A Q&A with Dr. Sanjay Gupta

On Jan. 29, CNN will debut Big Hits, Broken Dreams, a documentary exploring concussions in high school football. SI.com's Ben Glicksman talked with Dr. Sanjay Gupta, CNN chief medical correspondent and practicing neurosurgeon, about his findings and what parents, coaches and athletes need to know to try to protect themselves.

SI.com: What's the biggest misconception of concussions in high school football?

Dr. Sanjay Gupta: People think it's a ding, or getting your bell rung. The terminology that surrounds concussions minimizes what they are. A concussion is a brain injury. That's the number one misconception.

SI.com: Why do you think the problem is so readily overlooked?

Gupta: People want to win. I think that for so long, trickling down from professional football into college and high school, that's been the mentality. To be clear, I don't think any institution is being malicious or purposely trying to hurt people. But that's the culture that's formed since football has been around. Remember, this is a game that Teddy Roosevelt wanted to outlaw. It has a long and sordid history with this sort of thing.

SI.com: What precautions should players take before they're allowed to return to the field?

Gupta: The best way to heal the brain is to essentially let it rest. No screen time. No texting. No reading for a few days. One of the players that we followed in the documentary was trying to exercise and lift weights during his healing period, and that's a no-no. You really have to rest your body and rest your brain. It's only when you're completely symptom-free when you should be allowed back in the game.

SI.com: Is there a cumulative effect of concussions?

Gupta: If concussions happen really close to each other, then you start running into the potentially catastrophic issue of what's known as Second Impact Syndrome. That's a concussion on top of a brain that's not healed. Like any other place in your body, if [the brain] gets injured, you think of that area as inflamed. If you were to punch a sore arm again, it really hurts. Same thing in the brain. That second hit can be exponentially worse on an already inflamed brain.

SI.com: Are there long-term effects?

Gupta: There is now evidence -- and some of it's brand new that we're presenting in the documentary -- of what are known as plaques and tangles. These are protein deposits, the same sort of protein deposits that you see in someone with Alzheimer's disease. What I think is most striking is we saw the brain of a 17-year-old football player who also had it. The idea that these types of changes are occurring in the brain of someone in their teen years is pretty remarkable.

SI.com: In the documentary you spotlight Jaquan Waller, a 16-year-old student from Greenville, N.C., that died from concussive blows. What can we learn from his tragic case?

Gupta: Jaquan was a preventable death. He had a concussion, and less than 48 hours later, when he was clearly still having symptoms, he was on the field and he got hit again. That's the prescription for a real problem. The lesson is someone who has a brain injury or concussion needs to be examined and cleared to go back in the game. We also need to have athletic trainers come to all practices and all games so they can recognize if someone has had a concussion.

SI.com: What difference does age make in concussion victims?

Gupta: It's interesting, because it's a little non-intuitive. In most cases, being young is helpful. Your body can rebound more quickly and repair itself. When it comes to the brain, because the brain is still developing, it actually can be more traumatic because the deposits can make it really tough for a brain to develop normally. For younger players, sometimes the impact of multiple concussions can be worse than on someone who's older.

SI.com: What precautions are most high schools currently taking during games?

Gupta: This is literally starting to change in front of our eyes. There are 35 states and the District of Columbia that now have specific mandates with regards to high school football. A few years ago, there weren't mandates to have an athletic trainer on the sideline who is trained to diagnose concussions. Now, you have to have that. Obviously, there are also penalties for leading with your head and helmet-to-helmet contact.

SI.com: Speaking of penalties, concussions have come to the national fore with the NFL's crackdown and the experience of Sidney Crosby. How is the publicity changing people's perceptions?

Gupta: Before, I think it was glorified. There were big-hits reels that people like to watch. I think people look at them a little bit differently now. They think that people are getting hurt. It almost has this coliseum-like quality, people getting hurt for other people's enjoyment. That doesn't sit well.

SI.com: How widespread is the problem?

Gupta: In high school players, it's estimated that about one in 10 players have probably had a concussion. Forty percent of them went back to play in the same game, and sixty percent of players who got knocked out cold by their concussion also went back to play the same day. If you start doing the math, you're talking about tens of thousands of kids every year who are literally taking a gamble. And this time the risk is their brain. Kids who don't know better are willing to gamble their entire futures on a sport that they love.

SI.com: From your research, what did you find most telling?

Gupta: One of the things that I really wanted to ask in the documentary was, if you create a safer game of football, is it still football? And the answer is yes. It can still very much be football if you don't use a three-point stance but you use a two-point stance. If you move the kickoff line five yards farther ahead so you get fewer kick returns -- which are the most dangerous part of the game. The culture is starting to change and it's not taking away from the sport that we are so passionate about.