Think about this from the standpoint of an NFL player. The players union (NFLPA) has a very specific set of rules over how frequently a player can be drug tested, and there is a clear outline for the procedure. Yes, I understand that a blood test for a concussion should not be testing for performance enhancing drugs. These are different things, I get it. But, in the collective minds of the players and the union, do you think that they would be comfortable giving blood samples that could in theory be used to test for banned substances? Unless there was a bullet-proof system hammered out and agreed to by the NFLPA, there is no way a player would voluntarily give a blood sample which could reveal so much more than simply a concussion diagnosis.

In case I didn’t make it clear, I’m 100% in favor of the research. We need every test, treatment, and solution in regards to concussions. In this case, the problem I see is everyone’s knee-jerk reaction to think that this particular test might be applicable to the NFL. In the current NFL, it seems like there’s not much upside to blood samples.

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Although, I haven’t been able to clear protocol the specialist I have met with have told me they expect a full recovery. I’m looking forward that, returning to form, having a good offseason and an even better 2016 season.

It’s notable that this piece was published December 14th, a full six weeks after Haden’s second concussion. So after six weeks, Haden still hadn’t been cleared from his concussion, and yet he’s talking about how everyone expects him to have a full recovery. Again, I can’t stress this enough, I hope that he does recover. But to throw this out there like it’s a given is just ridiculous.

It even gets a little worse, as two weeks after that quote, Browns beat writer Nate Ulrich tweeted this:

#Browns CB Joe Haden said he experienced headaches, light sensitivity, was hidden in his house for a month or two.

— Nate Ulrich (@NateUlrichABJ) December 31, 2015

Does this sound like a man who we should expect a full recovery from? Maybe this is a bias in my own memory, but Haden’s case reminds me of that of Raiders LB Nick Roach, and that one didn’t end so well.

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One obvious problem here is that the NFL seems to be asking one medical spotter to do too much. This person is located in an upper-level booth, and although they have access to a broadcast feed (as well as a video technician to work the video equipment) they’re being asked to do much more than just watch the same video feed that we watch at home. Since the action that they’re concerned with isn’t always on the broadcast feed, these spotters are also using their naked eye as well as binoculars in order to see what unfolds on the field. So when we at home see seconds of obvious concussion symptoms on video, the spotter might actually not be watching the same feed. It seems like this is a system that could easily be improved by simply adding another set of eyes. One spotter could watch the broadcast feed while the other focuses on what the cameras aren’t capturing.

The second flaw, and I believe the more serious one, is that the spotters have very little power. They do have the power to stop the game, but here are the rules on that from the official NFL Operations page: (bold text in original, not from me)

New in 2015, ATC spotters may use a medical timeout to stop the game to remove a player from the field for medical examination. The spotter can only stop play with clear visual evidence of two very specific criteria:

1. A player who displays obvious signs of disorientation or is clearly unstable; and
2. If it becomes apparent that the player is attempting to remain in the game and not be attended to by the club’s medical or athletic training staff.

You see the way the NFL printed that, “clear visual evidence,” in bold? Seems like they’re really stressing that these spotters aren’t going to order any medical timeouts unless they’re absolutely, iron-clad certain that they are correct. Plus, the NFL is saying that obvious concussion symptoms aren’t even enough to warrant a medical timeout, as criteria #2 needs to be met as well. In essence, the NFL is saying that the medical spotter cannot call a timeout until a player has already been left in harm’s way.

Shy of this medical timeout, the spotters really have no power. Here’s another quote taken directly from NFL Ops:

When immediate action is required, the spotter can call the bench to speak with the team physician or head athletic trainer and provide details of a potential injury. The spotter can send the video via fiber optic cable to a sideline monitor where the physician or trainer can see the play. The medical staff, assisted by an on-field injury video technician, can ask for slow motion, specific angles, rewind and more.

Do you see what’s missing there? The spotter can call the sideline and talk to a trainer or physician. The spotter can tell that person what he or she witnessed. But there is no mention of a hierarchy or power structure there. There is no obligation for the team’s medical staff to actually follow through and act on what the spotter tells them. Obviously, you would hope that the medical staff would act on this, but history tells us that medical staffs, for a variety of reasons, don’t always follow up properly. For example, a spotter could call the sideline to report a possible concussion, but the sideline medical staff could simply decide that a concussion assessment test is unnecessary, as they don’t suspect that the player suffered a concussion. That’s the same loophole (without the spotter part) that the Steelers sideline staff used to decide that neither Ben Roethlisberger or Heath Miller needed concussion tests during a playoff game against the Ravens last year.

