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Media Question Mike Tomlin's Use of 'Concussion Like Symptoms' of Polamalu on NFL Injury Report

There's much ado about concussions.

And rightly so. No one is endorsing the enabling of a generation of mindless former gridiron gods, lest we can prevent it. Last I checked, though, what words the teams of the allegedly concussed players choose to use in press conferences is the least of the problem.

Star-divide

Ed Bouchette of the Post-Gazette recently asked whether Steelers SS Troy Polamalu suffered a concussion during the first quarter of Pittsburgh's 13-9 win over Kansas City.

That brought out one of Steelers head coach Mike Tomlin's favorite phrases, one for which he's criticized.

"He had concussion-like symptoms."

The use of that phrase instantly conjures skepticism from the media - a group that's apparently far more schooled in medicine than we may have guessed. The overlying thought, as Bouchette questions, is if it has feathers, webbed feet and quacks, it's a duck.

If he has concussion-like symptoms and he got hit in the head, he must have suffered a concussion, right?

What's the difference?

If having CLS (concussion-like symptoms) requires a player to sit the remainder of the game despite all medically trained personnel saying those symptoms were gone by the start of the second half, and the player is still subjected to tests to confirm he's still asymptomatic, Tomlin's use of the catch-phrase CLS seems appropriate.

This is the reality of the NFL. If a player has a concussion, he shouldn't be playing. If he merely showed some symptoms of a concussion - but those symptoms are no longer present - Tomlin is simply diffusing the power of the buzz-word the media themselves have imposed.

This says nothing of the fact the injury report does not require any coach to list the nitty gritty details of any injury. According to the rules, coaches are required to grade the injury on a scale of Out, Doubtful, Questionable and Probable, then list the general area of the injury. Some call it a "knee" injury, some call it a "leg" injury. It's hard to believe a team's medical staff is unsure whether his ankle or knee is what's injured, but they list "leg" because the injury isn't in his "shoulder."

Why does anyone need to know anything else?

Nowhere in the rules is the coach required to study the nature of the injury and provide a scientific explanation as to what happened to the player, how he's likely to respond and how that may affect his future playing time, earning potential or ability to run for Congress.

Tomlin owes nothing to the media outside of the rules he follows every game.

I don't claim to be Tomlin's biographer, but judging by his background, he does not appear to be a medical professional. He's required to report on the status of his players pertaining to the upcoming game. The team is required to ensure the safety of its players in regards to head injuries, and Tomlin has not blown off that responsibility.

If he's admitting something happened to Polamalu's head during the game, did not allow Polamalu to return to the game and is ok with team trainers running him through the league-mandated battery of tests in order to be cleared to play, what difference does it make if he calls it CLS or a straight-up concussion?

He's not breaking any rules. Let's cut the Al Michaels "Steelers East German-like approach to disclosing information" dramatics. I would hope Marvin Lewis has watched film of the Steelers win over Kansas City, and I'm going to trust he noticed Polamalu wasn't on the field. He's probably heard Polamalu was ok after the game, therefore, he knows enough to reasonably expect today that Polamalu will play Sunday. He'll follow the injury reports, and if Polamalu takes a turn for the worse, he'll know that based on the status Tomlin will designate.

Tomlin has no competitive advantage. He can't hide anything relevant to the next game, and that's what the rules outline. If there are media types that feel Tomlin or any coach owes them something (this isn't a criticism of Bouchette, he simply asked the question), they're mistaken.

The real problem is they paint both Tomlin and the Steelers organization as insensitive to the safety of their players in regards to head injuries. That's irresponsible. Just because Mike Florio has to guess about the validity of the injury, instead of getting off his butt and investigating like a real journalist, doesn't mean he has the justification to openly criticize Tomlin or the Steelers approach to protecting their players.

I don't claim to be a medical professional either, but if Florio's main contention is Steelers players who suffer apparent head injuries remain on the sideline with their team (because, you know, they're part of the team) instead of immediately rushing to the locker room to be treated, then I fail to see what the problem is. If he's not in the game, it seems the responsible action has been done.

As someone who's had multiple concussions, the best thing you can do immediately after the injury occurs is discontinue whatever it is you're doing that's causing you to get hit in the head, and stay awake.

Let's not lose site of reality, here. Polamalu did not play the rest of the game. Hines Ward was removed from the Steelers Week 9 game against Baltimore after suffering a hit to the head. Ward was yanked from a game last season after taking a shot to the head.

