Despite quarterback Alex Smith's head bouncing off the rock-hard Lucas Oil Stadium turf twice on Sunday _ a surface one player compared to concrete after the Chiefs' 30-14 victory over the Indianapolis Colts _ the Chiefs' head athletic trainer said Monday that he doesn't believe Smith has a concussion.
"We don't think that in either episode he had a concussion," head athletic trainer Rick Burkholder said of Smith, who will continue to undergo testing this week. "I know there was some confusion yesterday."
Burkholder cited a breakdown in communication as the reason for the confusion and explained the NFL-mandated concussion protocol.
It started on the sideline, as players who are suspected of being concussed are administered a five-question "Maddocks Test" by a team physician (Cris Barnthouse) and an unaffiliated, independent, neurotrauma consultant (Mike Monaco). Burkholder said Smith passed all five questions _ which are something like "who did you play last week, what quarter are we in now, what time of day is it," etc. _ both times he left the game Sunday.
Smith also was taken to locker room both times and the staff continued the second part of the protocol, a sports concussion assessment test that includes memory recall, balance testing, symptom questioning and eye testing and is administered via iPad.
"Every player on our roster has that test on a baseline," Burkholder said. "Both our team physician and the (consultant) went through that with Alex, and both times he passed through that with a passing grade."
When Smith left the game the second time, the club announced that he was out of the game because of a concussion. After the game, Chiefs coach Andy Reid originally said Smith passed concussion protocol both times he left the game but was corrected by a team spokesman, who told Reid that Smith did not pass the second time.
But Burkholder said Monday that Reid's original assessment was correct. Burkholder said he miscommunicated with Chiefs vice president of communications Ted Crews, who announced Smith's status to the media.
"The confusion came from this _ that the first time we said he was returning after being in the protocol," Burkholder said. "The second time, he was in the middle of the protocol ... and we wanted to let the media know that he wasn't coming back out. So I said to Ted that he was out with a concussion, when the reality was he was out and he was in the middle of the concussion protocol."
Burkholder said the last part of the concussion protocol had not occurred at the time of Crews' announcement. That part requires the team physician, the independent consultant and/or Burkholder to review video of the hit.
"(Like) whether we think he was unconscious (and) he said not," Burkholder said of what he looks for on the video. "So there's a lot of steps there and it takes 15, 20 minutes to get through.
"The confusion came when I told Ted 'concussion, out' when really, he was out and in the middle of the concussion protocol, but we weren't going to return him in the same game."
Burkholder said Smith will now go through the "return to play" protocol, even though they think he did not sustain a concussion.
"We're going to be cautious and we're going to take him through all those steps before we put him back on the field," Burkholder said, "just to make sure we're not missing anything."
Burkholder said the "return to play" protocol will include impact testing. Smith also will see an independent neurologist in Kansas City before he returns to play.
"From last night on, and certainly I was with him on the plane and I was talking to him last night _ Coach talked to him on the phone _ and he's been in this morning, he's absolutely asymptomatic," Burkholder said. "And this is a player that had a concussion before and he knows _ he's missed time with it, all that _ he's aware of the situation, we're aware of the situation, and he's doing very well."
Burkholder said it was "certainly possible" that Smith could return to practice as soon as Wednesday and play on Sunday.
"We will go through the return to play protocol and see where he's at," Burkholder said.
Burkholder was asked about Smith appearing groggy after the second hit and remaining on the ground for several seconds. He essentially said that concussion symptoms don't necessarily always equal a concussion.
"We're not absolutely sure why he had those events, and certainly, the independent (neurologist) could shed some light on that for us," Burkholder said. "Remember, your balance centers are in your ears, and he had a laceration on his right ear. He also has hematomas, which are a little fluid collection behind both ears from two separate events and we think, maybe, his helmet came down and hit him there when he was hit."
Burkholder, who said Smith told him he has had balance issues before, said that if you go to the hospital with chest pain, it doesn't always mean you're having a heart attack.
"You have a symptom, you go in there and they check you and sometimes, they even keep you overnight and they keep you out until they're sure," Burkholder said. "I'd say in any medicine, any injury we have _ concussion, sprains, anything like that _ that happens. And our head coach allows us to be super cautious, the NFL is super cautious and our team doctors are educated that way."
Burkholder acknowledged the NFL has stated players can have a concussion and still pass concussion protocol, because of the test's limitations. But he said he trusts Barnthouse and Monaco, who helped conduct Smith's testing Sunday.
"Those two guys, who absolute experts in this area, felt that he was fine to return to play the first time," Burkholder said, "and the second time, they felt that he passed through the protocol but they decided to hold him, out of caution, until we could do more today, tomorrow. You trust physicians.
"Maybe the only mistake in the whole thing was just me telling Ted 'concussion,' instead of being in the middle of the concussion protocol. And I know it caused a lot of confusion, and I'm sorry about that."
