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NFL Standardizes Testing for Concussions During Games

Posted on Apr 01, 2011

The National Football League (NFL) has changed their approach regarding concussions and how players are dealt with during a game or practice.  The league has adopted a baseline test and a post-injury test that all NFL teams will utilize if a concussion is the suspected injury to a player.  The protocol was developed by the Return-to-Play Subcommittee, chaired by Dr. Margot Putukian, of the NFLs Head Neck and Spine Committee.

The committee found that much of what was being suggested as the standard protocol was already what team physicians and athletic trainers were doing, but now the testing is in a standardized format.  The protocol is two pages, and back-to-back it can be laminated. 

According to Dr. Richard Ellenbogen, co-chair of the Head, Neck and Spine Committee, the NFL commissioner, Roger Goodell, wanted an approach that could be used during the heat of the game.  When thousands of fans are screaming and the player is pushing to go back in, this will provide a consistency that did not exist before.

So how does the new system work?  The protocol states:  "If any significant abnormality is found, a conservative 'safety first' approach should be adopted.  An athlete suspected of sustaining a concussion is a 'No Go' and does not return to play in the same game or practice."

If a player is suspected to have sustained a concussion, they will be put to tests immediately on the sideline:

• They will be told three numbers, such as 5-9-4, and asked to repeat them in reverse order.
• They will be asked to stand with feet together, eyes closed, hands on hips and hold that position for 20 seconds
• They will be told a list of words (such as elbow, apple, carpet, saddle and bubble) and asked to repeat them back in any order
• They will be asked basic things like, "Who did we play last game?" and What quarter is it?"

There is a list of six "No Go" signs:

1. LOC (loss of consciousness) of unresponsiveness
2. Confustion
3. Amnesia
4. New and/or persistent symptoms (such as headache and nausea)
5. Abnormal neurological finding (such as balance issues)
6. Progressive, persistent or worsening symptoms 

Further, if a player displays worsening symptoms, they will be screened for possible spinal injury or brain trauma more serious than concussions, like a brain bleed or a skull fracture.  Those tests are:

1. Orientation:  Naming the month or the year
2. Word recall:  The player is given a five-word list that they are then asked to repeat
3. Balance:  In addition to a test with two feet together, there are other test with one foot behind the other and standing on one leg
4. Symptoms checklist:  Such as headache, nausea and dizziness

In the 2010 season there were 223 concussions reported in 333 games during the 2010 season.  Next season, each player will be given a baseline test so team physicians and trainers have a solid starting point in evaluating players.  The baseline tests are not intended to be a replacement for the clinical judgement of medical personnel.  Fortunately, the medical personnel associated with the teams know the players and know when they are injured. 

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