撞头，请注意！

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.

在脑震荡这个问题上，橄榄球无疑是最先要被提及的。不是因为这项运动更危险，而是因为我们比几十年前有了更多的认识。概括地说，脑部受到冲击会导致一系列医学上的病害，包括改变人生的短期、中期和长期的健康问题，其中包括头痛、抑郁以及痴呆。自杀率也令人担忧。

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.

简单的处理不够好，好的处理又不简单。这对这项运动所产生的影响已经足够深远，以致有人已经预见到了橄榄球的消亡，或者说接近消亡，比如说马尔科姆·格拉德维尔。

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.

总体上说，篮球很早就预见到了这一点，并从中脱身。研究表明，很多运动都会导致严重的脑震荡问题，但是篮球并没有上榜。

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，联盟对此依旧相当积极谨慎，他们和广受赞誉的密歇根大学神经学家杰弗里·库彻博士签订合约，后者曾经作为体育脑震荡方面的专家在美国国会作证，同时在美国神经学院、密歇根体育神经中心以及美国橄榄球联赛中担任多项职务。库彻作为带头人，目前正在制订新的头部受伤规定——通过增加检查和治疗措施，以及让出现脑震荡的球员得以休息的方法，让球员处于更安全的环境下。

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.

当专家们对头部受冲击了解得越多，他们就越明白，如果没有长期观察，很难对脑震荡进行明确划分。

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."

库彻表示，NBA球员“不像橄榄球和冰球运动员那样持续受到撞击，但他们也会时常面对冲撞。这些冲撞也许只是轻微一碰，但有些人的大脑会更容易受到损害。无论撞击程度多严重，我们该在整个赛季或球员的职业生涯中都关注他们的大脑健康”。

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比赛，看到某人头部受到重击只是个时间问题。本赛季保罗·加索尔和安东尼·戴维斯都遭受过重度脑震荡，但他们只能代表头部被手肘、膝盖和地板撞击这一小部分。更常见的是脸部、太阳穴、头顶和后脑被打，而这些通常都被认为是“好的干净的打法”。在篮球里，尽管头部受到冲击不像橄榄球那么频繁，但它也是比赛中常见的一部分。

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.

有些看起来很轻微的动作也会产生严重的后果。人的大脑也许是地球历史上最敏感、最精确的构造。头撞在篮球场上，可以和拿锤子砸法拉利车的引擎相提并论。也许不会有任何损伤，也许会产生致命的打击。而且你很难确定，有时候一个小小的动作就会产生最严重的后果。

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.

现在连足球运动员的大脑已被严密关注。关于大脑受冲击的问题，医学上还不能确切地说：“对头部的撞击都不是大问题”。只有神经学家使用上百万美元的诊疗器械和大量时间后，才能确定不同撞击造成的不同伤害，而普通人几乎是无法做到的。

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.”

脑震荡纪录片“大脑游戏”中，来自宾夕法尼亚大学的神经学专家道格拉斯·史密斯注意到，有15%左右经历过一次脑震荡的人会出现持续的认知障碍，这意味着他们在学习、工作甚至生活上都会与过去发生改变。出现脑震荡后，他们会面临长期、持续的问题。

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.”

在密歇根大学的一次演讲中，他认为跳过必要的治疗是错误的做法。“最大的风险在于，他们的伤病会变得更复杂……原本7天的脑震荡，会演变成7周。而两周的，也许会变成6个月。”

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.

因为不害怕身体接触，杰拉德·华莱士得到了“Crash”的绰号，这当然值得尊敬。但是截止到2008年，那时还在山猫的华莱士在四个赛季里出现了四次脑震荡。最近的一次来自于米基·摩尔的肘击，这导致华莱士无法动弹，平躺在球场上。

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.

这事发生在NBA脑震荡计划出台前。山猫那时的训练师乔·夏普找不到合适的办法，所以他转向咨询NFL。“我和黑豹的医疗组进行了交流，请他们帮我处理这种情况。”夏普在美联社的一篇报道中这样说道。

"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.

