Baltimore Ravens vs Miami Dolphins: TE Maxx Williams undergoing concussion protocol

Maxx Williams missed most of the week 12 matchup against the Cleveland Browns due to a concussion. Still sitting on the injury report as "did not participate," it is easy to assume that Williams won't be seeing any of the Ravens playing against the Miami Dolphins either.

We got a chance to talk to Dr. David Wang, the Primary Care Sports Medicine Physician at Hospital for Special Surgery about concussions and how this might impact the Ravens tight end not only this week, but moving forward.

What is a concussion?

According to the American Medical Society for Sports Medicine’s position statement, a concussion is defined as a traumatically induced transient disturbance in brain function.  It is considered a subset of a mild traumatic brain injury.  A concussion results when force is applied to the brain, either from direct contact to the head or transmitted from contact lower in the body.  It typically results in a constellation of physical, mental, emotional and sleep related symptoms, and DOES NOT have to include a loss of consciousness. 

What must Maxx do to be cleared?

The first step in clearance is complete resolution of symptoms.  This is typically accomplished through cognitive and physical rest.  In our adult population, symptoms typically resolve within about 7 days of the concussion, but every concussion is different.  The athlete must also return to their baseline level of cognition and balance.  Once these have occurred, the athlete is placed through a step-wise return to play protocol that gradually increases the amount of physical activity and demand on the brain.  The steps typically consist of light aerobic exercise such as walking, swimming, or riding a stationary bike for a short period to increase the body’s heart rate.  This is followed by sport-specific exercise such as sprinting to add movement.  Next comes non-contact training drills to add more exercise, coordination and cognitive load.  The final step is a full contact practice.  If symptoms return or cognition worsens during the progression, the athlete is rested for a period, and the progression is restarted at the previous level.  Once the athlete progresses through all of these levels without a return in symptoms or change in their cognitive status, they are then cleared for return to play.  

What is the concussion protocol test like?

There are many different tests that are used, and not treating this athlete in particular, I cannot speak to the exact tests being used.  In general, the tests used to evaluate and monitor concussions consist of symptom scores; evaluation of cognition including orientation, immediate and delayed memory, and concentration; balance testing; and a neurologic physical examination.  In addition, there are computerized tests that evaluate memory, cognitive processing speed and reaction time.  When available, these tests are compared to baseline testing the athlete performed before the season to determine when the athlete has recovered from the concussion.

Concussions in the NFL have been a hot button issue because of the long-term affects they have on the body. We've seen the league do a lot better at policing concussions this season, even going so far as to have players go on injured reserve because they can't pass the rigorous testing procedure in place. While there will always be players that slip through the cracks for whatever reason, like St. Louis Rams quarterback Case Keenum, it's the players like Maxx Williams here that show the league is on the way to getting it right.