For several minutes Sunday, a stadium full of fans stood in silence as Indianapolis Colts receiver Austin Collie lay motionless. A forearm to the helmet – a seemingly routine hit – left Collie down on the field for several minutes before walking off. This injury marked the third game in seven weeks that the receiver left a game with a concussion. As of late Monday afternoon, the Colts reportedly have not ruled out Collie for this week’s game. Coach Jim Caldwell said “…things are moving in the right direction from what I saw after the game.” This column is in no way meant to criticize the Indianapolis Colts medical staff or the NFL. Collie’s injury may serve as an example of the potential dangers of returning to play after concussions.

I don’t know the severity of Collie’s prior concussions or whether he was still having symptoms just prior to Sunday’s game. I have read speculation that the dark shield on Collie’s helmet Sunday was added because he was still experiencing sensitivity to bright lights – a sign his symptoms had not completely resolved.

I am not a neurologist or neurosurgeon, so I do not have to make the ultimate decision about the severity of the head injuries I see as a team physician on the field. At MUSC, we are fortunate to have experts to diagnose and treat injuries to the central nervous system (like concussions) and peripheral nervous system (like stingers). But I frequently have to decide whether to pull an athlete out of a game or keep him from returning to play. I am very familiar with the pressure applied by coaches, parents, and the players themselves to try to play after a concussion.

Bobby Weisenberger, an athletic trainer with MUSC Sports Medicine who covers the Charleston Battery, West Ashley High School, and the SC High School Hockey Association, unfortunately is all too familiar with head injuries in sports. He claims that he has had to send at least 9 players by ambulance to the emergency room after head and cervical spine injuries in the three years he has worked with us. Those are unfortunately easy decisions. What is more concerning to me is the questioning he gets about seemingly mild injuries.

“It happens constantly. I’ve gotten it days after a concussion and a few minutes after one. Coaches, and sometimes parents, want the kid the play. They will say things like, ‘He seems to be himself. His symptoms have resolved.’ Fortunately we work with coaches who allow us to do what we feel is right, but the pressure is there,” Weisenberger says.

What is worrisome about Collie’s injury Sunday was that it resulted from what seemed like a fairly mild hit. The defender’s forearm hit Collie’s helmet as he caught a pass over the middle. That kind of contact happens all the time. It seems to me that this is a classic example of the slippery slope with concussions.

Dr. Jonathan Edwards, a neurologist at MUSC who leads the MUSC Sport Neurosciences program, often describes recurrent injuries as low threshold concussions. “It’s often a warning sign. The first one often requires a major blow. After one or more, the player often notes that it didn’t even seem like a bad hit. The threshold seems to reset at a lower level if the athlete hasn’t fully recovered,” Edwards points out.

This situation hits close to home for me. My brother played rugby at Davidson College. After a mild “ding” earlier in his senior season, he played a noon game against Appalachian State. He woke up in the emergency room at Carolinas Medical Center – nine hours later. He didn’t remember the hit or any part of the game itself, and he still doesn’t. Everything ultimately resolved, but he decided that game would be his last.

I realize that the Colts had to win Sunday to keep their playoff hopes alive. I do hope that Collie didn’t play against medical advice or before his symptoms resolved. If anyone should see the bigger picture, it is probably Collie, whose wife delivered his first child last week.

I realize that this column sounds preachy, but I think concussions are that important. I want kids to play. I do everything I can to get athletes back on the field. But if the teams, schools, and leagues we work with want to choose another program because we are too conservative, I can live with that choice. Dr. Edwards is known for saying, “If you rush them back, they get a game. If you let them fully heal, they get a career.” Sometimes there are more important things in life than the next game.

Note: This column appears in today’s edition of The Post and Courier. Also please check out my page on The Post and Courier site to read past sports medicine columns.