“我并不是说我们落后了，只是因为对于篮球来说，这是个全新的领域。”夏普表示。他说的没错。直到最近也很少有人把脑震荡视为篮球的问题，但是从联盟的角度，一切都不一样了。

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，华莱士和夏普的经历会大大不同。2011-12赛季前，NBA请库彻制定并实施了最尖端的脑震荡规定。每一次脑震荡都会由球队医疗组诊断，同时还会得到库彻的复查。尽管库彻在是否允许球员上场的问题上没有决定权——这个权利仍然属于队医，但是库彻已经成为联盟在脑震荡诊断上的把关人物。

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.”

库彻制定了一份三步诊断和治疗程序。赛季开始前，球员会接受一系列测验认知功能的检查，同时还要提交个人和家庭脑外伤的病史。库彻表示，这有助于“了解球员受伤时，他们的大脑可能或不可能出现的症状”。

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.

球员还要接受艾克森体育神经认知器的检查，以测量诸如反应时间、记忆和注意力。想了解大脑受到冲击时所产生的影响，首先要了解球员大脑正常的运作的情况。

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.

在比赛中，所有NBA训练师都会有一份清单，这能帮他们确定何时该把球员换下场。在过去很多年力，“被击昏”——完全丧失神智——是判断球员是否脑震荡的标准。而现在我们知道了，脑震荡会有多种多样的形式，这套测试就是被设计用来帮助训练师确定，当球员头部受到撞击时，他们是否要退出比赛。

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."

库彻表示，当球员头部受到撞击后，队医就会开始定性。“这不意味着到我的诊所来，我给你开个诊断，填个表格，然后送你回去，让你一个月后再来找我。而是，我看到你受到了很大的撞击，我会评估你的状况。如果你通过了所有测试，我也不会放弃。让你继续打球，一周后再来复查。我会观察你，我会观察你在场上场下的行动，在中场休息时观察，会在比赛结束后找你谈话。这是一个持续的过程，针对脑震荡需要这样的处理方法。这同样证明，当你拥有足够的资源时，高层面对相同的情况就会有不同的管理方式。”

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.

对于NBA来说，同样全新的在于，一旦球员被诊断为脑震荡，他们必须通过联盟“回归球场”的测验，这是一套更为复杂的测试。

“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.”

“一直以来，对于脑震荡，他们缺少诊断和客观的测试，”库彻说，“而我们所做的是，在大脑处于休息不发生任何波动时，对它进行刺激——以观察大脑怎么样应对第一次出现的物理刺激。然后才是有间隔性的训练，敏捷性训练和继续深入的检查，以及跟踪大脑在每个阶段的反应，从而确定球员的伤病已经恢复。”

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.

和大多数伤病一样，不经过休息，大脑是无法恢复的。但是让大脑休息和穿上固定保护靴休养脚踝是两回事。连看电视都会加重大脑的损害，从而延长脑的修复时间。库彻的规定在于保证球员得到康复时间，这也是像安东尼·戴维斯和保罗·加索尔这样的球员不允许上场的关键原因。

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的队医们在治疗伤病和保证球员在磨人的82场常规赛赛季中不至于垮掉做出了卓越贡献，但是正如库彻所说，处理脑震荡“需要知道如何检查一个活人的大脑，这是第一要做的，也是最重要的，这不是体育医学、运动训练或者物理治疗。”

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.

库彻说，NBA的队医和训练师们在处理脑部伤病时，会很乐意看到有他这样的专家。NBA给训练师和队医分发了教学录像，而且库彻还会在每年两次的联盟大会上为球队医疗组培训。

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.

相对于库彻的这些看法，在典型的NBA比赛中，队医和训练师有着长年累月处理膝盖、肩膀或其他部分伤势的经验。但是对神经学的知识，他们的了解就不够深入了。

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.

