Prevention Library
Medical field helping NFL to learn about concussions
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The Philadelphia Eagles were driving against the Cleveland Browns during the late 1950s. Seconds remained before halftime, and the Eagles were out of timeouts.
"One of my teammates, Jim Shofner, makes a tackle, and he's knocked out cold," said Paul Wiggin, Minnesota Vikings director of pro scouting. "We knew he had a concussion. But nobody gave concussions any credibility back then."
The only concern as Shofner lay unconscious was keeping the game clock running. "We're screaming at Jim to get up," Wiggin said. "Finally, we picked him up and stood him there long enough that the referee didn't stop the clock." Wiggin shook his head at the naive and carefree attitude toward concussions prevalent in the NFL until about 10 years ago. "We were darn lucky we didn't lose somebody," Wiggin said. "Take Jim, for instance. Not only did he start the next week, he started the second half against Philadelphia. If you had a headache, you just played with a headache."
In 2001-02, Dr. Julian Bailes, chairman of the Department of Neurosurgery at the University of West Virginia, set up, in conjunction with the NFL Players' Association, the Center for the Study of Retired Athletes at the University of North Carolina. According to a study of 2,488 retired NFL players ages 24 to 95, 61 percent said they had suffered at least one concussion during their careers. Of that 61 percent, 16 percent reported that concussions have had a permanent effect on thinking and memory skills as they've gotten older.
Vikings linebacker Raonall Smith still has headaches and memory loss from a concussion suffered in a 34-13 loss to the New York Giants four weeks ago. It was his second concussion in three weeks. He hasn't played since.
"I came to the facility the next day and people were saying, 'You made a pretty good play on that play or this play,' and I was like, 'What are you talking about?'" Smith said. "I didn't remember any of it. When I watched the film, I'm looking at myself, but it's like I'm watching someone else. That's pretty scary when you think about it."
Players better informed
Dr. Elliott Pellman, the New York Jets' team doctor and the chairman of the NFL's mild traumatic brain injury committee, said there is a much better understanding today that players who return to the field too quickly following a concussion are susceptible to permanent post-concussion syndrome, which can include malaise, decreased appetite, memory loss, mood swings, difficulty concentrating, and—in extreme cases—death.
"I'd say as late as 1987, you were still hearing players refer to concussions as a ding or, 'I got my bell rung,'" Pellman said. "The culture has changed tremendously." According to Pellman, one NFL player per team suffers a concussion every three games. Vikings center Matt Birk suffered a mild one against Tennessee, which was the week between Smith's two concussions.
"It's like you're half drunk," Birk said. "They said I was on the sideline laughing and making jokes. I don't remember it. In fact, we had eight more plays after I had mine. I had no clue the next day what went on in those eight plays."
Former NFL fullback Merril Hoge won $1.55 million from a lawsuit against the Chicago Bears' team doctor following a career-ending concussion in 1994. Hoge claimed the team failed to re-evaluate him for symptoms of post-concussion syndrome or warn him of the danger of returning to play too soon after a major concussion. He suffered another major concussion and never played again.
Concussion changed Hoge's life
As he speaks, Hoge is looking at the crushed facemask he wore the day he suffered a second major concussion in four weeks. Neurologists argue it actually was one concussion that didn't heal properly. Either way, the hit Hoge took landed him in intensive care for two days, and changed his life forever.
For three years after his injury, Hoge would get lost going to and from places he had been to hundreds of times. He couldn't read more than two paragraphs of a newspaper without losing his concentration. After a productive career that included one season in Chicago and seven in Pittsburgh, Hoge was an ex-player in trouble. "I basically had to teach myself how to read again," said Hoge, who works as an NFL analyst for ESPN. "I still get headaches and have trouble being in sunlight or around bright lights for too long." Like most athletes, Hoge wanted to come back quickly after his initial concussion.
"I wanted to come back the next day," Hoge said. "But that's not my job to decide. I didn't go to medical school to make that determination. The team doctors are the gate-keepers on this injury. They have to make the right decision because this is an injury that can be fatal. It's not like you get a hip replacement when you're 50. You can die."
According to Dr. Mickey Collins, the director of the University of Pittsburgh Medical Center's Sports Medicine Concussion Program, six to eight high school football players die each year because of "second impact syndrome." A lack of understanding and funding, combined with athletes who have younger, less-developed brains, make high school players a greater risk for death or permanent brain damage caused by coming back too soon from a concussion.
"The NFL actually does a great job and is a leader in the field of concussions," said Collins, who is a consultant for several professional sports teams, including the Vikings. "The real danger is at the high school level, which is why I can't stress enough that high school players who suffer concussions receive the proper medical attention." Dr. Pellman said he was the first physician to "retire" a player because of concussions. He told Jets receiver Al Toon his career was over in 1992.
Players forced to retire
Other prominent NFL players have been forced out because of concussions, including Hall of Fame quarterback Roger Staubach and future Hall of Fame quarterbacks Troy Aikman and Steve Young. Aikman had 10 concussions, although neurologists say the number of concussions isn't as significant as the severity and quality of treatment of each concussion.
In 1998, Collins and his colleague, Dr. Mark Lovell, who is on the NFL's mild traumatic brain injury committee, developed the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) program. It's a computerized evaluation system used to evaluate the effects and severity of concussions and help determine when it is safe for the athlete to return to contact.
According to Pellman, all 32 NFL teams use either ImPACT or similar neurocognitive testing. "It is well-documented in studies to be the best available test, but it is an imperfect test," Pellman said. "You can have a normal test result and the player might not be doing well. Or you may have an abnormal test and the player is fine. The tests are only one helpful piece of the puzzle."
Under the ImPACT program, a preseason baseline test is administered to every player. It takes 20 minutes and measures brain processing, speed, memory and visual motor skills. If a player suffers a concussion, he takes the test again. Reaction time can be measured to the 100th of a second. But, as Pellman said, the test isn't foolproof. Smith passed the test after his first concussion at New Orleans. He said he felt fine, and Vikings head athletic trainer Chuck Barta said Smith showed no post-concussion symptoms before returning the next week against Tennessee. A week later, Smith suffered a more severe concussion that he's still battling. He hasn't passed the ImPACT test since the second concussion.
"When you think about how far we've come, it really is amazing," Collins said. "Not too long ago, we waved smelling salts under an athlete's nose and sent him back in there. In just the last five years, we've learned more about concussions and how to treat them than we learned in the 25 or 30 years before that combined."
Reprinted with permission. 2005 Copyright Oakland Tribune.