CTE Is Not a Concussion: What Athletes and Parents Need to Know with Dr. Reece Granger | E81

Dr. Reece Granger: 00:00 And to jump back to the point of concussion and the actual movie with Will Smith that you're talking about, that's where earlier you stated about media and media framing is really important because the name of that movie is concussion. But realistically, it is not about concussion. It is about chronic traumatic encathalopathy, CTE, Benedamalu diagnosing CTE in Mike Webster. But the movie is about CTE, but the media framed it about concussion. Dr. Ayla Wolf DAOM: 00:31 Welcome to Life After Impact, the Concussion Recovery Podcast. I'm Dr. Ayla Wolf, and I will be hosting today's episode where we help you navigate the often confusing, frustrating, and overwhelming journey of concussion and brain injury recovery. This podcast is your go-to resource for actionable information. Whether you're dealing with a recent concussion, struggling with post-concussion syndrome, or just feeling stuck in your healing process, know that you are not alone. This podcast can be your guide and partner in recovery, helping you build a better life after impact. Dr. Reese Granger, welcome to Life After Impact. Dr. Reece Granger: 01:11 Thank you so much for having me. An absolute pleasure to be here. Dr. Ayla Wolf DAOM: 01:15 Yes. What what time is it there in Perth, Australia? Dr. Reece Granger: 01:19 Moment, it is 9.04 PM. Not too late. Dr. Ayla Wolf DAOM: 01:22 Okay. So you have a concussion, I would say a sports-related concussion podcast called Head First. And you're a chiropractor, Dr. Ayla Wolf DAOM: 01:31 but you're also um neck deep in a PhD program. Is that correct? Dr. Reece Granger: 01:36 Yes, that is that is correct. So run a podcast. Uh you could attest to the work that that comes, and we can get into the story of how we ended up actually starting a podcast. Uh a registered chiropractor have been practicing now since 2019, 2020, a bit of background in strength and conditioning, powerlifting, bodybuilding and sport, love sports since I was a wee young man running around in nappies and PhD student and neck deep in that as well. And that is about concussion and rugby league. Dr. Ayla Wolf DAOM: 02:10 Okay. And what is I know with a PhD you've got to have kind of a very narrow focus for your thesis paper. What is that looking like? Dr. Reece Granger: 02:19 A mess, in short. Um in terms of the actual thesis paper that we're looking at with the PhD, it is a continuation of my master's project. And my master's project, we looked at the National Rugby League, we looked at concussion incidence rates, return to play times, how actual player was concussed, and then also head injury assessments, how many head injury assessments were in season, what were the categories of the head injury assessments, and I literally went through and coded everything through every player and every team. Obviously, it's all been de-identified and it's been done in accordance with a collective bargaining agreement which the sports have through their players' association, which means you can collect all information that's publicly available in the actual public domain as long as you de-identify team sex and then the actual players' names. And as soon as you do that, then you can comment on it. And that's how we angled into that. And it was how would you say it? It was shocking, not shocking. It it's probably actually a very bad word. It was it was eye-opening but not unexpected, if if that's if that describes it in a roundabout way. So I found in 2024 there was 200, and I think it was off the top of my head, 46 head injury assessments conducted, there was 91 concussions for the season. And then out of that, they have their categories that they go to. However, a caveat with that, if we think that's a fair bit and that's all it's a lot, is that we'll unpack this later on, that as rule changes are implemented and enforced, we also then the drop the threshold of what registers as a concussion. So you may say, okay, I've got a headache after that hit. Okay, you got a concussion, you come off. However, we don't know if that's caused due to dehydration, the headache. We can't tease them two apart. So therefore it gets ticked off as a concussion, not dehydration, because we can't prove one of the other. So let's just play it safe and conservative. And that may or may not inflate the stats too. So we've got to take it all in stride with other data. We're adding now uh across multiple years instead of a single year, with that for the qualitative piece. And then we're also looking at sports media and how media influences actual our perception and concussion, again, which we'll unpack later on. And then we're also going to be looking at um implementing how we can go about grassroots. Dr. Ayla Wolf DAOM: 04:52 Wow. Yeah. And so amazing that you have access to all that data and you don't necessarily have to go collect all of that yourself Dr. Ayla Wolf DAOM: 05:00 in order to start looking at it. Now, I just interviewed Dr. Joseph Maroon, and he was talking about the mouthpiece with the sensors that lights up when there's a certain amount of rotational forces. Are the rugby teams in Australia using that particular mouth guard or mouthpiece? Dr. Reece Granger: 05:20 That is a great question and also a