In the Dark about Concussions

Austin Collie lies motionless on the ground after being hit in the second quarter of an NFL football game against the Jacksonville Jaguars. (AJ Mast | AP Photo)

One year ago today, Sidney Crosby was scoring the Golden Goal, leading the Canadian Men’s Olympic Hockey team to a 3-2 victory over the United States in overtime. Two months ago today, Sidney Crosby was in the midst of the most prolific season in the modern NHL. Fifty-seven days ago today, Sidney Crosby laid prone on the ice, having suffered a blindside hit to the head.

Today, Crosby is sitting in his house.  No lights, no television, no workouts, and certainly no hockey. A season that started off so well that Crosby, who has missed the past two months of the season, is still in the top-10 in all statistical categories will end with questions of when the player deemed to be “The Next One” will take the ice.

Four months ago today, Austin Collie was one of the league leaders in all receiving categories. He was Peyton Manning’s most trusted weapon, and was a stabilizing force on an offense that was suffering from a rash of injuries and inconsistent play. Ninety-one days ago today, Austin Collie laid motionless on the turf after taking a blow to the head while being tackled.

Today, Collie, who is only 25 years old, is not spending his off-season running routes and restoring his timing with Manning. He is not worrying about the impending labor troubles that may shorten the 2011-2012 NFL Season. Instead, the concern with Collie is whether he will ever take the field again.

Both Crosby and Collie suffered the same injury: concussions. It is not known how many concussions either player suffered over a short time frame. What is known is that both players attempted to make a quick return from their initial concussions. In both cases, the players took another blow to the head that knocked them out of action. Collie would make one more attempt at a comeback, where he took a final blow to the head that ended his season. Crosby, on the other hand, has yet to be cleared for non-contact practice, as he and his doctors wait for his symptoms to subside.

Concussions are insidious, debilitating injuries that attack the most vital human organ: the brain. Unlike other serious injuries, there is no timetable for a concussion. We know a player with a broken bone will be sidelined for 4-8 weeks. We know an arthroscopic procedure will require 1-2 months of rehab. We know that an ACL injury is approximately an 8 month recovery. There is no time frame for the brain. There is no pill, no rehab, no exercise that a player can do to reverse the effects of the swelling and bruising.

There are two factors that compound the devastating effects of concussions:

First, like the players who suffer from them, science is largely in the dark when it comes to understanding concussions and their long- and short-term effects. Doctors and scientists have barely begun to scratch the surface when it comes to understanding the inner workings of a healthy brain – never mind a brain with a lifetime’s worth of bruising and scarring.

Complicating matters is the fact that the medical community seems unable to reach a consensus on how to respond to concussions. Until recently there would be no baseline testing for players who were ‘dazed’ or ‘had their bell rung.’ They would simply be asked if they were okay, and if so, they would go back into the game. While we have come a long way in a short period of time, there is still not enough caution in these situations. One has to look no further than the Green Bay Packers at Philadelphia Eagles match-up from Week 1 to see that players that have suffered a head trauma are still able to get back into games without the proper precautions being taken.

That brings us to the second devastating concussion factor: a culture of toughness.  From parents when the child is playing midget or peewee sports, to the coaches at the high school and college levels, players are taught to be tough, maybe to a fault. “Walk it off,” or, as Peyton Manning would say, “rub some dirt on it,” are common phrases heard during a game. After all, if you can walk, how bad can it be?

This thought process continues right to the pros, where any player knows he is only one hit from being replaced by his backup. With a million dollar paycheck on the line, is a special teams player going to risk losing his job to a rookie making the league minimum? Or will he take another pain pill and ignore the warning signs his body is giving him, just so he can stay on the field?

Worse, this attitude of toughness even affects concussion prevention. In baseball, potential concussion-preventing helmets go unused because of their appearance. Players would rather risk taking a fastball to the head than wear a goofy looking helmet. After all, they can walk off that blow to the head, why look silly while doing it?

In football, Ryan Clark and James Harrison of the Pittsburgh Steelers threatened to retire if the NFL kept fining them for head shots on opposing receivers. Seahawks’ linebacker Aaron Curry complained about the new rules over twitter. After all, how can you be an effective player if you cannot adversely effect someone’s quality of life off the field?

In hockey, there have been cries of outrage from players and fans alike over new rules that would eliminate all blindside hits from the game. Those who oppose the new rules use the reasoning that, if you remove unnecessary hits to the head, the next step will be eliminating all hitting from hockey.

The truth is, we are all a little to blame for this attitude of toughness that is affecting sports. As fans, we cheer, scream for, and crave the big hit. We demand our team’s players get up, get back on the field, do whatever it takes to win. As coaches we replace hardworking, dedicated players that do not fight through injuries, no matter what the long term effects of doing so might be.

As doctors, we sometimes ignore the facts and evidence right in front of us, because our employer is telling us they need their star player back on the field, and if we do not clear him, they will find someone who will. As players, we refuse to acknowledge those who walked this path before us, we refuse to see their scars, their pain, their wheelchairs. It is a tough sport, we reason, and we are tough guys. If you cannot take a little hit to the head, maybe you should go take up baking.

Sidney Crosby and Austin Collie are in the dark.  Countless other athletes join them, helplessly, hopelessly seeking answers about what is wrong with them and if and when they will be better. The rest of us are in the dark, too. We do not understand concussions. We may never understand how to prevent and fully treat them. But we can all step into the light and realize concussions are serious, that they cannot be walked off or ignored. This is a tough challenge for players, coaches, doctors, and fans, but not nearly as tough as it is for those players suffering from their effects.

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