Concussion protocols owe debt to steroid era

Steroids' gift to Major League Baseball is the seven-day disabled list.

Say what you may about performance-enhancing drugs, their pervasiveness made the sport's brass infinitely more conscientious. And the new willingness to look within, admit flaws and emerge with solutions led directly to the implementation Tuesday of a new policy on concussions – one lauded by public-health experts and those in the sport alike as strong, proactive and supportive.

In other words, everything baseball wasn’t with steroids.

"It's a huge step forward," said Chris Nowinski, a leading advocate for concussion safety in sports. "This sort of program closes a lot of the major holes in their policy. This puts them at a very reasonable place. Leagues should have concussion protocols, if not for the ethics than at least to keep their best players on the field.

"It's nice to see an innovation like the seven-day disabled list."

The new DL, to be used only for concussions and other mild traumatic brain injuries, is the first change to disabled-list rules in more than 20 years. The shortened duration – the typical DL is 15 days – is sufficient to evaluate head injuries. Teams reluctant to lose a player for more than two weeks will be willing to err on the side of caution for a one-week absence.

And the change represents a willingness from MLB and the MLB Players Association, who worked jointly on the new protocol, to come up with inventive answers to recognized problems.

Though not nearly as prevalent in baseball as football and hockey, concussions nonetheless occur in baseball. Research in the last five years has revealed an unimaginable ugliness to them: severe long-term brain damage, memory loss, depression and, in many cases, suicide. The most harrowing connection to baseball came last year, when a study showed that Lou Gehrig may not have had the disease named after him. His symptoms, in fact, mimicked that of chronic traumatic encephalopathy, a degenerative brain disease caused by untreated concussions.

Between that and the season-ending concussion to former American League MVP Justin Morneau(notes) last July, baseball's awareness on the issue spiked. It had seen concussions mishandled – notably that of then-Mets outfielder Ryan Church(notes), whose symptoms worsened after he returned too quickly from the injury in 2008 – and understood that even though concussion research is a budding medical field, it is one with enough validity to prompt action.

MLB and the union formed a committee that included five doctors with expertise in concussions and a group of other doctors and trainers to formulate a plan good for player and team. MLB's Dan Halem and the union's Ian Penny worked with them for months to lay out the specifics. In addition to the short-term DL, MLB is mandating "return-to-play" paperwork to be evaluated by the league's medical director for those who suffer head injuries; setting protocols for treating concussions when they happen; and making mandatory baseline testing at the beginning of the season, which most teams already do.

"I'm not sure they're missing a whole lot," said Nowinski, who started the Sports Legacy Institute, dedicated to solving sports concussions, while running the Center for the Study of Traumatic Encephalopathy at Boston University. "The only thing, and I don't know if it's appropriate, is education for the players and managers."

That's coming. MLB is formalizing education plans that include concussion webinars with team medical staff throughout the season, live training during the winter meetings and the distribution of concussion posters throughout clubhouses. Reaching players, of course, is the toughest part, and no matter the good done with the new rules, it's often incumbent upon them to report symptoms to trainers or doctors.

"There's no reason for the athlete to pull himself out," Nowinski said, "unless he's been educated on the risks to his career."

Even after Morneau's injury – which came on a rare head to the knee as he slid into second base – protection isn't a big concern for players. Only a handful of major leaguers wear the S100 batting helmet, which protects heads significantly better than the traditional helmet. While the S100 became mandatory in the minor leagues last season, players who transitioned to the big leagues almost always chose the thinner version.

While part of it is undoubtedly peer pressure – who can forget David Wright(notes) getting compared to the Great Gazoo when he wore the initial S100 model? – a greater issue is unfamiliarity. Until MLB puts pressure on youth leagues, high schools and colleges to adopt helmets with a greater ability to prevent concussions, generations will see them as bulky, costly and unnecessary. Not only does concussion safety need to be the standard, it must be the focus of future helmet design.

MLB soon will distribute a memo reminding players of the S100's availability. Morneau is using it this spring. The league hopes others will follow. It can't unilaterally implement wearing the helmets without the players' approval, and that's too hard a sell for union leaders – for now.

The advances in the meantime are plenty. For so long, when MLB made an announcement concerning the health of its players, it involved harsher penalties for steroids, and within five minutes came the trail of anti-doping wingnuts relieving themselves all over it. Unlike with performance-enhancing drugs, doctors have a relatively good grasp of traumatic brain injury, so the medical community's response is valued and its opinion measured.

After all that steroids begat, this is a small comeuppance. It's an important one, though, and the next time a player gets beaned or runs into the outfield wall or takes a shattered bat to the skull, he can thank his juicing forbearers.

They may have saved a life.