Why can't sports teams learn what a concussion looks like?

The sports world is supposed to have made progress on understanding and dealing with brain injuries and concussions. Leagues have implemented concussion protocols that mandate specific forms of testing for brain injuries before players are allowed back into play. Coaches understand that when it comes to concussions, they can’t put pressure on doctors or players to speed things up. Even players, long the most resistant population to taking brain injuries seriously, are starting to understand that a brain injury should not be played through. I think the sports world really has made progress… and then something mind-numbingly stupid happens and I wonder if we’ve made any progress at all.

Last night, the Golden State Warriors qualified for the NBA Finals last night by beating the Houston Rockets 104-90 in Game Five of the Western Conference Championships. They won the series with relative ease, four games to one but they didn’t get through unscathed. In each of their last two games, one of their best players was forced to leave the game with a head injury. In Game Four, it was league Most Valuable Player, Steph Curry. In Game Five, it was his backcourt mate, Klay Thompson. Their injuries, and the way they were handled by team physicians, make me think that despite all of the progress the sports world has made on the concussion issue, we still don’t have even a basic understanding of what a concussion-causing injury looks like. Gah! Let’s break this down.

Steph Curry was injured when he was fooled on defense by a clever fake from Trevor Ariza. Ariza was ahead of Curry but knew that if he moved to lay the ball into the hoop, he’d be at danger of having his shot blocked by the athletic Curry. So, he faked as if he was about to shoot the ball but kept his feet on the ground. Curry fell for the fake and leapt into the air. Unfortunately, this meant that instead of meeting Ariza in midair, Curry’s jump took him up and almost over a grounded Ariza. As he passed the peak of his jump and started coming back down, his momentum and Ariza’s body acted as a pivot, twisting Curry backwards so that he hit the ground upside-down and head first.

It’s a bad fall, to be sure, but despite Curry’s head hitting the floor, it’s not one that screams concussion. Why? First, Curry knows what’s happening. He can’t stop himself from hitting the ground, but he’s aware that he’s falling. It may not seem like there’s time to do a lot in midair but remember that basketball players are world-class athletes who are used to making decisions and acting on them during a jump. Curry is remarkable even in the NBA population. He knows he’s falling, knows which way he’s going to land. He has time to brace himself for the fall, and he does it extremely well. He takes a tiny bit of the fall on his hand, arm, and wrist, but not enough to break any bones. That’s smart. He also rolls as much as possible, continuing the motion of the tumble so take pressure off his neck. Although we can’t see it, he surely tensed up his neck and shoulder muscles to support his head as he falls. Perhaps the most important thing is that his head doesn’t twist or rotate relative to his body as he hits the ground.

Curry was helped off the court a few minutes after this play. He went to his team’s locker room where he was monitored and tested for a concussion based on the NBA’s concussion protocol. After passing the tests, he returned to the game and has had no concussions symptoms since then. Watch the fall a few more times. It’s a good fall.

Now compare that to Klay Thompson’s injury from Game Five. This time, the injured player was playing offense. He was in the act of making a shot fake — just like the one that Trevor Ariza made when he unintentionally became part of Curry’s injury. Thompson lifts the ball as if he’s going to shoot it and as intended, he tricks an opponent (coincidentally ALSO Trevor Ariza) into trying to block the shot. Ariza takes a running leap from the side to get his hand in front of the shot. Instead of jumping himself, Thompson stays on the ground. This puts him in the path of the leaping Ariza, who’s knee gives Thompson a glancing blow to the side of the head as he passes him.

It looks like nothing, or at least something much less dramatic than Curry’s fall, but it’s much more dangerous. Thompson does not see it coming. Oh, sure, he knows that a defender has been fooled by his fake and has “bit” enough to jump, but he doesn’t specifically know that a knee is about to hit him in the head. As such, he has no way of bracing for the impact. The impact, when it comes, twists his neck and head, as they rotate in response to the knee.

Thompson was taken to the locker room where he had a cut to his ear attended to. After getting stitched up, he returned to the bench and was reportedly cleared to play. In fact, a sideline reporter at the game reported that he hadn’t taken any concussion tests because he didn’t need them. After the game, Thompson complained of concussion symptoms — according to Jesus Gomez of SB Nation, Thompson couldn’t drive home and threw up. In the aftermath of the game, some uncertainty about what tests he was given and whether he passed them has either been revealed by more detailed reporting or (cynically speaking) was generated by the team in a CYA maneuver. Kevin Draper actually amended his Deadspin article on Thompson by writing that “the post has been updated to better express the uncertainty over exactly what tests Thompson did or did not undergo.”

