NFL Outlines Standards for Concussion Management
May 27, 2007 by David Kindervater
Filed under NFL - NFL
I was watching Real Sports with Bryant Gumbel on HBO the other night and there was a segment on post-concussion syndrome in the NFL (Episode 122, Story 1, Head On) that caught my attention. The preview at HBO.com read:
In the violent world of the NFL, helmet-crushing hits that sometimes cause concussions are commonplace. Research has shown that multiple concussions can cause permanent brain injuries, possibly leading to debilitating memory loss, confusion, dementia and even suicidal depression. A host of former players and one unlikely advocate from the world of pro wrestling have turned to the NFL for answers, but have been disappointed with the response. REAL SPORTS correspondent Bernard Goldberg investigates this volatile topic.
It was very much a slam on the NFL’s concern regarding concussions, but that is simply not justifiable anymore. If there was, in fact, previous disregard by the league on this subject, it looks like that’s about to change. Earlier this week at the NFL’s Spring Meetings, Commissioner Goodell reviewed with NFL clubs consensus medical recommendations regarding the management of concussions.
The standards are based on extensive medical research and discussion. They were recommended by the NFL’s independent committee on mild-traumatic brain injury (MTBI) chaired by Dr. Ira Casson of the Long Island Jewish Medical Center and the Albert Einstein School of Medicine, and Dr. David Viano of Wayne State University. Commissioner Goodell said:
“NFL clubs do an excellent job in the care and management of concussions that affect NFL players. It is important that we articulate for our clubs and players, and for the broader medical community, the standards our clubs are applying as we work together to protect the health of our players. The overriding principle governing management of concussions in the NFL is that medical considerations must always have priority over competitive situations.”
The recommended standards include the following elements:
- Medical decisions must always override competitive considerations.
- Neuropsychological baseline testing will be required for all NFL players beginning this season, using a standardized test to establish an individual functional baseline. Neuropsychological testing is one tool a physician can use to assist in the management of MTBI. It cannot be used by itself to make clinical decisions. For players removed from games due to concussions, repeat testing will be done during the season to track recovery and to help decide when they can return to play. These players also will be re-tested against their baseline performance the following season at training camp.
- An NFL MTBI conference will be held on June 19 in Chicago for all NFL team physicians and athletic trainers to share the most up-to-date information on state-of-the-art care and management of concussions.
- The MTBI Committee will continue to operate as an independent group. Three non-NFL affiliated physician have been added to the committee (Joseph Maroon, Joel Morgenlander, and Thomas Naidich). The goal of the committee remains the advancement of scientific knowledge of MTBI through well-conceived research to protect the health of NFL players and improve the safety of the game.
- To promote the use of best practices by all teams, the evaluation procedures used by NFL teams will be shared among all medical and training staffs.
- A brochure will be developed and distributed to NFL players to help educate players and their families about concussions, including how to recognize the symptoms of a concussion and recommended treatment procedures.
- Return-to-play decisions should continue to be made by team medical personnel using their expertise and professional judgment.
- The NFL rule requiring every player to wear a chin strap that is completely and properly buckled to the helmet will be strictly enforced. Teams and players will not be permitted to modify the attachment of the chin strap to the helmet or improperly modify the helmet in any other way. The longstanding safety-related rules related to the use of the helmet also will be strictly enforced.
- The NFL will establish a “whistle blower” system so that anyone may anonymously report any incident in which a doctor is pressured to return a player to play from a concussion or that a player with a concussion is pressured to play. The NFL will investigate any such reports and take whatever action is necessary.
I will be curious to see if anything develops further after the NFL MTBI conference in a few weeks, but these above-mentioned elements are strong in outlining the care of concussions and treating them with the seriousness in which they need to be treated.
The NFL MTBI Committee is nothing new. It was established in 1994, but they’ve launched a new study to determine if there are any long-term effects of concussions on retired NFL players. I think it’s pretty clear after watching the HBO piece that there are. Retired tight end John Mackey is pretty much a basket case, sadly suffering from a form of dementia that has removed nearly all of his short-term memory. Ted Johnson (former Patriots LB) now forgets people’s names, misses appointments and suffers from depression and an addiction to amphetamines. He said coach Bill Belichick subjected him to hard hits in practice while he was recovering from a concussion, which was against the advice of the team’s top trainer.
The studies will continue, but one thing we can be sure of is that the NFL is taking a proactive approach to ensure the safety of the players.
