The League

Dr. A. Brion Gardner
Orthopedic Surgeon

Dr. A. Brion Gardner

Staff Orthopedic Surgeon at Camp LeJeune

Know when to walk away, know when to run

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There has been more discussion, debate, and disagreement about the apparent increase in concussions sustained by NFL players this year than any other injury in recent history. There is so much interest in this condition, that even Congress has gotten involved in the study of its natural history.

We have discussed the science behind concussions in this forum pretty well. That is to say that we know what we don't know about concussions. When it comes down to the bottom line, the long term consequences of sustaining a first time concussion and the likelihood of this being season ending or career ending is almost a guessing game. The U.S. Congress and the NFL are investing many resources to find an answer to these questions.

While this research is being conducted, several players sit by and contemplate the pros and cons of continuing to play. Most notably this season, Brian Westbrook and the Philadelphia Eagles have this difficult decision to make.

I do not know the details of the symptoms that Brian Westbrook continues to have or not have. However, there are some trends in the natural history of concussions that would make me recommend a certain course of action.

We do know that with each sustained concussion, there is an increased risk of a subsequent concussion, the so called second hit or second impact syndrome. This usually occurs when a player returns to play too soon and develops a second concussion with a much less intense blow to the head. I believe Westbrook was a victim of the second hit.

There is no consensus how many concussions is too many. A general rule of thumb is that three in one season should end that season of play. With the rapidity in which Westbrook sustained his second injury, I don't think he should chance the "third strike". It is a risk/reward situation that I believe the risk far outweighs the reward. The Eagles could definitely use Westbrook's electric talents as they make a push to advance deep in to the playoffs, but they could be mortgaging a young man's future after football if he develops another injury.

I think the wise professional and medical recommendation would be for Brian Westbrook to call it quits this season. This will give him the best chance of returning for future seasons. If he returns, my instinct is that eventually he will sustain another head injury and at that point, I would recommend permanent retirement. He should listen to the old school advice that advises to "live to fight another day."

By Dr. A. Brion Gardner  |  December 16, 2009; 10:56 AM ET  | Category:  Concussions , NFL , Philadelphia Eagles Save & Share:  Send E-mail   Facebook   Twitter   Digg   Yahoo Buzz   Del.icio.us   StumbleUpon   Technorati  
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