When the National Football League issued its new guidelines on how teams should handle on-the-field concussions, it represented a significant change in the way football players who suffer head injuries are treated. The announcement took on more urgency after five high profile players — Jamal Lewis, DeSean Jackson, Kurt Warner, Ben Roethlisberger and Brodney Pool– suffered head injuries on one Sunday’s worth of NFL action.
“Everyone has heard the term ‘ding,’ and that is how an athlete who suffered a seemingly mild head injury was described, as getting ‘dinged,’ or getting his ‘bell rung,’” he said.
Most players didn’t realize these injuries were important and kept trying to play without letting coaches and doctors know they were injured. The athletes wanted to play, and the coaches wanted them to play. Sideline evaluation was not as thorough as it is today, Dr. Geier pointed out.
The new guidelines reflect new research and science that point to the potential risks of allowing players to return to play after a concussion. The new approach emphasizes recognition of warning signs that the athlete has not fully recovered.
According to Dr. Geier, when an athlete suffers a concussion, doctors today usually pull the athlete out of the game for a certain amount of time regardless of how trivial the injury seems. During that time, a thorough history of the injury and evaluation for signs of concussion is performed. Symptoms such as headaches, dizziness, nausea, blurry vision, amnesia, loss of consciousness, or feeling dazed usually mandates withholding the players for the rest of the game. The player cannot return until he or she has no symptoms, and often this warrants holding him or her out for a week or longer. If the symptoms are more severe, especially with significant amnesia, loss of consciousness, or headaches, formal diagnostic workup, including tests such as CT scans or MRI, are often performed.
Additionally, many physicians and sports medicine groups are now performing preseason neuropsychological testing of all athletes in contact and collision sports in order to establish a baseline.
“By doing this testing, a physician then can compare post-injury testing results to what the player scored in the preseason to have an objective measure when the player has fully recover, “ Dr. Geier said.
The new NFL guidelines recognize that returning a player to game play too soon after a concussion increases the chances of getting another concussion or getting a more severe focus on the concerns for returning a player too soon after a concussion include increased chance of getting another concussion or getting a more severe concussion after even less trauma to the head, both of which have been shown in long-term studies of head injuries in sports.
Dr. Geier stressed that this new approach to treating concussions seeks to avoid a potentially fatal event known as “second impact syndrome.”
“This is an injury where an athlete suffers a head injury but returns to play before the symptoms have resolved, then he receives a second blow to the head that causes swelling and biochemical reactions in the brain that is possibly fatal.
Today, according to the new NFL guidelines, a player who suffers a concussion should not return to play or practice on the same day if any of the following symptoms or signs is identified based on the initial medical evaluation of the player:
- Loss of consciousness;
- Confusion as evidenced by disorientation to person, time or place; inability to respond appropriately to questions; or inability to remember assignments or plays;
- Amnesia as evidenced by a gap in memory for events occurring just prior to the injury; inability to learn and retain new information; or a gap in memory for events that occurred after the injury;
- Abnormal neurological examination, such as abnormal pupillary response, persistent dizziness or vertigo, or abnormal balance on sideline testing.
- New and persistent headache, particularly if accompanied by photosensitivity, nausea, vomiting or dizziness;
- Any other persistent signs or symptoms of concussion.