The first step in fixing this system might be to push for spotters to flex their muscle and be more proactive in calling medical timeouts. But there’s a problem here as well. If a timeout is called, the rules state that the player has to go to the sideline for evaluation and stay out, “at least one play.” So again, we’re back to trusting that the team medical staff will be responsible and conservative, and not simply allow a player to return (the same way Roethlisberger and Miller did). So really, the whole system is flawed. It’s easy to blame the one person who really should’ve seen and reported the problem, but the truth is we have no way of knowing whether that person dropped the ball or why. The true problem here is that, despite recent focus, the NFL still has no real accountability when it comes to protecting the safety of the players. For now, all we have are scapegoats.

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In Saturday’s preseason game, New York Giants linebacker Mark Herzlich suffered a concussion. As I said, it’s impossible to know with any certainty how long his recovery could take. But there are a few things that we do know. In general, repeated concussions manifest with more severe symptoms and longer recoveries, especially when they occur close together. There are many questions that are still unanswered in that summary, such as, “how close together is too close?” but that statement is about as accurate as can be based on what we currently know about concussions. Because of this, one of my typical angles is to check if a concussed player has a history of concussions. As it turns out, Mark Herzlich has a history that troubles me. In a Week 13 game in 2014, Herzlich suffered a concussion yet remained on the field to close out the game. From the video at that link, you can see some odd, uncoordinated movements from Herzlich that make you wonder why he wasn’t pulled out for evaluation. Instead, Herzlich stayed in for the next few plays, including a kickoff, and finished the game.

Herzlich ended up missing the following week as his concussion symptoms lingered. You can read specific details on his symptoms and rehab here. Aside from the initial mistake of not being pulled from the game, I have no reason to think that Herzlich’s concussion was handled improperly. It would appear that Herzlich was fine to return after that one week absence… no beef there. But it’s this history of a November concussion that makes we worry a little when I read that he’s now suffered another concussion. I have no details on this latest one. I have no idea when he will return. For all I know, he’ll be fine and practicing this week. But because this is his second concussion in nine months, I see an increased risk that he will miss extended time. I hope this is not the case. Nobody has any idea how increased this risk is, so I don’t mean to overhype this angle. Hopefully Herzlich recovers quickly. Maybe he sits out the rest of the preseason as a precaution. But this latest concussion might be something worth watching, especially given how depleted the Giants defense already is.

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Dr. Maroon says some really crazy garbage, mostly downplaying the danger of the NFL and brain injuries in general. Yes, that’s nuts, but let’s choose to ignore that right now. I’d rather focus specifically on how Dr. Maroon’s words match up with the actions of the Pittsburgh Steelers, the very team that he works with. In a previous post, I talked about how irresponsible the Steelers were during the playoff game against Baltimore. In that game, sideline medical staff allowed both Ben Roethlisberger and Heath Miller back into the game without giving them the proper NFL concussion assessment tool. Both players were checked on the sideline due to suspicion of having suffered concussions. That is a fact. Both players were allowed back into the game in far less time than the NFL concussion assessment tool takes to administer. That is also a fact. You can read about those details in that piece I wrote. In fact, it could even be said that both players continued to suffer concussion symptoms after returning to the game, though that is a judgement call. If you saw the games, it was a pretty obvious judgement call, but it’s still subjective.

Now given that recent history, let’s dig into what Dr. Maroon said. Here’s a quote that stood out to me (1:51 mark):

The worst thing that can happen with a concussion is to go back in if you’re still suffering the lingering effects, because the brain is more vulnerable at that time.

Doesn’t that sound exactly like what unfolded with Roethlisberger and Miller? Didn’t they both go back in while still suffering lingering effects? If nothing else, they were not properly checked using the very tool the NFL has created to assess possible concussions.

Dr. Maroon follows this up with this little gem (2:10 mark):

… if you do have a concussion, or any symptoms of a concussion, you get out of the sport until the brain has a chance to heal.

