Should NFL implement minimum concussion recovery timeline? 

The Telegram

February 4, 2021

Believe it or not, the NFL has done an admirable job of tackling its concussion problem.

Critics will tell you there’s still one omission. And that’s establishing a minimum number of days a concussed player must sit out.

True? Read on.

On Wednesday the league held (virtually) its annual pre-Super Bowl health-and-safety news conference from Tampa. It announced more good news in this realm, in that the incidence of concussions in 2020 dropped 5%, season-over-season.

“This is progress, not success,” Jeff Miller, an NFL executive VP in charge of health and safety, said.

While a decrease was not unexpected — given that August training-camp practices are included in the annual totals and, because of the pandemic, fewer padded practices were permitted in 2020 — it still might be more numerical proof the league’s earnest attempts at protecting players’ brains during practices and games are working.

Since 2017 the NFL has employed in-game brain-injury diagnostic tests that are in keeping with the sporting world’s best standards and practices. Indeed, it’s been at least a couple seasons since any egregious on-field incident has left NFL critics questioning either the league’s sincerity and willingness to adopt the best detection practices, or any team medical staff’s earnestness in implementing them.

It was a great sign for safety’s sake last month, when the two most recently named league MVPs — Kansas City Chiefs quarterback Patrick Mahomes (2018) and Baltimore Ravens quarterback Lamar Jackson (2019) — were concussed within 24 hours of one another, in different quarter-final playoff games. Each was prevented from returning to play once diagnosed, at crucial second-half junctures.

Think that would have happened 10 or more years ago? Doubtful.

As well, the league’s current post-concussion, five-stage, return-to-play protocol — also implemented in 2017, within months of one of the world’s leading neurotrauma experts, Dr. Allen Sills of Nashville, being named the NFL’s first chief medical office — is in keeping with global best practices. Sills was even a member of the global medical body that published the most recent practices.

The NFL still does not receive enough credit for these 2017 initiatives, and upgrades since, especially compared to other North American sports leagues, pro or otherwise, which don’t receive a tenth of the scrutiny or criticism.

But there’s still one safety omission from the NFL’s return-to-play protocol, critics say: The league still has no minimum sit-out time, nor any minimum progression time period through each of the five recovery stages.

The world’s leading sport-concussion authority suggests (but does not officially recommend) “it would be typical to have 24 hours (or longer)” go by before a recovering athlete advances to the next stage.

The U.S. Centers for Disease Control and Prevention (CDC) says on the matter: “In some cases, the athlete may be able to work through one step in a single day, while in other cases it may take several days to work through an individual step. It may take weeks to months to work through the entire five-step progression.”

In the NFL, as recently as the last three weeks we have seen two household-name players return to the practice field only four days after being concussed. Is that concerning?

Yes, if only from the standpoint of convincing skeptics the NFL fully lives up to commissioner Roger Goodell’s long-stated mantra that player safety takes priority over everything.

The first above-referenced concussed player last month was Taysom Hill, backup New Orleans Saints quarterback. He suffered his brain injury in the Saints’ regular-season finale on Sunday, Jan. 3, yet practised Wednesday, Jan. 6 on a limited basis (surely in a return-to-play recovery stage) and fully practised (according to the Saints’ league-filed injury report) on Thursday, Jan. 7. Hill played in a Jan. 10 playoff defeat of Chicago.

The other player was Mahomes himself, the defending Super Bowl MVP and Kansas City’s starter again this week.

After being concussed on Sunday, Jan. 17 in a win over the Cleveland Browns, Mahomes practised on a limited basis on the following Wednesday through Friday (Jan. 20-22), before getting fully cleared that Friday afternoon (the 22 nd ) to play against the Buffalo Bills in the AFC championship game on Sunday, Jan. 24.

This is not to suggest that either Hill or Mahomes was unfit to play, or that any funny business was done by either player’s medical staffs, or by the locally assigned independent neurotrauma expert who cleared each to play, following club-doctor clearance.

But seeing as concussion symptoms can take two or more days following impact to emerge at all, wouldn’t minimum sit-out times be most prudent? Even just, say, three or four days of mandated complete rest before any substantial physical activity may resume?

During Wednesday’s call, I asked Sills if the NFL is considering implementing any such minimum recovery timelines. Short answer? Doesn’t sound like they’re coming any time soon.

First, Sills properly reminded, every concussion is different. There are “a lot of different recovery trajectories,” plus “there’s a saying in the field that when you’ve seen one concussion, you’ve seen one concussion. Each one can be unique.”

Secondly, Sills said, experts around the world agree that symptoms disappear at different rates, sometimes even re-emerging.

“So the whole goal of the return-to-play process is: Is the brain fully healed? We have to understand that we don’t have a blood test or a scan that tells us that. Right now our best way to assess, as clinicians, if the brain is healed, is do we see symptoms re-emerge as (a concussed athlete) ramps up activity?

“And so that’s why we haven’t put a particular time stamp on it, because people do recover at different rates. And we have to acknowledge that. Some people will recover faster than others, just because of their own individual physiology, or concussion history, as well as the severity of the injury.”

Sills added that the league’s head, neck and spine medical committee — which includes both outside and NFLPA medical experts — looks “very carefully” at every concussion case, including the time it took to return.

“We’ll do that same season this off-season as well,” Sills said.

The NBA is one North American pro sports league that has a minimum return-to-play concussion-recovery timeline. It’s two days off. Seriously, that’s it. That’s worse than no timeline at all.

Why not be the first to implement a respected one, NFL?

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