By Dev K. Mishra, M.D.
President, Sideline Sports Doc
Did anyone see these comments from New Orleans Hornets coach Monty Williams over the past weekend? I found them published on ESPN online, with Williams commenting on his big man Anthony Davis, who had been diagnosed with a concussion on contact that Williams apparently considered insignificant: “When you’re dealing with the brain, I guess what’s happening in football has impacted everybody. He got touched up a little bit last night. That happens a lot in basketball. It’s just that now they treat everybody like they have white gloves and pink drawers and it’s getting old. It’s just the way the league is now.”
Later in the article Williams tried to back down a bit by saying “”We’ve got to protect the players, but I think the players should have more say so in how they feel.” There are several implications from the comments that I’ll expand on here.
The brain doesn’t care if it got hurt in a car, on the football field, on the basketball court…
One of the implications of the comments is that there is somehow a sport specific concussion, that football concussions are just not the same as basketball concussions. This is flat out not true. What changes from sport to sport are the forces involved, level of head protection, surfaces hit, etc. There’s a lot we have yet to learn about concussions but what we do know is that Dale Earnhardt Jr. can get a concussion in a very well protected car with a state of the art helmet protecting his head the same way Jahvid Best can. And for that matter players without helmets, like Anthony Davis, can get one too. Symptoms may differ, recovery times may differ, every person will respond differently but the brain doesn’t care if it was playing a sport when it got hurt.
Players should have a say in return to play?
I’m definitely not a lawyer but I do know that athletes in any sport assume a certain level of risk when playing. There are medical waivers, release of liability, arbitration agreements, etc., all designed to limit risk to the caregivers and allow for some personal responsibility from the adult player. Williams seems to be asking whether a player in the NBA can simply assume the liability of playing and override the medical professionals’ opinion. Certainly all medical professionals will discuss options for treatment, risks of the available options, and benefits of the options with the injured player in a process we call “informed consent”. But no medical professional would present an option known to cause probable harm, based upon the best available evidence. For concussions our best available evidence calls for specific testing and return to play protocols. Until the evidence changes I don’t see us allowing players to put themselves in a position we currently believe may cause permanent damage.
Let’s play doctor!
Who gets to diagnose and manage a player with a concussion? I won’t belabor the point but concussions are tricky to diagnose and manage, we generally defer to physicians specifically trained in sport concussion management. Mr. Davis likely had a very thorough concussion evaluation. In the world of major professional sports in the U.S. that task typically falls to a neurologist with no specific ties to the team. The testing is very comprehensive; players can’t really “cheat” their way through a test as easily as once possible. As much as we want to see the professionals at their craft we still need to treat them as we would any patient with a suspected concussion. Caution rules the day.
And if you’re a kid?
You’ve got 70…80…maybe 90 years of your life left. If you think you’ve had a concussion get treated properly from the start. Your best game is right around the corner.