Hey, MSU (and NCAA): Let’s Talk Concussion Protocol

Surely you have not forgotten University of Tennessee Quarterback Brian Maurer’s month of head injuries (if you need a refresher, you can catch up here) throughout consecutive games in October. Well, another university has decided to ignore a solid hit to the head after Michigan State Quarterback Lewerke remained in the game this past Saturday. Although MSU issued conflicting statements to cover its tracks, Lewerke clearly had his bell rung and remained in play without entering concussion protocol. Seems like poor decision making has a domino effect in the NCAA where concussion protocol is less than effective.

Lewerke takes a solid hit, falls to his knees, drops the ball, and throws a pick-six on the very next play. When questioned about why Lewerke did not enter concussion protocol, Coach Dantonio stated the QB did not show signs of a concussion and was “quickly checked out.” I beg to differ. Lewerke stated after the game that he was “fine,” but what starting QB playing in a contentious game wouldn’t try to shake it off? Mind you, in Lewerke’s official statement he stated, “my head was ringing for a little bit, but it wasn’t anything serious I don’t think. It was a tough hit and it definitely rung my bell for a little bit, but I think I was fine.” Given the QB’s head was ringing after what he acknowledges as a “tough hit” you would think the coach would want to send him to concussion protocol. Safety first, right?

Similar to Tennessee Coach Pruitt’s infamous statement regarding Maurer’s injury, “I mean, I guess we could stop the game and evaluate everybody out there, but I don’t think we have time for that”, Coach Dantonio had one of his own when addressing the hit Lewerke suffered. Coach Dantonio stated, “We looked at him very quickly. I asked him and he said he’s good, and he motioned that to our trainers as well, so he just went on with it.”

“We looked at him very quickly.” “So he just went on with it.” Famous last words.  

Concussion protocol exists to protect players and it is not competent to simply ask a player in the heat of a contentious game if they are “good” following a hard hit to the head. However, this is not the first time a university has been less than diligent in assessing its players after a head injury. Why does this seem to be a bigger issue with college players than professional players? The answer is simple: because the NFL has a real concussion protocol (as amended in 2017) to ensure the safety of players. You know, a pretty good idea given the extreme effect head injuries can have upon the future health of those affected (CTE anyone?).

In 2017 the NFL revamped its own protocol in response to increased incidents of player concussions. Team doctors may face a conflict as they are to provide medical assistance to the player, but are employees of the team. Therefore, in 2017, the NFL began requiring (1) a physician who is not affiliated with any NFL team assigned to each team must monitor games from the sidelines, identifying concussion symptoms, noting when hard hits warrant concussion evaluation and working with the team physicians to conduct those evaluations and (2) athletic trainers must sit in stadium booths during all games to spot potential concussions in players from both teams. The spotters can review game film to identify plays potentially resulting in concussions and can call “medical timeouts” to relay that information to the medical personnel on the sidelines so that further evaluation can be conducted.

NFL players in concussion protocol cannot even speak at a press conference after the game. If MSU was bound by the NFL rules, Lewerke would first have been actually evaluated by a physician, would also have been evaluated by an unaffiliated medical provider, and there would have been booth review.

The NCAA’s Best Practices state, “[i]nstitutions should make their concussion management plan publicly available, either through printed material.” Note how this indicates what an institution should do. The Best Practices goes on to list guidelines regarding diagnosis, post-concussion management, and return to activity. Despite this, the NCAA simply recommends certain procedures and clearly states that return to full activity is hard to project and that the guidelines have not been validated by evidence-based studies. The Best Practices elaborate:

“Sport-related concussion is a challenging injury for student-athletes and, unlike other injuries, the timeline for return to full activity (including return-to-play and return-to-learn) is often difficult to project. The psychological response to injury is also unpredictable. 

Once a student-athlete has returned to his/her baseline, the return-to-play decision is based on a protocol of a stepwise increase in physical activity that includes both an incremental increase in physical demands and contact risk supervised by a physician or physician-designee. It is noteworthy that all return-to-play guidelines are consensus-based and have not been validated by evidence-based studies. McCrea and colleagues have reported that a symptom-free waiting period is not predictive of either clinical recovery or risk of a repeat concussion.”

Because the NCAA only dictates what universities should do and does not require evaluation by a third-party medical provider, situations like this will continue to occur. After a hard hit to the head, the MSU football staff quickly looked Lewerke over and deferred to the player’s judgment on whether he was “good.” The judgment of someone who just took a solid hit to the head and admitted to ringing in his ears and neck pain. Sounds like a great system.

As long as the NCAA requires minimal guidelines for concussion protocol, universities will continue to take advantage of the system – especially in contentious games where the player insists he is “good.”

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