Next week's big, nationally televised "Monday Night Football" showcase could feature a quarterback matchup of journeyman Jason Campbell of the Bears vs. untested Colin Kaepernick of the 49ers. Not exactly the creme de la creme of the NFC.
Why? Concussions, of course.
With so much attention paid to replacement refs and bounty ruling appeals this season, it's an issue that's slipped a bit under the radar lately. But it's hard to ignore this: 25 percent of Sunday's NFL games saw a starting QB leave with a concussion.
Two were Chicago's Jay Cutler and San Francisco's Alex Smith, whose teams play each other next Monday. Both stayed in Sunday's games for several plays after what appeared to be head-rattling hits. Smith even threw a TD pass while playing with blurred vision before he departed, according to coach Jim Harbaugh.
"It's a reminder that you've got to err on the side of caution," said Dr. Richard Ellenbogen, co-chairman of the NFL's head, neck and spine committee, who was not familiar with the particulars of Sunday's quarterback injuries. "The question that I would ask is: Why did Mr. Smith not report this to his team physician, and say, 'Hey, I've got blurred vision, is that a problem?' ... We have to educate the medical teams to be really conservative. And we still have to educate players to self-report. If they don't feel 100 percent, they have to be willing to very strongly tell somebody."
More than 3,500 former players — including at least 26 members of the Pro Football Hall of Fame — have sued the NFL, saying not enough was done to inform them about the dangers of concussions in the past, and not enough is being done today to take care of them.
The instructions now used for in-game sideline concussion assessments in the NFL include a box that reads: "Signs and symptoms of concussion may be delayed, and therefore it may be prudent to remove an athlete from play, not leave them alone, and serially monitor them over a period of time." After that, in all capital letters, it reads: "When in doubt, take a 'time out.'"
The NFL looked into the Cutler and Smith cases — and Philadelphia's Michael Vick, the third quarterback who got a concussion this weekend — and came away satisfied that the proper protocol was followed. Players who exhibit any concussion symptoms are supposed to be removed from a game immediately and not be allowed to return to play or practice until fully without symptoms.
"Our medical advisors routinely review with team medical staffs all significant injuries," league spokesman Greg Aiello wrote in an email. "In these cases, we learned that the teams handled the injuries properly and removed the players from the game as soon as they displayed symptoms and were diagnosed with a concussion."
Ellenbogen pointed out that concussion symptoms might take time to emerge. That's apparently what happened with another noteworthy player, Buffalo Bills running back Fred Jackson, who took a late hit to the head in a loss at the New England Patriots on Sunday.
He was examined Monday — a day after showing what coach Chan Gailey called "concussion-like symptoms" on the flight home. Gailey said Jackson will miss Thursday's game against Miami.
After Cleveland Browns quarterback Colt McCoy returned to a game in December 2011 despite not being checked for a head injury following an against-the-rules hit to the helmet, the league put certified athletic trainers in booths above the field to watch for injuries and added video feeds on sidelines to make it easier to track dangerous hits immediately.
Aiello said that video was used by the Bears and 49ers to look at their quarterbacks' injuries.
The league spokesman declined to comment on Harbaugh's description of what happened with Smith: The QB threw a TD pass a half-dozen plays after he began experiencing blurred vision on a 1-yard keeper — and a dozen plays after taking a vicious hit from St. Louis linebacker Jo-Lonn Dunbar.
Smith scrambled to his left and started to slide before turning when Dunbar got him in the back of the neck with 1:10 left in the first quarter. He briefly grabbed his face mask and grimaced but stayed in the game
"He said he had the blurred vision after the quarterback sneak," Harbaugh said. "There's no telling. Did that earlier hit contribute? I don't know. I don't know Alex knows for sure, either."
Added Harbaugh: "You don't want him out there with blurred vision. ... He came up from the sneak and he had blurred vision and he felt that it would go away. He came over to the sideline and sat down and felt it would go away and it didn't."
Bears coach Lovie Smith said Cutler showed no symptoms of a concussion immediately after a helmet-to-helmet hit from Houston's Tim Dobbins in the second quarter. Cutler finished the half, then was held out after halftime. While the play with Dobbins' hit was being reviewed by the officials, Smith said: "Our trainers talked to him, evaluated him; he was fine from there. Players in the huddle didn't see anything wrong with him at the time."
Vick, meanwhile, was diagnosed with a "pretty significant" concussion, coach Andy Reid said. Reid wouldn't rule Vick out for next Sunday's game at the Washington Redskins; rookie Nick Foles would play if Vick doesn't.
"You've got to get ready for both. We're not too sure what the situation is, so we'll wait and see there," Redskins coach Mike Shanahan said. "With the concussion that he had, I don't think you're really sure."