Players gaming the concussion protocols…

just read this excellent article from the Althetic. i know it’s specific to NFL but i think it applies to CFL too.

i’m going to post the whole article here, since it’s behind the paywall. it’s long but well worth the read.

'We make our paychecks by being on the field': NFL players game sideline...

by Kaylen Kahler

A defensive starter in the NFL blitzed into what looked like an uncovered gap when the opposing right tackle peeled off his assignment and the left tackle pushed another player across the formation, sandwiching the defender between their 300-plus-pound bodies.

The two tackles’ helmets knocked the side of the defender’s helmet and compressed it. He felt like he’d been punched in the jaw. He knelt on the field, slow to get up.

An official saw all of this and pulled the defender off the field for a concussion evaluation. Just three days earlier, Tua Tagovailoa had left the Dolphins game in Cincinnati in an ambulance after his head hit the turf hard and his arms and fingers froze in the bent pose that indicates a brain injury.

This defensive player, who requested anonymity because his team didn’t authorize him to speak for this story, watched that Week 4 Thursday night Dolphins-Bengals game with his whole position group. They’d all seen the replays from the previous Sunday, when Tagovailoa shook his head and stumbled to the ground after a big hit against the Bills. They talked about how messed up it was that Tagovailoa played in the Thursday night game. How was he even out there in the first place?

After being sandwiched by the two tackles, the defender found himself in a similar situation, pulled from a game to go through the concussion test after a questionable-looking hit.

“It’s a hot topic in the NFL,” he said.

This player said he suspected he didn’t have a concussion because he’s had two earlier in his NFL career, and those didn’t feel like this.

“I usually can tell because I find myself wandering,” he said. “I’m not thinking about the score or the plays we are running, I will start thinking about, ‘Oh man, did I have clothes in the dryer that I forgot to take out?’ And I’ll go from thought to thought to thought kind of randomly, and at that point, I’m like, ‘Oh s—, I have a concussion.'”

He self-reported symptoms during games for both of his prior concussions as a pro. This was the first time he’d ever been pulled from a game by someone else. He knew what it looked like when he went down to one knee to collect himself after getting smushed, but he didn’t feel any of that usual mind wandering. He said he chose to stay down longer than necessary to allow his coach to make a substitution.

“My face hurt,” the player said. “I didn’t want to play the next play knowing my face hurt because I might not be as willing to make the tackle that I need to make.”

The player’s team doctor and the unaffiliated neurotrauma consultant asked him the time of the game, who they played last week, what time of day it was and what just happened on the play. He answered all the questions correctly, then the two doctors consulted their tablets to watch the film of what happened to him on the play. They both agreed that there wasn’t enough forceful contact to the head, so they cleared the player to return for the second half.

In this instance, the in-game concussion evaluation process seemed to have landed on a safe decision. But the defender said he is extra cautious when it comes to taking hits to the head — his first concussion, which came as a teenager, resulted in a scary blackout — and is not representative of other NFL players, many of whom are not as experienced with brain injuries.

And even this player, who has voluntarily removed himself from games, admitted that his familiarity with the sideline concussion test means he could probably successfully get back into a game even if he was concussed.

“I know when they do the concussion test they are going to give me 10 words at the beginning of the test and then ask me a whole bunch of random other s— to try to get my mind off of it and then bring up those 10 words at the end of the test,” he said. “So I know if I just keep saying those 10 words over and over and over in my head while I am answering other questions … it will be like my ‘short-term memory recall’ is there.”

The eight players interviewed for this story — seven former and one current — each have different experiences with the league’s concussion protocol, but they all agreed on one thing: When dealing with the question of whether or not to pull someone off the field because of a suspected concussion, the onus often falls on the player to make his own diagnosis in a very personal conflict of interests.

“Players are going to want to play, that’s what we do for a living,” the defender said. “We make our paychecks by being on the field.”

In the immediate moments after the Bengals beat the Dolphins, 27-15, Amazon Prime Thursday Night Football contributor and former Bengals and Rams offensive lineman Andrew Whitworth told his own story about passing the sideline evaluation in 2012, a year before the NFL and NFLPA added an independent neurologist to the protocol.

“I can literally remember playing the Philadelphia Eagles on a Thursday Night Football game myself years ago getting concussed, wobbling around, a ref actually removed me from the game,” Whitworth said on Amazon’s broadcast. “I go back in the game because you want to play, I was able to get myself through the test and explain that I’m fine. I seemed pretty good. And then I had a teammate that was like, man, this guy is just not right and I don’t feel right, letting him keep playing. And he actually pulled me out of the game and told the coaches I need to be removed.”

