Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Heavy Metal music as an educational tool
- Steven B Nimmo (21 December 2008)
-
Left-right confusion!
- Arindam Chaudhuri (22 December 2008)
-
Beware of Heavy Metal Music
- Hugh Mann (25 December 2008)
-
Heavy Metal Music: Associated Breast Injuries
- Philip J Drew, TR1 3LJ (25 December 2008)
-
A injury personally recieved whilst Head Banging
- David J White (28 December 2008)
-
Head bangers may provide important clues to understanding shaken baby syndrome
- Peter D Sidebotham (29 December 2008)
-
What about the beer?
- Rebecca A. Drayer (8 January 2009)
-
The Kids are Alright: head banging poses no special risk of head or neck injury
- James R Funk (26 February 2009)
-
Where are the variables?
- Alice R. Iott (8 September 2009)
|
|
|||
|
Steven B Nimmo, Consultant in Occupational Medicine Derriford Hospital Plymouth PL6 8BG
Send response to journal:
|
Patton and McIntosh's study into the risks of injury associated with head banging to heavy metal music raises some important issues. I would however take issue with 2 points. The man playing the guitar in the photo accompanying the article was clearly an imposter. While suitably hirsute, he was playing the guitar upside down and had no visible tattoos or piercings. My guess is that he is a lab technician and not a heavy metal guitar hero. The authors' suggestion that substituting Celion Dion or Richard Clayderman to reduce the risk of injury underestimates the importance of heavy metal as an educational tool. Dion and Clayderman, while accomplished musicians, simply lack the incisive sociological comment and educational value of heavy metal. For example ‘Psychosocial’, the latest single from the popular heavy metal band ‘Slipknot’, is in fact a learned treatise on the factors predicting chronicity, disability and sickness absence in simple mechanical back pain. The full title of the song is ‘Psychosocial predictors of failure to return to work in non-specific low back pain: a systematic review’. However, in a break from tradition, Slipknot’s next single (Effects of PCBs, p,p'-DDT, p,p'-DDE, HCB and â-HCH on thyroid function in children) is about being mad at your dad. Competing interests: None declared |
|||
|
|
|||
|
Arindam Chaudhuri, Consultant Vascular Surgeon Bedford General Hospital, MK42 9DJ
Send response to journal:
|
The discrepancy in the pictures of the long-haired guitarist in the paper version and the online version ties in nicely to the article on p1426 (BMJ 2008;337:a2906). The online version shows the right-handed picture which is correct, whereas the paper version has the guitarist playing the guitar left-handed with the guitar upside down. Clearly there were left-right coordination issues in the proof reading!! Left-handed guitars are easily available (check www.dolphinmusic.co.uk); however, while Dr Nimmo may be accurate in his comment, I would hasten to add that are many left-handed guitarists who played a right handed-guitar upside down, classic examples being the late Jimi Hendrix and Kurt Cobain. Current lefties playing right handed instruments turned around are Jimmy Haslip, bass player for the Yellowjackets, to name a few. There is the odd right-handed bass plater (Keith Horne) who has switched to playing left-handed with a bass turned upside down which is a testament to their right-left coordination! There are dedicated websites to support them (e.g. www.leftybass.com) and specific shops for lefties (e.g.www.anythingleft-handed.co.uk). Right-left coordination is very important in surgery and is something I try to impress on my trainees early on, especially in terms of making progress during an operation. Interestingly, whether the gender basis for co-ordination is something that might partially account for the male- female number differences in surgery makes interesting speculation, having worked with female surgeons with excellent right-left hand co-ordination, though a non-randomised, and most likely completely non-scientific test suggested one had 'male'-type control over this aspect! Competing interests: I am a right-handed vascular surgeon who plays a 6-string bass guitar, which requires a bit of left-right coordination, but I tie my knots left-handed, and occasionally cut and dissect left- handed as well! |
|||
|
|
|||
|
Hugh Mann, Physician Eagle Rock, MO 65641 USA
Send response to journal:
|
Heavy metal music, a counter-culture witches’ brew of cacophony, stimulants, hallucinogens, and neck gyrations, creates the euphoria of oblivion, wisdom, and freedom, and the sickness of deafness, confusion, and whiplash. The euphoria of oblivion, wisdom, and freedom, and the sickness of deafness, confusion, and whiplash are polar opposites, which reinforce each other: the euphoria blinds you to the sickness; and the sickness makes you crave the euphoria. Ironically, heavy metal music creates and aggravates the very sickness it seems to cure. Competing interests: None declared |
|||
|
|
|||
|
Philip J Drew, Professor / Consultant Breast Surgeon Royal Cornwall Hospitals Trust, TR1 3LJ
Send response to journal:
|