Tomlin's choice to not bring on more criticism by injecting his opinion on the largely unknown nature of head injuries seems both responsible and wise. There isn't anything either illegal or immoral about his use of CLS. He's not paid to make sure Florio has something to write about. If the story is the way in which Tomlin is speaking about something he's not qualified to speak on, then write about how coaches should be medical experts as well.

Otherwise, get over yourselves and let the doctors handle it.

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Wow, I'm 1st

I totally agree. But then if the media types didn’t have the creativity to make stuff up or twist things just enough, they would be out of jobs—no jab at Bouchette, but some of the others.

Things can always be worse....

by ncmt40 on Nov 30, 2011 9:37 AM EST reply actions  

agree

with everything you said Neal. I have had plenty of concussions in my life from boxing and skate boarding. I have also had concussion like symptoms without having an actual concussion, these came about from whiplash like neck injuries and knock outs.

People don't ever seem to realize that doing what's right is no guarantee against misfortune.
- William McFee

by stillergorillar on Nov 30, 2011 9:46 AM EST reply actions  

A Knock Out

Is a level 3 concussion.

by biggcat on Nov 30, 2011 5:53 PM EST up reply actions  

not always

there are times you just go blank, for a second. Sorta like a head rush when you stand up to fast, it isn’t always related to the hit. It can be a combination of not getting enough air and not controlling your heart rate, you get a little dizzy and then glancing blow sends you down. It’s not an out cold KO, but it can take you a little bit to recover.

People don't ever seem to realize that doing what's right is no guarantee against misfortune.
- William McFee

by stillergorillar on Dec 1, 2011 9:21 AM EST up reply actions  

The only thing I see with the distinction

between CLS and a concussion is, I believe, the rules this year mandate a player with a concussion can not stay on the sidelines either. He must leave the field entirely.

Hey! At least he wasn’t caught using a cell phone this time! If he did use one, he hid better than the Chargers’ kicker did!

by Larrybob8187 on Nov 30, 2011 9:54 AM EST reply actions  

The media needs stories

unfortunately, creating controversy (and therefore traffic) often becomes a more important goal than credibility, which is why you get these types of stories. I hate the fact that the Steelers organization is painted in such a bad light even though they (seemingly) do the right thing in sitting players that exhibit symptoms, so thanks for the article Neal.

by Simonsen on Nov 30, 2011 10:25 AM EST reply actions  

This stuff is annoying

Of course we know guys like Belichick are super mum about their injury reports. As you stated, the rules are pretty simple. The Cheaters love to list a guy probable when there’s nothing wrong or something extremely minor, just to plant that seed of doubt in the next team.

If I were the other team, I’d plan against the other teams starting lineup every week regardless of who plays, because as we say ‘the standard is the standard’

But we obviously handle things well here, we never force a player back (Woodley or Smith) and I think we make the right decisions in that regard.

discontinue whatever it is you’re doing that’s causing you to get hit in the head

This is what concerns me, how long until Polamalu ‘discontinues’ playing for good?

by Mechem on Nov 30, 2011 10:33 AM EST reply actions  

I think that time may come sooner than later

he has expressed in the past that football is just what he does to support his family and that they are what is most important – How long before his wife convinces him he has taken enough blows to the head and it is time to hang up the cleats?

"My mentality is singular in that I want to be world champs each and every year, so that's what we work toward. I have a tough time acknowledging levels of success short of that. That's just how I'm wired." - Mike Tomlin

by MDSTEELERSFAN on Nov 30, 2011 11:05 AM EST up reply actions  

Media needs to Back OFF

What the heck does it matter what it is called or is told to the media/public. We are “fans” of the team, not part of the team. We do not need any of the info. And the only reason that any of it is given to the public during the week is for betting. Bets are closed once the game starts. The only person that needs to know the status of the player during the game is the Head Coach (and maybe Troy’s wife, but text her, skip the fine).

Being an athletic trainer in professional sports, I get many a text messages when a player gets injured about their status, heck I get text messages when players are substituted for a defensive replacement because the media wants to know…

Wait till the game is over we will be told all in good time.

BTW – concussion like symptoms, much like flu like symptoms, or shoulder symptoms is a diagnosis. Until further testing can be done we do not want to jump to conclusions, lest the media, the staff and most importantly the patient receive the wrong diagnosis.

by Polamalu's Locks of Love on Nov 30, 2011 11:17 AM EST reply actions  

BTW – concussion like symptoms, much like flu like symptoms, or shoulder symptoms is a diagnosis.

I, too, have symptoms of having a shoulder. Two of them, actually.

