The League

Dr. A. Brion Gardner
Orthopedic Surgeon

Dr. A. Brion Gardner

Staff Orthopedic Surgeon at Camp LeJeune

Teams Keep Quiet When Players Have Their Bell Rung

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Concussions have become increasingly more prevalent in the NFL. Each season we hear reports of players that retire because of the residual effects of multiple concussions. There are also an increasing number of players that miss games or the entire season because of headaches, memory loss, and disorientation after multiple concussions. Fortunately, the NFL has acknowledged that this is a problem and is placing more emphasis on the prevention and treatment of concussions.

A concussion (medically referred to as a mild traumatic brain injury) is defined as a head injury with transient loss of brain function. They can range from mild to severe. Fortunately, approximately 90% of them are mild and do not have permanent sequelae. In 1994, the NFL established the Mild Traumatic Brain Injury Committee (MTBI). In the past couple of years this committee has funded research and study to advance the understanding of concussions and player safety. This research has led to the analysis and definition of concussions, development and enforcement of rules to promote player safety, improved testing and other helmet related developments, and increased the understanding and management of post concussion syndromes.

Post concussive symptoms include headache, nausea and vomiting, fatigue, memory loss (both short and long term), sleep disturbance, dizziness, neurologic deficit and mood changes (depression). These symptoms can last for a couple of days up to several months. The likelihood of a persistence of symptoms increases with an increasing number of concussions sustained by an individual.

Under the NFL concussion policy, team physicians are tasked with the responsibility of clearing a player to return to activity. According to published sports medicine guidelines, a player must be free from post concussive symptoms and have a normal neurologic exam before returning to play. The NFL policy also includes an anonymous "whistle blower" program to allow for reporting of undue pressure placed on team medical personnel to return a player to activity prior to meeting the criteria for participation.

The NFL has done an excellent job in trying to prevent concussions and protecting its players. What the NFL has done a dismal job in doing is identifying and treating one of the major post concussive symptoms, DEPRESSION. There are numerous reports each training camp and regular season of a player not reporting to practice because of "mental or personal issues". It is not unexpected given the high pressure, high stakes culture of the NFL. Many studies have concluded that repeated concussions are linked to depression. A 2007 study that examined 2552 retired NFL athletes found that those that had at least three concussions had triple the risk of developing major depression.

Over the last two years, more and more NFL players are admitting to having depression or depressed moods. Psychiatric and psychological counseling is being sought more frequently. Most teams, unfortunately, do not acknowledge that depression is a problem. In the arena of pro football where machismo, bravado, and invincibility are promoted, teams do not want to appear vulnerable. As opposed to validating a players mental fragility, teams far too often tell the player "shake it off" or "get your head right". The fans are told the players "need time to get through some things."

The NFL is no more than a microcosm of our society. Our sports heroes are no less human than we are. The pressures of life may even be magnified for them. It is therefore understandable that the rate of depression amongst NFL athletes would be at or above the rate of the average person. The NFL, if they have any real concern or compassion for each individual player, should establish a similar committee to study the prevalence of depression in the league and identify the impact that it has. It is commendable that the league has taken interest in reducing concussions. Depression deserves the same attention.

By Dr. A. Brion Gardner  |  June 10, 2009; 9:06 AM ET  | Category:  Concussions , Medical Save & Share:  Send E-mail   Facebook   Twitter   Digg   Yahoo Buzz   Del.icio.us   StumbleUpon   Technorati  
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