NFL Outlines Standards for Concussion Management

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.