As a somehwhat aging "headbanger" myself I was interested in the article by Patton and MacIntosh. However they failed to mention the more modern development of associated headbanging behaviour known as the "Mosh Pit." At a recent Black Sabbath concert (Heaven and Hell line up re-union with Dio as lead singer)it would appear that they thought it necessary to engage a number of more modern thrash metal bands in order to attract a younger audience. During the set by "Lamb of God" I was amazed to see what appeared to be fight breaking out in front of the stage. People were pushing, punching, kicking each other with abandon. I made some enquiries from younger members of the audience and apparently this is referred to as "Moshing." This must surely represent a greater risk of injury than the more traditional headbanging and I was glad to see it all stopped once Sabbath took the stage. I have seen a case of extensive bruising to the breasts associated with underlying fat necrosis caused by trauma inflicted during a "Moshing" session - a case of "Mosh Pit" breast perhaps? Competing interests: None declared |
|||
|
|
|||
|
David J White, Healthcare Assistant Royal Liverpool University Hospital L7 8XP
Send response to journal:
|
I can personally testify to the dangers of this dance form. Four years ago I was frequenting a heavy metal venue in Birkenhead, Wirral, England. The Disc Jockey started playing 'Cowboys From Hell' by a band called Pantera. This is a high tempo track from their album of the same name, and is always a 'floor filler'. A few of my drinking partners and I started Head Banging quite vigorously. It was during this attempt to be 'more metal' that my head forcibly collided with one of my drinking partners. The result - as is to be expected - was a mutual bout of unconsciousness for an undetermined period of time. Although I sustained no obvious injuries, my drinking partner was not so lucky. He received a moderate sized lesion to his fore head, which upon further examination, it was decided my drinking partner would be better off in the care of the local accident and emergency department. Alas, as I elected to try and continue my evenings merriment, I am unaware of how this incident was recorded statistically. Also, incidently, I was barred from the partaking of alcoholic beverages for the rest of the night, in case I had suffered a concussion. The injuries I have sustained in 'Mosh Pits' have - fortunately - never required any form of treatment. Competing interests: I am an avid fan of most forms of rock music, particularly Heavy Metal. |
|||
|
|
|||
|
Peter D Sidebotham, Senior Lecturer in Child Health Warwick Medical School, University of Warwick, Coventry CV4 7AL
Send response to journal:
|
Patton and McIntosh (1) describe the potential for mild traumatic brain injury and neck injury amongst head bangers, but only cite three documented injuries: a stroke, a traumatic aneurysm of the cervical vertebral artery and a subdural haematoma. With no overall prevalence data for head banging, it is impossible to determine an incidence of intracranial trauma, but regardless of incidence, interesting parallels emerge with respect to shaken baby syndrome. The incidence of the latter is estimated to be 21 per 100,000 babies under 1 year, with a case fatality rate of 27% and significant morbidity amongst survivors (2). Both conditions are presumed to involve a violent shaking of the head resulting in substantial angular acceleration. In shaken babies, this is presumed to be an involuntary forwards-backwards motion, sometimes suddenly interrupted by contact with a solid surface (shaken-impact syndrome) and caused by a carer shaking the baby (3). In head bangers Patton and McIntosh describe different styles, including up-down, circular, full body and side-to-side; contact of the head with a stage is described. So wherein the differences? One presumes that head bangers retain some control of the degree of head movement, though in the heat of a heavy metal concert this may be debatable. The age of the head bangers, their relative head to body weight and the strength of their neck muscles may all protect against intracranial damage; factors that are presumed to contribute to the vulnerability of infants to shaking. These similarities and differences are worthy of further study. Drawing on postulated theories in relation to shaken baby syndrome, one could hypothesize that head bangers are at risk of subdural haemorrhages due to shearing of the bridging veins during rapid angular acceleration and deceleration; one could further hypothesize that this risk is mitigated by the factors described above, particularly if the forces involved were shown to be less than those described in biomechanical models of shaken baby syndrome. Both hypotheses are amenable to testing: first by undertaking brain scans (and ophthalmoscopy, looking for evidence of retinal haemorrhages) of head bangers after a concert; and second by movement analysis of a head banger’s head and neck during the concert itself. Such experiments would be ethical, relatively easy to conduct, and could potentially provide much needed insight into the tragedy of infants with subdural haemorrhage. 1. Patton D, McIntosh A. Head and neck injury risks in heavy metal: head bangers stuck between rock and a hard bass. BMJ 2008;337:a2825. 2. Jayawant S, Rawlinson A, Gibbon F, Price J, Schulte J, Sharples P, et al. Subdural haemorrhages in infants: population based study. BMJ 1998;317(7172):1558-61. 3. Cobley C, Sanders T. Non-accidental head injury in young children : medical, legal and social responses. London: Jessica Kingsley, 2007. Competing interests: Dr Sidebotham acts as both a professional and expert witness in child protection cases |
