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An inside look into concussions after Eddie Lacy's case

Kelly Hodgson, Packers contributor

Eddie Lacy. Photo: Image by Milwaukee Journal Sentinel

An inside look into concussions after Eddie Lacy's case

CREATED Sep. 19, 2013

Once again, a high-profile Packers player brings our focus to concussions in the NFL.

In December 2010 the spotlight shined on Aaron Rodgers after he went down with his second concussion of the season, missing a game and nearly two weeks of practice as he healed.
 
This year it is Eddie Lacy.

Whether he wants to or not, he is now one of the faces of head injuries in the NFL.
 
Few will forget Brandon Meriweather’s punishing—and illegal—helmet-to-helmet blow to Lacy’s head.

The Packers running back crumpled to the ground and swiftly exited the game. 

The Packers were quick to announce that he sustained a concussion, but as of Wednesday, there was no initial word on when he will return to play.

But make no mistake, the process for his return has already begun.
 
Even as recently as a few years ago, he may have even returned to the line of scrimmage the same day. But what we know about head injuries has evolved quickly in the past five years that this is no longer the practice. Concussions have always been a nebulous topic.
 
While Coach McCarthy often gives cryptic medical updates on injured players such as, “He has a knee,” when it comes to concussions, he is quite accurate when he says, “He is going through the protocol.”
 
It's no longer a sniff some smelling salts and get back out there culture. The NFL has changed, and the concussion protocol is a process that starts with an injury and ends with a player that is safely cleared to return to play.
 
Unlike a fracture that you can put a cast on or a cut that can be stitched up, there’s nothing for the eye to see when it comes to concussions.

Some symptoms are straight forward such as headache, nausea or dizziness. Others are a vague assortment of intangible complaints—difficulty concentrating, confusion, or feeling like you are “in a fog.”
 
Assessing the symptoms may be more of an art than a science, but technology has advanced with bona fide measures to assess neurocognitive (ie, concentration, memory, impulse control, etc) function before and after a head injury.
 
While evaluations such as the Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) have come under fire recently, such protocols are still standard measuring tools used by professionals to assess athletes as young as middle school and as elite as those in the pros to quantitate those intangible symptoms and gauge progress toward resolution.
 
Protocols like this are not diagnostic tools to determine if a concussion has or has not occurred. Rather they compare neurologic functions against a baseline test that athlete took before the head injury had even taken place.

Unlike an SAT test, it does not compare scores to everyone else who took the test, they compare function in a before and after side-by-side comparison of that athlete and that athlete alone.
 
While it is easy to minimize how bad a headache is (and let’s face it, players do that all the time), it is next to impossible to lie on this type of assessment.
 
A player needs to be back to that baseline before he is cleared to start the process to return. But what if that player tanked memory drills in the original test?

That’s okay. Again, this isn’t a test comparing him to others. As long as he is at or above his personal baseline, it is considered a pass.
 
But that is only one piece to the puzzle.

The return to play protocol is a gradual process that factors in the physical symptoms such as headache, dizziness, or nausea.

They have to be resolved before he can even get on a stationary bike.  Those symptoms need to remain gone if he is then progressed to running or lifting.

They must remain absent, and the player must pass the neurocognitive testing in order to be cleared to full play.
 
Each player is as unique as his own fingerprint.  Each injury is different as well.

It took Aaron Rodgers less than a week to return to play with his first concussion in 2010, but it took him two weeks to progress through the entire protocol with his second head injury later that season.
 
Eddie Lacy’s progress will follow its own independent path.
 
Yet no matter what tools are used to assess that healing process, the mainstay of therapy will be no different than when Rodgers left the game in Detroit.

Eddie Lacy needs physical and mental rest in order to heal. It’s why Aaron was sent home from even watching film and famously told to rest.

It is why Eddie is likely doing the same.
 
If Lacy has not yet appeared in practice, it simply means he has not progressed from the resting stage and is still symptomatic. 

The longer he is held from even simple cardiovascular drills, the less likely he will be on the active roster come Sunday.
 
The NFL is evolving to prevent long-term injuries. No one will argue that Chronic Traumatic Encephalopathy (CTE) is a devasting chronic injury.
 
As the medical field continues to understand more about the chronic effects of repeated head trauma, the league will continue to adapt in the name of player safety.

Gone are the days of shaking it off. Concussion awareness is here to say.
 
Hopefully athletes like Lacy and Rodgers will benefit from these extra precautions as they eventually transition from current players to healthy older men entering the next chapters of their lives.

The views in the article are solely those of the author and not that of her employer or Journal Broadcast Group. Any information provided in this article should not be construed as medical advice and, in no way, is a substitute for an evaluation by your own physician.

Kelly Hodgson (@ceallaigh_k on Twitter) who grew up across the river from Lambeau Field, is the co-host of the podcast "Out of the Pocket" at Packerstalk.com.  Her other Packers musings can be found at PocketDoppler.com.

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