Alex Smith's Trade Following Week 10 Concussion Adds Fuel to Growing Fire

Dave Siebert, M.D.@DaveMSiebertFeatured ColumnistFebruary 28, 2013

ATLANTA, GA - JANUARY 20:  Quarterbacks Colin Kaepernick #7 and quarterback Alex Smith #11 of the San Francisco 49ers warm up before taking on the Atlanta Falcons in the NFC Championship game at the Georgia Dome on January 20, 2013 in Atlanta, Georgia.  (Photo by Streeter Lecka/Getty Images)
Streeter Lecka/Getty Images

A sequence of events set in motion by Alex Smith's Week 10 concussion culminated on Wednesday when Fox Sports' Jay Glazer reported the San Francisco 49ers quarterback will be moving to the Kansas City Chiefs next season (h/t Will Brinson, CBS Sports).

The move will be analyzed and re-analyzed ad nauseam over the coming weeks and months, and it will be done so from a football point of view, a draft point of view and a financial point of view. Just as importantly, it will also be evaluated from a medical point of view.

At the time of his concussion, no one knew that Smith would eventually be replaced due to the injury. That is bad enough. What's even worse—now everyone does.

In hindsight, the writing was on the wall. Though he consistently led the 49ers to victory, Smith never made jaws drop, and the perfect storm of his concussion, an electric backup in Colin Kaepernick and a struggling Chicago Bears team eventually sealed his fate in San Francisco.

The ramifications of Smith's saga extend far beyond the 49ers and Chiefs. Players will not look at the trade and see a quarterback who left one team for another due to the ascension of the talented, young Kaepernick. Rather, they will see a player who—as a direct result of a concussion—went from captaining a perennial Super Bowl contender to instead taking snaps for a badly struggling franchise.

More importantly, they will also be correct.

Like it or not, concussions aren't going anywhere. Current technology cannot prevent the brain injury, and the medical community now knows that concussion deterrence does not simply come down to thicker helmets.

As a result, emphasis should continue to be placed on the proper management of concussions. Unfortunately, the completely understandable business and football move of benching and then trading Alex Smith threatens the foundation of concussion treatment altogether—a player's self-report of symptoms.

If, after years and years of training, a bench player successfully scratches and claws his way to a starting position in the ultra-competitive NFL only to watch players around him lose their jobs due to concussions, what will he likely elect to do? Will he report his symptoms and risk the bench, or will he try to secretly push through them?

For an answer to that question, look no further than Greg McElroy of the New York Jets.

Last December, McElroy reportedly hid his concussion symptoms from the Jets medical and training staffs in an effort to keep his starting job. Gregg Rosenthal beautifully summed up McElroy's flawed logic when he wrote, "Greg McElroy got the first start of his NFL career last week. He didn't want anything—even a concussion—to stand in the way of his second start."

In some ways, McElroy's reasoning is understandable, but fighting to keep a starting job is one thing.

Just not getting it is another.

In a January interview with Tom Junod of Esquire magazine, Denver Broncos running back Willis McGahee said he didn't consider his 2009 concussion an "injury."

"So you don't consider the concussion an injury?" Junod asked.

"That's what they consider it." McGahee responded. "But getting a concussion and hurting your knee are two different things. You get back up from a concussion."

Junod then continued:

Willis McGahee was knocked out cold against the Steelers. He went out on the board. He didn't consider himself injured, though, because like all NFL players he considers himself an expert in what qualifies as an injury and what doesn't. The loss of consciousness he suffered in Pittsburgh didn't qualify because it didn't require rehabilitation. It didn't put his career in jeopardy. It didn't exile him from his teammates.

And most of all, it didn't hurt.

A similar situation occurred this year involving New York Jets defensive lineman Muhammad Wilkerson.

After the Jets reported Wilkerson suffered a concussion during their Dec. 23 game against the San Diego Chargers—a medical diagnosis—Wilkerson insisted he did not (h/t Matt Ehaly, When asked about the team putting him through the concussion-testing protocol, Wilkerson said, "They were making sure I didn't have a concussion. But I didn't have one. I just showed symptoms, but I was fine."

What may initially seem like a logical statement is actually representative of the disconnect that still exists between medical personnel and players—showing symptoms is a concussion. Whenever a player has difficulty maintaining their balance, becomes nauseous or "sees stars" following a blow to the head, a concussion has occurred.

In other words, formal concussion education—such as the Pittsburgh Steelers' new program aimed at school-age children—needs to be re-emphasized. Rumors and hearsay regarding the severity of the issue mean nothing if a player isn't willing to recognize the symptoms when they arise.

The placement of independent neurological consultants on the sidelines will help somewhat. However, formal concussion education and pen-on-paper testing may soon prove to be a needed next step.

Frankly, the fact that such a protocol remains nonexistent is staggering. As the world's preeminent football organization, the NFL and NFLPA must lead the way in this area, not follow suit (h/t B/R's Bryan Toporek).

Regrettably, Alex Smith's pending relocation as a downstream consequence of a concussion certainly does not help the problem. There is no denying that Smith might very well have started this year's Super Bowl had he been able to play Week 11.

Reporting concussions is—without exception—in a player's best interest, and Smith's benching and looming trade does not represent evidence to the contrary. Rather, it represents an unfortunate reality of the modern-day sport of football. Hopefully, that reality will one day change, but that day is not today.

The brutal truth is that the NFL faces serious scrutiny from countless groups over the safety of the game. Lawsuits, concern over chronic traumatic encephalopathy (CTE) and criticism of the violent nature of the sport abound, and players hiding concussions will only serve to continue to set back the public's perception of the sport.

After all, if the NFL doesn't exist in 30 years, there won't be any starting jobs to cling to, anyway.



Dave Siebert is a medical Featured Columnist for Bleacher Report who will graduate from medical school in June. He plans to specialize in both Family Medicine and Primary Care (non-operative) Sports Medicine. Concussion information discussed above is based on his own knowledge.


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