NFL doctor defends treatment of Jay Cutler, Alex Smith concussions


Twelve days ago, Bears quarterback Jay Cutler and 49ers quarterback Alex Smith both stayed in games and continued to play after suffering concussions serious enough that neither of them has been cleared to play yet.

So does the fact that Cutler and Smith weren’t immediately pulled indicate that the NFL’s concussion protocols aren’t working? Not according to Dr. Richard Ellenbogen, co-chair of the NFL’s Head, Neck and Spine Committee. Ellenbogen told USA Today it’s simply not realistic to think that every concussion every player suffers will be caught immediately. And he said the players themselves, in the heat of the action, often don’t realize anything is wrong.

“Remember, the problem is that with all the adrenaline, the concussion was not immediately obvious to the players,” Ellenbogen said. “Both became symptomatic as they played further. It certainly is not uncommon for concussions to evolve. . . . Smith’s and Cutler’s symptoms both evolved as they played, according to team doctors and athletic trainers who know them best.”

Ellenbogen’s comments suggest that there’s nothing the league could ever do to make sure every player who suffers a concussion is immediately removed from a game. The bottom line from the doctor the NFL trusts to oversee its handling of concussions is that everything was done properly in the cases of Cutler and Smith — and they were still able to continue playing after suffering concussions.

23 responses to “NFL doctor defends treatment of Jay Cutler, Alex Smith concussions

  1. “It certainly is not uncommon for concussions to evolve. . . . ”

    If this is true, shouldn’t the protocol then be that the player should be automatically called out of the game after suffering a serious hit to the head, EVEN if the neurological exam immediately after the hit is normal. Otherwise, as a team physician it is practically malpractice to clear a player knowing the fact that the initial exam is not reliable, and that “symptoms evolve.” Ironically, Dr. Ellenbogen is making a very compelling argument FOR the flawness of sideline decision making regarding concussions.

  2. Ankle sprains also evolve once injured but you can see swelling ecchymosis deformity and touch where it hurts. Without empirical evidence for concussion you have to take the athletes word for it and you think they won’t lie? Let’s just call it what it is. It’s not lying anymore, it’s just refusing medical attention. Give players that right to refuse and note when they do, then releasing the team and NFL from liability. Or get rid of football altogether because concussions are going to happen and players will play with them.

  3. And how precisely, is a team supposed to “immediately remove” a player when said player does not display, feel or report immediate symptoms? Locker room MRIs for every sack? Cognitive tests for every hit? Sure, that makes sense. As long as you suit up 100 players for every game, name 44 starters before every kickoff.

    From Mayo Clinic, Concussion Tests & Diagnosis: “If a blow to your head, neck or upper body has caused symptoms such as a headache, dizziness, nausea or loss of consciousness, you’ve had a concussion. ***Signs and symptoms of these injuries may not appear until hours or days after the injury.***” [ ]

  4. This is football NOT golf. The players know what they are getting into and they get paid a lot of money to do it. they have team doctors.. and doctors of there own.
    Plus they can think for them selves. The NFL should let the players and the doctors of the teams control that.

  5. I think the concussion came on the first hit Alex took, the nasty one from Dunbar. They showed a close up of his face and I thought he was gone but if I’m remembering correctly, Alex went to the sideline and was cleared to go back out. He did well on that next drive:–nfl.html. Players try very hard not to leave games and what is happening to Alex now demonstrates why.

    He gave Kaep a chance to show his stuff and he impressed. Even though Alex has a 104.1 QB rating and a lot more experience (and baggage), his starting role is in question. He would have beaten the Rams and none of us would be talking about him losing his starting job had he fought through that concussion; this is how players think about all injuries that aren’t debilitating (like an ACL or broken arm).

    Somehow the doctors let him get back in there and I’m sure Alex was telling them “I’m fine” while answering all of their questions correctly. What else can they do; it is his head? He wants to make sure he plays and it is easy to see why. If a doctor can’t overrule him for medical reasons then its the player’s right to choose. I say we just accept it.

  6. Smith was obviously coherent enough to stay in the game and throw three more passes, including a TD to Michael Crabtree.

    It was a little annoying to see the comments by some folks in the media questioning why Harbaugh kept Smith in the game after sustaining the concussion. It was obvious they hadn’t been watching the game, yet they couldn’t resist the urge to voice their uninformed opinions.

  7. The practice of medicine is not an exact science. It would be pure ignorance to believe that every concussion could be immediately diagnosed. All that can be expected is that doctors administer the necessary tests when appropriate. Unfortunately, some concussions will not (and cannot) be diagnosed immediately.

  8. The practice of medicine us an inexact science. It is pure ignorance to believe that every concussion be diagnosed immediately. All that can be expected is that doctors administer the appropriate tests when necessary.

  9. I can’t blame the doctor with respect to the players’ adrenaline. At the same time I would rather hear from him than the previous doctor Ira Casson. Casson has been on the record of saying “‘My position is that there is not enough valid, reliable or objective scientific evidence at present to determine whether or not repeat head impacts in professional football result in long term brain damage.'”

  10. The doctor is right. Short of a player being knocked unconscious, it’s not always easy to diagnose a concussion immediately after it happens. There are a variety of reasons: #1 the symptoms may not appear right away.
    #2 adrenaline may mask the symptoms for awhile.
    #3 And here’s the biggest reason….. many players try to hide the fact they have a concussion
    The NFL will NEVER be able to eliminate concussions (unless it’s flag football), and they will NEVER be able to diagnose every single concussion right after it happens.

  11. Concussions are a form of brain damage and as such don’t always manifest all symptoms immediately. No way can they catch everything every time the second it happens.

  12. Man, we went from “getting his bell rung” and smelling salts on the sidelines, to 2 weeks off in a heartbeat.

    They’re going to have to increase roster sizes dramatically soon.

  13. drewsylvania says:
    Nov 23, 2012 9:14 PM

    Sounds like a pack of lies to me.

    Lies or not, it can help stop the madness of turning the game into flag football. It’s like a declaration saying the players and the NFL are not to blame.

  14. What people may not realize, is that physical exertion can worsen the symptoms of a concussion. Initially asymptomatic but that can change, & that changes the assessment of the player & return to play. There is no magical test that a neurologist or anyone else can do to uncover a diagnosis, during the game, in an asymptomatic person. The alternative is to remove all players after big hits & I don’t believe that to be based in science. They removed players when the medical concerns suggested a risk to player health. Sounds to me like they are good doctors…

  15. Players just keep getting bigger and stronger. We need better helmets.


    I agree. Except I would change “better” to “leather.” Guys won’t use their heads as weapons if their helmet was leather, right? Call me crazy, but I think it would be safer. (And make them wear leg pads, for Pete’s sake! Slow them down a bit!)

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