A week later, Whitworth expanded on how he’d skated past the sideline concussion test after demonstrating “gross motor instability”, or wobbling around after a play. He’d just landed back in L.A. after broadcasting a game in Denver that saw Colts running back Nyheim Hines demonstrate that same gross motor instability and leave the game for good.

Whitworth said he was pulled from the 2012 TNF game after a safety threw his shoulder in late to hit a running back on top of the pile but caught Whitworth on the side of the head instead, right in the earhole of his helmet. An official saw Whitworth fall in both directions after he tried to stand up from a big pile.

“I can remember just being in a daze, like feeling that I wasn’t there but I was,” he said. But that didn’t stop him from successfully passing the sideline test.

“They ask you the generic questions, what’s the date, where are you?” Whitworth said. “I think anybody who is somewhat cerebral and intelligent could pass that test in any state.”

Former NFL quarterback and current ESPN analyst Matt Hasselbeck said that because players get evaluated for concussions regularly, sometimes after “any kind of normal hit,” there’s a level of familiarity with the test that works against the process.

“You know what the questions are,” he said. “They are going to ask you to remember three random words. ‘Refrigerator, gasoline, Alabama,’ something like that, and then they are going to do the test and then at the end they are going to ask you the three words. You know that, and you know you are going to get asked to do the alphabet backward, which is hard anyway. You know you are going to get asked to count backward from 100 by 7, you know you are going to get asked a lot of different things.”

In 2015, Hasselbeck, then playing for the Colts, got hit in the jaw in the fourth quarter of the Week 15 game against the Texans. Houston linebacker Whitney Mercilus rushed up the middle and slammed the top of his helmet into Hasselbeck’s chin as he drove him backward into the ground. Hasselbeck’s head hit the turf when he landed, and he didn’t try to get up, grabbing his facemask while the Colts’ medical staff rushed onto the field.

Hasselbeck was in his final NFL season at 40 years old, and he’d been starting the second half of the season for an injured Andrew Luck. The Colts, at 6-7, were locked in a battle to hold the division over Houston.

“I was competitive, I knew that the backup to me probably wasn’t ready to play, he had just got there,” Hasselbeck said. “I was Luck’s backup, now I’m in the game, it just gets thin after me. I didn’t want to let the team down. We win the game and go to the playoffs. We lose the game, we probably don’t go.”

So with the doctors kneeling over him, Hasselbeck repeatedly pointed to his jaw. And when he headed to the bench to get checked out by the team doctor and the independent neurologist, he was explicitly clear about what his problem was and what it wasn’t.

“I was just really really, emphasizing, ‘No, no I can’t hear, no it’s just my jaw, my mouth, my jaw, my mouth,” he said. “‘How’s your head? How’s your head? How’s your head?’ ‘No, no, my head’s fine, just my ear, no, no, no, it’s right here, it’s right here, no I got hit in the chin. Are my teeth OK? Is my mouth bleeding?’

“I don’t want to say I was throwing him off the scent.”

Hasselbeck isn’t sure if he had a concussion at that moment or not. His other documented concussions in the NFL presented more severe symptoms — one caused him to vomit on the sideline and another made him so dizzy he couldn’t walk to the correct bench. In the game versus Houston, Hasselbeck ended up getting diagnosed with a sprained jaw. He couldn’t hear well out of his right ear, but he returned to the game for the Colts’ next drive, with three minutes left in the game. The Colts lost, 16-10, and Hasselbeck’s hearing was “cloudy” in his right ear for months afterward.

“Quite honestly,” Hasselbeck said, “Now that I am looking back, my jaw hurts more, my ear — not being able to hear was a really big thing — but to think there was no head issue also, like, I am probably lying to myself or not capable of really giving an honest answer.”

Ben Braunecker played tight end for the Bears from 2016 to 2019, when he decided to quit football after his second concussion in the NFL left him with double vision in his right eye. He couldn’t get a concrete answer as to whether his vision would get worse if he continued to play football.

“Plus, who wants to hire a guy that, you know, has vision damage?” he said. “Our job is to catch a football.”

So when the Bears released him in July of 2020, he decided to quit. He’s now in his first year of medical school at Mayo Clinic Alix School of Medicine in Arizona, where he’s studying to become a neurologist and help bridge the gap between brain science and football players.

Braunecker self-reported for both of his NFL concussions, the first during a game, a few minutes after the contact; the second following a game, three quarters of football after he knew he’d been concussed.

