RUNIT collision sport: collisions cause injury in competitive events, death in social media challenge parroting the sport (5/29/25 Newsletter)
In this newsletter: Opportunities, Diagnostics, Self-Care, Youth, Culture
Writers: Ella Webster, Malayka Gormally, Conor Gormally
Editors: Conor Gormally & Malayka Gormally
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Opportunities
April 28 - June 15, 2025: Highly Recommended! A free, multi-week, self-paced Online Concussion Course presented in English and French by the Universities of Calgary and Laval. Register by May 31; you must finish the course by June 15. Each of the 4 modules takes 2-3 hours to complete, so it is possible to sign up now and complete the course.
Wednesdays, starting July 9, 11:00–12:15 pm EST: A free, virtual program, MindSet for Veterans, offers group discussions and gentle yoga for veterans, active service members, and military families who have been affected by brain injury. Hosted by the nonprofit LoveYourBrain. Register in advance; space is limited.
Monday, July 21, 12-2 pm EDT: A webinar, Minds Matter Concussion Model: Acute Clinical Concussion Management, “is open to anyone responsible for implementing a concussion protocol following injury,” and all participants will receive an evaluation and treatment toolkit. Presenters include Christina L. Master, MD, who is considered one of the top clinician–researchers in this field. General admission (no continuing education credits) is $30. CEUs are available for ATs, Nurses, PTs, and Physicians; tickets range from $45 to $75.
Diagnostics
Leading experts propose a new framework for diagnosing traumatic brain injury
You can read our extended coverage of this article on our blog.
In a significant paradigm shift, 50 years in the making, 94 experts from 14 countries have proposed a new, multidimensional framework for classifying traumatic brain injury (TBI). The existing classification system utilizes the Glasgow Coma Scale (GCS), a 15-point scale that measures visual, verbal, and motor responsiveness, to classify TBIs as “mild, moderate, or severe.” The new framework proposed, CBI-M, consists of four pillars: Clinical assessment, Biomarker testing, Imaging, and Modifier, the latter capturing injury-, patient-, and social-environmental-related information. This new framework is an attempt to give providers (and patients) a more nuanced understanding of their injury, prognosis, and recovery needs. In this Policy View paper published in The Lancet Neurology, authors Geoffrey T. Manley et al. outline the structure and rationale for the CBI-M framework, including proposed diagnostic documentation for each pillar.
The terms “mild, moderate, and severe” further carry their own stigmas that can worsen patient outcomes. Patients with “mild” TBIs often report struggling to get providers to take their symptoms seriously and can spend months or years trying to get appropriate care. On the other end of the spectrum, some patients with severe TBI may be “given up on,” and taken off life support after only a few days; those who do go on to make full recoveries and their families still live with having faced a decision on removing life support.
While the CBI-M framework appears to constitute a significant improvement over solely using GCS to indicate “mild, moderate, or severe,” it is not finalized and will need to be validated through field testing in a wide variety of settings. There are also concerns about the global applicability of this framework, particularly in areas with limited resources and lower access to imaging tools and the necessary equipment for processing biomarker samples. Additionally, the authors acknowledge that this framework is also limited for patients outside of the acute window, a challenge magnified by findings that as many as 42% of patients with any severity of TBI don’t seek care immediately after injury.
The new proposed framework consists of four pillars: clinical, biomarker, imaging, and modifier (CBI-M). Assessing the clinical pillar is the highest priority. Next, if the clinical pillar indicates an obvious need for imaging, providers should prioritize imaging over biomarkers; biomarkers are more relevant when providers are uncertain about the need for imaging. The modifier pillar serves as a catch-all for relevant modifiers related to the injury, categorized into three classes of factors: injury-related, patient-related, and community and society-related. Some components of the modifier pillar (e.g., mechanism of injury, secondary injury, fall risk) should be assessed acutely, but others that are likely more relevant to the recovery process (e.g., mental health history or alcohol and substance misuse) may be assessed later.
Self-Care
Cognitive Shuffling may be a promising technique to counter insomnia
Christina Caron explores a technique called Cognitive Shuffling as a potential tool for those who struggle to fall asleep at night in an article for The New York Times. This simple technique was created by cognitive scientist Dr. Luc P. Beaudoin over 15 years ago as a solution to his own insomnia. Dr. Beaudoin studied the technique in his lab at Simon Fraser University in Canada and presented his findings at the 2016 Associated Professional Sleep Societies conference in Denver. Cognitive Shuffling revolves around distracting your mind enough to remove thoughts that may keep you up but not so much as to be stimulating.
Previous research has found that when people naturally fall asleep, their minds have several “vivid images or distant thoughts.” Cognitive Shuffling aims to mimic this mental state to trick the brain into falling asleep. Cognitive Shuffling involves mentally coming up with unrelated words. This process begins by choosing a random word, taking a moment to visualize it, and then coming up with another word that starts with the same letter. You repeat this process until you are no longer able to think of words beginning with the same letter. At this point, come up with a new starter word and continue.
For information specific to insomnia related to concussion, including evidence-based methods such as cognitive behavioral therapy for insomnia, see our resources Sleep and Sleep Problems, our blog posts on new research related to concussion and sleep, and the section on sleep in our Self-Care resource.
While this method may be beneficial for some people, currently, there is not enough evidence to support its use as a primary treatment for those suffering from insomnia. That said, there is no harm in trying this method if you are having trouble falling asleep. Clinical psychologist Dr. Shelby Harris recommends that if it isn’t working or you are getting frustrated after roughly 20 minutes, get up and try something else to calm your mind, such as stretching, coloring, or doing a puzzle. With further research, cognitive scientists hope to solidify the methodology and evidence to validate Cognitive Shuffling as a tool for those with insomnia.
