League defends absence of independent neurologists during games


The NFL informed PFT on Wednesday that independent neurologists are not present during games to control the determination of whether a player should, or shouldn’t, return to action after possibly suffering a concussion.

On Thursday, NFL spokesman Greg Aiello provided some additional information regarding the in-game medical arrangements.

“Given the fact that teams are mandated to have board-certified medical physicians and athletic trainers on each sideline that have been trained to recognize and triage a wide range of medical issues, including concussions, we have complete confidence in our medical staffs to follow the guidelines,” Aiello said via email.  “It is no different than an orthopedic doctor making a diagnosis of a fractured spine and then the spine specialist takes over. . . .

“The doctors and athletic trainers are fully trained to diagnose concussion. It is also important to note that because team medical staffs know the players so well they are in excellent position to observe changes in behavior that may be symptoms of concussion.  The role of the outside neurologist is to guide the treatment and return-to-activity decisions of a player removed from play or practice with a concussion.  The player cannot return to practice or play until clear by the neurologist.”

The explanation, while both thorough and helpful, doesn’t account for the possibility that team-hired physicians will not err on the side of caution when assessing whether a player has suffered a concussion during a game, given that they are hired by the team.  The “WHEN IN DOUBT, LEAVE THEM OUT” memo mandates removal from play when there is “any suspicion” that a player has suffered a concussion.  Surely, there was at least some suspicion that Eagles quarterback Mike Vick suffered a concussion on Sunday against the Redskins.  A rule that would prevent a player in that situation from returning to action until cleared by an independent neurologist would help eliminate media and fan suspicion that the team’s official diagnosis — “dirt on the face” and, later, having the “wind knocked out of him” — was aimed at concealing the possibility that a concussion had been suffered.

The fact that the NFL uses independent neurologists represents an implicit acknowledgment that independence is needed in order to best navigate the tension between player safety and the on-field needs of the team.  In the wake of the handling of both Vick and Lions running back Jahvid Best (who returned to action after banging his head on the ground and then was diagnosed with a concussion based on symptoms that somehow didn’t appear until an hour after the game), it seems prudent and appropriate for the league to find a way to inject true independence into a heat-of-the-moment process that could prompt team-hired doctors to succumb to the traditional pressures and tensions that have resulted over the years in plenty of injured players “rubbing dirt on it” and returning to action.

32 responses to “League defends absence of independent neurologists during games

  1. All the androgynous helge hat wearers at the MN lavender Larry games should used by the league as people exhibiting severe neurotic behavioral traits.

  2. Concussions are serious business–we should all acknowledge that after Duerson’s suicide. But is the best use of a neurologist having him or her stand on the sideline of a football game? Does that strike anyone else as enormously wasteful?

    Too many guys are playing immediately after receiving concussions, when they’re most vulnerable. Everybody knows that. But I’m not sure Mike’s idea is such a slam-dunk decision. NFL stadiums need to be less opulent, not more: adding a specialized MD to the sideline is a move in the wrong direction.

  3. So are we to automatically assume that these independent neurologists will be non-biased in their decision-making on the sidelines? Leave the system the way it is. I guarentee that if an independent neurologist cleared Vick to go back in the game and it was found out that he/she was from the Philadelphia area you would be just as skeptical. Or if the neurologist didn’t allow him to go back into the game and was later found out to be an avid lover of canines there would also be skepticism. At the end of the day, skeptics can never be satisfied and will always exist.

  4. When sitting ten million dollar players becomes the norm, the incentive will rise enough for some smart company to develop a decent helmet.

  5. There are some improved helmet designs out there, but no helmet can prevent your brain from colliding with the inside of your skull when your head suddenly decelerates. Actually, padding the outside of the helmet provides some improved protection from deceleration and reduces the use of the helmet as a weapon, particularly in helmet to helmet hits.

  6. It doesn’t matter how “safe” the helmet is, nothing is going to stop your brain from smashing against the skull. It’s not possible. Maybe the league should hire 16 neurologists to travel as a member of the official crew. That way they’d be held to a similar standard as far as partiality.

  7. Honestly, if a team puts a guy back on the field who they think has a concussion, they are complete morons. How the heck is a player supposed to understand what a play is and where to lineup, where to go, what route to run, etc, if they have a concussion?

  8. “League defends absence of independent neurologists during games” but they will spend tens of thousands of dollars to make sure gamblers don’t get ripped off as they pay for instant replay.
    The NFL is sick.

  9. Dang, get off their back already.

    The NFL has come along way in looking out for concussions, treating them, protecting against them, and overall just making players wait a long time before re-entering the game.

    The medical staff is human just like writers, players and coaches. They got Best out as soon as they realized there was an issue. Stop trying to sensationalize this as your own crusade against one team because a player went in the game one player longer than you, a non medical expert that wasn’t on the sideline, deemed necessary.

    Go back to talking about Football and leave medical issues to those that are in the know and WERE ACTUALLY THERE AT THE TIME.

    This personal self-centered stage your putting yourself up on is making me ill. If the Lions had forced Best to play through it for an entire half or something I would understand what your doing but the Lions actions do not warrant the attack you have besieged on them.

  10. Okay so according to Salary.com, the top 10% of Neurologists make $279,900 annually…..break that down to daily ($279,900/(52 weeks*5 days week)= $1,076 day.

    All these punks who held out for more money can’t afford to chip in to hire one Neurologist on Game Day whose sole purpose is just to look for concussions? Heck one dirty hit is a $15k fine, that pretty much would cover the season.

  11. Of course they are fully certified and trained. But they are paid by teams that they know can find another certified and trained medical doctor to say the player is fine NEXT week if they don’t agree to look the other way when the player says they are fine and the team needs them to have a chance to win. What a joke! That’s like asking Congress to enforce ethics rules to ensure that no votes are bought by special interests.

