Iowa sports physician sees progress in combating concussions

IOWA CITY — Concussions are still a moving target.

In the years since the sports world was introduced to chronic traumatic encephalopathy (CTE) and what it means for contact sports — predominantly in football terms — there's still not really a consensus in the medical field about concussions or how best to approach combating them.

Dr. Andrew Peterson, in his seventh year as a University of Iowa physician on the sports medicine staff, spoke last week to the UI President's Committee on Athletics, and gave his yearly update on concussion statistics in college sports. Apart from showing Iowa's low number of reported concussions in athletes (11 last year total, one non-sports-related), Peterson gave an update on the progress that has been made in identifying and treating concussions.

Peterson designed Iowa's concussion protocol, oversees its implementation and administers the test when an in-game hit merits a player going through the protocol.

He's confident in Iowa's process.

'Are there some that slip through our fingers? Yeah, there's probably some that slip through our fingers. We try to be extra cautious,' Peterson said. 'If we're not comfortable that someone is definitely normal and has an injury, we don't return them to play. There's a bit of a saying: 'When in doubt, sit them out.' We try to live by that mantra.'

While rule changes and independent spotters in press boxes have helped, there's still not been significant ground made up in terms of equipment, Peterson said.

He said there are devices in testing, but that 'those things aren't quite ready for prime time.' He said there are instrumented helmets and shoulder pads that are intended to help identify people who've been hit hard. There's a helmet system being tested by Riddell that will learn how hard an individual player hits, and be able to tell trainers if something is out of the ordinary.

None of those devices in testing are ready, Peterson said, because there's no consensus on what type of threshold of G-forces that should be used to identify someone as having a concussion.

If Peterson could ask for one thing that would be a 'game-changer' in all this, it would be a diagnostic test. Currently there are tests being developed — including by Peterson and the sports physicians at Iowa — but nothing ready for implementation. With no black-and-white test, it's still up to physicians to determine a concussion by the clinical means they do now.

Peterson has hope that will change.

'I suspect within the next 10 years there will be some type of blood test, some type of scanning test or some type of eye scanning test that will help us identify when someone has a concussion. But it's not there yet. That's the big next leap in concussion care,' Peterson said. 'A diagnostic test would be a game-changer for two reasons. One, you'd know when you need to remove someone from a game and when you could let them play. Two, from a research standpoint, it would make it a lot less muddy.'

Peterson has been a part of some of those rule changes in the last several years that have altered how athletes are handled when sustaining a head injury during competition, such as mandatory no-contact periods and thresholds for athletes coming out of or going back into games.

There's no way to eliminate the risks the athletes face, he said, but the risks can be mitigated. The NFL has more evidence, at this point, than the NCAA on effectiveness of things like moving the kickoff up. Peterson said that move in the NFL decreased the number of kickoff returns, thereby reducing concussions on those plays by 40 percent.

The addition of that independent spotter — an athletic trainer, not a physician — in the press box during games has been helpful in that it offers those in Peterson's position a literal eye in the sky with which to work.

Peterson said it's important to have that independent spotter be an athletic trainer rather than a physician. The trainers work far more often and far closer to the athletes than the team doctors do, so because of that, it makes them more effective at recognizing when a player has suffered a head injury. Trainers — professional, graduate-assistant and student — are around the players daily, know the nuances of the game, are well-versed in hard hits and, in Peterson's view, are the 'right people for that job.' Those working in booths are professionally trained.

'I do as much sports medicine as anyone in the country, and our lowest-trained athletic trainer has seen more hard collisions on a football field than I have,' Peterson said.

Peterson's job comes with an appropriate level of scrutiny. His responsibility in diagnosing a concussion during a game is one he does not take lightly. He said there's no uniform standard for putting a player through the entire concussion protocol — for example, if a player is clearly concussed, he doesn't need to do the entire test. An entire test happens, he said, when it's not fully clear.

All the advancements in the works and work that's already been done offer some light at the end of the tunnel.

Still, it can be a rocky road, but it's one he's just fine navigating. Coach Kirk Ferentz and his staff offer Peterson the room to do his job the way he sees fit.

'That's my job to take a little bit of that heat,' Peterson said. 'If we need to remove someone from play, we remove them from play. If I take heat from the media or a blog, I don't care at all. Lucky for me, our coaches, players and trainers support me, so I don't take heat there. It's entirely a medical decision. (Ferentz) isn't pushing me to clear someone when they're not ready to return. He's great with us.

'We're lucky here. It's not that culture at every institution, even within the Big Ten. We're very well-supported at Iowa.'

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