Pau Gasol will return to the Los Angeles Lakers' lineup for the team's nationally televised Thursday game against the defending NBA champion Miami Heat after missing five games with a concussion brought on by an inadvertent elbow from Denver Nuggets center JaVale McGee on Jan. 6. He'll play because he passed a series of physical tests without signs of post-concussion symptoms returning and was cleared by a neurologist to resume game activity, as laid out by the concussion protocol the league rolled out in December 2011. We feel good about him coming back, because we take that comeback as an indication that, after 11 days without a game, his symptoms have disappeared and a medical professional has judged him healthy, capable and ready.
That protocol wasn't in place during the summer of 2009, though, which might be why former NBA player Brian Scalabrine was allowed to return to the floor for the Boston Celtics during the 2008-09 playoffs despite having suffered multiple concussions in less than a month and being shut down for the season by team doctors. Then again, as Scalabrine told ESPN.com's Beckley Mason in the latest installment in TrueHoop's "Working Bodies" series, he got cleared by a neurologist, too, and getting cleared wasn't too hard:
The symptoms were this: I couldn’t sleep longer than three-and-a-half hours. So every three-and-a-half hours I would wake up for two hours then try to go back to sleep for three hours, then I’d wake up again.
Another symptom was that I couldn't handle light, at all, so I’d wear dark, dark sunglasses all the time. And every time I tried to exercise I would get really lightheaded. So for me to be cleared I had to be cool on all three.
Well, I just lied. [...]
I just told the doctor, Man this is great! I don’t have any issues with light, I’m sleeping better, I’m doing this, I’m doing that.
Were those things happening? Eh, not really. I wasn’t sleeping much better, I wasn’t feeling much better. But at the end of the day there was an opportunity to play so I played.
The opportunity presented itself because the Celtics had been hit hard by frontcourt injuries, with Kevin Garnett sidelined by a knee injury and backup power forward Leon Powe tearing his ACL in Game 2 of Boston's first-round playoff series against the Chicago Bulls; that left only Scalabrine and fellow backup Mikki Moore behind starters Kendrick Perkins and Glen Davis.
To that point in his career, Scalabrine had played a total of 168 (mostly garbage-time) postseason minutes in 26 appearances while a member of the New Jersey Nets; this was his chance, after eight NBA seasons, to actually see legitimate, extended floor time in a playoff run. So he did what he thought he had to do to get back on the floor; after missing a full two months following his most recent concussion, he apparently did a good enough job of fooling the doctors to accomplish his goal, averaging more than 20 minutes per game in 12 appearances on the Celtics' run to the Eastern Conference Semifinals.
Scalabrine left Boston after the '09-'10 campaign, played two more years with the Chicago Bulls and retired after last season to become an announcer on Celtics broadcasts. He tells Mason he's happy with the decision he made and is "completely fine" with taking advantage of an opportunity presented to him ... and yet, in the same breath, he acknowledges that he "had no business being out there."
And that, of course, gets at the heart of what makes the concussion/head injury issue so difficult to address, not only in the NBA, but in pro sports in general — highly competitive athletes have an incredible drive (and, in many cases, overwhelming incentive) to compete, and do whatever is in their power to do so, even if it's ultimately to their own detriment. Beyond that, of course, there's also the fact that many of the things commonly associated with post-concussion symptoms — increased fatigue, lack of awareness, etc. — can easily be rationalized away by players as problems solved simply by harder work or greater toughness, as Scalabrine said:
[When struggling post-concussions,] I always just said this is physical fatigue, push yourself through it. The last rotation and all those things, or even being a step slow and not getting somewhere. If I would have been like, "Man, this is because of my concussion," that’s just an excuse. Mentally, I just told myself: What do you expect? You couldn’t do anything for two months. Stop being a p----, push yourself through it. It’s not about the concussion. And that was the way I dealt with it.
That's the way a lot of players in a lot of sports have dealt with it over the years, which is why concussions, head trauma and chronic traumatic encephalopathy have become so prevalent and such massive issues, and why the major professional sports leagues, including the NBA, now have and enforce concussion protocols, which is a massive step forward. But getting past that idea of the need to "stop being a p----" ... that seems like a trickier problem to solve.
Maybe the way forward there is for more prominent athletes to speak out strongly in favor of strict adherence to post-concussion treatment guidelines and vigilance in maintaining one's health after a head injury. Lakers star Kobe Bryant — Gasol's teammate and someone who's experienced an in-game concussion himself — did just that this week, according to Lakers beat man Mark Medina:
Even though Bryant rightfully pointed out there’s nothing anyone can do to “expedite” his recovery, he also expressed irritation over how the Lakers’ forward has handled it.
“I was a little angry with him the other day because he’s coming to practice and coming to the games,” Bryant said. “Stay home. Cut all the lights off. Just rest. Let your brain rest. But he wants to be around [the team]. That’s the type of teammate he is.” [...]
Bryant managed to receive medical clearance three days after [his] concussion and didn’t miss any games, partly because he spent every waking hour in dark rooms with minimal noise. He continued that process between games. Bryant also wore a plastic mask to protect the whiplash and tenderness of a broken nose.
“That’s the difference between me and him,” Bryant said. “I’ll stay home and cut the damn lights off. He’s more of a team guy. He wants to be around the fellas. He wants to do his treatment around the fellas.”
It's great to hear a star as huge and well-respected as Bryant emphasize the importance of rest and avoiding overstimulation in recovering from a concussion, and even better that his words back up his own prior actions; it'd be great if more top-flight stars followed suit in advocating for smarter, healthier practices in similar situations.
Then again, Hall of Fame-caliber players like Bryant and Gasol exist in a very different world from career end-of-the-benchers like Scalabrine; while the former, no matter how competitive, are treated as valued assets that need to be carefully managed, the latter are frequently viewed as interchangeable fodder, which only helps feed the notion that whenever opportunities present themselves, they must be seized, no matter the cost. Figuring out how to bridge that gap for even lower-tier players could prove to be one more difficult problem in an already incredibly thorny and multifaceted issue.