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NCAA Texas A&M Notre Dame Basketball

Notre Dame's Jackie Young, right, shoots over the Texas A&M defense during the first half of a regional semifinal game in the NCAA women's basketball tournament Saturday in Chicago. Young was hurt in the game when she ran into a high screen, but she returned to the court minutes later.

I’ve written before how a torn ACL is much like a death in the family. That was entirely evident during Auburn’s news conference Saturday, which opened with an emotional head coach Bruce Pearl announcing that forward Chuma Okeke had torn his left ACL.

Of course, the news was no surprise, Pearl saying the night before that he thought the injury was “serious,” the knee having “buckled.” Video re-play moments after the incident revealed the nature of the injury. When the knee buckled, it bent inward and that valgus stress at high speed is the mechanism for a torn ACL. The accompanying audio removed any doubt, with Okeke letting out the reflexive shout or scream so common with ACL tears.

I am sure a physical exam in the locker room revealed the tell-tale joint laxity that athletic trainers and team physicians dread discovering. The MRI on Saturday morning merely confirmed the obvious.

Unfortunately, when it comes to a concussion there is no such definitive test. Contrary to popular opinion, a CT scan or MRI will not show a concussion. They will show a more serious head injury that involves bleeding in the brain.

Two plays in the last week, one each in the men’s and women’s NCAA basketball tournaments, offer excellent examples of what seemed obvious on video being essentially ignored in the arena because unlike after a torn ACL, an athlete is often able to continue functioning shortly following an initially disabling blow to the head.

On Friday, Virginia Tech’s Nickeil Alexander-Walker was sandwiched between two Duke players while in the air and ended up landing on the back of his head. If the video left any doubt — it didn’t — then the audio thud of his skull hitting the floor eliminated it.

If that wasn’t enough, while Alexander-Walker grimaced on the floor, a teammate did precisely what all players should be instructed never to do when a head or neck injury is suspected. He dragged Alexander-Walker to his feet while his head hung limply backwards.

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One might expect that Alexander-Walker would then have been removed from the game to be evaluated. However, the fall occurred in front of the Duke bench and the Virginia Tech medical staff may very well not have seen what occurred. Alexander-Walker was not sent to the sideline by the referees. Consequently, he continued playing.

On Saturday, Notre Dame’s Jackie Young was removed from the game after she folded up like an accordion, face first to the floor — the result of running head first into a high screen. Nonetheless, minutes later, presumably after a sideline exam, she was back on the floor. Again this time, since the collision was away from the ball, the Notre Dame medical staff may not have seen the incident.

Yet, had they reviewed the video, seen the hit and considered the images of the immediate aftermath, I wonder if they would have been so willing to trot her back out there.

Then again, this was an NCAA tournament game, much like the college football semifinal at the Cotton Bowl where Notre Dame defensive back Julian Love missed much of the first half with a head injury but was allowed to return for the second half.

Several years ago, I was sitting courtside at a collegiate postseason basketball game when a key player went down and was clearly impaired after striking his head. It took more than a minute for the athletic trainer to get the player off the floor, whereupon he was allowed to sit at the end of the bench without any further examination. Those sitting around me, observed the same things I did and asked if I thought the player was done for the night. I replied, “Championship players do not come out of championship games.”

The comment was meant as neither praise nor criticism, just an observation of fact. Players do not want to come out of high stakes games nor do team medics wish to hold them out. Sure enough, the player in question eventually moved from the end of the bench to a seat next to his coaches and then returned to the game.

If college basketball used unaffiliated “eye-in-the-sky” athletic trainers and/or sideline neurologists with video replay access, like the NFL and several college football conferences do, concussion controversy could be avoided. Until that happens, though, it will seem that concussions either do not happen or the rules governing their management are bent or ignored at basketball tournament time.

John Doherty is a licensed physical therapist and athletic trainer. This column reflects solely his opinion. Reach him at jdoherty@comhs.org. Follow him on Twitter @JDohertyATCPT.

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