Return to Play

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

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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.  Continue reading →

“Contussiongate”*: The Steph Curry Incident

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*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 Continue reading →

How Can This Be?

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A group of researchers including R. Dawn Comstock released data, published earlier this year, regarding concussions what was initially found is not surprising, or shouldn’t be;

Of 14,635 high-school sports injuries reported during the 2008-10 school years, 1,936 (13.2 percent) were concussions, according to an epidemiological study published in January in the American Journal of Sports Medicine. This was nearly twice the rate reported in earlier studies of high-school athletes.

Part of the reason the increase exists is because of the inclusion of boys hockey and lacrosse, however taking that away there would be a significant increase otherwise.  This too can be attributed to the increased awareness and better assessment of concussions.  It is of my opinion that we are just now on the verge of finding the “true” rate of concussions, for many years it has been under-reported due to the lack of understanding/awareness (also an issue with general and serious injury tracking as well, see Matt Chaney)

What makes this research “eye-opening” is what the researches found about recovery; Continue reading →

NFL to Implement New Sideline Test

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The National Football League sent out a presser that they will be implementing a standard sideline assessment for concussions in the upcoming year.  The presser reads in whole via the AP;

NDIANAPOLIS — The NFL says it will use a new sideline test to determine concussions next season.The league said in a release Wednesday that more details of the evaluation will be announced on Friday in Indianapolis, where the annual scouting combine is being held this week.

But the NFL said the new sideline test will include a checklist of symptoms, a limited neurological evaluation and a balance assessment. It will employ many components of the evaluation process developed during a Concussion in Sport meeting at Zurich in 2008.

The test was developed by the NFL’s Head, Neck, and Spine Committee, with input from the NFL team physicians and athletic trainers and their professional associations.

If this assessment is based upon Zurich as stated one could expect to see a version of the SCAT2 used, along with the Baseline Error Scoring System.

Sideline Concussion Assessment Tool-2

Baseline Error Scoring System (BESS)

This long overdue as the NFL, weather they like it or not, sets standards that most will grasp and comform to when it comes to concussions in football and sports.

A small disclaimer on the Zurich-2008 Recommendations; professional American football is the ONLY sport that has an exception about allowing players to return to play on the same day;

This issue was extensively discussed by the consensus
panelists and it was acknowledged that there is evidence
that some professional American football players are able to return
to play more quickly, with even same day RTP supported by
National Football League studies without a risk of recurrence or
sequelae.61 There are data, however, demonstrating that at the collegiate
and high school level, athletes allowed to RTP on the same
day may demonstrate NP deficits post-injury that may not be evident
on the sidelines and are more likely to have delayed onset of
symptoms.62–68 It should be emphasized, however, that the young
(<18 years) elite athlete should be treated more conservatively
even though the resources may be the same as for an older professional
athlete (see Section 6.1).

USA Today Article

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Kelly Whiteside, writing for the USA Today, put together a great article discussing what we believe is the most important aspect of concussion recovery – return to school and academia.

Brianna is a typical high school athlete, not a future college star, just a kid whose life revolves around the sport of the season. Her story has become all too familiar. She was medically cleared to return to sports too soon and continued to take a full course load at school. The mental demands of the classroom slowed her recovery as well. Addressing the roomful of her peers on this November evening, Brianna describes what life has been like since suffering her first concussion in February when she took a knee to the head during a basketball game.

“It’s been nine months, and I still have headaches every single day I wake up. I don’t want to go to school. I barely get out of bed. My mom is constantly trying to get me up, and I just don’t want to get up. I’m late for school, which is no fun. I get really dizzy when I get up from a chair, and I am also tired all the time. I sleep for 16 hours, and I’m still exhausted.”

What is also typical of Brianna is that those that have been concussed across the nation are experiencing the same thing she is, but Continue reading →

Cutler Coming Back

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It is being reported the Jay Cutler, quarterback for the Chicago Bears, is cleared to return after his concussion on Monday Night Football against the Giants over 10 days ago.  However, they are now reporting that this is his 5th known concussion which leads us to a good point.

The old grading scale used to have limits to playing contact sports if you had sustained multiple concussions.  The thought process has changed, and no longer is a certain number a disqualification for the athlete.  Every person reacts differently to a concussion, therefore there is not an all encompassing number that would be “too many” for someone.

As long as the individual has FULLY recovered from the concussion and can pass the graded return to play criteria they would be allowed to play contact sports.  But, with each successive concussion it becomes harder to progress in a timely manner, as your brain has been compromised previously, it is now working harder to do the same work.  Once you have had a concussion you are more susceptible for another concussion.

What we need to understand and be aware for is the multiple concussions in the adolescent, in particular getting concussed before all brain function and symptoms have resolved.  It is of my professional opinion that if you have kids getting 3 or more concussions in a high school career, it is time to take a closer look at what they are doing.  And with each successive one it may be time to limit their actions, or make severe corrections in their actions.