Thursday, December 15, 2011
Friends don’t let friends drive drunk. Teammates don’t let teammates play after getting a concussion. Truths to live by unless, it seems, you are Colt McCoy, Cleveland Brown quarterback who lay on the field after getting hit in the head. Though he was helped off the field, no assessment of his mental status was done and he was allowed to continue to play. By the time the game was over, McCoy was complaining of noise and lights bothering him and he hasn’t practiced since.
NFL guidelines suggest that a player not be allowed to return to a game or practice if he has lost consciousness. Further, if other signs of concussion are present, the player should not play or practice until he is symptom free. Those signs can include confusion, amnesia, headache, nausea or vomiting, light or sound sensitivity and of course, an abnormal neurologic exam. These are common sense suggestions; head injury and not normal means no more play.
The problem of concussion is self-recognition and is no different than being drunk. It is hard for the injured or intoxicated person to realize that they are having thinking issues. As with alcohol, judgment is impaired in a head injury and it is up to those people surrounding the victim to take control of the situation. In the case of Mr. McCoy, team officials report that the trainers and doctors were unaware that he was injured, not having seen the helmet to helmet hit that laid him out on the ground. The question should not be asked of those on the sideline but rather the players standing next to the quarterback. With a blow to the head, loss of consciousness can be brief and the victim may not know that it occurred. Initial confusion can clear quickly and the only witnesses may be the people nearby in time and space.
Concussion symptoms can often be delayed and subtle. There can be difficulty with sleep patterns and concentration, lights and sound can be annoying. Headaches are common and all symptoms can be provoked by exercise. There is no magic number when the symptoms will resolve. Some do within a day or two, some never go away. The return to practice and play is beyond the ability of a player’s ability or love of the game. Sidney Crosby, the superstar who is the face of the NHL, has yet to recover from a concussion that occurred a season ago. His return to competition was stopped short by recurrent concussion symptoms.
The treatment for concussion is rest, not only physical but mental as well. It is not good enough for an athlete to avoid strenuous physical exertion but there has to be a commitment to rest the brain as well. It may be that computer games and other major stimuli need to be put on hold to give brain cells and synapses a chance to recover, no matter how long that takes.
The NFL is talking about putting more doctors on the sideline to test players before allowing them back into the game. This may be a shortsighted and misguided approach. It presumes that there is recognition that the player has been concussed. Practically, once a concussion has occurred, the player should be removed from the game and not allowed to return. There will be plenty of opportunity in the following days to decide the extent of brain injury and the time frame for full recovery. Meanwhile, teammates don’t let teammates play hurt.