With the continued focus on the concussion issue throughout the sporting world the major focus is without a doubt on the National Football League. What should merely be an injury issue all of its own may now be harboring a troubling side, “damaged goods”. Eric Ball of Bleacher Report has opined about such a case in the League, Clinton Portis;
Sure Portis isn’t half the back he once was when he rushed for 1,591 yards and 14 TDs in 2003, but there is still gas left in the tank. He has been dealing with concussion issues for the better part of the past two seasons at the worst possible time. Nobody ever really cared about concussions before the New York Times began to do some investigative reporting into the matter. Now it’s one of the top priorities of the league. Portis would have missed half the time he did in 2010 if the concussion controversy hadn’t erupted.
Perhaps in the past teams either didn’t know of previous head injuries or looked the other way; there were surely players in the past that have dealt with repeated issues as they relate to concussions and were signed (Troy Aikman and Steve Young come to mind). The concussion issue is just an injury and should be treated no different from an ACL tear or strained rotator cuff in terms of future performance. Yes, we have seen the possible devastating long-term effects of mismanaged brain injury but the fact remains that the properly treated concussion has little if any serious issues in the short-term. In fact, I would say that a concussion that is treated and managed properly is far less of an issue than a surgically repaired joint.
Research has shown that because you have sustained a concussion it DOES NOT predispose you to another separate injury. Empirically we have seen that the previous insult to the brain may contribute to longer recovery and possible increase in severity of another separate incident, but again has no effect on receiving another concussion. This is akin to having meniscus surgery, just because you have had an injury to the padding of the knee and it was treated correctly it does not make the knee more predisposed to another separate problem. It could mean that if and when that second injury occurs the complications and rehabilitation might be more troubling compared to the individual that has never had a surgery.
This is a fact/observation that must also be learned by everyone involved in sports. Understanding this principle gives rise to the recommendations that you are hearing now: less contact at a younger age, proper (longer) initial recovery, and taking stock of a career full of multiple concussions. Again, this is not dissimilar to any other orthopedic injury.
Is Portis getting “colluded” against due to his recent concussions? Ball brings up a great observation, however we cannot really answer that question because Portis also has a myriad of other injuries as well as a “different” approach off the field. What we do and should know is that if Portis is medically cleared from all his injuries and feels that continuation in this career is still in his best interest, then teams could use his services. Remember that when buying a used car one would probably by less for a vehicle that has more mileage and an accident or two on the record versus a brand new model.
The Concussion Blog 
“that because you have sustained a concussion it DOES NOT predispose you to another separate injury. Empirically we have seen that the previous insult to the brain may contribute to longer recovery and possible increase in severity of another separate incident, but again has no effect on receiving another concussion”
Dustin, your blog is a great resource for anyone concerned with concussions in sports, but this statement is factually incorrect. A number of studies showed that sustaining previous concussions increases likelihood of experiencing another one. For example see Guskiewicz et al from 2003 that finds that “there was an association between reported number of previous concussions and likelihood of incident concussion. Players reporting a history of 3 or more previous concussions were 3 times more likely to have an incident concussion than players with no concussion history”
However, it is unclear whether it is this effect is due to increased vulnerability of the brain or continued use of poor technique. Probably both of these factors are in play, and therefore it is really important that athletes with history of mTBI are given extra attention in learning safe playing techniques.
I appreciate the comment Brain Nerd. Those studies did not control for whether the “previous concsussions” were managed correctly or if those that has previous concussions never rested/recovered. In all of those cases it could also be assumed that the previous injury was never properly healed. A classic example of this is Sidney Crosby. He did not have two seperate concussions, rather a complication/”blow up” of the first concussion because he did not allow it to recover.
This is a very hot topic, one that we should work hard in clearing up. If the literature was so one sided in this manner than the NFL would be in a world of hurt as it relates to the current law suit.
Thank you for the comment once again, I am loking forward hearing from your company soon, I have sent multiple emails your way…
Will you provide a link to literature that shows there is no increased risk of recurrence?
Also, what’s your take on why Justin Morneau and Denard Span took so long to recover from concussions, while football players are often back the next week, even with concussions that look brutal (DeSean was back in two weeks after the Atlanta game)?
http://ajs.sagepub.com/content/37/5/877.short
http://www.neurology.org/content/50/3/677.abstract?ijkey=2a6730e1ba38fca968a131eef500b6557c891f05&keytype2=tf_ipsecsha
http://www.ajol.info/index.php/sasma/article/viewFile/44484/27996
Re: MLB vs. NFL it is a two fold thing, one is contract (MLB guaranteed money NFL not), the other is that the vision/balance is a much bigger issue when trying to hit a baseball…
Re: Collie, yes he did return too early, still dealing with the original concussion thus having more difficult return, I would even suggest that the latest concussion (the one I list as the third) was still the original concussion…
Maybe I just missed it while reading through, or maybe it’s not included in the abstracts/results, but I didn’t see anything in those links saying there’s no increased risk of future concussions if the first one is allowed to completely resolve.
Here’s an article that says differently: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC155416/
“However, that does not mean no preventive measures can be taken to minimize recurrence of concussions and other head injuries. Again, athletes sustaining a concussion are at a 3-fold increased risk for future concussions, and that risk increases with each successive injury.”
I have seen that article, it was in 2001, and a dang good one at that. In the other articles it does not specifically say, as studies (other than that one) have not been able to show without limitation issues the cause-effect relationship of previous concussion and likelihood of another. What we do not know from this article is the ACTUAL recovery of the subjects. Was it all subjective? Where there other tests to bring them back to baseline. To be honest it was so early that the identifying if one concussion has an effect on a second, different concussion is unknown.
Simply put, if the injury is healed and managed correctly, like any orthopedic issue, the likelihood of another incident is equal to the first. Statistically speaking, the randomness of any injury should be equal. However a previous injury can make the recovery of a new separate injury more difficult and longer lasting.
Also… I’m going to assume Austin Collie returned too early from his first concussion, because he left the Patriots game with symptoms. Now that he’s had a second concussion since then, what do you think about his chances for recurrence in the future?