By: Joseph Person
One of my last concussions in college came on a catch against Bucknell University on a beautiful Virginia fall day in 1990.
I held onto the football after getting hit on a route down the middle of the field, got up and made my way back to the huddle.
I stayed in for a couple more plays, but I didn’t know where I was supposed to line up or what I was supposed to do. Finally, a William & Mary teammate got a coach’s attention and got me out of the game.
Our athletic trainers recognized the signs of a concussion immediately and took my helmet so I wouldn’t try to go back in. When we watched the game tape the following evening, it was like an out-of-body experience. I was watching someone else run the route, make the catch and take the hit.
I didn’t remember any of it.
Trainers and the team doctor examined me after the game and the following day, and I was given Tylenol or something similar for the headaches. But I don’t remember missing any practices the following week, and I played the next game against Lehigh.
That wouldn’t happen today. Or shouldn’t happen.
The NFL, colleges and every other major sports organization have made strides in their handling of concussions.
After a series of violent collisions during the 2011 season, the NFL implemented a number of rule changes to outlaw helmet-to-helmet hits and protect what the league calls defenseless receivers. The crackdown on hits to the head coincided with a series of concussion lawsuits (later consolidated) brought by more than 5,000 retired players.
The NFL could pay upwards of $1 billion to ex-players suffering from Alzheimer’s, Parkinson’s and other neurological conditions in the settlement, although payouts have been held up by appeals.
Beginning in 2013 the league required independent neurologists to assist teams’ medical staffs during games. The addition of independent doctors, who are also part of the concussion protocol, was done to include an outside expert who in theory wouldn’t be influenced by the inherent pressures a team doctor faces.
The league says concussions in regular-season games are down 35 percent since 2012, while concussions caused by helmet-to-helmet hits have decreased 43 percent.
Before the Panthers hosted the Eagles on Oct. 25, I was given a behind-the-scenes look at how the Panthers’ medical staff diagnoses concussions during games, as well as the steps taken before a player is cleared to return.
As part of the tour, which came at the invitation of the NFL Physicians Society, I took the test the league uses to assess a player with a head injury on game day and a widely-used neurocognitive exam that is part of the concussion protocol.
One takeaway: Recalling the various word, letter, number and shape patterns is challenging even for someone who hasn’t sustained a head injury.
I aced the word memory drills, where I was given five nouns and asked to recall them after different intervals. But I struggled when it came to the shapes, failing to remember many of the odd, squiggly patterns, several of which looked like plays an offensive coordinator might draw up.
It’s hard to know whether my difficulty pinpointing which shapes I’d been shown minutes earlier was the result of the seven concussions I’ve had or the fact I’m more of a word guy rather than a visual-spatial learner. I hope it’s the latter.
Researchers with the Dept. of Veterans Affairs and Boston University found that 87 of 91 deceased NFL players whose brains they studied showed signs of chronic traumatic encephalopathy.
The study also revealed that 79 percent of all football players, including high school and college players, had CTE, which is triggered by repeated head trauma and can lead to memory loss, depression and dementia.
NFL teams administer the 30-minute, computerized ImPACT test before every season to establish a healthy athlete’s baseline score, which trainers and doctors use as the measuring stick after a player gets a concussion.
The ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) is used by the NFL, NASCAR, major league baseball, the NHL and several national sports associations.
Panthers head athletics trainer Ryan Vermillion has players take the ImPACT in the morning before they’ve worked out. He waits 24 to 48 hours after a player has sustained a concussion before giving him the ImPACT.
Some Panthers’ players then will visit a neuropsychologist, who analyzes their ImPACT results and can administer an additional test. The neuropsychologist, whom the Panthers would not identify, doesn’t have the ability to clear a player from the protocol. A concussed player has to advance through four steps before being cleared to play:
▪ Be symptom-free in rest and exertion.
▪ Return to baseline on the ImPACT.
▪ Gradually increase exercise/practice levels without symptoms returning.
▪ Be cleared by the team physician and the independent neurological consultant.
Panthers internist Robert Heyer says he and independent neurologist Jerry Petty (the team also uses Charlotte neurologist Tim Adamson) consult with Vermillion because of how closely he works with the players.
“Sometimes the ImPACT can be stone-cold normal and there will be something subtle about the player’s personality that (Vermillion) will know that I won’t know,” Heyer said. “So we are constantly talking to one another about how’s the player doing and what’s going on.”
Vermillion, who joined the Panthers in 2002, said a number of factors go into clearing a concussed player, not the least of which is a trainer’s first-hand knowledge and intuition.
“No independent neurosurgeon, independent neurophysiologist knows the player like we know them,” Vermillion said.
Each team’s medical staffs track a player’s concussion history, which is filed in a league-wide injuries database. Vermillion believes the key is for an athlete to be completely healed from the initial concussion.
“We have so many more tools now that we didn’t have before to make sure that person is ready to go back out on the field,” Vermillon said.
The concussions I’ve sustained have spanned nearly the entire course of my life. My earliest one occurred during a sandlot football game when I was 12, while my most recent one was the result of a tubing accident two summers ago when I was 43.
My mom was ahead of the concussion curve, taking me to a neurologist 30 years ago before I started high school. We didn’t get any concrete answers from the doctor, who essentially said as long as I continued playing football I would run the risk of more concussions.
I don’t pretend to think the collisions I was involved in come close to those seen every week in the NFL, where players are bigger, stronger and faster than their predecessors and deliver more jarring hits.
That’s the scary part.
And while Vermillion’s right in saying the tools for managing concussions have come a long way, some experts believe the NFL can do more.
The league has been slow to embrace helmet sensors, which can identify where a collision occurred and the amount of force generated by the hit. North Carolina is among 20 colleges using the technology, but NFL advisers aren’t convinced of the sensors’ reliability and the players’ union doesn’t want teams to arbitrarily use the censor data to negatively impact players’ careers.
NFL officials say they will continue studying the research involving the helmet sensors. Even if the league decides to try the sensors in an experimental basis next preseason, it seems like a good place to start.
