In the last decade, football has made great progress in its awareness and treatment of concussions.
The NCAA recently passed new rules mandating schools develop a concussion management plan (which has been critiqued by some as being too vague), and New York’s Concussion Management Awareness Act has standardized concussion treatment for its high school and college athletes.
However, in the wake of the death of a high school football player in upstate New York earlier this week, how much do we really know about the science of concussions? Doctors admit that there is still a lot to learn.
“The brain is one of the most difficult things to study in medicine,” said Dr. William Levine, the head physician of Columbia University’s athletics program. “We still don’t know what kinds of hits, or what types of brains leave someone more susceptible to a concussion.”
To combat this, last year the NCAA commissioned a $400,000 concussion study. Levine estimated that millions, possibly billions of dollars are now poured into concussion research.
Concussion treatment is also another tricky subject, because each brain is wired differently.
“Symptoms like headaches and blurry vision are easy to quantify,” Levine said. “But often a player will complain of ‘not being right’ and it’s difficult to predict when they’ll feel better. It’s different for each athlete.”
In 2010, the NCAA administered a five-step process for athletes to return from a concussion. If a player receives a concussion, he first has to be symptom-free for 24-hours before he can begin the next step, which usually involves light aerobic exercise. The last step is passing a neuro-cognitive test that measures things like reaction time and memory. ImPACT and Headminder are the most popular ones used by high-school and college football programs.
The Ivy League has taken a more proactive approach on concussions. In 2011, the league approved stricter measures for lowering concussion rates. In addition to these, the Ivy League football schedule is 10 games as opposed to 12 or 13 for other NCAA schools.
Levine says Columbia’s concussion treatment program is a model for other schools. “We’ve been doing everything the NCAA has mandated for over a decade,” Levine said. “I like to think we’ve been ahead of the curve when it comes to concussion management.”
Dr. Levine said that Columbia’s trainer, Jim Gossett, is now employed by the New York Giants as the team’s “eye in the sky” – a specialist set up in the coaches box to watch for potential concussive hits.
“Often when trainers are on the field, they’ll see a dislocated finger but miss an incidental knee to the head,” Levine said. “Jim can now sit in the booth and call down to the sidelines to say ‘Check on number 88, he got hit in the head on the last play.’”
Levine said an impartial eye in the sky has not been mandated by the NCAA yet.
Concussions are a neuro-metabolic disorder in which a blow to the head rattles the brain around in the skull. This affects neurochemicals and blood flow to the brain. In addition to producing cognitive symptoms such as memory problems and poor concentration, they can also produce secondary symptoms such as depression, anxiety and mood swings.
Dr. Wilfred van Gorp is the head of NY Concussion Clinic, one of the few private practices in New York devoted exclusively to treating concussions. His training is in clinical neuropsychology, and before going into private practice, van Gorp worked at Columbia’s Concussion Clinic. Van Gorp said his concussion patients often get seen by someone not skilled in the sub-specialty, such as an ER doctor or a pediatrician.
“People may not realize it, but there is a dearth of providers in New York City with a specialty in concussions,” van Gorp said. “The private high schools are way ahead of the medical providers in terms of comprehensive concussion programs.”
Van Gorp said that treatment recommendations from one of these doctors can delay a player’s recovery time, due to the physician’s unfamiliarity with the intricacies of concussions. One reason for this is New York State’s Concussion Management Awareness Act states that a player can be evaluated by any type of physician for concussion treatment.
“You can have a dermatologist, someone with no expertise in concussions, treating a kid under the law,” said Dr. Dennis Cardone, head of the NYU Langone Concussion Center. “The reason for this is because we still have not established criteria for who is an expert in the field of concussions.”
In March, NYC opened the Langone Concussion Center to research and treat concussions. “The key for our center is the multi-disciplinary aspect,” Cardone said. “We have neuropsychologists, vestibular therapists, neurologists and orthopedists convening to weigh in on concussions and bring their expertise in examining concussion cases.”
Cardone said that while most college programs have athletic trainers on the sidelines monitoring athletes who sustain blows to the head, many public high schools do not. To address this challenge, Cardone and his colleagues at Langone visit high schools around the city to provide training to athletic staff in how to recognize and treat concussion symptoms.
Joe DiBari, the sports information director at Fordham University, says each incoming player at the school gets tested with the ImPACT test. When they sustain a concussion, they go through the five-step process before taking the test again. “The concussion treatment program has been pretty standardized by the NCAA,” DiBari said. “We make sure that our guys have met every criteria before they get back on the field.”
Many high school and colleges use tests like ImPACT and Headminder to determine when a player is ready to return from a concussion. However, Cardone said that at their current state, they represent more of a business interest than a effective tool. “The test scores are simply not reproducible,” Cardone said. “You could be in good health, take the Headminder test and score well, and two weeks later if you’re a little bit off it would read as though you had sustained a concussion.”
Follow Alex Eidman on Twitter @TheEidz