The concussion Pace suffered last year shows you no matter how big you are no one is immune. The latest story in the NY times suggests most play through the dizziness and symptoms of a blow. They have found the same brain damage in boxers. Pointing to a device designed for boxers and used for two decades by the NE Patriots. Players attest to less dizziness and symptoms, the NFL’s own statistics confirm, the Pats have the lowest concussion rate in the league. Yet, the doctor who invented the procedure will not present at the Chicago Summit. He may be in the audience, hopefully the press will seek him out for his opinion on the diagnosis and evaluation which has proven to determine susceptibility and a means of prevention. http://www.mahercor.com
On the HBO concussion special, Nowinski admits he has white spots on his brain in MRI.
In his address to the MA brain injury meetings he states, “I got kicked in the chin” also on chronicle. One theory is, His repeated concussions from blows to the jaw have led to the white spots. Vasa spasms are commonly found in boxers, Andre Waters, soldiers and
are known precursors to Parkinson’s, Alzheimers and brain decease.
Because of the similarity in chin strap design, Soldiers in Iraq with Multiple IED exposure are developing these Vasa spasms. Ted Johnson recently stated on WEEI in Boston, he does not have these white spots or Vasa spasms. He also said he wore the Maher mouth guard for all of his thirty concussion events. The question is, does this procedure protect against vasa spasms also.
Tufts is now forming a study to find out. Yet no contact from the NFL for funding, just a grant rejection letter from Gene Upshaw and others. Ira Casson, Vianno were all investigators on the Riddell revolution study program with Pellman. They are deliberately stonewalling the media, ESPN, HBO about what really happened and why
we no nothing more about preventing concussion than before the studies. No mention of Labyrinthine concussion or the Boxers “Glass Jaw”. Even though its initial study confirmed 70% of concussions originated at the earhole down to the chin strap or TMJ. A study from 1934 on this area of the skull would lead one to the conclusion it should be protected, 2007 and they are still in the dark. I believe it was the basis for Stengers studies at Notre Dame in the 1960’s.
Tufts is the pioneer of TMJ research and should be consulted on this. The NFL has a perfect opportunity to fund an independent study with them, yet we only get a stonewall and the silent treatment from Goodell and his people. One bright spot is the work of Mike Haynes. He has connected the mouth guard with the commissioner of the Arena football league. The owners, primarily NFL owners, have widely accepted the mouth guard and seem to be in the dark on the intricasies of the concussion committee’s activities. It is Now the official mouth guard of the arena league and, at this point, won’t be present at the Concussion summit in Chicago. Why?
119-15-2009 @ 8:23PM
Stevieboy said…
http://www.mahercorlabs.com/news/article-20090831.htm
The latest research independent of the NFL concussion committee, shows a drastic reduction in concussion, in players treated for jaw cartilage damage prior to play. Boxers with this condition are known to have “Glass Jaw”, making them more prone. Answering the question, “WHY ARE SOME ATHLETES MORE PRONE TO CONCUSSION THAN OTHERS”,
A procedure proven in research and use in the NFL for over two decades, was developed with Marvin Hagler, a six time world champion boxer. He was never ko’d or knocked down. Today he is mentally clear with no signs of dementia. U.S. Army soldiers in Afghanistan are now protected by the very same device used on Sunday by N.E. Patriot player and many other NFL and NHL athletes. Yet the NFL has not investigated this element of concussion. http://www.mahercor.com
i’m a former rugby player. i’m a woman, but women’s and men’s rugby have exactly the same rules. it’s one of the few sports in which that’s true. the women’s game tends to be a bit faster, more based on speed and technique because we’re a but physically smaller. but trust me. i’ve laid out my fair share of folks, and been on the bottom of plenty of piles.
in rugby, we get penalized for hitting too high. a high hit is more likely to cause a head or neck injury. it’s also much less effective.
in rugby, we see fewer serious injuries than in football. one theory is that we’re not wearing pads, which means that when we hit, we feel it, so the hits are somewhat moderated.
and, there is a policy in USA rugby that someone who appears to be concussed:
“A mild/ first degree concussion causes the athlete to be confused dazed and experience slight amnesia. Asking the athlete questions such as time of day and how he/she got to the field can help detect the injury. Hesitation in answering is a good indication of concussion. If a player experiences unconsciousness for a few seconds or several minutes the athlete has a moderate/second degree concussion. A severe/third degree concussion means any lapse of consciousness for more than five minutes. The degree of concussion is determined by the force of impact.”
is not allowed to return to play for three weeks. which sucks when it’s you, or it’s one of your best players who’s out for a critical game. but it’s the rule.
i’m wondering why the NFL doesn’t treat their players with the same respect.
i’m an avid football fan. in fact, i’m a little crabby today because Baltimore has a bye. and i love to watch a good hard hit. but, the NFL needs to be more aggressive in preventing and treating brain injuries. and they need to start to do something to take care of the folks who have already been disabled by their cavalier policies.