The League

Doug Farrar
Writer

Doug Farrar

A FootballOutsiders.com staff writer

Very Little Has Changed

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I wrote the following text for a Scout.com magazine article called "The Concussion Game" in September of 2007, and I don't think there's much I could add regarding the severity of the concussion problem, and the conflict of interest when it comes to NFL teams and their medical staffs.

Fifteen Milliseconds

Biomechanical engineer Christopher Withnall has researched concussions for the NFL as part of a $2 million league study on the subject that began in 1994, and took place over several years. The study determined several things. From 1996 through 2001, almost 900 player concussions were reported by NFL teams - an average of 150 per season. Concussive impact on the field generally occurs at speeds from 17 to 25 miles per hour, and it happens, quite literally, in the blink of an eye.

"It takes about 15 milliseconds," Withnall told the Washington Post in 2003. "We can see the moment right before the hit and the moment right after, but not the exact moment." Certainly more clear than the actual moment of impact are the effects of those concussions. The study encompassed everything from "stingers" to severe cases like those of former Titans tight end Frank Wycheck, whose concussions left him with migraine headaches every single day from August through October of 2003 after he suffered two in a short space of time on the field.

Ex-Steelers and Bears fullback Merrill Hoge's concussions affected his life in and out of football more than most - he once spent two days in intensive care as the result of one - and he speaks to the myths that still seem to drive the game. It was Hoge's final concussion, which stopped his breathing for a short amount of time, that triggered the study in the first place. Players are taught to be tough, to push through the pain, and their own desire to succeed can put them in some very unsafe situations.

To a point, that's simply a part of football that can't be eliminated - it's a violent game, end of story. "You wear a helmet, you assume you're protected," Hoge, once said. "All I thought back then was that if you knew who you were, and could count to five, you were okay."

Still, while many players continue to ride that risk for all it's worth, a new league concussion policy and improved helmet technology may provide some relief over time, The real question is whether new mandates, and new helmets, will be trumped by competitive concerns.

Of Miracles and Migraines

In the second quarter of his team's Week 2 win over the Minnesota Vikings, Detroit Lions quarterback Jon Kitna left the game with a concussion. After being checked out by the team's medical staff, Kitna returned to the game in the third quarter and played the rest of the game. He later called his recovery "a miracle," though he was "really out of it" after bring tackled by two Vikings, and he thought his day was over until his head began to clear at halftime.

"I've never felt anything like that, and for it to clear up and go right back to as normal as I can be, is nothing short of a miracle," Kitna said. "I just definitely feel the hand of God. That's all it was. You can't explain it.

"I have no headaches, no symptoms, no lingering effects. But that was the worst my head has ever felt, and the worse my memory was in the second quarter. Yet, after halftime there was nothing."

Though Kitna passed a physical the next day, and Lions head coach Rod Marinelli categorized the concussion as "very mild" after talking to doctors, there are those who still believe that in cases like Kitna's, such an early return is irresponsible and dangerous.

Former New York Jets receiver Wayne Chrebet, who estimates that he suffered nine concussions during his 11-year career, told the New York Times on the Wednesday after the game in question that he couldn't believe Kitna was allowed back in. "I don't think it was right," Chrebet said. "I saw his eyes on the sideline and I know that look because I've seen it in my eyes and other players'. I disagree with what they did. I'm sure he wanted to go back in, and I'm sure he told them that. But I think they have to look at the best interest of the player.

"I don't think it was fair to him because he really could have gotten hurt out there."

On that same day, Miami Dolphins linebacker Zach Thomas led his team with 10 tackles despite suffering a concussion as early as the first play of the game, a 37-20 loss to the Dallas Cowboys. Thomas has suffered several concussions during his 12-year NFL career, and considered retiring in 1999 when every hit he inflicted or took resulted in a "flash" in his head. According to the Palm Beach Post, Thomas suffered four concussions in a two-week span early in his career. And though he says he "doesn't worry about that stuff", his family has repeatedly asked him to retire.

