After an initial review, the NFL Players Association medical director said Monday that the Philadelphia Eagles' training staff and doctors followed the proper injury procedures in the cases of quarterback Kevin Kolb and linebacker Stewart Bradley, but the union is still gathering more information and the team "has not yet been cleared," according to George Atallah, assistant executive director of external affairs of the NFLPA.
Kolb and Bradley both suffered concussions Sunday against the Green Bay Packers. Kolb was hurt in the second quarter when he was driven into the ground from behind by Packers linebacker Clay Matthews. Kolb, who fumbled the ball out of bounds, looked pained as he rolled over and rested his face on the ground. Later in the second quarter, Bradley was hurt when his head slammed into teammate Ernie Sims while they both tried to tackle Greg Jennings. Bradley struggled with his balance and collapsed. Both Kolb and Bradley returned to play with a head injury later in second quarter before being removed for good at halftime.
Under the return to play guidelines adopted by the NFL in December 2009: "A player who suffers a concussion should not return to play or practice on the same day if any of the following symptoms or signs is identified based on the initial medical evaluation of the player ... including confusion as evidenced by disorientation to person, time or place."
Philadelphia Eagles coach Andy Reid was asked specifically about Bradley being allowed to return to the game after exhibiting those signs and says the team's medical staff did look at the linebacker.
"I will tell you that when he came off the field and went through the protocol and the testing there, that he was clear-minded and able to pass through," Reid said.
"We are still gathering more information" about the return of both players in the second quarter, Atallah said.
Dr. Thomas Mayer, the union's medical director who spearheaded the implementation of new guidelines for head trauma, does not believe the Eagles were negligent when they allowed both Kolb and Bradley to briefly return to game action after it appeared both had suffered concussions.
Mayer said he was watching the Eagles-Packers game when he observed the injuries to Kolb and Bradley. When he saw that both players had returned to the game, he called Dr. Elliot Pellman, a medical adviser whose duties include gathering information for the NFL's Brain, Head and Neck Medical Committee.
"I wanted to make sure we knew exactly what happened there," said Mayer. "The review so far shows they did follow the guidelines. Now, there's a matter of trust with the medical people on site. They know the guidelines. If the players' symptoms return to normal initially, they are allowed to return to the game if neither player has lost consciousness."
The cases of Kolb and Bradley are different since Bradley may have shown evidence of disorientation on the field, Atallah said.
Bradley's case was more complex than Kolb's because the Eagles' medical personnel never saw his injury because they were treating Kolb at the time, Mayer said.
Mayer spoke with Eagles athletic trainer Rick Burkholder to review the team's treatment of Kolb and Bradley.
Asked what prompted the Eagles to reverse their decision by sitting out both players in the second half, Mayer said he was told the players regressed upon a second exam.
"I was told that [Kolb] had interval symptoms but returned to normal until halftime," Mayer said. "Kevin later showed some confusion when they talked about plays and [pass] coverages. They shut down Bradley, too, but the problem on him is that the medical people were all working on Kolb and never saw Bradley's injury; they never saw him stumbling and wobbling off the field. He returned to the field on his own -- they got him out once they realized what had happened and did the exam. Based on the information I have, it appears the appropriate guidelines were followed and subsequent actions were taken."
Mayer said he and the league will continue to review the matter.
"Until we have had a chance to review all of the data, it is premature to say the care was appropriate," Mayer said.
Reid said that the team has done a complete re-evaluation of the team's response to both players' injuries and insisted that the team trainer and doctors followed the new guidelines.
"I don't want to do anything that puts these guys at risk," said Reid. "That's not what we're here to do."
Reid would not allow Burkholder to speak to reporters on Monday, saying: "I gave you everything that needed to be done."
He staunchly supported Burkholder and the medical staff for the way they addressed the injuries.
"They go to the extreme to make sure that they follow the medical protocol that's set for everything and it's no different for this situation."
Kolb and Bradley have begun a five-day evaluation process and will not practice until at least Friday, Reid said.
Dr. Hunt Batjer, co-chairman of the NFL's Brain, Head and Neck Medical Committee, doesn't see four concussions sustained by players in the first weekend of the regular season as a trend. But Batjer says the rate of concussions is something the league and its medical staff will closely monitor throughout the season.
"One weekend doesn't make a trend," Batjer said. "It's certainly a number that caught everyone's eye.
"If this pace continues, it's either better reporting of the symptoms, or it is something else systemic. We must keep a close eye on this and we will."
Batjer says the injuries were properly treated in Philadelphia and East Rutherford, N.J., according to the guidelines set by NFL commissioner Roger Goodell and the NFL Players Association.
"We are all comfortable with the fact the players received appropriate treatment," he said.
Batjer believes players are so cognizant of the symptoms of concussions that they no longer try to hide such injuries.
"I think we are looking at a culture change that the players are aware and all the people on the field are aware and are taking them out of games," Batjer said.
The follow-up on the latest NFL concussions came as researchers at Boston University said they have found early signs of a disease caused by hard hits in the brain of a University of Pennsylvania football player who killed himself in April. The New York Times reported that a brain autopsy on Owen Thomas showed he had chronic traumatic encephalopathy, an affliction primarily connected to NFL players who suffer depression and impulse control issues.
Dr. Adam Shunk, a neuropsychologist at St. Vincent Sports Performance Center in Indianapolis, treats athletes who have had effects from head injuries. He believes the pressure on athletes to be in the lineup impacts their decisions.
"Some are very responsible with their own health and others are going back to play because it determines their salaries and bonuses," he said. "But athletes generally are aware now that they have to think about whether they should return to play or not."
And the game they return to, Shunk says, is getting more dangerous.
"I think the game is unsafer," he said. "Just look at the physicalness of football now. Athletes are bigger and stronger and faster, and mass media has the effect of glamorizing big hits and it increases risks of concussions."
Chris Mortensen is ESPN's senior NFL analyst. Sal Paolantonio is an NFL reporter for ESPN. Information from The Associated Press contributed to this report.