New MLB Concussion Policy a Hit With MDs

I don’t often unreservedly praise Major League Baseball or the commissioner’s office, other than the John Thorn hire, which was admittedly minor news. But Major League Baseball appears to have taken an intelligent and decent approach to the very real problem of concussions, and I applaud their efforts. In the last couple of years, concussions have become a hot topic in three of the four major sports. Alan Schwarz’s crusading New York Times articles about concussion in the NFL have led to a culture change in the sport, as Ben McGrath has written in The New Yorker. Moreover, while concussions have always been a part of hockey — Eric Lindros had six diagnosed concussions over the course of his career — the issue has taken on a new prominence in the NHL as Sidney Crosby, possibly the best player in the league, has been out for three months since being injured in early January, with no clear return date.

Concussions aren’t as common in baseball as in either football or hockey, but both Jason Bay and Justin Morneau missed most of the second half of the 2010 season due to concussion symptoms, and Ryan Church’s career appears to be on the verge of ending due to concussions. So it’s a very real issue. Last Tuesday, Major League Baseball quietly announced a new concussion policy to deal with concussion in players and umpires: a mandatory seven-day DL with monitoring by doctors required before players could be cleared to play. The next day, I spoke to Julian Bailes, the chair of West Virginia University’s Department of Neurosurgery and former team doctor for the Pittsburgh Steelers. “I would say at least it’s a start,” Bailes told me on Wednesday. “Seven days or a week is kind of standard for what I would call mild, or grade 1 concussion. It’s probably okay, and anything more than that would have been hard to get pushed through.”

Baseball provides a good laboratory for a new concussion policy, since head injury in the sport is not uncommon but it tends to result accidentally. “Baseball is not a high-impact contact sport,” says Bennet Omalu, a forensic pathologist who has done pioneering work examining the effects of head injury on retired football players, reached by phone on Wednesday morning. “Concussion in baseball is strictly an accident. It’s not part of the game, unlike football. In football, impact to the head is intrinsic to the game.” Because baseball head injuries are accidental, the risk of concussion tends to be low, which means that players rarely suffer multiple concussions in rapid succession.

But it can happen, as in the case of Ryan Church, who suffered two concussions in 2008 and has seen his career deteriorate. That’s another reason the new policy is so important, says Joseph Herrera, a doctor of sports medicine at Mount Sinai in New York City and a member of the New York State Athletic Commission. “Just like with football or baseball or any other sport, athletes try to hide it,” Herrera says. He noted that the NFL and NCAA have begun to use a concussion diagnostic tool called imPACT, and explained that made the close monitoring required in the policy much more effective. “That’ll prevent a lot of other injuries, such as second-impact syndrome. You don’t want another disaster like that Church incident.” Omalu, the pathologist who works in a coroner’s office, is even blunter about the long-term effects: “If a player who has been concussed is returned [to the field], you are increasing risk of permanent irreversible brain damage and early onset dementia.”

One factor for increased risk among baseball players may be undiagnosed head injuries while playing other sports. Jason Bay and Justin Morneau grew up playing hockey in Canada, as did Corey Koskie, who retired after suffering a concussion in 2006, wrote Jorge Ortiz in USA Today. NFL star Troy Polamalu has suffered at least seven concussions in his career, including one in high school and three more in college. And concussions can often go undiagnosed, because they do not necessarily show up in CT scans or MRIs.

However, other factors may be easier to control, both in terms of equipment and positioning. Morneau now swears by a new, more durable batting helmet. Umpire Joe West, the head of the major league baseball umpire’s union, has helped to design umpires’ chest protectors. West also told me that new research has even changed where umpires stand behind the plate. The end of the bat moves more quickly than the handle, and therefore a batted ball comes slower off the handle off the handle of the bat than off the end. So West instructs his umpires to stand on the inside corner, and if any of them are hit in the head, they undergo imPACT testing, as well. “That doesn’t mean we’re not going to be hurt, but it means we’re going to be safe,” he said. West also argued that accuracy of strike calls wouldn’t be affected. “You’re looking out into the strike zone instead of down through it, so I think it helps your accuracy,” he said.” You have to adjust… but you’re able to look down to the low pitch.” According to West, umpire head injuries have markedly decreased since umpires began working the inside corner more frequently.

Ultimately, as Bailes said, seven days is just the starting point. Many players will remain on the DL far longer than the initial week, as they are monitored for symptoms. Just how long depends entirely on the case. Herrera noted that boxers are mandatorily suspended from fighting or even training for 90 days following a knockout; Omalu said that he sometimes advises concussed youth athletes to avoid contact sports for three months to a year. Moreover, the more concussions an athlete sustains, the longer his or her symptoms are likely to persist.

However, diagnosis of concussion symptoms is still as much an art as a science, noted Omalu. The imPACT system aids teams and doctors, but concussion symptoms can be mild, wide-ranging, and often difficult to distinguish. In other words, there is no perfect objective test for concussion symptoms yet. “Maybe we’re optimistically five to ten years away from that,” said Herrera.

So, in the meantime, we will have to watch and wait. “Spend the first season studying it, and see how it goes,” said Bailes. That’s what we’ll all be doing. But right now, it looks like they’ve taken a smart and important first step.

UPDATE: as bluejaysstatsgeek points out below, it appears that the seven-day DL is not mandatory. Instead, like the 15-day and 60-day DL, it’s optional.