NFL still gathering data on concussions after instituting a new policy a year ago
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By Bill Coats
St. Louis Post-Dispatch
ST. LOUIS - It was a simple play, a run to the left side Sunday by Oakland's Darren McFadden. As Rams safety Craig Dahl closed in for the tackle, McFadden lowered his head. The result was a nasty helmet-to-helmet collision.
Dahl sank to one knee, was helped off the field, and was done for the day. He hasn't yet returned to practice.
In the violent world of the NFL, getting a concussion is easy. In today's increasingly cognizant NFL, getting back on the field is not.
At least, that's the way the league's year-old - and much stricter - policy on concussions is designed. Players who suffer a concussion cannot return to practice or the game that day. They then must be free of all symptoms and pass a battery of tests, including one administered by an independent neurological consultant.
"This new return-to-play statement reinforces our commitment to advancing player safety," commissioner Roger Goodell said in a memo to the NFL clubs. "It will make our game safer for the men who play it, and set an important example for players at all levels of play."
Rams tackle Jason Smith missed several weeks last season after suffering a concussion Nov. 22 against Arizona. "My situation was real serious," he said. "I'm really happy the NFL is doing what they're doing.
"I mean, it's your brain."
A concussion is defined as an injury to the brain resulting from an impact to the head. Concussions vary in severity and can cause a variety of physical, cognitive and emotional symptoms.
It used to be thought that a concussion diagnosis required a loss of consciousness. More recent research, however, shows that most people who sustain concussions remain conscious. They can suffer from a variety of other symptoms, though, including nausea, dizziness, light sensitivity, confusion, amnesia and persistent headaches.
Rams linebacker David Vobora stayed in the game after he took a shot to the head last season against Green Bay. "I had no idea I was concussed. I just kept trying to shake it off," Vobora said.
The symptoms lasted for "at least 10 days," Vobora said. "Even now, I don't remember anything from that game."
The league has tried to increase awareness by emphasizing the importance of players being forthright about head injuries. The players are shown a video during training camp, and posters in every NFL locker room urge accurate self-reporting on concussions.
"Guys are definitely more candid, and that's a very, very important issue in us combating this concussion thing," said Reggie Scott, the Rams' head trainer. "And also, other players are helping us out with their teammates. We tell them, 'If you know a guy might've gotten hit, it's OK to speak up and tell us.' There's no question that's helped the whole process of concussion management."
Chuck Cecil, a hard-hitting defensive back, estimates that he was knocked out more than 50 times during his seven years in the NFL. He never missed a game or a practice. "Basically, the thinking was, 'What, you've got a headache? Get back in the game,'" Cecil told the Nashville Tennessean.
"You used to give them the finger test: One, two or three, and if they could figure that out, you'd send them back in," Washington coach Mike Shanahan said. The Redskins meet the Rams on Sunday at the Edward Jones Dome.
Despite the urging by the league, players still sometimes are reluctant to confess their symptoms, fearing an extended period on the sideline and a threat to their jobs.
"I'm kind of old school, so I'd like to get in there and play," said Rams wide receiver Danny Amendola, who suffered a concussion on a vicious hit while returning a kickoff last year at Detroit. "It doesn't hurt too bad; it isn't excruciating pain. But ... ultimately, I think you've got to go with what the doctors say and protect yourself long-term."
Added Dahl: "If it prevents a player from going out there too early, before his brain is fully healed, then I think it's a good step that the league has taken."
Players who have suffered concussions - particularly those with multiple occurrences - sometimes experience devastating effects years after their playing days are over.
Hall of Fame tight end John Mackey developed early-onset dementia, and his wife, Sylvia Mackey, helped initiate an assistance plan for such families.
Andre Waters, a former NFL safety, killed himself in 2006. An analysis showed that Waters suffered from chronic traumatic encephalopathy - his brain tissue resembled that of an 85-year-old.
The case of Hall of Fame center Mike Webster was similar. He was diagnosed with a form of degenerative brain damage and died at age 50.
Other chilling stories exist of former players who experience impaired brain function and other maladies widely thought to be tied to previous concussions.
"It used to be just assumed that concussions were benign, that you could shake it off and get back in there and you'd be fine, with no long-term problems," said Dr. David Brody of the Washington University department of neurology. "We can't assume that anymore."
The Washington U. School of Medicine has established one of five centers nationwide that are part of a new neurological care program for retired NFL players. The program, which began in March, was established by the league in conjunction with the NFL Alumni Association.
"We have seen effects of concussions for many years, but the situations are often complicated. There's a lot of other things that happen to NFL players besides just concussions in their lives," said Brody, director of the Washington U. center. "Some of the former players are doing very well; they're extremely healthy and don't seem to be having any residual effects of concussion at all. And some of them have problems with thinking and memory, and problems making decisions and planning, problems with controlling their emotions."
A 2007 study by the University of North Carolina of more than 2,500 retired NFL players found that of the 595 who recalled suffering three or more concussions, 20 percent said they had been diagnosed with depression - three times the rate of players who hadn't suffered concussions.
Ultimately, the five centers will compare data and issue their findings, Brody said. They are in the early stages of collecting information.
"We don't know whether how many concussions it takes to cause these problems, whether there are genetic influences, whether impacts that are less severe than would even cause a concussion can contribute to these problems, whether other factors play a big role. So really, there's more questions than answers right now," Brody explained.
"My best guess is that concussions are going to play a role. But other factors in former players' lives are also going to play a role and there's going to be a genetic vulnerability factor, that some people are going to be susceptible to long-term effects of concussions, and some people are going to be relatively resilient ... because of those genetic factors."
Despite the NFL's enhanced policy, rules changes designed to reduce impacts to the head, and improvements in helmets and other equipment, concussions in football are unavoidable. But as more is learned, steps can be taken to keep players at as little risk as possible. That's the ultimate goal.
"It's something that's important," Rams quarterback Sam Bradford said. "As big and as fast as guys are moving now, there's been an increase in head injuries. I think it's something you have to take very seriously."
(c) 2010, St. Louis Post-Dispatch.
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