Daniel Feinberg can’t recall ever holding a soccer ball, but he’s ready to aid the pros playing this month at the FIFA World Cup games in Philadelphia — should one take a hard hit to the head.
Feinberg, a neurologist and concussion specialist at Temple University Hospital, is part of a team of doctors on call to help injured players, coaches, and others in town for the games.
The Inquirer spoke to Feinberg, who also serves as chief medical officer for Temple University Hospital Inc., in an interview lightly edited for length and clarity about his upcoming role, and what people should know about concussions.
How did you get involved with FIFA?
When the World Cup [medical team] was being put together, it was done under the guidance of Dr. PJ Brennan, the chief medical officer of University of Pennsylvania Health System. I was the chief medical officer of Pennsylvania Hospital until mid-March, and then I transitioned to Temple on April 1. PJ, who is my mentor and friend, said we’d still like you to be part of the medical consultative group for the World Cup coverage.
What is your background in neurology for athletes?
When I came to Philadelphia, I practiced at Pennsylvania Hospital for many years, and they had a large sports medicine presence. I was on the medical staff of the Flyers and the Eagles for many years. I was never on the sidelines watching all the games, but I was the one seeing them the day after. In very rare situations, I would have to meet them in an emergency room setting. I also took care of players’ families and friends, if someone had another neurological problem.
What will your role be during the World Cup?
I will be available to consult with trainers on the field, team physicians who are accompanying the groups, and I will see patients as necessary. Dr. Brennan will call me and say, “Dan, I need you to see player X for this problem.“ It will likely be a concussion or concussion-type symptoms, but it could be other neurological symptoms. I would see them at Temple University Hospital.
What happens when you get a concussion?
The brain is inside of the skull, and it’s floating in the skull — it’s not actually packed into the skull. Around the brain is fluid that communicates from around the brain all the way down the spine to the tailbone. It serves as a buffer for the brain and the spinal cord to make sure that they don’t literally push up against the bone.
What happens when someone has a concussion is the brain actually shifts — whether it’s a neck movement, like whiplash, or a direct head hit — and the brain literally will push up against the bone or smack up against the bone.
The severity of that impact will dictate how severe the concussion is. If there’s not much movement of the brain in the skull, it’ll produce mild symptoms, headaches, nausea, light sensitivity, sound sensitivity, maybe some balance trouble.
If it smacks up against the skull harder, that’s when people have word-finding difficulty, memory trouble, concentration trouble, along with those other things that happen with the milder concussions.
What do you want people to know about concussion treatment?
People are very nervous — the parents of the high school athletes, particularly, and maybe even the college athletes — when they come in with their kids to these visits.
They ask questions like, is my kid going to get Alzheimer’s disease earlier? Is my kid going to get a neurodegenerative disease earlier? And there’s no real proof that’s the case. A lot of what I do in these visits, especially when I’m seeing someone for the first time, is alleviating anxiety and putting to rest some of the myths.
The vast majority of concussions only have symptoms for a few hours to a few weeks with proper guidance — which is usually rest, avoiding screen time, and staying really well hydrated. When kids or adult athletes are less symptomatic or asymptomatic, they can resume physical activity slowly.
Is it bad to fall asleep after a concussion, or is that a myth?
That concern comes from the idea that if someone falls asleep, they could be unconscious. And that could be a sign that a bad thing is happening, that there is bleeding in the brain, or pressure in the brain — and you wouldn’t want to miss something like that.
The other danger signs that would go along [with risk of unconsciousness] are things you would go to an emergency room for — a bad headache, sick to their stomach, a lot of light or sound sensitivity. Those things would make me say get evaluated at an emergency room.
When bad things happen, they’re going to happen in the first few hours. When I talk about getting a good night’s sleep, I’m talking about after they’ve been cleared.
