Hard knock life

Doc wraps his head around the NFL’s concussion problem

“The object of the game of football – getting from one end of the field to the other – can be achieved without hurting players, whether it is on the NFL, high school or college level,” says Javier Cardenas, a neurologist and brain injury expert with Barrow Neurological Institute at St. Joseph’s Hospital and Medical Center in Phoenix.

Cardenas specializes in diagnosing and treating traumatic brain injuries and serves as an unaffiliated neuro-trauma consultant (UNC) for the National Football League.

“This is the first season for UNCs,” he says. “Two are assigned to each of the 32 teams in the NFL. We attend each game and are there to assist team medical staffs in the diagnosis and management of suspected concussions or spine injuries that may occur during the game. We serve both home and away teams. I am usually at the Arizona Cardinals’ games but can go anywhere.”

Spotlight on a problem

The establishment of UNCs comes at a time when the NFL has tentatively agreed to a $765 million settlement over concussion-related brain injuries among its 18,000 retired players.

“Football is the number one sport for concussions, simply because it is the highest contact sport,” says Cardenas, who received his medical degree from the University of Arizona in 2004. “With literally millions of young people playing, it is a ripe environment for concussions, but it is only recently that the matter has really come to be forefront of public interest and discussion. The interest has been sparked largely by the focus on what has happened to many NFL players who have sustained multiple concussions followed by long-term damage.”

As a result, fans and the players themselves started to ask questions and the NFL was forced to respond. Initially the NFL published its own studies saying that returning to play after a concussion did not involve significant risk of a second injury in the same game or during the rest of the season. But the league backtracked when a host of independent studies contradicted its findings and injured players started to come forward to tell their stories.

“Returning to the field too soon after concussion injury is the leading cause of long-term problems,” Cardenas says. “We call this second-impact syndrome. The first impact may be relatively minor, but even a minor concussion causes swelling of the brain. If a player goes back to playing before the swelling has completely gone down and a second concussion occurs, he can be in serious trouble, including being at risk for dying.”

Cardenas says that on a national level about a half-dozen young football players die each year from second-impact syndrome.

Multiple concussions, often experienced by NFL players, can lead to a host of prolonged and debilitating symptoms over time. These include loss of brain function, chronic headaches, attention disorders, depression, amnesia, dementia and symptoms like those of Parkinson’s disease.

“One now-documented condition, chronic traumatic encephalopathy, or CTE, has actually resulted in some player suicides,” Cardenas says. “Victims are plagued by behavior and personality changes, alternations in their ability to think and a range of physical symptoms. Unfortunately, CTE can only be diagnosed during a brain autopsy after death.”

Coming to grips

Cardenas says now that the problem of football concussions has come to the fore, the NFL has invested many millions of dollars in research on CTE, concussion recovery rates, long-term consequences and the starting of the UNC program. The league has also changed game rules and instituted the use of high-tech helmets to lessen the chances of concussion injuries.

“In this vein, the National Football league’s UNC program, in my view, is a quantum leap forward,” he says. “It sprang out of the 2011 players’ agreement with the NFL. Players advocated for themselves and this is one of the results.”

As a UNC, Cardenas focuses on player protection.

“I serve as a sideline consultant and assist in identifying collisions that may result in concussion or other neurological injuries. Whether I am on the home or away sidelines, the team’s medical staff uses my unbiased opinion in the event of a suspected concussion.”

In addition to watching for suspicious hard collisions, Cardenas looks to see how the players are behaving on the field.

“During sideline assessment, I look for abnormal eye movements, imbalance, trouble with memory, concentration and processing information.”

“Fortunately, we have an entire team working on this process, including an athletic trainer in the video booth, support on the ground and access to game video like the officials have. It is a team effort to maintain player safety.”

Concerns for young players

In addition to his role as a UNC, Cardenas created the nation’s first comprehensive concussion prevention, treatment and education program for young athletes. Called the Barrow Concussion Network, it includes resources for concussion education, voluntary pre-injury testing and post-injury medical follow-up.

Cardenas also created the Barrow Brainbook, an interactive module for student athletes on the signs, symptoms and dangers of concussions and how to take preventive action. Using the program, the state of Arizona became the first in the nation to require that all male and female student athletes undergo concussion education and pass a formal test before playing any sport.

“Fortunately, most football games, whether it’s the NFL or at the high school level, come and go with few or no injuries,” Cardenas says. “There are actually more injuries in the pre-season before players have been fully conditioned and honed their skills.”

On the youth level, Cardenas says that both parents and their children need to educate themselves on the dangers of concussions.

“Young athletes need to know they need their brain to work properly throughout their lives and parents need to know the signs and symptoms of concussion. When injured, young players, as well as adults, need more time to heal. The younger the players, the more at risk they are. Second-impact syndrome is completely preventable. My mantra is ‘When in doubt, sit them out.’ The child’s health obviously outweighs the outcome of the game.”

Cardenas says he is encouraged by recent positive developments related to concussions in football. Shining a light on the subject has proven beneficial.

“The game is here to stay, but it needs to evolve,” he says. “Rules are changing for the better every year. We need to focus on making this a safer sport for both adults and children, and I believe we are well on our way to seeing a much-needed cultural shift in attitudes toward serious neurological injuries.”

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