Concussions Raise Questions on Player Safety

According to a report from Washington Redskins lead writer Brian Tinsman, Robert Griffin III was cleared to practice on Wednesday after suffering a “mild” concussion.  In this case, “mild” means that he couldn’t remember the score or quarter of the game he was playing in.  Griffin has passed all the proper testing in order to get back on the field which includes cardio, agility and baseline testing. He was examined and cleared by an independent neurologist.

Detroit Lions running back Jahvid Best who suffered multiple concussions in college and two last year, is still recovering from a concussion from Oct 16th of last year.  He will be undergoing a battery tests this week to determine if he can come off the physically unable to perform list next week. According to a report by Tim Twentyman on the Detroit Lions, if he is cleared by an independent neurologist he may return to practice following the Philadelphia Eagles game.

Meanwhile, Adam Teicher of the Kansas City Star reports that Matt Cassel has not yet been cleared to return to practice. It isn’t clear if Cassel could recall the score or quarter of the game he was playing, although he was clearly disoriented as he lay on the turf, to the disappointing cheers of his hometown fans.

So it begs the question, how can Griffin be cleared to play so quickly?  It is true that all players heal differently, and that is particularly true for concussions which are difficult to diagnose and treat.  But how are they being evaluated and what is the metric for measuring whether an athlete has recovered?

Unfortunately, there isn’t a testing standard dictated by the NFL, and one of the most common tools available lacks the accuracy and rigor necessary for effectively diagnosing concussions and giving the athletes sufficient information to make appropriate return-to-play decisions.  Most NFL teams use a test referred to as ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) as part of their testing protocol.  ImPACT is used as a baseline test prior to the season and for concussion evaluation during the season, and ImPACT is working with Dick’s Sporting Goods to bring free baseline testing to high school and college athletes across the country.

The problem is that the ImPACT test when used alone does not provide sufficient information.  ImPACT has been shown to have a false positive rate of 30-40 percent, and the false negative rate is believed to be just as high.  That means that up to 4 out of 10 people without a concussion will fail an ImPACT test to indicate that they are concussed, and up to 4 out of 10 players with a concussion will pass it.  Peyton Manning, years before his neck injury, said that he intentionally “sandbagged” his preseason baseline test to make it easier to get back on the field after a concussion.  Clearly, ImPACT alone is not the answer for concussion screening.

Requiring the evaluation of an independent neurologist was a step in the right direction by the NFL, but how independent are they?  And what tests are they using to evaluate the players?  Are they all using the latest science and best medical practices, or is there a variety of skill levels and different levels of experience available to the players across the league?

A couple of incidents from last season highlight the glacial pace of change within the NFL, and the need for more rigorous standards.  The first was the Kris Dielman case, where the Chargers offensive lineman appeared to millions of TV viewers to have suffered a concussion as he stumbled around the field, but was allowed to stay in the game.  He had a seizure on the flight back to San Diego and ultimately retired later on in the season.  After the Dielman incident, the NFL instituted spotters in the booth for each game, who had a direct telephone line to the medical personnel on each sideline to notify them of players that should be checked for a concussion.

A few weeks later, after the spotters were installed, Colt McCoy suffered what appeared to be another obvious concussion during a last minute drive for the Browns, but was reinserted back into the game after two plays on the sidelines while trainers checked his ankle (but not his head).  Back in the game, he looked disoriented but thankfully wasn’t hit again as he threw an interception a couple plays later to end the game.

After that incident, the NFL changed the rules to put a “trained” spotter in the booth, calling on the ranks of college athletic trainers.  Does that mean that the initial solution was to put untrained spotters in the booth?

Rushing players back too early can increase the chances of a second concussion.  Multiple concussion syndrome can end NFL careers much earlier, not to mention lead to serious long term implications such as dementia and early onset Alzheimer-like symptoms.  A talk with former Bears quarterback Jim McMahon, one of the league’s top faces from the 1980s who can no longer remember what happens from one minute to the next serves as a chilling reminder of what can happen long term.

Rushing Griffin back too early could significantly shorten his career or lead to serious long-term health issues after he is done playing.

For Lions running back Jahvid Best, after suffering multiple concussions from college through last year, he has been on the sidelines for almost a year and still hasn’t been cleared to practice.  At least his doctors appear to be taking a cautious approach, but he needs to get thorough advice about the potential long term repercussions of another concussion before he thinks about getting back on the football field.  The same holds true for for Indianapolis Colts wide receiver Austin Collie whose career was also in question after he suffered yet another concussion this past preseason.

If the NFL is sincere about protecting the integrity of the game and supporting player safety, there needs to be more rigor put into the concussion screening program and into return-to-play decisions.  They shouldn’t be relying on a single test, particularly one demonstrated to have limited accuracy.

However with the NFL’s constant push for an 18-game season and lack of concern for player safety when it came to using replacement officials, their concern for the primacy of player safety has to be questioned.


Written by Joey Rivaldo

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