NFL Tackles Concussions with Hard Line Stance; Will It Impact All Sports?

Jeffrey Kutcher, M.D., assistant professor of neurology at the University of Michigan and director of U-M’s Michigan Neurosport Concussion program. He has served on the NFL’s concussion committee, testified before a Congressional committee about concussion and also works with and treats athletes from a variety of sports including soccer, ice hockey, and wrestling at all levels, from youth to professional leagues. He is the team neurologist for the University of Michigan and Eastern Michigan University athletic programs and a neurological consultant for several high schools and the USA Hockey Development Program. He was instrumental in crafting the concussion policy of the NCAA, Big Ten, and Mid-American Conference.

We recently had the opportunity to send Dr. Kutcher some questions regarding the NFL’s recent announcement that it would escalate the penalties for players who deliver illegal blows (read more about the changes in a recent Washington Post feature) and how these new regulations might impact sports in general.

1) What are your thoughts on the current state of how the NFL deals with concussions? Are they doing enough to protect the players in terms of equipment and having them return to their baseline tests before returning from a concussion?

Concussion management is much more complicated than using baseline tests. Complete and thorough neurological histories and examinations are essential. This injury needs to be diagnosed and managed by physicians with experience in sports concussion. The most important aspect of concussion care, therefore, is what occurs with each team's medical staff. The NFL's policies are designed to make sure that certain basic standards are met, but that is only the beginning. I am glad to see the NFL addressing the seriousness of the injury by emphasizing the need to eliminate intentional hits to the head. Regarding equipment, there is always room for improvement and advancing the science of protection.

2) Football is a physical sport by nature, and has always had a violent element to it, making it hard to draw the line between intense competition and unwarranted violence. What do you say to players like Ray Lewis who have publicly voiced their concern for what the new rules and regulations will do to the nature of the sport?

I understand their concern. They have learned the game, and played it their entire life, a certain way, and have been rewarded for excelling at every level. Understanding now that these injuries may have longer lasting effects, however, that argument only goes so far. None of our sports have remained the same over time. They evolve as conditioning and equipment improves, as strategies change, and as society determines what is popular. In this way, our sports are a reflection of where we are at the time. As we begin to know more about concussions, we are already seeing a culture shift at the fan level, which will ultimately lead to a change in what is determined to be acceptable. Contact sports like football will always have some inherent risk of injury. That doesn't mean, however, that there isn't a level of risk that is acceptable and that we shouldn't strive to make our sports safer.

3) Several reports have come out in the past referring to retired NFL players who have abnormally higher rates of dementia, Alzheimer’s disease, etc. Are there any studies you can point to on the horizon that intend to look a little more in depth at the causes behind this and how big a role concussions play?

There are several studies, mainly case series, using pathological results that continue to shed light on this relationship. To clearly understand it, however, there needs to be a large scale, prospective cohort study that follows athletes over decades. This type of effort requires a tremendous level of organization and funding. To my knowledge, there are no such studies ongoing. We are, however, currently in the planning phase of such a study that would enroll college athletes and follow them indefinitely.

4) You work with football players of all ages and skill levels, but what about other sports? Major League Baseball recently announced that they are considering the institution of a 7-day disabled list (the current minimum is 15 days) specifically for concussions. Do you believe this is a step in the right direction, and do you believe that other sports should take the initiative to take concussions more seriously? If so, what kind of recommendations would you propose to become standard across all sports (ie, players should always be out “x” number of days, etc)?

Actually I work with athletes from all sports and at all levels of competition. Clearly, the contact sports have more at stake in regards to concussion, but many other sports, such as soccer, basketball, baseball, and many others, also need to be concerned. Regarding concussion standards, we must understand that these injuries are diverse and individual. Given the diversity of individuals, it follows that having a pre-determined time frame for returning to play after concussion is not feasible. Rather, these injuries need to be managed actively, with close monitoring of signs and symptoms as the athlete recovers.