Michael Vick's Concussion: Effects of Repeated Injury Are Validating NFL Policy

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Michael Vick's Concussion: Effects of Repeated Injury Are Validating NFL Policy
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As the weeks go by, Michael Vick's concussion is becoming more and more concerning.

It is also serving as validation for the NFL's strict concussion policy.

Vick suffered his concussion all the way back on November 11th during the Philadelphia Eagles' Week 10 38-23 loss to the Dallas Cowboys.

Nick Foles has started for the Eagles since, and this week, Andy Reid named Foles the starting quarterback for the remainder of the season regardless of Vick's health.

Yet the story doesn't end there.

According to the Associated Press, Vick has once again been ruled out for Week 14, the fourth game in a row that he will miss due to his concussion.

The fact that Vick is still experiencing symptoms should not be overlooked just because he is no longer the Eagles' starter.

Quite the opposite.

Tom Pennington/Getty Images
Nick Foles will remain the Philadelphia Eagles' signal-caller for the remainder of the 2012 season.

Vick's persistent symptoms represent an ominous sign for his future as well as a testimony to the necessity of extreme caution when handling concussions.

NFL policy dictates that an athlete must complete a series of five tests before returning to play:

  1. Symptoms (headache, nausea and confusion, for example) resolve for 24 consecutive hours
  2. Symptoms do not return with light activity
  3. Symptoms do not return with sport-specific activity
  4. Symptoms do not return with non-contact practice
  5. Symptoms do not return with full practice

Each test is 24 hours long, and they must be completed in order.

If an athlete can complete all five tests without return of symptoms, he or she can return to competitive play.  In addition, the NFL requires clearance from an independent neurologist.

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However, if symptoms return during any step, the athlete is rested for 24 hours and then resumes the process at one step lower than where he or she was when symptoms resurfaced.

Vick remains on step four, the step that an athlete could theoretically complete a mere four days following a concussion.

Yet for Vick, it has been nearly four weeks, and his symptoms remain.

That is extremely concerning for two reasons.

First, Vick has suffered at least one concussion previously (and likely more during his long football career that either went undiagnosed or undocumented), and repeated concussions can make subsequent concussions more severe and longer lasting.

Second, most concussions would have resolved by now.

In their 2006 article in the scientific journal Practical Neurology, Tim Anderson and colleagues wrote that most of the time concussion symptoms resolve on their own within two to three weeks, but sometimes they "can be disabling and require specific investigation and treatment."

It appears that Vick's most recent concussion falls into that category.

According to the same aforementioned report by the Associated Press, Philadelphia Eagles' athletic trainer Rick Burkholder said on Friday that Vick is undergoing additional testing such as eye-tracking monitoring.

Diagram of the nerves, canals and structures of the inner ear, one of the areas that can be affected by concussion. Vestibular therapy helps to restore its proper function. Photo from Wikimedia Commons.

Also called vestibular therapy, eye-tracking and more intensive balance testing are usually only used if recovery from a concussion is occurring very slowly or has stalled out, as Burkholder claims Vick's has.

Burkholder also said that Vick has still not passed his league-mandated ImPACT Test, meaning his cognitive abilities are still not back to normal.

In other words, doctors are concerned.

They should be.

A few weeks ago, I suggested that the Eagles would be best-served to rest Vick for the remainder of the season.  This suggestion was based on the fact that the hit or hits that caused Vick's concussion were not terribly impressive when compared to, for instance, the collision that knocked Darrius Heyward-Bey unconscious.

Now, those not-terribly-impressive hits on Vick have caused a concussion that has lasted a whopping 27 days and has no end in sight.

That suggests that the force of impact needed to give Vick a concussion is low, and Vick's concussions can result in unusually persistent symptoms.

Runningback Jahvid Best suffers a frightening concussion as a member of the Cal Golden Bears. Now in the NFL, Best was placed on Injured Reserve this season by the Detroit Lions in November due to persistent symptoms stemming from two concussions in 2011. He has now suffered at least three concussions, and this year marked the second time he was placed on season-ending Injured Reserve due to the injury.

For the sake of his future, both on the field and off, the Eagles should place Vick on Injured Reserve and allow him to recover away from the football field.  Such a move could help him avoid any additional physical or cognitive stress that could lead to a scenario similar to that of Pittsburgh Penguins player Sidney Crosby.

Despite the frustrations it can produce, the NFL should also continue to mandate, and possibly augment, its strict concussion protocol.

Improper management of concussions, returning to play too early and repeated hits to the head before full recovery has been attained can lead to drastic short-term and long-term consequences.

One of those consequences is the dreaded post-concussion syndrome, a condition where the symptoms of a concussion persist for months or even years following the injury, leading to a dramatically decreased quality of life.

Fortunately, post-concussion syndrome is rare.

Unfortunately, concussions are not.

Eventually, better diagnostic techniques and concussion prevention strategies will come about.

Until then, the occasionally overwhelmingly large amount of caution when handling the injury needs to stay.

Michael Vick has reminded us why.

 

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 information on concussions discussed above 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 by the recommendations from the 3rd International Consensus Conference on Concussion in Sport from November of 2008.  A 4th International Conference was held in November of 2012, and highlights of the newest recommendations that are currently pending publication can be found here.


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