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Injury Analysis: The Concussion Protocol

Jeff Stotts

Jeff Stotts works as a Certified Athletic Trainer (MAT, ATC, PES, CES). He won the 2011 Best Fantasy Football Article in Print from the Fantasy Sports Trade Association.

Jay Cutler, Michael Vick, and Alex Smith
Three quarterbacks made early exits in Week 10, leaving the field after suffering a head injury. Each of the three concussed quarterbacks has a history of concussions and all must be individually evaluated following the guidelines of the NFL's concussion policy. Before we look at each individual case, let's review the protocol they will each be required to complete.

A NFL player suffering from a concussion will be inserted into the protocol and evaluated immediately following the diagnosis. The player will first be subjected to a neurocognitive test known as ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing). All NFL and NHL teams and numerous teams in the MLB and NBA utilize the ImPACT Test to help provide data on a concussed athlete. Each athlete reacts to a concussion differently and ImPACT testing allows for each individual to be properly screened.

The test is carried out on a computer and analyzes the individual's current status through neuropsychological tests that include memory recall, immediate shape and color recognition, and matching. The results are than compared to a set of baseline information gathered prior to the start of the season. Before an athlete can return to play their IMPACT scores must return to their initial baseline numbers. They must also be symptom free at rest, as well as following exertional activity. Finally an independent neurologist must provide clearance in order for a player to return to the field.

The IMPACT test also can store data from previous concussions to allow medical personnel to compare and contrast the severity of the concussion and its associated symptoms. The effects of a concussion are cumulative, meaning the damage and the symptoms of each successive concussion build on one another. The more serious the damage, the more likely an individual will miss a prolonged period of time.

Cutler, Smith, and Vick have all suffered concussions in recent years. Cutler suffered a concussion during the 2010 season after getting sacked nine times in the first half of a loss to the Giants. Cutler returned after a brief one-game absence. In San Francisco, Smith's concussion history dates back to last season when he suffered a concussion in a Week 2 loss to the Cowboys. He did not miss any time. However this particular concussion seems more severe, with Smith suffering blurry vision during the game against the Rams. It's reasonable to think both Cutler and Smith could be available in Week 11. Both quarterbacks are reportedly making progress and hope to visit with a neurologist soon. However since this isn't the first concussion for either, anticipate this carrying over into the latter potions of the week.

Vick's situation is a bit murkier. Vick has taken a number of shots throughout his career. Prior to Sunday, his most recent concussion came in Week 2 of last year. He left early in a game against the Falcons but returned to play the following week. He briefly exited a game in Week 6 of the same season but did not miss any time. The concussion he suffered following a hit against Dallas on Sunday is considered to be significant and the Eagles are already planning on starting rookie Nick Foles. Given Vick's recent erratic play, the move could be more permanent than he would like. However Andy Reid continues to insist a healthy Vick is the starting quarterback. Of course he said the same thing about Kevin Kolb before Vick replaced him as the starter. Strangely, Vick's opportunity arose after Kolb missed time with a concussion. The injury provides fantasy owners a good reason to look elsewhere. Vick may be talented but he has not produced like many had hoped. Pick up Foles and hope he can ignite a spark in a surprisingly quiet Philly offense.

Ben Roethlisberger
The Steelers could be without the services of Big Ben for several weeks after he suffered a shoulder injury in the team's overtime win against Kansas City. Roethlisberger was injured when he has sacked, forcing his elbow into the ground before he continued to fall, landing on the same shoulder. The early reports were that the shoulder is sprained while some have suggested it is separated. I'm telling you it's possible for it to be both. A separated shoulder occurs when the ligaments at the acromioclavicular (AC) joint are damaged. Since the term sprain refers to a ligamentous injury, a separated shoulder is also indeed sprained. However it has been revealed that Roethlisberger suffered an injury to his sternoclavicular (SC) joint.

The SC joint is located opposite the AC joint at the junction where the collarbone meets the sternum, allowing the arm to move in multiple planes. Early this season Rams receiver Danny Amendola suffered a posterior dislocation of the SJ joint and missed five weeks recovering. The severity of the damage will determine how long Roethlisberger will be out and that timeline would only be extended if any associated fractures were found. The Steelers will provide an update after the conclusion of a second MRI but it sounds like Byron Leftwich will be behind center for the immediate future. He's worth a look in all formats.

Turf Burns

Percy Harvin: The Vikings are on a bye this week, allowing Harvin an extra week to rest his ailing ankle. Minnesota is hopeful he will play in Week 12.

Fred Jackson: Jackson also suffered a concussion in Week 10 and has already been ruled out for Buffalo's Thursday night game.

Maurice Jones-Drew: Drew will miss his fourth straight game recovering from a midfoot sprain. MJD has not been ruled out for the season but his stock is quickly falling.

Jeremy Maclin: Foles may be without a big name target in his first career start. Maclin remains sore after suffering a lower back strain against Dallas. It doesn't sound serious as of right now but monitor his availability throughout the week before starting him with confidence.

DeMarco Murray: Murry is another running back sidelined with a midfoot injury. He has missed four games and seems poised to miss his fifth. He still has not received clearance to return to practice and the Cowboys play two games in five days starting Sunday. A Week 11 is possible but I'm betting he sits out until at least one more game.

Jeff Stotts is a Certified Athletic Trainer, MAT, PES and the Injury Analyst for You can follow him on twitter @RotoWireATC.