Kevin Glenn’s set to start despite his “headache”, raising questions about CFL concussion protocols

There's likely going to be a sharply-divided reaction to the news that Calgary Stampeders quarterback Kevin Glenn will be starting Friday against the Edmonton Eskimos. For Stampeders' fans, that's probably terrific news, especially in the short term; following the hit Glenn took late in Sunday's loss to Saskatchewan, which left him lying dazed on the field before he was helped off, it looked like Calgary might have to rely on inexperienced rookie Bo Levi Mitchell. Glenn being set to go likely boosts the Stamps' chances of winning, especially considering that Edmonton may be starting an inexperienced third-stringer of their own (Mitchell's the backup at the moment, but he's technically a third-stringer, as season-opening starter Drew Tate is still hurt too) in Matt Nichols. However, given that Glenn took a hard hit to the head, appeared dazed afterwards and reportedly has been experiencing headaches, the news that he may not even miss a game is concerning considering what we know about some of the effects of head trauma, and it brings the way the CFL handles concussions into question.

To be clear, no one has diagnosed Glenn with a concussion. In fact, the Stampeders have emphatically stated over and over again that he was not concussed. However, that may be the most concerning element of this story; under-reporting concussions is a significant problem throughout football, and you have to wonder if that's what's going on here given Glenn's apparent symptoms. Here's what Calgary head coach/general manager John Hufnagel said about Glenn Monday:

"The same as we knew last night," Calgary Stampeders' coach John Hufnagel confirmed Monday, regarding the uncertain status of quarterback Kevin Glenn. "It's not a concussion. He has a headache. But he went through the tests this morning and everything's fine. It's whether or not the headache relieves itself between now and the game.

"I'm very optimistic, though."

And here's what Glenn himself told The Calgary Sun's Scott Mitchell:

"It's scary when you have those head injuries," Glenn said following Tuesday's late-afternoon walkthrough,. "Whether it's a bad headache, whether it's you just get hit and your head's hurting, it's scary because of all this concussion stuff that's going around."

But Glenn, who finished the game 24-of-38 for 270 yards with two touchdowns and one interception, is adamant he has never suffered a concussion during his 12-year CFL career.

"I passed all the tests, as far as concussions," Glenn said.

Had the hit occurred earlier in the game, Glenn guessed he may have been able to return to the game. But at that late juncture, there wasn't enough time to properly assess the injury and regroup.

It's worth pointing out that as a CFL club, the Stampeders are presumably following the national concussion policy the league was heavily involved with designing in May 2011. That policy has some interesting elements that may be relevant to this situation. Take a look at the standardized poster designed as part of that endeavour, which was meant to be displayed in locker rooms at the professional, college and lower levels, and can be seen in its entirety on the CFL's site here (PDF). The crucial part:

You'll notice a couple of key elements in there, including the listing of headaches (something Glenn has clearly admitted to) and "feeling stunned or dazed" (something that he certainly appeared to be exhibiting when he was lying on the field) as concussion symptoms. The poster also points out that you don't need to lose consciousness to have a concussion, which is critical, and that symptoms are often subtle. That's why it's so hard to believe that Glenn wasn't concussed here, and particularly his claim that he's never been concussed. Of course, not all headaches are signs of a concussion, but ones that arise after a powerful hit don't seem likely to be unrelated. Most importantly, there's no way a player should even consider returning to a game (or be allowed to consider returning) while suffering any symptoms, so Glenn's comment that he could have gone back in if the hit had happened earlier in the game is frightening.

It's worth pointing out that the handling of the Glenn situation seems to violate established international standards for returning to play following a head hit. Here's what he told Allen Cameron of The Calgary Herald Tuesday about when his symptoms cleared up:

"(The headache) went away (Monday) evening," said Glenn. "It was more the late night (Sunday) and early morning after we got back when it was pretty bad. I wasn't taking anything for it. It's pain — we play a painful sport. It's just like getting hit in the arm or having a bruise on your leg. It takes time for it wear off."