great get with a guest. Congratulations on that one. One of the goats of the actual concussion space. Yeah. When it comes to the mouthpieces, I personally haven't worked with the mouthpieces. I know what they do, the strengths and the limitations. In rugby league, they don't use the mouthpieces and the sensors and the chips in the actual mouth guards. However, rugby union, I'm aware that they do do that. However, that is probably a little bit far removed from where I am. So I'm not going to beat around the bush and think that I know about something I don't know. I'll stick in my wine and say, I know what they are, I know what they do, and that's where I am on that. Dr. Ayla Wolf DAOM: 06:01 Yeah. Well, and I know that you do follow rule changes in sports really closely, and that's something you talk a lot about on your podcast. How what are your thoughts? Like if you were in charge, what would be some of the what are some of the rule changes that you agree with? What are some of the rule changes maybe you'd like to see? And what are some that maybe you think were unnecessary? Dr. Reece Granger: 06:25 Wow, that's a great question. Never had it put to me like that. In terms of rule changes, sport, concussion, and protecting individuals, I guess it comes down to is what is your ultimate goal when it comes to a rule change? Are we protecting for the now or are we protecting for the later and the future? And if I say we're protecting for the now, you look at in-play head high hits that we're actually talking about. And I I know a lot of your followers and listeners probably don't know much about Australian rules football. But the first thing that comes to mind with that is in 2006 there was a player for Collingwood called Blake Carousella. He got taken out, hit in the head from a hip and shoulder by Tim Noddin, who was for Brisbane Lions, fractured and broke his neck. And ultimately they then started changing the hip and shoulder to protect for the the now. Okay, so we're protecting the actual player from a serious injury. And then if you go to the NFL, they're looking at the hip drop tackles from dislocated and broken ankles. That's for the now. If we're looking for the future, we're looking at repetitive heading packs with heading in soccer and decrease in heading. It's not going to do much now, today, tomorrow, next week. Accumulative over the years, that's where it's going to have its protective factor that we're talking about. So to circle back to your question. I was pretty dogmatic when it came to rule changes in the beginning. I was that old keyboard warrior, armchair critic, person down the park that was like, How dare you? You're destroying the fabric of the game, the fabric of the sport. You just want to. Dr. Ayla Wolf DAOM: 08:03 You were one of those. Dr. Reece Granger: 08:05 I was one of them. Now, as I've been more entrenched in this space, and uh the biggest bit of advice I can give people is don't be so dogmatic you can't turn the ship. You've got to be able to listen to other people's opinions and arguments that they put forth because a lot of the time, even if you don't agree with something, there's a gold nugget in there that you can learn from. And that's how I now approach it. So one thing I agree with now that has been brought in is heading in soccer and actual trying to reduce heading or banning heading from under twelves, maybe under fourteens, down. At the end of the day, kids at that age, they just want to play with their mates. They just want to have fun. They're not really associated with needing to learn heading at that point when they can learn to control it with their chest, control the ball with their foot, their knee, thigh, bring it down, pass it, one-two touch. So when we say heading for kids, that's that I agree with. And if we go back to Robert Cantu in the early 2010s, I think it was, and the amount of criticism and heat he got when it comes to checking in ice hockey and actually removing uh literally smashing people into the backboards. A 15-year-old, I don't think they're really wanting to put someone through a glass panel in the backboard. And they've reduced the concussions, reduced the risk. So in a roundabout way, I agree with that. In terms of rules that I don't agree with, it's not so much I don't agree with the rule. Sometimes I think it comes from a knee-jerk reaction, and we don't look at the consequences of a rule that we're implementing. So if I go back to both rugby styles, Lee and Union, they're so worried about protecting the head of the ball carrier, the bloke that's got the ball under his arm running 100 mile an hour, and all the onus is on the tackler. They've seen in the last 15 to 20 years, it was the ball carrier that was always concussed because he was copping shoulders and shoulder charges to the head. Now, 90% of the time, it's actually the tackler that is getting concussed because he is now adjusting his body to not hit the head, and he's putting his head down below the hip, and he's getting collected by the hip, and he's actually knocking himself Dr. Reece Granger: 10:30 out because he doesn't want to get suspended and he's trying to protect the ball carrier. So that's a case of where we have to look at the rule changes and then what are the effects of the rules and the changes that we make later on