  12. Not trying to compare this to Best’s situation at all, especially considering his documented history of at least one severe concussion.. but it is possible to experience “concussion like symptoms” later in the day after a game. In high school I got hit real hard in a game and it took a couple seconds to shake off but I really felt fine after and was totally with it and knew what was going on.. After the bus ride home I started to have a headache and felt loopy and went to the team trainer and he did the concussion test on me and it was revealed I had a low grade concussion. Point is that it is possible that Best did not experience the concussion symptoms until an hour later, but I am not discounting the possibility (or probability) that the Lions just ignored it and put him in.

  13. 1) Having a neurologist on each sideline would effectively do nothing as they’d simply be hired neurologists by the team, which given your theory, would just be puppets for the teams wishes.

    2) Concussion symptoms can be delayed. Look it up. Javhid Best very well may not have had symptoms until following the game.

    3) The NFL will never be able to tell a player they have to stay out with the result being the player stays out. Players want to play and will simply lie and avoid falling into the concussion category. Payton Manning said this earlier in the year.

    4) Develop a helmet that better distributes the energy from a hit so the brain does not smash around inside the head as much. That is the only real solution to the problem.

  14. It is time for these clowns to get together on the proper est methods for all of these injuries. Players will continue to hide the effects of hard hits as much as they can because that is what they have always done. You always want to be back in the game and the coach must figure out what is a real injuryt. ‘Right now. Onc the player is back in the evaluation period he is working against the evaluation that will place him on a restricted list.

    The system doesn’t work against the players natural nendenccy to be approved for playing time in the next game.

  15. I personally think they should be able to play on with a mild concussion if they choose to. It is going to happen in the Super Bowl some day, and what are they going to do, pull Rogers or Brady because they got hit in the head? Yeah right.

    Besides, who doesn’t like their players a little scrambly-brained for the post-game press conferences? More fun and interesting that way.

  16. What if these independent nuerologists are fans of rival teams? Or a fan of the team whose players he is under oath to protect?

    The league has to protect players.

    Any independent nuerologists should be screened and weed out any that follow football, or else there is conflict of interest.

    Good luck.

  17. The leauge shoud not have to put independent neurologists on the sidelines. If the doctors on the sidelines are not doing their jobs, then something is clearly wrong. A doctor who owes his diagnosis to a team over a player is a douche bag.

  18. This exemplifies my main issue with the League. It stands up and boasts big about things like player safety but six months later hides it’s head in it’s shell while owners and players run roughshod over the rules.

    Either you are interested in the concussion problem or you aren’t. You can’t sometimes be interested when you think it will earn you PR points.

    The League leadership needs to steer the course and not float with the tide of public opinion. I respect leaders who lead and detest leaders who follow.

  19. kashonly says: Oct 21, 2011 12:08 AM

    Okay so according to Salary.com, the top 10% of Neurologists make $279,900 annually…..break that down to daily ($279,900/(52 weeks*5 days week)= $1,076 day.

    All these punks who held out for more money can’t afford to chip in to hire one Neurologist on Game Day whose sole purpose is just to look for concussions? Heck one dirty hit is a $15k fine, that pretty much would cover the season.

    That’s how much they make in profit. Given the multi-million dollar salaries in the NFL and the risk of lawsuit if they send someone back into a game who then gets seriously injured, I would imagine the increase in malpractice insurance for someone working the sidelines would be significant, so I don’t think your calculation is quite enough. Plus, there would be travel costs and those neurologists would likely have to devote additional time throughout the year for league-wide neurology meetings and other “administrivia”.

    However, I still agree with your overall point that the cost to implement this would be a pittance.

    The real difficulty is going to be finding 16 well-heeled neurologists willing to give up their time on the weekends.

    Practices providing team doctors advertise themselves as such and use their work with a team for all sorts of benefits. Being independent, any such marketing or other benefits would be a conflict of interest for these neurologists.

  20. “Surely, there was at least some suspicion that Eagles quarterback Mike Vick suffered a concussion on Sunday against the Redskins. ”

    Mike, you absolutely do not know that. Stating such a thing as fact is reckless and irresponsible. It may have looked like a possibility to you, but you are not a doctor and are not down on those sidelines. I am not an Eagles fan in the least, but your crusade here is ridiculous.

  21. @jwill: it is certainly possible to exhibit symptoms of a concussion a day later, even if minimal to no symptoms were present the day of. Especially in the case of professional athletes whose bodies have withstood the effects of mild traumatic brain injury multiple times.

    In the case of athletes, they have been playing these sports (in most cases) as long as they can remember. The develop motor memory and much of what they do is literally ingrained or automatic. Prior to the increase in awareness, they didn’t even know something might be wrong because it may have been the norm.

    As far as independent neurologists, concussion assessment is a multifaceted approach and the physician monitors physical, cognitive, and emotional changes (and sleep). By teams having physicians that are familar with the players, they are attune to the smallest of personality changes and by far the best people for the job.

    I have attended multiple conferences and seminars involving NFL team physicians and I have complete confidence that a comprehensive approach will always be taken.

  22. You really shouldn’t comment on things you know nothing about.

    “who returned to action after banging his head on the ground and then was diagnosed with a concussion based on symptoms that somehow didn’t appear until an hour after the game”

    –its called a subdural hematoma. Damage occurs to the veins instead of the arteries so the bleeding is slower therefore symptoms take longer to present

  23. Don’t doctors take that “hyprocrite oath” thing which means they are HONEST or something like that? You know…..the same one that lawyers ta…..wait…never mind….

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