I’m less concerned with a single incident than with what it reveals. Despite hundreds of thousands of words written about the topic, hundreds of millions of dollars spent in settlements with retired players, and hundreds of thousands of dollars paid annually to keep neurologists of staff, sports teams still don’t seem to understand what a dangerous head injury looks like. The mechanics of a concussion are simple: rotational force is more dangerous than a straight ahead blow. When an athlete sees a collision before it happens and has time to prepare himself, he is less likely to suffer a concussion. It would be better to play on the safe side and have treated both of these injuries as potential concussions but to go through the protocol for the less dangerous one and potentially skip it for the more dangerous one is difficult to understand or accept. It’s time for sports teams to learn what a concussion looks like.

Football brilliance and its price, but is there hope?

Football, football, football. It’s mid-fall and my brain is still full of football. Soon, basketball, and hockey will creep in. Once in a while, a blip of tennis or soccer or volleyball pops up, but for the most part, it’s football, football, football. The sports media is equally obsessed and luckily for all of us, its producing a ton of great stories about football. Here are three from the past week that I want to share with you because of their great writing and impressive subjects.

Odell Beckham Jr.’s Catch Was A Culmination: A Former WR Explains

by Nate Jackson for Deadspin

Nate Jackson is a retired NFL player and the author of an insightful book about life in the NFL called Slow Getting Up. In this article for Deadspin, Jackson gives his thoughts on the incredible catch made by Odell Beckham last week that has widely been called the (or one of the) best catch in the history of the NFL. Jackson describes how difficult playing receiver is and also how little leeway the NFL’s obsessive coaches give players to practice the incredible.

But you can’t just play catch and call yourself a receiver. You have to get open. To get open on a route, you tell a lie with your body. This is harder than it seems. You may think you are leaning one way, but you’re not. To pretend to go one way when you really plan to go another way is counterintuitive. To do so at top speed requires a full-scale deception perpetrated against yourself. Every muscle, every bone, every ligament must be in on the lie, lest the defensive back see through you, and crush you.

But let’s think about something here, for one moment. ODB, a man with the football skills we just witnessed, is not allowed to trust his football instinct UNTIL the ball is in flight. He must stick to the PLAN until the ball is let go. …in the NFL, the freedom to improvise exists only for the quarterback. And even for him, it is rare. Our finest football players, men who would make Batman blush, must adhere to the small-minded tactics of a bygone era. And the arbiters of that era, uncoincidentally, are the men who also cannot conceive of such a catch being made in the first place.

Real Life or Fantasy?

by Joe Posnanski for NBC SportsWorld

It’s probably worth noting that Odell Beckham, the player who made the amazing catch described in the first article, didn’t finish the game he made it in. He left the game hurt although he did play in the next game. That’s the life of an NFL player — play, get hurt, play, get hurt. Rinse, repeat, until it’s time to retire. This is the story of a player who, in his day, scored more touchdowns and took more hits than almost anyone else and what his life is like now.

Housewives wrote thank you notes to him. Office workers built desk shrines to him. People around America would spend more time in the fall thinking about Priest Holmes than they would about their families. They named their fantasy teams after him – “Holmes Wreckers” and “Judas Priests” and “The High Priest of Touchdowns” – and they moved their lineups around him and they spent their Sundays shrugging when opponents took a big lead because nothing mattered, nothing at all, until Priest Holmes stepped on the field and began his weekly fantasy football scoring spree.

The greatest fantasy football player of them all looks for cracks in the ground when he walks now. “Cracks,” he says. “Divots. Unlevel ground. A shift in the pavement. A crack in the hall.”

He looks for these things because the tiniest variation in elevation can throw his body now. If he hits one of those cracks just a little bit wrong, his ankle turns. His hip jolts. “I can blow out a knee,” he says. The body that once bounced off the ground after the most savage crash went dark now teeters with the slightest incline or dip.

Each week took a terrible toll on him. He would remember Friday nights when he still wasn’t sure if he could play. That’s because: The feeling happened every Friday night. “Something would happen between Friday night and Saturday night,” he says. “I guess it was the mental training of it, I’d just done it so many times that my body would come together. “But I would know that the minute that game ended on Sunday, I wasn’t going to be healthy Monday, Tuesday, Wednesday or Thursday. It would be back to Friday, and me saying: ‘Come on body, I need you one more time.’”

Concussions, by the New Book

by Bill Pennington for The New York Times

Times have changed in the NFL since Priest Holmes played. Sure, his career would have been ended by the knee and hip injuries that ended his career anyway, but perhaps, thanks to a new comprehensive policy on head injuries, the mood swings and scary loss of feeling that Holmes suffers from may have been lessened or prevented. There is some hope.

