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The NFL and Head Injuries
The stricter 2009 statement on return-to-play was developed by the NFL’s medical committee on concussions in conjunction with team doctors, outside medical experts, and the NFL Players Association in order to provide more specificity in making return-to-play decisions.
The new guidance supplements the 2007 statement on return-to-play that encouraged team physicians and athletic trainers to continue to take a conservative approach to treating concussions and established that a player should not return to the same game after a concussion if the team medical staff determined that he had lost consciousness.
The 2009 statement advises that a player who suffers a concussion should not return to play or practice on the same day if he shows any signs or symptoms of a concussion that are outlined in the return-to-play statement. It further states: “Once removed for the duration of a practice or game, the player should not be considered for return-to-football activities until he is fully asymptomatic, both at rest and after exertion, has a normal neurological examination, normal neuropsychological testing, and has been cleared to return by both his team physician(s) and the independent neurological consultant.”
“A critical element of managing concussions is candid reporting by players of their symptoms following an injury. Accordingly, players are to be encouraged to be candid with team medical staffs and fully disclose any signs or symptoms that may be associated with a concussion.”
Based on the 2009 statement, a player who suffers a concussion should not return to play or practice on the same day if any of the following symptoms or signs is identified based on the initial medical evaluation of the player:
- Loss of consciousness;
- Confusion as evidenced by disorientation to person, time or place; inability to respond appropriately to questions; or inability to remember assignments or plays;
- Amnesia as evidenced by a gap in memory for events occurring just prior to the injury; inability to learn and retain new information; or a gap in memory for events that occurred after the injury;
- Abnormal neurological examination, such as abnormal pupillary response, persistent dizziness or vertigo, or abnormal balance on sideline testing.
- New and persistent headache, particularly if accompanied by photosensitivity, nausea, vomiting or dizziness;
- Any other persistent signs or symptoms of concussion.
- “The evidence demonstrates that team medical staffs have been addressing concussions in an increasingly cautious and conservative way,” Commissioner Goodell said in a memo to the NFL clubs.
“This new return-to-play statement reinforces our commitment to advancing player safety. Along with improved equipment, better education, and rules changes designed to reduce impacts to the head, it will make our game safer for the men who play it, and set an important example for players at all levels of play.”