View Full Version : Hoge helping players at all levels with head injuries

06-07-2010, 02:27 AM
Hoge helping players at all levels get ahead of curve on head injuries

By Jason La Canfora | NFL.com


WASHINGTON, D.C. - Few people are more aware of the signs of concussions than Merril Hoge, so when the former NFL running back saw one of the youngsters he coaches in youth football suffering from the symptoms, he immediately pulled him off the field.

Hoge made sure the player, just 13, was being cared for, assuming that everyone on the sideline understood there was no chance of him playing football again on that day, or perhaps for quite some time. He told his assistants to watch the child for signs of nausea and headaches. Five minutes later, one of his assistant coaches was tugging at Hoge's arm, telling him the young man was feeling fine and ready to return, urging Hoge to put him back in the game.

Hoge, who suffered numerous concussions during his 8-year NFL career and eventually retired in 1994 after suffering two in close succession, was on the one hand stunned -- this particular assistant coach was the older brother of the player who had been concussed -- yet not altogether surprised given his years of experience in youth football.

"I understand the magnitude of what's going on (in regard to concussions)," Hoge said, "but here it was his own brother and he was willing to put him back out there. That may be an extreme example, but it's an indication of the kind of ignorance about concussions that is still out there. He had no clue. This is what we're dealing with."

Hoge was speaking outside a massive ballroom at the Renaissance Hotel in downtown Washington Wednesday morning, during a break in an all-day symposium to further research and discourse about brain trauma in football. Hoge, a cancer survivor and a member of the NFL's Head, Neck and Spine Committee, was among those giving a presentation. Johns Hopkins Medicine was conducting the event, at the behest of the league, with more than 300 doctors and experts in attendance, including 49ers owner John York (a doctor), and many military representatives, who are gathering more information on ways to limit head injuries for those who serve our country.

Hoge has become quite educated on brain injuries, but concedes that much of the medical lingo being bantered about is beyond his reach (or that of pretty much anyone; "Chronic Traumatic Encephalopathy: A Distinct Pathologic Entity Associated with Repeated Brain Injuries," was the title of one presentation, for instance). But he easily intermingled with the surgeons and team physicians during the break from the meetings, and was there to lend his real-world experience, tell his story and try to help the cause.

Most importantly, Hoge continues to forge ahead with USA Football to inform players at all levels about the severity of these injuries and to work to attain a singular voice on this topic that can be easily digested by novices -- a voice free of any divisiveness between the NFL, NFLPA or any other interested party.

"To me the most important thing that can come from events like this is to continue to develop one voice and one message," Hoge said. "We're really working to change a mindset, and it's not going to happen overnight. It's an arduous process."

Hoge likens the movement to make advancements in concussion awareness across all sports to the generational differences with wearing seatbelts. Many of us can remember, as children, seeing adults routinely drive without them, until laws were strengthened and, over a decade or so, norms changed to the point where strapping on a seatbelt is second nature to most drivers now.

Hoge's work at the grassroots level involves promoting proper running, tackling and drill techniques, and informing parents and coaches of the signs and symptoms to look for in concussion victims. At the NFL level, it involves working within his committee to find the best practices and equipment possible for players, while realizing the intense physical demands of the game will always require a certain risk.

"Equipment alone will not eliminate concussions," he said.

Hoge is still flabbergasted at times by emails he receives, detailing that some family practitioners have mistreated concussions, telling parents that their child couldn't be suffering from a concussion since they never lost consciousness. "You don't have to be unconscious to have a concussion," Hoge said.

He still recalls his first concussion, playing for the Steelers against Kansas city in a Monday night game. "I've never been in an earthquake," he says, "but that's the only thing I relate it to." It's a confused, awkward, scary feeling he hopes others won't have to experience.

With that in mind, Hoge isn't interested in getting involved in any "mudslinging" over the past, and what were clearly dark ages in terms of concussion treatment and care during his playing days. And he's enthused about the direction the league is headed in, particularly the commitment exhibited by Commissioner Roger Goodell. When first approached about joining the committee, Hoge was a little skeptical, but was quickly won over.

"(Goodell) didn't just give me lip service," Hoge said. "He was an advocate. He wants to understand more and do more."

Goodell addressed the doctors assembled here Wednesday before the symposium began, outlining several priorities, including: "Make sure medical decisions always override competitive considerations. No compromises." Goodell also stressed the need to "be open and transparent."

"We have to understand what we don't know, and work together," he told the symposium. "Transparency is critical."

Goodell also spoke of being able to help usher in critical changes over the coming years that will have a positive impact not only in football, but in the progress of concussion advancements worldwide.

"We'll look back at this moment in time and how many strides we're making to keep this game safer and more appealing to all who play it at every level," Hoge said.


06-07-2010, 03:41 PM
If Goodell wants to do something positive for the league to minimize the impact of head injuries (we aren't going to be able to completely eliminate concussions from a collision sport like football, but we can test for concussions, and take the decision to sit players out of the hands of coaches and the players themselves), then every player should be subject to basic neuropsychological testing after every game, not only when the symptoms of a concussion become visibly noticeable.

It should be a requirement that all players take Dr. Maroon's ImPACT test (Immediate Post-Concussion Assessment and Cognitive Testing) not only at the beginning of training camp to get a baseline reading, and whenever a concussion is suspected on the field, but they should require every player to take the test after every game...every active player every single week. It's only a 20 minute long computer-based test involving basic neuropsychological functions such as discriminating words, matching symbols, distinguishing colors, etc.

If the players post-game scores are significantly below the baseline level from the first day of training camp, they must sit out the next game...no questions asked. They would take the test again the following week with all of their teammates, and if their functioning is still significantly sub-par as compared to their training camp scores, they sit another week until it is essentially normal again. That way the player is not tempted to try to be some kind of a soldier and risk their future by playing with a concussion, and it is out of the coaches' hands as well...it is a league mandate that is consistent for every player on every team.