Two weeks ago, I explained how it appears that, at playoff time, the rules governing the management of a suspected concussion seem to be suspended.
It certainly was not the first time I have covered the issue.
In 2013, during the American League Championship Series, Tigers outfielder Torii Hunter nearly robbed Red Sox designated hitter David Ortiz of a game-tying grand slam — only to be knocked out when he slammed head first into the ground of the Red Sox bullpen. Yet, he remained in the game.
In 2015, during the NBA playoffs, Golden State Warrior stars Stephen Curry and Klay Thompson endured suspicious cerebral circumstances. In fact, if not for Thompson’s father, retired NBA star Mychal Thompson, Klay Thompson may never have been fully evaluated and sidelined for a game. Fortunately, father knew best.
In 2017, it was Houston Texans quarterback Tom Savage being leveled and displaying the "fencing response" — raised, rigid or slightly twitching forearms — at the feet of the referee. He came off briefly but was allowed to return for one series after a sideline exam of less than three minutes. At least in that case, the NFL changed its concussion protocol within a few weeks to use "a centralized, unaffiliated neurotrauma consultant at the league office to monitor feeds of all games and contact the team medical staff on the sidelines if they see anything that deserves further evaluation," according to a 2017 Associated Press story.
Then late last month, Virginia Tech’s Nickeil Alexander-Walker and Notre Dame’s Jackie Young struck their heads in separate NCAA Tournament games and video evidence suggested the possibility of concussion. Alexander-Walker stayed on the floor while Young left for a brief sideline exam, only to return.
Those two incidents prompted the column of April 1 in which I suggested video review should be a part of college basketball, just as it is in the NFL and several college conferences.
Just a few days later, in a case of convenient timing, the British Journal of Sports Medicine published online an article entitled “International consensus definitions of video signs of concussion in professional sports.”
Concussion experts from the Australian Football League, Cricket Australia, MLB, NFL, NHL, the National Rugby League in Australia and World Rugby, identified six signs of concussion that can be seen on video. And those signs would apply to any level of sport participation, not just the pros. The presence of any one of them indicates, according to the article, “the need to remove the athlete from the playing arena for formal assessment and evaluation from a suitably qualified health practitioner.”
The six signs are lying motionless for more than two seconds, motor incoordination, impact seizure, tonic posturing, no protective action when falling and a blank/vacant look.
Hunter qualified by lying motionless. He admitted in a 2018 interview with the Detroit Free Press that he was concussed and suffered symptoms for three months.
Curry checked off motor incoordination and blank/vacant look.
Thompson displayed no protective action when falling — barely. On slow motion replay, after being kneed in the ear, his body goes momentarily limp before he recovers in midair to bring both hands to his head as he rolls up in a ball. He does not lie motionless but continues holding his hands to his head for a prolonged period. “Clutching the head” was a sign identified by some of the experts but they did not arrive at the consensus on this sign as they did with the above-listed six.
Savage’s “fencing response” was tonic posturing.
Alexander-Walker didn’t hit his head until he hit the ground but his body was limp when his teammates initially attempted to help him to his feet.
Young went down without protecting herself and displayed some motor incoordination when assisted to her feet.
In almost all of these instances, it is likely that sideline medical personnel did not get a good view of the collision and/or fall. Consequently, video review would have been helpful.
Unfortunately, at the small college, high school and youth levels, video review is less likely to be immediately available or available at all. However, parents’ eyes, as was the case with the Thompsons, are usually pretty reliable.
Their vantage point from the stands is often better than that of those sitting or standing on the sidelines. Consequently, when parents see these signs, they should not be shy about alerting an athletic trainer, coach and/or team physician about their suspicions.
Failure to do so could leave their athlete vulnerable to a second concussion in the same game, which may trigger far greater consequences. That is why state laws governing concussion in Indiana and Illinois, for those 18 and younger, mandate removal from participation for at least one day and until cleared by a qualified medical professional.