You make a valid point, this isn’t Troy Polamalu’s medical exam, it’s letting everyone know how he’s doing. An earlier point was made that apparently the rule is if he has a concussion, he’s supposed to go to the locker room. That seems like the most asinine, juvenile rule in the league, and if any team is guilty of that, I think I can find it within myself to forgive them for it.

I’ve ripped to shreds Carson Palmer on this site for going home during the playoff game in which he was injured, because leaders don’t just leave when their team is playing. I will not back off this stance (many have tried, Bean in particular). Troy and Hines are paid a lot of money and are expected to be leaders of this team – both on and off the field. It’s beyond hypocritical to say sitting in the locker room is somehow more healthy for them but still expecting them to be pillars of the organization.

That’s why I wrote this. Utterly effing ridiculous.

The fact is, an “asymptomatic concussion” is the medical term for a “mild concussion.” Doctors on hand can evaluate his symptoms and monitor him over the course of 1-2 days. In doing that, they said they could see more and more evidence that he had an asymptomatic concussion (which could be described as having “concussion like symptoms,” with those symptoms not indicating a severe concussion), which clearly means he was in no imminent danger by being on the sideline.

The fact is, he didn’t play anymore. I’ll bet he wanted to. They took his helmet. He stayed there because he’s a man (not meant to be a gender-based comment, but rather one to indicate he fits the stereotype of someone who sticks with his family through everything) and he’s not going to turn his back on his team.

by Neal Coolong on Nov 30, 2011 11:43 AM EST up reply actions  

How can you tell?

You let everyone know, by letting him stand on the sidelines.

It is not a asymptomatic concussion, he was “asymptomatic”, meaning that his symptoms of the current concussion had resolved.

He did have a Mild Traumatic Brain Injury. He possibly lost consciousness after the hit, did have dizziness when standing and looked to have some sort of impairment. This is what the NFL is trying to cut down on (second impact) and the Steelers, their Medical Staff and most importantly their Athletic Trainers should be commended on their handling of Troy and Hines. It also helps to have the center of concussion research at UPMC.

by Polamalu's Locks of Love on Nov 30, 2011 1:30 PM EST up reply actions  

I had read up on all of this during the lockout, but admittedly, did not confirm asymptomatic concussion before I commented. I thought we were both saying basically the same thing. I will defer to you, being that you seem far more knowledgeable than I on the subject.

I would think the NFL would be far more likely to let the Steelers’ doctors lead the way on this, especially considering the information used in the lawsuits from a generation or two down the line will be based on the groundbreaking research the UPMC has done on this subject. Just my useless $0.02.

by Neal Coolong on Nov 30, 2011 3:28 PM EST up reply actions  

Agree

Neal, first – great posts, I am a familial ex-pat from pittsburgh living in philly grown up in baltimore.

Second – I may have come off strong, but I am passionate about my job and the perception that we have in the public eye.

Third (being on both sides fan and professional) – The perceived accountability(read immediate) to the public is over the top. I read an article the other day about Mariano Rivera and his personal medical issue. I wish him the best, he deserves the privacy he wants

by Polamalu's Locks of Love on Nov 30, 2011 4:52 PM EST up reply actions  

Florio is notoriously biased against the steelers. Further, he knows cicks and controversy makes money, and pays his salary. He wants to paint the steelers as cheaters and hypocrites, especially when it comes to player safety.

It’s also clear in both the Polumalu and Ward concussion-like injuries that they were not going back in the game. Standing on the sidelines certainly makes them out to be cheaters, right?

What is this business about the rules stating that if you have two concussions in a season you need to sit out two games after the second one? Am I making that up? Is that what he’s getting at?

by IronJake on Nov 30, 2011 11:38 AM EST reply actions  

Any good trainer will tell you you have to trust the athletes. They know their body. I understand making them take tests, and I fully support erring on the side of caution, but trust cannot be established between the trainers (who swore an oath to protect those they treat) and the players, whom, without their talents, do not make the kind of living for themselves or their families.

You cannot hold them to the same standard you do morons like me, who get hurt in their family’s Thanksgiving Day game.

