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SPORTS MEDICINE: In NBA bubble concussion acumen absent
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SPORTS MEDICINE

SPORTS MEDICINE: In NBA bubble concussion acumen absent

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Celtics 76ers Basketball

Philadelphia 76ers forward Tobias Harris is attended to by Indiana State graduate Kevin Johnson after hitting his head against the Boston Celtics during Game 4 of an NBA first-round playoff series Aug. 23, 2020, in Lake Buena Vista, Fla.

There was only one way to describe the fall Philadelphia 76ers' Tobias Harris took a week ago, late in the third quarter of his team’s playoff loss to the Boston Celtics. Almost every headline used the word “scary.” Yahoo Sports deviated slightly from the narrative, describing it as “frightening.”

Regardless, with 2:45 left in the third quarter, Harris’ feet became entangled between Celtics' Jayson Tatum’s legs, which resulted in Harris falling head first to the floor. His head bounced hard, and though it was the left side that struck the playing surface, Harris grabbed both sides of his skull as he rolled and twisted awkwardly, partially onto his stomach. His legs writhed briefly before he became completely motionless.

By then, 76ers head athletic trainer Kevin Johnson had rushed to his side and within moments had raised his fist overhead to signal potentially serious trauma had occurred. Harris was bleeding from a laceration over is left eye but eventually was able to walk unaided to the locker room while holding a towel to his head. Johnson, an Indiana State graduate and Indianapolis native, was right behind Harris as they left the floor.

Radio.com describes best what then happened with 5:12 remaining in the game. “Miraculously,” read the website’s story, “Harris not only cleared concussion protocol and returned to the bench, but checked back into the game with a bandage over his eye.”

Celtics 76ers Basketball

Philadelphia 76ers forward Tobias Harris reenters play after injuring himself during Game 4 of an NBA first-round playoff series against the Boston Celtics Aug. 23, 2020, in Lake Buena Vista, Fla.

Miraculously, indeed.

Queried by the media as to why he returned, Harris replied, “Just because I could. I felt OK enough to go back out there, and be able to try to do something to help us try to win. I’d rather go down with my guys than sitting in the back. So really, that was the main reason why.”

Noble sentiments but certainly not wise. Harris also acknowledged he was still hurting, specifically referencing his ribs. Still, even if his head was not hurting, I am baffled that he “passed” the NBA’s protocol.

Perhaps, I should not be. This is not the first time a miraculous recovery from an apparent concussion has occurred during the NBA playoffs. It was five years ago during the Western Conference Finals that Golden State Warriors Stephen Curry and Klay Thompson were allowed to return to play despite obvious signs of concussion. Thompson, thanks to the insistence of his father — former NBA star Mychal, was ultimately diagnosed with the injury. Curry never was.

Furthermore, the league’s policy offers a lengthy explanation of how to manage a concussion but precious little on how to diagnose one. Instead, it references and defers to the 2017 Consensus Statement from the Concussion in Sports Group, published in the British Journal of Sports Medicine.

Celtics 76ers Basketball

Philadelphia 76ers players react as forward Tobias Harris (not shown) is attended to after hitting his head against the Boston Celtics during Game 4 of an NBA first-round playoff series Aug. 23, 2020, in Lake Buena Vista, Fla.

Even that document focused largely on the sideline examination rather than what is observed at the moment of injury and immediately thereafter when a sports medic first reaches the injured athlete’s side. However, the statement also advised, “The addition of sideline video review offers a promising approach to improving identification and evaluation of significant head-impact events.”

I do not know if the 76ers medical staff reviewed any video of the incident. It certainly would have been available to them. If they did not, they should have. If they did review it, they never should have allowed Harris back in the game, even if he was symptom-free of concussion after having his laceration sutured.

Celtics 76ers Basketball

Philadelphia 76ers forward Tobias Harris is attended to after hitting his head against the Boston Celtics during Game 4 of an NBA first-round playoff series Aug. 23, 2020, in Lake Buena Vista, Fla.

In April of last year, the British Journal of Sports Medicine published 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. 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.

Harris qualified by lying motionless.

“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. Reviewing both videos, Harris and Thompson did so identically in the instants after they fell.

Celtics 76ers Basketball

Philadelphia 76ers forward Tobias Harris is attended to after hitting his head against the Boston Celtics during Game 4 of an NBA first-round playoff series Aug. 23, 2020, in Lake Buena Vista, Fla.

Thompson, similar to Harris, passed sideline/locker room exams before being allowed to return. His symptoms did not become pronounced until post-game. That is why the 2017 Consensus Statement, the NBA protocol and multiple state laws that govern concussion in youth and high school sports recommend or mandate a minimum 24-hour waiting and reevaluation period after a suspected concussion.

With the 76ers’ season having ended after the loss to the Celtics, they have been under no obligation to inform the media of Harris’ medical status during the last week. Still, it would be beneficial to know.

It would be more beneficial for younger athletes, their coaches, and parents to know that how Harris was treated is not the model to follow should they encounter similar circumstances.

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

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

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