How did Stephen Curry not get a concussion? Medical expert explains

By Allie Davidson

NBA MVP Stephen Curry took a nasty fall and hit his head on the court during the first half of the Game 4 matchup Monday night between his Warriors and the host Rockets. He returned to the game after being diagnosed with a head contusion.

Will he be ready to go for Game 5 on Wednesday? Sporting News spoke with James Gilbert, a sports medicine surgeon with The Centers for Advanced Orthopedics. Gilbert has been the team physician for DC United, U.S. Soccer and the Washington Spirit of the National Women's Soccer League and is considered a leading expert on concussions. 

What is the difference between a head contusion and a concussion?

“It’s a big distinction actually because had he been diagnosed with a concussion it would have triggered a protocol that conceivably would have left him out seven to 10 days, at minimum, and probably would have missed the next couple of games.

“A contusion is just a soft tissue injury. It doesn’t affect the brain. ... A concussion is a mild traumatic brain injury.”

Is it rare to not see a concussion come out of a fall like that?

“Concussions come in all varieties. That’s one of the difficult things about taking care of them is some innocuous hits can lead to serious concussions. It doesn’t really correlate really well.

“Their big concern was probably his cervical spine because of the way he fell. If you noticed, they were holding his head and keeping him still. They did a great job of taking care of him — checking him and making sure he was OK to get up and move.

“When it looks bad, it doesn’t necessarily imply that it’s going to result in a concussion.”

Was he OK to go back on the court?

“It did look like he was holding his head and rubbing it, but once you put someone through the S.C.A.T (sideline concussion assessment test) exam you have a pretty good idea that they are safe to play. He checks out negative for concussion, you can put him back in and let them play.”  

What will go on in the days before Game 5 Wednesday?

“Delayed onset concussion is what you worry about. If you’ve had trauma to the brain, it instigates a cascade of chemical changes. It lowers the threshold to becoming symptomatic. Cognitive challenges like reading and thinking can elicit symptoms and so can physical challenges. There can be a chemical crisis that is not evident right away.

“The important thing is to be diligent. So if you suspect that someone might have had some significant head trauma, even though they might not be showing initial signs and symptoms (red flags), you need to just really follow them. The CDC divides them into four different categories: Physical, cognitive, emotional and sleep-related. If you were to get any of those red flags, they would leave the athlete out. You would have to put them through the NBA protocol.”           

What would be the protocol if he has red flags?

“If you were to come back with any of the red flags, they would repeat the S.C.A.T exam and his symptom checklist. They will keep monitoring him. If any of the red flags start manifesting themselves, they will institute the protocol.

“First thing they would do is rest him for two to three days. Then they would take an impact test, which is a neurocognitive exam. If that was off from his baseline from the beginning of the season they would rest him until it returned to baseline. There is no timetable for that, not every concussion is the same. Once the impact is returned to normal, you can start instituting physical and exercise challenges. The whole process for a player to return can take a while. When you’re making a diagnosis as a team physician between a contusion and a concussion, you’re basically deciding if that athlete can play for the next 10 to 14 days.”

Could an athlete fake being healthy to keep playing?

“I’ve never known a physician who would cross the line and do something that was against the best interest of the athlete. Those protocols are set up to eliminate bias. The athlete can lie about their symptoms. That can occur, and you can’t do anything about that as a team physician. You still are at the mercy of the athlete being forthcoming about what they are actually experiencing. It does happen. The protocols in place are meant to minimize that.”

Is it common for a contusion to turn into a delayed concussion?

“That’s a great question, but we don’t have a great answer for that. The only thing I can tell you is that research shows it is a little more common in children, but it probably happens a lot more than we recognize. It is something that we are trying to figure it out.”

How long will a contusion injury stick around?

“A contusion should resolve quickly within 24 hours. He won’t have any problems from it. You’ll treat it symptomatically with ice, maybe some anti-inflammatories, and maybe some work with a physical therapist. I’m sure he is going to have some soreness and tenderness. As long as he doesn’t have any neurological damage, he can play with reckless abandonment.”

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