更复杂的问题在于，大多数有价值的观察其实来自于球员本人提供的病症。但出现脑震荡的球员通常在这方面做得都不好，由于出现脑震荡，连判断是否异常都不容易。此外，球员还面临多重压力——从教练组，到他们自己，再到经济方面的考虑——这都会导致他们不愿汇报自己的病情，而愿意带伤打球。

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·里弗斯的视频，2009年季后赛，当格伦·戴维斯被德怀特·霍华德肘击后，里弗斯仍然催促已经出现明显昏厥症状的戴维斯回去防守。或者听听黄蜂主教练蒙蒂·威廉姆斯的说法——他说自己球员时代经历过的四次脑震荡——在他的明星新秀戴维斯由于脑震荡而缺席时，他说联盟的脑震荡政策是在“用对待小孩子的办法对待每个人”。

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球员保罗·格兰特说，在他短暂的职业生涯中，他经历过几次脑震荡，他说他没有汇报病情，因为“在训练室里的人是无法得到上场机会的”。

“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.”

“你必须比赛。”格兰特说，“你必须上场，你必须尽一切努力上场。”

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.”

库彻表示，“政策必须反映这样的事实，诊断和治疗脑震荡必须依靠球队的努力，因为受伤的球员很多时候并不知道自己受伤了”。

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

库彻同时警告，如果球员头部受到撞击就被教练换下场的话，这会促使球员隐瞒伤情。

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.

训练师该怎么做呢？很多球员不想被替换下场，他们有动力去隐瞒自己的病情。很多教练则把脑震荡规定当作桎梏，连NBA专家都称场边的测试存在缺陷。

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·邓肯低头坐在地板上，他刚刚被肯特里克·帕金斯的肘子打中了下巴。其他9名球员在邓肯的身边继续比赛，雷霆投丢了，然后马刺把球推进到了场地另一边。邓肯摇摇晃晃站起来，抓住自己的膝盖，死死地盯着地板。

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.

当球再次回到雷霆半场时，邓肯回到了比赛中，但他的比赛节奏明显慢了。当雷霆换上充满活力的尼克·科林斯后，邓肯在防守端彻底迷失。几分钟后，雷霆确立了锁定胜局的优势，而邓肯也被换下场，再也没有上场。

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.

邓肯坐下后四秒左右，场上又出现了一次头部受到重大冲击的情形。拉塞尔·韦斯布鲁克突破到中线，然后他高高跃起，跳得比任何人都高……但他在跳到最高面对邓肯的替补德胡安·布莱尔时失去了平衡。韦斯布鲁克摔倒在地，他先是手腕着地，随后脸颊着地。

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.

这些情形比你想象的更为常见。同一天晚上在纽约，泰森·钱德勒由于肘击林书豪的头部而吃到恶意犯规。在奥兰多，凯文·勒夫的肘子打中了格伦·戴维斯的脸。

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.

几十年来，由于有伤而不能打球，NBA球员受到了不少责难，而且很多说法让头部受伤听起来变得滑稽，比如“他给自己摇铃”，篮球词典也因此变得更加丰富。

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

现实是，我们知道，即便是微小的撞击也会造成医学问题，有时候带伤打球并不明智。

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.

当然，这里也出现了很明显的进步。NBA的训练师不必再向NFL的人咨询如何处理脑震荡，但是NBA仍有不少球员头部受到撞击，而联盟缺乏神经学方面的诊断经验。

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.

未来科学的发展可能会让场边的检查变得更快速和准确。总有一天，对球员的跟踪会提醒训练师，当一名球员的头部反应的剧烈变化预示着脑震荡的出现。也许有一天，体育神经学家会成为球队的重要组成，做好准备将NBA训练师的观察能力、即时诊断能力和专业知识结合在一起。

Until then， theres no substitute for caution.

但在那前，没有什么比谨慎更重要。