The Concussion Blog

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…