Concussions in the National Basketball Association: Analysis of Incidence, Return to Play, and Performance From 1999 to 2018

Abstract

Background: The effect of concussions on professional athletes has been investigated in many sports. However, few studies have evaluated concussions in National Basketball Association (NBA) players. Hypothesis: We hypothesized that concussion incidence has increased, yet the return-to-play (RTP) rate will remain high following the institution of the NBA concussion policy (NBACP). We also hypothesized that the incidence of repeat concussions will be similar to first occurrences and that player performance and game availability will not be significantly affected by sustaining a concussion. Study Design: Descriptive epidemiology study. Methods: Publicly available records were searched to identify all concussions from NBA seasons 1999-2000 to 2017-2018. Player demographics and information regarding career history were tabulated. Incidence of concussion and RTP timing were evaluated before and after institution of the NBACP (2011). Minutes per game and game score per minute were evaluated pre- versus postconcussion. Player availability and performance were also compared with an age-, body mass index–, position-, and experience-matched control group of players who did not sustain a concussion. Results: A total of 189 concussions were reported in the NBA from 1999 to 2018, with a mean ± SD incidence of 9.7 ± 7.3 concussions per season. Following implementation of the NBACP, incidence significantly increased from 5.7 ± 2.8 to 16.7 ± 7.5 concussions per season ( P = .007). All players returned to play following first-time concussion after missing 7.7 ± 8.6 days and 3.5 ± 4.1 games. RTP time was not significantly different after implementation of the NBACP (games missed, P = .24; days missed, P = .27), and there was no difference in concussion-free time interval ( P = .29). Game score per minute and minutes per game were not significantly affected by sustaining a concussion (both P > .05). Conclusion: Concussion incidence in NBA players is approximately 17 instances per season since the 2011 institution of a league-wide concussion policy. The number of reported concussions significantly increased following the policy, in line with trends seen in other professional sports leagues. Players have retained a high rate of RTP after 3 to 4 missed games. Player performance and availability are not affected by sustaining a concussion following successful RTP.

Temporal trends in incidence of time-loss injuries in four male professional North American sports over 13 seasons

“…Our NBA concussion data demonstrated an increase in concussions beginning in the 2011 season, except for a decreased in the 2013 season. This supports the initiation of the NBA concussion protocols beginning in the 2011–2012 season 35 . It should be noted that concussion incidence did not change throughout the reporting period.…”

“…Football and ice hockey reported the greatest seasonal proportional concussion incidence, which is supported by previous literature 33 , 34 . Professional sports have instituted concussion teams, return to play protocols, and rules and regulations to improve player safety 34 , 35 . Our NFL concussion data demonstrated a steady increase in concussion incidence since 2009, with the NFL concussion incidence increasing by 31.6% in the 2015 seasons compared to the 2014 season.…”

Systematic Review of Orthopaedic and Sports Medicine Injuries and Treatment Outcomes in Women's National Basketball Association and National Basketball Association Players

“… 43 , 45 , 56 The reporting of concussion has increased in recent studies, which may be because of increased awareness; increased reporting; mandated preseason education; the standard use of screening tools, such as the Sport Concussion Assessment Tool; and the institution of the NBA Concussion Protocol (NBACP) in 2011. 12 , 43 , 45 Patel et al 45 noted significantly greater concussive events recorded per season after (16.7 ± 7.5) compared with before (5.7 ± 2.8) institution of the policy ( P = .007). Return to play did not significantly differ before and after institution of the NBACP.…”

“…For instance, the NBACP led to an increased identification of concussions in athletes. 12 , 43 , 45 Understanding the reasons for injuries in away games and if other injuries are influenced by cumulative game time could be beneficial in deciding how much rest players should have.…”

Concussion Is Associated With Increased Odds of Acute Lower-Extremity Musculoskeletal Injury Among National Basketball Association Players

“…These methods were validated by previous studies. 14 , 15 , 16 , 17 , 18 , 19 , 20 For each instance of confirmed concussive event, the following information was collected and reviewed by 2 of the authors: primary position, date of injury, season of injury, age at injury, LE injury within 90-day period, location of LE injury, type of injury, and date of RTP. One author collected the player’s information, followed by a confirmation by the second author.…”