down the line. So, in terms of disagreeing, I don't disagree as such. I just think it's like Newton's law, every action's gonna have an opposite nequel reaction. Dr. Ayla Wolf DAOM: 10:54 Right. It's kind of like when you're trying to protect one animal in the wildlife, and so you say, okay, we're no longer hunting wolves, and then all of a sudden the deer population explodes, and then we're like, oh, now it's you know, now we need the wolves to kill the deer. Dr. Reece Granger: 11:08 Yeah, yeah. Australia, mate, they brought in the cane toad to kill the cane beetle, and the cane toad didn't eat the cane beetle, and now we're overrun with cane toads. Dr. Ayla Wolf DAOM: 11:17 Yes, I I watched a show on that. I know I know a little bit about that. Okay, so it sounds like when it comes to youth sports, these regulations for protecting the head make a lot of sense. You're on board with that. But I know over the years you've also spent a lot of time thinking about professional athletes, their choice to participate in a sport that comes with risk. And so talk a little bit about where you've landed on people who choose willingly to participate in a sport that has a high risk for head injury, and maybe how society looks at that, how the media looks at that, and how you look at that. Dr. Reece Granger: 12:04 There's a lot of questions in there. I could take it a lot of ways. There's always going to be an element of risk when it comes to contact sports, collision sports, all sports. It it doesn't matter what it is in life, there is always going to be an element of risk. I guess it comes down to informed consent, you informed decisions, and the way that we actually look and we profile that risk when it actually comes to sports. So I can again, I can only speak to Australia because that's where I've done a lot of my reading and a lot of research on this. And we can extrapolate it to other countries, but when it comes to an actual workplace, because ultimately a professional athlete is the product. Myself and you watching a sport, we're the consumer of that product. Now, I think where it gets a little bit lost is we frame sport as a vocation still, in terms of that the individual is lucky to be playing this sport, so therefore they accept the risk of playing the sport, and they're just a lucky individual to be in the position that they are earning multiple millions of dollars. And players come out and say, I accept the risk of playing, but I think that is a bit of misguided empathy from our part being like socially conditioned to respect that. And it was Dr. Stefan Casper that really challenged my thought process on this. And when he did, we were talking about the run it, which I don't know if you've seen how they literally it's the rugby soul tackle game where they attack a ball under the arm and they just both run at each other like the Simpsons, how they put the pots Dr. Reece Granger: 13:40 on their heads and then just it's last men stand him. No. So look it up, run it, look up run it nation. Not that I'm saying that it's bad or good. And where I landed on this is that as society, we are constantly come down with rules and regulations in all walks of life that we get a little bit fatigued and sick of told them what we can do. And then on the other hand, we are conditioned to respect one's decision. If they want to do something, we respect that and we have full right to do that decision. That's where I say it's misguided empathy, because we're respecting these decisions to play a collision-based sport or a contact-based sport and saying they accept the risk. However, when it comes to that risk, no one is there to protect them. Because you look at the Goldman's dilemma that they can only see today and next week. They can't see 30, 40 years down the track. Sure, a broken ankle, leg, a dislocation. They're not thinking about brain injury. So therefore, we actually have to protect them from themselves. And that's where I actually come in and think sometimes respecting one's autonomy can be a little bit of a slippery and dangerous slope because in the 1970s in Australia they removed workers' compensation from professional sports. So professional athletes aren't covered in workers' compensation at all. They're they're by themselves. Then when they actually retire from, and there's a bit of media framing, as we say retire and end of an era, we don't say that they've resigned from their chosen sport to exact same meanings, just framed a little bit different. So they have usually 12 to 24 months to fix up any injuries. And after that 12 to 24 months, they've kind of then gone by the wayside, they're out of the system, and then they have to apply, and sometimes they can't meet the thresholds to apply, and ultimately that's what ends up in to the to the lawsuit. So we need to protect the players, and just because they accept the risks, that's advocating all responsibility from a governing body. And it's like you go into work saying, Ayla, you accept the risk to go in for work. If you slip down the stairs and break your ankle, that is on you. You're lucky to be doing what you're doing. It doesn't have that same feel to it, the same as a crane driver or anything along those lines. And the other thing about advocating the responsibility there, it's like me telling you that you've hopped