Why I Don't Want RG3 On the Field this Week

All week we're going to be hearing the catchphrase "mild concussion." Excuse me for saying this phrase is major bullshit. The "minor" comes from the term "Minor Head Trauma (MHT.)" It's also known as "MTBI" (mild traumatic brain injury.) That's exactly what happened to Robert just a few hours ago, a minor traumatic brain injury. This week doctors will attempt to discover the specific condition, severity and area of the brain that was impacted. Every MTBI at a minimum involves a physical impact/ distortion to the brain, resulting in a temporary loss of brain function. Should I try to make that more palatable by hiding it behind the parlance "electrochemical disruption?" This would help all of us glide over the truth this was a physical injury to Robert's brain. Done reading? I can't say I blame you, considering I'm as guilty of wishful thinking and blind optimism as anyone on this board.

Tomorrow when your co-workers are minimizing Robert's MTBI, saying, "Hey, it's not like he was knocked unconscious.", bear in mind fewer than 10% of sports-related concussions do involve a loss of consciousness. What's true of all concussions (brain traumas) is they can cause physical, cognitive and emotional issues.

Consider. Multiple independent studies have proven:
* People who have had one concussion are statistically more susceptible to more (when measured against people engaged in the same activities who haven't had one.)
* Repeated concussions increase a person's risk later in life of developing dementia..
* General studies as well as studies specifically involving former NFL players proved individuals who have had 3 or more concussions, compared to those who haven't, have a far greater chance of developing clinical depression.
* If all of that isn't bad enough, general and NFL player studies have proven three or more concussions results in:
* - A 3-fold greater chance of developing memory deficits, and
* - A 5-fold greater chance of developing Alzheimer's disease earlier.

So try to forgive me for my over-reaction to a MTBI incurred by one the most charismatic people any of us has come across. Speaking of that larger than life young man, did you know the NFL required Robert to go to the locker room?

The Requirement. The NFL Requires the following of all teams. (Here's some select verbiage taken directly from the NFL mandate:

"If you have any suspicion about a player being concussed, remove him from the game. Always err on the side of caution."

"Any player suspected of having a concussion is a ‘NO GO’ and does not return to play in the same game or practice, and cannot return to play at all until he is cleared by both his team physician and an independent neurologist."

"If a player is diagnosed with a concussion and removed from a game, he MUST leave the field and be immediately escorted to the locker/training room, and a member of the medical staff MUST remain with the player to observe him if his injury does not require immediate hospitalization. There are NO EXCEPTIONS to this rule and the player is not to return to the field under any circumstances."

NFL rules forced the Redskins coaches to immediately place Robert in a quiet, calm environment. This has been proven to be highly conducive to the recovery from head trauma. Immediate and continued reduction of stimuli coupled with extensive rest has been proven to reduce or avoid the cumulative effects of an MTBI.

Here's what RG3's week will look like. He'll be prohibited from returning to play before he is completely symptom-free during both rest and exertion. Further, the Redskins are required to adhere to the following staged approach this week in their attempt to return RG3 to normal activity. If he has difficulties with any stage he is required to revert to the previous stage.
Stage 1: Must submit to standardized physical and cognitive tests until independently reviewed results indicate a return to normal cognitive function, though these tests are far from definitive.
Stage 2: May engage in light aerobic activity but his heart rate must remain below 70% or normal maximum. No resistance training is allowed.
Stage 3: May engage in light football-related activities that involve no significant coordination, mental load or exercise.
Stage 4: Can attempt to resume normal weekly game prep and training.

This is a multi-day protocol. The neuropsychological tests must indicate he has returned to a normal, healthy level of cognitive, physical and psychological functioning. The tests RG3 will take are based on the most reliable indicators of lingering symptoms/ impairment from MTBI (mild traumatic brain injury.) Unfortunately these types of tests are far from infallible when it comes to detecting all lingering effects. The tests typically require only 30-45 minutes. Yet they allow neuropsychologists and neurologists to get a pretty good grasp of quite a few abilities that are impaired following a concussion. These areas of focus include the individual's attention, visual scanning, information processing, visual memory, verbal memory, visual-motor coordination and speech fluency.

Here's some specific examples of these types of rapid tests. (I have a couple motivations for going into this much detail.) The patient will receive 12-word lists in three consecutive trials where he will be tested on his ability to immediately repeat the words. 20 minutes later he'll be asked to repeat them again. The patient will be shown a series of abstract spacial designs. The individual is immediately tested to see how many design elements he can recall from each of the graphics. He's asked again 20 minutes later. The patient is given one minute to recall as many words as possible that begin with a given letter of the alphabet. The test is repeated 3 times (using a different letter each time) An attention test could require the patient to repeat increasingly longer strings of numbers forward and backward. Another test could require the patient to visually scan and try to rapidly match series of numbers and symbols.

So why do I go into all this detail other than to show you why you shouldn't read anything into the fact RG3 won't be practicing for a few days? It's because I've got a major problem with the NFL's approach and its potential deleterious effect on all players, including Robert. You've likely already identified the problem in asking yourself how you would do on those types of tests even without sustaining a MTBI. It's obvious the NFL's protocol leaves out a crucial step, one the NFL easily could implement. The tests, as given, don't accurately measure an individual's cognitive and psychological changes. There's no baseline. Obviously Robert's "normal" cognitive function is going to be significantly different than Michael Vick's. The NFL easily could have required and implemented standard tests that establish each player's individual baseline before training camp. Without knowing RG3's baseline, there's a significant risk he'll be allowed to return before he should. Not only are the tests not definitive but they're further weakened by the lack of a baseline. So why should fans be against Robert returning sooner rather than later? Because any athlete who suffers a MTBI is far more susceptible to another mild traumatic brain injury when he returns before every symptom of the previous concussion has completely disappeared.

Here's one more exception I take to the NFL's protocol. As far as I know the NFL does not require multi-year post-injury follow-up testing. An annual pre training camp base-line test would automatically provide this multi-year post-injury information for players at least during their careers.

It's heartening to know the vast majority of people who suffer a MTBI show no symptoms within a few short days. At the same time I don't want RG3 to permanently be more susceptible to repeated concussions because he was allowed to come back too soon.

I'm a fanatic when it comes to my Redskins but if I was given the choice between multiple Redskins Super Bowl victories or Robert Griffin's future mental and psychological health, I'd gladly accept the latter. There's no way to know what the future holds. All there is are calculated risks. That's the concussion conundrum. Here's to our coaches and quarterback correctly calculating those risks during every off-field and on-field move during RG3's career.


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