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Perfect? No, but NFL concussion recognition definitely progressing

Week 10 in the NFL saw the vexing issue of concussions raise its ugly (and groggy) head again, with three starting quarterbacks in the NFC going down like so many bowling pins. Michael Vick on the East Coast, Alex Smith on the West Coast and Jay Cutler in the country's midsection all were knocked out of action by second-quarter blows, and not coincidentally, none of their teams rallied to win in their absence.

Predictably, given the heightened awareness and seriousness of the concussion dilemma, there was immediate debate on whether the Chicago Bears were negligent in allowing Cutler to remain in the game another seven plays after he was leveled on a head-high hit by Houston Texans linebacker Tim Dobbins. Covering the game, I myself tweeted from Soldier Field that the Bears and head coach Lovie Smith might have some explaining to do in light of Cutler not leaving the game until he was diagnosed with a concussion at halftime.

But upon further review, with a little time to reflect on Sunday's events, maybe focusing on that part of the concussion issue is looking at it through too narrow a lens. Yes, the Bears could have been more proactive on Cutler's behalf, given the violent nature of Dobbins' hit and the quarterback being laid flat on his back by the blow. There's room for improvement there, when it comes to reaction time and a team deciding whether to administer a concussion test, even if the NFL on Monday ruled the Bears handled the injury "properly,'' noting that Cutler was removed once he showed concussion symptoms at halftime and was diagnosed with a concussion.

In San Francisco's tie with St. Louis, Alex Smith played another 12 snaps after absorbing a hit to the head by Rams linebacker Jo-Lonn Dunbar, even throwing a 14-yard touchdown pass to Michael Crabtree on his final play in the game. The 49ers on Monday said they believe Smith actually sustained his concussion six plays after the Dunbar hit, on a 4th-and-1 quarterback sneak, and that Smith was evaluated on the sideline for concussion symptoms during the break between the first and second quarter, before re-entering the game. But Smith did leave the game complaining of blurred vision after the touchdown, and at the very least the Dunbar hit probably contributed to his concussion.

In Philadelphia, the exact occurrence of Vick's concussion wasn't completely definitive either, because he took big hits on consecutive plays against Dallas, only leaving the game after the second one.

Sunday's examples are to be learned from, not overlooked. But stepping back and taking a bigger picture view of the challenges inherent in quickly and accurately diagnosing concussions in the middle of a game, the NFL already has made quite a bit of improvement in what is a rather inexact science. Are mistakes still being made? Undoubtedly. Is the idea of an independent neurologist on every sideline a step that still needs to happen? Probably so, if the league wants to do everything possible to mitigate the chance of an injured player doing further harm to himself.

But I also think it's quite clear we're never going back to the day where a woozy Colt McCoy can get back on the field and keep playing in Cleveland after being concussed, which happened just last December. As concerning as Week 10 was on the concussion front, it's important to realize that none of the three quarterbacks injured (or Buffalo running back Fred Jackson, for that matter) returned to action once their concussion symptoms became obvious. That's progress.

According to Smith, Cutler tried to convince Bears coaches that he could continue playing, but the decision wasn't his or theirs to make. He didn't pass the diagnostic concussion protocol established by the league, and he didn't have a say in the matter after that. Case closed.

The same applied to Smith, Vick and Jackson. Like Cutler, all three were involved in tight games that their teams needed to win to protect or improve their place in the standings, but once their concussions symptoms became clear, they were done for the day. That being a given is an indication of the ground we've already covered on the concussion issue.

Not to sound like the voice of naivete, but progress on a significant problem like concussions in football rarely ever comes in leaps and bounds, with a solution that arrives all at once. It's the steady drip, drip, drip of knowledge, awareness and practice that builds and builds until it all comes together to make up a new norm, and establish new standards. Improvement comes slowly, not at the speed that's always preferred or even necessary, but better to keep heading toward it in small, incremental steps than to not be moving at all.

Playing the blame game in the wake of Cutler's concussion is a satisfying exercise for some, and as earlier noted, I stuck my toe into those waters as well. We live in a world that demands instant clarity and snap judgments on every issue, but it's not that easy or clear-cut when it comes to concussions. We want something for concussions that works kind of like instant replay, as it were, which shows us everything we need to know to make the right call. But I don't think that really exists.

Maybe some day it will. Maybe the technology and the science is coming, and some day we'll know immediately if a player is concussed and how badly, before another snap is taken and further risk is incurred. Perhaps players will do their part as well in those tougher to discern borderline cases, speaking up during a game when they should, rather than trying to mask their symptoms or practice the gladiator mentality that does the education against concussions no good.

But for now, it still feels like a moving target, with the league finally trying to minimize the wiggle room in the diagnostic process, and adjust the game's rules and safety measures as we go. Heightened concussion awareness doesn't provide a panacea, but it beats the heck out of the ignorance or inattentiveness that once prevailed.

After all, the concussion debate will always be with us to some degree, because football is a collision sport, and collisions produce concussions. But we're chipping away at what was once considered collateral damage in the game, trying harder to discern between a big hit and a brain-damaging hit, and make changes to limit the long-term impact and frequency of concussions.

On that front, Sunday was another headline day in the NFL's belated efforts to come to grips with brain injuries. When starting quarterbacks get sidelined with concussions, everyone in the game takes notice, and that's actually a good thing in the long term. Because some post-mortems are in order and necessary, if only to keep learning and keep the process moving forward. Knowing exactly what to do for players and when to do it in every situation, when events are unfolding in real time, is a still-evolving practice. Experience and a longer track record with the game's new sensibilities will only help increase the effectiveness of concussion recognition and hopefully prevention.

But it's a fight that takes time. Zero tolerance in terms of concussion diagnosis remains a goal, not a reality. To keep moving in the right direction, as quickly as possible, is the only option the NFL can entertain.

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