in a car, you've accepted the risk of hopping in the car. If you get in a serious accident in Australia, the state and then the federal government look after you for being in a serious accident. It's like me saying, you know what, mate, you can sit on the side of the street, you accepted the risk of hopping in that car, your injury is not my problem. And that is exactly the same when we kind of look at it at sports, and it's very sociology lens of it. And ultimately, the people left to pick up the pieces are the loved ones, the carers, the family, sons, daughters, mothers, and most cases it's the wives that pick up the pieces. So that's where I come from in that aspect. Dr. Ayla Wolf DAOM: 16:50 Yeah, and I think that that's where the research is so important. The whole movie concussion was really all about did the NFL know that football increased their risk of CTE and they tried to hide this information, right? That was like the sensational reason for the movie was were these long-term consequences trying to be hidden so that the players would continue to play, right? And so when it comes to this idea of autonomy, we also have to say, well, do we have all of the information with which to make an informed decision? And that's where all of this research on CTE and repetitive head impacts becomes so important. Dr. Reece Granger: 17:34 Yeah, exactly. And I look, I want to caveat it. It's uh I'm I'm not bashing sport because when it comes to rugby, 13 men dictate my emotional status for the weekend. When it comes to AFL, I've got intergenerational trauma with St. Kildra, and they've been around for over 150, 160 years, and only won one premiership and the butt of all jokes and finished last the most amount of times in the history. It's like I love sport. I don't know where I would be without sport today. But the more I've dived into this space, and originally it was out of with my PhD and masters, it was out of fun wanting to track it, and then the podcast wanting to actually look for podcasts that were talking about sports-related concussion, I could only find sporotic episodes, and the two main ones that were there at the time had stopped podcasting, and there was a couple of months between that that's how I actually got into it. Sometimes I wish I could still be a little bit ignorant and not worry about that, but the more and deeper entrenched you are in the space, and I'm sure you've probably had a couple of these light bulb moments when it comes to concussion and treating, you you start to be skeptical to the point of being cynical. And to jump back to the point of concussion and the actual movie with Will Smith that you're talking about, that's where earlier you stated about media and media framing is really important because the name of that movie is concussion. But realistically, it is not about concussion, it is about chronic traumatic encathalopathy, CTE, Benada Maru diagnosing CTE in Mike Webster. And I say bring in CTE into the 21st century because it was you could say discovered, but put forth by Harrison Martlin in 1928 and then built upon in 1937 with Dementia Pugilistica. But the movie is about CTE, but the media framed it about concussion, and then it's only really the last couple of years that we actually start to be able to tease apart concussion does not cause CTE. It is repetitive head impacts that cause CTE, but we don't know the dose response. So therefore, that's where the ambiguity lies. And like the the media and reporting, it's if you have little Mickey, he's in a hospital, you go to Mum, as a doctor says, Little Mickey's had a head knock, then little Mickey's had a concussion to his mum, so little Mickey's got a mild traumatic brain injury, you're gonna elicit three different sponsors from mum. All about the way that you frame the question and the injury, but by definition, they all mean the same thing. Dr. Ayla Wolf DAOM: 20:08 And I think that that is very confusing to the public when we have these different terms, such as concussion, subconcussive hits to the head, repetitive head injuries, CTE. You know, it I think it is very easy for the public, the media to just kind of conflate all of it and just roll it into all the same ball of yarn. And then that does create a lot of fear around, and and I get asked this all the time, you know, my patients, many of my patients have had more than one concussion, right? Like they've come to me because their most recent concussion has caused some long-term symptoms. But when you talk about their past, they will say, Well, yeah, I remember I was a kid, I fell off my bike, Dr. Ayla Wolf DAOM: 20:50 I was bleeding, I had to have stitches, I lost consciousness. And so many of my patients have had more than one concussion in their history and they are concerned. What does this mean for me? Right. And so I think it is really important that we can tease apart what does, you know, repetitive subconcussive head trauma over a career of 15 years playing football versus somebody who had a concussion when they were three and then maybe had another one when they were 34. You know, what does like, what is the outcome, the long-term trajectory of those two situations? Because they are very, very different. And the research says that they are very, very different in terms of the risk for CTE. Dr. Reece Granger: 