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Head Athletic Training Rick Burkholder

Posted Nov 24, 2012

Opening remarks: "As far as the two guys with concussions, I think what I’ll do right now is go back to some of the original stuff because there was some conflict yesterday about what phases and what stages guys were in.

"First of all when somebody gets a concussion on our team they have to pass certain criteria before they can ever get back to playing. The first thing is that they have to pass an ImPACT test. Some kind of neurological evaluation that the NFL requires. We use ImPACT. That’s a pass or fail thing so for them to get back on the field they have to pass that. They have to see an independent neurologist or neurosurgeon. They have to be cleared by them. They have to be cleared by our team physician, Dr. Gary Dorshimer, who has a whole set of tests that he does on the sideline and as we progress.

"Then the five phase rehab program that keeps coming up (and guys ask), ‘What phase are these guys in?’ That’s kind of our rehab program and the five phases are: In the first phase, they're either resting or getting ready to exercise, and the exercise portion of it is very low key. Like 30 to 40 percent of their target heart rate or their max heart rate on a bike. They’re doing exercise on a table like straight-leg lifts, stuff like that. Once they get through that phase without any symptoms, so they do that (and) they don’t get a headache, don’t get dizzy or anything like that, they can move on to phase two. Phase two is 40 to 60 percent of their heart rate. They do a little bit more dumbbell work. They do some balance work where they’re not changing their head position. Phase three you jump it up to almost 80 percent of their heart rate so they’re in a good, full sprint-mode type workout. They go back to normal lifting with our strength coaches, they’re in a more noisy environment, that kind of thing. The fourth phase is (that) they return to football activity. They may be doing practice activity (or) skill work. They may do that with us, they may do that with the team but it’s all non-contact. Then the fifth phase is (that) they return to contact. Now this time of year it is hard to get contact. We’ll have them do football stuff and we may do some contact stuff with them in that fifth phase. That’s how our program works and that’s the couple criteria that they have to have.

"Let’s go on to Michael and where he’s at right now. Currently, today, as of this moment, he is in phase three of that rehab program. How’d he get to that phase? He went through the program where he rode the bike (and) didn’t get any symptoms. Then we upped his exercise thing, he got some symptoms (so) we had to stay in that phase until he could get out of that which was phase two. And now he is currently in phase three. He doesn’t have any symptoms. He reports no symptoms, no headache, no vision problems, no nausea, no fatigue, (or) anything right now. He hasn’t reported any symptoms today after his workout this morning. He didn’t report any symptoms there.

"In all likelihood, if nothing happens tonight, he’ll progress into phase four tomorrow which is football activity. He’ll start doing some throwing possibly tomorrow morning if he’s okay. I’ll get a couple receivers that he can throw to. We’ll go through a little workout with maybe (quarterbacks coach) Doug (Pederson) or (offensive quality control coach) Matt Nagy or (offensive coordinator) Marty (Mornhinweg) and just get him to throw a little bit. He’s seen Dr. Dorshimer three or four times during the process. Everything is progressing as normal with him. He has not seen the independent neurologist yet. That will probably occur next week. We just went through this thing where he’s just getting into phase four. It’s Thanksgiving weekend (and) he’ll probably in all likelihood see him early next week if everything goes well.

"Then as far as the ImPACT test, he has not gotten back to baseline on that. He’s still off in a few areas. That’s not alarming to us. It happens and he will not return to total football practice until I can get him to do a little better on that ImPACT test, and that’s what I was telling you guys last week. None of this stuff is like, ‘Well if he passed the ImPACT does he do this?’ No, they're all independent of each other. He’s got to fulfill this criteria. Some guys pass the ImPACT right away and can’t get through the rehab program. Some guys get through the rehab program but can’t do the ImPACT test. Some of them do everything and won’t get cleared by the neurologist. Some won’t get cleared by Dr. Dorshimer. That’s why I tell you that every day we take it day by day. What I anticipate tomorrow is, if he doesn’t have any symptoms tonight, we’ll do some football stuff tomorrow. We’ll probably do another ImPACT test on Monday if everything goes well and then we’ll see.

"As far as LeSean (McCoy) goes, LeSean’s got symptoms right now; still has symptoms today. He’s got a headache. He’s got periodic dizziness with exertion. So, we’re not exercising him, but if he goes up and down the steps too fast or tries to pick up his baby, that kind of thing, he gets a little fuzzy. It’s not nearly as bad as it was in Washington, but he’s still there. (He’s) very fatigued. He’s got some sleep issues where he sleeps a lot and then he’s awake and then he can’t get back to sleep, that kind of thing. One of the things that he complains about is sensitivity to noise, so just noise in general is bothering him. He’s foggy and he’s slowed down. Currently, he’s in phase one, although we’re not ready to exercise him yet until symptoms diminish. He took an ImPACT test today and, obviously, that’s below baseline as well with his symptoms and some of the things that are going on."

On whether there are 24 hours between stages for the concussed players: "Yeah, we try to give them 24 hours. Michael did phase three stuff today and then I’ll wait until tomorrow at this time to see whether he gets any symptoms in between there. Now, it’s not always like a stopwatch 24 hours, but it’s overnight."

