Six years later, Colt McCoy cannot remember going back into the game, or what happened after he did. In December 2011, McCoy, playing quarterback for the Cleveland Browns, rolled to his left. Pittsburgh Steelers linebacker James Harrison launched his helmet into McCoy’s face mask, leaving McCoy flattened on the turf and concussed. On the sideline, doctors inspected his bruised hand. After two plays, coaches sent him back in.
When he watched the film a week later, McCoy felt like he was watching another person. He made throws and decisions disconnected to the play he called in the huddle. I don’t know what I’m doing, he thought as he watched himself. It would be six weeks before he felt normal again, before lights stopped hurting his head.
“You certainly don’t want that to happen,” McCoy said. “But because of that, there’s even more enhanced protocol. Guys are taking it a bit more serious.”
The hit McCoy absorbed, the brain injury he suffered and the aftermath became a touchstone in the NFL’s concussion crisis. Perhaps more than any play, it changed how the league approached in-game concussions, leading to a series of policy and rules changes that continue to evolve.
The NFL has improved its practices for handling concussions, and players have grown more aware of the signs and dangers. But as this week illustrated, the NFL is still grappling with how to diagnose concussions and protect players during games, in the fury of competition. Even after efforts to improve the process and a public-relations push to convince fans the game is safer, several high-profile cases have revealed imperfections in the NFL’s concussion protocol, either inherent complications or failures in implementation.
The NFL’s concussion protocol received a fresh round of criticism after multiple quarterbacks returned to the field in Week 10 after showing clear signs of a potential concussion or experiencing symptoms afterward. The NFL is doing more than ever. Is it doing enough?
So far this season, preseason included, the NFL has tested players 379 times for concussions, NFL chief medical officer Allen Sills said. “We want that number to remain high,” Sills said. “We want to have a high bar set for screening. Our motto to all of our personnel on game day is if you see something, say something. We want anyone who has a concern to point it out, we want to be very aggressive in our screening.”
One case drew attention Sunday afternoon. Colts quarterback Jacoby Brissett took a vicious hit to the back of his head scrambling for a first down. He grabbed his head as he lay on the ground and then dropped his arms to his side. Doctors returned him to the field without him missing any offensive plays, but Brissett showed symptoms afterward and remained in the concussion protocol early this week.
The Colts said Brissett cleared two concussion tests during the game, in adherence to the league’s protocol, one of them by an independent neurologist. “Our guys, if they’re not 100 percent, they’re not going to put them back out there, period,” Colts Coach Chuck Pagano said.
Concussion Legacy Foundation CEO and co-founder Chris Nowinski said this kind of thinking is a flaw. Passing a sideline concussion test does not mean a player didn’t suffer a concussion. Players can experience a concussion but not show symptoms until the next morning, and they would still be at risk of suffering the grave consequences of a second concussion. Nowinski said teams and doctors need to be more aggressive in holding out players.
“If they show signs of concussion like holding their head after impact and you cannot find another reason why they would hold their head, you have to assume concussion and you cannot clear them,” Nowinski said. “I’ve talked to a lot of doctors. No one can come up with any reason why his hands would go to his head and drop to his side and not move, other than a concussion.”
Dr. Allen Sills, the NFL’s chief medical officer, said both Colts medical staff and independent docots continued to monitor throughout the game, in adherence with the NFL’s unstated policy. Brissett only experienced symptoms after he had showered and was ready to leave the stadium, Sills said.
“One of the things that is important to point out about this that may not be evident and does not necessarily show up on our protocol sheet, is once a player gets a sideline evaluation, that is not the end of their contact with the medical staff,” Sills said. “Let’s say that a player comes off, gets the sideline evaluation and clears that, they pass that evaluation and are cleared to go back in and play. That player is still going to be monitored by the medical staff as the game progresses. They are going to touch base with that player, they’re going to look at the emergence of any new symptoms, they’re going to continue to maintain contact with that player both verbally as well as visually. They are going to watch that player as they go back on the field and make sure there are no visible signs of head trauma as they go on.”
In its protocol, the NFL urges caution. Listed under additional best practices: “It is important to recognize players may be able to equal or exceed their performance under the Sideline Concussion Assessment compared to their baseline level yet still have a concussion, underscoring the importance of the physicians’ knowledge of the player. If there is any doubt about the presence of a concussion, regardless of the Sideline Concussion Assessment results, the player is to be removed from practice or play.”
Though Los Angeles Chargers quarterback Phillip Rivers showed no apparent symptoms of a concussion Sunday, Rivers landed in the concussion protocol Monday after he showed symptoms the day after Los Angeles’s loss in Jacksonville. Since Rivers did not take an obviously concussive blow, the Chargers could not have known. “In 2017, we have to accept that’s going to happen,” Nowinski said.
