As early as this season's playoffs, National Football League players will have to get the approval of an independent neurosurgeon or neurologist before they can return to play following a head injury or concussion. Currently, each team's general physician gives the "okay" for players to get back in the game, sometimes, experts fear, when athletes have not fully recovered.

NFL Commissioner Roger Goodell described this shift and other changes in how the league will handle head injuries, such as continuing research to help improve equipment safety, in a statement released on November 24 by the NFL. The decision to work with external neurosurgeons is meant to give players the best medical advice, Goodell said in a November 23 interview on NBC's "Football Night in America." "This is a chance for us to expand [the advice] and bring more people into the circle to make sure we're making the best decisions for our players in the long term," he added.

The decision comes in the wake of mounting evidence that head injuries lead to long-term effects such as brain damage and dementia. One survey commissioned by the NFL recently concluded that there was greater incidence of cognitive damage among retired players than in the national population, but some NFL officials dismissed the findings. At a congressional hearing in October on the issue of football and brain injuries, Rep. Linda Sanchez said that the league's denial of long-term effects of head injuries was reminiscent of tobacco companies denying a link between smoking and disease, the Associated Press reported Wednesday.

Dr. Thom Mayer, medical director of the NFL Players Association, says he instigated the policy change, adding: "It was a growing sense that we needed a clearer cut mandate independent of the league" to determine when players could return to play.

Mayer pointed out that, currently, each of the league's 32 teams has a physician who, depending on their background, may or may not be trained in concussion management. Only the Pittsburgh Steelers and the Indianapolis Colts employ a team neurosurgeon.

But even for teams that have concussion experts onboard, critics say there could be pressure from the coaching staff to unduly speed the return of injured players to the game.

The new policy will improve players' medical care in two ways: "One is that we wanted expertise, and two is a voice that is independent of the team itself," Mayer says.

Mayer and Dr. Elliot Pellman, medical advisor for the NFL, are in the process of appointing the independent neurosurgeons and neurologists, which should be completed within the next few weeks. At each game, the home team's appointed expert will provide care for head injuries. Moreover, the neurosurgeon's or neurologist's recommendation will be mandated, Mayer says. A player will not be able to return to the game until he passes a cognitive test and has approval from this specialist.

It is unclear how these physicians will be paid for their work.

The changes will make the NFL's treatment of head injuries more similar to that of the National Hockey League. Both teams have been doing baseline cognitive tests of each player prior to the start of each season. Since 1997 the NHL has also had independent neuropsychologists perform these tests on players after they recovered from a head injury and before they could return to play. But, unlike the NFL's proposed plan, these neuropsychologists do not actually make an argument for or against return-to-play. Instead, the NHL teams' physicians consider the test results in making the decision.

Mayer hopes the attention brought to head injuries in the NFL could help encourage players to report head injuries and their effects to the team's medical staff. Pride and a sense of obligation to their team, he says, drive players to hide injuries. Mayer, along with current and retired players, is starting a committee that will meet for the first time in January to talk with other players and their families about the threat of head injuries.

Image courtesy of flickr/courteney