to resubmit. This is a similar trend for the authors of many other concussion-based studies (Keating, “NFL Retools Approach to Concussion Research” 2).

The NFL continues to justify its practices because if it becomes apparent that the league was placing its employees at risk, it would be a legal and financial nightmare. While doctors, including Dan Kelly, agree hormonal dysfunction testing in NFL players who have had concussions should be implemented, the NFL is far from ready. Today’s court system now looks at head trauma as a disability. Two million dollars was awarded to the Webster family for benefits that were denied him (Farrey, “The Case for HGH” 3). The court agreed that Webster’s brain damage was caused by a long career in the NFL. Many other suits would follow if the NFL acknowledged what a majority of studies suggest.

With a new NFL commissioner, Roger Goodell, comes an opportunity to change how the NFL is perceived when dealing with its players. Next season will be the first in which all thirty-two teams will be required to give baseline concussion tests. A larger empirical NFL concussion study is already underway. Only this time it is using thehelping hand of outside researchers. Could this be a change in the guard? Will the NFL finally give its players the protection they deserve? Only time will tell.

Change is needed. The NFL has left many of its gridiron greats with debilitating injuries and little financial security to show for it. The NFL, the world’s most successful sports league, has one of the worst pension plans. The MLB pays out on average thirty-six thousand dollars per year, nearly three times the amount given out by the NFL (Colston 4). A new program to give in-home care for ex-players has recently been initiated by NFL Players’ Association leader Gene Upshaw. Unfortunately this program can only sustain a small group of a few dozen players. It overlooks the thousands who have similar injuries and disorders.

Neither rule changes nor technology will save players from concussions. The only way to prevent or better treat the injuries is through education. Education can act as a catalyst for change. With a better understanding of concussions and their long-term effects, players will be more likely to speak up. Players must be willing to understand “a successful player has to play through injury but this does not apply to brain injuries” (Nowinski 130). If we want to help players avoid the horrible effects of concussions, our top priority should be to diagnose a greater amount of concussions.

The NFL must take more preventative measures to protect its current players from falling into the same fate as their predecessors. Once the league acknowledges the overwhelming evidence linking TMBIs and deteriorating effects on long-term health, more proactive measures in prevention could be taken. More preventative assessments, including pituitary screening, could greatly reduce the lasting effects of head trauma in the NFL. Merril Hoge, former NFL player and now ESPN analyst was forced to retire due to “post-concussion syndrome” expresses how he believes concussions should be treated, “In order to avoid all the pressures of the game, I still wish there were a guideline implemented in the NFL for when a guy has experienced a certain kind of concussion. For example, if his symptoms are A,B,C, then he has to sit out a week, or two weeks, etc. That would really take the pressures off the medical staff, the player, and the team” (Nowinski 82).

Soon we may even see the supplementation of testosterone and growth hormone, under a doctor’s supervision, as a viable treatment option for athletes with a history of head trauma. It is already a reality in the NFL for a small number of players with testicular disease. Additionally the World Anti-Doping Agency has granted several exemptions for use of HGH and testosterone for those with hypopituitarism (Farrey, “The Case For HGH” 4). Use of these substances could one day help a players’ body better cope with the physical nature of football. Injuries such as those that have afflicted Andre Waters and Justin Strzelczyk could be a worry of the past. America’s ultimate sport obsession could once again be loved for its violence with a clear conscience knowing that its idols will have the medical protection that they deserve.

Written By Trevor Mooney

University of Delaware

4/10/2008

Here is Chris Nowinski’s website, an excellent resource for those interested in further reading on the topic

Sources

Benvenga, Salvatore, et al. “Hypopituitarism Secondary to Head Trauma.” The Jouranl of Clinical Endocrinology and Metabolism 85.4 (2008): 1353-1361.

Burke III, Charles J. “Sports Injuries: Concussions.” ESPN Network 29 September 2007: 4 pp. 25 March 2008. http://espn.go.com/trainingroom/s/1999/0929/85532.html.

Chen, Jen-Kai, et al. “Neural Substrates of Symptoms of Depression Following Concussion in Male Athletes With Persisting Postconcussion Symptoms.” Arch Gen Psychiatry 65.1 (2008): 81-89.

Colston, Chris. “NFL Retirees Feel Forgotten as Fight for Benefits.” USA Today 25 July 2007: 5 pp. 25 March 2008. http://www.usatoday.com/sports/football/nfl/2007-07-08-sw-retirees_N.htm.

Estes, Susie M., and Randall J Urban. “Hormonal Replacement in Patients with Brain Injury-Induced Hypopituitarism: Who, When, and How to Treat?.” Pituitary 8 (2005): 267-270.

