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.

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Alex is a writer for FanGraphs and The Hardball Times, and is a product manager for The Washington Post. Follow him on Twitter @alexremington.

30 Responses to “New MLB Concussion Policy a Hit With MDs”

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  1. LionoftheSenate says:

    The NFL has to be embarrassed right now. The NFL is in the stone age for statistics and now concussions.

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    • CircleChange11 says:

      Yeah, they’re embarrassed.

      Aren’t they in the process of trying to figure out how to divide up billions of dollars.

      They’re humiliated because they are on the cutting edge of statistics or because they “play hurt”.

      Absolutely ashamed.

      IMO, fans are the conflicted ones. We want all this safety stuff, but then rip players when they actually look out for their own safety.

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  2. Worry says:

    Great Read.

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  3. Llewdor says:

    I’ve always thought that the reason Canadian players seem to suffer worse concussions is that they almost certainly suffered some as children. I suffered a concussion as a child (not playing hockey – I was hit by a car), and I had post-concussion symptoms for many weeks.

    Hell, Johnny Damon says his symptoms never went away after his collision with Damian Jackson in 2003. That’s over 7 years now. Concussions are brain injuries. Concussions are bad.

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  4. hairball says:

    This is a major catcher concern, although I didn’t see that highlighted in the article (strange, seeing as the catcher is closer to the bat end than the umpire). Case in point: Mike Matheny, who not only had his career ended by concussions, but AFAIK still suffers permanent damage as a result.

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    • You’re absolutely right. I didn’t speak to any catchers and didn’t read about the Matheny incident specifically, so I couldn’t speak to the risk to specific positions on the field — I only included the umpire information because umpires were specifically mentioned in the press release and I spoke to Joe West. But there is no question that catchers face major risk.

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      • Thanks very much for that piece. Matheny was a hell of a backstop, and I’m really glad to hear that he’s doing well now. Good for him for raising awareness on the issue.

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      • CircleChange11 says:

        From the article …

        Before, if they told me I had a concussion they might as well have told me I had a bad haircut, it didn’t really matter. It meant absolutely nothing to me. As soon as they told me I had a concussion I knew I was going to go back out there the next day.

        That’s pretty much how it is with all types of injuries. Baseball has a “hidden bravado” to it. It’s not like football where it’s all right there in front of your face. It’s Chase Utley playing a full season while not telling his team about injuries. It’s a pitcher throwing even though his fingers go numb. That type of stuff.

        I think fans also have to be honest about how they really feel about it. The sense I get from a lot of fans is that these guys “make millions” and should therefore be on the field, even if they “have a headache” (concussion … because (and we all know this comment was coming), “If I were making millions for playing a kid’s game, I would …”

        How many fans talk out of both sides of their mouth in regards to concussions?

        On the same night that David Wright was beaned in the head leading to an injury and a new helmet, etc … Ian Kinsler was drilled in the head. He got up and jogged to first. Even the players don’t treat the same situations similarly.

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  5. Apparently, it is not a mandatory 7 day DL. Yunel Escobar had a “mild” concussion and is not going on the DL.

    This is probably the first decision by Jays’ management under AA that I have disagreed with.

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    • That’s fascinating. I didn’t realize the teams had that much discretion; it’s certainly not apparent in the press release.

      I disagree very strongly with that Anthopoulos decision.

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      • JC says:

        Well, they sure could have used an extra bat off the bench today.

        Why not 7-day DL him and make sure he’s ok? He will be back by Thursday, and the Jays don’t have to play short for the next week.

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      • This baffles me. AA should remember what they went through three years ago with Hill, and they saw a similar collision at the Dome last July 7th between JohnnyMac and Justin Morneau. Yunel Escobar is a core asset for the next couple of years at least. Take the long view and protect him by putting him on the DL.

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      • Gorlak357 says:

        He still needs to be okayed by MLB’s doctors.

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    • Bo says:

      The Jays apparently didn’t want Escobar to become the answer to an obscure baseball trivia question.

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  6. pft says:

    “a mandatory seven-day DL with monitoring by doctors required before players could be cleared to play”

    I read on ESPN that the DL is not mandatory. The 7 day DL was put in place to “encourage” teams to put players on the DL (harder to take losing a player for 15 days instead of 7 days).

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    • Yes, the “mandatory” aspect was something that I had assumed from talking to doctors — but they didn’t have first-hand knowledge either. I have updated the article to reflect this.

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      • jorgath says:

        The impression I’m getting is that the player has to be cleared to return to play regardless of the DL — that’s mandatory — but the 7-day-DL is there so that teams don’t suffer as much if they need to call up a replacement but don’t want the guy out for the whole 15 days. So the clearing by doctors is mandatory, the new DL is not.

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  7. Steven Ellingson says:

    Can someone with a physics background explain to me why it’s better to stand near the handle? The bat is moving in the opposite direction of the ball, so it going faster near the end would actually make it go slower, wouldn’t it?

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    • Steven Ellingson says:

      Should have made that more clear:

      The end of the bat is moving faster, so when the ball deflects off of the bat and goes towards the umpire, shouldn’t it slow the ball down more than if the bat was going slower?

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      • Patrick says:


        Due to the nature of the collision, the faster the bat is going the faster the ball is going when it leaves. This is because the bat is so much heavier than the ball – much greater momentum.. Deflection is a bit different, of course, but I think this would still hold.

        Sorry, my physics is too far behind me to remember the correct terms for describing the collision..

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  8. Dan says:

    Maybe the force off the bat that pushes the ball up (rather than just the horizontal force) is much higher with the faster, denser head of the bat?

