"In some form or another, it would certainly be my recommendation that all 30 clubs use [neurological testing] in some shape or form when they deem it appropriate," said Dr. Elliott Pellman, MLB's top medical advisor and the team physician for the NHL's Islanders and NFL's Jets, when reached by telephone on Wednesday in New York.
After losing players Pat LaFontaine and Brett Lindros for good because of the injury, the NHL instituted mandatory neurological baseline testing of all players. After losing star quarterbacks Steve Young and Troy Aikman to repeated concussions, all 32 NFL teams voluntarily insisted that each player be subjected to a series of various neurological tests.
But baseball isn't quite there yet.
"I can't say right now how many clubs are doing some sort of testing and how many are not," said Pellman, who was instrumental in football and hockey adopting their current programs.
The subject is topical because of the presence of Jim Edmonds in this National League Division Series between the Cardinals and Padres, which continues on Thursday at PETCO Park with the Cards leading the best-of-five series, 1-0.
The St. Louis center fielder suffered a concussion back in June when he fell backward and hit his head on the turf at U.S. Cellular Field. He missed three days, went back in the lineup, and came out again in August after he dove for a ball and felt spaced out when he rose to his feet.
Edmonds didn't play for a month because of the trauma of post-concussion syndrome. Brewers third baseman Corey Koskie and Giants catcher Mike Matheny have been out for months because of the same syndrome.
"It seems like there's been a rash of them this year, but when you're talking about one of our favorite guys, Mike Matheny, you know it's very serious," said Cards manager Tony La Russa, who had Matheny behind the plate on his 2004 team that was swept in the World Series by the Red Sox. "You don't ever mess with the coconut, man."
That Edmonds is back in the lineup at this point is a minor miracle, but that's the Catch 22 of post-concussion syndrome. It all depends on each individual's reaction and how many concussions he or she has previously suffered.
There are differences of opinion among physicians about the long-term affect of concussions and repeated blows to the head. But one matter they all came to agreement on during the late 1990s: The more concussions a person suffers, the longer it takes to shake the next one off.
"As you watch them get post-concussion syndrome, they seem to get more susceptible to the injury," Pellman said.
Aikman and Young suffered multiple concussions before ending their respective careers. LaFontaine sat out a year and came back to play for the New York Rangers. When he eventually banged his head again in a mid-ice collision, his career was over.
Matheny was struck by a foul tip in May and was dumb-struck when he returned to the dugout bench. Giants trainer Stan Conte asked him a series of questions and when he realized Matheny was out on his feet, he pulled him from the game. Matheny hasn't played since and before he was let go on Monday, former Giants manager Felipe Alou said there was a question whether Matheny would play again.
Conte, when asked about it not long after the incident, said the Giants didn't do baseline or any other neurological tests on their players, although that will probably change. He said he'd been offered such a program from Pellman and his staff during the last offseason, but he turned it down because concussions are not considered a major problem in baseball.
Not a problem? Just ask Koskie, who was baffled by the symptoms of post-concussion syndrome. The inability to focus. The quick level of fatigue. The loss of memory. Koskie said it was difficult to sit on the bench during a baseball game or play with his kids.
"They get frustrated with me," Koskie said late in August. "They say, 'Dad, let's do something,' and I can't do it. I have to sit down after a while."
Edmonds said there was never any doubt about him playing in the series, but he needs to be cautious about his future. Once the series of concussions and ensuing malaise gets started, it is a seemingly unbroken chain. And even the doctors can't tell you how it's going to end.
"There are theoretical considerations," Pellman said. "If you continue to play and you keep getting concussions, maybe you can have brain damage later on. But no one has been able to prove that."
The injury, the aftermath, that theory already has been enough to give at least two major professional sports leagues pause. Baseball should be next.