撞頭，請注意！

Football is in upheaval over concussions -- not because the game has become more dangerous， but because we now know things we didnt a few decades ago. In a nutshell， blows to the head come with an evolving list of medical risks including a collection of life-altering short-， medium- and long-term health problems， including headaches， depression and dementia. The suicide rates are alarming.

在腦震蕩這個問題上，橄欖球無疑是最先要被提及的。不是因為這項運動更危險，而是因為我們比幾十年前有了更多的認識。概括地說，腦部受到?jīng)_擊會導(dǎo)致一系列醫(yī)學(xué)上的病害，包括改變?nèi)松亩唐?、中期和長期的健康問題，其中包括頭痛、抑郁以及癡呆。自殺率也令人擔(dān)憂。

Easy solutions are not good； good solutions are not easy. The implications for the sport are profound enough that some --Malcolm Gladwell① comes to mind -- have predicted footballs demise， or close to it.

簡單的處理不夠好，好的處理又不簡單。這對這項運動所產(chǎn)生的影響已經(jīng)足夠深遠，以致有人已經(jīng)預(yù)見到了橄欖球的消亡，或者說接近消亡，比如說馬爾科姆·格拉德維爾。

By and large， basketball has seen all this from afar and breathed a sigh of relief. Studies have shown many sports have profound issues to wrestle with here， but basketball has not made the list.

總體上說，籃球很早就預(yù)見到了這一點，并從中脫身。研究表明，很多運動都會導(dǎo)致嚴重的腦震蕩問題，但是籃球并沒有上榜。

Even so， the league has been proactive， having contracted with respected University of Michigan neurologist Dr. Jeffrey Kutcher， who has served as a sports concussion expert in testimony before Congress as well as in various roles at the American Academy of Neurology， Michigan NeuroSport and at the NFL. Kutcher is leading the implementation of new head injury protocols to keep players safer-- by increasing the likelihood head injuries are detected and treated， and to keep concussed players from taking the floor.

即便如此，聯(lián)盟對此依舊相當積極謹慎，他們和廣受贊譽的密歇根大學(xué)神經(jīng)學(xué)家杰弗里·庫徹博士簽訂合約，后者曾經(jīng)作為體育腦震蕩方面的專家在美國國會作證，同時在美國神經(jīng)學(xué)院、密歇根體育神經(jīng)中心以及美國橄欖球聯(lián)賽中擔(dān)任多項職務(wù)。庫徹作為帶頭人，目前正在制訂新的頭部受傷規(guī)定——通過增加檢查和治療措施，以及讓出現(xiàn)腦震蕩的球員得以休息的方法，讓球員處于更安全的環(huán)境下。

The more experts learn about blows to the head， the more they learn how hard it is to classify any as without long-term health implications.

當專家們對頭部受沖擊了解得越多，他們就越明白，如果沒有長期觀察，很難對腦震蕩進行明確劃分。

NBA players， says Kutcher， "are not taking the repetitive hits like they are in football or in hockey， but they do get hit， quite a bit. They may be mild bumps， those kinds of things， but certain brains are susceptible to trauma more than others and to be able to monitor brain health over the course of the season and a career is something that we have to do regardless of the level of impact."

庫徹表示，NBA球員“不像橄欖球和冰球運動員那樣持續(xù)受到撞擊，但他們也會時常面對沖撞。這些沖撞也許只是輕微一碰，但有些人的大腦會更容易受到損害。無論撞擊程度多嚴重，我們該在整個賽季或球員的職業(yè)生涯中都關(guān)注他們的大腦健康”。

Watch NBA basketball， and its only a matter of time before you see someone take a hard blow to the head. Pau Gasol and Anthony Davis have suffered high-profile concussions this season， but they represent a tiny fraction of the instances when heads are rattled by hitting elbows， knees or the floor. Even more common are whacks to the face， temple， top of the head and back of the head on what are usually considered "good， clean basketball plays." In basketball， blows to the head are nothing like as common as in football， but they are a regular part of play nonetheless.