|||
|
|
|||
|
Rebecca A. Drayer, Instructor of Medicine University of Rochester Medical Center
Send response to journal:
|
One flaw in this study is that the authors did not take into account the effects of alcohol. Someone who is more heavily intoxicated might experience injury at a lower song tempo, due to the lack of physical coordination observed with alcohol overindulgence. Furthermore, some of the symptoms attributed to mild traumatic brain injury might have stemmed from intoxication. Clearly, the confounding effects of alcohol on head banging injuries need to be studied further. Competing interests: None declared |
|||
|
|
|||
|
James R Funk, Biomechanical Engineer Biodynamic Research Corporation, 5711 University Heights Blvd., Suite 100, San Antonio, TX 78249 USA
Send response to journal:
|
While immensely entertaining, the research article by Patton and McIntosh (BMJ 2008;337:a2825) suggesting that head banging to heavy metal music poses a definite risk of concussion and neck injury is also fundamentally flawed. Patton and McIntosh based their conclusions on a theoretical model of the head rotating about the base of the neck. Unfortunately, they published Head Injury Criterion (HIC) values for head banging that were 300 times higher than the theoretical model actually predicted. I was able to reproduce the erroneous curves by calculating the HIC with head acceleration in units of metres per second squared rather than in the correct dimensionless units of gravities (g), so a unit conversion error may explain the discrepancy. Obviously, this error has a huge impact on the interpretation of their results. While a HIC value of 1000 is exceedingly dangerous, a HIC value of 3 is utterly benign. Furthermore, Patton and McIntosh presented no experimental data to back up their claim that one can voluntarily shake one’s head hard enough to cause brain injury. Testing conducted in our laboratory on 20 instrumented human volunteers demonstrates that head banging produces trivial head accelerations, far below suggested thresholds for even mild brain injury (1). In fact, plopping down in a chair and slapping one’s forehead generated higher head accelerations than head banging. We found that the most harmful consequence of head banging, apart from appearing deranged, was short-term neck muscle soreness. It should be emphasized that head banging in this context consists only of vigorous head shaking without any kind of head impact. All can agree that actually banging one’s head into a hard object such as a wall, stage, or another concertgoer’s head could cause injury and should be discouraged. Although written with tongue firmly in cheek, the article by Patton and McIntosh has been taken seriously by the lay press as well as by some readers of the BMJ (see Rapid Response by Dr Sidebotham). Sadly, accuracy must trump entertainment in this case. The assertion that concussion can result from an activity as benign as dancing defies common sense and has potentially harmful clinical and medicolegal implications. 1. Funk JR, Cormier JM, Bain CE, Guzman H, Bonugli E. An evaluation of various neck injury criteria in vigorous activities. Proceedings of the International Research Conference on the Biomechanics of Impact 2007;233- 48. Competing interests: Dr Funk serves as an expert witness in the area of head injury biomechanics. |
|||
|
|
|||
|
Alice R. Iott, student Kalamazoo, MI 49006
Send response to journal:
|
I applaud your analysis and research, Dr. Funk, but I would like to expand on it and ask the authors of this study another question: where have you listed all the variables which could have skewed your observations, not to mention your results? I saw no mention of the many variations in the physical and emotional state of a headbanging fan and/or musician, or any of their possible effects; many fans headbang while under the influence of any number of substances, legal or not, and this could influence a possibly injurious outcome. Emotional involvement may also play a significant part as well, causing the headbanger to choose different tempos and ranges of motion; there are so many nuanced reasons for the action itself besides merely conveying a state of euphoria. Some follow a beat-derived pattern corresponding to only that of their favorite instrument, for example. All of these variables and more are involved in the behavior of heavy metal fans and musicians, even simultaneously or for only seconds at a time. Your light tone is not without merit, but I hope that future research into heavy metal-related phenomena will take these variables into account as well as drawing from a wider and/or more rigorously selected sample of the heavy metal fan base. Competing interests: B.A. in psychology, enjoys heavy metal music recreationally but also studied it from a socio/anthro perspective |
|||