Concussion evaluations should be done in locker room


Over the last two years, the NFL has done plenty to improve the procedures that apply after a player has been diagnosed with a concussion.  The next frontier will be improving the procedures for determining that the player has a concussion in the first place.

The league’s various measures, which came promptly after Congress rattled the antitrust exemption sword in Octoer 2009, include the requirement that a player with a concussion be cleared by an independent neurologist before being allowed to practice or to play in a subsequent game.  More recently, the league promulgated the “Madden Rule,” which provides that any player diagnosed with a concussion “must leave the field and be immediately escorted to the locker/training room, and a member of the medical staff . . . must remain with the player to observe him if his injury does not require immediate hospitalization.”

But while the league also has generally mandated that if there is “any suspicion” that a player has suffered a concussion, he must be pulled from the game, the league has yet to implement specific procedures for ensuring that such suspicions will be acknowledged before a given game ends.  There is no independent neurologist available during games — there isn’t even a requirement that the teams have neurologists present.  Also, the NFL has no system in place for flagging players who may need to be evaluated for the presence of a concussion.

As a result, we’ve heard terms lately like “dirt on the face” and “concussion-like symptoms,” and we saw Chargers guard Kris Dielman stumble and bumble and ultimately remain in the game after giving a quick “I’m good” wave to the sideline.

Improvements also are needed as to the process of evaluating players who may have concussions.  As Dr. Julian Bailes, Chairman of the Department of Neurosurgery at the NorthShore University HealthSystem, told PFT via email this morning, “Making the diagnosis of concussion on the field or sideline has always been difficult.  Lately I’ve come to think that the safest way if an athlete has ‘concussion-like symptoms,’ is to remove them to the locker room where you can be away from the noise, cold, and distractions.  If there is any suspicion that a concussion has occurred, then they are not put back in the game.”

Dr. Bailes, who has been instrumental in the detection of Chronic Traumatic Encephelopathy, used that approach during his time as the on-field neurologist at West Virginia University.  And it makes plenty of sense.  It’s loud and it’s hectic and teammates are milling about and coaches are sticking their noses into the situation, hoping that their guys will get back on the field.  The better approach is to get the player into a more calm environment, get his shoulder pads off, let him sit and rest and try to collect his wits, and then engage in an assessment of his condition.

Of course, before it ever gets to that point, the league and its teams need to have a quicker trigger for conducting the review.  But these various steps must be taken by the NFL as soon as possible.  If another Congressional hearing is needed in order to make that happen, then another Congressional hearing should be held.

14 responses to “Concussion evaluations should be done in locker room

  1. I think PFT is a little off base on this issue. I support encouraging safety, but this thing may get to the point where you’ll have doctors on the sidelines pulling people out who simply take a hit. And if players think that any little misstep or stumble after a hit will earn them an automatic trip to the locker room, I think they’ll lie to stay in the game even more.

    I think the answer here is do the following:

    1) Work to change the culture so that players are not willing to play with concussions. Scare them half to death with videos, studies, horror stories, etc. Maybe provide some incentive for players to be willing to report themselves as possibly concussed.

    2) Continue to police helmet to helmet hits aggressively. First offense should be $10,000. Second offense should be $50,000. Third offense should be $100,000 and a two game suspension (per season). Fourth offense and you’re done for the year and are fined another $100,000.

    3) Players that are diagnosed with a concussion should be mandated to sit for the next game. Loss of consciousness mandates sitting for two games, no matter what the independent tests show.

  2. Say goodbye to high school football. Paranoid parents are going to shrink and eliminate programs and all sports will be wearing head gear; soccer, field hockey, women’s lacross, you name it.

  3. I agree with the idea that they should scare the players in the offseason with horror stories.

    The idea that players will be drug from the field for something as small as a stumble and that will influence the result of games just won’t work.

    These men are modern day gladiators. They sacrifice their bodies andndo it for huge amounts of compensation and personal benefit. They, in some respects, have to bear some responsibility for their own safety and well being.

    Bad knees, bad backs, heart problems from being overweight (remember….just because someone is fit and muscular, they’re still overweight and their heart has to pump harder to get blood to all their parts). These guys make these sacrifices for the life they live andnthe glory that goes along with sport.

