Every year, the National Football League (NFL) stages its annual “Draft Combine,” where highly regarded college players undergo medical examinations and perform drills for teams that might consider drafting them in the spring. This week-long event also serves as an opportunity for league officials and medical specialists to update the teams and the public on the state of prevention and treatment of NFL players from injuries suffered in games and in practices.
Since the 2017 season, the league has instituted several rule changes and on-field concussion protocols. A spokesman for the NFL said that the league is particularly interested in whether key rule changes, such as banning the lowering of the helmet to initiate contact and eliminating blind-side blocks, has reduced injuries.
In the not-so-distant past, having a concussion was perceived as an “occupational hazard” for professional football players and many players ignored the risks of these injuries. Now, athletes in all sports and at all levels – middle school, high school, college and professional, are concerned about the health risks of head injuries.
These two neurological experts recently offered insights on the diagnosis and treatment of concussions.
What is a Concussion?
“In layman’s terms, a concussion is defined as an immediate alteration of the brain due to trauma,” Dr. Kosztowski said. “This occurs when the brain is ‘stunned’ by some impact. Since the brain is swimming in fluid and surrounded by the skull, when there is an impact of the skull, the brain hits against it and, in some cases, it can recoil back.”
Dr. Boah added, “It is also important to note that a concussion is transient. This means the effect is usually short-term and the brain returns to normalcy.
“In the determination of the severity of concussions, there are literally hundreds of protocols to follow, but the best are from the American Academy of Neurology (AAN) and the NFL. Since concussions can affect athletes of any age and any contact sport – from soccer, rugby, football and hockey – and even cheerleading, it is important for coaches and parents to know what to do when there is a possibility of a concussion.
“There are specific questions to ask the athlete who may have sustained a concussion, and these are available online with a simple search or clicking on the AAN link above. The next step is to hold the athlete out of any sports activity for at least 24-hours. This to ensure that if there was a concussion, there is no additional trauma which might compound the injury to the brain.”
“With concussions, there is a wide spectrum of grades of severity. This runs from minor injuries to the brain which would not show up on a CT or MRI scan to major bruising along with blood inside or outside the brain,” Dr. Kosztowski said.
“While the player is on the field, it is also important to ascertain if there was a loss of consciousness as a result of the trauma or if the athlete seems to be groggy or confused. If this is the case, a trip to the emergency room is suggested.”
Is the NFL Doing Enough?
Since the 2017 season, the NFL has placed a greater emphasis on detecting and preventing possible brain injuries to players, including having on-field injury tents, high-tech helmets and strict guidelines for removing players from action if a concussion is suspected.
So, is the NFL doing enough to protect players from short term and long-term effects of concussions?
“Probably not,” Dr. Boah said. “There is certainly more emphasis on managing this injury, but players are often less than candid about their injuries, especially those related to concussions.”
Dr. Kosztowski noted, “There is mounting evidence of Chronic Traumatic Encephalopathy (CTE) which is a condition resulting from constant blows to the brain. The NFL is gathering more and more data on this condition, but I believe it is still under-reported. Football is a fundamentally physical sport, which can be unnecessarily harmful, and no amount of high-tech headgear or rule changes will change the nature of the game.
“We may have to rethink how we view this sport. More and more parents are hesitant to allow their kids to participate in sports such as football, hockey, and soccer because of their concerns about head injuries. The brain is so critical to the health of every person that we must try and protect it from impact from these sports.”
The Rising Awareness of Concussions
The awareness of the dangers of concussions has risen in recent years. Is this due to better data about the injury, more self-reporting from athletes, or more incidents of concussion?
“There are many factors in this change,” Dr. Boah said. “When the NFL and Congress began their discussions about these injuries, more fans and athletes started to take notice. Plus, each season, in every sport, there is usually a high-profile athlete who is sidelined by a concussion or other head injury. Some retired players have shown severe cognitive decline and other effects of CTE. The media has certainly added to this awareness with their reporting on these long-term effects.”
Prevention and New Treatment
“With concussions, prevention is more effective than treatment,“ Dr. Kosztowski said. “A person dramatically decreases the chances of this injury by taking preventive measures. There is on-going research and there are experimental medications for neurological trauma but unfortunately, there is no ‘magic pill’ which can reverse the damage of this trauma. The nervous system is much more sensitive than other organs of the body and it is very unforgiving, especially as we get older. Again, prevention is critical.”
“Over the past few years, eye-tracking is becoming more important in evaluating the severity of concussions,” Dr. Boah said. “This involves tracking extraocular movements to see if a person has had a concussion or if it has been resolved. In the Canadian Football League, the teams have started to use a computer program where a practitioner can assess baseline cognitive function and the NFL is closely monitoring this data.”
Non-Athletes and Concussions
Every year, millions of non-athletes sustain a concussion from accidents.
“We see a lot of automobile accidents and ground-level falls that cause concussions,” Dr. Kosztowski said. “This is another reason it is so important to wear seatbelts.”
“Falls can be extremely dangerous,” Dr. Boah added. “Falling from a ladder can do just as much neurological damage as driving 100 miles per hour and crashing into another vehicle.”
As for preventing brain injuries in day-to-day activities, Dr. Kosztowski offers some simple advice, “Don’t do dangerous activities when you’re intoxicated. Thousands of brain injuries could be avoided if this advice is heeded.”
Dr. Boah concluded, “If something doesn’t look right or feel right, get an appointment with a physician and get an examination.”
If you or a loved one has experienced head trauma and are concerned about a concussion, contact us for an appointment with one of our neurosurgeons.