21:37 Yeah, it's a great point that you bring up there. And you can have two, three concussions and be perfectly fine and not have CTE. I say have as if we diagnose it in the living, but you can be posthumbly not diagnosed with CTE after just three concussions. You're right. It's like the repetitive head impacts over time, as you'd know, working with. Fighters and seeing some of the declines in fighters and boxing and fighting is a live lab for head injuries. And the the language piece and the fear, ultimately, you look at it, a bit of onus goes on the journalists and the actual scientists because it's like this symbiotic relationship that we both need each other in a way, in terms of we need the journalists to get the science out there to the public to educate. However, the journalists need to actually deliver it in such a way that it's engaging, it's going to drive attention, we're going to get clicks off it, and ultimately they're going to make money out of the article that we're publishing. So in a way, it needs to be sensationalized, otherwise we're not going to read it. It's simple as that. Like you go to framing. If I say, you know, we got 100 people had X treatment, and I said 10 people died after X treatment compared to 90 people survive after X treatment. Even though they're the same, you're going to look at the one where it said 10 people die and go, ooh, no, I'm staying away from that. But if I frame it as 90 people survived, you're going to be like, that that's actually pretty good. So there comes the framing that really needs to be tweaked. How do you get the buy-in then with patients that you that come in and see you with like the post-concussive symptoms? How do you get them then to buy in and see the overall picture of this is going to take four, six, twelve weeks and some real heavy lifting on your part? I can only do 10, 20% in this room. Dr. Ayla Wolf DAOM: 23:36 Yeah. The buy-in, I think, really comes after doing a very comprehensive functional neurological exam where I'm doing tests that maybe they've never had done before, and they suddenly realize, you know, you just asked me to walk down the hall and say every other letter of the alphabet, and I can't do it. And I feel like I should be able to do that. And, you know, or I'm having them stand on a foam pad with their head tipped back into the left and they fall over, but they can do that with their head tipped back into the right. And so when we start to collect so much data on so many different levels as far as the autonomic nervous system, the vestibular system, the ocular motor, the balance, the coordination, the sensory input, the motor output, when you start to collect a ton of data and people see in the exam where they struggle, um, and sometimes people are shocked at like, I'm having them do a finger tapping, and then they turn their head to the left and all of a sudden they can't do that finger tapping anymore. And they're like, what is going on? Right. And so when you start to um show them how their body is responding, and when they can see the areas that they struggle in, and you've now identified very specific situations, then they start to say, okay, somebody has taken the time, two hours, uh, to really run me through the paces and laid out like a very informative review of what they just saw and have a path forward. That's the buy, that's the buy-in. And um, a lot of times, if I can make at least a small change, it may be a temporary change, it may not last forever, but if I can at least make a small change and improve one of those exam findings in that, like in that moment, that's usually also a really good buy-in for people to say, okay, I was struggling with, you know, doing this finger tapping with my head turned to the left. You did a few things and all of a sudden it was easier. Now it's like, okay, clearly um we're able to change the brain, change the sensory input, change the motor output. There's a path forward here. I just saw something improve. Um I think those little wins are the the buy-in. Dr. Reece Granger: 26:02 Yeah, it's I guess it it all comes back to patient education. Dr. Ayla Wolf DAOM: 26:07 Yeah. And I I do think that people are used to other injuries that have a shorter recovery time. And so we there is the education around the brain. We're literally trying to update the way that the brain is is wired, and that does take time. You know, creating neuroplasticity takes time, repetition, frequency. So the the education piece is huge. And that's where, you know, most mainstream medical models, doctors don't have time to be educators. They have to see a certain number of patients per hour, and so they don't have the time to explain neuroscience to their patients or to necessarily talk about expectations or um what's happening in their brain. And so I think that for me, taking a lot of that time to provide the education is also just as important as the treatment. Dr. Reece Granger: 27:05 And I guess that's also where like myths of concussion tie in is the patient education and that we're talking about, and can unpack this more if if you want, but it's not so much a myth. It's pre-existent and predated research now that has actually been updated that then GPs or manual therapists that aren't in the concussion space and the concussion field haven't been