What is Purdue's concussion protocol?
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Concussion protocol.
It’s a term Purdue starting quarterback Elijah Sindelar has become familiar with this month as he battles back from a concussion sustained on Purdue’s final offensive play vs. Vanderbilt in the second game of the season on September 7.
The fifth-year senior went into concussion protocol and ultimately was ruled out for the September 14 home game vs. TCU. The status of Sindelar for this week’s game vs. Minnesota is unknown as he remains in concussion protocol.
“We are still doing exactly what the doctors say,” said Jeff Brohm at his Monday press conference. “I think he’s making progress. We will see how this week goes. Really, (the week of the TCU game), we thought he was making progress, Monday, Tuesday, Wednesday. It wasn’t until Thursday that something popped up again. That’s where we started the process over.”
What exactly is Purdue’s concussion protocol?
It’s laid out in detail on the school's athletic website in a six-page, 10-section document that deals with topics ranging from concussion definition, to pre-season assessment, to concussion management, to reducing exposure to head trauma, among other subjects.
“We all look at concussions the same,” said Doug Boersma, Purdue’s associate athletic director of sports performance/director of sports medicine. “We look at independent medical care. The doctors and medical staff have unchallengeable authority. The things we have in place protect us and allow us to protect the student-athlete.”
There was a time when student-athletes would try to hide their symptoms because they wanted to continue to play.
“And you still get some kids who will do that,” said Boersma. “But now, everyone is so aware of what a concussion is and what the symptoms are that you have teammates that are telling us: ‘Hey, so and so isn’t doing the right thing on each play. You guys should take a look at him.’ Back years and years ago, we never had that. You’d hear about (head trauma) on Sunday during injury check.“
With concussion awareness at the forefront, there is momentum for everyone to get on the same page with concussion protocols.
“It has scared our kids a little bit,” said Boersma. “They don’t want to hear about themselves 20 years down the road and what they are doing to their brains. So, they are taking care of themselves now.”
The big worry?
“It’s called second-impact syndrome,” said Dr. Rick Lehman, an orthopedic surgeon based in St. Louis who serves as the founder and medical director of the U.S. Center for Sports Medicine. “You just don’t want to have a concussion not be completely resolved and then have another impact. That’s the big issue. That’s where you get into real trouble.”
Education is a big part of Purdue’s concussion protocol.
"The preseason education is something that’s required,” said Boersma. “We run that for our contact sports and extend it beyond our contact sports. We talk about what a concussion is with a Power Point presentation. We educate them.”
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And all athletes undergo at least one pre-participation baseline concussion assessment. Once a concussion has been diagnosed by the Purdue staff, the following takes place immediately, according to the school’s concussion protocol.
• The athlete must be removed from practice or competition.
• The athlete must be evaluated by a member of the medical team with concussion experience.
• The athlete must be removed from practice/play for that calendar day if concussion is confirmed or suspected.
The concussion protocol goes on to discuss “return to activity” procedures. In that section of Purdue’s concussion protocol, there are two subsets. One is called “return-to-learn,” pertaining to academic functions. The other is “return-to-play,” pertaining to athletic functions that includes five steps to getting back on the field:
1. Light aerobic exercise such as walking, swimming or riding a stationary bike for at least 15 minutes. No resistance training is permitted. IF asymptomatic with light aerobic exercise, then;
2. Sport-specific activity (mode, duration and intensity specific) exercise with no head impact. IF asymptomatic with sport-specific activity, then;
3. Non-contact sport drills and resumption of progressive resistance training. IF asymptomatic with non-contact drills and resistance training, then;
4. Full-contact practice or simulated full-contact practice and unrestricted training. IF asymptomatic with full-contact practice, then;
5. Return-to-competition is allowed.
That brings us back to Sindelar: When will he be out of concussion protocol? That’s not an easy question to answer.
“That is the individualization of it,” said Boersma. “Even in our policy, it says most athletes with a concussion resolve in about 7-10 days. But everyone is different. It depends on if the individual has had concussions (before). Maybe that were undiagnosed earlier. Everyone is different.”
Sindelar practiced on Wednesday the week of the TCU game, but he reportedly suffered a setback on Thursday and was ruled out for the September 14 game. Purdue was off last week but has been preparing for a visit from Minnesota this Saturday. Sindelar was practicing on Tuesday.
“If someone has to stay in the protocol, it means that they are still symptomatic or that we’ve gotten to a stage during their return to play that we just aren’t comfortable with,” said Boersma. “That it’s not quite reached their baseline.”
How are concussions dealt with? How does a person go about “healing” their brain?
“So, everything has changed,” said Dr. Lehman, who has been the team physician for the Florida Panthers, Tampa Bay Lightning and St. Louis Blues and also has been a consulting physician for UCLA track and field and has covered four Olympic Games. “Five years ago, we had the NFL protocol that we all lived by. I wrote a big part of it. And what ended up happening is we realized a lot of what we were doing was just resting, people being in the dark, no sensory input, etc., really wasn’t working.”
Lehman says over the past 14, 15 months, concussion protocol has changed in some circles.
“We don’t like a lot of loud noises, we don’t like a lot of light because bright lights seem to trigger kind of a post-concussion flare,” said Lehman. “What we like to do is have them do simple puzzles and we put them in a very sedate room, it’s not dark anymore. And we give them 15 minutes out of every two hours to try to do a puzzle. It may be something as simple as crossword puzzles, Sudoku, something that is really pretty tame and isn’t really difficult for them.
"And then we try to have them remember things. We actually are trying to stimulate the nerve endings a little bit to reproduce a normal pattern. And that has seemed to work.”
For now, Sindelar waits.
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