Farrey, Tom. “The Case for HGH.” ESPN Network. 18 January 2007: 4 pp. 25 March 2008. http://sports.espn.com/nfl/new/story?id=2733919.

– – -. “Former Saint Leggett Takes HGH.” ESPN Network. 21 January 2007: 4 pp. 25 March 2008. http://sports.espn.com/nfl/new/story?id=2734254.

– – -. “Pathologist Says Waters’ Brain Tissue Had Deteriorated.” ESPN Network 19 January 2007: 2 pp. 25 March 2008. http://sports.espn.com/nfl/new/story?id=2734941.

Guskiewicz, Kevin M., et al. “Association between Recurrent Concussion and Late-Life Cognitive Impairment in Retired Professional Football Players.” Neurosurgery 57.4 (2005): 719-726.

Guskiewicz, Kevin M., et al. “Cumulative Effects Associated With Recurrent Concussion in Collegiate Football Players: The NCAA Concussion Study.” Journal of the American Medical Association. 290.19 (2003): 2549-2555.

Gusklewicz, Kevin M, et al. “Epidemiology of Concussion in Collegiate and High School Football Players.” American Journal of Sports Medicine. 28.5 (2000): 643-650.

Holsinger, et al. “Head Injury in Early Adulthood and the Lifetime Risk of Depression.” Arch Gen Psychiatry 59 (2002): 17-22.

Jorge, Ricardo E., et al. “Major Depression Following Traumatic Brain Injury.” Arch Gen Psychiatry 61 (2004): 42-50.

Keating, Peter. “Concussions Research Remains Question for NFL.” ESPN Network. 7 March 2007: 3 pp. 25 March 2008. http://sports.espn.go.com/nfl/columns?id=2790047.

– – -. “Head-Trauma Researchers Want to Study Benoit’s Brain.” ESPN Network. 30 June 2007: 3 pp. 25 March 2008. http://sports.espn.com/nfl/new/story?id=2920925.

– – -. “NFL Retools Approach to Concussion Research.” ESPN Network. 20 April 2007: 3 pp. 25 March 2008. http://sports.espn.go.com/nfl/news/story?id=2844041.

– – -. “See No Evil: The NFL Won’t Face Concussion Facts.” ESPN Network 19 January 2007: 3 pp. 25 March 2008. http://sports.espn.com/nfl/new/story?id=2736505.

– – -. “Study Suggests Brain Damage May Have Affected Benoit.” ESPN Network. 6 September 2007: 3 pp. 25 March 2008. http://sports.espn.com/nfl/new/story?id=3005520.

Kelly, Daniel F., et al. “Neurobehavioral and Quality of Life Changes Associated with Growth Hormone Insufficiency after Complicated Mild, Moderate, or Severe Traumatic Brain Injury.” Journal of Neurotrauma 23.6 (2006): 929-938. Trevor Mooney went to the University of Delaware and Received an Honors Bachelor’s of Science in Economics Degree

Klein, Milton J. “Post Head Injury Endocrine Complications.” eMedicine. 16 March 2006: 20 pp. 25 March 2008. http://www.emedicine.com/pmr/topic109.htm.

Lieberman, Steven A., et al. “Prevelance of Neuroendocrine Dysfunction in Patients Recovering from Traumatic Brain Injury.” The Journal of Clinical and Endocrinology and Metabolism 86.6 (2001): 2752-2756.

“Mayo Clinic Researchers Discover Significant Link Between Head Injury and Parkinson’s Disease.” Science Blog 5 May 2005: 5 pp. 25 March 2008. http://www.scienceblog.com/community/older/2003/F/20033835.html.

Milhoces, Gary. “Concussions Force Hard Look Inward Around NFL.” USA Today 14 April 2007: 5 pp. 25 March 2008. http://www.usatoday.com/sports/football/nfl/2007-06-18-concussions-cover_N.html.

Nowinski, Christopher. Head Games: Football’s Concussion Crisis. East Bridgewater: Drummond Publishing Group, 2007.

Oelke, Brian. Personal Interview. 6 April 2008.

Omalu, Bennett I, et al. “Chronic Traumatic Encephalopathy in a National Football League Player.” Neurosurgery 57.1 (2005): 128-134.

Omalu, Bennett I, et al. “Chronic Traumatic Encephalopathy in a National Football League Player: Part II.” Neurosurgery 59.5 (2006): 1086-1093.

