Dr. Joseph Maroon, Steelers Neurosurgeon
Dr. Joseph Maroon, Steelers Neurosurgeon (July 11, 2011):
First, can you tell readers about your work with ImPACT and as the Steelers team neurosurgeon – what specifically does your job entail – and how you got involved in working with the Steelers organization?
I became involved with the Steelers at the request of Coach Chuck Noll over 25 years ago.
Several of the players had concussions at the time and because of my interest in the management of head injuries, particularly those related to sports, I was asked to become the team consultant in neurosurgery.
In 1990 I told Coach Noll that his starting quarterback could not play against the Dallas Cowboys the following week. He asked, “Why?”. I stated because he had a concussion and the guidelines specifically state a minimum of 2-3 weeks without contact—regardless of symptoms.
He questioned this and said that he wanted “objective evidence” for keeping a player out of sports rather than just arbitrary guidelines. He was correct!
I then called my friend and neuropsychologist colleague, Mark Lovell, and we put together the first pen and pencil ImPACT test which subsequently has evolved to a computerized version.
The ImPACT system has now been used to baseline over 1.8 million athletes in all sports.
Your ImPact system is the first computerized evaluation system for determining the severity of concussions. How accepting have teams been in adopting this system – what reluctance if any have they shown in adopting it?
Initially it was thought to be just a neuropsychological test and there was some resistance.
It subsequently was recognized that the test provided objective data that allowed some players to actually return earlier rather than arbitrarily delaying their return to contact sports and it became gradually accepted.
Concussions are such a huge issue not just with the NFL – but across all sports at all levels. Why do you think this issue has just now become more well-known and appreciated as a serious issue?
The NHL was the first to mandate it for all teams in 1997. Concussion and concussion management in the last 4-5 years has taken on a markedly increased importance. This is because it is now recognized that there can be very significant long term negative health and brain affects if concussions are not managed properly.
Did you help work with the Penguins’ Crosby at all? There seemed to be a good deal of frustration by many on the uncertainty of the severity of his concussion and when he could return. How do the medical and professional sports communities help better educate fans and media to help avoid that confusion and resulting frustration?
The ImPACT system is now used in over 3,000 colleges and high schools in the United States and is the standard of care in the NFL, NHL, Major League Baseball, NASCAR, Formula I racing and many other sports. I cannot comment on Sidney Crosby, however, athletes are not allowed to return until they meet three criteria:· 1) They are completely asymptomatic in terms of headache, nausea, visual abnormalities, etc. 2) They are completely asymptomatic after aerobic activity. 3) They have returned to their baseline ImPACT neuropsychological test score.
We help the medical and professional sports communities get better educated by pronouncements and articles such as this and also recommending that people go to the www.impacttest.com home page.
You’re an excellent athlete in your own regard – having participated in over 50 triathlon events and having been an Scholastic All American in Football at Indiana. How has this experience helped you in working with athletes?
Having participated in football at the college level and now over 70 triathlons—the last on July 9 (Ironman 70.3 distance race in Muncie, Indiana), I know the motivation of athletes to return to sports after injuries. I also recognize that return to contact sports needs to be done in the safest possible way to avoid longer term problems.
In this way I can very well identify with the athletes emotional as well as physical needs.
There’s a great deal of concern among former players on NFL benefits. Many players – including a number of Steelers – have had a great need for surgery/rehab/therapy due to the effects of the game, but can’t afford it under the NFL’s current benefits package. What are your thoughts on this and how can the NFL improve their support for veterans in need of help?
Concerning the NFL’s position on injuries, I have to defer that question to the NFL but I think the management is very concerned about potential long term affects and is one of the reasons they have initiated the Mackey 88 provision for players who develop neurological problems after retirement.
What do you think are the next necessary steps for the NFL and all teams to take in regards to preventing and treating concussions, and what will it take for them to get there?
I think the NFL has taken major steps in the prevention and treating of concussions and now it is imperative that the rules and recommendations of the NFL be disseminated to the 1.2 million high school and college players and the 3 million little league players in this country.
In a recent interview with former Steelers lineman Brian Blankenship (http://www.pittsburghsportsdailybulletin.com/page118.html), he mentions coming to you after suffering his career ending injury and later worrying about his financial future since he had not yet signed his new contract. Despite suffering the injury before signing it, Art Rooney told him to sign it anyway. Have you heard stories like this before with the Steelers? Do you see the Steelers organization being different from other organizations in this type of player treatment?
Concerning the Steelers organization, I have been associated with the team and the Rooney family for over 25 years. Stories like Brian Blankenship’s are actually very common. I don’t believe there is a sports organization in the country as loyal, committed, dedicated and honest with their players and employees.
I asked Tony Quattrini once what were the criteria they used to select Coach Tomlin as the head coach. His response was quick and simple—1) faith, 2) family, 3) football—in that order. The Rooney family lives, works and exemplifies those criteria.
Do you often discuss your work with the neurosurgeons of other teams? How progressive have the Steelers been in comparison with other teams in the treatment of neurological injuries and in their prevention?
I frequently work with neurosurgeons of other teams and can state that the Steelers were the most innovative in the NFL.
They were the first to have a neurosurgeon as a full-time consultant. It was also with the support of Chuck Noll and Mr. Dan Rooney that ImPACT was not only developed but spread throughout the NFL due to Dan Rooney’s personal intercession with Paul Tagliabue informing him of the system we had developed to evaluate concussions.
What have been the most rewarding moments over the years as a neurological surgeon?
As a neurosurgeon my responsibility is primary the management of concussions as well as spinal problems such as ruptured discs, sprain/strains and even fracture dislocations of the spine. Because of this I have had the opportunity to deal with many incredible athletes over the years and help them with their decision making in return to play.
Hippocrates, the father of medicine, said that the first role of a physician is to prevent disease, if that be impossible to cure and if that to be impossible to relieve pain. In my role with the Steelers I, along with my colleagues, Mark Lovell and Micky Collins have done all we possibly can do to prevent neurological and neuropsychological problems and also return athletes to play using strict safety requirements.
Now because of Chuck Noll and Dan Rooney we have reached over 1.8 million high school and college athletes with ImPACT—the best system for concussion management available today.
This has been my greatest satisfaction.