How to spot a concussion in the NFL

It turned out that unlucky week 13 wasn’t too unlucky after all. But silly week 14 decided not to follow the trend that its predecessor set. Here’s week 14 by the numbers:

49 = Number of players who missed game time due to injury.

6 = Number of players placed on season-ending IR.

15.64 = Salary cap hit (in millions) of the highest paid injured player this week (Andre Johnson).

6 = Number of head injuries.

xg2jxlzgz9tw4ebkppjcThe theme for this week is bone-crunching hits. First, we shall pay our respects to Mr. Brandon Marshall, 5-time Pro Bowl wide receiver for the Chicago Bears. Poor ol’ Marshall took a rather unsuspecting knee to the back in the Bears’ tilt against the Cowboys. Turns out Marshall was diagnosed with 2 broken ribs and a punctured lung. D’oh! The Bears ended their all star wide receiver’s season by placing him on injured reserve. The bad news is that fans won’t see any more highlight reel catches from Marshall for the rest of the season. But the good news is that Marshall will have oodles of time to recover for next year. Oodles, I tell you! He should be back in 2015 with no adverse effects. See you then, Brando!

With every week that passes by, I think to myself,  “Why yes, you are getting better looking with age!” Another thought that always crosses my mind is, “Man, there are a lot of concussions this week. I should probably write about this!” And until now, I’ve found other injury to discuss. But the time has come. Prepare to be enlightened about head injuries!

There were 6 players who sustained a concussion this week. With guys flying around and hitting each other with massive helmets, it’s really no surprise that this is a common injury. Of the concussed athletes, 2 are receivers. We’re going to hone in on these gentlemen in particular. The first is Andre Johnson of the Houston Texans (shown below) and the second is Jared Cook of the St. Louis Rams.


Think about life without your arm. Sucky? Yes. But doable? Yes. Now think about life without your noggin. Sucky? Heck yes! But doable? Umm not so much. Like anything else in the body, our brain can get banged up too. The only thing is our brain is a wee bit more vital to our general fun2concussionctioning than one limb or joint or muscle. And like everything else, our brains needs time to rest and heal if it’s bruised up.

The NFL defines a concussion as a “complex pathophysiological process affecting the brain induced by biomechanical forces.” If we translate this to normal English, it means that a concussion occurs when a direct blow to the head alters brain function. Concussions are a form of mild brain trauma.

Now, I have to admit, I was not totally familiar with the U138P200T1D205733F8DT20081218023220NFL concussion protocols before this post. So I channeled my old university student ways and did a little bit of research. (Thank you, Google). I’m not going to pretend to be an expert in this field because the last thing I want to do is lie and end up on Santa’s naughty list. That’s the cool part about this week’s blog though: we both get to learn!

Concussions are tricky, to say the least. Head injuries present with a wide spectrum of signs and symptoms – from physical to cognitive to emotional issues. And to top it off, sometimes a player won’t show immediate symptoms as a result of head trauma. These inconsistencies make diagnosing a concussion difficult, especially on a hectic NFL sideline.

The NFL lists possible concussion signs (objective and observable indicators) as:

  1. Any loss of
  2. Slow to get up following a hit to the head – whether the contact was made with another player or with the ground.
  3. Coordination or balance problems.
  4. Blank look.
  5. Disorientation to place or time.
  6. Clutching head after hit.
  7. Visible facial injury.

The NFL lists possible concussion symptoms (subjective indicators, according to player) as:

  1. Headache.
  2. Dizziness.
  3. Difficulty with coordination or balance.
  4. Nausea.
  5. Amnesia or memory loss – no matter how brief.
  6. Light or sound sensitivity.
  7. Ringing in the ears.

If you’ve ever watched football before, I’m sure you’ve seen someone get smoked in the head and stay down on the field. Even though this poor guy might stagger off the field, it’s not to be mixed up with your drunk friend stumbling around on a Saturday night. Yes,  Kristen appears to have concussion-like characteristics but it’s more likely booze-induced rather than head trauma-induced.airplane-scene-from-bridesmaidsSo what happens when a player like Johnson or Cook appears to be hurt following a head shot? It’s the responsibility of the medical team (including an independent neuropsychologist) to remove the athlete from the game if they notice any of these signs or symptoms. It doesn’t matter if the guy presents with only one sign from the list above or all seven symptoms, he has be taken out of the game to determine if he has suffered a concussion. Furthermore, the medical staff is also accountable for not allowing the player to return to the field until a head injury has been completely ruled out.

And here’s when things get a little grey (or gray, if you’re reading this from ‘Merica). There are some issues when it comes to allowing an athlete to return to play. In some instances,  the medical team has seemingly missed a big hit and failed to inspect the injured athlete. And on the other end of the spectrum, there have been times when the player denies experiencing any symptoms in order to stay in the game.

And, folks, that is why concussion testing was implemented. The NFL has a specific
Sideline Concussion Assessment tool that was developed to diagnose potential concussions in games and practices. Testing actually begins in the preseason! Before the season starts and playoff beards grow, every player undergoes a series of physical and neuropsychological (aka cognitive, memory, coordination, etc.) tests to determine their “baseline” function. FORSALEWhen injuries occur during the season, team physicians apply the same tests on the sidelines and compare the player’s current findings with their initial assessment to rule in (or rule out) a concussion. If the injured player scores lower than in preseason, he is automatically taken out of the game. No soup (or football) for you! The testing is great because it makes the diagnosis of a concussion more objective.

So in the case of Cook, he was hit in the head (sorry, no footage) and left the game to be evaluated for a concussion. Fortunately for the Rams, Cook passed the tests, returned to the game, and caught 2 touchdowns! What a boss! No concussion and 14 points make Jared Cook a happy man.

However, you look at a guy like Johnson who was obviously knocked out after getting hit. Loss of consciousness is the most evident sign of a concussion. Johnson clearly failed the Sideline Concussion Assessment as the Texans staff yanked him from the game and he did not return. High five medical dudes on a job well done! Johnson will be evaluated using these concussion tests before every practice and game and must pass them before he can play again.

54728848As with any injury, there is a gradual exercise progression that concussed players must undergo before returning to the big show. The first stage of recovery for Johnson is rest. I’m talking about chillin’ out, relaxin’, maxin’ looking all cool. When his concussion symptoms finally dissipate, he can start light aerobic activity – perhaps biking. From there, it’s back to sport specific exercises. As a wide receiver, Johnson will likely run routes and catch footballs. If he has no setbacks with these activities, the next step is return to practice. But there is one caveat: he has to wear the red non-contact jersey for his first practice. It’s really okay, red brings out the colour of his eyes. When he’s cleared by the medical staff, Johnson is given the green light to fully participate in practice and eventually return to games! Typical recovery will take a week with 24 hours between each stage in recovery.

Sometimes this gradual return to play doesn’t go so smoothly. If at any time during rehab Johnson experiences any signs or symptoms of a concussion, all of his progress resets and he must rest like a fresh prince once again. So there’s a chance he makes it all the way to non-contact practice, gets a slight headache, and then has to start from square one.

That makes rehab after a head injury potentially very frustrating. If athletes get upset, they might want to fake good health to get back into the game quicker. This makes the role of the medical team even more crucial so players understand the consequences of returning to their sport too early. If a guy comes back even one day too soon, he is at risk for additional brain damage. You need your brain as much as (if not more than) your arms and legs to kick ass!

Best of luck to both Johnson, Cook, and their NFL bros who took a bump to the noggin this week. May your recovery be short but safe! Take care of those beautiful brains, y’all!

– Chris (5-9)

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