Every time a player like Boston’s Al Horford, Oklahoma City’s Steven Adams and New York’s Lance Thomas sustains some kind of head or neck injury and are placed in the NBA’s concussion protocol, Dr. Jeffrey Kutcher is given a call.
Kutcher is in his sixth season as the director of the NBA’s concussion program, and few people in professional sports play a larger role in coordinating player safety in terms of head injuries than this board-certified sports neurologist.
In a lengthy exclusive interview with The Comeback, Dr. Kutcher laid out his role with the league, how the NBA’s concussion protocol operates and some myths and facts regarding how concussions and head injuries truly work.
“Medically, I am a person who with each concussion evaluation that’s done in the league, I am contacted,” Kutcher told The Comeback. For a full overview on how the concussion protocol works, CSN New England laid it out pretty well.
- He is without concussion-related symptoms at rest.
- He has been evaluated by a physician.
- He has successfully completed the NBA return-to-participation exertion protocol.
- A team physician has discussed the return-to-participation process and decision with the Director of the NBA concussion program, Dr. Jeffrey Kutcher.
After the team evaluates its injured player, the team’s physician then discusses the case with Kutcher. Was the player diagnosed with a concussion? How did the injury occur? How was it taken care of?
Kutcher is kept in the loop “to provide sort of one location where we can keep a close eye on everything that’s going on in the league.”
https://youtu.be/Id8QFe-Mf5c
“I don’t have the legal authority, the medical authority, to actually clear players,” Kutcher said. “That’s the job of the team physicians locally who have licenses in those states.”
Yet those team physicians are not neurologists, nor are NBA teams — or teams from any sport, for that matter — required to have neurologists on staff, Kutcher said.
“The reality is I bring something to the conversation that they don’t have, that experience and training,” Kutcher said. “So I really consider myself almost as more of a mentor in some way, providing that level of support that they just don’t have.”
In addition to his work with the NBA, Dr. Kutcher is the national director of The Sports Neurology Clinic at The CORE Institute, a concussion advisor to the NFL and NHL and he served as the team neurologist for the U.S. Olympic team at the 2014 Winter Games in Sochi.
Kutcher described these phone calls and correspondences with team physicians as professional and cordial, and said he couldn’t remember a single time where he and a team physician did not see eye to eye.
“It’s physicians discussing nuances of history and exams and diagnostic criteria,” Kutcher said. “There’s a basis in science but also there’s a lot, especially in this area, that you can add to the process by having experience. And that’s what I have, and I can help lend my experience to the physicians that basically make sure we’re all on the same page.”
https://youtu.be/0AyrrjUJ6bE
Having every concussion protocol case go through Kutcher allows the league to have a central database and a streamlined order of operations, further facilitating a program aiming to provide support and education on an ongoing basis. Kutcher believes that rooting the concussion program in critical thought and science is crucial, and that team physicians treating each case individually is truly vital.
“If you over-protocol things,” Kutcher said, “if you try to create a recipe for ‘every concussion must be handled the same way,’ whether it’s the diagnostic approach, or especially the management approach, you’re actually going to do your patients harm.”
Along with being apprised on what happens on the court, Dr. Kutcher leads a committee of concussion and brain health experts, NBA officials and team physicians. This group— in addition to separate meetings involving only team physicians— usually meets over the All-Star break, at the league’s pre-draft scouting combine and again shortly after the season to discuss everything from issues that may have come up over the previous months to evolving science in the field.
“[To] make sure that as the science evolves, that we have a policy that reflects that,” Kutcher said. “One of my main jobs is to help coordinate that effort and see that we’re all moving forward.”
Baseline Testing
One major way the league tries to move forward on head injuries is having every NBA player go through what the league calls baseline testing before each season. That includes what the league describes as “testing of baseline brain function, via a neurological and cognitive assessment.”
Kutcher clarified that this annual baseline test is not a test that can be passed or failed, but just another piece of a physician’s overall examination that’s a part of the larger clinical decision-making process.