Incidentally, anyone know anything about knee injuries? Doesn’t hurt, but it keeps giving out when I walk on it wrong.

by Neal Coolong on Nov 30, 2011 11:45 AM EST up reply actions  

and if that still doesn’t work, try walking on it left.

by klompus on Nov 30, 2011 12:21 PM EST up reply actions  

sounds like you guys are writing some kind of a dance.

by Neal Coolong on Nov 30, 2011 12:38 PM EST up reply actions  

try the hokey pokey

"I think the beard will decide when the time is right to come back. It will know when the time is right and all of a sudden appear." -The Deisel

by count'em_six on Nov 30, 2011 1:21 PM EST up reply actions  

Yep...

the fun part is putting it in then out, then in again and shaking it all about

Things can always be worse....

by ncmt40 on Nov 30, 2011 4:51 PM EST up reply actions  

shake three times and you're...

nevermind…

"I think the beard will decide when the time is right to come back. It will know when the time is right and all of a sudden appear." -The Deisel

by count'em_six on Nov 30, 2011 5:00 PM EST up reply actions  

we haven’t got to the part where you walk the line

by klompus on Nov 30, 2011 4:34 PM EST up reply actions  

Had a stress fracture once

That sucked. Got it in gym class falling hard on my knee. Really small crack, hardly visible on the x-ray. It usually didn’t hurt but sometimes, I think when the weight was pushed right on the crack, it hurt like hell. Oddly running didn’t hurt much but downhill walking or stairs did sometimes.

Sucky thing with knees is all you can do is put a brace on it (if it’s nothing super serious) and just NOT move. Which, when you have a life/job/family is pretty hard to do

by Mechem on Nov 30, 2011 12:22 PM EST up reply actions  

My Job

Please call us Athletic Trainers, there is no oath, but it is my job to protect them, but at times I have to protect them from themselves. Other times I have to push them to keep their job.

Most likely patella tracking incorrect/subluxation or patellar tendonitis.

Any previous injury?

by Polamalu's Locks of Love on Nov 30, 2011 1:39 PM EST up reply actions  

I think I did the same thing when I was like 16. It almost feels like something moves under my the edge of my kneecap, and sometimes when I step down, it’s like it gets pinched under the kneecap and bone.

I cut to my left off my right leg in a football game on Thanksgiving. First play of the game. I had been running wind sprints in my backyard for the few weeks leading up to the game, but that’s grass. We played on turf.

by Neal Coolong on Nov 30, 2011 3:32 PM EST up reply actions  

My guess

Without evaluating you in person: patellar subluxation
Or Tendonitis or plica

Either way strengthen the medial quad and hip.

by Polamalu's Locks of Love on Nov 30, 2011 4:57 PM EST up reply actions  

just a couple quotes.

http://en.wikipedia.org/wiki/Concussion

Concussion, from the Latin concutere (“to shake violently”)1 or the Latin concussus (“action of striking together”),2 is the most common type of traumatic brain injury. The terms mild brain injury, mild traumatic brain injury (MTBI), mild head injury (MHI), minor head trauma, and concussion may be used interchangeably,34 although the latter is often treated as a narrower category.5 The term “concussion” has been used for centuries and is still commonly used in sports medicine, while “MTBI” is a technical term used more commonly nowadays in general medical contexts. Frequently defined as a head injury with a temporary loss of brain function, concussion can cause a variety of physical, cognitive, and emotional symptoms.

http://en.wikipedia.org/wiki/Concussion_grading_systems

Concussion grading systems are sets of criteria used in sports medicine to determine the severity, or grade, of a concussion, the mildest form of traumatic brain injury. At least 16 such systems exist,1 and there is little agreement among professionals about which is the best to use.2 Several of the systems use loss of consciousness and amnesia as the primary determinants of the severity of the concussion.2

……..

sorry for my noobish lack of quoting skills but i thought this to be someone relevant to the discussion.

by greentreee on Nov 30, 2011 2:51 PM EST reply actions  

Technical Jargon

This is the most current consensus statement on the treatment of concussions. More and more data continues to be presented, but this is what is agreed upon for a “standard of care”

http://sportconcussions.com/html/Zurich%20Statement.pdf

by Polamalu's Locks of Love on Nov 30, 2011 3:05 PM EST reply actions  

What bothers me

is that they want to rake MT over the coals for correct reporting, but how long has Belichick been falsely reporting on his injury reports?

Things can always be worse....

by ncmt40 on Nov 30, 2011 4:54 PM EST reply actions  

Concussion like Symptoms vs. concussions aside...

The truth is the Steelers do have a history of shooting less than straight with injuries. Marvel Smith had back surgery in 2008 — and they didn’t report that until well after the fact.

Remember too, the issue of Ben’s spinal concussion vs. non-spinal concussion in 2008 vs. the Browns.

And wasn’t it “possible” that LaMarr Woodley was going to play less than a week after suffering his hamstring injury…?

by Hombre de Acero on Nov 30, 2011 11:52 PM EST reply actions  


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