NFL teams now have new, stricter instructions for when players should be allowed to return to games or practices after head injuries, guidelines that go into effect this week.
In the latest step by the league to address a hot-button issue, commissioner Roger Goodell sent a memo to the 32 clubs Wednesday saying a player who gets a concussion should not return to action on the same day if he shows certain signs or symptoms.
Those include an inability to remember assignments or plays, a gap in memory, persistent dizziness, and persistent headaches.
The old standard, established in 2007, said a player should not be allowed to return to the same game if he lost consciousness.
Wednesday's memo also says players "are to be encouraged to be candid with team medical staffs and fully disclose any signs or symptoms that may be associated with a concussion."
Nearly one-fifth of 160 NFL players surveyed by The Associated Press from Nov. 2-15 replied that they have hidden or played down the effects of a concussion.
The new policy states, in part: "Once removed for the duration of a practice or game, the player should not be considered for return-to-football activities until he is fully asymptotic, both at rest and after exertion, has a normal neurological examination, normal neuropsychological testing, and has been cleared to return by both his team physician(s) and the independent neurological consultant."
Teams were told this month they have to find an outside neurologist who can be consulted on concussions, and NFL spokesman Greg Aiello said this week the league is "very close" to having all of those independent doctors approved and in place.
Since last month's congressional hearing on NFL head injuries, momentum has been building for changes in league policy. The revised return-to-play rules come about a week after Goodell sent a memo to clubs informing them that the two co-chairmen of the league's concussions committee had resigned and that he has been looking into possible rule changes.
On Wednesday, word emerged that Cleveland Browns running back Jamal Lewis will miss Sunday's game with an unspecified head injury, raising the possibility his NFL career is over. Lewis had previously said he would retire at the end of the season. His teammate, starting safety Brodney Pool, got at least his fourth known concussion last weekend and is likely out for the year.
The two starting quarterbacks from last season's Super Bowl — Pittsburgh's Ben Roethlisberger and Arizona's Kurt Warner — sat out last Sunday after saying during the week they planned to play despite getting head injuries the previous week.
"The evidence demonstrates that team medical staffs have been addressing concussions in an increasingly cautious and conservative way," Goodell wrote in Wednesday's memo. "This new return-to-play statement reinforces our commitment to advancing player safety. Along with improved equipment, better education, and rules changes designed to reduce impacts to the head, it will make our game safer for the men who play it, and set an important example for players at all levels of play."