Best's Type of Injury Can Be "Very Complex"

Lions' insider Mike Mady interviews Dr. Jeffrey Kutcher, Director of NeuroSport for the University of Michigan, to shed some light on the enigmatic injury plaguing the return of running back Jahvid Best.

The Detroit Lions announced that Jahvid Best will start the regular season on the reserved-physically unable to perform (PUP) list earlier this week.

The move ensures Best will not occupy a spot on the team's 53-man roster for – at minimum – the first six weeks of the season, preventing the third-year back from practicing or playing with the team until the Lions have completed their first six games.

When healthy, Best is the top running threat on the Lions roster. He possesses blazing speed and is as dangerous as any back in space. Best's high-end skill set only increases the anticipation of his return, causing frustration outside of Allen Park regarding his extended recovery.

The details provided on Best's healing process have been vague -- likely a product of the uniqueness of a concussion, the most enigmatic injury a professional athlete can suffer.

In an effort to gain some insight I recently spoke with Dr. Jeffrey Kutcher, Director of NeuroSport for the University of Michigan.

Dr. Kutcher hasn't specifically worked with Best but he established Michigan NeuroSport, which is the first comprehensive academic sports neurology program in the country to evaluate and treat neurological conditions affecting competitive athletes.

Dr. Kutcher has extensive experience in the field and his expertise may help us wrap our own minds around what happens in these types of situations as well as what Best might be experiencing.

Best has been sidelined since suffering a concussion in a game against the San Francisco 49ers back in October of 2011. Since he will begin the season on the PUP list, it can be guaranteed Best will have went a full year without participating in a football game – or even a full-contact practice.

In situations where such an extended time has been missed, there is the possibility of greater issues surrounding the injury.

Said Dr. Kutcher, "Anytime there is a situation of a context for an athlete who has been out for greater than two-to-three months to a year or more, there are almost always multiple factors at play and the approach to these situations has to be one of a comprehensive approach to the brain -- in other words you hear all sorts of things about particular specialties or particular approaches, rarely is it just one thing, there is usually a combination of things."

Some fear that Best will never be able to avoid concussions in the future due to his history with the injury. Not only did he suffer two concussions last season, Best was concussed after leaping into the end zone – landing head first – in 2009 when he was a member of the University of California football team.

Although that may be true for some, Dr. Kutcher believes "for the majority it's not."

Of course, the significance of the matter - Best's future susceptibility to injury - hinges on his return.

One of the most confusing aspects of the situation is that Best has gone on record to say that he was not experiencing symptoms and has been cleared to work out for several months.

He has even "looked extremely good in all of his physical stuff" according to head coach Jim Schwartz.

"Symptoms are just one part of it," explained Dr. Kutcher. "Again I can't comment on a particular case but if someone is symptom free and been working out and fine, that's great but you'd also want to look for evidence of any increase of brain function or brain injury that may not be reaching a clinical threshold -- there are other parts to it, not just ‘how are you feeling?' that come into play.

"Depending on the complexity of the history, athletes that have had multiple issues with concussions, multiple concussions in the past and have been out a long time, there are a lot of reasons why it would take long to do so."

Of course, with Best, the largest fear is that he may never return. Although Best himself has not given indication this may be a possibility.

Dr. Kutcher shares some factors he may consider before telling a player to cease his career.

"For me the things that make me recommend retirement are; ‘are you getting injured too easily?', where routine hits are causing problems they (normally) wouldn't; or is the symptom produced just not worth it," said Dr. Kutcher.

"The third scenario where I would recommend retirement is basically if there is any evidence or reason to expect that brain function is being permanently affected. That is probably the most common scenario that we look for but the rarest one to be able to document. You can see why it sometimes is pretty obvious a week after a concussion you will say ‘yeah, you should retire' and sometimes it takes a year or two."

So the biggest question is, what would the next steps be for Best? Dr. Kutcher may not be able to provide that information but he can give us a glimpse of what might happen in similar situations.

"The first step is always to make sure it's safe for them to play from a catastrophic injury perspective," said Dr. Kutcher. "The answer to that is almost always ‘no' when you are this far out but that would be the first step. Then it would be, is there any evidence of neurodegeneration process and if that's not the case then it just really comes down to symptom management. It comes down to looking at, are there issues you are worried about, let's identify those, let's treat those, let's design a rehabilitation paradigm that makes sense to address those directly.

"It can be very complex because you're probably going to address two, three, four, five different things and you need to address them all at once. Regardless of what you're trying to address specifically, what you need to do is continue to progressively challenge them and put them through dynamic scenarios where it's fine that you feel this way at rest but let's see how you do after working out a little bit, after a pretty rigorous workout, how do you do after football related drills and sort of mark somebody the whole time."

Ultimately, it is impossible for us to know exactly where Jahvid Best is in his recovery. However, using Dr. Kutcher's expertise as a reference point, we know that Best should return unless it is identified that he is getting too easily injured, his experienced symptoms are not worth continued playing, future concussions could produce catastrophic injury or significant brain issues have developed from his concussions.

There is nothing we can do but wait and see.

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