Glenn has never dealt with concussion issues in his football career, and the followup tests on Monday cleared him to return to action, and that knowledge may have played a role in his rapid recovery.

"It's scary when you have those head injuries, whether it's a bad headache or you just get hit and your head's hurting," admitted Glenn. "It's scary with all this concussion stuff that's going around. But when you have the injury and you come out on the up-and-up after the tests you have to take for the concussion stuff, and all those tests are fine, then it puts you in a better situation and you feel like you're OK."

Some of the most reputed return-to-play guidelines following concussions have been developed by Dr. Robert Cantu, the chief of neurosurgery and chairman of the department of surgery at Massachusetts' Emerson Hospital and a co-director of Boston University's Center For The Study of Traumatic Encephalopathy (which has been at the forefront of many football-related concussion issues, and recently found evidence of chronic traumatic encephalopathy in the brain of former CFL player Doug MacIver). In his new book, Concussions And Our Kids, Cantu mentions that a concussion is "a shaking of the brain inside the skull that changes the alertness of the injured person" (which certainly would seem to apply to Glenn, given how he responded after the hit Sunday), and includes a chart of return-to-play guidelines. For grade one (the least severe) or grade two concussions, that chart states that a player may return to play if asymptomatic for one week, specifying that asymptomatic includes "no headache, dizziness, or impaired orientation, concentration or memory during rest or exertion." Under those guidelines, if Glenn's headache went away Monday, there's no way he should be playing for at least a week, which would rule him out of Friday's game. The CFL's guidelines (based on that concussion poster) are similar, mandating a six-step process with at least 24 asymptomatic hours between each step, which would also rule Glenn out for Friday. Here they are:

Of course, the Stampeders' defence here is undoubtedly that Glenn passed the baseline tests given by team doctors and wasn't diagnosed with a concussion. Baseline tests are not foolproof though, and they are not the only metric of determining when a player has a concussion. The most common is the ImPACT cognitive test, and while it's very useful on certain fronts, it has limitations. As Cantu writes, "As effective as it can be, it is a cognitive test only; it measures the brain's ability to think. It has nothing to do with the critical brain functions of balance and vision, which can also be adversely affected by head trauma. For that reason, ImPACT (and other tests measuring cognition only) should not be used as the one and only baseline exam." Moreover, it's very possible to cheat on an ImPACT test by purposefully scoring lower than you're capable of when healthy, and players like Peyton Manning have admitted to this in the past (although Manning later said he was "joking"). It's not always easy to cheat on these, but it's doable, which is further proof that they shouldn't be the only element involved in determining if a player has a concussion. Here's what David Hovda, professor and director of the University of California-Los Angeles' Brain Injury Research Center, told The Houston Press about the limitations of ImPACT testing:

"It's better than nothing," said Hovda about ImPACT. "I don't mean any disrespect, but neuropsychological tests, which require responses and performance from individuals, are always going to have problems because there's always going to be variances."

By the letter of the law, the Stampeders may not be violating CFL concussion policies here. They've determined that Glenn does not have a concussion, so the concussion policies don't come into play. However, when a player has admitted to at least one of the symptoms (and a significant one: his headache, which seems very likely to have come about as a result of this hit, didn't go away for over 24 hours!) and appeared to show more (any viewer watching Sunday's game would easily characterize the way Glenn laid on the field as "dazed" at the least), it seems highly questionable to plan on starting him only a few days after his symptoms have reportedly subsided.

This also raises issues about the CFL's concussion policies. On paper, they look impressive, but if teams won't characterize head injuries as concussions, they lose much of their force. Sure, the team has more information about the specific nature of Glenn's injuries than outside observers, and perhaps he is as completely fine as they say he is. Based on everything that's come out here, though, it's easy to be skeptical, and that raises questions about just how seriously the league and its clubs are really taking concussions.