Valley neurologist to serve as consultant on sidelines for Super Bowl
PHOENIX — How do you alter a long-standing culture where toughness and team are sometimes emphasized to the detriment of the individual? When it comes to the NFL and concussions, Dr. Javier Cardenas believes that change is achieved through immersion, understanding, education, support and the formation of new habits.
Cardenas is the director of Barrow Neurological Institute’s Concussion Center. Because of Barrow’s expertise, two of its physicians, Cardenas and Taro Kaibara, will be on the sidelines during Super Bowl XLIX to act as consultants to the Patriots’ and Seahawks’ physicians when evaluating potential brain and spinal injuries.
"We have two jobs," Cardenas said. "Look for injuries, like a knee to the head where a guy is walking out woozy, or has problems with balance or coordination. That information gets radioed up to spotter — the eye in the sky — who then informs the team’s athletic trainer.
"Our primary role is as a consultant. In the event of an injury or a potential injury, we evaluate on the sideline or, more often, in the locker room."
Cardenas’ presence (he stands outside the player and coaches box around the 25-yard line) is one of the many things to come out of the 2011 NFL lockout and the subsequent collective bargaining agreement. Players requested the presence of an independent neurotrauma consultant not affiliated with the team to provide a second opinion.
Cardenas’ expertise is well known in the Valley and football circles, from preps to pros. In addition to working Cardinals games, he serves as a consultant on the sidelines for Arizona State games. In conjunction with the Cardinals and the Arizona Interscholastic Association, he also helped craft a community-based online education tool called the Barrow Brainbook. High school players must study the book and then pass a test with a score of 85 percent or better in order to play high school football or any other AIA sanctioned sport.
In addition to those duties, he is part of the NFL’s head, neck and spine committee, which designed the league’s concussion protocol based on science and international medical consensus on concussions.
"When it comes to the science of the brain in general, we’re at the most exciting time in medical science history in terms of innovations, research and dollars dedicated to brain research," Cardenas said. "We are at the beginning of the peak of understanding this whole process.
"What I described before about NFL games is largely subjective, but we’re looking for that objective marker that says, number one, this athlete has a concussion and No. 2, this athlete has recovered and can play again. That’s really the Holy Grail of concussion research."
Even when medical science achieves that milestone, however, Cardenas admits it must also change the culture of football where so much value is placed on playing through pain.
Seahawks defensive end Michael Bennett said that is already happening with the mere presence of independent consultants.
"They don’t have reason not to do the right thing," Bennett said. "Sometimes with the team doctors, you get the feeling they’re looking out for the team’s best interest. With these other people on the sidelines, they’re looking out for your interests."
Cardenas said NFL players show more willingness to self-report than college players or high school players.
"My first year, I had a terrible time understanding why," he said. "What I discovered is that at the college and high school levels, they want to be recognized by scouts, so they have short-term goals. But at the professional level, they understand that they are an asset to themselves. They want to play that next game for themselves and their teammates, but they also want to play next year."
Bennett said that attitude is beginning to permeate the league.
"Sometimes you can’t be tough," he said. "It’s like when you’re at home and you’re watching a sad movie with your wife. Sometimes you’ve got to cry and sometimes in sports you’ve got to let people in and let them know what’s going on with you. This makes it a lot easier."
Bennett said the knowledge of how brain injuries and chronic traumatic encephalopathy (C.T.E.) have tragically affected former players such as Junior Seau and Dave Duerson has made players more vigilant about their own injuries and more careful on the playing field.
"A long time ago, people wanted to see big hits all the time," he said. "Now people are respecting guys for not taking other guys out."
Cardenas does not have the final say in whether a player remains in a game or gets pulled due to injury. That authority still rests with the team doctor. But he insists there has never been a conflict between him and a team doctor, and he knows of no such situation with other teams.
"They trust our judgment and expertise and many times they will defer to our judgment," Cardenas said. "I’ve been incredibly impressed with the NFL as a league, and also the level of self-reporting that occurs.
"You can argue as to how much past lawsuits have impacted that approach, but the fact of the matter is they have a very progressive program in their hands — a great model for approaching these injuries."