Concussions have received a tremendous amount of media attention lately. The NFL has very publicly tried to decrease the incidence of head injuries, enforcing rules about helmet-to-helmet contact and fining players for dangerous hits. And certainly physicians seem to be more aware of the dangers of concussions. Indianapolis Colts’ receiver Austin Collie was placed on injured reserve after sustaining multiple concussions in the same season, but is he an exception or the norm?

In the January-February 2011 issue of Sports Health, Ira R. Casson, MD et al. present the results of a study looking at concussions in the NFL from 1996 to 2007. Specifically they focused on players suffering repeat concussions. They compared the data from the most recent six years (2002-2007) to data from the first six years to see if increased awareness and caution have led to fewer repeat concussions.

In the 12-year-period studied, 1,741 concussions occurred in 1200 players. Almost half of the concussions (48.7%) were single events. 29.4% of players experienced repeat concussions. The player positions that experienced the most repeat concussions were defensive secondary, kicking team, wide receivers, and running backs.

What is interesting about this study is the finding that the incidence of repeat concussions (24.2% of players with concussions from 2002-2007, compared to 24.7% from 1996-2001) remained essentially the same despite more conservative management of the injuries. During the second six-year period, significantly fewer players were allowed to continue playing after a concussion, and significantly more were held out for more than seven days. These precautions apparently did not decrease the incidence of repeat concussions.

By no means in presenting this study am I discouraging efforts to protect players from concussions. I would argue that it is absolutely critical for physicians to properly evaluate players with suspected head injuries and to hold players out from practices and games if there is any question of lingering symptoms. Players need to notify coaches and physicians of any continuing headaches, blurry vision, nausea, light sensitivity, feeling dazed, or other unusual sensations. Particular caution needs to be utilized for players on special teams due to the high-speed, high-impact nature of the collisions among players on these units. This study just points out that we have a long way to go to improve on treatment and prevention of concussions in football.