Concussions, once an injury of unclear regularity and rare discussion, are now a common topic of conversation in the sports world. While the NFL continues to struggle most with the issue, the NBA has taken what looks like a progressive approach to the injury, instituting an extensive policy on the diagnosis and treatment of concussions before the 2011-12 season. When people have criticized it, they have been fined.
The events of Tuesday's Game 2 of the Eastern Conference Finals have thrown the efficacy and enforcement of that policy into question. With minutes left in a close game between the Miami Heat and Indiana Pacers, All-Star Paul George was hit in the back of the head by Dwyane Wade while struggling for a loose ball. After a timeout, George stayed in the game and looked out of sorts for the duration, serving as a non-factor as the Pacers lost late. After the game, he informed reporters that he had blacked out after the blow and suffered from blurred vision. It was not exactly clear what Pacers doctors had known at the time, or why George wasn't given a full examination in accordance with the concussion policy. On Wednesday, the Pacers confirmed what seemed likely — George has a concussion and isn't a sure thing for Saturday's Game 3.
It is not entirely clear why George stayed on the court under these circumstances, but we do know that he didn't budge despite identifying a period of unconsciousness and subsequent blurred vision. By all relevant standards, that's the wrong action to take when faced with such symptoms.
Yet, as explained by LeBron James and others, it's a decision that most NBA players would make under the same circumstances. From Brett Pollakoff for ProBasketballTalk:
“I think every last player in the Final Four would have played through it,” James said. “This is the conference finals, and obviously, a concussion is very serious. Our concussion test is not as extensive as the NFL. It doesn’t happen as much. I think all of us would have played through it under the circumstances.”
That doesn’t make it right, but LeBron wasn’t alone in this line of thinking. David West similarly said that it might be difficult for a player to be completely honest in terms of his symptoms if he wants to stay in the game.
“I think sometimes it is [difficult],” West said. “You want to play. Particularly if you know if it’s an ankle or something like that. If you tighten the shoe up or whatever, you’re able to get through. And with the time of year it is. But you’ve got to stick to the protocol, and you’ve got to do what’s best for yourself long term.”
“You have to let the team know and the doctors know, the trainers know when you have symptoms,” Pacers big man Roy Hibbert said. “You have to think about your longevity as a human being before just the game. He has the right people around him and the organization is behind him, so whenever he’s ready to go, he’ll be back.”
There are two separate but related issues at play here — first, what the Pacers knew at the time and what they tested and, second, the factors that led George to conclude he should stay in the game. The first problem is easier to solve, regardless of these particular circumstances, because team doctors should always consider the long-term health of the player. Their job is theoretically to assess damage and provide information, not consider if diagnosing an injury in a particular moment lets their employers win games. If George received any concussion testing at all but was not taken off the court for complete evaluation, then the Pacers screwed up. The concussion policy does not set out helpful tips — it serves as a standard of responsible medical care.
The second issue is tougher to figure out because George and all players make a habit of sacrificing their long-term health for the rewards of team championships and personal success. At this point in the season, virtually every player who sees the court is dealing with some kind of discomfort or injury. This is often seen as a point of pride for athletes, who are often spoken of as warriors. For that matter, retired athletes will usually exhibit the lifelong effects of playing through pain — it's not as if players don't understand what they're risking.
Concussions are different, though, because they have extremely negative long-term effects without immediately hindering a basketball player's basic ability to run and jump. That lack of obvious external injury could even make a simple discussion of the injury seem like it's not a priority. For instance, in 2012, James waved off a question about his history of concussions with a dumb joke. In the 2013 playoffs, George's teammate George Hill had one of the biggest games of his life while playing with a concussion, wasn't diagnosed for a few days, and didn't receive the same kind of praise associated with suffering through a broken leg or the flu.
On the other hand, if athletes are regularly put in a position in which the ever-present necessities of winning and achieving on-court glory can trump their attention to their own health, then it's even more essential that doctors and officials act decisively to protect them from harm. Otherwise, as Tom Ziller of SB Nation argues, the concussion policy is worthless. Oversight systems are put in place when directly involved parties can't handle the issues themselves. Perhaps these watchmen need to be watched themselves.
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