On whether he is encouraged enough by the progress that Vick is making to say he could practice next week: "I guess, if everything checks out. He’s still got some criteria to meet. He’s got to pass an ImPACT test, he’s got two more phases to get through, he’s got to see an independent neurologist and he’s got to be cleared by Dr. Dorshimer. In reality, he hasn’t checked off anything off of his sheet yet except the first three phases of rehab. I’m encouraged at the way he’s (going), but like I told you last week, that’s not what I get paid to do. If he plays, he plays and if he doesn’t, he doesn’t. But he’s going to be healthy before he plays."

On whether it is safe to say whether McCoy will or will not be ready to go next week: "No, that’s not safe to say at all because he’s got to go through his criteria and that can go day-to-day-to-day and by Tuesday or Wednesday next week, he may have fulfilled all the things and be fine. We’ve had guys that have gone weeks and then all of the sudden, one day, they just are able to sail through the program."

On whether McCoy has been coming into the facility every day: "Both those guys have been coming in. They come in the mornings. With LeSean, I haven’t had LeSean in any meetings. With Michael, he’s been back in meetings this week. One of the things that we do is that we introduce them back into meetings and if the video bothers them or anything like that, we pull them back out, but Mike’s been pretty good. LeSean’s not ready to do that. LeSean’s still, earlier in the week, he was having trouble focusing on TV and all that kind of stuff so we just backed him out of meetings for now."

On whether it is surprising that McCoy doesn’t seem to have the same symptoms as Vick: "These things never surprise me. We’ve had guys that have had very little symptoms but just can’t get it together. So, that’s why these things are hard to manage because they’re so different. It’s not like, you say, ‘Wow, he tore his MCL (medial collateral ligament) in his knee and he’s going to be out 4-6 weeks.’ It’s just not that way. So, no, I’m not surprised at all and I’m not discouraged at all and I like the process that we’re going through and we’ll see what happens."

On what the baseline test consists of: "The baseline test is the regular test on the computer program. They take that back in the summer, so what they have to do is they have to get their levels back to what they were in the summer. So, that’s what makes it a baseline. It’s a 25 minute to half-an-hour test on the computer."

On whether he has a better grasp on concussions since the NFL has made it a priority over the years: "I think the other guys that do what I do in the National Football League are the same. It’s just that we’re so focused in Philly on Philly. But I think the National Football League has done a tremendous job in giving us assistance in handling these and getting the message out to not only the coaches and the fans, but the players. To handle these things right, it takes everybody. It takes the players, it takes the coaches, it takes the athletic trainers, it takes the physicians, it takes (the media). Everybody’s got to be responsible with this thing and we’ve got to take it very seriously. The NFL has done an amazing job of making this priority number one when it comes to the players’ health and safety and I’m happy about that because anytime in anybody’s job you take the grey area out of it, you’re better off, and they’ve helped us with that. Concussions are concussions; there’s still grey area. But they’ve done an amazing job of trying to eliminate a lot of the stuff."

On how long the team has used the five-phase protocol: "I wish I could give you a year. I know it was before (former RB Brian) Westbrook had his in Washington (in 2009). I adopted it from the University of Pittsburgh Medical Center, who’s a leader in concussion management. It was through them and through some other conferences that we’ve kind of come up with our own little program. But we’ve been doing it for a while."

On whether other teams use the same protocol: "Yeah, a lot of teams do. I think if you saw some of the (49ers QB) Alex Smith stuff in San Francisco, they were talking about (how) he’s got to pass a contact test. They do the contact thing too. I think everybody does their own thing, but I think for the most part, the athletic trainers in the National Football League have developed some kind of program that they trust and a process that they can go through and it’s all backed by the NFL, so that helps."

On whether this is McCoy’s first concussion: "With us, yeah, the first."

On whether he has a sense on how tough it is on Vick not being able to play: "I think these guys are all competitors and I think that’s one of the inherent problems with the concussion management. These guys, they want to play and they know the consequences of everything, but they want to play. So now, Michael’s starting to feel better and he’s in meetings and he’s around his teammates and guys are talking to him and he wants to get back out there. But that’s where I have to step in. Mike and I have a good relationship that way and we’ve talked everything through and Coach Reid’s great about it. So, everybody’s on board with Michael and we know that he’s anxious to go out there and play but we’ve got to be careful with him."

On why it is not a concern that Vick has not yet passed the baseline test: "Same thing as always: with these things, it’s the way they work. Sometimes guys just can’t do it. We’ve had players in the past that have gotten through all five phases of the rehab, been cleared by our physician, basically – not cleared because he didn’t pass the ImPACT test – but he fulfilled all that and could not get back to baseline. Then, we went away for a trip and we came back and he fulfilled that obligation to get back to baseline. It happens, and that’s what’s great about the test. It’s sensitive enough that you know that they can’t fudge it. We’re dealing with symptoms and when we’re dealing with symptoms, the players have to tell me what they are and I have to believe them. On this ImPACT test, there’s enough sensitivity in the test that they can’t fudge it. They can’t get away (with it). It’s matching and matching designs and looking at and recognizing colors and stuff like that that they can’t hide."

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