“Our baseline testing program reflects the idea that while our physicians and athletic trainers are trying to recognize injury and manage injury, we want to gather clinically relevant information on individuals that will help them make those determinations and manage that patient most appropriately,” Dr. Kutcher said.
That set of information includes other things that can impact a player’s experience with concussions, including whether someone has a history of migraine headaches or a history of having attention issues.
“It includes a physical examination that is, again, designed to look at findings that we potentially see sometimes in concussions so that we could document things that may have been there when somebody wasn’t injured,” Kutcher said.
“Because it is the nature of concussions that oftentimes, you’re not creating abnormal signs that are frankly abnormal when compared to an abnormal variant of an individual’s performance. We do the history. We do the physical. We then combine it with the Cogstate sport test, which is a computerized test to help look at memory reaction time and other cognitive functions.”
When asked about coordinating baseline testing with the NCAA and other European leagues, Kutcher said that it would be hard to get a consistent approach among such a wide variety of schools and organizations.
“When our players come into the league, we think we owe it to them to start over and start from scratch and take a very comprehensive, complete history that goes over their entire life,” Kutcher said, “because we can’t really vouch for the quality of other people’s work as much.”
Dispelling Concussion Myths
A 2014 story from FiveThirtyEight said that there were only nine known concussions in the NBA during the 2013-2014 regular season, or one for every 149.5 NBA games, as opposed to one every 1.4 games during the 2013 NFL season. Despite a seeming larger awareness about head injuries in the NBA and more media coverage and transparency regarding players entering and going through the protocol, Kutcher said that the frequency of concussions has remained about the same over his six years as program director.
“From my perspective, diagnoses actually have been pretty stable across the years that I’ve been working with the NBA, and so have the evaluations,” Dr. Kutcher said. “The number of evaluations hasn’t really changed. I think you do see more reporting about them, you see more stories about them. Players are asked more about these things in postgame media.”
https://youtu.be/mVGMIK1K_Zg
Another prevalent line of thinking among fans and writers is that players who have been previously diagnosed with a concussion are more likely or susceptible to getting another one.
“That’s actually pretty much a myth that the number of concussions matters, that one concussion makes the next one more likely to get based on any scientific data that’s reliable at all,” Kutcher said.
He said that there are two things he and team physicians are looking at when it comes to concussions. One is treating the current injury the player has to the best of the team’s and the league’s ability, but at the same time looking at that player’s total exposure to force to the head area over time.
“Again, the number of concussions is really overemphasized and is not the issue,” Kutcher said. “With each case, we do step back and look at the bigger picture and say okay, this individual, how old are they? Are they having any issues that are bigger than just this concussion?”
Looking Forward
What can the league do better as it tries to improve player safety when it comes to concussions and other injuries?
“We’re always asking that question,” Dr. Kutcher said. “I don’t think we’ve gone a year without changing the protocol to reflect that concept.”
He declined to get into any specifics since we’re in the middle of the season, stressing that “we want to capture the whole season’s experience before we reflect on the next year.”
“We’ll continue to look at every aspect of it,” Kutcher said, “whether it’s the policy itself or any particular test that could help us.”
https://youtu.be/CJOX146eTdk
Not surprisingly, program director Kutcher thinks the concussion protocol and evaluation system is working, and is proud of what he and the league have put together.
“I think what we’ve done has been successful,” Dr. Kutcher said, “in that we’ve provided the team physicians and the athletic trainers— and even players and GMs and everybody else— with a basic level of education, with a structure to evaluate people on a yearly basis.”
And when players get evaluated year after year with baseline tests and are monitored during the season if and when a player has to enter the concussion protocol, Kutcher and the league are able to look at the big picture and monitor brain health over the course of the careers of hundreds, if not thousands of players.
“Because,” Kutcher concluded, “that’s really what I think our players deserve.”
