The Concussion Blog

*I will admit that I could not come up with a catchy title for this post so I ripped this from Mike Freeman’s twitter feed (@mikefreemanNFL) last night:

But not only is this funny but it is about as accurate as it could have been when summing up the Steph Curry incident last night in Game 4 of the Western Conference series. So, thank you Mr. Freeman for your insightfulness and wonderful wordplay.

Those that were watching the game last night and happened to be on Twitter should know the entire process this sequelae; because of that I will be as brief as possible while injecting the overriding issues and thoughts on this.

It all began in about halfway thought the second quarter as the Warriors were getting throttled by the Rockets;

There is not speculation when looking at that vine, Curry hit his head on the court after taking an uncontrolled fall. What is not seen in the vine is Curry laying prone on the floor for a few minutes as the medical staff took a look at him (even noted checking his c-spine). When the world was brought back to the game from commercial we saw Steph getting assistance off the floor to the locker room, where further evaluation was to be done, obviously.

The first point to note in this event is that Curry not only immediately grabbed his head where it contacted the floor but he also was “down” for some time, that is obviously not normal. He hit his head and very hard so of course he would be slow to get up, but it was the amount of time that would and did have me concerned.

Before we go further we should define concussion for all of you out there, if you want the drawn out and dictionary definitions you can find it HERE, but for the simplest and most poignant way: a concussion is a disruption of normal brain function after a traumatic event. Notice there is nothing about getting hit in the head or having to have symptoms or even signs, at its simplest form the brain injury of concussion is disruption of normal activity.

It is not normal for a professional player to be lying on the ground being attended to by medical personnel after hitting ones head. It is also not normal, from what I have seen of Curry, to see him assisted off the court and have a dazed look in his eyes (the “dazed” comment was also said on the TV coverage of the game). Right then and there, alarm bells and red flags should be going up.

However, it is not that simple in a professional sport.

What followed is what has created most of the fuss. Curry went to the locker room and was being tested by team personnel per the NBA protocol. Meanwhile, in our thirst for information the Warriors released information to the media that they were calling the injury a “head contusion”, leading to mass speculation and borderline hysteria from many places.

I wouldn’t call my response hysterical, but if judged by my timeline last night you could noticed I would have been perturbed by this. Reason being that of all the work that concussion experts and those wanting to make this injury more understood and handled correctly, the narrative of the images did not mesh with the narrative of the team. That is not to say the Warriors were wrong, as Will Carroll pointed out in one of his tweets following the incident the perception is the issue here.

We (player safety advocates/concussion experts) have been steadily trying to get everyone on the same page when it comes to concussion; it is incidents like this and in other well televised sports, football and soccer, that the message gets a bit muddy. Here is why…

Professional sports are a different breed when it comes to concussion, although the injury at its base is just as problematic for their brains too (in the moment and possibly long-term). Pro athletes are paid a lot of money to perform and are judged and compensated by their results — see winning. So, keeping them off the court, field or rink is a task in and of itself with any injury, much less an “invisible” one like concussion. We also need to be cognizant to the fact that these players also have the best possible care at their fingertips not only athletic trainers (only 55% of high school students have access to them, much less as you get younger), but doctors and really good ones at that. Being adults the professional athlete also understands the risks associated, have been educated on them, and can – at times – say the “right” things when it comes to a concussion to be able to play. All of this being said this is NOT how it is and should ever be handled at the adolescent ages — see college, high school and younger — the end roads we have made in education is far more important than a game at that age. In fact, it is far more important than any game on any level, in my humble opinion.

When Curry came back to the court after completing and passing his full work up on concussion (which included some balance testing via the Doris Burke hit from the tunnel, updating all of us on the situation) many were confused to A) how is that possible after what we had seen and learned and B) would he be OK?

The Warriors never declared Curry to have a concussion, so he did not have to be removed from play that day, per protocol, and he passed the exams given to him, per protocol, so he is allowed to return in the NBA (same for all sports). He was OK – although some argued that he seemed “off” upon his return.

The overriding problem in this case is that the “management” does not measure up to the information and knowledge we have about concussions. It became a semantic issue – for me – because I have been trained to understand this issue, intimately, and this just was a hot mess from the beginning.

Unequivocally, if this were to happen under my watch in a game I was covering for a high school athlete, that fall + those signs (on ground for a long period, assistance walking off, and dazed look) would have me working real hard to eliminate a concussion as suspected injury. I don’t believe there would be the right words spoken by a hypothetical athlete in my care in this case that would have even led to a full evaluation, he/she would have been done. “When in doubt, sit them out.”

(Quick aside here, not all hits to the head or body will result in a concussion, but if this were the mechanism of injury I would have anticipated the player getting up in relatively short order and not needing assistance to get to the locker room)

I am generally happy for the following:

• Protocols were followed
• Curry seems to be OK
• People want to know more about this

With this incident being a learning tool, hence the time I have spent typing, what we should all learn from this is the following:

• Most concussions in sports occur with adolescents, they should be treated differently than pros.
• Signs (things you can observe) should trump symptoms or reported non-symptoms.
• Delayed symptoms are an issue with concussion and need to be observed.
• It’s OK to miss part of or a few games when it comes to brain injury/concussion.
• This injury along with all injuries seen in sports shows the utter need for athletic trainers, get one.
• We are not done educating on concussions, but we are getting there.

This is the message I am trying to convey to all of those interested in this. When dealing with the adolescent athlete your eyes and clinical evaluation are the best objective tools you have when making a call on a concussion. It does not matter how many bells, whistles, impact sensors, sideline evaluation tools or education you have if it walks like a duck and quacks like a duck it’s probably not a rhinoceros.

I am sure I missed plenty and the post is a bit disjointed but if you want more information about this incident feel free to look at my timeline and hit me up with some questions if you like. And remember this…

The issue of concussions are not the injury itself, it is the mismanagement of the injury that is the true problem of concussion.