Concussions

What's the protocol for Rob Gronkowski's return?

What's the protocol for Rob Gronkowski's return?

When Jaguars safety Barry Church connected on a helmet-to-helmet hit with Rob Gronkowski, it didn't just throw the Patriots' plan for the AFC title game out of whack. Once the Patriots won, the hit also cast some doubt on exactly how much Gronkowski would be able to do as the team prepares for Super Bowl LII.

Based on what happened in the game, it appears as though it was determined that Gronkowski showed "no-go" signs or symptoms soon after the hit. He was helped to his feet by receiver Chris Hogan, he met with Patriots medical personnel, and he was headed to the locker room less than a minute after hitting the sidelines.

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According to the NFL's Head, Neck and Spine Committee's concussion management protocol, which we've quoted throughout this post, if a player exhibits or reports loss of consciousness, confusion or amnesia, "he must be removed immediately from the field of play and transported to the locker room." Players exhibiting those signs or symptoms are considered to have suffered a concussion and may not return to participation on the same day under any circumstances.

Inside the locker room, per the NFL's protocol, Gronkowski would have been evaluated by the team's medical staff and a designated unaffiliated neurotrauma consultant using the NFL Locker Room Comprehensive Concussion Assessment, which is based on the Standardized Concussion Assessment Tool, published by the International Concussion in Sport Group. In conjunction with preseason baseline testing, the assessment is meant to provide "a comprehensive and detailed picture of each athlete's injury and recovery course."

"The team physician shall be responsible for determining whether the player is diagnosed as having a concussion," according to the protocol, which may be the case even if a player can complete the locker room assessment "within normal limits" compared to their baseline because of the assessment's limitations.

"Such limitations underscore the importance of knowing the athlete," per the league's protocol, "and the subtle deficits in their personality and behaviors that can occur with concussive injury."

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Once a player is diagnosed with a concussion, he then must pass through the return-to-participation protocol. Because recovery from concussions varies from player to player, there is no time-frame for return laid out by the league. The decision to return a player to participation "remains within the professional judgment of the head team physician or team physician designated for concussion evaluation and treatment," and all return to full participation decisions must be confirmed by an independent neurological consultant (INC). 

The return-to-participation protocol is a five-step process, and a player must demonstrate a tolerance of all activities in each step "without recurrence of signs or symptoms of concussion being observed or reported" before proceeding to the next step. 
 
1) Rest and Recovery: Players may take part in some stretching and balance activity. Once players reach their baseline level of signs and symptoms and neurological examination, he can proceed to Step 2. 

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2) Light Aerobic Exercise: Players begin, under oversight of team medical staff, a graduated exercise program. Dynamic stretching and balance work is allowed, as is cardiovascular exercise, the duration and intensity of which may be gradually increased as long as players remain at baseline during and after activity. Players in Step 2 may attend team meetings and study film. Weight training is not permitted. 

3) Continued Aeobic Exercise and Introduction of Strength Training: The duration and intensity of aerobic exercise (for example, more intense or longer time on a stationary bike or treadmill) can be increased. Players can also begin to participate in supervised strength training and some sport-specific conditioning drills like change-of-direction drills and cone drills. 

4) Football Specific Activities: Players may participate in all non-contact activities -- throwing, catching, running and other position-specific activities -- for the typical duration of a full practice. Contact with players, tackling dummies or sleds is not permitted. 

5) Full Football Activity/Clearance: Players may participate in all aspects of practice without restrictions on contact. Upon clearance by the team physician, the player must then be examined by the INC assigned to the team. If the INC confirms the team doctor's conclusion, then the player is cleared and can fully participate in his team's next game or practice. 

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Rask recovering from concussion, may be ready to play on Saturday

bruins-tuukka-rask-032316.jpg

Rask recovering from concussion, may be ready to play on Saturday

BRIGHTON -- Tuukka Rask is quickly making his way through the concussion protocol and may return to action this weekend.

The Bruins netminder skated with the other injured players ahead of Monday’s main team practice at Warrior Ice Arena, and is on track to rejoin the team at regular practice on Tuesday barring any setbacks in his concussion recovery. That would leave Rask with just a couple of games missed after getting trucked by Anders Bjork at practice last week, and it would give the Bruins back their No. 1 goaltender after Anton Khudobin let in five goals vs. the Sabres on Thursday night.

“He’s in the protocol and progressing well,” said coach Bruce Cassidy. “He’ll probably join us [on Tuesday] for the next step if there are no ill effects from today. That’s a positive. If there are no setbacks, I think Saturday is a more realistic [timetable for a return].”

The hope would be that Rask could start elevating his game when he does return, and play better than the goalie that’s posted the 1-3-0 record, 3.30 goals against average and .882 save percentage thus far this season. But first things first with the recovery to his first career concussion as an NHL goalie, and the set of hurdles that must be passed before Rask is again allowed to jump back into game action as early as this weekend.

Here are the line combos and D-pairings from Bruins practice with Rask, David Krejci and Noel Acciari all skating prior to practice, Patrice Bergeron staying off ice with a maintenance day and Kevan Miller skating in main practice with a maroon, no-contact jersey:

Marchand-Schaller-Bjork
DeBrusk-Backes-Pastrnak
Agostino-Nash-White
Beleskey-Kuraly-Vatrano

Chara-McAvoy
Krug-Carlo
Miller-Postma

Khudobin

CTE found in 110 of 111 deceased NFL players' brains

CTE found in 110 of 111 deceased NFL players' brains

In a study published by medical journal JAMA, chronic traumatic encephalopathy (CTE) was found in 99% of deceased NFL players' brains that were donated to scientific research.

According to CNN, each brain studied was required to have football as its main exposure to head trauma. 202 total brains of deceased football players, including high school, college and professional, were studied. A whopping 177 were diagnosed with CTE.

It should be noted the study points out potential bias since relatives of players could have submitted the brains due to clinical symptoms they noticed while the players were alive.

Regardless, the JAMA study's results are alarming, especially since it is the largest CTE study to date.