如果看NBA比賽，看到某人頭部受到重擊只是個時間問題。本賽季保羅·加索爾和安東尼·戴維斯都遭受過重度腦震蕩，但他們只能代表頭部被手肘、膝蓋和地板撞擊這一小部分。更常見的是臉部、太陽穴、頭頂和后腦被打，而這些通常都被認為是“好的干凈的打法”。在籃球里，盡管頭部受到?jīng)_擊不像橄欖球那么頻繁，但它也是比賽中常見的一部分。

Some of those that look mild can have serious effects. The human brain might be the most sensitive and precise instrument in the history of the planet； hitting it on the hardwood is analogous to swinging a hammer at a Ferrari engine. Might do nothing， might have a dreadful effect. And its hard to know； sometimes a small shot is all it takes.

有些看起來很輕微的動作也會產(chǎn)生嚴重的后果。人的大腦也許是地球歷史上最敏感、最精確的構(gòu)造。頭撞在籃球場上，可以和拿錘子砸法拉利車的引擎相提并論。也許不會有任何損傷，也許會產(chǎn)生致命的打擊。而且你很難確定，有時候一個小小的動作就會產(chǎn)生最嚴重的后果。

Even soccer headers are under scrutiny now. There is no way to say， with any medical certainty， “that was nothing” about any shot to the head. Telling one from the other is almost impossible for anyone but a neurologist with millions of dollars in diagnostic tools and lots of time.

現(xiàn)在連足球運動員的大腦已被嚴密關(guān)注。關(guān)于大腦受沖擊的問題，醫(yī)學(xué)上還不能確切地說：“對頭部的撞擊都不是大問題”。只有神經(jīng)學(xué)家使用上百萬美元的診療器械和大量時間后，才能確定不同撞擊造成的不同傷害，而普通人幾乎是無法做到的。

In the concussions-focused documentary"Head Games，" Douglas Smith， a neuroscientist from the University of Pennsylvania， cautions that “15 or so percent of people with a single concussion have persisting cognitive dysfunction， meaning they dont go back to school or to work or just carry on life the way they had it. They have long-term， persisting problems after one concussion.”

腦震蕩紀錄片“大腦游戲”中，來自賓夕法尼亞大學(xué)的神經(jīng)學(xué)專家道格拉斯·史密斯注意到，有15%左右經(jīng)歷過一次腦震蕩的人會出現(xiàn)持續(xù)的認知障礙，這意味著他們在學(xué)習(xí)、工作甚至生活上都會與過去發(fā)生改變。出現(xiàn)腦震蕩后，他們會面臨長期、持續(xù)的問題。

In a presentation at the University of Michigan， Kutcher says skipping the proper care is a mistake： “The biggest risk is their injury is going to be a lot more complicated. ... Instead of a seven-day concussion， its going to be a seven-week concussion. Instead of two weeks， its going to be six months.”

在密歇根大學(xué)的一次演講中，他認為跳過必要的治療是錯誤的做法。“最大的風(fēng)險在于，他們的傷病會變得更復(fù)雜……原本7天的腦震蕩，會演變成7周。而兩周的，也許會變成6個月。”

Gerald Wallace earned the nickname Crash for his willingness to throw his body into the fray. It was an honorific， but by 2008， Wallace， then with the Bobcats， had suffered four concussions in four seasons， the latest coming from a Mikki Moore elbow that left Wallace unmoving， lying flat on the hardwood.

因為不害怕身體接觸，杰拉德·華萊士得到了“Crash”的綽號，這當然值得尊敬。但是截止到2008年，那時還在山貓的華萊士在四個賽季里出現(xiàn)了四次腦震蕩。最近的一次來自于米基·摩爾的肘擊，這導(dǎo)致華萊士無法動彈，平躺在球場上。

This was before the NBAs concussion program was in place. The Bobcats trainer at the time， Joe Sharpe， had so few tools at his disposal to deal with Wallaces condition that he sought counsel from the NFL. "I talked to the Panthers② medical staff and asked them to maybe help me out in this situation，" said Sharpe in a report from The Associated Press.