Rivers’s case, in some ways, makes the Brissett example more exasperating. Sometimes, even coaches, doctors and spotters with the best intentions cannot diagnose a concussion and prevent a concussed player from entering the game. But Brissett showed unmistakable evidence he may have suffered a concussion.
Teams sometimes make the mistake of putting a concussed player back into a game. Rarely, if ever, do teams hold out players out of an abundance of caution. Nowinski believes teams should be erring on the other side — holding out a player despite his ability to pass a concussion test, if he took a hit that likely caused a concussion.
“It sounds like if you pass the protocol, you’re forced to put him back in,” Nowinski said. “We need to know what kind of guidance [independent doctors] are given. Are any NFL players kept out just in case? Or are we just accepting [several players] are going to show symptoms after the fact, and thank god they survived?”
Sills disagreed with the notion a replay could provide clear evidence of a concussion. “There is no medical professional or scientific body in the world that would say that video is alone is sufficient to cause a concussion,” Sills said.
In some cases, the protocol protects such players. On Sunday, the Redskins announced wide receiver Ryan Grant had cleared tests after his head bounced off the turf. And yet trainers escorted him to the locker room, and he stayed out of the game and remained in the recovery protocol this week.
“I do think that process has gotten much, much better throughout the league,” McCoy said. “The issue is, it’s hard during a game to evaluate a concussion when a player is in the moment, he’s played in the game, he feels fine, he’s answering all the questions. That’s a tough deal. Every guy is different. Some guys might not experience symptoms, immediately, right away. Everything is normal. I don’t think you could pull a player out at that point, regardless of if he wakes up the next day and is experiencing symptoms.”
At times, though, teams skirt the protocol entirely, despite the presence of an independent doctor on the sidelines. On Thursday night, officials removed Seattle Seahawks quarterback Russell Wilson after he took a hit to the head, but Wilson returned after scurrying underneath a sideline medical tent, receiving no apparent attention and returning to the field after one play. ESPN reported the NFL found that Seattle violated the concussion, for which the Seahawks could be fined or docked draft picks.
In Wilson’s case, an easy fix would prohibit such a return. In one international rugby league, Nowinski said, players who are suspected of having a concussion must sit out for a minimum of 10 minutes. It gives longer time for symptoms to surface and decreases pressure on doctors.
“That’s a clear choice by the NFL not to have a time minimum, and that’s going to increase the number of guys that return too soon,” Nowinski said.
Quarterbacks have been at the center of most controversies, because their big hits happen in the open. “Think about an offensive lineman or a defensive lineman,” McCoy said. “They hit every single play. How do you know?” Those linemen are most often sustaining sub-concussive blows, the accumulation of which, researchers say, can lead to debilitating brain diseases later in life, such as chronic traumatic encephalopathy.
No concussion protocol could prevent or mitigate damage from those hits. It could be argued the concussion protocol is only an attempt to make an inherently damaging game appear safer.
“The reality is, the concussion protocol does matter,” Nowinski said. “Players can die of second-[impact] syndrome. Careers can end from concussion symptoms. We have to get this right.”
The NFL’s system is protecting some players. Six years later, McCoy believes what happened to him wouldn’t happen again.
“The mentality was, just get back in there, you’re fine, don’t worry about it,” New Orleans Saints quarterback Drew Brees said. “There’s a system in place to make sure guys are doing the right thing for their health.”
But there are cracks in the system, too, and this week showed the NFL still has more work to do.
>>> NFL owners have charged Cowboys owner Jerry Jones with conduct detrimental to the league, Mark Maske reports. From Maske’s story, an excerpt of a letter the NFL sent to David Boies, Jones’s lawyer:
“With due respect, we urge Mr. Jones to drop his misguided litigation threats and media campaign to undermine the Committee’s mandate. We urge Mr. Jones to honor the resolution that he and his fellow owners adopted and allow the Committee to continue its work, in compliance with the May 2017 Resolution and the League Constitution. And we urge Mr. Jones to support the Committee’s deliberations, not attempt to sabotage them.”
It’s worth remembering that uncommon unity among owners helped them beat the NFLPA in the last round of collective bargaining negotiations. Jones’s lawsuit, and the inevitable alliances that will form around it, could shatter that comity.
>>> Ezekiel Elliott dropped his appeal and will serve the rest of his six-game suspension without further legal challenge, Clarence Hill Jr. writes. The Cowboys will miss him against the Eagles, Chargers, Redskins, Giants and Raiders after losing to the Falcons in their first game without him. As the Falcons loss showed, the Cowboys need left tackle Tyron Smith and linebacker Sean Lee to return to health. They missed those two even more than they missed Elliott.
>>> The Cardinals are still deciding between Drew Stanton and Blaine Gabbert for their game Sunday against the Texans, Kent Somers writes. Arizona also signed Matt Barkley in the event they need a backup.
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