Extra Caution for Concussions Needed

If the NCAA was the World Boxing Council, and Tim Tebow wasn't a Heisman trophy-winning quarterback but the owner of a world championship belt, there would be no handwringing over Tebow's status for his next scheduled contest. He'd be out. End of story.

That is how seriously boxing now takes the brain injury known as a concussion, which is what No. 1-ranked Florida's quarterback suffered last weekend against Kentucky. A boxer who is knocked out can't fight again for at least two months.

It is, of course, the aim of boxing to discombobulate the opponent before he discombobulates you. By discombobulating, I mean scrambling the brain.

That is not the aim of football, but it is sometimes a result as Tebow reminded. And whether a concussion results from a series of jabs, hooks and uppercuts over several three-minute rounds, or one unencumbered bum rush from a defender who knocks you on your back in a split second and sends your head crashing into another guy's knee, as it happened to Tebow, the outcome is the same. It's like the difference between winning the lotto by playing it every day or by playing it once in your life: none.

Unfortunately for football players, who suffer concussions more than any of us probably realize, there isn't any mandatory recovery period. Frighteningly, it's usually just until the next big game. In Tebow's case, that's two Saturdays from now against LSU. It probably would've been this Saturday if Florida wasn't off then.

"Florida is very lucky that [Tebow's injury] happened with a bye week coming," Dr. Robert Cantu told me from his Concord, Mass., office. "Pressures would have mounted."

Unfortunately for football players, who suffer concussions more than any of us probably realize, there isn't any mandatory recovery period.He wasn't talking about anything in Tebow's skull. He was talking about prodding by Florida football fans, boosters, teammates and coaches like Gators headman Urban Meyer to get Tebow back under center as if the injury that left him supine, nauseated and a hospital specimen for a night was nothing more than a twisted ankle. Cantu knows better than most. Concussions in sports are his field of expertise.

Dr. Cantu is chief of neurosurgery and director of sports medicine at Emerson Hospital in Concord, Mass., and medical director of the National Center for Catastrophic Sports Injury Research. He published the first ever return-to-play guidelines for sports concussions in 1986 and has refined it since to include a grading system based on symptoms.

"There is solid science and agreement that they [concussed athletes] should sit out until they are asymptomatic, first at rest and then when they are asymptomatic ... through an exercise program and not develop any subsequent symptoms when they are physically stressed," Dr. Cantu said. "Where there is legitimate difference of opinion, because there is not solid science behind it, is once you're asymptomatic at rest and exertion, how much longer now should you stay out? Guidelines we've put out said a week. But not everybody agrees with that."

By asymptomatic, Dr. Cantu said he means not suffering from any of the more than 25 post-concussion symptoms. They include things like dizziness, fatigue, irritability, difficulty sleeping, anxiety, trouble concentrating, memory problems, sensitivity to noise or light, etc.

"All those symptoms need to be gone," the doctor said.

Meyer said Wednesday on the weekly Southeastern Conference teleconference that Tebow "looked terrific" when he saw him late Tuesday night. But Meyer also said that Tebow was still having headaches and was restricted to a "non-stimulus environment" that meant no watching of film or TV. Tebow obviously is not yet asymptomatic at rest, let alone exertion, and Dr. Cantu believes an athlete suffering a concussion should be for an entire week before playing again. Tebow has until Saturday.

"Now, he's got a really good chance because of the bye week that he could be asymptomatic by the end of this week and then started back on an exercise program and be asymptomatic by next weekend's game and play," Dr. Cantu said. "But ... only time will tell. You can't predict today while he's still recovering."

Dr. Cantu didn't argue that football should become as cautious as boxing is about concussions and implement some sort of rule regulating when a concussion patient like Tebow can play again. He said he thought it best that each athlete's recovery be considered on its own merits.

But the danger in such a laissez-faire approach to this issue is that fanaticism can obfuscate judgment. A player who should not be playing will be pushed or shamed to do so, or not forced to restrain his own desire to do so. The result is what a study by researchers at the University of Michigan and commissioned by the NFL showed upon its release Wednesday: retired professional football players may have a higher rate than normal of Alzheimer's disease and other memory problems, probably as a long-term result from suffering concussions. The study looked at 1,063 ex-players who were asked if they'd ever been diagnosed with dementia, Alzheimer's disease or other memory-related disease. About 2 percent of the former players ages 30 to 49 said yes, which is 19 times the rate for the same age group in the general population. For retirees over 50, the rate of about 6 percent was about five times higher than the same pool in the general population.

That comes on top of a study released early this year by doctors at Boston University's School of Medicine that found brain damage commonly associated with boxers was found in six dead former NFL players 50 or younger. Called chronic traumatic encephalopathy, or CTE, the condition comes from repetitive head trauma and can bring on dementia in people in their 40s or 50s.

Despite the ever-improving football equipment and other safety procedures, concussions aren't decreasing, Dr. Cantu said.

"It's being recognized more now, but it's also happening more frequently because the players are bigger, stronger, faster," he reminded, "and the collisions are harder than ever before."

This all suggests to me that today's football players would be better off paying now for a concussion by sitting out like boxers -- rather than paying later like their predecessors in these new studies.