Concussion information has improved but isn't exact science

Had Gators coach Urban Meyer known then what he knows now about concussions, Leak's backup, Tim Tebow, might have started his first college game as a freshman. Coincidentally, the player who backed up Leak in 2006 has become the face of major college football's relatively new, more medically sound approach to concussion recovery.

In years past Tebow almost certainly would start on Saturday night when the top-ranked Gators face No. 4 LSU at Tiger Stadium. Old-school coaches would have used the following logic: Sure, Tebow got his bell rung on Sept. 26, when Kentucky defensive end Taylor Wyndham creamed him and sent Tebow's head flying into offensive lineman Marcus Gilbert's knee. But he's had two weeks. He took some Advil. He can shake it off. He's a warrior.

But as the Gators wrapped their LSU preparation on Thursday, Tebow remained a gametime decision. A team of physicians still hadn't cleared him to play against the Tigers. Why the wait? Because, as recent research has shown, allowing a player to return too soon after a concussion can have serious and even deadly consequences. (Last year a high school football player in New Jersey died after returning from a concussion and suffering another one.)

"There are many coaches still ignorant on this subject, but there are an increasing number that are beginning to understand the importance of concussions and the importance of allowing people to completely recover from them," said Dr. Robert Cantu, the neurosurgeon who in 1986 published the first concussion grading scale. "If you do recover properly, most of the time, there are no permanent implications. Whereas if you don't, there can be very dire problems down the road."

Chris Nowinski knows that better than most. As a freshman defensive end at Harvard, Nowinski took "an absurd blow underneath the chin" during a practice drill. He remembers blacking out before he hit the ground. Nowinski didn't complain, and he didn't receive any type of treatment. Looking back, Nowinski realizes he should have recognized a problem when he arrived at the dining hall that night for dinner.

"I specifically remember calling a lot of people by the wrong name at dinner that night and people calling me out on it," said Nowinski, whose research led to his book, Head Games. "It was very embarrassing, but I couldn't understand why. I just could not piece together people's names."

After Nowinski graduated from Harvard, he starred on a reality show featuring young wrestlers hoping to earn a spot in the WWE. Nowinski impressed WWE brass, and his star rose quickly in the wrestling world. But one day a kick that wasn't supposed to connect blasted him under the chin. He suffered headaches and memory loss. For the first time, he was diagnosed with a concussion.

That concussion and its lingering effects knocked Nowinski out of wrestling at age 24. Soon after, he began researching concussions and he determined that he suffered at least six during his football and wrestling careers. Convinced he could raise awareness, Nowinski joined with Cantu to found The Sports Legacy Institute, an organization committed to studying the effects of concussions and educating coaches about how to properly handle players who have suffered concussions.

Nowinski, who also works for a financial consulting firm outside of Boston, said he still struggles with the effects of his concussions. "I had severe memory problems for two years. Headaches for five, but they're pretty much under control now," he said. "I still feel like I don't recognize faces well. It's very, very hard for me to remember anybody I've ever met. For some reason, faces never click -- even when I spend entire days with people."

It could have been worse. Nowinski could have ended up like former Patriots linebacker Ted Johnson, who told HBO's Real Sports that his depression is so severe that he can barely leave home. Or he could have ended up like former Eagles defensive back Andre Waters, who committed suicide in 2006 at age 44. Nowinski helped research Waters's case, and Dr. Bennet Omalu examined Waters's brain and determined that the tissue resembled that of an 85-year-old man. After also examining the brains of other former NFL players who died too young, Omalu came up with a name for a new disease: Neurofibrillary Football Linked Dementia, or NFL Dementia.

The NFL has disputed Omalu's findings, but they should be enough to give any football player pause after he takes a severe shot to the head. Florida coach Meyer said he has learned much about concussions in the past few years, and that's why the Gators are being so careful with Tebow. How careful? Aside from their team physicians and consultations by a neurosurgeon and a neurologist from UF's Shands teaching hospital, the Gators have consulted Mickey Collins, the assistant director of the Sports Medicine Concussion Program at the University of Pittsburgh.

"Concussions are much different than injuries like a sprained ankle," Meyer said. "Some injuries you want to test and have players push to recover from. With concussions, you don't push at all. It's not the first concussion we've had; probably our fifth or sixth this year. Tim has been methodically doing what he is told."

It sounds as if Meyer has listened to his medical team. Collins can't speak about a patient he's treating, but he made it clear in a 2007 interview with PBS that concussions are delicate, complicated injuries.

"The minute I hear a clinician say, 'You've had a concussion, sit one week out, and you'll be fine,' is the minute I realize the clinician has no idea what they're talking about," Collins told PBS. "And if you try and shove this injury into a little cubbyhole, that's when you are going to make mistakes."

So what would convince doctors that Tebow can play Saturday? Cantu said doctors would first ensure that Tebow no longer has any telltale symptoms, such as headaches or blurred vision. According to Meyer, those symptoms disappeared last week. Doctors would also compare Tebow's memory and cognitive functions to baseline levels. Tebow last took a baseline test in June, and Florida uses the ImPACT testing system, as well as the Standard Assessment of Concussion (SAC), Balance Error Scoring System (BESS) and the Post Concussion System Scale (PCSS).

Doctors allowed Tebow to begin lifting weights on Monday. They allowed him to return to practice Tuesday, meaning Tebow had three practices to prepare to play. But because quarterbacks are off-limits to defenders at practice, Tebow has yet to take a hit. Meyer said doctors discussed testing Tebow with some light hits to the chest or back, but they decided against it during the Tuesday and Wednesday practices.

Such hits are standard procedure, Cantu said. If concussion symptoms return, the player is not ready to play. Cantu said Florida's medical staff has handled Tebow ideally so far, but he said placing Tebow in live game action without any preliminary postcontact testing could be risky.

"I suspect that what's going to happen if he does play is that he won't have taken any hits," Cantu said. "He's going to be given a gametime decision, but he's going to be doing it without knowing whether those kinds of hits will produce symptoms. And once you get the adrenaline rush of actually being in the game, then those symptoms tend to be overlooked by the athlete."

Nowinski said Florida's treatment of concussions has improved dramatically since Leak's situation three years ago. "I think Florida is up to speed," Nowinski said. "I don't think they necessarily were when I did myarticle on SI.com about Chris Leak. They're up to speed on the modern standards for return to play."

Still, Nowinski suggested that even if Tebow is cleared, he might be better off waiting another week. "If he's done all that, it's hard to make a good argument to not play him from the clinical side," Nowinski said. "I think, in the big picture and where this research is moving, there have been papers and research studies showing that the brain doesn't actually recover within that 7-to-10-day window as much as we think.... The big picture is if you're Tim Tebow and you have a huge future, erring on the side of caution isn't a terrible idea."

Nowinski hopes to add to that research. His Sports Legacy Institute has a partnership with Boston University to study concussions, and he said 200 athletes have agreed to donate their brains for research after their deaths. Nowinski hopes that eventually doctors will be able to cure post-concussion complications and prevent future concussions. At the moment, Nowinski is just happy that coaches have begun to treat concussions like the serious injuries they are.

"There's no question that greater awareness has led to people being held out longer," Nowinski said. "Some coaches are no longer fighting with their medical staff. We have to understand that no one's ever educated the coaches.... The coaches are on our side. They want players to be healthy and happy. No one has ever told them that concussions have to be treated differently than other injuries."