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Doctor: Hard to recover from repeated concussions

Falcons coach Dan Quinn was elated to share the news that running back Devonta Freeman cleared the NFL’s concussion protocol for the second time this season on Wednesday. He will return after missing the past two games when the Falcons host the Vikings Sunday.

The Falcons still have cornerback Desmond Trufant in the concussion protocol. He was hit by teammate Keanu Neal during the Tampa Bay game last Sunday.

The key for Freeman return-to-play process was that he cleared the league’s five-step program and was free of concussion symptoms. 

“I guess there was some speculation that he had one that maybe wasn’t diagnosed before he got the one that was definitely diagnosed,” said Dr. Erin E. Manning, a neurologist at the Hospital for Special Surgery in New York. “Basically the first thing is the diagnosis, which Desmond Trufant has been diagnosed and that puts him in the concussion protocol. The first step is you have to be symptom free before you can progress through the protocol.”

Freeman returned to practice in a limited manner on Thursday, but was declared out of the Tamp Bay game on Friday. He’s since cleared the fourth and fifth steps of the protocol.

The fifth step includes full participation in practice and contact without restriction. The doctors are looking for tolerance of all football activities without any recurrent concussion signs or symptoms. 

“That can take anywhere from a few hours, a day, weeks to months, depending on the situation,” Manning said. “It’s always hard to know that. In Devonta Freeman’s case, it (was) probably worst that he definitely had a concussion in the (exhibition) season and possibly another one. A lot of times repeated concussions, especially in a short period of time, are hard for people to recover from.”

The Falcons have denied that Freeman had a concussion in the Carolina game on Nov. 5, one week before being diagnosed early in the game against Dallas.  Freeman was out with a concussion from Aug. 14-17. He also had a concussion in November 2015.

So, it will be wise for the Falcons to ease Freeman back into the offense, which is finally flowing and on a three-game winning streak. 

The collision between Trufant and Neal came on an attempted tackle. 

“The interesting thing about concussions is that you don’t have to have a direct head injury to get a concussion,” Manning said. “Even something like a neck injury, what causes the concussion is not necessarily the blow to the head, although that can be part of it. Something like a neck injury or whiplash injury ... it’s the brain moving in the skull, hitting against the skull, basically is what causes it.”

Trying to prevent concussions in a contact sport is problematic. 

“Right now, I don’t know if we have a clear way of preventing them other than avoiding situations where you’re going to have a head injury,” Manning said. “So far, there are a lot of different things that they are trying in football. The biggest part of probably is avoiding some of the concussions, especially for the defensive players, is avoiding those tackles where you lead with the head.

“Avoiding those head-to-head hits are certainly some of the more concerning ways that people get concussions. That is something that you can modify. Proper tackling techniques can really help to avoid some of those head injuries.”

Some players have tried using more protective helmets, but they can’t eliminate concussions.

“You don’t have to have a direct head injury to get a concussion,” Manning said. “So, even if the helmets could prevent some of the shock from having the direct head injury, I don’t know that they are going to prevent all of the concussions. Right now, we don’t have the information on whether or not if they prevent any concussions.” 

Hospital for Special Surgery is nationally ranked No. 1 in orthopedics by U.S. News and World Report (2017-18) and is a world leader in sports medicine performance and rehabilitation. 

Doctors from the hospital work for the New York Knicks, New York Mets, Brooklyn Nets and several other pro and college teams and associations.

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