Report: Paul George Diagnosed With Concussion

According to a release by the Indiana Pacers, Paul George suffered a concussion in Game 2 against the Miami Heat on Tuesday night. We intimated as much when George told reporters following the game he “blacked out” when Dwyane Wade kneed his head and it bounced awkwardly off the court, but now it’s confirmed and the George will be evaluated before he’s allowed to play in Game 3 Saturday night.

Here’s the play in question again, which occurred with a little under seven minutes left in the game:

As we mentioned last night, the NBA’s policy for concussions seems simple enough, even during a playoff game. Here’s the verbiage that seems most important after what happened last night (emphasis ours)

If a player is suspected of having a concussion, or exhibits the signs or symptoms of concussion, they will be removed from participation and undergo evaluation by the medical staff in a quiet, distraction-free environment conducive to conducting a neurological evaluation.

Now here’s the Pacers’ opening paragraph about how they addressed the situation last night:

Tuesday night, Indiana Pacers forward Paul George took a knee to the back of his head during the fourth quarter of the Eastern Conference Finals game against Miami. Immediately after the play, George exhibited no symptoms of a concussion and, in response to questions from the Pacers’ medical staff, he denied dizziness, nausea, and issues with his vision. He was also active and aware of his surroundings. As a result, the Indiana medical staff did not suspect a concussion.

Because George told reporters after the game he “blacked out,” the team conducted the NBA-mandated concussion assessment, which did not reveal any active symptoms of concussion.

Then, the release adds:

Because of the statement and Indiana’s ongoing evaluation and management of potential concussions, George underwent further testing and evaluation Wednesday morning. He has been diagnosed by the team’s consulting neurologist with a concussion, based on his post-game reporting that he had briefly lost consciousness during the game. He will begin the NBA-mandated protocol for return-to-participation after a diagnosed concussion.

The Pacers also quoted Dr. Jeffrey Kutcher, the Director of the NBA Concussion Program, who has been in contact with the team’s medical staff:

“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.”

There’s a problem after sifting through all of the NBA’s wording on concussion evaluation, prevention and treatment — plus, the NFL’s concussion issues lurk over all of this like the specter of all those broken retired players. Namely, George shouldn’t have been allowed to re-enter the game. It’s not like he gave the Pacers much through the last half of the fourth quarter, anyway (as noted last night, he missed a shot, turned the ball over and hit 1-of-2 free throws).

In George’s case, the test to see if he was concussed was a simple: “Hey, you OK?” followed by George’s obvious answer of “yes.” It’s the playoffs and players aren’t going to be making a sound decision, especially after getting bonked on the head enough to lose consciousness. Nobody wants to say, ‘my head hurts, I can’t play’ in what could by a pivotal playoff game against their noted Eastern Conference rivals.

George wasn’t taken to the locker room to “undergo evaluation by the medical staff in a quiet, distraction-free environment conducive to conducting a neurological evaluation,” as stipulated by the NBA above. He didn’t exhibit any signs of a concussion, but he also remained mum about those symptoms, which the Pacers will (and should) use for any potential liability issues.

Putting all those moral and ethical issues aside, now the question becomes whether George will be cleared in time for Game 3.

Click for more on how George will be cleared to play in time for Game 3…

What is the process for George’s return to action? It’s as complicated and convoluted as you’d expect. We can remember Magic center Nikola Vucevic sitting out a number of games over a couple weeks after a concussion during the 2012-13 season. Pacers fans better hope that’s not the case here.

Here’s how the NBA mandates a Return-to Participation Decision:

Once a player is diagnosed with a concussion he is then held out of all activity until he is symptom-free at rest and until he has no appreciable difference from his baseline neurological exam and his baseline score on the computerized cognitive assessment test.

The concussed player may not return to participation until he is asymptomatic at rest and has successfully completed the NBA concussion return-to-participation exertion protocol.

Here’s the NBA’s Return-to Participation Protocol:

The return to participation protocol involves several steps of increasing exertion — from a stationary bike, to jogging, to agility work, to non-contact team drills.

With each step, a player must be symptom free to move to the next step. If a player is not symptom free after a step, he stops until he is symptom free and begins again at the previous step of the protocol (i.e., the last step he passed without any symptoms).

While the final return-to participation decision is to be made by the player’s team physician, the team physician must discuss the return-to-participation process and decision with Dr. Jeffrey Kutcher, the Director of the NBA’s Concussion Program, prior to the player being cleared for full participation in NBA Basketball.

It’s important to note that there is no timeframe to complete the protocol. Each injury and player is different and recovery time can vary in each case.

That last point is important because it leaves the decision with the team, with some hazy language about discussing the process with Dr. Kutcher. What if Dr. Kutcher says he’s not ready to play, but the team says he is? That’s a real possibility.

The wording in the policy summary allows some flux on a complicated matter for the most important organ in the human body. It remains to be seen whether George will be allowed to suit up for a huge Game 3 on Saturday in Miami, but most would agree he should have been held out through the last six plus minutes of the fourth quarter on Tuesday night. He was concussed, but no one knew, even George. Now we’re here.

(; NBA Official Concussion Policy)

Will George play on Saturday, but more importantly, should he?

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