Again, isn’t this exactly what the Steelers did not do with Roethlisberger and Miller? Weren’t Roethlisberger and Miller sent right back in after suffering what staff suspected might have been a concussion?

I’m not trying to tear into the Steelers in particular. Both the Seahawks and the Patriots had similar irregularities during the postseason. But at least their team doctors didn’t go on television to tell me that everything was peachy. In Dr. Maroon’s defense, I do not know if he was present on the sideline or had any part in treating the particular cases I outlined above. But even if he was not present or involved, he is still the team neurosurgeon, and one would think that the sideline medical staff answers to him on all concussion matters. The fact that the NFL Network would overlook this recent history and hypocrisy to have Dr. Maroon give us his expert opinion only tells us (yet again) how out of touch the NFL is on safety issues. No surprise there, I guess.

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Holy crap! 49er’s linebacker Chris Borland just announced his retirement at age 24, one year into his NFL career. ESPN’s Mark Fainaru-Wada and Steve Fainaru reported it here, and that is easily the best injury-related piece you’ll read this month. I can’t recommend it enough.

Chris Borland was already on my injury radar, as I wrote this about him pre-draft, and, even after his huge rookie season, I was planning on revisiting his ongoing health concerns. My concerns were all in regards to his shoulder injury history though, nothing to do with the concussion concerns which led Borland to call it quits.

That piece has plenty of great, honest, intelligent quotes from Borland, all of which outline how seriously he took this decision. For my money, the best was this thought he had after playing through what he thinks was a concussion:

What am I doing? Is this how I’m going to live my adult life, banging my head, especially with what I’ve learned and knew about the dangers?

Before anyone gets all stupid macho and throws around jock-talk about, “passion,” or, “dedication,” they should really read the piece. Borland is an intelligent man who thought this through and researched the hell out of it before making his decision. Any players that react poorly to Borland’s decision in the following days might want to consider that perhaps Borland knows something that they do not.

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We’ve all heard by now that the NFL is getting tough and really taking concussions seriously, right? There are new regulations, rules, and an overall enlightened awareness that are all supposed to come together and protect the players. In practice, well, not so much. The trouble is, there’s a really simple way to bypass all these new safety measures, and we saw it at least four times during the post-season this year. Did you catch it? It had a huge impact on the game each time it happened, and while it was later discussed, I was surprised that it didn’t get more media traction.

In theory, here’s how it’s supposed to work. When a team suspects that a player has suffered a concussion (or even if they see the potential of a possible head injury), the player is supposed to undergo an extensive test, referred to as the, “NFL sideline concussion assessment tool.” It’s publicly available here, so you can read it yourself. It’s a pretty beefy questionnaire that checks for both physical and cognitive symptoms of a concussion. There’s no real consensus for how long the test takes to complete, but I’ve read different opinions from sports doctors that range from eight minutes to twenty minutes for a thorough test. In fact, if you read the test itself, you can see that there is a delayed-recall portion in there that must be given a minimum of five minutes after the beginning of the test. Given that fact, any test that takes less than five minutes, is, by definition, not a complete test and does not follow this protocol.

The true concussion assessment test can’t be manipulated. It’s a good test, and, when followed correctly, it’s an important step in protecting players from risking further brain injury. It can’t prevent the concussions, but it’s still light years ahead of where we were a few years ago. But here’s where it gets interesting. In assessing a player for a concussion, teams can decide that the concussion assessment tool is not necessary. A player who has been sent to the sideline for concussion evaluation can be ruled to not have a concussion, even without taking this test. That’s madness! Concussions can be difficult to detect, which is why there is an assessment tool. Nobody should be allowed to simply chat for a few seconds with a player who is suspected of having a head injury and then determine that no further assessment is needed. That’s the very purpose of the assessment tool!

