In Reply: Does Mechanism of Injury Affect Recovery After Sport-Related Concussion in Basketball? A Pilot Study

To the Editor: We appreciate the thoughtful and constructive analysis of our recent work1 by Dickerman et al.2 Overall, we share their assessment regarding the strengths and limitations of this initial exploration and welcome the opportunity to elaborate further. We agree entirely with the authors on the importance of standardized sideline data collection tools, such as the SCAT6,3 as well as increasing the availability of sideline assessment results to regional sports concussion centers. There are inherent limitations to retrospective studies that rely on electronic medical records, such that: (1) athletes may have received a sideline assessment, but this was not available to treatment providers when the athlete presented to a sports concussion center; (2) athletes received their initial assessment/diagnosis from a health care facility that is not integrated into concussion research (eg local pediatrician office, local urgent care); or (3) the athlete did not receive a formal concussion assessment/diagnosis until several days after injury. Although the benefits of standardized sideline assessments are well established,4 implementation, documentation, and sharing of records remains a challenge. Unfortunately, fewer than one-third of US public high schools employ a full-time athletic trainer,5 and schools without athletic training coverage show clear disparities in both concussion incidence and management practices.6 Although improving the quality of sideline data is necessary, it must be paired with broader efforts to expand staffing and resources to ensure all student-athletes receive equitable evaluation and care. We also acknowledge the importance of more detailed descriptors for mechanism of injury and head impact characteristics. Our study was limited by the retrospective nature of physician documentation, which often lacked granularity regarding precise impact vectors, locations, or laterality. Although more specific data would certainly enrich future analyses, a consideration is that large variability can complicate group-level comparisons. We opted for broader categorical groupings to enable statistical analysis across our cohort.7 Going forward, systematic video analysis may offer a promising tool for capturing these biomechanical details more reliably, and we fully support prospective efforts in this area.8 We particularly appreciated the authors' emphasis on backward falls and occipital impacts, which we noted as a key finding in our study, especially in the context of “taking a charge.” Given the leaner body habitus and lower BMI often seen in basketball players, there is a strong biomechanical rationale for preventive strategies such as neck strengthening and fall training.9,10 These approaches have shown promise in other sports11 and are low-cost, easily coachable, and seamlessly integrated into existing warm-up routines, making them highly feasible at the high school level. We thank Dickerman and colleagues again for their insightful comments, highlighting both the importance of improved research methodology and the opportunities for enhancing athlete safety through targeted preventive measures. We hope this exchange adds to the growing conversation around basketball-specific injury prevention and the broader effort to keep players safe.