Baseball isn't the sport that first comes to mind when it comes to concussions, but that didn't stop Major League Baseball from being proactive. A 7-day disabled list, created specifically for players suffering from the effects of a concussion, was introduced in 2011. The very first player to be placed on this new DL was the Brewers Erick Almonte, during his first trip back to the majors since 2003.
Almonte needed more than seven days before returning from his concussion, and was released from the 15-day DL (to which he had been transferred once it became clear he needed more time to recover) in early June after suffering the concussion in late April. That's allowed by the new DL, just like you can transfer someone from the 15- to the 60-day -- the purpose is to ensure that teams don't rush players with concussions back into action, while also attempting to help them shuffle their rosters around as necessary.
Concussions come in varying degrees of severity, and it's difficult to know just when the effects will wear off. The concussion that knocked Justin Morneau out in July of 2010 was considered "mild", but he was still recovering from it before the 2011 campaign began.* The Twins still weren't sure what they were going to get out of him in the present day, as he was once again dealing with concussion issues in late August of last year.
*Mild is a relative term -- a minor brain injury is still a brain injury.
Most "average" concussions for position players clear within five-to-seven days, hence the 7-day DL. But sometimes, as with Morneau, it's difficult to gauge just what is an average or mild concussion, as there's no real way to know if someone has recovered other than a lack of symptoms. If they are failing the tests required to get them back on the field, then symptoms are persisting, and the waiting game continues.
These tests exist uniformly thanks to an agreement between MLB and MLBPA meant to protect their players, in the hopes of avoiding another Morneau situation. That agreement, as Corey Dawkins and I wrote about last year when it occurred, is outlined as follows:
- Mandatory neuropsychological pre-season testing using the ImPACT system. These computerized tests, developed by doctors Mark Lovell and Joseph Maroon in the early 1990s, take roughly 20 minutes to complete and provide objective measurements across several characteristics, including memory, reaction time, cognitive function, and impulse control. While the system can be used without a baseline, it is most effective when one is able to compare a test score after a concussion to a pre-concussion baseline, since everyone's baseline is different. Most clubs already do this, but now it is mandatory.
- Protocols for the evaluation of potential concussions among players and umpires were created. Based on recommendations by the National Athletic Trainers Association (NATA) in a position statement, these protocols are to be used for any high-risk incidents. Obvious activities include being beaned, hit by a batted ball, or collisions with a player, umpire, or fixed object, in addition to any time the head is forcibly rotated, in order to account for those indirect forces capable of producing a concussion. An important element of these protocols is the league-wide adoption of a sideline assessment tool called, surprisingly enough, the sport concussion assessment tool (SCAT2), which is also used by organizations such as FIFA and the Olympics.
- The creation of a seven-day disabled list specifically for concussions. There has never been a disabled list for one particular injury before, and the length of the term is important, as we will discuss later.
- The creation of standardized protocols for clearing anyone to return to play. The medical qualifications have remained constant for some time based on the same NATA position statement, in terms of absence of symptoms and progression of activities. Now they are standardized, and a return-to-play form must be filled out and submitted to the MLB medical director for players with concussions, regardless of whether the player in question was placed on the disabled list. The team must also name an MTBI specialist in the home city, in case any further evaluation is needed.
Even without the use of the disabled list, players experiencing concussion symptoms need to pass those tests and be cleared by MLB in order to return to action. This is the stage Ryan Sweeney finds himself in, as he hasn't been placed on the 7-day DL, but hasn't passed the necessary exams to go back to playing, either.
As for how Sweeney will perform once he's back, there's no real pattern to player production following a return from concussions. They have played slightly worse as a unit than injured players suffering from other afflictions, but the samples are a bit too small to conclude anything definitive, and there are also questions about those who perform worse and whether they returned to action too soon, since it's so much more difficult to gauge whether a concussion is finished causing problems relative to, say, a broken bone.
Essentially, the 7-day DL was created to better treat players who suffer from concussions, but also to allow teams a chance to compete more effectively while they wait for a return from the head trauma. The tests are becoming more advanced, and are uniform throughout the league, and whether or not a player utilizes the 7-day DL or not, they still need to be cleared by medical personnel through the passing of tests designed specifically for concussions.
MLB might not have as many concussion issues as high-contact sports, but they're still dedicated to keeping their players healthy both in the short- and long-term view. While that means the Red Sox can't use Ryan Sweeney in their outfield until he's cleared, that's something everyone can be thankful for down the line, as he is being given the appropriate -- and necessary -- time to heal.