able to keep on top of because they've got so many other things to worry about, whether it be diseases, heart conditions, dealing with general public in ED. And one of the the big things is you you look in the late 80s, early 90s when we had no concussion protocols or management, and I'll say that was in mainstream because rugby union actually had it in the 1970s at a 21-day, nearly 30-day stand-down policy, or created by neurologists, but I'll just park that one there, is we graded concussion, grade one, where it was like a loss of consciousness under five minutes, grade two was over five minutes, grade three was I think over five minutes, and like there was post-traumatic amnesia uh tied to them, and Dr. Reece Granger: 28:20 then there was some guidance on stand down times. Now we still get conflated that we've had a grade one, two, or three concussion, and it's it's not that that was wrong. It was just no one at the time was doing research in the space to try and solve a problem. So they've gone out and okay, where where do we start? We've got to start somewhere. So that's where they started. And I feel I feel for them in a sense that sometimes they get a little bit of a whack over it, and I'm like, well, hold on, that we've actually developed off them and made things shorter and realized that this or isn't is or is not a concussion. It's like the same with cocooning and going in a dark room and not doing exercise. It wasn't really till John Letty started doing the Buffalo concussion treadmill test that he developed with his colleague at the university, and they used to do that in heart condition patients to elevate the heart condition, and the same thing happened there. It's like we've gone from, okay, let's not cocoon and rest for prolonged periods of time, and let's actually get out, do a little bit of moderate intensity exercise, enough that you can actually tolerate to maybe replicate or produce your symptoms that you can handle, maybe a one or a two out of ten, but no more, because we've obviously got to elicit some sort of symptomology to actually get a beneficial change. Dr. Ayla Wolf DAOM: 29:46 Yeah. I think the don't quote me on the years, but there was a there was a statistic that said that it takes 40 years for research findings to actually make their way into clinical practice. Dr. Reece Granger: 30:00 It sounds about right. I'll I'll get that as well. Like if you just look at how long it takes for a drug to get to market. unknown: 30:06 Right. Dr. Reece Granger: 30:07 You know, this and the and the money, like it's yeah, um it would sound about right. Dr. Ayla Wolf DAOM: 30:12 Yeah. And even if we cut that in half and just said it takes 20 years for research to make it into clinical practice, that still feels too long for the patient who is suffering. And again, even in the last five years, I've had at least one person come in and tell me, I was told I had a grade two concussion. Uh, I've had people tell me that their doctor said, well, you didn't lose consciousness, so it wasn't a concussion. And so even in the last five years, I still have patients coming in telling me what their doctor told them, and it is outdated practices for concussion. Dr. Reece Granger: 30:46 Yeah, and the thing that makes that harder, and again, I can only speak for Australia here and from some GPs that I've spoken to, but you think of the amount of lawsuits that come out of sports-related concussion, and it's kind of sad that sport and concussion are like so entangled when we know that it's only about 10% of over overall concussions, yet it gets the most coverage. You got I think it's up around the 50% mark is from slip trips and falls with granny down the road, and then you got motor vehicle accidents, and then unfortunately domestic violence and interpersonal violence, which is absolutely horrific in itself, but sport gets all the attention. Now, going back to the doctors' pieces, I know doctors some that I want to be careful how I word this. The last thing you want to do is cop a lawsuit. Is you know I'll say there may or may not be some some doctors there that they don't want to actually now treat a concussion and touch a concussion because as soon as they accept that patient that comes under their care, if that patient is or isn't getting better and it's deemed negligent, well then they're on the hook for actually not treating them properly. And there's been some precedents set here in Australia with the AFO where players are suing club doctors over the treatment of concussion and the handling of the injury, and it's actually filtering down now through some of the medical practitioners and the practitioner boards. And when I have to write sick notes at times, like sometimes I actually get very wary about writing it, and I'm like, what am I actually on the hook here for if someone doesn't agree that that person come in with X condition? So it that does also tie into the GP aspect. If they've gotten to know so many other conditions, other stuff, other things, why would they want to, with the greatest due respect, treat somebody with a concussion when there's actually their livelihood is at stake and then it just it leaves the poor individual that is actually that's had a concussion suffering from the actual the symptoms with nowhere to go. Dr. Ayla Wolf DAOM: 