George Hill missed Game 5 of the series between the Indiana Pacers and the New York Knicks. The Pacers' loss sends the teams back to Indianapolis for Game Six on Saturday, but will Hill be back on the floor? Let's take a look at the questions he and the Pacers face:
During Game 4, Hill, listed at 6'2", took an elbow to the head from Tyson Chandler, who is 7'1" tall. This kind of height differential often leads to concussions, as an accidental elbow is more likely. The NBA's strict policies against elbows (this rulebook page has more than a dozen elbow references) prevent this from happening more often with players of equal height, where the players have more control.
While symptoms did not come on fully until the following day, the damage was done at this point. Looking at tape, there's no real sign that Hill was dealing with anything other than the initial trauma and a bit of pain at this stage, which is no surprise. The medical staff acted appropriately and was seen speaking with Hill at the next game break. (The video below is cued to a replay of Hill and Chandler colliding.)
Thursday, Hill was able to participate in the shootaround, but did complain of a headache. He was given medication and put under the terms of the NBA's concussion protocol. Hill was tested that afternoon and when he did not pass, he was ineligible to play.
Why was there a delay to symptom onset?
This is not unusual for a concussion. While Hill was likely experiencing some symptoms, they were not severe enough to notice. The adrenaline of an NBA game is often enough to keep a player from noticing mild vision changes, a headache or some light sensitivity.
Hill not only had a headache, but apparently had some light sensitivity as well. He was kept off the bench on Thursday and listened to the game from a darkened room near the Pacers' locker room. It is unclear if the symptoms are ongoing or if there are other symptoms that have not been noted publicly, like altered speech, nausea, or disorientation.
A similar issue occured with Harrison Barnes on Thursday. Barnes fell and needed stitches, but left later with headaches. He is very likely going to be tested under terms of the concussion policy.
What is the NBA's concussion protocol?
The NBA instituted a strict concussion policy in 2011. Administered by a league neurologist, the player must be symptom-free, then must pass a baseline test, likely the ImPACT testing used by the NFL and MLB. After this test is passed, a player is put through a series of increasingly intense activities. Then the player's tests are reviewed by the administrator, who has the final say on a player being cleared to play.
The NBA says the clearance should take "days, even weeks," which is good as to the level of care and making sure players do not rush (or are not rushed), but does create issues for players with relatively mild concussions that can return in a short period of time. It definitely makes it difficult for a player like Hill to make it back by Saturday.
What tests does Hill have to pass to play on Saturday?
Hill will need to pass a baseline test, likely the ImPACT test. While there are many that think the ImPACT test should be replaced, it remains the standard used in most situations. It is a computerized test that takes about 20 minutes. The test compares a player's results to a previous test, done prior to the season. That baseline is used as the point of comparison.
The biggest criticism of the test is that athletes can "sandbag" the test, setting their baseline lower. Peyton Manning discussed the widespread use of this technique a few years ago, setting off a firestorm about athletes trying to short-circuit a system designed to protect them.
Newer tests are in development that use more objective measures that would be tougher to alter. One promising technology comes from Notre Dame. The voice of a possibly concussed player can be tested on site via a tablet app.
After that test is passed, there are physical tests. Mark Montieth of Pacers.com says they include riding a stationary bike, jogging, agility drills and non-contact team drills. These are done to make sure that symptoms do not return with activity, which is common.
Is there any protection he could wear?
Unlike the clear plastic masks that players wear after breaking a nose or cheekbone, there is no real protection that a player can wear after concussion. Theoretically, a helmet would help, but no one has chosen to go the full B.D. just yet.
A helmet would be effective, but the tradeoff and ridicule would make it very difficult for a player to wear it. Instead, it is important for a player to be symptom-free before returning.
What are the risks of playing after a concussion?
The NBA's policy is focused on minimizing the risks of post-concussion issues by not allowing a player back on the court until they are symptom-free. One of the key things overlooked by the public is that concussions, when treated properly, are very manageable. While there is much left to learn about concussions, giving the brain time to heal is key to health.
Some leagues have instituted time restrictions before a return to play, such as the UFC's very effective medical suspension system. In some cases, such as Rugby Union, the time restriction caused players and some teams to hide symptoms in order to keep their players available. It is widely agreed that in most cases, the player is safe to return after he is symptom-free.
Mature athletes are not at risk of second impact syndrome, so once Hill (or any player) is symptom-free and cleared to return, he should be at no more risk than any other player, both in terms of likelihood and severity.
How long could Hill miss?
The issue with concussions is that no two act alike. While we often call concussions "mild" or "severe," we really don't know until after a player recovers. A big hit might lead to a mild concussion, where a bump on the head could keep a player out of the game for months or even end a career.
Hill could miss a matter of days or his season could be over. The time he misses will be predicated entirely on when he is able to pass the tests and when he is symptom-free. It is an entirely individualized response that is often frustrating to the player and the fan base.