Pro Football Talk was forwarded a memo about concussions and getting players off the field from the National Football League;
Under the heading, “WHEN IN DOUBT LEAVE THEM OUT,” the memo states: “If you have any suspicion about a player being concussed, remove him from the game. Always err on the side of caution.”
This is common sense – rather should be – and it is a practice that has and should be going on at the lower level of football (except in isolated cases in college see Lockergate). I have stated and am fully aware that professional athletes can make their own informed decisions, but it is good to practice what you preach.
It seems that the NFL is starting to at least begin to tighten the screws a little more on this issue. What was originally unclear to me back in July was the process by which they were going to accomplish this. I spoke to a member of the Head, Neck and Spine Committee in July and specifically asked if the NFL was going to follow suit of the NHL by establishing a “quiet room” technique. The answer at that time was “it has not been established, and it will be a team decision.” This now has changed, as in the memo there was the inclusion of the “Madden Rule”;
“Named for John Madden, who suggested it, this rules states that, if a player is diagnosed with a concussion and removed from a game, he must leave the field and be immediately escorted to the locker/training room, and a member of the medical staff (e.g., an ATC, paramedic, MD, fellow, or resident capable of medical intervention) must remain with the player to observe him if his injury does not require immediate hospitalization,” the memo says. “There are no exceptions to this rule and the player is NOT to return to the field under any circumstances. The Madden Rule is intended to protect the players. It provides a quiet environment to permit the player time to recover without distraction. This rule has been endorsed by the NFL Competition Committee and approved by the Commissioner.”
I would like to take credit for that one, although Madden Rule sounds better, hahaha.
In one final note on the memo I was rather surprised to see the following;
The NFL is telling medical staffs that they have the authority to order a player to the locker room whether he wants to go or not.
This has been a major issue in all professional sports; who pulls the most weight? The athlete, coach, agent, owner or medical staff. I would like to think that the organization would hire very competent medical staff’s (except some “team doctors” actually pay for the privilege), that would make decisions based upon safety. I do know the AT’s do get a check from the organization so if they are hired by the club then shouldn’t they be listened to? I mean, coaches are hired to make play calls and players are hired to run said plays, do the organizations meddle in there business (see Jerry Jones). I would expect that teams would allow the AT’s and doctors to do what is right, and with that hope that the medical teams forgo score/importance and be proactive.
Sounds good in theory, but we’ll have to watch it in place this season. It was hard enough to keep Jason Witten on the sideline after the Cowboys medical staff thought he had a concussion in 2010. What if it’s a really important game and they feel they need to take him to the locker room? Good Luck, guys!
As Conflicts of Interest (COIs), double speak and other shell games possibly continue?
1- Concussion diagnosis – A rush to judgment? Why?
To return the disposable modern gladiator back to the playing field too soon may risk further brain injury. If it is known and accepted that a concussion is both an event and may also result in evolving injurious neurometabolic and neurochemical changes that occur after the initial event/impact…
Why is there any question about recommending that a player immediately sit out for an indeterminate period of time until his suspected concussion is thoroughly assessed by qualified clinicians?
Why screen to determine if the athlete should sit out? The axon “When in doubt…sit out’ should always apply. Should not the athlete’s health remain the 1st priority when making RTP decisions?
As Strauss (1997) stated…You can’t ice your brain like your quads and hope it works next week.
2- Concussion screenings…given the many faces and potentially serious adverse effects of concussions…are athletes being short-changed with various neurocognitive screenings?
Forget the reliability, validity and COIs issues that have been raised in the literature…re the value of the screenings…
or the fact that though an athlete obtains a typical post concussion test score it is possible that the concussed athlete needed to expend an unusually higher amount of cognitive energy to achieve these ‘normal scores’ (Gronwall, 1991).
Knowing that adverse cognition, physical and emotional effects are possible from a concussion…then should not ALL 3 areas be thoroughly assessed re each concussion? Perhaps the recent number of reported athlete suicides may have been adverted if all 3 areas of the brain were continually and thoroughly assessed…each time a suspected concussion occurred…?
If I went to a medical doctor for my annual physical exam and only a portion of my functions were assessed while other fundamental areas were overlooked…and then I was told that I appeared overall fine…I would be concerned about the quality of the exam that I received.
3- A quick look at the SRC history reveals significant SRC COIs…
The issue of a neutral examining physician has been bounced around since the 1980’s (documentation that I easily found) and probably earlier…;
Earlier concussion management guidelines reportedly were influenced by NFL team physicians (Kelly and O’Shanick, 2003);
for interesting related reading see Dr. Huizenga’s 1994 text.
And close associates being the reviewer of another associate’s submitted article for publication consideration.
4- Numerous SRC guidelines are now acknowledged to lack scientific evidence…
Why were these guidelines initially put into motion if the science was not there to support the professional opinions?
5- Science, like team clinicians, can be biased…
Martin (1979) specifically cautioned about accepting research conducted under the cloak of ‘science’ and added further concern that human interest and social forces influence both the direction and content of scientific research. And it seems clearer that the institution of Sport has become intertwined with powerful, wealthy and prestigious forces…
Thanks for taking the time to listen…