Despite this contradiction, NFL teams seemed to skip the assessment tool plenty this past season. The Steelers skipped it with both Ben Roethlisberger and Heath Miller in the Wild Card round of the playoffs. The Washington Post’s Adam Kilgore wrote about that here. For what it’s worth, the Washington Post’s Adam Kilgore and Mike Jones are both doing some great, detailed injury coverage. Both Roethlisberger and Miller took severe blows to the head and, through their subsequent actions, appeared to have suffered concussions. But both were spoken to on the sidelines far too briefly to have undergone the assessment tool, and both were returned to the game almost immediately. Also, both seemed to make uncharacteristic mistakes after returning, leading to plenty of speculation as to how healthy they truly were. In the NFC Championship game, Russell Wilson faced a similar sideline diagnosis that allowed him to skip the full concussion assessment tool. You can read the details about it here. In the Super Bowl, Patriots receiver Julian Edelman never missed an offensive snap after taking what everyone at home saw as a concussion-causing hit. Later reports said that he, “passed a concussion test,” but they do not indicate if this was the full concussion assessment tool, although it seems unlikely given how little time he spent on the sideline. Also, there is no explanation of why he was allowed to stay in the game and delay this testing until after the offensive series was completed. While we lack the exact details, it seems fairly likely that Edelman was given the same concussion loophole bypass that Wilson, Roethlisberger, and Miller experienced.

If the NFL is really serious about treating concussions and protecting the health of the players, why is there such a simple way for the medical staff to avoid a thorough concussion test? What is the purpose of having a clear protocol if there is no requirement to follow it? With all the increased focus on concussions in the NFL, this is a loophole that needs to be closed immediately.

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Today, the Raiders released LB Nick Roach. Read about it here, if you like. Roach’s story is a sad one, and I do not take pleasure in being right at the expense of his health. But this is the perfect time to discuss some of the shitty reporting in the NFL in regards to injuries, and I’m not going to pass that up. Roach suffered a concussion in an August 2014 preseason game, and hasn’t played a snap since.

Here’s where it gets interesting. Back in October, ESPN’s Adam Schefter, wrote this piece, saying that Roach was pretty much going to be fine. Read it for yourself. I called bullshit, and wrote this piece, saying I felt it was irresponsible for any reporter to look at Roach’s health and be so ridiculously optimistic. Obviously, Schefter was simply reporting what a source had told him… I get that. But I felt that this was a case where the story simply didn’t match the facts as we knew them. That was five months ago, and it looks like I was right to point out the hypocrisy there. I feel bad for Nick Roach. But I also refuse to wave the NFL pom-poms and believe that everyone will be alright just because that’s what an anonymous source told me.

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Tennessee TE Delanie Walker left the game today after taking a brutal hit and suffering a concussion. Concussions are severe injuries, and as anyone who follows football knows, it seems as though we still have a ton to learn about how concussions should be handled. There’s no standard return-to-play estimate for concussions, as some players pass all test and miss zero games, while for other players the symptoms linger (and linger and linger). When trying to throw out a quick spitball estimate though, one important thing to consider is the player’s concussion history. Players with a history of concussions tend to miss more time with subsequent concussions than players with no history of concussions. We’re seeing this right now with Browns TE Jordan Cameron, who has been out the last two weeks with his latest concussion. This was Cameron’s third known concussion, having suffered one in 2012 and another in 2013.

Given this importance of concussion history, let’s take a look at Walker’s injury file. Turns out that he suffered a concussion in Week 13 of 2013, and the injury was severe enough to keep him benched for one game. While that’s certainly not as severe as Cameron’s history, it’s nothing to sneeze at either. With today’s injury, Walker has now suffered two concussions within one calendar year, and that’s scary. If I were to guess, I’d say there’s no way Walker plays next week. It’s important to note that Tennessee’s next game is a Monday night matchup, so he does have one additional day to rehab and pass concussion protocol tests. But really, I don’t see that one day making a difference… especially given the severity of that shot he took today.

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Linebacker Vontaze Burfict (same guy from Lewis’ other quote) had to leave the week 7 game early because of a neck injury he suffered while smashing his helmet into Colts QB Andrew Luck. Just for a refresher, Burfict had one concussion in 2013. Then he had one this year. Then he had another this year. Then it looked like he had another this year, but he kept playing. Now he suffered what they’re politely calling a, “cervical strain.” Maybe it’s a concussion, maybe not, but with Burfict’s history, you have to be worried. Not Lewis. When asked about Burfict’s health, he summed it up in one word. “Fine.” Yet again, Darin Gantt took the exact right approach on this one, having this to say. In case you’re a wealthy industrialist and far too busy to follow that link, the headline will suffice:

Dr. Marvin Lewis says Vontaze Burfict is “fine”

Well played Gantt. The next move is yours, concussion-denier head coach.

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