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NBA Star Demonstrates Difficulty of Enforcing Concussion Policies

Game 2 of the NBA's Eastern Conference Finals provided a not-so-welcome reminder of why concussion policies aren't the be-all, end-all when it comes to the prevention of serious head injuries.

During the fourth quarter on Tuesday evening, Indiana Pacers forward Paul George and Miami Heat guard Dwyane Wade both lunged for a loose ball. Wade's knee connected with the back of George's head, leaving both players sprawled out on the court.

George played the rest of the game, but told reporters afterward, "I blacked out as soon as it happened and then...however much time was remaining, I was just blurry," per Pacers.com's Scott Agness. Unsurprisingly, the next morning, the team's consulting neurologist diagnosed George with a concussion, leaving his status for Saturday's Game 3 up in the air.

According to the Pacers' public relations staffGeorge answered questions on the bench after the collision with Wade in accordance with the NBA's concussion protocol, and displayed no signs of concussion. His only symptom was pain in the back of his head, where Wade's knee had banged into it moments earlier. He remained symptom-free after the game, Agness tweeted, but due to his comments about blacking out, he had to undergo further evaluation the next morning.

NBA rules dictate that players suspected of a concussion "will be removed from participation and undergo evaluation by the medical staff in a quiet, distraction-free environment conducive to conducting a neurological evaluation." In a statement, Dr. Jeffrey Kutcher, the director of the league's concussion program, said, "The Indiana Pacers medical team followed the NBA concussion protocol and there was no indication of concussion during the game. This case illustrates that concussion evaluation is an ongoing process and manifestations of the injury may not always present immediately."

Based on the team's comments after the game, however, it appears as though the Pacers' medical staff did not follow the NBA's guidelines to a T. Examining George on the bench can hardly be construed as a "quiet, distraction-free environment."

Kutcher's larger point is sound, though: It's entirely possible for concussion symptoms to develop in the days after the initial injury. (A recent study of youth athletes found physical symptoms often present immediately, while emotional symptoms may take days or weeks to appear.)

As SB Nation's Tom Ziller notes, this isn't the first time in recent years that the Pacers' handling of a head injury raised eyebrows. During the Eastern Conference semifinals against the New York Knicks last season, starting point guard George Hill found himself on the wrong end of an elbow from Knicks center Tyson Chandler. Hill remained in the game, however, and played 37 minutes in total that evening.

Two days later, the team diagnosed Hill with a concussion and ruled him out for Game 5. He returned to play four days after initially suffering the injury, helping the Pacers close out New York in Game 6.

The experiences with Hill and George highlight the ongoing difficulty of enforcing concussion guidelines at all levels of sport. Until there's a 100-percent concrete method of diagnosing concussions, medical staffs must rely on athletes to be completely forthcoming about their symptoms. And unfortunately, in high-stakes situations, athletes may feel inclined to hide such symptoms to avoid missing significant playing time.

"I think every last player in the Final Four would have played through it," Miami Heat forward LeBron James told reporters on Thursday in reference to George's concussion. "This is the conference finals, and obviously, a concussion is very serious. Our concussion test is not as extensive as the NFL. It doesn't happen as much. I think all of us would have played through it under the circumstances."

Is it any wonder that the Institute of Medicine and National Research Council say there's plenty of work remaining in terms of changing athletes' handling of concussions? As ThinkProgress' Travis Waldron writes:

So it isn't just Paul George, the Pacers, and the NBA who have to make sure they set aside the short-term incentive to put wins over brains. It's young athletes who need them to do the same, and who need their coaches and leagues to do the same themselves. Because every time we pretend that victory, glory, and maybe even your spot on the roster are on the line but your brain isn't, we're telling every athlete from the NBA to youth sports to treat concussions the same way, consequences be damned.

Given all we've learned about concussions over the past few years, it's imperative that youth-athletes don't follow George's lead here. If you suffer a head injury, be honest with your medical staff. Don't hide your symptoms to stay in the game. The short-term gains are not worth the potential long-term ramifications, no matter how shiny a trophy or ring you may win.

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