這事發(fā)生在NBA腦震蕩計劃出臺前。山貓那時的訓(xùn)練師喬·夏普找不到合適的辦法，所以他轉(zhuǎn)向咨詢NFL?！拔液秃诒尼t(yī)療組進行了交流，請他們幫我處理這種情況?！毕钠赵诿缆?lián)社的一篇報道中這樣說道。

"Im not saying were behind the ball， because this is very new to basketball，" said Sharpe at the time， and he was right. Until recently， few people considered concussions to be a basketball issue. From the leagues perspective， that has all changed.

“我并不是說我們落后了，只是因為對于籃球來說，這是個全新的領(lǐng)域?！毕钠毡硎?。他說的沒錯。直到最近也很少有人把腦震蕩視為籃球的問題，但是從聯(lián)盟的角度，一切都不一樣了。

Today， the experience of Wallace and Sharpe would have been much different. Before the 2011-12 season， the NBA contracted Kutcher to design and implement a cutting-edge concussion protocol. Every concussion case is diagnosed by the team medical staff and then reviewed by Kutcher. Though he does not have the final say in whether a player is cleared to play -- that is still the purview of the team physician -- Kutcher does act as a league-wide quality control in concussion diagnosis.

放到今天，華萊士和夏普的經(jīng)歷會大大不同。2011-12賽季前，NBA請庫徹制定并實施了最尖端的腦震蕩規(guī)定。每一次腦震蕩都會由球隊醫(yī)療組診斷，同時還會得到庫徹的復(fù)查。盡管庫徹在是否允許球員上場的問題上沒有決定權(quán)——這個權(quán)利仍然屬于隊醫(yī)，但是庫徹已經(jīng)成為聯(lián)盟在腦震蕩診斷上的把關(guān)人物。

Kutcher installed a three-part diagnosis and treatment procedure. In the preseason， players fill out a form designed to show aspects of typical cognitive functioning， as well as a personal and family history of brain trauma. Kutcher says this helps “understand how [the players] brain may or may not be set up to produce symptoms when its injured.”

庫徹制定了一份三步診斷和治療程序。賽季開始前，球員會接受一系列測驗認知功能的檢查，同時還要提交個人和家庭腦外傷的病史。庫徹表示，這有助于“了解球員受傷時，他們的大腦可能或不可能出現(xiàn)的癥狀”。

Players also undergo tests with the Axon Sports neurocognitive tool to measure things like reaction time， memory and distractability. To understand the impact of a blow to the head， it helps to first understand a players normal brain functioning.

球員還要接受艾克森體育神經(jīng)認知器的檢查，以測量諸如反應(yīng)時間、記憶和注意力。想了解大腦受到?jīng)_擊時所產(chǎn)生的影響，首先要了解球員大腦正常的運作的情況。

During games， all NBA trainers have a second form， essentially a checklist， to help decipher when to pull a player. For many years， being "knocked out" -- a total loss of consciousness -- has been the rule of thumb for telling who is concussed. We now know concussions come in many more varieties. This test is designed to help team trainers determine whether a blow to the head requires a player to come out of the game.

在比賽中，所有NBA訓(xùn)練師都會有一份清單，這能幫他們確定何時該把球員換下場。在過去很多年力，“被擊昏”——完全喪失神智——是判斷球員是否腦震蕩的標準。而現(xiàn)在我們知道了，腦震蕩會有多種多樣的形式，這套測試就是被設(shè)計用來幫助訓(xùn)練師確定，當球員頭部受到撞擊時，他們是否要退出比賽。

The team staff goes into action， Kutcher says， any time theres a blow to the head： "Its not come see me in my clinic and Im going to give you a diagnosis and fill out a form and send you on your way， come back and see me in a month. Its I saw a big hit， Im now going to evaluate you. If you pass everything， Im not going to turn my back on you and let you play then check in in a week. Im going to watch you every series， Im going to watch you up and down the court， Im going to watch you at halftime， Im going to talk to you after the game. Its a continued process and a concussion sort of requires that approach， which speaks to how different management is in the upper levels of sports when you have the resources to do that."