32:59 Yeah, that's a that's a really tough one. And obviously, uh again, a statistic that I heard a while back, but it's probably still semi-accurate, is that 90% of all lawsuits worldwide happen in the United States. So we are a very litigious country. We love to sue. Uh and I think that that really does affect how doctors practice and how they choose and what they do choose to do and not do. Um sadly, it's uh I think it's a fact the of part of the risk of being in a medical profession is um is that very thing. Dr. Reece Granger: 33:38 Yeah. Oh well. I don't know an answer. I always love to, if we're gonna highlight a problem, give an answer, but it's one of those things where I don't know how how to solve that or how to fix it. I know that in in Australia, again, the manual therapists aren't allowed to diagnose a concussion, whether it be a Cairo, an osteo, a physio, we are not allowed to diagnose a concussion, only a GP. So it's putting more of a burden on them. But hey, I can go play with your brainwaves, put an EEG cap on you and light you up like a Christmas tree and see how you go. That's perfectly legal and fine, which still blows my mind playing with brainwaves. But I think if we can change that and take some of the burden off the healthcare system in being able to diagnose a concussion, because we see all around the world that we're making parents and coaches, volunteers, and even other players recognize the signs and symptoms of a concussion to remove a fellow teammate, but yet we're not allowed to diagnose a concussion. So it's almost like we're the middleman, we've been pulled out to say no. Players and parents are expected to know the signs and symptoms. GPs are allowed to diagnose it, and that's it. Dr. Ayla Wolf DAOM: 34:59 One of the things Dr. Ayla Wolf DAOM: 35:00 about the podcast is you start learning about all these technologies and tools that are out there that can diagnose like different aspects of brain function, but there isn't one defined diagnostic for concussion, right? So, like, yes, we can look at event-related potentials in the brain. We can look at blood biomarkers in the blood, we can look at eye movements, we can look at balance, we can look at memory, you know. So it's like we we know how to assess the brain really, really well. But what then are we going to use as our diagnostic criteria for a concussion? And sadly, we still don't have a really, really good, clean rubric that every single person can follow. Dr. Reece Granger: 35:46 Yeah, it's like there's so much ambiguity over what is a concussion. You've got the concussion in sports group, then you've got the American Neurology Association, they've got a different diagnosis again. Then sometimes when you go through the literature, what they write and diagnose as a concussion in the literature isn't backed up by either of them two. So you're like, where are you getting your definition from that you're working from? Dr. Ayla Wolf DAOM: 36:11 Yeah. Any other myths that you hear? Dr. Reece Granger: 36:16 The only one thing I would kind of question people's thoughts on and challenge them on a little bit is sometimes we may have to ease up on and this is only for professional, but ease up on the professional athletes a little bit in terms of getting them to self-report their concussions and before everyone takes them in with a baseball bat. What I mean by that is they're neurologically impaired because they've just had a concussion. That's basically what it is. It is like asking a dementia patient and telling them off why did you lose your car keys and where did you put them? I see where you're going with this. It's almost the same thing. So and what makes it more complicated when it comes to professional athletes is the stand down times, whether it be 11 days, 12 days, 7 days, 48 hours, they're all based off the best available evidence and research, but not one of them's actually put it in the public domain, and they've all got different times. So that's another topic for another another day. But they're they are programmed to win. They are the 1% of the 1%. They are trained and almost programmed to actually play through that pain barrier. It's why they are there. Like you we glorify athletes for the injuries that they actually play through and and how they carry on. So naturally they're gonna do it. And to them, concussion is another injury, and it's just the same mentality, unfortunately. Now we're starting to cut through that. But I still think that the owners should come back to us to understand and when these reports come out that like 40% hid their concussion symptoms when they're at training that they thought they were concussed or might be concussed, and we all kind of gasp. Understand that in in context. Now I do understand that the kids watch the professional athletes and they copy the professional athletes, and if reports come out saying they're reporting it, well then a kid is going to report a headache as well. So I get that aspect, and that is really serious as well when it comes to grassroots. So that that's probably the other angle that I come back on that then we should actually be pulling them up saying, hey, we need more surveillance to actually withdraw that athlete and not r rely entirely on them to actually report their symptoms. Dr. Ayla Wolf DAOM: 38:48 