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  9. Scott G says:

    Thanks for writing on such an important issue. As a Met fan. i still feel terrible that Ryan Church was put in such a dangerous situation. Its Inexcuxable for any team not to use the minimum of 7 day DL for even a possible concussion. Its your BRAIN!!

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  10. Paul says:

    Nice article, Alex. I wonder what impact insurance has on the issue. Teams file insurance claims when players are placed on the DL, but perhaps insurance companies are balking at a mandatory? I suppose they would argue it’s a slippery slope, or just on the merits of the diagnosis and effects of the injury being wildly different depending on the player. Do you have any info on this aspect?

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    • pft says:

      Most insurance policies don’t kick in until a player has missed many games, I have seen numbers as high as 100 games or more. Insurance companies don’t pay a dime for a player that misses 7 to 15 days, even 60 days, otherwise premiums would be much higher than they are, and they are already high. Teams are more concerned with injuries that keep a highly paid player out for long periods, in some cases for most of or all of or all of the contract length, and have no problem paying a player out for short periods..

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  11. MikeS says:

    I am a physician so I hope people take this as informed opinion and not doctor bashing….

    Maybe I need to put on my tin foil hat but I always wonder about the phrase “the doctor cleared him to play.” I think it is important that the doctor be independent of the league, team and player. An employee or even a fan for that matter is subject to pressure whether it is from his patient, their employer or even himself. If the doc is a Twins fan or employed by the Twins is he more likely to clear Morneau just a little faster? What if the player says “C’mon doc, I feel fine! Be cool” and they’ve known each other for years. It’s hard to tell a friend he can’t do what he desperately wants to do.

    I know, they are doctors. They are supposed to have the patients best interest so far above all else it shouldn’t matter and most docs do an excellent job of that. But they are people too. They grew up watching sports like the rest of us. They could lose their gig with the team if they don’t toe the party line like anybody could lose their job for interpreting a large set of data in a way harmful to an employer. Conflict of interest is a fact of life. Inf act, the AMA recommends that physicians don’t take so much as a free 5 cent pen from a drug manufacturer and if a physician accepts a $5 sandwich it is reported and can be found by the public on certain websites.

    Numerous studies have shown that advertising works on doctors just like anybody else and advertising is just another form of pressure. Tests like imPACT help and they are much better than nothing at all but all test results are open to interpretation. Combine all that with a “science” as inexact as concussions and it becomes very important to keep everything as free of conflict of interest as possible.

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  12. Bob says:

    Having played football through college, the articles on brain injuries freaked me out a little bit. I was discussing this a few weeks ago with a friend and we were in agreement that we wouldn’t allow our kids to play the sport. Knowing the physical costs of the game probably is what drove me into being a much more involve baseball fan. It seems that MLB is on the right track. However, the players must be proactive in protecting their own health. They can’t just say “I’m fine. Put me in coach.”

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  13. CircleChange11 says:

    Eric Lindros had six diagnosed concussions over the course of his career

    If I recall the sentiment from that time period, the thinking was this, “On 6 separate occasions it was confirmed that Eric Lindros is a pussy.”

    I wrote about this at Tango’s blog but when Lindros was floored the first time (blindside hit just past the blue line), fans went nuts … the loved it … “and G9oliath fell to the ground”. Lindros was basically the perfect combination of everything, and that he would have this “Concussion Kryptonite” seemed to bring quite a few fans absolute, unbridled glee … and they voiced it quite a bit.


    The problem with the NFL is not a lack of rules or policy, etc … it’s the mentality of the players. Better equipment (safer helmets) has simply led to more “head-leading tackles” instead of form tackling. Rather than using your shoulder, these guys get their helmets “in the QB’s chin” intentionally … to do damage … to get him out … to help their team win.

    James harrison can say what he wants, but if they weren’t wearing helmets, he would tackle very differently (just for his own safety).

    If baseball had the same mentality, when it was announced that they have made a safer helmet, pitchers would have said “Cool, now we can headhunt.”

    The problem is also with the players and fans … as noted by the unwillingness to admit a concussion in order to play (or keep the respect of your teammates), and fans that still look at concussions as “Really? He’s gonna miss 2 games for a concussion? Staubach used to knocked sideways twice a game, and then led a 4th quarter comeback.”


    Honestly, I think the concussion thing has a long way to go, both in terms of general understand, and the best way to handle it.

    It’s ironic that parents don’t let their kids play football because of the injury risk … and push them towards soccer … the “ultimate concussion sport”, outside of boxing.

    Do soccer players ever miss games for concussions due to headers? I ask because I read some literature a decade+ ago, detailing the effects back in the day when they were debating requiring prep soccer player to wear essentially “padded headbands”. Of course the players hated it … mostly because it looked stupid (similar to baseball players and David Wright’s “Great Gazoo” helmet).

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  14. CircleChange11 says:

    Reporter: Rocky, do you think you have brain damage?
    Rocky: I don’t see any.

    Jeremy Reonick, one of my favorite hockey players had some comments recently about concussions and how guys from his generation are starting to take them very seriously, since Probie’s death from chronic traumatic encephalopathy.

    This has been big news here in Northern Illinois because Probie was a hated rival for Detroit, but also a Blackhawk for some time. Around the same time former Bear Dave Duerson killed himself and then requested his brain be used for CTE research.

    The scary thing about concussions is not the headaches or inability to focus, but what it may lead to … a general breakdown of the brain and thinking, leading to serious health problems.

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