庫徹表示，當球員頭部受到撞擊后，隊醫(yī)就會開始定性?！斑@不意味著到我的診所來，我給你開個診斷，填個表格，然后送你回去，讓你一個月后再來找我。而是，我看到你受到了很大的撞擊，我會評估你的狀況。如果你通過了所有測試，我也不會放棄。讓你繼續(xù)打球，一周后再來復(fù)查。我會觀察你，我會觀察你在場上場下的行動，在中場休息時觀察，會在比賽結(jié)束后找你談話。這是一個持續(xù)的過程，針對腦震蕩需要這樣的處理方法。這同樣證明，當你擁有足夠的資源時，高層面對相同的情況就會有不同的管理方式。”

Also new in the NBA is that once diagnosed with a concussion， NBA players must pass through the leagues “return to play” protocol， a more involved series of tests.

對于NBA來說，同樣全新的在于，一旦球員被診斷為腦震蕩，他們必須通過聯(lián)盟“回歸球場”的測驗，這是一套更為復(fù)雜的測試。

“Since they have no diagnostic， objective test for concussion，” Kutcher says， “were basically challenging the brain once it is essentially not producing symptoms at rest -- how can that brain handle first straight-up physical exertion， then more interval training， then agility and so on and so forth， tracking the brain at each level to make sure the injury is over.”

“一直以來，對于腦震蕩，他們?nèi)鄙僭\斷和客觀的測試，”庫徹說，“而我們所做的是，在大腦處于休息不發(fā)生任何波動時，對它進行刺激——以觀察大腦怎么樣應(yīng)對第一次出現(xiàn)的物理刺激。然后才是有間隔性的訓(xùn)練，敏捷性訓(xùn)練和繼續(xù)深入的檢查，以及跟蹤大腦在每個階段的反應(yīng)，從而確定球員的傷病已經(jīng)恢復(fù)。”

Like most injuries， the brain will not heal without rest. But resting the brain is not as simple as resting， say， an ankle by donning an immobilizing boot. Even watching TV could tax an injured head and extend a brain injurys duration. Kutchers protocol is designed to ensure players get the rest they need to recover， and is a key reason players like Anthony Davis and Pau Gasol have been kept from competition.

和大多數(shù)傷病一樣，不經(jīng)過休息，大腦是無法恢復(fù)的。但是讓大腦休息和穿上固定保護靴休養(yǎng)腳踝是兩回事。連看電視都會加重大腦的損害，從而延長腦的修復(fù)時間。庫徹的規(guī)定在于保證球員得到康復(fù)時間，這也是像安東尼·戴維斯和保羅·加索爾這樣的球員不允許上場的關(guān)鍵原因。

NBA medical staffs do incredible work to not only treat injuries but also to keep players from breaking down during the grinding 82-game season. But， as Kutcher says， treating concussions “requires knowledge of how to examine the brain of a living person， first and foremost， and that is not something that in general is taught in the sports medicine curricula either at the athletic training level or the physician level.”

NBA的隊醫(yī)們在治療傷病和保證球員在磨人的82場常規(guī)賽賽季中不至于垮掉做出了卓越貢獻，但是正如庫徹所說，處理腦震蕩“需要知道如何檢查一個活人的大腦，這是第一要做的，也是最重要的，這不是體育醫(yī)學(xué)、運動訓(xùn)練或者物理治療?！?/p>

Kutcher says NBA physicians and trainers have been happy to have him as a resource when it comes to brain injuries. The NBA distributes educational videos to trainers and physicians， and Kutcher consults with team medical staffs at their twice-yearly league-wide meetings.

庫徹說，NBA的隊醫(yī)和訓(xùn)練師們在處理腦部傷病時，會很樂意看到有他這樣的專家。NBA給訓(xùn)練師和隊醫(yī)分發(fā)了教學(xué)錄像，而且?guī)鞆剡€會在每年兩次的聯(lián)盟大會上為球隊醫(yī)療組培訓(xùn)。

The flip side of Kutchers point is that， at a typical NBA game， there are trainers and physicians on hand with decades of know-how looking after injured knees and shoulders and the like. But the neurological knowledge doesnt run anything like as deep.