Once, the treatment of players with head injuries varied from team to team and could be haphazard. Beginning last season, all players suspected of having a head injury — should they lose consciousness from a collision or experience symptoms like a headache, dizziness or disorientation — were required to go through the concussion protocol system. It features a broad cast: a head-injury spotter in the press box, athletic trainers on the bench, doctors and neuro-trauma specialists on the sideline and experts in neuro-cognitive testing in the locker room.

Each doctor interviewed for this article said a consensus in the “Go or No Go” moment is usually reached easily and without disagreements. No one recalled discord. “Ninety percent of the time, it’s pretty obvious,” Kinderknecht said. “It’s not a whole lot different than talking to somebody who is intoxicated. You can tell.”

It is becoming more commonplace for players to self-report a head injury… Players are also policing one another, tipping off the trainers that a teammate acted oddly in the huddle. Gossett said he had seen game officials alerting medical personnel as well.

Help fund a sensor that can help diagnose concussions

Jolt Sensor

Before the domestic violence and now child abuse scandals rocked the NFL, the leading concerning narrative was the prevalence of concussions or brain injuries. Concussions are a big problem in sports because we’re beginning to understand how frequently they occur to athletes and how serious their long-term consequences are. My colleague, Dean Russell Bell, wrote a post for Dear Sports Fan a couple of years ago explaining the issue of brain injuries in sports. In it he wrote that:

What also contributes to [the problem of brain injury in sports] is the so-called “sub-concussive” hits – the thousands of times a player will clash with someone and jostle the brain around in the skull just a little bit. This is one of the things that makes football the center of the brain injury story. In football, offensive and defensive linemen clash every single play with the force of a small automobile accident. Turns out these add up too, especially when you consider these guys have been playing football since they were kids. All of those little hits keep accumulating, and the concern now is that this is an issue that’s even bigger than pro football – that college and maybe even high school players may do some long-term brain damage. That issue is much more difficult to address, because you can’t get rid of that type of contact – it happens every play, all over the field.

What do you do if you can’t remove the source of danger? Well, you might look to at least monitor it so that you can pull a player out of a game once he or she has suffered a brain-rattling hit. Two MIT graduates are trying to make that goal a reality and they could use our help for their Kickstarter campaign. Ben Harvatine and Seth Berg started working on the Jolt Sensor while they were students at MIT. Harvatine suffered a concussion while wrestling for the MIT team but, like many athletes, he didn’t identify it as a concussion, and kept playing for a while. In their intro video, the two entrepreneurs mention that “the most dangerous thing an athlete can do after suffering a concussion is to get back on the field and continue playing.” Right after a first concussion, people are more likely to get a second concussion, and those concussions are more likely to have serious effects. In a tiny segment of athletes, unfortunately almost totally young athletes, a second concussion, can lead to second impact syndrome which is often fatal. Preventing secondary concussions by identifying first concussions is a valuable mission.

The Jolt sensor is basically a tiny clip with an accelerometer in it. Clip it to a football helmet or a headband and it will track the motion of an athlete’s head and send off alerts when it senses dramatic and potentially dangerous motion. Not only does the sensor buzz and light up, but more importantly, it sends an immediate alert to a mobile app where a parent or coach can see it and act to take the player off the field. Once on the sidelines, the Jolt app switches over to a diagnostic exam which tests against a player’s baseline scores to see if they have a concussion. I admire the way Harvatine and Berg have thought about the operational problems of brain injuries in sports as well as the scientific and medical ones.

A couple notes of caution about this project. The first, which is made very clear in the Kickstarter campaign page, is that Harvatine and Berg are not doctors, they make no promises that this device can actually diagnose concussions, and they recommend that any athlete who suspects having had a concussion be treated by a real, live doctor. The second is that devices like this have faced an uphill battle in the past. As the Washington Post’s Marissa Payne wrote in her profile of the Jolt Sensor, there have been serious objections from helmet makers, leagues, and schools to other devices like this. It’s hard to understand why anyone would object to a device that tries to make sports safer for everyone but if you think about it in terms of being an authority that could get sued, it makes a twisted kind of sense. The use of a concussion prevention device by a league or school might make it seem like that organization is vouching for the safety of anyone who doesn’t trigger the sensor’s alert. If that person gets a concussion and keeps playing because the sensor didn’t work, then you could perceive it as being the organization that bought the sensors’ fault. As for the helmet makers? Sensors like this simultaneously point out that helmets are virtually useless against concussions and undercut the great new concussion technology that the helmet companies are themselves trying to develop.

All objections aside, the Jolt sensor looks like a great device and its mission is a good one. They’re trying to raise $60,000 by Friday, September 26 to produce a final batch of sensors for testing and certification, and if all goes well, public consumption. If you want to give, even as little as a dollar, to this campaign, go do it here!