Schneider, Manfred, Harald J. Schneider, and Gunter K. Stalla. “Anterior Pituitary Hormone Abnormalities following Traumatic Brain Injury.” Journal of Neurotrauma 22.9 (2005): 937-946. Trevor Mooney Tight End University of Delaware 84

Trevor Mooney played at the University of Delaware as a Tight End #84

Trevor Mooney played college football at the University of Delaware as a tight end #84 and was a member of the ESPN Academic All-Region team and ESPN All-American Finalist.

Duerson Tragedy Sheds Light on Larger Issue for NFL


The death of former NFL All-Pro Dave Duerson has helped to shed light on head trauma in the NFL.

With the recent news of Dave Duerson’s unfortunate passing, the implications surrounding brain trauma are once again a relevant fixture in the media. The Chicago Bears great shot himself to death on Thursday February 17, according to the New York Times. His last requests came in the form of a text message, “ ‘Please, see that my brain is given to the NFL’s brain bank.’ ”

 In recent weeks the tragic news has stunned players around the NFL and throughout the sports world. Duerson, an all-American at Notre Dame and two-time Super Bowl Champion retired in 1993 after a career of being known as one of the NFL’s heaviest hitters. After his after the completion of his athletic career, Duerson went into the food hospitality industry and continued to stay active the NFLPA. More specifically he took part on a panel for the players association that reviewed retired player’s claims under the NFL disability plan.

Duerson read hundreds of applications that encompassed detailed doctors’ reports of players with multiple injuries. As a common theme, many of the retirees were suffering from similar symptoms of the onset of demensia. Several of the retirees had received enough damage to require full-time care.

By 2007 Duerson began to fall onto tough times. His company filed for bankruptcy and his home went into foreclosure followed by an ensuing domestic dispute. Soon after, he filed for divorce from his wife of several years. Those close to him in his final days remember his difficulty with short-term memory recall that was becoming increasingly significant. Duerson was also falling deeper and deeper into depression, even before 2007, complaining of blurred vision and pain, his ex-wife said, “on the left side of his brain.”

Many of the actions that Duerson displayed were symptomatic of the onset chronic traumatic encephalopathy (CTE). CTE is a devastating condition of deteriorating brain capacity that can eventually lead to Alzheimer’s down the road. Under normal conditions some people are more genetically predisposed than others to develop the condition, but with the repeated traumatic brain injuries that accompany the collisions of professional football, at times having a force of over 120Gs, there is strong and justified suspicion of the direct link between the short term trauma and the lingering after effects that can develop into CTE.  Boston University researchers will have the opportunity to examine the evidence of the former defensive back’s brain over the next several months to scrutinize these claims.

After seeing countless similar stories of mental decline from the medical claims of his peers, it is understandable, though heartbreaking to see the decisive actions that Duerson took to end his life. It is not unjustified to assume that he saw on a day to day basis the damage that had been done to his peers’ bodies and the traumas of his playing days were being to haunt him as well.

 In light of the similar stories that are the former players’ lives after their playing days are over, the NFL has worked to reduce brain injury by implementing rule changes and improved protocols for dealing with brain trauma. Unfortunately, only so much can be done. Much of the lasting brain damage lies within the physics of the game. Many argue that improvements to protective gear such as helmets can help to significantly reduce brain injuries. Improved helmet construction has helped to reduce injuries caused by the linear forces of hits, but has no effect on the rotational forces that are responsible for a majority of the concussions on the field today (Head Trauma in the NFL) leaving players still helplessly exposed to the risk of concussion.

The dire consequences that brain trauma can cause should be of great concern to those that currently play the game, even at the high school level. Education is critical to helping reduce the seriousness of injuries and long-lasting effects of brain trauma. Players need to have a strong grasp of the symptoms to understand when they need to stay out of the game and on the sideline. Six players on NFL rosters today and over one hundred retirees have pledged to give their brains up to research after they die, signifying the realism of the problem. Unfortunately many of the players have a laze-faire attitude about concussive injuries as Baltimore Ravens center Matt Birk recently put it best, “It’s almost now to the point that — not that it’s not tragic — but now it’s almost becoming common, some former players with some form of brain problems. Is it something that I think about? Yeah, absolutely. There’s a little bit of, ‘Well, it’s not going to happen to me.’ ”

Written By Trevor Mooney

3/10/2011

Sources

NY TIMES: N.F.L. Players Shaken by Duerson’s Suicide Message

NY TIMES: A Suicide, a Last Request, a Family’s Questions

Webpress: Head Trauma in the NFL

Trevor Mooney played college football at the University of Delaware as a tight end #84 and was a member of the ESPN Academic All-Region team and ESPN All-American Finalist.