Concussion Protocol and the WNBA

This week the Seattle Storm played two home games - Tuesday versus the LA Sparks and Saturday versus the Dallas Wings.  Both games were hard fought battles.  As I've previously written about here, the 2018 WNBA season is shortened due to the upcoming World Championships in September,  so teams are cramming the same 34-games into a shorter length season.  I was concerned that the increased level of fatigue could correspond with increased injuries.

Unfortunately, one of the Storm players experienced a concussion this week - media release here.  I of course cannot blame the season schedule on the concussion - there's no way to determine cause and effect here - but there have been several injuries throughout the WNBA this year, and it seems like there are more than in previous seasons, though I don't have the data to be certain.  (This is one of my concerns about WNBA injury reporting - I wish this data was more readily available!)  Anyways, I thought this would be a great opportunity to discuss concussions a little bit from an acute response perspective - rather than what the longer term care looks like when I treat kids who've experienced a concussion at Seattle Children's Hospital. 

I think it is of key importance to mention that a concussion is a brain injury.  No two people experiencing a concussion have the same symptoms or present the same way.  This differs from your general ankle sprain patients where they mostly behave similarly and follow a similar trajectory for recovery.  Where there is a similarity: athletes at all levels who experience a concussion generally want to get right back into the game.  It makes sense - they're competitors.  But this is dangerous and as a sports medicine provider, it would be irresponsible to allow a symptomatic athlete to participate in activities that could be life-threatening.  I'll say it again - a concussion is a mild traumatic brain injury.

Every (major male) professional sports league has a concussion policy.  During WNBA training camp before the season gets underway, players complete a baseline testing on a computer for neurological and cognitive function.  If a concussion occurs in a game, a physician evaluates the athlete and then this same computer testing can be completed for comparison.  You can see the moment of injury at the Storm versus Sparks game at the 2:45 mark in this video - also included below.   

If a head injury occurs on the basketball court, the athlete needs to be evaluated in a quiet area without distractions.  This initial screening is conducted by an athletic trainer or team physician and includes a lot of questions such as any symptoms they may be experiencing: headache, dizziness, nausea, sensitivity to light or sound.  Then a physical exam including a screen of what the eyes are doing - if they can track a moving target or if they operate abnormally, an evaluation of the neck is conducted, the nervous system is assessed, and balance, memory, and comprehension are all considered.  Generally concussion symptoms don't always show up right away and it's best to wait several minutes to determine if anything comes on after a delay.  This is a complication for sports such as football where an athlete may take a hard hit and initially seem symptom-free, only to worsen a few minutes later where sideline assessment often occurs on the field where there isn't really a quiet place to conduct a thorough assessment. 

The NBA announced that they would initiate a concussion protocol in 2011 - following in the steps of many other professional sports leagues, particularly the NFL who was dealing with CTE (chronic traumatic encephalopathy - a neurological disease found in athletes and veterans likely related to repeated hits to the head and diagnosed post-mortem).  The WNBA Concussion Protocol wasn't easily accessible from my search - but it's based on the NBA's policies which are summarized here.  Basically the athlete will go through five stages of recovery including 1) asymptomatic at rest, 2) asymptomatic with bike riding, 3) asymptomatic with jogging, 4) asymptomatic with basketball drills without defense, and 5) asymptomatic in full practice.  The computerized testing will be conducted between stages to compare to baseline and determine that the athlete is not having increased symptoms.  These stages can be completed in as few as about 3 days, more typically a minimum of 5 days based on articles about players I've read about online - but the maximum duration varies based on the individual athlete's response to their progressively increasing activity level.

The stages for recovery are fairly similar to what is used at Seattle Children's - but the key difference is that physical therapy interventions on kids who have experienced a concussion generally only occur if the child has been experiencing post-concussion syndrome (sometimes referred to as delayed symptom resolution).  By definition - this means they've had symptoms for at least a month, but usually by the time I'm evaluating a kid for concussion in the clinic, they've generally been experiencing symptoms for more than 3 months. (At least 70% recover spontaneously in less than one month).  

This paper that examined concussions in multiple sports found that 4.7% of all injuries in women's basketball are concussions.  In general, only football, women's soccer, men's and women's ice hockey, and men's and women's lacrosse had more concussions than in women's basketball.  Across all sports, 5% of all sports injuries were concussion.  The paper also breaks down mechanisms of injury for concussion for each sport which interestingly showed that, in basketball, women tend to experience the injury while ball handling or playing defense whereas men tend to have it diving for a loose ball or rebounding.  Interestingly, the mechanism of injury you'll see in the video link above for the Storm injury was a loose ball retrieval effort.  In my personal opinion, as the level of play of the WNBA has gotten increasingly better year after year, the difference in mechanism of injury is likely to change.  WNBA athletes are incredibly athletic and are doing things on the basketball court that we didn't see in women's sports 15 years ago when this data was collected. 

If you or someone you know experiences a head injury, please get them examined by the appropriate healthcare provider.