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In Street Clothes

Covering sports injuries from the perspective of a certified athletic trainer and backed by analytics.

Paul George and the NBA Concussion Protocol

The current focus in the NBA isn’t on the Cavaliers unprecedented and odd-defying win at last night’s NBA Draft Lottery. No, instead it is on Paul George and the concussion he sustained during last night’s Game 2 loss. The injury occurred in the fourth quarter following a collision with Miami’s Dwyane Wade. Wade’s knee appears to strike George twice in the back of the head, forcing his head into the floor. George remained down on the floor but eventually made his way to the bench and never missed a second of playing time.

Normally this would have been no big deal but in post games interviews George mentioned he blacked out following the play and experienced blurry vision for the remainder of the contest. These symptoms are indicative of a concussion, an injury that according to the NBA concussion protocol should have resulted in George’s removal from the game and the performance of a neurological evaluation in a quiet area.

Testing performed by a neurologist on Wednesday confirmed the diagnosis of a concussion and now George will be place into the standardized NBA protocol for concussion management. The program was first initiated during the lockout-shortened 2011-12 season. Since it’s inception several big names, including Kobe Bryant, Stephen Curry, and Anthony Davis, have all successfully completed the protocol following a head injury. In all 43 concussions have occurred under the new program, including nine concussions sustained this season. These numbers give the NBA the lowest concussion rate of any of the four major North American sports.

The program begins before an injury ever occurs. Prior to the start of the season, players complete a neurocognitive exam that provides an injury-free, baseline score. Once a concussion has occurred, the injured athlete must then retake the exam and display scores at or better than their baseline results before they will be eligible to return to play. Additionally, each player must remain asymptomatic after undergoing various exertion tests that increase the heart rate and mimic the skills required to play the game. A return of the symptoms at any point suspends the athlete’s progression and they must restart the exam from their previously passed level.

Once the team’s medical personnel have cleared the individual, the player’s medical information is sent to the director of the league’s concussion program, Dr. Jeffrey Kutcher. Dr. Kutcher makes the finally decision if the player will or will not return to play.

The concussion policy is sound in principal and designed to protect the players from significant trauma, in the short-term and long-term. The effects of a concussion are cumulative, meaning for every subsequent concussion, the resulting symptoms are likely be more severe and last longer. The odds of an injury occurring are even higher if the player has yet to completely recover from the initial concussion.

However, the weakest link in the chain remains player compliance. If George did not report any of his aforementioned symptoms to the Indiana medical staff and their sideline evaluation gave them no reason to suspect a head injury, it’s difficult to fault Indiana for putting him back in the game. The NBA shares this sentiment as Dr. Kutcher said the Pacers did everything they were suppose to do, given the information they possessed. Look for the Pacers to address the situation internally and follow the NBA’s protocol to a tee.

George’s availability for Game 3 remains in doubt. History suggests he will likely miss a game as the average number of games missed for the 43 players to sustain a concussion over the last three years sits at 3.8. However the additional time off between Games 2 and 3 could prove beneficial and may improve George’s odds of being in uniform on Saturday night.