This Is Unacceptable, In My Humble Opinion

Dustin.Fink Dustin Fink

Yesterday I wrote about concussions and the difference between professionals and adolescents using Jamaal Charles as an example.  What happened last night on the professional field with millions watching was completely unacceptable, professional athlete not withstanding.

Late in the third quarter of the game, last night, San Diego’s defensive back Jahleel Addae (#37) ran into a pile to finish the tackle on the Denver running back.  He was running at full speed and led with his left shoulder, but as he made contact with the RB his head dropped and he also made (incidental) helmet to helmet contact with the runner.  This type of collision is very frequent and looked innocuous…  Until you saw the after math…

Addae was bounced back, still on his feet, and began “short circuiting” for the national audience to see.  He begins to look around, kind of, and stumble, kind of, and lose full control of his extremities, all of them.  As a medical professional and athletic trainer I would have documented this OBJECTIVE finding as “unsteadiness and disorientation”.  It looked like a boxer/MMA fighter catching a fist/kick in the face late in a boxing match; the type of reaction that any referee in those sports would stop a match for and award a TKO to the other guy.

It happens from time to time in this and other sports, that is not the issue here.  The issue is that Addae returned to the game (oh, it gets worse).  Here is the tweet from last night (h/t to Brady Phelps’ Vine);

https://twitter.com/concussionblog/status/525487638481235968

From what I can piece together this play was the last of the 3rd quarter and reports had him taking the field on the first play of the 4th quarter.  HE DIDN’T MISS A SINGLE SNAP!  Even with the long commercial break between quarters there is a maximum of 4 minutes, but if my DVR time was correct it was between 2 and 3 minutes.  This is not nearly enough time for a full concussion evaluation, by anyone.

“Maybe he was screened, like you said yesterday, Fink.”

There was absolutely no reason for a cursory “screen” in this situation, Addae showed a clear and overt sign of neurological impairment, in concussion recognition jargon: a sign.  When any player shows a sign there is no screen it means they get evaluated.  In my book and the way I evaluate for concussions the sign doesn’t even get an evaluation, they get their helmet taken, coach notified player is done and parents are summoned to the sideline (further evaluation is done after to asses if case is emergent);

https://twitter.com/concussionblog/status/525491242277560320

“Maybe no one saw it, like you have mentioned before, Fink.”

Although this is plausible, it cannot be used in this case, in my opinion.  The NFL employs an “eye in the sky” – an athletic trainer watching from above and on video – who is watching for such circumstances; if “untrained” eyes can catch this in real-time and post on Vine and YouTube there is no excuse for this being missed, period.  Let us not forget all the trained eyes on the medical staff and the independent neurologist on the sidelines.  Heck even the opposing team could have seen it.

Although the injury and presentation following was a classic case of normal brain function, the fact that he was returned was abhorrent.  However, later on Twitter I came to find out it was even worse than this short period of time, Addae possibly experienced an earlier incident.  The following is a Vine (h/t Mike Costa) from the FIRST PLAY of the game;

https://twitter.com/sfujita55/status/525493133526958080

1. Addae loses voluntary control of his body and falls to the turf, again a sign.

2. It was right in front of the San Diego bench with a clear view of the aftermath.

3. He obviously returned to play.

4. The innocuous hit in the 3rd quarter is now much scarier, because it demonstrates that less force was needed for him to exhibit neurological impairment.

HOW CAN THIS CONTINUE TO HAPPEN?

It reminds me of the Chicago/Atlanta game, two weeks ago, when defensive back Chris Conte ran into a pile for a tackle, not unlike Addae, and once he made contact he immediately grabbed his head and went down.  Although I don’t have any Vine’s of that, I know many people saw it on Twitter.

“They called Addae’s injury a stinger, you weren’t there you don’t know, Fink”.

They called Conte’s injury a neck injury, too, but lets not get caught up in the nomenclature.  I can speculate for days and be told I am wrong and I have no idea; that is fine I can understand the reasons for this, but I know what my extremely trained eyes see.  I see it all the time in my job.

Back to Addae, even if they want to classify it as a stinger – which is possible with the mechanism of injury – there was additional brain involvement.  Stingers do not effect the lower limbs as evidenced in the first Vine.

This type of incident provides us with a learning/teaching point, from the overt sign to the case of mismanagement.  But, we are beyond teaching points in this constant evolution of the concussion issue.  This case, hopefully limited to this level of sport, is one that can be emulated at the levels below.  In fact, I had a player tell me just yesterday that “‘X’ player played with a concussion last week why can’t I?”

Yes, it happens.  Not only the younger players falsely thinking they can do what professional players do, but they also mimic the style of play and techniques they see at that level.  There is a 100% trickle down effect of what people see at the professional level, in all sports (similar conversations with soccer players in reference to World Cup incidents).  This is a time to put forth the effort to make sure this type of situation does not happen at any level.  If this were to be repeated in the younger ages, instead of talking about a player missing some time with a concussion we could be talking about a kid losing their life due to second impact syndrome (reminder that SIS has only be documented in developing brains, not adults).

Do better!