When and How ‘Not a Concussion’ Becomes a Concussion: Klay Thompson Injury


The Western Conference Finals not only provided an opportunity for the Golden State Warriors a chance at winning an NBA title it has provided a wonderful opportunity for people to learn more about concussions. The knee-jerk reaction to incidents like we have seen in Games 4 and 5 are often a mix of truth, hyperbole and eye-rolling; however what is clear they are cases that we can use to forge further understanding and education.

Last night in the would be close-out game of the WCF, Klay Thompson shot faked and the defender rose as he [Thompson] ducked and the defender’s knee blasted the side of Thompson’s head right in his right ear.

Unlike his teammate from the game before, Steph Curry, Thompson did not show overt signs, to my trained eyes, of a concussion. His face was “scruntched” in pain and he immediately grabbed for his ear, plus after the incident he immediately rose to his feet and walked straight to the locker room without assistance. As noted in Tuesday’s post signs are paramount when making critical in-game decisions about return to play; if they are there, there should be no doubt about removal.

The next report we received on TV or Twitter was about Thompson having an ear laceration and that they didn’t need to do a concussion evaluation. Which is entirely possible but unlikely, because I do believe they did a concussion “screen” at the time. The Warriors med staff probably didn’t do the full-blown evaluation because five minutes would not have been sufficient for that, but that was enough time to go over any symptoms and quick balance assessment (think roadside sobriety test). It is also important to know that because concussion are mainly subjective that a massive portion of any concussion evaluation is the interview: talking, questions and mental challenges about venue/score/date/etc. 

I do believe that the team was forthright about this and did do what the standard of care calls for in that instance/injury evolution. Again the Warriors doing due diligence, if only to be nitpicked by the semantic issue with the PR release at the time of return.

Then came the proverbial “bombshell” after the game when Doris Burke was interviewing Klay about how he was feeling, to which he answered “I’m a little dizzy” — there goes Twitterverse with the sideline medical officials. But at that point there could have been a myriad of reasons he was dizzy, concussion being one of them (hypoglycemia, dehydration, inner ear issue, etc.).

OR… It could have been one of the biggest bugaboos for us as healthcare professionals with the injury of concussion – delayed onset of symptoms.

This is one of the most problematic issues I/we face as athletic trainers; we can screen, even full evaluate, a player and they pass with not one issue but 10 minutes to 2 days later they have a problem. Everyone’s brain is different, every concussive injury is unique and the progression of this cascade differs making it entirely possible and plausible for someone to have “not a concussion” that turns into a concussion.

Late last night the Warriors released information about Klay in an official capacity;

*Side note: I freaking hate the term “concussion-like”… Just say concussion symptoms, as I have noted many times, this article included, just because you have a symptom of concussion does not mean you have a concussion, that’s what the medical team is for. PLEASE FOR THE LOVE OF ALL THINGS AWESOME, STOP USING THE TERM CONCUSSION-LIKE!*

As you can see the injury that Thompson had seems to have been slow in developing, the theory for this in most cases, is that adrenaline does a good job of masking any of the issues and as that naturally wears off the symptoms blossom. I was impressed with the fact that the Warriors were candid, this is a good sign and really needs to start being adopted by all professional leagues.

If you had missed that and happened to be listening to Mike & Mike this morning you would have heard an interview with Klay’s dad, Mychal, talk about having to drive his son home due to him being “woozy” and when the got home he “threw up a couple of times”. If we’ve all learned something from this blog vomiting would be a definite sign. That mixed with reported symptoms of dizziness and wooziness would leave one to believe that Klay unfortunately suffered a possible concussion (it has not been officially diagnosed as such, again keeping him out of the protocol at this point – darn semantic game).

The takeaways from this incident are:

  • Not every blow to the head results in a concussion.
  • An isolated symptom may or may not be a result of a concussion, even after a traumatic event.
  • Every sequelae is different for concussion (I’m really trying to get you to adopt that word, haha).
  • Delayed symptoms and even signs are entirely possible due to masking effects of the body.
  • The need for constant evaluation after a suspected injury is paramount.
  • No one did anything wrong in this instance, even for a pro athlete versus an adolescent.
  • Having trained medical professionals — see athletic trainers — available for incidents like this need to be a priority for all youth and secondary school sports and even club activities (don’t get me started on that last one).
  • Education, education, education about concussion is important.

