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Harper homers in return to lineup, but concerns about concussion linger

Bryce Harper, NationalsBryce Harper ran into the wall at Dodger Stadium earlier in the week, leading to fears he had suffered a concussion. (Stephen Dunn/Getty Images)

Thursday night brought a welcome sight, as Bryce Harper was back in the Nationals lineup for the first time since Monday, when he left in the fifth inning after running into Dodger Stadium's rightfield wall at nearly full speed. The 20-year-old leftfielder went hitless in his first three plate appearances against Padres starter Edwin Volquez, grounding out twice and striking out once, but he fared just a bit better in his final plate appearance against reliever Tyson Ross:

[mlbvideo id="27183531" width="480" height="270" /]

Estimated at 432 feet by ESPN Home Run Tracker, the shot gave Harper sole possession of second place in the NL with 11 homers, though his 1-for-4 evening knocked his batting average below .300 for the first time all year; he's hitting .298/.393/.629, with the league's top slugging percentage.

Since running into the wall, Harper had been limited to a ninth-inning pinch-hitting appearance on Wednesday; he grounded out against the Dodgers' Brandon League. Understandably, the Nationals were plenty concerned about his condition following the collision. He needed 11 stitches to close a gash on his chin — a wound that cost him his goatee — and complained of soreness in his legs, shoulder, wrist and hands in the aftermath, though various X-rays proved negative.

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Harper also complained of nausea the day after the crash, which set off alarm bells because that's a common symptom of a concussion. Particularly when coupled with the spectacle of his post-collision wooziness, concerns were raised about whether the Nationals followed the concussion protocol Major League Baseball put in place in 2011.

On Wednesday, the Washington Post's Adam Kilgore reported that both the Nationals and Harper's agent, Scott Boras, said that Harper did not suffer a concussion. Head athletic trainer Lee Kuntz told Kilgore that Harper had undergone two SCAT2 (Sports Concussion Assessment Tool, Version 2) tests, one on the night of the collision and the second administered the next day by an outside physician. Designed for first responders and medical personnel, SCAT2 is a standardized method of determining whether a player has suffered a concussion, following guidelines from the National Athletic Trainers Association.

Additionally, Nationals general manager Mike Rizzo told USA Today's Robyn Norwood that Harper received the ImPACT test as well:

"We did all the tests, the ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing), and he passed," Rizzo said. "The first day we did two of the tests, and the next day we did two of the tests."

ImPACT is a battery of neurocognitive tests that measures a player's brain processing speed, memory and reaction time for comparison against a baseline set of tests that the player took in the preseason. Even when a player reports the absence of symptoms, such tests can show cognitive deficits.

Not everyone was satisfied by the Nationals' explanations. Deadspin's Barry Petchesky pointed to ESPN's Outside the Lines investigation of ImPACT, which is a commercial product sold to more than 7,000 professional, college and high school teams as well as sports medicine centers, and has become popular thanks to excellent marketing. OTL cited a series of studies published in Current Sports Medicine Reports that concluded:

"[T]he false positive rate appears to be 30 percent to 40 percent of subjects of ImPACT … the false negative rate may be comparable. … The use of baseline neuropsychological testing … is not likely to diminish risk, and to the extent that there is a risk associated with 'premature' return-to-play … may even increase that risk."

Still, when the Nationals maintained that Harper didn't suffer a concussion, they weren't necessarily wrong. By MLB standards, if he passed the ImPACT and SCAT2 tests and satisfied the concerns of the physicians who examined him, he wasn't required to go through the formal return-to-play procedure that's part of the concussion protocol.

With concerns about the long-term effects of concussions now part of the daily landscape, many observers would have preferred to see him treated with even more caution, with the Nationals using the seven-day concussion disabled list MLB created for such purposes. The team's decision-makers, doctors and trainers are the ones who know the results of the tests and examinations, and after holding him out of the lineup for two days and gradually introducing more activity — a "building process" of "stack[ing] blocks" as Kuntz termed it, they cleared him to return.

It's not as though Washington has acquired a reputation for mishandling concussions in recent years the way the Mets have with regards to Ryan Church and Jason Bay. In fact, with their preemptive shutdown of Stephen Strasburg last season, the Nationals demonstrated a willingness to place the welfare of their top players ahead of the team's fate, a controversial decision that garnered them criticism and even ridicule, and may have cost them a trip to the World Series or more. As such, it's reasonable to grant them the benefit of the doubt with regards to Harper.

Speaking of Strasburg, he was the Nationals starting pitcher on Thursday night, pitching in front of his hometown crowd for the first time since he reached the majors; he grew up in a San Diego suburb and starred at San Diego State University. Throwing a season-high 117 pitches over a career-high eight innings, he notched his first win since Opening Day. The 24-year-old righty allowed just three hits and three walks, two runs (one earned) while generating a season-high 15 groundballs and striking out four.

Strasburg came into the game carrying a 3.10 ERA, but that mark conceals eight unearned runs. Both his 4.56 RA/9 and his 3.48 FIP to that point were better reflections of his performance, and something of a microcosm of the Nationals' season. Expected to dominate the rest of the league, they're now just 22-19, second in the NL East by half a game but two games back in the wild-card race. Perhaps Strasburg's strong showing and the return of Harper will be the spark the team needs to live up to those lofty expectations.

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