Alex Smith of the 49ers and Michael Vick of the Eagles eventually lost their starting jobs.
Starting quarterbacks in the NFL on teams with quality or rookie back-ups, take notice.
Smith and Vick may be only the first of many to be benched indefinitely after suffering the dreaded head injury.
In the NFL, head-jarring contact to the helmet or neck causes concussions on a weekly basis. In Week 13, Rashad Jennings of the Jaguars was among several players who went down.
Yet Jennings only handles the football when the offense calls his number.
Quarterbacks have their hands on the ball nearly every offensive play.
Which makes them the players among the highest risk of suffering concussions.
Following a concussion, the NFL requires players to clear a sophisticated testing protocol before returning to the field that takes, at minimum, five days.
The tests are as follows:
- 24 consecutive hours of no concussion symptoms (headache, nausea, light sensitivity and confusion among many others)
- Symptoms do not return with light activity such as swimming or biking
- Symptoms do not return with sport-specific activity, such as running in football
- Symptoms do not return with non-contact practice
- Symptoms do not return with full-contact practice
Each of the five steps lasts for 24 hours, and they must be completed in order. If an athlete can complete all five steps, they can return to play.
The NFL also mandates that players must be cleared by an independent neurologist.
However, if symptoms return during or after any of the activities, the athlete is rested for 24 hours and then resumes the testing at one level below where he or she was when symptoms returned.
Many times, symptoms do return.
They did for Alex Smith.
Enter Colin Kaepernick, Smith's back-up out of Nevada.
In Smith's absence, Kaepernick led the 49ers to a Monday Night Football slaughter of the Chicago Bears, and he has owned the 49ers' starting job since.
For Michael Vick, symptoms never went away.
Prior to Week 13, Vick "failed" his ImPACT test, a computer-based exam that tests visual memory, verbal memory, spatial reasoning and other brain functions affected by a concussion.
In other words, at the time, Vick's mental abilities were not back to his baseline.
Nick Foles has now started three consecutive games in Vick's stead, and the Associated Press reported on Monday that Andy Reid has named Foles the starter for the rest of the season, even once Vick fully recovers from his concussion.
Don't be surprised if this continues to happen in the years to come.
Heightened awareness of concussions has led to the implementation of the testing protocol mentioned above, and the nature of the protocol requires at least five days of recovery after the injury.
Because NFL games happen weekly, that means that in the majority cases, a quarterback who has suffered a concussion will miss, at minimum, the next week's game.
The reason is that concussion symptoms take time to resolve. If that resolution takes more than a day or two, there will not be enough time before a team's next game for a quarterback to be cleared.
If the backup waiting on the bench is young or highly anticipated, like Foles and Kaepernick, one start might be enough to earn the job indefinitely.
Additionally, Alex Smith's case shows that no job is "truly" safe. Didn't he nearly lead the 49ers to the Super Bowl last year?
Tyrod Taylor of the Baltimore Ravens comes to mind as a possible future injury replacement-turned-starter for Joe Flacco in the seasons to come.
Matt Flynn of the Seattle Seahawks does, as well, though Russell Wilson's heroic comeback victory against the Bears in Week 13 may have done wonders to cement his position as lead signal-caller.
So does current Heisman candidate Johnny Manziel of Texas A&M.
All of that said, it is important to note that the pendulum of concern over concussions has likely swung as far to one side as it possibly can.
As the medical community learns more about concussions, specifically about the unique nature of each individual's injury, it is possible that personalized return-to-play testing may be developed at some point in the future.
That is a conversation for another day.
Yet for the time being, a concussion could be a huge blow to the job security of a starting quarterback.
Just ask Alex Smith.
The author of this article is a soon-to-be Family Medicine resident physician with plans to specialize in Primary Care (non-operative) Sports Medicine. The above discussion on concussions is based on the author's own clinical experience in the evaluation and management of concussions under the direct supervision of Sports Medicine physicians and concussion specialists, and it can be confirmed and supplemented by the International Consensus Statement on Concussion in Sport.
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