And when you have adrenaline coursing through your body, when you get a concussion in that moment, you probably are not even you, you're not like stopping and thinking, like, oh, did I just get a concussion? Should I take myself out? It's like, no, somebody's coming at you and you need to defend yourself and keep going, right? And so the adrenaline component of it when you're talking about a concussion in sport, um, that really overrides a lot of what people might be able to feel in that moment. Dr. Reece Granger: 39:24 And so Yeah, and that's that that that ties actually what you back set into with an actual myth as well. Is that a adrenaline component? And I I don't think when it comes to head injury assessments in sport, a lot of people probably don't actually understand the the tablets that they do the head injury assessments on, they've got 15 minutes to conduct that head injury assessment. But that first couple of minutes and sometimes up to five minutes, they're actually not allowed to be tested. They're sitting there in the corner, letting the adrenaline and everything drop to get the game out of the heads before they do the assessment, because that ties into how we have now this is a myth and it's not outdated research as far as I'm aware, is that delayed concussion. It's not a delayed concussion. It's not like you got a hit and then the concussion decides to come on in 48 hours. It's just the adrenaline of the moment that you were in that sport or the activity or whatever you were doing, even at home, masked the signs and symptoms of the concussion in that given period, in that given moment. And then when the adrenaline's dropped, it's dropped enough that it's not masking the signs and symptoms, and then they take over, and that may be 12, 24, 48 hours later, but it gets reported as a delayed onset concussion. Now, that one drives me nuts a bit. Dr. Ayla Wolf DAOM: 40:49 That drives you nuts. Well, you know, I just interviewed Dr. Ryan Darcy from Neurocatch, which is looking at event-related potentials, and what they were finding was that the data on event-related potentials in the brain within the first 24 hours of a concussion were radically different than than what they were 24 Dr. Ayla Wolf DAOM: 41:10 hours after the concussion. And so even the way that the brain is firing in response to information is completely different immediately after a concussion versus 24 hours later. And so it is true. There's, you know, that 24-hour period, um, there's a lot happening in it that can affect your data and your findings. Dr. Reece Granger: 41:34 Yeah. Exactly. Dr. Ayla Wolf DAOM: 41:37 And going back to the media, I think that's where podcasts like ours can provide a really important gap in the fact that we're actually calling up these researchers and saying, hey, will you come on my show and talk about your research in a way that is not sensationalized or reduced down to a soundbite? Uh, being able to have hour-long conversations with the people actually doing the research and hearing them talk, I think is is a place where podcasts are filling in a very much needed gap. So keep doing what you're doing. Dr. Reece Granger: 42:15 Cheers. Thanks. And and likewise yourself. And I say when it comes to the podcast, as I said earlier, I'm I'm just the medium for the message. Yeah. With all these researchers, keep coming on. It's great. Dr. Ayla Wolf DAOM: 42:29 Yep. Uh amazing. Well, thank you so much for your time. Why don't you let people uh know where they can find your podcast and your work and everything that uh you're doing? Dr. Reece Granger: 42:39 Yeah, no, thanks for the plug. Uh my podcast is headfirst, the concussion podcast. Pretty much type in that same name, Spotify, Google, Apple, everything, and it'll all come up the same with Instagram. It's just headfirst at Instagram. And they'll also find your episode on there as well, uh, from unpacking everything that you talked through as well. And yeah, it's just it's it's an honor and privilege, and I could say I'll speak with both of us that the people that we're able to speak to come on, give their time, their resource, their knowledge to actually talk about their research. Because at the end of the day, they don't have to, and extremely grateful for that. Dr. Ayla Wolf DAOM: 43:19 Mm-hmm. Yep, absolutely. And and you've had some really big names in the the research world on your show, which I enjoy listening to. Uh so thank you for for your work and the information that you're putting out there as well. It's uh really important. Dr. Reece Granger: 43:35 Greatly appreciate it. It's been an absolute pleasure and thank you for the support. Dr. Ayla Wolf DAOM: 43:40 Absolutely. Medical disclaimer. This video or podcast is for general informational purposes only and does not constitute the practice of medicine or other professional healthcare services, including the giving of medical advice. No doctor-patient relationship is formed. The use of this information and materials included is at the user's own risk. The content of this video or podcast is not intended to be a substitute for medical advice, diagnosis, or treatment, and consumers of this information should seek the advice of a medical professional for any and all health related issues. A link to our full medical disclaimer is available in the notes.