Bills Concussion Woes

Reviewing the NFL concussion protocol including return to play criteria and how this affects the Bills QB situation.

It’s been well known that being a Bills fan is hard. Losing Super Bowls, long extended playoff droughts, ill-timed injuries, the list goes on and on. Right now, that trend appears to be continuing with the 2017 preseason. After the loss to the Ravens by a score of 13-9, the Bills are now 0-3, heading into a show down at New Era Field tonight against the Lions. As mentioned last post, the Bills continue to demonstrate some luck by missing all the ACL tears, sprains, and injuries that can derail a season even before it starts. Unfortunately, the Bills don’t escape totally free. Tyrod Taylor and T.J. Yates both went down with concussions, leading Nathan Peterman to play most of the game. After Taylor and Yates entered the concussion protocol, the Bills signed Keith Wenning to fill in until both QB’s are medically cleared.

After a player sustains a concussion, the player enters the NFL concussion protocol. Most of the time, that’s all we hear until the player is cleared to return to play and contribute. But what does the NFL concussion protocol consist of? What is classified as a concussion? I will break down what classifies a concussion, what the protocol looks like, and the general timeline to return. Hopefully, this will give a clearer indication of what to expect.

A concussion is defined as a violent blow to the head which can disrupt brain function temporarily. Some concussions cause loss of consciousness, but not always necessary for a official concussion diagnosis. The brain is surrounded by cerebrospinal fluid which helps bring nutrients to the brain along with providing some protection during light trauma. However, the brain does not have air bags to protect from larger impacts. In the case of a more significant blow, the brain will strike against the inside of the skull, and then possibly strike the other side of the skull. This is known as a coup-contrecoup injury. This does not always happen in every concussion, but may intensify the symptoms if more areas of the brain are affected.

Upon striking the brain, immediate changes occur with physical symptoms including headaches, confusion, amnesia, dizziness, nausea, vomiting, fatigue, and delayed response time. Further symptoms include sleep disturbances, light and noise sensitivities, irritability, and difficulty with concentration, among other symptoms.

The NFL Head, Neck, and Spine Committee came up with a comprehensive protocol to identify and effectively treat a concussion. To keep it brief, the criteria are: a direct blow to the head or a force that translates towards impact to the head; rapid onset of transient impairment of neurological function, changes in neuropathological changes, and clinical symptoms that may or may not involve a loss of consciousness.

Down on the field, the NFL uses the SCAT2 which is the Standardized Concussion Assessment Tool to assess the player. This protocol has been modified for the NFL and is consistent with the SCAT3 released in 2013. The advantage is that this test can be administered multiple times with valid results to determine a concussion immediately or if symptoms are delayed. This is a test to assess for a concussion but a more formal screening process is done during the preseason and after suspected concussion to fully diagnose.

Each NFL team has a plan in place consisting of an unaffiliated neurotrauma consultant and ATC spotter to indicate whether the player may have a concussion. The player must have been removed from the field, video replay must have occurred of the injury, and an assessment must be performed. If there is any doubt of whether a concussion has been sustained, then the full evaluation must be performed. No more will there be a player being waved back into games or being rushed back in. Numerous players have stated they went back into games and they don’t remember being a part of those games when asked later.

Players will continue to be checked periodically to ensure they do not develop symptoms later and incur further damage. These results will be checked against their baseline assessment to determine the severity. Players could exceed the baseline score but still have a diagnosis of a concussion. This prevents a physician from looking at the diagnosis of a yes/no and look at the entire situation rather than a score.

If the player has sustained a concussion, there are 5 levels of recovery that must be performed in order to return to the game. These must be achieved in order to be medically cleared to return to playing. They are as follows:

  1. Rest and recovery: Players should avoid or limit meetings, social media, electronics to allow the brain to rest and minimize symptoms until player returns to baseline function. The player may engage in stretching and balance activities that allow them to lightly stress the body and being the process to improve. During this time, neurocognitive testing will be performed to assess for clearance towards normal activities.
  2. Light Aerobic Activity: A graduated exercise program consisting of cardiovascular exercise which may include a stationary bicycle or treadmill along with stretching and balance activities. This will be gradually increased as the player remains symptom free and begin to return to team meetings, film study, etc.
  3. Continued Aerobic Exercise and Introducing Strength Training: Cardiovascular exercise will continued to increase intensity and simulate the sport specific activities, progressing to supervised strength training. Once again, if the player is symptom free, they can proceed.
  4. Football specific activity: All activities continue to increase in intensity and duration and resume football activities. These activities must remain non-contact to ensure no recurrence of symptoms.
  5. Full football activity/clearance: Once the player has achieved the first 4 steps, contact may be re-initiated and determine that they have no recurrence of symptoms. The player will be reevaluated by a team physician and if cleared, resume normal activity. If at anytime the player experiences symptoms, they are placed back in the concussion protocol and restart the process until they are symptom free.

If you would like to review the actual documents in greater detail, please click here & here.

While this is a fairly comprehensive protocol, this should continue to improve as we learn more about concussions. Unfortunately, this protocol does not give a specific timeline for return as each concussion is different. Observing the hit on Taylor showed him getting his bell rung may keep him out for an extended period of time. Yates concussion was not as clear as when it occurred which may indicate a better prognosis. While it is not guaranteed that Taylor will be ready to start, CBS Sports reports that Taylor should be ready by Week 1 and has not had any setbacks. Recent reports on Twitter that he is out signing autographs before tonight’s game, tolerating lights and music which could signify he is already on Level 2-3. I believe Taylor will be cleared to start Week 1 and lead the offense to several touchdowns. Continue to follow for updates following cut down day, full recap of preseason injuries, and analysis of the Bills going into Week 1.

Author: Dr. Trimble

My name is Dr. Kyle Trimble and I am, first and foremost, a Buffalo Bills fan!! When I am not cheering on the Buffalo Bills, I am a Physical Therapist. To give a background on myself; I was born and raised in Erie, PA, moved to Buffalo in 2006 to begin my studies at D'Youville College towards becoming a Physical Therapist at which time I became a devoted Buffalo Bills fan.  I graduated in 2013 with my Doctorate in Physical Therapy and moved home for several years. Moving back to the Buffalo area in 2016, I have gained extensive experience in outpatient orthopedics, skilled nursing, acute care hospital, and home care. Having obtained a significant wealth of knowledge that continues to grow, along with a undying fandom of the Bills, puts me in the unique position to educate my fellow fans about our great team. 
I am currently an injury spotter working with Dr. David Chao, Orthopedic Surgeon @ProFootballDoc based out of San Diego. In this role, I provide real time updates regarding injuries during the game. I hope you enjoy what I publish and I welcome any comments or questions you may have.
Disclaimer: My opinions are my own.  Any thoughts I have on the injuries is based on media reports, my knowledge of the injury, and speculation based on the information currently available.


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