Concussions should be taken seriously, experts say

When Tim Tebow was laid low during the Florida Gators' football game Saturday, many fans figured their unstoppable quarterback would bounce right back.

But with concussions, bouncing back isn't quite so easy.

Neurologists say Americans don't take concussions seriously enough, and warn that if you have more than one concussion, your brain suffers cumulative damage that could add up to memory loss or permanent damage.

Usually caused by a blow to the head, a concussion injures the brain by slamming it against the skull, temporarily interfering with the way the brain works. Tebow, who was hit hard during Saturday's 41-7 win over the University of Kentucky Wildcats, was released from the hospital Sunday with a concussion. University of Florida Coach Urban Meyer said Monday that Tebow was suffering from only headaches and soreness.

The injury caused by a concussion is widespread but hard to detect. And there's no medicine a doctor can give to speed healing. Recovering from a concussion takes time and lots of rest, doctors say.

Although concussions can be caused by car accidents or falls – even shaken-baby syndrome is a form of concussion -- people who play contact sports run a higher risk, doctors say. Football is not the only culprit, though. Head injuries are also common in soccer, cheerleading, hockey, gymnastics, lacrosse and boxing.

Experts can only estimate how many people suffer concussions each year because so many go unreported or undiagnosed. Although the U.S. Centers for Disease Control estimates that 300,000 high-school athletes suffer concussions each year, the real numbers are probably much higher, said Dr. Melvin Field, co-director of the Florida Hospital Sports Concussion Program. "In high school over 50 percent of time they're not being diagnosed or they're being mistreated," Field said.

Part of the problem is machismo. Many players are reluctant to admit they're hurt, and some believe that a concussion is a badge of honor.

"When it comes to a concussion, it isn't about being tough," said former UF quarterback Shane Matthews, who suffered a concussion in the NFL. "Football players are human beings. It may take several weeks. It can linger," Matthews said, adding that a player "can be sick to his stomach, lightheaded, headaches, not have an appetite. It's a serious injury."

While athletes may be reluctant to admit they're hurt, doctors urge parents and coaches to be alert for signs of concussion after a hit or fall. Symptoms include confusion, headache, dizziness, slurred speech, ringing in the ears and nausea or vomiting.

Dr. Bayard Miller, a UF neurologist, said that although a CT scan should be done to rule out bleeding or bruising of the brain, he believes that a patient's memory and reflexes are a better gauge of a concussion. Miller suggests that trainers or coaches give athletes phrases or two- or three-digit numbers to repeat back to them.

In addition, Miller said, coaches should ask the player to sprint or do a sit-up and see how he or she performs.

Concussions are often labeled as mild or serious, but there's a growing controversy among doctors about "grading" concussions, Field said. Although some doctors still grade concussions on a scale of 1 to 3, with 1 being mild, Field said there are 25 scales, and nearly all grade the concussion based on how long the patient was unconscious. That, he said, is misleading. In some concussions, the patient never loses consciousness.

"In the past 10 years, we've done a lot of research and found loss of consciousness has nothing to do with severity of concussion," Field said.

Instead, Field and a growing number of experts recommend that athletes – from high school to professional – be screened at the beginning of each season. To establish how their brains work normally, the athletes take a computerized test that measures their memory, reaction times and information processing abilities. If an athlete suffers a concussion during the season, the team trainer can make him take the test again – and until the athlete can match his previous score, he's not allowed to play.

Doctors are usually reluctant to say how long it takes for a concussion to heal – because every head injury is different. But a 2001 study comparing high school athletes to college athletes, Field said, found that while college athletes could recover from a mild concussion in three to seven days, high-school athletes often needed two to four weeks to recover. In children, Field said, the brain has a much more dramatic response to trauma.

To recover, "you have to rest the brain," Field said. "It also means no exercising, getting your rest and your schoolwork has to be decreased – no stressful tests while you're healing."

If a player heads back on the field with a concussion that hasn't fully healed, he or she could be at risk for permanent, or even fatal, brain damage.

Called "second-impact syndrome," it occurs when an unhealed brain is hit again – and leads to massive brain swelling. "Second impact can be fatal; it can leave you paralyzed," said Field.

Likewise, repeated concussions are a red flag for doctors. "The closer the interval between concussions, the higher the risk [of permanent damage]," said Dr. Tetsuo Ashizawa, chairman of UF's neurology department. "Even three minor concussions within a season would be a big concern."