Treating Concussions Better: An Interview with Brain Injury Expert Joseph F. Waeckerle, MD (Part 2)

In Part 1 of our interview with Joseph Waeckerle, MD, we discussed education efforts for physicians and other healthcare practitioners treating patients with concussions and other forms of head injury. In part 2, Waekcerle discussed some of the misconceptions surrounding the National Football League’s handling of player safety relating to concussions and plans for the future of treatment and diagnosis.

Much attention has been focused on head injuries in football, but concussions can and do happen in any sport, and even through daily life. Tell us a bit about the incidence of concussion through your experience.

You can never prevent concussions; they are always going to be a part of recreational activity. They’re inevitable. But many more are caused by accidents, falls, and other mechanisms. In America, the focus is on football, which ignores the vast majority of other cases. Every time you have a collision in any sport, you’re doing the same thing you’re doing in football: You’re rattling the brain. That’s true in rugby, lacrosse, MMA, boxing, and every time you dive into a pool from a high dive. It’s an inherent part of life and recreational participation. So the idea is to find strategies for diagnosis and treatment regardless of the cause of head injury.

In the old days of continuing medical education, a course would be published and would become out of date very quickly. You follow the clinical research into head injury very closely. How do you keep this course up to date with the pace of ongoing research?

Technology is so different today. I try to read hours every day on concussions. I look at all the literature, do searches on PubMed, and talk to research colleagues every day. If anything comes up that is substantially different than what’s in the course and is of benefit, we can go in and add [that resource] to the course. For example, very recently we added some new research about functional MRIs in children, and how the best approach for “return to play” conditions is a conservative one. Over the next 3 years, which we consider the realistic life of the course, we can continue to modify it to keep it current.

You mentioned earlier the prominence of the NFL in this country and the focus on the league as having been either lax or intentionally evasive about the frequency and impact of head injury. Tell us about your experience consulting for the league.

I want to be clear that I’m not compensated by the NFL. I’ve done head injury brain trauma my whole life. I was the team physician for the Kansas City Chiefs [from 1990 through 2010]. We were very forward in thinking about non-orthopedic injuries. I had seen terrible outcomes with concussions both in sports and non-sports accidents, including sudden impact result in death in kids in the athletic community. When you lose a young one, that puts the fear of God in you. I thought, we need to get this right from the get-go.

I served on the concussion committee for the NFL, and I was there for all the meetings represented in the movie Concussion. What I can tell you is that everyone in the rooms had good intentions and the safety of the players top of mind. You can’t have the game without players. Those of us in the head trauma community need to better define the problem, take better care of our patients, and take better care of the game. I care very passionately about improving care. The NFL has a cadre of experts, unlimited funds, and unlimited specialists. And they take the responsibility to care for them very seriously. Maybe had different philosophical approaches, but everyone was on board for making the game safer and protecting our athletes.

What do you hope the long-term impact will be of this CME course and of your efforts to advance the science behind the treatment of concussions?

You always hope to make a difference in the end and contribute to the betterment of society. Specifically my goal has been to improve care for every person who presents to the ED with a brain injury and search for improvements in the science of diagnosis and treatment, even as far as the technology behind better pads and helmets. If our work can incite people to be more active in any of those ways, I’ll have made a little bit of a difference.