Cam Newton’s down, but is it a concussion? Experts say call is critical, harder than it appears

Imagine you’re the spotter in the booth whose job it is to decide whether Cam Newton is showing signs of a concussion from the helmet-to-helmet hit, the fourth of the night, he just received.

His long-term health could be at stake. If he continues to play with a concussion and gets hit again, brain damage could be severe.

You shouldn’t consider that there’s less than a minute to play, that Newton’s Carolina Panthers are down by just one point and driving Thursday. Nor should you pay attention that it’s the NFL season opener, a rematch of Super Bowl 50 being watched by 25.4 million viewers on prime time national TV.

Nor should it matter that if you think you see Newton showing symptoms of a concussion and report it, he’ll come to the sideline to be checked, likely missing at least one play, or go to the locker room for further review, likely missing the rest of the game.

How do you make the call?

Two of the nation’s leading experts on sports concussions agree that having a spotter to flag visible signs of a potential concussion is a positive step for the NFL. The challenge, they say, is that a concussion is so hard to spot.

Here’s what you’re looking for, according to Dr. Robert Cantu, co-founder and medical director of the Concussion Legacy Foundation, and Dr. Kevin Guskiewicz, co-director of the Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center at the University of North Carolina:

1. When Newton gets up, does he appear confused? Does he walk toward the Broncos huddle as if it were his own?

2. Or, does he not get up for a long time? But even that could be related to an injury or pain in another part of his body.

Other signs are more subtle and not visible from afar: Momentary loss of consciousness, a blank or vacant stare, visible facial injuries. Newton could take himself out of the game, but studies show most athletes don’t report concussion – they continue to play. Or, the Panthers could elect to take Newton out.

Safety first?

Both Cantu and Guskiewicz have been leading proponents for making sports safer from head injuries. They’ve helped parents of young athletes understand that it doesn’t take being knocked unconscious or a devastating blow to the head to be concussed. A bump or jolt to the head can cause concussions. Their message to youth coaches has been: If in doubt, sit them out. And to parents: If there are any signs of a head injury, such as a headache or nausea, get your child checked by a doctor.

Concussions symptoms can show up hours or even days later. But in a situation like Newton’s on Thursday, the clock was running.

Cantu says he expects a spotter who sees a potential concussion to flag it whatever the game situation. But he acknowledges, “In the final minute of a close game, I think that human nature is that it would probably honestly be a little harder to make the call.”

Cantu was involved in a World Rugby study that demonstrated diagnosing concussions on the field was even harder than he expected.

“I thought that with all the work I had done over the years, I would be able to be more accurate at calling a concussion,” he said. “A number of times I thought a guy was concussed he wasn’t.

“It’s obviously always better to be sure.”

‘So much is subjective’

Guskiewicz says having a spotter is a great thing, but the problem is that “so much is subjective.” He says that’s clear in studies measuring the g-force (a measure of force on a body that is subjected to rapid acceleration) of a hit.

“You can’t look at a big hit itself and say there will be a concussion,” he says. “We see concussions at 55g. And we see hits that are 155g and there’s no head injury.”

In Thursday’s case, the NFL said, there was communication between two independent certified athletic trainer spotters in the booth and doctors on the Carolina sideline – Panthers team doctor Robert Heyer and an unaffiliated neurotrauma consultant.

“During stoppage in play while on-field officials were in the process of administrating penalties, the unaffiliated neurotrauma consultant and team physician requested video from the spotters and reviewed the play. They concluded there were no indications of a concussion that would require further evaluation and the removal of the player from the game,” the league said in a statement.

Through a team spokesman, Heyer declined to comment. Coach Ron Rivera has said he relies on the team doctor.

Protocol followed?

The NFLPA could launch an investigation to determine whether proper protocol was followed. A spokesman for the union said Friday afternoon the situation was still being reviewed.

Guskiewicz says what was most troubling to him was that there were four helmet-to-helmet hits on Newton after all the focus in the NFL on protecting players from head injuries

“I’m most disappointed that we can’t seem to modify behavior with players who are tackling by leading with their heads,” he said. “The next step I think is that coaches should be suspended in a game like that when there are a number of illegal hits to the head. Coaches need to be held accountable. Make the player say, ‘Do I want to be the person responsible for my coach having to sit out a game?’ Maybe then the behavior will change.”

This story was originally published September 10, 2016 at 2:06 PM with the headline "Cam Newton’s down, but is it a concussion? Experts say call is critical, harder than it appears."