Tackling Concussion Head On in the NFL
After decades of permitting on-field
violent play, numerous well publicized cases of brain injury, and a
multimillion dollar settlement with former players, the National
Football League has begun making significant strides in improving
the safety of the game and minimizing head trauma among
"The publicity about concussion in football has had a huge impact,
greatly increasing awareness that you have to treat head injury
differently than injuries to any other part of the body and that
there are dire consequences to mismanagement," said Robert C.
Cantu, MD, co-director of Boston University's Center for the Study
of Chronic Traumatic Encephalopathy, who is senior adviser to the
NFL's Head, Neck, and Spine Committee.
In the past it was common for a player to return to the game after
a hit to the head if he hadn't lost consciousness. "Today there's a
much greater recognition that we need to keep concussed players off
the field for a longer period of time," Cantu said.
Today a player with a suspected concussion not only can't go back
in the game, but he has to be evaluated according to a concussion
protocol by the team's medical staff and also by an independent
But that isn't enough, said Tanzid Shams, MD, director of sports
neurology at Tufts Medical Center in Boston. "In an ideal setting,
the clinicians on the field should have no financial relationship
with the teams. Instead, they should function as independent
observers similar to referees. This model would take out the
conflict of interest," Shams argued.
"We now understand that concussion symptoms are subtle, and the
derangement in brain metabolism after trauma can last for days to
weeks," he added.
Much more needs to be done, experts agree, particularly in the
area of mild concussions and subconcussive hits to the head.
Probably 80% of mild concussions are missed from the sideline,
according to Cantu. "It's very easy to hide your symptoms if you
have 30 seconds to stand around and collect your thoughts. Even if
you're a little off balance or slow or didn't get the play quite
right, unless you're the quarterback, it's unlikely that people
would even notice," Cantu said.
To aid in identifying hits to the head that might have been
overlooked by sideline observers, in each game during the 2013
season a certified trainer sat in the stadium box watching and
reviewing television replays.
References and further information