NFl Concussion Comments from Dr. Lorenc
A recent anonymous NFL Nation survey of 320 NFL players asking if they would still participate in the Super Bowl with a concussion revealed that 85 percent would indeed still participate. For many reasons, these results are not surprising. Athletes at this high level of competition are often incredibly goal-oriented, wanting to be the best at what they do. This perspective, combined with elements of ego, potential financial or celebrity gain, along with a sense of responsibility and obligation to coaches, teammates, family, mentors and fans often manifests as the willingness to sacrifice one’s own health and well-being. They would consciously make that decision to play regardless of the reality that it could be damaging, not only in the short term, but possibly in their long-term health to reach ultimate achievements in performance. This “goal at any cost” mentality is not exclusive to only professional football players in the NFL, but can be seen in parallel surveys of other high performance athletes across virtually all sports. Another example would be a past survey of Olympic athletes. They were asked whether or not they would use performance-enhancing drugs (PEDs) should they be guaranteed a gold medal with the condition of not getting caught, knowing that the effects of the drug would kill them in five years. “Yes” responses weighed heavily in the majority.
Contributing to these aforementioned traits, that seemingly make high performing athletes more willing to sacrifice their own well-being for their goals, but also may be self-selecting traits that gravitate these athletes to perform at higher levels, is the tendency to see competition, life and injuries existing in the immediate term rather than the future. A knee injury affecting running, cutting and pivoting, will have a greater impact on an athlete’s decision to play than a concussion which may not have the classic symptoms of headache, dizziness or nausea that players typically associate with concussions. Unfortunately, because of the lack of “classic” symptoms, a decision to play under these conditions could have devastating long-term effects in basic cognitive functioning such as memory, concentration and general daily functioning.
Fueled by the additional mindset of physical “invincibility” commonly found in players of this age and performance level, the perceived vagueness of a physician diagnosis of concussion in cases where the athlete isn’t experiencing “classic” symptoms, breeds mistrust from this athlete, their teammates and coaches toward the treating physician. Regardless of the impairments that are present upon examination and articulated by the physician, said athlete cannot fully appreciate the potential long-term damage with repeated injury or returning before complete recovery. Due to this, athlete suspicion is amplified that the providers who are directing their treatment, have the interests of protecting the team, its ownership and league offices from potential litigation, superseding the best interests of the athletes.
Concussion diagnosis, management and treatment and reduction have made tremendous strides in the last few decades. Through initiatives in conjunction with professional football, numerous changes in all aspects of injury treatment and in the rules and equipment of the game itself have allowed for not only a better appreciation of the subtle signs and symptoms of concussion, but have also brought some element of more enhanced player safety to an inherently violent sport. Gone are the days when concussion diagnosis entailed asking “What’s your name?”, “What’s the score?”, and “Who are we playing?” and, if answered correctly, the athlete returned to play without significant concern.
Today, concussions are diagnosed and treated in an environment of more uniform initial sideline testing. With computer based testing of brain functioning, both prior to and after injury, that details injury and impairment uniquely to each patient, we can better optimize and individualize treatment. More detailed scanning of the brain, testing of postural balance and even specialized heart rate monitoring have brought concussion management to new levels that permit detection of even the most subtle symptoms that suggest lingering effects on the brain and incomplete concussion recovery. An unfortunate result of these better means of diagnosis and ability to detect these subtle and miniscule symptoms is the potential for aforementioned mistrust between providers and athletes who don’t experience definitive outright symptoms. They believe their withholding from competition is related to some ulterior motive of protection from lawsuit than for reduced risk of potential sequelae, which is in the athlete’s long-term health interests.
A main focus of medical providers, no matter what population they encounter, is to act in the best interest of patients. A crucial part of this focus is the obligation to provide our patient with the most accurate and up-to-date information regarding their injuries so that they may make the best-informed decision regarding their health and their current injury or condition. To counter potential mistrust between athletes and providers regarding treatment in concussions, better means of informing and educating the athletic population as to the potential long-term effects and prolonged recovery that can come about from returning to play too soon is necessary. Unfortunately, despite the persistent banging of the drum getting the word out of even slight concussion symptoms being potentially devastating in the long term, credence needs to be given to the athletes as an individual having the ability to make educated decisions regarding their health and well-being. This autonomy of the athlete, in some cases, contradicts our better judgment as providers as to what is best for the patient’s health. In addition to better educating and informing our athletic population, there may also need to be a focus on trying to alter the culture of sports, and football in particular, as to how injuries, namely concussions, are viewed and perceived.