相對于庫徹的這些看法，在典型的NBA比賽中，隊醫(yī)和訓(xùn)練師有著長年累月處理膝蓋、肩膀或其他部分傷勢的經(jīng)驗。但是對神經(jīng)學(xué)的知識，他們的了解就不夠深入了。

Further complicating things is that a lot of the most valuable insight comes from players themselves reporting symptoms. But concussed players often do a poor job， because of the concussion， even identifying whats abnormal. In addition athletes are under tremendous pressure -- from the coaching staff， from themselves， from economic incentives --to under-report symptoms and play through injuries of all kinds.

更復(fù)雜的問題在于，大多數(shù)有價值的觀察其實來自于球員本人提供的病癥。但出現(xiàn)腦震蕩的球員通常在這方面做得都不好，由于出現(xiàn)腦震蕩，連判斷是否異常都不容易。此外，球員還面臨多重壓力——從教練組，到他們自己，再到經(jīng)濟方面的考慮——這都會導(dǎo)致他們不愿匯報自己的病情，而愿意帶傷打球。

Watch this video of Doc Rivers， in the 2009 playoffs， urging a clearly woozy Glen Davis to sprint back on defense after being dropped by a Dwight Howard elbow. Or listen to Hornets coach Monty Williams -- who says he received about four concussions as a player-- say the NBAs concussion policy seeks to“treat everybody like they have white gloves and pink drawers” after his star rookie， Davis， was held out with a concussion.

看看道格·里弗斯的視頻，2009年季后賽，當格倫·戴維斯被德懷特·霍華德肘擊后，里弗斯仍然催促已經(jīng)出現(xiàn)明顯昏厥癥狀的戴維斯回去防守?；蛘呗犅狘S蜂主教練蒙蒂·威廉姆斯的說法——他說自己球員時代經(jīng)歷過的四次腦震蕩——在他的明星新秀戴維斯由于腦震蕩而缺席時，他說聯(lián)盟的腦震蕩政策是在“用對待小孩子的辦法對待每個人”。

Former player Paul Grant， who says he suffered a few concussions in his short NBA career， says he did not report his symptoms because “you dont make the team in the training room.”

前NBA球員保羅·格蘭特說，在他短暫的職業(yè)生涯中，他經(jīng)歷過幾次腦震蕩，他說他沒有匯報病情，因為“在訓(xùn)練室里的人是無法得到上場機會的”。

“You got to play，” Grant says. “You got to get on the court. You got to do whatever you can to get on the court.”

“你必須比賽。”格蘭特說，“你必須上場，你必須盡一切努力上場?！?/p>

Kutcher says “the policies need to reflect the fact that its a team effort to diagnose concussions and look out for injuries， because the injured athletes oftentimes dont know theyre injured.”

庫徹表示，“政策必須反映這樣的事實，診斷和治療腦震蕩必須依靠球隊的努力，因為受傷的球員很多時候并不知道自己受傷了”。

Kutcher also warns that yanking players every time they get hit in the head can encourage players to hide symptoms.

庫徹同時警告，如果球員頭部受到撞擊就被教練換下場的話，這會促使球員隱瞞傷情。

What is a trainer to do？ Many players dont want to be pulled from games and have incentive to under-report symptoms. Many coaches see concussion protocols as an imposition. Even the NBAs own expert calls the sideline test an imperfect tool.

訓(xùn)練師該怎么做呢？很多球員不想被替換下場，他們有動力去隱瞞自己的病情。很多教練則把腦震蕩規(guī)定當作桎梏，連NBA專家都稱場邊的測試存在缺陷。

Its Dec. 17， and Tim Duncan is sitting on the floor with his head down， having just been leveled by a Kendrick Perkins elbow to the jaw. Nine players continue around the fallen forward， and somehow the Thunder miss. The Spurs take off the other way. Duncan staggers to his feet， grips his knees and stares intently at the floor.

