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Why immediate removal from play after a concussion is critical

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Will football players take medicine to prevent brain damage?

The NFL and NCAA have made more rules in their attempt to decrease concussions in football. File/AP Photo

The NFL and NCAA have adopted a number of rules changes this offseason — fair catches on kickoffs inside the 25-yard line and penalizing players for lowering the head when tackling — to try to decrease concussions in football. Several recent scientific studies highlight why these changes are so important.

Researchers at the National Institute of Neurological Disorders and Stroke at the National Institutes of Health appear to have discovered why an athlete who suffers repeated concussions could struggle with symptoms for months and even have permanent brain damage.

Normally when we suffer a concussion, many of us will have damage to the blood vessels in the connective tissue that lines the brain. The contents of the blood vessels can leak out, potentially damaging the brain cells underneath this connective tissue. Fortunately, for most people, the damage to the blood vessels repairs itself over several weeks.

In a study using mice, the NIH researchers found that a second brain injury within a 24-hour period prevented the normal regeneration of these damaged blood vessels. This interruption of the brain’s repair process might explain athletes’ post-concussion syndrome. These athletes can experience headaches, dizziness, sensitivity to light and nausea for months.

We know that many athletes who experience repeat concussions do so within a short period of time from the initial trauma. The NCAA Concussion Study of 2,905 college football players found that 92 percent of repeat concussions occurred within 10 days of the initial concussion.

These repeated concussions can take a tremendous toll, not just at the time of trauma, but years later.

Zachary Y. Kerr, Ph.D, and other researchers studied 204 football players who played college football between 1999 and 2001 but never went on to play at the professional level. Athletes with a history of three or more concussions had worse overall health scores and worse indicators of mental health almost two decades later. In addition to the poorer health scores, which were on average worse than the U.S. population, these multiply concussed athletes were more likely to have moderate or severe depression and alcohol dependence.

Allow me to be cynical for a minute. Maybe you don’t understand what a second or third concussion means for the healing of your son's or daughter’s brain. Maybe you don’t  believe how serious the risks can be to their long-term health.

You just want him or her to play. “The playoffs are starting. He needs to play,” you might argue. “The team can’t win without my daughter,” you might believe.

For win-at-all-cost parents, here’s your reason to hold out your kids after a concussion:  they will return to play faster.

Researchers from 25 collegiate institutions and military service academies studied athletes in 18 sports. The physicians treating the concussed athletes were asked two questions. Did the athlete immediately report the injury? Was the athlete immediately removed from play?

If the answer to both questions was yes, then the concussed athlete was labeled immediate removal of play. Sadly, about two-thirds of the athletes fell into the delayed removal from play category.

The athletes who reported their injuries and who were immediately removed from play missed less time from their sport (about three days less) and had a shorter duration of symptoms than the delayed removal athletes. The immediate removal athletes also had a lower risk of having recoveries that took 14 or 21 days or more.

These studies unquestionably show why the steps taken by the NCAA and NFL are necessary. We must absolutely take efforts to decrease the incidence of concussions athletes suffer. It also shows, though, that parents and coaches need to understand that athletes must be removed from play immediately after a concussion — no matter what.

Dr. Geier is an orthopedic surgeon in Charleston and author of 'That's Gotta Hurt: The Injuries That Changed Sports Forever.'