By Dr. Sudip Bose, MD, FACEP, FAAEM
Football season has begun again, and already concussions have made news. This past Saturday during Labor Day weekend, the opening weekend for most college football teams, I happened to be at the University of Texas game against the University of Maryland. I was reminded, as was everyone watching the game at the stadium or elsewhere, just how violent the sport can be. A Maryland player sustained a head injury in the third quarter while trying to make a tackle. It knocked him out of the game.
Maryland cornerback Antwaine Richardson, a sophomore from Delray Beach, Florida, had to be carted off the field after a collision with Texas’ Lil’Jordan Humphrey. Richardson, who had already recorded six solo tackles in the game, suffered a head injury and lay motionless on the field for several minutes. He was eventually carted off the field and taken to a hospital, where he was responsive and moving, according to a Maryland spokesman who reported back. Richardson currently is in concussion protocol ― as he should be ― is listed as day-to-day, and is out for an undisclosed amount of time.
Maryland’s second-year coach, DJ Durkin, while happy about getting the program’s first win over a Top 25 team in seven years, had a decidedly serious tone at his news conference Tuesday when he confirmed just how severe several injuries were that were suffered not only by Richardson, but by quarterback Tyrrell Pigrome and linebacker Jesse Aniebonam. Durkin said that quarterback Pigrome would miss the rest of the season with a torn ACL of his right knee and that Aniebonam will be out “several months” with a fractured ankle.
“Unfortunately, injuries are part of our game, and they happen,” Durkin said at his news conference.
A brain, a knee, an ankle ― from head to toe, the game of football can have a devastating effect on a body. Players accept that risk, coaches understand the risk and try to train players to use techniques that will help avoid injuries, and parents pray that their children will be lucky enough to avoid serious injury.
But there’s no denying that head injuries and concussions happen weekly across the country at every level of the game ― youth leagues, junior high or middle school, high school, college, and certainly the pros.
Several years ago, Frank Deford, the late, much-acclaimed sportswriter, wrote an article for National Public Radio on the subject entitled, “Mind Games: Football And Head Injuries.” In it, he said:
“It’s not just NFL football that is dangerous. If professional players, through the years, have suffered injuries — especially to their brains — players have also suffered football concussions in college, in high school and all the way down to youth football. In fact, of the nearly 5 million adolescents playing football below the college level, it’s estimated that half have sustained concussions, a third of them on multiple occasions — and the human brain is not fully developed until the mid-20s.”
The NFL, which began its 2017-2018 season Thursday night, has seen the incidence of concussions trending higher season after season. According to data collected and published in a graphic by Ohio University, there has been a 58 percent increase in concussions in regular-season NFL games just from 2014 to 2015. And a July article in the New York Times revealed that the brains of 110 out of 111 deceased former NFL players showed signs of CTE ― Chronic Traumatic Encephalopathy ― a degenerative brain condition believed to be caused by repeated blows to the head. The cumulative effect of those blows is just beginning to be understood.
A blow to the head can lead to many types of injuries, as I point out in this video on Vimeo. A hard enough hit can cause a skull fracture; a hit can cause bleeding on the brain or even inside the brain; it can cause bruising to the brain, otherwise known as a concussion. If someone suffers an injury like this ― which can’t always conclusively be diagnosed with a CAT scan ― we look for symptoms such as dizziness, blurred vision, sensitivity to light, headaches, a feeling of being tired or feeling nauseous. One of the most important things to do if you suffer an injury like this is simply to rest. I knew one football player who got upended by a tackler when he went up for a pass and hit the field hard, landing headfirst. He suffered a concussion and couldn’t get out of bed for three days; he just stayed balled up under sheets and a blanket to try to block out the daylight because light hurt his head so much. No image scans revealed any injury, but he clearly was suffering.
There is definitely a heightened awareness around head injuries in football, and there are mandatory protocols to follow now at every level of the game. For example, at the NFL level, identification of a concussion includes some of the things that I reviewed in that video, such as loss of consciousness, balance problems, disorientation, blurred vision, a blank or vacant look, a clutching of the head or feeling sick to the stomach.
In the NFL, there are no fewer than 29 medical professionals at each game, at least one of whom (not affiliated with any NFL team) is assigned to watch the game specifically for signs of head trauma. Also, athletic trainers are used as spotters in each team’s booth, and they can review video to see if there were any plays in question that could potentially cause a concussion. They can call medical timeouts or have a player sidelined for evaluation.
The Centers for Disease Control (CDC) also offers a booklet titled, “Get a Heads Up on Concussion in Sports Policies,” which details what coaches, parents and others can do at their level to recognize and help treat someone with a head injury.
As I note on the title of the video in which I spoke on this subject, “Keep Your Inner Army Strong,” ― an overarching heath and wellness theme of mine ― an important part of concussion protocol includes knowing when to, and having the courage to, remove a player from competition due to a possible concussion. We can’t ignore this, perhaps the most devastating of all football injuries, particularly considering the cumulative effect this kind of injury could have over a player’s lifetime. Medical professionals cannot look away from head injuries or concussions because it might hurt the team to remove a player who shows these symptoms. A medical professional who makes that kind of a call in a game may end up being the most reviled person on the field if he or she benches a star player. We have to accept that, because we know it’s the right thing to do.