Last week when the Chiefs played the Chargers running back Jamaal Charles scored a touchdown and was blasted in the end zone by Brandon Flowers. A shot that Charles bounced up from and headed to the sideline while Flowers was slow to get to his feet. The hit was helmet to face mask and the resulting forces were a classic case of what is typically needed to produce a concussion for one or both of the players. Whether or not it actually did, we will never “officially know.”
The issue is not with the hit or the fact that Charles apparently cleared the screening done on the sideline after such a hit, the issue is with his comments a few days after on the Dan Le Batard show;
“It definitely hurt,” Charles said. “A couple plays later, I just [saw] this light buzz around my eyes and I was trying to catch ’em. But I was like, ‘Let’s get the ball and run again.'”
I am 100% confident that Head Athletic Trainer Rick Burkholder did his job on Sunday – screening Charles after the hit – it was evidenced on Tuesday/Wednesday when Burkholder placed Charles in the protocol as a precaution solely due to the comments Charles made.
Why you may ask? Simple, by the absolute letter of the definition of concussion – disruption of normal brain function following a traumatic event – Charles admitted he was “not normal”.
Whether or not Charles had a concussion is up for debate among many people, not only externally – us blogging/media type – but likely internally – Charles and med staff. Here in lies the problem with concussions and the issue of concussions.
As we tried to explain in the University of Michigan post, concussion is most often a subjective injury, we as medical professionals rely upon the athlete or injured to tell us what is going on. If there are no overt or outward signs (loss of consciousness, wobbliness, gaze, vomiting, etc.) then all we can do is screen the athletes. And by screening I mean simply asking the athlete if they are OK.
GAMING THE SYSTEM
I heard Mark Schlereth on Mike and Mike this morning saying something to the effect of; “there has to be more than just asking the player if they are ‘OK’?”. The truth of the matter is that there is not really anything other than that; although just asking one question is not due diligence. In my experience I ask more questions and even try to trick athletes into giving up any ruse they are trying to pull on me. I have a to questions and line of questioning that has produced many responses that then warranted them to be fully examined with a sideline evaluation, even for the best “liars” (I won’t share them here because it can be used for people to study and then find a way around it).
The more complex yet simple reason we as athletic trainers feel confident with screening, even with limited questions, is that we know the athlete. Their usual demeanor, behavior and general presentation. People often ask me how long it takes me to know if someone has a concussion. When they are my players, the ones I am around on a daily basis, usually it takes me about five (5) SECONDS. Yes, I can detect a concussion that fast, and many other ATC’s can too. Now, there are some players that are very good at hiding symptoms; those are usually the ones that have been concussed before (they know the routine) but what they cannot hide is their presentation after hits.
The root of the concussion problem, that does not produce the outward signs, is the player and their honesty/candor. If the player does not tell the medical professionals that they are hurt, how can we help them? Sure some will say “sensors we need sensors”… That won’t fix much, in fact, it may make it worse. Imagine if we did the full-blown sideline assessment for every player that sustained a hit beyond a predetermined threshold. There would literally be 10’s of kids/players out of the game for at least six minutes (at the least) at a time, if you did that why not just have a “concussion time out” after every series to test them all? Not every hit at high force creates a concussion; in the same breath not every hit below a “threshold” does not produce a concussion.
A vast majority of athletes, in any sport male or female, are not dissimilar to Jamaal Charles. They want to compete and if they are not experiencing issues beyond their inherent “threshold” of pain or discomfort they are apt not to tell anyone or even lie if confronted with circumstantial evidence.
THERE IS A DIFFERENCE
Although we tell you that concussions are concussions are concussions; there are no “mild” or “severe” concussions at the time of injury. There is a massive difference between a concussion in a professional athlete and adolescent.
The injury is pathophysiolocially the same, the management – in theory – should be the same, but the dynamics and minutia (I know I dislike minutia) is different.
A. Professional athletes are adults and can make decisions on their own volition, when not mentally compromised. Sure a concussion can be defined mentally compromising, but if the injury did not inhibit their ability to reason and knowingly lie how would anyone be the wiser?
B. Professional athletes get paid A LOT of money to play their sport. This is a massive factor in this subset of athlete not being fully truthful about injuries
C. Professional athletes have the best medical care possible surrounding them, seemingly at all times.
The adolescent athlete does not have any of those factors going for them. This is why when dealing with concussions below the professional level we must be much more stringent and vigilant. Other factors include: the adolescent athlete is in school and learning, the adolescent athlete brain is still developing, the adolescent concussion is far less researched, and quality of life, at this point, is not up to them.
Less accepted and often overlooked, but a real and present danger, is the fact that concussion symptoms can be delayed. I have seen concussion symptoms be delayed up to three days. It takes sleuthing and sticktoitiveness to make sure those with possible concussions do not slip through the cracks. Most of the delayed symptoms present within 12-24 hours in my experience, that is why we/I run SCAT’s and other assessment tools up to 24 hours after a possible incident.
If we do not follow-up on the possible injury this can give the perception that no one cares or that it is acceptable to have a screaming headache the day after a game. What this does is prolong the issue and injury, putting the player in danger.
This was not the case with Charles, however this is the case with many concussions. At the professional level the adults can then rationalize the injury based on their years of experience and the “machismo” of sport. Years and years of constant berating about weakness due to injury, especially an unseen injury, prevent the athlete from being honest. This is a culture issue and yes it trickles all the way down to youth sports.
I wish there was an easier answer and one that did not have so much gray area, but there is not. The best way to grasp this issue is to understand that concussions are part of sports and life. Know the signs and symptoms, implore athletes to be honest, educate about ongoing risks and current information and be there for them.
The “Million Dollar” question is simple: How do we fix this loop-hole/problem?
The best answer, in my opinion, is also simple: invest in athletic trainers that can be around and protecting athletes at all times.