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NFL’s proactive measures address concussions as they happen

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While some may have been taken aback to watch quarterbacks Jay Cutler, Alex Smith and Michael Vick depart games with concussions last Sunday, one member of the NFL's Head, Neck and Spine Committee saw progress thanks to the league's return-to-play guidelines. 

"That was the best news I've heard this year," said Dr. Stan Herring, also the Seattle Seahawks' team physician.

Already, the NFL faces lawsuits by almost 4,000 former players claiming it concealed the long-term consequences of head injuries. Those plaintiffs, representing nearly a third of all retired players, include 28 Hall of Famers, according to a count by The Washington Times.

That provided the background for last Sunday, when Cutler (Chicago Bears), Smith (San Francisco 49ers) and Vick (Philadelphia Eagles) sustained head injuries.

Eagles coach Andy Reid labeled Vick's concussion "significant," one that could sideline him for Sunday's game against the Washington Redskins at FedEx Field. The Redskins are familiar with head injuries, after quarterback Robert Griffin III left last month's game against the Atlanta Falcons because of a concussion, described as "mild" by coach Mike Shanahan, and recovered in time to play the following week.

"It's just as much on the player as it is on the staff," Griffin said of the league's guidelines. "You have to be honest with the coaches and be honest with everybody no matter how bad you want to play. I knew something was wrong, and you had to get out."

After Griffin's big hit, he told Shanahan "I'm OK." The coach disagreed and sent him to a doctor.

"I think common sense prevails," Shanahan said. "I know when our quarterback comes to the sideline, you look in his eyes and you can tell something is wrong and you don't put him back in."

The high-profile injuries opened a window into the NFL's strict return-to-play protocol for concussions, adopted in 2009 and adjusted in 2011, that is a cornerstone of its effort to improve the game's safety. The issue is impossible to escape, from the large posters in every NFL locker room demonstrating proper tackling technique and warning about life-altering consequences of concussions to NFL commissioner Roger Goodell delivering a speech Thursday at Harvard's School of Public Health entitled "Leadership on the road to a safer game."

"No one is more excited than me to see everybody embracing what I've talked about for three decades," Herring said. "There's a culture changing among the players and teams. I think the NFL protocol is more robust than any other sport. But I don't care how robust it is, you're never going to make a correct diagnosis every time on every player."

The surge of interest in concussions after last Sunday doesn't mean the number of head injuries is surging. Through Week 9 of the regular season, NFL concussions are actually down, according to data on publicly-disclosed concussions compiled by the respected "Concussion Blog." It reports 77 regular-season concussions, an average of 8.55 per week compared to 10.2 per week in 2011. Eighty concussions were recorded through the first nine weeks of the 2011 season and 77 over the same period in 2010.

Using slightly different methodology, another group studying the injuries tallied 141 concussions, including the preseason and 10 weeks of the regular season.

"Three concussions on one Sunday is nothing new," said Paul Anderson, an attorney who tracks the concussion lawsuits at NFLConcussionLitigation.com. "There were probably just as many prior to [the return-to-play protocol's adoption in] 2009, but nobody was really talking about concussions. Concussions weren't even part of our lexicon. Now it's a polarizing term."

The NFL's adoption of the return-to-play protocol in 2009 and increased awareness of the long-term dangers of concussions and subconcussive hits leave the league's previous weekly injury reports of little use for comparison.

That the three quarterbacks were removed from Sunday's games and not allowed to return demonstrates the impact of the protocol in contrast to commonplace stories from former players involved in the litigation about finishing games after sustaining frightening hits. Concern over when, exactly, each of the three quarterbacks left games after their concussions misses the difficulty in diagnosing an injury that can look different from hit to hit, player to player, Herring believes.

Cutler, for example, stayed in the game seven plays after absorbing a significant hit and wasn't diagnosed with a concussion until halftime. Shanahan coached Cutler three seasons with the Denver Broncos and noted his reluctance to leave games coupled with being difficult to read after hard hits. A swirl of blame that Cutler didn't exit soon enough followed in Chicago.

"I've never had so many people diagnose a condition on television in my life sometimes it's a bit of ready, fire, aim," Herring said. "But all this attention is good."

Before the season, players complete baseline testing including balance, thinking skills and concentration. After a possible head injury, the Sideline Concussion Assessment Tool (known as SCAT) is administered and matched against the baseline. The player isn't allowed to return if the difference between tests is too great.

A 2011 NFL memo directs teams to remove players from games if there is "any" suspicion of a concussion.

"Always err on the side of caution," the memo says.

A red box on the assessment provides six "no-go" symptoms such as confusion and amnesia which result in immediate disqualification.

If a player is diagnosed with a concussion, he is escorted to the locker room and — under the John Madden rule, named after the man who suggested it in 2011 — isn't allowed to return to the field.

Media interviews aren't allowed with a concussed player until he has been cleared to return, a process that takes, at minimum, a couple of days. He must have normal neurological and neuropsychological tests, pass exertion tests like running on a treadmill and agility drills and be cleared by an independent neurologist and team physician. Only then is a player allowed to return to practice.

"The NFL is now the ivory tower," Anderson said. "They're under the perfect conditions. I don't think they could do any better considering the inherent violence of the game."

Rich Campbell contributed to this report.

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