the concussion conundrum

Concussion care made big news this week when the NFL called for new guidelines for the management of players who sustain a head injury during the course of play. The NFL has agreed to make changes to its concussion protocol mandating that concussed players be removed from the game whenever signs and symptoms appear. The problem is that a concussion can be hard to diagnose accurately on the field. Symptoms can mimic orthopedic conditions (ie. when ataxia is misdiagnosed as a limp). And some symptoms, such as nausea and vomiting, blurred vision, numbness, dizziness, and seizures may not develop until hours, days, or weeks later. Some symptoms are relatively vague, including moodiness, irritability, memory loss, and sleep disturbance. The first concussion is serious enough, but if the player sustains a second concussion, even a mild injury before he recovers from the first one, it can be deadly. (Second Impact Syndrome) And we all know that repetitive traumatic brain injury increases the risk of dementia (Chronic Traumatic Encephalopathy)

~"If in doubt, sit them out."~

~Sydney Children's Hospital Network~

The protocols that guide concussion diagnosis and management have been under study and revision for as long as I have practiced medicine. Most of the early research concentrated on childhood injuries without establishing clear guidelines for adults. So, while this effort to mitigate the toll traumatic head injuries exact on professional football players sounds like a good thing, it seems to me a case of too little, too late. It does nothing to prevent concussions. By the time the problem is recognized, diagnosed, and treated...it is too late. The damage has been done. And if you are willing to acknowledge the fact that many players sustain hundreds, even thousands, of blows to the head over the course of their careers, you might wonder why we allow it. Encourage it. Cheer it on...

"The millionaire players of professional football

are suiting up for the new season

with a startling caution on their locker room walls.

A poster headlined “CONCUSSION” warns players

that lifelong brain damage can result

if they persevere with macho gallantry

through multiple head injuries."

~NYT Editorial quoted by Michael Craig Miller, MD

in Harvard Health Publishing~

It's a tragedy that the sports culture in this country refuses to protect young men who are conditioned to become macho millionaires at all costs. 

"(American) football is not a contact sport.

It is a collision sport.

Dancing is a contact sport."

~Vince Lombardi~

jan