    I’m not saying that there shouldn’t be someone there to make the call in obvious cases…….but we can’t drag guys back to the locker-room every time there is a big hit. Rosters will have to expand to 70 players because of all the players being eval’d after every play.

  4. mancave i agree with your first two points for the most part; but concussions are no longer graded like other injuries and loss of consciousness has no bearing on how long a player is out. The research that is out shows that the severity of the initial concussion does not have a linear relationship with how long or severe symptoms are. Which is what makes them so hard to give prognoses on. A player can be knocked out and have no lingering symptoms and they can take the most inconspicuous hit on the head and be out for weeks (see this in hockey all the time).

  5. It just feels like there is an inevitable move towards eliminating football in this country. The mainstream media is focusing more and more on critical injuries suffered by high school football players. Justify eliminating high school football and the NFL will wither on the vine.

  6. NFL doesn’t protect it’s athletes, who don’t know the effect of concussions enough to be able to gauge their fitness to continue playing in a game.

    It’s like saying a drunk person should be allowed to drive themselves home because they say they’re fine.

    College and high school athletes should have weight limits by law, and the player’s union should insist upon one for the NFL.

  7. I’m always reminded of the movie “The Replacements” when I hear talk of concussions and players coming in.

    The one guy is a concussion away from some real permanent damage, but also close to a big money bonus, and he says to the doctor, “I’ll shake like a leaf for a million bucks.”

  8. I think there is a difference between getting serious about concussions and taking some steps to reduce your risk of being seen as negligent in a court of law. I think the NFL is skirting that line right now. It’s clear the program needs tweaking, and this article suggests some possible tweaks.

    I’m always stunned by the difference in time it takes an NHL player to return from a concussion vs. an NFL player. Do NFL players have faster healing brains? A concussion like Desean Jackson had cost him several weeks A similar concussion (severity wise) has cost Sidney Crosby a year. I know everyone is different, but this seems to be a trend when comparing the two leagues.

    Football is a physical and violent game, but to the players, its their occupation. You cannot eliminate all of the risk. Roofing and logging are dangerous occupations, but there are rules and standards in place to reduce that risk. The NFL should be the same way. We aren’t going to stop playing the game, but we can make it safer.

  9. The arguments in favor of safety are sound. That said, the NFL will never put itself in the position of having doctors decide games, especially with only a cursory examination and a hunch.

  10. Enough is enough. These guys get paid big money and part of the reason for that is because it is a dangerous sport. They will get hurt, they will get concussions. Let’s quit pussifying the game and let them play football!

  11. Cardmagnet..that is from “any given Sunday” and it wasn’t from a concussion ….movie was on yesterday just saying what happen to personal responsibility

  12. Look at all the concussions…just like last year and the year before that !

    Obviously, everything the NFL and Roger Goodell have done, has had little effect on the number of concussions…they just keep on coming.

    …Roger doesn’t seem to be able to “fine” (the players) his way to a concussion free NFL.

    …Riddell created the new Riddell Revolution Speed helmet, that now measures the impact of the hits…which does absolutely nothing to protect the player’s wearing them.

    If the NFL was really concerned about the players, they would mandate a safer helmet design..a design that has been used in the past and been proven to work.

    …when the NFL upgrades the safety of their helmet design to include adding padding to the outside of the rock hard plastic outer shell, then and only then will the concussion rate decline.

    I’m not saying the “Pro-Cap” is the only design that should be tried, but the fundamental design of the Pro-Cap is the only logical choice that Roger Goodell has left, “if” he truly is concerned about the concussion issue and the safety of the players.

    Adding padding to the outside of NFL helmets has been successfully tried and used by NFL players, dating back to 1967, when Willie Lanier’s team trainer applied padding to his helmet, after he suffered a career threatening concussion during his rookie season.

    IT WORKED… for Willie Lanier and adding padding to the outside of helmets has worked for other NFL players over the last 40 years.

    Someone needs to explain why the NFL is dragging their feet on the issue of concussions and helmet safety.

  13. I’m all for personal responsibility so soon as the NFL stops blackmailing cities into paying for stadiums … until then, ever taxpayer is going to have a say in NFL operations.

  14. macbull helmets do not prevent concussions. They were implemented to reduce the number of skull fractures that occur. While the new designs are trying to reduce the amount energy transferred from the helmet to the head you can only do so much when a 220lb man running a 4.4 hits another man running at the same speed.

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