East Jefferson General Hospital

Damage Control Week 9: New Orleans Saints vs. Philadelphia Eagles
Written by Mackie Shilstone   

Have you ever wondered just how thick the human skull is? Research of 3,000 hospital patients who were CT scanned in China at Tiangin University of Science and Technology determined that the adult male human skull is 0.25 inches thick and 0.28 inches thick for the adult female skull. Maybe NFL Commissioner Roger Goodell asked the same question.

Back in week 13 of the 2009 NFL season, media reports stated that Commissioner Goodell "will reportedly expand restrictions on returning to games for players who sustain head trauma." In 2009, "a player (could) return to the game after being diagnosed with a concussion, if he is asymptomatic at rest and under exertion, and is cleared by the team doctor. The lone exception is if the medical staff determines that the player lost consciousness, in which case he is ruled out for the remainder of the game." The report, among other recommendations, went on to stress that Goodell wanted any player who is "woozy, has general dementia, or memory loss to be barred from returning to the game."

Much of that came about then because of the concussions to high-profile players like Steelers quarterback Ben Roethlisberger and Arizona QB Kurt Warner, along with concern by the medical community and Congressional attention.

Flash forward to the 2011 season, when the NFL changed the placement of the ball on kickoffs from the kicking team's 30-yard line to the 35-yard line to prevent the high impact trauma potential of all types, especially concussions. In August of this year, the Washington Post reported, "that players suffered 266 concussions last season (2011), including 20 on kickoffs, (which is) down from 270 concussions suffered by NFL players during the 2010 season with 35 on kickoffs." Just this week, lawyers for thousands of former NFL players who are suing the NFL "for failure to warn players of the dangers of concussive and sub-concussive impacts," said "football has become the site of perhaps the gravest health crisis in the history of sports."

The Mayo Clinic defines a concussion as, "a traumatic brain injury that alters the way your brain functions." The University of Pittsburgh Department of Neurological Surgery states that "concussions cause a significant and sustained neuropsychological impairments in information - processing speed, problem solving, planning, and memory. And these impairments are worse with multiple concussions."

In fact, there is a coined phrase, Second-Impact Syndrome (SIS) to define a second concussion, while still recovering from the symptoms of the first concussion. Since 1984, there have been at least 26 deaths in athletes attributed to SIS, 20 in the last 10 years.

"After a brain injury, the brain is primed for a second injury. It can take less impact to cause even more injury" - a set up for trouble, according to John Steck, a neurosurgeon at the Culicchia Neurological Clinic in New Orleans. Steck further states, "that the player who returns too soon to competition will potentially have a diminished reaction time and may not be able to protect himself effectively." The likelihood of sustaining a concussion while playing a contact sport, like football, is as high as 19 percent.

On Oct. 12 The New York Times ran a story, "The New Medical Technology, a Less Controversial Instant Replay," which tells how this season NFL team doctors "have access to sideline monitors to help diagnose and treat injuries - particularly potential concussions - as part of the increasingly high-tech bench area set up which features video, digital X-ray results, and tablet-assisted concussion examinations, all intended to make the in-game treatment as efficient as possible."

The NFL started the sideline replay system this year and placed a certified athletic trainer in the press box at each game to alert a team's medical staff of potential injuries that might be missed, as well as, operating the replays for team doctors to review.

Once a potential injury to the head is determined, the player can be taken inside and the medical staff can administer the standard league concussion assessment on an Ipad and compare the results to the player's baseline test scores. At present, there are 16 out of the 32 teams using this technology. By next season all the NFL teams are expected to use the technology.

In a recent Bears-Lions game, I witnessed Bears quarterback Jay Cutler take what one announcer called a legal, devastating blow, while in the process of passing. Cutler was hit from a side blow driving both his head and shoulder into the ground. I have not seen a hit like that since Riddick Bowe knocked out Jorge Louis Gonzales in a heavyweight title defense. Thank goodness Gonzales got up after a brief time out on the canvas and so did Cutler. He was taken to the sideline and was back, as I recall, one play later. After Cutler finished the short series and since it was very close to half time, he was taken into the locker room for what the announcers said was to check his ribs for an injury.

Going into week 8, Cutler was listed on the Bears' injury report as having a rib injury but with "full participation in practice," and "probable" for their next game against the Panthers, which the Bears won.

Wide receiver Devery Henderson was the only New Orleans Saints player to be noted to this point on the Saints' weekly NFL injury list with a "concussion" designation, which was first reported in week 2. He "did not practice," and was listed as "out" for the Saints' game against the Panthers. While on week 3, he was listed as, "full participation in practice," and "probable" for the game against the Chiefs.

According to Donald Adams, a neurologist specializing in neuro rehabilitation, "the extent of the concussion injury correlates directly to how long it takes the injured individual to recover." Interestingly enough, Adams says, "a period of being unconscious for as much as 30 minutes is considered mild, as long as a CT scan of the brain is normal and any amnesia associated with the impact does not last more than a day."

In the Saints' last game against the Broncos, Saints safety Roman Harper was suspected of suffering a concussion and was put through the concussion screening protocol by the Saints' medical staff. It was deemed that he did not experience a concussion and he was permitted to return to the game.

Reviewing the weekly injury reports with my Southeastern Louisiana University interns for each NFL team over the last eight weeks, it is interesting to note that under the category of "injury" there are not only notations for "concussions," but also "head injury," as well. It seems, based on my own investigation, that there does not seem to be a distinction between the two classifications in terms of notations by a team.

Through week 8, there have been 33 concussions and 19 head injuries.

Linebackers have had the highest combined incidence of both concussion and head injuries at 17.3 percent of all those which occurred so far this season, followed by wide receivers at 15.4 percent, tight ends at 13.5 percent, while running backs and safeties tied at 9.6 percent.

The Raiders had six players with concussions, twice as many as the team with the second most concussions.

On Tuesday of this week, Chiefs Coach Romeo Crennel said that QB Brady Quinn, who is being evaluated for a possible concussion, would start Thursday night against the Chargers, if he was cleared to play (by the Chiefs' medical staff). On Wednesday, a follow-up report said Quinn "has not been cleared to practice due to a concussion," so add one more victim to the 2012 NFL concussion list.

Monday night the Saints face off against the Philadelphia Eagles. The Saints have a strong chance to sack Eagles QB Michael Vick due to the Eagles having to shuffle their offensive line for the third time, as a result of injuries. Coming off a 30-17 loss to the Falcons last week, Vick was sacked three times. Eagles right guard Dennis Kelly made his career first start last week. The Eagles have also been without their All-Pro left tackle Jason Peters all season, while left tackle Kelly Dunlap returned after two weeks with a hamstring injury. In addition, guard Danny Watkins did not practice Thursday due to an ankle injury. So as I see it, with a porous offensive line, the question is can Dunlap and Kelly deliver a consistent performance? If the Saints overload the Eagles' O-line with different blitzing packages and force Vick to run, the defense can deliver some legal, physical impacts on Vick, which will not only keep him off balance but also slow him down.

On the Saints' side, wide receiver Courtney Roby, who injured his left shoulder in the game against Denver, did not practice Thursday, along with running back Darren Sproles, who is nursing a hand injury.

Next week will be the potential high point for injuries in the NFL. We will wait and see who shows up in the training room for treatment.