12月17日，蒂姆·鄧肯低頭坐在地板上，他剛剛被肯特里克·帕金斯的肘子打中了下巴。其他9名球員在鄧肯的身邊繼續(xù)比賽，雷霆投丟了，然后馬刺把球推進到了場地另一邊。鄧肯搖搖晃晃站起來，抓住自己的膝蓋，死死地盯著地板。

Duncan would rejoin the action when it returned to the Thunder end of the court -- but his game lacks zip. When the Thunder insert the overactive Nick Collison， Duncan loses him repeatedly. In a matter of minutes， the Thunder build a game-deciding lead and Duncan is pulled from the game， not to return.

當球再次回到雷霆半場時，鄧肯回到了比賽中，但他的比賽節(jié)奏明顯慢了。當雷霆換上充滿活力的尼克·科林斯后，鄧肯在防守端徹底迷失。幾分鐘后，雷霆確立了鎖定勝局的優(yōu)勢，而鄧肯也被換下場，再也沒有上場。

A mere four seconds after Duncan sits， there is another hard blow to the head. Thunder star Russell Westbrook drives the middle and elevates higher than almost anyone else can ... but loses his balance at the peak of his jump with help from Duncans replacement， DeJuan Blair. Westbrook falls from the sky， smacking first his wrist and then his cheek on the hardwood.

鄧肯坐下后四秒左右，場上又出現(xiàn)了一次頭部受到重大沖擊的情形。拉塞爾·韋斯布魯克突破到中線，然后他高高躍起，跳得比任何人都高……但他在跳到最高面對鄧肯的替補德胡安·布萊爾時失去了平衡。韋斯布魯克摔倒在地，他先是手腕著地，隨后臉頰著地。

These plays are more common that you might imagine. In New York that night， Tyson Chandler was called for a flagrant foul for hitting Jeremy Lin in the head while， in Orlando， a Kevin Love elbow to the face felled Glen Davis.

這些情形比你想象的更為常見。同一天晚上在紐約，泰森·錢德勒由于肘擊林書豪的頭部而吃到惡意犯規(guī)。在奧蘭多，凱文·勒夫的肘子打中了格倫·戴維斯的臉。

For decades， NBA players have been chided for not playing when they might be able to fight through injury， and phrases that make head injuries sound almost fun， such as “he got his bell rung，” pepper the basketball lexicon.

幾十年來，由于有傷而不能打球，NBA球員受到了不少責(zé)難，而且很多說法讓頭部受傷聽起來變得滑稽，比如“他給自己搖鈴”，籃球詞典也因此變得更加豐富。

The reality is that now we know even minor blows can contribute to real medical problems. Sometimes its indecent to play on.

現(xiàn)實是，我們知道，即便是微小的撞擊也會造成醫(yī)學(xué)問題，有時候帶傷打球并不明智。

There have been big improvements； no NBA trainer will need to call the NFL to find out what to do about a concussion. But there are still many blows to the head in the NBA， and little experience in neurological diagnoses on site.

當然，這里也出現(xiàn)了很明顯的進步。NBA的訓(xùn)練師不必再向NFL的人咨詢?nèi)绾翁幚砟X震蕩，但是NBA仍有不少球員頭部受到撞擊，而聯(lián)盟缺乏神經(jīng)學(xué)方面的診斷經(jīng)驗。

Future science may allow for immediate， accurate testing on the sideline. Player movement tracking could one day alert trainers when a players head rapidly changes directions in a way suggestive of concussive impact. Or perhaps one day sports neurologists will be mainstays on sidelines， ready to combine an NBA trainers powers of observation and real-time diagnosis with a specialists knowledge.

未來科學(xué)的發(fā)展可能會讓場邊的檢查變得更快速和準確?？傆幸惶?，對球員的跟蹤會提醒訓(xùn)練師，當一名球員的頭部反應(yīng)的劇烈變化預(yù)示著腦震蕩的出現(xiàn)。也許有一天，體育神經(jīng)學(xué)家會成為球隊的重要組成，做好準備將NBA訓(xùn)練師的觀察能力、即時診斷能力和專業(yè)知識結(jié)合在一起。

Until then， theres no substitute for caution.

但在那前，沒有什么比謹慎更重要。