00:00This is the Injury Report, presented by NYU Langone Health.
00:05Jets wide receiver Garrett Wilson is in concussion protocol after taking a helmet-to-helmet hit against the Raiders,
00:11leaving his availability against the Chiefs in question.
00:14So what goes into evaluating concussion, and what must happen before a player can return?
00:20Here to walk us through it all, this week on Injury Report, is Dr. Matthew Apicella,
00:24who is dual-trained in emergency and sports medicine.
00:27You see him right there, and he joins us now.
00:29How are you doing, Dr. Apicella?
00:31I'm doing great. Thanks for having me on.
00:33No, glad to have you on. Let's talk about it. Let's talk about concussions here.
00:36And we'll start with what's happening inside the helmet.
00:39What exactly happens to the brain during a concussion,
00:42and does a player have to lose consciousness in order to have one?
00:47Yeah, so it's a great question.
00:49And, you know, they definitely don't have to lose consciousness.
00:53Less than 10% of concussions have some level of loss of consciousness when they occur.
00:58So really what happens is the player or the athlete takes a hit to the head or neck area,
01:03and you get this rapid acceleration of the brain,
01:06and it either can hit kind of the inside of your skull or just kind of move really quickly.
01:11And this disrupts or stretches the neurons and leads to this kind of chemical and electrical imbalance
01:17within the brain that then has cascade effects that cause this kind of energy crisis or energy imbalance within the
01:23brain.
01:24And then you start to have all the symptoms that kind of go along with the concussion after this.
01:28So that's kind of what we think is going on when this happens.
01:31Okay, so with the Jets situation here with Garrett Wilson, they said that he played the final snap.
01:38So he experienced this during the game, but played to the final snap, and he experienced symptoms the next day.
01:43So generally speaking, how can concussion symptoms take time to appear,
01:47and what changes should an athlete watch for after a hit that might say, okay, this is a concussion symptom?
01:54Yeah, definitely not uncommon for athletes to report symptoms a little bit later on.
01:59Like we talked about, you can have these metabolic effects that take some time to really start to develop,
02:04up to hours or even days after a head injury like this.
02:09So it's really important to kind of monitor these athletes after they've taken a head injury
02:13and look for any sort of evolving symptoms that may start to progress later.
02:17And the symptoms that we look for are things like headaches, dizziness, nausea, light sensitivity,
02:22or even just kind of feeling slowed down or feeling off, not themselves.
02:27Gotcha.
02:27So take us inside the evaluation here, because we know this is always important when it comes to an injury,
02:32particularly one like this, around the brain.
02:34How do doctors determine whether a player has a concussion, I should say,
02:38and where do memory balance tests and brain scans, where does that fit into the evaluation process?
02:45For sure.
02:45So there are some standardized tests that we use to evaluate athletes after they have a head injury like this
02:52to look for deficits in exactly those things that you mentioned.
02:55So cognition, memory issues, balance issues.
02:59And a lot of times these athletes will have some baseline testing at the beginning of the season
03:05so that we can look backwards and compare them after they have a head injury and maybe have some symptoms
03:10and see, wow, has there been a lot of changes since then to kind of help us with our clinical
03:16diagnosis?
03:17But first and foremost, it's a clinical diagnosis.
03:19So some sort of mechanism plus these symptoms and our physical exam findings are really how we make the diagnosis.
03:25The imaging doesn't really help us here, unfortunately.
03:28Cat scans, MRIs can all be normal in patients who have concussions.
03:33Usually when we're getting those images, we're looking for more of a structural brain injury
03:38and not a functional brain injury like we see in a concussion.
03:42So for a wide receiver like Garrett Wilson, his job involves tracking the ball, making sharp cuts, reacting to defenders.
03:50How do you test readiness for those demands beyond the player simply saying, hey, you know what, I feel better?
03:57How do you test for his ability to do those things that his job requires?
04:01Yeah, I mean, feeling better is really just that first step, right?
04:05And so once their athletes start to feel better, then we start to test them out a little bit more,
04:10get them into doing more aerobic conditioning exercises,
04:12which can actually start to make them feel better a little bit faster.
04:15But then they have to go through this kind of protocol where they really can start to increase their activity
04:21level
04:21and then get back to doing cutting and pivoting motions without any symptoms at all
04:27to really make sure that they're ready to return to sport,
04:29especially somebody like Garrett Wilson, who has to be able to track the ball and make rapid, quick decisions.
04:35They can't be slowed down.
04:36They can't have any difficulties with their cognitive abilities to be able to do those activities safely.
04:42So Aaron Glenn, head coach, he called Wilson day to day.
04:46And without predicting his individual recovery,
04:49what determines whether a player can progress through the protocol before Sunday
04:52and who's got to sign off on his return?
04:56Yeah, so, I mean, in evaluating concussion athletes and returning them back to play,
05:01they go through this kind of stepwise progression of the protocol, right?
05:04So it starts with that kind of early aerobic exercises,
05:07and then it's more vigorous exercises and then more kind of sport specific exercises.
05:12And they have to be symptom free throughout this time period.
05:15And then they progress back to more kind of simulated gameplay or non-contact practices
05:20and then contact practices.
05:21And if they can tolerate that without any symptoms or any flare up of their symptoms,
05:26then they typically can progress back to sport.
05:28And every athlete is different, right?
05:30So it's very individualized.
05:32So depending on how they progress through that protocol really determines that day-to-day process of it.
05:37A lot of times it's the team physician who's signing off on this,
05:40but at the professional level in the NFL,
05:42they may have like an independent neurologic consultant who also weighs in at the end too.
05:47And it's a good thing they have that as well too.
05:48Some teams do have that.
05:50That is a very important thing.
05:51Let's finish with this, Dr. Abichella,
05:52because there's been a tough it out mentality that's always existed around the sport of football.
05:58What are the risks of returning before concussion has resolved?
06:02And what should be the message to athletes who might hesitate to report symptoms
06:06because they don't want to miss a game?
06:08What are the risks and what do you think athletes should know about
06:11why it's important to report those symptoms?
06:14For sure.
06:15And I always explain to athletes that this is one of those injuries that you can't just muscle through.
06:19You can't really tough it out.
06:21One, because if you're not ready to return to play and you're not reacting appropriately,
06:27you may put yourself at risk for a different type of injury or a worse type of injury.
06:31And then specifically in the concussion part of it,
06:33you can prolong your symptoms and make recovery down the line even worse.
06:38So, you know, again, I always tell them to kind of be honest about their symptoms
06:42and really report when they're feeling better or if they start to notice anything.
06:46That's always good advice there for the athletes.
06:49We'll see if Garrett Wilson is able to return this week in week nine
06:53or if he's going to take more time for his recovery as he's out in the NFL's concussion protocol.
06:58That is Dr. Matthew Apicello with NYU Langone doing a fantastic job.
07:02Dr. Apicello, appreciate you so much for joining us here on Injury Report
07:05and helping us break it all down.
07:06Thank you so much.
07:08Of course.
07:09Anytime.
07:09Thanks for having me.
