The NFL's battle against concussions certainly isn't getting any easier, and the reluctance of New York Jets quarterback Greg McElroy to discuss his symptoms may prove to be one of the biggest setbacks yet.
The always-entertaining quarterback soap opera in New York continues to outdo itself.
Unfortunately, its most recent development cannot be merely pushed aside as just more Jets drama.
Quite the contrary.
According to Jane McManus of ESPNNewYork.com, McElroy hid his concussion symptoms from coaches and trainers for at least part of this week.
However, that is not to say that no one knew.
As McManus also reports, McElroy approached his teammate, wide receiver Clyde Gates, on Christmas night for advice about his symptoms. Gates suffered a concussion of his own earlier this season.
Gates later told ESPNNewYork what he advised McElroy:
Bro, I know, I've been down that road already. I'm just saying you can't try to tough it out 'cause you going to end up hurting yourself. You've got to let everybody know how you really feel.
McElroy eventually followed Gates' advice.
But not until he developed a headache during a morning workout on Thursday, four days after his injury.
Clearly, McElroy thought he could work through his symptoms on his own, as his teammate, left guard Matt Slauson, claims he has done in the past.
"I didn't feel like it warranted [being reported]," Slauson told ESPNNewYork. "I was in bad shape, but I could focus on my plays. I figured I'd pop a couple Aspirin and be fine."
And there, ladies and gentlemen, lies the biggest problem facing the NFL about concussions: subjectivity.
Like it or not, the days of "shaking off" a concussion are over.
We know too much about the short-term and long-term consequences of brain injury to allow it to be handled lightly.
Yet as McElroy proved this week, coaching and medical staff can exert only so much control without a player's help.
The core of the problem lies in the fact that concussion symptoms are mostly player reported—a headache, some minor nausea, slight difficulty concentrating. Without a player admitting to these symptoms, the rest of the world might never know what he is going through.
Yes, some concussions result in loss of consciousness, obvious confusion, disorientation and vomiting.
But most don't.
To make the situation even more complicated, concussion symptoms often arise days or weeks later. This can give the false illusion that a player may have escaped a hit unscathed.
It also makes it easier to attribute future symptoms to illness or not sleeping well.
Nevertheless, trainers and medical personnel only have so much ability to detect concussion symptoms objectively.
For instance, following a severe concussion, an athlete may have difficulty tracking an object with his eyes. An examiner can observe this by asking a player to follow the examiner's finger with his eyes only.
A concussed player's eyes will often, without the player knowing, follow the examiner's finger at different rates. In other words, one eye "lags behind" the other.
This occurs because of decreased brain blood flow and less efficient energy utilization by the brain—specifically by the back of the brain—the hallmark of a concussion.
Sideline memory and orientation tests can also bring out an athlete's symptoms.
That said, the most common—and sometimes only—symptom of a concussion is headache, one entirely reliant on a player's report.
McElroy's case shows that while concussion awareness has recently increased, players themselves are lagging behind.
Can you blame them?
Michael Vick and Alex Smith already lost their starting jobs this season as direct results of concussions, a new trend I wrote about earlier this season that will only gain momentum in the coming years.
Add Greg McElroy to that list.
The trend represents a very real threat to quarterbacks due to the fact that league protocol requires players to miss at least five days of action following concussions as they progress through testing, and games are usually separated by only seven days.
Briefly, following a concussion, athletes must, in order:
- Be asymptomatic for 24 consecutive hours
- Participate in light activity—such as swimming—without symptoms returning
- Participate in sport-specific activity—such as running—without symptoms returning
- Participate in non-contact practice without symptoms returning
- Participate in full-contact practice without symptoms returning
Each step takes 24 hours, and if a player reexperiences symptoms at any point, he is rested for 24 hours before resuming the process one step below where he was when symptoms returned.
There is method to this madness.
The testing sequence represents a slow, stepwise return to play that ensures symptoms are truly resolved. The decreased blood flow to the brain in a concussion can hide itself when a player is at rest and may need to be brought about by increasing levels of exercise.
In McElroy's case, that exercise was Thursday morning's weightlifting session, and he put himself at huge risk by not reporting his symptoms until then.
Though incredibly rare, the dreaded second-impact syndrome (SIS) is a documented potential consequence of returning to the field of play too soon following a concussion.
In SIS, a second hit to the head causes a concussed brain to swell, potentially leading to permanent disability and even death.
Post-concussion syndrome, where concussion symptoms last for weeks, months or years after an injury, is also possible.
Additionally, scientists are just now scratching the surface of chronic traumatic encephalopathy (CTE), a chronic, permanent brain disorder that has the potential to drastically affect a player's long-term quality of life.
To avoid these outcomes, players must be educated further about concussions. The importance of reporting symptoms also needs to be re-emphasized.
Yet concussions are an ever-changing area of research.
As more technology and information comes out, the NFL must adapt and restructure its concussion-monitoring and -testing procedures.
Yes, it may lead to more quarterbacks losing their jobs.
Yet it may also lead to a safer game with fewer players hiding symptoms—something that has assuredly occurred countless times in the past but gone unrecognized.
However, one thing remains clear: The concussion problem is very, very real.
And as McElroy showed us this week, it isn't going away anytime soon.
Dave Siebert is a medical/injury Featured Columnist for Bleacher Report who will graduate from medical school in June 2013. He plans to specialize in and practice both family medicine and primary-care (nonoperative) sports medicine with a special focus in concussions. Injury information discussed above is based on his own knowledge and experience in the evaluation and management of concussions under the direct supervision of sports-medicine physicians and concussion specialists.