Youth
ADHD significantly predicts longer recovery time in high school athletes
ADHD significantly predicts a longer recovery period for both Return-to-Learn (RTL) and Return-to-Sport (RTS) in high school athletes with self-reported ADHD, according to a study published in the Journal of Athletic Training. High school athletes with self-reported ADHD took 16% longer to fully complete the Return-to-Learn (RTL) process and 17% longer to fully complete the Return-to-Sport (RTS) process compared with student-athletes without ADHD. Authors Kyoko Shirahata et al. provide this example: a 15-year-old male athlete with ADHD will take two days longer for a full RTL than his counterpart without ADHD (an estimated 12.61 days compared to 10.85). The study also found that female sex increased recovery time for RTL (13% longer) and RTS (by 7%), and a younger age also increased recovery time. Combining these modifying factors (ADHD, sex, and age) makes the variation in recovery time even more significant. The study authors recommend that “Clinicians should be aware of the possible longer recovery for athletes with ADHD, particularly younger female athletes, to provide anticipatory guidance and to address questions regarding the RTS recovery timeline following concussion.”
In an expert analysis (Michigan News), University of Michigan Concussion Center director and Concussion in Sport Group president Steven Broglio explains that prior research has found that “Athletes with ADHD are more susceptible to multiple concussions, exhibit more severe acute symptoms, and typically have at least one coexisting condition.” Asked how students with ADHD might be more susceptible to concussions and why they may have more symptoms, Broglio answered, “It is believed that those with ADHD are less likely to pay full attention to their environment and other players while participating in sport. In those instances, they may not appropriately brace for or avoid a head impact that results in a concussion.”
The study analyzed data on recovery outcomes for student-athletes from 60 schools from 2010 to 2018, including 553 males and 382 females; there were 78 athletes with ADHD. All the student-athletes included in the study were followed by an athletic trainer and guided through a 7-step concussion management protocol based on the state concussion management program. Full RTL was defined as “full return to school without any [new] accommodations,” and RTS was defined as “full participation in contact practice drills.” To preclude confounding variables, students who reported a history of more than two concussions, dyslexia, or autism were not included in the study.
The study authors found that the combination of ADHD, sex, and age could increase the disparities in recovery times. RTL for a 15-year-old female athlete with ADHD would take four days longer than an 18-year-old male athlete without ADHD (14.22 vs 10.70 days). Even more significantly, the RTS for a 15-year-old female athlete with ADHD would take an estimated six days longer than an 18-year-old male athlete without ADHD (23.10 vs 17.29 days).
The study did not exclude athletes who were taking stimulant medications. Some of the limitations include self-reported rather than clinical diagnosis of ADHD, lack of information about medication use, and lack of initial symptom scores.
Culture
RUNIT collision sport: collisions cause injury in competitive events, death in social media challenge parroting the sport
Experts in Australia and New Zealand are calling for a ban on RUNIT, a sporting competition predicated entirely on "[delivering] real athletes and the biggest collisions," after the death of a 19-year-old New Zealander died participating in the Run It Straight challenge, a social media trend based on RUNIT that has gained traction in the last few weeks. The RUNIT website advertises: "Born to go viral, built to break limits, it has taken social media by storm with tens of millions of views." However, experts warn of the dangers of events designed to maximize the intensity of collisions, and the social media trend of copycatting this impact-oriented sport has already led to tragedy. Sports Medicine New Zealand, a nonprofit organization that is" New Zealand's leading sports medicine special interest group," just put out a press release stating, "RunIt is not a sport. It is jousting without sticks, and whilst that may have been a sport in medieval times, it has no place in today's sporting arenas."
Brain injury expert Professor Patria Hume, PhD, FISBS, FRSNZ, warns there "will be a death" in RUNIT competitions. In communication with Concussion Alliance, Dr. Hume paints a worrying picture of RUNIT and the Run It Challenge: "In RunIt, two participants face off—one runs at full speed, the other prepares to tackle. The goal is to generate a single, powerful impact. After the first collision, the roles are reversed and the second round is played. The winner is typically the participant who dominates the impact, either by remaining standing, overpowering the other, or causing a more dramatic result." After a brutal collision at the RUNIT competition trials at the Trust Arena in Auckland, "one man hit the ground and began convulsing, his body visibly shaking, as onlookers rushed to help," causing Stacey Mowbray, CEO of Headway Brain Injury UK, to sound the alarm, "There is immediate brain damage happening right then and there." Concussion Alliance is deeply concerned that the RUNIT League plans to bring the competition to the United States, the UK, and Saudi Arabia later this year.
Dr. Hume is a leading concussion researcher and Professor of Human Performance at the Auckland University of Technology in New Zealand and has been vocal about the level of danger posed both by the sport's inherent risks and by the "lack of safety measures and regulations."
"The biomechanics of RunIt collisions are comparable to severe car crashes. When two 105 kg participants (average body mass of rugby players) sprint towards each other, the impact force can exceed 16,800 Newtons. This force is over three times that of a professional boxer's punch and more than 1.5 times the force of falling from two meters. Such high-impact collisions carry a significant risk of severe brain injury, fractures, and death," Dr. Hume told Concussion Alliance.
There is already pushback against RUNIT events, with Auckland's Trust Arena declining to host a RUNIT championship $200,000 finals event following "'overwhelming concern for the high-risk nature of the event,'" according to an article in The New Zealand Herald by Benjamin Plummer. In The Sydney Morning Herald, Nadine Roberts and Poppy Clark report that two similar events planned for Auckland were canceled after organizers failed to obtain the necessary permits.
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