This case of injury is way more important for us to learn from then Contussiongate*, because the delayed symptoms are real danger. Telling younger athletes that this could happen and to not be afraid to tell someone – have had kids tell me they didn’t re-report because they were confused why they were OK then not OK later, didn’t want to look weak. This is a natural occurrence and can be expected in a percentage of the injured population, so speak up!

Thanks for your time…

 

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5 thoughts on “When and How ‘Not a Concussion’ Becomes a Concussion: Klay Thompson Injury

  1. Jon May 28, 2015 / 13:51

    Good points Dustin!!

  2. jayman4 May 29, 2015 / 14:24

    Very helpful article. What is a reasonable return schedule? I see that it is highly variable but wondering. Weeks?

  3. brokenbrilliant July 18, 2015 / 13:06

    Reblogged this on Broken Brain – Brilliant Mind and commented:
    Another great post from Dustin Fink, demonstrating how concussion / TBI symptoms can set in *after* the window of time for evaluation has passed. In this case, the player seemed fine till later, when he was dizzy, woozy, couldn’t drive himself, and later threw up. All this, quite a while after the initial screen was done.

    Just something to keep in mind.

  4. brokenbrilliant July 18, 2015 / 13:07

    Great points. Some people don’t even start to so show signs that “something is up” for weeks, sometimes months. It’s tricky, in any case. One mystery after another.

  5. Don Brady, PhD, PsyD, NCSP April 6, 2017 / 17:38

    Don Brady, PhD, PsyD, NCSP
    Licensed Clinical Psychologist

    I stumbled across Dustin’s 2015 post earlier today while looking thru some of my older emails.

    The content and essence of his message remains pertinent in 2017.

    Dustin’s highlighting the importance of recognizing delayed concussions symptoms cannot and should not be undervalued and / or ignored…if we are to protect a human brain from further injury.

    Several months ago, during November 2016, I decided to post my personal experiences with a concussion on my linkedin page. Experiences that included multiple delayed effects.

    The article is entitled:

    A psychologist’s personal experience with a life changing concussion/brain injury
    Published on November 29, 2016 @ Don Brady, PhD, PsyD, NCSP linkedin page
    @ https://www.linkedin.com/pulse/psychologists-personal-experience-life-changing-don

    Since my experiences serve to support Dustin’s 2015 perspectives, I have decided to aslo respond to his theme via an excerpt from my November 2016 linkedin post.

    A psychologist’s personal experience with a life changing concussion/brain injury

    I am a brain injury survivor as a result of my stationary auto being rear ended by a distracted driver traveling at an estimated speed of 55+mph on Father’s Day of 1990. My auto was spun across the road, deemed ‘totaled,’ and the driver’s seat was broken. I temporarily lost consciousness.

    When the police arrived at the scene the 1st law enforcement officer exclaimed….. ‘I don’t believe you are alive!”

    Many of my brain injury symptoms took 5 to 7 days to reveal themselves… including, but not limited to, fatigue, difficulty concentrating, sleep difficulties and severe headaches. Some symptoms required a longer period of time to either reveal themselves and/or become more pronounced. I also suffered severe cervical spine injuries that required three years of 3 times a week physical therapy. Headaches would intensify if I did not allow for significant cognitive, physical and emotional rest each day. Some days were better than others as functional recovery was certainly not a linear progression.

    I was very fortunate to have a concussion/brain injury-knowledgeable family doctor, clinical psychologist colleague, and a neurologist who provided me with both support and accurate information. Furthermore, I had a kind and knowledgeable attorney who successfully assisted me in the interesting insurance maze. And an extremely supportive employment situation thru this sometimes very difficult journey.

    The auto accident occurred while I was employed as a School Psychologist and just prior to the onset of a 10 week summer vacation. More pronounced cognitive and physical difficulties emerged when I returned to work in the Fall for the 1990-1991 academic year. The cognitive demands of my position intensified my initial presenting concussion symptoms while another injury induced difficulty surfaced. My expressive language response time to any individual who posed a question to me was delayed. I would have to inform people, “I hear what you are saying to me but it takes me awhile to verbalize a response to your query. So please be patient with me.”

    My employment week was cut in half, and I ceased my meeting with clients in my private practice. I would frequently isolate myself and rest when I returned home from work as being around persons often became over stimulating… and correspondingly, my headaches and fatigue would intensify. …

    ….continued @
    https://www.linkedin.com/pulse/psychologists-personal-experience-life-changing-don

    Thanks for listening.

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