In the Dallas game, Thomas played all the way through, but began complaining of a migraine after the game, and later admitted that he felt the effects of the concussion early in the contest. "You know when you catch one, because you're really energized, and next thing you know you really can't sit on the bench or you want to fall asleep," Thomas told the media. "That's where everything goes from HD to regular TV - and that's the truth."

Thomas is still an elite player - he led all linebackers with 174 plays run in his direction in 2006, and he responded to those chances by finishing first in the league with 165 tackles. While such a high percentage of opportunity might be a good thing from a football perspective, it's clear that Thomas is adding further damage to a body and brain that have already seen a great deal of risk. It's also clear that most players who play Thomas' position - and most of those who play around him - will encounter similar, if not always so frequent, concerns. Channing Crowder, Thomas' teammate and fellow linebacker, told the Miami Herald that he believes it's possible to suffer one concussion per game.

Thomas was scratched from the Dolphins' follow-up contest, a 31-28 loss to the Jets, after team doctors ruled him out. Miami coach Cam Cameron said that the team will be careful with Thomas' return, but history says otherwise.

According to Chrebet, the teams aren't totally at fault. Players will do whatever it takes to get and stay in the game. "The honest truth is we're going to lie, whether it's your head or a knee or any kind of injury," Chrebet said in that same New York Times story. "(The league has) to take it out of the players' hands. We want to be out there. We want to be out there for our teammates, out there for the fans, out there for the organization, and that's how we're going to do things. If the guidelines say that you definitely have to miss a certain amount of time, that would probably help the cause."

Thomas' career proves two theories true - players tend to ignore the effects of concussions as long as they're playing well in the short term, and the league has a long way to go before it can actually manage players and their head injuries from an in-game perspective. Thomas never reported symptoms during the Cowboys game - only after - though his constant requests for a new mouthpiece should have been a hot tip.

"When you have a concussion or something, a new mouthpiece always fits tighter and you get a better grip on it," teammate Joey Porter said later. "He had a mouthpiece, but he just wanted another one. A brand new one is harder. The old one, you tend to chew on it, and you wear it out a little bit."

The League's Paper Tiger

According to the NFL's new concussion policy, detailed in an August, 2007 press release, cavalier attitudes toward even the most mild brain injury will not be tolerated. "We want to make sure all NFL players, coaches and staff members are fully informed and take advantage of the most up-to-date information and resources as we continue to study the long-term impact of concussions," Commissioner Roger Goodell said. "Because of the unique and complex nature of the brain, our goal is to continue to have concussions managed conservatively by outstanding medical personnel in a way that clearly emphasizes player safety over competitive concerns."

The policy was put in place after a June, 2007 conference attended by physicians and trainers from every NFL team, by active players, and by medical representatives of the NFL Players Association. The most current medical and scientific research was reviewed, and new guidelines were put in place regarding the in-game care of concussed players:

1. The player should be completely asymptomatic and have normal neurological test results, including mental status testing at rest and after physical exertion, before returning to play.

2. Symptoms to be taken into account include confusion, problems with immediate recall, disorientation to time, place and person, anterograde and retrograde amnesia, fatigue, and blurred vision.

3. If an NFL player sustains a loss of consciousness, as determined by the team medical staff, he should not return to the same game or practice.

4. NFL team physicians and athletic trainers will continue to exercise their medical judgment and expertise in treating concussions.

Will Carroll, injury expert for SI.com, Baseball Prospectus, Football Outsiders and Rotowire, told me that it will be very difficult for the policy to be anything but cosmetic.

"It's a nice PR move, but the fact is that the competitive concerns of the NFL trump the policy," Carroll said. "Clear misdirection is already happening to make sure that a player is available, whether he truly should be or not. The Kitna case compared to the Zach Thomas case shows how hard it is to do the right thing. (These cases) need to be handled by an independent physician in as objective a manner as possible rather than a conflicted team staff."

By Doug Farrar  |  June 10, 2009; 8:12 AM ET  | Category:  Concussions , Doug Farrar , Medical Save & Share:  Send E-mail   Facebook   Twitter   Digg   Yahoo Buzz   Del.icio.us   StumbleUpon   Technorati  
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