“Playing football, you experience central nervous system symptoms regularly, depending on the hit,” Braunecker said. As he spoke, it was 6:30 a.m. Mountain time, but he’d been up for two hours already studying anatomy.

“I would lose vision temporarily for a second or two, and that happens all the time. It’s the duration of the symptoms; I was kind of waiting and seeing how long it would last, because if this goes away in a minute, I can still play.”

His vision didn’t clear after the hit in 2018, and he self-reported when it got really blurry.

“I felt as if I was detached from reality, I was watching myself play in the game,” he said. “Like I was watching a movie of my experience.”

The stakes were higher when Braunecker got his second concussion. It was Week 12, 2019, and the two tight ends ahead of him on the Bears’ depth chart were both hurt. This game was his audition for the starting job. In the first quarter, he caught a short checkdown pass and then got nailed helmet to helmet by a Giants linebacker. When Braunecker stood up to point for the first down, he pointed across the field, instead of ahead. But no one took note of the forceful hit, not even Braunecker.

“I didn’t really think anything of it,” he said. “Other than it felt like head-to-head and was pretty jarring.”

On the next play, he ran a seam route and was wide open for what would have been a touchdown pass. But the ball went right between his outstretched hands.

“I was like, ‘What is going on?’ I couldn’t process the ball flying through the air,” he said. “My brain couldn’t make that connection and make the catch. My heart was pumping so hard. The adrenaline in the moment masked the way I was feeling, and I think the disorientation was real, I couldn’t make a pretty routine catch.”

A couple minutes later, he felt that same dissociation from reality again, and it got worse as the game went on.

“I don’t really have a good reason why I didn’t self-report in that instance,” he said. “I didn’t want to miss my shot, but then again, I was obviously inhibited … I was physically inhibited, and maybe cognitively. I wasn’t making correct decisions.”

In the locker room after the game, Braunecker told his position coach he wasn’t feeling right. He ended up never playing in another NFL game.

“I could have continued to hide it and play the next week, but I feel like it would have only gotten worse,” Braunecker said. “I demonstrated that same sort of behavior, like not wanting to get off the field, hiding my symptoms until I knew I was concerned for my own health and safety. But if I lacked that concern, or if I didn’t cross that threshold where I valued that it was more important for me to report than continue to play, then I would have continued to play.”

Braunecker said that at some point before the regular season, the team physician would give a presentation to the team going over common injuries, including concussions, and explaining the players’ obligation to report their symptoms to the medical staff. But “during the season, nobody is reminding you.”

If a player can’t or won’t self-report, it often falls on teammates to take action. Whitworth would have played out the rest of that game if it weren’t for a Bengals teammate intervening.

Hasselbeck has been that intervening teammate before. When he was a backup quarterback in Green Bay in 1999 and 2000, he said, an athletic trainer asked him about a tight end who had been hit hard blocking during a touchdown play.

“(The trainer) said, ‘Hey, will you talk to him on his way off the field right now, just to make sure he’s OK?” Hasselbeck said. “Ask him some questions, make sure he is OK? So I literally walk on the field — the guy is coming off the field — and I say to him, ‘Hey, what was the play call on the TD run?’ He’s like, ‘What? Oh, I don’t know, I wasn’t in on that play.’ I was like, ‘Yeah you were!'”

The trainer then removed the player from the game.

“I think it takes teamwork,” Hasselbeck said.

One veteran NFL agent who requested anonymity said teams have unfair expectations when it comes to players reporting their own concussions. Last season, he said a player he represents had a concussion and missed a game while in the protocol. The player returned before going back into the concussion protocol later in the season for lingering symptoms and eventually landing on IR. According to the agent, a team employee called him and encouraged the player to be more forthcoming with how he was feeling.

“I said, ‘Think about what you just said,'” the agent said. “The guy had an injury to his brain and you are telling me, ‘We know he can’t think clearly, but you need him to think clearly enough so that you can (cover your ass).’ He has a brain injury!

“Some teams think that their instincts are for the player, but they’re not.”

A change to the protocol announced last week means that players who stumble the way Tagovailoa and Whitworth did will not be allowed to re-enter a game. Ataxia, poor muscle control that causes clumsy voluntary movements, is now a no-go symptom. It’s meaningful, but it doesn’t solve every flaw in the protocol.

For the concussions that present differently, it’s still on the players to disclose their symptoms, and as Whitworth said, they know how to game the system.

“The onus comes on the player,” the current NFL defender said. “There’s no way to peer in a player’s head and know what is going on inside.”


Good article. Been there. Not an easy place