There are hundreds if not thousands of hits on any given weekend in football that will result in concussions across the football landscape, many go unnoticed, except by the trained medical staff (mainly athletic trainers); certainly we see a very limited number on national TV. However last week Robert Woods of USC was drilled in the head while blocking that resulted in OVERT signs of brain trauma. Before we go further we should define what a concussion is, in its simplest terms:
- A concussion, at the very base level, is a pathological event that results from forces to the brain that cause disruption of normal brain activity. These “disruptions” can occur immediately or in a delayed response. Regardless, any disruption of normal physical, cognitive or emotional behavior would fit this criteria.
The new standard of care for concussions across all levels is that if someone exhibits signs of a concussion they should be removed from play for a proper evaluation. If there is no one there to do a proper evaluation (see youth and HS levels) then that player may not be returned to the game and cannot return to sport without a medical clearance from a physician.
As I have stated many a time most evaluations on the sideline are either a case of detective work – weeding through the subjective nature of the injury – or not needed because of the overt signs and clinical presentation. I say this as an expert, one who deals with concussions in sport on almost a daily basis. Observation is the most trusted source for concussion detection; whether it be observation of overt signs like that of Robert Woods in the game last week, or observation of the demeanor of the player in question – knowing the personality of the person.
I surely do not enjoy “calling out” my professional peers but there are times we must all learn from situations that present themselves. I can tell you that if that happened on the football field I was covering a player with the similar reaction – it has happened to me – would not be allowed to return to the game, period.
To me what is more troubling is listening to Woods talk about the play in question and his reactions, watch the first 1:25 of the video;
Not only did Woods use the term “dazed” he also capitulated that he was not “OK” after the initial hit it, took him until he fell the second time before he had his wherewithal. The other concerning part of this interview is near the end of the 1:25 he discusses how he was being serial tested for concussion issues. Why would a team be testing a player for concussion issues if the player didn’t sustain a concussion? If I have a player go through the testing on the sidelines and passes and I am confident they did not sustain a concussion then I don’t test them; perhaps I may ask them how they are the next few hours or day, but not test them. Heck, when someone has been assessed with a concussion here they don’t even get follow-up computer and balance testing until they get through school, light aerobic activity and practice drills without symptoms, that is at best five days post injury.
If that is not enough of an indictment, how about his Woods’s quote in a piece on ESPN.com;
“First, I was like, ‘Wow,’ ” he said. “And then after, I was like, ‘Wait, I did all of that?’ I didn’t know I laid down on the ground that long.
“It’s fun to laugh at now, but it’s just a blessing that I’m all right.”
He stumbles and has zero balance after the hit, first sign (and enough in my book to remove him) then he tells the press he does not remember what happened immediately after the head injury, second red flag. Yet, the USC staff removed a player in the same game for “precaution” after he didn’t pass his sideline screen. So frustrating and head scratching.
I get the emotion of the game, I get that it could be your best player; that is all well and good if you are a coach, but if you are truly concerned about the brain health of any individual a case like this is why the legislative pieces are put into place. It removes all doubt and sits them out.
I had the opportunity to interview an athletic trainer from a FBS program about this situation the words were very important to share;
I work with my coaches, but I work FOR my athletes. My pressure is internal to do the best thing for my guys. I want the best for them. I want the best care to result in the best outcome. Situationally I think athletic trainers often times allow the environment drive their decision. For instance, if a player is “knocked out” in practice like Robert Woods was in the game, of course there would be plenty of time to properly evaluate and care for the young man. Right? The brakes would’ve been applied and there is no way he would have finished the practice because it is “just practice”. Game day seems to blur proper judgement. I just don’t see how it is any different from practice. Do the best at practice and games and your outcome will reflect the proper decision.
Football is violent and violent injuries occur each game. I marvel at what types of injuries some of these players are able to manage on a day-to-day basis. Sprains, strains, fractures are all treated and managed with the potential to return to play. ATF sprain can return to play. ACL should not return to play. Phalanx fracture might return to play. Tibia fracture should not return to play. Why would anyone consider concussion different? Current information tells us that concussion should not return.
I do think there is a perception of pressure other places that is completely misread by athletic trainers. Is the pressure felt directed from the coach or is it an internal belief that we have to fix/return all of our players to play as soon as possible? My feeling is no different from one injury to the next. Evaluate, assess, and make a plan of care to properly treat the injury directly in front of you. This certainly has evolved over time. I don’t treat a syndesmotic injury the same now as I did just five years ago. Same goes for concussion. Evolve and educate.
This athletic trainer is exactly right we all need to evolve and educate ourselves on concussions at EVERY level.