Dr. Julian Bailes (NorthShore)
good questions--PWF is currently working with a new Medical Advisory Committee structure to analyze, with the help of numerous experts, including physicians and notable coaches, these issues. This includes the practicality of substantially changing how the game is played, such as postponing tackling, as you asked. However, as you can imagine, there are many factors to consider. In general, the question is: is there a way to evolve the sport, beginning at a young age, to take head contact out of the game (as much as possible).

Dr. Julian Bailes (NorthShore)
Multiple concussions, in most players, particularly if spaced in long intervals and not of great severity and number, should be tolerated without long term consequences. However, in certain individuals, based upon the number, severity, age, recovery time,and possibly same as yet undetermined genetic factors, multiple concussions can lead to long term consequences in neurological function, and short term may affect the playing career.

Dr. Julian Bailes (NorthShore)
headache, memory disturbance, dizziness or balance difficulty, visual problems, and difficulty with school work. Sometimes the person is just "out of sorts". If any doubt I would have his pediatrician or primary care physician evaluate him.

Dr. Julian Bailes (NorthShore)
I agree-we often are asked if there are more or are we just more attuned and detecting them better. There is more information now than ever before about concussion recognition and management. The CDC and many other organizations have materials and educational programs for concussion

Dr. Julian Bailes (NorthShore)
that's a good question Coach. You know, many, over 30 states now have laws which govern the management of sports concussion and how they are returned to play. Some organizations have weighed in to assist in identifying who can best be identified to make return to play decisions. It may be hard to legislate it nationally, since all these laws were passed at the state levels. I think your idea is a good one; for coaches and players to be trained, not just the health care professionals, such as athletic trainers and team physicians.

Dr. Julian Bailes (NorthShore)
More is known about the use of certain techniques such as vestibular (inner ear) therapy, various medications, and dietary supplements, among others. In general, we know that both physical and mental rest, even taking time off from school are important, as well as avoiding stimuli from watching TV, playing videogames, etc

Dr. Julian Bailes (NorthShore)
being that it is a contact sport, there obviously are limitations. However, the coaching style which attempts to educate about concussions and the way in which they occur, and how to avoid them is valuable. If head to head contact can be eliminated, or reduced as much as possible, if tackling can be done using more arms/shoulders than initial head contact, there may be improvements. One day, perhaps the linemen will be taken out of the three point stance, so that the obligatory, mandatory head contact which occurs on every play will be reduced. In addition, the early or immediate recognition that a concussion may have occurred and removal from play until this has been figured out, is very important for a coach.

Dr. Julian Bailes (NorthShore)
It is persistent symptoms which linger after a concussion. Typically, most mild concussions resolve in a few days. However, some require up to 6 weeks to go away, and are "self-limited", meaning the symptoms are gone without any specific treatment. If longer than about 6 weeks, then a prolonged recovery or a "complicated" concussion has occurred. the management at that point often needs the assistance of a primary care, sports or neurological physician. That doctor may prescribe therapy, pharamceutical treatment aimed at the symptoms (e.g. sleep disturbance, headache), dietary supplements such as Omega-3 fatty acids or DHA, and others.

Dr. Julian Bailes (NorthShore)
That's true. Sometimes concussions aren't obvious on the day of the injury. That's why education about symptoms are important, so that parents, teammates, coaches and trainers are aware. Also, only about 10% of sports concussion occur where the athlete is "knocked out", and the vast majority of the times they are walking, talking, etc. So a high vigilance and low threshold for removing from play are important.

Dr. Julian Bailes (NorthShore)
probably the best is to be evaluated by a health care professional who has had special training in sports concussion--either a certified athletic trainer or a physician. This is especially true is the symptoms don't resolve or if there is a change in level of awareness or other neurological manifestation

Dr. Julian Bailes (NorthShore)
Not especially, although they may express how they feel differently. Remember the major concussion symptoms are headache, dizziness, amnesia, visual disturbance, sleep problems, difficulty at school, concentration abnormalities and others

Dr. Julian Bailes (NorthShore)
absolutely. Concussions are often classified as mild, moderate, and severe. They also may be by their duration, that is, the longer the symmptoms last the more severe the concussion is believed to be. The ones in which the player is knocked out, that have symptoms which don't resolve within a week or so, and which have memory loss are probably more severe. Just look, for instance, at the problems which NHL player Sidney Crosby is experiencing, after a concussion last January

Dr. Julian Bailes (NorthShore)
Avoid head impacts with other players, goalposts and the ground, as much as possible. Do not strike another player with the top or crown of your head. If you suspect a concussion, avoid exposure to contact until all symptoms have resolved and/or see a athletic trainer and/or physician

Dr. Julian Bailes (NorthShore)
Recurrent symptoms, more loss of time from play, becoming a career ending issue, problems with mental function (e.g. school or business )and if recurrent and major, perhaps long term detriment to brain function

Dr. Julian Bailes (NorthShore)
all sports which have the potential for head contact--- soccer, basketball, lacrosse (for these 3 girls and boys also), rugby, wrestling. maybe some others you can think of!

Dr. Julian Bailes (NorthShore)
I don't think so. Most occur however from blows to the temporal and frontal regions of the head

Dr. Julian Bailes (NorthShore)
yes they can be. especially in recent military conflicts, where explosions may cause concussions without there being any lethal brain injury, for instance, riding in a vehicle which is affected by an IED (improvised explosive device). There may be multiple exposures as well, like contact sport athletes. I have been told that over 90% of brain injuries in the military now are non-penetrating, that is are concussions.

Dr. Julian Bailes (NorthShore)
In general, one that allows for very little movement of the head inside the helmet, i.e. it is tight without being uncomfortable. The chin strap should be secure and not allow the head to rotate within the helmet.

Dr. Julian Bailes (NorthShore)
If she remains symptomatic, I would recommend that she sees her pediatrician or primary care physician. In general, until all concussion symptoms have resolved, she should avoid physical activity, intense reading or schoolwork, stimulation such as TV or videogames, etc

Dr. Julian Bailes (NorthShore)
Wow, good but broad question. It depends on many things, including what is their ability and their sports passion. All sports, if done with diligence, education, and proper technique, can be safe and beneficial in many ways. I think you just have to gather as much info as you can, meet with the coaches so that you feel comfortable, and then learn all you can about that particular sports' risks and how to recognize a problem if one occurs.