Will a concussion force Cam Newton to adjust his style of play?

Scrambling upfield has always been a part of QB Cam Newton's game, but it makes him more susceptible to big hits. Photo by Scott Cunningham/Getty Images

CHARLOTTE, N.C. -- Carolina Panthers quarterback Cam Newton reopened an issue that the coaching staff has gone back and forth on when he suffered a concussion on Sunday.

Should he run less?

If Newton wants the Panthers to avoid another situation like the one they are in now -- wondering whether the reigning NFL MVP will be available for Monday night's game against Tampa Bay -- the answer is yes.

The more Newton runs, the more opportunities he has to face a helmet-to-helmet hit -- and to sustaining another concussion.

"There is research that shows if you've had one concussion, you're at higher risk to have another," said Dr. Gillian Hotz, the director of the concussion clinic at UHealth-University of Miami Health System. "It's just the nature of the beast now."

Newton suffered the concussion on a two-point conversion run with 11:47 left in a 48-33 loss at Atlanta.

You can debate whether Newton let up as he approached the goal line, making him a bigger target for the hit. You can't debate that Newton was at risk because he took off running when he had options to throw.

Whether Newton misses a start isn't the issue. Carolina's medical team and the independent physician who ultimately will have to clear him won't put Newton on the field unless he's healthy.

The issue is how to use Newton moving forward, and not just in the running game. He often makes himself susceptible to helmet hits by holding on to the ball too long in an attempt to make a play.

Newton averages 2.57 seconds to release the ball, which ranks 26th in the NFL, but that number is actually a slight improvement from last season's 2.61 average for Newton. The league average this season is 2.46 seconds.

The season opener at Denver, in which Newton took at least three helmet-to-helmet hits, was a prime example of the quarterback holding on to the ball too long.

"We talk to him," offensive coordinator Mike Shula said. "He'll tell you. He could get rid of the ball a little quicker. He's trying to make a play and hold on to it until the end. Sometimes you've just got to say, ‘Get rid of the ball quicker. Don't take a hit. I know you're tough. I know you can take it. Just take the hit off yourself.'"

This isn't to suggest Newton has to totally change his approach. What makes him special is his threat as a runner in the read-option.

He's run 628 times for 3,354 yards and an NFL-record 45 touchdowns since entering the league in 2011. That's far more than any other quarterback.

But Newton also has proved he can be an effective pocket passer. His 35 touchdown passes last season were one shy of Tom Brady's league lead.

The Panthers did a better job of protecting Newton in the pocket on Sunday. He was sacked only once a week after Minnesota got to him eight times.

Meanwhile, what is Newton doing in the concussion protocol?

Typically, doctors spend the first few days monitoring and treating the symptoms a player experiences immediately after a hit. Those could be for headaches, dizziness, vision issues or a loss of focus.

Rest initially is prescribed to give the symptoms time to subside. There also is neurocognitive testing during this time to determine where a player is compared to a baseline test he took before the season.

Once the symptoms subside, there is a gradual return-to-play protocol. It starts with low exertion, walking or light aerobic exercise on a treadmill, stationary bike or elliptical.

If symptoms do not recur, the player will graduate to moderate and ultimately high-exertion exercise with some form of strength training.

Newton was not on the practice field on Wednesday, which could signal that the symptoms haven't gone away and he's more likely to miss at least one game.

"You usually give these people four or five days to chill out and make sure they're having no symptoms before you exert them again," Gillian said.

The next step for Newton would be a return to some form of football-specific, noncontact activity. This could involve running, throwing and other position-specific activities.

If Newton shows no recurring systems and his neurocognitive testing is back to baseline, he will be cleared for full football activity, including contact. He will also be evaluated by an independent physician for final clearance to play.

This typically takes seven to 12 days, although there have been cases where a player has been cleared after five days. The extra day the Panthers have between games gives Newton a chance to return ahead of Monday night's contest.

But there are no guarantees. Carolina linebacker Luke Kuechly missed three games with a concussion last season.

Dr. Michael Hoffer, who works with Gillian, said that metabolic changes that occur in the brain within the first five days after a concussion make you more susceptible to another concussion during that period. After that, the risk drops significantly.

"We actually found that once you go beyond that, if you prolong the rest, it actually isn't effective to rest too long," Hoffer said.

So if Newton progresses and is cleared -- whether it's this week or next -- he should play. After he returns, the question will be how he should play.

"A lot of the concussions the quarterbacks get are from hits they just didn't see coming," said Dr. Erin Manning, a neurologist at Hospital for Special Surgery. "There's just no way to prepare for that.

"But it would be good if he took less hits. If you're running the ball and about to get hit, it's better to slide instead of get hit."

Newton seldom slides. He's likely in the protocol because he didn't protect himself.

"Head injuries should be in the back of any player's mind, and to do the best that they can to try to avoid them," Manning said. "We do know if you've had a concussion, you're definitely more prone to having more prolonged symptoms after later concussions."